Hatice Canan HASANOĞLU, Mükremin ER, Berker ÖZTÜRK

Dış Ortam Hava Kirliliği ile Göğüs Hastalıkları Acil Başvurularıİlişkisinin Değerlendirilmesi: Retrospektif Kesitsel Bir Çalışma

Amaç: Hava kirliliği, akciğerde ve akciğer aracılığıyla sistemik dolaşıma ulaşarak solunum fonksiyonlarında azalmaya, solunum yolu enfeksiyonlarına, astım ve kronik obstrüktif akciğer hastalığı gelişimine ve alevlenmelerin artışına sebep olur. Literatürde Ankara ilinde hava kirliliği ile alt solunum yolu enfeksiyonu acil servis başvurularını gösteren çalışma mevcut değildir. Bu çalışmada, acil servise başvuran göğüs hastalıkları bulunan hastaların başvuru oranlarının hava kirliliği ile ilişkisinin gösterilmesi amaçlandı. Gereç ve Yöntemler: Çalışmaya, Ağustos 2018-Şubat 2019 tarihleri arasında Ankara Atatürk Eğitim ve Araştırma Hastanesi Acil Servisine göğüs hastalıkları konsültasyonu sonucunda primer pulmoner patoloji düşünülen hasta başvuruları alındı. Araştırmaya 302 hasta dahil edildi. Araştırmada hava kirliliği indikatörleri olarak $SO_2$ , $PM_10$ ve $PM_{2,5}$ seçildi. İndikatörlere ilişkin günlük veriler, T.C. Çevre, Şehircilik ve İklim Değişikliği Bakanlığı’nın Hava Kalitesi İzleme İstasyonları web sitesinden alındı. Araştırmada hastaların demografik özellikleri, acil servise başvuru semptomları ve başvuru tanıları, arter kan gazı (pH, $PaCO_2$ , $PaO_2$ , $SO_2$ ), tam kan sayımı, C-reaktif protein ve prokalsitonin düzeyleri incelendi. Bulgular: Göğüs hastalıkları acil başvurusunda hastaların %11,6’sı astım, %33,1’i kronik obstrüktif akciğer hastalığı, %13,9’u pulmoner tromboemboli, %44,7’si pnömoni, %11,2’si bronşiektazi, %4’ü interstisyel akciğer hastalığı, %2’si akciğer kanseri ve %44,7’si obstrüktif akciğer hastalığı tanılı idi. Hastaların %87,7’sinin öksürük, %40,4’ünün balgam, %64,9’unun nefes darlığı, %37,4’ünün göğüs ağrısı, %6’sının hemoptizi ve %27,8’inin diğer semptomlarla başvuru yaptıkları saptandı. Acil servise başvuruda aralık ayında hava kirletici parametrelerden $SO_2$ , $PM_10$ düzeylerinin en yüksek değerde olduğu saptandı. Astım, kronik obstrüktif akciğer hastalığı, pnömoni ve obstrüktif akciğer hastalıkları olanlarda olmayanlara kıyasla hava kirliliği parametresi/ parametreleri anlamlı olarak daha yüksek saptandı (p

The Relationship Between Ambient Air Pollution and Emergency Department Visits for Lower Respiratory Diseases: A Retrospective Cross-Sectional Study

Objective: Ambient air pollution was found responsible for many respiratory diseases that are among the leading causes of global deaths. No research on patients presenting to Emergency Departments for air pollution-related respiratory diseases is found. Material and Methods: This retrospective cross-sectional study was conducted in Ankara Atatürk Training and Research Hospital using medical records belonging to 302 EDVs for respiratory diseases. The data on ambient $SO_2$ and $PM_10$ levels corresponding to the EDV dates were retrieved from the National Air Quality Monitoring Network website. The demographics and clinical data gathered from electronic files of patients were compared with the levels of air pollutants. Statistical analyses were performed using SPSS 20.0. Results: The number of EDVs was significantly higher in patients over 65 and exposed to higher levels of $SO_2$ than that of the younger patients. The significantly higher levels of $SO_2$ and PM10 were observed in December. The patients exposed to higher $SO_2$ and $PM_10$ presented to the ED with significantly more cough, phlegm, dyspnea, and chest pain symptoms. A significant relationship between EDVs for COPD and pneumonia and high levels of $SO_2$ was observed, while high PM10 levels were significantly related with EDVs for asthma, COPD, pneumonia, and ACO. The results of laboratory investigations demonstrated significant correlations between high levels of $SO_2$ and blood pH, p$CO_2$ , $pO_2$ , COHb, and CRP. The mean procalcitonin value significantly correlated with high $SO_2$ and $PM_10$. Conclusion: The significant relationship between escalations in ambient $SO_2$ and $PM_10$ and increased EDVs for lower respiratory diseases observed in this retrospective cross-sectional study indicated that air pollution in Ankara continues to be a critical health problem.

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