Children with poorly controlled asthma: Randomized controlled trial of a home-based environmental control intervention
Correction(s) for this article
-
Corrigendum
- Volume 55Issue 5Pediatric Pulmonology
- pages: 1293-1293
- First Published online: March 16, 2020
Corresponding Author
Arlene Manns Butz ScD, RN, CRNP
Division of General Pediatrics and Adolescent Medicine, Baltimore, Maryland
The Johns Hopkins University School of Nursing, University of Maryland, Baltimore, Maryland
Correspondence
Arlene M. Butz, ScD, RN, CRNP, Department of Pediatrics, Johns Hopkins University School of Medicine, 200 N. Wolfe St, Baltimore 21287, MD, USA.
Email: [email protected]
Search for more papers by this authorMary E. Bollinger DO
School of Medicine, Department of Pediatrics, Baltimore, Maryland
Search for more papers by this authorJean Ogborn MD, MPH
Department of Pediatric Emergency Medicine, Johns Hopkins University, Baltimore, Maryland
Search for more papers by this authorShawna S. Mudd DNP, CRNP
The Johns Hopkins University School of Nursing, University of Maryland, Baltimore, Maryland
Search for more papers by this authorJoan E. Kub PhD, RN
Department of Nursing, USC Suzanne Dworak-Peck School of Social Work, Los Angeles, California
University of Maryland, Baltimore, Maryland
Search for more papers by this authorMelissa H. Bellin PhD, LCSW
School of Social Work, Johns Hopkins University School of Medicine, Baltimore, Maryland
Search for more papers by this authorCassia Lewis-Land MS
Division of General Pediatrics and Adolescent Medicine, Baltimore, Maryland
Search for more papers by this authorKelli DePriest BSN
The Johns Hopkins University School of Nursing, University of Maryland, Baltimore, Maryland
Search for more papers by this authorMona Tsoukleris PharmD, MS
The School of Pharmacy, University of Maryland, Baltimore, Maryland
Search for more papers by this authorCorresponding Author
Arlene Manns Butz ScD, RN, CRNP
Division of General Pediatrics and Adolescent Medicine, Baltimore, Maryland
The Johns Hopkins University School of Nursing, University of Maryland, Baltimore, Maryland
Correspondence
Arlene M. Butz, ScD, RN, CRNP, Department of Pediatrics, Johns Hopkins University School of Medicine, 200 N. Wolfe St, Baltimore 21287, MD, USA.
Email: [email protected]
Search for more papers by this authorMary E. Bollinger DO
School of Medicine, Department of Pediatrics, Baltimore, Maryland
Search for more papers by this authorJean Ogborn MD, MPH
Department of Pediatric Emergency Medicine, Johns Hopkins University, Baltimore, Maryland
Search for more papers by this authorShawna S. Mudd DNP, CRNP
The Johns Hopkins University School of Nursing, University of Maryland, Baltimore, Maryland
Search for more papers by this authorJoan E. Kub PhD, RN
Department of Nursing, USC Suzanne Dworak-Peck School of Social Work, Los Angeles, California
University of Maryland, Baltimore, Maryland
Search for more papers by this authorMelissa H. Bellin PhD, LCSW
School of Social Work, Johns Hopkins University School of Medicine, Baltimore, Maryland
Search for more papers by this authorCassia Lewis-Land MS
Division of General Pediatrics and Adolescent Medicine, Baltimore, Maryland
Search for more papers by this authorKelli DePriest BSN
The Johns Hopkins University School of Nursing, University of Maryland, Baltimore, Maryland
Search for more papers by this authorMona Tsoukleris PharmD, MS
The School of Pharmacy, University of Maryland, Baltimore, Maryland
Search for more papers by this authorAbstract
Background
Few trials have tested targeted environmental control (EC) interventions based on biomarkers of second hand smoke (SHS) exposure and allergen sensitization in reducing asthma emergency department (ED) visits in children with poorly controlled asthma.
Methods
Overall, 222 children with poorly controlled asthma were randomized into a home-based EC intervention (INT) or control (CON) group and followed for ED visits over 12 months. All children received allergen-specific IgE serologic testing and SHS exposure biomarker testing to inform the EC intervention. Pharmacy data was examined for asthma medication fills. Cox proportional hazards and multivariate regression models were performed to examine factors associated with repeat ED visits.
Results
There was no difference in increased risk of >1 ED visit at 12 months between INT and CON groups. Most children (75%) had moderate/severe persistent asthma. Over half (56%) had SHS exposure and 83% tested positive for >1 allergen sensitization. Among children without SHS exposure, the median time to first recurrent ED visit differed by group (CON: 195; INT: >365 days) after adjusting for child age, allergic sensitization, medication fills prior to baseline, controller medication use, and the interaction between group status and SHS exposure. Children who had positive allergic sensitizations, younger, had increased controller medication use and randomized to the CON group and had no SHS exposure had increased risk for a repeat ED visit over 12 months.
Conclusions
In this study, a home-based EC intervention was not successful in reducing asthma ED revisits in children with poorly controlled asthma with SHS exposure. Allergic sensitization, young age, and increased controller medication use were important predictors of asthma ED visits.
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