359 - Feasibility of a Home-Based Environmental Intervention in Central North Carolina Families Affected by Asthma

Millions of poor families live in substandard housing with limited means to maintain healthy indoor air quality (IAQ). Poor asthma control in US children is a major public health problem, commonly triggered by indoor allergens and pollutants. 

Objective: This pilot aims to assess feasibility and efficacy of a home-based environmental intervention (HEI) among at-risk Central North Carolina (NC) families.

Design/Methods:

We enrolled 21 children with poor asthma control from Duke Clinics in an open-label feasibility trial. Housing specialists completed 2 home visits (HV) to identify asthma triggers and provide HEI training. Families received high efficiency particulate air (HEPA)-filtered air purifier for child’s room, HEPA-filtered vacuum, hypoallergenic mattress/pillow covers, non-toxic pest control and cleaning products. Allergen sensitization (blood IgE >0.35 or wheal ≥ 3mm vs. control), blood eosinophils, asthma scores, and spirometry data were abstracted. IAQ (particulate matter PM2.5, PM10, total volatile organic compound (TVOC), and air quality index (AQI)) was measured at baseline and at ~4 weeks. Primary outcomes were study completion and satisfaction with the HEI. Secondary endpoints were asthma scores, change in IAQ, and spirometry.

Results:

The study is ongoing: 21 consented, 15 completed both HV 1 and 2, 7 completed the study; 10 active (3 awaiting HV 1, and 7 awaiting clinic visit 2); 4 lost to follow up. Of the 21, 13 (62%) were male and 15 (71%) were Black. More than 62% were on ≥2 asthma controller drugs. Mean baseline spirometry was normal: Forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV1) were 98 and 92% predicted, respectively. Allergen sensitization data was available for 20 (95%) participants: 17 (85%) sensitized to ≥1 aeroallergen and 15 (75%) sensitized to ≥1 indoor allergen (cat, dog, dust mite, cockroach, mouse, or mold). Blood eosinophil data were available for 17 (81%) participants with 6 (35%) having >500/μL. Home assessments revealed common triggers: pets (40%); pests (20%); mold/water damage (40%); structural damage (27%). More than 80% of families are engaged with study procedures. Post-intervention, asthma scores (Figure 1) and IAQ (Figure 2) trended towards improvement. All caregivers reported satisfaction with the HEI.

Conclusion(s):

Prevalence of indoor asthma triggers was high among at-risk NC children with asthma. This simple environment intervention is endorsed by families and shows trends toward improved asthma symptoms and IAQ. We plan to continue to assess changes in asthma healthcare use to advocate wider dissemination and payer support.