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Original Investigation
March 14, 2017

Effect of an Integrated Pest Management Intervention on Asthma Symptoms Among Mouse-Sensitized Children and Adolescents With AsthmaA Randomized Clinical Trial

Author Affiliations
  • 1Division of Pediatric Allergy/Immunology, School of Medicine, Johns Hopkins University, Baltimore, Maryland
  • 2Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, New York
  • 3Department of Biostatistics, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
  • 4Division of Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland
  • 5Division of Pediatric Allergy/Immunology, Boston Children’s Hospital, Harvard University Medical School, Boston, Massachusetts
  • 6Division of Pulmonary, Allergy, and Immunology, School of Medicine, University of Maryland, Baltimore
  • 7Division of Pulmonary, Allergy, and Critical Care Medicine, College of Physicians and Surgeons, Columbia University, New York, New York
  • 8Division of Pediatric Allergy, Immunology, and Rheumatology, College of Physicians and Surgeons, Columbia University, New York, New York
JAMA. 2017;317(10):1027-1036. doi:10.1001/jama.2016.21048
Key Points

Question  Does a professionally delivered intervention plus education aimed at mouse infestation reduce asthma symptoms among mouse-sensitized children and adolescents with persistent asthma compared with education alone?

Findings  In this randomized clinical trial, the median number of maximal symptom days, defined as the highest number of days of symptoms among 3 types of symptoms (days of slowed activity due to asthma; number of nights of waking with asthma symptoms; and days of coughing, wheezing, or chest tightness), within a 2-week period across 6, 9, and 12 months was 2.0 days with an intensive integrated pest management intervention and 2.7 days with education alone, with no statistically significant difference between groups.

Meaning  A year-long intensive integrated pest management intervention was no more effective than education in improving symptoms among mouse-sensitized children and adolescents with asthma.

Abstract

Importance  Professionally delivered integrated pest management (IPM) interventions can reduce home mouse allergen concentrations, but whether they reduce asthma morbidity among mouse-sensitized and exposed children and adolescents is unknown.

Objective  To determine the effect of an IPM intervention on asthma morbidity among mouse-sensitized and exposed children and adolescents with asthma.

Design, Setting, and Participants  Randomized clinical trial conducted in Baltimore, Maryland, and Boston, Massachusetts. Participants were mouse-sensitized and exposed children and adolescents (aged 5-17 years) with asthma randomized to receive professionally delivered IPM plus pest management education or pest management education alone. Enrollment occurred between May 2010 and August 2014; the final follow-up visit occurred on September 25, 2015.

Interventions  Integrated pest management consisted of application of rodenticide, sealing of holes that could serve as entry points for mice, trap placement, targeted cleaning, allergen-proof mattress and pillow encasements, and portable air purifiers. Infestation was assessed every 3 months, and if infestation persisted or recurred, additional treatments were delivered. All participants received pest management education, which consisted of written material and demonstration of the materials needed to set traps and seal holes.

Main Outcomes and Measures  The primary outcome was maximal symptom days defined as the highest number of days of symptoms in the previous 2 weeks among 3 types of symptoms (days of slowed activity due to asthma; number of nights of waking with asthma symptoms; and days of coughing, wheezing, or chest tightness) across 6, 9, and 12 months.

Results  Of 361 children and adolescents who were randomized (mean [SD] age, 9.8 [3.2] years; 38% female; 181 in IPM plus pest management education group and 180 in pest management education alone group), 334 were included in the primary analysis. For the primary outcome, there was no statistically significant between-group difference for maximal symptom days across 6, 9, and 12 months with a median of 2.0 (interquartile range, 0.7-4.7) maximal symptom days in the IPM plus pest management education group and 2.7 (interquartile range, 1.3-5.0) maximal symptom days in the pest management education alone group (P = .16) and a ratio of symptom frequencies of 0.86 (95% CI, 0.69-1.06).

Conclusions and Relevance  Among mouse-sensitized and exposed children and adolescents with asthma, an intensive year-long integrated pest management intervention plus pest management education vs pest management education alone resulted in no significant difference in maximal symptom days from 6 to 12 months.

Trial Registration  clinicaltrials.gov Identifier: NCT01251224

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