空氣污染已成為全球性的環境議題，隨著工商業的快速發展，空氣污染造成的健康效應影響日漸嚴重。根據空氣污染物之主要暴露途徑，人體之呼吸道系統受到的不良影響最為直接。此外，台灣高溫炎熱且地狹人稠之地理條件，更使得國民受空氣污染影響的程度加劇，短期易誘發急性呼吸道疾病發生。而氣喘為一種反覆發作的氣流阻滯病變，不易根治且需長期透過治療來控制症狀發生，一旦患者接觸到危險因子可能引起氣喘急性發作之症狀。
隨著醫療檢驗技術的發展，許多研究指出氣喘可依據患者氣喘發生年齡區分為早發型氣喘與遲發型氣喘，兩者之發作機制完全不同，然而以往相關的研究多直接以氣喘患者就醫年齡進行探討，並未針對不同氣喘種類進行分析，因此在成人氣喘患者氣喘急性發作方面，往往未看到與空氣污染物有相關。在相關研究中已指出空氣污染物確實與遲發型氣喘之發生有關，然而與遲發型氣喘之急性發作之間的關聯尚不明確。此外在空氣污染暴露方面，則受限於空氣品質監測站的數量及分布，在使用空間內插方法時，容易出現錯誤分類所導致的誤差。因此，本研究將以基於政府空品監測站與民間微型監測器之智慧空污暴露推估模式降低以往推估的誤差，並探討空氣污染物與不同類型的氣喘急性發作之關聯性。
本研究使用雙向病例交叉研究設計，以2008年至2015年衛生福利資料科學中心全民健康保險研究資料庫之全人口檔，依據國際疾病分類法第九版(ICD-9-CM)之疾病診斷碼篩選出氣喘患者，透過定義患者氣喘發生年齡將其區分成早發型氣喘患者及遲發型氣喘患者。本研究使用之環境監測資料取自環境保護署空氣品質監測資料以及中央氣象局自動氣象站觀測資料，回溯研究對象氣喘急性發作就醫前之環境暴露條件。研究對象之居住地則根據患者就醫情形錄進行推估，並使用反距離加權法推估各鄉鎮市區之空氣污染物日平均濃度。本研究將以條件式羅吉斯迴歸進行統計分析，估計短期空氣污染暴露與氣喘急性發作風險之勝算比(Odds Ratio，OR)以及95%信賴區間。
本研究共納入2008-2015年早發型氣喘個案共567,523人，平均年齡為4.07歲；遲發型氣喘個案共924,054人，平均年齡為49.5歲。在多重污染物模式下，早發型氣喘患者之氣喘急性發作受環境因子影響的程度，PM2.5每上升10 μg/m^3，將顯著增加0.8%(OR:1.008，95%CI:1.007, 1.009)的氣喘急性發作風險，O3每上升10ppb，將顯著增加0.7%(OR:1.007，95%CI:1.005,1.008)的氣喘急性發作風險，NOx每上升10ppb，將顯著增加1.5%(OR:1.015，95%CI:1.014, 1.017)的氣喘急性發作風險，SO2每上升1ppb，將顯著降低0.2%(OR:0.998，95%CI:0.997, 0.999)的氣喘急性發作風險，溫度每上升1℃，將顯著減少0.5%(OR:0.995，95%CI:0.994 ,0.995)的氣喘急性發作風險，相對溼度每上升10%，將顯著減少2.3%(OR:0.977，95%CI:0.975, 0.978)的氣喘急性發作風險。遲發型氣喘患者之氣喘急性發作受環境因子影響的程度，PM2.5每上升10 μg/m^3，將顯著增加0.5%(OR:1.005，95%CI:1.004, 1.006)的氣喘急性發作風險，O3每上升10ppb，將顯著增加0.9%(OR:1.009，95%CI:1.007, 1.010)的氣喘急性發作風險，NOx每上升10ppb，將顯著增加2.5%(OR:1.025，95%CI:1.023, 1.026)的氣喘急性發作風險，溫度每上升1℃，將顯著減少0.3%(OR:0.997，95%CI:0.997,0.998)的氣喘急性發作風險，相對溼度每上升10%，將顯著減少2.1%(OR:0.979，95%CI:0.977, 0.980)的氣喘急性發作風險。
在空氣污染物方面，PM2.5濃度在37.91 μg/m3以下時，氣喘急性發作的風險受到濃度區間差異的影響程度較輕微，但當PM2.5濃度超過37.91 μg/m3時，氣喘急性發作的風險受到濃度區間差異的影響有明顯的提升；O3濃度在35.60ppb以下時，幾乎不影響氣喘急性發作的風險，但當O3濃度超過35.60ppb時，則可以看到氣喘急性發作的風險受到濃度區間差異的影響有明顯的提升；NOx濃度差異越大時，對氣喘急性發作的風險影響也跟著變大。至於在氣喘類型方面，兩種類型的氣喘受到PM2.5與O3濃度差異的影響程度相近；在NOx方面無論濃度在何種區間，遲發型氣喘患者受到濃度區間差異的影響程度皆比早發型氣喘患者來的大，且濃度差異越大，上述差異會更加明顯；SO2濃度在高濃度區間下，僅增加遲發型氣喘患者氣喘急性發作的風險，對於早發型氣喘患者氣喘急性發作的風險影響較輕微。
本研究發現在控制性別、年齡、就醫季節、居住地後，早發型氣喘患者之氣喘急性發作與PM2.5、O3、NOx呈顯著正相關，與SO2、溫度及相對溼度呈顯著負相關。遲發型氣喘患者之氣喘急性發作與PM2.5、O3、NOx呈顯著正相關，與溫度及相對溼度呈顯著負相關，但與SO2未有顯著相關。NOx在所有空氣污染物之中，對於氣喘急性發作的風險影響程度最大。

Asthma is a recurrent attack of airflow obstruction. Once the patient is exposed to risk factors, it may cause symptoms of acute asthma. Many studies have pointed out that asthma can be divided into early-onset asthma and late-onset asthma according to the age. The mechanism of the attack between the two is completely different. Also, in terms of air pollutant exposure, it’s limited by the number and distribution of air quality monitoring stations. This study used a case-crossover study design to select asthma patients from National Health Insurance Research Database of Health and Welfare Data Science Center from 2008 to 2015, according to the disease diagnosis code of the International Classification of Diseases-9 code. The environmental monitoring data used in this study was taken from the air quality monitoring data of the Environmental Protection Administration and the observation data of the Central Weather Bureau automatic weather station. This study found that acute asthma attacks were positively correlated with PM2.5, O3, NOx, but only patients in early-onset asthma negatively correlated with SO2. Among all, NOx has the most significant impact on the risk of acute attacks, the higher the NOx concentration, the greater the impact on the risk of acute asthma attacks. When PM2.5 and O3 is below a certain concentration, the risk of an acute asthma attack is small. However, once the concentration exceeds this concentration range, the risk of the acute attack of asthma will increase significantly.

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空氣品質標準法規 (民101年5月14日)