{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,23]],"date-time":"2026-02-23T20:42:48Z","timestamp":1771879368043,"version":"3.50.1"},"reference-count":26,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2018,10,24]],"date-time":"2018-10-24T00:00:00Z","timestamp":1540339200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Korea Environmental Industry &amp; Technology Institute","award":["2016001360003"],"award-info":[{"award-number":["2016001360003"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Using real-world cases, asthma-related clinical data were clustered by patient; 5% of all asthmatics were found to have refractory asthma (RA) with a relatively low lung function (forced expiratory volume in 1 s\/forced vital capacity (FEV1\/FVC) less than 80%). Using a multilevel study design for clustered spirometry data observed between 2005 and 2014, we evaluated the association between changes in the ratio of FEV1 to FVC and variations in acute exposure to air pollution. We analyzed 2310 episodes of RA from 214 neversmoking patients. In spring, a 1 \u00b5g\/m\u00b3 increase in concentration of particles \u226410 \u03bcm (PM10) on Lag 1 significantly reduced the ratio by 0.4% (95% confidence interval (CI): 0.1\u20130.7%) after adjusting for sex, age, body mass index (BMI), and total Immunoglobulin E (IgE) level. Unit (ppb) increase in SO2 concentration on Lag 3 and 4 in fall and on Lag 6 in winter significantly reduced the ratio by 2 to 3% (p &lt; 0.05). We found that acute exposure to PM10 in spring or SO2 in fall or winter were positively associated with lung function drop indicating necessity of control strategies of target air pollutant source by season to protect susceptible population.<\/jats:p>","DOI":"10.3390\/ijerph15112349","type":"journal-article","created":{"date-parts":[[2018,10,24]],"date-time":"2018-10-24T10:40:48Z","timestamp":1540377648000},"page":"2349","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["Association between the Ratio of FEV1 to FVC and the Exposure Level to Air Pollution in Neversmoking Adult Refractory Asthmatics Using Data Clustered by Patient in the Soonchunhyang Asthma Cohort Database"],"prefix":"10.3390","volume":"15","author":[{"given":"Sol","family":"Yu","sequence":"first","affiliation":[{"name":"Department of Environmental Sciences, Soonchunhyang University, Asan 31538, Korea"},{"name":"Division of Environmental Health Research, National Institute of Environmental Research, Incheon 22689, Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sujung","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Environmental Sciences, Soonchunhyang University, Asan 31538, Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Choon-Sik","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Soonchunhyang Bocheon Hospital, Bucheon 22972, Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8726-9288","authenticated-orcid":false,"given":"Sungroul","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Environmental Sciences, Soonchunhyang University, Asan 31538, Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2018,10,24]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"American Thoracic Society (2000). 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