Asthma is a serious, chronic and potentially life threatening condition affecting an estimated 10 million people in the United States. Prevalence, morbidity and mortality rates have increased dramatically in the last decade. The purpose of this project is to validate analysis of induced sputum as a biological index of the efficacy of comprehensive clinical nursing care provided to adults with asthma.
The specific aims are to (1) correlate the biological markers of airway inflammation in asthmatic adults with clinical measures of airflow obstruction and asthma severity; (2) compare the pattern of change in clinical parameters to the pattern of change in biological markers of airway inflammation; and (3) train the Principal Investigator in the innovative techniques of induced sputum analysis. The long-term objective is to incorporate these biological indices of airway inflammation into an ongoing series of studies of clinical management of asthma. The project will produce pilot data on the correlation of markers of airway inflammation with symptom scores, and peak flow variability in a sample of asthmatic adults. These data will validate use of sputum analysis as clinical endpoint of treatment and support a future study of the most sensitive clinical indicator of airway inflammation. Such information would prove useful in designing management strategies and evaluating patient response to treatment. A prospective, correlational, repeated measures design will be used to study the impact of a comprehensive asthma intervention on biological markers of airway inflammation in induced sputum. A pilot sample of 12 adults with asthma will be recruited and followed for 8 weeks. The clinical intervention includes education about the pathogenesis of asthma, expected actions of prescribed medications, training in peak flow and symptom monitoring, and directions about when to seek urgent care. Induced sputum will be analyzed for cell counts and cell differential, for a permeability marker (albumin), a mediator (eosinophilic cationic protein), and a secretory product (mucin-like glycoprotein) at three points in time after institution of therapy. The constituents in induced sputum will be correlated with clinical and physiologic measures of airflow obstruction (severity of symptoms and peak flow variability) and the pattern of change observed over time.
