| Summary: | 碩士 === 國立成功大學 === 環境醫學研究所 === 90 === There is sufficient evidence that asthma prevalence and morbidity are on the rise despite of improved treatment regimen throughout the world. High prevalence rate of asthma in Taiwan, almost an 8-times increase of prevalence, was observed for primary school children compared with survey of 20 years ago. Meanwhile, childhood asthma is heterogeneous in severity. There are subjects who have daily wheezing and continuous pulmonary function abnormalities, and, yet, some subjects get symptoms infrequently. There are several reports on the prognosis of asthma in the western countries with varied results. Limited information is available for populations in the eastern half of the globe. Taiwan is located at subtropical region with high humility climate, which is suitable for growth of dust mites and fungi. There was void of report about the prognosis of childhood asthmatics in Taiwan. The aim of the study is to investigate the nature of bronchial asthma from middle school-aged childhood to adulthood and risk factors influencing the nature.
704 subjects had ever reported wheeze with difficult breathing in the past 12 months from a questionnaire survey of middle-school students at Chiayi County in 1995. Of these, 369 subjects received questionnaires and physical examination 7 years later. There was no statistical significance of our total subjects in gender (p=0.61), mean age (p=0.28), and physician-diagnosed asthma (p=0.5) compared with the original study subjects. 211 male and 158 female, with mean age of 20 have been interviewed to observe their asthma status in the past 12 months. Among them, 119 subjects (32%) were considered to have asthma persistence into adulthood, and 250 subjects (68%) had no more experienced asthma symptoms at least one year. A majority (60%) of those with inactive asthma were symptoms free for more than 5 years.
Among these 369 subjects contacted, 110 subjects (50 active asthmatics and 60 inactive asthmatics) came to a hospital visit with detail questionnaire, physical examination, pulmonary function test, and Immunoglobulin E check. Among all environmental- and hereditary- related factors evaluated, mold growth more than one wall of the residential walls was associated with an odds ratio of 5.0 and statistical significance (p=0.04) associated for presistence of asthma into adulthood. Familial history of asthma had an odds ratio of 2.9, and concomitant allergic rhinitis had an odds ratio of 3.4; both were observed to be significant risk factors (p=0.02 vs 0.003 respectively) for persistence of asthma into adulthood.
The asthma symptoms were no longer present in about two-thirds of the asthma subjects in this 20-year-old age group. Environmental and genetic factors played vital roles on the prognosis of middle-school aged asthmatics. Mold growth on the residential walls was an important pulblic health issue in Taiwan, especially for childhood asthmatics. Mold growth on the walls associated with the amounts of fungi and dust mites, and its influnce on the prognosis of asthma merit further investigation.
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