Home environment changes may relieve asthma

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Inner-city families can help relieve children’s asthma symptoms by making simple changes in their homes. Such steps include using pillow covers that are impermeable to dust mites, and air purifiers to get rid of tobacco smoke, mold and cat or dog allergens, according to new study findings.

“We have shown that you can make a difference in the inner-city indoor environment that improves the health of children with asthma,” lead study author Dr. Wayne J. Morgan of the University of Arizona College of Medicine told Reuters Health. “These findings are important because children who live in the inner city suffer an excess burden of illness and even death due to asthma.”

Previous studies of environmental interventions for asthma have focused on reducing the affected individuals’ exposure to a single allergen, or asthma trigger, rather than reducing exposure to multiple asthma triggers. In the current study, Morgan and his colleagues used a multifaceted approach for 937 children, aged 5 to 11 years, with atopic or allergic asthma.

The children were from inner-city areas in seven major cities across the US and were randomly assigned to an intervention group or a control group for comparison purposes.

The children in the study group received up to seven home visits during the 12-month intervention period, during which their caretakers were taught how to create “an environmentally safe sleeping zone,” by using mattress, pillow and box spring covers that were impermeable to allergens.

The intervention was also tailored to each child, as some caretakers were given specially equipped vacuum cleaners and air purifiers while others were given professional pest control to eliminate cockroach allergen.

Children in the comparison group received four home visits during which their home environment was surveyed and dust allergens were collected.

At each follow-up, children in the intervention group reported experiencing asthma symptoms on fewer days during a two-week period than did those in the comparison group. And, the report indicates, this greater reduction in asthma symptoms persisted for 12 months after the intervention period, for a total of two years.

Overall, children in the intervention group experienced about 34 fewer days with wheeze during a two-year period than did their peers in the comparison group, Morgan and his team report this week in the New England Journal of Medicine.

Altogether, the indoor environmental changes resulted in nearly 14 percent fewer unscheduled visits to the emergency department or clinic, 20 percent fewer days with symptoms, and 21 percent fewer missed school days per year for children in the intervention group.

Morgan emphasizes that controlling indoor asthma triggers is not a substitute for standard asthma therapy. Instead, he suggests that changes to the indoor environment be done in conjunction with standard treatments.

“Anti-inflammatory medicine is key in any child with persistent symptoms and it should be continued once the symptoms are under control to prevent their recurrence,” he said. “However, we strongly believe our study has shown that creating a safe home environment is also an important part of asthma management.”

In a related editorial, Dr. Albert L. Sheffer, from Brigham and Women’s Hospital in Boston, Massachusetts writes that decreasing, and preferably removing, the “offending environmental allergen” is “central to the reduction of the severity of allergic disease,” particularly when treating allergic asthma.

He added that Morgan’s study “shows that environmental control of multiple allergens, coupled with repeated educational endeavors, can significantly reduce asthma-related complications among inner-city children with atopic asthma.”

SOURCE: New England Journal of Medicine, September 9, 2004.

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