Kercsmar Carolyn M, Dearborn Dorr G, Schluchter Mark, Xue Lintong, Kirchner H Lester, Sobolewski John, Greenberg Stuart J, Vesper Stephen J, Allan Terry
Case Western Reserve University, Department of Pediatrics, Rainbow Babies and Children's Hospital, Cleveland, Ohio 44106, USA.
Environ Health Perspect. 2006 Oct;114(10):1574-80. doi: 10.1289/ehp.8742.
Home dampness and the presence of mold and allergens have been associated with asthma morbidity. We examined changes in asthma morbidity in children as a result of home remediation aimed at moisture sources.
In this prospective, randomized controlled trial, symptomatic, asthmatic children (n = 62), 2-17 years of age, living in a home with indoor mold, received an asthma intervention including an action plan, education, and individualized problem solving. The remediation group also received household repairs, including reduction of water infiltration, removal of water-damaged building materials, and heating/ventilation/air-conditioning alterations. The control group received only home cleaning information. We measured children's total and allergen-specific serum immuno-globulin E, peripheral blood eosinophil counts, and urinary cotinine. Environmental dust samples were analyzed for dust mite, cockroach, rodent urinary protein, endotoxin, and fungi. The follow-up period was 1 year.
Children in both groups showed improvement in asthma symptomatic days during the preremediation portion of the study. The remediation group had a significant decrease in symptom days (p = 0.003, as randomized; p = 0.004, intent to treat) after remodeling, whereas these parameters in the control group did not significantly change. In the postremediation period, the remediation group had a lower rate of exacerbations compared with control asthmatics (as treated: 1 of 29 vs. 11 of 33, respectively, p = 0. 003; intent to treat: 28.1% and 10.0%, respectively, p = 0.11).
Construction remediation aimed at the root cause of moisture sources and combined with a medical/behavioral intervention significantly reduces symptom days and health care use for asthmatic children who live in homes with a documented mold problem.
家庭潮湿以及霉菌和过敏原的存在与哮喘发病率相关。我们研究了针对潮湿源头进行家庭整治后儿童哮喘发病率的变化。
在这项前瞻性随机对照试验中，62名2至17岁有症状的哮喘儿童，居住在室内有霉菌的家中，接受了包括行动计划、教育和个性化问题解决的哮喘干预。整治组还接受了房屋修缮，包括减少水渗透、清除受水损坏的建筑材料以及对供暖/通风/空调进行改造。对照组仅收到家庭清洁信息。我们测量了儿童的总血清免疫球蛋白E和过敏原特异性血清免疫球蛋白E、外周血嗜酸性粒细胞计数以及尿可替宁。对环境灰尘样本进行了尘螨、蟑螂、啮齿动物尿蛋白、内毒素和真菌的分析。随访期为1年。
两组儿童在研究整治前阶段哮喘症状天数均有改善。整治组在改造后症状天数显著减少（随机分组时p = 0.003；意向性分析p = 0.004），而对照组的这些参数没有显著变化。在整治后阶段，与对照哮喘患者相比，整治组的加重率较低（实际治疗：分别为29例中的1例和33例中的11例，p = 0.003；意向性分析：分别为28.1%和10.0%，p = 0.11）。
针对潮湿源头的建筑整治并结合医疗/行为干预，可显著减少居住在有记录霉菌问题家庭中的哮喘儿童的症状天数和医疗保健使用。
