Abstract
ObjectivesThis study aimed to evaluate the effectiveness of systematic assessment of asthma-like symptoms and environmental tobacco smoke (ETS) exposure during regular preventive well-child visits between age 1 and 4 years by well-child professionals.MethodsSixteen well-child centres in Rotterdam, the Netherlands, were randomised into 8 centres where the brief assessment form regarding asthma-like symptoms and ETS exposure was used and 8 centres that applied usual care. 3596 and 4179 children (born between April 2002 and January 2006) and their parents visited the intervention and control centres, respectively. At child’s age 6 years, physician-diagnosed asthma ever, wheezing, fractional exhaled nitric oxide (FeNO), airway resistance (Rint), health-related quality of life (HRQOL) and ETS exposure at home ever were measured. Linear mixed models were applied.ResultsNo differences in asthma, wheezing, FeNO, Rint or HRQOL measurements between intervention and control group were found using multilevel regression in an intention-to-treat analysis (p>0.05). Children of whom the parents were interviewed by using the brief assessment form at the intervention well-child centres had a decreased risk on ETS exposure at home ever, compared to children who visited the control well-child centres, in an explorative per-protocol analysis (aOR = 0.71, 95% CI:0.59–0.87).ConclusionsSystematic assessment and counselling of asthma-like symptoms and ETS exposure in early childhood by well-child care professionals using a brief assessment form was not effective in reducing the prevalence of physician-diagnosed asthma ever and wheezing, and did not improve FeNO, Rint or HRQOL at age 6 years. Our results hold some promise for interviewing parents and using information leaflets at well-child centres to reduce ETS exposure at home in preschool children.Trial RegistrationControlled-Trials.com ISRCTN15790308.
Highlights
Asthma is a highly prevalent chronic condition associated with considerable morbidity, reduced health-related quality of life (HRQOL) and significant costs for public health [1,2]
This study aimed to evaluate the effectiveness of systematic assessment of asthma-like symptoms and environmental tobacco smoke (ETS) exposure between age 1 and 4 years by well-child professionals
To evaluate the brief assessment form regarding asthma-like symptoms and ETS exposure applied by well-child professionals, we used data that were collected in the Generation R Study
Summary
Asthma is a highly prevalent chronic condition associated with considerable morbidity, reduced health-related quality of life (HRQOL) and significant costs for public health [1,2]. While the majority of asthma management education for parents occurs in the clinical setting, increasingly, multifaceted environmental interventions to decrease asthma-like symptoms are delivered by community health workers [7]. Previous studies identified positive outcomes associated with community health worker-delivered interventions, including decreased asthma-like symptoms [7]. In the Netherlands, growth, development and health of all children (0–19 years) is monitored in a nationwide program with regular visits at set ages by well-child care physicians and nurses [10]. Until now, no systematic assessment of the presence of asthma-like symptoms in early childhood by well-child professionals has been applied at wellchild centres in the Netherlands. In the Netherlands, the nationwide well-child care program advises to interview parents regarding environmental tobacco smoke (ETS) exposure to preschool children [11]. Information leaflets with regard to ETS exposure are not yet given routinely to parents of children aged 1 to 4 years who are exposed to ETS
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