title: Environmental improvements brought by the legal interventions in the homes of poorly controlled inner-city adult asthmatic patients: a proof-of-concept study.
abstract: OBJECTIVE
  Domestic contamination with mold, cockroaches, rodents, and dust worsens asthma severity. This violates warranty of habitability laws in most of the states, but patients often find it beyond their means to remedy their housing situation. We aimed to study the effect of a medical-legal collaborative intervention to force landlords into providing better living conditions for patients with poorly controlled asthma.
  
  
  METHODS
  We retrospectively studied charts of adult patients aged 18 years or older with poorly controlled asthma (moderate or severe persistent) despite maximum medical therapy. Additionally, patients had self-reported domestic allergen exposures such as mold, cockroaches, mice or rats, and dust. The patients received legal assistance to improve their domestic environments, including fixing leaks, exterminating pests, or providing a different apartment. Post-intervention change in peak expiratory flow rate (PEFR), asthma severity class, medications, emergency department (ED) visits, hospitalizations, and requirement for systemic steroids for symptom control was assessed.
  
  
  RESULTS
  Data were available for 12 patients (9-12 months pre-intervention and 6-12 months post-intervention). Analysis of paired data revealed that mean PEFR rose by 38.6 LPM (95% CI: 9.9-67.3; p = .014). The number of ED visits and hospital admissions declined from 22 ED visits and 11 admissions to 2 ED visits and 1 admission (91% reduction), respectively. Of the 11 patients requiring systemic steroids, only three required these post-intervention. All patients had reductions in the dose and/or number of medications. During post-intervention, 11 (91.7%) patients dropped ≥2 classes in asthma severity.
  
  
  CONCLUSIONS
  Medical-legal collaboration is highly effective in improving the control of inner-city asthmatics by effecting improvements in the domestic environment.
authors.affiliation: Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, St. Luke's-Roosevelt Hospital Center, Columbia University College of Physicians and Surgeons, New York, NY, USA.
authors.forename: Mary M
authors.initials: MM
authors.lastname: O'Sullivan
authors.forename: Julie
authors.initials: J
authors.lastname: Brandfield
authors.forename: Sumedh S
authors.initials: SS
authors.lastname: Hoskote
authors.forename: Shiri N
authors.initials: SN
authors.lastname: Segal
authors.forename: Luis
authors.initials: L
authors.lastname: Chug
authors.forename: Ariel
authors.initials: A
authors.lastname: Modrykamien
authors.forename: Edward
authors.initials: E
authors.lastname: Eden
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000818:Animals; D018927:Anti-Asthmatic Agents / Q000008:administration & dosage; D001249:Asthma / Q000453:epidemiology / Q000628:therapy*; D003058:Cockroaches; D004391:Dust; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D004777:Environment; D004781:Environmental Exposure / Q000331:legislation & jurisprudence* / Q000517:prevention & control* / Q000706:statistics & numerical data; D005260:Female; D005658:Fungi; D006760:Hospitalization / Q000706:statistics & numerical data; D006798:Housing / Q000331:legislation & jurisprudence*; D006801:Humans; D008297:Male; D051379:Mice; D008875:Middle Aged; D010366:Peak Expiratory Flow Rate; D051381:Rats; D012720:Severity of Illness Index; D012959:Socioeconomic Factors; D014505:Urban Population
chemical_list: D018927:Anti-Asthmatic Agents; D004391:Dust