母乳喂养与大气污染对儿童呼吸系统疾病和症状影响的交互效应

目的 探讨母乳喂养与大气污染对儿童呼吸系统疾病和症状影响的交互效应。方法 采用横断面研究,在辽宁省7个城市即沈阳、大连、鞍山、抚顺、本溪、营口、辽阳共25个行政区随机抽取50所幼儿园,采用国际统一的标准问卷ATS(American Thoracic Society)调查表对所选幼儿园的所有儿童进行有关母乳喂养、生活环境以及儿童呼吸系统疾病情况的调查。根据各行政区环境监测中心提供的2006-2008年大气污染物(PM₁₀、SO₂、NO₂、O₃)浓度计算日平均浓度。结果 本次研究共调查10 822人,共回收有效问卷9 318份,应答率为86.1%,符合上机进行统计分析的要求。共分析四个污染物PM₁₀、SO₂、NO₂、O₃的日平均浓度,统计的25个行政区中PM₁₀、SO₂的日平均浓度不同程度地超出国家标准,100%的行政区PM₁₀、SO₂日平均浓度超出WHO标准,36%的行政区NO₂日平均浓度超出国家标准。母乳喂养儿童7 319人,非母乳喂养儿童1 999人,其中接受母乳喂养的男童多于女童(P<0.05);非母乳喂养儿童与母乳喂养儿童相比,大气污染物PM₁₀、SO₂、NO₂、O₃每增加一个单位,儿童患有持续咳嗽、持续咳痰的危险性均呈增加趋势(P<0.05);母乳喂养与大气污染物PM₁₀、SO₂、NO₂、O₃对儿童喘鸣现患存在交互作用且有统计学意义(P<0.20)。结论 母乳喂养和大气污染对儿童呼吸系统疾病和症状的影响存在显著的交互效应。     

Outdoor air pollution and health effects in urban children with moderate to severe asthma

Particulate matter less than 2.5 μm in diameter (PM_2.5) is associated with asthma morbidity. Recent studies have begun examining the role of various constituents of PM_2.5, their potential sources, and their effects on health. We examine their role in asthmatic children. Thirty-six children 6–14 years with moderate/severe asthma from inner city areas in New York City were studied for 2-week periods (summer and winter) using diaries and lung function. Outdoor data, including PM₁₀, PM_2.5, elements, elemental/organic carbon, and criteria gases (NO₂, SO₂, and O₃) were collected at two sites. Odds ratios (ORs) relating daily pollutant concentrations to asthma indicators were calculated. During summer significant ORs>1 for symptom severity were obtained (O₃, PM_10, PM_2.5, and S); after adjustment for O₃, the ORs were no longer significant. During winter, Cu, Fe, Si, and Zn were significantly but negatively (ORs<1) associated with symptoms. Lag effects in winter suggested delayed effects (ORs>1) on symptoms (As, K, Pb, and V). Albuterol use increased during summer (O₃, PM₁₀, PM_2.5, Na, and S); after adjustment for O₃, only Na and S remained significant. Reduced pulmonary function was significantly associated with O₃ and Cl. Components of PM_2.5 are associated with asthma exacerbation in asthmatic children. Same-day pollutant associations with symptoms are seen in summer. In winter, our analysis suggests delayed adverse associations of PM_2.5 components.     

Acute effects of urban ambient air pollution on respiratory symptoms, asthma medication use, and doctor visits for asthma in a cohort of Australian children

We enrolled a cohort of primary school children with a history of wheeze (n=148) in an 11-month longitudinal study to examine the relationship between ambient air pollution and respiratory morbidity. We obtained daily air pollution (ozone, particulate matter less than 10 microm, and nitrogen dioxide), meteorological, and pollen data. One hundred twenty-five children remained in the final analysis. We used logistic regression models to determine associations between air pollution and respiratory symptoms, asthma medication use, and doctor visits for asthma. There were no associations between ambient ozone concentrations and respiratory symptoms, asthma medication use, and doctor visits for asthma. There was, however, an association between PM(10) concentrations and doctor visits for asthma (RR=1.11, 95% CI=1.04-1.19) and between NO(2) concentration and wet cough (RR=1.05, 95% CI=1.003-1.10) in single-pollutant models. The associations remained significant in multipollutant models. There was no consistent evidence that children with wheeze, positive histamine challenge, and doctor diagnosis of asthma reacted differently to air pollution from children with wheeze and doctor diagnosis of asthma and children with wheeze only. There were significant associations between PM(10) levels and doctor visits for asthma and an association between NO(2) levels and the prevalence of wet cough. We were, however, unable to demonstrate that current levels of ambient air pollution in western Sydney have a coherent range of adverse health effects on children with a history of wheezing.     

Acute effects of urban air pollution on respiratory emergency hospital admissions in the Canary Islands

In the cities of Las Palmas (L/P) de Gran Canaria and Santa Cruz (S/C) de Tenerife, Canary Islands, particulate matter is highly influenced by mineral dust because their proximity to the Sahara desert (PM_10–2.5 levels are higher than PM_2.5). In this context, the short-term association between different PM fractions and gaseous pollutants with emergency hospital admissions for all respiratory, chronic obstructive pulmonary disease (COPD) and asthma was analyzed, evaluating the potential independent effect of PM_10–2.5. A generalized additive model was fitted controlling for seasonal patterns and time varying confounders. Different lag structures, polynomial distributed lag models, and two-pollutant models were examined. Under Lag01, in S/C de Tenerife, a 10 μg/m³ increase in PM_2.5 and PM_10–2.5 was associated with a 5.1 % risk increase (95 % confidence interval [CI] 1.0 to 9.2) in all respiratory and with a 7.7 % increase (95 % CI 0.9 to 14.9) in COPD emergency admissions, respectively. In L/P de Gran Canaria, a positive association between PM_10–2.5, PM_2.5, and NO₂ with the increased risk of asthma hospitalization was found: 11.2 % (95 % CI 0.5 to 22.9), 21.9 % (95 % CI 6.9 to 39.0), and a 17.4 % (95 % CI 6.6 to 29.4), respectively. The overall findings suggest that in these cities, (1) PM_2.5, PM_10–2.5, and NO₂ are associated with the risk of emergency hospital admission for respiratory diseases; (2) there is no evidence of confounding for the associations observed; and (3) PM_10–2.5 may have an impact on public health.     

Effects of air pollution on changes in lung function induced by exercise in children with chronic respiratory symptoms

Objective: To investigate how daily variations in ambient air pollution, especially in particles, during the cold of winter affect repeated measurements of baseline lung function and exercise induced bronchial responsiveness among primary school children with chronic respiratory symptoms.

Methods: During alternate school weeks (mamimum five) from February to April 1994, 33 children took part in exercise challenge tests (n=141 tests). The exercise challenges were conducted outdoors in a school yard in the centre of Kuopio, Finland. Spirometric lung functions were measured indoors before the exercise, and 3 and 10 minutes after. Daily mean concentrations of PM₁₀, black smoke (BS), NO₂, CO, SO₂, and particle size and numbers were monitored at a nearby fixed monitoring site.

Results: Daily variations in ambient air pollution were not associated with enhanced bronchial responsiveness. However, increased concentrations of BS, PM₁₀, particle numbers, NO₂, and CO were consistently associated with an impairment of baseline lung functions. The reductions in forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV₁) were 0.5% and 0.6%, respectively, for each 10 µg/m³ increase in BS (lag 2).

Conclusion: Particles derived from combustion affect baseline lung function rather than bronchial responsiveness among children with chronic respiratory symptoms.

     

Indoor air pollution and respiratory health in urban and rural China

During the summer of 1999, information about respiratory health outcomes and relevant covariates was collected from 3,709 Chinese adults in Beijing, Anqing City, and rural communities in Anqing Prefecture. Indoor PM10 and SO2 were measured in a random sample of selected households. Using logistic regression and controlling for important covariates (excluding PM10 and SO2) and familial intraclass correlation, highly significant differences were found between study areas in the prevalences of chronic cough, chronic phlegm, wheeze, and shortness of breath, but not physician-diagnosed asthma. Generally, the lowest prevalence of respiratory symptoms was observed in Anqing City, a higher prevalence in rural Anqing, and the highest prevalence in Beijing. Median indoor concentrations of PM10 were similar in Anqing City (239 microg/m3) and rural Anqing (248 microg/m3), but much higher in Beijing (557 microg/m3). Median indoor concentrations of SO2 were similar in all three areas (Beijing: 14 microg/m3, Anqing City: 25 microg/m3, rural Anqing: 20 microg/m3).     

Assessment of air pollution health effects on respiratory organs]

During the past three decades, industrial expansion in Japan has been remarkable, resulting in a numerous number of chemical substances got synthesized. Unfortunately, our living environment has concomitantly been polluted with such substances released through industrial activities and our daily lives, and health injuries have occasionally occurred in the human population. Although the critical conditions in the 1960s were overcome by the countermeasures we took, the potential for environmental pollution still remains. In the present social and economical situation, the management of environmental pollutants should be decided depending upon more quantitative and predictive evaluation of their health effects. In this paper the author tries to evaluate the relation of air pollution to chronic bronchitis, bronchial asthma and pulmonary cancer from a quantitative point of view.     

Daily air pollution effects on children's respiratory symptoms and peak expiratory flow

To identify acute respiratory health effects associated with air pollution due to coal combustion, a subgroup of elementary school-aged children was selected from a large cross-sectional study and followed daily for eight months. Children were selected to obtain three equal-sized groups: one without respiratory symptoms, one with symptoms of persistent wheeze, and one with cough or phlegm production but without persistent wheeze. Parents completed a daily diary of symptoms from which illness constellations of upper respiratory illness (URI) and lower respiratory illness (LRI) and the symptom of wheeze were derived. Peak expiratory flow rate (PEFR) was measured daily for nine consecutive weeks during the eight-month study period. Maximum hourly concentrations of sulfur dioxide, nitrogen dioxide, ozone, and coefficient of haze for each 24-hour period, as well as minimum hourly temperature, were correlated with daily URI, LRI, wheeze, and PEFR using multiple regression models adjusting for illness occurrence or level of PEFR on the immediately preceding day. Respiratory illness on the preceding day was the most important predictor of current illness. A drop in temperature was associated with increased URI and LRI but not with increased wheeze or with a decrease in level of PEFR. No air pollutant was strongly associated with respiratory illness or with level of PEFR, either in the group of children as a whole, or in either of the symptomatic subgroups; the pollutant concentrations observed, however, were uniformly lower than current ambient air quality standards. Moreover, since exposure estimation based on monitoring of ambient air likely results in misclassification of the true exposure, the negative findings of this study must be interpreted cautiously.     

煤烟型大气污染对儿童呼吸系统疾病及症状影响研究

采用现场流行病学调查 ,对太原市大气污染程度不同的 3个地区的小学生进行了健康问卷调查和五官检查 ,研究结果表明 :重 (中 )污染区儿童鼻炎、咽喉炎、扁桃体炎发病率分别大于相对清洁区 ,3个研究区域比较差异有极显著性 (P <0 0 1) ;儿童呼吸道症状的发生率和呼吸道疾病患病率表现为重污染区和中污染区较为接近 ,但明显高于相对清洁区 ,且有显著性差异 (P <0 0 5 )。Logistic分析结果显示儿童咳嗽、咳痰症状发生的危险性表现为重度污染区是相对清洁区的 1 6 4～ 2 92倍 ,中度污染区是相对清洁区的 1 83～2 2 7倍。儿童呼吸系统疾病发生的危险性表现为重度污染区是相对清洁区的 2 6 2～ 5 6 8倍 ,中度污染区是相对清洁区的 1 40～ 4 46倍。提示太原市煤烟型大气污染对儿童呼吸系统产生了一定危害     

Particulate air pollution and chronic respiratory symptoms among traffic policemen in Bangkok

In this cross-sectional study, the authors examined the relationship between traffic-based air pollution and chronic, nonspecific respiratory symptoms among traffic policemen in Bangkok, Thailand. A total of 1,603 policemen who lived and worked in areas that had 3 different levels of airborne particulates were evaluated. The authors used a modified standardized questionnaire to identify nonspecific respiratory disease (NSRD) in participants. The prevalence of NSRD in heavily polluted, moderately polluted, and suburban areas was 13.0%, 10.9%, and 9.4%, respectively. Among nonsmokers, the age-adjusted prevalence of NSRD in the heavily polluted areas was significantly higher than in the suburban control area. Also among nonsmokers, the odds ratio for NSRD for each 10-microg/m3 increase in ambient particulate matter was 1.11. The authors concluded that the increased prevalence of respiratory symptoms among traffic policemen in Bangkok was associated with urban traffic air pollution.     

Ambient air pollution and respiratory health effects in mail carriers

Mail carriers represent an occupational group suffering from respiratory symptoms and lung function impairment. Although environmental conditions may play role, information on the effects of air pollution exposure in this population is lacking.The present study was conducted in Athens, Greece, in order to investigate the adverse effects of long-term air pollution exposure on respiratory outcomes in mail carriers.A total of 226 mail carriers and 73 office employees were enroled. Information on respiratory symptoms, medical, occupational, residential and smoking history was obtained through a questionnaire. Flow-volume curves were performed in the workplace using a portable spirometer. Individualised personal exposure assessment has been applied based on long-term residential and occupational subject history linked with geographical air pollution distribution. Furthermore, personal measurements were obtained for forty-one mail carriers using NO₂ and O₃ passive samplers, assuming that current air pollution exposure is sufficiently representative of long-term, previous exposure to make a plausible link with current health status.The analysis based on exposures estimated on the basis of residential and work addresses showed that the most exposed to PM₁₀ postal workers have rhinitis at a higher rate (OR=1.67, 95% CI: 1.01-2.75). In mail carriers there is indication that those exposed to higher concentrations of Ο₃ or PM₁₀ have a greater possibility to present rhinitis (OR=1.63, 95% CI: 0.93-2.88 and OR=1.70, 95% CI: 0.96-3.03, respectively). The effect of O₃ on rhinitis became even more apparent in the analysis based on exposures assessed by personal measurements (OR=6.74, 95% CI: 1.24-36.55). Exposure to NO₂ was significantly associated with decrements in lung function. For office employees the exposure to air pollutants was not associated to any adverse respiratory outcome.Our findings suggest that air pollution is a contributing factor for the occurrence of rhinitis and lung function impairment in mail carriers.     

太原市空气污染对小学生呼吸系统症状的急性影响

目的 了解太原市重工业造成的空气污染对儿童呼吸系统症状的急性影响,探讨儿童呼吸系统症状与空气污染的相关性.方法 于2008年7月1日-2009年6月30日以定群研究方法选择479名6～11岁儿童,通过填写小学生健康日志来记录每日呼吸系统症状.同时收集距学校1.5 km处空气监测点PM10、SO2、NO2、CO日均浓度.应用广义估计方程(GEE)建立空气污染与小学生呼吸系统症状的剂量反应关系,估计污染物危险度.结果 调整了个体水平的危险因素之后,SO2影响的估计值稳定.在滞后效应中,lag1～lag 3和lag 5危险度相对较高,SO2浓度每升高1个四分位数间距(63 μg/m3),儿童呼吸系统症状增加8％～17％.在累积效应中,危险度随累积天数的增加而上升,SO2浓度每升高1个四分位数间距,儿童呼吸系统症状增加25％～74％.累积效应大于滞后效应.调整了其他污染物的影响之后,SO2的危险度略有升高,分析结果仍有统计学意义.结论 大气SO2污染可能导致本次调查的小学生呼吸系统症状发生率上升.     

室外空气污染对儿童呼吸系统健康的影响

目的 探讨空气污染对儿童呼吸系统健康的危害，根据本溪市历年空气质量监测结果，对不同污染区的儿童健康状况进行调查。方法 采取整群抽样方法，在本溪市轻、中、重污染区随机抽取小学和幼儿园各一所，全部幼童为调查对象。结果 本溪市儿童持续咳嗽、咯痰、哮喘、哮喘现患、喘鸣及喘鸣样症状的发生率分别为11．89％，5．44％，1．15％，0．62％，6．98％，5．83％。幼儿呼吸系统各病症发生率均高于学龄儿童的发生率；除幼儿男性持续咳嗽发生率低于女性的发生率外(OR=0．69，95％CI=0．49～0．98)，性别间差异无统计学意义。重、中污染区儿童的发生率高于轻污染区儿童的发生率，其中重污染区儿童喘鸣样症状的发生率高于轻污染区儿童的发生率(OR=1．50，95％CI=1．01～2．25)。沿街居住可使儿童呼吸系统疾病及症状的发生率增高，随着住房与交通干线距离的接近，儿童呼吸系统疾病的发生率也呈现增高趋势。易感因素与室外空气污染的联合作用较强，呼吸系统各种疾病的发生率均以受其他因素影响的易感儿童为高，无其他因素影响的非易感儿童发生率为低。结论 室外空气污染是儿童呼吸系统健康的影响因素。     

室内空气污染对呼吸道症状和肺功能的影响

目的 探讨室内空气污染对呼吸道症状和肺功能的影响。方法 通过逐步回归分析方法分析不同生活燃料造成的室内空气污染对肺功能的影响。结果 分析了10892人的调查资料，在调整了混杂因素影响后，家庭内使用有烟煤的人群产生呼吸道症状(气短、咳嗽和咳痰)的危险性高于使用无烟煤。使用有烟煤患有气短、咳嗽和咳痰的OR值分别为1．71、3．30和4．23；使用无烟煤发生咳嗽、咳痰的危险性分别是使用柴的1．35和1．67倍。改炉灶可以降低这些症状的出现率。结论 使用有烟煤造成的室内空气污染是最大呼气流速(PEER)降低的主要危险因素，其次是无烟煤和柴。     

Effects of air pollution episodes on pulmonary function and respiratory symptoms

In January 1985, a decline of primary school children's pulmonary function was observed during an air pollution episode. Ambient 24 hour average levels of SO2, TSP and RSP were in the range of 200-250 micrograms/m3. The response persisted for at least two weeks. In January 1987, again a decline of school children's pulmonary function was observed associated with an air pollution episode. Levels of TSP were about as elevated as in the 1985 episode. Two weeks after the episode, lung function levels were even lower than during the episode. In June 1987 a long term study was started to investigate potential effects of winter and summer air pollution episodes on pulmonary function and occurrence of acute respiratory symptoms of primary school children. An important issue for this study is the characterization of short term variation of lung function in absence of air pollution. Exposure is characterized by ambient levels of several gases (SO2, NO2, O3, HNO3), PM10, TSP and components of particulate matter (SO4(2-), NO3-, H-, NH4+). Sampling is being conducted on a daily basis to obtain a continuous exposure estimate. In the winter of 1987/1988, no air pollution episodes were observed. The study will continue through the winters of 1988/1989, and 1989/1990.     

Decline of ambient air pollution levels and improved respiratory health in Swiss children

The causality of observed associations between air pollution and respiratory health in children is still subject to debate. If reduced air pollution exposure resulted in improved respiratory health of children, this would argue in favor of a causal relation. We investigated whether a rather moderate decline of air pollution levels in the 1990s in Switzerland was associated with a reduction in respiratory symptoms and diseases in school children. In nine Swiss communities, 9,591 children participated in cross-sectional health assessments between 1992 and 2001. Their parents completed identical questionnaires on health status and covariates. We assigned to each child an estimate of regional particles with an aerodynamic diameter < 10 microg/m3 (PM10) and determined change in PM10 since the first survey. Adjusted for socioeconomic, health-related, and indoor factors, declining PM10 was associated in logistic regression models with declining prevalence of chronic cough [odds ratio (OR) per 10-microg/m3 decline = 0.65, 95% confidence interval (CI), 0.54-0.79], bronchitis (OR = 0.66; 95% CI, 0.55-0.80), common cold (OR = 0.78; 95% CI, 0.68-0.89), nocturnal dry cough (OR = 0.70; 95% CI, 0.60-0.83), and conjunctivitis symptoms (OR = 0.81; 95% CI, 0.70-0.95). Changes in prevalence of sneezing during pollen season, asthma, and hay fever were not associated with the PM10 reduction. Our findings show that the reduction of air pollution exposures contributes to improved respiratory health in children. No threshold of adverse effects of PM10 was apparent because we observed the beneficial effects for relatively small changes of rather moderate air pollution levels. Current air pollution levels in Switzerland still exceed limit values of the Swiss Clean Air Act; thus, children's health can be improved further.     

Acute health effects of urban fine and ultrafine particles on children with atopic dermatitis

Although ambient particulate pollutants have been shown to exacerbate existing allergic symptoms of mucous membranes including rhinitis and asthma, the effects on skin such as atopic dermatitis in childhood deserve further study. We investigated the effects of urban particulate pollutants including ultrafine particles on atopic severity in children with atopic dermatitis. We included 41 schoolchildren, 8–12 years old, who had been diagnosed with atopic dermatitis. For 67 consecutive days, all of them measured their symptoms in a diary. To assess exposure, the daily ambient mass concentrations of particulate matter less than 10, 2.5 and 1 μm (PM₁₀, PM_2.5 and PM₁, respectively) and concentrations of submicron particles (0.01–1 μm) were measured at a local school. The mean mass concentrations of PM₁₀, PM_2.5 and PM₁ were 74.0, 57.8 and 50.8 μg/m³, respectively. The mean concentrations were 41,335/cm³ ultrafine particles (UFPs) and 8577/cm³ accumulation mode (0.1–1 μm) particles. Significant associations were found between the concentrations of ultrafine particles and the itchiness symptom in children with atopic dermatitis. An interquartile range (IQR) increase in previous day ultrafine particles concentration (IQR: 28–140/m³) was significantly associated with a 3.1% (95% confidence interval, 0.2–6.1) increase in the itch symptom score for children with atopic dermatitis. The results suggested that the concentration of ambient ultrafine particles may exacerbate skin symptoms in children with atopic dermatitis.     

Acute effects of winter air pollution on respiratory function in schoolchildren in southern England

Aim: To investigate the acute health effects of winter outdoor air pollution (nitrogen dioxide (NO₂), ozone (O₃), sulphur dioxide (SO₂), sulphate (SO₄^2-) ,and particles (PM₁₀)) on schoolchildren in an area of southern England where levels of SO₂ had been reported to be high.

Methods: A total of 179 children, aged 7–13, from three schools (two urban and one rural location), were included. Peak expiratory flow rate (PEFR) and presence or absence of upper respiratory infections were recorded on 63 school days from 1 November 1996 to 14 February 1997. Air pollution and meteorological data were taken from monitors at each school site. The analysis regressed daily PEFR on pollutant level adjusting for confounders and serial correlation and calculated a weighted pooled estimate of effect overall for each pollutant. In addition, large decrements in PEFR were analysed as a binary outcome. Same day, lag 1, lag 2, and a five day average of pollutant levels were used.

Results: There were no clear effects of any pollutant on mean PEFR. In addition, we analysed large PEFR decrements (a binary outcome), observing consistent negative associations with NO₂, SO₄^2-, and PM₁₀, although few lag/pollutant combinations were significant: odds ratios (95% CI) for five day average effect: NO₂ 24 h average 1.043 (1.000 to 1.089), SO₄^2- 1.090 (0.898 to 1.322), PM₁₀ 1.037 (0.992 to 1.084). The observed effects of PM₁₀ (only) were stronger in wheezy children (1.114 (1.057 to 1.174)). There were no consistent negative associations between large decrements and ozone or SO₂ .

Conclusions: There is no strong evidence for acute effects of winter outdoor air pollution on mean PEFR overall in this area, but there is evidence for negative effects on large PEFR decrements.

     

Respiratory health effects of industrial air pollution on children in North Lebanon

This study assesses the association between the proximity of residence to cement and fertilizer plants in industrialized districts and respiratory health complaints among children (5-15 years old) in Northern Lebanon. A multi-stage random sample of households was selected from two exposed districts and a third non-industrialized. One child was randomly selected from each household for a total of 486 children. Living within 0-3 km of industries, as compared to living farther away (4-7 km), was associated with a statistically significant increase in the risk for cough with colds (adjusted odds ratio (OR) = 3.40), phlegm with colds (OR = 2.14), yearly episodes of cough and phlegm (OR = 4.63), yearly chest colds (OR = 4.12), and wheezing (OR = 2.23). When compared to living in the non-industrialized district, children living within 0-3 km of industries showed a significantly higher risk for yearly chest colds (OR = 2.30). However, living in the 4-7 km region of industries was associated with a lower risk of respiratory complaints, as compared to living in the comparison area. This was attributed to higher altitudes and different meteorological characteristics. A higher risk of respiratory problems was reported among children living close to cement than fertilizer industries. Policy intervention measures are recommended.