Results of a home-based environmental intervention among urban children with asthma.
BACKGROUND
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.


METHODS
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.


RESULTS
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).


CONCLUSIONS
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.
Morgan
Wayne J
WJ
Arizona Respiratory Center, University of Arizona, 1501 N. Campbell Ave., Tucson, AZ 85724, USA.
Crain
Ellen F
EF
Gruchalla
Rebecca S
RS
O'Connor
George T
GT
Kattan
Meyer
M
Evans
Richard
R
Stout
James
J
Malindzak
George
G
Smartt
Ernestine
E
Plaut
Marshall
M
Walter
Michelle
M
Vaughn
Benjamin
B
Mitchell
Herman
H
D016902:Air Pollution, Indoor / Q000009:adverse effects / Q000517:prevention & control; D000485:Allergens / Q000009:adverse effects; D000818:Animals; D039741:Antigens, Dermatophagoides / Q000009:adverse effects; D001249:Asthma / Q000276:immunology / Q000517:prevention & control*; D002648:Child; D002675:Child, Preschool; D003058:Cockroaches / Q000276:immunology; D004391:Dust; D004781:Environmental Exposure / Q000032:analysis / Q000517:prevention & control*; D005260:Female; D006266:Health Education; D006798:Housing; D006801:Humans; D006920:Hygiene; D006969:Hypersensitivity, Immediate / Q000517:prevention & control; D008297:Male; D012307:Risk Factors; D014028:Tobacco Smoke Pollution / Q000517:prevention & control*; D014481:United States; D014505:Urban Population
D000485:Allergens; D039741:Antigens, Dermatophagoides; D004391:Dust; D014028:Tobacco Smoke Pollution