Matsui E C
Division of Pediatric Allergy and Immunology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Allergy. 2014 May;69(5):553-8. doi: 10.1111/all.12361. Epub 2014 Feb 20.
A substantial disparity in asthma prevalence and morbidity among urban children compared with their nonurban counterparts has been recognized for more than two decades. Because of the nature of urban neighborhoods, pest allergens, such as cockroach and mouse, are present in high concentrations in US urban housing and have both repeatedly been linked to asthma morbidity in sensitized children. In addition, there is a growing body of evidence demonstrating that concentrations of many pollutants are higher indoors than outdoors in both US and European urban communities and that exposures to indoor pollutants such as particulate matter (PM) and nitrogen dioxide (NO2 ) are independently associated with symptoms in children with asthma. Although environmental interventions are challenging to implement, when they reduce relevant indoor allergen and pollutant exposures, they are associated with clear improvements in asthma. Other modifiable risk factors in urban childhood asthma that have emerged include dietary and nutritional factors. Overweight and obese children, for example, may be more susceptible to the pulmonary effects of pollutant exposure. Insufficiency of vitamin D and folate has also emerged as modifiable risk factors for asthma morbidity in children. The identification of these modifiable risk factors for urban childhood asthma morbidity offers a ripe opportunity for intervention.
二十多年来，人们已经认识到城市儿童与非城市儿童相比，哮喘患病率和发病率存在显著差异。由于城市社区的特性，美国城市住房中蟑螂和老鼠等害虫过敏原浓度很高，并且多次被证明与致敏儿童的哮喘发病率有关。此外，越来越多的证据表明，在美国和欧洲的城市社区，许多污染物的室内浓度高于室外，并且接触室内污染物如颗粒物（PM）和二氧化氮（NO2）与哮喘儿童的症状独立相关。尽管环境干预措施实施起来具有挑战性，但当它们减少相关的室内过敏原和污染物暴露时，与哮喘的明显改善相关。城市儿童哮喘中出现的其他可改变的风险因素包括饮食和营养因素。例如，超重和肥胖儿童可能更容易受到污染物暴露的肺部影响。维生素D和叶酸不足也已成为儿童哮喘发病的可改变风险因素。识别这些城市儿童哮喘发病的可改变风险因素为干预提供了成熟的机会。
