BACKGROUND: Avoidance of any one of the individual risk factors associated with childhood asthma has not been successful in preventing its development. OBJECTIVE: The purpose of this study is to determine the effectiveness of a multifaceted intervention program for the primary prevention of asthma in high-risk infants at 7 years of age. METHODS:Five hundred forty-five high-risk infants with an immediate family history of asthma and allergies were prospectively randomized into intervention or control groups prenatally. Intervention measures introduced before birth and during the first year of life included avoidance of house dust, pets, and environmental tobacco smoke and encouragement of breast-feeding with delayed introduction of solid foods. Assessment of outcomes at 7 years consisted of examination by pediatric allergists, methacholine inhalation tests, and allergy skin tests. RESULTS:At 7 years, 469 of the 545 children were contacted, and 380 returned for further assessment. The prevalence of pediatric allergist-diagnosed asthma was significantly lower in the intervention group than in the control group (14.9% vs 23.0%; adjusted risk ratio, 0.44; 95% CI, 0.25-0.79). The prevalence of allergic rhinitis, atopic dermatitis, atopy (defined as positive skin test reactions to any common allergen), and bronchial hyperresponsiveness (defined as the provocative concentration of methacholine that induced a 20% decrease in FEV 1 from a postsaline value of less than 7.8 mg/mL) were not significantly different between the 2 groups. The prevalence of asthma (defined as wheeze without colds and the presence of bronchial hyperresponsiveness) was also significantly lower in the intervention group compared with the control group (12.9% vs 25.0%; adjusted risk ratio, 0.39; 95% CI, 0.22-0.71). CONCLUSION: The multifaceted intervention program was effective in reducing the prevalence of asthma in high-risk children at 7 years of age.
RCT Entities:
BACKGROUND: Avoidance of any one of the individual risk factors associated with childhood asthma has not been successful in preventing its development. OBJECTIVE: The purpose of this study is to determine the effectiveness of a multifaceted intervention program for the primary prevention of asthma in high-risk infants at 7 years of age. METHODS: Five hundred forty-five high-risk infants with an immediate family history of asthma and allergies were prospectively randomized into intervention or control groups prenatally. Intervention measures introduced before birth and during the first year of life included avoidance of house dust, pets, and environmental tobacco smoke and encouragement of breast-feeding with delayed introduction of solid foods. Assessment of outcomes at 7 years consisted of examination by pediatric allergists, methacholine inhalation tests, and allergy skin tests. RESULTS: At 7 years, 469 of the 545 children were contacted, and 380 returned for further assessment. The prevalence of pediatric allergist-diagnosed asthma was significantly lower in the intervention group than in the control group (14.9% vs 23.0%; adjusted risk ratio, 0.44; 95% CI, 0.25-0.79). The prevalence of allergic rhinitis, atopic dermatitis, atopy (defined as positive skin test reactions to any common allergen), and bronchial hyperresponsiveness (defined as the provocative concentration of methacholine that induced a 20% decrease in FEV 1 from a postsaline value of less than 7.8 mg/mL) were not significantly different between the 2 groups. The prevalence of asthma (defined as wheeze without colds and the presence of bronchial hyperresponsiveness) was also significantly lower in the intervention group compared with the control group (12.9% vs 25.0%; adjusted risk ratio, 0.39; 95% CI, 0.22-0.71). CONCLUSION: The multifaceted intervention program was effective in reducing the prevalence of asthma in high-risk children at 7 years of age.
Authors: Denise Daley; Mathieu Lemire; Loubna Akhabir; Moira Chan-Yeung; Jian Qing He; Treena McDonald; Andrew Sandford; Dorota Stefanowicz; Ben Tripp; David Zamar; Yohan Bosse; Vincent Ferretti; Alexandre Montpetit; Marie-Catherine Tessier; Allan Becker; Anita L Kozyrskyj; John Beilby; Pamela A McCaskie; Bill Musk; Nicole Warrington; Alan James; Catherine Laprise; Lyle J Palmer; Peter D Paré; Thomas J Hudson Journal: Hum Genet Date: 2009-02-27 Impact factor: 4.132
Authors: G Feljandro P Ramos; Antoinette D I van Asselt; Sandra Kuiper; Johan L Severens; Tanja Maas; Edward Dompeling; J André Knottnerus; Onno C P van Schayck Journal: Eur J Health Econ Date: 2013-10-06
Authors: A Schroeder; R Kumar; J A Pongracic; C L Sullivan; D M Caruso; J Costello; K E Meyer; Y Vucic; R Gupta; J S Kim; R Fuleihan; X Wang Journal: Clin Exp Allergy Date: 2009-02 Impact factor: 5.018
Authors: Yohan Bossé; Mathieu Lemire; Audrey H Poon; Denise Daley; Jian-Qing He; Andrew Sandford; John H White; Alan L James; Arthur William Musk; Lyle J Palmer; Benjamin A Raby; Scott T Weiss; Anita L Kozyrskyj; Allan Becker; Thomas J Hudson; Catherine Laprise Journal: Respir Res Date: 2009-10-24