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OBJECTIVES: We assessed whether any household dust reduction intervention has the effect of increasing or decreasing the development or severity of atopic disease. DATA SOURCES: Electronic searches on household intervention and atopic disease were conducted in January 2007 in EMBASE, MEDLINE, and the Cochrane Central Register of Controlled Trials. No date or language restriction was placed on the literature search. DATA EXTRACTION: We included randomized controlled trials comparing asthma outcomes in a household intervention group with either placebo intervention or no intervention. DATA SYSNTHESIS: Fourteen studies met the inclusion criteria. Eight recruited antenatally and measured development of atopic disease. Six recruited known atopic individuals and measured disease status change. Meta-analyses on the prevention studies found that the interventions made no difference to the onset of wheeze but made a significant reduction in physician-diagnosed asthma. Metaanalysis of lung function outcomes indicated no improvement due to the interventions but found a reduction in symptom days. Qualitatively, health care was used less in those receiving interventions. However, in one study that compared intervention, placebo, and control arms, the reduction in heath care use was similar in the placebo and intervention arms. CONCLUSIONS: This review suggests that there is not sufficient evidence to suggest implementing hygiene measures in an attempt to improve outcomes in existing atopic disease, but interventions from birth in those at high risk of atopy are useful in preventing diagnosed asthma but not parental-reported wheeze. KEY WORDS: asthma, atopy, children, house dust mite, meta-analysis, randomized control trial, systematic review. Environ Health Perspect 115:1691-1695 (2007). doi:10.1289/ehp.10382 available via http://dx.doi.org/ [Online 25 September 2007], During the 1960s, hospital admission rates in England and Wales for childhood asthma steadily increased. This trend continued into the 1980s and began a steady decline in the 1990s, with [...]

Objectives. Follow-up with a primary care provider (PCP) is recommended after an emergency department (ED) visit for asthma to assess clinical status and develop a management plan to improve future care. However, previous ED-based studies of urban children with asthma have reported low follow-up rates. The objective of this study was to determine whether scheduling an appointment at the time of an ED visit improves PCP follow-up for urban children. A secondary goal was to assess the effect of this intervention on short-term health outcomes and the use of recommended preventive controller medications. Methods. This randomized trial enrolled a convenience sample of children who were 2 to 18 years old and discharged after treatment for acute asthma in an urban children's hospital ED. Both intervention and control subjects were instructed to follow up with their PCP within 3 to 5 days. Study staff assisted intervention subjects to call their PCP from the ED and schedule an appointment. When follow-up could not be scheduled, assistance continued after ED discharge by telephone until an appointment date was confirmed. Study outcomes included PCP visits, asthma-related morbidity, and daily use of preventive medication 4 weeks after the ED visit. Outcomes were assessed by telephone interview and confirmed by PCP record review. Results. A total of 278 eligible subjects were enrolled over 8 months; intervention and control groups were similar by demographic variables and PCP type as well as by asthma history, symptoms, and previous medication use. Only 38% of subjects reported using a daily controller medication, although 70% described persistent asthma symptoms for which these are recommended. For the intervention group, follow-up appointments were successfully obtained during the ED visit for 24% of subjects; when unsuccessful, a median of 3 telephone calls (range: 1-14) were needed to confirm that an appointment had been scheduled. During the 4 weeks after the ED visit, intervention subjects were more likely than controls to follow up with their PCP (64% vs 46%; relative probability for follow-up: 1.4; 95% confidence interval: 1.1-1.7). Study groups did not differ in return ED visits, missed school or work, or the percentage reporting daily use of a controller medication (58% vs 54%) 4 weeks after the ED visit. The median time to the next PCP visit was shorter among intervention subjects (13 vs 54 days). Conclusions. Scheduling an appointment after an ED visit increased the likelihood that urban children with asthma would follow up with a PCP. An appointment could not be obtained during the ED visit for most children. Other interventions are needed to improve linkage between ED and primary care for asthma and to improve the use of controller medications. Pediatrics 2003;111: 495-502; asthma, emergency, primary care, children., ABBREVIATIONS. NAEPP, National Asthma Education and Prevention Program; PCP, primary care provider; ED, emergency department; CI, confidence interval. Efforts to improve care for childhood asthma have received increasing attention in [...]

Death certificate data were used to examine asthma mortality among African Americans and Whites aged 5 through 34 years in Chicago from 1968 through 1991, African Americans experienced consistently higher asthma mortality throughout the period. Asthma mortality remained stable among Whites from 1968 through 1991 but increased by 337% among African Americans from 1976 through 1991 (P < .001). The increase was greatest among 20-through 34-year-olds. Between 1979 and 1991, outpatient and emergency department deaths increased significantly while the proportion of dead-on-arrival cases remained stable at 51%. This shift to non-inpatient deaths suggests that lack of access to health care may play a role in increasing asthma mortality. (Am J Public Health. 1994;84:1830-1833), Socioeconomic problems may contribute to increased asthma and death from asthma in the US. Deaths from asthma increased in the US among children and young adults in the 1980s and 1990s. Such mortality increased even more in major urban areas and disproportionately among African Americans compared to whites. A study of deaths in Chicago from 1968 through 1991 showed that 340 were caused by asthma among blacks and whites. Nearly 86% of these deaths were among blacks. The only other significant difference by group was the 54% of 20- to 34-year-olds who were dead on arrival at the hospital, compared to 44% of those younger than 20. Poverty, contributing to a lack of access to regular health care, may increase both the number of asthma cases and the mortality rates from asthma.

OBJECTIVE. Spirometry is an important component of the National Asthma Education and Prevention Program guidelines for asthma, yet published data show variable associations between forced expiratory volume in 1 second percentage ([FEV.sub.1]%) predicted, symptoms and health care utilization. The objective of this analysis was to examine the association between FEV1% and future risk of exacerbations among a well-characterized population of children with asthma. METHODS. Using data that are available from the Childhood Asthma Management Program, we examined the relationship between prebronchodilator [FEV.sub.1] % and important clinical outcomes. Multiple observations of [FEV.sub.1] were available for each patient; multivariate regression analysis, using a general estimating equation approach, was used to control for the correlation between repeated measurements among individuals and potential confounders. [FEV.sub.1] % was categorized into 4 levels and as a continuous variable. Outcomes of interest included mean symptom score (0-3), episode-free days, and asthma-related events (oral steroid use, emergency department visits, and hospitalizations) during the ensuing 4-month period. Our analysis was limited to the placebo group (N = 417). RESULTS. We observed a clear relationship between prebronchodilator [FEV.sub.1] % and important clinical outcomes. In multivariable models that simultaneously controlled for covariates of interest, age at baseline, time, previous event history, and nocturnal awakenings, a significant relationship between [FEV.sub.1] % and asthma symptoms and serious asthma exacerbations (oral steroids, emergency department visits, and hospitalizations) was observed. Compared with children with an [FEV.sub.1] % [greater than or equal to] 100%, children with [FEV.sub.1] % 80% to 99%, 60% to 79%, and CONCLUSIONS. In children with mild to moderate asthma, [FEV.sub.1] % predicted is independently associated with future asthma symptoms and health care utilization. Previous asthma-related hospitalizations and nocturnal symptoms also were independently associated with risk for future adverse events. [FEV.sub.1] is an important component of asthma health status and asthma severity classification. KEY WORDS. asthma, spirometry, treatment outcome, severity classification., URL: www.pediatrics.org/cgi/doi/10.1542/peds.2005-2962 Anne L. Fuhlbrigge, MD, Scott T. Weiss, MD, Karen M. Kuntz, ScD, A. David Paltiel, PhD, for the CAMP Research [...]