論文No3845
Improved childhood asthma control after exposure reduction interventions for desert dust and anthropogenic air pollution: the MEDEA randomised controlled trial (22 February, 2024)
Panayiotis Kouis, Emmanouil Galanakis, Eleni Michaelidou, Paraskevi Kinni, Antonis Michanikou, Constantinos Pitsios, Julietta Perez, Souzana Achilleos, Nicos Middleton, Pinelopi Anagnostopoulou, Helen Dimitriou, Efstathios Revvas, Gerasimos Stamatelatos, Haris Zacharatos, Chrysanthos Savvides, Emily Vasiliadou, Nikos Kalivitis, Andreas Chrysanthou, Filippos Tymvios, Stefania I Papatheodorou, Petros Koutrakis, Panayiotis K Yiallouros
Thorax 2024;79:495-507.
＜はじめに＞
人為起源および/または砂漠塵起源の粒子状物質（PM）濃度の上昇は、喘息児の罹患率の上昇と関連している。
＜目的＞
The Mitigating the Health Effects of Desert Dust Storms Using Exposure-Reduction Approaches（曝露低減アプローチを用いた砂漠の砂嵐の健康影響の緩和）無作為化対照試験では、
キプロスおよびギリシャにおける砂漠の砂嵐（DDS）の多い季節に、
室内空気濾過を含む曝露低減勧告が小児喘息のコントロールに及ぼす影響を評価した。
＜方法＞
喘息を有する小学生を、(a)介入なし（対照群）、(b)屋外介入（早期警報通知、DDS期間中の屋内滞在および屋外での身体活動の制限の推奨）、(c)複合介入（(b)と同じ）の3つの並行群に無作為に割り付けた。喘息症状のコントロールは、小児喘息コントロールテスト（c-ACT）、スパイロメトリー（強制呼気1秒量（FEV1）、強制換気量（FVC））、分画呼気一酸化窒素（FeNO）を用いて評価した。
結果 2019年から2021年にかけて、合計182人の喘息児（年齢；平均9.5、SD=1.63）が評価された。
3ヵ月の追跡調査後、複合介入群は対照群と比較してc-ACTの有意な改善を示し（β=2.63、95％CI 0.72～4.54、p=0.007）、
これはアトピー児でより深かった（β=3.56、95％CI 0.04～7.07、p=0.047）。
同様に、FEV1％予測値（β＝4.26、95％CI 0.54～7.99、p＝0.025）、喘息治療薬の必要性、予定外の受診は、
FVC％とFeNOではなく、複合介入において対照群と比較して有意に改善した。
＜結論＞
高濃度のPM汚染地域における曝露の低減と室内空気ろ過の使用を推奨することにより、喘息児の症状コントロールと肺機能が改善する可能性がある。
試験登録番号NCT03503812。
DeepL.com（無料版）で翻訳しました。
Introduction Elevated particulate matter (PM) concentrations of anthropogenic and/or desert dust origin are associated with increased morbidity among children with asthma.
Objective The Mitigating the Health Effects of Desert Dust Storms Using Exposure-Reduction Approaches randomised controlled trial assessed the impact of exposure reduction recommendations, including indoor air filtration, on childhood asthma control during high desert dust storms (DDS) season in Cyprus and Greece.
Design, participants, interventions and setting Primary school children with asthma were randomised into three parallel groups: (a) no intervention (controls); (b) outdoor intervention (early alerts notifications, recommendations to stay indoors and limit outdoor physical activity during DDS) and (c) combined intervention (same as (b) combined with indoor air purification with high efficiency particulate air filters in children’s homes and school classrooms. Asthma symptom control was assessed using the childhood Asthma Control Test (c-ACT), spirometry (forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC)) and fractional exhaled nitric oxide (FeNO).
Results In total, 182 children with asthma (age; mean=9.5, SD=1.63) were evaluated during 2019 and 2021. After three follow-up months, the combined intervention group demonstrated a significant improvement in c-ACT in comparison to controls (β=2.63, 95% CI 0.72 to 4.54, p=0.007), which was more profound among atopic children (β=3.56, 95% CI 0.04 to 7.07, p=0.047). Similarly, FEV1% predicted (β=4.26, 95% CI 0.54 to 7.99, p=0.025), the need for any asthma medication and unscheduled clinician visits, but not FVC% and FeNO, were significantly improved in the combined intervention compared with controls.
Conclusion Recommendations to reduce exposure and use of indoor air filtration in areas with high PM pollution may improve symptom control and lung function in children with asthma.
Trial registration number NCT03503812.