A Randomized Controlled Study on the Effectiveness of a Multifaceted Intervention Program in the Primary Prevention of Asthma in High-Risk Infants

Chan‐Yeung, Moira; Manfreda, Jure; Dimich‐Ward, Helen; Ferguson, Alexander C.; Watson, Wade; Becker, Allan B.

doi:10.1001/archpedi.154.7.657

Cited by 169 publications

(145 citation statements)

References 23 publications

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“…A major limitation is the fact that most of the environmental exposure-reducing measures, including breastfeeding, weaning practices, procuring pets and smoking, cannot be blindly executed. All birth cohort intervention studies experience this problem [17,20]. Therefore, reporting bias cannot be excluded as an explanation for the decrease in asthma-like symptoms in the intervention group at age 2 yrs.…”

Section: Discussionmentioning

confidence: 99%

“…Several randomised intervention studies have reported results on various clinical symptoms at age 1 [17,20,34], 2 [18,35], 3 [36], 4 [37] and 8 yrs [19]. When the results of intervention studies are compared, it has to be kept in mind that comparison is hampered, as the studies differ in defining high-risk cases, the applied intervention(s) and the definition of outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…Several primary prevention trials are currently in progress or will be finished soon, and have recently been reviewed [15]. Some trials study the preventive effect of a reduction in a single exposure, such as food allergens [16], or mite and pet allergens [17,18], or a dual approach of avoidance of food and mite allergens [19], combined with a reduction in passive smoking [20]. The study reported here, the Prevention of Asthma in Children (PREVASC) study, differs from the previously cited trials, as eligible cases were recruited from a primary care population in a routine primary care setting.…”

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confidence: 99%

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The PREVASC study: the clinical effect of a multifaceted educational intervention to prevent childhood asthma

Schönberger

Dompeling²,

Knottnerus³

et al. 2005

European Respiratory Journal

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As asthma is the most common chronic disease in childhood, much attention is directed towards primary prevention. Here, the clinical effectiveness of a multifaceted educational prevention was studied.A total of 476 high-risk children were recruited during the prenatal period by general practitioners and randomised to either: 1) a control group, receiving usual care; or 2) an intervention group in which families received instruction from nurses on how to reduce exposure of newborns to mite, pet and food allergens, and passive smoking.A total of 443 infants were followed-up for 2 yrs. At 2 yrs of age, the intervention group (n5222) had less asthma-like symptoms, including wheezing, shortness of breath and night-time cough, than the control group (n5221). No significant differences in total and specific immunoglobulin E were found between the groups. During the first 2 yrs of life, the incidence of asthma-like symptoms was similar in both groups; however, subanalysis revealed a significant reduction in the female, but not in the male, intervention group.In conclusion, the intervention used in this study was not effective in reducing asthma-like symptoms in high-risk children during the first 2 yrs of life, although it was modestly effective at 2 yrs. Follow-up is necessary to confirm whether the intervention can actually prevent the development of asthma.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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The PREVASC study: the clinical effect of a multifaceted educational intervention to prevent childhood asthma

Schönberger

Dompeling²,

Knottnerus³

et al. 2005

European Respiratory Journal

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“…The most successful programs are those that have combined environmental interventions with face-to-face education over multiple home visits. 7,[17][18][19][20][21] …”

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confidence: 99%

Healthy Homes University: A Home-Based Environmental Intervention and Education Program for Families with Pediatric Asthma in Michigan

et al. 2011

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Environmental conditions within the home can exacerbate asthmatic children's symptoms. To improve health outcomes among this group, we implemented an in-home environmental public health program-Healthy Homes Universityfor low-income families in Lansing, Michigan, from 2005 to 2008. Families received four visits during a six-month intervention. Program staff assessed homes for asthma triggers and subsequently provided products and services to reduce exposures to cockroaches, dust mites, mold, tobacco smoke, and other triggers. We also provided asthma education that included identification of asthma triggers and instructions on specific behaviors to reduce exposures. Based on self-reported data collected from 243 caregivers at baseline and six months, the impact of asthma on these children was substantially reduced, and the proportion who sought acute unscheduled health care for their asthma decreased by more than 47%.

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“…As to the effect of exposure on the development of asthma in infancy, the proof of the pudding will lie in controlled trials with randomised reduction of allergen exposure in birth cohorts. There are many ongoing randomised clinical trials but only a few of these with sufficient follow-up have thus far been published: the Isle of Wight study [12], a Canadian multifaceted intervention program in high-risk infants [13] and the NAC-MAAS study [14]. These three studies all investigated high-risk children (according to parental atopic status) and allocated them randomly to environmental manipulation in which several combined measures to reduce prenatal and postnatal allergen exposure were undertaken.…”

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confidence: 99%

No clinical evidence base to support the hygiene hypothesis

Schayck

Knottnerus

2004

Primary Care Respiratory Journal

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KEYWORDS Clinical evidence;Allergy; Hygiene hypothesisSummary The hygiene hypothesis is a popular explanation for recent increases in allergy in the western world. This hypothesis suggests that development of allergy (or asthma) could be prevented by exposure to immune stimulants such as viruses, bacteria and endotoxins, in particular in the prenatal period or early childhood. How evidence-based are the observations which support the hygiene hypothesis? All clinical epidemiological indications in favour of the hypothesis are based on observational (cross-sectional and cohort) studies and not on observations in randomised controlled intervention studies. In cross-sectional studies no causal relationships can be assessed with sufficient validity. Also in cohort studies there are validity problems, as the exposure is not determined by chance (by means of randomisation) and could be influenced by behaviour. And behaviour might well be a confounder, since it can be associated with both exposure and outcome. A problem is that, without being appropriately tested in well designed prospective research, the hygiene hypothesis has currently already become so popular in the news media that an increased occurrence of asthma might even be induced as a result of an increased exposure. Although the currently available evidence to support the hygiene hypothesis is poor, it appears that the hypothesis has to some become a matter of faith or ideology. Scientists should take care that messages imparted to the general public do not go beyond or conflict with existing evidence. © 2004 General Practice Airways Group. Published by Elsevier Ltd. All rights reserved.General practitioners and other health care providers are in receipt of conflicting information on the pathopysiology of allergy (and asthma), especially in relation to the hygiene hypothesis. It is difficult for these health care professionals to translate this information into practical advice for their patients who want to know how to avoid the development of these diseases in their children. 1

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A Randomized Controlled Study on the Effectiveness of a Multifaceted Intervention Program in the Primary Prevention of Asthma in High-Risk Infants

Abstract: Background:The prevalence of asthma has increased in developed countries in the past 2 decades. The effectiveness of intervention measures on the primary prevention of asthma has not been well studied.

Cited by 169 publications

References 23 publications

The PREVASC study: the clinical effect of a multifaceted educational intervention to prevent childhood asthma

The PREVASC study: the clinical effect of a multifaceted educational intervention to prevent childhood asthma

Healthy Homes University: A Home-Based Environmental Intervention and Education Program for Families with Pediatric Asthma in Michigan

No clinical evidence base to support the hygiene hypothesis

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