A randomized trial of parental behavioral counseling and cotinine feedback for lowering environmental tobacco smoke exposure in children with asthma: results of the LET'S Manage Asthma trial.
A randomized trial of parental behavioral counseling and cotinine feedback for lowering environmental tobacco smoke exposure in children with asthma: results of the LET'S Manage Asthma trial.
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DOI：
10.1378/chest.10-0772
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发表时间：
2011-03
期刊：
影响因子：
9.6
通讯作者：
Sandra R. Wilson;H. Farber;S. Knowles;P. Lavori
中科院分区：
文献类型：
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作者：
Sandra R. Wilson;H. Farber;S. Knowles;P. Lavori
二手烟草烟雾暴露损害儿童哮喘的控制。关于干预措施减少儿童接触和改善疾病结果的有效性的证据还没有定论。方法：519名3 ~ 12岁哮喘儿童的护理人员参加了两次基线评估访视，包括家长访谈、儿童尿液采样（用于可替宁测定）和肺功能测定（≥5岁儿童）。有显著暴露记录（可替宁≥10 ng/mL）的护理人员和儿童（n=352）参加了基础哮喘教育课程，提供了第三份尿样，并随机接受降低环境烟草烟雾：让我们管理哮喘（LET'S）干预（n=178）或常规护理（n=174）。让我们包括三个面对面的，基于改变阶段的咨询会议加上三个后续电话。可替宁反馈在每次面对面会议上给出。随机化后6个月和12个月的随访访视重复基线数据收集。多变量回归分析估计了干预对可替宁与肌酐比值（lnCCR）自然对数、医疗服务使用和其他结局的影响。结果：在样本总体中，LET'S干预组儿童的随访lnCCR值低于常规治疗组儿童，但组间差异不显著（β系数=-0.307，P = 0.064），且两组间哮喘相关就诊次数> 1次的几率无差异（β系数=0.035，P= 0.78）。然而，高危哮喘儿童的随访lnCCR值在统计学上低于接受常规治疗的儿童（β系数=-1.068，P=.006）。结论：在整个样本中，LET的干预与烟草烟雾暴露或医疗服务使用的统计学显著减少无关。然而，它似乎有效地减少了儿童暴露在高风险的后续恶化。试验注册表ClinicialTrials.gov;编号：NCT00217958; URL：clinicaltrials. gov。
BACKGROUND Secondhand tobacco smoke exposure impairs the control of pediatric asthma. Evidence of the efficacy of interventions to reduce children's exposure and improve disease outcomes has been inconclusive. METHODS Caregivers of 519 children aged 3 to 12 years with asthma and reported smoke exposure attended two baseline assessment visits, which involved a parent interview, sampling of the children's urine (for cotinine assay), and spirometry (children≥5 years). The caregivers and children (n=352) with significant documented exposure (cotinine≥10 ng/mL) attended a basic asthma education session, provided a third urine sample, and were randomized to the Lowering Environmental Tobacco Smoke: LET'S Manage Asthma (LET'S) intervention (n=178) or usual care (n=174). LET'S included three in-person, stage-of-change-based counseling sessions plus three follow-up phone calls. Cotinine feedback was given at each in-person session. Follow-up visits at 6 and 12 months postrandomization repeated the baseline data collection. Multivariate regression analyses estimated the intervention effect on the natural logarithm of the cotinine to creatinine ratio (lnCCR), use of health-care services, and other outcomes. RESULTS In the sample overall, the children in the LET'S intervention had lower follow-up lnCCR values compared with the children in usual care, but the group difference was not significant (β coefficient=-0.307, P=.064), and there was no group difference in the odds of having>one asthma-related medical visit (β coefficient=0.035, P=.78). However, children with high-risk asthma had statistically lower follow-up lnCCR values compared with children in usual care (β coefficient=-1.068, P=.006). CONCLUSIONS The LET'S intervention was not associated with a statistically significant reduction in tobacco smoke exposure or use of health-care services in the sample as a whole. However, it appeared effective in reducing exposure in children at high risk for subsequent exacerbations. TRIAL REGISTRY ClinicialTrials.gov; No.: NCT00217958; URL: clinicaltrials.gov.