High indoor allergen and pollutant levels have repeatedly been linked to asthma morbidity, especially among urban children, who have among the highest asthma morbidity in the US. However, environmental intervention trials for asthma have typically compared an environmental control strategy (ECS) to no intervention, a design that does not reflect the recommended approach to asthma management, which includes ECSs in conjunction with titration of controller medication. As a result, it remains unknown whether the addition of an ECS to controller medication titration results in improved asthma control, and therefore a reduced controller medication requirement. Another unanswered question is whether the addition of an ECS to controller medication titration results in greater reduction of allergic inflammation than medication titration alone. ECSs may have a greater effect on allergic inflammation than controller medications because ECSs target the most upstream point of the asthma inflammatory pathway by reducing pro-inflammatory environmental exposures, while controller medications target a downstream point of this pathway. Surprisingly, it is also unknown whether the improvement in asthma in ECS trials is mediated by reductions in allergen levels and/or reduction in pollutant levels. Understanding the factors that mediate the effects of an ECS on asthma is important for refuting, or supporting, a causal role for indoor allergens and/or pollutants in asthma morbidity, and also for optimizing the design of ECSs to target the most influential factors. We therefore hypothesize that the addition of an individually-tailored, multi-faceted ECS to guidelines-based controller medication titration will result in less controlle medication requirement and allergic inflammation than controller medication titration alone among urban asthmatic children. We will test this hypothesis and identify the factors that mediate the clinical effects of the ECS with a parallel-arm, randomized controlled trial of ECS plus controller medication titration vs. controller medication titration alone.
Our aims are: (1) T determine the effect of the addition of ECS to controller medication titration on controller medication requirements and allergic inflammatory biomarkers, and (2) To determine whether reductions in particulate matter (PM) and/or indoor allergens mediate the effects of an ECS on asthma. This proposed trial will answer a pivotal question because if ECSs do not provide additional benefit in the context of treatment with controller medication, the role of ECS in asthma management should be downgraded. On the other hand, if ECSs do indeed reduce controller medication requirements, greater emphasis should be placed on the importance of ECSs in asthma management, studies should be conducted to identify best ECS practices, and policies should be changed to require third party payers to cover ECS costs.

Public Health Relevance

The project aims to determine the role of environmental control measures as add-on therapy to guidelines based controller medication titration. The study also aims to determine whether reduction in allergens, pollutants, or both are responsible for improvements in asthma control seen with environmental interventions.

National Institute of Health (NIH)
National Institute of Environmental Health Sciences (NIEHS)
Research Project (R01)
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Infectious Diseases, Reproductive Health, Asthma and Pulmonary Conditions Study Section (IRAP)
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Gray, Kimberly A
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Johns Hopkins University
Schools of Medicine
United States
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Ahluwalia, Sharon K; Matsui, Elizabeth C (2018) Indoor Environmental Interventions for Furry Pet Allergens, Pest Allergens, and Mold: Looking to the Future. J Allergy Clin Immunol Pract 6:9-19
Gordon, Julian; Reboulet, Rachel; Gandhi, Prasanthi et al. (2018) Validation of a novel sampling technology for airborne allergens in low-income urban homes. Ann Allergy Asthma Immunol 120:96-97.e1
Wu, Tianshi David; Brigham, Emily P; Peng, Roger et al. (2018) Overweight/obesity enhances associations between secondhand smoke exposure and asthma morbidity in children. J Allergy Clin Immunol Pract 6:2157-2159.e5
Davis, Meghan F; Ludwig, Shanna; Brigham, Emily P et al. (2018) Effect of home exposure to Staphylococcus aureus on asthma in adolescents. J Allergy Clin Immunol 141:402-405.e10
Grant, Torie; Aloe, Charles; Perzanowski, Matthew et al. (2017) Mouse Sensitization and Exposure Are Associated with Asthma Severity in Urban Children. J Allergy Clin Immunol Pract 5:1008-1014.e1
Hughes, Helen K; Matsui, Elizabeth C; Tschudy, Megan M et al. (2017) Pediatric Asthma Health Disparities: Race, Hardship, Housing, and Asthma in a National Survey. Acad Pediatr 17:127-134
Matsui, Elizabeth C; Keet, Corinne A (2017) Weighing the evidence: Bias and confounding in epidemiologic studies in allergy/immunology. J Allergy Clin Immunol 139:448-450
Matsui, Elizabeth C; Perzanowski, Matthew; Peng, Roger D et al. (2017) Effect of an Integrated Pest Management Intervention on Asthma Symptoms Among Mouse-Sensitized Children and Adolescents With Asthma: A Randomized Clinical Trial. JAMA 317:1027-1036
Miller, Rachel L; Zhang, Hanjie; Jezioro, Jacqueline et al. (2017) Reduced mouse allergen is associated with epigenetic changes in regulatory genes, but not mouse sensitization, in asthmatic children. Environ Res 156:619-624
Ludwig, Shanna; Jimenez-Bush, Isabel; Brigham, Emily et al. (2017) Analysis of home dust for Staphylococcus aureus and staphylococcal enterotoxin genes using quantitative PCR. Sci Total Environ 581-582:750-755

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