Strategies for preventing wheezing and asthma in small children

Authors

  • M. Wickman,

    1. Department of Occupational and Environmental Health, Stockholm County Council, Stockholm, Sweden;
    2. Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden;
    3. Sachs's Children's Hospital, Institute of Södersjukhuset, Karolinska Institute, Stockholm;
    Search for more papers by this author
  • E. Melén,

    1. Department of Occupational and Environmental Health, Stockholm County Council, Stockholm, Sweden;
    2. Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden;
    Search for more papers by this author
  • N. Berglind,

    1. Department of Occupational and Environmental Health, Stockholm County Council, Stockholm, Sweden;
    2. Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden;
    Search for more papers by this author
  • S. Lennart Nordvall,

    1. Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden;
    Search for more papers by this author
  • C. Almqvist,

    1. Department of Occupational and Environmental Health, Stockholm County Council, Stockholm, Sweden;
    2. Department of Woman and Child Health, Astrid Lindgren Children's Hospital, Stockholm, Sweden;
    Search for more papers by this author
  • I. Kull,

    1. Department of Occupational and Environmental Health, Stockholm County Council, Stockholm, Sweden;
    2. Sachs's Children's Hospital, Institute of Södersjukhuset, Karolinska Institute, Stockholm;
    Search for more papers by this author
  • M. Svartengren,

    1. Department of Occupational and Environmental Health, Stockholm County Council, Stockholm, Sweden;
    2. Department of Public Health Sciences, Karolinska Institute, Stockholm, Sweden
    Search for more papers by this author
  • G. Pershagen

    1. Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden;
    Search for more papers by this author

Magnus Wickman
Department of Environmental Health
Norrbacka, level 3 Karolinska Hospital
SE-171 76 Stockholm
Sweden

Abstract

Objective:  To assess the effects of living in agreement with allergy preventive guidelines on wheezing and asthma at 2 years of age.

Design:  Prospective birth cohort study (BAMSE). Questionnaires on heredity and environmental factors were answered when the child was 2 months, and detailed questionnaires on symptoms at 1 and 2 years of age.

Participants:  4089 children, born during 1994–1996.

Setting:  Child Health Centres in central and north-western parts of Stockholm, Sweden.

Main outcome measures:  Wheezing and asthma up to the age of 2.

Results:  The effects of preventive guidelines regarding breastfeeding, maternal tobacco smoke and home dampness on wheezing and asthma were assessed in multiple logistic regression models. The cumulative incidence of recurrent wheezing at 2 years of age was 12.6% and of asthma 6.8% among those with a lifestyle in agreement with all guidelines and 24.1 and 17.9%, respectively, in families exposed to at least two of the three risk factors. Among children with no heredity, family lifestyle according to the guidelines gave a twofold reduction of asthma (5.3 vs. 10.5%), while the group with heredity had a threefold reduction (9.1 vs. 27.3%). The attributable fraction for asthma associated with the guidelines was 23% in total and 33% among those with heredity.

Conclusion:  In this observational study, family lifestyle according to preventive guidelines is associated with an important reduction of recurrent wheezing and asthma at 2 years of age, especially among children with allergic heredity. A follow-up will determine whether there still a risk reduction of both symptoms and disease.

Ancillary