氣喘是世界上常見的慢性呼吸道疾病，目前已經有許多研究針對空氣污染對氣喘的影響，但是鮮少研究是對成人中空氣污染與急診就診與住院治療之關聯性進行統合分析，而某些風險值仍然有不一致性，並且延遲效應及懸浮微粒引發的風險尚未受到深入探討。因此，本研究以系統性文獻回顧搜尋空氣污染與成人氣喘的急診就診與住院治療之文獻，利用統合分析進行效應的量化。
於系統性文獻回顧的方面，我們利用Ovid MedLine、EmBase及Scopus等資料庫搜尋，篩選探討成人氣喘的急診就診或住院治療與空氣污染相關性的文獻。統合分析的方面，使用隨機或固定效應模式估算研究結果，以不同污染物之個別的暴露期之結果來統合，接著以相對風險及95％ 信賴區間(95％ CI)呈現。
本研究共納入79篇文獻進行量化分析，結果皆以10單位的污染物之上升當基準，並以延遲型態與表現顯著的風險值呈現。以急診的單一性效應，NO2、PM2.5及CO每上升 10 μg/m3 的相對風險分別為1.028 (95% CI: 1.005-1.052) (急診就診前第3天)、1.017 (95% CI: 1.008-1.026)(急診就診前第1天)及1.137 (95% CI: 1.007-1.285)(急診就診前第5天)。急診的累積性效應，每上升 10 ppb 的SO2 的相對風險為 0.805 (95% CI: 0.712-0.899)(急診就診當天至前第4天)，每上升 10 μg/m3 的PM2.5的相對風險分別為 1.020 (95% CI: 1.003-1.037)(急診就診當天至前第1天)、1.009 (95% CI: 1.006-1.012)(急診就診當天至前第2天)、1.024 (95% CI: 1.016-1.031)(急診就診當天至前第3天)及1.009 (95% CI: 1.005-1.013)(急診就診當天至前第4天)，而每上升 10 ppb的O3的相對風險為1.107 (95% CI: 1.039-1.179)(急診就診當天至前第3天)。住院治療的單一性效應，每上升 10 μg/m3 的PM2.5的相對風險為1.024 (95% CI: 1.006-1.042)(住院治療前第2天)，每上升 10 μg/m3 的PM2.5的相對風險為1.023 (95% CI: 1.005-1.041)(住院治療前第4天)，而每上升 10 ppb的 O3的相對風險分別為 1.013 (95% CI: 1.007-1.019)(住院治療前第1天)、1.009 (95% CI: 1.003-1.014)(住院治療前第2天)及1.013 (95% CI: 1.003-1.022)(住院治療前第3天)。住院治療的累積性效應，每上升 10 μg/m3 的SO2 的相對風險分別為1.018 (95% CI: 1.010-1.024)(住院治療當天至前第1天)及1.016 (95% CI: 1.000-1.033)(住院治療當天至前第3天)，每上升 10 μg/m3 的PM10的相對風險為1.003 (95% CI: 1.000-1.006)(住院治療當天至前第1天)、1.005 (95% CI: 1.001-1.009)(住院治療當天至前第2天)及1.008 (95% CI: 1.003-1.013)(住院治療當天至前第5天)，每上升 10 μg/m3 的的相對風險NO2分別為1.009 (95% CI: 1.005-1.014)(住院治療當天至前第1天)、1.007 (95% CI: 1.006-1.007)(住院治療當天至前第3天)及 1.020 (95% CI: 1.009-1.030)(住院治療當天至前第4天)，每上升 10 μg/m3 的PM2.5的相對風險分別為1.014 (95% CI: 1.004-1.024) (住院治療當天至前第1天)、1.026 (95% CI: 1.016-1.036)(住院治療當天至前第3天)、1.019 (95% CI: 1.007-1.032)(住院治療當天至前第4天)及1.019 (95% CI: 1.010-1.027)(住院治療當天至前第5天)，而每上升 10 ppb的 O3的相對風險分別為1.032 (95% CI: 1.019-1.044)(住院治療當天至前第1天)及1.017 (95% CI: 1.006-1.027)(住院治療當天至前第3天)。
由上述的結果可知，以急診的累積性效應而言，PM10、PM2.5 與 O3 對此健康狀況有顯著性的影響。以住院治療的單一性效應和累積性效應而言，PM10、PM2.5、O3、SO2 及 NO2對此健康狀況有顯著性的影響。延遲效應對成人有重要的影響。

關鍵字: 氣喘、空氣污染、急診及住院治療、延遲效應、統合分析

SUMMARY

This study estimated the effects of air pollutants on hospital admissions and emergency room visits for asthma in adult population using meta-analysis. Lag effects were also studied. We used Embase, Ovid MEDLINE and Scopus to search the literature. We used NOS (Newcastle-Ottawa Scale) to assess the quality of each study included. For single effects for emergency room visits, each 10 μg/m3 increase in NO2, PM2.5 and CO was associated with a relative risk (RR) of 1.028 with a lag of 3 days, 1.017 with a lag of 1 day and 1.137 with a lag of 5 days, respectively. For cumulative effects for emergency room visits, each 10 ppb increase in SO2 was associated with a RR of 0.828 at lag 0-4, each 10 μg/m3 increase in PM10 was associated with a RR of 1.023 at lag 0-2, each 10 μg/m3 increase in PM2.5 at lag 0-1, lag 0-2, lag 0-3 and lag 0-4 was associated with a RR of 1.197, 1.047, 1.021 and 1.015, and each 10 ppb increase in O3 was associated with a RR of 1.107 at lag 0-3. For single effects for hospital admission, each 10 μg/m3 increase in NO2 was associated with a RR of 1.078 at lag 5, PM2.5 was associated with a RR of 1.023 at lag 4, and each 10 ppb increase in O3 at lag 1 to lag 3 was associated with a RR of 1.013, 1.010 and 1.013. For cumulative effects for hospital admission, each 10 μg/m3 increase in SO2 at lag 0-1 and lag 0-3 was associated with a RR of 1.018 and 1.017, each 10 μg/m3 increase in PM10 at lag 0-1, lag 0-2 and lag 0-5 was associated with a RR of 1.003, 1.005 and 1.009, each 10 μg/m3 increase in NO2 at lag 0-1, lag 0-3 and lag 0-4 was associated with a RR of 1.022, 1.007 and 1.020, each 10 μg/m3 increase in PM2.5 at lag 0-3 to lag 0-5 was associated with a RR of 1.028, 1.029 and 1.019, and each 10 ppb increase in O3 at lag 0-1 and lag 0-3 was associated with a RR of 1.032 and 1.017. PM10, PM2.5 and O3 have significant effects on emergency room visits for asthma. PM10, PM2.5, O3, and SO2 have significant effects on hospital admissions for asthma.

Keywords: asthma, air pollution, emergency room visits, lag effect, meta-analysis

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社區氣喘照護-白話氣喘 2018 徫生福利部國民健康署