Study: Parents of Asthmatic Children Fail to Rid Homes of Smoke and Other Asthma Attack Triggers [08/31-3]

Excerpts from: Breathing Lessons

By January W. Payne The Washington Post [08/31/04]

A new study, published in this month's Journal of Allergy and Clinical Immunology, suggests that many parents of children with asthma don't do as well. The study shows that parents implement some widely recommended measures to rid their homes of things likely to trigger an asthma attack. But they also take other, sometimes more expensive actions that were not likely to be useful. And they often fail to take other measures that could be more beneficial.

In 2002, 20 million people in the United States were reported to have asthma -- a chronic inflammatory lung disease characterized by wheezing, difficulty breathing, chest tightness and coughing -- according to the National Heart, Lung, and Blood Institute (NHLBI). About 6.1 million were children under age 18. Asthma attacks occur after exposure to environmental allergens (such as animal dander, mold and pollen), irritants (such as cigarette smoke, strong odors or air pollution), viral infections and some medications.

The new study found that parents often invest in expensive HEPA filters for vacuum cleaners and ventilation systems -- both steps recommended by NHLBI. But some still allow cigarette smokers to light up around the child (or continue to smoke themselves), or keep windows open, allowing pollen into the home.

Four out of five parents surveyed reported knowing of "at least one environmental trigger of their child's asthma," according to the study. Of those families, about 81 percent attempted "some action to remediate or remove it. However, most of these actions were not specifically endorsed by current NHLBI asthma guidelines."

Of 1,788 actions parents described taking, more than "half were not included in NHLBI recommendations and were not likely to be useful in controlling the trigger that the parent reported," the authors wrote.

Nineteen percent of respondents made no attempt to address environmental triggers of their child's asthma.

The five most common actions parents reported taking were purchasing special air filters (25 percent of all survey respondents); reducing their child's exposure to dust (22 percent); using a special vacuum cleaner (17 percent); purchasing mattress, comforter and/or pillow covers (16 percent); cleaning the home more often (13 percent); and reducing the child's exposure to animals (11 percent).

Despite NHLBI's caution that tobacco smoke is "the most important environmental indoor irritant," just 7 percent of study participants in smoking households reported "any attempts to reduce or eliminate smoke exposure," according to the study. Smokers were present in 24 percent of the households surveyed.

"Parents [will] . . . pursue a lot of elaborate actions as opposed to the most straightforward one," study co-author Michael D. Cabana, a professor of pediatrics at the University of Michigan, said in an interview. That "tells me that sometimes the most straightforward action -- quitting smoking -- might not be the simplest and easiest for parents."

Martha White, a physician at the Institute for Asthma and Allergy, a private practice in Wheaton and Chevy Chase, said parents of children with asthma should make that sacrifice. "Parents should stop smoking, and if they can't, they should limit their smoking to outdoors," she said.

"Clinicians should identify triggers, refer patients as needed for allergen testing and educate patients about triggers and possible control measures," the study said.

The study's authors said the results confirm findings that physicians are not good judges of which parents will follow their advice.

"Physicians have been shown to be inaccurate when predicting which parents will adhere to their therapeutic recommendations," the study said. "We found no demographic characteristics [such as race, age, or economic status] to be associated consistently with taking environmental actions."

click here to view the abstract of this study

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