title: Prevention of asthma in genetically susceptible children: a multifaceted intervention trial focussed on feasibility in general practice.
abstract: BACKGROUND
  Although the effectiveness of the multifaceted allergen-reducing interventions for the prevention of asthma in susceptible children was showed to be proven, the feasibility was not clear.
  
  
  METHODS
  The research question of the PREVention of asthma in susceptible children (PREVASC) trial was focused on the assessment of the effectiveness and feasibility of a multifaceted intervention on the prevention of allergic asthma in general practice. The effectiveness and feasibility of an intervention aimed at the simultaneous reduction in the environmental exposures to inhalant- and food allergens in susceptible children was investigated. A total of 476 children susceptible for developing asthma were initially included during pregnancy and were randomly divided over an intervention group of n = 222 children whose parents were offered a multifaceted environmental exposure-reducing intervention. Controls (n = 221) received usual care. The main outcome was 'diagnosis of allergic asthma at age 6'.
  
  
  RESULTS
  A significant reduction in inhalant allergen exposure levels of house dust mite [(Der p1), p = 0.043], cat [(Fel d1), p = 0.037], and dog [(Can f1), p = 0.012] was reached. Significantly more intervention group children started using cow's milk and solids after the age of 6 months (p ≤ 0.001). No statistical difference, however, was reached between groups on the duration of breast-feeding (p = 0.635) and the reduction in smoke exposure (p = 0829). At age 6, the intervention had no influence on the development of main outcome allergic asthma (OR = 1.010 (CI 0.580-1.758).
  
  
  CONCLUSIONS
  Other primary preventive asthma-reducing interventions were shown to be effective in reducing the occurrence of asthma for at least the first 7-8 yr of life. The multifaceted PREVASC allergic asthma primary preventive intervention was effective in reducing the exposure to inhalant and food allergens, but was not feasible for the parents. A lack of sufficient room for improvement focus on stimulating adherence seemed to be involved. It is suggested that a multifaceted environmental exposure-reducing intervention may have to be adapted to the personal circumstances of patients at baseline.
authors.affiliation: Department of General Practice, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands. tanja.maas@maastrichtuniversity.nl
authors.forename: Tanja
authors.initials: T
authors.lastname: Maas
authors.forename: Edward
authors.initials: E
authors.lastname: Dompeling
authors.forename: Jean W M
authors.initials: JW
authors.lastname: Muris
authors.forename: Geertjan
authors.initials: G
authors.lastname: Wesseling
authors.forename: J André
authors.initials: JA
authors.lastname: Knottnerus
authors.forename: Onno C P
authors.initials: OC
authors.lastname: van Schayck
mesh_terms: D016902:Air Pollution, Indoor / Q000009:adverse effects; D000485:Allergens / Q000009:adverse effects / Q000276:immunology*; D000818:Animals; D001249:Asthma / Q000453:epidemiology* / Q000235:genetics / Q000503:physiopathology / Q000517:prevention & control*; D001942:Breast Feeding; D002415:Cats; D002648:Child; D002675:Child, Preschool; D004285:Dogs; D004781:Environmental Exposure / Q000009:adverse effects; D005240:Feasibility Studies; D005260:Female; D058006:General Practice; D020022:Genetic Predisposition to Disease; D006801:Humans; D008297:Male; D009426:Netherlands; D011247:Pregnancy; D039981:Pyroglyphidae / Q000276:immunology; D014028:Tobacco Smoke Pollution
chemical_list: D000485:Allergens; D014028:Tobacco Smoke Pollution