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Children with asthma who live in the inner city are exposed to multiple indoor allergens and environmental tobacco smoke in their homes. It is difficult to reduce these triggers and previous studies have not shown any significant decrease in morbidity.
In this randomised controlled trial of an environmental intervention over 1 year, 937 children (age 5–11 years) with atopic asthma in seven major US cities were enrolled. Intervention included education and various behavioural and environmental modifications to reduce exposure to dust mites, tobacco smoke, cockroaches, pets, rodents, and mould. Home environmental exposures were assessed every 6 months and asthma related complications were assessed every 2 months during the intervention and for 1 year after the intervention. The results showed that there was a greater decline in the levels of dust mite allergens (Der f 1 and Der p 1) and cockroach allergen (Bla g 1) in the intervention group. For every 2 week period the intervention group had fewer days with symptoms than did the control group, both during the intervention year (3.39 v 4.20 days, p<0.001) and in the year afterwards (2.62 v 3.21 days, p<0.001). Reductions in the level of cockroach allergen and house dust mite on the bedroom floor were significantly correlated with reduced complications of asthma (p<0.001), such as number of hospital admissions and the number of unscheduled visits to the emergency department or clinic for asthma.
This study shows that, among inner city children with atopic asthma, an individualised home based comprehensive environmental intervention decreases exposure to indoor allergens, including cockroach and house dust mite allergens, and results in reduced asthma associated morbidity. The estimated cost of the intervention was $1500–2000 per child.