Title

大氣中真菌孢子與氣喘急診之相關性

Translated Titles

Association Between Ambient Fungal Spore Concentrations and Emergency Asthma Visits

DOI

10.6342/NTU201602867

Authors

蔡宜秦

Key Words

戶外 ; 真菌孢子 ; 急診 ; 氣喘 ; 病例交叉研究 ; Outdoor ; Fungal spores ; Emergency visits ; Asthma ; Case-crossover study

PublicationName

臺灣大學職業醫學與工業衛生研究所學位論文

Volume or Term/Year and Month of Publication

2016年

Academic Degree Category

碩士

Advisor

郭育良

Content Language

英文

Chinese Abstract

研究背景:據文獻指出,2010年約有三億人口受氣喘影響。先前的研究顯示暴露高濃度生物氣膠,與過敏、肺功能下降及其他不良之健康影響有關。生物氣膠包含花粉、真菌孢子及動、植物所產生的細胞碎片。而本篇研究主要想了解不同年齡層其氣喘發作之季節性,及真菌孢子與氣喘發作之相關性。研究方法:空氣採樣使用Burkard-7-day於古亭國小三層樓高之屋頂處(同環保署空氣品質監測站地點),以10公升/分鐘之流速不間斷採樣,採樣時間自2015年1月至12月,以1000倍之光學顯微鏡鏡檢分析包含26種真菌種類,取得每日大氣真菌平均濃度 (spores/ m3)。病例資料取自台大醫學院附設醫院2015年全年之急診資料,依據患者主診斷之ICD碼493判斷患者是否罹患氣喘。本研究為一病例交叉研究 (case-crossover study),以病患自己做為其對照組,在病例確診後,同一確診月分內其他星期數則為對照組。利用條件式邏輯斯迴歸評估大氣中真菌孢子濃度與氣喘之相關性。本研究亦考慮遲滯效應(1-day lag)。結果:研究期間共採集309個空氣樣本,其中以Ascospores, Aspergillus/Penicillium, Basidiospores和 Cladosoprium最常見。研究期間中氣喘急診之人次達640次,其中又以學齡前兒童(0-5歲兒童)之人次最多。本研究主要發現於成人中(15歲以上),Aspergillus/ Penicillium濃度會顯著提高隔日因氣喘急診之風險 (OR: 2.007, 95% CI:1.034, 3.894),且存在劑量效應關係(p-value = 0.034)。結論:本研究發現不同年齡層氣喘發作之季節性不同。Aspergillus/ Penicillium 顯著增加成人氣喘發作之風險。

English Abstract

Background and Aim: It was estimated that about 334 million people were influenced by asthma in the world in 2010. Previous studies showed that exposing to high level of bioaerosols is associated with allergies, lung function decreasing and other adverse health effect. Bioaerosols are composed of pollens, fungal spores and debris generated by animals and plants. In this study, we aim to understand the seasonal pattern of emergency asthma visits among different age people and determine whether exposure to ambient fungal spores is associated with emergency room visit due to asthma. Methods: The air samples were collected by Burkard 7-day recording volumetric spore trap daily on the 3-floor rooftop in Guting elementary school with 10 liters per minute of flow rate from January to December 2015. Fungal spores were identified as 26 categories by trained mycologists with 1000X microscope to retrieve the average of daily fungal spore concentrations. The health data was attained from National Taiwan University Hospital. Visits related to asthma in emergency rooms were identified by the main diagnose of ICD-9 code 493. This was a case-crossover study. The subjects were matched to themselves. After the cases were identified, we chose the control group by choosing the same day of the week in the same month. Conditional logistic regression was applied to examine the association between ambient fungal spore concentrations and asthma. And the 1-day lag effect was considered. Results: There were 309 air samples in total. The most prevalent fungal spores were Ascospores, Aspergillus/Penicillium, Basidiospores, and Cladosoprium. There were 640 asthma emergency visits in National Taiwan University Hospital in 2015. The visits were contributed to children more than to adults. We found that at 1-day lag, the concentration of Aspergillus/ Penicillium was associated with the emergency visits due to asthma for adults (4th quartile OR: 2.007, 95 % CI: 1.034, 3.894). And there was a dose-response relationship (p-value = 0.034). Conclusion: The seasonal pattern of emergency visits for asthma varied among different age groups. Ambient levels of Aspergillus/ Penicillium spores were significantly associated with asthma attack in adults with one day lag.

Topic Category 醫藥衛生 > 預防保健與衛生學
公共衛生學院 > 職業醫學與工業衛生研究所
Reference
  1. 1. EPR-3., Expert Panel Report 3: Guidelines for the diagnosis and management of asthma. 2007, National Heart, Lung, and Blood Institute: Bethesda, MD.
  2. 2. The Global Asthma Report 2014. 2014: Auckland, New Zealand: Global Asthma Network.
  3. 3. Chen, C.H., et al., Current Asthma in Schoolchildren Is Related to Fungal Spores in Classrooms. Chest, 2014. 146(1): p. 123-34.
  4. 4. Chen, B.Y., et al., High ambient Cladosporium spores were associated with reduced lung function in schoolchildren in a longitudinal study. Sci Total Environ, 2014. 481: p. 370-6.
  5. 5. Gioulekas, D., et al., Allergenic fungi spore records (15 years) and sensitization in patients with respiratory allergy in Thessaloniki-Greece. J Invest Allergol Clin Immunol, 2004. 14(3): p. 225-31.
  6. 6. Ho, H.M., et al., Characteristics and determinants of ambient fungal spores in Hualien, Taiwan. Atmos Environ, 2005. 39: p. 5839-50.
  7. 7. Wu, P.-C., et al., Increased levels of ambient fungal spores in Taiwan are associated with dust events from China. Atmos Environ, 2004. 38(29): p. 4879-4886.
  8. 8. Kallawicha, K., et al., The spatiotemporal distributions and determinants of ambient fungal spores in the Greater Taipei area. Environ Pollut, 2015. 204: p. 173-80.
  9. 9. Fleming, D.M., et al., Comparison of the seasonal patterns of asthma identified in general practitioner episodes, hospital admissions, and deaths. Thorax, 2000. 55: p. 662-5.
  10. 10. Kimbell-Dunn, M., N. Pearce, and R. Beasley, Seasonal variation in asthma hospitalizations and death rates in New Zealand. Respirology, 2000. 5: p. 241-6.
  11. 11. Grech, V., et al., Seasonal Variations in Hospital Admissions for Asthma in Malta. J Asthma, 2002. 39(3): p. 263-268.
  12. 12. Akinbami, L.J., et al., Trends in Asthma Prevalence, Health Care Use, and Mortality in the United States, 2001–2010. 2012, National Center for Health Statistics: Hyattsville, MD.
  13. 13. Chen, C.H., S. Xirasagar, and H.C. Lin, Seasonality in adult asthma admissions, air pollutant levels, and climate: a population-based study. J Asthma, 2006. 43(4): p. 287-92.
  14. 14. Hwang, C.Y., et al., Prevalence of atopic dermatitis, allergic rhinitis and asthma in Taiwan: a national study 2000 to 2007. Acta Derm Venereol, 2010. 90(6): p. 589-94.
  15. 15. Denning, D.W., et al., Fungal allergy in asthma–state of the art and research needs. Clin Transl Allergy, 2014. 4(1): p. 1-23.
  16. 16. Zukiewicz-Sobczak, W.A., The role of fungi in allergic diseases. Postepy Dermatol Alergol, 2013. 30(1): p. 42-5.
  17. 17. Burge, H.A. and C.A. Rogers, Outdoor Allergens. Environ Health Perspect, 2000. 108: p. 653-9.
  18. 18. Artac, H., et al., Alternaria and Cladosporium spores in the atmosphere of Konya and their relationship with meteorological factors. Asthma Allergy Immunol, 2014. 12: p. 130-9.
  19. 19. Zureik, M., et al., Sensitisation to airborne moulds and severity of asthma: cross sectional study from European Community respiratory health survey. BMJ, 2002. 325: p. 7.
  20. 20. Atkinson, R.W., et al., Temporal associations between daily counts of fungal spores and asthma exacerbations. Occup Environ Med, 2006. 63(9): p. 580-90.
  21. 21. Dales, R.E., et al., Influence of Ambient Fungal Spores on Emergency Visits for Asthma to a Regional Children’s Hospital. AJRCCM, 2000. 162(6): p. 2087-90.
  22. 22. Jaakkola, J.J.K., Case-crossover design in air pollution epidemiology. Eur Respir J, 2003. 21(Supplement 40): p. 81S-85s.
  23. 23. Carracedo-Martinez, E., et al., Case-crossover analysis of air pollution health effects: a systematic review of methodology and application. Environ Health Perspect, 2010. 118(8): p. 1173-82.
  24. 24. Chan, T.C., et al., Spatiotemporal analysis of air pollution and asthma patient visits in Taipei, Taiwan. Int J Health Geogr, 2009. 8: p. 26.
  25. 25. Tsai, S.S., et al., Air pollution and hospital admissions for asthma in a tropical city: Kaohsiung, Taiwan. Inhal Toxicol, 2006. 18(8): p. 549-54.
  26. 26. Sun, H.L., M.C. Chou, and K.H. Lue, The relationship of air pollution to ED visits for asthma differ between children and adults. Am J Emerg Med, 2006. 24(6): p. 709-13.
  27. 27. Trasande, L. and G.D. Thurston, The role of air pollution in asthma and other pediatric morbidities. J Allergy Clin Immunol, 2005. 115(4): p. 689-99.
  28. 28. Buckley, J.P. and D.B. Richardson, Seasonal modification of the association between temperature and adult emergency department visits for asthma: a case-crossover study. Environ Health, 2012. 11(55).
  29. 29. Lincoln, D., et al., Childhood asthma and return to school in Sydney, Australia. Public Health, 2006. 120(9): p. 854-62.
  30. 30. Julious, S.A., L.M. Osman, and M. Jiwa, Increases in asthma hospital admissions associated with the end of the summer vacation for school-age children with asthma in two cities from England and Scotland. Public Health, 2007. 121(6): p. 482-4.
  31. 31. Zubairi, A.B., et al., Association of airborne Aspergillus with asthma exacerbation in Southern Pakistan. Asia Pac Allergy, 2014. 4(2): p. 91-8.
  32. 32. McAleer, R., et al., Allergic bronchopulmonary disease caused by Curvularia lunata and Drechlera hawaiiensis. Thorax, 1981. 36: p. 338-44.
  33. 33. Chowdhary, A., et al., Allergic bronchopulmonary mycosis due to fungi other than Aspergillus: a global overview. Crit Rev Microbiol, 2014. 40.
  34. 34. Bateson, T.F. and J. Schwartz, Control for Seasonal Variation and Time Trend in Case-Crossover Studies of Acute Effects of Environmental Exposures. Epidemiology, 1999. 10.