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New approaches are needed to encourage parents of children with asthma to reduce their exposure to household allergens

Asthma rates have increased in the past two decades and are highest among poor, urban, and minority populations. National asthma care guidelines highlight the importance of reducing indoor allergens and irritants that worsen childhood asthma. Unfortunately, exposure to household asthma triggers continues to be a significant problem, with few parents adopting environmental control measures to reduce allergen exposure, concludes a new study.

In a study of 638 children (ages 3 to 15 years) with asthma, 30 percent lived in households that included a smoker, 18 percent had household pests (cockroaches or mice), and 59 percent had furry pets. Other exposures included bedroom carpeting (78 percent), which increases exposure to dust mites. Most children did not have appropriate mattress covers (65 percent) or pillow covers (84 percent) to reduce exposure to dust mites.

Further discouraging news is that 45 percent of parents had received written instructions about avoiding asthma triggers—11 percent had received the instructions in the past year—and 42 percent had discussed household asthma triggers with a clinician in the past 6 months. Receipt of instructions about how to reduce environmental triggers was not associated with efforts to do so.

Some household asthma triggers closely linked to housing problems (for example, cockroaches and mold due to unrepaired leaks) may be difficult for families living in multi-unit buildings to change. Nevertheless, new methods for educating parents to reduce household exposure to asthma allergens and triggers should be sought and evaluated, concludes Kevin B. Weiss, M.D., M.P.H., of Northwestern University Medical School. Dr. Weiss is principal investigator of the Pediatric Asthma Care Patient Outcomes Research Team (PORT), which is supported in part by the Agency for Healthcare Research and Quality (HS08368).

In a recent study funded by AHRQ and the National Heart, Lung, and Blood Institute, Dr. Weiss and his colleagues assessed the prevalence of potential environmental triggers in the households of 638 children with asthma in three managed care practices, and they looked at whether prior parental education about trigger avoidance was associated with fewer such exposures.

See "Parent-reported environmental exposures and environmental control measures for children with asthma," by Jonathan A. Finkelstein, M.D., M.P.H., Anne Fuhlbrigge, M.D., M.S., Paula Lozano, M.D., M.P.H., and others, in the March 2002 Archives of Pediatric and Adolescent Medicine 156, pp. 258-264.

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