Project on TRAC: Improving Asthma Control in Children

描述(由申请人提供)：哮喘是一种慢性呼吸道疾病，在美国有1200万至1400万人患有哮喘，导致大量住院、急诊科就诊和缺课。哮喘发病率和死亡率的惊人增长加剧了人们对呼吸阻力增加与所察觉到的症状之间的差异的兴趣。由于基本未知的原因，一些哮喘患者似乎比其他人更能意识到症状，尽管他们的呼吸道阻塞程度相似。无法检测到气流剧烈波动的哮喘患者，低估气流阻塞严重程度的患者，以及肺功能受损的患者，可能会增加哮喘发作更频繁和更严重的风险。我们假设，当气流阻塞程度与呼吸阻力增加的感觉一致时，哮喘的控制应该得到改善。我们进一步假设，自我效能感的改变和症状感知的改变有助于哮喘自我管理行为，从而改善与健康相关的结果。300名9至12岁的哮喘儿童以及至少一名父母或其他法定监护人将参加该项目。我们提出了一个3×3的独立分组随机试验来检验自我监测经验和知觉训练的结合可以不同地改善哮喘控制的假设。第一个组间因素(自我监控体验)的三个水平包括：无PEFR(仅限于症状日记)、PEFR(和症状日记)和有即时反馈的PEFR(和症状日记)。第二组间因素(感知训练)的三个水平包括：不训练(仅限阻力呼吸)；歧视训练(没有绩效反馈)；以及带有即时绩效反馈的歧视培训。我们预测，由于患者辨别是否存在气流阻塞的能力增加，哮喘控制的客观和主观措施之间的一致性有所提高，这将改善哮喘儿童的症状管理、功能状态和与健康相关的生活质量。

DESCRIPTION (provided by applicant): Asthma is a chronic disease of the airways that afflicts 12-14 million individuals in the United States and accounts for large numbers of hospitalizations, emergency department visits, and missed school days. Alarming increases in asthma morbidity and mortality have accelerated interest in disparities between levels of increased resistance to breathing and perceived symptoms. For largely unknown reasons, some asthmatics seem more aware of symptoms than others despite similar degrees of airway obstruction. Asthmatic patients unable to detect acute fluctuations in airflow, those who underestimate the severity of airflow obstruction, and those with compromised lung function could be at increased risk for more frequent and severe attacks of asthma. We hypothesize that the control of asthma should improve when there is concordance between levels of airflow obstruction and the perception of increases in the resistance to breathing. We further hypothesize that changes in self-efficacy and changes in symptom perception serve to enable asthma self-management behaviors that result in improved health-related outcomes. Three hundred children with asthma between the ages of 9 and 12 years of age, and at least one parent or other legal guardian, will be enrolled in the project. We propose a 3 x 3 independent groups randomized trial to test the hypothesis that the control of asthma is improved differentially by the combination of self-monitoring experiences and perception training. The three levels of the first between-groups factor (self-monitoring experience) include: no PEFR (symptom diary only); PEFR (and symptom diary); and, PEFR with immediate feedback (and symptom diary). The three levels of the second between-groups factor (perception training) include: no training (resistance breathing only); discrimination training (without performance feedback); and, discrimination training with immediate performance feedback. We predict that demonstrated increases in the concordance between objective and subjective measures of asthma control, enabled by increases in the ability of patients to discriminate between the presence or absence of airflow obstruction, improves symptom management, functional status, and health-related quality of life in children with asthma.