Asthma Clinical Research Network-Washington University

描述（由申请人提供）：本申请的总体目标是优化大多数哮喘患者的哮喘管理。我们的应用程序将利用哮喘临床研究网络（ACRN）的优势来解决两个常见的临床问题：1)当使用哮喘行动计划时，哮喘自我管理的最佳方法是什么？2)在呼吸道感染期间预防哮喘加重的最佳治疗方法是什么？目前没有足够的证据支持使用以峰值流量或症状为基础的书面哮喘行动计划来改善卫生保健利用、症状或肺功能。因此，我们提出的第一个方案“哮喘行动计划改善哮喘控制”（AAPAC试验）（Aim I）将调查基于症状和基于峰值流量的书面哮喘行动计划在改善成人持续性哮喘控制方面的有效性。此外，AAPAC试验将探讨哮喘行动计划是否比单独医疗管理更好。第二个重要的临床问题是如何治疗由最常见的病因——呼吸道感染引起的哮喘加重。当使用敏感的检测方法时，大多数导致成人和儿童哮喘恶化的呼吸道感染都是由病毒引起的。目前尚不清楚，当患者开始出现上呼吸道感染症状时，卫生保健提供者应该向他们的患者推荐什么最佳治疗方法来预防哮喘恶化。在这方面，我们为ACRN提出的第二个方案，“预防呼吸道感染引起的哮喘加重方案”（the PRACTICAL Trial）， （Aim II）将调查在呼吸道感染症状发作后立即使用皮质类固醇（吸入或口服）是否会预防或改善哮喘加重。我们相信这些方案是ACRN的理想研究，因为它们评估常见和相关临床问题的治疗策略，需要大量可比患者，并且需要标准化的治疗方案。此外，根据设计，这两项试验都可以在相对较短的时间框架内完成（例如12-18个月），然后获得的信息可以迅速传播给保健专业人员和公众。我们建议，只有通过这样的合作，才能回答有关当前和新型哮喘治疗和管理的重要问题。

DESCRIPTION (provided by applicant): The overall goal of this application is to optimize asthma management for the majority of patients with asthma. Our application will utilize the strengths of the Asthma Clinical Research Network (ACRN) to address two common clinical issues: 1) What is the best method of asthma self-management when using an asthma action plan? And 2) What is the best treatment to prevent an asthma exacerbation during a respiratory tract infection? There is currently insufficient evidence to support the use of written asthma action plans that are peak flow- or symptom-based in improving health care utilization, symptoms or lung function. For that reason, our first proposed protocol, "Asthma Action Plans improve Asthma Control" (The AAPAC Trial), (Aim I) will investigate the effectiveness of symptom-based and peak flow-based written asthma action plans in improving asthma control in adults with persistent asthma. Furthermore, the AAPAC trial will address whether either asthma action plan is better than medical management alone. A second important clinical question addresses the treatment of asthma exacerbations due to the most common etiology - respiratory tract infections. The majority of respiratory tract infections which lead to exacerbations of asthma in adults and children are caused by viruses when sensitive detection methods are utilized. It is unclear what is the optimal therapy that health care providers should recommend to their patients to prevent an asthma exacerbation, when the patients start to experience upper respiratory tract infection symptoms. In that regard, our second proposed protocol for the ACRN, "Preventing Respiratory TrACT Infection-induCed Asthma exacerbations protocol" (The PRACTICAL Trial), (Aim II) will investigate if prompt use of corticosteroids (either inhaled or oral) following the onset of respiratory tract infection symptoms will prevent or ameliorate an asthma exacerbation. We believe these protocols are ideal studies for the ACRN, as they evaluate treatment strategies for common and pertinent clinical issues, necessitate large numbers of comparable patients, and require standardized treatment protocols. Furthermore, by design, both of these trials can be completed in relatively short time frame (e.g. 12-18 months) and the information obtained can then be rapidly disseminated to health care professionals and the public. We propose that it is only through such a collaboration that important questions regarding current and novel therapies and management of asthma can be answered.