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

Abstract

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.

Keywords:

• Urban asthma
• indoor exposures
• environmental control
• pediatric asthma

Disclosure statement

The authors report no conflict of interest.

Additional information

Funding

This work was supported by the following sources: Torie Grant - National Institutes of Health (NIH) grant no. K23AI159144 and the American Academy of Allergy, Asthma, and Immunology (AAAAI) Foundation Faculty Development Award; Meredith McCormack - NIH grant no. P50ES018176 and the U.S. Environmental Protection Agency (EPA) assistance agreement no. 83615201; Corrine Keet - NIH grant no. U01AI125290; Meghan Davis - NIH grant no. K01OD019918; and Elizabeth Matsui - NIH grant nos. K24AI114769, R01ES023447, and R01ES026170. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH, AAAAI, nor EPA.