ENVIRONMENTAL AGENTS--ASTHMA DEVELOPMENT AND SEVERITY

哮喘是美国一种主要的慢性病，影响着2000万人 每年耗资62亿美元。疾病的流行和严重程度 儿童哮喘正在增加，发病率不成比例， 西班牙裔和非裔美国人的死亡率。空气污染物与室内 过敏原被认为是发育和疾病的主要风险因素 儿童哮喘的恶化。我们对这些影响的了解 治疗哮喘的环境因素源自有限的横截面 学习。 在这项前瞻性队列研究中，我们仔细地检验了假设 室内过敏原暴露(包括屋尘螨、狗、猫) 以及蟑螂抗原和真菌)和空气污染物暴露 (环境烟草烟雾、二氧化氮、亚硝酸、臭氧、罚款 颗粒质量、细颗粒质量组成和花粉)相关联 随着儿童哮喘的发病率和严重程度的变化， 家族史、抗原特异性IgE状态、家庭环境和 对潜在的混杂因素进行了仔细的描述。重点放在 一种研究设计，其中结果将适用于一般情况 并将解决#年哮喘发病率的增加问题 少数族裔。研究人群是通过筛选问卷来选择的 对在四家地区医院分娩的新生儿的母亲进行了管理。一个 共有1000名母亲，她们有健康的婴儿，也有孩子的年龄 被医生诊断为哮喘的3-7人将被选入 在书房里。在最初的风险因素问卷(父母 哮喘史、出生体重、污染源和自闭症)，兄弟姐妹 将跟踪一年的哮喘严重程度(急诊室就诊频率， 药物使用和活动限制)和同时暴露于 室内空气过敏原和空气污染物。在夏季的几个月 500名兄弟姐妹日最大流量差及每日用药情况 被分类为轻度或中度哮喘的患者将被记录并进行比较 每天测量的环境空气污染物浓度。婴儿们 将每三个月追踪一次，为期四年，以评估哮喘 通过医生诊断、使用支气管扩张剂或 一阵阵喘息。将使用嵌套暴露评估方案，并 将使用多变量控制潜在的混杂因素 分析。这项研究将为优先考虑环境问题提供依据 减少儿童哮喘发病率的干预措施。

Asthma is a major chronic disease in the U.S. affecting 20 million people and costing 6.2 billion dollars per year. The prevalence and severity of asthma in children is increasing, with disproportional morbidity and mortality among Hispanic and African-Americans. Air pollutants and indoor allergen are hypothesized to be major risk factors in development and exacerbation of asthma in children. Our knowledge of the impact of these environmental agents on asthma is derived from limited cross-sectional studies. In this prospective cohort study we test the hypothesis that carefully quantitated indoor allergen exposures (including house dust mite, dog, cat and, cockroach antigen, and fungi) and air contaminant exposures (environmental tobacco smoke, nitrogen dioxide, nitrous acid, ozone, fine particle mass, fine particle mass composition and pollen) are associated with the incidence and severity of asthma in children whose health status, familial history, antigen-specific IgE status, home environment, and potential confounders are carefully characterized. Emphasis is placed on a study design where the results will be applicable to the general population and will address the increase in asthma morbidity in minorities. The study population is selected via a screening questionnaire administered to mothers delivering newborns at four area hospitals. A total of 1,000 mothers who have healthy infants and also have a child age 3 - 7 diagnosed with asthma by a physician will be selected for inclusion in the study. After an initial risk factors questionnaire (parental history of asthma, birthweight, pollutant sources, and SES), the siblings will be followed for one year for asthma severity (frequency of ER visits, medication usage, and activity limitations) and concurrent exposures to indoor aeroallergens and air contaminants. During the summer months diurnal peak flow differences and daily medication use for 500 siblings classified as mild or moderate asthmatics will be recorded and compared with daily measured ambient air contaminant concentrations. The infants will be followed on a tri-monthly basis for four years to assess asthma development as measured by a physician diagnosis, bronchodilator use or episodes of wheeze. A nested exposure assessment protocol will be used and potential confounding factors will be controlled using multivariate analysis. This study will provide a basis for prioritizing environmental interventions to reduce asthma morbidity in children.