human
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND Children with asthma who live in the inner city are exposed to multiple indoor allergens and environmental tobacco smoke in their homes . Reductions in these triggers of asthma have been difficult to achieve and have seldom been associated with decreased morbidity from asthma . The objective of this study was to determine whether an environmental intervention tailored to each child 's allergic sensitization and environmental risk factors could improve asthma-related outcomes . METHODS We enrolled 937 children with atopic asthma ( age , 5 to 11 years ) in seven major U.S. cities in a r and omized , controlled trial of an environmental intervention that lasted one year ( intervention year ) and included education and remediation for exposure to both allergens and environmental tobacco smoke . Home environmental exposures were assessed every six months , and asthma-related complications were assessed every two months during the intervention and for one year after the intervention . RESULTS For every 2-week period , the intervention group had fewer days with symptoms than did the control group both during the intervention year ( 3.39 vs. 4.20 days , P<0.001 ) and the year afterward ( 2.62 vs. 3.21 days , P<0.001 ) , as well as greater declines in the levels of allergens at home , such as Dermatophagoides farinae ( Der f1 ) allergen in the bed ( P<0.001 ) and on the bedroom floor ( P=0.004 ) , D. pteronyssinus in the bed ( P=0.007 ) , and cockroach allergen on the bedroom floor ( P<0.001 ) . Reductions in the levels of cockroach allergen and dust-mite allergen ( Der f1 ) on the bedroom floor were significantly correlated with reduced complications of asthma ( P<0.001 ) . CONCLUSIONS Among inner-city children with atopic asthma , an individualized , home-based , comprehensive environmental intervention decreases exposure to indoor allergens , including cockroach and dust-mite allergens , result ing in reduced asthma-associated morbidity Objective Home dampness and the presence of mold and allergens have been associated with  asthma morbidity . We examined changes in  asthma morbidity in children as a result of home remediation aim ed at moisture sources . Design In this prospect i ve , r and omized controlled trial , symptomatic , asthmatic children ( n = 62 ) , 2–17 years of age , living in a home with indoor mold , received an asthma intervention including an action plan , education , and individualized problem solving . The remediation group also received household repairs , including reduction of water infiltration , removal of water-damaged building material s , and heating/ventilation/air-conditioning alterations . The control group received only home cleaning information . We measured children ’s total and allergen-specific serum immuno-globulin E , peripheral blood eosinophil counts , and urinary cotinine . Environmental dust sample s were analyzed for dust mite , cockroach , rodent urinary protein , endotoxin , and fungi . The follow-up period was 1 year . Results Children in both groups showed improvement in asthma symptomatic days during the preremediation portion of the study . The remediation group had a significant decrease in symptom days ( p = 0.003 , as r and omized ; p = 0.004 , intent to treat ) after remodeling , whereas these parameters in the control group did not significantly change . In the postremediation period , the remediation group had a lower rate of exacerbations compared with control asthmatics ( as treated : 1 of 29 vs. 11 of 33 , respectively , p = 0 . 003 ; intent to treat : 28.1 % and 10.0 % , respectively , p = 0.11 ) . Conclusion Construction remediation aim ed at the root cause of moisture sources and combined with a medical/behavioral intervention significantly reduces symptom days and health care use for asthmatic children who live in homes with a documented mold problem We performed a prospect i ve cohort study from September 2003 to December 2004 to delineate attributing the effect of different respiratory viral infections including newly discovered ones to asthma exacerbations in children in Hong Kong . One hundred and fourteen children aged 6–14 years with chronic stable asthma and on regular inhaled steroid were monitored for  respiratory symptoms  over a full calendar year from recruitment . They would attend the study clinic if peak expiratory flow rate decreased to below 80 % of their baselines , if they met a predefined symptom score , or if parents subjectively felt them developing a cold . Virological diagnosis using virus culture , antigen detection , and polymerase chain reaction methods on nasal swab specimens would be attempted for all these visits irrespective of triggers . Physician diagnosed outcome of each episode was documented . Three hundred and five episodes of respiratory illnesses were captured in the cohort . Nasal specimens were available in 166 episodes , 92 of which were diagnosed as asthma exacerbations , and 74 non-asthma related episodes . Respiratory viruses were detected in 61 of 166 episodes ( 36.7 % ) . There was no significant difference in virus detection rate between asthma exacerbations ( 32 out of 97 episodes , 34.8 % ) and non-asthma respiratory illnesses ( 29 out of 79 episodes , 39.2 % ) . Although newly discovered respiratory viruses were identified in these episodes , rhinovirus was the commonest organism associated with both asthma exacerbations and non-asthma related episodes . Plausible explanations for much lower virus detection rate than previously reported include improved personal hygiene and pre caution ary measures taken during respiratory tract infections in the immediate post-severe acute respiratory syndrome period together with a significant contribution of other adverse factors like environmental air pollution . We conclude that not all viral infections in children with asthma lead to an asthma exacerbation and the attributing effect of different triggers of asthma exacerbations in children vary across different time periods and across different localities BACKGROUND Although sensitization to fungal allergens is prevalent in inner-city children with asthma , the relationship between fungal exposure and morbidity is poorly understood . OBJECTIVE We examined relationships between fungal sensitization , exposure , and asthma morbidity in inner-city children . METHODS Participants were 5 to 11 years old and enrolled in the Inner-City Asthma Study . This report includes the subset of children with at least 1 positive skin test ( PST ) response to a fungal allergen extract ;  for these children , indoor and outdoor airborne culturable fungi levels were measured at baseline and throughout the 2-year study . Asthma morbidity measures were collected prospect ively . The primary outcome was symptom days per 2 weeks . RESULTS At baseline , children with a PST response to a fungal allergen extract had significantly more symptom days compared with those without a PST response to any fungal allergen extract ( 6.3 vs 5.7 days per 2 weeks , P = .04 ) . During the study , increases in total fungal exposure and indoor Penicillium species exposure were associated with increases in symptom days and asthma-related unscheduled visits . Indoor exposures to total fungi and to Penicillium species were associated with significant increases in unscheduled visits , even after controlling for outdoor fungal levels . Adverse effects associated with exposure to a specific fungus were stronger among children with PST responses to that fungal allergen extract compared with those seen in children with negative skin test responses . CONCLUSION Outdoor fungal exposure is primarily associated with increased asthma symptoms and increased risk of exacerbations in this population Background : Adverse respiratory effects in children with asthma are associated with exposures to nitrogen dioxide ( NO2 ) . Levels indoors can be much higher than outdoors . Primary indoor sources of NO2 are gas stoves , which are used for cooking by one-third of U.S. households . We investigated the effects of indoor NO2 exposure on asthma severity among an ethnically and economically diverse sample of children , controlling for season and indoor allergen exposure . Methods : Children 5–10 years of age with active asthma ( n = 1,342 ) were recruited through schools in urban and suburban Connecticut and Massachusetts ( 2006–2009 ) for a prospect i ve , year-long study with seasonal measurements of NO2 and asthma severity . Exposure to NO2 was measured passively for four , month-long , periods with Palmes tubes . Asthma morbidity was concurrently measured by a severity score and frequency of wheeze , night symptoms , and use of rescue medication . We used adjusted , hierarchical ordered logistic regression models to examine associations between household NO2 exposure and health outcomes . Results : Every 5-fold increase in NO2 exposure above a threshold of 6 ppb was associated with a dose-dependent increase in risk of higher asthma severity score ( odds ratio = 1.37 [ 95 % confidence interval = 1.01–1.89 ] ) , wheeze ( 1.49 [ 1.09–2.03 ] ) , night symptoms ( 1.52 [ 1.16–2.00 ] ) , and rescue medication use ( 1.78 [ 1.33–2.38 ] ) . Conclusions : Asthmatic children exposed to NO2 indoors , at levels well below the U.S. Environmental Protection Agency outdoor st and ard ( 53 ppb ) , are at risk for increased asthma morbidity . Risks are not confined to inner city children , but occur at NO2 concentrations common in urban and suburban homes BACKGROUND House dust mite ( HDM ) allergy is a frequent cause of allergic asthma in children . Reduction of exposure seems to be the most logical way to treat these patients . OBJECTIVE Our aim was to investigate whether mattress and pillow encasings result ed in an effective long-term control of HDM allergen levels , thereby reducing the need for asthma medication in children with asthma and HDM allergy . METHODS In a prospect i ve , double-blind , placebo-controlled study 60 children ( age range , 6 - 15 years ) with asthma and HDM allergy were r and omized to active ( allergy control ) or placebo mattress and pillow encasings . After a 2-week baseline period , follow-up was performed every 3 months for 1 year . During the entire study period , the dose of inhaled steroids was tapered off to the lowest effective dose according to well-defined criteria . RESULTS Fifty-two patients completed the trial , and 5 were excluded , leaving data from 47 children ( 26 in the active treatment group and 21 in the placebo group ) for analysis . A significant perennial reduction in HDM allergen concentrations was seen only for the active treatment group . Also , a significant decrease in the dose of inhaled steroids ( mean , 408 to 227 microg/d ; P < .001 ) was found for the active treatment group only , with significant differences between groups after 9 and 12 months . After 1 year , the dose of inhaled steroids was reduced by at least 50 % in significantly more children in the active treatment group than in the placebo group ( 73 % vs 24 % , P < .01 ) . CONCLUSION Encasing of mattresses and pillows result ed in a significant long-term reduction in HDM allergen concentrations in mattresses and in the need for inhaled steroids in children with asthma and HDM allergy There is growing evidence that asthma symptoms can be aggravated or events triggered by exposure to indoor nitrogen dioxide ( NO2 ) emitted from unflued gas heating . The impact of NO2 on the respiratory health of children with asthma was explored as a secondary analysis of a r and omised community trial , involving 409 households during the winter period in 2006 ( June to September ) . Geometric mean indoor NO2 levels were 11.4 μg·m−3 , while outdoor NO2 levels were 7.4 μg·m−3 . Higher indoor NO2 levels ( per logged unit increase ) were associated with greater daily reports of lower ( mean ratio 14 , 95 % CI 1.12–1.16 ) and upper respiratory tract symptoms ( mean ratio 1.03 , 95 % CI 1.00–1.05 ) , more frequent cough and wheeze , and more frequent reliever use during the day , but had no effect on preventer use . Higher indoor NO2 levels ( per logged unit increase ) were associated with a decrease in morning ( -17.25 mL , 95 % CI -27.63– -6.68 ) and evening ( -13.21 , 95 % CI -26.03– -0.38 ) forced expiratory volume in 1 s readings . Outdoor NO2 was not associated with respiratory tract symptoms , asthma symptoms , medication use or lung function measurements . These findings indicate that reducing NO2 exposure indoors is important in improving the respiratory health of children with asthma Objective To assess whether non-polluting , more effective home heating ( heat pump , wood pellet burner , flued gas ) has a positive effect on the health of children with asthma . Design R and omised controlled trial . Setting Households in five communities in New Zeal and . Participants 409 children aged 6 - 12 years with doctor diagnosed asthma . Interventions Installation of a non-polluting , more effective home heater before winter . The control group received a replacement heater at the end of the trial . Main outcome measures The primary outcome was change in lung function ( peak expiratory flow rate and forced expiratory volume in one second , FEV1 ) . Secondary 
    Output:
    
agent
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND Children with asthma who live in the inner city are exposed to multiple indoor allergens and environmental tobacco smoke in their homes . Reductions in these triggers of asthma have been difficult to achieve and have seldom been associated with decreased morbidity from asthma . The objective of this study was to determine whether an environmental intervention tailored to each child 's allergic sensitization and environmental risk factors could improve asthma-related outcomes . METHODS We enrolled 937 children with atopic asthma ( age , 5 to 11 years ) in seven major U.S. cities in a r and omized , controlled trial of an environmental intervention that lasted one year ( intervention year ) and included education and remediation for exposure to both allergens and environmental tobacco smoke . Home environmental exposures were assessed every six months , and asthma-related complications were assessed every two months during the intervention and for one year after the intervention . RESULTS For every 2-week period , the intervention group had fewer days with symptoms than did the control group both during the intervention year ( 3.39 vs. 4.20 days , P<0.001 ) and the year afterward ( 2.62 vs. 3.21 days , P<0.001 ) , as well as greater declines in the levels of allergens at home , such as Dermatophagoides farinae ( Der f1 ) allergen in the bed ( P<0.001 ) and on the bedroom floor ( P=0.004 ) , D. pteronyssinus in the bed ( P=0.007 ) , and cockroach allergen on the bedroom floor ( P<0.001 ) . Reductions in the levels of cockroach allergen and dust-mite allergen ( Der f1 ) on the bedroom floor were significantly correlated with reduced complications of asthma ( P<0.001 ) . CONCLUSIONS Among inner-city children with atopic asthma , an individualized , home-based , comprehensive environmental intervention decreases exposure to indoor allergens , including cockroach and dust-mite allergens , result ing in reduced asthma-associated morbidity Objective Home dampness and the presence of mold and allergens have been associated with  asthma morbidity . We examined changes in  asthma morbidity in children as a result of home remediation aim ed at moisture sources . Design In this prospect i ve , r and omized controlled trial , symptomatic , asthmatic children ( n = 62 ) , 2–17 years of age , living in a home with indoor mold , received an asthma intervention including an action plan , education , and individualized problem solving . The remediation group also received household repairs , including reduction of water infiltration , removal of water-damaged building material s , and heating/ventilation/air-conditioning alterations . The control group received only home cleaning information . We measured children ’s total and allergen-specific serum immuno-globulin E , peripheral blood eosinophil counts , and urinary cotinine . Environmental dust sample s were analyzed for dust mite , cockroach , rodent urinary protein , endotoxin , and fungi . The follow-up period was 1 year . Results Children in both groups showed improvement in asthma symptomatic days during the preremediation portion of the study . The remediation group had a significant decrease in symptom days ( p = 0.003 , as r and omized ; p = 0.004 , intent to treat ) after remodeling , whereas these parameters in the control group did not significantly change . In the postremediation period , the remediation group had a lower rate of exacerbations compared with control asthmatics ( as treated : 1 of 29 vs. 11 of 33 , respectively , p = 0 . 003 ; intent to treat : 28.1 % and 10.0 % , respectively , p = 0.11 ) . Conclusion Construction remediation aim ed at the root cause of moisture sources and combined with a medical/behavioral intervention significantly reduces symptom days and health care use for asthmatic children who live in homes with a documented mold problem We performed a prospect i ve cohort study from September 2003 to December 2004 to delineate attributing the effect of different respiratory viral infections including newly discovered ones to asthma exacerbations in children in Hong Kong . One hundred and fourteen children aged 6–14 years with chronic stable asthma and on regular inhaled steroid were monitored for  respiratory symptoms  over a full calendar year from recruitment . They would attend the study clinic if peak expiratory flow rate decreased to below 80 % of their baselines , if they met a predefined symptom score , or if parents subjectively felt them developing a cold . Virological diagnosis using virus culture , antigen detection , and polymerase chain reaction methods on nasal swab specimens would be attempted for all these visits irrespective of triggers . Physician diagnosed outcome of each episode was documented . Three hundred and five episodes of respiratory illnesses were captured in the cohort . Nasal specimens were available in 166 episodes , 92 of which were diagnosed as asthma exacerbations , and 74 non-asthma related episodes . Respiratory viruses were detected in 61 of 166 episodes ( 36.7 % ) . There was no significant difference in virus detection rate between asthma exacerbations ( 32 out of 97 episodes , 34.8 % ) and non-asthma respiratory illnesses ( 29 out of 79 episodes , 39.2 % ) . Although newly discovered respiratory viruses were identified in these episodes , rhinovirus was the commonest organism associated with both asthma exacerbations and non-asthma related episodes . Plausible explanations for much lower virus detection rate than previously reported include improved personal hygiene and pre caution ary measures taken during respiratory tract infections in the immediate post-severe acute respiratory syndrome period together with a significant contribution of other adverse factors like environmental air pollution . We conclude that not all viral infections in children with asthma lead to an asthma exacerbation and the attributing effect of different triggers of asthma exacerbations in children vary across different time periods and across different localities BACKGROUND Although sensitization to fungal allergens is prevalent in inner-city children with asthma , the relationship between fungal exposure and morbidity is poorly understood . OBJECTIVE We examined relationships between fungal sensitization , exposure , and asthma morbidity in inner-city children . METHODS Participants were 5 to 11 years old and enrolled in the Inner-City Asthma Study . This report includes the subset of children with at least 1 positive skin test ( PST ) response to a fungal allergen extract ;  for these children , indoor and outdoor airborne culturable fungi levels were measured at baseline and throughout the 2-year study . Asthma morbidity measures were collected prospect ively . The primary outcome was symptom days per 2 weeks . RESULTS At baseline , children with a PST response to a fungal allergen extract had significantly more symptom days compared with those without a PST response to any fungal allergen extract ( 6.3 vs 5.7 days per 2 weeks , P = .04 ) . During the study , increases in total fungal exposure and indoor Penicillium species exposure were associated with increases in symptom days and asthma-related unscheduled visits . Indoor exposures to total fungi and to Penicillium species were associated with significant increases in unscheduled visits , even after controlling for outdoor fungal levels . Adverse effects associated with exposure to a specific fungus were stronger among children with PST responses to that fungal allergen extract compared with those seen in children with negative skin test responses . CONCLUSION Outdoor fungal exposure is primarily associated with increased asthma symptoms and increased risk of exacerbations in this population Background : Adverse respiratory effects in children with asthma are associated with exposures to nitrogen dioxide ( NO2 ) . Levels indoors can be much higher than outdoors . Primary indoor sources of NO2 are gas stoves , which are used for cooking by one-third of U.S. households . We investigated the effects of indoor NO2 exposure on asthma severity among an ethnically and economically diverse sample of children , controlling for season and indoor allergen exposure . Methods : Children 5–10 years of age with active asthma ( n = 1,342 ) were recruited through schools in urban and suburban Connecticut and Massachusetts ( 2006–2009 ) for a prospect i ve , year-long study with seasonal measurements of NO2 and asthma severity . Exposure to NO2 was measured passively for four , month-long , periods with Palmes tubes . Asthma morbidity was concurrently measured by a severity score and frequency of wheeze , night symptoms , and use of rescue medication . We used adjusted , hierarchical ordered logistic regression models to examine associations between household NO2 exposure and health outcomes . Results : Every 5-fold increase in NO2 exposure above a threshold of 6 ppb was associated with a dose-dependent increase in risk of higher asthma severity score ( odds ratio = 1.37 [ 95 % confidence interval = 1.01–1.89 ] ) , wheeze ( 1.49 [ 1.09–2.03 ] ) , night symptoms ( 1.52 [ 1.16–2.00 ] ) , and rescue medication use ( 1.78 [ 1.33–2.38 ] ) . Conclusions : Asthmatic children exposed to NO2 indoors , at levels well below the U.S. Environmental Protection Agency outdoor st and ard ( 53 ppb ) , are at risk for increased asthma morbidity . Risks are not confined to inner city children , but occur at NO2 concentrations common in urban and suburban homes BACKGROUND House dust mite ( HDM ) allergy is a frequent cause of allergic asthma in children . Reduction of exposure seems to be the most logical way to treat these patients . OBJECTIVE Our aim was to investigate whether mattress and pillow encasings result ed in an effective long-term control of HDM allergen levels , thereby reducing the need for asthma medication in children with asthma and HDM allergy . METHODS In a prospect i ve , double-blind , placebo-controlled study 60 children ( age range , 6 - 15 years ) with asthma and HDM allergy were r and omized to active ( allergy control ) or placebo mattress and pillow encasings . After a 2-week baseline period , follow-up was performed every 3 months for 1 year . During the entire study period , the dose of inhaled steroids was tapered off to the lowest effective dose according to well-defined criteria . RESULTS Fifty-two patients completed the trial , and 5 were excluded , leaving data from 47 children ( 26 in the active treatment group and 21 in the placebo group ) for analysis . A significant perennial reduction in HDM allergen concentrations was seen only for the active treatment group . Also , a significant decrease in the dose of inhaled steroids ( mean , 408 to 227 microg/d ; P < .001 ) was found for the active treatment group only , with significant differences between groups after 9 and 12 months . After 1 year , the dose of inhaled steroids was reduced by at least 50 % in significantly more children in the active treatment group than in the placebo group ( 73 % vs 24 % , P < .01 ) . CONCLUSION Encasing of mattresses and pillows result ed in a significant long-term reduction in HDM allergen concentrations in mattresses and in the need for inhaled steroids in children with asthma and HDM allergy There is growing evidence that asthma symptoms can be aggravated or events triggered by exposure to indoor nitrogen dioxide ( NO2 ) emitted from unflued gas heating . The impact of NO2 on the respiratory health of children with asthma was explored as a secondary analysis of a r and omised community trial , involving 409 households during the winter period in 2006 ( June to September ) . Geometric mean indoor NO2 levels were 11.4 μg·m−3 , while outdoor NO2 levels were 7.4 μg·m−3 . Higher indoor NO2 levels ( per logged unit increase ) were associated with greater daily reports of lower ( mean ratio 14 , 95 % CI 1.12–1.16 ) and upper respiratory tract symptoms ( mean ratio 1.03 , 95 % CI 1.00–1.05 ) , more frequent cough and wheeze , and more frequent reliever use during the day , but had no effect on preventer use . Higher indoor NO2 levels ( per logged unit increase ) were associated with a decrease in morning ( -17.25 mL , 95 % CI -27.63– -6.68 ) and evening ( -13.21 , 95 % CI -26.03– -0.38 ) forced expiratory volume in 1 s readings . Outdoor NO2 was not associated with respiratory tract symptoms , asthma symptoms , medication use or lung function measurements . These findings indicate that reducing NO2 exposure indoors is important in improving the respiratory health of children with asthma Objective To assess whether non-polluting , more effective home heating ( heat pump , wood pellet burner , flued gas ) has a positive effect on the health of children with asthma . Design R and omised controlled trial . Setting Households in five communities in New Zeal and . Participants 409 children aged 6 - 12 years with doctor diagnosed asthma . Interventions Installation of a non-polluting , more effective home heater before winter . The control group received a replacement heater at the end of the trial . Main outcome measures The primary outcome was change in lung function ( peak expiratory flow rate and forced expiratory volume in one second , FEV1 ) . Secondary 
    Output:
    