家戶空氣汙染物與孩童呼吸道健康

The Association between Indoor Air Pollutants and Respiratory Health of Children

顏昱娟(Yu-Chuan Yen)

指導教授 ： 陳培詩

高雄醫學大學/健康科學院/公共衛生學系環境暨職業安全衛生博士班/博士(2020年)

摘要

氣喘是常見的孩童慢性呼吸道疾病，其中環境(例如: 內毒素和空氣汙染物的暴露)是重要的影響因子之一。依據過去研究調查，台灣孩童約有95.48%的時間待於室內，故室內空氣品質亟須特別注意，尤其是在工業城市的孩童家戶，其汙染可源於室內活動產生，及室外工業和交通活動產生而擴散至室內。本研究目的是探討工業城市-高雄市家戶室內空氣品質的影響因子(包含: 孩童跳床行為、家戶開窗及煮飯行為等)，及探討家戶暴露空氣內毒素、空氣汙染物等與孩童氣喘，過敏，及肺功能的關係。此外，呼吸道的發展始於胎兒形成4-7周，而未發育成熟的肺更容易遭受到疾病的侵害，故本研究亦探討孕婦家戶暴露與孩童早期呼吸道疾病的關係。分成六大部分討論:

(一)探討孩童跳床行為與鋪床行為對臥室空氣懸浮微粒，細菌和真菌濃度的影響。
本研究於60間國小學童家戶進行模擬跳床(拍床)和鋪床的動作，在執行與背景期間量測臥室PM10，PM2.5，PM1，細菌和真菌濃度，研究結果發現，孩童跳床行為會顯著增加臥室414μg/ m3的PM10濃度，353μg/ m3的PM2.5濃度，及349μg/ m3的PM1濃度，在生物性方面，增加6569 CFU/ m3的細菌濃度，和978 CFU/ m3的真菌濃度。鋪床行為則增加臥室4.69 μg/ m3的PM10濃度，4.09 μg/ m3的PM2.5濃度，及4.15 μg/ m3的PM1濃度，在生物性方面，增加8569 CFU/ m3的細菌濃度，和779 CFU/ m3的真菌濃度。空氣內毒素在跳床和鋪床行為顯著增加21.76 EU/ m3。另外，飼養寵物的家戶在跳床時有較高的PM2.5和PM1，公寓型家戶跳床揚起的真菌也比居住透天厝少。使用精油的家戶在鋪床時的空氣真菌濃度較低。最後，飼養寵物及有抽菸的家戶在跳鋪床期間的空氣內毒素顯著的高，而與開窗則呈顯著附相關。
(二)探討煮飯和開窗行為對孩童家戶空氣品質的影響。
本研究於高雄市選取三間國小 (分別代表”一般國小”，”交通國小”，及”工業國小”) 學童的家戶，進行室內24小時空氣品質的量測，包含氣狀汙染物CO，CO2，NO2，SO2，和O3，及粒狀汙染物PM2.5，並探討其影響因子，例如: 使用每小時的活動紀錄表探討煮飯和開窗行為對室內空氣品質的影響。研究結果發現，居住於交通區的家戶室內CO濃度顯著高於居住於工業區和一般區，而開窗期間的家戶NO2和PM2.5濃度顯著高於參考期間，煮飯期間的CO2，NO2和PM2.5濃度顯著高於參考期間。
(三)空氣內毒素與孩童氣喘或過敏狀態的關係。
本研究於高雄市選取120間國小學童家戶，包含60名氣喘或過敏的學童(Case組)，及60名非氣喘及非過敏的學童(Control組)，配對Case- Control家戶於同一星期採樣，以控制大氣環境的影響，進行24小時的家戶採樣，測量項目包含空氣內毒素，細菌，真菌，及利用問卷收集人口學及家戶環境參數。研究顯示與家戶空氣內毒素濃度落於 <0.31 EU/m3 相比，家戶空氣內毒素濃度落於0.67- 1.97 EU/ m3的孩童比較易有氣喘或過敏(OR 4.88; 95% CI: 1.16- 20.55)，而與家戶空氣真菌濃度落於 <159 CFU/ m3 相比，家戶空氣真菌濃度落於314- 699 CFU/ m3的孩童亦較易患氣喘或過敏(OR = 4.47; 95% CI: 1.13- 17.69)。
(四)空氣內毒素與空氣汙染物交互作用後對孩童肺功能的影響。
本研究於選取120間國小學童家戶，採集24小時客廳空氣內毒素及空氣汙染物 (CO，CO2，NO2，SO2，O3，PM10，及PM2.5) 濃度，和環境採樣前後量測學童肺功能，以兩天數值的平均為學童肺功能健康參數，此研究亦探討空氣內毒素與空氣汙染物間的交互作用對孩童健康效應的影響。研究結果發現室內O3和PM10濃度會修飾家戶空氣內毒素與孩童肺功能的關係; 在O3 (≥ 0.01 ppm)或PM10 (≥ 62 μg/m3)濃度較高的環境下，空氣內毒素與孩童肺功能呈負相關。反之，在O3或PM10濃度較低的環境下，空氣內毒素與孩童肺功能呈正相關。
(五)空氣汙染物對孩童肺功能的影響。
本研究於選取60間國小學童家戶，採集24小時家戶室內和室外空氣汙染物 (CO，CO2，NO2，SO2，O3，PM10，PM2.5，及PM1) 濃度，及24小時環境採樣前後量測學童肺功能，以兩天數值的差值-學童肺功能改變量為健康參數。我們發現，氣喘孩童家戶室內外的CO2和SO2濃度顯著高於非氣喘孩童家戶，而室內PM10，PM2.5，和PM1濃度在氣喘孩童家戶則顯著較非氣喘孩童家戶高。此外，室內CO和SO2濃度則與孩童肺功能呈顯著負相關，室內CO2濃度與孩童肺功能呈正相關。
(六)孕婦暴露空氣汙染物對孩童早期呼吸道健康的影響。
本研究欲探討懷孕期間暴露家戶室內汙染物與孩童早期呼吸道健康效應的關係，我們於產科門診招募受試者，同意環境採樣的孕婦，我們計畫於第一孕期(≤ 12週)，第二孕期(13- 27週)，第三孕期(28- 40週)，出生後3個月，6個月，1歲，2歲，和3歲進行家戶空氣內毒素、空氣塵螨、空氣汙染物的採樣，並於各孕期間收集孕婦血液和尿液，出生時臍帶血的收集，及3歲的孩童健康檢查及過敏原檢測。初步研究成果顯示孕期間暴露家戶室內空氣內毒素，CO，NO，SO2和O3與孩童出生六個月內的感冒次數無關。未來需要擴增樣本數與更全面且精確地暴露評估探討懷孕期間與孩童早期暴露對孩童呼吸道健康的影響。

關鍵字

室內空氣汙染物 ； 呼吸道健康 ； 孩童 ； 工業城市 ； 空氣內毒素

並列摘要

Asthma is the most prevalent chronic respiratory disease in children, and environmental exposure is one of the important factors. In Taiwan, elementary school children spend 95.48 % of their time inside, so indoor air quality is worth noting, especially in children's households of the industrial cities. Because indoor air quality may be affected by indoor human activities such as cooking, smoking, cleaning, etc. and the infiltration of outdoor pollutants produced from the traffic or industrial sources. Moreover, according to the World Health Organization (WHO) reported, children in the womb were vulnerable to mothers’ exposure to air pollutants, while the immature lung is more vulnerable to respiratory insults. Thus, the aims of the study were to investigate the indoor air quality and discuss its influence factors, in addition, also to evaluate the association between indoor air pollutants and health effects of children. Six parts were discussed as follows:
I. Jumping on the Bed and Associated Increases of PM10, PM2.5, PM1, Airborne Endotoxin, Bacteria, and Fungi Concentrations
Simulation of jumping on the bed and making the bed was performed at sixty schoolchildren's houses in Taiwan. PM10, PM2.5, PM1 and airborne bacteria, fungi and endotoxin concentrations were simultaneously measured over simulation and background periods. Our results show the increase of PM10, PM2.5, PM1, airborne bacteria and fungi through the behavior of jumping on the bed (by 414 μg m-3, 353 μg m-3, 349 μg m-3, 6569 CFU m-3 and 978 CFU m-3, respectively). When making the bed, the PM10, PM2.5, PM1, airborne bacteria and fungi also significantly increased by 4.69 μg m-3, 4.09 μg m-3, 4.15 μg m-3, 8569 CFU m-3, and 779 CFU m-3, respectively. Airborne endotoxin concentrations significantly increased by 21.76 EU m-3 following jumping on the bed and making the bed. Moreover, when jumping on the bed, higher PM2.5 and PM1 concentrations in houses with furry pets rather than no furry pets, and less airborne fungi in apartments than in townhouses were found. For making the bed, lower airborne fungi was found in houses using essential oils rather than no essential oils using. The airborne endotoxin concentrations were positively associated with furry pets and smokers in the homes and negatively correlated to the home with window opening with a statistical significance during the periods of jumping on the bed and making the bed.
II. Cooking/ Window opening and associated increases of indoor PM2.5 and NO2 concentrations of children’s houses in Kaohsiung, Taiwan
Children in the “general school”, “traffic school”, and “industrial school” were randomly and proportionally selected. Air pollutants were sampled for 24 h in the living rooms and on the balcony of their houses and questionnaires of time–microenvironment–activity-diary were recorded. The indoor CO concentration of the traffic area was significantly higher than that of the industrial area and the general area. In regard to the effects of window opening, household NO2 and PM2.5 concentrations during window opening periods were significantly higher than of the reference periods. For the influence of cooking, indoor CO2, NO2, and PM2.5 levels during the cooking periods were significantly higher than that of the reference periods.
III. Household airborne endotoxin association with asthma and allergy in elementary-school-age children: A case-control study in Kaohsiung, Taiwan
To evaluate the association between the presence of asthma and allergy, and airborne endotoxin in homes of school-age children in Kaohsiung City, Taiwan, with a case-control study design by matching the age and class exposure. Data collection of home visits included an interviewer-administered questionnaire and air sampling of participants’ homes for endotoxin, bacteria, and fungi, as well as temperature and relative humidity measurements. Endotoxin was detected in all air samples with a median value of 0.67 EU m-3. In the adjusted logistic regression model, household airborne endotoxin was associated with higher prevalence of asthma and allergy; OR= 4.88 (95% CI: 1.16-20.55) for Q3 (between 0.67 and 1.97 EU m -3) vs. Q1 (< 0.31 EU m -3), with statistical significance. Airborne fungi were associated with higher prevalence of asthma and allergy; OR = 4.47 (95% CI: 1.13- 17.69) for Q3 (between 314 and 699 CFU m -3) vs. Q1 (< 159 CFU m -3) in adjusted logistic regression models.
IV. Indoor Ozone and Particulate Matter Modify the Association between Airborne Endotoxin and Schoolchildren's Lung Function
The objective of this study is to evaluate whether indoor air pollutants such as CO, CO2, NO2, SO2, O3, PM10, and PM2.5 can modify the association between airborne endotoxin and school children's lung function in a heavy industrial city in Taiwan. We recruited 120 elementary school-age children in Kaohsiung City, Taiwan. Aerosol samples were collected on a filter membrane for 24h period and then analyzed for endotoxin. Air pollutants were measured for 24h in living rooms while school children's lung function was measured. The modification of air pollutants on the relationship between airborne endotoxin and children's lung function was estimated after adjusting the gender, age, height, weight, and case-control status. We found that both O3 and PM10 concentrations significantly modified the relationships between airborne endotoxin and school children's lung function. Among children living in homes with O3≥ 0.01ppm or PM10≥ 62μg/m3, airborne endotoxin was negatively associated with lung functions, whereas among those living in homes with O3< 0.01ppm or PM10< 62μg/m3, airborne endotoxin was positively associated with lung functions.
V. The correlation between household air pollutants and schoolchildren's asthma and lung functions in an industrial city: a case-control study
A case- control study of healthy children and asthmatic children was conducted. The indoor and outdoor air pollutants samples in children’s house were measured by real-time monitoring equipment for 24 hours, and children’s lung function was also assessed before and after air sampling. This study found industrial households’ CO and SO2 decreased lung function in schoolchildren.
VI. Early exposure of household airborne endotoxin and development of respiratory health
In this study, we conducted a birth cohort study to evaluate the relationship between household airborne endotoxin concentrations exposure during pregnancy and respiratory health of children. In 2015, pregnant women have recruited form obstetric clinics. After obtaining the assent of pregnancy women, we recorded the subjects who agree to home visits for environmental sampling. The environmental samplings of pregnant women’s homes were implemented in the first trimester (≤12weeks), the second trimester (13-27 weeks), and the third trimester (28-40 weeks). To date, we recruited 41 pregnant women and successfully performed sampling in homes 91 times to evaluate the association between household air pollutants exposure during pregnancy and respiratory health of children. Preliminary results found household airborne endotoxin, CO, NO2, SO2, O3, bacteria, and fungi exposure during pregnancy were not associated with the number of colds within six months of birth (all P-value> 0.05). To our knowledge, our study is the first study to discuss the effects of indoor airborne endotoxin during the three stages of pregnancy on respiratory health. Furthermore, this study was also the first study to assess the association between household CO, NO2, SO2, and O3 exposure during pregnancy and health effects. In the future, the sample size in this study should be increased and a more comprehensive and accurate assessment of the relationship between household airborne endotoxin and respiratory health in children.

並列關鍵字

indoor air pollutants ； respiratory health ； children ； Industrial city ； airborne endotoxin

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