Comotti Anna, Alberti Ilaria, Spolidoro Giulia Carla Immacolata, Vassilopoulou Emilia, Agostoni Carlo, Bonzini Matteo, Carugno Michele, Milani Gregorio Paolo
Occupational Medicine Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
Pediatric Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
Pediatr Allergy Immunol. 2025 May;36(5):e70102. doi: 10.1111/pai.70102.
Bronchiolitis is one of the leading causes of hospitalization among infants. Established risk factors include young age, prematurity, and exposure to tobacco smoke. Emerging evidence suggests that air pollution may also contribute to the burden of respiratory diseases. However, its link with bronchiolitis hospitalizations remains debated. To address this, we conducted a systematic review and meta-analysis to assess whether exposure to air pollutants is associated with an increased risk of hospitalization for bronchiolitis in infants. A systematic review and meta-analysis were conducted following the PRISMA guidelines. PubMed, Embase, and Web of Science were searched up to May 2024. Eligible studies examined the relationship between air pollutants and bronchiolitis hospitalizations in infants up to 2 years of age. Meta-analyses were performed to estimate the association between pollutant levels and hospitalization risk. Out of 788 identified studies, 23 met the inclusion criteria. Studies were heterogeneous regarding design, adjustment for confounders, and statistical approaches. Particulate matter with diameter ≤2.5 μm (PM) or ≤10 μm (PM) and nitrogen dioxide (NO) were the most studied pollutants, with positive associations found between short-, medium-, and long-term exposure and increased hospitalization risk. Meta-analyses showed a 2%-9% increase in hospitalization risk for exposure to PM, PM, and NO; however, statistical significance was reached only for short-term exposure to PM. In contrast, data on sulfur dioxide, carbon monoxide, ozone, and black carbon were sparse and inconsistent. PM, PM, and NO are likely relevant risk factors for an increased risk of hospitalization for bronchiolitis in infants. Further research using a standardized approach is needed to clarify the role of other pollutants in bronchiolitis.
细支气管炎是婴儿住院的主要原因之一。已确定的风险因素包括年龄小、早产和接触烟草烟雾。新出现的证据表明，空气污染也可能导致呼吸道疾病负担加重。然而，其与细支气管炎住院之间的联系仍存在争议。为解决这一问题，我们进行了一项系统评价和荟萃分析，以评估接触空气污染物是否与婴儿细支气管炎住院风险增加有关。按照PRISMA指南进行了系统评价和荟萃分析。检索了截至2024年5月的PubMed、Embase和Web of Science数据库。符合条件的研究考察了空气污染物与2岁以下婴儿细支气管炎住院之间的关系。进行荟萃分析以估计污染物水平与住院风险之间的关联。在788项已识别的研究中，23项符合纳入标准。这些研究在设计、混杂因素调整和统计方法方面存在异质性。直径≤2.5μm（PM）或≤10μm（PM）的颗粒物以及二氧化氮（NO）是研究最多的污染物，短期、中期和长期接触这些污染物与住院风险增加之间存在正相关。荟萃分析显示，接触PM、PM和NO会使住院风险增加2% - 9%；然而，仅短期接触PM时达到统计学显著性。相比之下，关于二氧化硫、一氧化碳、臭氧和黑碳的数据稀少且不一致。PM、PM和NO可能是婴儿细支气管炎住院风险增加的相关危险因素。需要采用标准化方法进行进一步研究，以阐明其他污染物在细支气管炎中的作用。
