Home Repairs Helps Asthma Patients Reduce Steroids and Improve Disease Symptoms

SALT LAKE CITY, UT -- October 27, 2006 -- Teamwork between a hospital asthma clinic and a legal assistance project resulted in asthma patients improving their health status by getting their homes' environments repaired.

"Our asthma patients were amazingly compliant in taking their medication, but they weren't getting any better," said Mary O'Sullivan, MD, pulmonary specialist and chief, asthma clinic, St. Luke's-Roosevelt Hospital, New York, New York. "They were living in roach-infested, rodent -infested, moldy, dusty apartments."

Attempts to get landlords to clean up the patients' homes had no results -- until the hospital partnered with a legal assistance firm, Dr. O'Sullivan said in a presentation on October 23rd at CHEST 2006, the 72nd annual meeting of the American College of Chest Physicians.

"I wrote letters [to the landlords] until I was blue in the face, and nothing happened," Dr. O'Sullivan. But the lawyer, Julie Brandfield of New York Legal Assistance Group, got the job done.

Ten patients opted not to go to the lawyers to get help. "Most of these people were afraid to take legal action," Dr. O'Sullivan said.

In the 11 of 21 patients who sought legal help:

  • Need for supplemental oral steroid use decreased from 20 courses during the year before the legal intervention to 2 courses in the year after the homes were cleaned up.
  • Need for visits to the hospital emergency department for asthma decreased by 94% -- from 14 trips before to 2 visits after the homes were fixed.
  • Significantly improved patients' overall measures of asthma control (P < .05).

Luis Chug, MD, resident, asthma clinic, St. Luke's-Roosevelt Hospital, said, "We were able to show that when living condition are severely degraded, improving those conditions will improve asthma control."

Dr. Chug and his colleagues reviewed the cases of 21 patients who had asthma that had shown little improvement despite compliant use of inhaled steroid medication. All patients lived in substandard housing and complained of roach infestation (76%), rodent infestation (56%), mold (52%) and dust (29%) that they believed was affecting their asthmatic condition.

Dr. O'Sullivan said the letters told each landlord that legal action would be taken against them if they did not fix up the patient's home.

Commenting on the study, Paula Anderson, MD, professor of pulmonary and critical care, University of Arkansas for Medical Sciences, Little Rock, Arkansas, said, "While the numbers of patients involved in this study were small and the fact that this is a retrospective study, the results show that patients with asthma cannot get better when they live among irritants and allergens,".

"This study shows how brilliantly practical public health measures can be to correct health problems," Dr. Anderson added.