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Asthma: Home-Based Multi-Trigger, Multicomponent Environmental Interventions – Adults with Asthma

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What the CPSTF Found

About The Systematic Review

The CPSTF finding is based on evidence from a systematic review of 3 studies (search period 1966 - February 2008).

The systematic review was conducted on behalf of the CPSTF by a team of specialists in systematic review methods, and in research, practice, and policy related to asthma control.

Summary of Results

Detailed results from the systematic review are available in the CPSTF Finding and Rationale Statement pdf icon [PDF - 154 kB].

Three intervention studies reported one or more outcome measurements in adults. Although two studies observed improvements in quality of life or symptom scores, the results for health care utilization, and productivity outcomes showed borderline or no improvement. No studies in adults reported any physiologic outcomes.

Summary of Economic Evidence

An economic review of this intervention was not conducted because the CPSTF did not have enough information to determine if the intervention works.

Applicability

Applicability of this intervention across different settings and populations was not assessed because the CPSTF did not have enough information to determine if the intervention works.

Evidence Gaps

The CPSTF identified several areas that have limited information. Additional research and evaluation could help answer the following questions and fill remaining gaps in the evidence base. (What are evidence gaps?)

The following outlines evidence gaps for home-based multi-trigger, multicomponent environmental interventions for adults and for children and adolescents.

Effectiveness

  • What are the independent contributions of particular intervention components to overall intervention effectiveness? Which components are the most important for inclusion in this intervention?
  • What is the required intensity (number of home visits, intensity of remediation, intensity of education) needed for an effective home intervention program?
  • How does household member smoking impact the effects of this intervention? Should smoking cessation counseling be a necessary component of all home-based environmental interventions for asthma?

Applicability

  • How effective is this intervention in adult populations?
  • Are there differences in intervention effectiveness between children and adolescents?
  • How effective is this intervention in rural populations?
  • Is this intervention more effective in participants with more severe asthma symptoms?
  • How does the type of dwelling (apartment, duplex, single family home) impact the effectiveness of the intervention?

Implementation

  • How should this intervention be integrated in the health care system to insure appropriate access and sustainability?
  • Which asthma patients should this intervention target?
  • Who are the most effective intervention implementers (CHW, nurses respiratory therapist, etc.) and does this change depending on intervention setting?

Study Characteristics

The following characteristics describe studies used in systematic reviews of home-based multi-trigger, multicomponent environmental interventions for adults and for children and adolescents.

  • Of the 23 included studies, 20 studies evaluated interventions targeting homes in which only children or adolescents had asthma; one study exclusively targeted adults; and two studies targeted children and adults (results of these last two studies were included both in the child and adult analyses).
  • The number of participants in the studies ranged from 18 to 1033, with a median number of 104 participants (interquartile interval [IQI]: 64–274).
  • Follow-up periods ranged from 1 month to 48 months, with a median follow-up period of 12 months (IQI: 12–18 months).
  • Education focus ranged from primarily environmental education to primarily asthma self-management education, including monitoring asthma symptoms and the use of asthma management plans.
  • Most studies focused equally on both environmental and self-management education.
  • Two studies (9%) focused only on remediation and did not have an educational component.
  • Fourteen studies were tailored based on exposure to asthma triggers in the home; of these, seven also included specific allergen sensitivities in tailoring the intervention.
  • Number of home visits was one (3 studies), two to seven (15 studies), and eight or more (5 studies).
  • Home visits were made exclusively by community health workers (6 studies), nurses (5 studies), respiratory therapists (2 studies), physicians (2 studies), social workers (1 study), housing officers (1 study), environmental educators (1 study), and trained sanitarians (1 study). Or they were conducted by mixed teams of community health workers and nurses (2 studies), social worker, nurse, and respiratory therapist (1 study), and research assistant and pest control professional (1 study).

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