Indoor environmental control strategies to manage asthma in children
Individually tailored environmental control strategies have been shown to reduce asthma symptoms.
The American Academy of Pediatrics (AAP) has outlined strategies to help control indoor environmental exposures among children with asthma, according to a report published in Pediatrics. Strategies include source removal, source control, and asthma education.
Children with asthma who are exposed to indoor allergens such as dust mites, rodents, cockroaches, and pet allergens tend to have worse asthma control and greater morbidity than children who are not exposed to these allergens. Therefore, Elizabeth C. Matsui, MD, MHS, FAAP, from the AAP's Section on Allergy and Immunology Executive Committee and the Council on Environmental Health, and colleagues published the report to raise awareness among pediatricians regarding the need to implement indoor environmental control practice measures.
Environmental control measures should be tailored to each individual child and are based on the underlying characteristics of the exposure. Individual control strategies have been shown to reduce asthma symptoms, have similar efficacy as controller medications, and are cost-effective in reducing the number of days with asthma symptoms.
Patients should not be tested for large panels of allergens because the test may reveal positive results for allergens that are not relevant to the child's environment. Instead, patients should undergo allergen-specific immunoglobulin E (IgE) antibody tests to identify allergens that are most likely to be clinically relevant.
The authors note that an environmental history should be obtained to evaluate environmental exposures that could trigger asthma symptom exacerbation, including indoor pollutants and allergens. The environmental history should include questions regarding the presence of pets or pests, and whether the climatic characteristics in the community favor dust mites. The history should also focus on sources of indoor air pollution, including the presence of smokers in the home, the use of gas stoves or appliances, and the presence of mold.
“The environmental history and assessment of allergic sensitization will inform a tailored environmental control plan for the patient,” the study authors wrote. “It is important to note that environmental interventions that target all relevant exposures are more likely to be successful than those that target only 1 or 2 exposures.”
Strategies include source removal, source control, and mitigation strategies such as the use of particulate air purifiers and allergen-proof mattress or pillow cases. Primary care pediatricians, allergy specialists, and pediatric pulmonologists can also provide asthma education to patients to encourage the use of environmental control strategies.
- Matsui EC, Abramson SL, Sandel MT. Indoor environmental control practices and asthma management. Pediatrics. 2016;138(5): doi: 10.1542/peds.2016-2589.