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And I'm Renee Montagne.

Today In Your Health, dust. There's no doubt dust triggers asthma. And asthma sends more kids to the hospital than any other cause.

NPR's Richard Knox begins today's segment with a story of an innovative program that treats a child's environment so doctors don't have to treat the child as much.

RICHARD KNOX, BYLINE: Margie Lorenzi works with a program called the Community Asthma Initiative.

(SOUNDBITE OF KNOCKING)

KNOX: Today she's paying a call on Maria Texeira-Gomes.

MARGIE LORENZI: Hi, Maria.

MARIA TEXEIRA-GOMES: Hi. How are you?

LORENZI: Good.

KNOX: Her five-year-old son, Matheo, has had asthma nearly all his life.

TEXEIRA-GOMES: Nice to see you again. In here, come on in.

KNOX: Gomes and her family live in a low-income area of Boston. Doctors at Children's Hospital here noticed that lots of kids were coming in from neighborhoods like this with asthma attacks. So they wondered if they could do something about the environment these kids are living in. That's where Margie Lorenzi comes in.

After Matheo was hospitalized last fall, she went to his house to help his mother eliminate the things that kept triggering his asthma attacks.

LORENZI: So we'll go over the triggers just like we did the first time and the second time around and see what changes you have implemented within the home, changes that we've talked about.

KNOX: Things like the way she cleans, when she cleans and the products she uses. Gomes says she's made a lot of changes.

TEXEIRA-GOMES: Lots of changes. Awesome.

(LAUGHTER)

TEXEIRA-GOMES: Lots of changes. We have the HEPA filtered vacuum, which is what I use to dust and vacuum the home. I try to vacuum when he's at school or if he's going to be away for an extended amount of time. I try to keep away from Fabreze, which I loved. But I no longer use Febreze or any aerosol sprays in the home or any candle-lighting. Just kind of being diligent and thinking about his needs.

KNOX: Now she uses vinegar and water to clean.

TEXEIRA-GOMES: You know, within our culture we like to do the excessive cleaning with bleach and Lysol and...

LORENZI: I understand.

TEXEIRA-GOMES: ...all that stuff. So I try to minimize it.

KNOX: Lorenzi also checks for other asthma triggers.

LORENZI: OK, no cockroaches?

TEXEIRA-GOMES: No.

LORENZI: And what about mice?

TEXEIRA-GOMES: Not really, no.

LORENZI: Haven't seen no mice? OK.

KNOX: Matheo used to end up in the hospital every time he got a cold. And in between there were many trips to the emergency room. But all these changes really seem to be paying off.

LORENZI: How much of the time did the asthma keep him from going to school and kept you from going to work?

TEXEIRA-GOMES: None of the time.

LORENZI: Awesome. Great. And so, again, during the past four weeks, how much of the time did he have shortness of breath that you noticed? Would you say once a day? Three to six times a week? Once or twice a week? Or not at all?

TEXEIRA-GOMES: Not at all.

LORENZI: Wow, Mr. Mateo is doing great.

TEXEIRA-GOMES: Yeah, he's doing awesome.

KNOX: Matheo still has to take his asthma medicine but less often. His asthma isn't waking him up at night anymore. And he's swimming every week.

LORENZI: Matheo seems to be controlled. So I'm very happy you were able to make changes within the home...

TEXEIRA-GOMES: Yes.

LORENZI: ...and that they're working for the family.

KNOX: The program has served more than a thousand families over the past seven years. It costs about $2,300 per family; that's not only for staff time but things like the vacuum cleaners that filter out fine dust, special mattress covers, plastic bins for shoes and toys.

It's not cheap and not what hospitals usually do. But just a few visits over a year's time really make a difference.

DR. ELIZABETH WOODS: For every dollar spent, you save a $1.46 for hospitalizations and emergency department visits.

KNOX: Dr. Elizabeth Woods is the program's director.

WOODS: There's a 56 percent reduction in patients with any emergency room visits, an 80 percent reduction in patients with any hospitalizations.

KNOX: And that doesn't include savings from less use of medication, or the cost of time off work for parents caring for a sick child.

The program's beginning to catch on around the country. Proponents hope to persuade Medicaid and other insurers to pay for this simple re-engineering of the environment so they don't have to pay so much for treating asthma attacks.

Richard Knox, NPR News, Boston.

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