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

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Findings and Recommendations

The Community Preventive Services Task Force (CPSTF) finds insufficient evidence to determine the effectiveness of home-based multi-trigger, multicomponent interventions with an environmental focus for adults with asthma based on the small number of studies identified and the mixed results across the outcomes of interest.

The full CPSTF Finding and Rationale Statement and supporting documents for Asthma: Home-Based Multi-Trigger, Multicomponent Environmental Interventions Adults with Asthma are available in The Community Guide Collection on CDC Stacks.

Intervention

Home-based multi-trigger, multicomponent interventions with an environmental focus for persons with asthma aim to reduce exposure to multiple indoor asthma triggers (allergens and irritants). These interventions involve home visits by trained personnel to conduct two or more activities. The programs in this review conducted environmental activities that included:

  • Assessment of the home environment
  • Changing the indoor home environment to reduce exposure to asthma triggers
  • Education about the home environment

Most programs also included one or more of the following additional non- environmental activities:

  • Training and education to improve asthma self-management
  • General asthma education
  • Social services and support
  • Coordinated care for the asthma client

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.

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).

Summary of Results

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 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 CPSTF did not have enough information to determine if the intervention works.

Evidence Gaps

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

Effectiveness. The effectiveness of home-based multi-trigger, multi-component interventions has been established. Important questions still remain regarding the intervention composition and intensity as well as effectiveness in different settings and populations. Some of these questions include:

  • 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. This intervention has been studied most in low-income, urban minority populations but is most likely effective in most settings and populations. The following questions remain about the applicability of this intervention in various settings and populations:

  • 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. This intervention has been implemented in a variety of ways. However, questions still remain as to what is the most effective and cost-effective way to implement this intervention in a “real-world setting.” These questions include:

  • How should this intervention be integrated in the health care system to ensure 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?

Implementation Considerations and Resources

CPSTF did not have enough evidence to determine whether the intervention is or is not effective. This does not mean that the intervention does not work, but rather that additional research is needed to determine whether or not the intervention is effective.