Helping City Kids With Asthma

Summary: A study was conducted in poor inner-city neighborhoods where asthma is rife among children. A program that reduces allergens and tobacco smoke in the home was found to result in fewer illnesses related to asthma. This study showed "the first significant reduction in asthma-related complications induced by the avoidance of environmental allergens."

Comment: The environmental interventions did not work miracles but they did have a moderate positive effect. All of the environmental interventions can easily be implemented and are cost-effective.

Barbara K. Hecht, Ph.D.
Frederick Hecht, M.D.
Medical Editors,

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Customized Program Reduces Asthma-Related Illness in Inner-City Children

A program that reduces allergens and tobacco smoke in the home resulted in fewer asthma-related illnesses in children participating in the intervention than in those who were not, according to a new study sponsored by the National Institutes of Health (NIH). Children taking part in the intervention had 21 fewer days of asthma-related symptoms over the 1-year course of intervention.

The study - co-funded by the National Institute of Allergy and Infectious Diseases (NIAID) and the National Institute of Environmental Health Sciences (NIEHS), two NIH institutes - appears in the September 9th issue of The New England Journal of Medicine.

"The burden that childhood asthma places on our society is enormous - accounting for roughly 14 million missed school days each year and $3.2 billion per year in treatment," says Anthony S. Fauci, M.D., director of NIAID. "This important research will provide long-term practical benefits to the millions of children who live with asthma in the form of better quality of life, fewer emergency room visits and hospitalizations and lower healthcare costs."

"These study results are exciting because they show that changes made in the home environment can produce a reduction in symptoms comparable to that achieved with asthma inhalers," notes Kenneth Olden, Ph.D., director of NIEHS.

Asthma, a chronic lung disease characterized by coughing, wheezing and difficulty breathing, affects roughly 20 million Americans. However, children who live in the inner city - in particular African-American and Hispanic children - suffer disproportionately from the disease. Elevated asthma-related illness in this population may stem from exposure to high levels of multiple indoor allergens and tobacco smoke.

More than 900 children ages 5 to 11 with moderate to severe asthma participated in the study. Each participant had to be allergic to at least one common indoor environmental allergen, such as cockroach allergen or mold. The children, most of whom were African American or Hispanic, lived in low-income sections of seven major metropolitan areas - the Bronx, Boston, Chicago, Dallas, New York City, Seattle/Tacoma and Tucson. Once accepted into the study, they were randomly assigned to either the intervention group or a control group.

Based on the child's sensitivity to the selected indoor allergens, investigators designed an individualized environmental intervention, carried out by the child's mother or another caretaker. The intervention focused on educating the family about ways to reduce or eliminate all allergens to which the child was allergic, as well as to reduce exposure to tobacco smoke, and motivating them to pursue these steps. The investigators developed separate interventions tailored to tobacco smoke and to the following allergens - house dust mite, cockroach, pet, rodent and mold.