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The Resource Effectiveness of indoor allergen reduction in management of asthma, Brian F. Leas, Kristen E. D'Anci, Andrea J. Apter, Tyra Bryant-Stephens, Karen Schoelles, Craig A. Umscheid

Effectiveness of indoor allergen reduction in management of asthma, Brian F. Leas, Kristen E. D'Anci, Andrea J. Apter, Tyra Bryant-Stephens, Karen Schoelles, Craig A. Umscheid

Creator
Author
Contributor
Summary
OBJECTIVES: This review evaluates the effectiveness of allergen reduction interventions on asthma outcomes in adults and children. DATA SOURCES: We systematically searched the gray literature and five bibliographic databases, MEDLINE(r), Embase(r), PubMed(r), CINAHL(r), and the Cochrane Library, through April 21, 2017. REVIEW METHODS: Eligible studies included systematic reviews, meta-analyses, randomized controlled trials (RCTs), and nonrandomized controlled interventional studies. Studies were evaluated for risk of bias using the Cochrane Risk of Bias instrument or the Newcastle-Ottawa scale, and the evidence base was assessed using the methods guidance established by the Evidence-based Practice Center Program. Qualitative comparative analysis was conducted to support the primary analysis. RESULTS: Our literature searches identified 72 publications describing interventions to reduce exposure to indoor allergens and their effects on asthma. This included 60 unique RCTs with data published in 64 articles, as well as 8 non-RCTs. Validated measures of asthma control were infrequently reported across studies, and findings were often inconclusive. Thirty-eight studies evaluated single component interventions. Use of acaricides (dust mite pesticides) was not shown to improve pulmonary function (moderate strength of evidence [SOE]). Air purification devices, used alone, improved quality of life (low SOE) but did not reduce exacerbations or health care utilization (low SOE) or improve pulmonary function (low SOE). Impermeable mattress covers were not associated with improved asthma control (moderate SOE) and did not reduce exacerbations or health care utilization (moderate SOE) or improve quality of life (high SOE). Single intervention studies did not adequately examine carpet removal, high-efficiency particulate air-filtration (HEPA) vacuums, mold removal, pet removal, and pest control. Thirty studies assessed multicomponent interventions, but wide differences among study interventions (and combinations of interventions) precluded meta-analysis. When examined as a component within a broader set of interventions, use of air purification reduced school absenteeism (low SOE) but did not improve asthma control (low SOE), reduce exacerbations (high SOE), or improve quality of life (high SOE). HEPA vacuums, when included in a multicomponent approach, reduced exacerbations and improved quality of life (moderate SOE) for children. Mattress covers used within multicomponent interventions reduced school absenteeism and missed activities (low SOE) but had no effect on emergency department visits (low SOE), hospitalizations (high SOE), or quality of life (moderate SOE). Pest control strategies incorporated into multicomponent interventions reduced exacerbations (moderate SOE), improved quality of life (low SOE), and reduced school absenteeism (low SOE) but did not reduce emergency department visits (moderate SOE), hospitalizations (high SOE), or worker absenteeism (low SOE). Other multicomponent interventions included carpet, mold, and pet removal, but the evidence for these strategies was inconclusive. CONCLUSIONS: Single intervention studies were not associated with improvement in clinical asthma outcomes, with most strategies showing inconclusive results or no effect. Multicomponent intervention studies demonstrated improvement in various outcomes, but no specific combination of interventions was identified as more effective than others. High or moderate strength evidence suggests that multicomponent interventions that include HEPA vacuums or pest control may be effective in reducing exacerbations and improving quality of life. For many primary outcomes for both single and multicomponent interventions, the evidence is inconclusive because of a lack of studies. Further research is needed examining well-defined (standardized) indoor allergen reduction interventions in comparative studies, with sufficient population size of well-characterized patients to detect clinically meaningful differences in validated and relevant asthma outcomes
Language
eng
Work
Instance
Label
Effectiveness of indoor allergen reduction in management of asthma
Title
Effectiveness of indoor allergen reduction in management of asthma
Statement of responsibility
Brian F. Leas, Kristen E. D'Anci, Andrea J. Apter, Tyra Bryant-Stephens, Karen Schoelles, Craig A. Umscheid
Creator
Contributor
Author
Issuing body
Sponsoring body
Subject
Genre
Language
eng
Summary
OBJECTIVES: This review evaluates the effectiveness of allergen reduction interventions on asthma outcomes in adults and children. DATA SOURCES: We systematically searched the gray literature and five bibliographic databases, MEDLINE(r), Embase(r), PubMed(r), CINAHL(r), and the Cochrane Library, through April 21, 2017. REVIEW METHODS: Eligible studies included systematic reviews, meta-analyses, randomized controlled trials (RCTs), and nonrandomized controlled interventional studies. Studies were evaluated for risk of bias using the Cochrane Risk of Bias instrument or the Newcastle-Ottawa scale, and the evidence base was assessed using the methods guidance established by the Evidence-based Practice Center Program. Qualitative comparative analysis was conducted to support the primary analysis. RESULTS: Our literature searches identified 72 publications describing interventions to reduce exposure to indoor allergens and their effects on asthma. This included 60 unique RCTs with data published in 64 articles, as well as 8 non-RCTs. Validated measures of asthma control were infrequently reported across studies, and findings were often inconclusive. Thirty-eight studies evaluated single component interventions. Use of acaricides (dust mite pesticides) was not shown to improve pulmonary function (moderate strength of evidence [SOE]). Air purification devices, used alone, improved quality of life (low SOE) but did not reduce exacerbations or health care utilization (low SOE) or improve pulmonary function (low SOE). Impermeable mattress covers were not associated with improved asthma control (moderate SOE) and did not reduce exacerbations or health care utilization (moderate SOE) or improve quality of life (high SOE). Single intervention studies did not adequately examine carpet removal, high-efficiency particulate air-filtration (HEPA) vacuums, mold removal, pet removal, and pest control. Thirty studies assessed multicomponent interventions, but wide differences among study interventions (and combinations of interventions) precluded meta-analysis. When examined as a component within a broader set of interventions, use of air purification reduced school absenteeism (low SOE) but did not improve asthma control (low SOE), reduce exacerbations (high SOE), or improve quality of life (high SOE). HEPA vacuums, when included in a multicomponent approach, reduced exacerbations and improved quality of life (moderate SOE) for children. Mattress covers used within multicomponent interventions reduced school absenteeism and missed activities (low SOE) but had no effect on emergency department visits (low SOE), hospitalizations (high SOE), or quality of life (moderate SOE). Pest control strategies incorporated into multicomponent interventions reduced exacerbations (moderate SOE), improved quality of life (low SOE), and reduced school absenteeism (low SOE) but did not reduce emergency department visits (moderate SOE), hospitalizations (high SOE), or worker absenteeism (low SOE). Other multicomponent interventions included carpet, mold, and pet removal, but the evidence for these strategies was inconclusive. CONCLUSIONS: Single intervention studies were not associated with improvement in clinical asthma outcomes, with most strategies showing inconclusive results or no effect. Multicomponent intervention studies demonstrated improvement in various outcomes, but no specific combination of interventions was identified as more effective than others. High or moderate strength evidence suggests that multicomponent interventions that include HEPA vacuums or pest control may be effective in reducing exacerbations and improving quality of life. For many primary outcomes for both single and multicomponent interventions, the evidence is inconclusive because of a lack of studies. Further research is needed examining well-defined (standardized) indoor allergen reduction interventions in comparative studies, with sufficient population size of well-characterized patients to detect clinically meaningful differences in validated and relevant asthma outcomes
Member of
Cataloging source
NLM
http://library.link/vocab/creatorName
Leas, Brian F
Funding information
Prepared for: Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services1 15600 Fishers Lane, Rockville, MD 20857; www.ahrq.gov Contract No. 290-2015-00005-I. Prepared by: ECRI Institute-Penn Medicine Evidence-based Practice Center, Plymouth Meeting, PA
Government publication
federal national government publication
Illustrations
illustrations
Index
no index present
Literary form
non fiction
Nature of contents
  • dictionaries
  • surveys of literature
NLM call number
WA 754
http://library.link/vocab/relatedWorkOrContributorName
  • United States
  • ECRI Institute-Penn Medicine Evidence-based Practice Center
Series statement
  • Comparative effectiveness review
  • AHRQ publication
Series volume
  • number 201
  • no. 18-EHC002-EF
http://library.link/vocab/subjectName
  • Air Pollution, Indoor
  • Asthma
  • Allergens
  • Air Filters
  • Pest Control
  • Comparative Effectiveness Research
  • United States
  • United States
Label
Effectiveness of indoor allergen reduction in management of asthma, Brian F. Leas, Kristen E. D'Anci, Andrea J. Apter, Tyra Bryant-Stephens, Karen Schoelles, Craig A. Umscheid
Instantiates
Publication
Bibliography note
Includes bibliographical references
Carrier category
online resource
Carrier category code
  • cr
Carrier MARC source
rdacarrier
Color
multicolored
Content category
text
Content type code
  • txt
Content type MARC source
rdacontent
Control code
1047615646
Dimensions
unknown
Extent
1 online resource (1 PDF file (various pagings))
Form of item
online
Media category
computer
Media MARC source
rdamedia
Media type code
  • c
Other physical details
illustrations.
Specific material designation
remote
System control number
(OCoLC)1047615646
Label
Effectiveness of indoor allergen reduction in management of asthma, Brian F. Leas, Kristen E. D'Anci, Andrea J. Apter, Tyra Bryant-Stephens, Karen Schoelles, Craig A. Umscheid
Publication
Bibliography note
Includes bibliographical references
Carrier category
online resource
Carrier category code
  • cr
Carrier MARC source
rdacarrier
Color
multicolored
Content category
text
Content type code
  • txt
Content type MARC source
rdacontent
Control code
1047615646
Dimensions
unknown
Extent
1 online resource (1 PDF file (various pagings))
Form of item
online
Media category
computer
Media MARC source
rdamedia
Media type code
  • c
Other physical details
illustrations.
Specific material designation
remote
System control number
(OCoLC)1047615646

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