Image via WikipediaIn a study published in Pediatric Allergy, Immunology, and Pulmonology (Volume 23, Number 2, 2010) called “Home Is Where the Triggers Are: Increasing Asthma Control by Improving the Home Environment” by James Krieger, MD, MPH discusses effectiveness of a home visit strategy. A home visit strategy should include an environmental component that addresses multiple triggers. Visitors assess home environmental conditions, tailor education on how to eliminate triggers to the client’s sensitization status and exposures found in the home, provide trigger reduction resources (eg, vacuums, cleaning supplies, bedding encasements and referral to smoking cessation), help with cockroach and rodent integrated pest management, make minor repairs and provide social support. An important part of the strategy is that visitors build trusting relationships with clients, thus enhancing their effectiveness in motivating behavior changes. These home visits reduce exposure to triggers, decrease symptoms and urgent health-care use, and increase quality of life. Home visit program cost per client ranges from $200 to $1500 based on the type of home visitor and the intensity of the intervention. However, a cost-effectiveness analysis concluded that these home visits have a return on investment of 5.3 – 14.0 and a cost of $12 – $57 per symptom-free day gained. It is important to note that the annual cost of inhaled fluticasone (220ug) is approximately $1567. The study discusses the Seattle-King County Healthy Homes program as an example of a successful program.

The study also talks about the strong evidence that links exposure to allergens commonly found in homes such as those derived from dust mites, cockroaches, rodents, molds, and pet dander, to sensitization and subsequent asthma incidence and morbidity. Exposure to indoor allergens is widespread, with >92% of homes containing sufficient concentrations of at least one allergen in dust to cause symptoms in sensitized individuals and 46% with exposure to three or more. In addition to allergens, other indoor asthma triggers include tobacco smoke, nitrogen oxides from combustion devices, irritants from volatile organic compounds, and fungi.