1 Division of Infection, Immunity and Respiratory Medicine, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, United Kingdom.
2 University Hospital of South Manchester, Manchester, United Kingdom.
Am J Respir Crit Care Med. 2017 Jul 15;196(2):150-158. doi: 10.1164/rccm.201609-1966OC.
Allergen exposure in sensitized individuals with asthma interacts with viruses to increase the risk of asthma exacerbation.
To evaluate the use of house dust mite-impermeable bedding and its impact on severe asthma exacerbations in children.
We randomized mite-sensitized children with asthma (ages 3-17 yr) after an emergency hospital attendance with an asthma exacerbation to receive mite-impermeable (active group) or control (placebo group) bed encasings.
Over a 12-month intervention period, the occurrence of severe asthma exacerbations was investigated. Of 434 children with asthma who consented, 286 (mean age, 7.7 yr; male sex, 65.8%) were mite sensitized, and 284 were randomized (146 to the active group and 138 to the placebo group). At 12 months, significantly fewer children in the active group than in the placebo group had attended the hospital with an exacerbation (36 [29.3%] of 123 vs. 49 [41.5%] of 118; P = 0.047). In the multivariable analysis, the risk of emergency hospital attendance was 45% lower in the active group (hazard ratio, 0.55; 95% confidence interval [CI], 0.36-0.85; P = 0.006) than in the placebo group. The annual rate of emergency hospital attendance with exacerbations was 27% lower in the active group than in the placebo group, but this did not reach significance (estimated marginal mean [95% CI], active, 0.38 [0.26-0.56] vs. placebo, 0.52 [0.35-0.76]; P = 0.18). No difference between the groups in the risk of prednisolone use for exacerbation was found (hazard ratio, 0.82; 95% CI, 0.58-1.17; P = 0.28).
Mite-impermeable encasings are effective in reducing the number of mite-sensitized children with asthma attending the hospital with asthma exacerbations but not the number requiring oral prednisolone. This simple measure may reduce the health care burden of asthma exacerbations in children. Clinical trial registered with www.isrctn.com (ISRCTN 69543196).
在患有哮喘的致敏个体中，过敏原暴露与病毒相互作用会增加哮喘恶化的风险。
评估尘螨不可渗透的床上用品的使用及其对儿童重度哮喘恶化的影响。
我们对因哮喘急性发作而在急诊就诊的尘螨致敏哮喘儿童（3-17 岁）进行了随机分组，分别接受尘螨不可渗透的（实验组）或对照（安慰剂组）床罩。
在 12 个月的干预期间，我们调查了重度哮喘恶化的发生情况。在同意参与的 434 名哮喘患儿中，286 名（平均年龄 7.7 岁；男性 65.8%）对尘螨过敏，284 名患儿被随机分组（实验组 146 名，安慰剂组 138 名）。在 12 个月时，实验组中因恶化而到医院就诊的患儿明显少于安慰剂组（36 [29.3%]例患儿比 49 [41.5%]例患儿；P=0.047）。多变量分析显示，实验组患儿因哮喘恶化而急诊就诊的风险降低了 45%（风险比，0.55；95%置信区间[CI]，0.36-0.85；P=0.006）。实验组患儿因哮喘恶化而急诊就诊的年发生率比安慰剂组低 27%，但无统计学意义（估计边际均值[95%CI]，实验组 0.38 [0.26-0.56]，安慰剂组 0.52 [0.35-0.76]；P=0.18）。两组患儿因哮喘恶化而使用泼尼松龙的风险无差异（风险比，0.82；95%CI，0.58-1.17；P=0.28）。
尘螨不可渗透的床罩可以有效减少尘螨致敏的哮喘儿童因哮喘恶化而到医院就诊的次数，但不能减少需要口服泼尼松龙的人数。这种简单的措施可能会降低儿童哮喘恶化的医疗保健负担。该临床试验已在 www.isrctn.com 注册（ISRCTN 69543196）。
