A randomized controlled study on the effectiveness of a multifaceted intervention program in the primary prevention of asthma in high-risk infants

被引:141
作者
Chan-Yeung, M
Manfreda, J
Dimich-Ward, H
Ferguson, A
Watson, W
Becker, A
机构
[1] Univ British Columbia, Dept Med, Div Resp, Occupat & Environm Lung Dis Unit, Vancouver, BC, Canada
[2] Univ British Columbia, Dept Paediat, Div Allergy, Vancouver, BC, Canada
[3] Univ Manitoba, Dept Med, Winnipeg, MB, Canada
[4] Univ Manitoba, Dept Community Hlth Sci, Winnipeg, MB R3T 2N2, Canada
[5] Univ Manitoba, Dept Paediat & Child Hlth, Allergy & Clin Immunol Sect, Winnipeg, MB, Canada
来源
ARCHIVES OF PEDIATRICS & ADOLESCENT MEDICINE | 2000年 / 154卷 / 07期
关键词
D O I
10.1001/archpedi.154.7.657
中图分类号
R72 [儿科学];
学科分类号
100202 ;
摘要
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. Objective: To assess the effectiveness of a multifaceted intervention program in the primary prevention of asthma in high-risk infants (in this study, infants are defined as persons from birth to the age of 1 year). Design: Prospective, prenatally randomized, controlled study with follow-up through the age of 1 year. Setting: University hospital-based settings at 2 Canadian centers: Vancouver, British Columbia, and Winnipeg, Manitoba. Participants: A total of 545 high-risk infants (at least 1 first-degree relative with asthma or 2 first-degree relatives with other IgE-mediated allergic diseases) identified before birth. Interventions: Avoidance of house dust mite and pet allergens and environmental tobacco smoke, encouragement of breastfeeding, and supplementation with a partially hydrolyzed formula. Main Outcome Measures: Probable or possible asthma, rhinitis without apparent colds, and a prick skin test result positive for common inhalant allergens. Results: Thirty-eight (15.1%) of the 251 infants available for assessment in the intervention group and 49 (20.2%) of the 242 infants available for assessment in the control group fulfilled the criteria for possible or probable asthma (adjusted relative risk, 0.66; 90% confidence interval, 0.44-0.98). Also, 16.7% of the infants in the intervention group and 27.3% of the infants in the control group developed rhinitis without colds (adjusted relative risk, 0.51; 90% confidence interval, 0.35-0.74). The incidence of positive skin test results to 1 or more inhalant allergens was similar in both groups (4.4% in the intervention group and 4.6% in the control group). Conclusions: Our multifaceted intervention program resulted in a modest but significant (P = .04) reduction in the risk of possible or probable asthma and rhinitis without apparent colds at the age of 12 months in high-risk infants. In the absence of a validated definition of asthma at the age of 12 months, follow-up studies are needed to determine the effectiveness of the intervention program in the primary prevention of asthma in high-risk infants.
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页码:657 / 663
页数:7
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