First-Of-Its Kind Research Examines the Relationship Between Asthma Control and Depression
$3.4 Million Study to Understand Why Older Adults Have Worse Asthma Outcomes
Asthma is underdiagnosed and undertreated in older Americans, leading to poor outcomes. Older patients who have both asthma and depression are twice as likely to have an asthma-related hospitalization as those without depression. In light of this, physician-researchers at the Icahn School of Medicine at Mount Sinai, Montefiore Health System and Albert Einstein College of Medicine are launching the first study to examine the relationships between asthma-related inflammation, adherence to treatment, and major depression in older adults, with the goal to improve care and quality of life for this vulnerable population.
The $3.4 million National Heart, Lung and Blood Institute-funded research is one of the largest studies ever conducted on asthma in the aged. The socio-demographics of the population in this study mirror those of most urban cities in the United States.
The study will enroll 400 English- and Spanish-speaking adults over 60 who have persistent asthma and are receiving an asthma-control medication. Half of the participants will have major depression. Following the initial assessment, they will be followed at 6, 12, and 18 months with repeated assessments of depression, inflammation, and medication adherence. The four-year study will launch this September.
Previous studies have linked depression with changes in inflammation, but how and why this happens is unknown. Asthma and aging are also characterized by increased inflammation of the airway and blood, so it is believed that depression can exacerbate these inflammatory changes and contribute to worse clinical outcomes.
“Asthma in older patients is largely understudied and a major unmet medical need,” said Paula J. Busse, MD, Associate Professor of Medicine (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 is 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, MD, DrPH, Chief of the Division of General Internal 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.”
“People with asthma and depression are impacted in two ways—they have greater inflammation of the lung’s airways and are less likely to take their daily controller medications, which are the first line of defense,” said Jonathan Feldman, PhD, Associate Professor of Pediatrics (Academic General Pediatrics), Albert Einstein College of Medicine. “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.”
Previous studies by this team of researchers found that inner-city older adults with asthma had:
- A 36 percent rate of depressive symptoms.
- Worse asthma control and quality of life scores, particularly among minorities.
- Rates of adherence to asthma-control medications as low as 50 percent, even following asthma-related hospitalizations.
Controlling asthma in this population also has implications for the entire U.S. health care system. A nationwide database for emergency department visits between 2006 and 2008 shows that people ages 55 and older who visited the emergency department for asthma had higher rates of related hospitalizations, longer stays, and more near-fatal asthma events. Among the aged, incidents have been tied to cognitive impairment, not avoiding asthma triggers such as smoking, and diminished physical capacity to properly use inhalers.
About Montefiore Health System
Montefiore Health System is one of New York’s premier academic health systems and is a recognized leader in providing exceptional quality and personalized, accountable care to approximately three million people in communities across the Bronx, Westchester and the Hudson Valley. It is comprised of 10 hospitals, including the Children’s Hospital at Montefiore, Burke Rehabilitation Hospital and more than 200 outpatient ambulatory care sites. The advanced clinical and translational research at its medical school, Albert Einstein College of Medicine, directly informs patient care and improves outcomes. From the Montefiore-Einstein Centers of Excellence in cancer, cardiology and vascular care, pediatrics, and transplantation, to its preeminent school-based health program, Montefiore is a fully integrated healthcare delivery system providing coordinated, comprehensive care to patients and their families. For more information please visit www.montefiore.org. Follow us on Twitter and view us on Facebook and YouTube.
About Albert Einstein College of Medicine
Albert Einstein College of Medicine is one of the nation’s premier centers for research, medical education and clinical investigation. During the 2018-2019 academic year, Einstein is home to 711 M.D. students, 160 Ph.D. students, 107 students in the combined M.D./Ph.D. program, and 265 postdoctoral research fellows. The College of Medicine has more than 1,800 full-time faculty members located on the main campus and at its clinical affiliates. In 2018, Einstein received more than $172 million in awards from the National Institutes of Health (NIH). This includes the funding of major research centers at Einstein in aging, intellectual development disorders, diabetes, cancer, clinical and translational research, liver disease, and AIDS. Other areas where the College of Medicine is concentrating its efforts include developmental brain research, neuroscience, cardiac disease, and initiatives to reduce and eliminate ethnic and racial health disparities. Its partnership with Montefiore, the University Hospital and academic medical center for Einstein, advances clinical and translational research to accelerate the pace at which new discoveries become the treatments and therapies that benefit patients. Einstein runs one of the largest residency and fellowship training programs in the medical and dental professions in the United States through Montefiore and an affiliation network involving hospitals and medical centers in the Bronx, Brooklyn and on Long Island. For more information, please visit www.einstein.yu.edu, read our blog, follow us on Twitter, like us on Facebook, and view us on YouTube.
About the Mount Sinai Health System
The Mount Sinai Health System is New York City's largest academic medical system, encompassing eight hospitals, a leading medical school, and a vast network of ambulatory practices throughout the greater New York region. Mount Sinai is a national and international source of unrivaled education, translational research and discovery, and collaborative clinical leadership ensuring that we deliver the highest quality care—from prevention to treatment of the most serious and complex human diseases. The Health System includes more than 7,200 physicians and features a robust and continually expanding network of multispecialty services, including more than 400 ambulatory practice locations throughout the five boroughs of New York City, Westchester, and Long Island. The Mount Sinai Hospital is ranked No. 14 on U.S. News & World Report's "Honor Roll" of the Top 20 Best Hospitals in the country and the Icahn School of Medicine as one of the Top 20 Best Medical Schools in country. Mount Sinai Health System hospitals are consistently ranked regionally by specialty and our physicians in the top 1% of all physicians nationally by U.S. News & World Report.