The overall goal of this application is to optimize asthma management for the majority of patients with asthma. Our application will utilize the strengths of the Asthma Clinical Research Network (ACRN) to address two common clinical issues: 1) What is the best method of asthma self-management when using an asthma action plan? And 2) What is the best treatment to prevent an asthma exacerbation during a respiratory tract infection? There is currently insufficient evidence to support the use of written asthma action plans that are peak flow- or symptom-based in improving health care utilization, symptoms or lung function. For that reason, our first proposed protocol, """"""""Asthma Action Plans improve Asthma Control"""""""" (The AAPAC Trial), (Aim I) will investigate the effectiveness of symptom-based and peak flow-based written asthma action plans in improving asthma control in adults with persistent asthma. Furthermore, the AAPAC trial will address whether either asthma action plan is better than medical management alone. A second important clinical question addresses the treatment of asthma exacerbations due to the most common etiology - respiratory tract infections. The majority of respiratory tract infections which lead to exacerbations of asthma in adults and children are caused by viruses when sensitive detection methods are utilized. It is unclear what is the optimal therapy that health care providers should recommend to their patients to prevent an asthma exacerbation, when the patients start to experience upper respiratory tract infection symptoms. In that regard, our second proposed protocol for the ACRN, """"""""Preventing Respiratory TrACT Infection-induCed Asthma exacerbations protocol"""""""" (The PRACTICAL Trial), (Aim II) will investigate if prompt use of corticosteroids (either inhaled or oral) following the onset of respiratory tract infection symptoms will prevent or ameliorate an asthma exacerbation. We believe these protocols are ideal studies for the ACRN, as they evaluate treatment strategies for common and pertinent clinical issues, necessitate large numbers of comparable patients, and require standardized treatment protocols. Furthermore, by design, both of these trials can be completed in relatively short time frame (e.g. 12-18 months) and the information obtained can then be rapidly disseminated to health care professionals and the public. We propose that it is only through such a collaboration that important questions regarding current and novel therapies and management of asthma can be answered.
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| Sutherland, E Rand; Goleva, Elena; King, Tonya S et al. (2012) Cluster analysis of obesity and asthma phenotypes. PLoS One 7:e36631 |
| McGrath, Kelly Wong; Icitovic, Nikolina; Boushey, Homer A et al. (2012) A large subgroup of mild-to-moderate asthma is persistently noneosinophilic. Am J Respir Crit Care Med 185:612-9 |
| Szefler, Stanley J; Chinchilli, Vernon M; Israel, Elliot et al. (2012) Key observations from the NHLBI Asthma Clinical Research Network. Thorax 67:450-5 |
| Sutherland, E Rand; King, Tonya S; Icitovic, Nikolina et al. (2010) A trial of clarithromycin for the treatment of suboptimally controlled asthma. J Allergy Clin Immunol 126:747-53 |
| Peters, Stephen P; Kunselman, Susan J; Icitovic, Nikolina et al. (2010) Tiotropium bromide step-up therapy for adults with uncontrolled asthma. N Engl J Med 363:1715-26 |
| Sutherland, E Rand; Lehman, Erik B; Teodorescu, Mihaela et al. (2009) Body mass index and phenotype in subjects with mild-to-moderate persistent asthma. J Allergy Clin Immunol 123:1328-34.e1 |
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