MAINTENANCE VS INTERMITTENT INHALED STEROIDS IN WHEEZING TODDLERS (MIST)

这个子项目是许多研究子项目中的一个 由NIH/NCRR资助的中心赠款提供的资源。子项目和 研究者（PI）可能从另一个NIH来源获得主要资金， 因此可以在其他CRISP条目中表示。列出的机构是 研究中心，而研究中心不一定是研究者所在的机构。 学龄前儿童经常反复发作和间歇性喘息发作，需要全身性皮质类固醇或急诊室就诊/住院治疗，这是一个重大的公共卫生挑战。 与年龄较大的哮喘儿童相比，这组年龄较小的哮喘儿童具有两个主要的有害特征：（1）他们遭受更大的医疗保健利用和死亡率增加的风险，（2）他们对哮喘管理策略的反应不太有利。国家哮喘教育和预防计划（NAEPP）和全球哮喘倡议需要更多的临床证据来确定这些儿童的最佳治疗方案，以减少与症状负担相关的急性发作和损害。NAEPP指南强调哮喘控制的两个主要领域：风险和损害。 风险涉及急性加重频率/严重程度、肺功能丧失和药物副作用。损伤/负担是指症状、缺课/工作、运动问题、夜间觉醒和当前肺功能。 本研究涉及250例特征明确的高危API阳性儿童，年龄12-53个月，前一年有严重急性发作史。研究问题包括： 1.在RTI期间维持低剂量ICS是否比间歇性高剂量ICS更有效地改变复发性哮喘的风险（需要全身皮质类固醇的急性发作率是主要结局）和损害领域？ 2.是否存在与ICS反应性相关的人口统计学或哮喘/特应性特征或CD 14 -159基因型和其他基因型？ 3.这两种ICS方案的治疗相关不良反应是否存在差异？ 4.哪些病毒与急性加重相关，如果有，哪种ICS方案能够更好地改善这些急性加重？

This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. Preschool children with frequent recurrent and intermittent wheezing episodes requiring systemic corticosteroids or ER visits/hospitalizations are a major public health challenge. This group of younger asthmatic children has two major deleterious characteristics compared to older asthmatic children: (1) they suffer greater risk of increased health care utilization and mortality and (2) they experience less favorable responses to asthma management strategies. The National Asthma Education and Prevention Program (NAEPP) and Global Initiative for Asthma require more clinical evidence to define optimal treatment options for these children to reduce acute episodes and impairment related to symptom burden. NAEPP guidelines emphasize two major domains of asthma control: risk and impairment. Risk addresses exacerbation frequency/severity, loss of lung function, and medication side effects. Impairment/burden refers to symptoms, school/work absences, exercise problems, nocturnal awakenings, and current pulmonary function. This study involves 250 well-characterized high-risk API positive children age 12-53 months, with a history of a severe exacerbation in the prior year. Study questions are: 1. Is maintenance low-dose ICS more effective than intermittent high-dose ICS administered during RTI on modifying the risk (rate of an exacerbation requiring systemic corticosteroids is the primary outcome) and impairment domains of recurrent asthma? 2. Are there demographic or asthma/atopic features or CD14-159 genotypes and other genotypes related to ICS responsiveness? 3. Are there are differences in treatment associated adverse effects with these two ICS regimens? 4. Which viruses are associated with exacerbations and which, if any, ICS regimen is better able to ameliorate these exacerbations?