![](media/image1.png){width="5.96875in" height="0.41944444444444445in"}

Top of Form

## Complete Summary

#### GUIDELINE TITLE

Environmental management of pediatric asthma. Guidelines for health care
providers.

#### BIBLIOGRAPHIC SOURCE(S)

National Environmental Education & Training Foundation (NEETF).
Environmental management of pediatric asthma. Guidelines for health care
providers. Washington (DC): National Environmental Education & Training
Foundation (NEETF); 2005 Aug. 56 p. \[112 references\]

#### GUIDELINE STATUS

This is the current release of the guideline.

### COMPLETE SUMMARY CONTENT

 SCOPE\
 METHODOLOGY - including Rating Scheme and Cost Analysis\
 RECOMMENDATIONS\
 EVIDENCE SUPPORTING THE RECOMMENDATIONS\
 BENEFITS/HARMS OF IMPLEMENTING THE GUIDELINE RECOMMENDATIONS\
 QUALIFYING STATEMENTS\
 IMPLEMENTATION OF THE GUIDELINE\
 INSTITUTE OF MEDICINE (IOM) NATIONAL HEALTHCARE QUALITY REPORT
CATEGORIES\
 IDENTIFYING INFORMATION AND AVAILABILITY\
 DISCLAIMER

### SCOPE

#### DISEASE/CONDITION(S)

Pediatric asthma

#### GUIDELINE CATEGORY

Management

#### CLINICAL SPECIALTY

Allergy and Immunology\
Emergency Medicine\
Family Practice\
Internal Medicine\
Nursing\
Pediatrics\
Pulmonary Medicine

#### INTENDED USERS

Advanced Practice Nurses\
Health Care Providers\
Nurses\
Physician Assistants\
Physicians\
Respiratory Care Practitioners\
Social Workers

#### GUIDELINE OBJECTIVE(S)

-   To integrate environmental management of asthma into pediatric
    health care

-   To educate health care professionals on how to advise families about
    environmental interventions that can reduce or eliminate triggers
    for children who are already diagnosed with asthma

-   To guide primary care providers to consider environmental factors
    that may affect their patients\' asthma. In some cases triggers may
    be more readily apparent than others

#### TARGET POPULATION

Children 0 to 18 years of age already diagnosed with asthma

#### INTERVENTIONS AND PRACTICES CONSIDERED

1.  Administration of environmental history

    -   Environmental History Form for Pediatric Asthma Patient

2.  Allergy testing if indicated

3.  Referral to asthma specialist if indicated

4.  Counseling of patient and patient\'s family on controlling exposures
    that trigger child\'s asthma:

    -   Dust mites

    -   Animal allergens

    -   Cockroach allergen

    -   Mold/mildew

    -   Tobacco smoke

    -   Air pollution

5.  Follow-up visits

#### MAJOR OUTCOMES CONSIDERED

-   Asthma associated morbidity

-   Reduction or elimination of triggers for children who are already
    diagnosed with asthma

### METHODOLOGY

#### METHODS USED TO COLLECT/SELECT EVIDENCE

Hand-searches of Published Literature (Primary Sources)

#### DESCRIPTION OF METHODS USED TO COLLECT/SELECT THE EVIDENCE

Not stated

#### NUMBER OF SOURCE DOCUMENTS

Not stated

#### METHODS USED TO ASSESS THE QUALITY AND STRENGTH OF THE EVIDENCE

Expert Consensus

#### RATING SCHEME FOR THE STRENGTH OF THE EVIDENCE

Not applicable

#### METHODS USED TO ANALYZE THE EVIDENCE

Review

#### DESCRIPTION OF THE METHODS USED TO ANALYZE THE EVIDENCE

Not stated

#### METHODS USED TO FORMULATE THE RECOMMENDATIONS

Expert Consensus

#### DESCRIPTION OF METHODS USED TO FORMULATE THE RECOMMENDATIONS

Not stated

#### RATING SCHEME FOR THE STRENGTH OF THE RECOMMENDATIONS

Not applicable

#### COST ANALYSIS

A formal cost analysis was not performed and published cost analyses
were not reviewed.

#### METHOD OF GUIDELINE VALIDATION

Peer Review

#### DESCRIPTION OF METHOD OF GUIDELINE VALIDATION

This document was reviewed in draft form by individuals chosen for their
unique perspectives and technical expertise. The purpose of this
independent review was to elicit candid and critical comments that would
assist in making this publication as sound and effective as possible.

### RECOMMENDATIONS

#### MAJOR RECOMMENDATIONS

**Environmental History Form**

-   The Environmental History Form is available in the original
    guideline document and as a Word document on the Web
    (<http://www.neetf.org/Health/asthmahistoryform.htm>)

-   This form is intended for use with children already diagnosed with
    asthma. Designed for ease of use, the Environmental History Form is
    obviously not comprehensive and is intended as an initial intake
    tool.

-   It is recommended that a health care provider (physician, nurse,
    nurse practitioner, or physician\'s assistant) administer the
    questions rather than being given to the patient\'s caregiver to
    fill out.

-   This form should also be used to elicit information on triggers
    commonly overlooked, such as weekly trips to a relative where a
    hobby or pet is located.

**Environmental Intervention Guidelines**

-   These environmental intervention guidelines are to be used for
    children already diagnosed with asthma. A separate fact sheet is
    provided for each of the major environmental asthma triggers. The
    questions on these fact sheets are intended to supplement the
    questions listed in the environmental history form related to each
    trigger. Interventions that are thought to be the most crucial for
    each asthma trigger are listed first and in **bold** type.

-   In addition to educating families on effective interventions, it is
    also important to explain why certain interventions are not
    recommended, particularly the use of ozone-generating air cleaners
    which may be harmful.

-   Providers should give families affected by asthma: educational
    materials (an example of a patient handout is listed under each
    trigger); relevant website information; and information about
    allergy supplies, smoking cessation programs, and other community
    resources. A variety of these materials available from a number of
    organizations are listed at
    <http://www.neetf.org/Health/asthma_resources.htm>.

-   The intervention guidelines assume a two-visit concept for the
    patient. The first visit includes taking an environmental history,
    possible allergy testing or referral, and a commitment by the parent
    to work on reducing exposures to known allergens or irritants. The
    second, follow-up visit involves counseling of the patient or
    patient\'s family on controlling the exposures that trigger the
    child\'s asthma. In addition to this two-visit concept, providers
    should work with the family to schedule appropriate follow-up visits
    to evaluate the patients\' self-management skills. It is very
    important to ask about all environments in which a child with asthma
    may be spending significant amounts of time, including all
    residences where the child sleeps or spends time, such as schools,
    daycares, camps, and college dorms.

-   Although primary care providers do not perform skin testing as an
    asthma specialist might, in vitro testing is an option that may be
    considered. However, any testing should be focused on allergens that
    are identified by the environmental history, and should not replace
    timely allergy referral. The health care provider should try to
    document sensitivity for each suspected allergen through allergy
    testing before making any major or costly recommendations related to
    environmental controls. However, some simple and low cost
    recommendations may be reasonable, particularly in areas where
    widespread exposure to cockroaches or dust mites is well known.
    Providers can assist families in implementing environmental
    interventions by helping them prioritize the changes they make in
    the home. For example, providers can encourage families to begin by
    creating a safe sleeping zone for the child.

-   A separate fact sheet is not provided for outdoor pollens (from
    trees, grass, or weeds) and molds. To avoid exposures, children
    should be recommended to stay indoors with windows closed in an air
    conditioned environment --- if possible --- during the season in
    which they have problems with outdoor allergens, especially during
    the afternoon.

-   Viral illnesses are not included in this list of environmental
    triggers, although their importance in triggering and exacerbating
    asthma is recognized. Primary care providers should remain aware
    that when a child with known asthma develops an upper respiratory
    infection, an asthma exacerbation is likely to follow.

-   Environmental management is only one component of a comprehensive
    asthma management plan. It is recommended that these materials be
    used in conjunction with the National Asthma Education and
    Prevention Program\'s clinical and pharmacological guidelines.

**Dust Mites and Asthma**

*Additional History Questions to Supplement the History Form*

-   Did you know that dust mite exposure can trigger asthma symptoms?

-   What type of floor covering is in your child\'s bedroom?

-   Do you have a vacuum cleaner with a high efficiency particulate air
    (HEPA) filter?

-   What have you tried so far to reduce dust/dust mite exposure?

-   How often do you wash your child\'s bed linens?

-   Are you currently using a mattress or pillow covering on your
    child\'s bed?

-   Do you use other ways to decrease dust mite exposure?

*Possible Interventions*

No matter how clean a home is, dust mites cannot be totally eliminated.
The following suggestions can reduce exposure. Emphasis should be placed
on reducing dust mite exposure where the child sleeps.

-   **Encase all pillows and mattresses of the beds that the child
    sleeps on using allergen impermeable encasings**. (There are
    numerous sources for allergen impermeable encasings, and prices as
    well as quality may vary.)

-   **Wash bedding weekly to remove allergen. Wash in hot water (130˚ F)
    to kill mites**

-   Replace wool or feathered bedding with synthetic materials that will
    withstand repeated hot water washing

-   Either remove from the bedroom or wash and thoroughly dry stuffed
    toys weekly

-   Move stuffed toys away from the pillow the child sleeps on

-   Vacuum once or twice weekly preferably using a vacuum cleaner with a
    HEPA filter or a double-layered microfilter bag (when the child is
    not around)

-   Use a damp mop or rag to remove dust, not a dry cloth that just
    stirs up dust mite allergens

-   Avoid use of humidifiers

-   The following interventions are expensive and are only recommended
    after an allergist has identified your child as allergic to dust
    mites:

    -   Consider replacing draperies with blinds or other wipeable
        window covering

    -   Consider carpet removal in the child\'s bedroom

    -   Consider removing upholstered furniture

    -   Consider using portable air cleaner with HEPA filter for
        child\'s bedroom

-   **Avoid use of ozone generators and certain ionic air cleaners which
    can actually generate harmful ozone**

**Animal Allergens and Asthma**

*Additional History Questions to Supplement the History Form*

-   What type of furry pet(s) do you have (and how many of each)?

-   Is it a strictly indoor pet? outdoor? indoor/outdoor?

-   Does your child sleep with the pet?

-   Has your child\'s asthma become worse since having the pet?

-   If you moved your pet outdoors, did your child\'s asthma improve?

-   If there is evidence of rodents in your home, how severe is the
    problem (mild, moderate, severe, very severe)

-   Does your child\'s classroom (or other places he/she spends time)
    have a furry pet that he/she plays with?

*Possible Interventions*

Interventions with regard to pets should only be recommended if the
child is allergic to the animal. Testing should therefore be done before
making any recommendations. To reduce your child\'s exposure to animal
allergens, the first two options below have been shown to be the most
effective:

-   **Consider finding a new home for indoor cats, dogs, and pet
    rodents**

-   **At a minimum, keep pets outside**

-   If neither of those are possible, the following may help reduce
    exposure:

    -   Keep pets out of the child\'s bedroom

    -   Encase mattresses and pillows

    -   Remove carpets

    -   Vacuum regularly using a cleaner with a HEPA filter or a
        double-layered microfilter bag (when the child is not around)

    -   Use portable air cleaner with HEPA filter for child\'s bedroom

    -   Keep pets off furniture and out of cars

    -   Bathing cats and dogs has been shown to decrease these
        allergens, however, it must be done at least twice a week to be
        effective

-   **If rats or mice have been observed, use the least toxic
    extermination method, such as traps and baits**

-   **Also use methods listed for cockroach control (See Cockroach
    Allergen and Asthma fact sheet below and on page 22 of the original
    guideline document)**

**Cockroach Allergen and Asthma**

*Additional History Questions to Supplement the History Form*:

-   Approximately how many cockroaches do you see in your home on a
    daily basis?

-   Do you see evidence of cockroach droppings?

-   How do you get rid of the cockroaches in your home?

-   Does your child\'s school (or other places she/he spends time) have
    cockroaches?

*Possible Interventions*

Eradication can be very difficult, especially in apartment buildings,
and it is often temporary. Roaches follow food and water sources in your
house. In general, the **least toxic methods of roach control should be
employed first**.

-   **Clean up all food items/crumbs/spills as soon as possible**

-   **Store food and trash in closed containers**

-   **Limit spread of food around house, especially bedrooms**

-   **Fix water leaks under sinks**

-   **Mop kitchen floor at least once a week**

-   **Clean counter tops daily**

-   Take garbage out daily

-   Check for and plug up crevices outside your house that cockroaches
    may enter

-   **Use the integrated pest management (IPM) approach for
    extermination --- least toxic methods first**

-   Use boric acid powder under stoves and other appliances

-   Use bait stations and gels. It is highly recommended to use a
    professional, licensed exterminator.

-   If you choose to apply the pesticides yourself, read the product
    label and follow all directions carefully

-   Avoid using liquid sprays inside the house, especially near places
    children crawl, play, or sleep

-   **Never attempt to use industrial strength pesticide sprays that
    require dilution**

**Mold/Mildew and Asthma**

*Additional History Questions to Supplement the History Form*

-   Do you see mold growth in any part of your home?

-   How large an area is the mold growth? (i.e. greater than 3 ft. x 3
    ft?)

-   Does your child\'s school (or other places he/she spends time) have
    mold growth?

-   Do you have problems with moisture or leaks in your home?

-   Do you frequently have condensation on your windows?

-   Have you tried using something to decrease the humidity in your
    home?

*Possible Interventions*

**The emphasis should first be on controlling all sources of moisture in
the house. Items that are too moldy to clean should be discarded**. The
size of the mold contamination in the house should determine how the
mold gets cleaned up. Generally, an area of 3 feet x 3 feet or larger
should be cleaned by a professional.

-   Check faucets, pipes, and ductwork for leaks and repair as soon as
    possible

-   Control indoor humidity

    -   Use a dehumidifier or air conditioner (non-evaporative or
        water-filled type) to maintain indoor relative humidity below
        50%

    -   Clean the dehumidifier as instructed by the manufacturer

    -   Do not use a humidifier

    -   Vent bathrooms and clothes dryers to the outside

    -   Install and use exhaust fans in the kitchen, baths and damp
        areas

    -   Avoid carpet and wallpaper in rooms prone to dampness

    -   For those who own a home with an evaporative cooler, control the
        humidity level with a dehumidifier

-   When first turning on home or car air conditioners, have your child
    leave the room or drive with the windows open for several minutes to
    allow mold spores to disperse

-   Remove decaying debris from the yard, roof, and gutters

-   Your child should avoid raking leaves, mowing lawns, or working with
    peat, mulch, hay, or dead wood if he/she is allergic to mold spores

-   If you choose to clean mold yourself, use chlorine solution diluted
    1:10 with water but do not mix bleach with other cleaning solutions
    containing ammonia due to toxic fumes

-   Quaternary ammonium compounds are effective fungicides when bleach
    cannot be used

-   For extensive mold contamination, (greater than 9 square feet -- 3
    ft. x 3 ft.) professional removal is recommended.

**Environmental Tobacco Smoke and Asthma**

*Additional History Questions to Supplement the History Form*

-   Who in the family smokes cigarettes?

-   How many cigarettes per day?

-   Does he/she (they) smoke in the house?

-   Outside? Both inside and outside? In the car?

-   Does anyone who spends time at your house smoke (friends, neighbors,
    relatives)?

-   Have you established a smoking ban or no smoking policy in the
    household?

-   Does anyone smoke in childcare settings where the child stays?

-   Describe the circumstances when your child may be exposed to smoke?

*Possible Interventions*

-   **Keep your home and car smoke-free**

-   **Seek support to quit smoking, consider aids such as nicotine gum,
    patch, and medication from your doctor to help you in quitting**

-   **Choose smoke-free childcare and social settings**

-   Seek smoke-free environments in restaurants, theaters, and hotel
    rooms

-   If you choose to smoke, do not smoke near your child

**Air Pollution and Asthma**

*Additional History Questions to Supplement the History Form*

[Indoor Air Pollution Questions]{.underline}

-   Do you live in a home that was built in the past 1 to 2 years?

-   If you recently made changes to your house -- installed new carpets,
    painted, or other changes -- how long ago was that?

-   Was there a change in your child\'s asthma symptoms after moving to
    a new house or having the work mentioned above done in your home?

-   Do you ever notice a chemical smell in your home?

-   If you have a wood burning fireplace or stove, how many times per
    month in the winter do you use it?

-   Does anyone in your house use strong-smelling perfumes, scented
    candles, hairsprays, or other aerosol substances?

[Outdoor Air Pollution Questions]{.underline}

-   Do you live within 300 yards of a major roadway or highway? An area
    where trucks or other vehicles idle? A major industry with
    smokestacks?

-   Is residential or agricultural burning a problem where you live?

-   How do you hear about air quality alerts?

*Possible Interventions*

For **indoor** air pollution, the two best approaches to reducing indoor
air pollution are source control and ventilation.

-   **Eliminate tobacco smoke**

-   **Use good housekeeping practices to control particles**

-   **Install an exhaust fan close to the source of contaminants, and
    vent it to the outside**

-   Properly ventilate the room where a fuel-burning appliance is being
    used

-   Ensure that wood stove doors are tight-fitting

-   Follow manufacturers\' instructions when using an unvented kerosene
    or gas space heater

-   Ensure that fireplaces are properly vented so smoke escapes through
    the chimney

-   Never use a gas-cooking appliance as a heating source

-   Open windows especially when indoor pollutant sources are in use
    (this option must be balanced against the concern of mold or other
    plant allergens and outdoor air pollution)

-   Parents should change clothes prior to returning from work if they
    work around any strong smelling chemicals or paints or other toxic
    substances

-   Avoid strong odors and minimize use of products and materials that
    emit irritants, such as smoke, strong perfumes, talcum powder, hair
    sprays, cleaning products, paint fumes, sawdust, chalk dust, air
    freshener sprays, and insect sprays

**Outdoor** air pollution, especially ozone and particulate matter can
increase asthma symptoms.

-   **Monitor air quality index levels and reduce your child\'s outdoor
    activities when the Air Quality Index (AQI) is in the unhealthy
    range**

-   **If your child\'s symptoms are worse or he/she requires more
    albuterol (rescue medicine) the day after AQI levels are in the
    unhealthy range, contact your health care provider**

-   Use HEPA filters in household vents

-   Reduce use of candles, wood-burning stoves and fireplaces

-   If particle pollution levels are high outdoors, do not vacuum the
    floor since this increases particle levels indoors

-   Advise your child to stay away from the exhaust pipe of idling
    school buses and trucks

-   Consider moving to a new location if this is possible

#### CLINICAL ALGORITHM(S)

None provided

### EVIDENCE SUPPORTING THE RECOMMENDATIONS

#### TYPE OF EVIDENCE SUPPORTING THE RECOMMENDATIONS

The type of evidence supporting the recommendations is not specifically
stated.

### BENEFITS/HARMS OF IMPLEMENTING THE GUIDELINE RECOMMENDATIONS

#### POTENTIAL BENEFITS

Environmental management of pediatric asthma will reduce or eliminate
triggers for children with asthma, reducing exacerbations and decreasing
asthma related morbidity.

#### POTENTIAL HARMS

Not stated

### QUALIFYING STATEMENTS

#### QUALIFYING STATEMENTS

-   It is important to recognize that environmental management is only
    one component of a comprehensive asthma management plan. These
    guidelines are founded upon the National Asthma Education and
    Prevention Program\'s (NAEPP) \"Guidelines for the Diagnosis and
    Management of Asthma\" and it is recommended that they be used in
    conjunction with the clinical and pharmacological components of the
    NAEPP Guidelines. Additional guidance includes the use of pulmonary
    function testing and referral to an asthma specialist, either a
    pulmonologist or an allergist. No attempt is being made with these
    guidelines to supersede those of NAEPP, but rather to complement
    them. All children should have a written asthma care plan, and every
    child with mild persistent or more severe asthma should be treated
    with long-term control medication.

-   Environmental asthma triggers include indoor and outdoor
    allergens---such as dust mites, cockroaches, animal allergens, and
    pollens---and indoor and outdoor pollutants and irritants, including
    environmental tobacco smoke (or secondhand smoke), chemicals,
    combustion by-products, and ozone and particulate matter. Although
    viruses and upper respiratory infections can exacerbate an asthma
    attack, they are not considered environmental asthma triggers for
    purposes of these guidelines.

### IMPLEMENTATION OF THE GUIDELINE

#### DESCRIPTION OF IMPLEMENTATION STRATEGY

Rather than compete with a crowded curriculum by adding separate course
content, environmental management of asthma content can be integrated
into existing pediatric instruction. This can be done by using
environmental management of pediatric asthma to enhance existing case
studies, or as exemplars. Additional opportunities for integration
include the full range of continuing education programs, including
Internet-based continuing education offerings, policy statements issued
by national professional associations, and certification of training in
environmental management of pediatric asthma.

For both medical and nursing education, a primary strategy for
incorporating environmental management of pediatric asthma into existing
curricula is to develop and support faculty champions/leaders who can
take a leadership role in integrating children\'s environmental health
into their institution in a sustainable fashion. These faculty members
can lend expertise and support in their institutions and surrounding
communities, teach courses, integrate competencies into curriculum, and
serve as role models for how to integrate environmental health into
health professional education. Residency Review Committees can require
that such content be included in the residency curriculum. In addition,
medical and nursing students can play a role in influencing curricula by
educating fellow students through student organizations, such as the
American Medical Student Association and National Student Nurse
Association, and by encouraging school faculty and deans to introduce
such content into the courses they offer.

Below are specific examples of points of insertion for environmental
management of pediatric asthma content in medical and nursing curricula.
It is recommended that such content be incorporated at all levels of the
curricula.

-   For medical education, the competencies can be incorporated into
    various courses throughout the four years of medical school and in
    residency. In the 1st and 2nd year of medical school, competencies
    can be taught in physical diagnosis, introduction to clinical
    medicine, and introduction to patient assessment courses. In the 3rd
    year, this material can be reinforced during clinical rotations and
    be included in medical school clerkships in pediatrics and family
    medicine. In the 4th year, such content can be included in electives
    for evidence-based medicine, environmental health, preventive
    health, epidemiology, or similar subject curriculum; in rotations
    for emergency medicine, public sector medicine, primary care, and
    pediatric medicine; and in instruction in ethical and legal issues
    of medical practice. Education should continue throughout residency
    training so that when a physician sees a child with asthma,
    environmental exposures and potential interventions are always
    included in the asthma management plan.

-   For nursing education, environmental management of pediatric asthma
    content can be incorporated into various courses, electives, and
    units of instruction, depending on the curricula and course
    offerings of each school. For example, competencies in the
    knowledge, identification, and management of asthma triggers could
    be incorporated into patho-physiology, pediatric nursing, or
    community health nursing courses. Each of the competencies can be
    taught in classroom settings and reinforced in clinical rotations
    for various subjects, such as community health, public health, home
    health, maternal/child health, and primary care management.
    Competencies could also be incorporated into additional units of
    instruction on topics such as health promotion, health
    education/teaching; protection and prevention of illness and injury;
    leadership in nursing; and current trends and issues in nursing
    practice including school nursing. The communication skills and
    advocacy competencies can be included in instruction on ethical,
    legal, and public policy issues and the patient advocacy role of the
    nurse. Additional points of insertion include environmental health
    nursing electives and fieldwork emphasizing environmental health.

There are numerous opportunities for incorporating environmental
management of pediatric asthma content into pediatric health care
practice. Practicing clinicians can introduce environmental management
of pediatric asthma content into their daily practice by incorporating
environmental history-taking and management of environmental triggers
into the practices and protocols of the health settings where they
deliver health care. Examples include adding environmental
history-taking to electronic medical records, understanding the
reimbursement available for teaching about environmental triggers and
asthma management, or making referrals to asthma specialists or
educators. Medical and nursing organizations and institutions can
promote inclusion of environmental management of pediatric asthma in
continuing education by offering continuing medical and nursing
education sessions at conferences, grand rounds, and other educational
functions, and by posting online modules on their websites.

In addition to medical and nursing curricula and clinical practice, it
is recommended that environmental management of pediatric asthma content
be integrated into the education and training of physician assistants,
respiratory therapists, and licensed case/care management professionals.

#### IMPLEMENTATION TOOLS

Chart Documentation/Checklists/Forms\
Patient Resources\
Staff Training/Competency Material

For information about
[availability](#identifying-information-and-availability), see the
\"Availability of Companion Documents\" and \"Patient Resources\" fields
below.

### INSTITUTE OF MEDICINE (IOM) NATIONAL HEALTHCARE QUALITY REPORT CATEGORIES

#### IOM CARE NEED

Living with Illness

#### IOM DOMAIN

Effectiveness\
Patient-centeredness

### IDENTIFYING INFORMATION AND AVAILABILITY

#### BIBLIOGRAPHIC SOURCE(S)

National Environmental Education & Training Foundation (NEETF).
Environmental management of pediatric asthma. Guidelines for health care
providers. Washington (DC): National Environmental Education & Training
Foundation (NEETF); 2005 Aug. 56 p. \[112 references\]

#### ADAPTATION

The Pesticides Initiative\'s National Pesticide Competency Guidelines
for Medical & Nursing Education and the National Pesticide Practice
Skills Guidelines for Medical & Nursing Practice served as models for
the asthma guidelines.

#### DATE RELEASED

2005 Aug

#### GUIDELINE DEVELOPER(S)

National Environmental Education and Training Foundation, Inc. - Private
Nonprofit Organization

#### SOURCE(S) OF FUNDING

This project was made possible through a grant from the National
Institute of Environmental Health Services

Additional funding was provided by American Legion Child Welfare
Foundation.

#### GUIDELINE COMMITTEE

Pediatric Asthma Initiative Steering Committee

#### COMPOSITION OF GROUP THAT AUTHORED THE GUIDELINE

*Committee Members*: James Roberts, MD, MPH (*Chair*) Medical University
of South Carolina; Representative, American Academy of Pediatrics;
Elizabeth Blackburn, RN, U.S. Environmental Protection Agency, Office of
Children\'s Health Protection; Allen Dearry, PhD, National Institute of
Environmental Health Sciences; Peyton Eggleston, MD, Johns Hopkins
University, School of Medicine; Ruth Etzel, MD, PhD, George Washington
University, School of Public Health & Health Services; Joel Forman, MD,
Mount Sinai Medical Center; Jackie Goeldner, MPH, Kaiser Permanente;
Robert Johnson, MD, Agency for Toxic Substances and Disease Registry;
Philip Landrigan, MD, MSc, Mount Sinai School of Medicine; Leyla Erk
McCurdy, MPhil, The National Environmental Education & Training
Foundation; Stephen Redd, MD, National Center for Environmental Health,
Centers for Disease Control and Prevention; Richard M. Roth, MD, Kaiser
Permanente; David Rowson, MS, U.S. Environmental Protection Agency,
Indoor Environments Division; Barbara Sattler, RN, DrPH, University of
Maryland, School of Nursing; Alisa Smith, PhD, U.S. Environmental
Protection Agency, Indoor Environments Division; Laurel Talabere, PhD,
RN, AE-C, Capital University, School of Nursing; Representative,
American Association of Colleges of Nursing; Robert Wood, MD, John
Hopkins University, School of Medicine; Lorrie Yoos, PhD, CPNP,
University of Rochester; Representative, Association of Faculties of
Pediatric Nurse Practitioners

*Primary Authors*: James R. Roberts, MD, MPH; Leyla Erk McCurdy, MPhil

*Staff*: Rebecca Love; Edna Termilus

*Reviewers*: Stephanie Chalupka, EdD, APRN, BC, University of
Massachusetts Lowell; Ellen Crain, MD, PhD, Albert Einstein College of
Medicine; Michael Fleming, MD, Board Chair, American Academy of Family
Physicians; Geralyn Glenn, MHSA, America\'s Health Insurance Plans;
Antoinette Gardner, RN, MEd, AE-C, Chair, National Asthma Educator
Certification Board; Vincent Hutchinson, MD, Harlem Children\'s Zone
Asthma Initiative; Ameesha Mehta-Sampath, MPH, U.S. Environmental
Protection Agency; Karen Rance, MSN, CPNP, AE-C, National Association of
Pediatric Nurse Practitioners; Susan Rappaport, MS, American Lung
Association; Elaine Rubin, PhD, Association of Academic Health Centers;
Jonathan Samet, MD, MS, The John Hopkins Bloomberg School of Public
Health; Megan Sandel, MD, MPH, Boston University Medical Center; 
Michael Shannon, MD, Harvard Medical School;  Lauren Sorce, RN, MSN,
CPNP-AC/PC, National Association of Pediatric Nurse Practitioners; Susan
Stone, PhD, U.S. Environmental Protection Agency; Darryl Zeldin, MD,
National Institute of Environmental Health Sciences

#### FINANCIAL DISCLOSURES/CONFLICTS OF INTEREST

Not stated

#### ENDORSER(S)

Ambulatory Pediatric Association, American Association of Colleges of
Nursing - Professional Association\
Association of Faculties of Pediatric Nurse Practitioners - Professional
Association

#### GUIDELINE STATUS

This is the current release of the guideline.

#### GUIDELINE AVAILABILITY

Electronic copies: Available in Portable Document Format (PDF) from the
[National Environmental Education and Training Foundation Web
site](http://www.neetf.org/health/asthma/Asthma_Guidelines.pdf).

Print copies: Available from The National Environmental Education &
Training Foundation, 4301 Connecticut Avenue NW, Suite 160, Washington,
DC 20008.

#### AVAILABILITY OF COMPANION DOCUMENTS

The following is available:

-   Resources for environmental management of pediatric asthma.
    Washington (DC): National Environmental Education & Training
    Foundation (NEETF). Electronic copies: Available from the [National
    Environmental Education and Training Foundation Web
    site](http://www.neetf.org/Health/asthma_resources.htm).

The following are also available in the [original guideline
document](http://www.neetf.org/health/asthma/Asthma_Guidelines.pdf):

-   Set of competencies for the environmental management of asthma (Part
    1)

-   Environmental history form for pediatric asthma patient (Part 2)

-   Asthma home environment checklist (Appendix)

#### PATIENT RESOURCES

Sample patient flyers and patient information sheets on environmental
allergens are available in the [original guideline
document](http://www.neetf.org/health/asthma/Asthma_Guidelines.pdf).

Please note: This patient information is intended to provide health
professionals with information to share with their patients to help them
better understand their health and their diagnosed disorders. By
providing access to this patient information, it is not the intention of
NGC to provide specific medical advice for particular patients. Rather
we urge patients and their representatives to review this material and
then to consult with a licensed health professional for evaluation of
treatment options suitable for them as well as for diagnosis and answers
to their personal medical questions. This patient information has been
derived and prepared from a guideline for health care professionals
included on NGC by the authors or publishers of that original guideline.
The patient information is not reviewed by NGC to establish whether or
not it accurately reflects the original guideline\'s content.

#### NGC STATUS

This summary was completed by ECRI on February 14, 2007. The information
was verified by the guideline developer on March 2, 2007.

#### COPYRIGHT STATEMENT

This NGC summary is based on the original guideline, which is subject to
the guideline developer\'s copyright restrictions.

### DISCLAIMER

#### NGC DISCLAIMER

The National Guideline Clearinghouse™ (NGC) does not develop, produce,
approve, or endorse the guidelines represented on this site.

All guidelines summarized by NGC and hosted on our site are produced
under the auspices of medical specialty societies, relevant professional
associations, public or private organizations, other government
agencies, health care organizations or plans, and similar entities.

Guidelines represented on the NGC Web site are submitted by guideline
developers, and are screened solely to determine that they meet the NGC
Inclusion Criteria which may be found at
<http://www.guideline.gov/about/inclusion.aspx> .

NGC, AHRQ, and its contractor ECRI Institute make no warranties
concerning the content or clinical efficacy or effectiveness of the
clinical practice guidelines and related materials represented on this
site. Moreover, the views and opinions of developers or authors of
guidelines represented on this site do not necessarily state or reflect
those of NGC, AHRQ, or its contractor ECRI Institute, and inclusion or
hosting of guidelines in NGC may not be used for advertising or
commercial endorsement purposes.

Readers with questions regarding guideline content are directed to
contact the guideline developer.

Bottom of Form

© 1998-2008 National Guideline Clearinghouse

Date Modified: 11/3/2008