NHALES (Natural History of Asthma With Longitudinal Environmental Sampling)

  • STATUS
    Recruiting
  • End date
    Apr 1, 2030
  • participants needed
    400
  • sponsor
    National Institute of Environmental Health Sciences (NIEHS)
Updated on 28 July 2022
corticosteroids
cough
wheezing
forced expiratory volume
atopy
methacholine
allergic asthma
chest tightness
methacholine challenge

Summary

Background
  • Asthma is a serious clinical and public health problem. Researchers want to collect data to better understand how bacteria and other things in the environment can affect people's asthma.
    Eligibility
  • Nonsmoking adults age 18 - 60 who have moderate to severe asthma and are not pregnant or breastfeeding.
    Design
  • Partaicipants will complete a medical history form before the first visit.
  • Study visits will include collecting medical history, and conducting physical exam, lung and smoking tests. Participants will give blood, urine, stool, dust, saliva, and sputum samples.
  • Participants will take tests that measure their breathing abilities. They will give saliva samples for DNA study. They will get kits to collect stool and dust samples at home. They will fill out surveys.
  • Participants will have visits every 6 months for 5 years. They can schedule sick visits, if needed, at no cost to the participant. For all visits, they will have asthma check-ups and get treatment, at no cost to the participant.
  • Some participants may take part in a sub-study that includes one 4-hour visit. They will have medical history, physical exam, and lung tests. They will have urine tests to check for pregnancy and tobacco exposure. Then they will have bronchoscopy. For this, an intravenous line will be placed in an arm vein. The nose and throat will be numbed. A flexible fiber-optic tube will be inserted into their airways through the nose. Their airways will be examined and areas of their lung will be washed. A small sample of cells will be taken.

Description

This study will be a prospective, longitudinal, observational, single-center, exploratory, natural history study to collect samples and data that will enable prospective explorations of the interaction between environmental exposures and disease progression over time in moderate-severe atopic asthmatics with persistent disease, and facilitate the formation of mechanistic hypotheses. Environmental and body microbiome samples will be collected and stored from participants for future correlation to effects on asthma symptoms and control.

Samples of blood, urine, DNA, saliva, sputum, stool, and household dust will be collected from approximately 200 participants, as well as quality of life information using asthma symptom questionnaires and, if consented, through the use of home devices. Additionally, samples will be collected from the airways of participants enrolled in the bronchoscopy visit. The samples and survey information collected may be used to explore the microbiological and genetic influences of atopic asthma. Data from the analyses of these samples and survey responses may be evaluated in the context of the environmental exposures, clinical outcomes (symptoms, exacerbations, and quality of life), and response to therapy.

Male and female participants aged 18 to 60 years old with moderate-severe, symptomatic atopic asthma will be enrolled. Participants will be excluded from enrollment if they have a history of chronic obstructive pulmonary disease, cystic fibrosis, non-cystic fibrosis bronchiectasis, pulmonary fibrosis, pulmonary hypertension, emphysema, sarcoidosis, or unstable angina. Additionally, participants will be excluded if they have DVT, pulmonary

embolism, class III - IV congestive heart failure, or a malignancy under treatment. Current smokers, and individuals who are allergic to methacholine will not be eligible to enroll. Participants will be enrolled for five years and will receive standard of care asthma therapy as indicated. After the initial screening and baseline visits, participants will return for visits semi-annually and for sick visits as needed. Volunteers participating in the bronchoscopy visit will have an additional single visit after completing the baseline visit.

This cohort of 200 participants will form the basis for future asthma study recruitment, and analysis of collected samples and data. Further expansion of the study beyond five years and 200 participants will be desirable if logistically possible.

Details
Condition Asthma
Clinical Study IdentifierNCT02327897
SponsorNational Institute of Environmental Health Sciences (NIEHS)
Last Modified on28 July 2022

Eligibility

Yes No Not Sure

Inclusion Criteria

Participants must meet all of the following criteria for enrollment
Male or female, 18 to 60 years of age
Must have clinical evidence of moderate-severe atopic asthma
self-reported symptoms suggestive of asthma (such as wheezing, chest tightness, shortness of breath, cough nocturnal symptoms)
within the past year, and
-a positive methacholine test confirming diagnosis [provocative concentration causing a
% fall in forced expiratory volume in 1 second (PC20 FEV1) <16 mg/mL for participants on
inhaled corticosteroids and <8 mg/mL for participants not on inhaled corticosteroids] or
postbronchodilator FEV1 with at least 12% or 200 mL increase in FEV1 or forced volume vital
Permanently resides within 50 miles of the CRU
capacity (FVC) on bronchodilator challenge, and
-no other diagnosis that could explain symptoms
Able to receive asthma treatment medication(s) via mail
If there is documentation of a recent methacholine challenge, those results may be used in
lieu of conducting a secondary methacholine challenge
Access to a vacuum cleaner with a detachable hose component
Able to present a valid government issued form of identification for entry to the
NIEHS campus
Willingness to comply with instructions regarding medication regimen, diet, and life
Bronchoscopy Visit Inclusion Criterion
style as directed by the investigator that are required per protocol
If a woman is found to be pregnant or breastfeeding at the screening or baseline
visit, they may continue their participation in the study but will be excluded
from participation in the methacholine challenge and bronchoscopy procedures in
this study while pregnant
In addition to the above inclusion criteria, participants must be able to fast for 6 hours
(no food or drink, except a small amount of water if needed to take approved medications)
prior to the bronchoscopy visit in order to be eligible for enrollment in the bronchoscopy
visit

Exclusion Criteria

piCO Smokealyzer value of >11ppm
Allergy or history of adverse reactions to methacholine
Participants meeting any of the following criteria at screening will not be eligible for
enrollment or to continue with study visits
Bronchoscopy Visit Exclusion Criteria
Current smoker, significant second-hand smoke exposure (defined by urine cotinine >200
ng/mL at screening), or a history of smoking greater than 5 pack years. Smoking
encompasses all inhaled products, including e-cigarettes
History of the following comorbidities: chronic obstructive pulmonary disease, cystic
fibrosis (CF), emphysema, non-CF bronchiectasis, pulmonary fibrosis, sarcoidosis
Bleeding disorders
unstable angina, pulmonary hypertension
Facial deformity, major facial surgery
Any condition that, in the investigator's opinion, places the participant at undue
Severe persistent asthma, defined as by ATS-ERS criteria
risk for complications associated with required study procedures
Allergy or history of adverse reactions to lidocaine
Comorbid diseases that affect global health or survival- such as DVT, pulmonary
embolism, class III - IV congestive heart failure, or a malignancy under treatment
Body weight <50 kg (<110 lbs)
The following abnormal lab values (values obtained during clinical assessment)
In addition to the above exclusion criteria, participants meeting any of the following
Platelet count <100,000 per microliters
criteria will not be eligible for enrollment into the bronchoscopy visit
White blood cells count <3000 per microliters
Pregnancy, as indicated by urine pregnancy test, if of childbearing age and/or ability
Absolute neutrophil count <1000 per microliters
contraindication
Hematocrit <35% for both female and male
Any condition that, in the investigator's opinion, places the participant at undue
risk for complications associated with bronchoscopy
Serum creatinine >1.4 mg/dL
Asthma exacerbation or respiratory infection less than or equal to 4 weeks prior to
study visit
Temperature >37.6 (Infinite)C; blood pressure <90/50 mm Hg or >160/100 mm Hg; pulse
rate <50 or >100 beats/minute
Prothrombin time (PT) / abnormal international normalized ratio (INR) and partial
prothromboplastin time (PTT) based on reference laboratory established reference
ranges
If a participant is recruited for the Bronchoscopy Visit but does not have current lab
values (within 4 weeks), the participant may be asked to return to the CRU for an
additional blood draw in order to run the requisite clinical assessments for safety
purposes. The participant will be compensated for the additional visit. This is anticipated
to be a rare occurrence, as the study team will make all efforts to schedule and complete
the bronchoscopy procedure while the lab results are current
Participants with active bronchospasm on the day of the bronchoscopy will not undergo
bronchoscopy
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