Ann Am Thorac Soc. 2020 Apr;17(4):387-398. doi: 10.1513/AnnalsATS.202001-046ST.
Although it is well accepted that air pollution exposure exacerbates preexisting airway disease, it has not been firmly established that long-term pollution exposure increases the risk of new-onset asthma or chronic obstruction pulmonary disease (COPD). This Workshop brought together experts on mechanistic, epidemiological, and clinical aspects of airway disease to review current knowledge regarding whether air pollution is a causal factor in the development of asthma and/or COPD. Speakers presented recent evidence in their respective areas of expertise related to air pollution and new airway disease incidence, followed by interactive discussions. A writing committee summarized their collective findings. The Epidemiology Group found that long-term exposure to air pollution, especially metrics of traffic-related air pollution such as nitrogen dioxide and black carbon, is associated with onset of childhood asthma. However, the evidence for a causal role in adult-onset asthma or COPD remains insufficient. The Mechanistic Group concluded that air pollution exposure can cause airway remodeling, which can lead to asthma or COPD, as well as asthma-like phenotypes that worsen with long-term exposure to air pollution, especially fine particulate matter and ozone. The Clinical Group concluded that air pollution is a plausible contributor to the onset of both asthma and COPD. Available evidence indicates that long-term exposure to air pollution is a cause of childhood asthma, but the evidence for a similar determination for adult asthma or COPD remains insufficient. Further research is needed to elucidate the exact biological mechanism underlying incident childhood asthma, and the specific air pollutant that causes it.
尽管人们普遍认为空气污染暴露会使先前存在的气道疾病恶化，但尚未确定长期暴露于污染会增加新发病例哮喘或慢性阻塞性肺疾病（COPD）的风险。该研讨会汇集了气道疾病机制、流行病学和临床方面的专家，旨在审查关于空气污染是否是哮喘和/或 COPD 发展的因果因素的现有知识。演讲者介绍了他们在与空气污染和新气道疾病发病相关的各自专业领域的最新证据，随后进行了互动讨论。一个写作委员会总结了他们的集体发现。流行病学组发现，长期暴露于空气污染，尤其是与交通有关的空气污染指标（如二氧化氮和黑碳）与儿童哮喘的发病有关。然而，在成人发病的哮喘或 COPD 中，其因果作用的证据仍然不足。机制组得出结论，空气污染暴露会引起气道重塑，从而导致哮喘或 COPD，以及随着长期暴露于空气污染而恶化的哮喘样表型，尤其是细颗粒物和臭氧。临床组得出结论，空气污染可能是哮喘和 COPD 发病的一个合理原因。现有证据表明，长期暴露于空气污染是儿童哮喘的一个原因，但对于成人哮喘或 COPD 的类似决定，证据仍然不足。需要进一步的研究来阐明儿童哮喘新发病例的具体生物学机制，以及导致其发生的特定空气污染物。
