Researchers report lessons learned from Katrina
By Cindy Loose and Robin Mackar
Three new papers published online Aug. 15 in Environmental Health Perspectives provide insight into how researchers can work with communities to reduce children’s asthma rates, even under the most difficult conditions.
In the aftermath of Hurricane Katrina in 2005, NIEHS and several partners (see story) formed a community-based research collaboration, known as Head-off Environmental Asthma in Louisiana (HEAL), (http://heal.niehs.nih.gov/) with the goal of helping asthmatic children return to New Orleans and surrounding parishes, where much of the infrastructure had been destroyed. The new papers discuss some of the devastating conditions at the time, including mold growing in homes and buildings, and the fact that 50 percent of children who had previously had a healthcare provider were without one, after 4,500 physicians and health care workers left the region.
Despite the odds that faced both the researchers and the children recovering from the storm, HEAL was able to accomplish many things, including decreasing the numbers of days children suffered with asthma symptoms by nearly half, and clearly showing the relationships between environmental triggers and childhood asthma. HEAL children received a special type of asthma counseling, which included guidance for caretakers on reducing mold and allergens in the home.
One of the papers (http://ehp03.niehs.nih.gov/article/fetchArticle.action?articleURI=info%3Adoi%2F10.1289%2Fehp.1104242) points out that HEAL children were suffering asthma symptoms an average of 6.64 days before the study began, and 76 percent had problems that prompted unscheduled emergency room or clinic visits in the three months prior to the study’s start. However, by the end of the yearlong study, which included a number of tailored interventions and approaches, the children averaged only 3.6 days of asthma symptoms in a two-week period, and had fewer emergency room and clinic visits.
Public health implications
“The study has public health implications for the treatment of all cases of asthma,” said Patricia Chulada, Ph.D., a primary author of the study papers who, at the time of the study, was employed by NIEHS. “In HEAL, asthma counselors focused on specific asthma triggers that the children were sensitive to and helped caretakers deal with post-Katrina stress. These are measures that can be effective in any setting.” Chulada and her colleagues expect to publish several more papers on HEAL.
To conduct the study, children with moderate-to-severe asthma were recruited from 184 schools. The families of children studied had moved an average of three times in the previous year and 62 percent were living in homes that had experienced water damage from Katrina.
In the intervention phase of the study, detailed in two of the papers, homes were tested for mold and other allergens. Although researchers were pleased they did not find high levels of the most toxic molds, 98 percent of children’s bedrooms tested positive for some level of the mold Alternaria; 60 percent showed allergens associated with mice; and 20 percent had allergens associated with cockroaches.
In addition to testing the air, researchers tested each child to determine sensitivity to specific allergens and asthma counselors devised plans tailored to each child. For example, if a child was found to be highly sensitive to roach allergens, the counselor made sure caretakers knew how to reduce roaches in the homes by cleaning and keeping food tightly contained and, if necessary, provided food containers and helped caretakers find an exterminator, as well as a way to pay for it.
“This study shows that evidence-based clinical trials can be effective, even in real-world settings where a community is struggling to recover from disaster,” said Darryl Zeldin, M.D., scientific director at NIEHS and a leading asthma researcher. “The techniques and interventions used for HEAL are not only applicable during natural disaster situations, but for every child who suffers from asthma.”
Chulada PC, Kennedy S, Mvula MM, Jaffee K, Wildfire J, Thornton E, Cohn RD, Grimsley LF, Mitchell H, El-Dahr J, Sterling Y, Martin WJ, White L, Stephens KU, Lichtveld M. (http://ehp03.niehs.nih.gov/article/fetchArticle.action?articleURI=info%3Adoi%2F10.1289%2Fehp.1104239) 2012. The Head-off Environmental Asthma in Louisiana (HEAL) Study – Methods and Study Population. Environ Health Perspect; doi:10.1289/ehp.1104239 [Online 15 August 2012].
Grimsley LF, Chulada PC, Kennedy S, White L, Wildfire J, Cohn RD, Mitchell H, Thornton E, El-Dahr J, Mvula MM, Sterling Y, Martin WJ, Stephens KU, Lichtveld M. (http://ehp03.niehs.nih.gov/article/fetchArticle.action?articleURI=info%3Adoi%2F10.1289%2Fehp.1104840) 2012. Indoor Environmental Exposures for Children with Asthma Enrolled in the HEAL Study, Post-Katrina New Orleans. Environ Health Perspect; doi:10.1289/ehp.1104840 [Online 15 August 2012].
Mitchell H, Cohn RD, Wildfire J, Thornton E, Kennedy S, El-Dahr JM, Chulada PC, Mvula MM, Grimsley LF, Lichtveld MY, White LE, Sterling YM, Stephens KU Sr, Martin WJ 2nd. (http://ehp03.niehs.nih.gov/article/fetchArticle.action?articleURI=info%3Adoi%2F10.1289%2Fehp.1104242) 2012. Implementation of Evidence-based Asthma Interventions in Post-Katrina New Orleans: The Head-off Environmental Asthma in Louisiana (HEAL) Study. Environ Health Perspect; doi:10.1289/ehp.1104242 [Online 15 August 2012].
(Cindy Loose is a contract writer with the NIEHS office in Bethesda, Md. Robin Mackar is news director in the NIEHS Office of Communications and Public Liaison.)