Children With Uncontrolled Asthma

The July 2021 issue of AJPH contained an editorial discussing the importance of community-based asthma self-management interventions for children. In “Mind the Gap: Yet More Evidence for the Importance of Education for Children With Uncontrolled Asthma,” Homaira and Jaffe evaluated the methods and results of the Asthma Action at Erie Trial.¹ The results of this trial were published in the same issue.²

One important discrepancy in this evaluation must be pointed out. Because Martin et al.² did not fully describe the details of the community health worker (CHW) intervention, Homaira and Jaffe incorrectly interpreted that the Asthma Action at Erie Trial did not provide assessment and remediation of home environmental triggers. In actuality, the CHWs were trained in environmental remediation and integrated pest management to reduce home trigger exposures. Most of the CHW visits (95.2%) were conducted in the homes where trigger identification and reduction was one of the core topics and was addressed in 45.2% of the 722 visits.³ Tobacco exposure reduction was coded separately and was addressed in 15.5% of visits.³

What separates this trial from others is that the CHWs did not provide the actual remediation equipment such as vacuums and allergy covers. As an example, when a child had a dust mite allergy, the CHW would help the family understand the role of allergy mattress covers, figure out where the family could buy them, and strategize ways to pay for them. Our goal was to help families establish sustainable routes to obtain the equipment they needed. The fact that the trial’s asthma control results were similar to those of studies that provided this equipment (through research subsidies) is meaningful, as it shows that supporting families to obtain remediation equipment on their own works as well as providing the actual equipment, which is not covered by insurance.