Voynow Judith A, Auten Richard
Division of Pediatric Pulmonology, Children's Hospital of Richmond at Virginia Commonwealth University, Richmond, VA 23298.
Division of Neonatology, Department of Pediatrics, Duke University, Durham, NC 27710.
Clin Pulm Med. 2015 Jul;22(4):177-184. doi: 10.1097/cpm.0000000000000095.
In this review, we discuss the impact of environmental tobacco smoke and particulate and gaseous air pollutants derived from fossil fuel combustion on a particularly vulnerable population, infants and children. Indoor and outdoor air pollutants exacerbate chronic respiratory diseases and lower respiratory tract infections. However, there is an even more alarming impact of antenatal air pollution exposures. There are several reports in rodents and monkeys that maternal exposure to tobacco smoke or fossil fuel-generated air pollutants causes in utero growth retardation, lung remodeling, and immune cell activation which increase the risk for asthma or the risk of morbidity with respiratory infections. Importantly, epidemiologic studies confirm that maternal exposure to air pollutants decreases lung function in infants and children which may persist to young adulthood. Thus, environmental air pollutants contribute to childhood origins of chronic obstructive lung disease by changing the capacity for normal lung development and repair, by promoting early lung inflammation which increases the susceptibility to pollution-triggered symptomatic lung disease in adulthood, and by limiting the capacity for later adaptive/repair responses to environmental and infectious insults.
在本综述中，我们讨论了环境烟草烟雾以及化石燃料燃烧产生的颗粒物和气态空气污染物对一个特别脆弱的群体——婴幼儿和儿童的影响。室内和室外空气污染物会加重慢性呼吸道疾病和下呼吸道感染。然而，产前空气污染暴露有着更为惊人的影响。有几份关于啮齿动物和猴子的报告表明，母体暴露于烟草烟雾或化石燃料产生的空气污染物会导致子宫内生长迟缓、肺重塑和免疫细胞激活，从而增加患哮喘的风险或呼吸道感染发病的风险。重要的是，流行病学研究证实，母体暴露于空气污染物会降低婴幼儿和儿童的肺功能，这种影响可能会持续到青年期。因此，环境空气污染物通过改变正常肺发育和修复的能力、促进早期肺部炎症（这会增加成年后患由污染引发的症状性肺部疾病的易感性）以及限制后期对环境和感染性损伤的适应性/修复反应能力，导致慢性阻塞性肺疾病起源于儿童期。
