Population-wide preventive interventions for reducing the burden of chronic respiratory disease
Population-wide preventive interventions for reducing the burden of chronic respiratory disease
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DOI：
10.5588/ijtld.15.0034
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发表时间：
2015-09-01
影响因子：
4
通讯作者：
Dharmage, S. C.
中科院分区：
文献类型：
--
作者：
Abramson, M. J.;Koplin, J.;Dharmage, S. C.
慢性阻塞性肺病和哮喘造成了巨大的疾病负担。这种叙述性审查的重点是可能对这些疾病产生影响的潜在的全民干预措施。成人疾病的发育起源始于子宫内，特别关注母体营养。然而，迄今为止，母体过敏原避免、膳食补充剂或益生菌的试验尚未显示出一致的预防哮喘的保护作用。室内空气质量差，特别是生物质燃料和二手烟草烟雾，是慢性呼吸道疾病的公认风险因素。这可以通过更清洁的燃料、烹饪炉或加热器以及改善通风来改变。虽然过敏原是儿童哮喘的一个危险因素，但减少暴露的干预措施的结果令人失望。与哮喘相关的空气污染与儿童哮喘发病率增加有关。对空气污染不利影响的初级预防侧重于制定环境空气质量准则，但在许多国家，执行准则仍然是一项挑战。职业性哮喘可由工作场所的致敏物或刺激物诱发。预防包括消除病原体或尽可能减少接触，这比呼吸防护设备更有效。戒烟仍然是慢性呼吸道疾病的一个关键的行之有效的预防策略。现在有一个国际烟草控制框架，最近的创新包括烟草的简单包装。通过上述全民干预措施，慢性呼吸道疾病可以得到很大程度的预防。
Chronic obstructive pulmonary disease and asthma impose a substantial burden of disease. This narrative review focuses on potential population-wide interventions that are likely to have an impact on these diseases. The developmental origins of adult disease commence in utero, with maternal nutrition being of particular interest. However, to date, trials of maternal allergen avoidance, dietary supplementation or probiotics have not shown consistent protective effects against asthma. Poor indoor air quality, especially from biomass fuels as well as second-hand tobacco smoke, is a well-recognised risk factor for chronic respiratory diseases. This can be modified by cleaner fuels, cooking stoves or heaters, and improved ventilation. Although allergens are a risk factor for childhood asthma, the results of interventions to reduce exposures have been disappointing. Traffic-related air pollution is associated with an increased SUMMARY incidence of asthma in children. Primary prevention of the adverse effects of air pollution has focused on the development of ambient air quality guidelines, but enforcement remains a challenge in many countries. Occupational asthma may be induced by sensitisers or irritants in the workplace. Prevention involves eliminating the agent or reducing exposure as far as possible, which is more effective than respiratory protective equipment. Smoking cessation remains a key proven preventive strategy for chronic respiratory diseases. There is now an international framework for tobacco control, and recent innovations include plain packaging of tobacco. Chronic respiratory diseases can be substantially prevented by the above population-wide interventions.