The effect of pesticide spraying on the rate and severity of ED asthma

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Abstract

We report on the incidence of emergency department (ED) asthma presentations and admissions to the Lincoln Hospital, located in the South Bronx of New York City, during the 1999 eradication program of the mosquito vector for West Nile virus. Spraying of Malathion and Resmethrin occurred in the hospital's geographic area over 4 days in September 1999. During that time, 1318 pediatric and adult patients were seen in the ED for asthma-related symptoms. Of these, 222 (16.8%) were hospitalized. Emergency department visits, during days when spraying occurred, were compared with visits during days when no spraying occurred. Comparisons were made with previous years as a reference point. Findings showed that the spraying of insecticides did not increase the rate or severity of asthma presentations as measured by the Lincoln Hospital's ED asthma census or hospital admissions for asthma.

Section snippets

Background

The first known outbreak of the West Nile virus in the western hemisphere occurred in the summer of 1999 in an area in northern Queens, a borough of New York City. The New York City Department of Health (DOH) received a report of an unusual cluster of cases of meningoencephalitis associated with muscle weakness suggestive of an arboviral cause. An environmental investigation was undertaken and, simultaneously, an independent investigation by veterinarians and wildlife specialists found

Insecticide toxicity

Eradication of mosquito vectors may be accomplished by spraying of insecticides, although these have known toxicity to human beings depending on the dosage and extent of exposure [4], [5]. Malathion is an organophosphate insecticide that can be absorbed through virtually any route [6]. Organophosphates exert their toxicity primarily by the inhibition of acetylcholinesterase, resulting in excess accumulation of acetylcholine at the synapse. Organophosphate toxicity compromises the airway via a

Rationale for study

This study seeks to ascertain adverse risks of insecticide spraying in an area that has one of the highest rates of asthma in New York City. This study seeks to answer the question “To what extent did the spraying of insecticides over the South Bronx in 1999 contribute to an increase in asthmatic symptoms as measured by ED presentations?” It was hypothesized that the spraying of insecticides was not likely to have adverse health consequences to those exposed. Indeed it was thought that there

Study area

The densely populated South Bronx area of New York City has one of the highest rates of hospitalization and death from asthma [16], [17], [18] Hospitalization for asthma among those younger than 14 years in this area was approximately 23 per 1000 in 1997. The New York State, by contrast, had about one tenth the hospital admissions for asthma in this age group (2.4 per 1000) [19]. The ED at the Lincoln Hospital sees approximately 14 500 asthma visits per year, resulting in 1500 annual hospital

Methods

A retrospective review of all pediatric and adult asthma visits and asthma hospital admissions for August and September of 1999 was undertaken. Included were all patients with a primary diagnosis of asthma from the ED. To assess the usual patterns of asthma presentations to the ED, data were also collected on all adult and pediatric asthma ED visits for August and September of 1997 and 1998. Asthma presentations to and admission rates from the adult and pediatric EDs were noted for the 11th,

Results

Fig. 1 shows asthma presentations to the adult and pediatric EDs for August and September of 1997, 1998, and 1999. The expected seasonal increase in asthma was consistent for each year. During September 1999, a total of 1318 patients presented to the Lincoln Hospital ED with a primary diagnosis of asthma exacerbation (753 or 57.1% adult patients and 565 or 42.9% pediatric patients). Of those patients, 222 (16.8%) were admitted (102 or 45.9% adult patients and 120 or 54.1% pediatric patients).

Discussion

Since the first outbreak of the West Nile virus in New York City in 1999, the virus has spread across most of the United States and has become enzootic and endemic in the central and eastern parts of the country and increasingly in the West; there have been more than 200 known deaths in the United States from this arbovirus, primarily among the elderly individuals [22]. Transmission of the West Nile virus has been found to occur through organ donation, blood transfusions, and breast feeding [23]

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