School-Based Asthma Therapy: Stage 2 Effectiveness Study Revised

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， 对这些建议的遵守情况普遍较差，尤其是在城市贫困儿童中。的目标 拟议的项目是通过提高对哮喘的依从性， 护理指南。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， 建议以学校为基础的预防性哮喘药物的管理减少哮喘症状。 然而，该计划的有益效果只在没有暴露于环境的儿童中看到。 烟草烟雾（ETS）。我们提出了一个全面的随机试验， 包括在学校使用预防哮喘的药物（调整剂量 根据NHLBI指南），以及，对于吸烟暴露的儿童，在家中进行ETS减少计划。 我们假设，接受全面校本干预的儿童将经历更少的 与接受常规护理的儿童相比，哮喘相关发病率。第二个假设是， 在暴露于烟雾中的儿童中，接受综合干预的儿童将 哮喘发病率低于接受常规护理的患者。530个3岁的孩子 10年将从罗切斯特市学区的50所学校中确定，并将分配给 随机分配到校本护理组或常规护理组。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有效性（包括无哮喘日， 主要结果，以及额外次要结果测量），评估是否暴露于烟雾中 接受干预的儿童哮喘发病率低于吸烟暴露的儿童， 接受常规护理，并建立该计划的成本效益。这个项目可能会对 因为它提出了一个实际的系统变化，以确保坚持治疗， 减少贫困哮喘儿童的ETS暴露。如果它能成功地减少 症状和改善健康的年轻城市儿童哮喘，它有可能作为一个 改善城市社区哮喘护理的模式。

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-exposedchildren, 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.