Hlophe S T, Mphahlele R, Mortimer K, Masekela R
Department of Paediatrics and Child Health, School of Clinical Medicine, Nelson R Mandela School of Clincal Medicine, University of KwaZulu-Natal, Durban, South Africa.
Cambridge Africa, Department of Pathology, University of Cambridge, UK.
Afr J Thorac Crit Care Med. 2024 Oct 14;30(3):e1992. doi: 10.7196/AJTCCM.2024.v30i3.1992. eCollection 2024.
Exposure to air pollution can cause adverse health effects in people living with chronic lung disease. In people with asthma, it is not clear whether strategies to reduce outdoor air pollution can affect clinical symptoms and lung function.
To determine strategies to reduce air pollution exposure for people with asthma, and to describe the effect of reduced air pollution on asthma outcome.
A systematic review was conducted of six databases for English literature. Any study published between April 2012 and March 2022 that mentioned air pollution exposure reduction and asthma was reviewed. Two reviewers (STH and RMp) screened and extracted the data separately, using a standardised form based on the Cochrane data extraction tool. Risk of bias was assessed using the risk-of bias 2 tool. Outcome measures were the Asthma Control Test (ACT), the Childhood Asthma Control Test, exacerbations, and the forced expiratory volume in the 1st second (FEV ), forced vital capacity (FVC) and FEV /FVC ratio. The study was registered with PROSPERO (reg. no. CRD42022341648).
Of the 11 116 identified studies, eight met the inclusion criteria, with a total of 11 395 043 participants. Clean air policy implementation modestly improved lung function, as shown by an increase in FVC and FEV of 0.02 L/year and 0.01 L/year, respectively. Reduction of exposure to outdoor smoke pollution with use of mobile application alerts resulted in behavioural change and improved ACT scores over 8 weeks (mean (standard deviation (SD)) 21.5 (2.3) compared with baseline (20.0 (2.4); p<0.001). Asthma control improved during low levels of pollution related to COVID-19 lockdown, as shown by mean (SD) ACT scores (17.3 (4.7) v. 19.7 (4.5); p<0.001) and associated declines in mean daily hospital admissions (4.5 (3.4) days v. 2.8 (2.5) days; p<0.001).
Air pollution is a major hazard, and strategies to reduce exposure have a positive outcome in terms of the asthma morbidity. This field would benefit from further high-quality randomised clinical trial evidence to inform policy and decision-making.
The prevalence and burden of asthma are increasing globally. Air pollution exposure is a major cause of worse asthma symptoms. Strategies to reduce air pollution or exposure to it may contribute towards improved quality of life. This study highlights potential strategies and their effect on asthma outcome. A combination of individual activities and actions by governments to reduce air pollution can improve asthma outcome. A focus on education together with behavioural changes can reduce exposure at the individual level. Implementation of clean air policies reduces air pollution exposure and improves lung health.
暴露于空气污染中会对患有慢性肺病的人群产生不良健康影响。对于哮喘患者而言，尚不清楚减少室外空气污染的策略是否会影响临床症状和肺功能。
确定针对哮喘患者减少空气污染暴露的策略，并描述减少空气污染对哮喘结局的影响。
对六个英文文献数据库进行了系统综述。对2012年4月至2022年3月期间发表的任何提及减少空气污染暴露与哮喘的研究进行了综述。两名评审员（STH和RMp）分别使用基于Cochrane数据提取工具的标准化表格筛选和提取数据。使用偏倚风险2工具评估偏倚风险。结局指标包括哮喘控制测试（ACT）、儿童哮喘控制测试、病情加重情况，以及第1秒用力呼气量（FEV₁）、用力肺活量（FVC）和FEV₁/FVC比值。该研究已在国际前瞻性注册系统（PROSPERO）注册（注册号：CRD42022341648）。
在11116项已识别研究中，8项符合纳入标准，共有11395043名参与者。清洁空气政策的实施适度改善了肺功能，FVC和FEV₁分别以每年0.02升和0.01升的速度增加。通过使用移动应用警报减少室外烟雾污染暴露导致行为改变，并在8周内改善了ACT评分（均值（标准差（SD））为21.5（2.3），而基线时为20.0（2.4）；p<0.001）。在与新冠疫情封锁相关的低污染水平期间，哮喘控制得到改善，如ACT评分均值（SD）所示（17.3（4.7）对19.7（4.5）；p<0.001），且平均每日住院人数相应下降（4.5（3.4）天对2.8（2.5）天；p<0.001）。
空气污染是一项重大危害，减少暴露的策略在哮喘发病率方面具有积极结局。该领域将受益于更多高质量的随机临床试验证据，以为政策制定和决策提供参考。
哮喘的患病率和负担在全球范围内不断上升。暴露于空气污染是哮喘症状恶化的主要原因。减少空气污染或其暴露的策略可能有助于改善生活质量。本研究强调了潜在策略及其对哮喘结局的影响。个人活动与政府行动相结合以减少空气污染可改善哮喘结局。注重教育并改变行为可在个体层面减少暴露。实施清洁空气政策可减少空气污染暴露并改善肺部健康。
