ASTHMA RISK FACTORS AND MANAGEMENT IN INNER CITY ADOLESCENTS

内城区青少年的哮喘危险因素和管理

• 批准号: 6099554
• 负责人: Alkis Togias
• 金额: $ 13.52万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 1998
• 资助国家: 美国
• 起止时间: 1998-09-01 至 2000-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6099554
• 关键词: African American; adolescence (12-20); air pollution; allergens; asthma; behavioral /social science research tag; caucasian American; cooperative study; diagnostic respiratory lavage; disease /disorder proneness /risk; environmental health; health care service utilization; health education; human morbidity; human subject; longitudinal human study; methacholine; patient care management; questionnaires; respiratory airflow measurement; respiratory airway pressure; respiratory airway volume; socioeconomics; spirometry; urban poverty area

Poor urban populations, especially children, have been disproportionally affected by a striking increase in asthma morbidity and mortality. Among the pediatric population, adolescents bear unique psychosocial characteristics requiring tailored intervention to reduce asthma morbidity; however, there is minimal information on risk factors for asthma morbidity in this group. The current proposal is a continuation of Project 7 of the previous AAIDCC award. This project has 2 major aims: A) To test the hypothesis that increased asthma morbidity in inner city adolescents relates to the socioeconomic features of this environment which promote exposure and subsequent sensitization to unique allergens and irritants. Data from the first 97 patients in this study support this hypothesis: we find a strong correlation between asthma severity and the degree of sensitization to cockroach allergens which appears to be related to allergen exposure. B) Our second aim is to test the hypothesis that individually tailored, intense asthma management that combines education, environmental control, easy access to care and state-of-the-art medical intervention (SPECIAL ASTHMA CLINIC) will have higher impact in reducing asthma morbidity in moderate and severe adolescent asthmatics compared to a group-based interactive educational program (ASTHMA FAIRS). We propose, however, that the latter program can have significant impact in promoting asthma knowledge, a goal that may be adequate for patients with milder disease. Our project is enrolling 2 cohorts (150 per group) ranging from mild to severe disease and equally representing the African American and the Caucasian communities. In the first phase of the study, subjects undergo extensive evaluation to determine asthma severity. In addition, allergen sensitization and socioeconomic, psychosocial and access/quality of care aspects are being determined. Finally, detailed environmental assessment including quantification of allergens in house dust samples is performed. These data will allow us to test our first hypothesis and to further establish the risk factors for asthma morbidity in adolescents that we have preliminarily identified. In the second phase of the study, Cohort 1 participates in 2 Asthma Fairs over a period of 1 year and is observed for l year to assess improvement in asthma knowledge and, for the moderate/severe asthmatics (N=50), in asthma morbidity. The moderate/severe subjects of Cohort 2 (N=50) will be enrolled in a Special Asthma Clinic for a minimum of 2 years. Again, they will be followed closely to monitor all aspects of asthma morbidity, as in Cohort 1. Comparison between the moderate/severe asthmatics in the 2 Cohorts will be made after one year of follow-up. Further, comparisons between baseline and post intervention will be made separately for the mild and the moderate/severe subjects in Cohorts 1 and 2. We anticipate that the results of this study will have major impact in our understanding of the causes of increased morbidity from asthma in the inner city and will pave the way for cost-effective intervention that can be implemented nationwide.

城市贫困人口，特别是儿童， 受哮喘发病率和死亡率显著增加的影响。之间 在儿科人群中，青少年具有独特的心理社会 需要量身定制干预措施以减少哮喘的特征 发病率;然而，关于 哮喘发病率。目前的建议是 上一个AAIDCC奖的项目7。该项目有两个主要目标：A） 为了验证市中心哮喘发病率增加的假设， 青少年与这种环境的社会经济特征有关 其促进对独特过敏原的暴露和随后的致敏 和刺激物。这项研究中前97名患者的数据支持这一观点。 假设：我们发现哮喘严重程度与 对蟑螂过敏原的致敏程度似乎与 过敏原暴露。B）我们的第二个目的是检验假设， 个性化的，密集的哮喘管理，结合教育， 环境控制，易于获得护理和最先进的医疗 干预（特殊哮喘）将有更大的影响， 中度和重度青少年哮喘患者的哮喘发病率与 一个以小组为基础的互动教育计划（哮喘公平）。我们提议， 然而，后一项计划可以在促进 哮喘知识，一个目标，可能是足够的患者轻度 疾病我们的项目招募了2个队列（每组150人），范围从 轻度至重度疾病，同样代表非洲裔美国人和 高加索社区。在研究的第一阶段，受试者 进行广泛的评估，以确定哮喘的严重程度。此外，本发明还提供了一种方法， 过敏原致敏与社会经济、社会心理和获取/质量 护理方面正在确定。最后，详细的环境 评估，包括量化室内灰尘样本中的过敏原， 执行。这些数据将使我们能够测试我们的第一个假设， 进一步确定青少年哮喘发病的危险因素 我们已经初步确认了在研究的第二阶段， 队列1在1年内参加了2次哮喘博览会， 观察1年，以评估哮喘知识的改善， 中度/重度哮喘（N=50），哮喘发病率。的 队列2的中度/重度受试者（N=50）将入组特殊研究， 哮喘门诊至少2年。他们将再次被跟踪 密切监测哮喘发病率的各个方面，如队列1。 将比较2个队列中的中度/重度哮喘患者 在一年的随访之后。此外，基线之间的比较 和干预后将分别为轻度和 队列1和队列2中的中度/重度受试者。我们预计 这项研究的结果将对我们对 哮喘发病率增加的原因，并将铺平道路 可以实施的具有成本效益的干预措施 全国范围