Results of a home-based environmental intervention among urban children with asthma. House dust mite allergen avoidance and self-management in allergic patients with asthma: randomised controlled trial. Effects on patients with asthma of eradicating visible indoor mould: a randomised controlled trial Clinical evaluation of the effect of anti-allergic mattress covers in patients with moderate to severe asthma and house dust mite allergy: a randomised double blind placebo controlled study Reduction in Asthma Morbidity in Children as a Result of Home Remediation Aimed at Moisture Sources Effect of an Integrated Pest Management Intervention on Asthma Symptoms Among Mouse-Sensitized Children and Adolescents With Asthma: A Randomized Clinical Trial Clinical effects of purified air administered to the breathing zone in allergic asthma: A double-blind randomized cross-over trial. Allergen avoidance in house dust mite sensitive adult asthma. Clinical effects of air cleaners in homes of asthmatic children sensitized to pet allergens. Individualized Household Allergen Intervention Lowers Allergen Level But Not Asthma Medication Use: A Randomized Controlled Trial. A single intervention for cockroach control reduces cockroach exposure and asthma morbidity in children Double blind trial of ionisers in children with asthma sensitive to the house dust mite. Effect of a change to mite-free bedding on children with mite-sensitive asthma: a controlled trial. Using qualitative comparative analysis in a systematic review of a complex intervention Eradication of house dust mite from homes of atopic asthmatic subjects: a double-blind trial. House dust mite allergen levels and an anti‐mite mattress spray (natamycin) in the treatment of childhood asthma Clinical effects of air filters in homes of asthmatic adults sensitized and exposed to pet allergens Preventing Severe Asthma Exacerbations in Children. A Randomized Trial of Mite‐Impermeable Bedcovers Effect of mattress and pillow encasings on children with asthma and house dust mite allergy. Impact of a household environmental intervention delivered by lay health workers on asthma symptom control in urban, disadvantaged children with asthma. Encasing bedding in covers made of microfine fibers reduces exposure to house mite allergens and improves disease management in adult atopic asthmatics House dust mite barrier bedding for childhood asthma: randomised placebo controlled trial in primary care [ISRCTN63308372] Effect of a bed covering system in children with asthma and house dust mite hypersensitivity. Effects of anti-mite measures on children with mite-sensitive asthma: a controlled trial. Home intervention in the treatment of asthma among inner-city children. The effect of high-efficiency and standard vacuum-cleaners on mite, cat and dog allergen levels and clinical progress. ANTI-MITE MEASURES IN MITE-SENSITIVE ADULT ASTHMA: A Controlled Trial Efficacy of the acaricide: acardust for the prevention of asthma and rhinitis due to dust mite allergy, in children. Evaluation of Community Action Against Asthma: A Community Health Worker Intervention to Improve Children's Asthma-Related Health by Reducing Household Environmental Triggers for Asthma Outcomes of a home-based environmental remediation for urban children with asthma. Clinical effectiveness of a mite allergen-impermeable bed-covering system in asthmatic mite-sensitive patients. Environmental intervention for house dust mite control in childhood bronchial asthma Continuous avoidance measures with or without acaricide in dust mite-allergic asthmatic children. The Seattle-King County Healthy Homes Project: a randomized, controlled trial of a community health worker intervention to decrease exposure to indoor asthma triggers. Encasement of Bedding Does Not Improve Asthma in Atopic Adult Asthmatics Allergen‐avoidance measures in homes of house‐dust‐mite‐allergic asthmatic patients: effects of acaricides and mattress encasings Does a multifaceted environmental intervention alter the impact of asthma on inner-city children? The respiratory effects of reduction of mite allergen in the bedrooms of asthmatic children — a double‐blind controlled trial Effects of house dust mite avoidance measures on Der p 1 concentrations and clinical condition of mild adult house dust mite‐allergic asthmatic patients, using no inhaled steroids A randomized controlled trial of asthma self-management support comparing clinic-based nurses and in-home community health workers: the Seattle-King County Healthy Homes II Project. Allergen reduction measures in houses of allergic asthmatic patients: effects of air-cleaners and allergen-impermeable mattress covers. Dust mite allergen avoidance in the treatment of hospitalized children with asthma. Effect of application of benzyl benzoate on house dust mite allergen levels. A randomized controlled trial of mite allergen‐impermeable bed covers in adult mite‐sensitized asthmatics Preventive Measures in Mite Asthma Mechanical ventilation and high-efficiency vacuum cleaning: A combined strategy of mite and mite allergen reduction in the control of mite-sensitive asthma. Effect of pet removal on pet allergic asthma. Benzyl-benzoate foam: effects on mite allergens in mattress, serum and nasal secretory IgE to Dermatophagoides pteronyssinus, and bronchial hyperreactivity in children with allergic asthma. House dust mite avoidance for children with asthma in homes of low-income families. A randomized clinical trial to reduce asthma morbidity among inner-city children: results of the National Cooperative Inner-City Asthma Study. CONTROLLED TRIAL OF AN ELECTROSTATIC PRECIPITATOR IN CHILDHOOD ASTHMA Asthma outcomes workshop: overview. The Breathe-Easy Home: the impact of asthma-friendly home construction on clinical outcomes and trigger exposure.
BACKGROUND Children with asthma who live in the inner city are exposed to multiple indoor allergens and environmental tobacco smoke in their homes . Reductions in these triggers of asthma have been difficult to achieve and have seldom been associated with decreased morbidity from asthma . The objective of this study was to determine whether an environmental intervention tailored to each child 's allergic sensitization and environmental risk factors could improve asthma-related outcomes . METHODS We enrolled 937 children with atopic asthma ( age , 5 to 11 years ) in seven major U.S. cities in a r and omized , controlled trial of an environmental intervention that lasted one year ( intervention year ) and included education and remediation for exposure to both allergens and environmental tobacco smoke . Home environmental exposures were assessed every six months , and asthma-related complications were assessed every two months during the intervention and for one year after the intervention . RESULTS For every 2-week period , the intervention group had fewer days with symptoms than did the control group both during the intervention year ( 3.39 vs. 4.20 days , P<0.001 ) and the year afterward ( 2.62 vs. 3.21 days , P<0.001 ) , as well as greater declines in the levels of allergens at home , such as Dermatophagoides farinae ( Der f1 ) allergen in the bed ( P<0.001 ) and on the bedroom floor ( P=0.004 ) , D. pteronyssinus in the bed ( P=0.007 ) , and cockroach allergen on the bedroom floor ( P<0.001 ) . Reductions in the levels of cockroach allergen and dust-mite allergen ( Der f1 ) on the bedroom floor were significantly correlated with reduced complications of asthma ( P<0.001 ) . CONCLUSIONS Among inner-city children with atopic asthma , an individualized , home-based , comprehensive environmental intervention decreases exposure to indoor allergens , including cockroach and dust-mite allergens , result ing in reduced asthma-associated morbidity BACKGROUND The efficacy of bed covers that are impermeable to house dust mites has been disputed . AIM The aim of the present study was to investigate whether the combination of ' house dust mite impermeable ' covers and a self-management plan , based on peak flow values and symptoms , leads to reduced use of  inhaled corticosteroids  ( ICS ) than self-management alone . DESIGN OF STUDY Prospect i ve , r and omised , double blind , placebo-controlled trial . SETTING Primary care in a south-eastern region of the Netherl and s. METHOD Asthma patients aged between 16 and 60 years with a house dust mite allergy requiring ICS were r and omised to intervention and placebo groups . They were trained to use a self-management plan based on peak flow and symptoms . After a 3-month training period , the intervention commenced using house dust mite impermeable and placebo bed covers . The follow-up period was 2 years . Primary outcome was the use of ICS ; secondary outcomes were peak expiratory flow parameters , asthma control , and symptoms . RESULTS One hundred and twenty-six patients started the intervention with house dust mite impermeable or placebo bed covers . After 1 and 2 years , significant differences in allergen exposure were found between the intervention and control groups ( P<0.001 ) . No significant difference between the intervention and control groups was found in the dose of ICS ( P = 0.08 ) , morning peak flow ( P = 0.52 ) , peak flow variability ( P = 0.36 ) , dyspnoea ( P = 0.46 ) , wheezing ( P = 0.77 ) , or coughing ( P = 0.41 ) . There was no difference in asthma control between the intervention and control groups . CONCLUSION House dust mite impermeable bed covers combined with self-management do not lead to reduced use of ICS compared with self-management alone Background : It is not clear whether associations between respiratory symptoms and indoor mould are causal . A r and omised controlled trial was conducted to see whether asthma improves when indoor mould is removed . Methods : Houses of patients with asthma were r and omly allocated into two groups . In one group , indoor mould was removed , fungicide was applied and a fan was installed in the loft . In the control group , intervention was delayed for 12 months . Question naires were administered and peak expiratory flow rate was measured at baseline , 6 months and 12 months . Results : Eighty-one houses were allocated to the intervention group and 83 to the control group ; 95 participants in 68 intervention houses and 87 in 63 control houses supplied follow-up information . Peak expiratory flow rate variability declined in both groups , with no significant differences between them . At 6 months , significantly more of the intervention group showed a net improvement in wheeze affecting activities ( difference between groups 25 % , 95 % CI 3 % to 47 % ; p = 0.028 ) , perceived improvement of breathing ( 52 % , 95 % CI 30 % to 74 % ; p<0.0001 ) and perceived reduction in medication ( 59 % , 95 % CI 35 % to 81 % ; p<0.0001 ) . By 12 months the intervention group showed significantly greater reductions than the controls in preventer and reliever use , and more improvement in rhinitis ( 24 % , 95 % CI 9 % to 39 % ; p = 0.001 ) and rhinoconjunctivitis ( 20 % , 95 % CI 5 % to 36 % ; p = 0.009 ) . Conclusions : Although there was no objective evidence of benefit , symptoms of asthma and rhinitis improved and medication use declined following removal of indoor mould . It is unlikely that this was entirely a placebo effect Background : The use of anti-allergic mattress covers in patients with asthma can result in a large reduction in the level of house dust mite allergen in dust sample s. Apart from a reduction in histamine induced bronchial hyperresponsiveness , there are few data on the effect of mattress covers on clinical efficacy and quality of life in patients with moderate to severe asthma . Methods : Thirty patients with asthma and house dust mite allergy were studied in a r and omised , double blind , placebo controlled study . Before and after using anti-allergic covers for 1 year , dust was collected from the mattresses to determine concentrations of Dermatophagoides pteronyssinus ( Der p 1 ) , and bronchial hyperresponsiveness and quality of life were measured . The patients scored their symptoms ( lungs and nose ) , morning and evening peak flow values , and rescue medication for 14 days before and after the intervention period . Results : There was a significant reduction in the concentration of Der p 1 in the dust collected from the mattresses in the actively treated group after 1 year compared with before treatment ; no change was found in the placebo group . In both the actively treated and placebo groups there was no significant improvement in PC20 histamine . Quality of life improved similarly in both groups . The symptom score of the lower airways did not significantly change in either group . A significant decrease in nasal symptom score was seen in the actively treated group compared with before treatment , but there was no significant difference between the groups . No changes in morning and evening peak flow values , peak flow variability , nor in the use of rescue medication were found in either group . Conclusion : The use of anti-allergic mattress covers results in significant reductions in Der p 1 concentrations in carpet-free bedrooms . However , in patients with moderate to severe asthma , airways hyperresponsiveness and clinical parameters are not affected by this effective allergen avoidance 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 aim ed at moisture sources . Design In this prospect i ve , r and omized 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 material s , and heating/ventilation/air-conditioning alterations . The control group received only home cleaning information . We measured children ’s total and allergen-specific serum immuno-globulin E , peripheral blood eosinophil counts , and urinary cotinine . Environmental dust sample s 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 r and omized ; 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 aim ed 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 Importance Professionally delivered integrated pest management ( IPM ) interventions can reduce home mouse allergen concentrations , but whether they reduce asthma morbidity among mouse-sensitized and exposed children and adolescents is unknown . Objective To determine the effect of an IPM intervention on asthma morbidity among mouse-sensitized and exposed children and adolescents with asthma . Design , Setting , and Participants R and omized clinical trial conducted in Baltimore , Maryl and , and Boston , Massachusetts . Participants were mouse-sensitized and exposed children and adolescents ( aged 5 - 17 years ) with asthma r and omized to receive professionally delivered IPM plus pest management education or pest management education alone . Enrollment occurred between May 2010 and August 2014 ; the final follow-up visit occurred on September 25 , 2015 . Interventions Integrated pest management consisted of application of rodenticide , sealing of holes that could serve as entry points for mice , trap placement , targeted cleaning , allergen-proof mattress and pillow encasements , and portable air purifiers . Infestation was assessed every 3 months , and if infestation persisted or recurred , additional treatments were delivered . All participants received pest management education , which consisted of written material and demonstration of the material s needed to set traps and seal holes . Main Outcomes and Measures The primary outcome was maximal symptom days defined as the highest number of days of symptoms in the previous 2 weeks among 3 types of symptoms ( days of slowed activity due to asthma ; number of nights of waking with asthma symptoms ; and days of coughing , wheezing , or chest tightness ) across 6 , 9 , and 12 months . Results Of 361 children and adolescents who were r and omized ( mean [ SD ] age , 9.8 [ 3.2 ] years ; 38 % female ; 181 in IPM plus pest management education group and 180 in pest management education alone group ) , 334 were included in the primary analysis . For the primary outcome , there was no statistically significant between-group difference for maximal symptom days across 6 , 9 , and 12 months with a median of 2.0 ( interquartile range , 0.7 - 4.7 ) maximal symptom days in the IPM plus pest management education group and 2.7 ( interquartile range , 1.3 - 5.0 ) maximal symptom days in the pest management education alone group ( P = .16 ) and a ratio of symptom frequencies of 0.86 ( 95 % CI , 0.69 - 1.06 ) . Conclusions and Relevance Among mouse-sensitized and exposed children and adolescents with asthma , an intensive year-long integrated pest management intervention plus pest management education vs pest management education alone result ed in no significant difference in maximal symptom days from 6 to 12 months . Trial Registration clinical trials.gov Identifier : BACKGROUND Exposure to inhaled allergens is a pathogenetic factor in allergic asthma . However , most studies that previously looked at air cleaning devices have shown little or no effect on patients with perennial allergic asthma . AIMS AND OBJECTIVES We examined a novel treatment using temperature regulated laminar airflow with a very low particle concentration directed to the breathing zone of teenagers and young adults with mild to moderate allergic asthma during night sleep . We hypothesised that the decreased allergen exposure during the night would have an effect on bronchial inflammation and quality of life . METHOD Twenty-two patients ( mean 18.8 years ) were r and omized to start with active or placebo treatment for 10 weeks . All patients received both active and placebo treatment with unfiltered air , with a 2-week wash-out period in between treatments . Maintenance treatment with inhaled corticosteroids was unaltered during the trial period . Health related quality of life ( miniAQLQ ) was the primary effectiveness measure . Exhaled nitric oxide ( FeNO ) and spirometry were also investigated . RESULTS Active treatment result ed in an improved miniAQLQ compared to placebo ( mean score 0.54 , p<0.05 , n=20 ) . An effect on bronchial inflammation was also detected with significantly lower FeNO values during the active treatment period ( mean -6.95 ppb , p<0.05 , n=22 ) . Both effects were evident after 5 weeks . The change in lung function was not statistically significant . CONCLUSION Clean air , administered directly to the breathing zone during sleep , can have a positive effect on bronchial inflammation and quality of life in patients with perennial allergic asthma Fifty adult asthmatic patients with strongly positive skinprick tests to the house dust mite were admitted into a prospect i ve r and omised controlled trial of house dust mite avoidance in the community . Twenty-two of the experimental group completed one year of dust avoidance and 19 of these tolerated the use of plastic mattress and pillow covers .  Twenty of the control group ( who did not alter their housecleaning habits ) also completed one year of study . A fall in mite and dust levels was noted in the homes of the experimental but not the control group . Fifteen of the experimental group who completed the study were strongly RAST positive ( score 3 or more ) to the house dust mite . These patients had a significant improvement in FEV1/FVC , PEFR , PC20 , use of treatment , and symptom score at one year , whilst the seven experimental patients who were not strongly RAST positive ( score 2 or less ) did not , suggesting that the change noted in the former patients was not merely due to a placebo effect . Fifteen of the control group who completed the study were also strongly RAST positive for the house dust mite and these patients showed no change in any of the parameters . This study demonstrates that adult asthmatic patients can successfully carry out house dust eradication procedures in the community over a long period of time , and that those patients who are allergic to the house dust mite appear to have both subjective and objective improvement in their asthma BACKGROUND Exposure to cat and dog allergens is very common in the Western World and is a serious cause of asthma in sensitized subjects . OBJECTIVE We sought to study the clinical effects of air cleaners in living rooms and bedrooms of asthmatic children sensitized to cat or dog allergens . METHODS Twenty asthmatic children sensitized to pet allergens ( cat/dog ) and with an animal at home participated in a double-blind , placebo-controlled , cross-over study in which the effects of air cleaners placed in the living room and bedroom for 3 months were compared with the effects of sham air cleaners . Before and after each study period , lung function , airway hyperresponsiveness ( adenosine monophosphate ) , and peak flow variation were recorded . Cat and dog allergen levels were assessed in the filters of the air cleaners . RESULTS After a 3-month intervention with active air cleaners , airway hyperresponsiveness decreased significantly , showing a 1.2 doubling dose increase of PC(20 ) adenosine ( P = .003 ) . Peak flow amplitude also decreased ( P = . 045 ) . Substantial amounts of airborne cat and dog allergen were captured by the air cleaners in living rooms and bedrooms as well . Allergen levels in floor dust were not changed . CONCLUSION In young asthmatic patients sensitized and exposed to pets in the home , application of air cleaners in living rooms and bedrooms was accompanied by a significant improvement in airway hyperresponsiveness and a decrease in peak flow amplitude BACKGROUND Environmental exposures to indoor allergens are major contributors to asthma symptoms , particularly in inner cities . The effectiveness of household allergen reduction as an adjunct to National Asthma Education Prevention Program guideline -based pharmacologic therapy in asthma has not been prospect ively studied . OBJECTIVE To study the effect of individualized allergen reduction on ability to reduce asthma pharmacologic therapy over 40 weeks . METHODS We performed a r and omized controlled trial to determine the effect of multifaceted indoor allergen avoidance measures on the ability to reduce  asthma controller therapy in adults and children residing in New York City who were both sensitized and exposed to at least 1 indoor allergen . Asthma treatment and control were optimized in all subjects before r and omization . RESULTS A total of 125 subjects were r and omized to receive individualized household allergen reduction and 122 received a sham intervention .  Subjects in the intervention group significantly reduced all measured allergen levels ( cat , dog , dust mite allergens in the bedroom , cockroach and mouse allergens in the kitchen and bedroom ) ; those in the control group reduced only dust mite and mouse allergens in the bedroom and cockroach allergen in the kitchen . Participants in the intervention arm reduced  National Asthma Education Prevention Program-based therapy  from step 4.4 at r and omization to 3.50 postintervention ( range , 0 - 6 ) ; participants in the control arm reduced medication from step 4.4 to 3.4 ( P = .76 ) . There were no differences in other measured asthma outcomes . CONCLUSIONS Targeted allergen avoidance measures do not allow for reduction in asthma pharmacologic therapy compared with usual care in patients already receiving optimal controller therapy Background Exposure to cockroaches is an important asthma trigger , particularly for children with asthma living in inner cities . Integrated pest management is the recommended approach to cockroach abatement ; however , it is costly and difficult to implement . The impact of reducing cockroach exposure on asthma outcomes is not known . Objective We sought to test the use of a single intervention , insecticidal bait , to reduce cockroach exposure in the home of children with asthma in New Orleans and to examine the impact of cockroach reduction on asthma outcomes . Methods One hundred two children aged 5 to 17 years with moderate to severe asthma were enrolled in a 12‐month r and omized controlled trial testing the use of insecticidal bait on cockroach counts and asthma morbidity . Homes were visited 6 times and asthma symptoms were assessed every 2 months . Results After adjustment , intervention homes had significantly fewer cockroaches than did control homes ( mean change in cockroaches trapped , 13.14 ; 95 % CI , 6.88‐19.39 ; P < .01 ) . Children in control homes had more asthma symptoms and unscheduled health care utilization in the previous 2 weeks ( 1.82 , 95 % CI , 0.14‐3.50 , P = .03 ; 1.17 , 95 % CI , 0.11‐2.24 , P = .03 , respectively ) and a higher proportion of children with FEV1 of less than 80 % predicted ( odds ratio , 5.74 ; 95 % CI , 1.60‐20.57 ; P = .01 ) compared with children living in intervention homes . Conclusions Previous research has demonstrated improvement in asthma health outcomes using multifaceted interventions . The strategic placement of insecticidal bait , which is inexpensive , has low toxicity , and is widely available , result ed in sustained cockroach elimination over 12 months and was associated with improved asthma outcomes . This single intervention may be an alternative to multifaceted interventions currently recommended to improve asthma morbidity BACKGROUND Manufacturers of ionisers cl aim many benefits from the use of their devices , including the relief of asthma . Particles removed from the air are likely to include airborne allergens , so ionisers may achieve an effect by reducing the allergen load . METHODS The effect of ionisers on airborne concentrations of house dust mite allergen Der p I was investigated in a double blind , crossover , placebo controlled trial in the homes of 20 children with allergic asthma . Subjects recorded their peak expiratory flow rate ( PEFR ) twice daily and completed a daily symptom score and treatment schedule on a diary card for two six week periods , one with an active ioniser and the other with a placed ioniser ( r and omly allocated ) used in the living room and the bedroom . RESULTS Airborne Der p I concentrations fell significantly during the active period compared with the placebo period , but there was no significant change in PEFR , symptom scores , or treatment usage . There was an increase in night time cough which almost reached significance during the active period . CONCLUSIONS This study indicates that the use of ionisers can not be recommended in the homes of asthmatic subjects to improve their symptoms . The significant reduction of airborne allergen concentrations may be of use as part of a multidevice allergen avoidance regimen , but the increase in night time cough requires further study Twenty-one children with mite-sensitive asthma took part in a crossover r and omised controlled trial of mite-free bedding . Each child was issued with a new sleeping bag and pillow for a month , and twice-daily peak flow readings were compared with those obtained during a month in the child 's ordinary bedding . Seventeen of the children had higher mean peak flow readings during the period in the mite-free bedding ( p < 0.01 ) . The overall improvement was only modest , however , and some mites had appeared in most of the bedding by the end of the trial . New bedding may be helpful to patients with mite-sensitive asthma , but methods are needed to prevent colonisation by mites Background Systematic review s evaluating complex interventions often encounter substantial clinical heterogeneity in intervention components and implementation features making synthesis challenging . Qualitative comparative analysis ( QCA ) is a non-probabilistic method that uses mathematical set theory to study complex phenomena ; it has been proposed as a potential method to complement traditional evidence synthesis in review s of complex interventions to identify key intervention components or implementation features that might explain effectiveness or ineffectiveness . The objective of this study was to describe our approach in detail and examine the suitability of using QCA within the context of a systematic review . Methods We used data from a completed systematic review of behavioral interventions to improve medication adherence to conduct two substantive analyses using QCA . The first analysis sought to identify combinations of nine behavior change techniques/components ( BCTs ) found among effective interventions , and the second analysis sought to identify combinations of five implementation features ( e.g. , agent , target , mode , time span , exposure ) found among effective interventions . For each substantive analysis , we reframed the review ’s research questions to be design ed for use with QCA , calibrated sets ( i.e. , transformed raw data into data used in analysis ) , and identified the necessary and /or sufficient combinations of BCTs and implementation features found in effective interventions . Results Our application of QCA for each substantive analysis is described in detail . We extended the original review findings by identifying seven combinations of BCTs and four combinations of implementation features that were sufficient for improving adherence . We found reasonable alignment between several systematic review steps and processes used in QCA except that typical approaches to study abstract ion for some intervention components and features did not support a robust calibration for QCA . Conclusions QCA was suitable for use within a systematic review of medication adherence interventions and offered insights beyond the single dimension stratifications used in the original completed review . Future prospect i ve use of QCA during a review is needed to determine the optimal way to efficiently integrate QCA into existing approaches to evidence synthesis of complex interventions BACKGROUND House dust mite ( HDM ) allergens can accumulate to very high levels in homes . From the observed sensitivity of HDMs to heat and their allergens to steam , a novel treatment of furnishings has been developed . OBJECTIVE We sought to determine whether combined steam and heat treatment of home furnishings reduced asthmatic patients ' bronchial hyperreactivity ( BHR ) and lowered HDM antigen loads . METHODS The homes of 30 asthmatic subjects aged 18 to 45 years were r and omly allocated into 3 groups . In groups 1 and 2 mattresses and duvets were treated with hot air ( 110 degrees C ) , followed by steam and then heat again . All their carpets were steam cleaned . Group 2 also had a special ventilation system installed above each patient 's bedroom . The homes of subjects in group 3 were sham treated . Neither patient nor laboratory staff was aware of the types of treatment . Der p 1 and 2 levels in the household dust from the lounge , bedroom carpet , and beds were determined before and after treatment and then at 6 and 12 months . BHR , measured by using histamine PD(20 ) values , was recorded during the 4-week run-in period and at 3 , 6 , 9 , 12 months after treatment . RESULTS Active heat-steam treatment of homes caused a sustained reduction of Der p 1 ( P = .003 ) and Der p 2 ( P = .001 ) compared with no change in sham-treated group 3 homes . Patients whose homes were treated showed a 4-fold reduction in BHR at 9 months in group 1 and throughout the posttreatment period in group 2 . No change was observed in the asthmatic subjects whose homes were not treated . These improvements were sustained for 12 months in the homes with bedroom ventilation units . CONCLUSIONS A single treatment of home furnishings reduced mite allergen load to below the risk level for sensitization and improved the asthmatic patients '  BHR by 4-fold Natamycin , a fungicide marketed as Tymasil , is cl aim ed to reduce house dust mite numbers and would therefore be expected to improve asthma in children with mite sensitivity . We have tested this assertion by a double‐blind , placebo‐controlled trial . There was no significant effect on levels of Der p I in mattress dust between active and placebo groups at the end of the spraying period . Histamine inhalation challenge PC20 , clinic visit symptom scores and lung function tests reflecting either large or small airways obstruction were also unchanged . Therefore this product is not a therapeutic option for mite‐allergic patients using the manufacturer 's recommended dose and method of administration . Other factors influencing the Der p I levels were also investigated . Of these , only month of measurement and bedroom wall humidity showed any association Background Despite medical advice , many pet‐allergic asthma sufferers refuse to remove the pet to which they are sensitized from their home & NA ; Rationale : Allergen exposure in sensitized individuals with asthma interacts with viruses to increase the risk of asthma exacerbation . Objectives : To evaluate the use of house dust mite‐impermeable bedding and its impact on severe asthma exacerbations in children . Methods : We r and omized mite‐sensitized children with asthma ( ages 3‐17 yr ) after an emergency hospital attendance with an asthma exacerbation to receive mite‐impermeable ( active group ) or control ( placebo group ) bed encasings . Measurements and Main Results : Over a 12‐month intervention period , the occurrence of severe asthma exacerbations was investigated . Of 434 children with asthma who consented , 286 ( mean age , 7.7 yr ; male sex , 65.8 % ) were mite sensitized , and 284 were r and omized ( 146 to the active group and 138 to the placebo group ) . At 12 months , significantly fewer children in the active group than in the placebo group had attended the hospital with an exacerbation ( 36 [ 29.3 % ] of 123 vs. 49 [ 41.5 % ] of 118 ; P = 0.047 ) . In the multivariable analysis , the risk of emergency hospital attendance was 45 % lower in the active group ( hazard ratio , 0.55 ; 95 % confidence interval [ CI ] , 0.36‐0.85 ; P = 0.006 ) than in the placebo group . The annual rate of emergency hospital attendance with exacerbations was 27 % lower in the active group than in the placebo group , but this did not reach significance ( estimated marginal mean [ 95 % CI ] , active , 0.38 [ 0.26‐0.56 ] vs. placebo , 0.52 [ 0.35‐0.76 ] ; P = 0.18 ) . No difference between the groups in the risk of prednisolone use for exacerbation was found ( hazard ratio , 0.82 ; 95 % CI , 0.58‐1.17 ; P = 0.28 ) . Conclusions : Mite‐impermeable encasings are effective in reducing the number of mite‐sensitized children with asthma attending the hospital with asthma exacerbations but not the number requiring oral prednisolone . This simple measure may reduce the health care burden of asthma exacerbations in children . Clinical trial registered with www.is rct n.com ( IS RCT N 69543196 ) BACKGROUND House dust mite ( HDM ) allergy is a frequent cause of allergic asthma in children . Reduction of exposure seems to be the most logical way to treat these patients . OBJECTIVE Our aim was to investigate whether mattress and pillow encasings result ed in an effective long-term control of HDM allergen levels , thereby reducing the need for asthma medication in children with asthma and HDM allergy . METHODS In a prospect i ve , double-blind , placebo-controlled study 60 children ( age range , 6 - 15 years ) with asthma and HDM allergy were r and omized to active ( allergy control ) or placebo mattress and pillow encasings . After a 2-week baseline period , follow-up was performed every 3 months for 1 year . During the entire study period , the dose of inhaled steroids was tapered off to the lowest effective dose according to well-defined criteria . RESULTS Fifty-two patients completed the trial , and 5 were excluded , leaving data from 47 children ( 26 in the active treatment group and 21 in the placebo group ) for analysis . A significant perennial reduction in HDM allergen concentrations was seen only for the active treatment group . Also , a significant decrease in the dose of inhaled steroids ( mean , 408 to 227 microg/d ; P < .001 ) was found for the active treatment group only , with significant differences between groups after 9 and 12 months . After 1 year , the dose of inhaled steroids was reduced by at least 50 % in significantly more children in the active treatment group than in the placebo group ( 73 % vs 24 % , P < .01 ) . CONCLUSION Encasing of mattresses and pillows result ed in a significant long-term reduction in HDM allergen concentrations in mattresses and in the need for inhaled steroids in children with asthma and HDM allergy OBJECTIVES We examined whether a home-based educational and environmental intervention delivered by lay health educators would improve asthma symptom control in inner-city children with asthma . METHODS Children 2 to 16 years of age with diagnosed asthma and at least 1 asthma-related hospitalization or 2 emergency visits in the prior year were r and omly assigned into 2 groups ( immediate and delayed intervention ) in a crossover study . Each group participated in the active phase ( intervention ) and the inactive phase . Outcomes included asthma symptoms , albuterol use , emergency department visits , hospitalizations , and trigger reduction . RESULTS A total of 264 primarily Black ( 94 % ) children were enrolled . The mean number of emergency visits decreased by 30 % and inpatient visits decreased by 53 % ( P < .001 ) after the intervention . Reductions were seen in pests , presence of carpets in bedrooms , and dust . Nighttime wheezing was significantly reduced after the intervention in both groups ( P < .001 ) . CONCLUSIONS Lay health educators effectively reduced asthma triggers and increased caregiver asthma knowledge , which result ed in reduced emergency department visits , hospitalizations , and asthma symptoms . The relationships formed between the caregivers and the lay health educators appeared to positively impact asthma outcomes in this disadvantaged population Background Studies of avoidance of exposure to group 1 allergens of the Dermatophagoides group ( Der p 1 ) have not yielded consistent improvements in adult asthma through avoidance . We explored whether the use of pillow and bed covers and allergen-avoidance counseling result ed in Der 1-level reduction , as measured by enzyme-linked immunosorbent assay , and thus improved asthma symptoms in adult patients . Methods Twenty-five adult patients with moderate or severe atopic asthma were r and omized into intervention and control groups . Intervention patients slept on pillows and mattresses or futons encased in microfine-fiber covers and were counseled in allergen avoidance through bedroom cleaning . Control patients received neither special covers nor counseling . In the period August to October in 2009 ( pre-intervention ) and 2010 ( post-intervention ) , dust sample s were collected in open Petri dishes placed in bedrooms for 2 weeks and by rapid lifting of dust from bedding and skin using adhesive tape on the morning of 1 day of Petri dish placement . We examined the associations between changes in Der 1 level ( as measured by enzyme-linked immunosorbent assay ) and clinical symptom score , minimum % peak expiratory flow , and fraction of exhaled nitric oxide . Results Der 1 allergen levels on the mattress/futon covers and near the floor of the bedrooms of intervention patients , but not controls , were lower in 2010 than in 2009 . From 2009 to 2010 , asthma symptom scores decreased significantly , and minimum % peak expiratory flow increased significantly , in intervention patients . The fall in Der p 1 concentration was correlated with a reduction in the fraction of exhaled nitric oxide . Conclusions Minimization of Der 1 allergen exposure by encasing pillows and mattresses or futons and receiving counseling on avoiding exposure to indoor allergens improved asthma control in adult patients Background The house dust mite is the most important environmental allergen implicated in the aetiology of childhood asthma in the UK .  Dust mite barrier bedding is relatively inexpensive , convenient to use , and of proven effectiveness in reducing mattress house dust mite load , but no studies have evaluated its clinical effectiveness in the control of childhood asthma when dispensed in primary care . We therefore aim ed to evaluate the effectiveness of house dust mite barrier bedding in children with asthma treated in primary care . Methods Pragmatic , r and omised , double-blind , placebo controlled trial conducted in eight family practice s in Engl and . Forty-seven children aged 5 to 14 years with confirmed house dust mite sensitive asthma were r and omised to receive six months treatment with either house dust mite barrier or placebo bedding .  Peak expiratory flow was the main outcome measure of interest ; secondary outcome measures included asthma symptom scores and asthma medication usage . Results No difference was noted in mean monthly peak expiratory flow , asthma symptom score , medication usage or asthma consultations , between children who received active bedding and those who received placebo bedding . Conclusions Treating house dust mite sensitive asthmatic children in primary care with house dust mite barrier bedding for six months failed to improve peak expiratory flow . Results strongly suggest that the intervention made no impact upon other clinical features of asthma Allergen avoidance is regarded as an important approach to management of atopic asthma . The effect of Intervent bed covering systems on house dust mite ( HDM ) allergen exposure , asthma symptoms and markers of inflammation was investigated in 31 HDM sensitive asthmatic children . Dust concentrations of Dermatophagoides pteronyssinus allergen 1 ( Der p 1 ) were monitored before and after covering the mattress , duvet and pillow with active and placebo covers for 3 months , in a single-blind , cross-over trial . Twice daily peak expiratory flow rate ( PEFR ) , daily symptom scores and treatment schedule were recorded . Bronchial hyperresponsiveness was monitored by histamine challenge ( provocative concentration of histamine causing a 20 % fall in forced expiratory volume in one second ( PC20 ) ) , and inflammation by measuring eosinophil cationic protein ( ECP ) , eosinophil protein X ( EPX ) , eosinophil peroxidase ( EPO ) , and soluble interleukin-2 receptor ( sIL-2R ) in serum . There was a significant reduction in Der p 1 when the mattress , duvet and pillow were covered with the active bedding . There was no significant improvement in symptoms of asthma , PEFR , bronchodilator usage of PC20 . Also , ECP , EPX , sIL-2R concentrations did not change for either treatment . EPO concentrations were significantly lower in the active compared to the placebo period . The active bed covers reduced retrievable Dermatophagoides pteronyssinus allergen 1 ( Der p 1 ) from the bedding , with short term clinical benefit Mite counts and tests for mite antigen were performed on sample s of dust taken from the bedding of 53 children with mite-sensitive asthma . The sample s from damp houses and the beds or enuretic children had markedly more mites and mite-antigen than those from dry houses . although the predominant species was usually Dermatophagoides pteronyssinus , some of the beds in the damp houses were heavily infested with another pyroglyphid mite Euroglyphus maynei , so that this was the species found in the greatest numbers . D pteronyssinus antigen was found to be correlated broadly with the total mite count , but more antigen was present for a given number of mites in the mattresses than in the blankets . The children were r and omly allocated into two groups , one of which carried out rigorous anti-mite measures . The amounts of dust and mite antigen were reduced , though not the numbers of mites . Peak flow readings were monitored in the two groups for eight weeks and a final assessment made by a paediatrician who was unaware of the allocation of each patient in the trial . No significant differences emerged in the progress of the two groups , both tending to improve . Measures design ed to remove mites from bedding do not greatly benefit the majority of children with mite-sensitive asthma BACKGROUND In Atlanta , as in other major urban areas of the United States , asthma is a leading cause of school absenteeism , emergency department use , and hospitalization . Recent guidelines for asthma management recommend reducing exposure to relevant allergens , but neither the feasibility nor the efficacy of this form of treatment has been established for children living in poverty . OBJECTIVE We sought to investigate allergen avoidance as a treatment for asthma among inner-city children . METHODS One hundred four children with asthma living in the city of Atlanta were enrolled into a controlled trial of avoidance without being skin tested . The children were r and omized to an active avoidance group , a placebo avoidance group , and a second control group for which no house visits occurred until the end of the first year . Avoidance included bed and pillow covers , hot washing of bedding , and cockroach bait .  Eighty-five children completed the study , and the outcome was measured as unscheduled clinic visits , emergency department visits , and hospitalization for asthma , as well as changes in mite and cockroach allergen levels . RESULTS There was a significant decrease in acute visits for asthma among children whose homes were visited ( P < .001 ) . However , there was no significant difference between the active and placebo homes either in the effect on asthma visits or in allergen concentrations . When the children with mite allergy were considered separately , there was a significant correlation between decreased mite allergen and change in acute visits ( P < .01 ) . The avoidance measures  for cockroach allergen appeared to be ineffective , and the changes observed did not correlate with changes in visits . CONCLUSIONS Applying allergen avoidance as a treatment for asthma among children living in poverty is difficult because of multiple sensitivities and problems applying the protocol s in this environment . The current results demonstrate that home visiting positively influences the management of asthma among families living in poverty . Furthermore , the results for children with mite allergy strongly suggest that decreasing relevant allergen exposure should be an objective of treatment in this population The major triggers for allergic asthma are exposure to allergens of the house dust mite , Dermatophagoides pteronyssinus , and of pets . Unfortunately studies of techniques design ed to reduce house dust mite and pet allergens have had mixed results . However , new so-called ' improved ' products continue to appear on the market and require subjective evaluation . The homes of 60 house dust mite-allergic patients were studied to compare the effects of high-efficiency and st and ard vacuum-cleaners on allergen concentration . Der p 1 ( house dust mite ) , Fel d 1 ( cat ) and Can f 1 ( dog ) allergens were measured in four separate locations in each home . Clinical analysis was by lung function , bronchodilator usage and histamine challenge techniques . There was a significant reduction in Fel d 1 ( ng/m2 ) in dust sample s from the living-room carpet ( p = 0.046 ) , bedroom carpet ( p = 0.003 ) and mattress ( p = 0.013 ) and living-room sofa ( p = 0.005 ) after 12 months of using the high-efficiency cleaners , but only in the mattress sample using the st and ard cleaners ( p = 0.014 ) . Can f 1 ( ng/g dust ) was reduced in the mattress sample after using the high-efficiency vacuum-cleaners ( p = 0.028 ) , but not at other sites . Der p 1 levels were not significantly changed over this period . Clinical ly , patients in the high-efficiency group showed improvements in peak expiratory flow rate ( PEFR ) ( p = 0.004 ) , FEV1 ( p = 0.026 ) and bronchodilator usage ( p = 0.005 ) after 12 months . When the cat-sensitive patients were analyzed separately , improvements in histamine PC20 ( p = 0.039 ) were also seen . Reducing Fel d 1 concentrations , in the absence of any change in Der p 1 concentrations , can produce significant improvements in the lung function of atopic , asthmatic patients . This effect was primarily achieved in those patients with cat sensitivity , but who did not possess a cat themselves A cross-over controlled trial has been conducted among 32 adult patients with mite-sensitive asthma . The bedclothes and pillows of each subject were laundered and vacuum-cleaned and a plastic cover applied to the mattress for six weeks in an attempt to reduce exposure to mites . No improvement in daily peak-flow reading or drug usage was found in comparison with a control period A double blind , r and omized , comparative study versus placebo , was done during 6 months in 32 children , aged 4 - 12 years , who suffer from either allergic asthma or rhinitis or both , slept in a bedroom rich in dust mite , have well documented allergy solely to house dust mite ( H.D.M. ) , and a condition severe enough to require continuous medication . After thorough cleaning , their bedrooms were sprayed on day 0 and day 90 with the total content of a canister containing either Acardust or Placebo . Rooms were cleaned regularly throughout the study period . Each child completed an individual daily score card ( scales from 0 - 3 ) for asthma , and rhinitis symptoms , medication taken , and any additional symptoms . Peak flow was recorded twice weekly . All the children were examined every month ( at the clinic ) when also PFF , FEVI , doctor 's and patient 's opinion of clinical symptoms were recorded according to the same scale ( 0 - 3 ) and dust sample s from child 's bedroom were examined for H.D.M. antigen content . At day 0 , 90 and 180 , total IgE and dust mite specific IgE determination was done . At the end of the study , patient 's and doctor 's opinion about the spray 's efficacy were recorded on a scale from 0 - 3 . The results were in favor of Acardust for asthma , according to patient 's opinion ( p = 0.001 ) , doctor 's opinion ( p = 0.04 ) and individual score cards ( p = 0.03 ) , and for nasal secretion ( p = 0.01 ) , sneezing and lacrimation ( p = 0.02 ) ; concurrent medication dropped significantly ( p = 0.01 ) in the Acardust group . No side-effects were reported . We consider Acardust a safe and valuable preventive treatment in H.D.M. allergy This article describes the evaluation of a community-based participatory research ( CBPR ) community health worker ( CHW ) intervention to improve children 's asthma-related health by reducing household environmental triggers for asthma . After r and omization to an intervention or control group , 298 households in Detroit , Michigan , with a child , aged 7 to 11 , with persistent asthma symptoms participated . The intervention was effective in increasing some of the measures of lung function ( daily nadir Forced Expiratory Volume at one second [ p = .03 ] and daily nadir Peak Flow [ p = .02 ] ) , reducing the frequency of two symptoms ( “ cough that wo n't go away , ” “ coughing with exercise ” ) , reducing the proportion of children requiring unscheduled medical visits and reporting inadequate use of asthma controller medication , reducing caregiver report of depressive symptoms , reducing concentrations of dog allergen in the dust , and increasing some behaviors related to reducing indoor environmental triggers . The results suggest a CHW environmental intervention can improve children 's asthma-related health  , although the pathway for improvement is complex CONTEXT Increasing urban asthma prevalence and severity is found among minority , underserved population s. Improving asthma self-management includes home management of complex medical protocol s as well as environmental trigger removal . OBJECTIVE To study the effectiveness of a low-cost approach to improve control of asthma symptoms in an urban population through lay educators who promote a generalized approach to asthma trigger avoidance in the bedrooms of children with asthma . DESIGN AND PATIENTS Prospect i ve , r and omized controlled trial with two arms : historical controls and matched controls for each subject . SUBJECTS Two-hundred-eighty-one patients living in an urban environment , r and omized to receive home visits only ( n = 128 ) or home visits with environmental remediation ( n = 153 ) . One-hundred-fifteen controls matched according to age , gender and ethnicity did not receive any intervention . INTERVENTIONS In-home education visits covered asthma physiology , asthma trigger avoidance and asthma management . Environmental remediation was conducted together with the caregiver . OUTCOMES Primary outcomes include length of hospital stay , number of emergency visits and number of sick visits . Secondary outcomes are symptom frequency , medication management and trigger reduction . RESULTS Both intervention groups experienced reduction of hospitalizations , emergency room visits , sick visits and asthma symptoms . Both groups showed outcomes significantly superior to the matched control group . Intervention effectively reduced the presence of rodents and carpet in home and increased the use of mattress and pillow covers . CONCLUSIONS This study shows that low-cost in-home education and environmental remediation improve outcomes for children with asthma .  Lay educators can deliver effective asthma-specific education that results in improved asthma control BACKGROUND Exposure to allergens plays a role in the development of bronchial hyperresponsiveness and in the chronic inflammatory response seen in asthmatic patients . House dust mites ( HDMs ) are an important source of allergen . Reduction of these allergens might lead to better lung function and reduction of asthma symptoms . OBJECTIVE The effect of HDM-impermeable covers on HDM allergen levels , peak flow values , and asthma symptoms were measured . Therefore a r and omized clinical trial was carried out . METHODS Fifty-two allergic asthmatic patients were r and omly allocated to use the HDM-impermeable or placebo covers . During the study period , daily peak flow and asthma symptom scores were recorded . Dust sample s were taken from the mattresses . RESULTS We observed a significant reduction in HDM allergen levels on the mattresses after encasing them with HDM-impermeable covers ( reduction of 87 % of Der p 1 in micrograms per gram of dust ; P < .001 ) . Baseline symptoms were so low that no improvement could be established . Morning peak expiratory flow is significantly higher in the intervention group compared with that seen in the placebo group during the study period ( beta=20.2 ; P < .01 ) . CONCLUSIONS HDM-impermeable covers significantly decreased the level of HDM allergens . Furthermore , morning peak flow was significantly increased during the intervention period . This study indicates that HDM allergen-avoidance measures might have beneficial effects on allergen reduction and asthma outcome Objectives This study was carried out to determine the effectiveness of physical and chemical environmental control measures for house dust mites ( HDM ) in controlling bronchial asthma in children . Methods A total of 160 asthmatic children who were sensitized to HDM underwent clinical and environmental assessment .  The children were r and omly allocated into one of four groups according to the intervention ( chemical , physical , both chemical and physical , none ) and the effectiveness of the intervention was assessed at 8 and 16 weeks . Results The group for which physical control measures were used showed significant improvement in all outcome measures , including mean differences of forced expiratory volume after 1 s ( FEV1 ) and peak expiratory flow rate ( PEFR ) , which were 2.05 % and 4.65 l/min , respectively , at the 8-week follow-up evaluation . The percentage of severe asthma decreased from 45 to 22 % . Similar results were obtained for the group with both chemical ( tannic acid ) and physical interventions ( p < 0.05 for all measures ) . In the group where tannic acid was used as a chemical measure , the number of children with moderate and severe asthma decreased from 15 in each category to 11 and 7 , respectively . In the control group , only the mean difference of PEFR ( 1.62 l/min ) was significant after 16 weeks . Despite these promising findings , only the FEV1 was significantly different ( p = 0.014 ) when the four groups were compared . Conclusions Based on these results , we conclude that simple physical control measures have the potential to contribute to the control of asthma symptoms in asthmatic children sensitized to HDM allergen BACKGROUND Improvement in the quality of life in the Western world and increased time spent indoors by children have enhanced the spread of house dust mites and increased the exposure time for sensitive children . Also , exposure to house dust mites in infancy and subsequent development of childhood asthma have been clinical ly linked . Recently , new acaricides have been developed . OBJECTIVE To test the efficacy of the new acaricide ( esdepallethin and piperonyl butoxide--"Acardust " ) combined with environmental control compared with continuous house dust mite avoidance measures . METHOD Forty-six house dust mite-allergic , asthmatic children were evaluated for 6 months in a prospect i ve , r and omized , double-blind , and placebo-controlled study . Patients were r and omly allocated to active and placebo acaricide treatment combined with avoidance measures , whereas only continuous avoidance measures were taken in the third group . Symptom score , medication usage , and peak flow measurements were recorded daily . The amount of house dust mite allergen in the dust vacuumed from the bedrooms was also measured . RESULTS Morning and evening peak expiratory flow rates and forced expiratory volume in one second remained unchanged throughout the study period . In all groups , the symptom scores improved significantly , whereas the amount of house dust mite allergen decreased significantly at the end of the trial . CONCLUSIONS Continuous house dust mite avoidance measures have a significant positive effect on the symptomology of children with mild or moderate asthma . " Acardust " combined with continuous house dust mite avoidance measures is not more effective than continuous house dust mite avoidance measures alone in the treatment of house dust mite-allergic , asthmatic children OBJECTIVES We assessed the effectiveness of a community health worker intervention focused on reducing exposure to indoor asthma triggers . METHODS We conducted a r and omized controlled trial with 1-year follow-up among 274 low-income households containing a child aged 4 - 12 years who had asthma .  Community health workers provided in-home environmental assessment s , education , support for behavior change , and re sources . Participants were assigned to either a high-intensity group receiving 7 visits and a full set of re sources or a low-intensity group receiving a single visit and limited re sources . RESULTS The high-intensity group improved significantly more than the low-intensity group in its pediatric asthma caregiver quality -of-life score ( P=.005 ) and asthma-related urgent health services use ( P=.026 ) . Asthma symptom days declined more in the high-intensity group , although the across-group difference did not reach statistical significance ( P=.138 ) . Participant actions to reduce triggers generally increased in the high-intensity group . The projected 4-year net savings per participant among the high-intensity group relative to the low-intensity group were 189 - 721 dollars . CONCLUSIONS Community health workers reduced asthma symptom days and urgent health services use while improving caregiver quality -of-life score . Improvement was greater with a higher-intensity intervention Aim : We evaluated the impact of impermeable bed covers on asthma in asthmatics with clinical ly relevant house dust mite ( HDM ) sensitization . Methods : The study included 32 HDM-sensitized asthmatics in whom HDM allergy was considered as a significant factor in their asthma . They were r and omized into either an intervention group whose bedding was encased with impermeable covers , or a control group who received cotton covers . Before and 3 and 6 months after encasement , dust sample s were collected from the bedding and assayed for Der p 1 . Clinical outcomes included quality of life , lung function , bronchial reactivity to methacholine , symptoms , medications and peak flow rates . Results : Baseline Der p 1 levels in both the active and the placebo groups were comparable and high ( 19.2 vs 18.9 µg/g of dust ) . There was a significant reduction in Der p 1 levels in the active group after 6 months , but not in the placebo group ( 7.3 vs 21.9 µg/g of dust ) . Quality of life improved significantly in both the intervention and control groups , but there was no significant difference in the improvements between the groups . There was no significant change in lung function , symptoms , and requirements for medications . Conclusions : Encasement of bedding significantly reduced the Der p 1 levels . However , this was not sufficient to produce worthwhile clinical improvement in those in whom dust mite avoidance might well have been recommended as part of their clinical management This double‐blind , placebo‐controlled study investigated whether the application of an acaricide ( Acarosan ® ) on mattresses and on textile floor coverings in living rooms and bedrooms can contribute to improvement in lung function and airway hyperresponsiveness in 40 adult asthmatic patients sensitized to house‐dust mite . In a second group of 19 patients who refused chemical intervention , the clinical effects of application of allergen‐impermeable mattress encasings were studied . In all three treatment groups , Der p 1 levels in mattress dust were statistically significantly decreased after 12 months . However , this decrease was much greater in the group who received mattress encasings ( final mean level 430 ng/g ) than in groups with acaricide‐ or placebo‐treated mattresses ( final mean levels 1730 and 2100 ng/g , respectively ) . Treatment of textile floors with either Acarosan or placebo chemical caused a statistically significant decrease in the level of the house‐dust‐mite allergen Der p 1 in floor dust . In the group with mattress encasings , no significant changes of floor dust Der p 1 were found . Airway hyperresponsiveness ( as measured by the PC20 histamine ) improved significantly in the mattress cover group after 6 months . The Acarosan group also showed a small but statistically significant improvement after 12 months OBJECTIVE To evaluate the impact of a multifaceted environmental and educational intervention on the indoor environment and health in 5 - 12-year-old children with asthma living in urban environments . DESIGN Changes in indoor allergen levels and asthma severity measurements were compared between children who were r and omized to intervention and delayed intervention groups in a 14-month prospect i ve field trial . Intervention group households received dust mite covers , a professional house cleaning , and had roach bait and trays placed in their houses . RESULTS Of 981 eligible children , 410 ( 42 % ) were enrolled ; 161 ( 40 % ) completed baseline activities and were r and omized : 84 to intervention and 77 to delayed intervention groups . At the study 's end , dust mite levels were 163 % higher than at baseline for the delayed intervention group . Overall asthma severity scores did not change . However , the median functional severity score ( FSS ) component of the severity score improved more in the intervention group ( 33 % vs. 20 % ) than in the delayed intervention group . At the study 's end , the median FSSs for the intervention group improved 25 % compared with the delayed intervention group , ( p<0.01 ) . Differences between groups for medication use , emergency department ( ED ) visits or hospitalization were not significant . CONCLUSIONS Despite low retention , the intervention result ed in decreased dust mite allergen levels and increased FSSs among the intervention group . The interventions probably contributed to the improvements , especially among the more severely affected children . This study highlights the complexities of design ing and assessing the outcomes from a multifaceted asthma intervention Background Inhalation of house dust mite ( HDM ) allergen may provoke attacks of asthma Exposure to house dust mite ( HDM ) allergens often results in worsening of asthma . Therefore , avoidance of exposure to HDM allergens is often proposed . Unfortunately , the most effective and feasible avoidance strategy is still not completely assessed . Consequently , we investigated the effects of a combined HDM avoidance strategy on HDM allergen concentrations and clinical condition of allergic , mild asthmatic , patients using no inhaled steroids OBJECTIVE To compare the marginal benefit of in-home asthma self-management support provided by community health workers ( CHWs ) with st and ard asthma education from clinic-based nurses . DESIGN R and omized controlled trial . SETTING Community and public health clinics and homes . PARTICIPANTS Three hundred nine children aged 3 to 13 years with asthma living in low-income households . INTERVENTIONS All participants received nurse-provided asthma education and referrals to community re sources . Some participants also received CHW-provided home environmental assessment s , asthma education , social support , and asthma-control re sources . OUTCOME MEASURES Asthma symptom-free days , Pediatric Asthma Caretaker Quality of Life Scale score , and use of urgent health services . RESULTS Both groups showed significant increases in caretaker quality of life ( nurse-only group : 0.4 points ; 95 % confidence interval [ CI ] , 0.3 - 0.6 ; nurse + CHW group : 0.6 points ; 95 % CI , 0.4 - 0.8 ) and number of symptom-free days ( nurse only : 1.3 days ; 95 % CI , 0.5 - 2.1 ; nurse + CHW : 1.9 days ; 95 % CI , 1.1 - 2.8 ) , and absolute decreases in the proportion of children who used urgent health services in the prior 3 months ( nurse only : 17.6 % ; 95 % CI , 8.1%-27.2 % ; nurse + CHW : 23.1 % ; 95 % CI , 13.6%-32.6 % ) . Quality of life improved by 0.22 more points in the nurse + CHW group ( 95 % CI , 0.00 - 0.44 ; P = .049 ) . The number of symptom-free days increased by 0.94 days per 2 weeks ( 95 % CI , 0.02 - 1.86 ; P = .046 ) , or 24.4 days per year , in the nurse + CHW group . While use of urgent health services decreased more in the nurse + CHW group , the difference between groups was not significant . CONCLUSION The addition of CHW home visits to clinic-based asthma education yielded a clinical ly important increase in symptom-free days and a modest improvement in caretaker quality of life Recommendations for allergen avoidance or allergen reduction measures play an important part in the treatment of allergic asthmatic patients . The purpose of this study was to test recently developed air-cleaners with respect to their capacity to capture airborne allergen particles and to improve clinical parameters of asthmatic patients sensitized to aeroallergens . Forty five allergic asthmatic patients were studied in a double-blind procedure for 6 months . The patients were divided into three groups of 15 patients . In Group 1 , the intervention consisted of the application of active air-cleaners in living-rooms and bedrooms . In Group 2 , placebo air-cleaners were used in combination with allergen-impermeable mattress covers . In Group 3 , the same intervention was performed as in Group 2 but with active air-cleaners .  Allergen levels in mattress and floor dust were measured before , and 3 and 6 months after the interventions . After 6 months , the air-cleaners were dismantled and the filters were analysed for the amount of dust collected and allergen content . Immunological and lung function parameters were measured before , and 3 and 6 months after the interventions . Considerable amounts of airborne dust and allergenic particles were captured in the filters of the air-cleaners . Up to the 18.9 g of dust , 4,513 ng of house dust mite allergen , Der p 1 , and 50,000 mU of cat allergen , Fel d 1 , ( in houses with cats ) were collected by air-cleaners in living-rooms . Only in Group 3 ( in which both active air-cleaners and mattress covers were used ) was a small ( less than 1 doubling dose ) but statistically significant improvement of provocative concentration of histamine causing a 20 % fall in forced expiratory volume in one second ( PC20 ) observed ( from 5.96 to 9.02 mg x mL(-1 ) ) . The amount of dust and house dust mite allergen collected in the filters was significantly correlated with an improvement of peak flow variation . In combination with other allergen avoidance measures , the examined air-cleaners can contribute to diminished allergen exposure and improvement of airway hyperresponsiveness in asthmatic patients BACKGROUND Asthma is a leading cause of hospital admission in children . The majority of children with asthma are sensitized and exposed to inhalant allergens that may contribute to chronic airway inflammation . OBJECTIVE To evaluate the practicality and effects of dust mite ( D. farinae and D. pteronyssinus ) allergen avoidance in homes of children hospitalized with acute asthma . METHODS Children 5 to 18 years of age who were admitted with asthma to a suburban Atlanta hospital were r and omly assigned , without knowledge of allergen sensitization or exposure in their houses , to active ( n = 13 ) or placebo ( n = 10 ) treatment group . Active treatment included encasing mattress , box springs , and pillows in allergen impermeable covers ; weekly hot water wash of bed linens ; replacement of bedroom carpet with polished flooring ; and 3 % tannic acid spray to living room carpet . Placebo treatment included permeable encasing for bedding , cold water wash , and water spray for carpet . Dust sample s were analyzed for dust mite , cockroach , and cat allergens , while serum sample s were analyzed for IgE antibodies to the same allergens . Outcome measures included daily peak expiratory flow rates , spirometry , methacholine inhalation challenge , and hospital readmission . RESULTS Children in both groups were similar by demographics , sensitization , and exposure to dust mite allergen . Allergen levels fell > 3-fold in many active and placebo homes . Children in the active group had improved PEFR at 3 and 6 months after intervention ( P < .04 , P < .05 , respectively ) . Six of seven children in the study who were sensitized and exposed to dust mite allergen demonstrated improved PEFR at 3 months when allergen levels fell in both bedding and bedroom floor . There was no difference in FEV1 or methacholine challenge , although a few children in either group could tolerate methacholine because of bronchial hyperreactivity . Six children ( four active and two placebo ) were readmitted to hospital during the study . CONCLUSION Increases in PEFR were recorded among children in the active treatment group and also among sensitized patients whose dust mite allergens fell . These results support the hypothesis that avoidance can be effective even among children admitted to hospital . The study was complicated by insufficient numbers of mite-allergic children and poor compliance with diaries and the protocol . Recruitment from the hospital result ed in participants with more severe asthma than anticipated . The results also suggest that many of the patients in this group will continue to have exacerbations triggered by upper or lower respiratory tract infections BACKGROUND Several acaricides have become available for reducing house dust mite allergen levels . OBJECTIVE The purpose of this study was to assess whether the use of benzyl benzoate ( Acarosan ) provides additional benefit to the usual mite control measures including encasement of mattress and pillows with vinyl covers . METHODS A r and omized controlled trial was carried out in 26 homes ( 14 control versus 12 treatment ) of asthmatic patients in two cities ( Vancouver and Winnipeg ) . The control group had the usual house dust mite control measures including the use of vinyl covers for mattresses and pillows while the treatment group had application of benzyl benzoate to mattresses and carpets in the bedroom and the most commonly used room , in addition to the above control measures . Mite allergen levels were measured 3 months and immediately before , 1 week , and 1 and 3 months after the application of house dust mite control measures . Patients kept diary cards on asthma symptoms and peak expiratory flow rates morning and evening one month before and three months after the onset of mite allergen control measures . RESULTS A reduction of mite allergen level was found in mattress sample s in both groups , statistically significant at all times in the treatment group and at one and three months in the control group . Mite allergen levels on floor carpets also showed progressive reduction in both groups , but were significantly different in the treatment group ( compared with controls ) at 1 week , and were lower compared with baseline in the treatment group up to 3 months . No significant changes in asthma symptoms , peak expiratory flow rates , spirometric measurements , or bronchial hyperresponsiveness were observed among treatment or control group subjects . CONCLUSION The addition of benzyl benzoate to conventional house dust mite control measures result ed in a significant reduction in floor carpet dust mite levels that persisted for 3 months . The results of this study should be confirmed in a larger and longer study Background Mite‐allergic patients with allergic disease should benefit from avoiding mite allergens . Many physicians , however , are yet to be convinced that allergen avoidance can make a significant contribution to asthma management in these patients . Many allergen‐avoidance regimes include multiple measures of allergen reduction , but as mite exposure in the home is most likely to be greatest in bed dust , bedding is usually the first target for intervention To evaluate the effect of preventive measures 46 patients , all allergic to house‐dust mites ( Dermatophagoides spp . ) , were r and omly allocated to a study and a control group . According to the patients ' subjective recordings of symptom score and use of medicine , compared with the control group , the study group had improved . There was , however , no improvement when comparing the objective recordings of morning and evening peak flow and use of medicine , and it is concluded that the preventive measures in this programme are not very effective for patients allergic to house‐dust mites . The reduction in indoor humidity in the study group was limited and , as a high indoor humidity is the cause of huge population s of house‐dust mites in homes , it is emphasized that future programmes of preventive measures should focus more on damp problems , particularly those related to bad housing construction BACKGROUND The relationship between exposure to house dust mite ( HDM ) allergens and prevalence of sensitization to these allergens in patients with asthma has been confirmed in many studies . Mite population growth is regulated by humidity . Reducing humidity and removing allergen by efficient vacuuming should control mite allergen and reduce symptoms . OBJECTIVE We sought to investigate the effect of mechanical ventilation and high-efficiency vacuuming on HDM numbers and Der p 1 concentrations in the homes of mite-sensitive asthmatic subjects and to evaluate the effect of any reductions on symptoms . METHODS The homes of 40 HDM-sensitive asthmatic subjects were r and omized to receive ( 1 ) mechanical ventilation and a high-efficiency vacuum cleaner ( HEVC ) ; ( 2 ) mechanical ventilation alone ; ( 3 ) an HEVC alone ; and ( 4 ) no intervention . Homes and patients were monitored for 12 months . Change in absolute humidity , mite numbers , Der p 1 concentrations , lung function , bronchial hyperresponsiveness , and symptom scores were analyzed . RESULTS Homes with mechanical ventilation achieved significantly lower humidity levels than those without ( P < .001 ) , with an associated reduction of mite numbers ( P < .05 ) and Der p 1 concentrations ( P < .001 ¿ in nanograms per gram , P = .006 ¿ in milligrams per square meter ) in bedroom carpets and some other mite sources in the ventilated areas of the homes . The addition of a vacuum cleaner enhanced this effect . There was a trend for an improvement in histamine PC(20 ) ( P = .085 ) in the patients whose homes were ventilated . CONCLUSION The use of a mechanical ventilation system in suitable homes result ed in some reduction in numbers of HDM and Der p 1 concentrations . The addition of an HEVC slightly enhanced the effect but not sufficiently to see an improvement in symptoms BACKGROUND Allergen avoidance has been recommended in the management of allergic asthma . Very few studies have assessed the effect of pet removal on  pet allergic asthma .  OBJECTIVE We examined the effect of pet removal from homes on pulmonary function testing , airway hyperresponsiveness , and medication use . DESIGN Prospect i ve , nonr and omized , nonblinded observational study . PATIENTS AND METHODS Subjects included 20 symptomatic patients with newly diagnosed pet allergic asthma who were keeping domestic animals , including hamsters , cats , dogs , and ferrets , and were sensitized to the animals . They were treated with inhaled corticosteroids or other medications according to recommendations by level of severity of the Global Initiative for Asthma . Methacholine inhalation tests were performed regularly before and after starting medication . Clinical features were compared between the patients who gave away their pets according to recommendations by the clinician ( removal group ) and the patients who refused to give away their pets ( keeping group ) . RESULTS There were 10 patients in both the removal group and the keeping group . After > or= 1 year of follow-up with or without pet removal , a 5.9-fold increase in the provocative concentration of methacholine causing a 20 % fall in FEV(1 ) was observed in the removal group compared with a 2.3-fold increase in the keeping group ( p = 0.04 ) . There were no significant differences in the changes in FEV(1 ) and peak flow variability . Finally , no patient received  inhaled corticosteroids  in the removal group , whereas all but one of the patients needed beclomethasone dipropionate  ( mean dose , 600 mug/d ) in the keeping group . CONCLUSION This study indicates that removal of pets from homes reduces airway responsiveness in patients with pet allergic asthma more than optimal pharmacotherapy alone , thereby enabling a decrease in inhaled corticosteroid doses Home mattresses of 24 asthmatic children with house dust mite allergy were sprayed with either benzyl-benzoate foam or placebo in a double blind fashion , 10 days before the children left the residential house for asthmatic children Istituto Pio XII ( located in the Italian Alps in an environment free of mites ) and went back to their own home for the Christmas and Easter holidays . A further group of 8 children , whose mattresses received no treatment , was kept as an absolute control . Two days after spraying , benzyl-benzoate or placebo were vacuumed from the mattresses . Acarex test was performed immediately before spraying and at the end of each holiday period of 20 and 10 days , respectively . Bronchial hyperreactivity as well as serum and nasal secretory specific IgE for Dermatophagoides pteronyssinus were assessed in all children immediately before leaving and within 48 hr after returning to the residential house . The results of the study show that sprayed benzyl-benzoate foam was no more effective than placebo in reducing the level of house dust mite recovered from patients ' mattresses , or in reducing bronchial hyperreactivity and IgE concentration in serum and nasal secretions BACKGROUND Home exposure to high levels of house dust mite allergen has been shown to aggravate airways reactivity and asthma . OBJECTIVE The purpose of this study was to determine whether specific house dust mite control measures could reduce exposure levels and asthma severity . METHODS This double-blinded , r and omized trial compared asthma progression over 1 year in children whose homes received st and ard environmental control intervention with those whose homes received aggressive intervention for dust mite elimination .  The primary end point was doubling in PD20 methacholine . RESULTS Symptom scores and quality -of-life scores were similar for the st and ard and aggressive intervention groups . PD20 methacholine doubling occurred in 9 members of the aggressive intervention group vs 4 control patients ( P < .05 ) . Dust mite levels decreased in the aggressive intervention homes compared with the st and ard intervention homes ( P < .05 ) . CONCLUSION Aggressive dust mite intervention decreased dust mite levels and improved bronchial hyperresponsiveness OBJECTIVE To evaluate a family-focused asthma intervention design ed for inner-city children 5 to 11 years old with moderate to severe asthma . STUDY DESIGN R and omized , multisite , controlled trial to minimize symptom days ( wheeze , loss of sleep , reduction in play activity ) measured by a 2-week recall assessed at 2-month intervals over a 2-year follow-up period . The intervention was tailored to each family 's individual asthma risk profile assessed at baseline . RESULTS Averaged over the first 12 months , participants in the intervention group ( n = 515 ) reported 3.51 symptom days in the 2 weeks before each follow-up interview compared with 4.06 symptom days for the control group ( n = 518 ) , a difference of 0.55 ( 95 % CI , 0.18 to 0.92 , P = .004 ) . The reduction among children with severe asthma was approximately 3 times greater ( 1.54 d/2 wk ) . More children in the control group ( 18.9 % ) were hospitalized during the intervention compared with children in the intervention group ( 14 . 8 % ) , a decrease of 4.19 % ( CI , -8.75 to 0.36 , P = .071 ) . These improvements were maintained in the intervention group during the second year of follow-up , during which they did not have access to the asthma counselor . CONCLUSIONS We demonstrated that an individually tailored , multifaceted intervention carried out by Masters-level social workers trained in asthma management can reduce asthma symptoms among children in the inner city A cross-over trial was conducted on 10 children with moderate to severe asthma , who had positive skin tests to Dermatophagoides pteronyssinus and nocturnal wheeze .  An electrostatic precipitator was used during the night to remove airborne particles from the bedroom . During use of the precipitator  peak expiratory flow rates were no better than in a control period BACKGROUND Asthma clinical research will highly benefit from st and ardization of major outcomes in terms of definition and assessment methodology . This will permit useful comparisons across interventional or observational studies and will allow more effective data sharing . OBJECTIVE National Institutes of Health ( NIH ) institutes and the Agency for Healthcare Research and Quality convened a workshop involving 7 expert subcommittees to propose which asthma outcomes should be assessed with st and ardized methodology in future asthma clinical research studies . METHODS Each subcommittee utilized comprehensive literature review s and expert opinion to compile a list of asthma outcomes and classified them as either core ( required in future studies ) , supplemental ( to be used according to study aims and st and ardized ) , or emerging ( requiring validation and st and ardization ) . This work was discussed at an NIH-organized workshop in March 2010 and finalized in September 2011 . RESULTS Outcomes for study participant characterization , as well as for prospect i ve clinical trial intervention and observational studies , were proposed for adults and children , and method ologies for outcome collection and reporting were determined . Furthermore , the workshop identified areas in which new outcomes or instruments for their measurement need to be developed and vali date d. CONCLUSIONS St and ardized outcomes for clinical research in asthma have been proposed . Participating NIH institutes and other federal agencies will consider these recommendations in future clinical research initiatives in asthma OBJECTIVES We examined the asthma-control benefit of moving into an asthma-friendly Breathe-Easy home ( BEH ) . METHODS We used a quasi-experimental design to compare the asthma outcomes of 2 groups of low-income children and adolescents with asthma : 34 participants who moved into a BEH , and a local matched cohort of 68 participants who had received a previous asthma-control intervention .  Both groups received in-home asthma education . BEHs were constructed with moisture-reduction features , enhanced ventilation systems , and material s that minimized dust and off-gassing . RESULTS BEH residents ' asthma-symptom-free days increased from a mean of 8.6 per 2 weeks in their old home to 12.4 after 1 year in the BEH . The proportion of BEH residents with an urgent asthma-related clinical visit in the previous 3 months decreased from 62 % to 21 % . BEH caretakers ' quality of life increased significantly . The BEH group improved more than did the comparison group , but most differences in improvements were not significant . Exposures to mold , rodents , and moisture were reduced significantly in BEHs . CONCLUSIONS Children and adolescents with asthma who moved into an asthma-friendly home experienced large decreases in asthma morbidity and trigger exposure
Background This review will inform up date d National Asthma Education and Prevention Program clinical practice guidelines .
Objective We sought to evaluate the effectiveness of  allergen reduction interventions  on  asthma outcomes .