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Published in: Respiratory Research 1/2023

Open Access 01-12-2023 | Bronchial Asthma | Research

Prediction of the number of asthma patients using environmental factors based on deep learning algorithms

Authors: Hyemin Hwang, Jae-Hyuk Jang, Eunyoung Lee, Hae-Sim Park, Jae Young Lee

Published in: Respiratory Research | Issue 1/2023

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Abstract

Background

Air pollution, weather, pollen, and influenza are typical aggravating factors for asthma. Previous studies have identified risk factors using regression-based and ensemble models. However, studies that consider complex relationships and interactions among these factors have yet to be conducted. Although deep learning algorithms can address this problem, further research on modeling and interpreting the results is warranted.

Methods

In this study, from 2015 to 2019, information about air pollutants, weather conditions, pollen, and influenza were utilized to predict the number of emergency room patients and outpatients with asthma using recurrent neural network, long short-term memory (LSTM), and gated recurrent unit models. The relative importance of the environmental factors in asthma exacerbation was quantified through a feature importance analysis.

Results

We found that LSTM was the best algorithm for modeling patients with asthma. Our results demonstrated that influenza, temperature, PM10, NO2, CO, and pollen had a significant impact on asthma exacerbation. In addition, the week of the year and the number of holidays per week were an important factor to model the seasonality of the number of asthma patients and the effect of holiday clinic closures, respectively.

Conclusion

LSTM is an excellent algorithm for modeling complex epidemiological relationships, encompassing nonlinearity, lagged responses, and interactions. Our study findings can guide policymakers in their efforts to understand the environmental factors of asthma exacerbation.
Appendix
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Literature
1.
go back to reference Network TGA. The global asthma report 2022. Int J Tuberc Lung Dis. 2022;26:1–104.CrossRef Network TGA. The global asthma report 2022. Int J Tuberc Lung Dis. 2022;26:1–104.CrossRef
2.
go back to reference Chen Y, Kong D, Fu J, Zhang Y, Zhao Y, Liu Y, Chang Z, Liu Y, Liu X, Xu K, Jiang C, Fan Z. Associations between ambient temperature and adult asthma hospitalizations in Beijing, China: a time-stratified case-crossover study. Respir Res. 2022;23:1–2.CrossRef Chen Y, Kong D, Fu J, Zhang Y, Zhao Y, Liu Y, Chang Z, Liu Y, Liu X, Xu K, Jiang C, Fan Z. Associations between ambient temperature and adult asthma hospitalizations in Beijing, China: a time-stratified case-crossover study. Respir Res. 2022;23:1–2.CrossRef
3.
go back to reference D’Amato G, Holgate ST, Pawankar R, Ledford DK, Cecchi L, Al-Ahmad M, Al-Enezi F, Al-Muhsen S, Ansotegui I, Baena-Cagnani CE, Baker DJ, Bayram H, Bergmann KC, Boulet LP, Buters JT, D’Amato M, Dorsano S, Douwes J, Finlay SE, Garrasi D, Gómez M, Haahtela T, Halwani R, Hassani Y, Mahboub B, Marks G, Michelozzi P, Montagni M, Nunes C, Oh JJ, Popov TA, Portnoy J, Ridolo E, Rosário N, Rottem M, Sánchez-Borges M, Sibanda E, Sienra-Monge JJ, Vitale C, Annesi-Maesano I. Meteorological conditions, climate change, new emerging factors, and asthma and related allergic disorders. A statement of the World Allergy Organization. World Allergy Organ J. 2015;8:1–52.CrossRef D’Amato G, Holgate ST, Pawankar R, Ledford DK, Cecchi L, Al-Ahmad M, Al-Enezi F, Al-Muhsen S, Ansotegui I, Baena-Cagnani CE, Baker DJ, Bayram H, Bergmann KC, Boulet LP, Buters JT, D’Amato M, Dorsano S, Douwes J, Finlay SE, Garrasi D, Gómez M, Haahtela T, Halwani R, Hassani Y, Mahboub B, Marks G, Michelozzi P, Montagni M, Nunes C, Oh JJ, Popov TA, Portnoy J, Ridolo E, Rosário N, Rottem M, Sánchez-Borges M, Sibanda E, Sienra-Monge JJ, Vitale C, Annesi-Maesano I. Meteorological conditions, climate change, new emerging factors, and asthma and related allergic disorders. A statement of the World Allergy Organization. World Allergy Organ J. 2015;8:1–52.CrossRef
4.
5.
go back to reference Wood SN. Generalized additive models: an Introduction with R. 2nd ed. Boca Raton: CRC Press; 2017.CrossRef Wood SN. Generalized additive models: an Introduction with R. 2nd ed. Boca Raton: CRC Press; 2017.CrossRef
7.
go back to reference Ayyadevara VK. Random forest. In: Pro machine learning algorithms: a hands-on approach to implementing algorithms in Python and R. Berkeley, CA: Apress; 2018. p. 105–16. Ayyadevara VK. Random forest. In: Pro machine learning algorithms: a hands-on approach to implementing algorithms in Python and R. Berkeley, CA: Apress; 2018. p. 105–16.
8.
go back to reference Prettenhofer P, Louppe G. Gradient boosted regression trees in scikit-learn. InPyData 2014;2014. Prettenhofer P, Louppe G. Gradient boosted regression trees in scikit-learn. InPyData 2014;2014.
9.
go back to reference Cassino C, Ito K, Bader IR, Ciotoli C, Thurston G, Reibman JO. Cigarette smoking and ozone-associated emergency department use for asthma by adults in New York City. Am J Respir Crit Care Med. 1999;159:1773–9.CrossRefPubMed Cassino C, Ito K, Bader IR, Ciotoli C, Thurston G, Reibman JO. Cigarette smoking and ozone-associated emergency department use for asthma by adults in New York City. Am J Respir Crit Care Med. 1999;159:1773–9.CrossRefPubMed
10.
go back to reference Lee SW, Yon DK, James CC, Lee S, Koh HY, Sheen YH, Oh JW, Han MY, Sugihara G. Short-term effects of multiple outdoor environmental factors on risk of asthma exacerbations: age-stratified time-series analysis. J Allergy Clin Immunol. 2019;144:1542-50.e1.CrossRefPubMed Lee SW, Yon DK, James CC, Lee S, Koh HY, Sheen YH, Oh JW, Han MY, Sugihara G. Short-term effects of multiple outdoor environmental factors on risk of asthma exacerbations: age-stratified time-series analysis. J Allergy Clin Immunol. 2019;144:1542-50.e1.CrossRefPubMed
11.
go back to reference Sun X, Waller A, Yeatts KB, Thie L. Pollen concentration and asthma exacerbations in Wake County, North Carolina, 2006–2012. Sci Total Environ. 2016;544:185–91.CrossRefPubMed Sun X, Waller A, Yeatts KB, Thie L. Pollen concentration and asthma exacerbations in Wake County, North Carolina, 2006–2012. Sci Total Environ. 2016;544:185–91.CrossRefPubMed
12.
go back to reference Jeddi Z, Gryech I, Ghogho M, El Hammoumi M, Mahraoui C. Machine learning for predicting the risk for childhood asthma using prenatal, perinatal, postnatal and environmental factors. Healthcare (Basel). 2021;9:1464.CrossRefPubMed Jeddi Z, Gryech I, Ghogho M, El Hammoumi M, Mahraoui C. Machine learning for predicting the risk for childhood asthma using prenatal, perinatal, postnatal and environmental factors. Healthcare (Basel). 2021;9:1464.CrossRefPubMed
13.
go back to reference Medsker LR, Jain LC, editors. Recurrent neural networks: design and applications. Boca Raton: CRC Press; 1999. Medsker LR, Jain LC, editors. Recurrent neural networks: design and applications. Boca Raton: CRC Press; 1999.
15.
go back to reference Cho K, van Merrienboer B, Bahdanau D, Bengio Y. On the properties of neural machine translation: Encoder-decoder approaches. arXiv preprint arXiv:1409.1259; 2014. Cho K, van Merrienboer B, Bahdanau D, Bengio Y. On the properties of neural machine translation: Encoder-decoder approaches. arXiv preprint arXiv:​1409.​1259; 2014.
16.
go back to reference Woo J, Lee JH, Kim Y, Rudasingwa G, Lim DH, Kim S. Forecasting the effects of real-time indoor PM2.5 on peak expiratory flow rates (PEFR) of asthmatic children in Korea: a deep learning approach. IEEE Access. 2022;10:19391–400.CrossRef Woo J, Lee JH, Kim Y, Rudasingwa G, Lim DH, Kim S. Forecasting the effects of real-time indoor PM2.5 on peak expiratory flow rates (PEFR) of asthmatic children in Korea: a deep learning approach. IEEE Access. 2022;10:19391–400.CrossRef
17.
go back to reference Kim D, Cho S, Tamil L, Song DJ, Seo S. Predicting asthma attacks: effects of indoor PM concentrations on peak expiratory flow rates of asthmatic children. IEEE Access. 2019;8:8791–7.CrossRef Kim D, Cho S, Tamil L, Song DJ, Seo S. Predicting asthma attacks: effects of indoor PM concentrations on peak expiratory flow rates of asthmatic children. IEEE Access. 2019;8:8791–7.CrossRef
18.
go back to reference Chang M, Ku Y. LSTM model for predicting the daily number of asthma patients in Seoul, South Korea, using meteorological and air pollution data. Environ Sci Pollut Res Int. 2023;30:37440–8.CrossRefPubMed Chang M, Ku Y. LSTM model for predicting the daily number of asthma patients in Seoul, South Korea, using meteorological and air pollution data. Environ Sci Pollut Res Int. 2023;30:37440–8.CrossRefPubMed
19.
go back to reference Billa J. Dropout approaches for LSTM based speech recognition systems. In: 2018 IEEE International Conference on Acoustics, Speech and Signal Processing (ICASSP). IEEE; 2018. p. 5879–83. Billa J. Dropout approaches for LSTM based speech recognition systems. In: 2018 IEEE International Conference on Acoustics, Speech and Signal Processing (ICASSP). IEEE; 2018. p. 5879–83.
20.
go back to reference Pham V, Bluche T, Kermorvant C, Louradour J. Dropout improves recurrent neural networks for handwriting recognition. In: 2014 14th International Conference on Frontiers in Handwriting Recognition. IEEE; 2014. p. 285–90. Pham V, Bluche T, Kermorvant C, Louradour J. Dropout improves recurrent neural networks for handwriting recognition. In: 2014 14th International Conference on Frontiers in Handwriting Recognition. IEEE; 2014. p. 285–90.
21.
go back to reference Yoon H. Time series data analysis using wavenet and walk forward validation. J Korea Soc Simul. 2021;30:1–8. Yoon H. Time series data analysis using wavenet and walk forward validation. J Korea Soc Simul. 2021;30:1–8.
22.
go back to reference Tran TN, Phuc DT. Grid search of multilayer perceptron based on the walk-forward validation methodology. Int J Electr Comput Eng. 2021;11:1742. Tran TN, Phuc DT. Grid search of multilayer perceptron based on the walk-forward validation methodology. Int J Electr Comput Eng. 2021;11:1742.
23.
go back to reference Gulli A, Pal S. Deep learning with Keras. Birmingham: Packt Publishing Ltd; 2017. Gulli A, Pal S. Deep learning with Keras. Birmingham: Packt Publishing Ltd; 2017.
24.
go back to reference Raschka S, Mirjalili V. Python machine learning: machine learning and deep learning with Python, scikit-learn, and TensorFlow 2. Birmingham: Packt Publishing Ltd.; 2019. Raschka S, Mirjalili V. Python machine learning: machine learning and deep learning with Python, scikit-learn, and TensorFlow 2. Birmingham: Packt Publishing Ltd.; 2019.
25.
go back to reference Pedregosa F, Varoquaux G, Gramfort A, Michel V, Thirion B, Grisel O, Blondel M, Prettenhofer P, Weiss R, Dubourg V, Vanderplas J, Passos A, Cournapeau D, Brucher M, Perrot M, Duchesnay E. Scikit-learn: machine learning in Python. J Mach Learn Res. 2011;12:2825–30. Pedregosa F, Varoquaux G, Gramfort A, Michel V, Thirion B, Grisel O, Blondel M, Prettenhofer P, Weiss R, Dubourg V, Vanderplas J, Passos A, Cournapeau D, Brucher M, Perrot M, Duchesnay E. Scikit-learn: machine learning in Python. J Mach Learn Res. 2011;12:2825–30.
26.
go back to reference Altmann A, Toloşi L, Sander O, Lengauer T. Permutation importance: a corrected feature importance measure. Bioinformatics. 2010;26:1340–7.CrossRefPubMed Altmann A, Toloşi L, Sander O, Lengauer T. Permutation importance: a corrected feature importance measure. Bioinformatics. 2010;26:1340–7.CrossRefPubMed
27.
go back to reference Xiong X, Wei Y, Lam HCY, Wong CKH, Lau SYF, Zhao S, Ran J, Li C, Jiang X, Yue Q, Cheng W, Wang H, Wang Y, Chong KC. Association between cold weather, influenza infection, and asthma exacerbation in adults in Hong Kong. Sci Total Environ. 2023;857: 159362.CrossRefPubMed Xiong X, Wei Y, Lam HCY, Wong CKH, Lau SYF, Zhao S, Ran J, Li C, Jiang X, Yue Q, Cheng W, Wang H, Wang Y, Chong KC. Association between cold weather, influenza infection, and asthma exacerbation in adults in Hong Kong. Sci Total Environ. 2023;857: 159362.CrossRefPubMed
28.
go back to reference Hales S, Lewis S, Slater T, Crane J, Pearce N. Prevalence of adult asthma symptoms in relation to climate in New Zealand. Environ Health Perspect. 1998;106:607–10.CrossRefPubMedPubMedCentral Hales S, Lewis S, Slater T, Crane J, Pearce N. Prevalence of adult asthma symptoms in relation to climate in New Zealand. Environ Health Perspect. 1998;106:607–10.CrossRefPubMedPubMedCentral
29.
go back to reference Bloomer BJ, Stehr JW, Piety CA, Salawitch RJ, Dickerson RR. Observed relationships of ozone air pollution with temperature and emissions. Geophys Res Lett 2009;36. Bloomer BJ, Stehr JW, Piety CA, Salawitch RJ, Dickerson RR. Observed relationships of ozone air pollution with temperature and emissions. Geophys Res Lett 2009;36.
31.
go back to reference Graudenz GS, Landgraf RG, Jancar S, Tribess A, Fonseca SG, Faé KC, Kalil J. The role of allergic rhinitis in nasal responses to sudden temperature changes. J Allergy Clin Immunol. 2006;118:1126–32.CrossRefPubMed Graudenz GS, Landgraf RG, Jancar S, Tribess A, Fonseca SG, Faé KC, Kalil J. The role of allergic rhinitis in nasal responses to sudden temperature changes. J Allergy Clin Immunol. 2006;118:1126–32.CrossRefPubMed
32.
go back to reference Togias AG, Naclerio RM, Proud D, Fish JE, Adkinson NF Jr, Kagey-Sobotka A, Norman PS, Lichtenstein LM. Nasal challenge with cold, dry air results in release of inflammatory mediators. Possible mast cell involvement. J Clin Invest. 1985;76:1375–81.CrossRefPubMedPubMedCentral Togias AG, Naclerio RM, Proud D, Fish JE, Adkinson NF Jr, Kagey-Sobotka A, Norman PS, Lichtenstein LM. Nasal challenge with cold, dry air results in release of inflammatory mediators. Possible mast cell involvement. J Clin Invest. 1985;76:1375–81.CrossRefPubMedPubMedCentral
33.
34.
go back to reference Kim J, Lim Y, Kim H. Outdoor temperature changes and emergency department visits for asthma in Seoul, Korea: a time-series study. Environ Res. 2014;135:15–20.CrossRefPubMed Kim J, Lim Y, Kim H. Outdoor temperature changes and emergency department visits for asthma in Seoul, Korea: a time-series study. Environ Res. 2014;135:15–20.CrossRefPubMed
35.
go back to reference Bronte-Moreno O, González-Barcala FJ, Muñoz-Gall X, Pueyo-Bastida A, Ramos-González J, Urrutia-Landa I. Impact of air pollution on asthma: a scoping review. Open Respir Arch. 2023;5: 100229.CrossRefPubMedPubMedCentral Bronte-Moreno O, González-Barcala FJ, Muñoz-Gall X, Pueyo-Bastida A, Ramos-González J, Urrutia-Landa I. Impact of air pollution on asthma: a scoping review. Open Respir Arch. 2023;5: 100229.CrossRefPubMedPubMedCentral
36.
go back to reference Cohen AJ, Brauer M, Burnett R, Anderson HR, Frostad J, Estep K, Balakrishnan K, Brunekreef B, Dandona L, Dandona R, Feigin V, Freedman G, Hubbell B, Jobling A, Kan H, Knibbs L, Liu Y, Martin R, Morawska L, Pope CA 3rd, Shin H, Straif K, Shaddick G, Thomas M, van Dingenen R, van Donkelaar A, Vos T, Murray CJL, Forouzanfar MH. Estimates and 25-year trends of the global burden of disease attributable to ambient air pollution: an analysis of data from the Global Burden of Diseases Study 2015. Lancet. 2017;389:1907–18.CrossRefPubMedPubMedCentral Cohen AJ, Brauer M, Burnett R, Anderson HR, Frostad J, Estep K, Balakrishnan K, Brunekreef B, Dandona L, Dandona R, Feigin V, Freedman G, Hubbell B, Jobling A, Kan H, Knibbs L, Liu Y, Martin R, Morawska L, Pope CA 3rd, Shin H, Straif K, Shaddick G, Thomas M, van Dingenen R, van Donkelaar A, Vos T, Murray CJL, Forouzanfar MH. Estimates and 25-year trends of the global burden of disease attributable to ambient air pollution: an analysis of data from the Global Burden of Diseases Study 2015. Lancet. 2017;389:1907–18.CrossRefPubMedPubMedCentral
38.
go back to reference Li XY, Gilmour PS, Donaldson K, Macnee W. In vivo and in vitro proinflammatory effects of particulate air pollution (PM10). Environ Health Perspect. 1997;105(suppl 5):1279–83.CrossRefPubMedPubMedCentral Li XY, Gilmour PS, Donaldson K, Macnee W. In vivo and in vitro proinflammatory effects of particulate air pollution (PM10). Environ Health Perspect. 1997;105(suppl 5):1279–83.CrossRefPubMedPubMedCentral
39.
go back to reference Villeneuve PJ, Chen L, Rowe BH, Coates F. Outdoor air pollution and emergency department visits for asthma among children and adults: a case-crossover study in northern Alberta. Canada Environ Health. 2007;6:1–15. Villeneuve PJ, Chen L, Rowe BH, Coates F. Outdoor air pollution and emergency department visits for asthma among children and adults: a case-crossover study in northern Alberta. Canada Environ Health. 2007;6:1–15.
40.
go back to reference Delfino RJ, Zeiger RS, Seltzer JM, Street DH, Matteucci RM, Anderson PR, Koutrakis P. The effect of outdoor fungal spore concentrations on daily asthma severity. Environ Health Perspect. 1997;105:622–35.CrossRefPubMedPubMedCentral Delfino RJ, Zeiger RS, Seltzer JM, Street DH, Matteucci RM, Anderson PR, Koutrakis P. The effect of outdoor fungal spore concentrations on daily asthma severity. Environ Health Perspect. 1997;105:622–35.CrossRefPubMedPubMedCentral
41.
go back to reference Ostro B, Lipsett M, Mann J, Braxton-Owens H, White M. Air pollution and exacerbation of asthma in African–American children in Los Angeles. Epidemiology. 2001;12:200–8.CrossRefPubMed Ostro B, Lipsett M, Mann J, Braxton-Owens H, White M. Air pollution and exacerbation of asthma in African–American children in Los Angeles. Epidemiology. 2001;12:200–8.CrossRefPubMed
42.
go back to reference Tecer LH, Alagha O, Karaca F, Tuncel G, Eldes N. Particulate matter (PM(2.5), PM(10–2.5), and PM(10)) and children’s hospital admissions for asthma and respiratory diseases: a bidirectional case-crossover study. J Toxicol Environ Health A. 2008;71:512–20.CrossRefPubMed Tecer LH, Alagha O, Karaca F, Tuncel G, Eldes N. Particulate matter (PM(2.5), PM(10–2.5), and PM(10)) and children’s hospital admissions for asthma and respiratory diseases: a bidirectional case-crossover study. J Toxicol Environ Health A. 2008;71:512–20.CrossRefPubMed
43.
go back to reference Chang YJ, Kim HY, Albacker LA, Baumgarth N, McKenzie AN, Smith DE, Dekruyff RH, Umetsu DT. Innate lymphoid cells mediate influenza-induced airway hyper-reactivity independently of adaptive immunity. Nat Immunol. 2011;12:631–8.CrossRefPubMedPubMedCentral Chang YJ, Kim HY, Albacker LA, Baumgarth N, McKenzie AN, Smith DE, Dekruyff RH, Umetsu DT. Innate lymphoid cells mediate influenza-induced airway hyper-reactivity independently of adaptive immunity. Nat Immunol. 2011;12:631–8.CrossRefPubMedPubMedCentral
44.
go back to reference Feldman LY, Zhu J, To T. Estimating age-specific influenza-associated asthma morbidity in Ontario, Canada. Respir Med. 2019;155:104–12.CrossRefPubMed Feldman LY, Zhu J, To T. Estimating age-specific influenza-associated asthma morbidity in Ontario, Canada. Respir Med. 2019;155:104–12.CrossRefPubMed
45.
go back to reference Gerke AK, Yang M, Tang F, Foster ED, Cavanaugh JE, Polgreen PM. Association of hospitalizations for asthma with seasonal and pandemic influenza. Respirology. 2014;19:116–21.CrossRefPubMed Gerke AK, Yang M, Tang F, Foster ED, Cavanaugh JE, Polgreen PM. Association of hospitalizations for asthma with seasonal and pandemic influenza. Respirology. 2014;19:116–21.CrossRefPubMed
Metadata
Title
Prediction of the number of asthma patients using environmental factors based on deep learning algorithms
Authors
Hyemin Hwang
Jae-Hyuk Jang
Eunyoung Lee
Hae-Sim Park
Jae Young Lee
Publication date
01-12-2023
Publisher
BioMed Central
Published in
Respiratory Research / Issue 1/2023
Electronic ISSN: 1465-993X
DOI
https://doi.org/10.1186/s12931-023-02616-x

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