The association of allergic disease with clinical outcomes in COPD.

过敏性疾病与慢性阻​​塞性肺病临床结果的关联。

• 批准号: 8967303
• 负责人: Nirupama Putcha
• 金额: $ 16.29万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-07-15 至 2020-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8967303
• 关键词: Accounting; Address; Allergens; Allergic; Allergic Disease; Allergic inflammation; Ancillary Study; Area; Asthma; Award; Biological Markers; Cause of Death; Characteristics; Chronic Obstructive Airway Disease; Clinical; Clinical Investigator; Clinical Markers; Clinical Research; Clinical/Radiologic; Cohort Studies; Collaborations; Comorbidity; Critical Care; Data; Data Collection; Dedications; Development; Development Plans; Disease Outcome; Disease Progression; Dust; Ensure; Environment; Environmental Health; Epidemiology; Exposure to; Faculty; Future; General Population; Genetic Determinism; Goals; Guidelines; Heterogeneity; Home environment; House Dust; IgE; Immunology; Individual; Intervention; Knowledge; Learning; Link; Lung; Measures; Medicine; Mentors; Mentorship; Methods; Morbidity - disease rate; Motivation; Multicenter Studies; Outcome; Parents; Participant; Patient-Focused Outcomes; Patients; Phenotype; Physicians; Population; Population Study; Productivity; Publishing; Quality of life; Recommendation; Recording of previous events; Recruitment Activity; Research; Research Personnel; Research Project Grants; Research Proposals; Respiratory physiology; Risk; Risk Factors; Role; Sampling; Smoker; Smoking; Structure; Subgroup; Symptoms; Techniques; Testing; Time; Training; Universities; Work; airborne allergen; atopy; base; career; career development; clinical epidemiology; cohort; collaborative environment; environmental allergen; environmental intervention; experience; functional status; genetic epidemiology; high risk; improved; indoor allergen; meetings; member; mortality; patient oriented; patient population; public health relevance; research and development; respiratory; role model; screening; treatment strategy

 DESCRIPTION (provided by applicant): While the combination of specific sensitizations and exposure to allergens have been shown to be associated with morbidity in asthma, whether there is a similar subgroup of individuals with COPD with higher risk for COPD morbidity and progression remains unclear. Preliminary studies suggest that a subgroup of individuals with COPD with atopy have worse respiratory symptoms and worse cross-sectional COPD outcomes. However, the specifics of the allergic sub-phenotype of COPD and its association with COPD progression remain to be fully understood. In this application, we plan to investigate the allergic sub-phenotype of COPD and its association with progression of COPD in a group of individuals from the Genetic Epidemiology of COPD study (COPDGene). COPDGene is an ongoing cohort study of current and former smokers which seeks to investigate the risk factors for and genetic determinants of COPD development and progression. In this proposal, we will conduct an ancillary study which seeks to define a sub-phenotype of COPD including individuals with allergic disease. [Specifically, we will study clinical allergic symptoms in the full cohort o participants of COPDGene, and then focus on the presence of specific sensitizations and markers of general allergic inflammation in 600 individuals with moderate to severe COPD and correlate these characteristics with patient-centered outcomes of COPD longitudinally. We will also determine whether these allergic disease characteristics modify the known association between smoking and COPD progression. We will validate our findings from these steps in the SPIROMICS study to lend strength and generalizability to our findings.] Finally, we will collect settled dust samples from the homes of [160] individuals with COPD to understand whether the combination of sensitization and exposure to indoor allergens is associated with worse COPD morbidity. Ultimately, the information gained from this application will contribute to understanding a sub-phenotype of COPD that is currently poorly understood. Additionally, these data will have implications for the management of COPD and future testing of environmental and allergen abatement strategies for at-risk individuals. The applicant, a physician in Pulmonary and Critical Care Medicine as well as Clinical Epidemiology, has demonstrated a dedication to developing a career in clinical research. Though she is early in her career, she has shown a great deal of initiative, motivation, and productivity in her ongoing research endeavors. This application is structured to allow the candidate to achieve her long-term career goal of becoming an independent clinical investigator exploring the role of comorbidities in determining COPD outcomes with the goal of improving patient-oriented outcomes in COPD. In the immediate timeframe, this proposal would allow the applicant dedicated time to conduct the outlined research project, as well as pursue didactic training in immunology, [environmental health sciences], and further quantitative methods relevant to this project and future research plans. [Additionally, we hope that the data generated from this research proposal will form the basis for an R01 application seeking to study specialized interventions to improve outcomes in patients with the allergic sub-type COPD such as home allergen abatement.] The career development plan for this applicant includes a structured approach to mentoring, didactic coursework focused on a specific research goal, participation in local and national meetings and identification and regular assessment of career milestones. [Since the initial application, the candidate has been recruited to the faculty at Johns Hopkins University with protection of 80% of her time for the development of her research career. She has also expanded her list of published and ongoing projects, showing further commitment to the career of a researcher.] The research environment provided by Johns Hopkins University as well as the mentorship team described in this application will assist in Dr. Putcha's successful completion of her career and research goals. The Division of Pulmonary and Critical Care Medicine and Johns Hopkins University have a long history of training successful young clinical researchers in a supportive and collaborative environment. The pre-existing structure of the COPDGene and SPIROMICS studies, the parent studies for this application, as well as the applicant's established and ongoing collaboration with these groups, will ensure that the study goals will be completed within the timeframe of this award. We have assembled a mentoring team of established faculty with many years of productive research experience and substantial prior mentoring experience. Each has distinct, complementary strengths in areas of research relevant to this proposal. In addition, each member of the mentoring committee serves as an excellent role model for the applicant's career development into an independent investigator.

 描述(由申请人提供)：虽然特定致敏作用和接触变应原的组合已被证明与哮喘的发病率有关，但是否有类似的COPD个体亚群具有较高的COPD发病率和进展风险仍不清楚。初步研究表明，患有特应性疾病的COPD患者的一部分患者有更严重的呼吸道症状和更糟糕的COPD横断面结果。然而，COPD过敏性亚型的特异性及其与COPD进展的关系仍未完全清楚。在这项应用中，我们计划从COPD遗传流行病学研究(COPDgene)的一组个体中调查COPD的过敏性亚型及其与COPD进展的关系。COPD基因是一项正在进行的队列研究，对现在和以前的吸烟者进行研究，旨在调查COPD发生和发展的风险因素和遗传决定因素。在这项提案中，我们将进行一项辅助研究，试图确定COPD的亚型，包括患有过敏性疾病的个体。[具体地说，我们将研究COPD基因全部参与者的临床过敏症状，然后重点关注600名中到重度COPD患者中是否存在特定的过敏反应和一般过敏性炎症的标记，并从纵向上将这些特征与以患者为中心的COPD结果相关联。我们还将确定这些过敏性疾病特征是否改变了吸烟和COPD进展之间的已知联系。我们将在SPIROMICS研究中验证我们在这些步骤中的发现，以增强我们的发现的说服力和推广性。]最后，我们将从[160]名COPD患者家中收集尘埃样本，以了解致敏和暴露于室内过敏原是否与COPD发病率更高有关。最终，从这项应用中获得的信息将有助于理解目前知之甚少的COPD亚型。此外，这些数据将对慢性阻塞性肺疾病的管理以及未来针对高危个体的环境和过敏原减少策略的测试产生影响。申请者是一名肺部和重症监护医学以及临床流行病学的内科医生，他表现出了对发展临床研究事业的奉献精神。虽然她还处于职业生涯的早期，但在她正在进行的研究工作中，她表现出了极大的主动性、动力和生产力。此应用程序旨在允许应聘者实现她的长期职业目标，即成为一名独立的临床调查员，探索共病在确定COPD结果中的作用，目标是改善以患者为中心的COPD结果。在当前的时间框架内，这项建议将使申请者有专门的时间进行概述的研究项目，以及在免疫学、[环境卫生科学]以及与该项目和未来研究计划相关的进一步量化方法方面进行教学培训。[此外，我们希望这项研究提案产生的数据将成为R01应用的基础，该应用寻求研究专门的干预措施，以改善患有过敏性亚型COPD的患者的结果，例如家庭过敏原减少。]该申请者的职业发展计划包括一种结构化的指导方法、侧重于特定研究目标的教学课程、参加地方和国家会议以及确定和定期评估职业里程碑。[自最初申请以来，候选人已被约翰·霍普金斯大学录用，80%的时间为她的研究事业发展提供保护。她还扩大了已公布和正在进行的项目清单，表明她进一步致力于研究人员的职业生涯。]约翰斯·霍普金斯大学提供的研究环境以及本申请中描述的导师团队将有助于普查博士成功完成她的职业生涯和研究目标。肺部和重症监护医学部和约翰霍普金斯大学在支持和合作的环境中培养成功的年轻临床研究人员有着悠久的历史。COPDgene和SPIROMICS研究的现有结构、这项申请的父母研究以及申请者与这些组织建立和正在进行的合作，将确保在本奖项的时间框架内完成研究目标。我们组建了一支由资深教师组成的指导团队，他们拥有多年的富有成效的研究经验和丰富的先前指导经验。在与这一提议相关的研究领域，每个国家都有不同的、互补的优势。此外，指导委员会的每一名成员都是申请者职业发展成为独立调查员的优秀榜样。