抽象的
逃生项目为欧盟空气质量政策辩论提供了重要的证据http://ow.ly/cnd0m
我们不完全理解生活的许多领域:婴儿如何学习说话?为什么我们有时在阅读时笑?彼得·塞勒(Peter Sellers)为什么从未获得奥斯卡奖?建立连接并不总是那么容易。以类似的方式,经验丰富的呼吸专家经常说,有两种类型的呼吸研究在本质上很难:与烟草和环境流行病学有关的任何东西。
In medicine, it is often difficult to prove causal associations and establish mechanisms between exposures and health events that not only make sense but are plausible and coherent, the two most elusive of Sir Austin Bradford Hills’ criteria [1]。在这个问题上European Respiratory Journal(ERJ), A坝et al. [2] report an epidemiological study of air pollution and lung health. They aimed to investigate the association between long-term exposure to ambient air pollution and lung function in adults. They studied five of the 30 cohorts in the eight countries participating in the European Study of Cohorts for Air Pollution Effects (ESCAPE), which measured and modelled the outdoor levels of air pollution at participants’ home addresses in a standardised manner. A坝et al. [2]评估了参与者的肺活量测定测试结果(相距10年)。他们的发现为欧盟(EU)的空气质量政策辩论提供了重要证据。迄今为止,在欧洲范围内最大的元分析中,他们已经确定了肺功能与氮氧化物之间的关联(无2和不x)和颗粒物,截止空气动力学直径为10μm(PM)10).
The ESCAPE project is a unique, ambitious and unprecedented collaborative network with a growing list of deliverables [3]。It links spirometric parameters, such as forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC), in 7613 subjects, whose results were combined and analysed using both standard and sophisticated meta-analysis techniques. Although the study is not conclusiveper se(并且甚至可以认为其主要目标是阴性的,因为他们没有观察到空气污染与肺功能的纵向变化之间的关联),他们确实观察到10μg·M−3否2and PM10exposure was associated with lower levels of FEV1and FVC, and this association was particularly strong in obese people. Again, studying lung function decline, even in labs with experienced technicians and excellent quality control, has insurmountable complications [4]。
有不可争议的证据表明室外污染有助于总和呼吸特异性的发病率和死亡率,有些最近已通过Escape证实[5]。Less clear is the link between ambient air pollution and chronic obstructive pulmonary disease (COPD), both in terms of incidence as well as lung function. But in a way, the same statement could be applied to second-hand smoke (SHS). While tobacco smoking has been causally associated with COPD since the 1964 Surgeon General’s Report, the causative role of SHS exposure on COPD incidence and mortality remains unconfirmed. According to the 2006 Surgeon General Report update and a 2010 report from the American Thoracic Society, the available evidence is limited and suggestive of but not sufficient to infer a causal relationship between SHS exposure and COPD risk [6]。SHS exposure and COPD is a model for environmental pollution and COPD. Imagine if someone breathes in air from the exhaust of a car or a truck, for hours every day, and for many years…
Yet these hot issues are surrounded by obstacles, both in terms of measurement and practicality. Even in the über-controlled world of randomised trials of respiratory drugs, it is somehow more difficult to identify an association between a respiratory drug and changes in lung function decline, than it is with reductions in total and respiratory-specific mortality [7]。一种坝et al.[2] used, and even developedde novo, analytical tools to deal with measurement error to assess the most common outdoor pollutants, mainly traffic-related, such as NO2, NOx and PM metrics measured between 2008 and 2011, all based in monitoring units close to residential homes. Tools included land-use regression, multivariable mixed linear regression models with a random intercept, and other models, including plenty of back-extrapolation for missing values and variables; certainly not made for interpretation by the mere mortal or even the average clinician. There were also subgroup analyses by age, sex, obesity, smoking status, asthma-ever and geographic clustering of outcomes, and extra sensitivity analyses to avoid/reduce ecological fallacies, selection and information biases, as well as confounding. Most ESCAPE participants were younger adults (mean age 53 years), of whom a quarter were current-smokers and a third were already ex-smokers, with of course no children and few elderly participants included, as both of these groups would be likely to be more susceptible to the deleterious effect of outdoor exposures. It would add consistency to the conclusions if the associations were stronger not only in obese people but also in women, continuous- or ex-smokers, and asthmatics, although as the authors present in table 8 of the online supplementary material, neither NO2nor any of the others showed modification of the air pollution–lung function association.
作者必须普莱斯ed, yet no study is totally perfect, and this study has several drawbacks, beyond those identified in their limitations section. Compared to findings in respiratory drug trials, the noise to effect ratio of pre-bronchodilator spirometry measurements, with little to no quality control calculating slopes with a maximum of two spirometry measurements, makes it difficult to obtain a positive finding. An obesity threshold of a body mass index of (BMI) ≥30 kg·m−2is actually becoming normal, if normal means frequent, in many European countries and elsewhere. However, the perfect natural history study of lung function in the population [4,8], which would be required for full, definitive type A evidence of the need to reduce outdoor air pollution, is difficult, perhaps impossible, and we might never have it.
我们在欧洲大部分地区所经历的清洁室外空气主要归功于不懈的环境研究人员的科学,他们说服政客控制着工厂和车辆的排气,并减少对所有人的风险暴露,从而增加呼吸和全健康状况,并且比整个健康状况增加了可能已经帮助预期寿命[9]。The ongoing European Respiratory Society/European Lung Foundation “Healthy Lungs for Life” (HLfL) global initiative aims to raise awareness about lung health amongst all stakeholders in respiratory medicine, from scientists and clinicians to the public and policy makers. In its inaugural year (September 2014 to September 2015), this wide-reaching campaign will focus on the theme “Breathe Clean Air”. We must all spread the message of the importance of clean air for lung health, and HLfL provides us with the tools to do so. Go towww.healthylungsforlife.orgfor more information, statistics and resources, and find out how you can lend your support by holding a World Spirometry Day event or simply sharing the information provided. ESCAPEing from bad quality air with a general goal to achieving cleaner air appears to be a win–win situation in Europe and across the globe. We need more and better evidence on the harmful effects of pollution, and on the beneficial effects to the lungs and the bodies of all those who enjoy cleaner air.
脚注
Conflict of interest: P. Powell is an employee of the European Lung Foundation. S. Sealy is an employee of the European Respiratory Society.
- 已收到September 15, 2014.
- 一种cceptedSeptember 16, 2014.
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