Results

The search terms returned 212 abstracts (Figure 1). Twenty-two of the abstracts were removed because of type (ie, a methods paper that did not report results, a systematic review, or an abstract for a presentation or meeting). After review of the full-length articles, 182 were excluded, for 3 reasons: did not relate to a hurricane, did not include children, or did not report results related to asthma.

Figure 1.

Summary of articles identified from the literature search.

A total of 8 articles met the criteria. Because of heterogeneity in these articles, a meta-analysis was not performed. All 8 articles were related to Hurricane Katrina. Almost half (3/8) of the articles focused solely on children; the remainder included both children and adults. Most articles (6/8) involved people living in Louisiana after Hurricane Katrina. Two articles described people who lived in Louisiana before Hurricane Katrina but were displaced to other states (Texas, Mississippi) after the disaster. Only 1 article included comparison to other groups (ie, nondisplaced populations and nondisaster affected populations). ^{Reference Quast20}

Three articles focused on asthma and involved children; 1 also included young adults (aged 18-20 y) with asthma (Table 1). The largest and most recently published article in this group examined Medicaid claims data to assess the effect of a Medicaid Emergency Waiver program (“TexKat”) in Texas, which mostly served former Louisiana residents displaced by Hurricane Katrina. ^{Reference Quast20} People with asthma (aged 0-20 y) in the TexKat program appeared to have greater decreases in health-care use (office and emergency department visits) and asthma medication refills (controller and rescue medications) than in 3 comparison groups of nondisplaced populations.

Table 1.

Summary of included articles that focused solely on asthma and involved children

Abbreviations: ED, emergency department; HEAL, Head-off Environmental Asthma in Louisiana.

^a Of the 210,030 study participants, 1,151 were enrolled in the TexKat program and 208,879 were in the control groups (Louisiana residents who lived in a disaster-declared area prior to Hurricane Katrina but did not relocate to Texas [n = 62,317]; Louisiana residents who did not live in a disaster-declared area [n = 45,982]; and Texas residents enrolled in Medicaid not through TexKat [n = 100,580]).

^b Baseline evaluations began March 2007 through July 2008, between 19 and 35 mo after Hurricane Katrina. ^{Reference Grimsley, Chulada and Kennedy38}

The 2 other articles that focused exclusively on asthma were related to the Head-off Environmental Asthma in Louisiana (HEAL) study. This program provided home environmental assessments and asthma counseling sessions for 182 children (aged 4-12 y) with moderate to severe asthma in the greater New Orleans area after Hurricane Katrina. ^{Reference Thornton, Kennedy and Hayes-Watson21,Reference Grimsley, Wildfire and Lichtveld22} Both articles were pre-post analyses among the same population. The first of these articles, by Grimsley and colleagues, examined relationships between environmental allergen levels, allergy skin test sensitivity, and asthma symptoms but did not observe any consistent relationships. ^{Reference Grimsley, Wildfire and Lichtveld22} The authors found that lower indoor levels of airborne mold were significantly associated with asthma symptoms in their baseline data, but observed no significant associations between mold levels and asthma symptoms at 6-mo and 12-mo follow-up. These results led the study authors to question the usefulness of 1 set of exposure measurements from 18 mo after Hurricane Katrina (ie, their baseline measurements taken in 2007). ^{Reference Grimsley, Wildfire and Lichtveld22} The more recent article by Thornton and colleagues found that medication adherence among program participants significantly improved over the 12-mo study period. ^{Reference Thornton, Kennedy and Hayes-Watson21}

Most of the articles (5/8) in this review included but were not limited to participants with asthma (Table 2). Three reported the percentage of people with asthma in the study populations (10-18% ^{Reference Rath, Young and Harris23-Reference Rath, Donato and Duggan25} ); 2 did not report these data. ^{Reference Madrid, Sinclair and Bankston26,Reference Krol, Redlener and Shapiro27} Only 1 article, by Rabito and colleagues, focused exclusively on children (aged 7-14 y), of which 10% had asthma or bronchitis. ^{Reference Rabito, Iqbal and Kiernan24} Three articles included participants aged ≤24 y. In the 2011 Rath et al. article, 72% of participants were 10 y old or younger. ^{Reference Rath, Young and Harris23} In the 2007 Rath et al. article, 80% of participants were younger than 13 y old. ^{Reference Rath, Donato and Duggan25} In the 2008 Madrid et al. article, ages were not reported. ^{Reference Madrid, Sinclair and Bankston26} In the remaining article (Krol et al.), 29% of patient encounters were for individuals aged 0-21 y, but the percentage of encounters for individuals aged 0-17 y old was not reported. ^{Reference Krol, Redlener and Shapiro27}

Table 2

Summary of included articles that involved children with asthma or other health conditions

Abbreviations: CI, confidence interval; FEMA, Federal Emergency Management Agency; HSCAAK, Health Survey for Children and Adolescents After Katrina.

^a The Health Survey for Children and Adolescents After Katrina (HSCAAK) was administered to individuals aged ≤24 y in New Orleans health clinics between October 2005 and February 2006.

^b Upper respiratory symptoms included runny nose, stuffy nose, sore throat, flu-like illness, ear infection, new-onset cough, new-onset headache, red eye, and eye drainage.

^c Lower respiratory symptoms included shortness of breath, pneumonia, bronchitis, asthma attack, cough >2 wk, and difficulty breathing.

^d The Baton Rouge Children’s Health Project included a mobile medical unit to deliver primary care to people in a FEMA transitional housing site that housed approximately 1,600 Katrina evacuees (including about 600 children) near Baton Rouge, Louisiana.

^e A total of 296 of these 1,205 patient encounters were for patients aged 0–21 y. For this age group, 31 patient encounters were associated with a diagnosis of asthma.

The only article in Table 2 focused exclusively on children was a repeated measures follow-up study that assessed respiratory symptoms and spirometry over a 2-mo period in 2006, the year after Hurricane Katrina. ^{Reference Rabito, Iqbal and Kiernan24} The authors reported that lower respiratory tract symptoms decreased significantly over the 2-mo study period among 73 children aged 7-14 y (of which 10% had asthma or bronchitis). They found no significant associations between air sampling measurements of mold levels (indoor and outdoor) and respiratory symptoms or medication use. They also observed no differences in spirometry results between the 2 time periods.

Of the remaining 4 articles in Table 2, 2 were cross-sectional surveys, ^{Reference Rath, Young and Harris23,Reference Rath, Donato and Duggan25} 1 was a case study, ^{Reference Madrid, Sinclair and Bankston26} and 1 was a retrospective chart review. ^{Reference Krol, Redlener and Shapiro27} One cross-sectional survey, the Health Survey for Children and Adolescents After Katrina (HSCAAK), found that lower respiratory symptoms (including shortness of breath, asthma attack, and/or difficulty breathing) increased after Hurricane Katrina. ^{Reference Rath, Young and Harris23} Also, mold growth in the home was associated with lower respiratory tract symptoms (adjusted odds ratio = 1.47; 95% CI 1.02-2.12) and of the 81 children who evacuated and ran out of medications, 24% ran out of asthma medications or feared they would run out of asthma medications. The other cross-sectional survey in this group (Rath et al., 2007²⁵) compared people aged ≤24 y with and without chronic condition(s) before Hurricane Katrina. In this survey, 18% of participants reported asthma or another chronic lung disease. Among these individuals, 78% reported needing more asthma medication during the first 3 mo after Hurricane Katrina than before the hurricane. ^{Reference Rath, Donato and Duggan25}

Two articles of individuals with and without asthma reported observations from mobile medical units, which served people displaced by Hurricane Katrina and living in Federal Emergency Management Agency transitional housing. One of these articles was a retrospective chart review of patient encounters at 2 mobile medical units in Mississippi. This study found that asthma was the most common chronic illness associated with patient encounters in individuals aged 0-21 y old. ^{Reference Krol, Redlener and Shapiro27} The other article was a case study which described multiple challenges faced by people aged ≤24 y with asthma who received care from a mobile medical unit in Louisiana. ^{Reference Madrid, Sinclair and Bankston26} These challenges included expired controller medication prescriptions, inability to afford medications, lost Medicaid insurance cards, and loss of health insurance because of being dropped from Medicaid enrollment. ^{Reference Madrid, Sinclair and Bankston26} Assessment of prehurricane asthma morbidity was not available for either of these articles.