番茄社区

SAN ANTONIO -- Parents of kids with uncontrolled asthma may be told they need to re-home a beloved family dog or cat to help their child breathe easier.

But it turns out a much better strategy than saying goodbye to Fluffy or Fido may be to make sure children with asthma receive recommended treatments.

When researchers with Nationwide Children's Hospital in Columbus, Ohio, examined the impact of environmental exposures, such as living with a dog or cat in the home, on asthma control among children whose asthma was managed according to widely accepted guidelines, the results showed that the exposures had little impact on asthma improvement over time.

Once the treatment guidelines were followed, exposure to pet dander or even secondhand smoke were not found to be significant factors in overall asthma control.

Findings from the study by Shahid Sheikh, MD, and colleagues were presented at , the annual meeting of the American College of Chest Physicians.

Christopher Carroll, MD, medical director and research director for pediatric critical care at Connecticut Children's Medical Center in Hartford, who was not involved with the study, told 番茄社区 that it is not uncommon for physicians to tell the parents of their pediatric patients that having a dog or cat in the home can exacerbate their child's condition.

"I think parents may often interpret that as, 'Get rid of the pet,'" he said. "The message from this study to doctors is if they can convince parents to keep their children on appropriate meds and treatment schedules the pets can probably stay."

The 3-year prospective study included 395 children referred by primary care physicians with the diagnosis of uncontrolled asthma. All participants were enrolled in the Nationwide Children's Hospital acute care center for treatment, and all were provided asthma care as instructed by National Asthma Education and Prevention Program guidelines.

At each visit, every 3 to 6 months, asthma control was evaluated and families completed asthma questionnaires that included information about acute care needs, symptom control, and the Asthma Control Test (ACT).

The results were compared between patients with and without exposure to secondhand smoke (cigarette smoking by caretakers), and between patients with and without exposure to dogs or cats living in the home at baseline and over time.

The distribution of scores was measured by mean, standard deviation, median, and interquartile range depending on the normality of the data. Poisson Mixed Effects Modeling was used to evaluate changes in asthma indicators in 3-6 month increments.

The median age of the children included in the study was 6, and the majority had a diagnosis of either mild persistent asthma or moderate persistent asthma.

Exposure to secondhand smoke was documented in 98 children (25%) and exposure to a cat or dog in the home was documented in 215 children (55%). There was no significant difference in demographics among children with or without pet exposure or exposure to secondhand smoke.

In the total cohort, acute care need scores (hospital admissions, emergency department visits, urgent care visits, predicted forced expiratory volume in one second, mean ACT, and number of days with wheezing and night time cough) improved significantly by the follow-up visits at 3-6 months (P<0.001) for all patients, and the improvement persisted for the 3 years of follow-up.

Environmental exposures were not found to have a significant impact on asthma improvement over time when asthma guidelines were followed, the team concluded.

"These researchers showed that adherence to asthma treatment guidelines was more important than pet exposure, in terms of improving asthma symptoms over time," Carroll said.

He acknowledged that adherence to medications and treatment schedules is a continuing challenge for parents and clinicians, noting that as the parent of a child with asthma, he knows the issue from both sides.

"Remembering to give a medication twice a day is challenging, much less three or four times a day," he said. "I can personally attest to that as a parent and a doctor."

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