Abstract
BackgroundNonpharmacologic interventions for asthma management rely on identification and mitigation of important asthma triggers. Cockroach exposure is strongly associated with asthma morbidity. It is also associated with stress, another risk factor for asthma. Despite high prevalence of both in vulnerable populations, the impact of joint exposure has not been examined.MethodsParticipants included 173 children with asthma in New Orleans, Louisiana. Cockroach exposure was based on visual inspection using standard protocols. Caregiver stress was measured using Cohen’s 4-item Perceived Stress Scale. Outcomes included unscheduled clinic or emergency department (ED) visits, hospitalization, and pulmonary function. Multivariable logistic regression was performed to assess independent effects of the exposure on the outcome and effect modification was examined in stratified analysis based on stress. Path analysis to explore the mediation effect by stress was performed using a probit link with parameters based on Bayes’ method with non-informative priors.ResultsAdjusting for stress and other covariates, cockroach exposure was associated with unscheduled clinic/ED visits (aOR = 6.2; 95% CI 1.8, 21.7). Positive associations were also found for hospitalization and FEV1 < 80%. High stress modified the relationship with unscheduled clinic/ED visits (high aOR = 7.7 95% CI 1.0, 60.2, versus normal aOR = 4.1 95% CI 0.8, 21.9). Path models identified direct and indirect effects (p = 0.05) indicating that a majority of the total effect on unscheduled clinic/ED visits is attributed directly to cockroach exposure.ConclusionThe strong association between cockroach exposure and asthma morbidity is not due to uncontrolled confounding by stress. The combination of cockroach exposure and high stress, common in urban homes, are modifiable factors associated with poor asthma outcomes.
Highlights
Nonpharmacologic interventions for asthma management rely on identification and mitigation of important asthma triggers
To address whether stress level modifies the effect of cockroach exposure on asthma morbidity, we examined effect modification by caregiver stress level stratified as normal and high/very high
In unadjusted models, (Table 2) cockroach exposure was associated with unscheduled clinic/emergency department (ED) visits and hospitalizations
Summary
Nonpharmacologic interventions for asthma management rely on identification and mitigation of important asthma triggers. Exposure to environmental allergens is a leading cause of asthma exacerbation, estimated to trigger asthma attacks in 60–90% of children [2] through promotion of airway inflammation and bronchial hyperresponsiveness [3]. Among a cohort of moderate to severe asthmatics in New Orleans, Louisiana, children exposed to Bla g 1 > 2U/g were four times as likely to be hospitalized compared to their unexposed peers despite sensitization and exposure to multiple indoor allergens [5]. In the National Cooperative Inner-City Asthma Study children in the US sensitized and exposed to cockroach were 3.4 times as likely to be hospitalized [6]. Among patients with persistent asthma in Taiwan, IgEbinding to American cockroach allergen (Per a 2) was associated with severe airway allergy and elevated proinflammatory chemokines [9]
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