ASTHMA RISK FACTORS AND MANAGEMENT IN INNER CITY ADOLESCENTS

城市贫困人口，特别是儿童，已经不成比例地 受哮喘发病率和死亡率显著增加的影响。其中 在儿科人群中，青少年承担着独特的社会心理 需要量身定做干预以减少哮喘的特征 发病率；然而，关于疾病风险因素的信息很少。 哮喘在这一组中的发病率。目前的提案是以下内容的延续 上一届AAIDCC奖的项目7。该项目有两个主要目标：a) 来检验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 它们促进了对独特过敏原的暴露和随后的敏化 还有刺激物。来自这项研究的前97名患者的数据支持这一点 假设：我们发现哮喘的严重程度与 对蟑螂变应原的敏感度似乎与 与过敏原接触有关。B)我们的第二个目标是检验假设 个人量身定做的高强度哮喘治疗结合了教育， 环境控制、轻松获得护理和最先进的医疗 干预措施(哮喘专科诊所)将对减少 中、重度青少年哮喘患者的哮喘发病率与 以小组为基础的互动教育项目(哮喘博览会)。我们提议， 然而，后一种方案可以在促进 哮喘知识，一个可能足以满足轻度哮喘患者的目标 疾病。我们的项目正在招收2个队列(每个组150人)，范围从 从轻微到严重的疾病，同样代表非裔美国人和 高加索社区。在研究的第一阶段，受试者 接受广泛的评估以确定哮喘的严重程度。此外, 变应原敏化与社会经济、心理社会和获取/质量 正在确定护理方面的问题。最后，详细介绍了环境 评估包括对房屋灰尘样本中的过敏原进行量化 已执行。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。在研究的第二阶段， 队列1在1年内参加了2个哮喘博览会， 观察L年，以评估哮喘知识的改善情况，并为 中、重度哮喘患者(N=50)，在哮喘发病中。这个 队列2的中/重度受试者(N=50)将参加特别计划 哮喘诊所至少2年。再一次，他们将被跟踪 密切监测哮喘发病率的所有方面，如队列1所示。 两个队列中的中/重度哮喘患者的比较如下 在一年的跟踪调查后做出的。此外，基线之间的比较 并对轻度和重度患者分别进行后干预 第一组和第二组中的中度/重度受试者。我们预计 这项研究的结果将对我们理解 市中心哮喘发病率增加的原因并将为 可以实施的具有成本效益的干预措施的方法 全国范围内。

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.