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

摘要 2019冠状病毒（COVID-19）全球大流行是个人关注的重要原因 慢性呼吸道疾病，包括哮喘。据估计，超过60%的成年人 哮喘患者的症状不受控制，这对健康和经济造成了重大影响。 与儿童相比，成年人死于哮喘和哮喘相关疾病的可能性高出近五倍。 65岁及以上的人死亡率最高。病毒感染是一个突出的危险因素， 哮喘恶化，因此，SARS-CoV-2，导致COVID-19的病毒，是引起人们恐慌的原因。 被诊断为哮喘的人。就地庇护命令和建议、身体距离、穿戴 面部覆盖物、手部卫生以及加强清洁和消毒是COVID-19的主要预防措施 提倡的措施。家庭预防COVID-19策略的效果特别增加 成人哮喘患者的住宅暴露于清洁/消毒剂和颗粒物的情况尚不清楚。我们 长期目标是描述COVID-19对现有哮喘风险因素的影响， 量身定制的、以家庭为基础的哮喘干预措施，充分认识到COVID-19，并对 改变家居环境及日常生活。本研究的目的是：1） 确定可行性和可用性：（a）生态瞬时评估（EMA），以评估自我报告 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[VOC]、颗粒物[PM2.5]）和肺功能（家庭肺量计）; 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，2 B）评估 哮喘控制水平，如自我报告的哮喘症状和肺功能所示;以及3）探索 居民环境暴露的自我报告和客观测量与自我报告的 和哮喘控制的客观措施。我们将招募50名成年哮喘患者， 在线COVID-19和哮喘调查，表示愿意为未来的研究联系，报告高 使用消毒剂/清洁产品，哮喘控制不佳。参与者将获得一个室内 空气质量监测仪和家用肺活量计分别测量VOCs、PM2.5和FEV1%。EMA将 使用个人智能手机和EMA软件平台收集。参加者的申请将按计划发送， 随机EMA通知，以评估哮喘症状、环境暴露、肺功能和缓解措施 战略布局在14天的数据收集期后，参与者将回答与 可接受性、适当性和可行性。本可行性研究的结果将支持一项有把握度的研究 应对与COVID-19相关的环境暴露的影响，并加强防范 通过为哮喘患者制定创新的干预策略来预防未来的传染病爆发。

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.