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Strategies for preventing wheezing and asthma in small children
M Wickman1, E Melén, N Berglind
1Department of Occupational and Environmental Health, Stockholm County Council, Stockholm, Sweden.
Insights
Adhering to allergy prevention guidelines for breastfeeding, smoke-free homes, and managing dampness significantly reduced wheezing and asthma in 2-year-olds. This protective effect was most pronounced in children with a family history of allergies.
Area of Science:
- Pediatric Allergy and Immunology
- Environmental Health
- Public Health
Background:
- Allergy prevention guidelines aim to reduce the incidence of allergic diseases in children.
- Factors such as breastfeeding, maternal smoking, and home environment play a role in childhood allergies.
Purpose of the Study:
- To evaluate the impact of adherence to allergy preventive guidelines on the development of wheezing and asthma by age two.
- To assess the effectiveness of guidelines concerning breastfeeding, maternal tobacco smoke exposure, and home dampness.
Main Methods:
- A prospective birth cohort study (BAMSE) involving 4089 children born between 1994-1996 in Stockholm, Sweden.
- Data collected via questionnaires on heredity, environmental factors at 2 months, and symptom assessment at 1 and 2 years of age.
- Multiple logistic regression models were used to analyze the association between guideline adherence and wheezing/asthma outcomes.
Main Results:
- Children following all guidelines had significantly lower rates of recurrent wheezing (12.6%) and asthma (6.8%) compared to those exposed to risk factors.
- Adherence to guidelines showed a twofold reduction in asthma for children without allergic heredity and a threefold reduction for those with heredity.
- The attributable fraction for asthma due to guideline adherence was 23% overall and 33% in children with allergic heredity.
Conclusions:
- Family lifestyle aligned with allergy prevention guidelines is linked to a substantial decrease in recurrent wheezing and childhood asthma.
- The benefits of these guidelines are particularly evident in children with a predisposition to allergies.
- Further follow-up is needed to confirm the long-term risk reduction of these respiratory symptoms and diseases.
Objective:
To assess the effects of living in agreement with allergy preventive guidelines on wheezing and asthma at 2 years of age.
Design:
Prospective birth cohort study (BAMSE). Questionnaires on heredity and environmental factors were answered when the child was 2 months, and detailed questionnaires on symptoms at 1 and 2 years of age.
Participants:
4089 children, born during 1994-1996.
Setting:
Child Health Centres in central and north-western parts of Stockholm, Sweden.
Main Outcome Measures:
Wheezing and asthma up to the age of 2.
Results:
The effects of preventive guidelines regarding breastfeeding, maternal tobacco smoke and home dampness on wheezing and asthma were assessed in multiple logistic regression models. The cumulative incidence of recurrent wheezing at 2 years of age was 12.6% and of asthma 6.8% among those with a lifestyle in agreement with all guidelines and 24.1 and 17.9%, respectively, in families exposed to at least two of the three risk factors. Among children with no heredity, family lifestyle according to the guidelines gave a twofold reduction of asthma (5.3 vs. 10.5%), while the group with heredity had a threefold reduction (9.1 vs. 27.3%). The attributable fraction for asthma associated with the guidelines was 23% in total and 33% among those with heredity.
Conclusion:
In this observational study, family lifestyle according to preventive guidelines is associated with an important reduction of recurrent wheezing and asthma at 2 years of age, especially among children with allergic heredity. A follow-up will determine whether there still a risk reduction of both symptoms and disease.