Home/Housing

Low-income adults with uncontrolled asthma saw both their asthma control and quality of life improve with the help of an in-home, self-management asthma support program delivered by community health workers (CHWs), according to a report published online by JAMA Internal Medicine.

Asthma affects 24.6 million American, including 17.5 million adults. Control of asthma is inadequate despite the availability of effective methods to manage it. Home-based self-management support to improve asthma control among children is well established. However, the effectiveness of home visits for adults has not been well studied.

James Krieger, M.D., M.P.H., of Public Health-Seattle and King County, Washington, and co-authors report on the Home-Based Asthma Support and Education trial (HomeBASE). The study enrolled 366 participants with uncontrolled asthma: 189 to usual care and 177 to the intervention, which included CHWs who provided education, support and service coordination during home visits. The CHWs provided an average of 4.9 home visits during a one-year period.

The intervention group had greater increases in the average number of symptom-free days over two weeks (2.02 days per two weeks more) and quality of life as measured on a questionnaire increased an average of 0.50 points. However, average urgent health care use episodes in the past 12 months decreased similarly in both groups from an average of 3.46 to 1.99 episodes in the intervention group and from an average of 3.30 to 1.96 episodes in the usual care group.

“We anticipate that this intervention could be readily replicated by health organizations serving diverse, low-income clients, suggesting that it could reduce asthma-related health inequities. Intervention protocols can be implemented without specialized training or resources. The cost per participant was approximately $1,300 (2013 U.S. dollars), substantially less than one year’s supply of an inhaled corticosteroid,” the study concludes.

This tool kit is intended for organizations who want to start a new asthma home visit program or add to an existing program. It includes descriptions of each visit, pilot program data, lessons learned, successes, and more. The forms provided in the appendix of tools are for public use and can be edited to fit different organization’s needs. The guidance provided in this tool kit is not intended to replace comprehensive training prior to providing home visiting services to the public. 

The tools and information in this guidance will help keep the air clean where many Americans spend up to 90 percent of their time – indoors.  Some of the biggest threats to indoor air quality stem from moisture issues. Leaking roofs, plumbing problems, condensation issues, poor indoor humidity control, and lack of drainage around the base of buildings are  some of the commonly reported causes of moisture problems in the United States.  These problems can not only threaten the structural integrity of buildings, they can also increase exposure to mold and other biological contaminants. Such exposure is associated with increases in the occurrence and severity of allergies, asthma and other respiratory illnesses.