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Mary D. Klinnert, PhD; Andrew H. Liu, MD; Marcella R. Pearson, MSPH, PA; Suhong Tong, MS; Matthew Strand, PhD; Anne Luckow, MA; JoAnn L. Robinson, PhD

Arch Pediatr Adolesc Med. 2007;161(8):783-790.

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 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.

Author Affiliations: Department of Pediatrics (Drs Klinnert and Liu and Mss Pearson, Tong, and Luckow) and Division of Biostatistics (Dr Strand), National Jewish Medical and Research Center, and Departments of Psychiatry (Drs Klinnert and Robinson), Pediatrics (Dr Liu), and Preventative Medicine and Biometrics (Dr Strand), University of Colorado Health Sciences Center, Denver. Ms Pearson is now with Mountainland Pediatrics, Denver; Mss Tong and Luckow with the School of Nursing, University of Colorado Health Sciences Center; and Dr Robinson with the Department of Human Development and Family Studies, University of Connecticut, Storrs.

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