Adobe Flash Player is required to view this feature. If you are using an operating system that does not support Flash, we are working to bring you alternative formats.

Original Article Results of a Home-Based Environmental Intervention among Urban Children with Asthma Wayne J. Morgan, M.D., C.M., Ellen F. Crain, M.D., Ph.D., Rebecca S. Gruchalla, M.D., Ph.D., George T. O'Connor, M.D., Meyer Kattan, M.D., C.M., Richard Evans, III, M.D., M.P.H., James Stout, M.D., M.P.H., George Malindzak, Ph.D., Ernestine Smartt, R.N., Marshall Plaut, M.D., Michelle Walter, M.S., Benjamin Vaughn, M.S., and Herman Mitchell, Ph.D., for the Inner-City Asthma Study Group N Engl J Med 2004; 351:1068-1080 DOI: 10.1056/NEJMoa032097.

Results 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 vs. 4.20 days, P. Inner-city children with asthma are commonly exposed to multiple indoor allergens and environmental tobacco smoke, exposures that may contribute to the increased asthma-related complications in this population. Asthma-management guidelines have stressed the need for environmental control measures, but there is limited evidence of their efficacy.

Previous studies of environmental interventions for patients with asthma have focused on a single allergen, such as dust mites, or environmental tobacco smoke, rather than on the multiple exposures encountered by many urban children with asthma. Measures to avoid exposure to dust mites, including bedding encasement, have reduced the levels of exposure to these allergens, but their clinical effectiveness remains a matter of controversy. Exposure to cockroach allergens may aggravate asthma among sensitized urban children, but reducing allergen levels in inner-city homes has proven difficult and has had no apparent clinical benefit. Efforts to use educational approaches to reduce exposure to environmental tobacco smoke in the home have also been disappointing; however, the use of interventions including air filtration has not been reported in this population. One potential limitation of all these intervention strategies is their focus on decreasing exposure to a single allergen, rather than improving the indoor environment as a whole.

The Inner-City Asthma Study evaluated the effectiveness of a multifaceted, home-based, environmental intervention for inner-city children with asthma. The objective of the study was to determine whether an intervention tailored to each child's sensitization and environmental risk profile could improve the symptoms of asthma and decrease the use of health care services. Methods We enrolled children 5 through 11 years of age in whom asthma had been diagnosed by a physician at research centers in the Bronx, New York; Boston; Chicago; Dallas; New York City; the Seattle and Tacoma, Washington, area; and Tucson, Arizona. Eligibility was limited to residents of census tracts in which at least 20 percent of households had incomes below the federal poverty level. Kagan Cooperative Learning Timer Tools For Computer. Other eligibility criteria included at least one asthma-related hospitalization or two unscheduled, asthma-related visits to the clinic or emergency department during the previous six months and a positive skin test in response to at least 1 of 11 indoor allergens.

Children were not enrolled within three weeks after an asthma-related hospitalization or visit to the emergency department and could not have any other serious chronic illness. All appropriate institutional review boards approved this study. Written informed consent was obtained from each participant's parent or legal guardian, and children gave assent. A two-by-two factorial design was used to evaluate environmental and physician-feedback interventions in the same study population. The physician-feedback intervention included bimonthly reports of the children's asthma symptoms and use of health care services to their primary care physicians. There was no interaction between the two interventions, so their effects are considered separately; this article describes the results of the environmental intervention. A baseline clinical evaluation included questionnaires on complications related to asthma and the home environment.

Skin testing was performed with the use of the percutaneous MultiTest method (MultiTest II, Lincoln Diagnostics), involving extracts of German and American cockroach (Bayer) and of the dust mites Dermatophagoides farinae and D. Pteronyssinus, rat, mouse, the fungi Alternaria alternata, Cladosporium herbarum, aspergillus mix, and Penicillium chrysogenum, cat, and dog (all from Greer Laboratories). A response was considered positive if the diameter of the resulting wheal exceeded that caused by the saline control by 2 mm or more. Approximately three weeks after the baseline clinical examination, a baseline home evaluation was performed that involved both direct visual inspection and dust collection from the child's bedroom. Using a standardized protocol, the home-evaluation team collected separate, vacuumed dust samples from the child's bedroom floor and bed.