UNIVERSITY OF NORTH CAROLINA AT CHARLOTTE
Grant: $6,028 - National Institutes of Health - May. 29, 2009
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Award Description: Asthma is a chronic disease of the airways that afflicts 12-14 million individuals in the United States and accounts for large numbers of hospitalizations, emergency department visits, and missed school days. Alarming increases in asthma morbidity and mortality have accelerated interest in disparities between levels of increased resistance to breathing and perceived symptoms. For largely unknown reasons, some asthmatics seem more aware of symptoms than others despite similar degrees of airway obstruction. Asthmatic patients unable to detect acute fluctuations in airflow, those who underestimate the severity of airflow obstruction, and those with compromised lung function could be at increased risk for more frequent and severe attacks of asthma. We hypothesize that the control of asthma should improve when there is concordance between levels of airflow obstruction and the perception of increases in the resistance to breathing. We further hypothesize that changes in self-efficacy and changes in symptom perception serve to enable asthma self-management behaviors that result in imporved health-related outcomes. Three hundred children with asthma between the ages of 9 and 12 years of age, and at least one parent or other legal guardian, will be enrolled in the project. We propose a 3 x 3 independent groups randomized trial to test the hypothesis that the control of asthma is improved differentially by the combination of self-monitoring experiences and perception training. The three levels of the first between-groups factor (self-monitoring experience) include: no PEFR (Symptom diary only); PEFR (and symptom diary); and, PEFR with immediate feedback (and symptom diary). The three levels of the second between-groups factor (perception training) include: no training (resistance breathing only); discrimination training (without performance feedback); and, discrimination training with immediate performance feedback. We predict that demonstrated increases in the concordance between objective and subjective measures of asthma control, enabled by increases in the ability of patients to discriminate between the presence or absence of airflow obstruction, improves symptom management, functional status, and health-related quality of life in children with asthma.
Project Description: Our labor-intensive protocol has yielded voluminous amounts of information. Our symptom diaries are based on the work of Santanello and colleagues; the diaries assess overall levels of symptoms, cough, activity restriction, and chest tightness that occur on a daily basis. Data entry for each pair of diaries (one from the child and one from the caregiver) requires about one and one-half hours (depending on participant compliance) involving multiple Excel and Access algorithms and ?macros.? To date, we have completed data entry for all 261 of 261 diaries from the first self-monitoring period (Phase 2) and almost 100 of nearly 220 diaries from the second self-monitoring period. Support through the Administrative Supplement has allowed us to continue to coordinate collection of diaries from participants completing Phase 4 with symptom diary data reduction and analysis. In all ways, the support is leading to expeditious dissemination of results from our singular project, which involves a 3 x 3 independent groups randomized trial to test the hypothesis that improvements in the control of asthma in children are enabled differentially by the combination of self-monitoring experience and perception training. The three levels of the first between-groups factor (self-monitoring experience) include: no PEFR (symptom diary only); PEFR (and symptom diary); and, PEFR with immediate feedback (and symptom diary). The three levels of the second between-groups factor (perception training) include: no training (resistance breathing only); discrimination training (without performance feedback); and, discrimination training with immediate performance feedback.
Jobs Summary: The primary purpose of this Administrative Supplement was to support an undergraduate research assistant experienced with our protocol to 'accelerate the tempo' of data reduction and analysis of the symptom diaries already collected from about 100 families during the second self-monitoring experience (Phase 4); and to meaningfully assist in arranging and conducting about 35 follow-up sessions with families who have completed Phase 4 of the protocol and who were scheduled to complete the final phase of our program (Phase 5) during summer 2009. As predicted, Ms Melina Rodriguez has been instrumental as we move towards completing our data collection activities. Melina has arranged for, reminded families about, and prepared for or conducted about 60 meetings with families since June 1, 2009. In the past few months we have reduced the total number of 'active' families in Project On TRAC from nearly 90 to less than 40. (Total jobs reported: 1)
Project Status: More than 50% Completed
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