Air Pollution, Asthma and Circadian Clocks

Inclusion criteria

• >18 years of age,
• Physician's diagnosis of asthma,
• Prescribed an inhaled-steroid-containing medication for asthma (ensuring the patient is believed to have at least moderate reversible airways obstruction by their physician),
• severe persistent asthma according to the NHLBI Guidelines,
• evidence of reversible airflow obstruction: (a) forced expiratory volume in 1 second (FEV1) <80% predicted at the time of or within 3 years of screening, and (b) improvement with bronchodilator: either (i) an increase of ≥15% and 200mL in FEV1 with asthma treatment over the previous 3 years or (ii) after 4 puffs of albuterol by MDI (or 2.5 mg by nebulizer), an increase in FEV1 or FVC ≥12% and 200 mL in FEV1 within 30 min at screening,
• Own a smartphone.

Exclusion criteria

• Severe psychiatric or cognitive problems (obvious mania, schizophrenia, significant mental retardation) making study conduct impossible. Formal psychiatric evaluations are outside of the scope; however, research coordinators will be trained to identify such cases followed by review of the PI. Patients can be referred to mental health facilities.
• Past diagnosis of gastroesophageal reflux disease or obstructive sleep apnea,
• Transmeridian travel across ≥2 time zones in the past month,
• Planned transmeridian travel across more than ≥2 time zones during the planned study activities;
• Use of oral or intravenous antibiotics in the past 6 months,
• Episodes of bronchospasm in response to ultrasonic nebulizer treatment (to induce sputum collection non-invasively),
• Any contraindication listed below in the separate paragraph "Contraindications for the use of CorTemp® Disposable Temperature Sensors";
• Subjects, who have received an experimental drug, used an experimental medical device within 30 days prior to screening, or who gave a blood donation of ≥ one pint within 8 weeks prior to screening;
• > 2 drinks of alcohol per day;
• Use of illicit drugs;
• Smoking;
• Pregnant or nursing;
• Avoid over-the-counter NSAID use 2 weeks prior to 48 hour session & during 48 hour session (Visit 3, Visit 4 & Visit 5);
• Avoid Alcohol use 2 weeks prior to the 48 hour session and during the 3 day session (Visit 3, Visit 4 & Visit 5);
• Vitamins use 1 week prior to and during the 48 hour session.
• BMI > 30.