Asthma Clinical Research Network-Washington University

描述（由申请人提供）：本申请的总体目标是优化大多数哮喘患者的哮喘管理。 我们的申请将利用哮喘临床研究网络（ACRN）的优势来解决两个常见的临床问题：1）使用哮喘行动计划时，哮喘自我管理的最佳方法是什么？2）在呼吸道感染期间预防哮喘恶化的最佳治疗方法是什么？目前没有足够的证据支持使用基于峰值流量或峰值流量的书面哮喘行动计划来改善医疗保健利用率、症状或肺功能。 因此，我们提出的第一个方案“哮喘行动计划改善哮喘控制”（AAPAC试验）（目标I）将调查基于症状和基于峰值流量的书面哮喘行动计划在改善哮喘控制方面的有效性成人持续性哮喘。 此外，AAPAC试验将解决哮喘行动计划是否优于单独的药物管理。 第二个重要的临床问题是由于最常见的病因-呼吸道感染引起的哮喘急性发作的治疗。 当使用灵敏的检测方法时，导致成人和儿童哮喘恶化的大多数呼吸道感染是由病毒引起的。 目前尚不清楚当患者开始出现上呼吸道感染症状时，卫生保健提供者应向患者推荐什么样的最佳治疗方法来预防哮喘恶化。 在这方面，我们为ACRN提出的第二个方案，“预防呼吸道感染诱导的哮喘加重方案”（实用试验），（目的II）将研究在呼吸道感染症状发作后立即使用皮质类固醇（吸入或口服）是否会预防或改善哮喘加重。 我们认为这些方案是ACRN的理想研究，因为它们评估了常见和相关临床问题的治疗策略，需要大量可比患者，并且需要标准化的治疗方案。 此外，通过设计，这两项试验都可以在相对较短的时间内（例如12-18个月）完成，然后可以将获得的信息迅速传播给医疗保健专业人员和公众。 我们认为，只有通过这样的合作，才能回答关于哮喘当前和新疗法和管理的重要问题。

DESCRIPTION (provided by applicant): The overall goal of this application is to optimize asthma management for the majority of patients with asthma. Our application will utilize the strengths of the Asthma Clinical Research Network (ACRN) to address two common clinical issues: 1) What is the best method of asthma self-management when using an asthma action plan? And 2) What is the best treatment to prevent an asthma exacerbation during a respiratory tract infection? There is currently insufficient evidence to support the use of written asthma action plans that are peak flow- or symptom-based in improving health care utilization, symptoms or lung function. For that reason, our first proposed protocol, "Asthma Action Plans improve Asthma Control" (The AAPAC Trial), (Aim I) will investigate the effectiveness of symptom-based and peak flow-based written asthma action plans in improving asthma control in adults with persistent asthma. Furthermore, the AAPAC trial will address whether either asthma action plan is better than medical management alone. A second important clinical question addresses the treatment of asthma exacerbations due to the most common etiology - respiratory tract infections. The majority of respiratory tract infections which lead to exacerbations of asthma in adults and children are caused by viruses when sensitive detection methods are utilized. It is unclear what is the optimal therapy that health care providers should recommend to their patients to prevent an asthma exacerbation, when the patients start to experience upper respiratory tract infection symptoms. In that regard, our second proposed protocol for the ACRN, "Preventing Respiratory TrACT Infection-induCed Asthma exacerbations protocol" (The PRACTICAL Trial), (Aim II) will investigate if prompt use of corticosteroids (either inhaled or oral) following the onset of respiratory tract infection symptoms will prevent or ameliorate an asthma exacerbation. We believe these protocols are ideal studies for the ACRN, as they evaluate treatment strategies for common and pertinent clinical issues, necessitate large numbers of comparable patients, and require standardized treatment protocols. Furthermore, by design, both of these trials can be completed in relatively short time frame (e.g. 12-18 months) and the information obtained can then be rapidly disseminated to health care professionals and the public. We propose that it is only through such a collaboration that important questions regarding current and novel therapies and management of asthma can be answered.