Indoor environmental exposures among children with asthma seen in an urban emergency department

BACKGROUND. Current guidelines for asthma management emphasize the control of environmental irritants and allergens within the home. Understanding the prevalence of indoor home exposures within such a population may be important for any emergency department (ED) program that seeks to improve the quality of its asthma care and patient education. OBJECTIVE. We sought to determine the prevalence of indoor home exposures in a cohort of children with moderate to severe asthma who were treated in an urban pediatric ED and to correlate these exposures with household income, prior asthma morbidity, health care utilization, and quality of life (QoL). METHODS. We enrolled a cohort of children with chronic asthma who were 12 months through 17 years of age and who had at least one other unscheduled visit for asthma within the previous 6 months. Trained research assistants interviewed the children's parent or guardian regarding the prevalence of home exposures to environmental tobacco smoke (ETS) and common allergens. In addition, data were collected on each patient's prior asthma history, morbidity, health care utilization, medication use, and QoL. RESULTS. Of the 488 eligible children enrolled, 60.0% were < 6 years of age, 63.9% were male, 85.9% were black, 68.4% were publicly insured, and 51.8% had > 3 ED visits in the previous 12 months. Home exposure to ETS and potential allergens was high. Exposure to cockroach allergen was significantly associated with household income. Coexistence of exposures was common: significantly more patients reporting ETS exposure also reported exposure to cockroach allergen and mold than those not reporting ETS exposure. Poorer QoL was significantly associated with cockroach exposure, although this effect was limited to those also exposed to ETS. Higher rates of unscheduled health care utilization and persistent asthma symptoms were not associated with exposures. CONCLUSION. Additional investigation is necessary to clarify the role of exposure-avoidance measures as a component of ED-based interventions for asthma care.