Skip to main content
SpringerLink
Log in

Indoor Environmental Interventions and their Effect on Asthma Outcomes

  • Allergies and the Environment (M Hernandez, Section Editor)
  • Published:
Current Allergy and Asthma Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

The use of environmental interventions to improve outcomes in asthmatics has long been an elusive goal. While numerous interventions have been studied, the results of clinical trials have been mixed. This review aims to identify combinations of interventions that have been proven to be effective and to propose a model for using them in a clinical setting.

Recent Findings

An NIH workshop emphasized a need for research to identify effective interventions for reducing indoor exposures and improving asthma outcomes. A number of innovative measures were described, though evidence supporting their use was lacking. A recent systematic review described various interventions for which evidence is available. The greatest challenge for this approach is the same as that for the medical approach to treatment: nonadherence.

Summary

Given evidence for effective interventions, control of environmental exposures should lead to improved asthma outcomes. Methods to improve adherence need to be identified.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: •Of importance ••Of major importance

  1. •• Gold DR, Adamkiewicz G, Arshad SH, Celedon JC, Chapman MD, Chew GL, et al. NIAID, NIEHS, NHLBI, and MCAN Workshop Report: the indoor environment and childhood asthma—implications for home environmental intervention in asthma prevention and management. J Allergy Clin Immunol. 2017;140(4):933–49. https://doi.org/10.1016/j.jaci.2017.04.024. This NIH report outlines the current state of indoor allergen assessment and intervention and recommendations for future research.

    Article  PubMed  Google Scholar 

  2. •• Le Cann P, Paulus H, Glorennec P, Le Bot B, Frain S, Gangneux JP. Home environmental interventions for the prevention or control of allergic and respiratory diseases: what really works. J Allergy Clin Immunol Pract. 2017;5(1):66–79. https://doi.org/10.1016/j.jaip.2016.07.011. A recent systematic review that evaluated the effectiveness of various environmental interventions.

    Article  PubMed  Google Scholar 

  3. Schatz M, Zeiger RS. Telephone-based environmental control interventions in asthmatic patients: what are patients willing to do? Ann Allergy Asthma Immunol. 2012;109(2):99–102. https://doi.org/10.1016/j.anai.2012.03.001.

    Article  PubMed  Google Scholar 

  4. EPA. Asthma triggers: gain control. United States Environmental Protection Agency. 2017. https://www.epa.gov/asthma/asthma-triggers-gain-control. Accessed Nov 6, 2017 2017.

  5. •• Kanchongkittiphon W, Mendell MJ, Gaffin JM, Wang G, Phipatanakul W. Indoor environmental exposures and exacerbation of asthma: an update to the 2000 review by the Institute of Medicine. Environ Health Perspect. 2015;123(1):6–20. https://doi.org/10.1289/ehp.1307922. A recent systematic review documenting the relationship between exposure to indoor allergens and asthma morbidity.

    Article  CAS  PubMed  Google Scholar 

  6. Ciaccio CE, Kennedy K, Portnoy JM. A new model for environmental assessment and exposure reduction. Curr Allergy Asthma Rep. 2012;12(6):650–5. https://doi.org/10.1007/s11882-012-0297-9.

    Article  PubMed Central  PubMed  Google Scholar 

  7. American Pet Products Manufacturers Association 2009-2010 National Pet Owners Survey 2010. http://www.humanesociety.org/issues/pet_overpopulation/facts/pet_ownership_statistics.html. Accessed Nov 28 2010.

  8. Portnoy J, Kennedy K, Sublett J. Environmental assessment and exposure control: a practice parameter-furry animals. Ann Allergy Asthma Immunol. 2012;108(4):223 e1–e15. https://doi.org/10.1016/j.anai.2012.02.015.

    Article  Google Scholar 

  9. Asarnoj A, Hamsten C, Waden K, Lupinek C, Andersson N, Kull I, et al. Sensitization to cat and dog allergen molecules in childhood and prediction of symptoms of cat and dog allergy in adolescence: a BAMSE/MeDALL study. J Allergy Clin Immunol. 2016;137(3):813–21 e7. https://doi.org/10.1016/j.jaci.2015.09.052.

    Article  CAS  PubMed  Google Scholar 

  10. • O'Connor GT, Lynch SV, Bloomberg GR, Kattan M, Wood RA, Gergen PJ, et al. Early-life home environment and risk of asthma among inner-city children. J Allergy Clin Immunol. 2017; https://doi.org/10.1016/j.jaci.2017.06.040. A recent study demonstrating that early pet exposure does seem to reduce the risk of developing asthma. It includes microbiome data.

  11. Cohn RD, Arbes SJ Jr, Jaramillo R, Reid LH, Zeldin DC. National prevalence and exposure risk for cockroach allergen in U.S. households. Environ Health Perspect. 2006;114(4):522–6.

    Article  PubMed  Google Scholar 

  12. Matsui EC, Simons E, Rand C, Butz A, Buckley TJ, Breysse P, et al. Airborne mouse allergen in the homes of inner-city children with asthma. J Allergy Clin Immunol. 2005;115(2):358–63. https://doi.org/10.1016/j.jaci.2004.11.007.

    Article  CAS  PubMed  Google Scholar 

  13. Phipatanakul W, Eggleston PA, Wright EC, Wood RA. Mouse allergen. I. The prevalence of mouse allergen in inner-city homes. The National Cooperative Inner-City Asthma Study. J Allergy Clin Immunol. 2000;106(6):1070–4. https://doi.org/10.1067/mai.2000.110796.

    Article  CAS  PubMed  Google Scholar 

  14. Perry T, Matsui E, Merriman B, Duong T, Eggleston P. The prevalence of rat allergen in inner-city homes and its relationship to sensitization and asthma morbidity. J Allergy Clin Immunol. 2003;112(2):346–52. https://doi.org/10.1067/mai.2003.1640.

    Article  PubMed  Google Scholar 

  15. Phipatanakul W, Eggleston PA, Wright EC, Wood RA. Mouse allergen. II. The relationship of mouse allergen exposure to mouse sensitization and asthma morbidity in inner-city children with asthma. J Allergy Clin Immunol. 2000;106(6):1075–80. https://doi.org/10.1067/mai.2000.110795.

    Article  CAS  PubMed  Google Scholar 

  16. Grant T, Aloe C, Perzanowski M, Phipatanakul W, Bollinger ME, Miller R, et al. Mouse sensitization and exposure are associated with asthma severity in urban children. J Allergy Clin Immunol Pract. 2017;5(4):1008–14 e1. https://doi.org/10.1016/j.jaip.2016.10.020.

    Article  PubMed  Google Scholar 

  17. Phipatanakul W, Matsui E, Portnoy J, Williams PB, Barnes C, Kennedy K, et al. Environmental assessment and exposure reduction of rodents: a practice parameter. Ann Allergy Asthma Immunol. 2012;109(6):375–87. https://doi.org/10.1016/j.anai.2012.09.019.

    Article  PubMed Central  PubMed  Google Scholar 

  18. Gruchalla RS, Pongracic J, Plaut M, Evans R 3rd, Visness CM, Walter M, et al. Inner City Asthma Study: relationships among sensitivity, allergen exposure, and asthma morbidity. J Allergy Clin Immunol. 2005;115(3):478–85. https://doi.org/10.1016/j.jaci.2004.12.006.

    Article  PubMed  Google Scholar 

  19. Bush RK, Wood RA, Eggleston PA. Laboratory animal allergy. J Allergy Clin Immunol. 1998;102(1):99–112. https://doi.org/10.1016/S0091-6749(98)70060-0.

    Article  CAS  PubMed  Google Scholar 

  20. Chew GL, Carlton EJ, Kass D, Hernandez M, Clarke B, Tiven J, et al. Determinants of cockroach and mouse exposure and associations with asthma in families and elderly individuals living in New York City public housing. Ann Allergy Asthma Immunol. 2006;97(4):502–13. https://doi.org/10.1016/S1081-1206(10)60942-8.

    Article  PubMed  Google Scholar 

  21. Portnoy J, Chew GL, Phipatanakul W, Williams PB, Grimes C, Kennedy K, et al. Environmental assessment and exposure reduction of cockroaches: a practice parameter. J Allergy Clin Immunol. 2013;132(4):802–8 e1–25. https://doi.org/10.1016/j.jaci.2013.04.061.

    Article  PubMed  Google Scholar 

  22. Arbes SJ Jr, Cohn RD, Yin M, Muilenberg ML, Burge HA, Friedman W, et al. House dust mite allergen in US beds: results from the First National Survey of Lead and Allergens in Housing. J Allergy Clin Immunol. 2003;111(2):408–14.

    Article  PubMed  Google Scholar 

  23. Tovey ER, Chapman MD, Wells CW, Platts-Mills TA. The distribution of dust mite allergen in the houses of patients with asthma. Am Rev Respir Dis. 1981;124(5):630–5. https://doi.org/10.1164/arrd.1981.124.5.630.

    CAS  PubMed  Google Scholar 

  24. de Blay F, Heymann PW, Chapman MD, Platts-Mills TA. Airborne dust mite allergens: comparison of group II allergens with group I mite allergen and cat-allergen Fel d I. J Allergy Clin Immunol. 1991;88(6):919–26. https://doi.org/10.1016/0091-6749(91)90249-N.

    Article  PubMed  Google Scholar 

  25. Lodge CJ, Lowe AJ, Gurrin LC, Hill DJ, Hosking CS, Khalafzai RU, et al. House dust mite sensitization in toddlers predicts current wheeze at age 12 years. J Allergy Clin Immunol. 2011;128(4):782–8 e9. https://doi.org/10.1016/j.jaci.2011.06.038.

    Article  PubMed  Google Scholar 

  26. Llanora GV, Ming LJ, Wei LM, van Bever HP. House dust mite sensitization in toddlers predict persistent wheeze in children between eight to fourteen years old. Asia Pac Allergy. 2012;2(3):181–6. https://doi.org/10.5415/apallergy.2012.2.3.181.

    Article  PubMed Central  PubMed  Google Scholar 

  27. Clearing the air: asthma and indoor air exposures. The National Academies Press; 2000.

  28. Portnoy J, Miller JD, Williams PB, Chew GL, Miller JD, Zaitoun F, et al. Environmental assessment and exposure control of dust mites: a practice parameter. Ann Allergy Asthma Immunol. 2013;111(6):465–507. https://doi.org/10.1016/j.anai.2013.09.018.

    Article  PubMed Central  PubMed  Google Scholar 

  29. Park JH, Cox-Ganser JM. Mold exposure and respiratory health in damp indoor environments. Front Biosci (Elite Ed). 2011;3:757–71.

    Article  Google Scholar 

  30. Kennedy K, Grimes C. Indoor water and dampness and the health effects on children: a review. Curr Allergy Asthma Rep. 2013;13(6):672–80. https://doi.org/10.1007/s11882-013-0393-5.

    Article  PubMed  Google Scholar 

  31. Vesper S, Wymer L. The relationship between environmental relative moldiness index values and asthma. Int J Hyg Environ Health. 2016;219(3):233–8. https://doi.org/10.1016/j.ijheh.2016.01.006.

    Article  PubMed  Google Scholar 

  32. Quansah R, Jaakkola MS, Hugg TT, Heikkinen SA, Jaakkola JJ. Residential dampness and molds and the risk of developing asthma: a systematic review and meta-analysis. PLoS One. 2012;7(11):e47526. https://doi.org/10.1371/journal.pone.0047526.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  33. Institute of Medicine: damp indoor spaces and health. Washington, DC: National Academy of Sciences, Board on Health Promotion and Disease Prevention, National Academies Press 2004.

  34. Fisk WJ, Lei-Gomez Q, Mendell MJ. Meta-analyses of the associations of respiratory health effects with dampness and mold in homes. Indoor Air. 2007;17(4):284–96. https://doi.org/10.1111/j.1600-0668.2007.00475.x.

    Article  CAS  PubMed  Google Scholar 

  35. Arbes SJ Jr, Sever M, Archer J, Long EH, Gore JC, Schal C, et al. Abatement of cockroach allergen (Bla g 1) in low-income, urban housing: a randomized controlled trial. J Allergy Clin Immunol. 2003;112(2):339–45.

    Article  PubMed  Google Scholar 

  36. Miller DM, Meek F. Cost and efficacy comparison of integrated pest management strategies with monthly spray insecticide applications for German cockroach (Dictyoptera: Blattellidae) control in public housing. J Econ Entomol. 2004;97(2):559–69. https://doi.org/10.1093/jee/97.2.559.

    Article  CAS  PubMed  Google Scholar 

  37. Wang C, Bennett GW. Comparative study of integrated pest management and baiting for German cockroach management in public housing. J Econ Entomol. 2006;99(3):879–85. https://doi.org/10.1093/jee/99.3.879.

    Article  CAS  PubMed  Google Scholar 

  38. Eggleston PA, Butz A, Rand C, Curtin-Brosnan J, Kanchanaraksa S, Swartz L, et al. Home environmental intervention in inner-city asthma: a randomized controlled clinical trial. Ann Allergy Asthma Immunol. 2005;95(6):518–24. https://doi.org/10.1016/S1081-1206(10)61012-5.

    Article  PubMed  Google Scholar 

  39. Phipatanakul W, Cronin B, Wood RA, Eggleston PA, Shih MC, Song L, et al. Effect of environmental intervention on mouse allergen levels in homes of inner-city Boston children with asthma. Ann Allergy Asthma Immunol. 2004;92(4):420–5. https://doi.org/10.1016/S1081-1206(10)61777-2.

    Article  PubMed Central  PubMed  Google Scholar 

  40. • Rabito FA, Carlson JC, He H, Werthmann D, Schal C. A single intervention for cockroach control reduces cockroach exposure and asthma morbidity in children. J Allergy Clin Immunol. 2017;140(2):565–70. https://doi.org/10.1016/j.jaci.2016.10.019. While in general it requires a multifaceted approach to reduce allergen exposure, this study demonstrated that a single approach (chemical method) when done correctly was sufficient for eliminating cockroaches.

    Article  PubMed  Google Scholar 

  41. WHO guidelines for indoor air quality: dampness and mould. WHO Guidelines Approved by the Guidelines Review Committee. Geneva2009.

  42. •• Sauni R, Verbeek JH, Uitti J, Jauhiainen M, Kreiss K, Sigsgaard T. Remediating buildings damaged by dampness and mould for preventing or reducing respiratory tract symptoms, infections and asthma. Cochrane Database Syst Rev. 2015(2):CD007897. doi:https://doi.org/10.1002/14651858.CD007897.pub3. A recent systematic review of interventions to reduce dampness as a way to improve asthma outcomes.

  43. Kercsmar CM, Dearborn DG, Schluchter M, Xue L, Kirchner HL, Sobolewski J, et al. Reduction in asthma morbidity in children as a result of home remediation aimed at moisture sources. Environ Health Perspect. 2006;114(10):1574–80. https://doi.org/10.1289/ehp.8742.

    Article  PubMed Central  PubMed  Google Scholar 

  44. Howden-Chapman P, Matheson A, Crane J, Viggers H, Cunningham M, Blakely T, et al. Effect of insulating existing houses on health inequality: cluster randomised study in the community. BMJ. 2007;334(7591):460. https://doi.org/10.1136/bmj.39070.573032.80.

    Article  PubMed Central  PubMed  Google Scholar 

  45. Arlian LG, Neal JS, Morgan MS, Vyszenski-Moher DL, Rapp CM, Alexander AK. Reducing relative humidity is a practical way to control dust mites and their allergens in homes in temperate climates. J Allergy Clin Immunol. 2001;107(1):99–104. https://doi.org/10.1067/mai.2001.112119.

    Article  CAS  PubMed  Google Scholar 

  46. Salo PM, Yin M, Arbes SJ Jr, Cohn RD, Sever M, Muilenberg M, et al. Dustborne Alternaria alternata antigens in US homes: results from the National Survey of Lead and Allergens in Housing. J Allergy Clin Immunol. 2005;116(3):623–9. https://doi.org/10.1016/j.jaci.2005.05.030.

    Article  PubMed Central  PubMed  Google Scholar 

  47. Gotzsche PC, Johansen HK. House dust mite control measures for asthma. Cochrane Database Syst Rev 2008(2):CD001187. doi:https://doi.org/10.1002/14651858.CD001187.pub3.

  48. Shirai T, Matsui T, Suzuki K, Chida K. Effect of pet removal on pet allergic asthma. Chest. 2005;127(5):1565–71. https://doi.org/10.1378/chest.127.5.1565.

    Article  PubMed  Google Scholar 

  49. Schatz M, Zeiger RS. Ineffectiveness of telephone-based environmental control intervention to improve asthma outcomes. J Allergy Clin Immunol. 2010;126(4):873–5. https://doi.org/10.1016/j.jaci.2010.07.035.

    Article  PubMed  Google Scholar 

  50. Hodson T, Custovic A, Simpson A, Chapman M, Woodcock A, Green R. Washing the dog reduces dog allergen levels, but the dog needs to be washed twice a week. J Allergy Clin Immunol. 1999;103(4):581–5. https://doi.org/10.1016/S0091-6749(99)70227-7.

    Article  CAS  PubMed  Google Scholar 

  51. Nageotte C, Park M, Havstad S, Zoratti E, Ownby D. Duration of airborne Fel d 1 reduction after cat washing. J Allergy Clin Immunol. 2006;118(2):521–2. https://doi.org/10.1016/j.jaci.2006.04.049.

    Article  CAS  PubMed  Google Scholar 

  52. Woodcock A, Lowe LA, Murray CS, Simpson BM, Pipis SD, Kissen P, et al. Early life environmental control: effect on symptoms, sensitization, and lung function at age 3 years. Am J Respir Crit Care Med. 2004;170(4):433–9. https://doi.org/10.1164/rccm.200401-083OC.

    Article  PubMed  Google Scholar 

  53. Vojta PJ, Randels SP, Stout J, Muilenberg M, Burge HA, Lynn H, et al. Effects of physical interventions on house dust mite allergen levels in carpet, bed, and upholstery dust in low-income, urban homes. Environ Health Perspect. 2001;109(8):815–9. https://doi.org/10.1289/ehp.01109815.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  54. Sercombe JK, Liu-Brennan D, Causer SM, Tovey ER. The vertical distribution of house dust mite allergen in carpet and the effect of dry vacuum cleaning. Int J Hyg Environ Health. 2007;210(1):43–50. https://doi.org/10.1016/j.ijheh.2006.06.006.

    Article  PubMed  Google Scholar 

  55. Barnes CS, Kennedy K, Johnson L, Forrest E, Gard L, Pacheco F, et al. Use of dilute sodium hypochlorite spray and home cleaning to reduce indoor allergen levels and improve asthma health parameters. Ann Allergy Asthma Immunol. 2008;101(5):551–2. https://doi.org/10.1016/S1081-1206(10)60297-9.

    Article  PubMed  Google Scholar 

  56. Woodfolk JA, Hayden ML, Couture N, Platts-Mills TA. Chemical treatment of carpets to reduce allergen: comparison of the effects of tannic acid and other treatments on proteins derived from dust mites and cats. J Allergy Clin Immunol. 1995;96(3):325–33. https://doi.org/10.1016/S0091-6749(95)70051-X.

    Article  CAS  PubMed  Google Scholar 

  57. Sublett JL, Seltzer J, Burkhead R, Williams PB, Wedner HJ, Phipatanakul W, et al. Air filters and air cleaners: rostrum by the American Academy of Allergy, Asthma & Immunology Indoor Allergen Committee. J Allergy Clin Immunol. 2010;125(1):32–8. https://doi.org/10.1016/j.jaci.2009.08.036.

    Article  PubMed  Google Scholar 

  58. ASHRAE. Method of testing general ventilation air-cleaning devices for removal efficiency by particle size (ASHRAE Standard 52.2–2007). 2007.

  59. Wood RA. Air filtration devices in the control of indoor allergens. Curr Allergy Asthma Rep. 2002;2(5):397–400. https://doi.org/10.1007/s11882-002-0073-3.

    Article  PubMed  Google Scholar 

  60. Jhun I, Gaffin JM, Coull BA, Huffaker MF, Petty CR, Sheehan WJ, et al. School environmental intervention to reduce particulate pollutant exposures for children with asthma. J Allergy Clin Immunol Pract. 2017;5(1):154–9 e3. https://doi.org/10.1016/j.jaip.2016.07.018.

    Article  PubMed  Google Scholar 

  61. Wood RA, Johnson EF, Van Natta ML, Chen PH, Eggleston PA. A placebo-controlled trial of a HEPA air cleaner in the treatment of cat allergy. Am J Respir Crit Care Med. 1998;158(1):115–20. https://doi.org/10.1164/ajrccm.158.1.9712110.

    Article  CAS  PubMed  Google Scholar 

  62. van der Heide S, van Aalderen WM, Kauffman HF, Dubois AE, de Monchy JG. Clinical effects of air cleaners in homes of asthmatic children sensitized to pet allergens. J Allergy Clin Immunol. 1999;104(2 Pt 1):447–51. https://doi.org/10.1016/S0091-6749(99)70391-X.

    Article  PubMed  Google Scholar 

  63. Francis H, Fletcher G, Anthony C, Pickering C, Oldham L, Hadley E, et al. Clinical effects of air filters in homes of asthmatic adults sensitized and exposed to pet allergens. Clin Exp Allergy. 2003;33(1):101–5. https://doi.org/10.1046/j.1365-2222.2003.01570.x.

    Article  CAS  PubMed  Google Scholar 

  64. Kilburn S, Lasserson TJ, McKean M. Pet allergen control measures for allergic asthma in children and adults. Cochrane Database Syst Rev 2003(1):CD002989. doi:https://doi.org/10.1002/14651858.CD002989.

  65. Woodcock A, Forster L, Matthews E, Martin J, Letley L, Vickers M, et al. Control of exposure to mite allergen and allergen-impermeable bed covers for adults with asthma. N Engl J Med. 2003;349(3):225–36. https://doi.org/10.1056/NEJMoa023175.

    Article  PubMed  Google Scholar 

  66. Mihrshahi S, Marks GB, Criss S, Tovey ER, Vanlaar CH, Peat JK, et al. Effectiveness of an intervention to reduce house dust mite allergen levels in children’s beds. Allergy. 2003;58(8):784–9. https://doi.org/10.1034/j.1398-9995.2003.00194.x.

    Article  CAS  PubMed  Google Scholar 

  67. Shapiro GG, Wighton TG, Chinn T, Zuckrman J, Eliassen AH, Picciano JF, et al. House dust mite avoidance for children with asthma in homes of low-income families. J Allergy Clin Immunol. 1999;103(6):1069–74. https://doi.org/10.1016/S0091-6749(99)70181-8.

    Article  CAS  PubMed  Google Scholar 

  68. DiMango E, Serebrisky D, Narula S, Shim C, Keating C, Sheares B, et al. Individualized household allergen intervention lowers allergen level but not asthma medication use: a randomized controlled trial. J Allergy Clin Immunol Pract. 2016;4(4):671–9 e4. https://doi.org/10.1016/j.jaip.2016.01.016.

    Article  PubMed Central  PubMed  Google Scholar 

  69. •• Matsui EC, Abramson SL, Sandel MT, Section on A, Immunology, Council on Environmental H. Indoor environmental control practices and asthma management. Pediatrics. 2016;138(5):e20162589. https://doi.org/10.1542/peds.2016-2589 A comprehensive review of environmental control interventions and the evidence that their use reduces exposure to indoor allergens.

    Article  PubMed  Google Scholar 

  70. •• Winn AK, Salo PM, Klein C, Sever ML, Harris SF, Johndrow D, et al. Efficacy of an in-home test kit in reducing dust mite allergen levels: results of a randomized controlled pilot study. J Asthma. 2016;53(2):133–8. https://doi.org/10.3109/02770903.2015.1072721. This study showed that improved compliance that occurs simply by providing homeowners with allergen level information can lead to increased effectiveness of an intervention to reduce exposure to dust mite.

    Article  CAS  PubMed  Google Scholar 

  71. Krieger J, Song L, Philby M. Community health worker home visits for adults with uncontrolled asthma: the HomeBASE Trial randomized clinical trial. JAMA Intern Med. 2015;175(1):109–17. https://doi.org/10.1001/jamainternmed.2014.6353.

    Article  PubMed  Google Scholar 

  72. Campbell JD, Brooks M, Hosokawa P, Robinson J, Song L, Krieger J. Community health worker home visits for Medicaid-enrolled children with asthma: effects on asthma outcomes and costs. Am J Public Health. 2015;105(11):2366–72. https://doi.org/10.2105/AJPH.2015.302685.

    Article  PubMed Central  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Allergy, Asthma & Immunology, Children’s Mercy Hospitals & Clinics, 2401 Gillham Road, Kansas City, MO, 64108, USA

    Rebin Kader & Jay M. Portnoy

  2. Division of Toxicology and Environmental Health, Children’s Mercy, Kansas City, USA

    Kevin Kennedy

Authors
  1. Rebin Kader
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kevin Kennedy
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jay M. Portnoy
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jay M. Portnoy.

Ethics declarations

Conflict of Interest

The authors declare no conflicts of interest relevant to this manuscript.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

This article is part of the Topical Collection on Allergies and the Environment

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kader, R., Kennedy, K. & Portnoy, J.M. Indoor Environmental Interventions and their Effect on Asthma Outcomes. Curr Allergy Asthma Rep 18, 17 (2018). https://doi.org/10.1007/s11882-018-0774-x

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11882-018-0774-x

Keywords

Search

Navigation