改善居室供热对社区儿童哮喘的作用：随机对照研究
2009/05/18
在新西兰5个社区进行的此项随机对照研究是为了评价无污染，高能效的居室供热系统（热泵、木材颗粒燃烧器、烟道气体）是否对哮喘儿童的健康有利。共纳入409名经医生诊断为哮喘的6～12岁儿童。在冬季到来前安装无污染，高能效的居室供热系统，主要终点指标为肺功能的变化（PEF及FEV1），次要指标为患儿报告的呼吸道症状及每天预防和缓解药物的用量。在2005年（基线）和2006年（随访）冬季末由父母报告其子女的总体健康状况，就诊情况，总体呼吸道健康状况及房屋条件。在4个月内每月测定NO水平，每小时记录起居室和患儿卧室的温度。
结果发现肺功能无显著改善（平均FEV1差值为130.7 ml, 95%CI -20.3-281.7). 但干预组患儿误学时间较对照组少1.8天 (95% CI0.11-3.13),因哮喘就诊次数少0.40次 (0.11-0.62), 因哮喘取药次数0.25次 (0.09-0.32)。干预组健康状况不良者少 (校正后OR0.48, 95% CI0.31-0.74),较少因喘息影响睡眠(0.55, 0.35-0.85), 夜间干咳少(0.52, 0.32-0.83),下呼吸道症状积分下降 (0.77, 0.73 -0.81)。干预组起居室平均温度升高1.10ºC (95%CI 0.54ºC-1.64ºC) ,患儿卧室平均温度升高 0.57 ºC (95%CI0.05ºC -1.08ºC)。干预组起居室内NO浓度低于对照组 (几何均数8.5 microg/m(3) v 15.7microg/m(3), P<0.001)，干预组患儿卧室NO浓度也较低(7.3 microg/m(3) v 10.9 microg/m(3), P<0.001)。在哮喘患儿家中安装无污染，高能效的供热系统不能显著改善肺功能，但是可显著减轻小船症状，减少误学时间，就诊、取药次数。
（马艳良 北京大学人民医院呼吸科 100044 摘译）
（BMJ. 2008 Sep 23;337:a1411. doi: 10.1136/bmj.a1411）
Effects of improved home heating on asthma in community dwelling children: randomised controlled trial.
BMJ. 2008 Sep 23;337:a1411. doi: 10.1136/bmj.a1411.
He Kainga Oranga/Housing and Health Research Programme, University of Otago, Wellington, PO 7343, Wellington South, New Zealand. philippa.howden-chapman@otago.ac.nz
OBJECTIVE: To assess whether non-polluting, more effective home heating (heat pump, wood pellet burner, flued gas) has a positive effect on the health of children with asthma.
DESIGN: Randomised controlled trial.
SETTING: Households in five communities in New Zealand.
PARTICIPANTS: 409 children aged 6-12 years with doctor diagnosed asthma.
INTERVENTIONS: Installation of a non-polluting, more effective home heater before winter. The control group received a replacement heater at the end of the trial.
MAIN OUTCOME MEASURES: The primary outcome was change in lung function (peak expiratory flow rate and forced expiratory volume in one second, FEV(1)). Secondary outcomes were child reported respiratory tract symptoms and daily use of preventer and reliever drugs. At the end of winter 2005 (baseline) and winter 2006 (follow-up) parents reported their child’s general health, use of health services, overall respiratory health, and housing conditions. Nitrogen dioxide levels were measured monthly for four months and temperatures in the living room and child’s bedroom were recorded hourly.
RESULTS: Improvements in lung function were not significant (difference in mean FEV(1) 130.7 ml, 95% confidence interval -20.3 to 281.7). Compared with children in the control group, however, children in the intervention group had 1.80 fewer days off school (95% confidence interval 0.11 to 3.13), 0.40 fewer visits to a doctor for asthma (0.11 to 0.62), and 0.25 fewer visits to a pharmacist for asthma (0.09 to 0.32). Children in the intervention group also had fewer reports of poor health (adjusted odds ratio 0.48, 95% confidence interval 0.31 to 0.74), less sleep disturbed by wheezing (0.55, 0.35 to 0.85), less dry cough at night (0.52, 0.32 to 0.83), and reduced scores for lower respiratory tract symptoms (0.77, 0.73 to 0.81) than children in the control group. The intervention was associated with a mean temperature rise in the living room of 1.10 degrees C (95% confidence interval 0.54 degrees C to 1.64 degrees C) and in the child’s bedroom of 0.57 degrees C (0.05 degrees C to 1.08 degrees C). Lower levels of nitrogen dioxide were measured in the living rooms of the intervention households than in those of the control households (geometric mean 8.5 microg/m(3) v 15.7 microg/m(3), P<0.001). A similar effect was found in the children’s bedrooms (7.3 microg/m(3) v 10.9 microg/m(3), P<0.001).
CONCLUSION: Installing non-polluting, more effective heating in the homes of children with asthma did not significantly improve lung function but did significantly reduce symptoms of asthma, days off school, healthcare utilisation, and visits to a pharmacist.
TRIAL REGISTRATION: Clinical Trials NCT00489762.
结果发现肺功能无显著改善（平均FEV1差值为130.7 ml, 95%CI -20.3-281.7). 但干预组患儿误学时间较对照组少1.8天 (95% CI0.11-3.13),因哮喘就诊次数少0.40次 (0.11-0.62), 因哮喘取药次数0.25次 (0.09-0.32)。干预组健康状况不良者少 (校正后OR0.48, 95% CI0.31-0.74),较少因喘息影响睡眠(0.55, 0.35-0.85), 夜间干咳少(0.52, 0.32-0.83),下呼吸道症状积分下降 (0.77, 0.73 -0.81)。干预组起居室平均温度升高1.10ºC (95%CI 0.54ºC-1.64ºC) ,患儿卧室平均温度升高 0.57 ºC (95%CI0.05ºC -1.08ºC)。干预组起居室内NO浓度低于对照组 (几何均数8.5 microg/m(3) v 15.7microg/m(3), P<0.001)，干预组患儿卧室NO浓度也较低(7.3 microg/m(3) v 10.9 microg/m(3), P<0.001)。在哮喘患儿家中安装无污染，高能效的供热系统不能显著改善肺功能，但是可显著减轻小船症状，减少误学时间，就诊、取药次数。
（马艳良 北京大学人民医院呼吸科 100044 摘译）
（BMJ. 2008 Sep 23;337:a1411. doi: 10.1136/bmj.a1411）
Effects of improved home heating on asthma in community dwelling children: randomised controlled trial.
BMJ. 2008 Sep 23;337:a1411. doi: 10.1136/bmj.a1411.
He Kainga Oranga/Housing and Health Research Programme, University of Otago, Wellington, PO 7343, Wellington South, New Zealand. philippa.howden-chapman@otago.ac.nz
OBJECTIVE: To assess whether non-polluting, more effective home heating (heat pump, wood pellet burner, flued gas) has a positive effect on the health of children with asthma.
DESIGN: Randomised controlled trial.
SETTING: Households in five communities in New Zealand.
PARTICIPANTS: 409 children aged 6-12 years with doctor diagnosed asthma.
INTERVENTIONS: Installation of a non-polluting, more effective home heater before winter. The control group received a replacement heater at the end of the trial.
MAIN OUTCOME MEASURES: The primary outcome was change in lung function (peak expiratory flow rate and forced expiratory volume in one second, FEV(1)). Secondary outcomes were child reported respiratory tract symptoms and daily use of preventer and reliever drugs. At the end of winter 2005 (baseline) and winter 2006 (follow-up) parents reported their child’s general health, use of health services, overall respiratory health, and housing conditions. Nitrogen dioxide levels were measured monthly for four months and temperatures in the living room and child’s bedroom were recorded hourly.
RESULTS: Improvements in lung function were not significant (difference in mean FEV(1) 130.7 ml, 95% confidence interval -20.3 to 281.7). Compared with children in the control group, however, children in the intervention group had 1.80 fewer days off school (95% confidence interval 0.11 to 3.13), 0.40 fewer visits to a doctor for asthma (0.11 to 0.62), and 0.25 fewer visits to a pharmacist for asthma (0.09 to 0.32). Children in the intervention group also had fewer reports of poor health (adjusted odds ratio 0.48, 95% confidence interval 0.31 to 0.74), less sleep disturbed by wheezing (0.55, 0.35 to 0.85), less dry cough at night (0.52, 0.32 to 0.83), and reduced scores for lower respiratory tract symptoms (0.77, 0.73 to 0.81) than children in the control group. The intervention was associated with a mean temperature rise in the living room of 1.10 degrees C (95% confidence interval 0.54 degrees C to 1.64 degrees C) and in the child’s bedroom of 0.57 degrees C (0.05 degrees C to 1.08 degrees C). Lower levels of nitrogen dioxide were measured in the living rooms of the intervention households than in those of the control households (geometric mean 8.5 microg/m(3) v 15.7 microg/m(3), P<0.001). A similar effect was found in the children’s bedrooms (7.3 microg/m(3) v 10.9 microg/m(3), P<0.001).
CONCLUSION: Installing non-polluting, more effective heating in the homes of children with asthma did not significantly improve lung function but did significantly reduce symptoms of asthma, days off school, healthcare utilisation, and visits to a pharmacist.
TRIAL REGISTRATION: Clinical Trials NCT00489762.
