The effect of household air pollution on lung function growth in infants with pneumonia in sub-Saharan Africa.

项目摘要 肺炎是全世界幼儿死亡的主要传染性原因， 发生在低收入和中等收入国家。肺炎幸存的儿童患肺炎的风险增加 肺发育受损、肺功能下降和成年期慢性呼吸道疾病。我们 乌干达一项正在进行的队列研究的初步数据表明， 有肺炎病史和几乎普遍暴露于家庭环境的儿童中的症状 生物质燃料燃烧造成的空气污染。减少家庭空气污染可以提供一个机会， 改善肺炎患儿肺部发育，预防慢性呼吸道疾病。 我的中心假设是，从肺炎中恢复过来的婴儿， 暴露于家庭空气污染时肺功能的增长，以及减少暴露于家庭空气 污染会促进肺功能的发育。在这个K23指导以病人为导向的职业发展奖， 我将在我的导师已经建立的乌干达8,700名儿童的研究中验证这一假设， 观察性研究和初步干预试验，具体目的如下：（1）测量 肺炎对婴幼儿肺功能发育率的影响，（2）测量颗粒物的影响 PM2.5对肺功能发育的影响;（3）确定 清洁炉灶对婴幼儿肺炎家庭的干预。培训计划将 请允许我在现有的临床和流行病学技能的基础上，（1）发展婴儿 肺生理学和测试，（2）发展家庭空气污染研究方法的专业知识，（3）发展 在低资源环境下的定性研究和临床试验设计技能。这项研究将提供关键的 初步数据和培训平台，以启动我作为全球独立调查员的职业生涯 呼吸系统研究，长期目标是了解肺部发育受损的机制 制定干预措施，改善生活在低收入国家的儿童和成年人的呼吸健康， 国家在国际知名的肺炎专家导师和合作者的支持下， 家庭空气污染，婴儿肺功能，定性研究和临床试验设计，建议 研究将充分利用马萨诸塞州总医院/哈佛医学院的丰富资源 学校和长期合作与姆巴拉拉科技大学在乌干达。这 该提案涉及NHLBI的战略愿景目标#4，以调查导致以下差异的因素： 人口的健康，并直接响应在2014年NHLBI研讨会确定的研究差距 慢性肺部疾病的一级预防，研究儿童早期暴露如何影响 肺功能的发展以及随后的COPD和其他慢性呼吸系统疾病的风险。

PROJECT SUMMARY Pneumonia is the leading infectious cause of death among young children worldwide, with most cases occurring in low and middle-income countries. Children who survive pneumonia have an increased risk of impaired lung development, reduced lung function, and chronic respiratory disease in adulthood. Our preliminary data from an ongoing cohort study in Uganda demonstrate a high rate of chronic respiratory symptoms among children who had a prior episode of pneumonia and near-universal exposure to household air pollution from biomass fuel combustion. Reducing household air pollution may provide an opportunity to improve lung development in children with pneumonia and prevent development of chronic respiratory disease. My central hypothesis is that infants recovering from pneumonia are at particularly increased risk of reduced lung function growth when exposed to household air pollution, and that reducing exposure to household air pollution will improve lung function growth. In this K23 Mentored Patient-Oriented Career Development Award, I will test this hypothesis within my mentors’ already established study of 8,700 children in Uganda through an observational study and pilot intervention trial with the following Specific Aims: (1) to measure the effect of pneumonia on the rate of lung function growth among young infants, (2) to measure the effect of particulate matter exposure (PM2.5) on lung function growth, and (3) to determine the feasibility and acceptability of a clean cookstove intervention in families of young infants with pneumonia. The accompanying training plan will allow me to build on an existing foundation of clinical and epidemiologic skills to (1) develop expertise in infant lung physiology and testing, (2) develop expertise in household air pollution research methods, and (3) develop skills in qualitative research and clinical trial design for low-resource settings. This study will provide critical preliminary data and a training platform to launch my career as an independent investigator in global respiratory research, with a long-term goal of understanding the mechanisms of impaired lung development and developing interventions to improve respiratory health for children and adults living in low-income countries. Supported by mentors and collaborators who are internationally-known experts in pneumonia, household air pollution, infant lung function, qualitative research, and clinical trial design, the proposed research will leverage the wealth of resources available at Massachusetts General Hospital/Harvard Medical School and a longstanding collaboration with Mbarara University of Science and Technology in Uganda. This proposal addresses NHLBI’s Strategic Vision Objective #4, to investigate factors that account for differences in health among populations, and is directly responsive to a research gap identified in the 2014 NHLBI Workshop on the Primary Prevention of Chronic Lung Diseases, to study how early childhood exposures affect development of lung function and subsequent risk of COPD and other chronic respiratory diseases.