Department of Internal Medicine, Section of Allergology and Clinical Immunology, Erasmus Medical Center, Rotterdam, The Netherlands,
Department of Internal Medicine, Section of Allergology and Clinical Immunology, Erasmus Medical Center, Rotterdam, The Netherlands.
Int Arch Allergy Immunol. 2020;181(5):395-402. doi: 10.1159/000506284. Epub 2020 Mar 18.
We updated the meta-analysis published by McDonald et al. [Chest 2002;122;1535-1542] by reviewing the effectiveness of air purification for the treatment of home-related allergic asthma (dust mite, dog, cat, and cockroach). We analysed the trials included by McDonald et al. as well as studies published since 2000. Data on asthma symptoms scores (ASS), medication use, forced expiratory volume in 1 s as a percentage of the predicted value (FEV1 %pred), histamine provocative concentration causing a 20% reduction in FEV1 (PC20), Asthma Quality of Life Questionnaire (AQLQ) scores, and fractional exhaled nitric oxide (FeNO) levels were extracted. The effectiveness was examined using metafor (registered in Prospero CRD42019127227). Ten trials including a total of 482 patients (baseline characteristics: mean FEV1 %pred 83.2%, I2 = 96.7%; mean PC20 4.93 mg/mL, I2 = 44.0%; mean AQLQ 4.67 [max. 7], I2 = 93.7%; mean FeNO 36.5 ppb, I2 = 0%) were included. We assessed the mean differences in the AQLQ scores as +0.36 (95% CI 0.10 to 0.62, p = 0.01, n = 302, I2 = 0%) and the FeNO levels as -6.67 ppb (95% CI -10.56 to -2.77, p = 0.0008, n = 304, I2 = 0%). The standardised mean differences in all other health outcomes were not significant (ASS -0.68, p = 0.20; medication use: -0.01, p = 0.94; FEV1 %pred -0.11, p = 0.34; PC20 +0.24, p = 0.53). We found statistically significant mean differences in the AQLQ scores and FeNO levels in patients with predominantly mild to moderate asthma at baseline. A large trial reported great improvement in the subgroup of patients receiving Global Initiative for Asthma step 4 therapy. We recommend that future studies on air purification focus on patients with severe and poorly controlled allergic asthma.
我们通过回顾空气净化治疗家庭相关过敏性哮喘（尘螨、狗、猫和蟑螂）的有效性，更新了 McDonald 等人发表的荟萃分析[Chest 2002;122;1535-1542]。我们分析了 McDonald 等人纳入的试验以及 2000 年以来发表的研究。提取哮喘症状评分（ASS）、药物使用、1 秒用力呼气量占预计值的百分比（FEV1%pred）、引起 FEV1 下降 20%的组胺激发浓度（PC20）、哮喘生活质量问卷（AQLQ）评分和呼出气一氧化氮分数（FeNO）水平的数据。使用 metafor（在 Prospero CRD42019127227 中注册）检查有效性。共有 10 项试验，包括 482 例患者（基线特征：平均 FEV1%pred 为 83.2%，I2 = 96.7%；平均 PC20 为 4.93mg/mL，I2 = 44.0%；平均 AQLQ 为 4.67[最大值为 7]，I2 = 93.7%；平均 FeNO 为 36.5ppb，I2 = 0%）被纳入。我们评估了 AQLQ 评分的平均差异为+0.36（95%CI 0.10 至 0.62，p = 0.01，n = 302，I2 = 0%）和 FeNO 水平的平均差异为-6.67ppb（95%CI -10.56 至 -2.77，p = 0.0008，n = 304，I2 = 0%）。所有其他健康结局的标准化均数差异均无统计学意义（ASS-0.68，p = 0.20；药物使用：-0.01，p = 0.94；FEV1%pred-0.11，p = 0.34；PC20+0.24，p = 0.53）。我们发现，在基线时主要为轻度至中度哮喘的患者中，AQLQ 评分和 FeNO 水平存在统计学上显著的平均差异。一项大型试验报告称，接受全球哮喘倡议 4 级治疗的患者亚组有显著改善。我们建议未来关于空气净化的研究应关注严重和控制不佳的过敏性哮喘患者。
