Bronchial asthma and preventionJ45.9

In prevention (see below Prevention in medicine), a distinction is made according to the time of intervention (according to Caplan) in:

• Primary prevention (primary prevention)
• secondary prevention (secondary prevention)
• tertiary prevention (tertiary prevention)
• Quaternary prevention (Quaternary prevention)

The goal of primary asthma prevention is to prevent the development of the disease before the immunological course of the disease is set. Prerequisites are an exact allergy diagnosis for persons at risk (occupational and leisure history, maternity leave, skin and serological test procedures to detect type I allergens).

Secondary prevention of asthma (early detection of the disease) aims at an avoidance strategy of bronchial asthma in children and adults in whom a type I sensitization or other allergic organ manifestation (e.g. food allergy, extrinsic atopic dermatitis) has already been detected. These include exposure minimization (this also applies to the professional field in adults: flour and baking products, plant allergens, dust from food or animal feed, latex allergens, hairdressing products, cosmetics, isocyanates, etc.), but also specific immunotherapy (SIT) for allergic rhinitis to prevent the development of bronchial asthma (floor change).

Tertiary asthma prevention aims at preventing the worsening and thus the chronicity of an already existing bronchial asthma. It includes allergen-free periods, strict smoking bans, environmental rehabilitation with measures to prevent sensitization to house dust mites, infection prophylaxis, active immunization against pneumococci and influenza viruses, avoidance of excessive physical exertion (exertion asthma) and therapy of any gastroesophageal reflux (Schäfer T et al. 2004; Wahn U et al. 2001; Becker AB 2000).

Measures and aspects of primary prevention in bronchial asthma (varies according to S2k guideline for diagnosis and therapy of patients with asthma. AWMF register number 020-009)

Nutrition:

• Newborns should be exclusively breastfed for 4 months.
• After the 4th month of life, complementary food should be introduced; there should be no delay in the introduction of complementary food.
• Hydrolysed infant formulae: There is no evidence that the use of partially or extensively hydrolysed infant formulae is effective in preventing asthma.
• Diets during pregnancy: No dietary restrictions are required with regard to the mother's diet during pregnancy and lactation

Fur and feathered animals:

• Children without allergy risk do not have to do without pets. There are special features in the case of cat allergy.
• Children with allergy risk should not be kept or buy new fur and feathered animals. Cat keeping is to be avoided with these children in principle.
• A higher number of older siblings, attending a day care centre, growing up on a farm with animals and worm infections are negatively (!) associated with bronchial asthma.

Room climate:

• Active avoidance of tobacco smoke and strict avoidance of Environmental Tobacco Smoke (ETS) is the most important prevention measure in pregnancy Zacharasiewicz A (2016) (see also Bronchial asthma and pregnancy)
• High humidity and lack of ventilation in rooms, volatile organic compounds (e.g. formaldehyde) and exposure to vehicle exhaust fumes should be avoided.
• Mould growth: Mould growth in rooms should also be avoided or eliminated for primary prevention(mould allergy).
• House dust mites: A house dust mite sanitation is not necessary as a measure for primary prevention, but is advisable for secondary and tertiary prevention.

obesity:

• Overweight and obesity are positively associated with bronchial asthma. It is advisable to aim for a normal weight. Overweight should be counteracted with a suitable diet. (see bronchial asthma and comorbidity).

Other:

• Vaccinations: Also infants and children with increased risk of asthma should be vaccinated according to the general recommendations.
• Insecticide allergy: for children with increased risk of asthma, an emergency kit should be prescribed for life-threatening allergies (e.g. insecticide allergy). Relatives must be trained with regard to emergency situations.

1. Becker AB (2000) Is primary prevention of asthma possible? Pediatric Pulmonol 30: 63-72
2. Buhl R et al (2017) S2k guideline for the diagnosis and treatment of patients with asthma. AWMF register number 020-009
3. Schäfer T et al (2014) S3-Guideline on allergy prevention: 2014 update: Guideline of the German Society for Allergology and Clinical Immunology (DGAKI) and the German Society for Pediatric and Adolescent Medicine (DGKJ). Allergo J Int 23: 186-199
4. Schäfer T et al (2004) Evidence-based and consented guideline on allergy prevention]. J Dtsch Dermatol Ges 2: 1030-1036
5. Wahn U et al (2001) Childhood risk factors for atopy and the importance of early intervention. J Allergy Clin Immunol 107: 567-574
6. Zacharasiewicz A (2016) Maternal smoking in pregnancy and its influence on childhood asthma. ERJ Open Res 2: 00042