Allergy Asthma Immunol Res.  2017 Nov;9(6):517-525. 10.4168/aair.2017.9.6.517.

Seasonal Cycle and Relationship of Seasonal Rhino- and Influenza Virus Epidemics With Episodes of Asthma Exacerbation in Different Age Groups

• Lee SW
• Lee S
• Sheen YH
• Ha EK
• Choi SH
• Yang MS
• Hwang S
• Kim SS
• Choi JH
• Han MY

• KMID: 2421662
• DOI: http://doi.org/10.4168/aair.2017.9.6.517

Abstract

PURPOSE
Seasonal variations in asthma exacerbation (AE) are associated with respiratory virus outbreaks and the return of children to school after vacation. This study aims to elucidate the period, phase, and amplitude of seasonal cycles of AE in 5 different age groups with regard to rhino- and influenza virus epidemics in Korea.
METHODS
The number of daily emergency department (ED) visits for AE in all age groups of Korea and the nationwide weekly incidence of rhino- and influenza virus, were obtained for 2008-2012. Fourier regression was used to model rhythmicity, and the Cosinor method was used to determine the amplitude and phase of the cycles in each age group. The cross-correlation function (CCF) between AE and the rhino- and influenza virus epidemics was also calculated.
RESULTS
There were 157,559 events of AE (0.62 events/1,000 individuals/year) during the study period. There were spring and fall peaks of AE in children and adults, but only 1 winter peak in the elderly. The amplitude of the AE peak in infants was higher in spring than in fall (9.16 vs 3.04, P < 0.010), and the fall peak was approximately 1 month later in infants than in school children (October 11 vs November 13, P < 0.010). The association between AE and rhinovirus was greatest in school children (rho=0.331), and the association between AE and influenza virus was greatest in those aged ≥60 years (rho=0.682).
CONCLUSIONS
The rhythmicity, amplitude, and phase of the annual cycle of AE differed among different age groups. The patterns of AE were related to the annual rhino- and influenza virus epidemics.

Keyword

Asthma; seasons; periodicity; rhinovirus; influenza

MeSH Terms

Adult
Aged
Asthma*
Child
Disease Outbreaks
Emergency Service, Hospital
Humans
Incidence
Infant
Influenza, Human*
Korea
Methods
Orthomyxoviridae*
Periodicity
Rhinovirus
Seasons*

Figure

• 

  Fig. 1 Yearly average ED visits for AE per 1,000 people in different ages during the 5-year study period (January 1, 2008 to December 31, 2012). ED, emergency department; AE, asthma exacerbation.

• 

  Fig. 2 Daily number of ED visits for AE in each age group during the 5-year study period (0-2 years, infants; 2-5 years, preschool children; 6-17 years, school children; 18-59 years, adults; >60 years, elderly). Blue solid lines indicate fits to Fourier regression (first 8 consecutive sinusoidal functions), and indicate 1 cycle per year in the old age group, and 2 cycles per year in the other groups. ED, emergency department; AE, asthma exacerbation.

• 

  Fig. 3 Yearly average ED visits for AE per 1,000 people during the study period in 7 metropolitan areas and 9 other areas during the 5-year study period. Gwangju had 3-times more daily visits than Daegu. ED, emergency department; AE, asthma exacerbation.

• 

  Fig. 4 Moving average of daily number ED visits for AE in 7 metropolitan areas during the 5-year study period. During each year, the first AE outbreak (fall, red vertical lines), occurred almost concurrently in all 7 cities. ED, emergency department; AE, asthma exacerbation.

• 

  Fig. 5 Weekly ED visits for AE, rhinovirus infection, and influenza virus infection over 5 years. (A) Number of ED visits for AE and incidence of rhinovirus infection in school-age children. Cross-correlation analysis indicated a significant relationship (rho=0.331; P<0.010). (B) Number of ED visits for AE and incidence of influenza virus infection in the elderly. Cross-correlation analysis indicated a significant relationship (rho=0.682; P<0.010). ED, emergency department; AE, asthma exacerbation.

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