CAMP Continuation Study/Phase 3

描述（由申请人提供）： CAMPCS/3旨在对儿童哮喘管理项目（CAMP）试验中的持续性哮喘患者进行额外4年（至21-29岁）的随访，以确定肺功能下降模式的临床和遗传风险因素，这些模式指示成年后期的慢性气流阻塞。没有其他儿童哮喘研究的规模、详细的表型和纵向随访需要确定这些危险因素。CAMP招募了1041名持续性哮喘患者，以确定定期吸入皮质类固醇（ICS）对肺生长的影响。我们目前正在跟踪869例（占原始队列的83%），以确定持续性哮喘患者在成年早期达到最大肺生长的预测因子。我们已经确定了减少生长和发展气道阻塞的模式。对年龄在23岁或以上的CAMP参与者的分析表明，即使在支气管扩张后测量，28%的参与者也没有达到正常的最大FEV 1水平。我们还观察到，20%已经开始下降，平均下降年龄为19.4岁。这些异常可能是由于持续性炎症，提示早期慢性阻塞性肺疾病。我们提出三个具体目标：1）使用一系列正常比较人群，定义持续性儿童哮喘患者的易感亚组，这些患者处于降低的达到最大肺功能和随后的肺功能下降的模式的风险中，2）确定最大获得肺功能和早期肺功能下降的遗传相关性（遗传分析将由韦斯博士和哈佛遗传学和基因组学中心完成，本申请不承担任何费用）将700多个父母和CAMP患者的现有遗传数据与CAMP所有阶段收集的详细表型数据相关联，和3）确定4-6年前用吸入性抗炎药物连续治疗对成年早期的影响。肺量测定的数据收集程序和其他程序将与CAMP研究先前阶段使用的程序相同。使用支气管扩张剂前后每年进行一次肺功能测定，可准确测量肺功能。CAMP是规模最大、特征最完整的哮喘儿童队列。在CAMPCS/3中对该队列的随访将提供关于这种重要的儿童期肺部疾病的自然史的有价值的信息，这些信息可用于识别成年后有慢性气流阻塞风险的哮喘患者。 (End抽象）。

DESCRIPTION (provided by applicant): CAMPCS/3 is designed to follow patients with persistent asthma from the Childhood Asthma Management Program (CAMP) trial for 4 additional years (through ages 21-29) to determine clinical and genetic risk factors for patterns of lung function decline indicative of chronic airflow obstruction in later adulthood. No other study of childhood asthma has the size, detailed phenotyping, and longitudinal follow-up needed to determine these risk factors. CAMP recruited 1041 persistent asthmatics to determine the effect of regular inhaled corticosteroid (ICS) on lung-growth. We are currently following 869 (83% of the original cohort) to determine predictors of attained maximal lung growth in early adulthood for persistent asthmatics. We have identified patterns of reduced growth arid evolving airway obstruction. Analysis of CAMP participants, aged 23 years or older, indicate that 28% did not reach normal maximal level of FEV1 even when measured after bronchodilation. We have also observed that 20% have already started to decline, with the mean age of decline 19.4 years. These abnormalities may be due to persistent inflammation suggestive of early chronic obstructive pulmonary disease. We propose 3 specific aims: 1) Define, using a range of normal comparison populations, susceptible subgroups of patients with persistent childhood asthma who are at risk for patterns of reduced attained maximal lung function and of subsequent decline of lung function, 2) Identify genetic correlates of maximal attained lung function and early lung function decline (genetic analyses will be done by Dr. Weiss and the Center for Genetics and Genomics at Harvard, without cost to this application) relating existing genetic data on more than 700 trios of parents and CAMP patients to the detailed phenotypic data collected during all phases of CAMP, and 3) Determine effects into early adulthood of 4-6 years of prior continuous treatment with inhaled anti-inflammatory medications. Data collection procedures for spirometry and other procedures will be identical to those used in previous phases of the CAMP study. Annual pre- and post-bronchodilator spirometry will allow accurate measurement of lung function. CAMP is the largest, most completely characterized cohort of children with asthma. Follow-up of this cohort in CAMPCS/3 will provide valuable information about the natural history of this important childhood lung disease, which can be used to identify patients with asthma who are at risk of chronic airflow obstruction later in adult life. (End of Abstract.)