Reduction in Asthma Morbidity in Children as a Result of Home Remediation Aimed at Moisture Sources
Kercsmar, Carolyn M., Dearborn, Dorr G., Schluchter, Mark, Xue, Lintong, Kirchner, H. Lester, Sobolewski, John, Greenberg, Stuart J., Vesper, Stephen J., Allan, Terry, Environmental Health Perspectives
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 immunoglobulin 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.
KEY WORDS: asthma, children, damp housing, home remediation, indoor mold. Environ Health Perspect 114:1574-1580 (2006). doi:10.1289/ehp.8742 available via http://dx.doi.org/ [Online 25 April 2006]
Asthma is the single most common chronic disease of childhood, affecting > 3 million children in the United States. In addition, the burden of childhood asthma has increased over the past several decades despite the availability of excellent medications for controlling chronic symptoms and treating exacerbations. Moreover, asthma prevalence and morbidity are disproportionately high among inner-city children, most of whom are members of racial minorities. African-American children in the United States have a higher prevalence of asthma and greater morbidity as measured by acute care visits and hospitalizations compared with white children (Kattan et al. 1997; Mannino et al. 2002).
The role of the indoor environment in triggering and exacerbating asthma and other respiratory symptoms has been documented in several studies (Daisey et al. 2003; Engvall et al. 2001; Nafstad et al. 1998; Perry et al. 2003; Rosenstreich et al. 1997; Zock et al. 2002; Zureik et al. 2002). High exposures to dust mite, cockroach, and mold have all been implicated in producing respiratory illness, such as infections, cough, and wheeze. Home dampness and the presence of mold have also been associated with asthma, cough, and wheeze (Institute of Medicine 2004).
Dust mites, mold, and cockroach are indoor allergens and irritants related to home moisture content, and all are common in urban dwellings (Eggleston et al. 1999; Perry et al. 2003; Rosenstreich et al. 1997). High levels of indoor humidity promote the growth and survival of dust mites. Cockroaches can survive for long periods without food, as long as a water source, such as that from a leaky pipe, is available. Finally, growth of a number of indoor molds (Aspergillus species, Cladosporium, Penicillium, and Stachybotrys) may be promoted by high indoor humidity or water damage (Dales and Miller 1999). …