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 " credit card " asthma self-management plan provides the adult asthmatic patient with simple guidelines for the self-management of asthma , which are based on the self- assessment of peak expiratory flow rate recordings and symptoms . OBJECTIVE The study was a trial of the clinical efficacy of the credit card plan in a high-risk group of asthmatic patients . METHODS In this " before- and -after " trial , patients discharged from the emergency department of Wellington Hospital , after treatment for severe asthma were invited to attend a series of hospital outpatient clinics at which the credit card plan was introduced . Question naires were used to compare markers of asthma morbidity , requirement for emergency medical care , and medication use during the 6-month period before and after intervention with the credit card plan . RESULTS Of the 30 patients with asthma who attended the first outpatient clinic , 26 ( 17 women and 9 men ) completed the program . In these 26 participants , there was a reduction in both morbidity and requirement for acute medical services : specifically , the proportion waking with asthma more than once a week decreased from 65 % to 23 % ( p = 0.005 ) and the proportion visiting the emergency department for treatment of severe asthma decreased from 58 % to 15 % ( p = 0.004 ) . The patients attending the clinics commented favorably on the plan , in particular on its usefulness as an educational tool for monitoring and treating their asthma . CONCLUSIONS Although the interpretation of this study is limited by the lack of a r and omized control group , the findings are consistent with other evidence that the credit card asthma self-management plan can be an effective and acceptable system for improving asthma care in a high-risk group of adult patients with asthma BACKGROUND Isl and and mainl and Puerto Rican children have the highest rates of asthma and asthma morbidity of any ethnic group in the United States . OBJECTIVE We evaluated the effectiveness of a culturally adapted family asthma management intervention called CALMA ( an acronym of the Spanish for " Take Control , Empower Yourself and Achieve Management of Asthma " ) in reducing asthma morbidity in poor Puerto Rican children with asthma . METHODS Low-income children with persistent asthma were selected from a national health plan insurance cl aims data base by using a computerized algorithm . After baseline , families were r and omly assigned to either the intervention or a control group . RESULTS No significant differences between control and intervention group were found for the primary outcome of symptom-free days . However , children in the CALMA intervention group had 6.5 % more symptom-free nights , were 3 times more likely to have their asthma under control , and were less likely to visit the emergency department and be hospitalized as compared to the control group . Caregivers receiving CALMA were significantly less likely to feel helpless , frustrated , or upset because of their child 's asthma and more likely to feel confident to manage their child 's asthma . CONCLUSION A home-based asthma intervention program tailored to the cultural needs of low income Puerto Rican families is a promising intervention for reducing asthma morbidity Introduction Observational studies report inverse associations between the use of feather upper bedding ( pillow and /or quilt ) and asthma symptoms but there is no r and omised controlled trial ( RCT ) evidence assessing the role of feather upper bedding as a secondary prevention measure . Objective To determine whether , among children not using feather upper bedding , a new feather pillow and feather quilt reduces asthma severity among house dust mite ( HDM ) sensitised children with asthma over a 1-year period compared with st and ard dust mite avoidance advice , and giving children a new mite-occlusive mattress cover . Design RCT . Setting The Calvary Hospital in the Australian Capital Territory and the Children 's Hospital at Westmead , Sydney , New South Wales . Patients 197 children with HDM sensitisation and moderate to severe asthma . Intervention New upper bedding duck feather pillow and quilt and a mite-occlusive mattress cover ( feather ) versus st and ard care and a mite-occlusive mattress cover ( st and ard ) . Main outcome measures The proportion of children reporting four or more episodes of wheeze in the past year ; an episode of speech-limiting wheeze ; or one or more episodes of sleep disturbance caused by wheezing ; and spirometry with challenge testing . Statistical analysis included multiple logistic and linear regression . Results No differences between groups were found for primary end points – frequent wheeze ( OR 1.51 , 95 % CI 0.83 to 2.76 , p=0.17 ) , speech-limiting wheeze ( OR 0.70 , 95 % CI 0.32 to 1.48 , p=0.35 ) , sleep disturbed because of wheezing ( OR 1.17 , 95 % CI 0.64 to 2.13 , p=0.61 ) or for any secondary end points . Secondary analyses indicated the intervention reduced the risk of sleep being disturbed because of wheezing and severe wheeze to a greater extent for children who slept supine . Conclusion No differences in respiratory symptoms or lung function were observed 1 year after children with moderate – severe asthma and HDM sensitisation were given a mite-occlusive mattress cover and then received either feather upper bedding ( pillow and quilt ) or st and ard bedding care OBJECTIVE To test an air cleaner and health coach intervention to reduce secondh and smoke exposure compared with air cleaners alone or no air cleaners in reducing particulate matter ( PM ) , air nicotine , and urine cotinine concentrations and increasing symptom-free days in children with asthma residing with a smoker . DESIGN R and omized controlled trial , with r and omization embedded in study data base . SETTING S The Johns Hopkins Hospital Children 's Center and homes of children . PARTICIPANTS Children with asthma , residing with a smoker , r and omly assigned to interventions consisting of air cleaners only ( n = 41 ) , air cleaners plus a health coach ( n = 41 ) , or delayed air cleaner ( control ) ( n = 44 ) . MAIN OUTCOME MEASURES Changes in PM , air nicotine , and urine cotinine concentrations and symptom-free days during the 6-month study . RESULTS The overall follow-up rate was high ( 91.3 % ) . Changes in mean fine and coarse PM ( PM(2.5 ) and PM(2.5 - 10 ) ) concentrations ( baseline to 6 months ) were significantly lower in both air cleaner groups compared with the control group ( mean differences for PM(2.5 ) concentrations : control , 3.5 μg/m(3 ) ; air cleaner only , -19.9 μg/m(3 ) ; and air cleaner plus health coach , -16.1 μg/m(3 ) ; P = .003 ; and PM(2.5 - 10 ) concentrations : control , 2.4 μg/m(3 ) ; air cleaner only , -8.7 μg/m(3 ) ; and air cleaner plus health coach , -10.6 μg/m(3 ) ; P = .02 ) . No differences were noted in air nicotine or urine cotinine concentrations . The health coach provided no additional reduction in PM concentrations . Symptom-free days were significantly increased [ corrected ] in both air cleaner groups compared with the control group ( P = .03 ) . CONCLUSION Although the use of air cleaners can result in a significant reduction in indoor PM concentrations and a significant increase in symptom-free days , it is not enough to prevent exposure to secondh and smoke OBJECTIVE To present an interim analysis of the effect of a home-based intervention with low-income caregivers of wheezing infants at risk for childhood asthma on mediating variables . METHOD Infants aged 9 to 24 months with 3 or more physician-documented wheezing episodes were r and omly assigned to environmental support intervention ( ES ) ( n = 90 ) or control ( n = 91 ) groups . Nurse home visitors intervened for 1 year to decrease allergen and environmental tobacco smoke exposure and improve symptom perception and management . Assessment s at baseline and 12 months included allergens in house dust , infant urinary cotinine levels , caregivers ' symptom reports , quality of life , illness management , and quality of caregiving . Medical records were coded for hospitalizations , emergency department visits , and corticosteroid bursts . RESULTS Within the ES group , cockroach allergen levels were significantly reduced and there was a trend toward reduction in dog d and er levels . Among infants with detectable urinary cotinine , levels were significantly reduced in the ES group . Caregiver psychological re sources modified the impact , and low-re source ES caregivers were the most strongly affected . Asthma knowledge and provider collaboration improved significantly in the ES group . Neither reports of infant symptoms nor emergency department visits or hospitalizations showed positive intervention effects . Number of corticosteroid bursts for infants was significantly higher for the ES group . CONCLUSIONS The Childhood Asthma Prevention Study intervention was effective in reducing several environmental exposures and improving illness management . However , even with an intensive home-based intervention , we failed to reduce respiratory symptoms or medical use in the ES group relative to the control group , illustrating the difficulty of changing the course of early asthma development among low-income infants OBJECTIVE : The goal was to test the effects of high-efficiency , particulate-arresting ( HEPA ) air cleaners on unscheduled asthma visits and symptoms among children with asthma exposed to secondh and smoke . METHODS : We enrolled 225 eligible children who were 6 to 12 years of age , had physician-diagnosed asthma , and were exposed to ≥5 cigarettes per day . We conducted a double-blind , r and omized trial . Children were assigned r and omly to receive 2 active or inactive HEPA air cleaners . RESULTS : Of 225 enrolled children , 110 ( 49 % ) were assigned to the intervention group and 115 ( 51 % ) to the control group ; 215 ( 95 % ) completed the trial . During the trial , there were 42 fewer unscheduled asthma visits among children in the intervention group ( 18.5 % [ 95 % confidence interval : 1.25%–82.75 % ] ; P = .043 ) , compared with those in the control group , after adjustment for baseline differences . There was a significant difference in the reductions of levels of particles of > 0.3 μm according to group assignment ; there was a 25 % reduction in particle levels in the intervention group , compared with a 5 % reduction in the control group ( P = .026 ) . There were no significant differences in parent-reported asthma symptoms , exhaled nitric-oxide levels , air nicotine levels , or cotinine levels according to group assignment . CONCLUSIONS : These results hold promise for using HEPA air cleaners as part of a multifaceted strategy to reduce asthma morbidity , but further research is necessary before they can be recommended routinely for the medical management of asthma BACKGROUND The effectiveness of avoidance of house-dust-mite allergen ( Dermatophagoides pteronyssinus 1 [ Der p1 ] ) in the management of  asthma  is uncertain . METHODS We conducted a double-blind , r and omized , placebo-controlled study of allergen-impermeable bed covers involving 1122 adults with asthma . The primary outcomes were the mean morning peak expiratory flow rate over a four-week period during the run-in phase and at six months and the proportion of patients who discontinued inhaled corticosteroid therapy as part of a phased-reduction program during months 7 through  
    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 " credit card " asthma self-management plan provides the adult asthmatic patient with simple guidelines for the self-management of asthma , which are based on the self- assessment of peak expiratory flow rate recordings and symptoms . OBJECTIVE The study was a trial of the clinical efficacy of the credit card plan in a high-risk group of asthmatic patients . METHODS In this " before- and -after " trial , patients discharged from the emergency department of Wellington Hospital , after treatment for severe asthma were invited to attend a series of hospital outpatient clinics at which the credit card plan was introduced . Question naires were used to compare markers of asthma morbidity , requirement for emergency medical care , and medication use during the 6-month period before and after intervention with the credit card plan . RESULTS Of the 30 patients with asthma who attended the first outpatient clinic , 26 ( 17 women and 9 men ) completed the program . In these 26 participants , there was a reduction in both morbidity and requirement for acute medical services : specifically , the proportion waking with asthma more than once a week decreased from 65 % to 23 % ( p = 0.005 ) and the proportion visiting the emergency department for treatment of severe asthma decreased from 58 % to 15 % ( p = 0.004 ) . The patients attending the clinics commented favorably on the plan , in particular on its usefulness as an educational tool for monitoring and treating their asthma . CONCLUSIONS Although the interpretation of this study is limited by the lack of a r and omized control group , the findings are consistent with other evidence that the credit card asthma self-management plan can be an effective and acceptable system for improving asthma care in a high-risk group of adult patients with asthma BACKGROUND Isl and and mainl and Puerto Rican children have the highest rates of asthma and asthma morbidity of any ethnic group in the United States . OBJECTIVE We evaluated the effectiveness of a culturally adapted family asthma management intervention called CALMA ( an acronym of the Spanish for " Take Control , Empower Yourself and Achieve Management of Asthma " ) in reducing asthma morbidity in poor Puerto Rican children with asthma . METHODS Low-income children with persistent asthma were selected from a national health plan insurance cl aims data base by using a computerized algorithm . After baseline , families were r and omly assigned to either the intervention or a control group . RESULTS No significant differences between control and intervention group were found for the primary outcome of symptom-free days . However , children in the CALMA intervention group had 6.5 % more symptom-free nights , were 3 times more likely to have their asthma under control , and were less likely to visit the emergency department and be hospitalized as compared to the control group . Caregivers receiving CALMA were significantly less likely to feel helpless , frustrated , or upset because of their child 's asthma and more likely to feel confident to manage their child 's asthma . CONCLUSION A home-based asthma intervention program tailored to the cultural needs of low income Puerto Rican families is a promising intervention for reducing asthma morbidity Introduction Observational studies report inverse associations between the use of feather upper bedding ( pillow and /or quilt ) and asthma symptoms but there is no r and omised controlled trial ( RCT ) evidence assessing the role of feather upper bedding as a secondary prevention measure . Objective To determine whether , among children not using feather upper bedding , a new feather pillow and feather quilt reduces asthma severity among house dust mite ( HDM ) sensitised children with asthma over a 1-year period compared with st and ard dust mite avoidance advice , and giving children a new mite-occlusive mattress cover . Design RCT . Setting The Calvary Hospital in the Australian Capital Territory and the Children 's Hospital at Westmead , Sydney , New South Wales . Patients 197 children with HDM sensitisation and moderate to severe asthma . Intervention New upper bedding duck feather pillow and quilt and a mite-occlusive mattress cover ( feather ) versus st and ard care and a mite-occlusive mattress cover ( st and ard ) . Main outcome measures The proportion of children reporting four or more episodes of wheeze in the past year ; an episode of speech-limiting wheeze ; or one or more episodes of sleep disturbance caused by wheezing ; and spirometry with challenge testing . Statistical analysis included multiple logistic and linear regression . Results No differences between groups were found for primary end points – frequent wheeze ( OR 1.51 , 95 % CI 0.83 to 2.76 , p=0.17 ) , speech-limiting wheeze ( OR 0.70 , 95 % CI 0.32 to 1.48 , p=0.35 ) , sleep disturbed because of wheezing ( OR 1.17 , 95 % CI 0.64 to 2.13 , p=0.61 ) or for any secondary end points . Secondary analyses indicated the intervention reduced the risk of sleep being disturbed because of wheezing and severe wheeze to a greater extent for children who slept supine . Conclusion No differences in respiratory symptoms or lung function were observed 1 year after children with moderate – severe asthma and HDM sensitisation were given a mite-occlusive mattress cover and then received either feather upper bedding ( pillow and quilt ) or st and ard bedding care OBJECTIVE To test an air cleaner and health coach intervention to reduce secondh and smoke exposure compared with air cleaners alone or no air cleaners in reducing particulate matter ( PM ) , air nicotine , and urine cotinine concentrations and increasing symptom-free days in children with asthma residing with a smoker . DESIGN R and omized controlled trial , with r and omization embedded in study data base . SETTING S The Johns Hopkins Hospital Children 's Center and homes of children . PARTICIPANTS Children with asthma , residing with a smoker , r and omly assigned to interventions consisting of air cleaners only ( n = 41 ) , air cleaners plus a health coach ( n = 41 ) , or delayed air cleaner ( control ) ( n = 44 ) . MAIN OUTCOME MEASURES Changes in PM , air nicotine , and urine cotinine concentrations and symptom-free days during the 6-month study . RESULTS The overall follow-up rate was high ( 91.3 % ) . Changes in mean fine and coarse PM ( PM(2.5 ) and PM(2.5 - 10 ) ) concentrations ( baseline to 6 months ) were significantly lower in both air cleaner groups compared with the control group ( mean differences for PM(2.5 ) concentrations : control , 3.5 μg/m(3 ) ; air cleaner only , -19.9 μg/m(3 ) ; and air cleaner plus health coach , -16.1 μg/m(3 ) ; P = .003 ; and PM(2.5 - 10 ) concentrations : control , 2.4 μg/m(3 ) ; air cleaner only , -8.7 μg/m(3 ) ; and air cleaner plus health coach , -10.6 μg/m(3 ) ; P = .02 ) . No differences were noted in air nicotine or urine cotinine concentrations . The health coach provided no additional reduction in PM concentrations . Symptom-free days were significantly increased [ corrected ] in both air cleaner groups compared with the control group ( P = .03 ) . CONCLUSION Although the use of air cleaners can result in a significant reduction in indoor PM concentrations and a significant increase in symptom-free days , it is not enough to prevent exposure to secondh and smoke OBJECTIVE To present an interim analysis of the effect of a home-based intervention with low-income caregivers of wheezing infants at risk for childhood asthma on mediating variables . METHOD Infants aged 9 to 24 months with 3 or more physician-documented wheezing episodes were r and omly assigned to environmental support intervention ( ES ) ( n = 90 ) or control ( n = 91 ) groups . Nurse home visitors intervened for 1 year to decrease allergen and environmental tobacco smoke exposure and improve symptom perception and management . Assessment s at baseline and 12 months included allergens in house dust , infant urinary cotinine levels , caregivers ' symptom reports , quality of life , illness management , and quality of caregiving . Medical records were coded for hospitalizations , emergency department visits , and corticosteroid bursts . RESULTS Within the ES group , cockroach allergen levels were significantly reduced and there was a trend toward reduction in dog d and er levels . Among infants with detectable urinary cotinine , levels were significantly reduced in the ES group . Caregiver psychological re sources modified the impact , and low-re source ES caregivers were the most strongly affected . Asthma knowledge and provider collaboration improved significantly in the ES group . Neither reports of infant symptoms nor emergency department visits or hospitalizations showed positive intervention effects . Number of corticosteroid bursts for infants was significantly higher for the ES group . CONCLUSIONS The Childhood Asthma Prevention Study intervention was effective in reducing several environmental exposures and improving illness management . However , even with an intensive home-based intervention , we failed to reduce respiratory symptoms or medical use in the ES group relative to the control group , illustrating the difficulty of changing the course of early asthma development among low-income infants OBJECTIVE : The goal was to test the effects of high-efficiency , particulate-arresting ( HEPA ) air cleaners on unscheduled asthma visits and symptoms among children with asthma exposed to secondh and smoke . METHODS : We enrolled 225 eligible children who were 6 to 12 years of age , had physician-diagnosed asthma , and were exposed to ≥5 cigarettes per day . We conducted a double-blind , r and omized trial . Children were assigned r and omly to receive 2 active or inactive HEPA air cleaners . RESULTS : Of 225 enrolled children , 110 ( 49 % ) were assigned to the intervention group and 115 ( 51 % ) to the control group ; 215 ( 95 % ) completed the trial . During the trial , there were 42 fewer unscheduled asthma visits among children in the intervention group ( 18.5 % [ 95 % confidence interval : 1.25%–82.75 % ] ; P = .043 ) , compared with those in the control group , after adjustment for baseline differences . There was a significant difference in the reductions of levels of particles of > 0.3 μm according to group assignment ; there was a 25 % reduction in particle levels in the intervention group , compared with a 5 % reduction in the control group ( P = .026 ) . There were no significant differences in parent-reported asthma symptoms , exhaled nitric-oxide levels , air nicotine levels , or cotinine levels according to group assignment . CONCLUSIONS : These results hold promise for using HEPA air cleaners as part of a multifaceted strategy to reduce asthma morbidity , but further research is necessary before they can be recommended routinely for the medical management of asthma BACKGROUND The effectiveness of avoidance of house-dust-mite allergen ( Dermatophagoides pteronyssinus 1 [ Der p1 ] ) in the management of  asthma  is uncertain . METHODS We conducted a double-blind , r and omized , placebo-controlled study of allergen-impermeable bed covers involving 1122 adults with asthma . The primary outcomes were the mean morning peak expiratory flow rate over a four-week period during the run-in phase and at six months and the proportion of patients who discontinued inhaled corticosteroid therapy as part of a phased-reduction program during months 7 through  
    Output:
    