Symptom clusters in children with exacerbation-prone asthma

哮喘易加重儿童的症状群

• 批准号: 10410457
• 负责人: Anne Mentro Fitzpatrick
• 金额: $ 50.45万
• 依托单位: EMORY UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-09-10 至 2024-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10410457
• 关键词: Absenteeism; Adherence; Adrenal Cortex Hormones; Affect; Anger; Anxiety; Area; Asthma; Biological Markers; Cessation of life; Child; Childhood Asthma; Chronic; Chronic Disease; Clinical; Cognitive Therapy; Cohort Studies; Collaborations; Complex; Coughing; Depressed mood; Disease; Dyspnea; Emergency department visit; Environmental Irritants; Esthesia; Exposure to; Family; Fatigue; Fright; Future; Goals; Health; Health Services Accessibility; Impairment; Individual; Inflammation; Inflammatory; Intervention; Intervention Studies; Knowledge; Malignant Neoplasms; Mental Depression; Mental Health; Metabolic Pathway; Morbidity - disease rate; Outcome; Pain; Pain management; Parents; Patient Outcomes Assessments; Patients; Personal Satisfaction; Pharmaceutical Preparations; Phenotype; Population; Primary Health Care; Productivity; Psyche structure; Public Health; Quality of life; Recording of previous events; Reporting; Research; Respiratory Signs and Symptoms; Schools; Severities; Sleep; Sleep disturbances; Standardization; Strategic Planning; Stress; Symptoms; Testing; Time; Tobacco smoke; United States; Upper Respiratory Infections; Visit; Wheezing; affective disturbance; age group; associated symptom; asthma exacerbation; asthma inhaler; biobehavior; cost; cost estimate; cytokine; environmental allergen; experience; functional status; improved; individualized medicine; knowledge of results; metabolomics; multidisciplinary; national surveillance; peer; personalized intervention; physical conditioning; physical symptom; secondary outcome; social; study population; surveillance data; symptom cluster; symptom management; symptom science; treatment guidelines; trend

PROJECT SUMMARY/ABSTRACT Asthma symptom control is suboptimal in the majority of children in the United States, despite widespread availability of asthma controller medications and standardized treatment guidelines. While deaths from asthma have declined, more than 50% of children with asthma experience an exacerbation each year and the public health burden is substantial. While the factors associated with asthma symptom control are complex, it is also recognized that children with exacerbation-prone asthma are a heterogeneous group, with differing symptom profiles that may contribute to differing clinical outcomes. However, existing research on asthma symptoms in this age group is quite limited and has focused primarily on respiratory symptoms in isolation, ignoring other physical symptoms and symptoms of mental and social health that are important to overall functional status and quality of life. To date, there has been no attempt to comprehensively identify and phenotype symptom clusters (defined as two or more concurrent symptoms independent of other clusters) in children with exacerbation-prone asthma. Given this major shortcoming, this 48-week cohort study (N=173) will test the overarching hypothesis that symptom clusters and their associated inflammatory and metabolic pathways predict corticosteroid treatment responsiveness (primary objective outcome) and quality of life (patient-reported secondary outcome) in children 8-17 years with exacerbation-prone asthma. Specific aims are to: 1) identify and phenotype symptom clusters and assess their temporal trajectories, 2) determine associations between symptom clusters and clinical outcomes, and 3) identify inflammatory and metabolic pathways underlying symptom clusters in children with exacerbation-prone asthma. We anticipate that a cluster of children with the poorest physical, mental and social health symptoms will emerge; we further anticipate that the symptom presentations in this cluster of children will be stable over time and will result in the poorest corticosteroid treatment responsiveness, the poorest quality of life, and the greatest magnitude of inflammation. This project involves a multidisciplinary team with a history of collaboration and is aligned with the NINR Strategic Plan to “Advance Symptom Science Research” in chronic conditions through biobehavioral research. Expected deliverables from this project include: 1) refined knowledge regarding the identification and clinical utility of symptom clusters in children with exacerbation-prone asthma, and 2) identification of mechanisms underlying symptom clusters that can be targeted in future interventional studies. Because children with exacerbation- prone asthma rarely report a single symptom, these discoveries have the potential to significantly advance individualized treatment and improve clinical outcomes, ultimately reducing the high morbidity and improving quality of life in affected children.

项目摘要/摘要 在美国的大多数儿童中，哮喘症状控制是次优的，目的地宽度 哮喘控制器药物和标准化治疗指南的可用性。而哮喘死亡 每年有超过50％的患有哮喘经历的儿童中有50％以上的儿童和公众 健康伯恩很重要。虽然与哮喘症状控制相关的因素很复杂，但也是 认识到患有恶化的儿童哮喘是一个异质群体，症状不同 可能有助于区分临床结果的特征。但是，现有关于哮喘症状的研究 这个年龄组非常有限，主要集中于孤立的呼吸症状，忽略了其他 精神和社会健康的身体症状和症状对整体功能状况很重要 和生活质量。迄今为止，还没有尝试全面识别和表型症状 簇（定义为两个或更多的并发症状，独立于其他集群） 恶化的哮喘。鉴于这一重大缺点，这项为期48周的队列研究（n = 173）将测试 总体假设是症状簇及其相关的炎症和代谢途径 预测皮质类固醇治疗反应（主要客观结果）和生活质量（患者报告 次要结果）在8-17岁的儿童中患有哮喘。具体目的是：1）确定 和表型症状簇并评估其临时轨迹，2）确定 症状簇和临床结果，以及3）确定炎症和代谢途径 患有恶化的哮喘儿童的症状簇。我们预计有一群孩子 最糟糕的身体，精神和社会健康症状将出现；我们进一步预期症状 随着时间的流逝，这组儿童中的演讲将保持稳定，并导致最贫穷的皮质类固醇 治疗反应能力，最差的生活质量以及最大的炎症。这个项目 涉及一个具有协作历史历史的多学科团队，并且与NINR战略计划保持一致 通过生物行为研究在慢性病中的“预先症状科学研究”。预期的 该项目的可交付成果包括：1）有关识别和临床实用程序的完善知识 患有哮喘的儿童的症状簇和2）鉴定机制的识别 可以在以后的介入研究中针对的症状簇。因为患有恶化的孩子 - 这些发现倾向于哮喘很少报告单一症状，有可能显着前进 个性化治疗并改善临床结果，最终降低高发病率并改善 受影响儿童的生活质量。