Reducing risk of house dust mite and cockroach allergen exposure in inner-city children with asthma
Asthma prevalence among disadvantaged and minority children is disproportionately higher in inner-city populations. Environmental allergen exposure, particularly that of house dust mites and cockroaches, is known to contribute to asthma exacerbations in children. Environmental control of these particular triggers is a necessary component of asthma education and should be incorporated into the teaching plan for these children. The costs surrounding environmental control may not be within the means of many families living in urban, inner-city environments; therefore nurses should offer families creative ideas and cost effective suggestions for controlling environmental triggers.
Asthma is one of the most common chronic conditions affecting approximately 2.7 million children in the United States (Taylor & Newacheck, 1992). Prevalence of asthma increased dramatically between the years 1980 and 1987, and rates continue to rise. The estimated prevalence rate is 5%-10% in children (Gergen, Mullaly, & Evans, 1988; Starfield et al., 1984). Among children 5- 17 years of age, asthma accounts for a loss of more than 10 million school days (Weiss, Gergen, & Hodson, 1992). Statistics also show the overall age-adjusted death rate increased 40% from 1982 to 1991 (Centers for Disease Control [CDC], 1995). Furthermore, poor and minority populations, particularly blacks, living in urban areas experience a disproportionate prevalence of asthma and increase in morbidity and mortality as compared to whites (CDC, 1995; Taylor & Newacheck, 1992; Wing, 1993). Reported rates of prevalence and high morbidity associated with risk factors related to asthma have also been documented (Carter-Pokes & Gergen, 1993; Wood, Hidalgo, Prihoda, & Kromer, 1993).
Morbidity and mortality associated with asthma may be affected by patient compliance, patient education, and medical management (CDC, 1995). In response to the increases in prevalence, morbidity, and mortality associated with asthma - especially in children - the National Asthma Education Project implemented the Executive Summary Board's National Guidelines for the Diagnosis and Management of Asthma. These guidelines were implemented to increase public and professional awareness about asthma and to improve effective control of asthma with updated treatment information (National Asthma Education Project [NAEP], 1991). The guidelines emphasize patient education, including information about environmental control of common triggers that may aggravate or precipitate an asthma episode. For children with asthma living in the innercity, common triggers include house dust mites and cockroaches.
Role of Allergens in Asthma
Asthma is a lung disease characterized by reversible (in most cases) airway obstruction, airway inflammation, and increased airway responsiveness to a variety of stimuli (NAEP, 1991). Clinical manifestations of asthma such as shortness of breath and wheezing are the result of the airway obstruction. Airway obstruction is initiated by the infiltration of inflammatory cells in the airways of a person with asthma, which results in edema of the airway mucosa. The airways are thought to be hyperresponsive (Roberts & Holgate, 1993). This condition is manifested by exaggerated bronchoconstriction of the airways in response to many physical changes and to chemical and pharmacologic agents (Boushey, Holtzman, Sheller, & Nadel, 1980). A person with asthma may develop dyspnea and/or wheezing after exposure...