title: Effectiveness of home-based, multi-trigger, multicomponent interventions with an environmental focus for reducing asthma morbidity: a community guide systematic review.
abstract: BACKGROUND
  Asthma exacerbations are commonly triggered by exposure to allergens and irritants within the home. The purpose of this review was to evaluate evidence that interventions that target reducing these triggers through home visits may be beneficial in improving asthma outcomes. The interventions involve home visits by trained personnel to conduct two or more components that address asthma triggers in the home. Intervention components focus on reducing exposures to a range of asthma triggers (allergens and irritants) through environmental assessment, education, and remediation.
  
  
  METHODS
  Using methods previously developed for the Guide to Community Preventive Services, a systematic review was conducted to evaluate the evidence on effectiveness of home-based, multi-trigger, multicomponent interventions with an environmental focus to improve asthma-related morbidity outcomes. The literature search identified over 10,800 citations. Of these, 23 studies met intervention and quality criteria for inclusion in the final analysis.
  
  
  RESULTS
  In the 20 studies targeting children and adolescents, the number of days with asthma symptoms (symptom-days) was reduced by 0.8 days per 2 weeks, which is equivalent to 21.0 symptom-days per year (range of values: reduction of 0.6 to 2.3 days per year); school days missed were reduced by 12.3 days per year (range of values: reduction of 3.4 to 31.2 days per year); and the number of asthma acute care visits were reduced by 0.57 visits per year (interquartile interval: reduction of 0.33 to 1.71 visits per year). Only three studies reported outcomes among adults with asthma, finding inconsistent results.
  
  
  CONCLUSIONS
  Home-based, multi-trigger, multicomponent interventions with an environmental focus are effective in improving overall quality of life and productivity in children and adolescents with asthma. The effectiveness of these interventions in adults is inconclusive due to the small number of studies and inconsistent results. Additional studies are needed to (1) evaluate the effectiveness of these interventions in adults and (2) determine the individual contributions of the various intervention components.
authors.affiliation: Air Pollution and Respiratory Health Branch, Division of Environmental Hazards and Health Effects, National Center for Environmental Health, National Center for Immunization and Respiratory Diseases, CDC, Atlanta, Georgia 30333, USA.
authors.forename: Deidre D
authors.initials: DD
authors.lastname: Crocker
authors.forename: Stella
authors.initials: S
authors.lastname: Kinyota
authors.forename: Gema G
authors.initials: GG
authors.lastname: Dumitru
authors.forename: Colin B
authors.initials: CB
authors.lastname: Ligon
authors.forename: Elizabeth J
authors.initials: EJ
authors.lastname: Herman
authors.forename: Jill M
authors.initials: JM
authors.lastname: Ferdinands
authors.forename: David P
authors.initials: DP
authors.lastname: Hopkins
authors.forename: Briana M
authors.initials: BM
authors.lastname: Lawrence
authors.forename: Theresa A
authors.initials: TA
authors.lastname: Sipe
mesh_terms: D000293:Adolescent; D000328:Adult; D000485:Allergens / Q000009:adverse effects; D001249:Asthma / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D002648:Child; D004526:Efficiency; D004781:Environmental Exposure / Q000009:adverse effects / Q000517:prevention & control*; D052918:Environmental Restoration and Remediation / Q000379:methods; D006699:Home Care Services / Q000458:organization & administration*; D006792:House Calls; D006798:Housing; D006801:Humans; D011788:Quality of Life
chemical_list: D000485:Allergens