室内过敏原减少在哮喘管理中的有效性：一项系统评价
2018/05/03
摘要
背景：本篇综述将报告给最新的国家哮喘教育和预防计划临床实践指南。
目的：评估过敏原减量干预措施对哮喘预后的有效性。
方法：我们系统地搜索了灰色文献和五个书目数据库。合格的研究包括系统评价，随机对照试验和非随机干预研究。使用Cochrane偏倚风险工具和Newcastle-Ottawa量表评估偏倚风险。利用医疗保健研究机构和质量循证实践中心计划的方法对证据库进行评估。
结果：59项随机试验和8项非随机试验涉及8项干预措施：杀螨剂、空气净化、地毯移除、高效颗粒空气过滤（HEPA）真空装置、床垫罩、除霉、虫害防治和宠物隔离。37项研究评估了单一组分干预措施，30项研究评估了多组分干预措施。 异质性排除了荟萃分析。 对于大多数干预措施和结果，证据基础不确定或无效。 干预措施与验证的哮喘控制评估或肺生理学改善无关。在包含HEPA真空装置或虫害防治的多组分研究（两者均为中等强度的证据[SOE]）中，未发生哮喘急性。 在空气净化器研究（低SOE）和包括HEPA真空（中等SOE）或虫害控制（低SOE）的多组分研究中生活质量得到了改善。
结论：单一干预措施通常与哮喘的改善无关，大多数策略结果不确定或无效。 多组分干预改善了多种结局，但特定干预措施的组合并未更有效。由于缺乏研究，证据往往不确定。我们需要进一步的研究比较减少室内过敏原的干预措施对确认的哮喘评估的影响，以及足够的人群规模以检测临床意义上的差异。
Effectiveness of Indoor Allergen Reduction in the Management of Asthma: ASystematic Review.
Brian F. Leas, et al.
Abstract
BACKGROUND：This review will inform updated National Asthma Education and Prevention
Program clinical practice guidelines.
OBJECTIVE：To evaluate the effectiveness of allergen reduction interventions on asthma outcomes.
METHODS：We systematically searched the gray literature and five bibliographic databases.Eligible studies included systematic reviews, randomized controlled trials, and nonrandomized interventional studies. Risk of bias was assessed using the Cochrane Risk of Bias instrument and the Newcastle-Ottawa scale. The evidence base was assessed using the approach of the Agency for Healthcare Research and Quality’s Evidence-based Practice Center program.
RESULTS：Fifty-nine randomized and 8 non-randomized trials addressed 8 interventions: acaricide, air purification, carpet removal, high-efficiency particulate air-filtration (HEPA) vacuums, mattress covers, mold removal, pest control, and pet removal. Thirty-seven studies evaluated single component interventions, and 30 studies assessed multicomponent interventions. Heterogeneity precluded meta-analysis. For most interventions and outcomes, the evidence basewas inconclusive or showed no effect. No interventions were associated with improvement in validated asthma control measures or pulmonary physiology. Exacerbations were diminished in multicomponent studies that included HEPA vacuums or pest control (moderate strength of evidence [SOE] for both). Quality of life improved in studies of air purifiers (low SOE), and in multicomponent studies that included HEPA vacuums (moderate SOE) or pest control (low SOE).
CONCLUTIONS：Single interventions were generally not associated with improvement 67 in asthma
measures, with most strategies showing inconclusive results or no effect. Multicomponent interventions improved various outcomes, but no combination of specific interventions appears to be more effective. The evidence was often inconclusive because of a lack of studies. Further research is needed comparing the effect of indoor allergen reduction interventions on validated asthma measures, with sufficient population sizes to detect clinically meaningful differences.
背景：本篇综述将报告给最新的国家哮喘教育和预防计划临床实践指南。
目的：评估过敏原减量干预措施对哮喘预后的有效性。
方法：我们系统地搜索了灰色文献和五个书目数据库。合格的研究包括系统评价，随机对照试验和非随机干预研究。使用Cochrane偏倚风险工具和Newcastle-Ottawa量表评估偏倚风险。利用医疗保健研究机构和质量循证实践中心计划的方法对证据库进行评估。
结果：59项随机试验和8项非随机试验涉及8项干预措施：杀螨剂、空气净化、地毯移除、高效颗粒空气过滤（HEPA）真空装置、床垫罩、除霉、虫害防治和宠物隔离。37项研究评估了单一组分干预措施，30项研究评估了多组分干预措施。 异质性排除了荟萃分析。 对于大多数干预措施和结果，证据基础不确定或无效。 干预措施与验证的哮喘控制评估或肺生理学改善无关。在包含HEPA真空装置或虫害防治的多组分研究（两者均为中等强度的证据[SOE]）中，未发生哮喘急性。 在空气净化器研究（低SOE）和包括HEPA真空（中等SOE）或虫害控制（低SOE）的多组分研究中生活质量得到了改善。
结论：单一干预措施通常与哮喘的改善无关，大多数策略结果不确定或无效。 多组分干预改善了多种结局，但特定干预措施的组合并未更有效。由于缺乏研究，证据往往不确定。我们需要进一步的研究比较减少室内过敏原的干预措施对确认的哮喘评估的影响，以及足够的人群规模以检测临床意义上的差异。
（复旦大学附属中山医院 呼吸内科 罗锦龙 摘译 杨冬 审校）
（J Allergy Clin Immunol 2018 Feb 13）
（J Allergy Clin Immunol 2018 Feb 13）
Effectiveness of Indoor Allergen Reduction in the Management of Asthma: ASystematic Review.
Brian F. Leas, et al.
Abstract
BACKGROUND：This review will inform updated National Asthma Education and Prevention
Program clinical practice guidelines.
OBJECTIVE：To evaluate the effectiveness of allergen reduction interventions on asthma outcomes.
METHODS：We systematically searched the gray literature and five bibliographic databases.Eligible studies included systematic reviews, randomized controlled trials, and nonrandomized interventional studies. Risk of bias was assessed using the Cochrane Risk of Bias instrument and the Newcastle-Ottawa scale. The evidence base was assessed using the approach of the Agency for Healthcare Research and Quality’s Evidence-based Practice Center program.
RESULTS：Fifty-nine randomized and 8 non-randomized trials addressed 8 interventions: acaricide, air purification, carpet removal, high-efficiency particulate air-filtration (HEPA) vacuums, mattress covers, mold removal, pest control, and pet removal. Thirty-seven studies evaluated single component interventions, and 30 studies assessed multicomponent interventions. Heterogeneity precluded meta-analysis. For most interventions and outcomes, the evidence basewas inconclusive or showed no effect. No interventions were associated with improvement in validated asthma control measures or pulmonary physiology. Exacerbations were diminished in multicomponent studies that included HEPA vacuums or pest control (moderate strength of evidence [SOE] for both). Quality of life improved in studies of air purifiers (low SOE), and in multicomponent studies that included HEPA vacuums (moderate SOE) or pest control (low SOE).
CONCLUTIONS：Single interventions were generally not associated with improvement 67 in asthma
measures, with most strategies showing inconclusive results or no effect. Multicomponent interventions improved various outcomes, but no combination of specific interventions appears to be more effective. The evidence was often inconclusive because of a lack of studies. Further research is needed comparing the effect of indoor allergen reduction interventions on validated asthma measures, with sufficient population sizes to detect clinically meaningful differences.
上一篇：
生物加重群表明不同介质和微生物组的哮喘和COPD的重叠
下一篇：
小气道功能异常：过敏性鼻炎和过敏性哮喘之间的联系
