FIRST-OF-ITS KIND RESEARCH EXAMINES THE RELATIONSHIP BETWEEN ASTHMA RATES, DISEASE CONTROL AND DEPRESSION
August 13, 2019, NEW YORK - Asthma is underdiagnosed and undertreated in older Americans, leading to poor outcomes. Older asthma patients who also suffer from depression have double the rates of hospitalization than those without depression. Physician-researchers from premier academic health systems Montefiore and Mount Sinai, as well as Albert Einstein College of Medicine and the Icahn School of Medicine at Mount Sinai, are launching a first-of-its kind study to examine the relationships between asthma-related inflammation, adherence to treatment, and major depression in older adults, with the goal of improving care and quality of life for this vulnerable population.
Previous studies have linked depression and inflammation, but how and why they are linked remains unknown. Asthma and aging are also characterized by inflammation, and therefore depression can potentially exacerbate these inflammatory changes and contribute to worse clinical outcomes.
“People with asthma and depression are impacted in two ways—they have greater inflammation of the lungs’ airways and are less likely to take their daily controller medications, which are the first line of defense,” said Jonathan Feldman, Ph.D., associate professor of pediatrics, Division of Academic General Pediatrics, Einstein and the Children’s Hospital at Montefiore. “We know that depression leads to worse outcomes in patients with asthma, so we want to take a closer look at what is happening—both emotionally and physiologically.”
The $3.4 million National Heart Lung and Blood Institute-funded research is one of the largest studies ever conducted on asthma in the elderly. The socio-demographics of the population in this study mirror most urban cities in the United States.
Previous studies conducted by this team of researchers found that inner-city older adults with asthma had:
·A 36% higher rate of depressive symptoms,
·Worse asthma control and quality of life scores, particularly among minorities,
·Rates of adherence to asthma controller medications as low as 50%, even following asthma-related hospitalizations.
There are also negative implications for the entire U.S. healthcare system. A nationwide database for emergency department visits between 2006 and 2008, found that people 55 and older who visited the emergency department for asthma, had higher rates of related hospitalizations, longer stays and more near-fatal asthma events.
“Asthma in older patients is largely understudied and a major unmet medical need,” said Paula J. Busse, M.D., associate professor of medicine, Division of Clinical Immunology, at Icahn School of Medicine at Mount Sinai. “Older, compared to younger patients with asthma, tend to have worse outcomes including higher rates of morbidity and mortality from their disease. Furthermore, asthma in older patients is often not recognized and undertreated. This funding allows us to investigate the underlying inflammation in older patients with asthma, which is not well characterized, and how it can be altered by depression. This knowledge can translate to new approaches of asthma therapy in the aged, and document the need for developing a multidisciplinary treatment approach for this vulnerable patient population.”
“We have put together a multidisciplinary team of experts in psychology, behavioral medicine, chronic disease self-management, and inflammation to disentangle the mechanisms underlying the relationship between depression and worse asthma outcomes,” said Juan Wisnivesky, M.D., professor of medicine and pulmonary medicine at Icahn School of Medicine at Mount Sinai. “Our study may identify novel targets for asthma therapy as well as help develop behavioral interventions for self-management.”
The study will enroll 400 English and Spanish-speaking adults over 60 with persistent asthma who are receiving an asthma controller medication. Half of the study participants will have major depression. Following the initial assessment, they will be followed at six, 12 and 18 months with repeated assessments of depression, inflammation, and medication adherence. The four-year study will launch this September 2019.