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The effect of using personal-level indoor air cleaners and respirators on biomarkers of cardiorespiratory health: a systematic review
Environment International ( IF 11.8 ) Pub Date : 2021-11-16 , DOI: 10.1016/j.envint.2021.106981
Shuo Liu 1 , Rongshan Wu 2 , Yutong Zhu 3 , Tong Wang 3 , Jiakun Fang 3 , Yunfei Xie 3 , Ningman Yuan 3 , Hongbing Xu 3 , Xiaoming Song 3 , Wei Huang 3
Affiliation  

Background

Emerging studies have investigated potential cardiovascular and respiratory health impacts from the use of personal-level intervention equipment against air pollution exposure. The objective of this systematic review is to assess the efficacy of personal-level air pollution intervention on mitigating adverse health effects from air pollution exposure by using portable air cleaner or wearing respirator.

Methods

In this systematic review, we searched PubMed and Web of Science for published literatures up to May 31, 2020, focusing on personal-level air pollution intervention studies. Among these studies, we investigated the impacts on cardio-respiratory responses to the use of these interventions. The intervention of review interest was the use of personal-level equipment against air pollution, including using portable air cleaner indoors or wearing respirator outdoors. The outcome of review interest was impacts on cardio-respiratory health endpoints following interventions, including level changes in blood pressure, heart rate variability (HRV), lung function, and biomarkers of inflammation and oxidative stress. Weighted mean differences or percent changes were pooled in meta-analyses for these health endpoints. The heterogeneity across studies was assessed using the Cochran's Q-statistic test, and the individual study quality was assessed using the Cochrane risk of bias tool version 2 (RoB 2). We further applied the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) method to evaluate the certainty of evidence.

Results

From systematic literature search and screening, we identified 29 related eligible intervention studies, including 21 studies on indoor portable air cleaner use and 8 studies on respirator use. For portable air cleaner intervention, we observed suggestive evidence of beneficial changes on cardio-respiratory health endpoints. Collectively in these studies, we found significantly beneficial changes of 2.01% decreases (95% CI: 0.50%, 3.52%) in systolic blood pressure, as well as non-significantly beneficial changes of 3.04% increases (95% CI: -2.65%, 8.74%) in reactive hyperemia index and 0.24% increases (95% CI: −0.82%, 1.31%) in forced expiratory volume in 1 s. We also observed non-significant reductions in levels of inflammation and oxidative stress biomarkers, including C-reactive protein, interleukin-6, fibrinogen, fractional exhaled nitric oxide and malondialdehyde. For respirator intervention, we observed some beneficial changes on cardiovascular health endpoints, such as significant increases in HRV parameters [SDNN (2.20%, 95% CI: 0.54%, 3.86%)], as well as non-significant decreases in blood pressure [SBP (0.63 mmHg, 95% CI: −0.39, 1.66)]; however, no sufficient data were available for meta-analyses on lung function and biomarkers. RoB 2 assessments suggested that most intervention studies were with a moderate to high overall risk of bias. The certainty of evidence for intervention outcome pairs was graded very low for either portable air cleaner or respirator intervention. The common reasons to downgrade study evidence included loss to follow-up, lack of blinding, lack of washout period, small sample size, and high heterogeneity across studies.

Conclusions

The uses of indoor portable air cleaner and respirator could contribute to some beneficial changes on cardiovascular health, but with much limited evidence on respiratory health. Low certainty of the overall study evidence shed light on future research for larger sample size trials with more rigorous study design.



中文翻译:

使用个人级室内空气净化器和呼吸器对心肺健康生物标志物的影响:系统评价

背景

新兴研究调查了使用个人干预设备对抗空气污染暴露对心血管和呼吸系统健康的潜在影响。本系统评价的目的是评估个人层面的空气污染干预在通过使用便携式空气净化器或佩戴呼吸器来减轻空气污染暴露对健康的不利影响方面的效果。

方法

在这篇系统综述中,我们在 PubMed 和 Web of Science 中搜索了截至 2020 年 5 月 31 日已发表的文献,重点关注个人层面的空气污染干预研究。在这些研究中,我们调查了使用这些干预措施对心肺反应的影响。审查兴趣的干预是使用个人级设备来对抗空气污染,包括在室内使用便携式空气净化器或在户外佩戴呼吸器。审查兴趣的结果是干预后对心肺健康终点的影响,包括血压水平变化、心率变异性 (HRV)、肺功能以及炎症和氧化应激的生物标志物。加权平均差异或百分比变化汇总在元数据中-对这些健康终点的分析。使用 Cochran 的 Q 统计量检验评估研究间的异质性,使用 Cochrane 偏倚风险工具版本 2 (RoB 2) 评估个体研究质量。我们进一步应用了推荐分级评估、开发和评估 (GRADE) 方法来评估证据的确定性。

结果

通过系统的文献检索和筛选,我们确定了 29 项相关的符合条件的干预研究,包括 21 项关于室内便携式空气净化器使用的研究和 8 项关于呼吸器使用的研究。对于便携式空气净化器干预,我们观察到对心肺健康终点有益变化的暗示性证据。在这些研究中,我们发现收缩压下降 2.01%(95% CI:0.50%、3.52%)的显着有益变化,以及增加 3.04%(95% CI:-2.65%)的非显着有益变化, 8.74%) 反应性充血指数和 0.24% 增加 (95% CI: -0.82%, 1.31%) 在 1 秒内用力呼气量。我们还观察到炎症和氧化应激生物标志物(包括 C 反应蛋白、白细胞介素 6、纤维蛋白原、对肺功能和生物标志物的荟萃分析。RoB 2 评估表明,大多数干预研究具有中到高的总体偏倚风险。对于便携式空气净化器或呼吸器干预,干预结果对的证据质量等级非常低。降低研究证据等级的常见原因包括失访、缺乏盲法、缺乏清除期、样本量小和研究间的高异质性。

结论

室内便携式空气净化器和呼吸器的使用可能有助于心血管健康的一些有益改变,但关于呼吸健康的证据非常有限。总体研究证据的低确定性为未来研究提供了更严格的研究设计的更大样本量试验。

更新日期:2021-11-16
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