Comprehensive home environmental intervention did not reduce allergen concentrations or controller medication requirements among children in Baltimore.

Autor:	Grant TL; Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA.; Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA., McCormack MC; Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA., Peng RD; Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA., Keet CA; Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA.; Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC, USA., Rule AM; Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA., Davis MF; Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA., Newman M; Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA.; Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA., Balcer-Whaley S; Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA.; Department of Population Health, Dell Medical School, The University of Texas at Austin, Austin, TX, USA., Matsui EC; Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA.; Department of Population Health, Dell Medical School, The University of Texas at Austin, Austin, TX, USA.
Jazyk:	angličtina
Zdroj:	The Journal of asthma : official journal of the Association for the Care of Asthma [J Asthma] 2023 Mar; Vol. 60 (3), pp. 625-634. Date of Electronic Publication: 2022 Jun 03.
DOI:	10.1080/02770903.2022.2083634
Abstrakt:	Objective: To determine if the addition of home environmental control strategies (ECSs) to controller medication titration reduces asthma controller medication requirements and in-home allergen concentrations among children with persistent asthma in Baltimore City. Methods: 155 children ages 5-17 with allergen-sensitized asthma were enrolled in a 6-month randomized clinical trial of multifaceted, individually-tailored ECS plus asthma controller medication titration compared to controller medication titration alone. Participants had to meet criteria for persistent asthma and have had an exacerbation in the previous 18 months. Allergen sensitization (mouse, cockroach, cat, dog, dust mite) was assessed at baseline and home dust allergen concentrations were measured at baseline, 3 and 6 months. ECS was delivered 3-4 times over the trial. Asthma controller medication was titrated using a guidelines-based algorithm at baseline, 2, 4, and 6 months. The primary outcome was controller medication treatment step at 6 months (0-6, as-needed albuterol to high-dose ICS + LABA). Results: The population was predominately Black (90%), on public insurance (93%), and male (61%). The mean age was 10.1 years (SD 3.3). More than 70% were sensitized to a rodent, >50% to cockroach, and 70% were polysensitized. At 6 months, there were no differences in either treatment step (3.8 [SD 1.4] vs. 3.7 [SD 1.5]) or allergen concentrations between groups. Conclusion: Among this predominantly low-income, Black pediatric asthma population, the addition of ECS to controller medication titration reduced neither indoor allergen concentrations nor controller medication requirements compared to controller medication titration alone.
Databáze:	MEDLINE
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