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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    • "Similarly, there is a statistically significant difference in the proportion of intervention children requiring medical attention for chest infections at 24 months (12 percentage point difference). Diagnosing asthma in early childhood can be difficult, and the majority of childhood asthma onset manifests as wheezing illness in the first 2 to 3 years (Klinnert et al., 2005). The symptoms of wheezing and respiratory infections, such as bronchitis and chest infections, are often very similar to asthma which complicates its formal diagnosis. "
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    ABSTRACT: This article investigates the impact of an early intervention program, which experimentally modifies the parenting and home environment of disadvantaged families, on child physical health in the first 3 years of life. We recruited and randomized 233 (115 intervention, 118 control) pregnant women from a socioeconomically disadvantaged community in Dublin, Ireland into an intervention or control group. The treatment includes regular home visits commencing antenatally and an additional parenting course commencing at 2 years. Maternal reports of child health are assessed at 6, 12, 18, 24, and 36 months. Treatment effects are estimated using permutation testing to account for small sample size, inverse probability weighting to account for differential attrition, and both the stepdown procedure and an indices approach to account for multiple hypothesis testing. Following adjustment for multiple testing and attrition, we observe a positive and statistically significant main treatment effect for wheezing/asthma. The intervention group are 15.5 percentage points (pp) less likely to require medical attention for wheezing/asthma compared to the control group. Subgroup analysis reveals more statistically significant adjusted treatment effects for boys than girls regarding fewer health problems (d=0.63), accidents (23.9pp), and chest infections (22.8-37.9pp). Our results suggest that a community-based home visiting program may have favorable impacts on early health conditions.
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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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    • "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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