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Frontiers of Medicine

ISSN 2095-0217

ISSN 2095-0225(Online)

CN 11-5983/R

邮发代号 80-967

2019 Impact Factor: 3.421

Frontiers of Medicine  2022, Vol. 16 Issue (4): 574-583   https://doi.org/10.1007/s11684-021-0882-1
  本期目录
Lung function and air pollution exposure in adults with asthma in Beijing: a 2-year longitudinal panel study
Jun Wang, Wenshuai Xu, Xinlun Tian, Yanli Yang, Shao-Ting Wang, Kai-Feng Xu()
Department of Pulmonary and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China
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Abstract

The effect of air pollution on the lung function of adults with asthma remains unclear to date. This study followed 112 patients with asthma at 3-month intervals for 2 years. The pollutant exposure of the participants was estimated using the inverse distance weight method. The participants were divided into three groups according to their lung function level at every visit. A linear mixed-effect model was applied to predict the change in lung function with each unit change in pollution concentration. Exposure to carbon monoxide (CO) and particles less than 2.5 micrometers in diameter (PM2.5) was negatively associated with large airway function in participants. In the severe group, exposure to chronic sulfur dioxide (SO2) was negatively associated with post-bronchodilator forced expiratory flow at 50%, between 25% and 75% of vital capacity % predicted (change of 95% CI per unit: –0.34 (–0.55, –0.12), –0.24 (–0.44, –0.03), respectively). In the mild group, the effect of SO2 on the small airways was similar to that in the severe group, and it was negatively associated with large airway function. Exposure to CO and PM2.5 was negatively associated with the large airway function of adults with asthma. The negative effects of SO2 were more evident and widely observed in adults with severe and mild asthma than in adults with moderate asthma. Patients with asthma react differently to air pollutants as evidenced by their lung function levels.

Key wordslung function    asthma    air pollution    adult
收稿日期: 2021-03-11      出版日期: 2022-09-02
Corresponding Author(s): Kai-Feng Xu   
 引用本文:   
. [J]. Frontiers of Medicine, 2022, 16(4): 574-583.
Jun Wang, Wenshuai Xu, Xinlun Tian, Yanli Yang, Shao-Ting Wang, Kai-Feng Xu. Lung function and air pollution exposure in adults with asthma in Beijing: a 2-year longitudinal panel study. Front. Med., 2022, 16(4): 574-583.
 链接本文:  
https://academic.hep.com.cn/fmd/CN/10.1007/s11684-021-0882-1
https://academic.hep.com.cn/fmd/CN/Y2022/V16/I4/574
Total Severe Moderate Mild ANOVA
P value
Number of participants 112 12 63 83
Number of visits 827 47 280 500
Age (year) 49.8±13.2 60.5±9.6 53.0±12.5 47.0±12.9 <0.001
Male 439 (53.1) 33 (70.2) 152 (54.3) 254 (50.8) 0.034
COPD complications 216 (26.1) 47 (100) 169 (60.4) 0 (0) <0.001
Current smokers 59 (7.1) 8 (17.0) 13 (4.6) 38 (7.6) 0.008
Ever smokers 164 (19.8) 11(23.4) 43(15.4) 110(22.0) 0.187
Pet 223 (27) 17 (36.2) 55 (68.8) 151 (30.2) 0.043
Cooking frequency (times/day) 1.7±0.9 2.0±0.8 1.6±1.0 1.7±0. 9 0.054
Education <0.001
Primary school 8 (1) 1 (2.1) 7 (2.5) 0 (0)
Junior middle school 73 (8.8) 20 (42.6) 34 (12.1) 19 (3.8)
Senior high school 156 (18.9) 9 (19.1) 65 (23.2) 82 (16.4)
University 590 (71.3) 17 (36.2) 174 (62.2) 399 (79.8)
ICS+ LABA <0.001
None 176 (21.3) 2 (4.3) 51 (18.2) 123 (24.6)
Irregular use 137 (16.6) 1 (2.1) 39 (13.9) 97 (19.4)
Regular use 514 (62.1) 44 (93.6) 190 (67.9) 280 (56.0)
Season of visit >0.05
Summer 239 (29.6) 15 (31.9) 80 (28.6) 144 (28.8)
Spring 206 (24.7) 12 (25.5) 67 (23.9) 127 (25.4)
Autumn 195 (23.8) 11 (23.4) 71 (25.4) 113 (22.6)
Winter 187 (21.9) 9 (19.2) 62 (22.1) 116 (23.2)
Temperature 14.2±10.5 14.7±10.6 14.6±10.4 13.9±10.6 >0.05
Humidity 50.1±11.6 49.7±11.6 50.3±11.8 49.9±11.6 >0.05
Day of week 4.1±1.1 4.3±1.0 4.1±1.1 4.1±1.1 >0.05
Tab.1  
Total Severe Moderate Mild ANOVA
P value
Number of visits 827 47 280 500
Pre-FEV1 78.39±16.50 48.44±12.70 70.10±15.19 85.36±11.96 <0.001
Post-FEV1 84.81±15.31 54.79±11.94 78.57±13.62 91.16±11.08 <0.001
Pre-FVC 97.48±14.10 89.57±22.10 98.71±15.32 97.53±12.08 <0.001
Post-FVC 99.90±13.48 98.17±19.56 103.41±14.27 98.09±11.87 <0.001
Pre-FEV1/FVC 66.71±10.69 44.04±4.96 59.10±7.00 73.10±6.13 <0.001
Post-FEV1/FVC 70.71±10.83 45.36±4. 50 62.57±5.53 77.70±5.28 <0.001
Pre-FEF25-75 43.94±20.93 14.43±4.79 29.79±11.41 54.67±18.46 <0.001
Post-FEF25-75 54.08±24.49 16.50±4.93 35.40±11.38 68.15±19.75 <0.001
Pre-FEF50 46.65±21.80 14.07±5.38 32.13±12.79 57.86±18.66 <0.001
Post-FEF50 56.45±24.71 16.37±5.56 38.23±12.62 70.48±19.58 <0.001
Pre-FEF75 33.94±18.57 11.82±3.40 22.10±9.01 42.65±17.99 <0.001
Post-FEF75 43.33±23.80 13.35±3.57 26.32±9.90 55.75±21.91 <0.001
Pollution
O3 (μg/m3) 93.55±43.51 94.74±45.61 94.75±43.83 92.76±43.20 >0.05
CO (mg/m3) 0.93±0.31 0.88±0.23 0.91±0.29 0.94±0.33 >0.05
NO2 (μg/m3) 50.72±10.90 48.35±10.99 49.88±11.26 51.41±10.64 >0.05
SO2 (μg/m3) 7.65±4.35 7.13±3.80 7.35±4.27 7.87±4.44 >0.05
PM2.5 (μg/m3) 58.25±17.98 54.46±14.47 57.26±16.44 59.17±19.03 >0.05
PM10 (μg/m3) 92.24±24.09 88.81±22.40 90.65±22.79 93.46±24.90 >0.05
Tab.2  
Humidity Temperature CO NO2 O3 PM10 PM2.5 SO2
Humidity 1
Temperature 0.74 1
CO −0.04* −0.48 1
NO2 −0.19 −0.49 0.64 1
O3 0.45 0.87 −0.47 −0.60 1
PM10 −0.25 −0.23 0.55 0.57 −0.10 1
PM2.5 −0.09 −0.36 0.85 0.68 −0.31 0.83 1
SO2 −0.53 −0.61 0.70 0.57 −0.43 0.61 0.73 1
Tab.3  
Fig.1  
Fig.2  
Fig.3  
Fig.4  
Fig.5  
Fig.6  
1 GBD 2015 Chronic Respiratory Disease Collaborators. Global, regional, and national deaths, prevalence, disability-adjusted life years, and years lived with disability for chronic obstructive pulmonary disease and asthma, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet Respir Med 2017; 5(9): 691–706
https://doi.org/10.1016/S2213-2600(17)30293-X pmid: 28822787
2 M Zhou, H Wang, X Zeng, P Yin, J Zhu, W Chen, X Li, L Wang, L Wang, Y Liu, J Liu, M Zhang, J Qi, S Yu, A Afshin, E Gakidou, S Glenn, VS Krish, MK Miller-Petrie, WC Mountjoy-Venning, EC Mullany, SB Redford, H Liu, M Naghavi, SI Hay, L Wang, CJL Murray, X Liang. Mortality, morbidity, and risk factors in China and its provinces, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet 2019; 394(10204): 1145–1158
https://doi.org/10.1016/S0140-6736(19)30427-1 pmid: 31248666
3 M Guarnieri, JR Balmes. Outdoor air pollution and asthma. Lancet 2014; 383(9928): 1581–1592
https://doi.org/10.1016/S0140-6736(14)60617-6 pmid: 24792855
4 H Khreis, M Cirach, N Mueller, K de Hoogh, G Hoek, MJ Nieuwenhuijsen, D Rojas-Rueda. Outdoor air pollution and the burden of childhood asthma across Europe. Eur Respir J 2019; 54(4): 1802194
https://doi.org/10.1183/13993003.02194-2018 pmid: 31391220
5 D Norbäck, C Lu, Y Zhang, B Li, Z Zhao, C Huang, X Zhang, H Qian, Y Sun, J Wang, W Liu, J Sundell, Q Deng. Sources of indoor particulate matter (PM) and outdoor air pollution in China in relation to asthma, wheeze, rhinitis and eczema among pre-school children: Synergistic effects between antibiotics use and PM10 and second hand smoke. Environ Int 2019; 125: 252–260
https://doi.org/10.1016/j.envint.2019.01.036 pmid: 30731375
6 F Rosser, E Forno, KS Kurland, YY Han, C Mair, E Acosta-Pérez, G Canino, JC Celedón. Annual SO2 exposure, asthma, atopy, and lung function in Puerto Rican children. Pediatr Pulmonol 2020; 55(2): 330–337
https://doi.org/10.1002/ppul.24595 pmid: 31805225
7 LD Knibbs, AM Cortés de Waterman, BG Toelle, Y Guo, L Denison, B Jalaludin, GB Marks, GM Williams. The Australian Child Health and Air Pollution Study (ACHAPS): a national population-based cross-sectional study of long-term exposure to outdoor air pollution, asthma, and lung function. Environ Int 2018; 120: 394–403
https://doi.org/10.1016/j.envint.2018.08.025 pmid: 30125857
8 NN Hansel, KM Romero, SL Pollard, S Bose, KJ Psoter, L J Underhill, C Johnson, D Williams, FC Curriero, P Breysse, K Koehler, W; Checkley GASP Study Investigators. Ambient air pollution and variation in multiple domains of asthma morbidity among Peruvian children. Ann Am Thorac Soc 2019; 16(3): 348–355
pmid: 30365919
9 L Liu, R Poon, L Chen, AM Frescura, P Montuschi, G Ciabattoni, A Wheeler, R Dales. Acute effects of air pollution on pulmonary function, airway inflammation, and oxidative stress in asthmatic children. Environ Health Perspect 2009; 117(4): 668–674
https://doi.org/10.1289/ehp.11813 pmid: 19440509
10 JM Gaffin, M Hauptman, CR Petty, WJ Sheehan, PS Lai, JM Wolfson, DR Gold, BA Coull, P Koutrakis, W Phipatanakul. Nitrogen dioxide exposure in school classrooms of inner-city children with asthma. J Allergy Clin Immunol 2018; 141(6): 2249–2255.e2
https://doi.org/10.1016/j.jaci.2017.08.028 pmid: 28988796
11 AM Neophytou, MJ White, SS Oh, N Thakur, JM Galanter, KK Nishimura, M Pino-Yanes, DG Torgerson, CR Gignoux, C Eng, EA Nguyen, D Hu, AC Mak, R Kumar, MA Seibold, A Davis, HJ Farber, K Meade, PC Avila, D Serebrisky, MA Lenoir, E Brigino-Buenaventura, W Rodriguez-Cintron, K Bibbins-Domingo, SM Thyne, LK Williams, S Sen, FD Gilliland, WJ Gauderman, JR Rodriguez-Santana, F Lurmann, JR Balmes, EA Eisen, EG Burchard. Air pollution and lung function in minority youth with asthma in the GALA II (Genes-Environments and Admixture in Latino Americans) and SAGE II (Study of African Americans, Asthma, Genes, and Environments) Studies. Am J Respir Crit Care Med 2016; 193(11): 1271–1280
https://doi.org/10.1164/rccm.201508-1706OC pmid: 26734713
12 D Ierodiakonou, A Zanobetti, BA Coull, S Melly, DS Postma, HM Boezen, JM Vonk, PV Williams, GG Shapiro, EF McKone, TS Hallstrand, JQ Koenig, JS Schildcrout, T Lumley, AN Fuhlbrigge, P Koutrakis, J Schwartz, ST Weiss, DR; Childhood Asthma Management Program Research Group Gold. Ambient air pollution, lung function, and airway responsiveness in asthmatic children. J Allergy Clin Immunol 2016; 137(2): 390–399
https://doi.org/10.1016/j.jaci.2015.05.028 pmid: 26187234
13 E Fuertes, J Bracher, C Flexeder, I Markevych, C Klümper, B Hoffmann, U Krämer, A von Berg, CP Bauer, S Koletzko, D Berdel, J Heinrich, H Schulz. Long-term air pollution exposure and lung function in 15 year-old adolescents living in an urban and rural area in Germany: the GINIplus and LISAplus cohorts. Int J Hyg Environ Health 2015; 218(7): 656–665
https://doi.org/10.1016/j.ijheh.2015.07.003 pmid: 26220828
14 WJ Gauderman, R Urman, E Avol, K Berhane, R McConnell, E Rappaport, R Chang, F Lurmann, F Gilliland. Association of improved air quality with lung development in children. N Engl J Med 2015; 372(10): 905–913
https://doi.org/10.1056/NEJMoa1414123 pmid: 25738666
15 BB Arnetz, J Arnetz, JR Harkema, M Morishita, K Slonager, S Sudan, H Jamil. Neighborhood air pollution and household environmental health as it relates to respiratory health and healthcare utilization among elderly persons with asthma. J Asthma 2020; 57(1): 28–39
https://doi.org/10.1080/02770903.2018.1545856 pmid: 30810414
16 C Martínez-Rivera, I Garcia-Olivé, Z Stojanovic, J Radua, J Ruiz Manzano, J Abad-Capa. Association between air pollution and asthma exacerbations in Badalona, Barcelona (Spain), 2008–2016. Med Clin (Barc) 2019; 152(9): 333–338
pmid: 30149947
17 SW Shin, DJ Bae, CS Park, JU Lee, RH Kim, SR Kim, HS Chang, JS Park. Effects of air pollution on moderate and severe asthma exacerbations. J Asthma 2020; 57(8): 875–885
pmid: 31122089
18 CL Chan, DV Phan, NP Yang, RH Pan, CY Wu, CL Chen, CY Kuo. A survey of ambulatory-treated asthma and correlation with weather and air pollution conditions within Taiwan during 2001–2010. J Asthma 2019; 56(8): 799–807
https://doi.org/10.1080/02770903.2018.1497649 pmid: 30012027
19 Y Liu, J Pan, H Zhang, C Shi, G Li, Z Peng, J Ma, Y Zhou, L Zhang. Short-term exposure to ambient air pollution and asthma mortality. Am J Respir Crit Care Med 2019; 200(1): 24–32
https://doi.org/10.1164/rccm.201810-1823OC pmid: 30871339
20 S Yu, S Park, CS Park, S Kim. Association between the ratio of FEV1 to FVC and the exposure level to air pollution in neversmoking adult refractory asthmatics using data clustered by patient in the Soonchunhyang Asthma Cohort Database. Int J Environ Res Public Health 2018; 15(11): 2349
https://doi.org/10.3390/ijerph15112349
21 CH Chen, CD Wu, HC Chiang, D Chu, KY Lee, WY Lin, JI Yeh, KW Tsai, YLL Guo. The effects of fine and coarse particulate matter on lung function among the elderly. Sci Rep 2019; 9(1): 14790
https://doi.org/10.1038/s41598-019-51307-5 pmid: 31616001
22 L Chambers, J Finch, K Edwards, A Jeanjean, R Leigh, S Gonem. Effects of personal air pollution exposure on asthma symptoms, lung function and airway inflammation. Clin Exp Allergy 2018; 48(7): 798–805
https://doi.org/10.1111/cea.13130 pmid: 29526044
23 M Kraft. The distal airways: are they important in asthma? Eur Respir J 1999; 14(6): 1403–1417
https://doi.org/10.1183/09031936.99.14614039 pmid: 10624774
24 L Bjermer. The role of small airway disease in asthma. Curr Opin Pulm Med 2014; 20(1): 23–30
https://doi.org/10.1097/MCP.0000000000000018 pmid: 24296687
25 Q Hamid, Y Song, TC Kotsimbos, E Minshall, TR Bai, RG Hegele, JC Hogg. Inflammation of small airways in asthma. J Allergy Clin Immunol 1997; 100(1): 44–51
https://doi.org/10.1016/S0091-6749(97)70193-3 pmid: 9257786
26 V Siroux, A Boudier, M Dolgopoloff, S Chanoine, J Bousquet, F Gormand, J Just, N Le Moual, R Nadif, C Pison, R Varraso, R Matran, I Pin. Forced midexpiratory flow between 25% and 75% of forced vital capacity is associated with long-term persistence of asthma and poor asthma outcomes. J Allergy Clin Immunol 2016;137(6): 1709–1716.e6 PMID: 26688518
https://doi.org/10.1016/j.jaci.2015.10.029
27 DS Postma, C Brightling, S Baldi, M Van den Berge, LM Fabbri, A Gagnatelli, A Papi, T Van der Molen, KF Rabe, S Siddiqui, D Singh, G Nicolini, M Kraft; ATLANTIS study group. Exploring the relevance and extent of small airways dysfunction in asthma (ATLANTIS): baseline data from a prospective cohort study. Lancet Respir Med 2019; 7(5): 402–416
https://doi.org/10.1016/S2213-2600(19)30049-9 pmid: 30876830
28 D Xiao, Z Chen, S Wu, K Huang, J Xu, L Yang, Y Xu, X Zhang, C Bai, J Kang, P Ran, H Shen, F Wen, W Yao, T Sun, G Shan, T Yang, Y Lin, J Zhu, R Wang, Z Shi, J Zhao, X Ye, Y Song, Q Wang, G Hou, Y Zhou, W Li, L Ding, H Wang, Y Chen, Y Guo, F Xiao, Y Lu, X Peng, B Zhang, Z Wang, H Zhang, X Bu, X Zhang, L An, S Zhang, Z Cao, Q Zhan, Y Yang, L Liang, Z Liu, X Zhang, A Cheng, B Cao, H Dai, KF Chung, J He, C Wang; China Pulmonary Health Study Group. Prevalence and risk factors of small airway dysfunction, and association with smoking, in China: findings from a national cross-sectional study. Lancet Respir Med 2020; 8(11): 1081–1093
https://doi.org/10.1016/S2213-2600(20)30155-7 pmid: 32598906
29 HK Reddel, ED Bateman, A Becker, LP Boulet, AA Cruz, JM Drazen, T Haahtela, SS Hurd, H Inoue, JC de Jongste, RF Lemanske Jr, ML Levy, PM O’Byrne, P Paggiaro, SE Pedersen, E Pizzichini, M Soto-Quiroz, SJ Szefler, GW Wong, JM FitzGerald. A summary of the new GINA strategy: a roadmap to asthma control. Eur Respir J 2015; 46(3): 622–639
https://doi.org/10.1183/13993003.00853-2015 pmid: 26206872
30 MR Miller, J Hankinson, V Brusasco, F Burgos, R Casaburi, A Coates, R Crapo, P Enright, CP van der Grinten, P Gustafsson, R Jensen, DC Johnson, N MacIntyre, R McKay, D Navajas, OF Pedersen, R Pellegrino, G Viegi, J; ATS/ERS Task Force Wanger. Standardisation of spirometry. Eur Respir J 2005; 26(2): 319–338
https://doi.org/10.1183/09031936.05.00034805 pmid: 16055882
31 J McCreanor, P Cullinan, MJ Nieuwenhuijsen, J Stewart-Evans, E Malliarou, L Jarup, R Harrington, M Svartengren, IK Han, P Ohman-Strickland, KF Chung, J Zhang. Respiratory effects of exposure to diesel traffic in persons with asthma. N Engl J Med 2007; 357(23): 2348–2358
https://doi.org/10.1056/NEJMoa071535 pmid: 18057337
32 JR Balmes, M Cisternas, PJ Quinlan, L Trupin, FW Lurmann, PP Katz, PD Blanc. Annual average ambient particulate matter exposure estimates, measured home particulate matter, and hair nicotine are associated with respiratory outcomes in adults with asthma. Environ Res 2014; 129: 1–10
https://doi.org/10.1016/j.envres.2013.12.007 pmid: 24528996
33 P Penttinen, KL Timonen, P Tiittanen, A Mirme, J Ruuskanen, J Pekkanen. Number concentration and size of particles in urban air: effects on spirometric lung function in adult asthmatic subjects. Environ Health Perspect 2001; 109(4): 319–323
https://doi.org/10.1289/ehp.01109319 pmid: 11335178
34 RJ Delfino, N Staimer, T Tjoa, D Gillen, MT Kleinman, C Sioutas, D Cooper. Personal and ambient air pollution exposures and lung function decrements in children with asthma. Environ Health Perspect 2008; 116(4): 550–558
https://doi.org/10.1289/ehp.10911 pmid: 18414642
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