小児の尿中コチニンを測定して受動喫煙防止対策に役立てられるか?

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2011年04月06日(Wed) 12:21

小児の尿中コチニンを測定して受動喫煙防止対策に役立てられるか?
という介入試験の論文です。

有意差は出なかったようですが、その有効性は示唆されています。

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Chest. 2011 Mar;139(3):581-90. Epub 2010 Sep 23.
http://www.ncbi.nlm.nih.gov/pubmed/20864611?dopt=Abstract

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.

Wilson SR, Farber HJ, Knowles SB, Lavori PW.

Palo Alto Medical Foundation Research Institute, 795 El Camino Real, Ames Bldg, Palo Alto,
 CA 94301. Wilsons@pamfri.org.
Abstract

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.

PMID: 20864611 [PubMed - in process]PMCID: PMC3047287 [Available on 2012/3/1]


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