Upper Bedding As A Prevention Measure In Childhood Asthma: A Randomised Controlled Trial
Funder
National Health and Medical Research Council
Funding Amount
$198,075.00
Summary
Asthma has recently been identified as a National health Priority (1) by the Australian Government in view of the increasing prevalence of asthma and its great importance as a public health problem. The total health system costs of asthma are estimated to be in excess of $600 million (2). Recently, feather pillows have been shown to have more than five times less house dust mite allergen than other pillows. To date, several population-based studies have shown that children using feather upper be ....Asthma has recently been identified as a National health Priority (1) by the Australian Government in view of the increasing prevalence of asthma and its great importance as a public health problem. The total health system costs of asthma are estimated to be in excess of $600 million (2). Recently, feather pillows have been shown to have more than five times less house dust mite allergen than other pillows. To date, several population-based studies have shown that children using feather upper bedding are also reported by their parents to have less severe wheeze. These findings call into question the National Asthma Council recommendation that people with asthma who are allergic to house dust mite should use synthetic quilts rather than feather or down (3). However, concerns remain that these important findings may only have occurred because unmeasured factors, such as the socioeconomic status or child diet may be closely related to feather bedding use, and in themselves, protective against asthma. Alternatively, parents of a child with asthma symptoms may be more likely to have chosen non-feather bedding. The best way to address these concerns is to conduct a randomised controlled trial to evaluate whether the use of new feather upper bedding is associated with reduced asthma severity among house dust mite-sensitised children with severe asthma. This study is underway and has support in 2001-2002 from the Financial Markets Foundation for Children. The research will address the following NHMRC Primary Health Care project grant thematic research areas: Evidence based primary health care practice; Quality of primary care; and Illness prevention and health promotion as a primary health care strategy. (1) National Health Priority Areas: Asthma. http:--www.health.gov.au-hsdd-nhpq-asthma-index.htm (2) NH and MRC Evidence Based Clinical Practice Research Program Workshop - December 16-17, 1999. (3) National Asthma Campaign Asthma Management Handbook 1998Read moreRead less
Exploration Of Exposures Associated With Bedding That Are Risks For Childhood Allergy And Asthma Symptoms
Funder
National Health and Medical Research Council
Funding Amount
$263,500.00
Summary
Asthma prevalence in Australia has doubled in the last 20 years, with 1 in 4 children now affected. House dust mites are probably the single most important allergen associated with asthma. The prevalence of mite allergy is linked to exposure, and such allergy when combined with high exposure, is a potent risk factor for asthma exacerbations. The current international advice for managing mite-allergic asthma, strongly advocates the use of bedding encasings as the best way to reduce exposure. Howe ....Asthma prevalence in Australia has doubled in the last 20 years, with 1 in 4 children now affected. House dust mites are probably the single most important allergen associated with asthma. The prevalence of mite allergy is linked to exposure, and such allergy when combined with high exposure, is a potent risk factor for asthma exacerbations. The current international advice for managing mite-allergic asthma, strongly advocates the use of bedding encasings as the best way to reduce exposure. However, three recent major trials using encasings and a meta-analysis of earlier trials all fail to show a clinical benefit. One of the applicants (ET) recently showed, using expertise in measuring personal exposure, that these encasings, as used, fail to significantly reduce aeroallergen exposure. By contrast, 3 recent Australian studies, involving the applicants, AK, ALP and NG showed that feather bedding compared to synthetic bedding, was strongly protective for asthma - the opposite of public advice. The suggested mechanisms involve reduced exposure to mite allergens, or altered exposure to bacterial endotoxin, but persuasive experimental support is lacking. We also propose a novel hypothesis that feather exposure may induce allergic 'tolerance'. Currently there is a lack of certainty about valid approaches to prevent asthma, and the Global Initiative for Asthma has described the need to understand mechanisms and improve interventions as urgent. This project is an ideal opportunity to combine the expertise of the CIA (ET) in measuring airborne exposures (mite, endotoxin, proteins) with that of the others who have expertise in children's asthma, and who are already involved in two large clinical trails involving different bedding and allergen avoidance. Our measurements of these bedding exposures and their clinical outcomes will provide, for the first time, a quantitative basis to refine public health allergen-based interventions to prevent and manage asthma.Read moreRead less