DETERMINANTS OF RESPONSE TO INHALED IRRITANT IN ASTHMA

这个子项目是利用由NIH/NCRR资助的中心拨款提供的资源的许多研究子项目之一。子项目和调查员(PI)可能从另一个NIH来源获得了主要资金，因此可能会出现在其他CRISE条目中。列出的机构是针对中心的，而不一定是针对调查员的机构。哮喘影响了大约1000万美国人，其中三分之二是18岁以下的儿童。尽管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要进展，但哮喘的患病率和发病率仍在增加。哮喘的特征是对非特异性吸入剂，如烟雾、粉尘、烟雾以及组胺和乙酰甲胆碱等药剂产生高反应性。在哮喘患者中，安慰剂反应率很高；虽然其中一些反应代表着倒退到以前高度敏感的个体的平均值，但很可能存在高度的“真正”安慰剂反应。这项研究的总体假设是：吸入安慰剂将为一些人提供保护，防止吸入乙酰甲胆碱后出现支气管痉挛。其他具体假设包括：a)安慰剂反应的存在和大小将与包括个性特征在内的心理因素相关；b)安慰剂反应的存在和大小将受到研究人员(医疗保健提供者)和研究对象之间感知的互动/干预的影响；换句话说，患者预期的增强将增加对安慰剂或吸入β-激动剂沙美特罗引起的乙酰甲胆碱引起的支气管痉挛的保护作用。到目前为止，还没有研究考察患者期望对哮喘结果的影响。此外，还没有研究评估对哮喘患者的干预可以提高患者的预后预期，并可能导致肺功能的改善。

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.