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Effectiveness of Home-Based, Multi-Trigger, Multicomponent Interventions with an Environmental Focus for Reducing Asthma Morbidity

A Community Guide Systematic Review
  • Deidre D. Crocker
    Affiliations
    Air Pollution and Respiratory Health Branch, Division of Environmental Hazards and Health Effects, National Center for Environmental Health, National Center for Immunization and Respiratory Diseases, CDC, Atlanta, Georgia
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  • Stella Kinyota
    Affiliations
    Air Pollution and Respiratory Health Branch, Division of Environmental Hazards and Health Effects, National Center for Environmental Health, National Center for Immunization and Respiratory Diseases, CDC, Atlanta, Georgia
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  • Gema G. Dumitru
    Correspondence
    Address correspondence to: Gema Dumitru, MD, MPH, Community Guide Branch, Epidemiology and Analysis Program Office, the Office of Surveillance, Epidemiology and Laboratory Services, CDC, 1600 Clifton Road, MS E-69, Atlanta GA 30333
    Affiliations
    Air Pollution and Respiratory Health Branch, Division of Environmental Hazards and Health Effects, National Center for Environmental Health, National Center for Immunization and Respiratory Diseases, CDC, Atlanta, Georgia
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  • Colin B. Ligon
    Affiliations
    Air Pollution and Respiratory Health Branch, Division of Environmental Hazards and Health Effects, National Center for Environmental Health, National Center for Immunization and Respiratory Diseases, CDC, Atlanta, Georgia
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  • Elizabeth J. Herman
    Affiliations
    Air Pollution and Respiratory Health Branch, Division of Environmental Hazards and Health Effects, National Center for Environmental Health, National Center for Immunization and Respiratory Diseases, CDC, Atlanta, Georgia
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  • Jill M. Ferdinands
    Affiliations
    Influenza Division, National Center for Immunization and Respiratory Diseases, CDC, Atlanta, Georgia
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  • David P. Hopkins
    Affiliations
    Community Guide Branch, the Epidemiology and Analysis Program Office, the Office of Surveillance, Epidemiology and Laboratory Services, CDC, Atlanta, Georgia
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  • Briana M. Lawrence
    Affiliations
    Community Guide Branch, the Epidemiology and Analysis Program Office, the Office of Surveillance, Epidemiology and Laboratory Services, CDC, Atlanta, Georgia
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  • Theresa A. Sipe
    Affiliations
    Community Guide Branch, the Epidemiology and Analysis Program Office, the Office of Surveillance, Epidemiology and Laboratory Services, CDC, Atlanta, Georgia
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  • Task Force on Community Preventive Services

      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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