Housing Interventions and Control of Asthma-Related Indoor Biologic Agents

Abstract

Subject matter experts systematically reviewed evidence on the effectiveness of housing interventions that affect health outcomes, primarily asthma, associated with exposure to moisture, mold, and allergens. Three of the 11 interventions reviewed had sufficient evidence for implementation: multifaceted, in-home, tailored interventions for reducing asthma morbidity; integrated pest management to reduce cockroach allergen; and combined elimination of moisture intrusion and leaks and removal of moldy items to reduce mold and respiratory symptoms. Four interventions needed more field evaluation, one needed formative research, and three either had no evidence of effectiveness or were ineffective. The three interventions with sufficient evidence all applied multiple, integrated strategies. This evidence review shows that selected interventions that improve housing conditions will reduce morbidity from asthma and respiratory allergies.

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

“…Over the past 2 decades, knowledge of how to reduce exposure to indoor asthma triggers has increased dramatically. 7,[30][31][32][33][34][35][36][37][38][39][40][41] Single-trigger interventions generally ineffective Initial approaches for reducing trigger exposure focused on individual triggers. They generally have had minimal to no success.…”

Community Asthma Initiative to Improve Health Outcomes and Reduce Disparities Among Children with Asthma

“…First, this evaluation was not a randomized controlled trial, and the contributions of individual components of the program to outcomes were not evaluated. However, national evidence indicates that a comprehensive approach is most effective to address asthma triggers and medication adherence (3)(4)(5)(6)(7)(8)(9). Second, 35% of respondents were lost to follow-up by parent report, and potential biases might have been introduced.…”

“…Furthermore, racial/ethnic disparities in asthma prevalence are substantial (1,2). Evidence from national randomized clinical trials (3)(4)(5)(6), previous models of culturally sensitive care (6)(7)(8)(9), and National Asthma Education and Prevention Program 2007 guidelines (10) indicates that comprehensive community-based approaches are highly effective in reducing environmental allergens, missed school days, and emergency department (ED) visits, as well as increasing symptom-free days. The Guide to Community Preventive Services also recommends home-based education and interventions to reduce home environmental triggers of asthma, as well as asthma education and social supports to improve outcomes for children with asthma (11,12).…”

Assessment of Environmental Cockroach Allergen Exposure

“…Public health practitioners strongly recommend the use of integrated pest management (IPM) to control cockroaches in both homes and schools [37][38][39]. Two recent studies, one in schools and the other in homes, incorporated IPM principles as part of an allergen avoidance strategy.…”