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Moira Chan-Yeung, MB; Jure Manfreda, MD; Helen Dimich-Ward, PhD; Alexander Ferguson, MD; Wade Watson, MD; Allan Becker, MD

Arch Pediatr Adolesc Med. 2000;154:657-663.

Background  The prevalence of asthma has increased in developed countries in the past 2 decades. The effectiveness of intervention measures on the primary prevention of asthma has not been well studied.

Objective  To assess the effectiveness of a multifaceted intervention program in the primary prevention of asthma in high-risk infants (in this study, infants are defined as persons from birth to the age of 1 year).

Design  Prospective, prenatally randomized, controlled study with follow-up through the age of 1 year.

Setting  University hospital-based settings at 2 Canadian centers: Vancouver, British Columbia, and Winnipeg, Manitoba.

Participants  A total of 545 high-risk infants (at least 1 first-degree relative with asthma or 2 first-degree relatives with other IgE-mediated allergic diseases) identified before birth.

Interventions  Avoidance of house dust mite and pet allergens and environmental tobacco smoke, encouragement of breastfeeding, and supplementation with a partially hydrolyzed formula.

Main Outcome Measures  Probable or possible asthma, rhinitis without apparent colds, and a prick skin test result positive for common inhalant allergens.

Results  Thirty-eight (15.1%) of the 251 infants available for assessment in the intervention group and 49 (20.2%) of the 242 infants available for assessment in the control group fulfilled the criteria for possible or probable asthma (adjusted relative risk, 0.66; 90% confidence interval, 0.44-0.98). Also, 16.7% of the infants in the intervention group and 27.3% of the infants in the control group developed rhinitis without colds (adjusted relative risk, 0.51; 90% confidence interval, 0.35-0.74). The incidence of positive skin test results to 1 or more inhalant allergens was similar in both groups (4.4% in the intervention group and 4.6% in the control group).

Conclusions  Our multifaceted intervention program resulted in a modest but significant (P=.04) reduction in the risk of possible or probable asthma and rhinitis without apparent colds at the age of 12 months in high-risk infants. In the absence of a validated definition of asthma at the age of 12 months, follow-up studies are needed to determine the effectiveness of the intervention program in the primary prevention of asthma in high-risk infants.

From the Occupational and Environmental Lung Diseases Unit, Respiratory Division, Department of Medicine (Drs Chan-Yeung and Dimich-Ward), and the Division of Allergy, Department of Paediatrics (Dr Ferguson), University of British Columbia, Vancouver; and the Departments of Medicine and Community Health Sciences (Dr Manfreda) and the Section of Allergy and Clinical Immunology, Department of Paediatrics and Child Health (Drs Watson and Becker), University of Manitoba, Winnipeg. Dr Chan-Yeung is now with the University Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, Special Administrative Region, China.

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