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Previous Volume 351:1068-1080 September 9, 2004 Number 11 Next

	Full Text PDF PDA Full Text PowerPoint Slide Set Editorial by Sheffer, A. L. Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited E-mail When Letters Appear PubMed Citation

ABSTRACT

Background Children with asthma who live in the inner city are exposed to multiple indoor allergens and environmental tobacco smoke in their homes. Reductions in these triggers of asthma have been difficult to achieve and have seldom been associated with decreased morbidity from asthma. The objective of this study was to determine whether an environmental intervention tailored to each child's allergic sensitization and environmental risk factors could improve asthma-related outcomes.

Methods We enrolled 937 children with atopic asthma (age, 5 to 11 years) in seven major U.S. cities in a randomized, controlled trial of an environmental intervention that lasted one year (intervention year) and included education and remediation for exposure to both allergens and environmental tobacco smoke. Home environmental exposures were assessed every six months, and asthma-related complications were assessed every two months during the intervention and for one year after the intervention.

Results For every 2-week period, the intervention group had fewer days with symptoms than did the control group both during the intervention year (3.39 vs. 4.20 days, P<0.001) and the year afterward (2.62 vs. 3.21 days, P<0.001), as well as greater declines in the levels of allergens at home, such as Dermatophagoides farinae (Der f1) allergen in the bed (P<0.001) and on the bedroom floor (P=0.004), D. pteronyssinus in the bed (P=0.007), and cockroach allergen on the bedroom floor (P<0.001). Reductions in the levels of cockroach allergen and dust-mite allergen (Der f1) on the bedroom floor were significantly correlated with reduced complications of asthma (P<0.001).

Conclusions Among inner-city children with atopic asthma, an individualized, home-based, comprehensive environmental intervention decreases exposure to indoor allergens, including cockroach and dust-mite allergens, resulting in reduced asthma-associated morbidity.

Source Information

From the University of Arizona College of Medicine, Tucson (W.J.M.); the Albert Einstein College of Medicine/Jacobi Medical Center, Bronx, N.Y. (E.F.C.); the University of Texas Southwestern Medical Center at Dallas, Dallas (R.S.G.); Boston University School of Medicine, Boston (G.T.O.); Mount Sinai School of Medicine, New York (M.K.); Children's Memorial Hospital, Chicago (R.E.); the University of Washington School of Medicine and Public Health, Seattle (J.S.); the National Institute of Environmental Health Sciences, Research Triangle Park, N.C. (G.M.); the National Institute of Allergy and Infectious Diseases, Bethesda, Md. (E.S., M.P.); and Rho, Chapel Hill, N.C. (M.W., B.V., H.M.).

Address reprint requests to Dr. Morgan at the Arizona Respiratory Center, University of Arizona, 1501 N. Campbell Ave., Tucson, AZ 85724.

Full Text of this Article

Related Letters:

Environment and Asthma
Boyle R. J., Tang M. L.K., Morgan W. J., Plaut M., Mitchell H., Sheffer A. L.
Extract | Full Text | PDF  
N Engl J Med 2004; 351:2654-2655, Dec 16, 2004. Correspondence

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