Reducing Environmental Triggers of Asthma in the Home

Kathleen Norlien, Research Scientist Kelly Raatz, Asthma Program Coordinator

Minnesota Department of Health Asthma Program

Project Goal

To reduce or eliminate home environmental triggers of asthma for families living in Section 8 multi-family housing

Objectives of HUD Grant

• Assess the home environment for potential triggers of asthma • Provide allergen reducing products: bed/pillow encasements, HEPA air cleaner, and HEPA vacuum cleaner • Provide recommendations to assist child/family with control of the child’s asthma • Educate about asthma and importance of self management skills - including asthma medication use and asthma action plans

Focus on the bedroom of the child with asthma

Project Background

• Recruit 200 low income children under 18 years of age with asthma – Section 8 multi-housing • Diagnosis of asthma • Five local public health agencies recruit/enroll 40 children in each county or city • Other key partners: • Respiratory therapist – provided LPH training • American Lung Association of MN – clinician education • Data IQ – data collection & analysis • Wellshare International - community link for project recruitment

Hospitalizations by Zip Codes

LPH Agencies:

• Anoka County • Dakota County • Ramsey County/ St. Paul • City of Bloomington • City of Minneapolis

Public Health Nurse Training

1. Classroom training on home visit interviewing skills, documentation/ field forms, etc.

2. Between 2 and 5 mentoring visits –

Medical management:

EPR-3 Guidelines – 4 Components of Asthma Management, Asthma Control Test (ACT), Asthma Action Plan (AAP), medication check, correct use of equipment & storage of that equipment –

Address environmental triggers:

Identification of asthma triggers and methods to reduce or eliminate those triggers

Timeline

• • • • • Enrollment period for 40+ children

February 2012 through July 2013 Visits:

• Baseline visit • Product Delivery • 6 month visit (or telephone follow-up) • 12 month visit (or telephone follow-up)

July 2013 July 2014

- All baseline visits completed - Data submitted to MDH

Fall of 2014

- Data analysis/final report to HUD

LPH Recruitment Approaches

• Outreach at Cedar Riverside community events • HUD Property Managers – door hangers • Schools/ School Nurses • WIC Clinics • Head Start • Clinician presentations w/PCP • Health Plan – (Medica) mailing • Printed announcements – – newsletters, flyers, and other focused communications

Preliminary Results - Minneapolis

Asthma Triggers Inside the Home

N= 45

Common areas:

 Cooking odors  Smoking  Mustiness, dampness  Urine  Walk off mats, absent or dirty

Individual residences:

 Air fresheners/scented candles/incense (27%)  Smoking (20%)  Pets (18%)  Mold (29%)  Pests: • Cockroaches/bed bugs (31%) • Rodents (20%)

Products Provided

Targeted interventions

Bed encasements (84% ) Pillow encasements (84%) HEPA air cleaner (82%) HEPA vacuum cleaner (76%) Swiffer duster & mop (4%) Other cleaning supplies (4%)

Symptom Burden

33% 15 10 5 0 35 30 25 20 0% 22% 6% Severe Daytime Burden Severe Nighttime Burden Baseline 12 months

Functional Limitations

68% 70 60 50 40 30 20 10 0 26% Minimal Limitations Baseline 12 months

20 10 0 50 40 30

Asthma Control Test (ACT

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)

43% 14% Baseline 12 months In Control

Expected Results (past projects)

• Reductions – Emergency dept. visits – Unscheduled office visits – Hospitalizations • Improvements – Fewer daytime and nighttime symptoms – Fewer missed school/work days • Return on investment – RETA $1,960 medical costs saved per child – CRETA $5.25 savings for every $1 spent

Success Stories

Local Public Health Nurse

Contacts and Credits

Kathleen Norlien [email protected]

Kelly Raatz [email protected]

Minnesota Department of Health http://www.health.state.mn.us/asthma/ This project is made possible by the financial support from the US Housing and Urban Development, Office of Healthy Homes and Lead Hazard Control Grant (MNAIH0003-11)