PEDIATRICS Vol. 118 Supplement August 2006, pp. S9-S10 (doi:10.1542/peds.2006-0900P)
The PREVASC Study: The Clinical Effect of a Multifaceted Educational Intervention to Prevent Childhood Asthma
Boston, MA
ABSTRACT
PURPOSE OF THE STUDY.: To evaluate the clinical effectiveness of a multifaceted education intervention to prevent childhood asthma.
STUDY POPULATION.: General practitioners recruited 476 high-risk children during the prenatal period.
METHODS.: These high-risk children were randomly assigned to either a control group, receiving usual care, or an intervention group, in which families received instruction from nurses on how to reduce exposure of newborns to dust mite, pet, and food allergens and passive smoking.
RESULTS.: A total of 443 infants were followed up for 2 years. At 2 years of age, those in the intervention group (n = 222) had less asthma-like symptoms, including wheezing, shortness of breath, and nighttime cough, compared with those in the control group (n = 221). No significant differences in total and specific immunoglobulin E were found between the groups. During the first 2 years of life, the incidence of asthma-like symptoms was similar in both groups; however, subanalysis revealed a significant reduction in the females but not in the males in the intervention group.
CONCLUSIONS.: The intervention used in this study was not effective in reducing asthma-like symptoms in high-risk children during the first 2 years of life, although it was modestly effective at 2 years. Follow-up is necessary to confirm whether the intervention can actually prevent the development of asthma.
REVIEWER COMMENTS.: This is a well-designed study in a primary care environment to investigate the clinical effectiveness of a multifaceted approach to prevent the development of asthma in high-risk children. It seemed that the intervention was moderately able to reduce exposure to dust mite, pet, and food allergens, but no significant effect was observed on parentally observed symptoms or allergen-specific immunoglobulin E in the first 2 years of life. Perhaps a more focused intervention or longer follow-up period would have proven more useful. The effectiveness of a variety of multifaceted randomized intervention trials on asthma prevention has yet to be determined. Although a host of epidemiologic studies have helped identify risk factors, we will all be interested in determining whether any practical interventions may be promising in preventing asthma development.
Schonberger HJ, Dompeling E, Knottnerus JA, et al. Eur Respir J. 2005;25:660–670
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