Cockroach detritus triggers inner-city asthma

Simple, low-cost interventions effective

The combination of cockroach allergy and exposure is an important cause of asthma-related illness and hospitalization among inner-city children, according to a study published in the May 8 New England Journal of Medicine.

The National Cooperative Inner-City Asthma study, sponsored by the Bethesda, MD-based National Institute of Allergy and Infectious Diseases (NIAID), studied 476 African-American and Hispanic children. First, researchers measured levels of cockroach, dust mite, and cat dander present in the children’s homes and then performed allergy skin tests on the children.

According to the study:

• 36.8% of the children were allergic to cockroach allergen.

• 34.9% were allergic to dust mite allergen.

• 22.7% were allergic to cat dander.

Among the children’s bedrooms,

• 50.2% were found to have high levels of cockroach allergen in the form of dust.

• 9.7% had high levels of dust mites.

• 12.6% had high levels of cat allergens.

After adjusting for sex and family history of asthma, the researchers found that children who tested positive for cockroach allergy and had a high level of exposure to cockroach allergen were hospitalized an average of .37 times per year, compared with .11 times per year for other children. In addition, these children averaged 2.56 unscheduled medical visits for asthma per year, compared with 1.43 visits for the other children. They also "had significantly more days of wheezing, missed school days, and nights with lost sleep, and their parents or other care givers were awakened during the night and changed their daytime plans because of the child’s asthma significantly more frequently," according to the report. Similar problems were not associated with either dust mite or cat dander allergens.

In light of the findings, the NIAID contends that the use of "simple and relatively low-cost" interventions ... such as patient education, roach traps, and child-safe insecticides are potentially important adjuncts to previously established medical therapies that can help asthmatic patients."

Such solutions are nothing new to Patricia Hernandez, RN, nurse coordinator of the Asthma Control and Education program at Hartford (CT) Hospital. "If we use extermination, we remove old carpets or get someone to clean them twice a year, use mattress covers, little things; we can make a big difference," she says.

The problem, she says, is that many low-income families don’t have the resources to buy allergen-resistant products."Before I spoke with the community, I didn’t realize that some people don’t even have money to buy a regular soap, to buy a fan," she says. "What happens sometimes is that in order to keep their house clean, they use Chlorox or other sorts of chemicals that can trigger their asthma," she says.

That’s why it’s imperative that asthma managers work to address such problems in the home environment through education and community outreach, she says. "Sometimes people say that people in my community are a little lazy," Hernandez says. "But I have a good percent of patients who really make an effort. They are clean people. But they don’t have the help that they need."