Effectiveness of indoor allergen reduction in asthma management: A systematic review - 04/05/18
, Kristen E. D'Anci, PhD b, Andrea J. Apter, MD, MSc c, Tyra Bryant-Stephens, MD d, Marcus P. Lynch, PhD b, Janice L. Kaczmarek, MS b, Craig A. Umscheid, MD, MSCE a, cAbstract |
Background |
This review will inform updated National Asthma Education and Prevention Program clinical practice guidelines.
Objective |
We sought to evaluate the effectiveness of allergen reduction interventions on asthma outcomes.
Methods |
We systematically searched the “gray literature” and 5 bibliographic databases. Eligible studies included systematic reviews, randomized controlled trials, and nonrandomized interventional studies. Risk of bias was assessed by using the Cochrane Risk of Bias instrument and the Newcastle-Ottawa scale. The evidence base was assessed by using the approach of the Agency for Healthcare Research and Quality's Evidence–based Practice Center program.
Results |
Fifty-nine randomized and 8 nonrandomized trials addressed 8 interventions: acaricide, air purification, carpet removal, high-efficiency particulate air filtration (HEPA) vacuums, mattress covers, mold removal, pest control, and pet removal. Thirty-seven studies evaluated single-component interventions, and 30 studies assessed multicomponent interventions. Heterogeneity precluded meta-analysis. For most interventions and outcomes, the evidence base was inconclusive or showed no effect. No interventions were associated with improvement in validated asthma control measures or pulmonary physiology. Exacerbations were diminished in multicomponent studies that included HEPA vacuums or pest control (moderate strength of evidence [SOE] for both). Quality of life improved in studies of air purifiers (SOE: low) and in multicomponent studies that included HEPA vacuums (SOE: moderate) or pest control (SOE: low).
Conclusions |
Single interventions were generally not associated with improvement in asthma measures, with most strategies showing inconclusive results or no effect. Multicomponent interventions improved various outcomes, but no combination of specific interventions appears to be more effective. The evidence was often inconclusive because of a lack of studies. Further research is needed comparing the effect of indoor allergen reduction interventions on validated asthma measures, with sufficient population sizes to detect clinically meaningful differences.
Le texte complet de cet article est disponible en PDF.Graphical abstract |
Key words : Asthma, allergens, environmental, house dust mites, carpet, pests, pets, air purification, high-efficiency particulate air filtration vacuums, mattress covers
Abbreviations used : ACT, AHRQ, EPC, HEPA, NAEPP, NHLBI, RCT, SOE
Plan
| Supported under contract no. 290-2015-00005-I from the Agency for Healthcare Research and Quality (AHRQ), US Department of Health and Human Services. The authors of this manuscript are responsible for its content. Statements in the manuscript should not be construed as endorsement by the AHRQ or the US Department of Health and Human Services. AHRQ retains a license to display, reproduce, and distribute the data and the report from which this manuscript was derived under the terms of the agency's contract with the author. This topic was nominated by the National Heart, Lung, and Blood Institute (NHLBI) and selected by the AHRQ for systematic review by an Evidence-based Practice Center. A representative from AHRQ served as a Contracting Officer's Technical Representative and provide technical assistance during the conduct of the full evidence report and provided comments on draft versions of the full evidence report. AHRQ did not directly participate in the literature search, determination of study eligibility criteria, data analysis or interpretation, or preparation, review, or approval of the manuscript for publication. |
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| Disclosure of potential conflict of interest: B. F. Leas reports a grant from the Agency for Healthcare Research and Quality (AHRQ). K. E. D'Anci reports a grant from the AHRQ. A. J. Apter reports funding from the AHRQ (contract 290-2015-00005-1). T. Bryant-Stephens reports pending grants from the National Heart, Lung, and Blood Institute (NHLBI) and the Pennsylvania Department of Health. M. P. Lynch reports a grant from the AHRQ/NHLBI. C. A. Umscheid reports a grant from the AHRQ. The rest of the authors declare that they have no relevant conflicts of interest. |
Vol 141 - N° 5
P. 1854-1869 - mai 2018 Retour au numéro
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