Short-term Impact of a Randomized Multifaceted Intervention for Wheezing Infants in Low-Income Families

National Jewish Medical and Research Center, University of Colorado Health Sciences Center, Denver 80206, USA.
Archives of Pediatrics and Adolescent Medicine (Impact Factor: 5.73). 02/2005; 159(1):75-82. DOI: 10.1001/archpedi.159.1.75
Source: PubMed


To present an interim analysis of the effect of a home-based intervention with low-income caregivers of wheezing infants at risk for childhood asthma on mediating variables.
Infants aged 9 to 24 months with 3 or more physician-documented wheezing episodes were randomly assigned to environmental support intervention (ES) (n = 90) or control (n = 91) groups. Nurse home visitors intervened for 1 year to decrease allergen and environmental tobacco smoke exposure and improve symptom perception and management. Assessments at baseline and 12 months included allergens in house dust, infant urinary cotinine levels, caregivers' symptom reports, quality of life, illness management, and quality of caregiving. Medical records were coded for hospitalizations, emergency department visits, and corticosteroid bursts.
Within the ES group, cockroach allergen levels were significantly reduced and there was a trend toward reduction in dog dander levels. Among infants with detectable urinary cotinine, levels were significantly reduced in the ES group. Caregiver psychological resources modified the impact, and low-resource ES caregivers were the most strongly affected. Asthma knowledge and provider collaboration improved significantly in the ES group. Neither reports of infant symptoms nor emergency department visits or hospitalizations showed positive intervention effects. Number of corticosteroid bursts for infants was significantly higher for the ES group.
The Childhood Asthma Prevention Study intervention was effective in reducing several environmental exposures and improving illness management. However, even with an intensive home-based intervention, we failed to reduce respiratory symptoms or medical use in the ES group relative to the control group, illustrating the difficulty of changing the course of early asthma development among low-income infants.

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    • "Infants are prone to wheezes because of anatomic factors related to the lung and chest wall in addition to immunologic and molecular influences in comparison to older children [5]. The obstruction to flow is affected by the airway caliber and compliance of the infant's lung. "
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    ABSTRACT: Several population-based birth cohort studies documented that 30% of children suffer from wheezing during respiratory infections before their third birthday. Infants are prone to wheeze because of anatomic factors related to the lung and chest wall in addition to immunologic and molecular influences in comparison to older children. Viral infections lead to immunologic derangements that cause wheezing both in immunocompetent and immunodeficient infants. Anatomic causes of wheeze may be extrinsic or intrinsic to the airway. Not every wheeze is indicative of asthma but prediction of asthma in persistent wheezers is possible. Testing for allergy in these infants is worthwhile and can be of significant value in avoidable allergens. Treatment of an infant with wheezing depends on the underlying etiology. Response to bronchodilators is unpredictable and a trial of inhaled steroids may be warranted in a patient who has responded to multiple courses of oral steroids, has moderate to severe wheezing, or a significant history of atopy including food allergy or eczema. Ribavirin administered by aerosol, hyper-immune respiratory syncytial virus immunoglobulin (RSV IVIG), and intramuscular monoclonal antibody to an RSV protein have been used for RSV bronchiolitis in infants with congenital heart disease or chronic lung disease.
    World Allergy Organization Journal 05/2011; 4(5):85-90. DOI:10.1097/WOX.0b013e318216b41f
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    • "Several studies have evaluated the use of interventions in which residents were given equipment and taught how to use IPM principles to control cockroaches and allergens in their homes, either alone (Klinnert et al. 2005; Krieger et al. 2005; McConnell et al. 2005) or in combination with professional pest control using low-toxicity pesticides (Brenner et al. 2003; Condon et al. 2007; Morgan et al. 2004; Peters et al. 2007). These studies suggest that education about IPM, either alone or combined with commercial cleaning, successfully reduced either cockroach counts (Brenner et al. 2003; McConnell et al. 2005) or cockroach allergen levels (Klinnert et al. 2005; McConnell et al. 2005; Morgan et al. 2004). Another study compared IPM that included repeated visits with the use of insect growth regulator devices to treatment with spray pesticide alone in public housing, using a commercial service for both treatments (Miller and Meek 2004). "
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    ABSTRACT: Cockroaches and mice, which are common in urban homes, are sources of allergens capable of triggering asthma symptoms. Traditional pest control involves the use of scheduled applications of pesticides by professionals as well as pesticide use by residents. In contrast, integrated pest management (IPM) involves sanitation, building maintenance, and limited use of least toxic pesticides. We implemented and evaluated IPM compared with traditional practice for its impact on pests, allergens, pesticide use, and resident satisfaction in a large urban public housing authority. We assigned IPM or control status to 13 buildings in five housing developments, and evaluated conditions at baseline, 3 months, and 6 months in 280 apartments in Brooklyn and Manhattan, in New York City (New York). We measured cockroach and mouse populations, collected cockroach and mouse urinary protein allergens in dust, and interviewed residents. All statistical models controlled for baseline levels of pests or allergens. Compared with controls, apartments receiving IPM had significantly lower counts of cockroaches at 3 months and greater success in reducing or sustaining low counts of cockroaches at both 3 and 6 months. IPM was associated with lower cockroach allergen levels in kitchens at 3 months and in beds and kitchens at 6 months. Pesticide use was reduced in IPM relative to control apartments. Residents of IPM apartments also rated building services more positively. In contrast to previous IPM studies, which involved extensive cleaning, repeat visits, and often extensive resident education, we found that an easily replicable single IPM visit was more effective than the regular application of pesticides alone in managing pests and their consequences.
    Environmental Health Perspectives 09/2009; 117(8):1219-25. DOI:10.1289/ehp.0800149 · 7.98 Impact Factor
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