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

Abstract

Asthma is the most common chronic disease of childhood in the United States, causes significant morbidity, particularly in the inner-city, and accounts for billions of dollars in health care utilization. Home environments are established sources of exposure that exacerbate symptoms and home-based interventions are effective. However, elementary school children spend 7 to 12 h a day in school, primarily in one classroom. From the observational School Inner-City Asthma Study we learned that student classroom-specific exposures are associated with worsening asthma symptoms and decline in lung function. We now embark on a randomized, blinded, sham-controlled school environmental intervention trial, built on our extensively established school/community partnerships, to determine the efficacy of a school-based intervention to improve asthma control. This factorial school/classroom based environmental intervention will plan to enroll 300 students with asthma from multiple classrooms in 40 northeastern inner-city elementary schools. Schools will be randomized to receive either integrated pest management versus control and classrooms within these schools to receive either air purifiers or sham control. The primary outcome is asthma symptoms during the school year. This study is an unprecedented opportunity to test whether a community of children can benefit from school or classroom environmental interventions. If effective, this will have great impact as an efficient, cost-effective intervention for inner city children with asthma and may have broad public policy implications.

Emerging concepts and challenges in implementing the exposome paradigm in allergic diseases and asthma: a Practall document

“…The implementation of public smoking bans and clean air policies has led to a reduction in the hospitalization for asthma, and these policies should be reinforced in as many countries as possible . School‐specific targeted intervention work is ongoing …”

The Effects of the Environment on Asthma Disease Activity

“…Mouse allergen exposure, independent of sensitization and home allergen exposure, was significantly associated with more asthma symptoms days and decreased FEV 1 % predicted, suggesting the school environment's importance in urban asthma. An ongoing school specific environmental intervention is being conducted, targeting exposures including mouse, NCT02291302 15,28 .…”

Environmental Food Exposure: What Is the Risk of Clinical Reactivity From Cross-Contact and What Is the Risk of Sensitization

“…6 A current study evaluating the clinical impact of environmental measures to reduce aeroallergens in schools will also assess the effectiveness of these strategies to reduce peanut allergen levels in school dust. 23…”