室内环境控制在预防城区哮喘发病中的作用

Effectiveness of Home-Based Environmental Intervention Among Urban Asthmatics

目的探讨室内环境中过敏原的控制对预防城区哮喘患者发病的作用。方法2003年12月将96例(16～78岁)济南市城区过敏性哮喘患者随机分成干预组和对照组,根据患者病史及过敏原皮试确定过敏原,对干预组每位患者进行因人而异的去除、减少过敏原的环境控制教育及具体措施指导。2组实施相同药物治疗眼吸入布地奈德,按需使用β2-激动剂(沙丁胺醇)演,记录近2周无症状天数、误工(误学)天数、β2-激动剂喷数,进行肺功能检查。干预组患者还接受脱离室内过敏原的健康教育,6个月后对比2组的临床结果。结果室内环境控制6个月后,干预组2周无症状天数(13.4d)多于对照组(10.1d),P<0.001;β2-激动剂喷数(6.6喷)少于对照组(10.6喷),P<0.001;FEV1%(87.5%)高于对照组(82%),P<0.05;误工(误学)天数差异无统计学意义(P>0.05)。结论因人而异的室内环境控制策略使城区哮喘患者避免暴露在室内过敏原的影响之下,而减少哮喘发作。

Objective To determine whether an environmental intervention tailored to each patient＇s allergic sensitization and environmental risk factors could improve asthma-related outcomes. Methods Irritant or allergen sensitivity determined by the patient＇ s exposure history and confirmed with skin test. Patients were asked to record 2-week days without symptoms, days off-work （or school） and 13z-agonist puffs. Pulmonary function was also examined. Ninety-six asthmatics with atopic asthma （aged 16-78 years） were randomly assigned to a control group, an intervention group that received an educational handout monthly for 2 months. Asthmatics of both groups inhalded budesonide at a daily dose 200-800 μg and 132-agonist as needed. Environmental intervention lasted six months and included education and remediation for exposure to allergens. The control group had no special recommendations. Results The intervention group had more days without symptoms compared with the control group （13.4 vs. 10. 1 days, P〈0.001）. Intervention reduced 13β2-agonist （6.6 vs 10.6 puffs）and increased FEV1% compared with the controls （87.5%, 82.0% respectively, P〈0.05）. The intervention group had few days off-work （or school）, but no significant difference was seen （P= 0.15）. Conclusion Among inner-city patients with atopic asthma, an individualized, home-based environmental intervention may let them reduce the exposure of indoor allergens and the morbidity of asthma-associated will be decreased.