Aggravating Factors of Asthma in a Rural Environment

描述（由申请人提供）：哮喘和在农村环境中加重哮喘的因素是正在进行的社区-学术伙伴关系Proyecto Bienestar（PB）中确定的关键健康优先事项。这种长期的伙伴关系是西北社区教育中心（NCEC）/KDNA电台，亚基马山谷农场工人诊所（YVFWC），传统大学和华盛顿大学（UW）之间的合作。预防急性发作是哮喘治疗中最重要的挑战，国家指南认识到室内环境因素和交通相关污染物的作用。该项目解决了一个重要的数据差距，周围环境因素的作用，影响农村西班牙裔人口，哮喘发病率不成比例地高。在该项目的第一阶段，我们将在一组临床确诊的哮喘患者中对哮喘加重发作进行地理时间定位，并利用地理信息软件绘制可能导致这些发作的农业过程分布图。将优先考虑最常见的可疑环境触发因素。根据可疑农业过程和报告事件的时间安排，将使用一种创新的多通道采样器进行采样，并在社区监测器网格内对可疑的空气进行采样。哮喘队列将继续随访至第3年。分析将侧重于可疑触发物的浓度，并将其与受试者报告的新发哮喘急性发作进行比较。将根据已证实和（或）有强烈嫌疑的肇事者制定一个教育宣传方案，通过KDNA电台、YVFWC和华盛顿大学提供。将制定基于农村哮喘患者管理的临床医生培训课程，并提供给YVFWC临床提供者及其哮喘外展方案社区卫生工作者。评估将包括PB的过程评估，加强数据收集和哮喘管理的结果评估，以及包括论文、演示和学生参与者在内的产品量化，以及社区反应变化的影响评估。 公共卫生相关性：这个以社区为基础的项目通过跟踪50名哮喘社区受试者，在地理时间上绘制他们的病情加重图，并将其与已知的农业暴露进行比较，来表征农村环境中哮喘的环境触发因素。随后，使用创新和适应性强的采样器进行环境采样，以确认接触的性质，并开展宣传活动，与公众、临床医生和科学界分享调查结果。多方面的评估将评估该计划对伙伴关系、参与者、临床提供者和社区的过程、结果和影响。

DESCRIPTION (provided by applicant): Asthma and factors that aggravate asthma in the rural setting are key health priorities identified in an ongoing community-academic partnership, Proyecto Bienestar (PB). This longstanding partnership is a collaboration between the Northwest Community Education Center (NCEC)/KDNA Radio, the Yakima Valley Farm Workers Clinic (YVFWC), Heritage University and the University of Washington (UW). Preventing exacerbations is the most important challenge in asthma treatment and national guidelines recognize the role of indoor environmental factors and traffic-related pollutants. This project addresses an important data gap regarding the role of ambient environmental factors that affect a rural Hispanic population, where asthma morbidity is disproportionately high. In the first phase of the project we will geo- temporally locate episodes of asthma aggravation among a cohort of clinically confirmed asthmatics and utilize geographic information software to map the distribution of agricultural processes that may be responsible for triggering these episodes. The most common suspected ambient triggers will be prioritized. Guided by the timing of the suspected agricultural processes and the reported episodes, sampling with an innovative multi channel sampler will be done with a grid of community-based monitors which will sample air for the suspected aggravators. The asthmatic cohort will continue to be followed into year three. Analysis will focus on concentrations of the suspected triggers which will be compared to reports of new asthma exacerbations by subjects. An educational outreach program based on confirmed and/or strongly suspected aggravators will be developed for delivery through Radio KDNA, the YVFWC and the University of Washington. A clinician training curricula based on management of rural asthmatics will be developed and delivered to the YVFWC clinical providers and their Asthma Outreach Program community health workers. Evaluation will include process evaluation of PB, outcome evaluation of enhanced data collection and asthma management and product quantification including papers, presentations and student participants and impact evaluation of changes community response. PUBLIC HEALTH RELEVANCE: This community based project characterizes ambient triggers of asthma in the rural setting by following 50 asthmatic community subjects, geo-temporally plotting their exacerbations and comparing these with known agricultural exposures. Subsequently, ambient sampling with an innovative and adaptable sampler will confirm the nature of the exposures and an informational campaign will share the findings with the public, clinicians and the scientific community. A multifaceted evaluation will assess the process, outcomes and impact of the program on the partnership, the participants, the clinical providers and the community.