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NHLBI Childhood Asthma Management Program (CAMP): What Have We Learned?

NHLBI Childhood Asthma Management Program (CAMP): What Have We Learned?

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NHLBI Childhood Asthma Management Program (CAMP): What Have We Learned?

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  1. NHLBI Childhood Asthma Management Program (CAMP): What Have We Learned? • CAMP began as a multicenter (8 clinical + 1 data coordinating center) clinical trial to determine the effect of antiinflammatory therapy on lung growth in children 5-12 years old (N=1046) with persistent mild to moderate asthma. • It is now a longitudinal cohort follow-up study to determine the natural history of childhood asthma into adulthood. We currently are actively following 83% of the original cohort. Albuquerque Baltimore Boston Denver San Diego Seattle St Louis Toronto Johns Hopkins DCC

  2. CAMP and CAMPCS Follow-up Phases Screening & Baseline Phase Treatment Phase Transition Phase Routine Care 1- 4 visits per year 3 visits per year 2 visits 5 visits 1994 2 - 4 months 13years 4 – 6 years 4 months Discontinue Study Rx Enroll in CAMPCS, Rx directed by PCP per NAEPP Randomize Bud Ned Plbo

  3. Clinical Trial ICS improved bronchial hyper-responsiveness, symptoms, exacerbations, and healthcare utilization but not lung growth. ICS reduced linear growth but not BMD or HPA-axis, or cause cataracts or affect psychological development or neurocognitive functioning. Continuation Study Once discontinued all positive benefits lost (didn’t cure asthma). Lung growth exhibiting different patterns, unaffected by therapy. Linear growth still less in ICS group, bone-mineral accretion reduced by bursts of oral steroids but not ICS use. No increase in catarracts. Primary outcomes(123 peer-reviewed publications)

  4. Rationale for Continuation of CAMP Early Decline 100 Normal 75 FEV1 (% normal level at age 20) 50 Reduced Growth Rapid Decline 25 0 10 20 30 40 50 60 70 80 Age (yr)

  5. Genetics (60%) Beta-adrenergic response not related to Arg/Gly beta receptor polymorphisms. ICS response partially genetically determined, including growth suppression. Numerous papers on association of genes with asthma and various asthma characteristics. Others In utero smoke exposure impairs response to ICS. Low serum VitD levels associated with increase severe exacerbations. Correlations with HRCT structural findings and patterns of lung function decline. Post pubertal females have more severe bronchial responsiveness than males. Secondary outcomes(123 peer-reviewed publications)

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