Natural History of Asthma With Longitudinal Environmental Sampling
Background: \- Asthma is a serious clinical and public health problem. Researchers want to collect data to better understand how bacteria and other things in the environment can affect people's asthma.
Eligibility: \- Nonsmoking adults age 18 - 60 who have moderate to severe asthma.
Design: * Participants will complete a medical history form before the first visit. * Study visits will include collecting medical history, and conducting physical exam, lung and smoking tests. Participants will give blood, urine, stool, dust, saliva, and sputum samples. * Participants will take tests that measure their breathing abilities. They will give saliva samples for DNA study. They will get kits to collect stool and dust samples at home. They will fill out surveys. * Participants will have visits every 6 months for 5 years. They can schedule sick visits, if needed, at no cost to the participant. For all visits, they will have asthma check-ups and get treatment, at no cost to the participant. * Some participants may take part in a sub-study that includes one 4-hour visit. They will have medical history, physical exam, and lung tests. They will have urine tests to check for pregnancy and tobacco exposure. Then they will have bronchoscopy. For this, an intravenous line will be placed in an arm vein. The nose and throat will be numbed. A flexible fiber-optic tube will be inserted into their airways through the nose. Their airways will be examined and areas of their lung will be washed. A small sample of cells will be taken.
∙ Participants must meet all of the following criteria for enrollment:
⁃ Male or female, 18 to 60 years of age
⁃ Must have clinical evidence of moderate-severe atopic asthma:
‣ self-reported symptoms suggestive of asthma (such as wheezing, chest tightness, shortness of breath, cough nocturnal symptoms)
∙ within the past year, and
• -\*a positive methacholine test confirming diagnosis \[provocative concentration causing a 20% fall in forced expiratory volume in 1 second (PC20 FEV1) \<16 mg/mL for participants on inhaled corticosteroids and \<8 mg/mL for participants not on inhaled corticosteroids\] or postbronchodilator FEV1 with at least 12% or 200 mL increase in FEV1 or forced volume vital capacity (FVC) on bronchodilator challenge, and
• -no other diagnosis that could explain symptoms.
∙ If there is documentation of a recent methacholine challenge, those results may be used in lieu of conducting a secondary methacholine challenge.
⁃ Permanently resides within 50 miles of the CRU.
⁃ Able to present a valid government issued form of identification for entry to the NIEHS campus
⁃ Able to receive asthma treatment medication(s) via mail
⁃ Willingness to comply with instructions regarding medication regimen, diet, and life style as directed by the investigator that are required per protocol
⁃ Access to a vacuum cleaner with a detachable hose component
‣ If a woman is found to be pregnant or breastfeeding at the screening or baseline visit, they may continue their participation in the study but will be excluded from participation in the methacholine challenge and bronchoscopy procedures in this study while pregnant.
∙ Bronchoscopy Visit Inclusion Criterion
∙ In addition to the above inclusion criteria, participants must be able to fast for 6 hours (no food or drink, except a small amount of water if needed to take approved medications) prior to the bronchoscopy visit in order to be eligible for enrollment in the bronchoscopy visit.