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Published on: May 10, 2024
Outcome of a randomized multifaceted intervention with low-income families of wheezing infants
Mary D Klinnert1, Andrew H Liu, Marcella R Pearson
1Department of Pediatrics, National Jewish Medical and Research Center, 1400 Jackson St, G320, Denver, CO 80206, USA. klinnertm@njc.org
Insights
A home-based intervention for infants at risk for asthma did not reduce overall asthma rates but improved caregiver quality of life. The intervention was effective for children with less severe wheezing in infancy, reducing their asthma risk and symptom severity.
Area of Science:
- Pediatric Pulmonology
- Environmental Health
- Public Health Interventions
Background:
- Infants with early wheezing are at high risk for developing asthma.
- Early intervention strategies are crucial for managing pediatric respiratory conditions.
- Identifying effective interventions for high-risk urban populations is a public health priority.
Purpose of the Study:
- To evaluate the effectiveness of a secondary home-based intervention for infants at risk of developing asthma.
- To assess the impact of the intervention on asthma onset, severity, and related health outcomes up to age 4.
- To determine if the intervention benefits specific subgroups of high-risk infants.
Main Methods:
- Randomized controlled trial involving 149 low-income urban infants with recurrent wheezing before age 2.
- A 12-month multifaceted home intervention including allergen reduction, smoke avoidance, and illness management.
- Outcomes assessed at age 4 included asthma status, impulse oscillometry, caregiver quality of life, and healthcare utilization.
Main Results:
- The intervention did not significantly reduce the overall rate of asthma diagnosis by age 4 (46.0% vs. 54.9%).
- Caregiver quality of life significantly improved in the intervention group (P = .01).
- A significant benefit was observed in children with low baseline illness severity, who had lower odds of asthma (3x reduction, P = .04) and reduced symptom severity (P = .03).
Conclusions:
- A multifaceted home intervention did not decrease overall asthma incidence in high-risk infants.
- The intervention showed promise for reducing asthma burden in infants with low initial illness severity.
- Results highlight the potential for targeted interventions to mitigate asthma-related morbidity in vulnerable urban families.
Objective:
To evaluate the outcome of a secondary intervention conducted with infants at risk for asthma.
Design:
Families of wheezing infants were randomized to a 1-year intervention or control group; outcome evaluation occurred from April 1, 2000, through September 30, 2003, when children reached 4 years of age.
Setting:
Home intervention and clinic evaluation.
Participants:
A total of 149 children from low-income urban families with multiple wheezing episodes before the age of 2 years.
Intervention:
Nurse home visitors provided a multifaceted intervention (environmental allergen and tobacco smoke reduction as well as illness management) that lasted 12 months, with the goal of decreasing asthma onset and/or severity when children reached 4 years of age.
Main Outcome Measures:
Asthma status (parent-reported symptoms, impulse oscillometry, and documented asthma diagnosis), caregiver quality of life, medication use, and emergency department visits.
Results:
A total of 46.0% of children from the intervention group and 54.9% from the control group met criteria for asthma at the age of 4 years (P = .33). Caregiver quality of life was better for the intervention group (P = .01). Children in the intervention group were less likely to have reactive airways (prebronchodilator-postbronchodilator decrease in impulse oscillometry resistance at 10 Hz of > or =15%; P = .07). Outcome was modified by baseline illness severity; among children with low severity, odds of developing asthma by the age of 4 years were 3 times lower for intervention children than controls (P = .04), and symptom severity was lower for intervention children (P = .03).
Conclusions:
Multifaceted intervention did not decrease asthma among children with early wheezing illness as a whole, but only for children with low illness severity in infancy. Despite having an impact on only less severely ill children, results demonstrate the possibility of ameliorating illness burden for some inner-city families with children at high risk for poor asthma outcomes.
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