The New Zealand Asthma and Allergy Cohort Study (NZA2CS): assembly, demographics and investigations.

BACKGROUND: Asthma and allergy are highly prevalent in industrialised countries. Longitudinal and cross-sectional studies have identified a number of potential risk factors for these conditions, including genetic and environmental factors, with significant gene-environment relationships. Birth cohort studies have been proposed as an important tool to explore these risk factors, particularly exposures in early life that are associated with later disease or protection from disease. This paper describes the establishment of a birth cohort in New Zealand. METHODS: A birth cohort was established in 1996 in Christchurch and Wellington and infants recruited between 1997-2001. Expectant mothers were recruited by midwives. Children and mothers have undergone assessment by serial questionnaires, environmental assessment including mould and allergen exposure, skin-prick testing, and at age six years are undergoing full assessment for the presence of asthma, atopy and allergic disease, including genetic assessment. RESULTS: A total of 1105 children have been recruited, and the retention rate at fifteen months was 91.4%. 15.2% of the children at recruitment have been identified as Maori. A positive family history of asthma, eczema or hay fever has been reported in 84% of children. All children have now been assessed at fifteen months and 685 children from the cohort have reached age six years and have completed the six year assessment. CONCLUSIONS: The cohort is fully assembled, and assessment of children is well advanced, with good retention rates. The study is well placed to address many current hypotheses about the risk factors for allergic disease and asthma.

Self-management plans in the primary care of patients with chronic obstructive pulmonary disease.

OBJECTIVE AND BACKGROUND: The role of COPD self-management plans in improving health outcomes remains unclear. The objective of this study was to assess whether self-management plans administered in primary care have beneficial effects on quality of life, self-care behaviour and health outcomes in the long term for patients with COPD. MATERIAL, PATIENTS AND METHODS: The study was a prospective, unblinded, randomized controlled trial of usual care vs. usual care plus structured education on the use of a written self-management plan and patient-initiated short courses of antibiotics and oral corticosteroids. The study was conducted in general practice, in Christchurch, New Zealand. Participants were 159 patients with COPD randomized by general practice site into control or intervention groups. The primary outcome measure was change in St. George's Respiratory Questionnaire. Secondary variables were frequency of hospital and primary-care attendance, frequency of use of courses of antibiotics and oral corticosteroids over 12 months, and change in Hospital Anxiety and Depression Scale. Self-management knowledge was assessed using a structured interview, the COPD Self-Management Interview. RESULTS: Self-management plans and structured education were associated with higher levels of self-management knowledge at 12 months, but had no effect on change in St. George's Respiratory Questionnaire, health utilization, mental health or self-reported outcomes of patients with COPD managed in general practice. CONCLUSIONS: Self-management knowledge was higher in the intervention group but there was no difference in quality of life or health outcomes due to self-management plans.