Home intervention in the treatment of asthma among inner-city children

Background: In Atlanta, as in other major urban areas of the United States, asthma is a leading cause of school absenteeism, emergency department use, and hospitalization. Recent guidelines for asthma management recommend red ucing exposure to relevant allergens, but neither the feasibility nor the e fficacy of this form of treatment has been established for children living in poverty. Objective: We sought to investigate allergen avoidance as a treatment for a sthma among inner-city children. Methods: One hundred four children with asthma living in the city of Atlant a were enrolled into a controlled trial of avoidance without being skin tes ted. The children were randomized to an active avoidance group, a placebo a voidance group, and a second control group for which no house visits occurr ed until the end of the first year. Avoidance included bed and pillow cover s, hot washing of bedding, and cockroach bait. Eighty-five children complet ed the study, and the outcome was measured as unscheduled clinic visits, em ergency department visits, and hospitalization for asthma, as well as chang es in mite and cockroach allergen levels. Results: There was a significant decrease in acute visits for asthma among children whose homes were visited (P <.001). However, there was no signific ant difference between the active and placebo homes either in the effect on asthma visits or in allergen concentrations. When the children with mite a llergy were considered separately, there was a significant correlation betw een decreased mite allergen and change in acute visits (P <.01). The avoida nce measures for cockroach allergen appeared to be ineffective, and the cha nges observed did not correlate with changes in visits. Conclusions: Applying allergen avoidance as a treatment for asthma among ch ildren living in poverty is difficult because of multiple sensitivities and problems applying the protocols in this environment. The current results d emonstrate that home visiting positively influences the management of asthm a among families living in poverty. Furthermore, the results for children w ith mite allergy strongly suggest that decreasing relevant allergen exposur e should be an objective of treatment in this population.