Project on TRAC: Improving Asthma Control in Children

描述（由申请人提供）：哮喘是一种慢性气道疾病，在美国困扰着1200万至1400万人，并导致大量住院、急诊和缺课。哮喘发病率和死亡率的惊人增长加速了人们对呼吸阻力增加水平与感知症状之间差异的兴趣。由于很大程度上未知的原因，一些哮喘患者似乎比其他人更清楚症状，尽管气道阻塞程度相似。无法检测到气流急性波动的哮喘患者，低估气流阻塞严重程度的患者以及肺功能受损的患者可能会增加更频繁和更严重的哮喘发作的风险。我们推测，当气流阻塞程度和呼吸阻力增加的感觉一致时，哮喘的控制应该得到改善。我们进一步假设，自我效能的变化和症状感知的变化有助于哮喘自我管理行为，从而改善健康相关的结果。300名9 - 12岁的哮喘儿童和至少一名父母或其他法律的监护人将入组该项目。我们提出了一个3 × 3独立组随机试验来检验这一假设，即自我监测经验和感知训练的结合对哮喘的控制有不同的改善。第一个组间因素（自我监测经验）的三个水平包括：无PEFR（仅症状日记）; PEFR（和症状日记）;以及有即时反馈的PEFR（和症状日记）。第二个组间因素（感知训练）的三个水平包括：无训练（仅阻力呼吸）;辨别训练（无表现反馈）;和，辨别训练与即时表现反馈。我们预测，通过提高患者区分气流阻塞存在与否的能力，哮喘控制的客观和主观指标之间的一致性得到证实，哮喘儿童的症状管理、功能状态和健康相关生活质量得到改善。

DESCRIPTION (provided by applicant): Asthma is a chronic disease of the airways that afflicts 12-14 million individuals in the United States and accounts for large numbers of hospitalizations, emergency department visits, and missed school days. Alarming increases in asthma morbidity and mortality have accelerated interest in disparities between levels of increased resistance to breathing and perceived symptoms. For largely unknown reasons, some asthmatics seem more aware of symptoms than others despite similar degrees of airway obstruction. Asthmatic patients unable to detect acute fluctuations in airflow, those who underestimate the severity of airflow obstruction, and those with compromised lung function could be at increased risk for more frequent and severe attacks of asthma. We hypothesize that the control of asthma should improve when there is concordance between levels of airflow obstruction and the perception of increases in the resistance to breathing. We further hypothesize that changes in self-efficacy and changes in symptom perception serve to enable asthma self-management behaviors that result in improved health-related outcomes. Three hundred children with asthma between the ages of 9 and 12 years of age, and at least one parent or other legal guardian, will be enrolled in the project. We propose a 3 x 3 independent groups randomized trial to test the hypothesis that the control of asthma is improved differentially by the combination of self-monitoring experiences and perception training. The three levels of the first between-groups factor (self-monitoring experience) include: no PEFR (symptom diary only); PEFR (and symptom diary); and, PEFR with immediate feedback (and symptom diary). The three levels of the second between-groups factor (perception training) include: no training (resistance breathing only); discrimination training (without performance feedback); and, discrimination training with immediate performance feedback. We predict that demonstrated increases in the concordance between objective and subjective measures of asthma control, enabled by increases in the ability of patients to discriminate between the presence or absence of airflow obstruction, improves symptom management, functional status, and health-related quality of life in children with asthma.