A tailored approach, involving cockroach extermination and using air cleaners to reduce dust, smoke and levels of other indoor allergens may consequently reduce asthma symptoms in inner-city children, new study findings suggest.
“My bottom line is that you can change the environment in inner-city homes,” study author Dr. Peyton A. Eggleston, of the Baltimore, Maryland-based Johns Hopkins University School of Medicine, told Reuters Health. As the level of allergens is reduced, “asthma symptoms of the kids living in those homes is improved,” he said.
Various reports have pointed to indoor allergen and pollutant levels as important contributors to the disproportionate burden of asthma carried by inner-city children. In the current study, Eggleston and his colleagues created a multifaceted intervention that combined strategies to reduce children’s exposure to allergens and other asthma triggers.
They randomly divided 100 children with asthma, who were 6 to 12 years old, into a treatment group or a comparison group. The treatment, or study group, received home-based education, cockroach extermination as needed, rodent extermination, allergen-proof fitted mattress and pillow coverings and a high-efficiency air cleaner, while the comparison group received none of these interventions. The children underwent home evaluations six months after the start of the study, home and clinic evaluations at 12 months and quarterly telephone interviews.
At the start of the study, over half (54 percent) of the children said they experienced daytime asthma symptoms and 39 percent said they had experienced nighttime symptoms at some point during the previous two weeks. About one third of the children had visited a health care provider for their asthma symptoms within the previous three months and a similar, albeit slightly lower, proportion took daily medications to control their symptoms.
By the end of the 12-month intervention, levels of household dust and smoke - which has consistently been shown to be primarily due to smoking or cooking - decreased by up to 39 percent in the study group, but increased in the comparison group. Cockroach allergen levels dropped by 51 percent in the study group, Eggleston and his team reported in the Annals of Allergy, Asthma & Immunology.
Nighttime symptoms, emergency department use and other measures of asthma severity were not significantly different between the two groups. However, the treatment group experienced a decrease in daytime asthma symptoms, while the comparison group experienced an increase. “As a family, you can notice this - that the kid is getting better through the stuff you’re doing,” Eggleston said.
There may be several explanations for why the intervention did not provide more “striking” health effects, the researchers speculate, including problems with the study’s design, or with their inclusion of children with mild asthma and no evidence of allergies.
Citing a 2004 study, previously reported on by Reuters Health, which also showed an improvement in asthma symptoms via changes to the home environment, Eggleston said, “the fact that there are two studies and both improved asthma without using medication, I think, is a really important finding.”
Eggleston stressed that the parents of children with asthma should not neglect regular medical care and only make changes to their home environment to reduce their child’s symptoms.
“This isn’t a substitute for medicine but this is a good supplement,” he said.
Eggleston added that his findings “may be important to public health departments.” Considering that some poor people may not be able to afford air cleaners or cockroach extermination, “these are two things that public health departments might put money into,” he said.
At less than $500 per child, the intervention, if included in a comprehensive asthma treatment for inner-city children may “contribute to symptom reduction in this vulnerable population and should be feasible in a public health setting,” Eggleston and his team conclude.
SOURCE: Annals of Allergy, Asthma & Immunology, December 2005.
Revision date: June 18, 2011
Last revised: by Janet A. Staessen, MD, PhD