Better asthma outcomes: lowering tobacco smoke exposure.

描述(由申请人提供) 慢性环境烟草烟雾(ETS)暴露，特别是父母 吸烟，与更严重的哮喘相关-发病率增加 急诊科就诊、危及生命的发作、哮喘症状和 从哮喘加重中恢复的时间延长，需要 住院治疗。据报道，每天接触ETS的人数高达三分之一 社会经济地位低的哮喘儿童在美国样本中的比例。我们最近 报道了一项关于ETS减少的初步随机对照试验 基于社会认知学习理论的干预，包括持续干预 对低收入、以拉丁裔为主的ETS暴露的客观反馈 87名患有哮喘的非裔美国儿童样本，这与 从统计上看，急性呼吸道感染患者的医疗保健利用率显著下降 Athma和ETS暴露的减少，其影响大小与 家长报告和孩子的尿可替宁水平。复制和 需要推广以改善干预措施，验证暴露情况 减少，并更好地理解干预与 临床结果。我们建议对此进行为期18个月的随机对照试验 针对父母在吸烟方面的变化阶段量身定做的干预措施 实践中，在500名暴露于ETS的持续性哮喘儿童中，3-12岁 年龄，在北加州接受Kaiser Permanente照顾。全 儿童将接受适当的药物治疗，并接受同等的治疗 随机化前的哮喘教育。主要结果将是哮喘 急性护理利用和尿可替宁/肌酐比率；二次结局 将照顾者准备好改变吸烟行为(改变的阶段)， 哮喘功能严重程度，未出现在Kaiser Permanente名单上 “高危”哮喘患者，报告禁止在家中吸烟 和其他室内/封闭区域，报告父母戒烟，以及 报告的缺课情况。控制员服药依从性的变化将是 使用基于药房的配药指数进行评估。我们假设这是 干预将与哮喘危机护理利用率的降低相关， 较低的ETS暴露，以及后续疾病结局的改善- 与通常的医疗护理相比，这一比例有所上升。此外，我们假设 尿可替宁/肌酐比值下降，但控制者无变化 服药依从性，将被发现在干预中起到重要作用- 哮喘危机护理利用率的相关改善。特殊措施 将被用来提高可替宁作为一种指标的可靠性 长期的个人接触。

DESCRIPTION (provided by applicant) Chronic environmental tobacco smoke (ETS) exposure, particularly from parental smoking, is associated with more severe asthma - increased incidence of emergnecy department visits, life-threatening attacks, asthma symptoms, and prolonged time to recovery from asthma exacerbations requiring hospitalization. Daily ETS exposure has been reported in as many as one-third of low socioeconomic status children with asthma in U.S. samples. We recently reported a preliminary randomized control trial of an ETS reduction intervention based on social cognitive learning theory and including ongoing objective feedback on ETS exposure in a low-income, predominantly Latino and African American sample of 87 children with asthma, which was associated with a statistically significant reduction in health care utilization for acute athma and a reduction in ETS exposure of comparable effect size as measured by parental report and the child's urine cotinine level. Replication and extension are needed to improve the intervention, validate the exposure reduction, and better understand the mechanism(s) linking the intervention to clinical outcome. We propose an 18-month randomized control trial of this intervention, tailored to parental stage of change with regard to smoking practices, in 500 ETS-exposed children with persistent asthma, 3-12 years of age, receiving care from Kaiser Permanente in Northern California. All children will be on an adequate medication regimen and receive equivalent asthma education prior to randomization. Primary outcomes will be asthma acute care utilization and urine cotinine/creatinine ratio; secondary outcomes will be caregiver readiness to change smoking behavior (stage of change), asthma functional severity, non-appearance on the Kaiser Permanente list of "high risk" asthma patients, reported prohibition of smoking within the home and other indoor/enclosed areas, reported parental smoking cessation, and reported school absences. Changes in controller medication adherence will be evaluated using a pharmacy-based dispensing index. We hypothesize that this intervention will be associated with decreased asthma crisis care utilization, lower ETS exposure, and improvements in secondary disease outcomes at follow- up when compared with usual medical care. Further, we hypothesize that decreases in urine cotinine/creatinine ratio, but not changes in controller medication adherence, will be found to be instrumental in the intervention- associated improvements in asthma crisis care utilization. Special measures will be taken to enhance the reliability of cotinine as an indicator of chronic personal exposure.