Outcomes of a home-based environmental remediation for urban children with asthma

Context: Increasing urban asthma prevalence and severity is found among minority, underserved populations. Improving asthma self-management includes home management of complex medical protocols as well as environmental trigger removal. Objective: To study the effectiveness of a low-cost approach to improve control of asthma symptoms in on urban population through lay educators who promote a generalized approach to asthma trigger avoidance in the bedrooms of children with asthma. Design and Patients: Prospective, randomized controlled trial with two arms: historical controls and matched controls for each subject. Subjects: Two-hundred-eighty-one patients living in an urban environment, randomized to receive home visits only (n=128) or home visits with environmental remediation (n=153). One-hundred-fifteen controls matched according to age, gender and ethnicity did not receive any intervention. Interventions: In-home education visits covered asthma physiology, asthma trigger avoidance and asthma management. Environmental remediation was conducted together with the caregiver. Outcomes: Primary outcomes include length of hospital stay, number of emergency visits and number of sick visits. Secondary outcomes are symptom frequency, medication management and trigger reduction. Results: Both intervention groups experienced reduction of hospitalizations, emergency room visits, sick visits and asthma symptoms. Both groups showed outcomes significantly superior to the matched control group. Intervention effectively reduced the presence of rodents and carpet in home and increased the use of mattress and pillow covers. Conclusions: This study shows that low-cost in-home education and environmental remediation improve outcomes for children with asthma. Lay educators can deliver effective asthma-specific education that results in improved asthma control.