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Evaluation of systematic assessment of asthma-like symptoms and tobacco smoke exposure in early childhood by well-child professionals: A randomised trial

Author: Hafkamp-de Groen, E. · Valk, R.J.P. van der · Mohangoo, A.D. · Wouden, J.C. van der · Duijts, L. · Jaddoe, V.W. · Hofman, A. · Koning, H.J. de · Jongste, J.C. de · Raat, H.
Source:PLoS ONE, 3, 9
Identifier: 500746
doi: doi:10.1371/journal.pone.0090982
Article number: e90982
Keywords: Health · Nitric oxide · Tobacco smoke · Airway resistance · Asthma · Child · Clinical evaluation · Controlled study · Environmental exposure · Health care personnel · Outcome assessment · Patient assessment · Patient counseling · Prevalence · Professional practice · Qality of life · Risk assessment · Wheezing · Healthy for Life · Healthy Living · Behavioural Changes · CH - Child Health · ELSS - Earth, Life and Social Sciences


Objectives: This 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 wellchild professionals. Methods: Sixteen 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. Results: No 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). Conclusions: Systematic assessment and counselling of asthma-like symptoms and ETS exposure in early childhood by wellchild 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 Registration: ISRCTN15790308. © 2014 Hafkamp-de Groen et al. Chemicals/CAS: nitric oxide, 10102-43-9