Environmental factors and quality of life among poor children with asthma

Abstract Rationale Poor and minority children have greater asthma prevalence and morbidity, than their same-aged counterparts in more privileged groups. This may be due in part to difficulties controlling asthma triggers at home. We measured the prevalence of asthma triggers in the homes of poor, predominately African-American children and determined if the presence of triggers was associated with low health-related quality of life (QOL). Methods Parents/guardians of children with asthma, insured by Maryland Medicaid, were identified through healthcare claims and recruited. In-home interviews (n=162) were conducted by trained interviewers; both the child (8-18 years old) and adult caregiver were surveyed. Adults reported the presence or absence of common asthma triggers in the primary home, and if applicable, a second home. The following factors, if present in either home, were assigned 1 point each and summed to create an "environmental burden" score: cigarette smoking, carpet/rugs in the child's bedroom, mold or water leaks, cockroaches, mice or rats, having a dog or cat, and using a humidifier. Health-related quality of life was assessed using the 28-Item Child Health Questionnaire. Results Potential asthma triggers were common; scores averaged 2.7 (SD ± 1.4) factors present (range 0-7), with under 5% reporting 0 and 11% reporting 5-7 factors. The relationships between environmental burden and QOL were complex, varying by race (physical subscale) and asthma severity (psycho-social subscale). Dogs in the home were associated with higher, and humidifier use, lower QOL scores. Conclusions In this cohort, living with potential asthma triggers was common and may affect health-related quality of life.