Characterizing Asthma Sputum Elasticity in the UCSF Severe Asthma Research Program (CAESAR)
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|ClinicalTrials.gov Identifier: NCT02103348|
Recruitment Status : Recruiting
First Posted : April 3, 2014
Last Update Posted : June 25, 2019
|Condition or disease|
Asthma is a heterogeneous disease characterized by airway hyperreactivity and chronic airway inflammation. Published literature from the last few years has shown that asthma does not behave like a single disease but is more of a syndrome with vast heterogeneity in pathogenesis, severity, and treatment response. Various clinical phenotypes and endotypes have been described that advance our understanding of these differences and the mechanisms underlying them. We propose there is a subgroup of asthmatic patients that have sputum with abnormal biophysical properties. Healthy airway mucus is composed of a lightly cross-linked gel that is easily transported by the mucociliary apparatus, coughed and expectorated or swallowed. Pathologic mucus has, in contrast, abnormally high elasticity. This is due to a more cross linked structure which gives the sputum the properties of solid and makes sputum difficult to mobilize. Increased sputum elasticity makes expectoration of sputum more difficult and leads to airflow obstruction. Pathologic mucus contributes to airflow obstruction and airway infection in multiple lung diseases, including asthma. Mucus plugs are a particular problem in asthmatic patients with allergic bronchopulmonary aspergillosis (ABPA)The identification of phenotype of severe asthma with pathologic mucus contributing to disease severity may change how we think about severe asthma, moving towards therapies targeting mucus clearance such as in other conditions such as cystic fibrosis. Pathologic mucus in severe asthma is characterized by cellular inflammation, high concentrations of mucins and DNA polymers. Knowledge of specific cellular and biochemical constituents of pathologic mucus in severe asthma can guide targeted mucolytic treatment with n-acetylcysteine, rhDNAse, or novel mucolytic agents.
As part of the Severe Asthma Research Program (SARP), UCSF is in a unique position to recruit a large number of severe asthmatic subjects within which we expect a portion will demonstrate high sputum elasticity. We will also through CAESAR recruit additional subjects with moderate to severe airflow obstruction. We will perform rheological measurement on all subjects that are recruited to our site and from this identify a group of asthmatic cases that have an elastic modulus of ≥1 or <1 and compare properties of sputum from these subjects to healthy controls.
|Study Type :||Observational|
|Estimated Enrollment :||75 participants|
|Official Title:||Characterizing Asthma Sputum Elasticity in the UCSF Severe Asthma Research Program|
|Study Start Date :||September 2015|
|Estimated Primary Completion Date :||April 2020|
|Estimated Study Completion Date :||June 2020|
Those with mild-to-moderate persistent asthma as defined by the NAEPP EPR-3 guidelines.
Major Criteria: (1 required)
Minor Criteria: (2 required)
Those without asthma or other chronic lung disease.
- Lung function [ Time Frame: Cross sectional over 4-6 weeks ]Lung function as a measure of asthma severity.
- Inflammatory cellular markers [ Time Frame: Cross sectional over 4-6 weeks ]Changes in inflammatory cellular markers in sputum and blood. We will measure various indicators of airway inflammation and compare them with various phenotypic characteristics.
- CT Chest [ Time Frame: Cross sectional over 4-6 weeks ]Examining CT chest in asthmatics for evidence of retained mucus.
Biospecimen Retention: Samples With DNA
To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.
Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT02103348
|Contact: Gina M Grayson||415-502-3472||Gina.Evans-Young@ucsf.edu|
|United States, California|
|University of California, San Francisco||Recruiting|
|San Francisco, California, United States, 94143|
|Contact: John V Fahy, M.D. M.Sc 415-502-4849|
|Principal Investigator:||John V Fahy, M.D. M.SC.||University of California, San Francisco|