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The Canadian asthma primary prevention study: outcomes at 2 years of age
Allan Becker1, Wade Watson, Alexander Ferguson
1Section of Allergy and Clinical Immunology, Department of Pediatrics and Child Health, University of Manitoba, AE101-671 William Avenue, Winnipeg, Manitoba R3E 0Z2, Canada.
Insights
A multifaceted intervention program effectively prevented asthma in high-risk infants. This program reduced asthma incidence, persistent asthma, and recurrent wheeze by targeting environmental factors and infant feeding practices.
Area of Science:
- Pediatric Allergy and Immunology
- Preventive Medicine
- Environmental Health
Background:
- Individual risk factor avoidance has proven insufficient for preventing childhood asthma.
- Asthma remains a significant public health concern, necessitating effective primary prevention strategies.
- Identifying high-risk infants allows for targeted interventions to mitigate asthma development.
Purpose of the Study:
- To evaluate the efficacy of a comprehensive intervention program in the primary prevention of asthma among infants at high risk.
- To assess the impact of specific environmental and dietary modifications on asthma development.
- To determine the effectiveness of early-life interventions in reducing asthma incidence and related symptoms.
Main Methods:
- A randomized controlled trial involving 545 high-risk infants identified by family history of asthma.
- Intervention group received measures including avoidance of dust mites, pet allergens, and environmental tobacco smoke, alongside encouragement of breastfeeding and delayed introduction of solid foods.
- Control group received standard care, with subsequent comparison of asthma development and atopy at 2 years of age.
Main Results:
- The intervention group showed a significantly lower incidence of asthma (16.3%) compared to the control group (23.0%) at 2 years.
- A 60% reduction in persistent asthma and a 90% reduction in recurrent wheeze were observed in the intervention group.
- Maternal exposure to environmental tobacco smoke and early positive skin test responses (especially to food) were identified as risk factors for asthma development.
Conclusions:
- A multifaceted intervention program implemented during the first year of life effectively prevents asthma in high-risk children up to 2 years of age.
- The findings highlight the critical "window of opportunity" in early life for asthma prevention.
- Further longitudinal studies are warranted to track the long-term effects of this intervention into school age.
Background:
Avoidance of individual risk factors have not been successful in preventing the development of asthma.
Objective:
We sought to determine the effectiveness of a multifaceted intervention program in primary prevention of asthma in high-risk infants.
Methods:
We identified 545 high-risk infants on the basis of an immediate family history of asthma. Families were randomized into intervention or control groups. Intervention measures included avoidance of house dust mite, pet allergen, and environmental tobacco smoke. Breast-feeding was encouraged with formula supplementation if necessary, and introduction of solid foods was delayed.
Results:
At 2 years of age, 19.5% of the children had asthma, and 14.7% had atopy (positive skin test response to one or more common allergens). Significantly fewer children had asthma in the intervention group compared with in the control group (16.3% vs 23.0%), with 60% less persistent asthma at 2 years. There was a 90% reduction for recurrent wheeze in the intervention group compared with that seen in the control group. Exposure to maternal environmental tobacco smoke during pregnancy or the first year was a risk factor for asthma at 2 years of age. A positive skin test response, particularly to food, at 12 months predicted asthma at 2 years. There was no significant difference for atopy between the intervention and control groups, but daycare reduced atopy at 2 years.
Conclusion:
This multifaceted intervention program during a window of opportunity in the first year of life was effective in preventing asthma in high-risk children at 2 years of age. Future studies with this cohort at school age are important.
Related Concept Videos
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Asthma is classified as allergic and non-allergic. Allergens such as dust mites, pollen, and pet dander trigger allergic asthma, while factors like cold air, intense emotions, or exercise can induce non-allergic asthma.
01:29Asthma-I: Introduction
01:26Asthma-II: Pathophysiology and Classification
Additionally, environmental and genetic factors play crucial roles in determining an individual's susceptibility to asthma and the severity of their condition.
Critical processes in asthma pathophysiology include:
01:24Asthma-III: Symptoms and Complications
Classification of Asthma
01:28Asthma I: Introduction
01:13Asthma III: Clinical Manifestations