인천 지역 초등학교 학생에서 대기 오염물질의 농도와 알레르기 질환 유병률 및 폐기능과의 연관성
Relationship Between Air Pollutants and Prevalence of Allergic Disease/Pulmonary Function in Students in Incheon
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목적:인천의 초등학교 학생을 대상으로 학교의 대기 오염물질 수준과 알레르기 질환 및 폐기능과의 연관성을 규명하고자 하였다. 방법:인천 지역 11개 초등학교 2학년 학생 1,262명을 대상으로 하였다. 일산화탄소(CO), 이산화질소(NO2), 오존(O3), 아황산가스(SO2), 미세먼지(PM10)의 학교별 5년간 평균농도는 국립환경연구원의 자료를 바탕으로 지리정보체계를 이용해 추정하였다. 대기 오염물질 수준과 학생들의 알레르기 질환 유병률 및 폐기능의 연관성을 평가하기 위해 크게 두 가지 방법으로 나눈 군 학생간에 비교를 하였다. 학교에서 대기 오염물질 배출시설까지의 거리가 1 km 이상인 비인접학교와 1 km 이내인 인접학교로 나누어 두 군을 비교하였다. 또한, 각 대기 오염물질별 5년간 평균농도의 중간값을 기준으로 대기오염물질 농도가 상대적으로 높은 학교와 상대적으로 낮은 학교로 나누어 두 군을 비교하였다. 결과:오존을 제외한 대기 오염물질 농도는 인접학교에서 비인접학교에 비해 유의하게 높았다. 인접학교 학생들은 1초간 노력성 호기량(FEV1)과 최대호기속도(PEF)가 비인접학교 학생들에 비해 유의하게 낮았고, ‘최근 일년간 숨이 차서 말하기 힘든 증상 경험’은 비인접학교 학생들보다 유의하게 많았다. 또한, 이 말하기 힘들어하는 증상은 NO2, SO2, PM10의 상대적 농도가 높은 군에서도 각각의 상대적 농도가 낮은 군에 비해 유의하게 많았다. PM10의 상대적 농도가 높은 군에서는 알레르기비염의 유병률이 상대적 농도가 낮은 군보다 유의하게 높았다. 결론:학교의 대기 오염물질은 학생들의 알레르기 질환 특히, 알레르기비염의 유병률 증가와 폐기능 감소에 영향을 미치는 것으로 생각된다.
Abstract
Purpose:This study aimed to determine whether the standard clinical pathway based on evidence is applicable to pediatric asthma patients in the emergency room, and whether it is better for treatment effectiveness. Methods:The clinical pathway was applied to children who visited our emergency room due to acute asthma between January 1 and December 31, 2009. Medical records of the emergency room were reviewed to see if the clinical pathway was correctly applied. The patients were divided into 2 groups: those who the pathway was correctly applied and those who the pathway was incorrectly applied to (group B, n=41). Results:Acute asthma exacerbation occurred in 24 children (47%) in group A, while it occurred in 27 children (53%) in group B. The majority of patients in group B had moderate asthma exacerbation. The incorrect application of the clinical pathway and no use or insufficient use of inhaled anticholinergics was most frequently noted. The most common cause for the incorrect application of the clinical pathway was its misunderstanding of residents. The hospitalization rate was higher in group B than in group A. Conclusion:The application of the clinical pathway to pediatric asthma patients in the emergency room increased treatment effectiveness. However, training for the residents and intensive care for the patient with moderate asthma exacerbation are necessary for correct application of the clinical pathway.
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