Context
Asthma exacerbations are commonly triggered by exposure to allergens and irritants
within the home. The purpose of this review was to evaluate evidence that interventions
that target reducing these triggers through home visits may be beneficial in improving
asthma outcomes. The interventions involve home visits by trained personnel to conduct
two or more components that address asthma triggers in the home. Intervention components
focus on reducing exposures to a range of asthma triggers (allergens and irritants)
through environmental assessment, education, and remediation.
Evidence acquisition
Using methods previously developed for the Guide to Community Preventive Services, a systematic review was conducted to evaluate the evidence on effectiveness of home-based,
multi-trigger, multicomponent interventions with an environmental focus to improve
asthma-related morbidity outcomes. The literature search identified over 10,800 citations.
Of these, 23 studies met intervention and quality criteria for inclusion in the final
analysis.
Evidence synthesis
In the 20 studies targeting children and adolescents, the number of days with asthma
symptoms (symptom-days) was reduced by 0.8 days per 2 weeks, which is equivalent to
21.0 symptom-days per year (range of values: reduction of 0.6 to 2.3 days per year);
school days missed were reduced by 12.3 days per year (range of values: reduction
of 3.4 to 31.2 days per year); and the number of asthma acute care visits were reduced
by 0.57 visits per year (interquartile interval: reduction of 0.33 to 1.71 visits
per year). Only three studies reported outcomes among adults with asthma, finding
inconsistent results.
Conclusions
Home-based, multi-trigger, multicomponent interventions with an environmental focus
are effective in improving overall quality of life and productivity in children and
adolescents with asthma. The effectiveness of these interventions in adults is inconclusive
due to the small number of studies and inconsistent results. Additional studies are
needed to (1) evaluate the effectiveness of these interventions in adults and (2)
determine the individual contributions of the various intervention components.
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Article Info
Footnotes
Author affiliation is shown for the time research was conducted.
The names and affiliations of the Task Force members are listed at the front of this supplement and at www.thecommunityguide.org/about/task-force-members.html.
Identification
Copyright
Published by Elsevier Inc.
