How to Alleviate Asthma for City-Dwelling Children

Summary
Children living in cities are exposed to a wide range of indoor allergens and environmental tobacco smoke. This study was done to determine whether environmental intervention could improve the condition of children affected with asthma. It included 937 asthmatic children who were educated on the mitigation of environmental allergens. A post-remediation reassessment of their health and homes showed a reduction in the symptoms of asthma as well as in the level of household allergens.

Introduction
Although asthma-management guidelines stress the importance of environmental control measures, the efficacy of these could be limited. Earlier studies on asthma probed into the effect of a single allergen such as mites or smoke, rather than multiple allergens, which is exactly what children in cities are exposed to. The reduction of allergens in inner-city homes has always been a concern. Most intervention strategies focus on limiting a specific allergen, rather than all the allergens. This study, however, evaluates a home-based education and remediation strategy, targeting various allergens.

Methodology

  • The study included 937 children, aged 5 to 11 years. Skin tests were performed to identify sensitivity or reaction to common indoor allergens.
  • Half of the participants were assigned to a group in which their caretakers received education on remediation. The other half were not educated, but monitored.
  • In a year, there were five visits to the homes of the children and the caretakers were instructed on asthma and cleaning. They were provided with vacuum cleaners, and special filters were fixed in the child’s bedroom, in most cases.
  • The children were evaluated at the end of a year by telephonic interviews with their caretakers. Clinical tests were also done to assess the level of asthma prior to the study and at the end.

Results

  • Prior to the intervention, 68% of the rooms in all houses visited had detectable levels of cockroach allergen and 84% of dust-mite allergens.
  • The total number of days with asthma symptoms was much lower in the intervention group, with only 0.8 day per two weeks in the first year. There was a 34-day reduction in the number of days with wheezing in the intervention group.
  • Greater reductions of cockroach and dust-mite allergens were seen in the group with intervention.
  • There was a strong positive correlation between cockroach allergen and asthma-related sickness.

Shortcomings/Next steps
There were no home visits to the group that did not receive education on remediation. This could have affected the outcome of the study, as the intervention group had frequent visits. Higher frequency of visits could have raised the caretakers’ knowledge on asthma care or decreased their willingness to report the clinical symptoms.

Conclusion
The presence of allergens in city homes is inevitable. These allergens are of multiple types and therefore require more effective methods of elimination. This study shows the effectiveness of remediation strategies in inner-city houses. Intervention based on educating the caretakers and implementing adequate cleaning and preventive measures resulted in sustained reductions in allergen levels and environmental tobacco smoke. These remediation measures lowered the total days of asthma morbidities and the incidences of visits to the emergency room. The intervention techniques were based on previous models of behavioral changes, which could have led to a sustained reduction in allergens.

For More Information:
Home-based Environmental Intervention among Urban Children with Asthma
Publication Journal: The New England Journal of Medicine, September 2004
By Wayne J Morgan, MD; Ellen F Crain, MD
From the University of Arizona College of Medicine, Tucson, Arizona and the Albert Einstein College of Medicine, Bronx, New York

*FYI Living Lab Reports Are Summaries of the Original Research.

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