NATIONAL COOPERATIVE INNER CITY ASTHMA STUDY

全国合作的内城哮喘研究是一个多中心， 对照、随机临床干预试验， 儿童哮喘该研究旨在确定 初级保健，基于诊所的干预措施（哮喘顾问，医生 教育和控制）。 在纽约市，150名来自市中心地区的4至12岁儿童， 有中度至重度哮喘症状或长期服用药物 在过去一年中，将有资格进行调查。初级 护理诊所将随机分为3个干预组， 这些诊所的儿童将被随访3年（3次访视/年） 入组试验后。哮喘咨询师干预将 持续3年，包括减少环境污染的模块 （过敏原、二氧化氮、环境烟草烟雾、霉菌）和 与哮喘相关的心理社会风险，以增加依从性， 提高哮喘管理技能。医师教育干预 将包括每年2次关于哮喘管理的正式会议， 3年，每年对管理实践进行3次反馈。一个 将进行观测研究，以评估环境空气 污染对哮喘症状的影响一项子研究将评估以下因素的影响： 以指示灯取代火炉以减少室内二氧化氮 有自动点火灯的车 对照组和干预组的症状随访将由 每两个月打一次电话。将对各组进行比较， 症状天数此外，还将比较 利用率（计划外访视、住院）、依从性、质量 生活，医生知识和哮喘护理质量，哮喘相关 行为技能以及室内和室外环境暴露。

The National Cooperative Inner City Asthma Study is a multicenter, controlled, randomized clinical intervention trial carried out in children with asthma. The study is designed to determine the impact of primary care, clinic-based interventions (asthma counselors, physician education, and control) on symptom days. In New York City, 150 children, 4 to 12 years, from inner city areas, who have moderate to severe asthma with symptoms or on chronic medications during the past year, will be eligible for the investigation. Primary care clinics will be randomized into the 3 intervention groups and the children in these clinics will be followed for 3 years (3 visits/year) after enrollment into the trial. The asthma counselor intervention will be ongoing for 3 years and include modules to reduce environmental (allergens, nitrogen dioxide, environmental tobacco smoke, molds) and psychosocial risks associated with asthma, to increase adherence and to improve asthma management skills. The physician education intervention will consist of 2 formal sessions on asthma management per year for 2 years with feedback on their management practices 3 times per year. An observational study will be done to assess the relation of ambient air pollution to asthma symptoms. A substudy will evaluate the effect of reducing indoor nitrogen dioxide by replacing stoves with pilot lights with ones with auto-ignition lights. Follow-up of symptoms in control and intervention groups will be done by telephone every 2 months. The groups will be compared with respect to symptom days. In addition, comparisons will be made with respect to utilization (unscheduled visits, hospitalizations), adherence, quality of life, physician knowledge and quality of asthma care, asthma-related behavior skills and indoor and outdoor environmental exposures.