Poor asthma control and exposure to traffic pollutants and obesity in older adults
Poor asthma control and exposure to traffic pollutants and obesity in older adults
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DOI：
10.1016/j.anai.2012.04.009
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发表时间：
2012-06-01
影响因子：
5.9
通讯作者：
Bernstein, David I.
中科院分区：
文献类型：
--
作者：
Epstein, Tolly G.;Ryan, Patrick H.;Bernstein, David I.
背景：老年哮喘患者（65岁以下）哮喘控制的环境和宿主预测因素尚不清楚。目的：探讨住宅交通废气暴露及其他环境和宿主因素对老年人哮喘控制的影响。方法：来自俄亥俄州大辛辛那提市过敏及肺部门诊的104例65岁及以上的哮喘患者完成了经验证的哮喘控制问卷（ACQ）、肺功能测试和10种常见空气过敏原的皮肤点刺试验。患者经医生诊断为哮喘，1秒用力呼气量有显著可逆性或甲胆碱激发试验阳性，无慢性阻塞性肺病。利用土地利用回归模型估算了居民平均日交通元素碳暴露量。回归模型用于评估过去一年中自变量、ACQ评分和哮喘加重（定义为需要使用强的松的哮喘症状急性恶化）数量之间的关联。结果：在调整后的模型中，根据ACQ评分，ECAT的平均每日居住暴露量大于0.39 μ g/m(3)与哮喘控制较差显著相关（调整后的贝塔系数= 2.85；95%可信区间[CI]， 0.58-5.12; P = 0.02）。高ECAT水平也与哮喘发作风险增加显著相关（校正优势比为3.24；95% CI为1.01-10.37;P = 0.05）。较高的身体质量指数与较差的ACQ评分之间存在显著关联（校正β = 1.15; 95% CI, 0.53-1.76; P < 0.001）。特应性患者（皮肤点刺试验阳性）的ACQ评分明显优于非特应性患者（校正β = -0.39; 95% CI, -0.67 ~ -0.11; P < 0.01）。结论：在老年哮喘患者中，较高的每日平均住宅交通废气暴露量、肥胖和非特应性状态与较差的哮喘控制有关。(C) 2012年美国过敏、哮喘与免疫学学会Elsevier Inc.出版。版权所有。
Background: Environmental and host predictors of asthma control in older asthmatic patients (>65 years old) are poorly understood.Objective: To examine the effects of residential exposure to traffic exhaust and other environmental and host predictors on asthma control in older adults.Methods: One hundred four asthmatic patients 65 years of age or older from allergy and pulmonary clinics in greater Cincinnati, Ohio, completed the validated Asthma Control Questionnaire (ACQ), pulmonary function testing, and skin prick testing to 10 common aeroallergens. Patients had a physician's diagnosis of asthma, had significant reversibility in forced expiratory volume in 1 second or a positive methacholine challenge test result, and did not have chronic obstructive pulmonary disease. The mean daily residential exposure to elemental carbon attributable to traffic (ECAT) was estimated using a land-use regression model. Regression models were used to evaluate associations among independent variables, ACQ scores, and the number of asthma exacerbations, defined as acute worsening of asthma symptoms requiring prednisone use, in the past year.Results: In the adjusted model, mean daily residential exposure to ECAT greater than 0.39 mu g/m(3) was significantly associated with poorer asthma control based on ACQ scores (adjusted beta = 2.85; 95% confidence interval [CI], 0.58-5.12; P = .02). High ECAT levels were also significantly associated with increased risk of asthma exacerbations (adjusted odds ratio, 3.24; 95% CI, 1.01-10.37; P = .05). A significant association was found between higher body mass index and worse ACQ scores (adjusted beta = 1.15; 95% CI, 0.53-1.76; P < .001). Atopic patients (skin prick test positive) had significantly better ACQ scores than nonatopic patients (adjusted beta = -0.39; 95% CI, -0.67 to -0.11; P < .01).Conclusion: Higher mean daily residential exposure to traffic exhaust, obesity, and nonatopic status are associated with poorer asthma control among older asthmatic patients. (C) 2012 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.