Patients report satisfaction with virtual home allergy assessments

PHOENIX — Telemedicine was a feasible and satisfactory alternative to in-person visits for identifying asthma triggers in patient homes, according to a study presented at the American Academy of Allergy, Asthma & Immunology Annual Meeting.

“Asthma trigger identification and reduction is very important to asthma management,” Dieu Doan, MD, a third-year pediatric resident at University of Arkansas for Medical Sciences, told Healio.

Most research in reducing asthma triggers focuses on inner city populations rather than rural populations, where residents have less access to health care, Doan said, adding that the COVID-10 pandemic also has restricted access to patient homes.

“Because telemedicine has evolved in medicine and has been shown to have similar outcomes to in-person visits, we wanted to see if telemedicine home assessments could be used to identify and potentially reduce environmental asthma triggers,” Doan said.

The baseline stats

The study involved patients aged 5 to 18 years with persistent asthma, an asthma exacerbation within the previous 12 months, internet access with Wi-Fi coverage throughout the home and residency at the address for at least 6 months.

Patients were randomly assigned to the telemedicine group (TELE; n = 13) or standard-of-care group (SOC; n = 14). There were no significant differences in baseline demographics between the groups.

Based on skin or serum testing, grasses were the most common allergen among the TELE group (54%), followed by trees (46%), weeds (46%), molds (38%) and dust mites (38%). Dust mites (50%) and cats, trees, grasses and weeds (all, 29%) were the most common allergens in the SOC group.

Dust samples were collected in both groups at baseline and at 4 months, using a dust stream collector attached to a vacuum cleaner. Participants in both groups also completed a standardized questionnaire about their home environment.

“It was interesting to see the similarities and differences in the home environment of our patients,” Doan said. “For instance, some families had pets, some families had smoking within the home and some families don't own a vacuum cleaner.

“The majority of families use cleaning products with bleach or candles/potpourri, which are known asthma triggers,” Doan continued.

The home assessments

The researchers scheduled home assessments at baseline and for 2 and 4 months with an environmental checklist to identify potential asthma triggers. A phone call for follow-up is scheduled for 6 months.

So far, Doan said, 16 participants have completed their first assessments. Assessments were and will be conducted in person for the SOC group and virtually for the TELE group.

Both groups also received the same patient education, which included written materials in addition to counseling about asthma. Due to the COVID-19 pandemic, education was conducted via Zoom teleconferencing.

The participants in the TELE group additionally received an asthma home kit that included a sponge mop, child-resistant roach and mice bait stations, zippered mattress covers, zippered pillow covers and a trash can with a lid as well as instructions for using each item. The SOC group did not receive these kits.

At the end of each visit, the researchers conducted a satisfaction survey. After the first visit, 50% of the TELE group said they were completely satisfied, 25% said they were very satisfied and 25% did not respond. In the SOC group, 45% were completely satisfied, 11% were very satisfied and 44% did not respond.

“Many families enjoyed their experience and saw our study as a way to learn more about asthma and more about how to provide the best care for their children,” Doan said.

The researchers additionally assessed dust mite levels during the first visit. All the samples included less than 2 µg per 1g of dust, which the researchers considered too low to cause allergic symptoms, risk for sensitization or bronchial activity.

“The next steps will be collection of dust samples in 4 to 6 months and then determining if interventions affect patient outcomes,” Doan said.

The researchers concluded that telemedicine can be used as an alternative to in-person asthma education and identification of asthma triggers within the home.

“It can be especially useful to families that have difficulty attending office visits due to difficulty with transportation or for families who just want to have a medical professional directly help them reduce environmental triggers within their home,” Doan said.

Doan also expects remote monitoring to be an on option for more providers to consider.

“It has the potential to be more accessible for some patients, especially with the limitations caused by the COVID-19 pandemic,” Doan said.