EDUCATIONAL ASTHMA INTERVENTION NOT EFFECTIVE IN YOUNG CHILDREN

A multifaceted educational intervention was not effective in reducing asthma-like symptoms in high-risk children during the first two years of life, according to a report in the April European Respiratory Journal. However, researchers observed a modest effect at age 2 years.

From 1997 to 2000, 476 families were recruited during the prenatal period and randomized to either a control group or an intervention group in which families received instruction from nurses on how to reduce exposure of newborns to mite, pet, and food allergens and to passive smoking.

The researchers found no differences between the groups for parentally reported and general practitioner–observed asthma-like symptoms during the first two years. However, they found that parentally reported current asthma-like symptoms occurred significantly less in the intervention group.

When the study team analyzed females and males separately, they found that asthma-like symptoms in the first two years of life, as well as current asthma-like symptoms, occurred significantly less in the female intervention group compared with the female control group. In addition, a general practitioner–based diagnosis of asthma was less frequent in the female intervention group than in the female control group. No differences were found among males.

A multiple logistic regression analysis indicated that being breast-fed for one week or longer following birth, abstinence from maternal smoking, and reduced mite levels were all associated with a decreased risk of asthma-like symptoms at two years.

“[T]he current findings are a plea in favor of pursuing a multifaceted approach with respect to the prevention of asthma,” they said.

Schönberger HJAM, Dompeling E, Knottnerus JA, et al. The PREVASC study: the clinical effect of a multifaceted educational intervention to prevent childhood asthma. Eur Respir J. 2005;25:660-670.

PULMONARY FUNCTION A PREDICTOR OF SURGICAL OUTCOME IN LUNG CANCER

Lung function values, when expressed as a percentage of the predicted value, are more useful predictors of postoperative outcome than are absolute values, according to a study in the April European Respiratory Journal. Researchers found that “the threshold of predicted forced expiratory volume in 1 second for surgical intervention could be lower (45% to 50% of predicted) than is currently accepted without increased mortality.”

Before undergoing surgery for lung cancer, a total of 110 patients (44 female, 66 male; mean age, 69) had full lung-function testing performed in order to predict their postoperative lung function. Surgical interventions were performed as follows: Thirty-three percent of patients underwent pneumonectomy, 59% underwent single lobectomy, 4% underwent bilateral lobectomy, and 4% underwent wedge resection. Forty-four percent of patients had squamous cell carcinoma, 34% had adenocarcinoma, and 14% had a diagnosis of non–small cell lung cancer.

Researchers found that “preoperative FEV₁, preoperative Dlco, postoperative Dlco and postoperative FEV₁, all expressed as a percentage of the predicted value, were significantly associated with a complicated postoperative course” and poor operative outcome, defined as 30-day mortality or postoperative respiratory failure. Overall, four patients died within 30 days of lung cancer surgery and 24 patients had experienced a major complication. The most commonly occurring major complications were pneumonia (19%) and respiratory failure (10%).

The authors pointed out that although their study was a relatively large series, some of the negative predictive values were based on low numbers and were not measured with precision. They recommended that the appropriateness of these thresholds be confirmed in larger studies. In addition, they noted, a poor outcome was defined according to post-surgery indices. A longer-term follow-up period would be required to confirm the longer-term predictive value of the cut-off points used for lung function in the present study.

“Since it was found that, with vigorous investigation, lower thresholds could be safely applied, it may be necessary to reconsider the surgical assessment guidelines for lung cancer patients,” they concluded.

Using an FEV₁ threshold of 65% of predicted resulted in satisfactory postoperative outcome in 93% of patients with values above this threshold. However, 71% percent of patients with values below this threshold had satisfactory postoperative outcome, the researchers observed. Therefore, lower thresholds were established, using retrospective analysis—the thresholds of 47% of predicted for preoperative FEV₁, 45% of predicted for preoperative Dlco, and thus, 760 for predicted postoperative product were found to be optimum.

Win T, Jackson A, Sharples L, et al. Relationship between pulmonary function and lung cancer surgical outcome. Eur Respir J. 2005;25:594-599.

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