冬季气温下降和二氧化硫水平影响韩国难治性哮喘发作：对顺天乡哮喘队列数据的时间-趋势、对照、病例-交叉
2012/10/11
摘要
目的：基于美国胸科协会的报道，约5%的哮喘患者存在难治性哮喘（RA），这些患者即使是采用大剂量药物长期治疗，肺功能也未能显著改善。
方法：基于时间-趋势、对照、病例-交叉研究设计，计算优势比，评价入院当天（Lag 0）和入院前3天（Lag 1-3）的周围空气污染物暴露和气候条件是否与急性RA发作相关。对季节、吸烟和过敏原敏感性的影响进行控制后，进行分析；同时就每个月的气温，基于4季对数据进行分层，此外基于吸烟状态和皮肤针刺试验结果进一步分层。
结果：结果显示，居住在首尔和京畿道省的RA患者（n = 82）占2005年至2009年哮喘队列研究中所有哮喘患者（n = 2298）的3.7%。冬季，环境温度每下降1°C和Lag 1的二氧化硫浓度每增加1 ppb，分别可以使非吸烟者RA发作增加14.8%（95% CI: 0.9-26.7）和19.7%（95% CI: 3.3-38.7）。类似的相关性也在Lag 2中观察到。在排除对粉尘螨和屋尘螨过敏的患者后，该相关性仍然存在。
结论：Lag 1和Lag 2气温下降和二氧化硫含量增加与急性RA发作呈正相关。
（苏楠 审校）
J Asthma. 2012 Sep;49(7):679-87. Epub 2012 Jul 20.
J Asthma. 2012 Sep;49(7):679-87. Epub 2012 Jul 20.
Kim S, Kim Y, Lee MR, Kim J, Jung A, Park JS, Jang AS, Park SW, Uh ST, Choi JS, Kim YH, Buckley T, Park CS.
Source
Department of Environmental Health Sciences, Soonchunhyang University , Asan , South Korea.
Abstract
OBJECTIVE： According to the American Thoracic Society, approximately 5% of all asthmatics have refractory asthma (RA); these patients fail to recover lost lung function even after long-term treatment with high doses of medications.
METHODS:Using a time-trend controlled case-crossover study design, we calculated odds ratios to evaluate whether exposure to ambient air pollutants and certain meteorological conditions on the day of admission (Lag 0) and up to 3 days before admission (Lag1 through Lag 3) were associated with acute RA exacerbation. Results were obtained after controlling for the effects of seasonality, smoking, and allergen sensitivity; we stratified our data into four seasons with respect to the median temperature of each month and further stratified them according to self-reported smoking status and skin-prick test results.
RESULTS:In our study, RA patients (n = 82), living in metropolitan city of Seoul and Kyunggi Province, accounted for 3.7% of all asthmatics (n = 2298) registered in our asthma cohort between 2005 and 2009. In winter, a 1°C decrease in ambient temperature and a 1 ppb increase in sulfur dioxide concentration on the day of Lag 1 were associated with 14.8% (95% confidence interval [CI]: 0.9-26.7) and 19.7% (95% CI: 3.3-38.7) increases in the risk of RA exacerbation among nonsmokers, respectively. Similar associations were obtained on the day of Lag 2. The association remained unchanged after excluding patients sensitive to Dermatophagoides farinae and Dermatophagoides pteronyssinus.
CONCLUSIONS:Exposure to temperature drops and increased sulfur dioxide concentrations are positively associated with the occurrence of acute RA exacerbation during winter with 1 or 2 day lags.
J Asthma. 2012 Sep;49(7):679-87. Epub 2012 Jul 20.
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