This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. Clinical experience demonstrates that children, especially those under the age of 6 years, may have asthma which is truly intermittent (asymptomatic between exacerbations) and yet experience exacerbations, particularly during the respiratory viral season, that often are severe leading to visits to physician offices for urgent care, emergency department treatment, and hospitalization. Thus, it is plausible to consider these patients to have severe intermittent asthma. The National Heart, Lung and Blood Institute (NHLBI) Childhood Asthma Research and Education (CARE) Network has developed a trial entitled 'Acute Intervention Management Strategies (AIMS)', which will evaluate the effect of 3 intervention strategies in children age 12 months - 59 months with recurrent wheezing in the context of respiratory tract illnesses of sufficient severity to have resulted in previous treatment in the emergency unit, hospitalization, or urgent visit to a physician's office (i.e. severe intermittent asthma). We will attempt to answer the following questions: 1. Does early treatment with inhaled corticosteroid or leukotriene receptor antagonist change the course of severe intermittent asthma over the study period compared with conventional therapy? 2. Can the response to either intervention be related to either phenotypic (eosinophils, IgE, cysLT in nasal lavage, asthma predictive index positive/negative) or genotyic (such as B2-adrenergic receptor or 5-lioxygenase gene) features?
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