Cabana M, Slish K, Lewis D, et al. J Allergy Clin Immunol. 2004;114:352–357
Purpose of the Study.
To assess the type and frequency of attempts by families to control environmental precipitants of asthma symptoms and their degree of consistency with current National Heart, Lung, and Blood Institute (NHLBI) asthma guidelines.
A nationwide sample of 896 children (ages 2–12 years) with asthma who had used asthma-related health care within the previous 2 years. Patients were selected randomly from the panels of 106 primary care clinicians participating in a trial to evaluate the effect of physician asthma education on health care utilization.
A cross-sectional, telephone-based survey was conducted. Respondents were asked open-ended questions to identify triggers for their child’s asthma and to describe specific actions taken to eliminate these triggers in the home. Demographic information regarding the patient (age, race, gender, type of insurance, and health care utilization for asthma within the last year) and the household (income, number of persons in the household, education of the caregiver) was collected. Specific queries were used to discern patient asthma severity, if smokers resided in the home, and if the family had received asthma education from their primary care manager. Actions to address asthma triggers were categorized as recommended, reasonable, neutral, or not recommended based on NHLBI recommendations.
Eighty percent of parents (717 of 896) could identify at least 1 asthma trigger (mean: 2.2; range: 0–9). Eighty-two percent (582 of 717) of these parents had attempted an environmental-control measure. Of the 1788 actions reported by these respondents, 51% were not likely to be useful for the specified trigger (eg, the purchase of an air filter when the environmental trigger reported would not likely be addressed by an air filter). Two hundred sixteen (24%) children lived with a smoker. Only 16 of these 216 families (7%) reported attempts to reduce or eliminate smoke exposure. No specific demographic characteristic predicted which parents were more likely to institute environmental controls. Characteristics positively associated with addressing triggers included receiving asthma education (odds ratio [OR]: 1.78; 95% confidence interval [CI]: 1.26, 2.52) and the number of primary care office visits in the last year (OR: 1.05; 95% CI: 1.00, 1.10).
More than half of the environmental modifications initiated by families are not consistent with current NHLBI guidelines. Despite the proven benefits of reducing tobacco-smoke exposure, few families reported any attempt to decrease smoke exposure. The lack of reliable correlation between an identifiable demographic group and environmental modification underscores the importance of education and encouragement in all families.
Physician contact and physician asthma education, rather than family education or finances, seemed to correlate with attempts at environmental modifications. However, it is unclear from this study if the modifications instituted were endorsed by physicians. The NHLBI guidelines describe tobacco smoke as the “most important environmental indoor irritant.” Tobacco smoke remains a difficult challenge. Continued effort by health care providers to encourage smoking cessation is essential.