Prevention of chronic asthma: age 7 follow up

预防慢性哮喘：7 岁随访

• 批准号: 6545805
• 负责人: Mary D. Klinnert
• 金额: $ 23.96万
• 依托单位: NATIONAL JEWISH HEALTH
• 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 2006-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6545805
• 关键词: airborne allergen; antiinflammatory agents; asthma; caregivers; child behavior; clinical research; disease /disorder prevention /control; environmental stressor; health care service utilization; home health care; human morbidity; human subject; longitudinal human study; low socioeconomic status; maternal behavior; mental health; middle childhood (6-11); nursing intervention; passive smoking; patient monitoring device; patient oriented research; racial /ethnic difference; respiratory function; social psychology; spirometry; therapy compliance; urban area

DESCRIPTION (provided by applicant): The goal of the proposed project is to follow up and evaluate at age 7 a cohort of low income urban children who have participated in the Childhood Asthma Prevention Study (CAPS) since their enrollment prior to age 2. CAPS is a Demonstration and Education randomized, controlled intervention study, now in its 5th year of funding, that has been aimed at reducing asthma prevalence, severity, and morbidity among low income, urban children. Children ages 9-24 months with documentation of multiple wheezing episodes and additional risk factors for childhood asthma were enrolled. They received a nurse home visitor intervention that targeted allergens in the home, environmental tobacco smoke exposure, and quality of maternal caregiving, particularly in relation to asthma prevention and management. Original study goals included following the children to age 4. At this time almost half of the children have reached their 4th birthday and have been evaluated for asthma. Preliminary data suggest that the intervention may have been effective in reducing asthma at age 4. However, asthma at age 4 is a mixture of asthma phenotypes that will become much more clear by the time the children reach age 7. Thus, evaluating the children for asthma at age 7 will provide valuable information regarding the effects of the intervention. Further, for 4-year-olds methods for obtaining objective assessments of pulmonary functions are still under development, whereas by age 7 children can perform spirometry adequately to derive objective measures. Besides evaluating the long-term effects of the intervention, follow-up of the cohort to age 7 will provide an opportunity for a detailed examination of psychosocial, environmental, and ethnicity factors that were shown in baseline analyses to be associated with initial outcomes. Finally, the follow-up provides a unique opportunity to investigate the role of concurrent caregiver mental health on asthma morbidity and related health care utilization among these low-income children. We plan to obtain objective evaluations of cigarette smoke exposure (cotinine) and asthma medication adherence (electronic monitoring) at age 7 in order to determine the extent to which poor medication adherence and cigarette smoke exposure mediate the relationship between caregiver mental health and child asthma morbidity. In addition, we will use the early data to identify developmental precursors for poor adherence and increased asthma morbidity at age 7.

描述（由申请人提供）：拟议项目的目标是在7岁时随访和评估一组低收入城市儿童，他们在2岁之前参加了儿童哮喘预防研究（CAPS）。CAPS是一项示范和教育随机对照干预研究，目前已进入第5个资助年度，旨在降低低收入城市儿童的哮喘患病率、严重程度和发病率。入选的儿童年龄为9-24个月，记录有多次喘息发作和儿童哮喘的其他危险因素。他们接受了针对家中过敏原、环境烟草烟雾暴露和孕产妇健康质量的护理之家访问者干预，特别是与哮喘预防和管理有关的干预。最初的研究目标包括跟踪儿童到4岁。此时，几乎一半的儿童已经过了4岁生日，并接受了哮喘评估。初步数据表明，干预可能有效地减少了4岁时的哮喘。然而，4岁时的哮喘是多种哮喘表型的混合，到7岁时，这些表型将变得更加清晰。因此，在7岁时评估儿童的哮喘将提供有关干预效果的有价值的信息。此外，对于4岁儿童，获得肺功能客观评估的方法仍在开发中，而到7岁时，儿童可以充分进行肺量测定以获得客观的测量结果。除了评估干预措施的长期效果外，随访至7岁的队列将提供一个详细检查心理社会，环境和种族因素的机会，这些因素在基线分析中显示与初始结果相关。最后，随访提供了一个独特的机会来调查同时照顾者心理健康对这些低收入儿童哮喘发病率和相关医疗保健利用的作用。我们计划在7岁时对香烟烟雾暴露（可替宁）和哮喘药物依从性（电子监测）进行客观评估，以确定药物依从性差和香烟烟雾暴露在多大程度上介导了照顾者心理健康与儿童哮喘发病率之间的关系。此外，我们将使用早期数据来确定7岁时依从性差和哮喘发病率增加的发育前兆。