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 BACKGROUND The efficacy of bed covers that are impermeable to house dust mites has been disputed . AIM The aim of the present study was to investigate whether the combination of ' house dust mite impermeable ' covers and a self-management plan , based on peak flow values and symptoms , leads to reduced use of  inhaled corticosteroids  ( ICS ) than self-management alone . DESIGN OF STUDY Prospect i ve , r and omised , double blind , placebo-controlled trial . SETTING Primary care in a south-eastern region of the Netherl and s. METHOD Asthma patients aged between 16 and 60 years with a house dust mite allergy requiring ICS were r and omised to intervention and placebo groups . They were trained to use a self-management plan based on peak flow and symptoms . After a 3-month training period , the intervention commenced using house dust mite impermeable and placebo bed covers . The follow-up period was 2 years . Primary outcome was the use of ICS ; secondary outcomes were peak expiratory flow parameters , asthma control , and symptoms . RESULTS One hundred and twenty-six patients started the intervention with house dust mite impermeable or placebo bed covers . After 1 and 2 years , significant differences in allergen exposure were found between the intervention and control groups ( P<0.001 ) . No significant difference between the intervention and control groups was found in the dose of ICS ( P = 0.08 ) , morning peak flow ( P = 0.52 ) , peak flow variability ( P = 0.36 ) , dyspnoea ( P = 0.46 ) , wheezing ( P = 0.77 ) , or coughing ( P = 0.41 ) . There was no difference in asthma control between the intervention and control groups . CONCLUSION House dust mite impermeable bed covers combined with self-management do not lead to reduced use of ICS compared with self-management alone Background : It is not clear whether associations between respiratory symptoms and indoor mould are causal . A r and omised controlled trial was conducted to see whether asthma improves when indoor mould is removed . Methods : Houses of patients with asthma were r and omly allocated into two groups . In one group , indoor mould was removed , fungicide was applied and a fan was installed in the loft . In the control group , intervention was delayed for 12 months . Question naires were administered and peak expiratory flow rate was measured at baseline , 6 months and 12 months . Results : Eighty-one houses were allocated to the intervention group and 83 to the control group ; 95 participants in 68 intervention houses and 87 in 63 control houses supplied follow-up information . Peak expiratory flow rate variability declined in both groups , with no significant differences between them . At 6 months , significantly more of the intervention group showed a net improvement in wheeze affecting activities ( difference between groups 25 % , 95 % CI 3 % to 47 % ; p = 0.028 ) , perceived improvement of breathing ( 52 % , 95 % CI 30 % to 74 % ; p<0.0001 ) and perceived reduction in medication ( 59 % , 95 % CI 35 % to 81 % ; p<0.0001 ) . By 12 months the intervention group showed significantly greater reductions than the controls in preventer and reliever use , and more improvement in rhinitis ( 24 % , 95 % CI 9 % to 39 % ; p = 0.001 ) and rhinoconjunctivitis ( 20 % , 95 % CI 5 % to 36 % ; p = 0.009 ) . Conclusions : Although there was no objective evidence of benefit , symptoms of asthma and rhinitis improved and medication use declined following removal of indoor mould . It is unlikely that this was entirely a placebo effect Background : The use of anti-allergic mattress covers in patients with asthma can result in a large reduction in the level of house dust mite allergen in dust sample s. Apart from a reduction in histamine induced bronchial hyperresponsiveness , there are few data on the effect of mattress covers on clinical efficacy and quality of life in patients with moderate to severe asthma . Methods : Thirty patients with asthma and house dust mite allergy were studied in a r and omised , double blind , placebo controlled study . Before and after using anti-allergic covers for 1 year , dust was collected from the mattresses to determine concentrations of Dermatophagoides pteronyssinus ( Der p 1 ) , and bronchial hyperresponsiveness and quality of life were measured . The patients scored their symptoms ( lungs and nose ) , morning and evening peak flow values , and rescue medication for 14 days before and after the intervention period . Results : There was a significant reduction in the concentration of Der p 1 in the dust collected from the mattresses in the actively treated group after 1 year compared with before treatment ; no change was found in the placebo group . In both the actively treated and placebo groups there was no significant improvement in PC20 histamine . Quality of life improved similarly in both groups . The symptom score of the lower airways did not significantly change in either group . A significant decrease in nasal symptom score was seen in the actively treated group compared with before treatment , but there was no significant difference between the groups . No changes in morning and evening peak flow values , peak flow variability , nor in the use of rescue medication were found in either group . Conclusion : The use of anti-allergic mattress covers results in significant reductions in Der p 1 concentrations in carpet-free bedrooms . However , in patients with moderate to severe asthma , airways hyperresponsiveness and clinical parameters are not affected by this effective allergen avoidance 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 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 R and omized clinical trial conducted in Baltimore , Maryl and , and Boston , Massachusetts . Participants were mouse-sensitized and exposed children and adolescents ( aged 5 - 17 years ) with asthma r and omized 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 material s 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 r and omized ( 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 result ed in no significant difference in maximal symptom days from 6 to 12 months . Trial Registration clinical trials.gov Identifier : BACKGROUND Exposure to inhaled allergens is a pathogenetic factor in allergic asthma . However , most studies that previously looked at air cleaning devices have shown little or no effect on patients with perennial allergic asthma . AIMS AND OBJECTIVES We examined a novel treatment using temperature regulated laminar airflow with a very low particle concentration directed to the breathing zone of teenagers and young adults with mild to moderate allergic asthma during night sleep . We hypothesised that the decreased allergen exposure during the night would have an effect on bronchial inflammation and quality of life . METHOD Twenty-two patients ( mean 18.8 years ) were r and omized to start with active or placebo treatment for 10 weeks . All patients received both active and placebo treatment with unfiltered air , with a 2-week wash-out period in between treatments . Maintenance treatment with inhaled corticosteroids was unaltered during the trial period . Health related quality of life ( miniAQLQ ) was the primary effectiveness measure . Exhaled nitric oxide ( FeNO ) and spirometry were also investigated . RESULTS Active treatment result ed in an improved miniAQLQ compared to placebo ( mean score 0.54 , p<0.05 , n=20 ) . An effect on bronchial infl 
    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 BACKGROUND The efficacy of bed covers that are impermeable to house dust mites has been disputed . AIM The aim of the present study was to investigate whether the combination of ' house dust mite impermeable ' covers and a self-management plan , based on peak flow values and symptoms , leads to reduced use of  inhaled corticosteroids  ( ICS ) than self-management alone . DESIGN OF STUDY Prospect i ve , r and omised , double blind , placebo-controlled trial . SETTING Primary care in a south-eastern region of the Netherl and s. METHOD Asthma patients aged between 16 and 60 years with a house dust mite allergy requiring ICS were r and omised to intervention and placebo groups . They were trained to use a self-management plan based on peak flow and symptoms . After a 3-month training period , the intervention commenced using house dust mite impermeable and placebo bed covers . The follow-up period was 2 years . Primary outcome was the use of ICS ; secondary outcomes were peak expiratory flow parameters , asthma control , and symptoms . RESULTS One hundred and twenty-six patients started the intervention with house dust mite impermeable or placebo bed covers . After 1 and 2 years , significant differences in allergen exposure were found between the intervention and control groups ( P<0.001 ) . No significant difference between the intervention and control groups was found in the dose of ICS ( P = 0.08 ) , morning peak flow ( P = 0.52 ) , peak flow variability ( P = 0.36 ) , dyspnoea ( P = 0.46 ) , wheezing ( P = 0.77 ) , or coughing ( P = 0.41 ) . There was no difference in asthma control between the intervention and control groups . CONCLUSION House dust mite impermeable bed covers combined with self-management do not lead to reduced use of ICS compared with self-management alone Background : It is not clear whether associations between respiratory symptoms and indoor mould are causal . A r and omised controlled trial was conducted to see whether asthma improves when indoor mould is removed . Methods : Houses of patients with asthma were r and omly allocated into two groups . In one group , indoor mould was removed , fungicide was applied and a fan was installed in the loft . In the control group , intervention was delayed for 12 months . Question naires were administered and peak expiratory flow rate was measured at baseline , 6 months and 12 months . Results : Eighty-one houses were allocated to the intervention group and 83 to the control group ; 95 participants in 68 intervention houses and 87 in 63 control houses supplied follow-up information . Peak expiratory flow rate variability declined in both groups , with no significant differences between them . At 6 months , significantly more of the intervention group showed a net improvement in wheeze affecting activities ( difference between groups 25 % , 95 % CI 3 % to 47 % ; p = 0.028 ) , perceived improvement of breathing ( 52 % , 95 % CI 30 % to 74 % ; p<0.0001 ) and perceived reduction in medication ( 59 % , 95 % CI 35 % to 81 % ; p<0.0001 ) . By 12 months the intervention group showed significantly greater reductions than the controls in preventer and reliever use , and more improvement in rhinitis ( 24 % , 95 % CI 9 % to 39 % ; p = 0.001 ) and rhinoconjunctivitis ( 20 % , 95 % CI 5 % to 36 % ; p = 0.009 ) . Conclusions : Although there was no objective evidence of benefit , symptoms of asthma and rhinitis improved and medication use declined following removal of indoor mould . It is unlikely that this was entirely a placebo effect Background : The use of anti-allergic mattress covers in patients with asthma can result in a large reduction in the level of house dust mite allergen in dust sample s. Apart from a reduction in histamine induced bronchial hyperresponsiveness , there are few data on the effect of mattress covers on clinical efficacy and quality of life in patients with moderate to severe asthma . Methods : Thirty patients with asthma and house dust mite allergy were studied in a r and omised , double blind , placebo controlled study . Before and after using anti-allergic covers for 1 year , dust was collected from the mattresses to determine concentrations of Dermatophagoides pteronyssinus ( Der p 1 ) , and bronchial hyperresponsiveness and quality of life were measured . The patients scored their symptoms ( lungs and nose ) , morning and evening peak flow values , and rescue medication for 14 days before and after the intervention period . Results : There was a significant reduction in the concentration of Der p 1 in the dust collected from the mattresses in the actively treated group after 1 year compared with before treatment ; no change was found in the placebo group . In both the actively treated and placebo groups there was no significant improvement in PC20 histamine . Quality of life improved similarly in both groups . The symptom score of the lower airways did not significantly change in either group . A significant decrease in nasal symptom score was seen in the actively treated group compared with before treatment , but there was no significant difference between the groups . No changes in morning and evening peak flow values , peak flow variability , nor in the use of rescue medication were found in either group . Conclusion : The use of anti-allergic mattress covers results in significant reductions in Der p 1 concentrations in carpet-free bedrooms . However , in patients with moderate to severe asthma , airways hyperresponsiveness and clinical parameters are not affected by this effective allergen avoidance 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 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 R and omized clinical trial conducted in Baltimore , Maryl and , and Boston , Massachusetts . Participants were mouse-sensitized and exposed children and adolescents ( aged 5 - 17 years ) with asthma r and omized 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 material s 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 r and omized ( 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 result ed in no significant difference in maximal symptom days from 6 to 12 months . Trial Registration clinical trials.gov Identifier : BACKGROUND Exposure to inhaled allergens is a pathogenetic factor in allergic asthma . However , most studies that previously looked at air cleaning devices have shown little or no effect on patients with perennial allergic asthma . AIMS AND OBJECTIVES We examined a novel treatment using temperature regulated laminar airflow with a very low particle concentration directed to the breathing zone of teenagers and young adults with mild to moderate allergic asthma during night sleep . We hypothesised that the decreased allergen exposure during the night would have an effect on bronchial inflammation and quality of life . METHOD Twenty-two patients ( mean 18.8 years ) were r and omized to start with active or placebo treatment for 10 weeks . All patients received both active and placebo treatment with unfiltered air , with a 2-week wash-out period in between treatments . Maintenance treatment with inhaled corticosteroids was unaltered during the trial period . Health related quality of life ( miniAQLQ ) was the primary effectiveness measure . Exhaled nitric oxide ( FeNO ) and spirometry were also investigated . RESULTS Active treatment result ed in an improved miniAQLQ compared to placebo ( mean score 0.54 , p<0.05 , n=20 ) . An effect on bronchial infl 
    Output:
    