Compliance with environmental control measures in the homes of children and adolescents with asthma

Compliance with environmental control measures in the homes of children and adolescents with asthma 189 Original Article Compliance with environmental control measures in the homes of children and adolescents with asthma* NULMA SOUTO JENTZSCH 1 , PAULO AUGUSTO MOREIRA CAMARGOS 2, ELZA MACHADO DE MELO 3 ABSTRACT Objective: To determine, through home visits, the rate of compliance with environmental control measures in the homes of children with asthma. Methods: This study involved 98 asthma patients between the ages of 4 and 15. The parents of those children and adolescents received instruction in how to carry out environmental control measures and were encouraged to perform such measures continuously for a period of 90 days. Home visits, which included direct inspection of the domicile and administration of a questionnaire, were made before and after this 90-day period. In cases of noncompliance, parents were asked to explain why they did not carry out the control measures. Statistical analysis was performed using the McNemar test. Results: Overall compliance with the various items studied was 11.1%, ranging from -4.1% (for curtain control, p = 0.63) to 22.6% (for stuffed toys, p < 0.001). Passive smoking was reduced to 9.7% (p = 0.02). Among the families studied, the mean monthly income was 2.5 times the national minimum wage. When asked why they had not adopted the recommended measures, noncompliant parents gave, among others, the following explanations: “economic hardship" (60.1%); “the measures were too difficult to carry out" (6.1%); “nonparticipation of the father" (4%); and "lack of time on the part of the mother" (4%). Conclusion: Environmental control measures were carried out sporadically, possibly reflecting the influence of socioeconomic and cultural factors. Keywords: Asthma; Allergens; Environmental exposure; Hypersensivity/prevention & control; Compliance *Study carried out at the Faculdade de Medicina da Universidade Federal de Minas Gerais (UFMG, Federal University of Minas Gerais School of Medicine) - Belo Horizonte, Minas Gerais, Brazil. 1. Masters in Pediatrics from the Graduate Department of Medicine for Children and Adolescents of the Universidade Federal de Minas Gerais (UFMG, Federal University of Minas Gerais School of Medicine) - Belo Horizonte, Minas Gerais, Brazil 2. Full Professor in the Pediatrics Department of the Faculdade de Medicina da Universidade Federal de Minas Gerais (UFMG, Federal University of Minas Gerais School of Medicine) - Belo Horizonte, Minas Gerais, Brazil 3. PhD in Preventive Medicine from the Faculdade de Medicina da Universidade Federal de Minas Gerais (UFMG, Federal University of Minas Gerais School of Medicine) - Belo Horizonte, Minas Gerais, Brazil Correspondence to: Nulma Souto Jentzsch. Rua Raul Pompéia, 64, sala 306, Bairro São Pedro - CEP 30330-080, Belo Horizonte, MG, Brazil. E-mail: Submitted: 8 August 2004. Accepted after review: 9 May 2005. J Bras Pneumol. 2006;32(3):189-94 190 Jentzsch NS, Camargos PAM, Melo EM INTRODUCTION Asthma is a disease caused by the interaction of genetic and environmental factors.(1) Despite scientific advances, there is evidence that asthma prevalence and mortality are increasing. (2) One possible explanation for this increase is greater exposure to aeroallergens and home pollutants (such as dust, mites, mold, cigarette smoke, contact with furry animals, and exposure to chemical irritants).(3) One principal focus in asthma treatment is the control of allergen exposure. Therefore, environmental control measures are recommended for all patients with asthma.(4) In accordance with the Global Initiative for Asthma,(5) a document drawn up by various international authorities, asthma prevention is achieved through environmental control measures, use of medication, psychological support, and health education (for patients and their families). The factors that hinder compliance with environmental control measures are various and complex, including socioeconomic conditions, as well as cultural, psychological, and individual aspects, together with doctor-patient relationships and factors related to the treatment of asthma.(6-9) International studies have shown that the rate of compliance can vary from 17% to 46%.(9) In Brazilian studies, the rate of compliance has ranged from 37% to 42%. In two controlled clinical studies,(10-11) researchers found rates of compliance of 17% and 39%, respectively. In another study(12) evaluating 57 children and adolescents between the ages of 1 and 18 with hard-to-control asthma, a smoker in the home was found to be an aggravating factor (present in 40% of the cases evaluated). A work group of the American Academy of Asthma, Allergy and Immunology(13) published a review article on this topic, in which they stated that the rate of compliance might rise to as high as 48% if there were continuous education of the whole family. In two Brazilian cross-sectional studies of children and adults with asthma,(14-15) questionnaires were administered during medical visits (never in the home). The authors of those two studies found the rates of compliance with environmental control measures to be 42% and 37%, respectively. The appropriate management of asthma requires the reduction of exposure to allergens, dust in particular, in the home.(16) Since the beginning of the 19th century, it has been known that there is a J Bras Pneumol. 2006; 32(3):189-94 relationship between allergy symptoms and specific characteristics found in the homes of patients (mold and dust). However, environmental control measures were only considered important after the isolation and identification of home allergens, especially mites. (17) Establishing this causal relationship between symptoms and exposure to allergens has underscored the importance of such measures.(18-19) Nevertheless, some authors have called into question the importance of the environment for the onset of asthma and other allergic diseases. Some authors(20) have concluded that early exposure to endotoxins in the home leads to a lower prevalence of allergic sensitization. Another author postulated that exposure to environmental allergens is a significant factor only after the disease has become established.(21) In a meta-analysis(22) of 23 environmental control studies, no evidence was found to justify the recommendation that environmental control measures be routinely taken (neither changes in spirometric parameters nor improvement of clinical symptoms). The authors reported that most of the studies included in the meta-analysis had few participants. There was only one randomized study, and most of the studies included no control groups. The authors of another review study(23) concluded that there was evidence that exposure to allergens is a significant factor for the etiology of asthma and in the determination of its severity. Therefore, there is a reason for environmental control as a strategic procedure for the (...truncated)