Despite overall advances in improving childhood asthma outcomes, asthma morbidity remains high among children in racial/ethnic minority groups and those living in poverty. An important factor associated with the persistent disparity is greater exposure to allergens in the home. Exposure to cockroaches, dust mites, pet dander, and mold are known to worsen asthma. Reducing the level of indoor allergens is a key strategy to improve asthma outcomes.
Current clinical guidelines recommend a multicomponent strategy which targets reduction of all allergens. However, adoption of this method, particularly among those at highest risk, has not been widely embraced. Barriers to adoption include the complexity and cost of the recommended components. Simpler, less costly interventions are sought, and recent data suggest that individual components of the recommended intervention package may improve asthma. This approach would also be less expensive and more feasible to implement. Research comparing these methods is needed.
A 12-month, two-group randomized control trial of children with asthma and who are exposed to cockroaches is being conducted. Children ages 4-17 living in the Greater New Orleans area will be recruited from a variety of clinic and community settings. The overall goal of the study is to improve patient-centered asthma outcomes (asthma symptom days, healthcare utilization, asthma control, and quality of life) by targeting one key allergen: cockroach exposure in the child’s home. We propose a simple intervention of insecticidal bait that is low cost, simple to implement, and lower toxicity than other forms of pest control. The reduction in the number of cockroaches in the home is an environmental outcome that is patient centered and thus likely to be accepted by families of children with asthma.
Caregivers of children with asthma have reported that an important barrier to maintaining asthma control is the inability to perform activities recommended by physicians to reduce asthma triggers. The research question being addressed was developed with stakeholder partners (community and clinical) looking for a more effective approach to improving asthma outcomes through asthma trigger control. Decisions on the most relevant outcomes, the most appropriate recruitment and retention methods and locations, and avenues for maximal dissemination will be made together with our partners. Successful implementation and dissemination will rely on these collaborations.
*All proposed projects, including requested budgets and project periods, are approved subject to a programmatic and budget review by PCORI staff and the negotiation of a formal award contract.