# Depression in Older Asthmatics: Understanding Inflammatory and Behavioral Pathways

> **NIH NIH R01** · ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI · 2021 · $826,025

## Abstract

The overall objective of this study is to investigate the biological and behavioral pathways linking depression
with asthma outcomes in older adults. Major depression (MD) is highly prevalent among older asthmatics,
particularly in minorities, and is associated with increased asthma morbidity. MD leads to enhanced systemic
inflammation (increased levels of interleukin [IL]-1, IL-2, IL-6, and tumor necrosis factor-α). Some of these
pro-inflammatory cytokines have been linked to more severe asthma phenotypes, potentially explaining the
relationship between MD and worse asthma outcomes. However, biological pathways are likely only part of the
drivers of asthma morbidity. Prior studies show that depression is consistently linked with low medication
adherence in other chronic diseases. Additionally, theory and limited empirical evidence suggest that cognitive
and emotional illness representations in depressed patients may lead to maladaptive coping strategies that
result in low adherence to asthma self-management behaviors (SMB) and poorer outcomes in older adults.
This proposal brings together a multidisciplinary team of investigators to expand understanding of the
pathways through which MD is associated with increased asthma morbidity. The Specific Aims are to: 1)
Determine the relationship of MD with airway and systemic inflammation in older asthma patients and evaluate
the longitudinal association with outcomes and 2) Establish the longitudinal association between MD and
adherence to asthma SMB (medication adherence, trigger avoidance, and inhaler technique) among older
adults and identify the behavioral pathways linking them. We will use structural equation modeling to assess an
integrated model of the direct and indirect causal inflammatory and behavioral pathways, explore the
directionality of relationships in this biobehavioral model, and evaluate the contributions of specific pathways to
asthma outcomes in older patients with MD. We will conduct a longitudinal study of 400 English and Spanish-
speaking older adults (≥60 years) with persistent asthma (~50% with MD) recruited from 3 racially diverse
practices in New York City. Study subjects will undergo a comprehensive in-person baseline evaluation of their
asthma and will be assessed for current MD disorder using the gold standard for psychiatric interviews. We will
also collect peripheral blood and induced sputum for airway cytokine and cellular expression assessments.
Participants will be monitored for 4 weeks to obtain objective assessment of asthma medication adherence
using an electronic device. Subjects will be followed prospectively at 6, 12 and 18 months with repeated
assessments of MD, systemic inflammatory markers, SMB, illness and medication beliefs, and asthma
outcomes. Using these data, we will evaluate the interplay of biological and behavioral pathways underlying
the relationship of MD with increases in asthma morbidity in older adults. The clinical implications of this study
...

## Key facts

- **NIH application ID:** 10164846
- **Project number:** 5R01HL142749-03
- **Recipient organization:** ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI
- **Principal Investigator:** PAULA J BUSSE
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $826,025
- **Award type:** 5
- **Project period:** 2019-06-01 → 2023-04-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10164846

## Citation

> US National Institutes of Health, RePORTER application 10164846, Depression in Older Asthmatics: Understanding Inflammatory and Behavioral Pathways (5R01HL142749-03). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10164846. Licensed CC0.

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