Two important triggers of asthma attacks are rarely removed from homes of children with asthma, according to a new study by researchers at National Jewish Medical and Research Center. The study, published in the July issue of The Journal of Pediatrics, in

"In our study of children with asthma, we were quite surprised to learn that households with smokers differed quite significantly from those with furred or feathered pets," said Frederick Wamboldt, M.D., Head of the Division of Psychosocial Medicine at National Jewish. "Smoking was generally associated with poor, nonwhite and highly stressed families, whereas pet ownership was associated with white families with greater asthma knowledge, older children and better family functioning. We believe doctors can more effectively counsel their asthma patients to remove asthma triggers from their homes if they take these differences into account." Tobacco smoke and pet dander are two of the most common contributors to more severe asthma symptoms. The National Heart Lung and Blood Institute has recommended that the first step in controlling asthma is reduction of exposure to irritants, such as tobacco smoke, and allergens, such as pet dander. Dr. Wamboldt and his colleagues interviewed 152 children with asthma aged 7 to 18 years and at least one parent of each child about potential allergens and irritants in their homes, the child's asthma history, the family's asthma knowledge, education, occupation, family functioning, stressful life events and quality of life. At least one smoker lived in 38% of the homes, a prevalence comparable to large-scales studies indicating that 35% to 45% of homes in the United States contain at least one smoker. Sixty-seven percent of the children lived in homes with a furred or feathered pet, slightly more than the 59% of U.S. homes reported to have pets. However, smoking, pet ownership and adherence to asthma medications did not correlate with each other, indicating that they are different problems that must be addressed individually. When the researchers examined the socioeconomic and psychosocial data on these families they found distinctly different profiles for the households with smokers and those with pets. "I believe that many doctors have two basic asthma patients in their minds: good ones who take their medicine, and avoid all irritants and allergens and bad ones who smoke, have pets and don't take their medications," said Dr. Wamboldt. "We have learned that the picture is decidedly more complex than that." The households with smokers reported more stress and lower quality of life, less asthma-related knowledge and lower parental educational and occupational status than did non-smoking households. "This suggests to us that smoking among parents of children with asthma should be viewed as an addiction rather than willful nonadherence with a doctor's advice," said Dr. Wamboldt. "Many parents may want to reduce their children's exposure to smoke, but cannot overcome their addiction to tobacco." In light of that, Dr. Wamboldt and his colleagues recommend that doctors discuss the importance of smoking cessation repeatedly rather than only once when a child is first diagnosed with asthma. They also suggested giving advice on ways to reduce a child's exposure to smoke, such as smoking outside. Households with furred or feathered pets were associated with older children, being white, better parental asthma knowledge, and better family functioning. "Our findings suggest that families with pets have good resources and are otherwise relatively judicious in their asthma care," said Dr. Wamboldt. "As a result, physicians may have more success exploring the family's decision to acquire the pet, rather than simply telling them to get rid of the animal. If the family knows the child is not allergic to that particular animal or the child's exposure to the animal dander is well-controlled, then the benefits of pet ownership may outweigh potential liabilities. The physician could then discuss other strategies for controlling pet allergens, such as frequently bathing the pet."

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