Asthma: Home-Based Multi-Trigger, Multicomponent Environmental Interventions Adults with Asthma
Summary of CPSTF Finding
The CPSTF has related findings for this intervention specific to children and adolescents.
- 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
CPSTF Finding and Rationale Statement
- Community Preventive Services Task Force Publishes Findings on Home-Based Asthma Programs
Developed by The Community Guide in collaboration with CDC’s National Center for Environmental Health
About The Systematic Review
Summary of Results
Summary of Economic Evidence
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 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?
- 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).
Crocker DD, Kinyota S, Dumitru GG, et al. Effectiveness of home-based, multi-trigger, multicomponent interventions with an environmental focus for reducing asthma morbidity: a Community Guide systematic review. American Journal of Preventive Medicine. 2011;41(2S1):S5-32.
Nurmagambetov TA, Barnett SBL, Jacob V, et al. Economic value of home-based, multi-trigger, multicomponent interventions with an environmental focus for reducing asthma morbidity: a Community Guide systematic review. American Journal of Preventive Medicine. 2011;41(2S1):S33-47.
Task Force on Community Services. Recommendations from the Task Force on Community Preventive Services to decrease asthma morbidity through home-based, multi-trigger, multicomponent interventions. American Journal of Preventive Medicine. 2011;41(2S1):S1-4.
Crocker DD, Hopkins D, Kinyota S, Dumitru G, Herman E, Ligon C. A systematic review of home-based multi-trigger multi-component environmental interventions to reduce asthma morbidity. Journal of Allergy and Clinical Immunology. 2009;123(S20). Available at: http://www.jacionline.org/article/S0091-6749(08)02513-X/abstract.
Analytic Framework see Figure 1 on page S10
When starting an effectiveness review, the systematic review team develops an analytic framework. The analytic framework illustrates how the intervention approach is thought to affect public health. It guides the search for evidence and may be used to summarize the evidence collected. The analytic framework often includes intermediate outcomes, potential effect modifiers, potential harms, and potential additional benefits.
Summary Evidence Table
Summary Evidence Table Effectiveness Review
Contains evidence from reviews of home-based multi-trigger, multicomponent environmental interventions for adults and for children and adolescents
Barton A, Basham M, Foy C, Buckingham K, Somerville M. The Watcombe Housing Study: the short term effect of improving housing conditions on the health of residents. Journal of Epidemiology and Community Health 2007;61(9):771-7.
Brown MD, Reeves MJ, Meyerson K, Korzeniewski SJ. Randomized trial of a comprehensive asthma education program after an emergency department visit. Annals of Allergy, Asthma, & Immunology 2006;97(1):44-51.
Smith JR, Mildenhall S, Noble MJ, Shepstone L, Koutantji M, Mugford M, et al. The Coping with Asthma Study: a randomized controlled trial of a home based, nurse led psychoeducational intervention for adults at risk of adverse asthma outcomes. Thorax 2005;60(12):1003-11.
With the assistance of a CDC librarian, the team searched for published studies in the following databases: MEDLINE, Cochrane Library, CINAHL, PsychINFO, Web of Science, EMBASE, ERIC, and Sociological Abstracts. The team also searched bibliographic reference lists and accepted suggestions of studies from members of the team.
The team considered studies for inclusion if they:
- Were primary research published in a journal or a technical or government report
- Were published in English
- Met minimum research quality criteria for study design and execution specifically, using designs with before-and-after comparisons in the intervention group at least or comparisons across two groups receiving different levels of intervention
- Were community-based
- Evaluated one of nine identified asthma interventions
- Addressed secondary or tertiary prevention
Studies for home-based environmental interventions were considered if they also:
- Included at least one home visit
- Were multicomponent
- Were multi-trigger
- Evaluated one or more outcomes of interest
The team searched for and accepted for possible inclusion studies published from 1966 to February 2008.
Search Terms (Medline)
Database: MEDLINE (OVID) 722 results
Note: Search was the same for the other databases with the exception of terminology (such as use of exp, and Boolean terms) which was adapted according to database requirements.
- (exp asthma/ or asthma.mp)
- exp Bronchial Hyperreactivity/mo, nu, pc, ec, ep, th
- *Respiratory sounds/nu, pc, ep, th
- (wheeze or reactive airway$).mp.
Home Interventions to Reduce Environmental Triggers
- (trigger and (reduce or reduction$)).mp. [mp=title, original title, abstract, name of substance word, subject heading word]
- exp dust/ or exp allergens/
- (reduce or reduction$).mp. [mp=title, original title, abstract, name of substance word, subject heading word]
- 7 and 8
- 6 or 9
- exp air pollution, indoor/lj, ec, pc, sn or *dust mites/
- allergen level$.mp.
- exp Patient Education/ or exp Health Education/mt, ec, og, ed, st, sn, lj, ut or exp “Patient Acceptance of Health Care”/sn
- exp Environmental Remediation/ae, an, lj, ec, mt, st
- exp intervention studies/
- 14 or 15
- 16 and 17
- environmental control.mp.
- exp Inhalation exposure/
- exposure reduction$.mp.
- 10 or 11 or 12 or 13 or 18 or 19 or 20 or 21
- 5 and 9
- 5 and 10
- 23 or 24
- Randomized Controlled Trials/ or randomized trial$.mp. or program$.mp.
- controlled trial$.mp.
- impact$.mp. or exp Sickness Impact Profile/
- study effectiveness.mp.
- effectiveness of study.mp.
- effectiveness of stud$.mp.
- exp Program Evaluation/ or evaluation$.ab.
- trial$.mp. or “Randomized Controlled Trial [Publication Type]”/
- case report$.mp. or exp “Case Reports [Publication Type]”/
- comment$.mp. or exp “Comment [Publication Type]”/
- letter$.mp. or exp “Letter [Publication Type]”/
- newspaper article$.mp. or exp “Newspaper Article [Publication Type]”/
- news.mp. or exp “News [Publication Type]”/
- drug approval/ or drug evaluation/ or neurotic disorders/ or antibodies, monoclonal/ or randomized controlled trials/ or “United States Food and Drug Administration”/ or research design/ or clinical trials/
- drug$ trial$.mp. or placebos/
Asthma and included study designs/evaluations
- 5 and 34
Asthma + Home Interventions
- 5 and 25
Asthma + Home Interventions
Asthma + any of the above interventions or study designs-excluded study designs