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Preventie van astma

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Tijdschrift voor Kindergeneeskunde

Samenvatting

– Primaire preventie van astma is niet eenvoudig te bereiken. Maatregelen die bij alle kinderen zinvol zijn gebleken, zijn het voorkomen van blootstelling aan sigarettenrook en het geven van borstvoeding.

– Reductie van huisstofmijtallergenen heeft als enige maatregel geen zin.

– Bij hoogrisicokinderen (met één of meer eerstegraads verwanten met een allergische ziekte) is wel een gunstig effect aangetoond van een gecombineerde interventie, bestaande uit reductie van blootstelling aan dieren- en huisstofmijtallergenen, het geven van borstvoeding en stoppen met blootstelling aan sigarettenrook, op de ontwikkeling van astma op latere leeftijd.

– Bij kinderen met reeds aanwezige allergie zijn gecombineerde maatregelen gericht op de vermindering van huisstofmijt- en huisdierallergenen, stoppen met blootstelling aan sigarettenrook, ventilatie en vermindering van vochtplekken in huis zinvol.

– Het preventief verwijderen van huisdieren in de fase voorafgaand aan de ontwikkeling van allergieën en/of astma wordt niet aanbevolen.

– Bezoek aan een cre`che of kinderdagverblijf doet de frequentie van piepen/zagen en luchtweginfecties in de eerste levensjaren toenemen, maar lijkt het risico op de ontwikkeling van astma en allergieën op latere leeftijd niet te beïnvloeden. Cre`chebezoek wordt daarom niet afgeraden, maar in het kader van astmapreventie ook niet aangeraden.

– Voor de toepassing van probiotica bij kinderen ter preventie van astma bestaat geen evidentie. Het gebruik hiervan wordt niet geadviseerd.

– Vaccinaties van het Rijksvaccinatieprogramma verhogen het risico op allergische sensibilisatie en astma niet.

– Het nut van de influenzavaccinatie bij kinderen met astma is niet aangetoond.

– Blootstelling aan een kat of hond in huis bij gesensibiliseerde kinderen met astma leidt tot ernstiger astma. Het houden van huisdieren bij gesensibiliseerde kinderen met astma wordt daarom afgeraden.

Summary

– Primary prevention of asthma is not easy to achieve.

– Preventive measures which are useful in all children are prevention of passive smoking exposure in utero and/or in childhood and the use of breast-feeding during at least the first six months of life.

– Single interventions towards reduction of house dust mite allergens are not effective in preventing asthma; only a combined intervention with breast feeding, stopping of passive smoking, and reduction of allergens of pets and house dust mite appeared to be effective in young children at risk for asthma.

– In children with already existing asthma, a combination of (secondary) preventive measures with sanitation of the house, reduction of allergens of pets and house dust mite, and optimal ventilation is useful.

– Removal of pets from homes of children in the general population before the onset of atopy and allergic disorders is not effective.

– Children visiting day-care report more airway infections and respiratory complaints in the first years of life. However, the chance on asthma or atopy development in later life is not influenced. Therefore, there is no reason to avoid day-care attendance in the first years of life.

– There is no evidence for the use of probiotics in order to prevent asthma. Their use is not advised.

– The Dutch vaccination program does not increase the risk on atopy or asthma.

– There is no evidence for the benefit of influenza vaccination in children with asthma.

– Exposure to a dog or cat in already sensitised children with asthma is associated with more severe asthma. Therefore, pets are not advised with these children

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    G. H. Koppelman

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  1. G. H. Koppelman
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  2. W. A. F. Balemans
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  3. H. G. M. Arets
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  4. M. C. Kuethe
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Additional information

Dhr. dr. G.H. Koppelman, kinderarts-pulmonoloog, afdeling Kinderlongziekten en Kinderallergologie, Beatrix Kinderziekenhuis, UMCG Groningen. Dhr. dr. W.A.F. Balemans, kinderarts-pulmonoloog, St. Anthonius Ziekenhuis, locatie Nieuwegein. Dhr. dr. H.G.M. Arets, kinderarts-pulmonoloog, Wilhelmina Kinderziekenhuis, UMC Utrecht. Dhr. drs. M.C. Kuethe, kinderarts, Amphia Ziekenhuis, Breda. Dhr. dr. E. Dompeling, kinderarts-pulmonoloog, afdeling Kinderlongziekten, MUMC+, Maastricht.

Correspondentieadres: Dr. E. Dompeling, afdeling Kinderlongziekten, MUMC+, Postbus 5800, 6202 AZ Maastricht.

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Koppelman, G.H., Balemans, W.A.F., Arets, H.G.M. et al. Preventie van astma. KIND 77, 227–231 (2009). https://doi.org/10.1007/BF03086401

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