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).

Agency
National Institute of Health (NIH)
Institute
National Institute of Allergy and Infectious Diseases (NIAID)
Type
Research Project--Cooperative Agreements (U01)
Project #
3U01AI039761-02S1
Application #
2707430
Study Section
Special Emphasis Panel (ZAI1 (31))
Project Start
1996-08-01
Project End
2000-07-31
Budget Start
1997-08-01
Budget End
1998-07-31
Support Year
2
Fiscal Year
1998
Total Cost
Indirect Cost
Name
University of Washington
Department
Pediatrics
Type
Schools of Medicine
DUNS #
135646524
City
Seattle
State
WA
Country
United States
Zip Code
98195
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