CHICAGO INNER-CITY ASTHMA STUDY

哮喘是儿童慢性病的主要原因，发病率 死亡率正在上升，特别是在城市黑人和西班牙裔中 孩子们。据推测，与他们的白人同行相比 以及没有哮喘的儿童，4至11岁的黑人和西班牙裔儿童 患有哮喘的人有更多的医学、心理和社会方面的 环境风险因素以及疾病的严重性和并发症 哮喘与这些风险的存在和/或相互作用有关 各种因素。进一步的假设是，通过干预来减少 风险因素的数量是可行的，适当的干预措施 将减少与哮喘相关的发病率。在研究的第一阶段， 患有哮喘的儿童将通过#年的筛查计划进行识别。 诊所、急诊室和学校。患有以下疾病的儿童 轻度/中度和重度哮喘将接受一系列医学测试和 心理社会调查，以确定哮喘史和存在或 缺乏选定的医疗、心理和环境风险因素。 非哮喘儿童和白人儿童将接受相同风险因素的评估 为了评估风险因素的存在之间的关系 以及哮喘的存在和严重程度。家长也将接受评估 对于成人风险因素的存在，例如不良的育儿技能和 对哮喘的认识有限。一次抽样的哮喘史 患有严重哮喘的儿童将被详细重建。第二 研究阶段将涉及四个武装干预，目标是 减少患有严重哮喘的黑人或西班牙裔儿童的发病率。这个 将设计包括父母和孩子在内的干预措施 主要是为了解决第一阶段确定的心理社会风险因素。 所有受试者都将得到通常的护理。控件将不会收到 干预；第二个手臂上的孩子/父母将获得办公室模型 案例管理；在第三个臂中，孩子/父母将收到 教育和行为部分加上办公模式的案例管理。 (目前，Open Airways和STEP计划似乎将 分别用于教育干预和行为干预)。在 第四臂，孩子/家长将接受教育和行为 组件加上将包括家访在内的更密集的案例管理 帮助解决日常生活中的一些问题。结果来自于 将对干预的四个方面进行比较，以确定 哪种干预措施会有效。我们的目标是减少 缺课天数，住院和急诊室就诊。一个 减少发病率的有效干预措施将是一项重要的健康 对患有哮喘的黑人和西班牙裔儿童的好处，它还将提供 对哮喘儿童的家庭和 负担过重的城市医疗保健系统。

Asthma is the leading cause of chronic disease in childhood, and morbidity and mortality are on the rise, particularly among urban Black and Hispanic children. It is hypothesized that, compared with their white counterparts and children without asthma, 4- to 11-year old Black and Hispanic children with asthma have a greater number of medical, psychosocial, and environmental risk factors and that the severity and complications of asthma are related to the presence and/or interaction of these risk factors. It is further hypothesized that an intervention to reduce the number of risk factors is feasible and that an appropriate intervention will reduce asthma-related morbidity. In the first phase of the study, asthmatic children will be identified through a screening program in practices, clinics, emergency rooms, and schools. Children with mild/moderate and severe asthma will undergo a battery of medical tests and psychosocial surveys to determine asthma history and the presence or absence of selected medical, psychosocial, and environmental risk factors. Nonasthmatic and white children will be evaluated for the same risk factors in order to assess the relationship between the presence of risk factors and the presence and severity of asthma. Parents will also be evaluated for the presence of adult risk factors, such as poor parenting skills and limited understanding of asthma. The asthma histories of a subsample of children with sever asthma will be reconstructed in detail. The second phase of the study will involve a four-armed intervention targeted to reduce morbidity in Black or Hispanic children with severe asthma. The intervention-which will include both parents and children-will be designed primarily to address the psychosocial risk factors identified in Phase I. All subjects will receive usual care. Controls will receive no intervention; children/parents in the second arm will receive office-model case-management; in the third arm, children/parents will receive an educational and behavioral component plus office-model case-management. (At present, it seems likely that the Open Airways and STEP programs will be used for educational and behavioral intervention, respectively). In the fourth arm, children/parents will receive the educational and behavioral component plus more intensive case management that will include home visits and assistance with some problems of daily living. The results from the four arms of the intervention will be compared to ascertain the level at which intervention becomes effective. The goal is to reduce the numbers of days missed from school, hospitalizations, and emergency room visits. An effective intervention to reduce morbidity would be a significant health benefit to asthmatic Black and Hispanic children, and it would also provide substantial economic relief both to families of asthmatic children and to the overburdened urban health-care system.