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Am Fam Physician. 2002;65(12):2583

Over the past few years, the prevalence of childhood asthma has increased substantially. A major contributor to this increase appears to be exposure to indoor allergens and irritants, such as dust mites, cockroaches, mice, furry pets, and tobacco smoke. Part of the recommended current comprehensive treatment regimen for children with asthma includes reduction of environmental triggers. Despite these recommendations, a significant number of children with asthma continue to be exposed to environmental triggers that exacerbate asthma. Finkelstein and colleagues assessed the prevalence of potential environmental triggers, identified risk factors for such exposures, and evaluated whether previous parental education about trigger avoidance is associated with fewer exposures.

Children with mild to moderate asthma who participated in the Pediatric Asthma Care Patient Outcomes Research Team II were enrolled in the study. This was a multi-site study involving three health maintenance organizations. Parents of the study subjects were asked to report their children's recent asthma symptoms and any exposures to environmental triggers. Data analyses were performed to determine demographic risk factors for environmental exposures and to evaluate whether previous education about environmental exposure reduction was associated with fewer exposures.

The results showed that the participants had undergone a significant degree of environmental exposure, including tobacco smoke and household pets, particularly furry animals. Other substantial exposures included carpeting in the bedroom, forced-air heat, and no use of mattress or pillow covers. Forty-five percent of the parents remembered receiving written instructions about trigger avoidance, and 42 percent reported discussing trigger avoidance with a clinician within the past six months. The exposures varied with demographic and socioeconomic variables, but all children were at risk. No association was apparent between reduction of exposures and previous receipt ofenvironmental control instructions.

The authors conclude that, although current treatment guidelines include avoidance of environmental triggers, children with asthma continue to have exposures to triggers. In addition, recommendations about trigger avoidance are rarely adopted despite information from clinicians. The authors also state that new methods for educating parents of children with asthma should be developed to reduce unnecessary environmental exposures.

editor's note: Although current treatment standards for asthma include environmental trigger avoidance, parents of children with asthma are not receiving the message. Finkelstein and colleagues found that more than one half of the parents with children who have asthma did not receive any information on trigger avoidance. This situation occurs even though some of the measures are easy to implement, while others may cost money up front but could reduce expenses related to asthma exacerbations. Physicians who care for children with asthma must develop strategies to address trigger avoidance that include straightforward messages about physical measures and, when indicated, parental smoking cessation. These steps should be part of the routine care of children with asthma.—k.e.m.

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