Older patients with asthma are an underserved population, and new research will seek answers to why these patients often experience such poor outcomes.
“Their disease tends to be severe. They end up in the hospital or have frequent ER visits,” says Paula Busse, MD, associate professor at Icahn School of Medicine at Mount Sinai in New York City. “Asthma in older adults is not as well understood as it is in kids or younger patients. We want to look at depression and see if that’s why they are having worse asthma.”
When people are depressed, it affects an inflammatory component. “Their cytokines in the blood could be altered,” she adds. “We want to know if this alteration is why asthma may be worse in older patients.”
Cytokines, which are polypeptides, include those that are involved in acute inflammation. Some play important roles in mediating acute inflammatory reactions. “We know, clinically, that depression makes asthma worse in older patients,” Busse says. “We saw some preliminary data that some cytokines in asthma patients were changed.” There also might be changes in inflammation with asthma and depression in younger patients, but it is not well studied, she adds.
The creators of the recently launched, four-year study will enroll 400 adults older than age 60 with persistent asthma and are receiving an asthma control medication. Half of those enrolled also will have been diagnosed with major depression. The study participants will be assessed at six, 12, and 18 months for depression, inflammation, and medication adherence.
“We’ll follow patients over time and get repeated markers for depression through validated reports,” Busse says. “We’ll also collect sputum to look at cells in the airway, and we’ll do that over time.”
Adults with asthma include people who had the disease their entire life, as well as some people who developed it later in life. “Some had it as a kid and it went away and then came back later,” Busse says. “These patients tend to have a lot of frequent visits to the emergency room or hospitalization. They also have a lot of other comorbid diseases, such as heart failure, diabetes, and depression.”
The study will check patients’ well-being and their adherence to medication. “We’re focusing on things that may not be traditionally addressed, such as mood,” Busse says.
There are a variety of ways that depression can worsen a person’s asthma, she says. “If we don’t have proper medication for targeting their medication, or if patients don’t understand the importance of the medication or if they have comorbid conditions, it can make it worse,” Busse says.
“We want to see if there is a link between asthma and depression and worsening conditions,” she adds. “We want to see if depression could be treated and modified that could help with asthma in this population.”