Home is Where the Triggers Are: Increasing Asthma Control by Improving the Home Environment

Abstract

Asthma remains the most common chronic condition of childhood. Strong evidence has linked exposure to allergens and other triggers commonly found in homes to allergen sensitization and asthma incidence and morbidity. A growing body of evidence has demonstrated that a home visit strategy that includes an environmental component that addresses multiple triggers through multiple interventions is effective. Such home visits reduce exposure to triggers, decrease symptoms and urgent health-care use, and increase quality of life. To make home visits widely available will require health-care payor reimbursement, government and health plan funding, training and certification of home visitors, and active referrals from health-care providers. However, a strategy based solely on education and behavior change is limited, because it cannot adequately reduce exposures due to adverse housing conditions. Therefore, approaches that address substandard housing are needed. These include remediation of existing housing and construction of new asthma-friendly homes. Most studies of remediation have made relatively narrow and focused improvements, such as insulation, heating, or ventilation. Outcomes have been mixed. Studies of new asthma-friendly homes are in their infancy, with promising pilot data. Further investigation is needed to establish the effectiveness of improving housing. A final strategy is improving housing quality through policy change, such as implementation of healthy housing guidelines for new construction, enhancement and increased enforcement of housing codes, and assuring smoke-free multi-unit homes. The combination of home visits, improved housing construction, and policy change has great potential for reducing the global burden of asthma.

The Economic Burden of Asthma in the United States, 2008–2013

“…Previous studies have shown that indoor and outdoor environmental pollution are major factors contributing to higher risk for asthma attacks and higher cost of asthma. People with lower incomes often live in places with higher concentrations of environmental asthma triggers (49)(50)(51)(52). On one hand, the results of this study suggest that poor people (with incomes ,100% of the poverty threshold) have significantly higher medical costs because of asthma than those with higher incomes.…”

Determinants of asthma control among children in Saudi Arabia

“…This was an independent association between sharing a bedroom and the level of asthma control, after controlling for household income and number of siblings, along with other covariates (Table 2). Sharing a bedroom is a measure of crowding [40], which has been reported to decrease asthma control [41]. The seemingly contradictory effects of increased number of siblings and sharing a bedroom can be partially explained by our data, which showed that in the low income group (less than SAR 15 000), there was a strong positive relationship between the number of siblings (0-1 versus 2-3 versus 4 and more) and the prevalence of sharing a bedroom (34.8% versus 84.4% versus 95%, p50.001), whereas in the high-income group (SAR 15 000 or more) there was only a marginally significant association (20.0% versus 35.1% versus 52.2%, p ¼ 0.066).…”

Impact of the Environment on Asthma Control

“…According to Krieger (2010), multitrigger, multicomponent interventions are more effective than single-component interventions. Davis, Gordon, and Burns (2011) proclaimed further that interventions for children with asthma must be comprehensive, and include not only caregivers and school staff, but also focus on symptom management and avoidance, or a reduction of environmental triggers.…”