Children With Asthma in New Orleans After Hurricane Katrina
Condition: Asthma; Allergies
MeSH terms: Asthma
Study type: Observational

Summary: 
      This study will examine whether exposure to the increased levels of mold and other allergens
      in New Orleans post-Hurricane Katrina affect symptoms in children with asthma. It will also
      determine if having an asthma counselor (AC) can reduce a child s asthma symptoms in this
      setting. An AC helps the families in the study obtain appropriate health care, medicines and
      social services for their asthmatic child and instructs them about avoiding allergens and
      ridding allergens from the home.

      Children between 4 and 12 years of age living in Orleans Parish or surrounding areas impacted
      by flooding who have moderate to severe asthma may be eligible for this study.

      Parents provide a family medical history and information about the child s asthma symptoms,
      medications and medical history. The children undergo the following procedures:

        -  Medical examination and blood tests

        -  Spirometry (for children 6 and older) or peak flow (for children under 6) test: For
           spirometry, the child wears a nose clip and breathes into a mouthpiece attached to a
           machine that measures how fast air moves out of the child s lungs. For the peak flow
           meter test, the child blows into a plastic tube after taking a deep breath.

        -  Allergy skin testing: 24 common allergens are applied to the arm by little pricks or
           scratches and the skin is observed for reactions to the allergens.

      Study staff visit the participants homes three times during the 1-year study to test for
      moisture, mold and other allergens. After the first visit, families are randomly assigned to
      one of two groups. Group 1 participants attend two educational group sessions about asthma
      and then three individual sessions. An AC visits the home one time during the study to
      instruct the family on how to use supplies provided to reduce allergens in the home. Group 2
      participants have an individual special teaching meeting with the AC at the end of the study.
      After the meeting, the AC visits the home to instruct the family on use of the supplies.

      Families are surveyed by phone every 3 months during the study to answer questions about the
      child s asthma attacks, medicines used, doctor visits, school days, missed, or work days
      missed to care for the child. At the end of the study, the child has a final medical
      examination, blood test, and breathing test.
    

Detailed description: 
      This document presents the protocol for conducting the Head-off Environmental Asthma in
      Louisiana (HEAL) study in New Orleans, Louisiana. The goal of the HEAL study is to implement
      and test an Asthma Counselor (AC) intervention program that addresses the multidimensional
      impact of hurricane Katrina on children with asthma in New Orleans. HEAL is a prospective,
      controlled trial in which children will be randomly assigned to one of two treatment groups.
      Group 1 children will receive an AC intervention focused on case management, adherence to
      medications and education on allergen avoidance. The responsibilities of the AC in this study
      are enhanced relative to previous initiatives such as the National Cooperative Inner City
      Asthma Study (NCICAS) AC intervention to also provide families with education aimed at
      reducing mold, allergens, and moisture in their homes, and materials to aid this effort
      (dehumidifiers and HEPA air filters). Since 90% of children with asthma in New Orleans are
      sensitive to dust allergens, established allergen control measures will be incorporated into
      the AC intervention as well. Group 2 children will receive a high quality standard of care
      based on the National Asthma Education and Prevention Program (NAEPP)-NIH guidelines. An
      abbreviated AC intervention will be provided to children in Group 2 at the conclusion of the
      study. Both treatments will be administered over a 12-month period during which the children
      in both groups will receive an extensive clinical evaluation (at baseline and 12-months) and
      three environmental home evaluations (focused on moisture, mold and other allergens). In
      addition to monitoring the effectiveness of the AC at environmental remediation education,
      the environmental home evaluations will also allow some characterization of the relationships
      between allergens, post-Katrina environmental exposures and asthma morbidity.

      In addition to the enhanced AC intervention, a separate school based survey will be
      administered to a sample population of children to examine asthma prevalence and assess
      living conditions and stress levels that may have been influenced by hurricane Katrina. The
      survey population will consist of a sample of the families of Orleans Parish school children
      stratified by age, schools and geographic area of the Parish. The results of the survey, in
      combination with the results of the AC intervention, will give us an overview of the extent
      and severity of the asthma problem in post hurricane Katrina New Orleans.

      The HEAL project is a collaborative multi-institutional research project conducted by the
      Tulane University School of Public Health and Tropical Medicine and the New Orleans
      Department of Health. To support those efforts, Rho, Inc. will provide for coordination of
      data and study activities.
    

Time perspective: Prospective
Keywords: Asthma; Allergens; Mold; Asthma Counselor; Environmental Remediation