Division of Environmental Health, New York City Department of Health and Mental Hygiene, New York, NY, USA.
Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, USA.
J Asthma. 2021 May;58(5):616-624. doi: 10.1080/02770903.2019.1709870. Epub 2020 Jan 10.
To evaluate the effects of a one-time, apartment-level Integrated Pest Management (IPM) intervention on healthcare utilization and asthma symptoms among children with persistent asthma living in households with a pest infestation. In a randomized controlled trial of 384 children aged 5-12 years with persistent asthma, we assigned 183 to receive IPM and 197 to usual care (UC). The primary outcome was healthcare utilization from hospital and Medicaid claims records. Secondary outcomes included caregiver-reported asthma symptoms, pest infestation levels, missed days of school due to asthma, and rescue medication use. The entire cohort improved over the study period, with significant but equivalent declines in mean healthcare utilization in both groups. IPM group had fewer days with reduced activity due to asthma ( = 0.04) and larger declines that fell short of statistical significance in asthma symptom days ( = 0.22), severe symptoms ( = 0.16), missed school ( = 0.27) and rescue medication use ( = 0.27). Both roach ( = 0.001) and mice ( = 0.11) infestations decreased much more in the IPM group than the UC group. After a one-time, apartment-level IPM intervention, we found no difference in health care utilization, but fewer days of reduced activity and consistent suggestive evidence of clinically meaningful improvements relative to usual care across other secondary outcomes. Coupled with the established effectiveness of IPM in reducing allergens and scientific consensus on pest-related allergens as asthma triggers, these findings support adding home pest control to traditional medical management of children with severe asthma.
评估一次性公寓级别的综合虫害管理（IPM）干预对有虫害侵扰家庭中持续性哮喘儿童医疗保健利用和哮喘症状的影响。在一项针对 384 名 5-12 岁持续性哮喘儿童的随机对照试验中，我们将 183 名儿童分配接受 IPM 干预，197 名儿童接受常规护理（UC）。主要结局是从医院和医疗补助索赔记录中获取的医疗保健利用情况。次要结局包括护理人员报告的哮喘症状、虫害侵扰程度、因哮喘缺课的天数和急救药物的使用。整个队列在研究期间都有所改善，两组的医疗保健利用均值均有显著但相当的下降。IPM 组因哮喘导致活动减少的天数更少（ = 0.04），哮喘症状天数（ = 0.22）、严重症状天数（ = 0.16）、缺课天数（ = 0.27）和急救药物使用天数（ = 0.27）的降幅更大，但未达到统计学意义。蟑螂（ = 0.001）和老鼠（ = 0.11）侵扰在 IPM 组比 UC 组减少得更多。在单次、公寓级别的 IPM 干预后，我们发现医疗保健利用没有差异，但在其他次要结局方面，活动减少的天数更少，并且有持续的迹象表明相对于常规护理，在其他次要结局方面有更有临床意义的改善。考虑到 IPM 在减少过敏原方面的既定有效性以及科学界对与虫害相关的过敏原作为哮喘诱因的共识，这些发现支持在家中进行虫害控制，以加强对严重哮喘儿童的传统医疗管理。
