Sebastião Bruna F, Hortelão Raquel M, Granadas Sara S, Faria José M, Pinto Joana R, Henriques Helga Rafael
Nursing School of Lisbon, Lisbon, Portugal.
Hospital Center of Central Lisbon, Portugal.
Int J Nurs Sci. 2023 Dec 12;11(1):46-56. doi: 10.1016/j.ijnss.2023.12.003. eCollection 2024 Jan.
Asthma-chronic obstructive pulmonary disease (COPD) overlap (ACO) patients experience a lower quality of life, frequent exacerbations, and worse pulmonary function. Environmental management is essential in a complex chronic condition, as pollutant exposure can worsen symptoms and increase morbidity and mortality. We aimed to identify evidence that informs nursing interventions in promoting self-management of air quality in asthmatic people with COPD.
We conducted an integrative review in March of 2023. We searched the databases CINAHL, MEDLINE, Academic Search Complete, Cochrane Database of Systematic Reviews (CDSR), Scopus, Web of Science, Joanna Briggs Institute (JBI) Evidence-Based Practice Database, and Google Scholar. We included articles whose participants were adults with asthma, COPD, or both; the intervention was air quality management and the outcome of any exacerbations. We excluded editorials, letters, commentaries, opinion papers, position papers, study protocols, conference abstracts, and reviews. Data extraction and synthesis were performed, categorizing interventions according to nursing actions. Methodological quality assessment was conducted using the JBI Critical Appraisal Checklist tools. The review protocol was registered at Open Science Framework (https://doi.org/10.17605/OSF.IO/5Y4KW).
We included five articles from different countries. The interventions promoting air quality self-management for individuals with asthma and COPD included vigilance interventions (health professional regular visits, assessment of symptoms), monitoring interventions (measurement of indoor and outdoor trigger factors), and educational interventions (air quality alerts, allergen avoidance). Policy interventions such as smoke-free policies and comprehensive strategies to improve air quality were also identified. These areas of focus represent critical components of nurses' interventions and can integrate the fundamental patterns of knowing in nursing. Although the studies reveal heterogeneous interventions and the methodological quality is variable, these interventions showed potential for preventing exacerbations, reducing emergency department visits, and minimizing hospitalizations.
The study emphasizes the need for a comprehensive approach involving nurses in multidisciplinary teams to air quality self-management. They can use these results to inform their interventions and ways of knowing, benefiting individuals with asthma and COPD. Further research is needed to expand the evidence base and refine these interventions.
哮喘-慢性阻塞性肺疾病（COPD）重叠综合征（ACO）患者的生活质量较低，病情频繁加重，肺功能较差。在这种复杂的慢性病中，环境管理至关重要，因为接触污染物会使症状恶化，并增加发病率和死亡率。我们旨在找出可为护理干预提供依据的证据，以促进合并COPD的哮喘患者进行空气质量自我管理。
我们于2023年3月进行了一项综合综述。我们检索了CINAHL、MEDLINE、学术搜索完整版、Cochrane系统评价数据库（CDSR）、Scopus、科学网、乔安娜·布里格斯循证实践数据库和谷歌学术等数据库。我们纳入的文章的参与者为患有哮喘、COPD或两者皆有的成年人；干预措施为空气质量管理，结果为任何病情加重情况。我们排除了社论、信件、评论、意见书、立场文件、研究方案、会议摘要和综述。进行了数据提取和综合分析，根据护理行动对干预措施进行分类。使用乔安娜·布里格斯循证实践中心批判性评价清单工具进行方法学质量评估。该综述方案已在开放科学框架（https://doi.org/10.17605/OSF.IO/5Y4KW）上注册。
我们纳入了来自不同国家的五篇文章。促进哮喘和COPD患者进行空气质量自我管理的干预措施包括警惕性干预（医护人员定期探访、症状评估）、监测干预（测量室内和室外触发因素）和教育干预（空气质量警报、避免接触过敏原）。还确定了无烟政策和改善空气质量的综合策略等政策干预措施。这些重点领域是护士干预的关键组成部分，并且可以整合护理中的基本认知模式。尽管研究显示干预措施存在异质性且方法学质量参差不齐，但这些干预措施显示出预防病情加重、减少急诊就诊次数和尽量减少住院治疗的潜力。
该研究强调需要采取综合方法，让护士参与多学科团队进行空气质量自我管理。他们可以利用这些结果为自己的干预措施和认知方式提供依据，使哮喘和COPD患者受益。需要进一步研究以扩大证据基础并完善这些干预措施。
