Increasing adherence in inner-city adults with asthma

描述(由申请人提供)： 哮喘是以呼吸道发作为特征的常见慢性病。 症状。虽然有有效的治疗方法，但不充分的症状控制 仍然是一个重要的问题，特别是对于生活在 市中心。与其他慢性病一样，适当的自我管理技能是 这是减轻哮喘负担所必需的。然而，不遵守 有效的治疗方法已被反复确定为对不适当的患者 症状控制。仅专注于提高知识的战略并没有 哮喘患者一致的临床益处，强烈表明 单靠教育不能改变患者吗？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。 尤其是病人？自我效能感和对自己的态度/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程度。然而，最近 有证据表明哮喘的自我效能和对哮喘的态度/信念 在市中心的高危成年人中，控制措施可能不够充分。客观坚持 监测和患者反馈可以确定具体的依从性困难 并加强有效的用药模式，从而可能提高自我效能 以及对哮喘控制的态度/信念。基于这一结构， 我们假设，客观的用药监测和患者反馈将 改善吸入性皮质类固醇(ICS)的依从性，这是最广泛使用的 哮喘控制的调解。这项建议的主要目标是 将哮喘教育与客观依从性监测和患者结合起来 反馈作为提高中心城区ICS依从性的一种新的综合方法 哮喘控制不佳的成年人。为此，我们提出了两个相关的 这一人群中的研究：a)一项前瞻性队列研究，以客观地 描述遵守ICS的基线模式(具体目标1)，和b)a 评估这种新型药物有效性的随机干预试验 改进遵守ICS的综合办法(具体目标2)。 这一以患者为导向的指导研究机构将为克里希南博士提供新的 成功所需的知识、技能和协作关系 在第四年以独立调查员的身份申请资助 这个奖项。

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.