Airway Disease and Cockroach Exposure in Public Housing

描述（由申请人提供）：贫困城市人口的哮喘发病率和死亡率高得令人无法接受。我们和其他人提出，对蟑螂的过敏性可能是导致这个问题的原因。对我们先前完成的哮喘青少年研究的新分析表明，哮喘严重程度和蟑螂过敏之间的指数有更强的联系。然而，需要进一步深入评估，以制定环境政策和城市住房规划，在呼吸健康的背景下解决蟑螂侵扰问题。目前的拨款旨在提供额外的证据，支持哮喘发病率和蟑螂过敏/接触之间的因果关系。在这个项目的第一个阶段，我们通过对巴尔的摩市Claremont公共住宅综合体的全面调查得出的数据表明，该人群的哮喘患病率远高于全国平均水平。此外，我们发现该人群中60%的哮喘患者对蟑螂过敏。我们继续与巴尔的摩市住房管理局密切合作，我们正在开始我们在O'Donnell Heights综合体的工作。该发展项目预计于2005年底拆除，新单位将于2007年落成。我们请求以下列目的续期这项奖助金。在目标1中，我们将调查整个O'Donnell人口，这样我们就有了公共住房居民代表性样本的完整哮喘患病率数据。调查结果将通过确定气道反应性来验证。在O'Donnell人群中，我们将对哮喘患者进行横断面研究，评估哮喘发病的危险因素，重点是蟑螂和其他过敏原暴露、内毒素暴露、室内空气污染物（PM2.5和PM10）暴露和肥胖。为了确定上述危险因素与哮喘存在之间的关系，我们将进行一项病例对照研究，涉及患有哮喘的O'Donnell居民、一组患有单纯性鼻炎的居民和一组健康的居民。在目标2中，我们将纵向监测O'Donnell Heights所有哮喘居民的哮喘发病率，同时他们将被重新安置到新家。我们的假设是，那些对蟑螂过敏的人将被转移到没有蟑螂的环境中，呼吸道疾病将得到改善。目标3，包括一个随机的，平行的研究，利用个人搬迁到新的单位，取代Claremont综合体。本研究将测试教育/行为改变计划的有效性，结合有针对性的早期缓解措施，在不干预的情况下，避免新住宅的蟑螂侵扰。我们希望，随着数据的产生，我们将积极影响美国城市人口的健康，这些人口不成比例地遭受哮喘发病率和死亡率的折磨。

DESCRIPTION (provided by applicant): Asthma morbidity and mortality in poor, urban populations is unacceptably high. We and others have proposed that allergic sensitization to cockroaches may contribute to this problem. New analysis of our previously completed study of asthmatic adolescents shows even stronger association between indices of asthma severity and cockroach allergy. However, further in-depth assessment is required for the development of environmental policies and urban housing planning that address cockroach infestation in the context of respiratory health. The current grant was designed to provide additional evidence supporting the causal relationship between asthma morbidity and cockroach allergy/exposure. In the first period of this project, the data we have generated through a complete survey of the Claremont public housing complex in Baltimore City indicate that the prevalence of asthma in this population is much higher than the national average. In addition, we find that 60% of asthmatics in this population are sensitized to cockroaches. We continue our strong collaboration with the Housing Authority of Baltimore City and we are in the process of beginning our work in the O'Donnell Heights complex. This development is scheduled for demolition by the end of 2005, with new units available in 2007. We request renewal of this grant with the following aims. In Aim 1, we will survey the entire O'Donnell population so that we have full asthma prevalence data of a representative sample of public housing residents. Survey results will be validated with determination of airways responsiveness. Within the O'Donnell population, we will perform a cross-sectional study in individuals with asthma evaluating risk factors for asthma morbidity with focus on cockroach and other allergen exposure, endotoxin exposure, exposure to indoor air pollutants (PM2.5 and PM10) and obesity. To ascertain the relationship between the above risk factors and the presence of asthma, we will perform a case-control study involving the O'Donnell residents with asthma vs. a group of residents with lone rhinitis and a healthy group. In Aim 2, we will monitor asthma morbidity longitudinally in all asthmatic residents of O'Donnell Heights, while they are relocated into new homes. It is our hypothesis that those with cockroach allergy who will be relocated to cockroach-free environment will experience improvement in airway disease. Aim 3, consists of a randomized, parallel study utilizing individuals relocating into the new units that are replacing the Claremont complex. This study will test the effectiveness of an education/behavioral modification program, combined with precision-targeted early mitigation, against no intervention, in avoiding cockroach infestation of new homes. We hope that with the data to be generated, we will positively impact the health of urban US populations who are disproportionally suffering from asthma morbidity and mortality.