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Randomized Controlled Trial
. 2017 Mar 14;317(10):1027-1036.
doi: 10.1001/jama.2016.21048.

Effect of an Integrated Pest Management Intervention on Asthma Symptoms Among Mouse-Sensitized Children and Adolescents With Asthma: A Randomized Clinical Trial

Elizabeth C Matsui  1 , Matthew Perzanowski  2 , Roger D Peng  3 , Robert A Wise  4 , Susan Balcer-Whaley  1 , Michelle Newman  1 , Amparito Cunningham  5 , Adnan Divjan  2 , Mary E Bollinger  6 , Shuyan Zhai  1 , Ginger Chew  2 , Rachel L Miller  7 , Wanda Phipatanakul  5
Affiliations
Randomized Controlled Trial

Effect of an Integrated Pest Management Intervention on Asthma Symptoms Among Mouse-Sensitized Children and Adolescents With Asthma: A Randomized Clinical Trial

Elizabeth C Matsui et al. JAMA. .

Abstract

Importance: Professionally delivered integrated pest management (IPM) interventions can reduce home mouse allergen concentrations, but whether they reduce asthma morbidity among mouse-sensitized and exposed children and adolescents is unknown.

Objective: To determine the effect of an IPM intervention on asthma morbidity among mouse-sensitized and exposed children and adolescents with asthma.

Design, setting, and participants: Randomized clinical trial conducted in Baltimore, Maryland, and Boston, Massachusetts. Participants were mouse-sensitized and exposed children and adolescents (aged 5-17 years) with asthma randomized to receive professionally delivered IPM plus pest management education or pest management education alone. Enrollment occurred between May 2010 and August 2014; the final follow-up visit occurred on September 25, 2015.

Interventions: Integrated pest management consisted of application of rodenticide, sealing of holes that could serve as entry points for mice, trap placement, targeted cleaning, allergen-proof mattress and pillow encasements, and portable air purifiers. Infestation was assessed every 3 months, and if infestation persisted or recurred, additional treatments were delivered. All participants received pest management education, which consisted of written material and demonstration of the materials needed to set traps and seal holes.

Main outcomes and measures: The primary outcome was maximal symptom days defined as the highest number of days of symptoms in the previous 2 weeks among 3 types of symptoms (days of slowed activity due to asthma; number of nights of waking with asthma symptoms; and days of coughing, wheezing, or chest tightness) across 6, 9, and 12 months.

Results: Of 361 children and adolescents who were randomized (mean [SD] age, 9.8 [3.2] years; 38% female; 181 in IPM plus pest management education group and 180 in pest management education alone group), 334 were included in the primary analysis. For the primary outcome, there was no statistically significant between-group difference for maximal symptom days across 6, 9, and 12 months with a median of 2.0 (interquartile range, 0.7-4.7) maximal symptom days in the IPM plus pest management education group and 2.7 (interquartile range, 1.3-5.0) maximal symptom days in the pest management education alone group (P = .16) and a ratio of symptom frequencies of 0.86 (95% CI, 0.69-1.06).

Conclusions and relevance: Among mouse-sensitized and exposed children and adolescents with asthma, an intensive year-long integrated pest management intervention plus pest management education vs pest management education alone resulted in no significant difference in maximal symptom days from 6 to 12 months.

Trial registration: clinicaltrials.gov Identifier: NCT01251224.

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Conflict of interest statement

Conflict of Interest Disclosures: The authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Dr Matsui reported receiving grant support from the National Institutes of Health and Inspirotec LLC; travel reimbursment and research funding from ThermoFisher Scientific; travel reimbursment and honoraria from Indoor Biotechnologies Inc; and personal fees from Dwight & Church and the Environmental Defense Fund. Dr Perzanowski reported receiving honoraria from Indoor Biotechnologies Inc. Dr Peng reported receiving personal fees from the Health Effects Institute. Dr Wise reported receiving grants from Pearl Therapeutics; grants and personal fees from AstraZeneca, Boehringer Ingelheim, Bristol-Myers Squibb, and GlaxoSmithKline; and personal fees from Contrafect, Janssen, Mylan, Novartis, Pfizer, Pulmonx, Roche, Sarepta, Spiration, Sunovion, Teva, Theravance, Verona, and Vertex. Ms Balcer-Whaley reported receiving personal fees from Johns Hopkins University. Dr Bollinger reported receiving grants from the National Institutes of Health, National Institute of Allergy and Infectious Diseases. Dr Zhai reported receiving grants from the National Institute of Allergy and Infectious Diseases and the National Institute of Environmental Health Sciences. Dr Phipatanakul reported receiving grants from the National Institutes of Health. No other disclosures were reported.

Figures

Figure
Figure
Flow Diagram for Treatment Effect of an Intensive Integrated Pest Management Intervention on Maximal Symptom Days
See this image and copyright information in PMC

Comment in

References

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