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、急诊和缺课。哮喘发病率和死亡率的惊人增长加速了人们对呼吸阻力增加水平与感知到的症状之间差异的关注。由于很大程度上未知的原因，尽管气道阻塞程度相似，但一些哮喘患者似乎比其他人更能意识到症状。哮喘患者无法察觉气流的急性波动，低估气流阻塞的严重程度，以及肺功能受损的患者，更频繁和更严重的哮喘发作的风险可能会增加。我们假设，当气流阻塞水平与呼吸阻力增加的感知之间存在一致性时，哮喘的控制应该得到改善。我们进一步假设，自我效能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名年龄在9至12岁之间的哮喘儿童，以及至少一名父母或其他法定监护人将被纳入该项目。我们提出了一项3 × 3独立组随机试验，以检验自我监测经验和感知训练相结合对哮喘控制的不同改善的假设。第一组间因子（自我监测经验）的三个水平包括：无PEFR（仅症状日记）；PEFR（和症状日记）；PEFR与即时反馈（和症状日记）。第二组间因素（知觉训练）的三个层次包括：不训练（只有阻力呼吸）；歧视培训（无绩效反馈）；还有，歧视培训，并提供即时的绩效反馈。我们预测，通过提高患者区分气流阻塞存在与否的能力，哮喘患儿的症状管理、功能状态和与健康相关的生活质量得到改善，从而证明哮喘控制的客观和主观测量之间的一致性增加。

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.