Helping City Kids With Asthma

Last Editorial Review: 9/9/2004

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.

In addition, families were given specific allergen-reducing measures, such as allergen-impermeable covers for children's bedding and air purifiers with HEPA (high efficiency particulate air) filters, to be placed in key locations within their homes, including the children's bedrooms. Cockroach extermination visits were provided for children who were allergic to cockroach allergens. During the first year of the study, the investigators conducted educational home visits with the families in the intervention group. Throughout the yearlong study and the one-year follow-up, researchers closely monitored all participants' asthma symptoms and home allergen levels.

Children who participated in the intervention had significantly fewer asthma symptoms compared with those in the control group: an average of 21 fewer days of symptoms in the first year and an average of 16 fewer days during the second, or follow-up, year. In addition, the benefits of the intervention occurred rapidly: Investigators noted significant reductions in symptoms just 2 months after the study began.

The levels of cockroach and dust mite allergens in the children's bedrooms in the intervention group were substantially lower than in the control group. Furthermore, the researchers noted a direct correlation between allergen levels and asthma symptoms for the children in the intervention group: The greater the drop in cockroach or house dust mite allergen levels, the greater the reduction in asthma symptoms, suggesting that the allergy-reducing measures - not the educational visits - made the difference.


Asthma is a chronic respiratory disease. See Answer

Most previous environmental intervention studies that have focused on controlling a single allergen or tobacco smoke exclusively, have met with limited success.

"Children with asthma are usually sensitive to more than one allergen," says Daniel Rotrosen, M.D., director of NIAID's Division of Allergy, Immunology, and Transplantation. "By taking a multifaceted, home-based approach, this new study demonstrates the promising results families can achieve when they incorporate the recommended practices of allergen reduction into their everyday lives."

The Inner City Asthma Study, a cooperative, multicenter study comprising seven centers across the country, is an outgrowth of the National Cooperative Inner-City Asthma Study, which ended in 1996. The principal investigator of the study is Wayne J. Morgan, M.D., University of Arizona College of Medicine, Tucson.

Source: National Institutes of Health press release, September 8, 2004

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