Improving Outcomes of Inner-City Children with Asthma

Improving Outcomes of Inner-City Children with Asthma

Customized changes in the child's living environment may help.

Many environmental allergens contribute to poor health outcomes among inner-city children with asthma. In a study conducted in seven U.S. cities, 937 children with atopic asthma (age range, 5-11 years) were randomized either to a 1-year intervention to reduce allergen exposure or to a control group. The intervention involved five mandatory and two optional home visits, during which families were taught how to avoid exposing children to specific allergens (e.g., dust mites, cockroaches) based on children's skin-test profiles. At the first visit, allergen-impermeable covers were placed on children's beds, and vacuum cleaners with particulate air filters were provided.

During the intervention year and a second follow-up year, all measures related to number of days with asthma symptoms were significantly lower in the intervention group than in the control group (e.g., mean number of days with wheezing per 2 weeks during the second year, 2.28 vs. 2.87; school days missed during the second year, 0.54 vs. 0.71). Unscheduled visits to an emergency department or clinic also were significantly fewer in the intervention group than in the control group during both years, although no difference was noted in the percentage of children who were hospitalized. (Also see JW Pediatr Adolesc Med Aug 11 2003)

Comment: These results are impressive, but the intervention was enormously resource-intensive. Where does this leave the primary care physician? Perhaps, for inner-city children with persistent moderate-to-severe asthma that is poorly controlled with medication, referral to a specialty group that can focus on home-based environmental intervention is necessary. But whether any group can routinely provide such an intervention is unclear.

— Howard Bauchner, MD

Published in Journal Watch Pediatrics and Adolescent Medicine October 12, 2004