Economics Department, University of Massachusetts Lowell, Lowell, Massachusetts; Center for Community Research and Engagement, University of Massachusetts Lowell, Lowell, Massachusetts.
Public Health Department, University of Massachusetts Lowell, Lowell, Massachusetts.
Ann Allergy Asthma Immunol. 2019 May;122(5):486-491. doi: 10.1016/j.anai.2019.02.026. Epub 2019 Mar 1.
We describe a multifaceted home environmental intervention project involving low-income older adults with asthma who have a greater risk of asthma-related respiratory impacts because they spend up to 90% of their time in the home where many allergens and respiratory irritants are found. Although sufficient evidence suggests that home interventions are effective in improving health of children with asthma, the Task Force on Community Preventive Services has stated that evidence is insufficient for the effectiveness of home interventions on adults with asthma.
To evaluate the hypothesis that multifaceted home environmental interventions improve the respiratory health and reduce asthma triggers for older adults with asthma.
We conducted community health worker-led interventions in the homes of 86 low-income older adults (age 62 or older) diagnosed with asthma, residing in public and private subsidized housing in Lowell, Massachusetts, from 2014 to 2017. Health and environmental assessment at baseline and follow-up 1 year later included collecting data on respiratory health, quality of life, medication use, doctor/emergency room/hospital visits, using the St. George Respiratory Questionnaire and Asthma Control Test and evaluation of asthma trigger activities and exposures through questionnaires and home surveys. Interventions included education on asthma and environmental triggers and environmental remediation.
Statistically significant reductions in self-reported environmental asthma triggers and health improvements were found in the following areas: doctor visits, use of antibiotics for chest problems, respiratory symptoms and quality of life indicators, and asthma control (ACT score).
Our results provide evidence that multifaceted home interventions are effective in improving the environmental quality and respiratory health of an older adult population with asthma.
我们描述了一个多方面的家庭环境干预项目，涉及患有哮喘的低收入老年患者。这些患者由于 90%的时间都在家中度过，而家中存在许多过敏原和呼吸道刺激物，因此面临更大的哮喘相关呼吸道影响风险。尽管有充分的证据表明家庭干预措施在改善儿童哮喘患者的健康方面是有效的，但社区预防服务工作组指出，家庭干预措施对哮喘成人的有效性证据不足。
评估多方面家庭环境干预措施是否能改善哮喘老年患者的呼吸道健康并减少哮喘诱因。
我们在马萨诸塞州洛厄尔的公共和私人补贴住房中，对 86 名被诊断患有哮喘的低收入老年患者（年龄在 62 岁及以上）进行了社区健康工作者主导的干预。健康和环境评估在基线和 1 年后进行，包括收集呼吸道健康、生活质量、药物使用、医生/急诊室/医院就诊、使用圣乔治呼吸问卷和哮喘控制测试以及通过问卷和家庭调查评估哮喘诱因活动和暴露的数据。干预措施包括哮喘和环境诱因以及环境修复方面的教育。
在以下方面发现自我报告的环境哮喘诱因减少和健康状况改善具有统计学意义：医生就诊、因胸部问题使用抗生素、呼吸道症状和生活质量指标以及哮喘控制（ACT 评分）。
我们的研究结果提供了证据，表明多方面的家庭干预措施能够有效改善哮喘老年患者的环境质量和呼吸道健康。
