摘要：Objectives. We examined the asthma-control benefit of moving into an asthma-friendly Breathe-Easy home (BEH). Methods. We used a quasi-experimental design to compare the asthma outcomes of 2 groups of low-income children and adolescents with asthma: 34 participants who moved into a BEH, and a local matched cohort of 68 participants who had received a previous asthma-control intervention. Both groups received in-home asthma education. BEHs were constructed with moisture-reduction features, enhanced ventilation systems, and materials that minimized dust and off-gassing. Results. BEH residents’ asthma-symptom–free days increased from a mean of 8.6 per 2 weeks in their old home to 12.4 after 1 year in the BEH. The proportion of BEH residents with an urgent asthma-related clinical visit in the previous 3 months decreased from 62% to 21%. BEH caretakers’ quality of life increased significantly. The BEH group improved more than did the comparison group, but most differences in improvements were not significant. Exposures to mold, rodents, and moisture were reduced significantly in BEHs. Conclusions. Children and adolescents with asthma who moved into an asthma-friendly home experienced large decreases in asthma morbidity and trigger exposure. Asthma remains the most common chronic condition of childhood, affecting 9.1% of all US children. More than 6 million children have current asthma, leading to 205 000 pediatric hospitalizations and 697 000 emergency department visits each year. 1 Socioeconomic and racial/ethnic disparities in asthma prevalence and morbidity continue undiminished. 2 , 3 Exposure and sensitization to allergens and irritants found in the indoor environment are major factors in the development and exacerbation of asthma. 4 Low-income and racial/ethnic minority children have high levels of exposure and sensitization to indoor asthma triggers. 5 – 10 As much as 40% of the excess asthma risk in minority children may be attributable to exposure to residential allergens. 11 Disparities in asthma morbidity and allergic sensitization may be due in part to substandard housing. 7 , 12 – 14 Moisture and dampness, poor ventilation, deteriorated carpeting, and structural deficits can contribute to increased presence of indoor asthma triggers. 15 , 16 For the past 14 years we have been studying the asthma-control effectiveness of community health worker (CHW) home visits to low-income children with asthma in Seattle and King County, Washington. In these visits, CHWs provide asthma self-management support and help participants implement multifaceted interventions that address multiple triggers. We found that such comprehensive, relatively inexpensive interventions were effective at reducing asthma morbidity and improving quality of life, and studies of other home-visit programs have found similar results. 17 – 21 However, many low-income children with asthma live in substandard housing that exposes them to clinically significant levels of asthma triggers. Only rarely can home visits address the structural deficiencies that lead to these exposures. A public-housing redevelopment project in Seattle offered a unique opportunity to study the health impact that moving to specially constructed asthma-friendly homes would have on children with asthma. We assessed the effect of asthma-friendly homes on asthma-symptom days, urgent health care visits, caretaker quality of life, and exposure to indoor asthma triggers among children with asthma. We hypothesized that living in an asthma-friendly home would add benefits beyond those conferred by asthma-control education and self-management support.
