Increasing adherence in inner-city adults with asthma

描述（由申请人提供）： 哮喘是一种常见的慢性疾病， 症状虽然有有效的治疗方法，但症状控制不足 仍然是一个重要的问题，特别是对生活在 市中心与其他慢性病一样， 减轻哮喘的负担。然而，不遵守 有效的治疗方法已被反复确定在患者不充分 症状控制仅仅注重提高知识的战略并没有 哮喘患者的一致临床获益，强烈表明， 教育本身并不能改变病人的病情？护理模式。病人？ 对哮喘和哮喘护理的态度和信念也会影响行为。 尤其是患者？自我效能和对他们的态度/信念 有效处理哮喘症状的能力可能对 坚持有效治疗的适当水平。但最近的 有证据表明，哮喘自我效能和对哮喘的态度/信念 对高风险的市中心成年人的控制可能不足。客观依从性 监测和患者反馈可以识别特定的依从性困难 并加强药物使用的有效模式，从而提高自我效能 和对哮喘控制的态度/信念。基于这种结构， 我们假设，客观的药物监测与病人的反馈， 改善吸入性皮质类固醇（ICS）的依从性，ICS是最广泛使用的 哮喘控制的药物。这项建议的主要目的是 将哮喘教育与客观依从性监测和患者 反馈作为一种新的综合方法，以提高城市中心区对ICS的依从性 哮喘控制不佳的成年人。为此，我们提出了两个相关的 在这一人群中的研究：a）一项前瞻性队列研究， 描述ICS依从性的基线模式（具体目标1），和B）a 随机干预试验，以评估这种新的有效性， 采用综合方法提高ICS依从性（具体目标2）。 这一指导性的以患者为导向的研究机构将为Krishnan博士提供新的 知识、技能和合作关系， 在第四年作为独立调查员申请资助 这个奖。

DESCRIPTION (provided by applicant): Asthma is common chronic disease characterized by episodic respiratory symptoms. While there are effective therapies, inadequate symptom control remains an important problem, particularly for low-income adults living in the inner-city. As in other chronic diseases, adequate self-management skills are necessary to reduce the burden from asthma. However, non-adherence to effective therapy has been repeatedly identified in patients with inadequate symptom control. Strategies focused on improving knowledge alone have not had consistent clinical benefits in patients with asthma, strongly suggesting that education alone does not modify patients? patterns of care. Patients? attitudes and beliefs about asthma and asthma care can also affect behavior. In particular, patients? self-efficacy and attitudes/beliefs regarding their ability to effectively deal with asthma symptoms may be critical for appropriate levels of adherence to effective therapy. However, recent evidence suggests that asthma self-efficacy and attitudes/beliefs about asthma control may be inadequate in high-risk inner-city adults. Objective adherence monitoring and patient feedback can identify specific adherence difficulties and reinforce effective patterns of medication use, and may thus improve self-efficacy and attitudes/beliefs about asthma control. Based on this construct, we hypothesize that objective medication monitoring with patient feedback will improve adherence to inhaled corticosteroids (ICS), the most widely used mediation for asthma control. The primary objective of this proposal is to combined asthma education with objective adherence monitoring and patient feedback as a novel integrated approach to improve adherence to ICS in inner-city adults with poor asthma control. To this end, we propose two related studies in this population: a) a prospective cohort study to objectively describe baseline patterns of adherence to ICS (Specific Aim 1), and b) a randomized intervention trial to assess the effectiveness of this novel integrated approach to improve adherence to ICS (Specific Aim 2). This body of mentored patient-oriented research will provide Dr. Krishnan new knowledge, skills, and collaborative relationships necessary to successfully apply for funding as an independent investigator during the fourth year of this award.