Biomarkers of Irritant-Induced and Allergic Asthma

This study will have two asthma phenotypes and one control population. Patients will be recruited from the WTC EHC = 30 with WTC dust cloud exposure, patients will be recruited from the NYUBAR (n=30) and have asthma as defined by NIH guidelines, and control patients will be recruited from the NYUBAR (n=30) and will have no respiratory sx, no asthma diagnosis, or no WTC dust exposure.

The study will entail two to three visits. On visit 1 (V1) all individuals will sign informed consent to participate in the study under an NYU IRB approved protocol. A questionnaire will be completed with standardized questions that include information on WTC exposures, demographics, presence and severity of respiratory symptoms, tobacco history and past medical history. Individuals will undergo spirometry with inhaled bronchodilator. Individuals will undergo methacholine challenge test (visit 1a) if they have normal spirometry or no bronchial hyperresponsiveness. On visit 2, individuals will return to undergo ENO, EBC and spirometry with pre and post bronchodilator maneuvers and induced sputum. Blood will be obtained for CBC with differential cell count, and assessment of total IgE and allergen-specific IgE. Blood will also be stored for future analysis of inflammatory markers. Based on experience, there have been individuals unable to produce enough sputum and thus yield too small a number of cells. These individuals are excluded from data analysis. In addition, there will also be subjects who are able to produce sputum and return for repeat sputum testing.

Inclusion criteria

For the WTC population with Irritant-Induced Asthma (IA):

• > 18 years of age*
• Current nonsmoker*
• < 5 pack year (p-y) history of tobacco use*
• Spirometry in the past 6 months or on day of evaluation with a bronchodilator* response of ≥ 12% and 200 ml improvement in FEV*
• Positive methacholine challenge test (decrease in FEV1*

≥ 20% (PC20) after inhalation of < 16 mg/ml of methacholine)

• Inhaled corticosteroid use in previous 1 month or more will be allowed*
• Patients will be recruited from the WTC EHC and will have WTC dust cloud exposure
• New symptoms after 9/11
• Symptoms of wheeze and shortness of breath (> 2x / week) in the 4 weeks before inclusion (persistent symptoms).

Inclusion for Allergic Asthma Population (AA):

• All of the above items with an asterisk (*)
• Patients will be recruited from the NYUBAR or advertisement and will have asthma as defined by NIH guidelines, persistent symptoms, absence of WTC dust exposure.
• Participants who will have completed the Phase I of the study and were able to produce adequate sputum samples.

Inclusion of Control Population:

• Patients will be recruited from the NYUBAR and will have no respiratory symptoms, no asthma diagnosis, no WTC dust exposure, no current tobacco use, ≤ 5 p-y history of tobacco use, and normal spirometry with no bronchodilator response and negative methacholine challenge in past 6 months.

Inclusion criteria

for Phase II:

• Successfully completed Phase I
• Has asthma according to Phase I diagnostic criteria
• Signed consent to be re-contacted

Exclusion criteria

• Current Smoker
• Pulmonary diseases such as Chronic Pulmonary Disease (COPD) or Interstitial Lung Disease
• Cardiac Disease
• Inability to perform lung function or other maneuvers
• Upper respiratory tract infection within the last 4 weeks
• FEV1 <60% predicted normal pre-bronchodilator
• Oral corticosteroid treatment within the last 4 weeks.
• No vulnerable subjects will be part of this study.