Aggravating Factors of Asthma in a Rural Environment

描述（由申请人提供）：哮喘和加剧农村哮喘的因素是正在进行的社区-学术合作项目（Proyecto Bienestar， PB）确定的关键卫生优先事项。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。预防哮喘恶化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缺口，即影响农村西班牙裔人口的环境因素的作用，那里的哮喘发病率高得不成比例。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的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的分布图。最常见的可疑环境触发因素将被优先考虑。根据疑似农业过程的时间和报告事件的时间，将使用创新的多通道采样器进行采样，并采用社区监测员网格进行采样，这些监测员将为疑似加重因素进行空气采样。哮喘组将继续被跟踪到第三年。分析将侧重于可疑诱因的浓度，并将其与受试者报告的新哮喘加重进行比较。将通过KDNA电台、YVFWC和华盛顿大学制定一项基于已确认和/或强烈怀疑的加重因素的教育推广计划。将编制一套以农村哮喘患者管理为基础的临床医生培训课程，并将其提供给儿童儿童基金会的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产品量化，包括论文、演讲和学生参与者，以及对社区反应变化的影响评估。

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.