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

Abstract

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.

Interleukin 13,CD14, pet and tobacco smoke influence atopy in three Dutch cohorts: the allergenic study

“…In addition, a geneenvironment interaction of CD14 haplotype tagging SNPs with pet exposure was shown to be present with respect to total and FIGURE 2. Association of IL13 39UTR genotypes with logarithmised total serum immunoglobulin (Ig)E levels (mean and 95% confidence intervals) at ages 1, 2, 4 and 8 yrs in a) the pooled data, and b) the Prevention and Incidence of Asthma and Mite Allergy (PIAMA) [15], c) the Prevention of Asthma in Children (PREVASC) [16,17] specific IgE at ages 4 and 8 yrs, but absent at ages 1 and 2 yrs. Highly significant and consistent associations of IL13 and CD14 polymorphisms with IgE levels and sensitisation in childhood were found by pooling data from three birth cohorts.…”

“…n FIGURE 1. Interaction of CD14 -550C/T genotypes in the presence (+) and absence (-) of dog exposure at home in the first year of life on total serum immunoglobulin (Ig)E levels (mean and 95% confidence intervals) at age 4 and 8 yrs in: a) pooled data; b) the Prevention and Incidence of Asthma and Mite Allergy (PIAMA) study [15]; and c) the Prevention of Asthma in Children (PREVASC) [16,17] studies. IgE measurements were not available at age 4 yrs in the Child, Parent, Health, Focus on Lifestyle and Predisposition (KOALA) study [18] …”

“…The present study includes three prospective Dutch birth cohorts of similar design: Prevention and Incidence of Asthma and Mite Allergy (PIAMA) [15]; Prevention of Asthma in Children (PREVASC) [16,17]; and Child, Parent, Health, Focus on Lifestyle and Predisposition (KOALA) [18]. The three cohorts recruited children during pregnancy.…”

Meta-analysis of Parental Protection of Children From Tobacco Smoke Exposure

“…Seventy-five full-text articles were read. Forty-five studies were excluded for the following reasons: no relevant outcomes, 18 studies [38][39][40][41][42][43][44][45][46][47][48][49][50][51][52][53][54][55] ; the trial did not include a control group, 7 studies [56][57][58][59][60][61][62] ; the interventions were not aimed at parents of young children, 3 studies [63][64][65] ; the reporting period was ,1 month, 2 studies 66,67 ; data necessary for analysis were missing, 10 studies [68][69][70][71][72][73][74][75][76][77] ; the paper was a review article, 1 study 78 ; the article was a protocol, 2 studies 79,80 ; the article was a follow-up of a previous study, 1 study 81 ; there was no true control group (eg, 2 active interventions were compared), 1 study 82 .…”

Mortality in Asthma-Chronic Obstructive Pulmonary Disease Overlap in the United States

“…A meta-analysis found that studies of interventions focused on reducing exposure to a single allergen did not significantly affect asthma development, but that multifaceted interventions such as in the Isle of Wight study, 506 the Canadian Asthma Primary Prevention Study, 507 and the Prevention of Asthma in Children study 508 were associated with lower risk of asthma diagnosis in children younger than 5 years. 509 Two multifaceted studies that followed children beyond 5 years of age demonstrated a significant protective effect both before and after the age of 5 years.…”