title: Impact of a multi-trigger intervention on seasonal patterns of asthma symptoms in inner city children.
abstract: OBJECTIVE
  Peaks in childhood asthma symptoms and asthma morbidity occur universally in the fall and late winter/early spring. This study examines whether there is a time of the year best suited to implement environmental interventions to attenuate this pattern.
  
  
  METHODS
  From September 2006 to June 2010, mid-Atlantic inner-city children asthmatics with 1 asthma-related hospitalization (IP) or 2 emergency (ED) visits the year prior to enrollment received 5 in-home self-management education sessions which included multi-trigger avoidance techniques and supplies. Children's daily asthma symptoms were recorded for 12 months by caregivers.
  
  
  RESULTS
  One-hundred and thirty-six children (48%) completed 12 months of symptoms diaries. Symptom days were reduced by 4.5 days at 12 months follow-up (p < 0.001). Symptom severity improved with a decreased severity score of 29.0 to 7.9 at month 12 (p < 0.001). Sixty-one percent of patients with ≥2 ED visits at baseline dropped to 0-1visits (p < 0.001). Eighty percent of patients with ≥1 IP visits dropped to 0 visits at 12 months (p < 0.001). Patients who received intervention in the summer months had half the average monthly symptoms score (10.8) as those who received intervention in the spring months (20.8). When controlling for environment and morbidity, the summer enrolled group had a significantly lower (p = 0.021) symptom score than those in other seasons.
  
  
  CONCLUSIONS
  Home self-management/environmental interventions for this cohort appear to have the greatest effect for those receiving the intervention in the summer and fall. The largest impact occurs in the summer cohort. Further studies with a control group are necessary to confirm these findings.
authors.affiliation: a The Children's Hospital of Philadelphia , Philadelphia , PA , USA and.
authors.forename: Tyra
authors.initials: T
authors.lastname: Bryant-Stephens
authors.forename: Caroline
authors.initials: C
authors.lastname: West
authors.forename: Gary
authors.initials: G
authors.lastname: Klein
mesh_terms: D000293:Adolescent; D000485:Allergens; D018927:Anti-Asthmatic Agents / Q000627:therapeutic use; D001249:Asthma / Q000188:drug therapy / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D010353:Patient Education as Topic; D012621:Seasons; D012648:Self Care / Q000379:methods*; D012720:Severity of Illness Index; D014505:Urban Population
chemical_list: D000485:Allergens; D018927:Anti-Asthmatic Agents
keywords: Morbidity and mortality; pediatrics; prevention