• Establish in inner city children the immunologic causes for the development of recurrent wheezing. [ Time Frame: By 36 months of age ] [ Designated as safety issue: No ]
  

The prevalence of asthma has dramatically increased in recent years, particularly in inner cities. Evidence suggests that environmental factors unique to the inner city, such as certain allergens, infections, and pollutants, may affect immune system development and lead to the development of more severe asthma in early childhood. However, information on environmental effects is limited. This study will relate immune system development and early environmental influences to the development of asthma in inner city children.

This study will last 48 months and will include young children and their families. Ten phone interviews and seven study visits will occur. Phone interviews will take place at Months 6, 9, 15, 18, 21, 27, 30, 39, 42, and 45. During the interviews, families will be asked about their respiratory symptoms, environmental exposures, diet, health care utilization, medication use, and perceived stress.

Study visits will occur at a prenatal visit before the participating children are born and at Months 3, 12, 24, 33, 36, and 48. At Visit 1, mothers will complete questionnaires about their environment, stress level, demographic information, and medical history. At the time of birth, a sample of umbilical cord blood will be obtained. Visit 2 is a home visit and will occur 3 months after the mothers give birth. A home environment inspection and dust collection will be performed, as well as an assessment of respiratory symptoms and health care utilization. Monitors for nitrogen dioxide and nicotine will be placed in participants' homes for 2 weeks.

At Visits 3 and 4, blood will be collected from both mothers and their babies; mucus from the nose will be also collected from babies. Mothers will complete questionnaires about their babies' illnesses and asthma symptoms and changes in the home environment. At Visit 5, families will complete a health and environmental update and will receive a skin prick test to test for allergies. At Visit 6, blood and nasal fluid collection will occur in the children and questionnaires about the home environment will be completed by the families. A physical exam will occur at Visits 3, 4, and 6. Visit 7 will be a study close-out visit.

In addition to scheduled visits, the parents will be instructed to contact the study center at the earliest sign that their child is developing lower respiratory tract symptoms. There will be two additional times for dust collection between the child's first and third birthdays.