ENVIRONMENTAL AGENTS--ASTHMA DEVELOPMENT AND SEVERITY

哮喘是美国的一种主要慢性疾病，影响着2000万人 每年花费62亿美元。的普遍性和严重性 儿童哮喘正在增加，发病率不成比例， 西班牙裔和非洲裔美国人的死亡率。空气污染物和室内 假设过敏原是发育中主要危险因素， 儿童哮喘加重。我们对这些影响的了解 环境因素对哮喘的影响来自于有限的横断面研究， 问题研究 在这项前瞻性队列研究中，我们仔细检验了这一假设， 定量室内过敏原暴露（包括屋尘螨、狗、猫 蟑螂抗原和真菌）和空气污染物暴露 （环境烟草烟雾、二氧化氮、亚硝酸、臭氧、细 颗粒质量、细颗粒质量组成和花粉） 哮喘的发病率和严重程度与儿童的健康状况， 家族史，抗原特异性IgE状态，家庭环境，和 对潜在的混杂因素进行仔细表征。重点放在 研究设计，其结果将适用于一般 人口，并将解决哮喘发病率的增加， 少数群体通过筛选问卷选择研究人群 在四家地区医院给分娩新生儿的母亲注射。一 共有1 000名母亲，她们有健康的婴儿， 将选择3 - 7名经医生诊断为哮喘的患者纳入研究 在书房里。在初始风险因素问卷调查（父母 哮喘史、出生体重、污染源和SES），兄弟姐妹 将对哮喘严重程度进行为期一年的随访（ER访视的频率， 药物使用和活动限制）和同时暴露于 室内空气过敏原和空气污染物。在夏季 500名兄弟姐妹的昼夜峰值流量差异和每日药物使用情况 分类为轻度或中度哮喘将被记录和比较 每天测量的环境空气污染物浓度。婴儿 将在四年内每三个月进行一次随访，以评估哮喘 通过医生诊断、支气管扩张剂使用或 哮喘发作。将使用嵌套式暴露评估方案， 将使用多变量控制潜在混杂因素 分析.这项研究将为优先考虑环境问题提供依据。 降低儿童哮喘发病率的干预措施。

Asthma is a major chronic disease in the U.S. affecting 20 million people and costing 6.2 billion dollars per year. The prevalence and severity of asthma in children is increasing, with disproportional morbidity and mortality among Hispanic and African-Americans. Air pollutants and indoor allergen are hypothesized to be major risk factors in development and exacerbation of asthma in children. Our knowledge of the impact of these environmental agents on asthma is derived from limited cross-sectional studies. In this prospective cohort study we test the hypothesis that carefully quantitated indoor allergen exposures (including house dust mite, dog, cat and, cockroach antigen, and fungi) and air contaminant exposures (environmental tobacco smoke, nitrogen dioxide, nitrous acid, ozone, fine particle mass, fine particle mass composition and pollen) are associated with the incidence and severity of asthma in children whose health status, familial history, antigen-specific IgE status, home environment, and potential confounders are carefully characterized. Emphasis is placed on a study design where the results will be applicable to the general population and will address the increase in asthma morbidity in minorities. The study population is selected via a screening questionnaire administered to mothers delivering newborns at four area hospitals. A total of 1,000 mothers who have healthy infants and also have a child age 3 - 7 diagnosed with asthma by a physician will be selected for inclusion in the study. After an initial risk factors questionnaire (parental history of asthma, birthweight, pollutant sources, and SES), the siblings will be followed for one year for asthma severity (frequency of ER visits, medication usage, and activity limitations) and concurrent exposures to indoor aeroallergens and air contaminants. During the summer months diurnal peak flow differences and daily medication use for 500 siblings classified as mild or moderate asthmatics will be recorded and compared with daily measured ambient air contaminant concentrations. The infants will be followed on a tri-monthly basis for four years to assess asthma development as measured by a physician diagnosis, bronchodilator use or episodes of wheeze. A nested exposure assessment protocol will be used and potential confounding factors will be controlled using multivariate analysis. This study will provide a basis for prioritizing environmental interventions to reduce asthma morbidity in children.