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: 6235043
• 负责人: Alkis Togias
• 金额: $ 13.17万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 1997
• 资助国家: 美国
• 起止时间: 1997-09-01 至 1998-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6235043
• 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，尤其是儿童，比例过高 哮喘发病率和死亡率显着增加。之中 儿科人群、青少年具有独特的社会心理 需要量身定制干预措施以减少哮喘的特征 发病率；然而，关于风险因素的信息很少 该组的哮喘发病率。目前的提案是以下提案的延续 上届AAIDCC奖项目7。该项目有 2 个主要目标：A) 检验内城区哮喘发病率增加的假设 青少年与该环境的社会经济特征有关 促进对独特过敏原的暴露和随后的敏感性 和刺激物。本研究中前 97 名患者的数据支持了这一点 假设：我们发现哮喘严重程度与 对蟑螂过敏原的敏感程度似乎相关 过敏原暴露。 B）我们的第二个目标是检验以下假设： 个性化定制、强化哮喘管理，结合教育、 环境控制、轻松获得护理和最先进的医疗 干预（特殊哮喘诊所）将在减少哮喘方面产生更大的影响 中度和重度青少年哮喘患者的哮喘发病率与 基于小组的互动教育计划（ASTHMA FAIRS）。我们建议， 然而，后一个计划可以对促进 哮喘知识，对于病情较轻的患者来说可能足够的目标 疾病。我们的项目正在招收 2 组（每组 150 人），范围从 从轻微到严重的疾病，同样代表非裔美国人和 白人社区。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， 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。最后是详细的环境 评估包括室内灰尘样本中过敏原的量化 执行。这些数据将使我们能够检验我们的第一个假设并 进一步确定青少年哮喘发病的危险因素 我们已经初步确定了。在第二阶段的研究中， 第 1 组在 1 年内参加了 2 次哮喘博览会，并且是 观察一年来评估哮喘知识的改善情况 中度/重度哮喘患者 (N=50)，哮喘发病率。这 第 2 组 (N=50) 的中度/重度受试者将被纳入特殊项目 哮喘诊所至少 2 年。再次，他们将被跟踪 密切监测哮喘发病率的各个方面，如队列 1 所示。 两个队列中中度/重度哮喘患者之间的比较将是 经过一年的随访后做出的。此外，基线之间的比较 并针对轻度和重度分别进行后期干预 第 1 组和第 2 组中的中度/重度受试者。我们预计 这项研究的结果将对我们的理解产生重大影响 内城区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方式 全国。