Asthma Control: Home-Based Multi-Trigger, Multicomponent Environmental Interventions

Home-based multi-trigger, multicomponent interventions with an environmental focus for persons with asthma aim to reduce exposure to multiple indoor asthma triggers (allergens and irritants). These interventions involve home visits by trained personnel to conduct two or more activities. The programs in this review conducted environmental activities that included:

• Assessment of the home environment
• Changing the indoor home environment to reduce exposure to asthma triggers
• Education about the home environment

Most programs also included one or more of the following additional non- environmental activities

• Training and education to improve asthma self-management
• General asthma education
• Social services and support
• Coordinated care for the asthma client

Summary of Task Force Recommendations & Findings

The Community Preventive Services Task Force recommends the use of home-based multi-trigger, multicomponent interventions with an environmental focus for children and adolescents with asthma based on evidence of effectiveness in improving overall quality of life and productivity, specifically:

• Improving asthma symptoms
• Reducing the number of school days missed due to asthma

The Task Force finds insufficient evidence to determine the effectiveness of home-based multi-trigger, multicomponent interventions with an environmental focus for adults with asthma based on the small number of studies identified and the mixed results across the outcomes of interest.

Task Force Finding & Rationale Statement for review of interventions for children and adolescents

Task Force Finding & Rationale Statement for review of interventions for adults

Economic Review

The Task Force finds that home-based multi-trigger, multicomponent interventions with a combination of minor or moderate environmental remediation with an educational component provide good value for the money invested based on:

• Improvement in symptom free days
• Savings from averted costs of asthma care and improvement in productivity

Results from the Systematic Reviews

Twenty-three studies qualified for the effectiveness review.

Children and Adolescents:

• Asthma symptom days: median decrease of 21 days per year (6 studies)
• School days missed: median decrease of 12 days per year (5 studies)
• Acute healthcare visits: combined median decrease of 0.57 visits per year (10 studies)
  • Hospitalizations: median decrease of 0.4 hospitalizations per year
  • Emergency department visits: median decrease of 0.2 visits per year
  • Unscheduled office visits: median decrease of 0.5 visits per year
• Pulmonary function: overall, no significant improvement (7 studies)

Adults:

Three intervention studies reported one or more outcome measurements in adults. Although two studies observed improvements in quality of life or symptom scores, the results for health care utilization, and productivity outcomes showed borderline or no improvement. No studies in adults reported any physiologic outcomes.

Applicability

The reviewed multi-trigger multicomponent intervention studies were conducted:

• Mostly in the homes of US urban minority children
• By a wide range of organizations including:
  • State and local health departments
  • Health care systems
  • Community organizations
• By a wide range of trained personnel including:
  • Community health workers (most common)
  • Nurses
  • Respiratory therapists
  • Social workers
  • Physicians

These results were based on a systematic review of all available studies, conducted on behalf of the Task Force by a team of specialists in systematic review methods, and in research, practice and policy related to asthma control.

Economic Review

Thirteen studies described in fourteen papers qualified for the economic review. All numbers are in $2007 US dollars.

• Program cost per participant: $231 to $14,858 (13 studies)
  • Interventions with major environmental remediation: $3,796 to $14,858 (3 studies)
  • Interventions with minor to moderate remediation and an educational component: $231 to $1,720 (10 studies)
• Six studies with minor to moderate remediation demonstrated that these interventions provide good value for money invested based on substantial returns for money invested and a cost per symptom free day that is below the standard cut-off for what is considered cost-effective in the literature.
  • Cost-benefit studies show a return of $5.3 to $14.0 for each dollar invested (3 studies)
  • Cost-effectiveness studies show a cost of $12 to $57 per additional symptom free day (3 studies)
• The majority of studies in the economic review were interventions for children with asthma, and studies that included adults also included children.

Supporting Materials

• Analytic framework – see Figure 1 on page S10 [PDF - 29.6MB]
• Research gaps
• Summary evidence tables [PDF -216KB]
• Summary evidence tables [PDF - 136KB] - Economic Review
• Included studies
• Search strategy

Publications

Crocker DD, Hopkins D, Kinyota S, et al. A systematic review of home-based multi-trigger multi-component environmental interventions to reduce asthma morbidity. Journal of Allergy and Clinical Immunology 2009; 123: S20-S20.

Crocker DD, Kinyota S, Dumitru GG, Ligon CB, Herman EJ, Ferdinands JM, Hopkins DP, Lawrence, BM, Sipe TA, Task Force on Community Preventive Services. Effectiveness of home-based, multi-trigger, multicomponent interventions with an environmental focus for reducing asthma morbidity: a Community Guide systematic review. Am J Prev Med 2011;41(2S1):S5-32.

Nurmagambetov TA, Barnett SBL, Jacob V, Chattopadhyay SK, Hopkins DP, Crocker DD, Dumitru GG, Kinyota S, Task Force on Community Preventive Services. Economic value of home-based, multi-trigger, multicomponent interventions with an environmental focus for reducing asthma morbidity: a Community Guide systematic review. Am J Prev Med 2011;41(2S1):S33-47.

Task Force on Community Preventive Services. Recommendations from the Task Force on Community Preventive Services to decrease asthma morbidity through home-based, multi-trigger, multicomponent interventions. Am J Prev Med 2011;41(2S1):S1-4.

More Community Guide publications about Asthma Control

Promotional Materials

Community Guide News

• Community Guide News: Community Preventive Services Task Force Publishes Findings on Home-Based Asthma Programs
  Developed by The Community Guide in collaboration with CDC's National Center for Environmental Health

More promotional materials for Community Guide reviews about Asthma Control.

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Sample Citation

The content of publications of the Guide to Community Preventive Services is in the public domain. Citation as to source, however, is appreciated. Sample citation: Guide to Community Preventive Services. Asthma control: home-based multi-trigger, multicomponent interventions. www.thecommunityguide.org/asthma/multicomponent.html. Last updated: MM/DD/YYYY.

Review completed: June 2008