Asthma is the most common chronic illness of childhood, a burden disproportionately shared by inner-city, African-American children. Factors that may decrease asthma morbidity are high-quality comprehensive medical care, culturally-sensitive outreach which emphasizes self-management skills, environmental and behavioral modification, and a more coordinated approach to care delivery. The applicants propose a prospective, randomized controlled trial to evaluate the effectiveness of a culturally-sensitive, coordinated approach to asthma care in inner-city children with moderate or severe asthma. Children will be randomized into three groups: (1) augmented usual care (Group I); (2) coordinated care (Group II); and (3) coordinated care plus environmental modification (Group III), each of 24-months duration. Providers for all groups will be trained in National Heart Lung and Blood Institute (NHLBI) asthma management guidelines and will have several educational and management enhancements. Group II will receive bi-monthly home visits by a lay asthma outreach worker and weekly assessments by the school nurse. The pediatricians caring for these children will use this information during scheduled clinic visits, which will include an asthma education curriculum. Group III will receive the coordinated care intervention plus specific interventions designed to minimize the child's exposure to dust mites and environmental tobacco smoke (ETS). The impact of the interventions in Groups II and III will be assessed according to the following four domains: (1) physiologic measures (methacholine challenge, forced expiratory volume in one second (FEV-1), peak expiratory flow rate; (2) health care use (asthma hospitalizations and acute visits to clinics and emergency rooms); and (3) environmental measures (household dust mite concentrations, nitrogen dioxide (N02) and fine particulate matter concentrations, urinary cotinine levels, and household dampness); and (4) functional status measures (medication use, quality of life, and family function).
| Pongracic, Jacqueline A; O'Connor, George T; Muilenberg, Michael L et al. (2010) Differential effects of outdoor versus indoor fungal spores on asthma morbidity in inner-city children. J Allergy Clin Immunol 125:593-9 |
| Pongracic, Jacqueline Ann (2010) Asthma in adolescents living in the inner city. Adolesc Med State Art Rev 21:34-43, viii |
| O'Connor, George T; Neas, Lucas; Vaughn, Benjamin et al. (2008) Acute respiratory health effects of air pollution on children with asthma in US inner cities. J Allergy Clin Immunol 121:1133-1139.e1 |
| Stout, James W; Visness, Cynthia M; Enright, Paul et al. (2006) Classification of asthma severity in children: the contribution of pulmonary function testing. Arch Pediatr Adolesc Med 160:844-50 |
| Kattan, Meyer; Crain, Ellen F; Steinbach, Suzanne et al. (2006) A randomized clinical trial of clinician feedback to improve quality of care for inner-city children with asthma. Pediatrics 117:e1095-103 |
| Gruchalla, Rebecca S; Pongracic, Jacqueline; Plaut, Marshall et al. (2005) Inner City Asthma Study: relationships among sensitivity, allergen exposure, and asthma morbidity. J Allergy Clin Immunol 115:478-85 |
| Kattan, Meyer; Stearns, Sally C; Crain, Ellen F et al. (2005) Cost-effectiveness of a home-based environmental intervention for inner-city children with asthma. J Allergy Clin Immunol 116:1058-63 |
| Morgan, Wayne J; Crain, Ellen F; Gruchalla, Rebecca S et al. (2004) Results of a home-based environmental intervention among urban children with asthma. N Engl J Med 351:1068-80 |
| Wright, Rosalind J; Mitchell, Herman; Visness, Cynthia M et al. (2004) Community violence and asthma morbidity: the Inner-City Asthma Study. Am J Public Health 94:625-32 |
| O'connor, George T; Walter, Michelle; Mitchell, Herman et al. (2004) Airborne fungi in the homes of children with asthma in low-income urban communities: The Inner-City Asthma Study. J Allergy Clin Immunol 114:599-606 |
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