Tham Rachel, Katelaris Constance H, Vicendese Don, Dharmage Shyamali C, Lowe Adrian J, Bowatte Gayan, Taylor Philip, Burton Pamela, Abramson Michael J, Erbas Bircan
Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia.
Western Sydney University, Department of Medicine, Immunology and Allergy, Campbelltown Hospital, Campbelltown, New South Wales, Australia.
Environ Res. 2017 Apr;154:42-49. doi: 10.1016/j.envres.2016.12.016. Epub 2016 Dec 23.
Some fungal spores can trigger asthma exacerbation but knowledge of which outdoor fungal spores contribute to asthma hospitalisation is limited.
To examine the role of outdoor fungal spores in child and adolescent asthma hospitalisations.
We conducted a bi-directional time-stratified case-crossover study of child and adolescent asthma hospitalisations over 5 years. Conditional logistic regression assessed the role of 20 fungi taxa (Same day [L0] and lagged [L1-3]) adjusted for maximum temperature, humidity and grass pollen. Strata specific effects were explored if there was evidence of effect modification by age, sex, air pollutants or grass pollen. Non-linear effects examined with Generalized Additive Models.
Of 2098 children hospitalised for asthma, 60% were boys; mean age was 5.5±3.7 years. Fungal spore counts peaked during warm months. Regression models found weak associations with Coprinus [L0,L1: OR=1.03, 1.01-1.06], Periconia [L0: OR=1.03, 1.001-1.07] and Chaetomium [L2: OR=1.08, 1.0-1.2]. Sex appeared to act as an effect modifier with girls having stronger associations with Cladosporium, Coprinus and total fungi. Older adolescent (14-18 years) hospitalisation was significantly associated with Coprinus and Ustilago/smuts. Air pollutants and grass pollen did not appear to act as effect modifiers. Non-linearity was not detected.
There may be associations between some outdoor fungal spores and asthma hospitalisations. Further research needed to explore whether these findings can be replicated; and examine whether fungal sensitisation and/or human rhinovirus infections are associated with stronger effects. If findings are replicated, then the need to develop predictive models for fungal spore distribution and levels may become more important.
一些真菌孢子可引发哮喘加重，但关于哪些室外真菌孢子会导致哮喘住院的了解有限。
探讨室外真菌孢子在儿童和青少年哮喘住院中的作用。
我们对5年间儿童和青少年哮喘住院情况进行了一项双向时间分层病例交叉研究。条件逻辑回归评估了20种真菌分类群（当日[L0]和滞后[L1 - 3]）的作用，并对最高温度、湿度和草花粉进行了校正。如果有证据表明年龄、性别、空气污染物或草花粉存在效应修饰，则探索分层特定效应。使用广义相加模型检查非线性效应。
在2098名因哮喘住院的儿童中，60%为男孩；平均年龄为5.5±3.7岁。真菌孢子计数在温暖月份达到峰值。回归模型发现与鬼伞属[L0，L1：比值比（OR）=1.03，1.01 - 1.06]、围丛梗孢属[L0：OR = 1.03，1.001 - 1.07]和毛壳菌属[L2：OR = 1.08，1.0 - 1.2]存在弱关联。性别似乎起到了效应修饰作用，女孩与枝孢属、鬼伞属和总真菌的关联更强。年龄较大的青少年（14 - 18岁）住院与鬼伞属和黑粉菌属显著相关。空气污染物和草花粉似乎未起到效应修饰作用。未检测到非线性。
一些室外真菌孢子与哮喘住院之间可能存在关联。需要进一步研究以探讨这些发现是否可重复；并检查真菌致敏和/或人鼻病毒感染是否与更强的效应相关。如果研究结果得到重复，那么开发真菌孢子分布和水平预测模型的需求可能会变得更加重要。
