Asthma Control Begins at Home
October 21, 2004—The results of a new study indicate that reducing allergens in the home can significantly decrease symptoms of asthma in children, reports the New England Journal of Medicine (2004;351:1068–80).
Asthma is the most common chronic disease of childhood, affecting 4.8 million children in the US. Characterized by inflammation of the airways that causes attacks of wheezing, coughing, and difficult breathing, asthma is a serious condition that must be managed appropriately. Children are at an increased risk for developing asthma if other members of their families have asthma, eczema, or seasonal allergies. Exposure to tobacco smoke and certain inhalant allergens are also known to increase the risk of developing asthma. The most common inhalant allergens associated with asthma come from things frequently found in the home: dust mites, animal dander, and cockroaches. Asthma-related complications result in missed days of school for children, lost work time for caregivers, emergency visits to clinics and hospitals, and even death.
Asthma is typically managed through a combination of medications and by avoiding common allergens. However, previous studies have focused on controlling exposure to a single allergen, and because of their restricted focus have not always been successful. Medications used to treat asthma include corticosteroids such as fluticasone (Flovent™) that are taken to prevent asthma attacks and rescue medications such as albuterol (Proventil™) that are used at the onset of an attack. While they may help control asthma, corticosteroids are associated with slowed growth, skin thinning, and easy bruising. Albuterol may cause tremors and rapid heart beat.
The current study was designed to determine the effectiveness of an individually tailored allergen reduction program on the symptoms of asthma in urban children. Results were obtained from 869 children, aged 5 to 11, who were assigned to either an intervention group or a control group for one year. The intervention group families were given information and support regarding indoor allergen reduction, with emphasis on decreasing exposure to dust mites, cigarette smoke, cockroaches, pets, rodents, and mold. The plan was specifically tailored to address the particular exposures of each child based on the results of laboratory tests and surveys of the home environment. Each family in the intervention group was given a vacuum cleaner with a high-efficiency particle-arresting (HEPA) filter and allergen-impermeable covers for bedding. If necessary, a HEPA air filter was provided for the bedroom, and a cockroach-elimination treatment was performed. The control group did not receive information or tools necessary to decrease allergens in the home. Phone calls made to the participants’ caregivers assessed asthma symptoms, including the degree of wheezing, chest tightness, cough, nights of disturbed sleep, and the number of days the child had to slow down or discontinue play due to asthma. Surveys of the home environment and collection of dust for allergens were performed at the beginning of the study and at regular intervals thereafter. The children in the intervention group had significantly fewer asthma symptoms during the intervention period than did the control group, and this improvement lasted for the year following the intervention as well. There was a significant relationship between a decrease in the levels of allergens in the home and improvement in asthma symptoms. In particular, a decrease in the levels of cockroach and dust mite allergens was associated with fewer days with asthma symptoms, less hospitalizations, and fewer unscheduled clinic visits.
This is the first study to demonstrate the effectiveness of a multi-faceted approach to allergen reduction in the home for the control of asthma. The annual cost of the program is comparable to that of asthma medications and causes no side effects.
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Kimberly Beauchamp, ND, received her bachelor’s degree from the University of Rhode Island and her Doctorate of Naturopathic Medicine from Bastyr University in Kenmore, WA. She is a co-founder and practicing physician at South County Naturopaths, Inc., in Wakefield, RI. Dr. Beauchamp teaches holistic medicine classes and provides consultations focusing on detoxification and whole-foods nutrition.
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