A comprehensive environmental exposure indicator and respiratory health in asthmatic children: a case study

The primary goal of asthma management is to achieve and maintain asthma control, which can be influenced by environmental factors. This longitudinal study aimed to construct a comprehensive environmental indicator to predict asthma control in children with asthma in Palermo, Italy. The study included 179 asthmatic children aged 5–16 years. The Normalized Difference Vegetation Index (NDVI) was used to measure green cover, and the Coordination of Information on the Environment (CORINE) framework was used to assess land use based on each home address. A land use regression (LUR) model centered on the home address estimated NO₂ exposure for each child using GIS. An environmental indicator, including environmental and personal exposure, was formulated using an additive value model approach. A logistic regression mixed model assessed the association between the environmental indicator and uncontrolled asthma. A probability map of uncontrolled asthma was constructed. In conclusion, a comprehensive environmental indicator proved effective in identifying areas at higher and lower risk of uncontrolled asthma.