1 Division of Pulmonary and Critical Care, and.
2 Biomedical Research Unit, Asociacion Benefica PRISMA, Lima, Peru.
Ann Am Thorac Soc. 2019 Mar;16(3):348-355. doi: 10.1513/AnnalsATS.201807-448OC.
A large portion of asthma morbidity occurs in low- and middle-income countries, and Peru suffers particularly high asthma prevalence. Ambient air exposures are also high, and likely play a role. Most studies of environmental exposures focus on understanding contributors to health care utilization or mortality risk; however, less severe outcomes may still impact quality of life (QOL).
To study the association between multiple pollutants and several asthma domains in Peruvian children.
A total of 484 children aged 9-19 years with asthma were followed for 6-9 months, and evaluated for asthma control, asthma-related QOL, missed school days, and health care utilization. We used geographically distributed monitors to estimate air pollutant concentrations and multivariable generalized linear mixed models to model asthma outcomes as a function of pollutants.
A total of 67% of children had moderate to severe persistent asthma. In multipollutant models, higher particulate matter less than 2.5 μm in aerodynamic diameter (PM), black carbon, and nitrogen dioxide concentrations were independently associated with worse asthma control. For each interquartile range increase in PM or nitrogen dioxide concentration, there was a 59% or 34% higher odds of uncontrolled asthma, respectively. If the proportion of PM that was black carbon increased, there were increased odds of uncontrolled asthma. Similarly, pollutants were independently associated with worse asthma-related QOL, and PM exposure was associated with increased risk of health care utilization.
Our study highlights the importance of pollutant exposures on multiple domains of asthma morbidity among Peruvian children, including not only acute exacerbations, but also on general asthma burden, such as worse asthma symptom control and QOL.
哮喘发病率较高的国家大多为中低收入国家，而秘鲁就是其中之一。此外，其环境中空气污染物的暴露水平也较高，这可能也是导致哮喘发病率高的原因之一。大多数关于环境暴露的研究都集中在了解导致医疗利用率或死亡率风险的因素上；然而，即使是不太严重的后果仍可能影响生活质量（QOL）。
研究秘鲁儿童多种污染物与多个哮喘领域之间的关联。
共 484 名年龄在 9-19 岁之间的哮喘患儿参与了此项研究，随访时间为 6-9 个月，对其哮喘控制情况、与哮喘相关的 QOL、缺课天数和医疗保健利用率进行评估。我们使用地理分布的监测器来估计空气污染物浓度，并使用多变量广义线性混合模型来模拟污染物与哮喘结果之间的关系。
共有 67%的患儿患有中重度持续性哮喘。在多污染物模型中，较小粒径的颗粒物（PM）、黑碳和二氧化氮浓度的升高与哮喘控制较差独立相关。PM 或二氧化氮浓度每增加一个四分位距，未控制哮喘的可能性分别增加 59%或 34%。如果 PM 中黑碳的比例增加，未控制哮喘的可能性就会增加。同样，污染物与哮喘相关的 QOL 恶化独立相关，PM 暴露与医疗保健利用率增加的风险相关。
我们的研究强调了污染物暴露对秘鲁儿童哮喘发病率多个方面的重要性，包括不仅是急性加重，还包括一般哮喘负担，如更差的哮喘症状控制和 QOL。
