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Ionisers for chronic asthma
Abstract
Background: Previous reports have shown that ion content in the air may have an effect on respiratory function. Results from studies which test the efficacy of air ionisers to reduce asthma symptoms are often inconclusive and their use as a treatment for asthma remains debatable. Objectives: We conducted a systematic review of the available evidence to determine the effectiveness of positive and negative ion generators in people with asthma. Search methods: We searched the Cochrane Airways Group Specialised Register, Cochrane Central Register of Controlled Trials (CENTRAL) as well as the alternative medicine database AMED. Searches were current as of June 2012. Selection criteria: Randomised controlled trials (parallel or crossover design studies) comparing ionisers with dummy ionisers (being negative or positive ion emitters), in children or adults with chronic asthma. Data collection and analysis: Two reviewers independently assessed titles and abstracts of studies and assessed trial quality. Study quality was determined using two methods:The Cochrane approach to allocation concealment and the five point Jadad scale. Main results: Six studies were selected for inclusion (106 participants). No results were combined as the studies were all of a crossover design. EFFECTS OF NEGATIVE ION GENERATORS (five studies)No study reported a significant difference in lung function between ionised and control air (morning Peak expiratory flow (PEF) - three studies; forced expiratory flow in one second (FEV1) - one study). There were no significant differences in symptoms or beta-2 agonist usage between ionised and control air in three studies. EFFECTS OF POSITIVE ION GENERATORS (one study)This study demonstrated that although positively ionised air was associated with a larger fall in FEV1 with exercise, this did not reach statistical significance. Baseline FEV1 was not demonstrated to be significantly different between treatment groups. Authors' conclusions: Based on the evidence currently available from randomised controlled trials, a recommendation cannot be given for the use of room air ionisers to reduce symptoms in patients with chronic asthma. © 2017 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
... A meta-analysis of 23 randomized controlled trials (RCTs) focused on physical methods (such as air aspiration systems) or chemical methods (miticides) to reduce exposure to dust mite allergens in the homes of adults or children with asthma who were sensitive to acarids (Table 1), [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27]. These interventions were found not to improve asthma control when used in an isolated manner 11 . ...
... The use of air purifiers in living rooms and children's rooms was assessed in several studies [16][17][18][19][20][21][22]. A meta-analysis of air filtration reported an association with fewer symptoms, but none of the trials had employed validated scales to measure outcomes [18]. ...
... Two RCTs showed a reduction of symptoms in inner-city children [16] or on the use of unscheduled asthma visits in children exposed to second-hand smoke at home [17]. Systems using ionizers or dehumidifiers were not effective [21,22]. Adapting bedding as the sole measure to reduce exposure to dust mite allergens showed no positive effect on asthma control [23][24][25]. ...
Background: Despite growing access to effective therapies, asthma control still needs improvement. Many non-drug factors, such as allergens, air pollutants and stress also affect asthma control and patient quality of life, but an overview of the effectiveness of non-drug interventions on asthma control was lacking.
Objectives: To identify non-drug interventions likely to improve asthma control.
Methods: A systematic review of the available literature in Medline and the Cochrane Library was conducted in March 2017, without any time limit. Initial searching identified 884 potentially relevant clinical trial reports, literature reviews and meta-analyses, which were screened for inclusion using criteria of quality, relevance, and reporting outcomes based on asthma control.
Results: Eighty-two publications met the inclusion criteria. In general, the quality of the studies was low. Patient education programmes (22 studies) significantly improved asthma control. Multifaceted interventions (10 studies), which combined patient education programmes with decreasing exposure to indoor allergens and pollutants, significantly improved asthma control based on clinically relevant outcomes. Renovating homes to reduce exposure to allergens and indoor pollutants improved control (two studies). Air filtration systems (five studies) were effective, especially in children exposed to second-hand smoke. Most measures attempting to reduce exposure to dust mites were ineffective (five studies). Dietary interventions (eight studies) were ineffective. Promoting physical activity (five studies) tended to yield positive results, but the results did not attain significance.
Conclusion: Twenty-six interventions were effective in asthma control. Simultaneously combining several action plans, each focusing on different aspects of asthma management, seems most likely to be effective.
... For example, a variety of pulmonary benefits and drawbacks have been reported after exposure to negatively charged air ions. The consulted literature does not enable an unambiguous conclusion regarding the possible beneficial role of ionized air on pulmonary, respiratory, or metabolic disorders [7,14,17,38,61,62]. ...
... It is known that by-products are generated with these technologies. The effects of long-term exposure to these by-products are mentioned in a few studies [61,80]. Ozone production by air purifiers in particular is investigated and assessed as positive if it exceeds a certain limit. ...
The COVID-19 (SARS-CoV-2) pandemic increased the focus on preventing contamination with airborne pathogens (e.g. viruses, bacteria, and fungi) by reducing their concen tration. Filtration, UV or ionization technologies could contribute to air purification of the indoor environment and inactivation of microorganisms. The aim of this study was to identify the relevant literature and review the scientific evidence presented on the efficacy of filter and germicidal technologies (e.g. non-physical technologies) in air purification applications used to capture and inactivate microorganisms and airborne viruses (e.g. SARS-CoV-2, rhinovirus, influenzavirus) in practice. A scoping review was performed to collect literature. Adopting exclusion criteria resulted in a final number of 75 studies to be included in this research. Discussion is presented on inactivation efficiencies of ultraviolet germicidal irradiation (UVGI) and ionization applications in laboratory studies and in practice. Specific attention is given to studies relating the use of UVGI and ion-ization to inactivation of the SARS-CoV-2 virus. Based on the consulted literature, no unambiguous conclusions can be drawn regarding the effectiveness of air purification technologies in practice. The documented and well-controlled laboratory studies do not adequately represent the practical situation in which the purifier systems are used.
... The effects of ionization units have been studied in homes and poultry stable environments, with conflicting results. 13,[16][17][18]20 . A significant reduction in airborne dust (particle size 0.3-100 lm) concentrations, using real-time area measurements, as well as reduced bacterial growth in hatching cabinets was demonstrated. ...
... . A significant reduction in breathing area aerosols and respirable dust particles in confined indoor spaces was demonstrated.13 However, a large review explored the clinical effect of ionization installations on chronic asthma variables in humans and failed to identify any significant improvement.20 The fact that no reduction of airborne dust and endotoxin concentrations was detected in the current study could be related to the size of the compartment studied. ...
Background:
Organic dust is associated with Equine asthma. Ionization should reduce airborne dust levels.
Objectives:
To determine the effect of ionization of air, type of bedding, and feed on the levels of airborne dust, endotoxin, and fungal colonies in horse stables.
Animals:
24 healthy University-owned horses occupied the stables.
Methods:
A randomized controlled cross-over study. Four units with 6 stables were equipped with an ionization installation (25 VA, 5000 Volt Direct Current). Horses were kept either on wood shavings and fed haylage (2 units), or on straw and fed dry hay (2 units). Measurements were performed with and without activated ionization, during daytime and nighttime, repeatedly over the course of a week and repeatedly during 4-6 weeks. Statistical analysis was performed using a mixed effect model with Akaike's Information Criterion for model reduction and 95% profile (log) likelihood confidence intervals (CI).
Results:
Ionization did not alter concentrations of dust, endotoxin, or fungi, fewer. In the units with straw and hay, the concentration of dust, endotoxin, and fungi (difference in logarithmic mean 1.92 (95%CI 1.71-2.12); 2.86 (95%CI 2.59-3.14); 1.75 (95%CI 1.13-2.36)) were significantly higher compared to wood shavings and haylage.
Conclusions and clinical importance:
The installation of a negative air-ionizer in the horse stable did not reduce concentrations of dust, endotoxin, and viable fungal spores. The substantial effect of low dust bedding and feed is confirmed.
... 6 RCT a 0 + b n/a n/a c n/a n/a Strong Reduction of exposure to dust mites, Gotzsche (2008) 25 21,d 0 g n/a n/a n/a n/a n/a n/a n/a Ionizers, Blackhall (2003) 22 The review found no conclusive evidence to favor any particular organizational form (e.g., inpatient, outpatient, asthma clinic, or specialist care). Interventions were heterogeneous, and organizational components were not isolated from other intervention elements. ...
... 6 RCT a 0 + b n/a n/a c n/a n/a Strong Reduction of exposure to dust mites, Gotzsche (2008) 25 21,d 0 g n/a n/a n/a n/a n/a n/a n/a Ionizers, Blackhall (2003) 22 The review found no conclusive evidence to favor any particular organizational form (e.g., inpatient, outpatient, asthma clinic, or specialist care). Interventions were heterogeneous, and organizational components were not isolated from other intervention elements. ...
A descriptive, cross-sectional and prospective study was carried out in 120 pregnant women with bronchial asthma in "José Félix Ribas" district of the Venezuelan municipality of Sucre, from January to December 2010, to characterize them clinically and epidemiologically. For gathering information a data sheet and a questionnaire that was processed with version 6.0 of Epi Info program were used. Adolescents (56.6 %) prevailed in the case material, of them 55.8 % had active or passive contact with the cigarette smoke, and 68.3 % presented with grade I of bronchial asthma. Also, trigger factors prevailed (100.0 %), followed by causal factors (95.8 %), so that clinical and epidemiological characteristics of these pregnant women make a health problem of bronchial asthma in this population group.
... In the present review [6], the effect of treatment with an ioniser apparatus was compared with so-called "dummy ionisers". In the dummy ionisers, the motors of the ionisers were, in principle, running, but without having any de-ionising effect. ...
Key points
Currently, there are no reliable data documenting the effects of CAM treatment on asthma, although this does not automatically mean that CAM is worthless.
In most studies, it is difficult to sift out exactly what it is in the treatment that is effective, as most therapists tend to treat each subject in a unique manner.
Scientifically well-controlled, randomised CAM trials are possible and should be performed.
Educational aims
To review the range of complementary and alternative (CAM) treatments currently available.
To provide information about the systematic overviews in the Cochrane database concerning CAM and asthma.
Summary
Asthma and allergies are chronic conditions that cause considerable distress. In most cases, the use of modern medical therapy can control these conditions; however, there is still no cure for asthma. Therefore, many patients and, in the case of children, many parents seek CAM. This is often, but not always, concealed from the doctor treating the patient. Traditionally, there has been an antagonistic relationship between CAM and orthodox medicine, and this is why many patients do not inform their doctors that they are seeking CAM. This study aims to assess the current clinical medical value of CAM.
... В учебных помещениях с большим количеством отрицательно заряженных аэроионов происходит уменьшение количества микроорганизмов, снижается концентрация пыли в воздухе, нейтрализуются некоторые газы, устраняются электростатические заряды с поверхностей оборудования. Неоптимальное соотношение аэроионов в воздухе помещений обуславливает снижение защитных сил организма человека, недомогание, вялость, усталость, потерю аппетита, головную боль, бессонницу, ослабление памяти [22][23][24][25]. Доказано, что излучение компьютеров приводит к снижению числа аэроионов и их влияния на бактериальный фон в помещении [26,27]. ...
Introduction: Active introduction of electronic learning tools in educational institutions poses new health risks to school-age children. Creating a modern and secure digital educational environment requires constant monitoring of the conditions and modes of use of new electronic tools, the diversity of which is changing rapidly. The purpose of this work was to assess certain parameters of indoor school environment influenced by the use of interactive panels (IPs), an e-learning tool of the latest generation. Materials and methods: We studied the parameters of electromagnetic radiation, microclimate (air temperature and relative humidity), artificial lighting levels, chemical composition of indoor air, concentrations of positive and negative air ions during the school day in classrooms with and without interactive panels. The measurements were carried out in accordance with the approved methods of laboratory and instrumental research, and the results were then assessed for compliance with current sanitary rules and regulations. Statistical processing of the results was carried out using parametric methods of statistical analysis. Results and conclusion: Indices of the microclimate and air ions in IP-equipped classrooms demonstrated a more pronounced negative dynamics during the school day. Our findings indicate the need for hygienists to pay close attention to the problem of using new electronic teaching aids and interactive panels in particular, to continue research in the area under study in order to elaborate hygienic regulations for applying IPs in the classroom and to prevent overwork and health risks to school-age children.
... One of the included studies in children (n=12, age range 3-11) showed that positively-ionised air was associated with bronchoconstriction, and another (n=20, age range 9-15) showed an increase in night-time cough, although this was not statistically significant. 398 1 ++ 1 + 1 ++ 1 + A Air ionisers are not recommended for the treatment of asthma. ...
SIGN 158
British Guideline on the Management of Asthma.
A National Clinical Guideline
BTS/ SIGN
Full text is available here:
https://www.sign.ac.uk/sign-158-british-guideline-on-the-management-of-asthma.html
... Treatments assessed within the reviews included: acupuncture [32], breathing exercises/training [30,33,34]; dietary measures [35][36][37][38][39]; Heliox [29,31]; homeopathy [40]; control of allergens [41,42]; humidity control/ionisers [43,44]; education programs [45][46][47]; manual therapy [48]; primary care clinics [49]; psychological interventions [50,51]; individualised care plans [52]; and non-invasive positive pressure ventilation (NIPPV) [53], which enhances ventilation by compensating for fatigued ventilator muscles. ...
Background: breathlessness is a debilitating and distressing symptom in a wide variety of diseases and still a difficult symptom to manage. An integrative review of systematic reviews of non-pharmacological and pharmacological interventions for breathlessness in non-malignant disease was undertaken to identify the current state of clinical understanding of the management of breathlessness and highlight promising interventions that merit further investigation. Methods: systematic reviews were identified via electronic databases between July 2007 and September 2009. Reviews were included within the study if they reported research on adult participants using either a measure of breathlessness or some other measure of respiratory symptoms. Results: in total 219 systematic reviews were identified and 153 included within the final review, of these 59 addressed non-pharmacological interventions and 94 addressed pharmacological interventions. The reviews covered in excess of 2000 trials. The majority of systematic reviews were conducted on interventions for asthma and COPD, and mainly focussed upon a small number of pharmacological interventions such as corticosteroids and bronchodilators, including beta-agonists. In contrast, other conditions involving breathlessness have received little or no attention and studies continue to focus upon pharmacological approaches. Moreover, although there are a number of non-pharmacological studies that have shown some promise, particularly for COPD, their conclusions are limited by a lack of good quality evidence from RCTs, small sample sizes and limited replication. Conclusions: more research should focus in the future on the management of breathlessness in respiratory diseases other than asthma and COPD. In addition, pharmacological treatments do not completely manage breathlessness and have an added burden of side effects. It is therefore important to focus more research on promising non-pharmacological interventions
... A Cochrane review of five studies using negative ion generators and one with a positive ion generator found no evidence of benefit in reducing symptoms in patients with asthma. 382 One study demonstrated an increase in night-time cough to a level which approached statistical significance. 383 A Air ionisers are not recommended for the treatment of asthma. ...
... High-altitude climate therapy has been shown to positively affect medical parameters and symptoms of patients suffering from allergic airway diseases. Clinical studies verified that a stay at high altitude improves relevant surrogate parameters for allergy and asthma, such as the reduction in specific IgE levels, improved clinical asthma markers, 28 or mitigate nonspecific BHR and epithelial shedding. 15,[29][30][31][32][33] As a second major parameter, relative air humidity (RH, %) was postulated to significantly influence HDM growth, and low indoor RH was recommended to reduce HDM. ...
Purpose:
Several studies over the past 4 decades have indicated a significant reduction in house dust mite (HDM) and HDM allergen concentration in areas higher than 1,500 m above sea level. These have served as basis of allergen avoidance therapies for HDM allergy and asthma. However, modern construction techniques used in the insulation, heating, and glazing of buildings as well as global warming have changed the environmental parameters for HDM living conditions. The present study revisits the paradigm of decreasing HDM allergen concentrations with increasing altitude in the alpine region of Germany and Austria.
Methods:
A total of 122 dust samples from different abodes (hotels, privates and mountain huts) at different altitudes (400-2,600 m) were taken, and concentrations of HDM allergens were analyzed. Humidity and temperature conditions, and numerous indoor environmental parameters such as fine dust, type of flooring, age of building, and frequency of cleaning were determined.
Results:
HDM allergen concentrations did not significantly change with increasing altitude or relative humidity. At the level of indoor parameters, correlations could be found for different flooring types and the concentration of HDM allergens.
Conclusions:
In contrast to the widespread view of the relationship between altitude and HDM allergen concentrations, clinically relevant concentrations of HDM allergens could be detected in high-lying alpine regions in Austria and Germany. These results indicate that improvement in conditions of asthmatic patients sensitized against HDMs during a stay at high altitude can no longer be ascribed to decreased levels of HDM allergens, instead, other mechanisms may trigger the beneficial effect.
... In addition, 2 CSRs applied both the Cochrane handbook standard and the Jadad Scale [11,12]. Though several CSRs [13][14][15] considered "wash out" or "carry-over effect" in cross-over studies, none of the sampled CSRs comprehensively followed the suggestions from Cochrane handbook to formally assess the potential risk of bias. ...
Background:
It is possible that cross-over studies included in current systematic reviews are being inadequately assessed, because the current risk of bias tools do not consider possible biases specific to cross-over design. We performed this study to evaluate whether this was being done in cross-over studies included in Cochrane Systematic Reviews (CSRs).
Methods:
We searched the Cochrane Library (up to 2013 issue 5) for CSRs that included at least one cross-over trial. Two authors independently undertook the study selection and data extraction. A random sample of the CSRs was selected and we evaluated whether the cross-over trials in these CSRs were assessed according to criteria suggested by the Cochrane handbook. In addition we reassessed the risk of bias of these cross-over trials by a checklist developed form the Cochrane handbook.
Results:
We identified 688 CSRs that included one or more cross-over studies. We chose a random sample of 60 CSRs and these included 139 cross-over studies. None of these CSRs undertook a risk of bias assessment specific for cross-over studies. In fact items specific for cross-over studies were seldom considered anywhere in quality assessment of these CSRs. When we reassessed the risk of bias, including the 3 items specific to cross-over trials, of these 139 studies, a low risk of bias was judged for appropriate cross-over design in 110(79%), carry-over effects in 48(34%) and for reporting data in all stages of the trial in 114(82%).Assessment of biases in cross-over trials could affect the GRADE assessment of a review's findings.
Conclusion:
The current Cochrane risk of bias tool is not adequate to assess cross-over studies. Items specific to cross-over trials leading to potential risk of bias are generally neglected in CSRs. A proposed check list for the evaluation of cross-over trials is provided.
... Natural environments, especially coastal, forest, and vegetation-rich locations, also have higher levels of negative ions within the outdoor air sampled in built urban settings [140,189,190]. Although there are mixed results on the influence of negative ion generators in clinical studies related to asthma and lung function [191], some research suggests value in the treatment of depression [192,193]. Moreover, natural environments contain soundscapes with layered complexity (as found in birdsongs or the fractal patterns of a babbling brook) or a near-silence that might have a beneficial effect on stress reduction and cognitive restoration [194][195][196]. ...
This paper summarizes the discussions from the Natural Environments Initiative meeting hosted by the Harvard School of Public Health’s Center for Global Health and the Environment and the Harvard Radcliffe Institute for
Advanced Studies in October 2013. It presents ongoing worldwide research on health benefits stemming from exposure to natural environments and design cues with particular attention applications in urban environments.
This meeting generated a Workshop statement forged by the participants that affirms the health benefits of nature and presents the need for additional collaborative, transdisciplinary to refine salutogenic planning and design practices.
Workshop participants represented disciplinary and professional perspectives from medicine, landscape architecture, public heath, and forestry science rooted in the cultural, ecological and political realities of a dozen countries and five continents. When framing the benefits of nature, they considered health outcomes including mental health disorders, obesity, Type 2 diabetes, metabolic disorders, allergies, cardiovascular disease, and more. Many environmental factors (including those related to physical activity, residential planning, environmental contamination and severe weather attributed to climate change) mediate these health outcomes at local, regional and global levels. This paper provides an illustrative review that captures many relevant studies discussed during the workshop. Although not exhaustive, our review indicates that the available evidence is applicable to various populations and ecological settings, and broadly supports the association of improved health outcomes with exposure to natural environments.
Full report available at: http://www.chgeharvard.org/sites/default/files/resources/Paper-NaturalEnvironmentsInitiative_0.pdf
... Natural environments, especially coastal, forest, and vegetation-rich locations, also have higher levels of negative ions within the outdoor air sampled in built urban settings [140,189,190]. Although there are mixed results on the influence of negative ion generators in clinical studies related to asthma and lung function [191], some research suggests value in the treatment of depression [192,193]. Moreover, natural environments contain soundscapes with layered complexity (as found in birdsongs or the fractal patterns of a babbling brook) or a near-silence that might have a beneficial effect on stress reduction and cognitive restoration [194][195][196]. ...
This paper summarizes the discussions from the Natural Environments Initiative meeting hosted by the Center for Health and the Global Environment at the Harvard School of Public Health and the Harvard Radcliffe Institute for Advanced Studies in October 2013. It presents ongoing worldwide research on health benefits stemming from exposure to natural environments and design cues with particular attention applications in urban environments.
This meeting generated a Workshop statement forged by the participants that affirms the health benefits of nature and presents the need for additional collaborative, transdisciplinary to refine salutogenic planning and design practices. Workshop participants represented disciplinary and professional perspectives from medicine, psychology, landscape architecture, public heath, and forestry science rooted in the cultural, ecological and political realities of a dozen countries and five continents. When framing the benefits of nature, they considered health outcomes including mental health disorders, obesity, Type 2 diabetes, metabolic disorders, allergies, cardiovascular disease, and more. Many environmental factors (including those related to physical activity, residential planning, environmental contamination and severe weather attributed to climate change) mediate these health outcomes at local, regional and global levels. This paper provides an illustrative review that captures many relevant studies discussed during the workshop. Although not exhaustive, our review indicates that the available evidence is applicable to various populations and ecological settings, and broadly supports the association of improved health outcomes with exposure to natural environments.
http://www.chgeharvard.org/sites/default/files/resources/NaturalEnvironmentsInitiative.pdf http://www.chgeharvard.org/resource/natural-environments-initiative-illustrative-review-and-workshop-statement http://www.chgeharvard.org/NEI_Paper
... A Cochrane review of five studies using negative ion generators and one with a positive ion generator found no evidence of benefit in reducing symptoms in patients with asthma. 354 One study demonstrated an increase in night-time cough to a level which approached statistical significance. 355 A Air ionisers are not recommended for the treatment of asthma. ...
... In a review of six randomized controlled trial studies, investigating the use of portable ion generators in homes, researchers found no evidence to suggest an association between use of ion generators and health benefits, including changes in asthma and allergy-related symptoms, medication use, peak expiratory flow (PEF) or forced expiratory volume in one second (FEV1). 18 A systematic review of 10 randomized trials involving portable HEPA filters found that the use of these air cleaners was associated with fewer asthma and allergy-related symptoms, including wheeze, cough, and rhinitis, but was not associated with medication use or peak expiratory flow values. 19 Findings from several studies that have found positive associations between air cleaner use and health benefits indicate that when air cleaners are used together with other interventions aimed at improving air quality, including the removal of sources (e.g., cigarette smoking in homes), removal of carpets, use of impermeable bed coverings, and reduced AER, greater reductions in asthma and allergy-related symptoms can result. ...
... A review 5 of nonfeather bedding versus feather bedding identifıed no studies meeting inclusion criteria. Another review, 34 which examined the use of air ionizers, found that neither negatively (fıve studies) nor positively charged (one study) air improved asthma outcomes. Data from a review 35 of the effectiveness of residential air fılters were equivocal, with meta-analyses of a small number of studies indicating improvements in symptoms, but inferences being weakened by heterogeneity of results and inconsistent use of validated scales to measure clinical symptoms or quality of life. ...
Asthma is a chronic respiratory disease increasingly prevalent in the U.S., particularly among children and certain minority groups. This umbrella review sought to assess and summarize existing systematic reviews of asthma-related interventions that might be carried out or supported by state or community asthma control programs, and to identify gaps in knowledge.
Eleven databases were searched through September 2010, using terms related to four concepts: asthma, review, intervention, and NOT medication. Reviews of the effectiveness of medications, medical procedures, complementary and alternative medicine, psychological interventions, family therapy, and nutrients or nutritional supplements were excluded. Two coders screened each record and extracted data from the included reviews.
Data analysis was conducted from May to December 2010. Of 42 included reviews, 19 assessed the effectiveness of education and/or self-management, nine the reduction of indoor triggers, nine interventions to improve the provision of health care, and five examined other interventions. Several reviews found consistent evidence of effectiveness for self-management education, and one review determined that comprehensive home-based interventions including the reduction of multiple indoor asthma triggers are effective for children. Other reviews found limited or insufficient evidence because of study limitations.
State or community asthma control programs should prioritize (1) implementing interventions for which the present review found evidence of effectiveness and (2) evaluating promising interventions that have not yet been adequately assessed.
Zusammenfassung
Das Management von Asthma hat sich in den letzten Jahrzehnten fundamental gewandelt. Die vorliegende Leitlinie zur Diagnostik und Therapie von Asthma wurde für pneumologisch tätige Fachärztinnen und Fachärzte entwickelt, welche detaillierte und evidenzbasierte Informationen zu den neuen diagnostischen und therapeutischen Optionen von Asthma benötigen. Die Leitlinie zeigt die neue Bedeutung der Biomarker, insbesondere der Bluteosinophilen und des exhalierten NO (FeNO), in den diagnostischen Algorithmen von Asthma. Als erste Asthma-Leitlinie weltweit benennt die vorliegende Leitlinie die nachhaltige Symptomprävention und die Asthma-Remission als Asthma-Therapieziele, welche durch den Einsatz individuell angepasster, krankheitsmodifizierender Medikamente (wie inhalative Steroide, Allergenimmuntherapie oder Biologika) erreicht werden können. Die zentrale Bedeutung der Behandlung von typischen Asthma-Komorbiditäten wird zudem betont. Schließlich wird auch auf besondere Herausforderungen im Asthma-Management eingegangen, wie bspw. die Therapie von Asthma in der Schwangerschaft, die Behandlung von schwerem Asthma oder die Diagnostik und Therapie von arbeitsbedingten Asthma-Formen.
Todos los pacientes asmáticos están en riesgo de padecer una crisis asmática aguda, la
cual eventualmente puede ser fatal. La hospitalización y la atención en el Sistema Pre-
Hospitalario y el Departamento de Emergencias (DE) constituyen un aspecto
fundamental en el cuidado del paciente asmático, en el cual la sociedad invierte un
porcentaje considerable de los aportes económicos para el cuidado de la salud. Es
importante establecer planes de prevención, educación y racionalización terapéutica a
nivel de la asistencia primaria, con la finalidad de estabilizar la enfermedad y
disminuir el número de crisis agudas. La mortalidad está principalmente vinculada a la
inadecuada valoración del paciente y como consecuencia, al tratamiento inapropiado y
al retraso en la admisión hospitalaria.
Esta Guía de Práctica Clínica pretende constituir una ayuda para la toma de decisiones
durante la asistencia de pacientes adultos portadores de una crisis de asma aguda. Si
bien la Guía de Práctica Clínica está basada en la más reciente evidencia publicada
disponible sobre el tema, no es de obligado cumplimiento ni sustituye el juicio clínico
del personal de salud en cada caso particular.
p class="Default"> The aim is to analyze the effectiveness of non-drug methods of treatment and rehabilitation of children and adults with bronchial asthma.
Methods. To realize the purpose of the study, a system-functional analysis of special literature and materials of the Internet was used.
Results. The standard approach to antiasthmatic therapy does not always lead to a controlled course. Reducing the impact of allergens both in the home and in the workplace is an effective measure to control the disease. Phytotherapy and reflexology are widely and effectively used. Diet therapy is ineffective, the use of vitamin D in the treatment and rehabilitation of patients with bronchial asthma is encouraging. The vaccine does not increase the risk of the disease, but it is not effective for prevention. Increasing physical activity is the most effective method of rehabilitating patients. Evidence from recent studies suggests that interventions aimed at eliminating a single allergen may be effective in reducing allergen levels and asthma incidence, and this approach deserves further study. Currently, a comprehensive multifaceted study of acupuncture, which will be able to provide reliable clinical evidence of the effectiveness of acupuncture for the treatment and prevention of asthma. At the same time, there is a need for comprehensive research in the field of phytotherapy and training of respiratory muscles.
Conclusion. Non-drug methods of prevention and rehabilitation are widely used (as additional) in bronchial asthma. Despite many years of use of phytotherapy, acupuncture, breathing exercises in the treatment and rehabilitation of asthma, so far there are no clear recommendations for their use: indications, dosage, duration, frequency and the lack of standardization makes it difficult to use them.</p
Eine Maschinenbedienerin in einer Bürstenfabrik erschien zu einer gutachterlichen Untersuchung aufgrund des Verdachtes auf eine berufsbedingte obstruktive Atemwegserkrankung. Sie berichtete über das Auftreten starker Atemnot, immer dann, wenn Kollegen im gleichen Arbeitsbereich Tampicofasern beziehungsweise eine Mischung aus Tampicofasern und Bassine verarbeiteten. Die Herausforderung im Rahmen der Begutachtung bestand nun darin, bei der angegebenen arbeitsplatzbezogenen Beschwerdesymptomatik eine berufsbedingte Kausalität und eine IgE-vermittelte Sensibilisierung nachzuweisen oder auszuschließen. Zur weiteren diagnostischen Abklärung wurden vom Arbeitsplatz stammende Tampicofasern extrahiert, die Proteine biotinyliert und für die spezifische IgE-Testung an Streptavidin-ImmunoCAP gekoppelt. Das Material vom Arbeitsplatz wurde hinsichtlich Kontamination mit Milbenallergenen überprüft. Weiterhin wurde eine systematische Literaturrecherche in Pubmed zu „Agave-/Tampicofasern und Erkrankungen“ durchgeführt. Im Patientenserum konnten Tampico-spezifische IgE-Antikörper (10,5 kU/L und im Immunoblot Markierung von Proteinbanden im Bereich 25 kDa) nachgewiesen werden. Der Inhibitionsassay zeigte, dass die Kontamination des Tampicomaterials mit Milbenallergenen nicht für die IgE-Reaktivität ursächlich war. Tampicofasern sind robuste Fasern, die aus den Blättern der mexikanischen Agave lechugilla gewonnen werden. In der Literatur wurden mehrfach Hautreaktionen in Form einer irritativen Kontaktdermatitis beschrieben, aufgrund beruflicher Exposition gegenüber Agavenblättern beziehungsweise durch Kontakt mit Agavensaft. Im vorliegenden Fall wurden die asthmatischen Beschwerden einer Beschäftigten in einer Bürstenfabrik auf eine inhalative Bystander-Exposition mit Tampicofaserstaub am Arbeitsplatz zurückgeführt. Der eindeutige Sensibilisierungsnachweis gegen Tampicofasern lieferte die medizinischen Voraussetzungen für die Anerkennung einer Berufskrankheit (BK 4301).
Das Asthma bronchiale bleibt eine der häufigsten chronischen Erkrankungen in Deutschland mit enormer volkswirtschaftlicher Bedeutung. Hier finden Sie die für den Hausarzt relevanten Änderungen in Diagnostik, Phänotypisierung und Therapie des Asthmas nach den lange erwarteten Neufassungen der Asthmaleitlinie von 2017 und der Nationalen Versorgungsleitlinie (NVL) von 2018.
Zusammenfassung
Die vorliegende Leitlinie ist eine Neufassung und Aktualisierung der Leitlinie zur Diagnostik und Therapie von Patienten mit Asthma, welche die bisher für den deutschen Sprachraum gültige Version aus dem Jahr 2006 ablöst. Die Fülle an neuen Erkenntnissen zur Pathophysiologie und zu den Phänotypen von Asthma und das erweiterte Spektrum an diagnostischen und therapeutischen Möglichkeiten bei dieser Erkrankung machte eine Neufassung und Aktualisierung notwendig. Es werden sowohl für Kinder und Jugendliche als auch für Erwachsene mit Asthma die aktuellen, Evidenz-basierten diagnostischen und therapeutischen Empfehlungen dargelegt.
Asthma is a complex disease with many phenotypes. Its definition and treatment by a number of cultures around the world may play a role in the efficacy of such treatments. Western medicine defines asthma based on inflammation, obstruction, and mucus production which are reversible with treatment. A number of studies focusing on natural products, mind–body medicine, manipulative therapy, and others have not been able to reproducibly demonstrate efficacy in treating asthma. This may be due to a number of factors including methodology, study design, and—most importantly—the definition of asthma used for each study. The Western definition of asthma may differ greatly from the definition used by those cultures which originally created the therapies used in studies of complementary and alternative medicine (CAM). Because of this difference, the outcome of the studies may not be an accurate reflection of the ability of these therapies to treat the disease process they were originally designed to treat. Future studies in CAM will likely need to address these differences.
Since the beginning of the 20th century there has been a scientific debate about the potential effects of air ions on biological tissues, wellbeing and health. Effects on the cardiovascular and respiratory system as well as on mental health have been described. In recent years, there has been a renewed interest in this topic. In an experimental indoor setting we conducted a double-blind cross-over trial to determine if higher levels of air ions, generated by a special wall paint, affect cognitive performance, wellbeing, lung function, and cardiovascular function. Twenty healthy non-smoking volunteers (10 female, 10 male) participated in the study. Levels of air ions, volatile organic compounds and indoor climate factors were determined by standardized measurement procedures. Air ions affected the autonomous nervous system (in terms of an increase of sympathetic activity accompanied by a small decrease of vagal efferent activity): In the test room with higher levels of air ions (2194/cm³ vs. 1038/cm³) a significantly higher low to high frequency ratio of the electrocardiography (ECG) beat-to-beat interval spectrogram was found. Furthermore, six of nine subtests of a cognitive performance test were solved better, three of them statistically significant (verbal factor, reasoning, and perceptual speed), in the room with higher ion concentration. There was no influence of air ions on lung function and on wellbeing. Our results indicate slightly activating and cognitive performance enhancing effects of a short-term exposure to higher indoor air ion concentrations.
Seven patients with bronchial asthma requiring continuous medication were subjected to eight weeks of nocturnal exposure to negatively ionized air, and their progress was followed using objective tests of lung function and clinical assessment. During exposure, four patients showed significant increases in morning PEFR, which in two of these patients was not sustained when exposure ceased. In two patients the observed increase in PEFR was accompanied by subjective improvement. From the results of all our assessments we conclude that, although this treatment may lead to an improvement in some patients with asthma, further objective studies are required to determine the value of negatively ionized air in the routine management of asthma.
To evaluate the effect of negative ionisation of inspired air on bronchial reactivity, 11 asthmatic children were challenged twice by exercise and 10 were challenged twice by histamine inhalation. The children breathed negatively ionised air (4 X 10(5) - 10 X 10(5) ions/cm3) or control room air in random order in a double-blind fashion. All challenges were matched in terms of basal lung function and the exercise tests were matched in terms of ventilation and respiratory heat loss. Exercise-induced asthma was significantly attenuated by exposure to negatively ionised air, the mean postexercise fall in one-second forced expiratory volume (FEV1) being 29% (SE 5%) of the initial value after the control and 21% (3%) after the ionised air test (p less than 0.02). Ten of the 11 subjects developed less exercise-induced asthma while breathing ionised air. Although the median dose of histamine (cumulative breath units) which caused a constant fall in FEV1 for each individual was higher with the ionised air challenge than with the control challenge the difference was not significant. Five of the 10 subjects were less sensitive to histamine and the other five more sensitive when breathing ionised air. It is concluded that negative ionisation of inspired air can modulate the bronchial response to exercise but the effect on the response to histamine is much more variable.
To evaluate the effect of positive ionisation of inspired air on bronchial reactivity, 12 asthmatic children were twice challenged by exercise in random order. During one test positively ionised air (5-10 X 10(5) ions/cm) was breathed. All challenges were matched in terms of basal lung function and exercise tests were matched in terms of ventilation and respiratory heat loss. Exercise induced asthma was significantly aggravated by exposure to positively ionised air, the postexercise fall in FEV1 (delta FEV1) being 24.7% (SEM and 5.3%) and 35.3% (5%) after the control and ionised air tests respectively (p less than 0.04). It is concluded that positive ionisation aggravates the bronchial response to exercise.
Manufacturers of ionisers claim many benefits from the use of their devices, including the relief of asthma. Particles removed from the air are likely to include airborne allergens, so ionisers may achieve an effect by reducing the allergen load.
The effect of ionisers on airborne concentrations of house dust mite allergen Der p I was investigated in a double blind, crossover, placebo controlled trial in the homes of 20 children with allergic asthma. Subjects recorded their peak expiratory flow rate (PEFR) twice daily and completed a daily symptom score and treatment schedule on a diary card for two six week periods, one with an active ioniser and the other with a placed ioniser (randomly allocated) used in the living room and the bedroom.
Airborne Der p I concentrations fell significantly during the active period compared with the placebo period, but there was no significant change in PEFR, symptom scores, or treatment usage. There was an increase in night time cough which almost reached significance during the active period.
This study indicates that the use of ionisers cannot be recommended in the homes of asthmatic subjects to improve their symptoms. The significant reduction of airborne allergen concentrations may be of use as part of a multidevice allergen avoidance regimen, but the increase in night time cough requires further study.
It has been suggested that the quality of clinical trials should be assessed by blinded raters to limit the risk of introducing bias into meta-analyses and systematic reviews, and into the peer-review process. There is very little evidence in the literature to substantiate this. This study describes the development of an instrument to assess the quality of reports of randomized clinical trials (RCTs) in pain research and its use to determine the effect of rater blinding on the assessments of quality. A multidisciplinary panel of six judges produced an initial version of the instrument. Fourteen raters from three different backgrounds assessed the quality of 36 research reports in pain research, selected from three different samples. Seven were allocated randomly to perform the assessments under blind conditions. The final version of the instrument included three items. These items were scored consistently by all the raters regardless of background and could discriminate between reports from the different samples. Blind assessments produced significantly lower and more consistent scores than open assessments. The implications of this finding for systematic reviews, meta-analytic research and the peer-review process are discussed.
A two-hour exposure of fifteen symptom-free patients to artificially ionized air of concealed polarity, followed by a repeat experiment with the opposite charge, revealed no difference in the biologic effect of positive and of negative atmospheric ions. To our surprise, the negative (like the positive) ions did not appear to influence the patient's typical pattern of wheezing and of remission. Dryness of the nose or throat was also a frequent side effect, regardless of charge.Contrary to expectations, wheezing in symptom-free asthmatic subjects seemed to occur with negative ionization of the air in some instances. No amelioration of this symptom once present was noticed when subjects were similarly exposed. Being essentially a double-blind study, it is unlikely that psychogenic influences colored these results.These findings discouraged us from further pursuit of the alleged therapeutic benefits of negative ionization in asthmatic patients.
The influence of artificially generated atmospheric ions is studied in 15 patients with bronchial asthma. A slight but significant (at 5% level) improvement in the lung function was demonstrated in nine patients during positive as well as negative ion exposure, but the patients' subjective votings of the air quality did not show any changes due to ion exposure. No change in the histamine threshold of the airways in six patients with bronchial asthma was demonstrated during exposure to ions. Further controlled studies with electro-aerosols are needed.
The dependence on the weather on the nightly morbidity figures can be demonstrated in a total of 10,200 patients who have used the Munich Emergency Medical Service within 3 months. No prognostic inferences emerge which could be useful in practice, because the effect of the weather is at first almost completely masked by the effect of the weekly rhythm and trend, and only a retrospective analysis over a longer period can make its substantiation possible. Using the Tölzer Weather Phase Schemes, a significant increase in the morbidity figures can be demonstrated for the passage of fronts, inversion positions and the development of warm damp air conditions near the ground. An effect on the number of notifications of illness on meteorologically perfectly defined foehn days is not demonstrable. Only an indifferent effect on the general symptomatology can be attributed to the weather; there is no statistically significant evidence of a specific effect on a single clinical picture.
We attempted to relate admission rate for acute myocardial infarction with some meteorological variables in a region having a temperate climate. We used 2830 consecutive episodes collected over a 2-year (1979-1980) period. The temperatures, atmospheric pressure, relative humidity, front passage, rain and snow and foehn wind have been associated in the past with acute myocardial infarction. No significant association with any of them was found in our study, nor any correlation over the time between admission rates in six different Coronary Care Units (at the time the only ones active in the area) which participated in the study.
Forty-one experiments with positive and negative atmospheric ions were performed on 19 children, of whom 13 were suffering from asthmatic (spastic) bronchitis. The results of these experiments indicate that the atmospheric ions have the following effects.
Negative ions
1. Shorter duration of the spastic attack as compared with duration of the attack in children receiving the conventional therapeutic treatment.
2. Reduction of tachypnea in cases of spastic bronchitis and bronchopneumonia.
3. Termination of spastic attacks induced by positive ionization.
4. The effect of negative ions on respiratory spasticity usually becomes obvious about 8 hours after the beginning of the ionization.
5. When the negative ionization is stopped, a moderate rebound of spasticity and tachypnea was noticed in several cases.
Positive ions
1. Induce spastic attacks in normal infants.
2. Cancel the therapeutic effects of negative ions on patients with spastic bronchitis.
3. Cause tachypnea in infants.
4. On the average, the effects of these ions on respiratory spasticity becomes evident about 10 hours after the beginning of ionization.
A cross-over trial was conducted on 10 children with moderate to severe asthma, who had positive skin tests to Dermatophagoides pteronyssinus and nocturnal wheeze. An electrostatic precipitator was used during the night to remove airborne particles from the bedroom. During use of the precipitator peak expiratory flow rates were no better than in a control period.
The effect of prolonged exposure to either positive or negative small air ions was studied in nine patients with bronchial asthma, of whom seven had reported increased respiratory symptoms in association with weather changes. On consecutive days, while grounded, patients were exposed for six hours to approximately 10,000/cc of either positive or negative ions. Pulmonary function, pulse and blood pressure were measured throughout the exposure. Questionnaires to assess emotional state and physical symptoms were completed after 15 minutes and five hours each day. Urinary 5-hydroxy indoleacetic acid (5HIAA) excretion was measured. Patients were continued on theophylline but adrenergics and corticosteroids were withheld. No patient experienced an exacerbation of asthma. Symptoms, pulmonary function, pulse and blood pressure, urinary 5HIAA excretion and the response to the questionnaires did not differ significantly between the two ion exposures. Thus moderately long exposure to positive or negative small air ions did not influence the clinical condition of these patients, many of whom reported exacerbations with weather changes. The findings do not support a significant role of small air ions in exacerbations or treatment of bronchial asthma.
Because of recent interest in the possible benefits to asthmatic patients of negative ion generators and the largely uncontrolled and inconclusive nature of earlier studies a double blind crossover study of this treatment was carried out in 20 subjects with stable asthma over six months. After an initial two week period without an ioniser, active or placebo ionisers were installed in subjects' bedrooms for two eight week periods separated by a four week "washout" period when no ioniser was present. The study was completed by a final four week period when no ioniser was present. Subjects were randomly allocated to receive an active or a placebo ioniser first. Subjects recorded their peak expiratory flow rate (PEFR) twice daily, completed a daily symptom score questionnaire, and noted any treatment they took on a diary card. Recordings were completed throughout the trial. Ion counts and dust concentrations were measured in subjects' bedrooms during the study. Mean ion counts rose considerably when ionisers were activated (p less than 0.001). There were no significant differences in PEFR, symptom score, or consumption of medication between the periods that active ionisers and either no ionisers or placebo ionisers were in operation. This study has failed to show a statistically significant benefit in asthmatic subjects from the use of negative ion generators.
The impact of weather on human health is a well-known fact, yet, alas, neglected in the past. Bioclimatology, a vast field of medical knowledge, has only been developed in the past few years. It shows that the air we breathe has a profound influence on our well-being. Electrical charges of the air, such as ions, spherics and electrofields can affect our endocrine, vegetative and autonomous nerve system. It may even be responsible for post-operative thromboembolism. The present article describes weather reactions, electric radiations, climate rhythm, medical aspects of weather changes, and their effect on health and disease. Special devotion is also given to the manifestations of evil winds.
Some patients with bronchial asthma report increased symptoms in association with weather fronts. It has been reported that a rise in positive small air ions occurs several hours before other evidence of a storm front, and it has been suggested that the increase in these ions might be responsible for the changes in clinical status reported by such patients. Twelve patients were selected on the basis of a history of weather-induced worsening of asthma. They measured pulmonary functions four times daily at the same time that measurements of small air ions and other meteorologic parameters were obtained. Two episodes of inclement weather were monitored during the study period. The mean peak flow rates in this group of patients did not vary significantly with the changes in ion levels or other meteorologic factors which resulted from the passage of these weather fronts.
In this double blind, placebo-controlled study we examined the value of using a device for ionizing the air in the immediate environment as a therapy for asthma bronchiale. Nineteen adult patients with stable, reversible asthma were randomised to blind treatment with either an active device or an inactive placebo-device. After four weeks treatment the patients were given the alternative device for another period of four weeks. We measured daily peak-flow, symptomscore, use of medicine and spirometry and found no differences between the two periods. Therapy with ionization of the environmental air in patients with bronchial asthma should not be recommended.