Reduction in Asthma Morbidity in Children as a Result of Home Remediation Aimed at Moisture Sources

摘要

OBJECTIVE:Home dampness and the presence of mold and allergens have been associated with asthma morbidity.We examined changes in asthma morbidity in children as a result of home remediation aimed at moisture sources.DESIGN:In this prospective,randomized controlled trial,symptomatic,asthmatic children(n = 62),2-17 years of age,living in a home with indoor mold,received an asthma intervention including an action plan,education,and individualized problem solving.The remediation group also received household repairs,including reduction of water infiltration,removal of water-damaged building materials,and heating/ventilation/air-conditioning alterations.The control group received only home cleaning information.We measured children's total and allergen-specific serum immuno-globulin E,peripheral blood eosinophil counts,and urinary cotinine.Environmental dust samples were analyzed for dust mite,cockroach,rodent urinary protein,endotoxin,and fungi.The follow-up period was 1 year.RESULTS:Children in both groups showed improvement in asthma symptomatic days during the preremediation portion of the study.The remediation group had a significant decrease in symptom days(p = 0.003,as randomized;p = 0.004,intent to treat)after remodeling,whereas these parameters in the control group did not significantly change.In the postremediation period,the remediation group had a lower rate of exacerbations compared with control asthmatics(as treated:1 of 29 vs.11 of 33,respectively,p = 0.003;intent to treat:28.1% and 10.0%,respectively,p= 0.11).CONCLUSION:Construction remediation aimed at the root cause of moisture sources and combined with a medical/behavioral intervention significantly reduces symptom days and health care use for asthmatic children who live in homes with a documented mold problem.