The Changing COVID-19 Landscape: A Feasibility Study to Capture Momentary Residential Environmental Exposures and Asthma Sypmtoms in Adults

ABSTRACT The global pandemic of coronavirus 2019 (COVID-19) is a substantial cause for concern among individuals with chronic respiratory diseases, including those with asthma. It is estimated that more than 60% of adults with asthma have uncontrolled symptoms and this represents a substantial health and economic impact. Compared to children, adults are nearly five times more likely to die from asthma and the asthma-related death rate is highest among those 65 years and older. Viral infections are a prominent risk factor for asthma exacerbation and, thus, SARS-CoV-2, the virus responsible for COVID-19, is cause for alarm among those diagnosed with asthma. Sheltering-in-place orders and recommendations, physical distancing, wearing face coverings, hand hygiene, and increased cleaning and disinfecting are primary COVID-19 preventative measures advocated. The effects of home-based strategies to prevent COVID-19, specifically increased residential exposure to cleaning/disinfecting agents and particulates on adults with asthma is unknown. Our long term goal is to characterize the impact of COVID-19 on existing asthma risk factors so as to develop tailored, home-based asthma interventions that adequately acknowledge COVID-19 and are responsive to the changing home environment and home routines resulting from this pandemic. The aims of this study are: 1) determine the feasibility and usability of: (a) ecological momentary assessment (EMA) to assess self-report residential environmental exposures and asthma symptoms, (b) home monitoring of objective environmental exposures (total volatile organic compounds [VOCs], particulates [PM2.5]), and lung function (home spirometry); 2a) assess the frequency and degree of residential environmental exposures (e.g., disinfectants/cleaners, second-hand smoke) via (a) self-reported data, and (b) home monitoring objective measures, 2b) assess the level of asthma control as indicated by self-reported asthma symptoms and lung function; and 3) explore associations of self-reported and objective measures of residential environmental exposures with self-reported and objective measures of asthma control. We will recruit 50 adults with asthma who completed our ongoing online COVID-19 and asthma survey, indicated willingness to be contacted for future studies, reported high use of disinfectant/cleaning products, and have not-well controlled asthma. Participants will receive an indoor air quality monitor and a home spirometer to measure VOCs, PM2.5, and FEV1% respectively. EMA will be collected using a personal smartphone and EMA software platform. Participants' will be sent scheduled and random EMA notifications to assess asthma symptoms, environmental exposures, lung function, and mitigation strategies. After the 14-day data collection period, participants will respond to survey items related acceptability, appropriateness, and feasibility. Findings from this feasibility study will support a powered study to address the impact of environmental exposures related to COVID-19 and to enhance preparedness for future infectious disease outbreaks by developing innovative intervention strategies for those with asthma.