Results of a Home-Based Environmental Intervention among Urban Children with Asthma

Arizona Respiratory Center, University of Arizona, 1501 N. Campbell Ave., Tucson, AZ 85724, USA.
New England Journal of Medicine (Impact Factor: 55.87). 09/2004; 351(11):1068-80. DOI: 10.1056/NEJMoa032097
Source: PubMed


Children with asthma who live in the inner city are exposed to multiple indoor allergens and environmental tobacco smoke in their homes. Reductions in these triggers of asthma have been difficult to achieve and have seldom been associated with decreased morbidity from asthma. The objective of this study was to determine whether an environmental intervention tailored to each child's allergic sensitization and environmental risk factors could improve asthma-related outcomes.
We enrolled 937 children with atopic asthma (age, 5 to 11 years) in seven major U.S. cities in a randomized, controlled trial of an environmental intervention that lasted one year (intervention year) and included education and remediation for exposure to both allergens and environmental tobacco smoke. Home environmental exposures were assessed every six months, and asthma-related complications were assessed every two months during the intervention and for one year after the intervention.
For every 2-week period, the intervention group had fewer days with symptoms than did the control group both during the intervention year (3.39 vs. 4.20 days, P<0.001) and the year afterward (2.62 vs. 3.21 days, P<0.001), as well as greater declines in the levels of allergens at home, such as Dermatophagoides farinae (Der f1) allergen in the bed (P<0.001) and on the bedroom floor (P=0.004), D. pteronyssinus in the bed (P=0.007), and cockroach allergen on the bedroom floor (P<0.001). Reductions in the levels of cockroach allergen and dust-mite allergen (Der f1) on the bedroom floor were significantly correlated with reduced complications of asthma (P<0.001).
Among inner-city children with atopic asthma, an individualized, home-based, comprehensive environmental intervention decreases exposure to indoor allergens, including cockroach and dust-mite allergens, resulting in reduced asthma-associated morbidity.

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    • "The findings of our pilot project are consistent with other studies reporting on the effectiveness of multi-component, environmental intervention in reducing asthma symptoms among children.6 In a randomized, controlled study, Morgan et al concluded that an individualized, targeted home-based environmental intervention approach for children with asthma was effective, resulting in reduced morbidity among inner-city children with asthma.8 In a systematic review of community health workers by Postma et al, seven home-based studies consistently identified decreases in asthma symptoms, ED, and clinical visits as a result of environmental interventions.9 "
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    ABSTRACT: OBJECTIVE Asthma is the most common chronic childhood condition affecting 6.3 million (US) children aged less than 18 years. Home-based, multi-component, environmental intervention studies among children with asthma have demonstrated to be effective in reducing asthma symptoms. In this study, a local hospital and university developed an environmental intervention research pilot project, Eastern Carolina Asthma Prevention Program (ECAPP), to evaluate self-reported asthma symptoms, breathing measurements, and number of asthma-related emergency department (ED) visits among low-income, minority children with asthma living in rural, eastern North Carolina. Our goal was to develop a conceptual model and demonstrate any asthma respiratory improvements in children associated with our home-based, environmental intervention. METHODS This project used a single cohort, intervention design approach to compare self-reported asthma-related symptoms, breathing tests, and ED visits over a 6 month period between children with asthma in an intervention study group (n = 12) and children with asthma in a control study group (n = 7). The intervention study group received intense asthma education, three home visits, 2 week follow-up telephone calls, and environmental intervention products for reducing asthma triggers in the home. The control group received education at baseline and 2 week calls, but no intervention products. RESULTS At the end of the study period, significant improvements were observed in the intervention group compared with the control group. Overall, the intervention group experienced a 58% (46 ± SD 26.9) reduction in self-reported asthma symptoms; 76% (34 ± SD 29.7) decrease in rescue medicine; 12% (145 ± SD 11.3) increase in controller medicine; 37% decrease in mean exhaled nitric oxide levels and 33% fewer ED asthma-related visits. CONCLUSION As demonstrated, a combination of efforts appeared effective for improving asthma respiratory symptoms among children in the intervention group. ECAPP is a low cost pilot project that could readily be adapted and expanded into other communities throughout eastern North Carolina. Future efforts could include enhanced partnerships between environmental health professionals at local health departments and pediatric asthma programs at hospitals to carry out ECAPP.
    Full-text · Article · Jun 2014 · Environmental Health Insights
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    • "Several studies cited above were randomized controlled trials (Eggleston et al., 2005; Evans et al., 1999; Kercsmar et al., 2006; Krieger et al., 2005; Morgan et al., 2004); others were quasiexperimental (Bryant-Stephens et al., 2009; Primomo et al., 2006). Wu and Takaro (2007) reviewed 15 randomized clinical trials published from 1992 to 2006. "
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    ABSTRACT: Objectives This program evaluation examines the outcomes of a multicomponent urban home-based asthma program implemented through a city health department in a large Midwestern city. The purpose of the program was to improve asthma outcomes by controlling indoor asthma triggers in the home environment.Design and SampleThis was a pre-post evaluation study. Participants received home-based education from a public health nurse or a health educator, cleaning and other supplies, and physical home interventions such as mold abatement and pest control. Asthma outcomes, caregiver quality of life, trigger-related activities, and asthma management activities at baseline and 6 months following the intervention were evaluated using survey data. A total of 115 participants for whom baseline and follow-up data were available were included in this analysis.MeasuresThis study used parent self-reported quantitative and qualitative data which were collected through baseline and follow-up surveys administered by program staff.ResultsSignificant reduction in asthma symptom days, nighttime awakenings, days with activity limitation, and albuterol use were observed. Emergency department visits, missed school days, and caregiver missed work days also were significantly reduced, and caregiver quality of life improved.Conclusions This multifaceted home-based intervention decreased asthma triggers and improved asthma outcomes in children, and improved the quality of life of their caregivers.
    Full-text · Article · May 2014 · Public Health Nursing
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    • "Asthma guidance for health care providers includes recommendations for controlling airborne allergens in the home [5]. Most interventions focus on housekeeping activities, such as using high-efficiency particulate air (HEPA) vacuum cleaners [7,8], improved bedding covers and laundering [7,9] and even use of high-efficiency portable air cleaners [7,10]. "
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    ABSTRACT: Objective Many interventions to reduce allergen levels in the home are recommended to asthma and allergy patients. One that is readily available and can be highly effective is the use of high performing filters in forced air ventilation systems. Methods We conducted a modeling analysis of the effectiveness of filter-based interventions in the home to reduce airborne asthma and allergy triggers. This work used “each pass removal efficiency” applied to health-relevant size fractions of particles to assess filter performance. We assessed effectiveness for key allergy and asthma triggers based on applicable particle sizes for cat allergen, indoor and outdoor sources of particles <2.5 µm in diameter (PM2.5), and airborne influenza and rhinovirus. Results Our analysis finds that higher performing filters can have significant impacts on indoor particle pollutant levels. Filters with removal efficiencies of >70% for cat dander particles, fine particulate matter (PM2.5) and respiratory virus can lower concentrations of those asthma triggers and allergens in indoor air of the home by >50%. Very high removal efficiency filters, such as those rated a 16 on the nationally recognized Minimum Efficiency Removal Value (MERV) rating system, tend to be only marginally more effective than MERV12 or 13 rated filters. Conclusions The results of this analysis indicate that use of a MERV12 or higher performing air filter in home ventilation systems can effectively reduce indoor levels of these common asthma and allergy triggers. These reductions in airborne allergens in turn may help reduce allergy and asthma symptoms, especially if employed in conjunction with other environmental management measures recommended for allergy and asthma patients.
    Full-text · Article · Feb 2014 · Journal of Asthma
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