The Changing COVID-19 Landscape: A Feasibility Study to Capture Momentary Residential Environmental Exposures and Asthma Sypmtoms in Adults

摘要 2019年冠状病毒的全球大流行(新冠肺炎)引起个人的极大关注 患有慢性呼吸道疾病，包括哮喘患者。据估计，超过60%的成年人 患有哮喘的人有无法控制的症状，这对健康和经济都有重大影响。 与儿童相比，成年人死于哮喘和哮喘相关疾病的可能性几乎是儿童的五倍 65岁及以上人群的死亡率最高。病毒感染是一个突出的风险因素 哮喘的加剧，以及导致新冠肺炎的SARS-CoV-2病毒，是引起 那些被诊断为哮喘的人。就地避难命令和建议，物理距离，佩戴 面罩、手部卫生以及增加清洁和消毒是新冠肺炎的主要预防措施 提倡的措施。预防新冠肺炎的居家战略的效果，特别是增加了 成人哮喘患者在住宅中接触清洁/消毒剂和微粒的情况尚不清楚。我们的 长期目标是表征新冠肺炎对现有哮喘危险因素的影响，从而发展 量身定做的、基于家庭的哮喘干预措施，充分承认新冠肺炎并对 这场大流行导致的家庭环境和家庭惯例的变化。本研究的目的是：1) 确定：(A)评估自我报告的生态瞬时评估(EMA)的可行性和可用性 住宅环境暴露和哮喘症状，(B)客观环境的家庭监测 暴露(总挥发性有机化合物[VOCs]、颗粒物[PM2.5])和肺功能(家庭肺活量测定)； 2a)评估住宅环境暴露的频率和程度(例如消毒剂/清洁剂、 二手烟)通过(A)自我报告的数据，和(B)家庭监测客观措施，2b)评估 通过自我报告的哮喘症状和肺功能来指示哮喘控制水平；以及3)探索 居住环境暴露的自报和客观测量与自报的关系 以及控制哮喘的客观措施。我们将招募50名哮喘成人，他们完成了我们正在进行的 在线新冠肺炎和哮喘调查显示，愿意被联系进行未来研究，报告说很高 使用消毒剂/清洁用品，并未很好地控制哮喘。参赛者将获得室内 空气质量监测仪和家庭呼吸仪分别测量VOCs、PM2.5和FEV1%。EMA将是 使用个人智能手机和EMA软件平台收集的数据。参与者将按计划发送，并 随机EMA通知以评估哮喘症状、环境暴露、肺功能和缓解 战略。在14天的数据收集期后，参与者将回答相关的调查项目 可接受性、适当性和可行性。这项可行性研究的结果将支持动力研究。 应对与新冠肺炎有关的环境暴露的影响，并加强准备工作 通过为哮喘患者开发创新的干预策略来应对未来的传染病暴发。

ABSTRACT The global pandemic of coronavirus 2019 (COVID-19) is a substantial cause for concern among individuals with chronic respiratory diseases, including those with asthma. It is estimated that more than 60% of adults with asthma have uncontrolled symptoms and this represents a substantial health and economic impact. Compared to children, adults are nearly five times more likely to die from asthma and the asthma-related death rate is highest among those 65 years and older. Viral infections are a prominent risk factor for asthma exacerbation and, thus, SARS-CoV-2, the virus responsible for COVID-19, is cause for alarm among those diagnosed with asthma. Sheltering-in-place orders and recommendations, physical distancing, wearing face coverings, hand hygiene, and increased cleaning and disinfecting are primary COVID-19 preventative measures advocated. The effects of home-based strategies to prevent COVID-19, specifically increased residential exposure to cleaning/disinfecting agents and particulates on adults with asthma is unknown. Our long term goal is to characterize the impact of COVID-19 on existing asthma risk factors so as to develop tailored, home-based asthma interventions that adequately acknowledge COVID-19 and are responsive to the changing home environment and home routines resulting from this pandemic. The aims of this study are: 1) determine the feasibility and usability of: (a) ecological momentary assessment (EMA) to assess self-report residential environmental exposures and asthma symptoms, (b) home monitoring of objective environmental exposures (total volatile organic compounds [VOCs], particulates [PM2.5]), and lung function (home spirometry); 2a) assess the frequency and degree of residential environmental exposures (e.g., disinfectants/cleaners, second-hand smoke) via (a) self-reported data, and (b) home monitoring objective measures, 2b) assess the level of asthma control as indicated by self-reported asthma symptoms and lung function; and 3) explore associations of self-reported and objective measures of residential environmental exposures with self-reported and objective measures of asthma control. We will recruit 50 adults with asthma who completed our ongoing online COVID-19 and asthma survey, indicated willingness to be contacted for future studies, reported high use of disinfectant/cleaning products, and have not-well controlled asthma. Participants will receive an indoor air quality monitor and a home spirometer to measure VOCs, PM2.5, and FEV1% respectively. EMA will be collected using a personal smartphone and EMA software platform. Participants’ will be sent scheduled and random EMA notifications to assess asthma symptoms, environmental exposures, lung function, and mitigation strategies. After the 14-day data collection period, participants will respond to survey items related acceptability, appropriateness, and feasibility. Findings from this feasibility study will support a powered study to address the impact of environmental exposures related to COVID-19 and to enhance preparedness for future infectious disease outbreaks by developing innovative intervention strategies for those with asthma.