亚洲粉尘对哮喘和非哮喘儿童呼吸道症状的影响及其敏感性
2021/12/24
摘要
关于亚洲粉尘暴露对易受环境因素影响的儿童呼吸道症状的影响的研究很少。在这项小组研究中，我们调查了亚洲粉尘对患有和不患有哮喘的儿童的呼吸道症状的影响，以及他们的敏感性。在两所小学就读的儿童（共计137名）和福冈县合作医疗机构的23名哮喘儿童被招募。受试者测量最大呼气流速（PEF），并记录2013年4月1日至2013年6月30日期间哮喘样症状、咳嗽、鼻部症状和用药情况。为了评估亚洲尘埃的暴露，我们使用了光探测和测距（LIDAR）数据。为了分析亚洲粉尘与呼吸道症状之间的关联，使用了病例交叉设计和广义估计方程（GEE）模型。考虑到个体对呼吸加重的敏感性，将受试者分为三组：无哮喘儿童。未使用长期预防性药物（CA）的哮喘儿童和使用长期预防性药物（ca-ltm）的哮喘儿童。对于CA，亚洲粉尘暴露于哮喘样症状显著相关，在Lag0时风险比为5.17（95%CI：1.02=26.12），在Lag0时%maxPEF变化为-1.65%（95%CI：-2.82，-0.48）。对于无哮喘的儿童，发现亚洲粉尘暴露与lag1时的%maxPEF 为-0.56% (95%CI: -1.31, -0.08)之间存在统计学显著关联。然而，在ca-ltm中没有观察到副作用。温度对三组的%maxPEF有显著影响。亚洲粉尘、光化学氧化剂和花粉同时对无哮喘儿童的鼻部症状造成累加不良影响。这项研究表明，长期预防性药物治疗哮喘可能会抑制亚洲粉尘引起的呼吸道症状加重，并可能是一种有效的预防方法。
Effect of Asian dust on respiratory symptoms among children with and without asthma, and their sensitivity
Hideki Hasunuma, Ayano Takeuchi, Rintaro Ono, Yuko Amimoto, Yoon Ha Hwang, Itsushi Uno, Atsushi Shimizu, Yuji Nishiwaki, Masahiro Hashizume, David J Askew, Hiroshi Odajima
Abstract
There has been little study on the effect of Asian dust exposure on respiratory symptoms among children who are vulnerable to environmental factors. In this panel study, we investigated the effect of Asian dust on respiratory symptoms among children with and without asthma, and their sensitivity. Children attending two elementary schools (137 total), and 23 children with asthma from cooperating medical institutions in Fukuoka prefecture were recruited. Subjects measured peak expiratory flow rate (PEF), and recorded asthma-like symptoms, cough, nasal symptoms and use of medication in a diary from April 1, 2013 to June 30, 2013. To assess exposure to Asian dust, we used Light Detection and Ranging (LIDAR) data. For the analysis of the association between Asian dust and respiratory symptoms, the case-crossover design and generalized estimating equation (GEE) models were used. Taking individual sensitivity to respiratory aggravation into consideration, the subjects were classified into three groups: children without asthma, children with asthma who do not use long-term preventive medication (CA) and children with asthma who use long-term preventive medication (CA-LTM). For CA, Asian dust exposure was significantly associated with asthma-like symptoms, with a hazard ratio of 5.17 (95%CI: 1.02=26.12) at Lag0, and the change in %maxPEF, -1.65% (95%CI:-2.82, -0.48) at Lag0. For children without asthma, a statistically significant association was found between Asian dust exposure and the change in %maxPEF, -0.56% (95%CI: -1.31, -0.08) at Lag1. However, no adverse effects were observed in CA-LTM. Temperature had significant effects on %maxPEF for three groups. Asian dust, photochemical oxidant and pollen caused simultaneously additive adverse effects on nasal symptoms for children without asthma. This study suggests the possibility that long-term preventive medication to manage asthma may suppress aggravation of respiratory symptoms due to Asian dust and may be an effective prevention.
关于亚洲粉尘暴露对易受环境因素影响的儿童呼吸道症状的影响的研究很少。在这项小组研究中，我们调查了亚洲粉尘对患有和不患有哮喘的儿童的呼吸道症状的影响，以及他们的敏感性。在两所小学就读的儿童（共计137名）和福冈县合作医疗机构的23名哮喘儿童被招募。受试者测量最大呼气流速（PEF），并记录2013年4月1日至2013年6月30日期间哮喘样症状、咳嗽、鼻部症状和用药情况。为了评估亚洲尘埃的暴露，我们使用了光探测和测距（LIDAR）数据。为了分析亚洲粉尘与呼吸道症状之间的关联，使用了病例交叉设计和广义估计方程（GEE）模型。考虑到个体对呼吸加重的敏感性，将受试者分为三组：无哮喘儿童。未使用长期预防性药物（CA）的哮喘儿童和使用长期预防性药物（ca-ltm）的哮喘儿童。对于CA，亚洲粉尘暴露于哮喘样症状显著相关，在Lag0时风险比为5.17（95%CI：1.02=26.12），在Lag0时%maxPEF变化为-1.65%（95%CI：-2.82，-0.48）。对于无哮喘的儿童，发现亚洲粉尘暴露与lag1时的%maxPEF 为-0.56% (95%CI: -1.31, -0.08)之间存在统计学显著关联。然而，在ca-ltm中没有观察到副作用。温度对三组的%maxPEF有显著影响。亚洲粉尘、光化学氧化剂和花粉同时对无哮喘儿童的鼻部症状造成累加不良影响。这项研究表明，长期预防性药物治疗哮喘可能会抑制亚洲粉尘引起的呼吸道症状加重，并可能是一种有效的预防方法。
(中日友好医院呼吸与危重症医学科 张清 摘译 林江涛 审校)
(Sci Total Environ. 2021 Jan 20;753:141585.doi:10.1016/j.scitotenv.2020.141585)
(Sci Total Environ. 2021 Jan 20;753:141585.doi:10.1016/j.scitotenv.2020.141585)
Effect of Asian dust on respiratory symptoms among children with and without asthma, and their sensitivity
Hideki Hasunuma, Ayano Takeuchi, Rintaro Ono, Yuko Amimoto, Yoon Ha Hwang, Itsushi Uno, Atsushi Shimizu, Yuji Nishiwaki, Masahiro Hashizume, David J Askew, Hiroshi Odajima
Abstract
There has been little study on the effect of Asian dust exposure on respiratory symptoms among children who are vulnerable to environmental factors. In this panel study, we investigated the effect of Asian dust on respiratory symptoms among children with and without asthma, and their sensitivity. Children attending two elementary schools (137 total), and 23 children with asthma from cooperating medical institutions in Fukuoka prefecture were recruited. Subjects measured peak expiratory flow rate (PEF), and recorded asthma-like symptoms, cough, nasal symptoms and use of medication in a diary from April 1, 2013 to June 30, 2013. To assess exposure to Asian dust, we used Light Detection and Ranging (LIDAR) data. For the analysis of the association between Asian dust and respiratory symptoms, the case-crossover design and generalized estimating equation (GEE) models were used. Taking individual sensitivity to respiratory aggravation into consideration, the subjects were classified into three groups: children without asthma, children with asthma who do not use long-term preventive medication (CA) and children with asthma who use long-term preventive medication (CA-LTM). For CA, Asian dust exposure was significantly associated with asthma-like symptoms, with a hazard ratio of 5.17 (95%CI: 1.02=26.12) at Lag0, and the change in %maxPEF, -1.65% (95%CI:-2.82, -0.48) at Lag0. For children without asthma, a statistically significant association was found between Asian dust exposure and the change in %maxPEF, -0.56% (95%CI: -1.31, -0.08) at Lag1. However, no adverse effects were observed in CA-LTM. Temperature had significant effects on %maxPEF for three groups. Asian dust, photochemical oxidant and pollen caused simultaneously additive adverse effects on nasal symptoms for children without asthma. This study suggests the possibility that long-term preventive medication to manage asthma may suppress aggravation of respiratory symptoms due to Asian dust and may be an effective prevention.
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