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A RETROSPECTIVE ANALYSIS OF THE EFFECT OF ENVIRONMENTAL IMPROVEMENT BROUGHT ABOUT BY LEGAL INTERVENTIONS IN POORLY CONTROLLED INNER-CITY ASTHMATICS

St.Luke’s-Roosevelt Hospital, New York, NY

PURPOSE: Inner-city adults with asthma are exposed to multiple indoor allergens that contribute to poor asthma control. Our hypothesis is that when living conditions are severely degraded, improving those conditions will improve asthma control in patients seriously ill on maximum pharmacologic therapy. We intend to show that legal intervention can improve living conditions for this purpose.

METHODS: Peak flow, quantitative and qualitative medication use, Emergency Department visits, and hospitalizations were extracted from the charts of asthmatics referred for legal intervention. Data was collected for up to one year before and after intervention.. Clinical measures of asthma control were compared between those with successful intervention and those without.

RESULTS: Of 17 patients referred, intervention was achieved in 10 (58.8%). Self-reported environmental contaminants were roaches (70%), rodents (40%), mold (40%), and dust (10%). Successful intervention was moving (60%) and repair with extermination (40%). All patients were taking at least 1 week of oral steroids per month before the intervention. In the intervention group, five patients (50%) stopped taking steroid for at least 6 months after the intervention. There were 50 to 100% fewer visits to the ED after the intervention in 8 patients (80%). There were no differences in hospitalizations. The peak flow did not change. In the 7 patients for whom the environmental improvement did not occur, all continued taking steroids. Three patients (42.85%) in this group increased their visits to the ED by 50%.

CONCLUSION: Successful intervention in improving household contamination results in reduced need for steroids and Emergency Department visits. Continued habitation in contaminated housing results in persistence of disease despite intensive therapy.

CLINICAL IMPLICATIONS: Correction of household contamination is an essential and underemphasized issue in managing serious asthma. Legal assistance should be available to achieve this.

DISCLOSURE: Modrykamien Ariel, None.