School-Based Asthma Therapy: Stage 2 Effectiveness Study Revised

虽然NHLBI指南建议所有患有持续性哮喘的儿童每天服用预防性药物， 遵守这些建议的情况很普遍，特别是在贫穷的城市儿童中。的目标是 拟议的项目是通过改善对贫困哮喘儿童的坚持来减少哮喘儿童的发病率。 护理指南。这项研究建立在我们对180名城市儿童的试点样本的经验基础上 建议以学校为基础进行预防哮喘药物的管理，以减少哮喘症状。 然而，该计划的有益效果只在没有接触环境的儿童中才能看到 烟草烟雾(ETS)。我们提出了一项全面的随机试验，并进行了综合干预 包括在学校管理预防哮喘药物(与剂量调整 根据NHLBI指南)，以及对于吸烟儿童，在家中实施ETS减少计划。 我们假设，接受全面的校本干预的儿童将会经历更少的 与接受常规护理的儿童相比，哮喘相关的发病率更高。第二个假设是， 在吸烟儿童亚组中，接受综合干预的儿童将 与接受常规护理的患者相比，哮喘发病率较低。530名3岁的儿童- 将从罗切斯特市学区的50所学校中确定10年，并将分配 随机分为校本托管组或常规托管组。将对数据进行分析以评估总体 校本干预在降低哮喘发病率方面的效果(包括无症状天数 主要结果，以及其他次要结果测量)，评估是否暴露在烟雾中 接受干预的儿童哮喘发病率低于吸烟儿童 接受通常的护理，并确定该计划的成本效益。这个项目可能会产生深远的影响 关于公共卫生，因为它提出了一种实际的制度变革，以确保坚持治疗和 减少贫困哮喘儿童的ETS暴露。如果事实证明它成功地减少了 症状和改善城市哮喘儿童的健康，它有可能成为一种 改善城市社区哮喘护理的模式。

While NHLBI guidelines recommend daily preventive medications for all children with persistent asthma, poor adherence to these recommendations is common, particularly among poor urban children. The goal of the proposed project is to reduce morbidity for impoverished children with asthma by improving adherence to guidelines for care. This study builds on our experience with a pilot sample of 180 urban children that suggested that school-based administration of preventive asthma medications reduces asthma symptoms. However, the beneficial effects of the program were seen only among children not exposed to environmental tobacco smoke (ETS). We propose a full-scale randomized trial with a comprehensive intervention that consists of both administration of preventive asthma medications in the school (with dose adjustments according to NHLBI guidelines), and, for smoke-exposedchildren, an ETS reduction program in the home. We hypothesize that children receiving the comprehensive school-based intervention will experience less asthma-related morbidity compared to children receiving usual care. The secondary hypothesis is that, among the subgroup of smoke-exposed children, those receiving the comprehensive intervention will experience less asthma morbidity than those receiving usual care. Five hundred and thirty children ages 3- 10 years will be identified from 50 schools in the Rochester City School District, and will be assigned randomly to the school-based care group or a usual care group. Data will be analyzed to assess the overall effectiveness of the school-based intervention in reducing asthma morbidity (including symptom-free days as the primary outcome, as well as additional secondary outcome measures), evaluate whether smoke-exposed children who receive the intervention have lower asthma morbidity than smoke-exposed children who receive usual care, and establish the program's cost-effectiveness. This project may have a profound impact on public health because it presents a practical system change to assure adherence to therapy and decrease ETS exposure among impoverished children with asthma. Should it prove successful in reducing symptoms and improving the health of young urban children with asthma, it has the potential to serve as a model for improved asthma care in urban communities.