Lee Swartz

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.

Knowledge and practice of dust mite control by specialty care.

BACKGROUND Dust mites are the primary indoor allergen risk for increasing asthma attacks and morbidity. Adherence to allergen avoidance recommendations decreases bronchial reactivity and asthma morbidity. OBJECTIVE This study compared the knowledge and practice of environmental control advice of families of children with asthma seen by an allergist or a pediatrician. Studies suggest that knowledge and practice of environmental control recommendations is inconsistent. METHODS Subjects were aged 6 to 17 years, diagnosed with asthma, and had positive skin test to dust mites. There were 114 eligible pediatric patients, and 69 had also seen an allergist before the study. An in-home evaluation was completed during which parents were asked about environmental control knowledge and practice. An environmental technician then completed a walk-through evaluation to observe which recommendations were implemented in the home. RESULTS Families who saw an allergist demonstrated significantly greater awareness of environmental control recommendations for dust mite allergens than those who had not. Knowledge and placement of allergen-proof mattress and pillow covers was significantly higher in these families. However, 30% of families who saw an allergist reported no knowledge of any environmental control recommendations for dust mites. Less than half of the allergist families (48%) who were advised to use mattress encasements actually had encasements on their childrens beds. CONCLUSIONS The parents of dust mite-sensitive, asthmatic children who saw an allergist were more aware of dust mite allergen control recommendations and made more indoor environmental changes.