Asthma in Older Adults: Identifying Phenotypes and Factors Impacting Outcomes

描述(申请人提供)：哮喘是一种常见的慢性炎症性疾病，以反复发作的症状、呼吸道炎症和可逆性气流收缩为特征。相反，它被认为是各种表型(特征)的集合 只有一种疾病。目前，还没有专门针对患有哮喘的老年人的综合表型，考虑到与这一群体相关的多种因素。不同的哮喘表型和暴露于独特的环境诱因可能会影响老年人的哮喘控制。此外，影响老年人哮喘生活质量的因素尚未被探讨。我们研究的目的是：(1)开发并系统地在老年哮喘患者中实施表型算法；(2)纵向研究哮喘表型和挥发性有机化合物(VOCs)暴露对老年哮喘患者哮喘控制的影响；(3)建立老年哮喘患者哮喘生活质量的预测模型。次级目标是探索从社区为基础到聚集生活环境(例如，辅助生活)对老年人哮喘病程的影响，并确定成功的哮喘药物管理的障碍。190名年龄在60岁或以上的参与者将被招募。纳入标准包括：符合哮喘的标准诊断标准，非吸烟者，没有其他慢性呼吸道疾病，没有居住在熟练的护理机构，以及最近没有重大内科疾病。在基线时，参与者将完成肺量测定、支气管扩张剂反应性、呼出一氧化氮分数、乙酰甲胆碱激发(如果在过去5年内未完成)、过敏反应、免疫球蛋白E(IgE)和痰分析，以及用于评估哮喘控制、生活质量、知识和自我效能的标准化问卷。在30天内，将进行家庭环境评估，以获得关于VOCs、空气颗粒物、湿度、温度、湿度、虫害和哮喘家庭环境清单的数据。在9个月和18个月时，将收集参与者的肺部状况、哮喘控制和哮喘生活质量的家庭数据。在9个月时，参与者还将完成药物管理措施。在18个月后，我们将进行后续的家居环境评估，收集我们在基线收集的相同数据。已经搬到集中生活设施的参与者将被问到关于他们对搬迁对他们哮喘病程的影响的开放式问题。利用因子分析，我们将进行全面的表型表征，其中将包括广泛的人口统计学、哮喘特有的知识和自我效能以及生物标志物。哮喘控制和哮喘生活质量的预测模型将使用广义线性混合效应建模来确定。调查结果： 这项研究将用于未来的研究，以开发和测试以患者为中心的干预措施对老年哮喘患者的效果，以改善哮喘控制和提高生活质量。

DESCRIPTION (provided by applicant): Asthma is a common chronic inflammatory disorder of the distal airways characterized by recurring symptoms, airway inflammation, and reversible airflow constriction. It is considered a collection of various phenotypes (characteristics) instead of a single disease. Currently, there is no comprehensive phenotyping specific to older adults with asthma that considers multiple factors relevant to this population. Divergent asthma phenotypes and exposure to unique environmental triggers may affect asthma control in the elderly. In addition, factors contributing to asthma quality of life in the elderly have not been wll explored. The aims of our study are to: (1) develop and systematically implement a phenotyping algorithm in older adults with asthma; (2) longitudinally investigate the effects of asthma phenotypes and volatile organic compounds (VOCs) exposures on asthma control in older adults with asthma; and (3) develop a predictive model for asthma quality of life for older adults with asthma. Sub-aims are to explore the impact on moving from community-based to congregate living settings (e. g, assisted living) on the course of asthma in older adults and to identify barriers to successful asthma medication management. One hundred ninety participants 60 years of age or older will be enrolled. Inclusion criteria are: meet standard diagnostic criteri for asthma, non-smokers, have no other chronic respiratory diseases, do not reside in a skilled nursing facility, and have not recently had a major a medical illness. At baseline, participants wil complete spirometry bronchodilator responsiveness, fractional exhaled nitric oxide, methacholine challenge (if not completed within past 5 years), allergic sensitization, Immunoglobulin E (IgE), and sputum analysis, as well as standardized questionnaires to assess asthma control, quality of life, knowledge, and self-efficacy. Within 30 days, an in-home environmental assessment will be conducted to obtain data on VOCs, air particulates, moisture, temperature, humidity, pests, and an asthma home environment checklist. At 9 and 18 months, in-home data will be collected on participants' pulmonary status, asthma control, and asthma quality of life. At 9-months, participants will also complete the measures of medication management. At 18-months, we will conduct follow-up in-home environmental assessments collecting the same data we collected at baseline. Participants who have moved to congregate living facilities will be asked open-ended questions about their perception of the effects of the move on the course of their asthma. Using factor analysis, we will perform a comprehensive phenotypic characterization that will include a wide range of demographics, asthma-specific knowledge and self-efficacy, and biomarkers. Predictive models for asthma control and asthma quality of life will be identified using generalized linear mixed-effects modeling. The findings of this study will be used in future research to develop and test the efficacy of patient-centered interventions for older adults with asthma to improve asthma control and enhance quality of life.