At-home changes may help control asthma symptoms

By Charnicia E. Huggins

NEW YORK (Reuters Health) – 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.