飲食中抗氧化劑維生素C、E之攝取已被探討是否能減緩空氣污染暴露對呼吸道疾患發生之影響，而過往文獻研究大多以成人為研究對象，對於兒童的相關性研究卻有限，且抗氧化劑的效能在成人與兒童之間並不一致，而抗氧化劑攝取情形對於改善與空氣污染物暴露有關之呼吸道疾患的作用亦尚未釐清，故本研究在不同的空氣污染物暴露區域，以呼吸道較敏感之氣喘兒童為對象，探討其飲食中抗氧化劑維生素C、E攝取量對呼吸道健康之影響，以了解是否能藉此提供氣喘兒童健康照護之參考方法.。
本研究首先以O3濃度分佈為考量，依據過去三年測站平均值，選取高、低污染暴露區，分別為台南市安南測站地區、花蓮縣花蓮測站地區。依人數比例配對選取3公里內各4所小學，依據篩選性問卷選出過去一年內發生氣喘症狀者以徵求自願參與，共184位同意參加。於92年1月及3月期間各執行一週評估，請家長協助記錄兒童每日的尖峰呼氣流速、呼吸道症狀及飲食狀況，再分析探討其相關性。
第一階段評估共有135位參與研究，台南、花蓮地區回收率分別有78.0％、71.1％。第二階段評估共123位參與，台南、花蓮地區回收率分別有76.2％、69.4％，經初步單一變項分析結果，在一、三月份觀察期間，症狀有無發生的比較上，發現台南地區傍晚及晚上PEFR較標準預測值下降>20%的發生比例較花蓮地區高，在呼吸道症狀方面，例如一月打噴嚏症狀和三月流鼻涕、鼻塞等症狀在花蓮地區發生的比例高於台南地區，而在個人症狀發生頻率之比較上，亦觀察到相同之結果。在維生素E攝取與健康症狀方面，本研究觀察到台南地區三月份研究對象流鼻涕症狀、花蓮地區一月份研究對象發生鼻塞症狀，及三月份去除感冒者後其發生聲音沙啞等症狀，在維生素E攝取濃度較高組發生的比例及發生頻率較高。在花蓮地區三月份觀察期間，發現在維生素E低攝取組中，研究對象之晨間、傍晚、晚上PEFR較預測值下降>20%的發生與否及發生頻率較高。在維生素C攝取量對呼吸道症狀影響部分，發現花蓮地區一月份觀察期間氣喘兒童發生晨間PEFR較預測值下降>20%的比例及頻率為低攝取組較高。在觀察台南地區氣喘兒童呼吸道症狀方面，發現一月份鼻塞症狀和三月份打噴嚏症狀發生之比例及頻率皆為高攝取組較高。
在低空氣污染地區其呼吸道症狀發生的比例及頻率較高空氣污染暴露區為高，可能的原因為花蓮地區孢粉濃度遠高於台南地區，因此觀察到較多的上呼吸道症狀，但其兩者之交互作用及對PEFR下降之影響，以及其他干擾因子之影響，仍需進一歩探討。本研究亦觀察到維生素C、E高攝取者，其PEFR較標準預測值下降>20%發生的比例及頻率較低攝取者少，但在呼吸道症狀的表現上並沒有一致的現象，推論可能為維生素C、E的攝取能夠保護肺功能，卻不能減緩呼吸道之症狀，亦或許為研究對象總食入的維生素C、E攝取量不足以減緩呼吸道症狀的表現。但能夠產生作用之最低的維生素C、E劑量值，仍需進一歩之研究。
本研究結果顯示，在三月的環境氣候條件下，維生素E攝取量對於低污染暴露區氣喘兒童肺功能有保護之作用，此發現希望可提供氣喘兒童對其呼吸道疾患發生之預防及照護的參考依據。

Reporting airway symptoms have been known to be associated with exposure to air pollution. There are also observations on modulation of acute respiratory effects of pollution such as ozone and nitrogen dioxide by anti-oxidant supplementation. Yet, most of the studies have dealt with adult subjects, and the information on children remains limited. Moreover, the effects of antioxidants in improving the respiratory health of children and adults are not consistent. The aim of this study is then to investigate effects of vitamin C, E Intake on respiratory health of asthmatic children with exposure to different levels of air pollution.
Subjects were selected from two districts according to the ambient O3 concentration distributions monitored in the past 3 years. Eight schools within 3 km of monitoring stations of Tainan City and Hualien County, Taiwan, were chosen. Screening questionnaire was applied to identify the active asthmatics. Children of ages 6-12 with diagnosed asthma and having been wheezing in the past 12 months were included, and 184 asthmatic children agreed to participate this study. Asthmatic children were asked to keep dietary record, take measurements of daily Peak Expiratory Flow Rate (PEFR, 3 times a day), and report respiratory symptoms for one week in January and March of 2003. Air pollutant concentrations were taken from the monitoring stations, and the characteristics of children, including home environments, were also collected by questionnaires. Regression analysis were conducted to explore the effects of vitamin C, E intake in different exposure areas.
In January and March, the participation was 78% and 76.2% in Tainan, and 71.1% and 69.4% in Hualien, respectively. After univariant analysis, the prevalence and frequency of reporting 20% PEFR decrements in the evening and at night were higher for children in high exposure district. No difference between the frequencies of respiratory symptoms reported by children of 2 exposure districts, except for sneeze in January. In March the higher prevalence and frequency of reported runny nose and stuffy nose in low exposure district was observed. In Tainan, the prevalence and frequencies of the respiratory symptoms such as stuffy nose and sneeze were higher in subjects with higher vitamin C intake, and stuffy nose and sneezing were higher in subjects with higher vitamin E intake. In Hualien, the prevalence and frequency of reporting 20% PEFR decrements in the morning in January were lower in subjects with higher vitamin C intake, and the prevalence and frequency of reporting 20% PEFR decrements in morning, evening and at night in March were lower for children with higher vitamin E intake.
The total spore counts in Hualien were higher than in Tainan from past study, and that may be one of the reasons that the frequencies of respiratory symptoms were higher in Hualien. The effects of vitamin C and E intake on 20% PEFR decrements and respiratory symptoms are different. it suggests that more vitamin C and E intake may be protective to lung function, but the quantity observed was not sufficient to modulate the performance of respiratory symptoms.
In this study, we identify the effects of vitamin E on 20% PEFR decrements for subjects in low exposure district. The result may offer certain preventive guideline for improving respiratory health of asthmatic children.

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