Published ahead of print on May 13, 2004, doi:10.1164/rccm.200401-083OC
Am. J. Respir. Crit. Care Med., Volume 170, Number 4, August 2004, 433-439
A more recent version of this article appeared on August 15, 2004
Submitted on January 19, 2004
Accepted on May 7, 2004
Early Life Environmental Control: Effect on Symptoms, Sensitization and Lung Function at Age 3 Years
Ashley Woodcock1, Lesley A Lowe1, Clare S Murray1, Bridget M Simpson1, Spyros D Pipis1, Patricia Kissen1, Angela Simpson1, and Adnan Custovic1*
1 Wythenshawe Hospital, North West Lung Centre, Manchester, United Kingdom
* To whom correspondence should be addressed. E-mail: a.custovic{at}man.ac.uk.
We investigated whether environmental control during pregnancy and early life affects sensitisation and lung function at age 3 years. High-risk children (n=251) were prenatally randomised to stringent environmental control (Active) or no intervention (Control). Questionnaires, skin testing, IgE and specific airway resistance measurement were completed at age 3 years. Children in the active group were significantly more frequently sensitized compared to controls (at least one allergen by skin tests: risk ratio 1.61, 95% confidence interval 1.02-2.55, p=0.04; mite by IgE: 2.85, 1.02-7.97, p=0.05). However, specific airway resistance was significantly better in the active group (kiloPascal/second, geometric mean [95%confidence interval]: 1.05 [1.01-1.10] vs. 1.19 [1.13-1.25], p<0.0001, active vs. control). Maximal flow at functional residual capacity was measured using rapid thoracic compression at age 4 weeks in a subgroup. Prospective lung function data (infancy and 3 years) were obtained in 32 children (14 Active, 18 Control). There was no difference in infant lung function between the groups, but at 3 years specific airway resistance was significantly lower in the Active compared to Control children (p=0.003). Stringent environmental control was associated with increased risk of mite sensitisation, but better results for some measurements of lung function in high-risk children at age 3 years.
Key words: Asthma, Atopy, Primary Prevention, Environmental control, Lung function
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