Effective education of adults with asthma who are allergic to dust mites

Huss, Karen; Squire, Edward N.; Carpenter, Gary; Smith, Laurie; Huss, Richard W.; Salata, Konrad; Salerno, Maria; Agostinelli, Damien; Hershey, Joyce

doi:10.1016/0091-6749(92)90439-9

Cited by 70 publications

(39 citation statements)

References 17 publications

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“…911 Patients had mostly been recruited from asthma and chest clinics. The specific criteria for the diagnosis of asthma were mentioned only in four papers 11141725…”

Section: Resultsmentioning

confidence: 99%

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House dust mite control measures in the management of asthma: meta-analysis

Gøtzsche

Hammarquist

Burr

1998

BMJ

192

110

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Objective To determine whether patients with asthma who are sensitive to mites benefit from measures designed to reduce their exposure to house dust mite antigen in the home. Design Meta-analysis of randomised trials that investigated the effects on asthma patients of chemical or physical measures to control mites, or both, in comparison with an untreated control group. All trials in any language were eligible for inclusion. Subjects Patients with bronchial asthma as diagnosed by a doctor and sensitisation to mites as determined by skin prick testing, bronchial provocation testing, or serum assays for specific IgE antibodies. Main outcome measures Number of patients whose allergic symptoms improved, improvement in asthma symptoms, improvement in peak expiratory flow rate. Outcomes measured on different scales were combined using the standardised effect size method (the difference in effect was divided by the standard deviation of the measurements). Results 23 studies were included in the meta-analysis; 6 studies used chemical methods to reduce exposure to mites, 13 used physical methods, and 4 used a combination. Altogether, 41/113 patients exposed to treatment interventions improved compared with 38/117 in the control groups (odds ratio 1.20, 95% confidence interval 0.66 to 2.18). The standardised mean difference for improvement in asthma symptoms was − 0.06 (95% confidence interval − 0.54 to 0.41). For peak flow rate measured in the morning the standardised mean difference was − 0.03 ( − 0.25 to 0.19). As measured in the original units this difference between the treatment and the control group corresponds to − 3 l/min (95% confidence interval − 25 l/min to 19 l/min). The results were similar in the subgroups of trials that reported successful reduction in exposure to mites or had long follow up times. Conclusion Current chemical and physical methods aimed at reducing exposure to allergens from house dust mites seem to be ineffective and cannot be recommended as prophylactic treatment for asthma patients sensitive to mites.

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“…911 Patients had mostly been recruited from asthma and chest clinics. The specific criteria for the diagnosis of asthma were mentioned only in four papers 11141725…”

Section: Resultsmentioning

confidence: 99%

“…Six studies used chemical methods to reduce exposure to mites, 91112161724 13 used physical methods, 5 – 8131518 – 222526 and four used a combination of methods. 10111423 Five studies did not assess the reduction of the population of mites 615182226.…”

Section: Resultsmentioning

confidence: 99%

House dust mite control measures in the management of asthma: meta-analysis

Gøtzsche

Hammarquist

Burr

1998

BMJ

192

110

View full text Add to dashboard Cite

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“…Effective house dust mite allergen avoidance will never be achieved using a single control measure; various methods are required to affect the multiple factors that facilitate high indoor allergen levels. Education of patients and their families also seems an important component of environmental control strategies [74]. This study suggests that a farming environment and rural lifestyle might be associated with unknown protective factors impacting the prevalence of allergies.…”

Section: Discussionmentioning

confidence: 97%

Dust mite allergens: Mitigation and control

Fernández-Caldas¹

2002

Curr Allergy Asthma Rep

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In recent years, greater attention has been given to the role of indoor allergens as a cause of sensitization and allergic respiratory diseases. Although indoor allergen control measures to reduce symptoms in individuals allergic to mites have produced controversial results, environmental allergen avoidance is today one of the four primary goals of asthma management recommended in several guidelines of asthma treatment. Exposure to high indoor aeroallergen levels, especially to house dust mite allergens, is an important environmental risk factor for allergic sensitization and the subsequent development and exacerbation of asthma. Therefore, effective aeroallergen avoidance is of use to prevent and treat allergic diseases. Although endotoxin exposure may be protective in early life, it has been demonstrated that the inhalation of endotoxin may exacerbate asthma in house dust mite sensitized patients. Mite-allergic asthmatic patients should be aware of the dangerous combination of mite allergen exposure associated with high endotoxin levels in house dust. These two immunologically active substances have been associated with severe asthma and seasonal exacerbation of symptoms. Effective house dust mite allergen avoidance will never be achieved using a single control measure; various methods are required to affect the multiple factors that facilitate high indoor allergen levels. Education of the patients and their families is also an important component of environmental control strategies.

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“…The final, overall compliance with environmental control measures increased by 11.1%, which was lower than the 15% predicted in the study and also lower than that reported in international studies, in which compliance ranged from 17% to 39%, as previously mentioned. (10)(11) The objective of the prospective design was to make possible the direct, in locus observation of each item studied. However, smoking in the home was registered as reported to the health agents during the visits and could not be truly confirmed.…”

Section: Discussionmentioning

confidence: 99%

“…In two controlled clinical studies, (10)(11) researchers found rates of compliance of 17% and 39%, respectively. In another study (12) evaluating 57 children and adolescents between the ages of 1 and 18 with hard-to-control asthma, a smoker in the home was found to be an aggravating factor (present in 40% of the cases evaluated).…”

Section: Introductionmentioning

confidence: 99%

Adesão às medidas de controle ambiental em lares de crianças e adolescentes asmáticos

2006

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Objective: To determine, through home visits, the rate of compliance with environmental control measures in the homes of children with asthma. Methods: This study involved 98 asthma patients between the ages of 4 and 15. The parents of those children and adolescents received instruction in how to carry out environmental control measures and were encouraged to perform such measures continuously for a period of 90 days. Home visits, which included direct inspection of the domicile and administration of a questionnaire, were made before and after this 90-day period. In cases of noncompliance, parents were asked to explain why they did not carry out the control measures. Statistical analysis was performed using the McNemar test. Results: Overall compliance with the various items studied was 11.1%, ranging from -4.1% (for curtain control, p = 0.63) to 22.6% (for stuffed toys, p < 0.001). Passive smoking was reduced to 9.7% (p = 0.02). Among the families studied, the mean monthly income was 2.5 times the national minimum wage. When asked why they had not adopted the recommended measures, noncompliant parents gave, among others, the following explanations: "economic hardship" (60.1%); "the measures were too difficult to carry out" (6.1%); "nonparticipation of the father" (4%); and "lack of time on the part of the mother" (4%). Conclusion: Environmental control measures were carried out sporadically, possibly reflecting the influence of socioeconomic and cultural factors.

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Effective education of adults with asthma who are allergic to dust mites

Cited by 70 publications

References 17 publications

House dust mite control measures in the management of asthma: meta-analysis

House dust mite control measures in the management of asthma: meta-analysis

Dust mite allergens: Mitigation and control

Adesão às medidas de controle ambiental em lares de crianças e adolescentes asmáticos

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