DETERMINANTS OF RESPONSE TO INHALED IRRITANT IN ASTHMA

该子项目是利用NIH/NCRR资助的中心赠款提供的资源的许多研究子项目之一。子项目和研究者（PI）可能从另一个NIH来源获得主要资金，因此可以在其他CRISP条目中表示。所列机构为中心，不一定是研究者所在机构。哮喘影响着大约1000万美国人，其中三分之二是18岁以下的儿童。虽然在确定加重环境因素和开发更有效的治疗方法方面取得了重大进展，但哮喘的患病率和发病率仍在增加。哮喘的特征在于支气管对非特异性吸入剂的高反应性，所述非特异性吸入剂例如烟、粉尘、烟雾和药理学物质例如组胺和乙酰甲胆碱。在哮喘中，观察到高安慰剂应答率;虽然其中一些应答代表回归到先前高度敏感个体的平均值，但很可能存在高度的“真实”安慰剂应答。本研究的总体假设是：吸入安慰剂将为某些个体提供保护，防止吸入乙酰甲胆碱后发生支气管痉挛。其他具体假设包括：a）安慰剂反应的存在和程度将与心理因素（包括人格特征）相关; B）安慰剂反应的存在和程度将受到研究人员之间感知的相互作用/干预的影响（卫生保健提供者）和研究对象;换句话说，提高患者期望值将增加安慰剂或吸入性β激动剂沙美特罗对乙酰甲胆碱诱导的支气管痉挛的保护作用。到目前为止，还没有研究检查患者期望对哮喘结果的影响。此外，没有研究评估哮喘患者的干预措施，这将提高患者的结局预期，并可能导致肺功能改善。

This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. Asthma affects approximately 10 million Americans, two-thirds of them children under the age of 18. Although important strides have been made in identifying aggravating environmental factors and developing more effective treatments, the prevalence and morbidity of asthma are increasing. Asthma is characterized by bronchial hyperresponsiveness to nonspecific inhaled agents, such as smoke, dusts, fumes and pharmacologics such as histamine and methacholine. In asthma, a high placebo-response rate is seen; while some of these responses represent regression to the mean of a previously highly sensitive individual, it is likely that a high degree of "true" placebo response exists. The overall hypothesis of this study is: inhalation of a placebo will offer some individuals protection against the development of bronchospasm following inhalation of methacholine. Additional specific hypotheses include: a) the presence and magnitude of a placebo response will correlate with psychological factors including personality characteristics; b) the presence and magnitude of a placebo response will be influenced by the perceived interactions/interventions between study personnel (health care providers) and research subjects; in other words, enhanced patient expectations will increase the protection against the development of methacholine-induced bronchospasm offered by placebo or by an inhaled beta agonist, salmeterol. To date, there have been no studies examining the influence of patient expectations on asthma outcomes. Additionally, there are no studies that evaluate an intervention in asthmatic patients that will enhance patient outcome expectations and presumably lead to improved lung function.