School-Based Asthma Therapy: Stage 2 Effectiveness Study

描述（由申请人提供）：虽然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，但对这些建议的依从性较差是很常见的，特别是在贫困的城市儿童中。拟议项目的目标是通过提高对护理指南的依从性来降低贫困哮喘儿童的发病率。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性哮喘药物管理可以减轻哮喘症状。然而，该计划的有益效果仅在未暴露于环境烟草烟雾（ETS）的儿童中可见。我们建议进行一项全面的随机试验，采用综合干预措施，包括在学校使用预防性哮喘药物（根据NHLBI指南进行剂量调整），以及在家中对暴露于烟雾中的儿童进行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会经历更少的哮喘相关发病率。第二个假设是，在烟雾暴露儿童亚组中，接受综合干预的儿童比接受常规护理的儿童哮喘发病率更低。从罗彻斯特市学区的50所学校中选出530名3- 10岁的儿童，并将他们随机分配到校本护理组或普通护理组。将对数据进行分析，以评估以学校为基础的干预在降低哮喘发病率方面的总体有效性（包括无症状天数作为主要结果，以及额外的次要结果测量），评估接受干预的吸烟暴露儿童的哮喘发病率是否低于接受常规护理的吸烟暴露儿童，并确定该计划的成本效益。该项目可能对公共卫生产生深远的影响，因为它提出了一种切实可行的系统变革，以确保治疗的依从性，并减少贫困哮喘儿童的ETS暴露。如果证明它能成功地减轻患有哮喘的城市儿童的症状并改善其健康状况，它就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.