Symptom clusters in children with exacerbation-prone asthma

项目总结/摘要 气候变化通过协同作用对哮喘患者的呼吸健康构成重大威胁 空气质量和空气中过敏原的干扰。然而，气候变化和空气污染的影响 在社会弱势儿童群体中，这一比例更高。如黑和 由于系统性的结构性种族主义，西班牙裔儿童更有可能生活在机会较低的社区 和历史上的红线做法，暴露于更多的污染物，并有更严重的哮喘恶化 归因于空气污染。这是一个公共卫生危机，因为哮喘急性发作是一个主要的预测因素， 未来的住院治疗，并显着增加哮喘相关死亡的风险。菲茨帕特里克医生已经建立了一个 广泛的研究计划集中在社会弱势群体的儿童哮喘。她现在的 R 01，易发作哮喘儿童的症状群（R 01 NR 018666），是一项为期12个月的 对最近哮喘急性发作的学龄儿童进行的纵向研究，这些儿童被聚集在单独的 基于一系列患者报告的结果（症状）测量结果进行分组。临床结局和 然后在簇组之间比较炎症和代谢途径。然而，气候和空气 质量没有评估。本行政补充文件将利用以前收集的数据和样本， R 01，并将增加新的评估（社会脆弱性和空气质量的表征），新的 实验（转录组学和多组学关联），以及其他具有专业知识的人员 气候变化与健康倡议。核心假设是气候变化引起的 空气质量的破坏恶化了学龄儿童的哮喘炎症、症状和纵向结果 这些影响是由社会脆弱性介导的。具体目标是：1） 确定气候、空气质量、症状和儿童病情加重结果之间的关联- 在两个气候季节中容易发生哮喘，2）确定气候和污染物的生物影响， 儿童哮喘易加重。这份行政补充文件涉及 CCH倡议：健康影响研究，调查气候变化对健康结果的影响 和生物机制，以及健康公平，承认和应对人口的需求最 处于危险之中完成的时间轴为一年。预计这些结果将推动系统级 了解与气候变化相关的空气污染对哮喘脆弱儿童的影响， 为该领域的R 01干预性研究提供关键的初步数据。

PROJECT SUMMARY/ABSTRACT Climate change poses a significant threat to respiratory health in patients with asthma through synergistic disturbances in air quality and airborne allergens. However, the effects of climate change and air pollution are not equal and are substantially greater in socially vulnerable populations of children. For example, Black and Hispanic children are more likely to live in lower opportunity neighborhoods due to systemic structural racism and historic red lining practices, are exposed to more pollutants, and have more severe asthma exacerbations attributable to air pollution. This is a public health crisis since asthma exacerbations are a primary predictor of future hospital admission and significantly increase the risk of asthma-related death. Dr. Fitzpatrick has built an extensive research program focused on socially vulnerable populations of children with asthma. Her current R01, Symptom Clusters in Children with Exacerbation-Prone Asthma (R01NR018666), is a 12-month longitudinal study of school-age children with a recent asthma exacerbation who are clustered into separate groups based on a battery of patient-reported outcome (symptom) measures. Clinical outcomes and inflammatory and metabolic pathways are then compared between cluster groups. However, climate and air quality are not assessed. This administrative supplement will utilize previously collected data and samples from the parent R01 and will add new assessments (characterization of social vulnerability and air quality), new experiments (transcriptomics and multi-omic associations), and additional personnel with expertise to pursue Climate Change and Health (CCH) initiatives. The central hypothesis is that climate change-induced disruptions in air quality worsen asthma inflammation, symptoms, and longitudinal outcomes in school-age children with asthma and that these effects are mediated by social vulnerability. Specific aims are to: 1) determine associations between climate, air quality, symptoms, and outcomes in children with exacerbation- prone asthma during two climate seasons, and 2) determine the biological impact of climate and pollutants in children with exacerbation prone asthma. This administrative supplement addresses two Core Pillars of the CCH Initiative: Health Effects Research, investigation of the influences of climate change on health outcomes and biological mechanisms, and Health Equity, recognizing and responding to the needs of populations most at risk. The timeline for completion is one year. The results are expected to advance systems-level understanding of the impact of climate change-associated air pollution on vulnerable children with asthma and provide key preliminary data for an R01 interventional study in this field.