Effect of an Integrated Pest Management Intervention on Asthma Symptoms Among Mouse-Sensitized Children and Adolescents With Asthma

Abstract

IMPORTANCE Professionally delivered integrated pest management (IPM) interventions can reduce home mouse allergen concentrations, but whether they reduce asthma morbidity among mouse-sensitized and exposed children and adolescents is unknown.OBJECTIVE To determine the effect of an IPM intervention on asthma morbidity among mouse-sensitized and exposed children and adolescents with asthma.DESIGN, SETTING, AND PARTICIPANTS Randomized clinical trial conducted in Baltimore, Maryland, and Boston, Massachusetts. Participants were mouse-sensitized and exposed children and adolescents (aged 5-17 years) with asthma randomized to receive professionally delivered IPM plus pest management education or pest management education alone. Enrollment occurred between May 2010 and August 2014; the final follow-up visit occurred on September 25, 2015.INTERVENTIONS Integrated pest management consisted of application of rodenticide, sealing of holes that could serve as entry points for mice, trap placement, targeted cleaning, allergen-proof mattress and pillow encasements, and portable air purifiers. Infestation was assessed every 3 months, and if infestation persisted or recurred, additional treatments were delivered. All participants received pest management education, which consisted of written material and demonstration of the materials needed to set traps and seal holes. MAIN OUTCOMES AND MEASURESThe primary outcome was maximal symptom days defined as the highest number of days of symptoms in the previous 2 weeks among 3 types of symptoms (days of slowed activity due to asthma; number of nights of waking with asthma symptoms; and days of coughing, wheezing, or chest tightness) across 6, 9, and 12 months. RESULTSOf 361 children and adolescents who were randomized (mean [SD] age, 9.8 [3.2] years; 38% female; 181 in IPM plus pest management education group and 180 in pest management education alone group), 334 were included in the primary analysis. For the primary outcome, there was no statistically significant between-group difference for maximal symptom days across 6, 9, and 12 months with a median of 2.0 (interquartile range, 0.7-4.7) maximal symptom days in the IPM plus pest management education group and 2.7 (interquartile range, 1.3-5.0) maximal symptom days in the pest management education alone group (P = .16) and a ratio of symptom frequencies of 0.86 (95% CI, 0.69-1.06).CONCLUSIONS AND RELEVANCE Among mouse-sensitized and exposed children and adolescents with asthma, an intensive year-long integrated pest management intervention plus pest management education vs pest management education alone resulted in no significant difference in maximal symptom days from 6 to 12 months.

The School Inner-City Asthma Intervention Study: Design, rationale, methods, and lessons learned

“…The intervention procedures will be those that were used in the Boston pilot home intervention study,[14] and the Inner-City Asthma Study (ICAS) Study,[11] and the NIAID funded Mouse Allergen Asthma Intervention Trial (MAAIT). [15] The school-specific IPM will focus on surrounding areas that feed into the classroom and harbor infestation by food and water sources (i.e. cafeteria).…”

“…Our methods are modeled off of successful intervention work in Boston homes[14] which led to our NIAID funded home based study Mouse Allergen Asthma Intervention Trial. [15] This trial utilized successful strategies targeted to the bedroom, inspection targeted in surrounding areas, and in the kitchen. Our school-based study will focus on the primary exposure school room of interest, the child’s classroom, surrounding support areas, and the cafeteria.…”

“…[10–13] We used established integrated pest management (IPM) measures that have been shown to reduce mouse allergen exposures in homes. [14,15] We then demonstrated that we could effectively decrease classroom-specific toxic exposures during the academic school year by utilizing classroom-suitable High Efficiency Particulate Air (HEPA) air filters specifically adapted to maximize flow while minimizing noise. [16]…”

Bedroom Allergen Exposure Beyond House Dust Mites

“…In addition, nonclinical measures such as missed school days and reduced sleep disruption are suggestive of a beneficial impact on asthma morbidity, although this has not been substantiated through clinical measures. Beyond these steps, any benefit to asthma morbidity associated with more intensive interventions, such as a professionally delivered, integrated pest management program delivered in combination with this education, has not been proven [183]. …”

“…Interestingly, some studies suggest that interventions that target only a single allergen, or even a single location, for example the bedroom, can be efficacious [183, 190, 198]. Although studies have reported mixed findings [53•, 123, 181, 197], they highlight the need to revisit the widely-debated issue of the efficacy of single- versus multifaceted interventions and to improve behavioral compliance in a sustainable way.…”