Symptom clusters in children with exacerbation-prone asthma

哮喘易加重儿童的症状群

• 批准号: 10410457
• 负责人: Anne Mentro Fitzpatrick
• 金额: $ 50.45万
• 依托单位: EMORY UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-09-10 至 2024-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10410457
• 关键词: Absenteeism; Adherence; Adrenal Cortex Hormones; Affect; Anger; Anxiety; Area; Asthma; Biological Markers; Cessation of life; Child; Childhood Asthma; Chronic; Chronic Disease; Clinical; Cognitive Therapy; Cohort Studies; Collaborations; Complex; Coughing; Depressed mood; Disease; Dyspnea; Emergency department visit; Environmental Irritants; Esthesia; Exposure to; Family; Fatigue; Fright; Future; Goals; Health; Health Services Accessibility; Impairment; Individual; Inflammation; Inflammatory; Intervention; Intervention Studies; Knowledge; Malignant Neoplasms; Mental Depression; Mental Health; Metabolic Pathway; Morbidity - disease rate; Outcome; Pain; Pain management; Parents; Patient Outcomes Assessments; Patients; Personal Satisfaction; Pharmaceutical Preparations; Phenotype; Population; Primary Health Care; Productivity; Psyche structure; Public Health; Quality of life; Recording of previous events; Reporting; Research; Respiratory Signs and Symptoms; Schools; Severities; Sleep; Sleep disturbances; Standardization; Strategic Planning; Stress; Symptoms; Testing; Time; Tobacco smoke; United States; Upper Respiratory Infections; Visit; Wheezing; affective disturbance; age group; associated symptom; asthma exacerbation; asthma inhaler; biobehavior; cost; cost estimate; cytokine; environmental allergen; experience; functional status; improved; individualized medicine; knowledge of results; metabolomics; multidisciplinary; national surveillance; peer; personalized intervention; physical conditioning; physical symptom; secondary outcome; social; study population; surveillance data; symptom cluster; symptom management; symptom science; treatment guidelines; trend

PROJECT SUMMARY/ABSTRACT Asthma symptom control is suboptimal in the majority of children in the United States, despite widespread availability of asthma controller medications and standardized treatment guidelines. While deaths from asthma have declined, more than 50% of children with asthma experience an exacerbation each year and the public health burden is substantial. While the factors associated with asthma symptom control are complex, it is also recognized that children with exacerbation-prone asthma are a heterogeneous group, with differing symptom profiles that may contribute to differing clinical outcomes. However, existing research on asthma symptoms in this age group is quite limited and has focused primarily on respiratory symptoms in isolation, ignoring other physical symptoms and symptoms of mental and social health that are important to overall functional status and quality of life. To date, there has been no attempt to comprehensively identify and phenotype symptom clusters (defined as two or more concurrent symptoms independent of other clusters) in children with exacerbation-prone asthma. Given this major shortcoming, this 48-week cohort study (N=173) will test the overarching hypothesis that symptom clusters and their associated inflammatory and metabolic pathways predict corticosteroid treatment responsiveness (primary objective outcome) and quality of life (patient-reported secondary outcome) in children 8-17 years with exacerbation-prone asthma. Specific aims are to: 1) identify and phenotype symptom clusters and assess their temporal trajectories, 2) determine associations between symptom clusters and clinical outcomes, and 3) identify inflammatory and metabolic pathways underlying symptom clusters in children with exacerbation-prone asthma. We anticipate that a cluster of children with the poorest physical, mental and social health symptoms will emerge; we further anticipate that the symptom presentations in this cluster of children will be stable over time and will result in the poorest corticosteroid treatment responsiveness, the poorest quality of life, and the greatest magnitude of inflammation. This project involves a multidisciplinary team with a history of collaboration and is aligned with the NINR Strategic Plan to “Advance Symptom Science Research” in chronic conditions through biobehavioral research. Expected deliverables from this project include: 1) refined knowledge regarding the identification and clinical utility of symptom clusters in children with exacerbation-prone asthma, and 2) identification of mechanisms underlying symptom clusters that can be targeted in future interventional studies. Because children with exacerbation- prone asthma rarely report a single symptom, these discoveries have the potential to significantly advance individualized treatment and improve clinical outcomes, ultimately reducing the high morbidity and improving quality of life in affected children.

项目概要/摘要 尽管哮喘症状广泛存在，但美国大多数儿童的哮喘症状控制效果不佳 哮喘控制药物和标准化治疗指南的可用性。虽然死于哮喘 已经下降，每年有超过 50% 的哮喘儿童病情恶化，公众 健康负担沉重。虽然与哮喘症状控制相关的因素很复杂，但也 认识到易加重哮喘的儿童是一个异质群体，具有不同的症状 可能导致不同临床结果的概况。然而，现有的关于哮喘症状的研究 这个年龄段的人相当有限，主要关注孤立的呼吸道症状，忽视其他症状 对整体功能状态很重要的身体症状以及心理和社会健康症状 和生活质量。迄今为止，还没有尝试全面识别和表型症状 儿童中的集群（定义为独立于其他集群的两个或多个并发症状） 易恶化的哮喘。鉴于这一重大缺陷，这项为期 48 周的队列研究（N=173）将测试 总体假设是症状群及其相关的炎症和代谢途径 预测皮质类固醇治疗的反应性（主要客观结果）和生活质量（患者报告 次要结局）针对 8-17 岁哮喘易加重儿童。具体目标是：1）确定 和表型症状群并评估其时间轨迹，2）确定之间的关联 症状群和临床结果，3) 确定潜在的炎症和代谢途径 哮喘易加重儿童的症状群。我们预计一群患有以下疾病的儿童 将会出现最差的身体、心理和社会健康症状；我们进一步预计该症状 随着时间的推移，这组儿童的表现将保持稳定，并将导致最差的皮质类固醇 治疗反应性、最差的生活质量和最严重的炎症。这个项目 涉及一个具有合作历史的多学科团队，并与 NINR 战略计划保持一致 通过生物行为研究来“推进慢性病症状科学研究”。预期的 该项目的可交付成果包括：1）关于识别和临床实用性的精炼知识 易加重哮喘儿童的症状群，以及 2) 识别潜在机制 未来干预研究中可以针对的症状群。因为病情加重的孩子—— 易患哮喘的人很少报告单一症状，这些发现有可能显着推进 个体化治疗并改善临床结果，最终降低高发病率并改善 受影响儿童的生活质量。