Home environmental intervention in inner-city asthma: a randomized controlled clinical trial.
BACKGROUND
Airborne pollutants and indoor allergens increase asthma morbidity in inner-city children; therefore, reducing exposure, if feasible, should improve asthma morbidity.


OBJECTIVE
To conduct a randomized controlled trial of methods to reduce environmental pollutant and allergen exposure in the homes of asthmatic children living in the inner city.


METHODS
After the completion of questionnaires, spirometry and allergen skin tests, home inspection, and measurement of home air pollutant and allergen levels, 100 asthmatic children aged 6 to 12 years were randomized to the treatment group (home-based education, cockroach and rodent extermination, mattress and pillow encasings, and high-efficiency particulate air cleaner) or to the control group (treated at the end of the 1-year trial). Outcomes were evaluated by home evaluations at 6 and 12 months, clinic evaluation at 12 months, and multiple telephone interviews.


RESULTS
In the treatment group, 84% received cockroach extermination and 75% used the air cleaner. Levels of particulate matter 10 microm or smaller declined by up to 39% in the treatment group but increased in the control group (P < .001). Cockroach allergen levels decreased by 51% in the treatment group. Daytime symptoms increased in the control group and decreased in the treatment group (P = .04). Other measures of morbidity, such as spirometry findings, nighttime symptoms, and emergency department use, were not significantly changed.


CONCLUSIONS
A tailored, multifaceted environmental treatment reduced airborne particulate matter and indoor allergen levels in inner-city homes, which, in turn, had a modest effect on morbidity.
Eggleston
Peyton A
PA
Department of Pediatrics Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, USA. pegglest@jhmi.edu
Butz
Arlene
A
Rand
Cynthia
C
Curtin-Brosnan
Jean
J
Kanchanaraksa
Sukon
S
Swartz
Lee
L
Breysse
Patrick
P
Buckley
Timothy
T
Diette
Gregory
G
Merriman
Barry
B
Krishnan
Jerry A
JA
D016902:Air Pollution, Indoor / Q000517:prevention & control*; D000485:Allergens / Q000009:adverse effects*; D000818:Animals; D001249:Asthma / Q000209:etiology / Q000517:prevention & control*; D001512:Bedding and Linens; D002648:Child; D003058:Cockroaches; D004781:Environmental Exposure / Q000517:prevention & control*; D005260:Female; D005374:Filtration / Q000379:methods; D006266:Health Education; D006798:Housing; D006801:Humans; D007300:Insect Control; D008297:Male; D051379:Mice; D010571:Pest Control; D012882:Skin Tests; D013147:Spirometry; D014505:Urban Population
D000485:Allergens