Asthma Clinical Research Network-Washington University

描述(由申请者提供)：此应用程序的总体目标是为大多数哮喘患者优化哮喘管理。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)使用哮喘行动计划时，哮喘自我管理的最佳方法是什么？2)预防呼吸道感染期间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基于高峰流量或症状的书面哮喘行动计划来改善卫生保健利用率、症状或肺功能。为此，我们的第一个拟议方案“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的试验将解决这两种哮喘行动计划是否比单独的医疗管理更好的问题。第二个重要的临床问题涉及由最常见的病因--呼吸道感染引起的哮喘加重的治疗。在使用敏感的检测方法时，大多数导致成人和儿童哮喘加重的呼吸道感染是由病毒引起的。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是预防哮喘恶化的最佳疗法。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”(实用试验)(AIM II)将调查在出现呼吸道感染症状后立即使用皮质类固醇(吸入或口服)是否可以预防或缓解哮喘恶化。我们认为这些方案是ACRN的理想研究，因为它们评估了常见和相关临床问题的治疗策略，需要大量可比较的患者，并需要标准化的治疗方案。此外，通过设计，这两个试验都可以在相对较短的时间内(例如12-18个月)完成，然后可以将获得的信息迅速传播给卫生保健专业人员和公众。我们认为，只有通过这样的合作，才能回答有关哮喘的当前和新疗法以及管理的重要问题。

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.