School-Based Asthma Therapy: Stage 2 Effectiveness Study Revised

描述(由申请人提供)：尽管NHLBI指南建议所有患有持续性哮喘的儿童每天服用预防性药物，但遵守这些建议的情况很常见，特别是在贫穷的城市儿童中。拟议项目的目标是通过改善对护理指南的遵守，减少患有哮喘的贫困儿童的发病率。这项研究建立在我们对180名城市儿童的试点样本的经验基础上，这些样本表明，以学校为基础的预防哮喘药物的管理可以减少哮喘症状。然而，该计划的有益效果只在没有暴露在环境烟草烟雾(ETS)中的儿童中看到。我们建议进行一项全面的随机试验，进行全面的干预，包括在学校使用预防性哮喘药物(剂量根据NHLBI指南进行调整)，以及对吸烟儿童在家中实施ETS减少计划。我们假设，与接受常规护理的儿童相比，接受综合学校干预的儿童将经历较少的哮喘相关发病率。第二个假设是，在吸烟儿童亚组中，那些接受综合干预的儿童比那些接受常规护理的儿童哮喘发病率更低。530名3-10岁的儿童将从罗切斯特市学区的50所学校中被识别出来，并被随机分配到校本保育组或普通保育组。将对数据进行分析，以评估以学校为基础的干预措施在降低哮喘发病率方面的总体效果(包括作为主要结果的无症状天数，以及其他次要结果指标)，评估接受干预的吸烟儿童是否比接受常规护理的吸烟儿童哮喘发病率更低，并确定该计划的成本效益。该项目可能会对公共卫生产生深远影响，因为它提出了一项切实的制度改革，以确保坚持治疗，并减少患有哮喘的贫困儿童暴露于ETS。如果它被证明在减轻症状和改善城市哮喘儿童的健康方面取得成功，它有可能成为改善城市社区哮喘护理的典范。

DESCRIPTION (provided by applicant): While NHLBI guidelines recommend daily preventive medications for all children with persistent asthma, poor adherence to these recommendations is common, particularly among poor urban children. The goal of the proposed project is to reduce morbidity for impoverished children with asthma by improving adherence to guidelines for care. This study builds on our experience with a pilot sample of 180 urban children that suggested that school-based administration of preventive asthma medications reduces asthma symptoms. However, the beneficial effects of the program were seen only among children not exposed to environmental tobacco smoke (ETS). We propose a full-scale randomized trial with a comprehensive intervention that consists of both administration of preventive asthma medications in the school (with dose adjustments according to NHLBI guidelines), and, for smoke-exposed children, an ETS reduction program in the home. We hypothesize that children receiving the comprehensive school-based intervention will experience less asthma-related morbidity compared to children receiving usual care. The secondary hypothesis is that, among the subgroup of smoke-exposed children, those receiving the comprehensive intervention will experience less asthma morbidity than those receiving usual care. Five hundred and thirty children ages 3- 10 years will be identified from 50 schools in the Rochester City School District, and will be assigned randomly to the school-based care group or a usual care group. Data will be analyzed to assess the overall effectiveness of the school-based intervention in reducing asthma morbidity (including symptom-free days as the primary outcome, as well as additional secondary outcome measures), evaluate whether smoke-exposed children who receive the intervention have lower asthma morbidity than smoke-exposed children who receive usual care, and establish the program's cost-effectiveness. This project may have a profound impact on public health because it presents a practical system change to assure adherence to therapy and decrease ETS exposure among impoverished children with asthma. Should it prove successful in reducing symptoms and improving the health of young urban children with asthma, it has the potential to serve as a model for improved asthma care in urban communities.