Loran T. Clement

Cockroach counts and house dust allergen concentrations after professional cockroach control and cleaning

BACKGROUND It is known that cockroach allergen exposure is both frequent in inner-city homes and associated with asthma severity in children living in those homes. However, there have been few studies of interventions to reduce exposures in this setting. OBJECTIVE To evaluate the effect of short-term professional cockroach control and intensive cleaning on allergen concentrations. METHODS Families of children from a school-based asthma treatment program who had skin test results positive to cockroach allergen were enrolled if the home had cockroaches. Forty-nine homes were randomly assigned to receive professional cleaning with bait traps containing insecticide, professional cleaning with bait traps without insecticide, or no cleaning or bait traps. In all homes, dust was collected repeatedly to evaluate cockroach allergen Bla g 2 in the kitchen and bedroom, and cockroaches were trapped and counted repeatedly for more than 11 weeks. RESULTS Median cockroach counts were reduced in the homes treated with insecticide bait traps but not in other groups. There were significant reductions in allergen concentration in the kitchen in homes that received professional cleaning and had higher initial cockroach counts (54), regardless of whether bait traps had insecticide or not. CONCLUSIONS We conclude that intensive cleaning can produce significant reductions in cockroach allergen in homes with heavy initial cockroach infestations.

Validation of a single survey that can be used for case identification and assessment of asthma control: the Breathmobile Program.

BACKGROUND Underdiagnosis of asthma and underrecognition of disease severity in lower socioeconomic populations continue to be significant health care concerns despite national efforts to better educate health care providers. OBJECTIVE To validate a 1-page survey as a point-in-time tool identifying uncontrolled vs controlled asthma and moderate-to-severe disease activity in an urban, lower-socioeconomic pediatric population. METHODS A previously validated survey (the Breathmobile Case Identification Survey) was evaluated as a point-in-time tool for identifying children with poorly controlled disease. Clinical validation was achieved in children (n = 1,826) presenting to a school-based asthma program for either an initial (n = 666) or a follow-up (n = 1,170) visit. Responses were compared with a comprehensive evaluation by a physician specialist as the gold standard. Response patterns were used to construct multimodel tiered scoring algorithms for baseline and follow-up visits that identify children with uncontrolled asthma, and children are likely to have moderate-to-severe disease activity at that time. RESULTS Surveys scored using the developed algorithms identified children with uncontrolled asthma (sensitivity: baseline, 77.0%; follow-up, 71.6%; specificity: baseline, 72.7%; follow-up, 71.5%) and detected moderate-to-severe disease activity (sensitivity: baseline, 69.2%; follow-up, 77.4%; specificity: baseline, 70.2%; follow-up, 70.3%). CONCLUSIONS The Breathmobile Case Identification Survey can be used in lower-socioeconomic, urban populations as a point-in-time tool for identifying children with uncontrolled vs controlled asthma and moderate-to-severe disease activity.

Allergic bronchopulmonary aspergillosis in cystic fibrosis.

The current standards of care for allergic bronchopulmonary aspergillosis in patients with cystic fibrosis are presented. Recent studies have increased understanding of the inflammatory process that occurs in cystic fibrosis patients with allergic bronchopulmonary aspergillosis. This has resulted in more precise diagnostic criteria that facilitate more timely diagnosis and treatment of ABPA in these patients. In addition to traditional treatment with systemic corticosteroids, promising results have been documented with antifungal therapy.