|New Study on Childhood Asthma Shows Home-Based Interventions
New data suggest that a home-based environmental intervention program is a cost-effective
way to improve the health of inner-city children who have moderate to severe
asthma. The program successfully decreased allergen levels in the home and reduced
asthma symptoms. The data also show that the cost would be substantially lower
if the interventions were implemented in a community setting, and that they would
be as cost-effective as many drug interventions.
The National Institute of Allergy and Infectious Diseases (NIAID), part of the
National Institutes of Health (NIH), provided major funding to researchers at
seven centers across the United States for the two-year study. The National Institute
of Environmental Health Sciences (NIEHS), part of NIH, also supported the research.
Study results are now available online in the Journal of Allergy and Clinical
“While the interventions were clearly effective in reducing asthma symptoms,
we wanted to know whether the measures were cost-effective,” says Meyer Kattan,
M.D., a pediatric pulmonologist with the Mount Sinai School of Medicine and lead
author on the study.
The home-based program was designed to target six major classes of allergens
that trigger asthma symptoms — dust mites, cockroaches, pet dander, rodents,
passive smoking and mold. The environmental interventions were tailored to each
child’s sensitivity to the selected allergens and evidence of exposure to these
Those enrolled in the program received educational home visits that included
specific measures for reducing or eliminating allergen levels inside the home.
These included allergen-impermeable covers on the child’s mattress, box spring
and pillows, air purifiers with high efficiency particulate air (HEPA) filters,
vacuum cleaners equipped with HEPA filters, and professional pest control.
The home-based interventions resulted in significant improvement in health status
and reductions in resource use among the asthmatic children. Children who received
the intervention had 19 percent fewer unscheduled clinic visits and a 13 percent
reduction in the use of albuterol inhalers, small applicators that deliver asthma
medication directly into the lungs. Children in the intervention group experienced
38 more symptom-free days over the course of the study than those in the control
“These results show that tailored interventions such as these may have a substantial
long-term impact on asthma symptoms and resource use among inner-city children,” says
NIEHS Director David A. Schwartz, M.D. “They may be particularly beneficial for
asthmatic children who are exposed to multiple allergens and lack the proper
access to quality health care.”
To evaluate the cost-effectiveness of the program, the researchers calculated
the direct costs of the services provided to each child, along with an estimate
of the symptom-free days gained as a result of the interventions. “The asthma
intervention resulted in an average increase of 37.8 symptom-free days over the
two-year period, at an estimated cost of $27.57 per symptom-free day,” says Dr.
“The findings of this study will enable policy makers and health care providers
to more effectively allocate resources to achieve maximum benefits,” says Peter
J. Gergen, M.D., M.P.H, of NIAID’s Division of Allergy, Immunology and Transplantation,
an author on the paper.
The study is part of the larger Inner-City Asthma Study, a multicenter project
created to evaluate the effectiveness of environmental interventions on asthma
incidence. The study participants included more than 900 children, ages 5 to
11, with moderate to severe asthma.
Most of the children were African American or Hispanic, living in low-income
sections of seven urban areas — the Bronx, Boston, Chicago, Dallas, Manhattan,
Seattle/Tacoma and Tucson. Each child had to be allergic to at least one common
indoor allergen, such as cockroach or house dust mite allergen.
News releases, fact sheets and other NIAID-related materials are available
on the NIAID Web site at http://www.niaid.nih.gov.
NIAID is a component of the National Institutes of Health, an agency of
the U.S. Department of Health and Human Services. NIAID supports basic and
applied research to prevent, diagnose and treat infectious diseases such as
HIV/AIDS and other sexually transmitted infections, influenza, tuberculosis,
malaria and illness from potential agents of bioterrorism. NIAID also supports
research on transplantation and immune-related illnesses, including autoimmune
disorders, asthma and allergies.
NIEHS, a component of the National Institutes of Health, supports research
to understand the effects of the environment on human health. For more information
about asthma, please visit our website at http://www.niehs.nih.gov/airborne/.
For more information on other environmental health topics, you may visit our
home page at www.niehs.nih.gov.
The National Institutes of Health (NIH) — The Nation's Medical Research
Agency — includes 27 Institutes and Centers and is a component of
the U. S. Department of Health and Human Services. It is the primary Federal
agency for conducting and supporting basic, clinical, and translational medical
research, and it investigates the causes, treatments, and cures for both common
and rare diseases. For more information about NIH and its programs, visit http://www.nih.gov.