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Published on: November 4, 2010
Home intervention in the treatment of asthma among inner-city children
M C Carter1, M S Perzanowski, A Raymond
1Department of Family Medicine, Emory University, Atlanta, Ga, USA.
Insights
Home visits for allergen avoidance reduced asthma-related emergency visits in children living in poverty. Reducing mite allergen exposure is key for managing asthma in this population.
Area of Science:
- Environmental Health
- Pediatric Allergy
- Public Health
Background:
- Asthma is a major health concern for urban children, causing significant school absenteeism and healthcare utilization.
- Current asthma management guidelines recommend allergen avoidance, but its effectiveness in low-income populations is not well-established.
- Inner-city children, particularly those in poverty, face unique challenges in implementing allergen avoidance strategies.
Purpose of the Study:
- To evaluate the efficacy of allergen avoidance as a treatment for asthma in inner-city children.
- To assess the feasibility of implementing allergen avoidance protocols in households with children living in poverty.
- To determine the impact of allergen avoidance on asthma-related healthcare utilization and allergen levels.
Main Methods:
- A controlled trial involving 104 children with asthma in Atlanta randomized to active avoidance, placebo avoidance, or a no-visit control group.
- Avoidance interventions included protective covers, hot water laundering of bedding, and cockroach bait.
- Outcomes measured included unscheduled clinic visits, emergency department visits, hospitalizations, and changes in mite and cockroach allergen levels.
Main Results:
- A significant reduction in acute asthma-related visits was observed in children whose homes were visited.
- No significant differences in asthma visits or allergen levels were found between active and placebo avoidance groups.
- A significant correlation was found between reduced mite allergen levels and fewer acute asthma visits in children with mite allergy.
- Cockroach allergen avoidance measures were ineffective in reducing asthma visits.
Conclusions:
- Implementing allergen avoidance for asthma in children living in poverty is challenging due to multiple sensitivities and environmental factors.
- Home visiting interventions positively impact asthma management for families in poverty.
- Reducing mite allergen exposure is a crucial treatment objective for pediatric asthma in vulnerable populations.
Background:
In Atlanta, as in other major urban areas of the United States, asthma is a leading cause of school absenteeism, emergency department use, and hospitalization. Recent guidelines for asthma management recommend reducing exposure to relevant allergens, but neither the feasibility nor the efficacy of this form of treatment has been established for children living in poverty.
Objective:
We sought to investigate allergen avoidance as a treatment for asthma among inner-city children.
Methods:
One hundred four children with asthma living in the city of Atlanta were enrolled into a controlled trial of avoidance without being skin tested. The children were randomized to an active avoidance group, a placebo avoidance group, and a second control group for which no house visits occurred until the end of the first year. Avoidance included bed and pillow covers, hot washing of bedding, and cockroach bait. Eighty-five children completed the study, and the outcome was measured as unscheduled clinic visits, emergency department visits, and hospitalization for asthma, as well as changes in mite and cockroach allergen levels.
Results:
There was a significant decrease in acute visits for asthma among children whose homes were visited (P < .001). However, there was no significant difference between the active and placebo homes either in the effect on asthma visits or in allergen concentrations. When the children with mite allergy were considered separately, there was a significant correlation between decreased mite allergen and change in acute visits (P < .01). The avoidance measures for cockroach allergen appeared to be ineffective, and the changes observed did not correlate with changes in visits.
Conclusions:
Applying allergen avoidance as a treatment for asthma among children living in poverty is difficult because of multiple sensitivities and problems applying the protocols in this environment. The current results demonstrate that home visiting positively influences the management of asthma among families living in poverty. Furthermore, the results for children with mite allergy strongly suggest that decreasing relevant allergen exposure should be an objective of treatment in this population.
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