Effectiveness of indoor allergen reduction in asthma management: A systematic review
This review will inform updated National Asthma Education and Prevention Program clinical practice guidelines. We sought to evaluate the effectiveness of allergen reduction interventions on asthma outcomes. We systematically searched the “gray literature” and 5 bibliographic databases. Eligible stud...
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| Vydáno v: | Journal of allergy and clinical immunology Ročník 141; číslo 5; s. 1854 - 1869 |
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| Hlavní autoři: | , , , , , , |
| Médium: | Journal Article |
| Jazyk: | angličtina |
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United States
Elsevier Inc
01.05.2018
Elsevier Limited |
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| ISSN: | 0091-6749, 1097-6825, 1097-6825 |
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| Abstract | This review will inform updated National Asthma Education and Prevention Program clinical practice guidelines.
We sought to evaluate the effectiveness of allergen reduction interventions on asthma outcomes.
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.
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).
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.
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| AbstractList | This review will inform updated National Asthma Education and Prevention Program clinical practice guidelines.BACKGROUNDThis review will inform updated National Asthma Education and Prevention Program clinical practice guidelines.We sought to evaluate the effectiveness of allergen reduction interventions on asthma outcomes.OBJECTIVEWe sought to evaluate the effectiveness of allergen reduction interventions on asthma outcomes.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.METHODSWe 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.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).RESULTSFifty-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).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.CONCLUSIONSSingle 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. This review will inform updated National Asthma Education and Prevention Program clinical practice guidelines. We sought to evaluate the effectiveness of allergen reduction interventions on asthma outcomes. 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. 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). 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. [Display omitted] This review will inform updated National Asthma Education and Prevention Program clinical practice guidelines. We sought to evaluate the effectiveness of allergen reduction interventions on asthma outcomes. 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. 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). 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. BackgroundThis review will inform updated National Asthma Education and Prevention Program clinical practice guidelines.ObjectiveWe sought to evaluate the effectiveness of allergen reduction interventions on asthma outcomes.MethodsWe 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.ResultsFifty-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).ConclusionsSingle 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. |
| Author | Umscheid, Craig A. Apter, Andrea J. Bryant-Stephens, Tyra Lynch, Marcus P. D'Anci, Kristen E. Leas, Brian F. Kaczmarek, Janice L. |
| Author_xml | – sequence: 1 givenname: Brian F. surname: Leas fullname: Leas, Brian F. email: brian.leas@uphs.upenn.edu organization: Center for Evidence-based Practice, University of Pennsylvania Health System, Philadelphia, Pa – sequence: 2 givenname: Kristen E. surname: D'Anci fullname: D'Anci, Kristen E. organization: ECRI Institute Plymouth Meeting, Plymouth Meeting, Pa – sequence: 3 givenname: Andrea J. surname: Apter fullname: Apter, Andrea J. organization: Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa – sequence: 4 givenname: Tyra surname: Bryant-Stephens fullname: Bryant-Stephens, Tyra organization: Children's Hospital of Philadelphia, Philadelphia, Pa – sequence: 5 givenname: Marcus P. surname: Lynch fullname: Lynch, Marcus P. organization: ECRI Institute Plymouth Meeting, Plymouth Meeting, Pa – sequence: 6 givenname: Janice L. surname: Kaczmarek fullname: Kaczmarek, Janice L. organization: ECRI Institute Plymouth Meeting, Plymouth Meeting, Pa – sequence: 7 givenname: Craig A. surname: Umscheid fullname: Umscheid, Craig A. organization: Center for Evidence-based Practice, University of Pennsylvania Health System, Philadelphia, Pa |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/29452202$$D View this record in MEDLINE/PubMed |
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| Copyright | 2018 American Academy of Allergy, Asthma & Immunology Copyright © 2018 American Academy of Allergy, Asthma & Immunology. All rights reserved. Copyright Elsevier Science Ltd. May 2018 |
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| Keywords | pets high-efficiency particulate air filtration vacuums mattress covers RCT environmental pests air purification SOE Asthma allergens HEPA house dust mites ACT NHLBI carpet AHRQ EPC NAEPP |
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| Title | Effectiveness of indoor allergen reduction in asthma management: A systematic review |
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