Adults with moderate and severe asthma may not have received optimal evaluation to determine if they were allergic to indoor allergens. Allergy and exposure to several indoor allergens like cockroach, dust mite, molds, and pets can play an important role in the worsening of asthma.
Previous studies have demonstrated that avoidance to these common indoor allergens in asthmatic patients can improve their asthma symptoms. In addition, inner-city populations tend to suffer from higher rates of asthma. Therefore, the NIH asthma treatment guidelines recommend that patients with moderate to severe asthma should be evaluated for an allergic component to their asthma.
In a paper published by Paula Busse, MD and Ethan Halm, MD, MPH of Mount Sinai in the July 2005 issue of the Journal of Allergy and Clinical Immunology a cohort of 169 adult patients from an inner-city population who were hospitalized with asthma were interviewed. Most of these patients had a history of frequent emergency department visits and hospitalizations for their asthma, and 82% had a regular source of asthma care.
This study found that, despite their high burden of disease, only 60% of the patients had been evaluated for allergies to common indoor allergens; Among those who were evaluated, 94% were sensitized to a least one common indoor antigen. Approximately one-half of the patients who were allergic to dust mites or mold recalled being instructed by their medical provider on how to reduce the dust mite or mold exposure. Even fewer of the patients who were counseled on allergen avoidance measures completed them.
This study suggests that adult patients with persistent asthma from inner-city populations are not being optimally evaluated and counseled for their allergies to indoor allergens, a factor which may be playing a role in their high rates of asthma symptoms and hospitalizations. In addition, these patients were not being routinely followed by a specialist in asthma. The authors recommend that patients with persistent asthma be seen not only by a general medicine practice, but also by specialists in asthma and allergy.