Rho Federal Systems Division, Inc., Chapel Hill, North Carolina 27517, USA.
Environ Health Perspect. 2012 Nov;120(11):1607-12. doi: 10.1289/ehp.1104242. Epub 2012 Aug 15.
Childhood asthma morbidity and mortality in New Orleans, Louisiana, is among the highest in the nation. In August 2005, Hurricane Katrina created an environmental disaster that led to high levels of mold and other allergens and disrupted health care for children with asthma.
We implemented a unique hybrid asthma counselor and environmental intervention based on successful National Institutes of Health asthma interventions from the National Cooperative Inner City Asthma (NCICAS) and Inner-City Asthma (ICAS) Studies with the goal of reducing asthma symptoms in New Orleans children after Hurricane Katrina.
Children (4-12 years old) with moderate-to-severe asthma (n = 182) received asthma counseling and environmental intervention for approximately 1 year. HEAL was evaluated employing several analytical approaches including a pre-post evaluation of symptom changes over the entire year, an analysis of symptoms according to the timing of asthma counselor contact, and a comparison to previous evidence-based interventions.
Asthma symptoms during the previous 2 weeks decreased from 6.5 days at enrollment to 3.6 days at the 12-month symptom assessment (a 45% reduction, p < 0.001), consistent with changes observed after NCICAS and ICAS interventions (35% and 62% reductions in symptom days, respectively). Children whose families had contact with a HEAL asthma counselor by 6 months showed a 4.09-day decrease [95% confidence interval (CI): 3.25 to 4.94-day decrease] in symptom days, compared with a 1.79-day decrease (95% CI: 0.90, 2.67) among those who had not yet seen an asthma counselor (p < 0.001).
The novel combination of evidence-based asthma interventions was associated with improved asthma symptoms among children in post-Katrina New Orleans. Post-intervention changes in symptoms were consistent with previous randomized trials of NCICAS and ICAS interventions.
路易斯安那州新奥尔良市的儿童哮喘发病率和死亡率位居全美前列。2005 年 8 月，卡特里娜飓风造成了一场环境灾难，导致霉菌和其他过敏原含量过高，扰乱了哮喘患儿的医疗保健。
我们实施了一种独特的混合哮喘辅导员和环境干预措施，该措施基于国家卫生研究院（NIH）从国家合作内城哮喘（NCICAS）和内城哮喘（ICAS）研究中成功实施的哮喘干预措施，目标是减少卡特里娜飓风后新奥尔良儿童的哮喘症状。
患有中重度哮喘的儿童（4-12 岁，n=182）接受了大约 1 年的哮喘咨询和环境干预。采用多种分析方法评估 HEAL，包括整个年度症状变化的前后评估、根据哮喘辅导员接触时间分析症状以及与以前基于证据的干预措施进行比较。
在过去的 2 周内，哮喘症状从登记时的 6.5 天减少到 12 个月时的 3.6 天（减少 45%，p<0.001），与 NCICAS 和 ICAS 干预措施后的变化一致（分别减少 35%和 62%的症状天数）。在 6 个月时与 HEAL 哮喘辅导员有联系的儿童，其症状天数减少了 4.09 天[95%置信区间（CI）：3.25-4.94 天]，而尚未见过哮喘辅导员的儿童则减少了 1.79 天（95%CI：0.90，2.67）（p<0.001）。
基于证据的哮喘干预措施的新颖组合与新奥尔良卡特里娜飓风后的儿童哮喘症状改善有关。干预后症状的变化与 NCICAS 和 ICAS 干预措施的先前随机试验一致。
