51
|
Shah SP, Grunwell J, Shih J, Stephenson S, Fitzpatrick AM. Exploring the Utility of Noninvasive Type 2 Inflammatory Markers for Prediction of Severe Asthma Exacerbations in Children and Adolescents. J Allergy Clin Immunol Pract 2019; 7:2624-2633.e2. [PMID: 31100552 DOI: 10.1016/j.jaip.2019.04.043] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 04/23/2019] [Accepted: 04/25/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Noninvasive markers of type 2 inflammation are needed to identify children and adolescents who might benefit from personalized biologic therapy. OBJECTIVE We hypothesized that blood eosinophil counts would predict 1 or more acute visits for asthma and that prediction could be improved with the addition of a second, noninvasive type 2 inflammatory biomarker. METHODS Children and adolescents 5 to 21 years (N = 589) with an asthma exacerbation necessitating systemic corticosteroid treatment in the previous year completed a characterization visit and telephone calls at 6 and 12 months. The primary outcome was an acute visit for asthma with receipt of systemic corticosteroids. Acute visits were verified by medical record review. Exploratory outcomes included time to first acute visit and hospitalization. RESULTS Acute visits occurred in 106 (35.5%) children and 72 (24.8%) adolescents. Elevated blood eosinophils were associated with increased odds and shorter time to first acute visit, but optimal cut-points differed by age (≥150 vs ≥300 cells/μL for children vs adolescents, respectively). The addition of a second marker of type 2 inflammation did not improve prediction in children, but increased the odds and hazard of an acute visit up to 16.2% and 11.9%, respectively, in adolescents. Similar trends were noted for hospitalizations. CONCLUSIONS Blood eosinophils and other noninvasive markers of type 2 inflammation may be useful in the clinical assessment of children and adolescents with asthma. However, features of type 2 inflammation vary by age. Whether children and adolescents also respond differently to management of type 2 inflammation is unclear and warrants further evaluation.
Collapse
Affiliation(s)
- Samar P Shah
- Department of Pediatrics, Emory University, Atlanta, Ga; Center for Cystic Fibrosis and Airways Disease Research, Children's Healthcare of Atlanta, Atlanta, Ga
| | - Jocelyn Grunwell
- Department of Pediatrics, Emory University, Atlanta, Ga; Center for Cystic Fibrosis and Airways Disease Research, Children's Healthcare of Atlanta, Atlanta, Ga
| | - Jennifer Shih
- Department of Pediatrics, Emory University, Atlanta, Ga; Center for Cystic Fibrosis and Airways Disease Research, Children's Healthcare of Atlanta, Atlanta, Ga
| | | | - Anne M Fitzpatrick
- Department of Pediatrics, Emory University, Atlanta, Ga; Center for Cystic Fibrosis and Airways Disease Research, Children's Healthcare of Atlanta, Atlanta, Ga.
| |
Collapse
|
52
|
Grunwell JR, Giacalone VD, Stephenson S, Margaroli C, Dobosh BS, Brown MR, Fitzpatrick AM, Tirouvanziam R. Neutrophil Dysfunction in the Airways of Children with Acute Respiratory Failure Due to Lower Respiratory Tract Viral and Bacterial Coinfections. Sci Rep 2019; 9:2874. [PMID: 30814584 PMCID: PMC6393569 DOI: 10.1038/s41598-019-39726-w] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 01/23/2019] [Indexed: 12/11/2022] Open
Abstract
Neutrophils are recruited to the airways of patients with acute respiratory distress syndrome (ARDS) where they acquire an activated pro-survival phenotype with an enhanced respiratory burst thought to contribute to ARDS pathophysiology. Our in vitro model enables blood neutrophil transepithelial migration into cell-free tracheal aspirate fluid from patients to recapitulate the primary airway neutrophil phenotype observed in vivo. Neutrophils transmigrated through our model toward airway fluid from children with lower respiratory viral infections coinfected with bacteria had elevated levels of neutrophil activation markers but paradoxically exhibited an inability to kill bacteria and a defective respiratory burst compared with children without bacterial coinfection. The airway fluid from children with bacterial coinfections had higher levels of neutrophil elastase activity, as well as myeloperoxidase levels compared to children without bacterial coinfection. Neutrophils transmigrated into the aspirate fluid from children with bacterial coinfection showed decreased respiratory burst and killing activity against H. influenzae and S. aureus compared to those transmigrated into the aspirate fluid from children without bacterial coinfection. Use of a novel transmigration model recapitulates this pathological phenotype in vitro that would otherwise be impossible in a patient, opening avenues for future mechanistic and therapeutic research.
Collapse
Affiliation(s)
- Jocelyn R Grunwell
- Emory University School of Medicine, Department of Pediatrics, Atlanta, GA, USA. .,Children's Healthcare of Atlanta at Egleston, Atlanta, GA, USA.
| | - Vincent D Giacalone
- Emory University School of Medicine, Department of Pediatrics, Atlanta, GA, USA
| | - Susan Stephenson
- Emory University School of Medicine, Department of Pediatrics, Atlanta, GA, USA
| | - Camilla Margaroli
- Emory University School of Medicine, Department of Pediatrics, Atlanta, GA, USA
| | - Brian S Dobosh
- Emory University School of Medicine, Department of Pediatrics, Atlanta, GA, USA
| | - Milton R Brown
- Emory University School of Medicine, Department of Pediatrics, Atlanta, GA, USA
| | - Anne M Fitzpatrick
- Emory University School of Medicine, Department of Pediatrics, Atlanta, GA, USA.,Children's Healthcare of Atlanta at Egleston, Atlanta, GA, USA
| | | |
Collapse
|
53
|
Guilbert TW, Bacharier LB, Mauger DT, Phipatanakul W, Szefler SJ, Boehmer S, Beigelman A, Fitzpatrick AM, Jackson DJ, Baxi SN, Benson M, Burnham CAD, Cabana MD, Castro M, Chmiel JF, Covar R, Daines M, Gaffin JM, Gentile DA, Holguin F, Israel E, Kelly HW, Lazarus SC, Lemanske RF, Ly N, Meade K, Morgan W, Moy J, Olin JT, Peters SP, Pongracic JA, Raissy HH, Ross K, Sheehan WJ, Sorkness C, Teague WG, Thyne S, Martinez FD. Challenges in assessing the efficacy of systemic corticosteroids for severe wheezing episodes in preschool children. J Allergy Clin Immunol 2019; 143:1934-1937.e4. [PMID: 30660645 DOI: 10.1016/j.jaci.2018.10.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 10/11/2018] [Accepted: 10/19/2018] [Indexed: 10/27/2022]
Affiliation(s)
- Theresa W Guilbert
- Department of Pediatrics, University of Cincinnati and Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
| | - Leonard B Bacharier
- Department of Pediatrics, Washington University in St Louis School of Medicine, St Louis, Mo
| | - David T Mauger
- Department of Public Health Sciences, Pennsylvania State University, Hershey, Pa
| | - Wanda Phipatanakul
- Division of Allergy/Immunology, Boston Children's Hospital, Boston, Mass
| | | | - Susan Boehmer
- Department of Public Health Sciences, Pennsylvania State University, Hershey, Pa
| | - Avraham Beigelman
- Department of Pediatrics, Washington University in St Louis School of Medicine, St Louis, Mo
| | | | - Daniel J Jackson
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wis
| | - Sachin N Baxi
- Division of Allergy/Immunology, Boston Children's Hospital, Boston, Mass
| | | | - Carey-Ann D Burnham
- Department of Pathology and Immunology, Washington University in St Louis School of Medicine, St Louis, Mo
| | - Michael D Cabana
- Departments of Medicine and Pediatrics, University of California, San Francisco, San Francisco, Calif
| | - Mario Castro
- Department of Pediatrics, Washington University in St Louis School of Medicine, St Louis, Mo
| | | | - Ronina Covar
- Department of Pediatrics, National Jewish Health, Denver, Colo
| | - Michael Daines
- Arizona Respiratory Center, University of Arizona, Tucson, Ariz
| | - Jonathan M Gaffin
- Division of Respiratory Diseases, Boston Children's Hospital, Boston, Mass
| | - Deborah A Gentile
- Department of Pediatrics, Allegheny General Hospital, Pittsburgh, Pa
| | | | | | - H William Kelly
- Department of Pediatrics, University of New Mexico School of Medicine, Albuquerque, NM
| | - Stephen C Lazarus
- Departments of Medicine and Pediatrics, University of California, San Francisco, San Francisco, Calif
| | - Robert F Lemanske
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wis
| | - Ngoc Ly
- Airway Clinical Research Center, University of California, San Francisco, San Francisco, Calif
| | | | - Wayne Morgan
- Arizona Respiratory Center, University of Arizona, Tucson, Ariz
| | - James Moy
- Stroger Hospital of Cook County Pediatric Services, Chicago, Ill
| | - J Tod Olin
- Department of Pediatrics, National Jewish Health, Denver, Colo
| | | | | | - Hengameh H Raissy
- Department of Pediatrics, University of New Mexico School of Medicine, Albuquerque, NM
| | - Kristie Ross
- Rainbow Babies and Children's Hospital, Cleveland, Ohio
| | - William J Sheehan
- Division of Allergy/Immunology, Boston Children's Hospital, Boston, Mass
| | | | - W Gerald Teague
- University of Virginia School of Medicine, Charlottesville, Va
| | - Shannon Thyne
- Department of Pediatrics, San Francisco General Hospital, San Francisco, Calif
| | | | | |
Collapse
|
54
|
Fitzpatrick AM, Bacharier LB. One step forward, 2 steps back: The enigma of preschool wheeze. J Allergy Clin Immunol 2019; 143:1734-1735. [PMID: 30660640 DOI: 10.1016/j.jaci.2019.01.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 01/02/2019] [Accepted: 01/08/2019] [Indexed: 12/21/2022]
Affiliation(s)
- Anne M Fitzpatrick
- Department of Pediatrics, Emory University, Atlanta, Ga; Children's Healthcare of Atlanta, Atlanta, Ga.
| | | |
Collapse
|
55
|
Fitzpatrick AM, Bacharier LB, Guilbert TW, Jackson DJ, Szefler SJ, Beigelman A, Cabana MD, Covar R, Holguin F, Lemanske RF, Martinez FD, Morgan W, Phipatanakul W, Pongracic JA, Zeiger RS, Mauger DT. Phenotypes of Recurrent Wheezing in Preschool Children: Identification by Latent Class Analysis and Utility in Prediction of Future Exacerbation. J Allergy Clin Immunol Pract 2018; 7:915-924.e7. [PMID: 30267890 DOI: 10.1016/j.jaip.2018.09.016] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 09/11/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Recurrent preschool wheezing is a heterogeneous disorder with significant morbidity, yet little is known about phenotypic determinants and their impact on clinical outcomes. OBJECTIVE Latent class analysis (LCA) was used to identify latent classes of recurrent preschool wheeze and their association with future exacerbations and inhaled corticosteroid (ICS) treatment response. METHODS Data from 5 clinical trials of 1708 children aged 12 to 71 months with recurrent wheezing were merged. LCA was performed on 10 demographic, exposure, and sensitization variables to determine the optimal number of latent classes. The primary outcome was the annualized rate of wheezing exacerbations requiring systemic corticosteroids during the study intervention period; the secondary outcome was the time to first exacerbation. Exploratory analyses examined the effect of daily ICS treatment on exacerbation outcomes. RESULTS Four latent classes of recurrent wheezing were identified; these were not distinguished by current symptoms or historical exacerbations but differed with regard to allergen sensitization and/or exposures. Annualized exacerbation rates (mean ± SEM/year) were 0.65 ± 0.06 for class 1 ("minimal sensitization"), 0.93 ± 0.10 for class 2 ("sensitization with indoor pet exposure"), 0.60 ± 0.07 for class 3 ("sensitization with tobacco smoke exposure"), and 0.81 ± 0.10 for class 4 ("multiple sensitization and eczema") (P < .001). In a research setting of high adherence, daily ICS treatment improved exacerbation rates in classes 2 and 4 but not the other groups. CONCLUSIONS Sensitization and exposure assessments are useful in the prediction of future exacerbation and may identify children most likely to respond favorably to daily ICS treatment.
Collapse
Affiliation(s)
- Anne M Fitzpatrick
- Department of Pediatrics, Emory University, Atlanta, Ga; Children's Healthcare of Atlanta, Atlanta, Ga.
| | | | - Theresa W Guilbert
- Cincinnati Children's Hospital and Medical Center, Cincinnati, Ohio; Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio
| | | | - Stanley J Szefler
- Children's Hospital Colorado, Aurora, Colo; Department of Pediatrics, University of Colorado, Aurora, Colo
| | | | - Michael D Cabana
- Department of Pediatrics, University of California San Francisco, San Francisco, Calif
| | - Ronina Covar
- Department of Pediatrics, National Jewish Health, Denver, Colo
| | - Fernando Holguin
- Department of Pediatrics, University of Pittsburgh, Pittsburgh, Pa
| | | | | | - Wayne Morgan
- Department of Pediatrics, University of Arizona, Tucson, Ariz
| | - Wanda Phipatanakul
- Boston Children's Hospital, Boston, Mass; Department of Pediatrics, Harvard Medical School, Boston, Mass
| | | | - Robert S Zeiger
- Kaiser Permanente, Southern California Region, San Diego, Calif; Department of Pediatrics, University of California San Diego, San Diego, Calif
| | - David T Mauger
- Department of Statistics, Pennsylvania State University, Hershey, Pa
| | | |
Collapse
|
56
|
Grunwell JR, Stephenson ST, Tirouvanziam R, Brown LAS, Brown MR, Fitzpatrick AM. Children with Neutrophil-Predominant Severe Asthma Have Proinflammatory Neutrophils With Enhanced Survival and Impaired Clearance. J Allergy Clin Immunol Pract 2018; 7:516-525.e6. [PMID: 30193935 DOI: 10.1016/j.jaip.2018.08.024] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 08/22/2018] [Accepted: 08/23/2018] [Indexed: 01/13/2023]
Abstract
BACKGROUND Airway neutrophils are abundant in some children with severe asthma, but their functions are poorly understood. OBJECTIVE To characterize that the inflammatory airway environment of children with neutrophil-predominant severe asthma promotes neutrophil survival and disrupts neutrophil-associated innate immune defenses. METHODS Sixty-seven children with severe asthma refractory to high-dose inhaled corticosteroid treatment undergoing bronchoscopy with bronchoalveolar lavage (BAL) for clinical indications were stratified into neutrophil "high" versus "low" groups on the basis of BAL differential counts. Neutrophil activation markers, functional assays, and phenotyping studies were performed, as well as airway macrophage functional assays. Results were compared with those from children with moderate asthma treated with inhaled corticosteroids. RESULTS Children with neutrophil-predominant severe asthma had increased markers of neutrophil activation/degranulation and a greater magnitude of airway proinflammatory cytokine and chemokine release. Primary neutrophils exposed to BAL of these children exhibited greater phagocytic capability and greater neutrophil extracellular trap formation, but a more impaired respiratory burst. Despite greater abundance of airway TGF-β1, the neutrophils were not more apoptotic. Instead, neutrophils had a highly proinflammatory phenotype associated with a number of surface markers that regulate neutrophil activation, recruitment/migration, and granule release. Airway macrophages from children with neutrophil-predominant severe asthma were also more proinflammatory with impaired phagocytosis and increased apoptosis. CONCLUSIONS Children with neutrophil-predominant severe asthma have proinflammatory neutrophils with enhanced survival. Airway macrophages are also proinflammatory and dysfunctional and may contribute to global innate immune impairment. Therapies that target neutrophils and related inflammation may be warranted in this subset of children.
Collapse
Affiliation(s)
- Jocelyn R Grunwell
- Department of Pediatrics, Emory University, Atlanta, Ga; Children's Healthcare of Atlanta, Atlanta, Ga
| | | | | | - Lou Ann S Brown
- Department of Pediatrics, Emory University, Atlanta, Ga; Children's Healthcare of Atlanta, Atlanta, Ga
| | | | - Anne M Fitzpatrick
- Department of Pediatrics, Emory University, Atlanta, Ga; Children's Healthcare of Atlanta, Atlanta, Ga.
| |
Collapse
|
57
|
DeBoer MD, Phillips BR, Mauger DT, Zein J, Erzurum SC, Fitzpatrick AM, Gaston BM, Myers R, Ross KR, Chmiel J, Lee MJ, Fahy JV, Peters M, Ly NP, Wenzel SE, Fajt ML, Holguin F, Moore WC, Peters SP, Meyers D, Bleecker ER, Castro M, Coverstone AM, Bacharier LB, Jarjour NN, Sorkness RL, Ramratnam S, Irani AM, Israel E, Levy B, Phipatanakul W, Gaffin JM, Gerald Teague W. Effects of endogenous sex hormones on lung function and symptom control in adolescents with asthma. BMC Pulm Med 2018; 18:58. [PMID: 29631584 PMCID: PMC5891903 DOI: 10.1186/s12890-018-0612-x] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 03/09/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although pre-puberty asthma is more prevalent in males, after puberty through middle-age, asthma is more prevalent in females. The surge of sex hormones with puberty might explain this gender switch. METHODS To examine the effects of sex hormones on lung function and symptoms with puberty, Tanner stage was assessed in 187 children 6-18 years of age (59% severe) enrolled in the NIH/NHLBI Severe Asthma Research Program (SARP). The effects of circulating sex hormones (n = 68; testosterone, dehydroepiandrosterone sulfate (DHEA-S), estrogen, and progesterone) on lung function and 4 week symptom control (ACQ6) in cross-section were tested by linear regression. RESULTS From pre-/early to late puberty, lung function did not change significantly but ACQ6 scores improved in males with severe asthma. By contrast females had lower post-BD FEV1% and FVC% and worse ACQ6 scores with late puberty assessed by breast development. In males log DHEA-S levels, which increased by Tanner stage, associated positively with pre- and post-BD FEV1%, pre-BD FVC %, and negatively (improved) with ACQ6. Patients treated with high-dose inhaled corticosteroids had similar levels of circulating DHEA-S. In females, estradiol levels increased by Tanner stage, and associated negatively with pre-BD FEV1% and FVC %. CONCLUSIONS These results support beneficial effects of androgens on lung function and symptom control and weak deleterious effects of estradiol on lung function in children with asthma. Longitudinal data are necessary to confirm these cross-sectional findings and to further elucidate hormonal mechanisms informing sex differences in asthma features with puberty. TRIAL REGISTRATION ClinicalTrials.gov registration number: NCT01748175 .
Collapse
Affiliation(s)
- Mark D DeBoer
- University of Virginia School of Medicine, Charlottesville, VA, 22908, USA
| | | | - David T Mauger
- Pennsylvania State University School of Medicine, Hershey, USA
| | - Joe Zein
- Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, USA
| | - Serpil C Erzurum
- Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, USA
| | | | | | - Ross Myers
- Rainbow Babies and Children's Hospital, Cleveland, USA
| | | | - James Chmiel
- Rainbow Babies and Children's Hospital, Cleveland, USA
| | - Min Jie Lee
- Emory University School of Medicine, Atlanta, USA
| | - John V Fahy
- San Francisco School of Medicine, University of California, San Francisco, USA
| | - Michael Peters
- San Francisco School of Medicine, University of California, San Francisco, USA
| | - Ngoc P Ly
- San Francisco School of Medicine, University of California, San Francisco, USA
| | - Sally E Wenzel
- University of Pittsburgh School of Medicine, Pittsburgh, USA
| | - Merritt L Fajt
- University of Pittsburgh School of Medicine, Pittsburgh, USA
| | | | - Wendy C Moore
- Wake Forest University School of Medicine, Winston-Salem, USA
| | | | - Deborah Meyers
- Wake Forest University School of Medicine, Winston-Salem, USA
| | | | - Mario Castro
- Washington University School of Medicine, St. Louis, USA
| | | | | | | | | | - Sima Ramratnam
- University of Wisconsin School of Medicine, Madison, USA
| | - Anne-Marie Irani
- Virginia Commonwealth University School of Medicine, Richmond, USA
| | | | - Bruce Levy
- Harvard University School of Medicine, Boston, USA
| | | | | | - W Gerald Teague
- University of Virginia School of Medicine, Charlottesville, VA, 22908, USA.
| |
Collapse
|
58
|
Jackson DJ, Bacharier LB, Mauger DT, Boehmer S, Beigelman A, Chmiel JF, Fitzpatrick AM, Gaffin JM, Morgan WJ, Peters SP, Phipatanakul W, Sheehan WJ, Cabana MD, Holguin F, Martinez FD, Pongracic JA, Baxi SN, Benson M, Blake K, Covar R, Gentile DA, Israel E, Krishnan JA, Kumar HV, Lang JE, Lazarus SC, Lima JJ, Long D, Ly N, Marbin J, Moy JN, Myers RE, Olin JT, Raissy HH, Robison RG, Ross K, Sorkness CA, Lemanske RF. Quintupling Inhaled Glucocorticoids to Prevent Childhood Asthma Exacerbations. N Engl J Med 2018; 378:891-901. [PMID: 29504498 PMCID: PMC5972517 DOI: 10.1056/nejmoa1710988] [Citation(s) in RCA: 96] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Asthma exacerbations occur frequently despite the regular use of asthma-controller therapies, such as inhaled glucocorticoids. Clinicians commonly increase the doses of inhaled glucocorticoids at early signs of loss of asthma control. However, data on the safety and efficacy of this strategy in children are limited. METHODS We studied 254 children, 5 to 11 years of age, who had mild-to-moderate persistent asthma and had had at least one asthma exacerbation treated with systemic glucocorticoids in the previous year. Children were treated for 48 weeks with maintenance low-dose inhaled glucocorticoids (fluticasone propionate at a dose of 44 μg per inhalation, two inhalations twice daily) and were randomly assigned to either continue the same dose (low-dose group) or use a quintupled dose (high-dose group; fluticasone at a dose of 220 μg per inhalation, two inhalations twice daily) for 7 days at the early signs of loss of asthma control ("yellow zone"). Treatment was provided in a double-blind fashion. The primary outcome was the rate of severe asthma exacerbations treated with systemic glucocorticoids. RESULTS The rate of severe asthma exacerbations treated with systemic glucocorticoids did not differ significantly between groups (0.48 exacerbations per year in the high-dose group and 0.37 exacerbations per year in the low-dose group; relative rate, 1.3; 95% confidence interval, 0.8 to 2.1; P=0.30). The time to the first exacerbation, the rate of treatment failure, symptom scores, and albuterol use during yellow-zone episodes did not differ significantly between groups. The total glucocorticoid exposure was 16% higher in the high-dose group than in the low-dose group. The difference in linear growth between the high-dose group and the low-dose group was -0.23 cm per year (P=0.06). CONCLUSIONS In children with mild-to-moderate persistent asthma treated with daily inhaled glucocorticoids, quintupling the dose at the early signs of loss of asthma control did not reduce the rate of severe asthma exacerbations or improve other asthma outcomes and may be associated with diminished linear growth. (Funded by the National Heart, Lung, and Blood Institute; STICS ClinicalTrials.gov number, NCT02066129 .).
Collapse
Affiliation(s)
- Daniel J Jackson
- From the Department of Pediatrics, University of Wisconsin School of Medicine and Public Health (D.J.J., R.F.L.J.), and the University of Wisconsin-Madison (C.A.S.) - both in Madison; the Department of Pediatrics, Washington University in St. Louis School of Medicine and St. Louis Children's Hospital, St. Louis (L.B.B., A.B.); the Department of Public Health Sciences, Penn State University, Hershey (D.T.M., S.B.), and the University of Pittsburgh Asthma Institute at University of Pittsburgh Medical Center-University of Pittsburgh School of Medicine (F.H.) and the Department of Pediatrics, Allegheny General Hospital (D.A.G.), Pittsburgh - all in Pennsylvania; the Department of Pediatrics, Case Western Reserve University School of Medicine, Rainbow Babies and Children's Hospital, Cleveland (J.F.C., R.E.M., K.R.); the Department of Pediatrics, Emory University, Atlanta (A.M.F.); the Divisions of Respiratory Diseases (J.M.G.) and Allergy-Immunology, Boston Children's Hospital (W.P., W.J.S., S.N.B.), Harvard Medical School, and Brigham and Women's Hospital, Harvard Medical School (E.I.) - all in Boston; the Arizona Respiratory Center, University of Arizona, Tucson (W.J.M., F.D.M.); Wake Forest University School of Medicine, Winston-Salem, NC (S.P.P.); the Departments of Pediatrics (M.D.C., N.L.), Epidemiology (M.D.C.), Biostatistics (M.D.C.), and Medicine (S.C.L.), University of California, San Francisco (UCSF), and UCSF Benioff Children's Hospital (M.D.C.) - both in San Francisco; Ann and Robert H. Lurie Children's Hospital of Chicago (J.A.P., R.G.R.), University of Illinois at Chicago (J.A.K., H.V.K.), and the Department of Pediatrics, Stroger Hospital of Cook County, Rush University Medical Center (J.N.M.) - all in Chicago; UCSF Benioff Children's Hospital Oakland, Oakland (M.B., D.L., J.M.); Nemours Children's Health System, Jacksonville (K.B., J.J.L.), and Nemours Children's Hospital, University of Central Florida College of Medicine, Orlando (J.E.L.) - both in Florida; the Department of Pediatrics, National Jewish Health, Denver (R.C., J.T.O.); and the Department of Pediatrics, University of New Mexico, Albuquerque (H.H.R.)
| | - Leonard B Bacharier
- From the Department of Pediatrics, University of Wisconsin School of Medicine and Public Health (D.J.J., R.F.L.J.), and the University of Wisconsin-Madison (C.A.S.) - both in Madison; the Department of Pediatrics, Washington University in St. Louis School of Medicine and St. Louis Children's Hospital, St. Louis (L.B.B., A.B.); the Department of Public Health Sciences, Penn State University, Hershey (D.T.M., S.B.), and the University of Pittsburgh Asthma Institute at University of Pittsburgh Medical Center-University of Pittsburgh School of Medicine (F.H.) and the Department of Pediatrics, Allegheny General Hospital (D.A.G.), Pittsburgh - all in Pennsylvania; the Department of Pediatrics, Case Western Reserve University School of Medicine, Rainbow Babies and Children's Hospital, Cleveland (J.F.C., R.E.M., K.R.); the Department of Pediatrics, Emory University, Atlanta (A.M.F.); the Divisions of Respiratory Diseases (J.M.G.) and Allergy-Immunology, Boston Children's Hospital (W.P., W.J.S., S.N.B.), Harvard Medical School, and Brigham and Women's Hospital, Harvard Medical School (E.I.) - all in Boston; the Arizona Respiratory Center, University of Arizona, Tucson (W.J.M., F.D.M.); Wake Forest University School of Medicine, Winston-Salem, NC (S.P.P.); the Departments of Pediatrics (M.D.C., N.L.), Epidemiology (M.D.C.), Biostatistics (M.D.C.), and Medicine (S.C.L.), University of California, San Francisco (UCSF), and UCSF Benioff Children's Hospital (M.D.C.) - both in San Francisco; Ann and Robert H. Lurie Children's Hospital of Chicago (J.A.P., R.G.R.), University of Illinois at Chicago (J.A.K., H.V.K.), and the Department of Pediatrics, Stroger Hospital of Cook County, Rush University Medical Center (J.N.M.) - all in Chicago; UCSF Benioff Children's Hospital Oakland, Oakland (M.B., D.L., J.M.); Nemours Children's Health System, Jacksonville (K.B., J.J.L.), and Nemours Children's Hospital, University of Central Florida College of Medicine, Orlando (J.E.L.) - both in Florida; the Department of Pediatrics, National Jewish Health, Denver (R.C., J.T.O.); and the Department of Pediatrics, University of New Mexico, Albuquerque (H.H.R.)
| | - David T Mauger
- From the Department of Pediatrics, University of Wisconsin School of Medicine and Public Health (D.J.J., R.F.L.J.), and the University of Wisconsin-Madison (C.A.S.) - both in Madison; the Department of Pediatrics, Washington University in St. Louis School of Medicine and St. Louis Children's Hospital, St. Louis (L.B.B., A.B.); the Department of Public Health Sciences, Penn State University, Hershey (D.T.M., S.B.), and the University of Pittsburgh Asthma Institute at University of Pittsburgh Medical Center-University of Pittsburgh School of Medicine (F.H.) and the Department of Pediatrics, Allegheny General Hospital (D.A.G.), Pittsburgh - all in Pennsylvania; the Department of Pediatrics, Case Western Reserve University School of Medicine, Rainbow Babies and Children's Hospital, Cleveland (J.F.C., R.E.M., K.R.); the Department of Pediatrics, Emory University, Atlanta (A.M.F.); the Divisions of Respiratory Diseases (J.M.G.) and Allergy-Immunology, Boston Children's Hospital (W.P., W.J.S., S.N.B.), Harvard Medical School, and Brigham and Women's Hospital, Harvard Medical School (E.I.) - all in Boston; the Arizona Respiratory Center, University of Arizona, Tucson (W.J.M., F.D.M.); Wake Forest University School of Medicine, Winston-Salem, NC (S.P.P.); the Departments of Pediatrics (M.D.C., N.L.), Epidemiology (M.D.C.), Biostatistics (M.D.C.), and Medicine (S.C.L.), University of California, San Francisco (UCSF), and UCSF Benioff Children's Hospital (M.D.C.) - both in San Francisco; Ann and Robert H. Lurie Children's Hospital of Chicago (J.A.P., R.G.R.), University of Illinois at Chicago (J.A.K., H.V.K.), and the Department of Pediatrics, Stroger Hospital of Cook County, Rush University Medical Center (J.N.M.) - all in Chicago; UCSF Benioff Children's Hospital Oakland, Oakland (M.B., D.L., J.M.); Nemours Children's Health System, Jacksonville (K.B., J.J.L.), and Nemours Children's Hospital, University of Central Florida College of Medicine, Orlando (J.E.L.) - both in Florida; the Department of Pediatrics, National Jewish Health, Denver (R.C., J.T.O.); and the Department of Pediatrics, University of New Mexico, Albuquerque (H.H.R.)
| | - Susan Boehmer
- From the Department of Pediatrics, University of Wisconsin School of Medicine and Public Health (D.J.J., R.F.L.J.), and the University of Wisconsin-Madison (C.A.S.) - both in Madison; the Department of Pediatrics, Washington University in St. Louis School of Medicine and St. Louis Children's Hospital, St. Louis (L.B.B., A.B.); the Department of Public Health Sciences, Penn State University, Hershey (D.T.M., S.B.), and the University of Pittsburgh Asthma Institute at University of Pittsburgh Medical Center-University of Pittsburgh School of Medicine (F.H.) and the Department of Pediatrics, Allegheny General Hospital (D.A.G.), Pittsburgh - all in Pennsylvania; the Department of Pediatrics, Case Western Reserve University School of Medicine, Rainbow Babies and Children's Hospital, Cleveland (J.F.C., R.E.M., K.R.); the Department of Pediatrics, Emory University, Atlanta (A.M.F.); the Divisions of Respiratory Diseases (J.M.G.) and Allergy-Immunology, Boston Children's Hospital (W.P., W.J.S., S.N.B.), Harvard Medical School, and Brigham and Women's Hospital, Harvard Medical School (E.I.) - all in Boston; the Arizona Respiratory Center, University of Arizona, Tucson (W.J.M., F.D.M.); Wake Forest University School of Medicine, Winston-Salem, NC (S.P.P.); the Departments of Pediatrics (M.D.C., N.L.), Epidemiology (M.D.C.), Biostatistics (M.D.C.), and Medicine (S.C.L.), University of California, San Francisco (UCSF), and UCSF Benioff Children's Hospital (M.D.C.) - both in San Francisco; Ann and Robert H. Lurie Children's Hospital of Chicago (J.A.P., R.G.R.), University of Illinois at Chicago (J.A.K., H.V.K.), and the Department of Pediatrics, Stroger Hospital of Cook County, Rush University Medical Center (J.N.M.) - all in Chicago; UCSF Benioff Children's Hospital Oakland, Oakland (M.B., D.L., J.M.); Nemours Children's Health System, Jacksonville (K.B., J.J.L.), and Nemours Children's Hospital, University of Central Florida College of Medicine, Orlando (J.E.L.) - both in Florida; the Department of Pediatrics, National Jewish Health, Denver (R.C., J.T.O.); and the Department of Pediatrics, University of New Mexico, Albuquerque (H.H.R.)
| | - Avraham Beigelman
- From the Department of Pediatrics, University of Wisconsin School of Medicine and Public Health (D.J.J., R.F.L.J.), and the University of Wisconsin-Madison (C.A.S.) - both in Madison; the Department of Pediatrics, Washington University in St. Louis School of Medicine and St. Louis Children's Hospital, St. Louis (L.B.B., A.B.); the Department of Public Health Sciences, Penn State University, Hershey (D.T.M., S.B.), and the University of Pittsburgh Asthma Institute at University of Pittsburgh Medical Center-University of Pittsburgh School of Medicine (F.H.) and the Department of Pediatrics, Allegheny General Hospital (D.A.G.), Pittsburgh - all in Pennsylvania; the Department of Pediatrics, Case Western Reserve University School of Medicine, Rainbow Babies and Children's Hospital, Cleveland (J.F.C., R.E.M., K.R.); the Department of Pediatrics, Emory University, Atlanta (A.M.F.); the Divisions of Respiratory Diseases (J.M.G.) and Allergy-Immunology, Boston Children's Hospital (W.P., W.J.S., S.N.B.), Harvard Medical School, and Brigham and Women's Hospital, Harvard Medical School (E.I.) - all in Boston; the Arizona Respiratory Center, University of Arizona, Tucson (W.J.M., F.D.M.); Wake Forest University School of Medicine, Winston-Salem, NC (S.P.P.); the Departments of Pediatrics (M.D.C., N.L.), Epidemiology (M.D.C.), Biostatistics (M.D.C.), and Medicine (S.C.L.), University of California, San Francisco (UCSF), and UCSF Benioff Children's Hospital (M.D.C.) - both in San Francisco; Ann and Robert H. Lurie Children's Hospital of Chicago (J.A.P., R.G.R.), University of Illinois at Chicago (J.A.K., H.V.K.), and the Department of Pediatrics, Stroger Hospital of Cook County, Rush University Medical Center (J.N.M.) - all in Chicago; UCSF Benioff Children's Hospital Oakland, Oakland (M.B., D.L., J.M.); Nemours Children's Health System, Jacksonville (K.B., J.J.L.), and Nemours Children's Hospital, University of Central Florida College of Medicine, Orlando (J.E.L.) - both in Florida; the Department of Pediatrics, National Jewish Health, Denver (R.C., J.T.O.); and the Department of Pediatrics, University of New Mexico, Albuquerque (H.H.R.)
| | - James F Chmiel
- From the Department of Pediatrics, University of Wisconsin School of Medicine and Public Health (D.J.J., R.F.L.J.), and the University of Wisconsin-Madison (C.A.S.) - both in Madison; the Department of Pediatrics, Washington University in St. Louis School of Medicine and St. Louis Children's Hospital, St. Louis (L.B.B., A.B.); the Department of Public Health Sciences, Penn State University, Hershey (D.T.M., S.B.), and the University of Pittsburgh Asthma Institute at University of Pittsburgh Medical Center-University of Pittsburgh School of Medicine (F.H.) and the Department of Pediatrics, Allegheny General Hospital (D.A.G.), Pittsburgh - all in Pennsylvania; the Department of Pediatrics, Case Western Reserve University School of Medicine, Rainbow Babies and Children's Hospital, Cleveland (J.F.C., R.E.M., K.R.); the Department of Pediatrics, Emory University, Atlanta (A.M.F.); the Divisions of Respiratory Diseases (J.M.G.) and Allergy-Immunology, Boston Children's Hospital (W.P., W.J.S., S.N.B.), Harvard Medical School, and Brigham and Women's Hospital, Harvard Medical School (E.I.) - all in Boston; the Arizona Respiratory Center, University of Arizona, Tucson (W.J.M., F.D.M.); Wake Forest University School of Medicine, Winston-Salem, NC (S.P.P.); the Departments of Pediatrics (M.D.C., N.L.), Epidemiology (M.D.C.), Biostatistics (M.D.C.), and Medicine (S.C.L.), University of California, San Francisco (UCSF), and UCSF Benioff Children's Hospital (M.D.C.) - both in San Francisco; Ann and Robert H. Lurie Children's Hospital of Chicago (J.A.P., R.G.R.), University of Illinois at Chicago (J.A.K., H.V.K.), and the Department of Pediatrics, Stroger Hospital of Cook County, Rush University Medical Center (J.N.M.) - all in Chicago; UCSF Benioff Children's Hospital Oakland, Oakland (M.B., D.L., J.M.); Nemours Children's Health System, Jacksonville (K.B., J.J.L.), and Nemours Children's Hospital, University of Central Florida College of Medicine, Orlando (J.E.L.) - both in Florida; the Department of Pediatrics, National Jewish Health, Denver (R.C., J.T.O.); and the Department of Pediatrics, University of New Mexico, Albuquerque (H.H.R.)
| | - Anne M Fitzpatrick
- From the Department of Pediatrics, University of Wisconsin School of Medicine and Public Health (D.J.J., R.F.L.J.), and the University of Wisconsin-Madison (C.A.S.) - both in Madison; the Department of Pediatrics, Washington University in St. Louis School of Medicine and St. Louis Children's Hospital, St. Louis (L.B.B., A.B.); the Department of Public Health Sciences, Penn State University, Hershey (D.T.M., S.B.), and the University of Pittsburgh Asthma Institute at University of Pittsburgh Medical Center-University of Pittsburgh School of Medicine (F.H.) and the Department of Pediatrics, Allegheny General Hospital (D.A.G.), Pittsburgh - all in Pennsylvania; the Department of Pediatrics, Case Western Reserve University School of Medicine, Rainbow Babies and Children's Hospital, Cleveland (J.F.C., R.E.M., K.R.); the Department of Pediatrics, Emory University, Atlanta (A.M.F.); the Divisions of Respiratory Diseases (J.M.G.) and Allergy-Immunology, Boston Children's Hospital (W.P., W.J.S., S.N.B.), Harvard Medical School, and Brigham and Women's Hospital, Harvard Medical School (E.I.) - all in Boston; the Arizona Respiratory Center, University of Arizona, Tucson (W.J.M., F.D.M.); Wake Forest University School of Medicine, Winston-Salem, NC (S.P.P.); the Departments of Pediatrics (M.D.C., N.L.), Epidemiology (M.D.C.), Biostatistics (M.D.C.), and Medicine (S.C.L.), University of California, San Francisco (UCSF), and UCSF Benioff Children's Hospital (M.D.C.) - both in San Francisco; Ann and Robert H. Lurie Children's Hospital of Chicago (J.A.P., R.G.R.), University of Illinois at Chicago (J.A.K., H.V.K.), and the Department of Pediatrics, Stroger Hospital of Cook County, Rush University Medical Center (J.N.M.) - all in Chicago; UCSF Benioff Children's Hospital Oakland, Oakland (M.B., D.L., J.M.); Nemours Children's Health System, Jacksonville (K.B., J.J.L.), and Nemours Children's Hospital, University of Central Florida College of Medicine, Orlando (J.E.L.) - both in Florida; the Department of Pediatrics, National Jewish Health, Denver (R.C., J.T.O.); and the Department of Pediatrics, University of New Mexico, Albuquerque (H.H.R.)
| | - Jonathan M Gaffin
- From the Department of Pediatrics, University of Wisconsin School of Medicine and Public Health (D.J.J., R.F.L.J.), and the University of Wisconsin-Madison (C.A.S.) - both in Madison; the Department of Pediatrics, Washington University in St. Louis School of Medicine and St. Louis Children's Hospital, St. Louis (L.B.B., A.B.); the Department of Public Health Sciences, Penn State University, Hershey (D.T.M., S.B.), and the University of Pittsburgh Asthma Institute at University of Pittsburgh Medical Center-University of Pittsburgh School of Medicine (F.H.) and the Department of Pediatrics, Allegheny General Hospital (D.A.G.), Pittsburgh - all in Pennsylvania; the Department of Pediatrics, Case Western Reserve University School of Medicine, Rainbow Babies and Children's Hospital, Cleveland (J.F.C., R.E.M., K.R.); the Department of Pediatrics, Emory University, Atlanta (A.M.F.); the Divisions of Respiratory Diseases (J.M.G.) and Allergy-Immunology, Boston Children's Hospital (W.P., W.J.S., S.N.B.), Harvard Medical School, and Brigham and Women's Hospital, Harvard Medical School (E.I.) - all in Boston; the Arizona Respiratory Center, University of Arizona, Tucson (W.J.M., F.D.M.); Wake Forest University School of Medicine, Winston-Salem, NC (S.P.P.); the Departments of Pediatrics (M.D.C., N.L.), Epidemiology (M.D.C.), Biostatistics (M.D.C.), and Medicine (S.C.L.), University of California, San Francisco (UCSF), and UCSF Benioff Children's Hospital (M.D.C.) - both in San Francisco; Ann and Robert H. Lurie Children's Hospital of Chicago (J.A.P., R.G.R.), University of Illinois at Chicago (J.A.K., H.V.K.), and the Department of Pediatrics, Stroger Hospital of Cook County, Rush University Medical Center (J.N.M.) - all in Chicago; UCSF Benioff Children's Hospital Oakland, Oakland (M.B., D.L., J.M.); Nemours Children's Health System, Jacksonville (K.B., J.J.L.), and Nemours Children's Hospital, University of Central Florida College of Medicine, Orlando (J.E.L.) - both in Florida; the Department of Pediatrics, National Jewish Health, Denver (R.C., J.T.O.); and the Department of Pediatrics, University of New Mexico, Albuquerque (H.H.R.)
| | - Wayne J Morgan
- From the Department of Pediatrics, University of Wisconsin School of Medicine and Public Health (D.J.J., R.F.L.J.), and the University of Wisconsin-Madison (C.A.S.) - both in Madison; the Department of Pediatrics, Washington University in St. Louis School of Medicine and St. Louis Children's Hospital, St. Louis (L.B.B., A.B.); the Department of Public Health Sciences, Penn State University, Hershey (D.T.M., S.B.), and the University of Pittsburgh Asthma Institute at University of Pittsburgh Medical Center-University of Pittsburgh School of Medicine (F.H.) and the Department of Pediatrics, Allegheny General Hospital (D.A.G.), Pittsburgh - all in Pennsylvania; the Department of Pediatrics, Case Western Reserve University School of Medicine, Rainbow Babies and Children's Hospital, Cleveland (J.F.C., R.E.M., K.R.); the Department of Pediatrics, Emory University, Atlanta (A.M.F.); the Divisions of Respiratory Diseases (J.M.G.) and Allergy-Immunology, Boston Children's Hospital (W.P., W.J.S., S.N.B.), Harvard Medical School, and Brigham and Women's Hospital, Harvard Medical School (E.I.) - all in Boston; the Arizona Respiratory Center, University of Arizona, Tucson (W.J.M., F.D.M.); Wake Forest University School of Medicine, Winston-Salem, NC (S.P.P.); the Departments of Pediatrics (M.D.C., N.L.), Epidemiology (M.D.C.), Biostatistics (M.D.C.), and Medicine (S.C.L.), University of California, San Francisco (UCSF), and UCSF Benioff Children's Hospital (M.D.C.) - both in San Francisco; Ann and Robert H. Lurie Children's Hospital of Chicago (J.A.P., R.G.R.), University of Illinois at Chicago (J.A.K., H.V.K.), and the Department of Pediatrics, Stroger Hospital of Cook County, Rush University Medical Center (J.N.M.) - all in Chicago; UCSF Benioff Children's Hospital Oakland, Oakland (M.B., D.L., J.M.); Nemours Children's Health System, Jacksonville (K.B., J.J.L.), and Nemours Children's Hospital, University of Central Florida College of Medicine, Orlando (J.E.L.) - both in Florida; the Department of Pediatrics, National Jewish Health, Denver (R.C., J.T.O.); and the Department of Pediatrics, University of New Mexico, Albuquerque (H.H.R.)
| | - Stephen P Peters
- From the Department of Pediatrics, University of Wisconsin School of Medicine and Public Health (D.J.J., R.F.L.J.), and the University of Wisconsin-Madison (C.A.S.) - both in Madison; the Department of Pediatrics, Washington University in St. Louis School of Medicine and St. Louis Children's Hospital, St. Louis (L.B.B., A.B.); the Department of Public Health Sciences, Penn State University, Hershey (D.T.M., S.B.), and the University of Pittsburgh Asthma Institute at University of Pittsburgh Medical Center-University of Pittsburgh School of Medicine (F.H.) and the Department of Pediatrics, Allegheny General Hospital (D.A.G.), Pittsburgh - all in Pennsylvania; the Department of Pediatrics, Case Western Reserve University School of Medicine, Rainbow Babies and Children's Hospital, Cleveland (J.F.C., R.E.M., K.R.); the Department of Pediatrics, Emory University, Atlanta (A.M.F.); the Divisions of Respiratory Diseases (J.M.G.) and Allergy-Immunology, Boston Children's Hospital (W.P., W.J.S., S.N.B.), Harvard Medical School, and Brigham and Women's Hospital, Harvard Medical School (E.I.) - all in Boston; the Arizona Respiratory Center, University of Arizona, Tucson (W.J.M., F.D.M.); Wake Forest University School of Medicine, Winston-Salem, NC (S.P.P.); the Departments of Pediatrics (M.D.C., N.L.), Epidemiology (M.D.C.), Biostatistics (M.D.C.), and Medicine (S.C.L.), University of California, San Francisco (UCSF), and UCSF Benioff Children's Hospital (M.D.C.) - both in San Francisco; Ann and Robert H. Lurie Children's Hospital of Chicago (J.A.P., R.G.R.), University of Illinois at Chicago (J.A.K., H.V.K.), and the Department of Pediatrics, Stroger Hospital of Cook County, Rush University Medical Center (J.N.M.) - all in Chicago; UCSF Benioff Children's Hospital Oakland, Oakland (M.B., D.L., J.M.); Nemours Children's Health System, Jacksonville (K.B., J.J.L.), and Nemours Children's Hospital, University of Central Florida College of Medicine, Orlando (J.E.L.) - both in Florida; the Department of Pediatrics, National Jewish Health, Denver (R.C., J.T.O.); and the Department of Pediatrics, University of New Mexico, Albuquerque (H.H.R.)
| | - Wanda Phipatanakul
- From the Department of Pediatrics, University of Wisconsin School of Medicine and Public Health (D.J.J., R.F.L.J.), and the University of Wisconsin-Madison (C.A.S.) - both in Madison; the Department of Pediatrics, Washington University in St. Louis School of Medicine and St. Louis Children's Hospital, St. Louis (L.B.B., A.B.); the Department of Public Health Sciences, Penn State University, Hershey (D.T.M., S.B.), and the University of Pittsburgh Asthma Institute at University of Pittsburgh Medical Center-University of Pittsburgh School of Medicine (F.H.) and the Department of Pediatrics, Allegheny General Hospital (D.A.G.), Pittsburgh - all in Pennsylvania; the Department of Pediatrics, Case Western Reserve University School of Medicine, Rainbow Babies and Children's Hospital, Cleveland (J.F.C., R.E.M., K.R.); the Department of Pediatrics, Emory University, Atlanta (A.M.F.); the Divisions of Respiratory Diseases (J.M.G.) and Allergy-Immunology, Boston Children's Hospital (W.P., W.J.S., S.N.B.), Harvard Medical School, and Brigham and Women's Hospital, Harvard Medical School (E.I.) - all in Boston; the Arizona Respiratory Center, University of Arizona, Tucson (W.J.M., F.D.M.); Wake Forest University School of Medicine, Winston-Salem, NC (S.P.P.); the Departments of Pediatrics (M.D.C., N.L.), Epidemiology (M.D.C.), Biostatistics (M.D.C.), and Medicine (S.C.L.), University of California, San Francisco (UCSF), and UCSF Benioff Children's Hospital (M.D.C.) - both in San Francisco; Ann and Robert H. Lurie Children's Hospital of Chicago (J.A.P., R.G.R.), University of Illinois at Chicago (J.A.K., H.V.K.), and the Department of Pediatrics, Stroger Hospital of Cook County, Rush University Medical Center (J.N.M.) - all in Chicago; UCSF Benioff Children's Hospital Oakland, Oakland (M.B., D.L., J.M.); Nemours Children's Health System, Jacksonville (K.B., J.J.L.), and Nemours Children's Hospital, University of Central Florida College of Medicine, Orlando (J.E.L.) - both in Florida; the Department of Pediatrics, National Jewish Health, Denver (R.C., J.T.O.); and the Department of Pediatrics, University of New Mexico, Albuquerque (H.H.R.)
| | - William J Sheehan
- From the Department of Pediatrics, University of Wisconsin School of Medicine and Public Health (D.J.J., R.F.L.J.), and the University of Wisconsin-Madison (C.A.S.) - both in Madison; the Department of Pediatrics, Washington University in St. Louis School of Medicine and St. Louis Children's Hospital, St. Louis (L.B.B., A.B.); the Department of Public Health Sciences, Penn State University, Hershey (D.T.M., S.B.), and the University of Pittsburgh Asthma Institute at University of Pittsburgh Medical Center-University of Pittsburgh School of Medicine (F.H.) and the Department of Pediatrics, Allegheny General Hospital (D.A.G.), Pittsburgh - all in Pennsylvania; the Department of Pediatrics, Case Western Reserve University School of Medicine, Rainbow Babies and Children's Hospital, Cleveland (J.F.C., R.E.M., K.R.); the Department of Pediatrics, Emory University, Atlanta (A.M.F.); the Divisions of Respiratory Diseases (J.M.G.) and Allergy-Immunology, Boston Children's Hospital (W.P., W.J.S., S.N.B.), Harvard Medical School, and Brigham and Women's Hospital, Harvard Medical School (E.I.) - all in Boston; the Arizona Respiratory Center, University of Arizona, Tucson (W.J.M., F.D.M.); Wake Forest University School of Medicine, Winston-Salem, NC (S.P.P.); the Departments of Pediatrics (M.D.C., N.L.), Epidemiology (M.D.C.), Biostatistics (M.D.C.), and Medicine (S.C.L.), University of California, San Francisco (UCSF), and UCSF Benioff Children's Hospital (M.D.C.) - both in San Francisco; Ann and Robert H. Lurie Children's Hospital of Chicago (J.A.P., R.G.R.), University of Illinois at Chicago (J.A.K., H.V.K.), and the Department of Pediatrics, Stroger Hospital of Cook County, Rush University Medical Center (J.N.M.) - all in Chicago; UCSF Benioff Children's Hospital Oakland, Oakland (M.B., D.L., J.M.); Nemours Children's Health System, Jacksonville (K.B., J.J.L.), and Nemours Children's Hospital, University of Central Florida College of Medicine, Orlando (J.E.L.) - both in Florida; the Department of Pediatrics, National Jewish Health, Denver (R.C., J.T.O.); and the Department of Pediatrics, University of New Mexico, Albuquerque (H.H.R.)
| | - Michael D Cabana
- From the Department of Pediatrics, University of Wisconsin School of Medicine and Public Health (D.J.J., R.F.L.J.), and the University of Wisconsin-Madison (C.A.S.) - both in Madison; the Department of Pediatrics, Washington University in St. Louis School of Medicine and St. Louis Children's Hospital, St. Louis (L.B.B., A.B.); the Department of Public Health Sciences, Penn State University, Hershey (D.T.M., S.B.), and the University of Pittsburgh Asthma Institute at University of Pittsburgh Medical Center-University of Pittsburgh School of Medicine (F.H.) and the Department of Pediatrics, Allegheny General Hospital (D.A.G.), Pittsburgh - all in Pennsylvania; the Department of Pediatrics, Case Western Reserve University School of Medicine, Rainbow Babies and Children's Hospital, Cleveland (J.F.C., R.E.M., K.R.); the Department of Pediatrics, Emory University, Atlanta (A.M.F.); the Divisions of Respiratory Diseases (J.M.G.) and Allergy-Immunology, Boston Children's Hospital (W.P., W.J.S., S.N.B.), Harvard Medical School, and Brigham and Women's Hospital, Harvard Medical School (E.I.) - all in Boston; the Arizona Respiratory Center, University of Arizona, Tucson (W.J.M., F.D.M.); Wake Forest University School of Medicine, Winston-Salem, NC (S.P.P.); the Departments of Pediatrics (M.D.C., N.L.), Epidemiology (M.D.C.), Biostatistics (M.D.C.), and Medicine (S.C.L.), University of California, San Francisco (UCSF), and UCSF Benioff Children's Hospital (M.D.C.) - both in San Francisco; Ann and Robert H. Lurie Children's Hospital of Chicago (J.A.P., R.G.R.), University of Illinois at Chicago (J.A.K., H.V.K.), and the Department of Pediatrics, Stroger Hospital of Cook County, Rush University Medical Center (J.N.M.) - all in Chicago; UCSF Benioff Children's Hospital Oakland, Oakland (M.B., D.L., J.M.); Nemours Children's Health System, Jacksonville (K.B., J.J.L.), and Nemours Children's Hospital, University of Central Florida College of Medicine, Orlando (J.E.L.) - both in Florida; the Department of Pediatrics, National Jewish Health, Denver (R.C., J.T.O.); and the Department of Pediatrics, University of New Mexico, Albuquerque (H.H.R.)
| | - Fernando Holguin
- From the Department of Pediatrics, University of Wisconsin School of Medicine and Public Health (D.J.J., R.F.L.J.), and the University of Wisconsin-Madison (C.A.S.) - both in Madison; the Department of Pediatrics, Washington University in St. Louis School of Medicine and St. Louis Children's Hospital, St. Louis (L.B.B., A.B.); the Department of Public Health Sciences, Penn State University, Hershey (D.T.M., S.B.), and the University of Pittsburgh Asthma Institute at University of Pittsburgh Medical Center-University of Pittsburgh School of Medicine (F.H.) and the Department of Pediatrics, Allegheny General Hospital (D.A.G.), Pittsburgh - all in Pennsylvania; the Department of Pediatrics, Case Western Reserve University School of Medicine, Rainbow Babies and Children's Hospital, Cleveland (J.F.C., R.E.M., K.R.); the Department of Pediatrics, Emory University, Atlanta (A.M.F.); the Divisions of Respiratory Diseases (J.M.G.) and Allergy-Immunology, Boston Children's Hospital (W.P., W.J.S., S.N.B.), Harvard Medical School, and Brigham and Women's Hospital, Harvard Medical School (E.I.) - all in Boston; the Arizona Respiratory Center, University of Arizona, Tucson (W.J.M., F.D.M.); Wake Forest University School of Medicine, Winston-Salem, NC (S.P.P.); the Departments of Pediatrics (M.D.C., N.L.), Epidemiology (M.D.C.), Biostatistics (M.D.C.), and Medicine (S.C.L.), University of California, San Francisco (UCSF), and UCSF Benioff Children's Hospital (M.D.C.) - both in San Francisco; Ann and Robert H. Lurie Children's Hospital of Chicago (J.A.P., R.G.R.), University of Illinois at Chicago (J.A.K., H.V.K.), and the Department of Pediatrics, Stroger Hospital of Cook County, Rush University Medical Center (J.N.M.) - all in Chicago; UCSF Benioff Children's Hospital Oakland, Oakland (M.B., D.L., J.M.); Nemours Children's Health System, Jacksonville (K.B., J.J.L.), and Nemours Children's Hospital, University of Central Florida College of Medicine, Orlando (J.E.L.) - both in Florida; the Department of Pediatrics, National Jewish Health, Denver (R.C., J.T.O.); and the Department of Pediatrics, University of New Mexico, Albuquerque (H.H.R.)
| | - Fernando D Martinez
- From the Department of Pediatrics, University of Wisconsin School of Medicine and Public Health (D.J.J., R.F.L.J.), and the University of Wisconsin-Madison (C.A.S.) - both in Madison; the Department of Pediatrics, Washington University in St. Louis School of Medicine and St. Louis Children's Hospital, St. Louis (L.B.B., A.B.); the Department of Public Health Sciences, Penn State University, Hershey (D.T.M., S.B.), and the University of Pittsburgh Asthma Institute at University of Pittsburgh Medical Center-University of Pittsburgh School of Medicine (F.H.) and the Department of Pediatrics, Allegheny General Hospital (D.A.G.), Pittsburgh - all in Pennsylvania; the Department of Pediatrics, Case Western Reserve University School of Medicine, Rainbow Babies and Children's Hospital, Cleveland (J.F.C., R.E.M., K.R.); the Department of Pediatrics, Emory University, Atlanta (A.M.F.); the Divisions of Respiratory Diseases (J.M.G.) and Allergy-Immunology, Boston Children's Hospital (W.P., W.J.S., S.N.B.), Harvard Medical School, and Brigham and Women's Hospital, Harvard Medical School (E.I.) - all in Boston; the Arizona Respiratory Center, University of Arizona, Tucson (W.J.M., F.D.M.); Wake Forest University School of Medicine, Winston-Salem, NC (S.P.P.); the Departments of Pediatrics (M.D.C., N.L.), Epidemiology (M.D.C.), Biostatistics (M.D.C.), and Medicine (S.C.L.), University of California, San Francisco (UCSF), and UCSF Benioff Children's Hospital (M.D.C.) - both in San Francisco; Ann and Robert H. Lurie Children's Hospital of Chicago (J.A.P., R.G.R.), University of Illinois at Chicago (J.A.K., H.V.K.), and the Department of Pediatrics, Stroger Hospital of Cook County, Rush University Medical Center (J.N.M.) - all in Chicago; UCSF Benioff Children's Hospital Oakland, Oakland (M.B., D.L., J.M.); Nemours Children's Health System, Jacksonville (K.B., J.J.L.), and Nemours Children's Hospital, University of Central Florida College of Medicine, Orlando (J.E.L.) - both in Florida; the Department of Pediatrics, National Jewish Health, Denver (R.C., J.T.O.); and the Department of Pediatrics, University of New Mexico, Albuquerque (H.H.R.)
| | - Jacqueline A Pongracic
- From the Department of Pediatrics, University of Wisconsin School of Medicine and Public Health (D.J.J., R.F.L.J.), and the University of Wisconsin-Madison (C.A.S.) - both in Madison; the Department of Pediatrics, Washington University in St. Louis School of Medicine and St. Louis Children's Hospital, St. Louis (L.B.B., A.B.); the Department of Public Health Sciences, Penn State University, Hershey (D.T.M., S.B.), and the University of Pittsburgh Asthma Institute at University of Pittsburgh Medical Center-University of Pittsburgh School of Medicine (F.H.) and the Department of Pediatrics, Allegheny General Hospital (D.A.G.), Pittsburgh - all in Pennsylvania; the Department of Pediatrics, Case Western Reserve University School of Medicine, Rainbow Babies and Children's Hospital, Cleveland (J.F.C., R.E.M., K.R.); the Department of Pediatrics, Emory University, Atlanta (A.M.F.); the Divisions of Respiratory Diseases (J.M.G.) and Allergy-Immunology, Boston Children's Hospital (W.P., W.J.S., S.N.B.), Harvard Medical School, and Brigham and Women's Hospital, Harvard Medical School (E.I.) - all in Boston; the Arizona Respiratory Center, University of Arizona, Tucson (W.J.M., F.D.M.); Wake Forest University School of Medicine, Winston-Salem, NC (S.P.P.); the Departments of Pediatrics (M.D.C., N.L.), Epidemiology (M.D.C.), Biostatistics (M.D.C.), and Medicine (S.C.L.), University of California, San Francisco (UCSF), and UCSF Benioff Children's Hospital (M.D.C.) - both in San Francisco; Ann and Robert H. Lurie Children's Hospital of Chicago (J.A.P., R.G.R.), University of Illinois at Chicago (J.A.K., H.V.K.), and the Department of Pediatrics, Stroger Hospital of Cook County, Rush University Medical Center (J.N.M.) - all in Chicago; UCSF Benioff Children's Hospital Oakland, Oakland (M.B., D.L., J.M.); Nemours Children's Health System, Jacksonville (K.B., J.J.L.), and Nemours Children's Hospital, University of Central Florida College of Medicine, Orlando (J.E.L.) - both in Florida; the Department of Pediatrics, National Jewish Health, Denver (R.C., J.T.O.); and the Department of Pediatrics, University of New Mexico, Albuquerque (H.H.R.)
| | - Sachin N Baxi
- From the Department of Pediatrics, University of Wisconsin School of Medicine and Public Health (D.J.J., R.F.L.J.), and the University of Wisconsin-Madison (C.A.S.) - both in Madison; the Department of Pediatrics, Washington University in St. Louis School of Medicine and St. Louis Children's Hospital, St. Louis (L.B.B., A.B.); the Department of Public Health Sciences, Penn State University, Hershey (D.T.M., S.B.), and the University of Pittsburgh Asthma Institute at University of Pittsburgh Medical Center-University of Pittsburgh School of Medicine (F.H.) and the Department of Pediatrics, Allegheny General Hospital (D.A.G.), Pittsburgh - all in Pennsylvania; the Department of Pediatrics, Case Western Reserve University School of Medicine, Rainbow Babies and Children's Hospital, Cleveland (J.F.C., R.E.M., K.R.); the Department of Pediatrics, Emory University, Atlanta (A.M.F.); the Divisions of Respiratory Diseases (J.M.G.) and Allergy-Immunology, Boston Children's Hospital (W.P., W.J.S., S.N.B.), Harvard Medical School, and Brigham and Women's Hospital, Harvard Medical School (E.I.) - all in Boston; the Arizona Respiratory Center, University of Arizona, Tucson (W.J.M., F.D.M.); Wake Forest University School of Medicine, Winston-Salem, NC (S.P.P.); the Departments of Pediatrics (M.D.C., N.L.), Epidemiology (M.D.C.), Biostatistics (M.D.C.), and Medicine (S.C.L.), University of California, San Francisco (UCSF), and UCSF Benioff Children's Hospital (M.D.C.) - both in San Francisco; Ann and Robert H. Lurie Children's Hospital of Chicago (J.A.P., R.G.R.), University of Illinois at Chicago (J.A.K., H.V.K.), and the Department of Pediatrics, Stroger Hospital of Cook County, Rush University Medical Center (J.N.M.) - all in Chicago; UCSF Benioff Children's Hospital Oakland, Oakland (M.B., D.L., J.M.); Nemours Children's Health System, Jacksonville (K.B., J.J.L.), and Nemours Children's Hospital, University of Central Florida College of Medicine, Orlando (J.E.L.) - both in Florida; the Department of Pediatrics, National Jewish Health, Denver (R.C., J.T.O.); and the Department of Pediatrics, University of New Mexico, Albuquerque (H.H.R.)
| | - Mindy Benson
- From the Department of Pediatrics, University of Wisconsin School of Medicine and Public Health (D.J.J., R.F.L.J.), and the University of Wisconsin-Madison (C.A.S.) - both in Madison; the Department of Pediatrics, Washington University in St. Louis School of Medicine and St. Louis Children's Hospital, St. Louis (L.B.B., A.B.); the Department of Public Health Sciences, Penn State University, Hershey (D.T.M., S.B.), and the University of Pittsburgh Asthma Institute at University of Pittsburgh Medical Center-University of Pittsburgh School of Medicine (F.H.) and the Department of Pediatrics, Allegheny General Hospital (D.A.G.), Pittsburgh - all in Pennsylvania; the Department of Pediatrics, Case Western Reserve University School of Medicine, Rainbow Babies and Children's Hospital, Cleveland (J.F.C., R.E.M., K.R.); the Department of Pediatrics, Emory University, Atlanta (A.M.F.); the Divisions of Respiratory Diseases (J.M.G.) and Allergy-Immunology, Boston Children's Hospital (W.P., W.J.S., S.N.B.), Harvard Medical School, and Brigham and Women's Hospital, Harvard Medical School (E.I.) - all in Boston; the Arizona Respiratory Center, University of Arizona, Tucson (W.J.M., F.D.M.); Wake Forest University School of Medicine, Winston-Salem, NC (S.P.P.); the Departments of Pediatrics (M.D.C., N.L.), Epidemiology (M.D.C.), Biostatistics (M.D.C.), and Medicine (S.C.L.), University of California, San Francisco (UCSF), and UCSF Benioff Children's Hospital (M.D.C.) - both in San Francisco; Ann and Robert H. Lurie Children's Hospital of Chicago (J.A.P., R.G.R.), University of Illinois at Chicago (J.A.K., H.V.K.), and the Department of Pediatrics, Stroger Hospital of Cook County, Rush University Medical Center (J.N.M.) - all in Chicago; UCSF Benioff Children's Hospital Oakland, Oakland (M.B., D.L., J.M.); Nemours Children's Health System, Jacksonville (K.B., J.J.L.), and Nemours Children's Hospital, University of Central Florida College of Medicine, Orlando (J.E.L.) - both in Florida; the Department of Pediatrics, National Jewish Health, Denver (R.C., J.T.O.); and the Department of Pediatrics, University of New Mexico, Albuquerque (H.H.R.)
| | - Kathryn Blake
- From the Department of Pediatrics, University of Wisconsin School of Medicine and Public Health (D.J.J., R.F.L.J.), and the University of Wisconsin-Madison (C.A.S.) - both in Madison; the Department of Pediatrics, Washington University in St. Louis School of Medicine and St. Louis Children's Hospital, St. Louis (L.B.B., A.B.); the Department of Public Health Sciences, Penn State University, Hershey (D.T.M., S.B.), and the University of Pittsburgh Asthma Institute at University of Pittsburgh Medical Center-University of Pittsburgh School of Medicine (F.H.) and the Department of Pediatrics, Allegheny General Hospital (D.A.G.), Pittsburgh - all in Pennsylvania; the Department of Pediatrics, Case Western Reserve University School of Medicine, Rainbow Babies and Children's Hospital, Cleveland (J.F.C., R.E.M., K.R.); the Department of Pediatrics, Emory University, Atlanta (A.M.F.); the Divisions of Respiratory Diseases (J.M.G.) and Allergy-Immunology, Boston Children's Hospital (W.P., W.J.S., S.N.B.), Harvard Medical School, and Brigham and Women's Hospital, Harvard Medical School (E.I.) - all in Boston; the Arizona Respiratory Center, University of Arizona, Tucson (W.J.M., F.D.M.); Wake Forest University School of Medicine, Winston-Salem, NC (S.P.P.); the Departments of Pediatrics (M.D.C., N.L.), Epidemiology (M.D.C.), Biostatistics (M.D.C.), and Medicine (S.C.L.), University of California, San Francisco (UCSF), and UCSF Benioff Children's Hospital (M.D.C.) - both in San Francisco; Ann and Robert H. Lurie Children's Hospital of Chicago (J.A.P., R.G.R.), University of Illinois at Chicago (J.A.K., H.V.K.), and the Department of Pediatrics, Stroger Hospital of Cook County, Rush University Medical Center (J.N.M.) - all in Chicago; UCSF Benioff Children's Hospital Oakland, Oakland (M.B., D.L., J.M.); Nemours Children's Health System, Jacksonville (K.B., J.J.L.), and Nemours Children's Hospital, University of Central Florida College of Medicine, Orlando (J.E.L.) - both in Florida; the Department of Pediatrics, National Jewish Health, Denver (R.C., J.T.O.); and the Department of Pediatrics, University of New Mexico, Albuquerque (H.H.R.)
| | - Ronina Covar
- From the Department of Pediatrics, University of Wisconsin School of Medicine and Public Health (D.J.J., R.F.L.J.), and the University of Wisconsin-Madison (C.A.S.) - both in Madison; the Department of Pediatrics, Washington University in St. Louis School of Medicine and St. Louis Children's Hospital, St. Louis (L.B.B., A.B.); the Department of Public Health Sciences, Penn State University, Hershey (D.T.M., S.B.), and the University of Pittsburgh Asthma Institute at University of Pittsburgh Medical Center-University of Pittsburgh School of Medicine (F.H.) and the Department of Pediatrics, Allegheny General Hospital (D.A.G.), Pittsburgh - all in Pennsylvania; the Department of Pediatrics, Case Western Reserve University School of Medicine, Rainbow Babies and Children's Hospital, Cleveland (J.F.C., R.E.M., K.R.); the Department of Pediatrics, Emory University, Atlanta (A.M.F.); the Divisions of Respiratory Diseases (J.M.G.) and Allergy-Immunology, Boston Children's Hospital (W.P., W.J.S., S.N.B.), Harvard Medical School, and Brigham and Women's Hospital, Harvard Medical School (E.I.) - all in Boston; the Arizona Respiratory Center, University of Arizona, Tucson (W.J.M., F.D.M.); Wake Forest University School of Medicine, Winston-Salem, NC (S.P.P.); the Departments of Pediatrics (M.D.C., N.L.), Epidemiology (M.D.C.), Biostatistics (M.D.C.), and Medicine (S.C.L.), University of California, San Francisco (UCSF), and UCSF Benioff Children's Hospital (M.D.C.) - both in San Francisco; Ann and Robert H. Lurie Children's Hospital of Chicago (J.A.P., R.G.R.), University of Illinois at Chicago (J.A.K., H.V.K.), and the Department of Pediatrics, Stroger Hospital of Cook County, Rush University Medical Center (J.N.M.) - all in Chicago; UCSF Benioff Children's Hospital Oakland, Oakland (M.B., D.L., J.M.); Nemours Children's Health System, Jacksonville (K.B., J.J.L.), and Nemours Children's Hospital, University of Central Florida College of Medicine, Orlando (J.E.L.) - both in Florida; the Department of Pediatrics, National Jewish Health, Denver (R.C., J.T.O.); and the Department of Pediatrics, University of New Mexico, Albuquerque (H.H.R.)
| | - Deborah A Gentile
- From the Department of Pediatrics, University of Wisconsin School of Medicine and Public Health (D.J.J., R.F.L.J.), and the University of Wisconsin-Madison (C.A.S.) - both in Madison; the Department of Pediatrics, Washington University in St. Louis School of Medicine and St. Louis Children's Hospital, St. Louis (L.B.B., A.B.); the Department of Public Health Sciences, Penn State University, Hershey (D.T.M., S.B.), and the University of Pittsburgh Asthma Institute at University of Pittsburgh Medical Center-University of Pittsburgh School of Medicine (F.H.) and the Department of Pediatrics, Allegheny General Hospital (D.A.G.), Pittsburgh - all in Pennsylvania; the Department of Pediatrics, Case Western Reserve University School of Medicine, Rainbow Babies and Children's Hospital, Cleveland (J.F.C., R.E.M., K.R.); the Department of Pediatrics, Emory University, Atlanta (A.M.F.); the Divisions of Respiratory Diseases (J.M.G.) and Allergy-Immunology, Boston Children's Hospital (W.P., W.J.S., S.N.B.), Harvard Medical School, and Brigham and Women's Hospital, Harvard Medical School (E.I.) - all in Boston; the Arizona Respiratory Center, University of Arizona, Tucson (W.J.M., F.D.M.); Wake Forest University School of Medicine, Winston-Salem, NC (S.P.P.); the Departments of Pediatrics (M.D.C., N.L.), Epidemiology (M.D.C.), Biostatistics (M.D.C.), and Medicine (S.C.L.), University of California, San Francisco (UCSF), and UCSF Benioff Children's Hospital (M.D.C.) - both in San Francisco; Ann and Robert H. Lurie Children's Hospital of Chicago (J.A.P., R.G.R.), University of Illinois at Chicago (J.A.K., H.V.K.), and the Department of Pediatrics, Stroger Hospital of Cook County, Rush University Medical Center (J.N.M.) - all in Chicago; UCSF Benioff Children's Hospital Oakland, Oakland (M.B., D.L., J.M.); Nemours Children's Health System, Jacksonville (K.B., J.J.L.), and Nemours Children's Hospital, University of Central Florida College of Medicine, Orlando (J.E.L.) - both in Florida; the Department of Pediatrics, National Jewish Health, Denver (R.C., J.T.O.); and the Department of Pediatrics, University of New Mexico, Albuquerque (H.H.R.)
| | - Elliot Israel
- From the Department of Pediatrics, University of Wisconsin School of Medicine and Public Health (D.J.J., R.F.L.J.), and the University of Wisconsin-Madison (C.A.S.) - both in Madison; the Department of Pediatrics, Washington University in St. Louis School of Medicine and St. Louis Children's Hospital, St. Louis (L.B.B., A.B.); the Department of Public Health Sciences, Penn State University, Hershey (D.T.M., S.B.), and the University of Pittsburgh Asthma Institute at University of Pittsburgh Medical Center-University of Pittsburgh School of Medicine (F.H.) and the Department of Pediatrics, Allegheny General Hospital (D.A.G.), Pittsburgh - all in Pennsylvania; the Department of Pediatrics, Case Western Reserve University School of Medicine, Rainbow Babies and Children's Hospital, Cleveland (J.F.C., R.E.M., K.R.); the Department of Pediatrics, Emory University, Atlanta (A.M.F.); the Divisions of Respiratory Diseases (J.M.G.) and Allergy-Immunology, Boston Children's Hospital (W.P., W.J.S., S.N.B.), Harvard Medical School, and Brigham and Women's Hospital, Harvard Medical School (E.I.) - all in Boston; the Arizona Respiratory Center, University of Arizona, Tucson (W.J.M., F.D.M.); Wake Forest University School of Medicine, Winston-Salem, NC (S.P.P.); the Departments of Pediatrics (M.D.C., N.L.), Epidemiology (M.D.C.), Biostatistics (M.D.C.), and Medicine (S.C.L.), University of California, San Francisco (UCSF), and UCSF Benioff Children's Hospital (M.D.C.) - both in San Francisco; Ann and Robert H. Lurie Children's Hospital of Chicago (J.A.P., R.G.R.), University of Illinois at Chicago (J.A.K., H.V.K.), and the Department of Pediatrics, Stroger Hospital of Cook County, Rush University Medical Center (J.N.M.) - all in Chicago; UCSF Benioff Children's Hospital Oakland, Oakland (M.B., D.L., J.M.); Nemours Children's Health System, Jacksonville (K.B., J.J.L.), and Nemours Children's Hospital, University of Central Florida College of Medicine, Orlando (J.E.L.) - both in Florida; the Department of Pediatrics, National Jewish Health, Denver (R.C., J.T.O.); and the Department of Pediatrics, University of New Mexico, Albuquerque (H.H.R.)
| | - Jerry A Krishnan
- From the Department of Pediatrics, University of Wisconsin School of Medicine and Public Health (D.J.J., R.F.L.J.), and the University of Wisconsin-Madison (C.A.S.) - both in Madison; the Department of Pediatrics, Washington University in St. Louis School of Medicine and St. Louis Children's Hospital, St. Louis (L.B.B., A.B.); the Department of Public Health Sciences, Penn State University, Hershey (D.T.M., S.B.), and the University of Pittsburgh Asthma Institute at University of Pittsburgh Medical Center-University of Pittsburgh School of Medicine (F.H.) and the Department of Pediatrics, Allegheny General Hospital (D.A.G.), Pittsburgh - all in Pennsylvania; the Department of Pediatrics, Case Western Reserve University School of Medicine, Rainbow Babies and Children's Hospital, Cleveland (J.F.C., R.E.M., K.R.); the Department of Pediatrics, Emory University, Atlanta (A.M.F.); the Divisions of Respiratory Diseases (J.M.G.) and Allergy-Immunology, Boston Children's Hospital (W.P., W.J.S., S.N.B.), Harvard Medical School, and Brigham and Women's Hospital, Harvard Medical School (E.I.) - all in Boston; the Arizona Respiratory Center, University of Arizona, Tucson (W.J.M., F.D.M.); Wake Forest University School of Medicine, Winston-Salem, NC (S.P.P.); the Departments of Pediatrics (M.D.C., N.L.), Epidemiology (M.D.C.), Biostatistics (M.D.C.), and Medicine (S.C.L.), University of California, San Francisco (UCSF), and UCSF Benioff Children's Hospital (M.D.C.) - both in San Francisco; Ann and Robert H. Lurie Children's Hospital of Chicago (J.A.P., R.G.R.), University of Illinois at Chicago (J.A.K., H.V.K.), and the Department of Pediatrics, Stroger Hospital of Cook County, Rush University Medical Center (J.N.M.) - all in Chicago; UCSF Benioff Children's Hospital Oakland, Oakland (M.B., D.L., J.M.); Nemours Children's Health System, Jacksonville (K.B., J.J.L.), and Nemours Children's Hospital, University of Central Florida College of Medicine, Orlando (J.E.L.) - both in Florida; the Department of Pediatrics, National Jewish Health, Denver (R.C., J.T.O.); and the Department of Pediatrics, University of New Mexico, Albuquerque (H.H.R.)
| | - Harsha V Kumar
- From the Department of Pediatrics, University of Wisconsin School of Medicine and Public Health (D.J.J., R.F.L.J.), and the University of Wisconsin-Madison (C.A.S.) - both in Madison; the Department of Pediatrics, Washington University in St. Louis School of Medicine and St. Louis Children's Hospital, St. Louis (L.B.B., A.B.); the Department of Public Health Sciences, Penn State University, Hershey (D.T.M., S.B.), and the University of Pittsburgh Asthma Institute at University of Pittsburgh Medical Center-University of Pittsburgh School of Medicine (F.H.) and the Department of Pediatrics, Allegheny General Hospital (D.A.G.), Pittsburgh - all in Pennsylvania; the Department of Pediatrics, Case Western Reserve University School of Medicine, Rainbow Babies and Children's Hospital, Cleveland (J.F.C., R.E.M., K.R.); the Department of Pediatrics, Emory University, Atlanta (A.M.F.); the Divisions of Respiratory Diseases (J.M.G.) and Allergy-Immunology, Boston Children's Hospital (W.P., W.J.S., S.N.B.), Harvard Medical School, and Brigham and Women's Hospital, Harvard Medical School (E.I.) - all in Boston; the Arizona Respiratory Center, University of Arizona, Tucson (W.J.M., F.D.M.); Wake Forest University School of Medicine, Winston-Salem, NC (S.P.P.); the Departments of Pediatrics (M.D.C., N.L.), Epidemiology (M.D.C.), Biostatistics (M.D.C.), and Medicine (S.C.L.), University of California, San Francisco (UCSF), and UCSF Benioff Children's Hospital (M.D.C.) - both in San Francisco; Ann and Robert H. Lurie Children's Hospital of Chicago (J.A.P., R.G.R.), University of Illinois at Chicago (J.A.K., H.V.K.), and the Department of Pediatrics, Stroger Hospital of Cook County, Rush University Medical Center (J.N.M.) - all in Chicago; UCSF Benioff Children's Hospital Oakland, Oakland (M.B., D.L., J.M.); Nemours Children's Health System, Jacksonville (K.B., J.J.L.), and Nemours Children's Hospital, University of Central Florida College of Medicine, Orlando (J.E.L.) - both in Florida; the Department of Pediatrics, National Jewish Health, Denver (R.C., J.T.O.); and the Department of Pediatrics, University of New Mexico, Albuquerque (H.H.R.)
| | - Jason E Lang
- From the Department of Pediatrics, University of Wisconsin School of Medicine and Public Health (D.J.J., R.F.L.J.), and the University of Wisconsin-Madison (C.A.S.) - both in Madison; the Department of Pediatrics, Washington University in St. Louis School of Medicine and St. Louis Children's Hospital, St. Louis (L.B.B., A.B.); the Department of Public Health Sciences, Penn State University, Hershey (D.T.M., S.B.), and the University of Pittsburgh Asthma Institute at University of Pittsburgh Medical Center-University of Pittsburgh School of Medicine (F.H.) and the Department of Pediatrics, Allegheny General Hospital (D.A.G.), Pittsburgh - all in Pennsylvania; the Department of Pediatrics, Case Western Reserve University School of Medicine, Rainbow Babies and Children's Hospital, Cleveland (J.F.C., R.E.M., K.R.); the Department of Pediatrics, Emory University, Atlanta (A.M.F.); the Divisions of Respiratory Diseases (J.M.G.) and Allergy-Immunology, Boston Children's Hospital (W.P., W.J.S., S.N.B.), Harvard Medical School, and Brigham and Women's Hospital, Harvard Medical School (E.I.) - all in Boston; the Arizona Respiratory Center, University of Arizona, Tucson (W.J.M., F.D.M.); Wake Forest University School of Medicine, Winston-Salem, NC (S.P.P.); the Departments of Pediatrics (M.D.C., N.L.), Epidemiology (M.D.C.), Biostatistics (M.D.C.), and Medicine (S.C.L.), University of California, San Francisco (UCSF), and UCSF Benioff Children's Hospital (M.D.C.) - both in San Francisco; Ann and Robert H. Lurie Children's Hospital of Chicago (J.A.P., R.G.R.), University of Illinois at Chicago (J.A.K., H.V.K.), and the Department of Pediatrics, Stroger Hospital of Cook County, Rush University Medical Center (J.N.M.) - all in Chicago; UCSF Benioff Children's Hospital Oakland, Oakland (M.B., D.L., J.M.); Nemours Children's Health System, Jacksonville (K.B., J.J.L.), and Nemours Children's Hospital, University of Central Florida College of Medicine, Orlando (J.E.L.) - both in Florida; the Department of Pediatrics, National Jewish Health, Denver (R.C., J.T.O.); and the Department of Pediatrics, University of New Mexico, Albuquerque (H.H.R.)
| | - Stephen C Lazarus
- From the Department of Pediatrics, University of Wisconsin School of Medicine and Public Health (D.J.J., R.F.L.J.), and the University of Wisconsin-Madison (C.A.S.) - both in Madison; the Department of Pediatrics, Washington University in St. Louis School of Medicine and St. Louis Children's Hospital, St. Louis (L.B.B., A.B.); the Department of Public Health Sciences, Penn State University, Hershey (D.T.M., S.B.), and the University of Pittsburgh Asthma Institute at University of Pittsburgh Medical Center-University of Pittsburgh School of Medicine (F.H.) and the Department of Pediatrics, Allegheny General Hospital (D.A.G.), Pittsburgh - all in Pennsylvania; the Department of Pediatrics, Case Western Reserve University School of Medicine, Rainbow Babies and Children's Hospital, Cleveland (J.F.C., R.E.M., K.R.); the Department of Pediatrics, Emory University, Atlanta (A.M.F.); the Divisions of Respiratory Diseases (J.M.G.) and Allergy-Immunology, Boston Children's Hospital (W.P., W.J.S., S.N.B.), Harvard Medical School, and Brigham and Women's Hospital, Harvard Medical School (E.I.) - all in Boston; the Arizona Respiratory Center, University of Arizona, Tucson (W.J.M., F.D.M.); Wake Forest University School of Medicine, Winston-Salem, NC (S.P.P.); the Departments of Pediatrics (M.D.C., N.L.), Epidemiology (M.D.C.), Biostatistics (M.D.C.), and Medicine (S.C.L.), University of California, San Francisco (UCSF), and UCSF Benioff Children's Hospital (M.D.C.) - both in San Francisco; Ann and Robert H. Lurie Children's Hospital of Chicago (J.A.P., R.G.R.), University of Illinois at Chicago (J.A.K., H.V.K.), and the Department of Pediatrics, Stroger Hospital of Cook County, Rush University Medical Center (J.N.M.) - all in Chicago; UCSF Benioff Children's Hospital Oakland, Oakland (M.B., D.L., J.M.); Nemours Children's Health System, Jacksonville (K.B., J.J.L.), and Nemours Children's Hospital, University of Central Florida College of Medicine, Orlando (J.E.L.) - both in Florida; the Department of Pediatrics, National Jewish Health, Denver (R.C., J.T.O.); and the Department of Pediatrics, University of New Mexico, Albuquerque (H.H.R.)
| | - John J Lima
- From the Department of Pediatrics, University of Wisconsin School of Medicine and Public Health (D.J.J., R.F.L.J.), and the University of Wisconsin-Madison (C.A.S.) - both in Madison; the Department of Pediatrics, Washington University in St. Louis School of Medicine and St. Louis Children's Hospital, St. Louis (L.B.B., A.B.); the Department of Public Health Sciences, Penn State University, Hershey (D.T.M., S.B.), and the University of Pittsburgh Asthma Institute at University of Pittsburgh Medical Center-University of Pittsburgh School of Medicine (F.H.) and the Department of Pediatrics, Allegheny General Hospital (D.A.G.), Pittsburgh - all in Pennsylvania; the Department of Pediatrics, Case Western Reserve University School of Medicine, Rainbow Babies and Children's Hospital, Cleveland (J.F.C., R.E.M., K.R.); the Department of Pediatrics, Emory University, Atlanta (A.M.F.); the Divisions of Respiratory Diseases (J.M.G.) and Allergy-Immunology, Boston Children's Hospital (W.P., W.J.S., S.N.B.), Harvard Medical School, and Brigham and Women's Hospital, Harvard Medical School (E.I.) - all in Boston; the Arizona Respiratory Center, University of Arizona, Tucson (W.J.M., F.D.M.); Wake Forest University School of Medicine, Winston-Salem, NC (S.P.P.); the Departments of Pediatrics (M.D.C., N.L.), Epidemiology (M.D.C.), Biostatistics (M.D.C.), and Medicine (S.C.L.), University of California, San Francisco (UCSF), and UCSF Benioff Children's Hospital (M.D.C.) - both in San Francisco; Ann and Robert H. Lurie Children's Hospital of Chicago (J.A.P., R.G.R.), University of Illinois at Chicago (J.A.K., H.V.K.), and the Department of Pediatrics, Stroger Hospital of Cook County, Rush University Medical Center (J.N.M.) - all in Chicago; UCSF Benioff Children's Hospital Oakland, Oakland (M.B., D.L., J.M.); Nemours Children's Health System, Jacksonville (K.B., J.J.L.), and Nemours Children's Hospital, University of Central Florida College of Medicine, Orlando (J.E.L.) - both in Florida; the Department of Pediatrics, National Jewish Health, Denver (R.C., J.T.O.); and the Department of Pediatrics, University of New Mexico, Albuquerque (H.H.R.)
| | - Dayna Long
- From the Department of Pediatrics, University of Wisconsin School of Medicine and Public Health (D.J.J., R.F.L.J.), and the University of Wisconsin-Madison (C.A.S.) - both in Madison; the Department of Pediatrics, Washington University in St. Louis School of Medicine and St. Louis Children's Hospital, St. Louis (L.B.B., A.B.); the Department of Public Health Sciences, Penn State University, Hershey (D.T.M., S.B.), and the University of Pittsburgh Asthma Institute at University of Pittsburgh Medical Center-University of Pittsburgh School of Medicine (F.H.) and the Department of Pediatrics, Allegheny General Hospital (D.A.G.), Pittsburgh - all in Pennsylvania; the Department of Pediatrics, Case Western Reserve University School of Medicine, Rainbow Babies and Children's Hospital, Cleveland (J.F.C., R.E.M., K.R.); the Department of Pediatrics, Emory University, Atlanta (A.M.F.); the Divisions of Respiratory Diseases (J.M.G.) and Allergy-Immunology, Boston Children's Hospital (W.P., W.J.S., S.N.B.), Harvard Medical School, and Brigham and Women's Hospital, Harvard Medical School (E.I.) - all in Boston; the Arizona Respiratory Center, University of Arizona, Tucson (W.J.M., F.D.M.); Wake Forest University School of Medicine, Winston-Salem, NC (S.P.P.); the Departments of Pediatrics (M.D.C., N.L.), Epidemiology (M.D.C.), Biostatistics (M.D.C.), and Medicine (S.C.L.), University of California, San Francisco (UCSF), and UCSF Benioff Children's Hospital (M.D.C.) - both in San Francisco; Ann and Robert H. Lurie Children's Hospital of Chicago (J.A.P., R.G.R.), University of Illinois at Chicago (J.A.K., H.V.K.), and the Department of Pediatrics, Stroger Hospital of Cook County, Rush University Medical Center (J.N.M.) - all in Chicago; UCSF Benioff Children's Hospital Oakland, Oakland (M.B., D.L., J.M.); Nemours Children's Health System, Jacksonville (K.B., J.J.L.), and Nemours Children's Hospital, University of Central Florida College of Medicine, Orlando (J.E.L.) - both in Florida; the Department of Pediatrics, National Jewish Health, Denver (R.C., J.T.O.); and the Department of Pediatrics, University of New Mexico, Albuquerque (H.H.R.)
| | - Ngoc Ly
- From the Department of Pediatrics, University of Wisconsin School of Medicine and Public Health (D.J.J., R.F.L.J.), and the University of Wisconsin-Madison (C.A.S.) - both in Madison; the Department of Pediatrics, Washington University in St. Louis School of Medicine and St. Louis Children's Hospital, St. Louis (L.B.B., A.B.); the Department of Public Health Sciences, Penn State University, Hershey (D.T.M., S.B.), and the University of Pittsburgh Asthma Institute at University of Pittsburgh Medical Center-University of Pittsburgh School of Medicine (F.H.) and the Department of Pediatrics, Allegheny General Hospital (D.A.G.), Pittsburgh - all in Pennsylvania; the Department of Pediatrics, Case Western Reserve University School of Medicine, Rainbow Babies and Children's Hospital, Cleveland (J.F.C., R.E.M., K.R.); the Department of Pediatrics, Emory University, Atlanta (A.M.F.); the Divisions of Respiratory Diseases (J.M.G.) and Allergy-Immunology, Boston Children's Hospital (W.P., W.J.S., S.N.B.), Harvard Medical School, and Brigham and Women's Hospital, Harvard Medical School (E.I.) - all in Boston; the Arizona Respiratory Center, University of Arizona, Tucson (W.J.M., F.D.M.); Wake Forest University School of Medicine, Winston-Salem, NC (S.P.P.); the Departments of Pediatrics (M.D.C., N.L.), Epidemiology (M.D.C.), Biostatistics (M.D.C.), and Medicine (S.C.L.), University of California, San Francisco (UCSF), and UCSF Benioff Children's Hospital (M.D.C.) - both in San Francisco; Ann and Robert H. Lurie Children's Hospital of Chicago (J.A.P., R.G.R.), University of Illinois at Chicago (J.A.K., H.V.K.), and the Department of Pediatrics, Stroger Hospital of Cook County, Rush University Medical Center (J.N.M.) - all in Chicago; UCSF Benioff Children's Hospital Oakland, Oakland (M.B., D.L., J.M.); Nemours Children's Health System, Jacksonville (K.B., J.J.L.), and Nemours Children's Hospital, University of Central Florida College of Medicine, Orlando (J.E.L.) - both in Florida; the Department of Pediatrics, National Jewish Health, Denver (R.C., J.T.O.); and the Department of Pediatrics, University of New Mexico, Albuquerque (H.H.R.)
| | - Jyothi Marbin
- From the Department of Pediatrics, University of Wisconsin School of Medicine and Public Health (D.J.J., R.F.L.J.), and the University of Wisconsin-Madison (C.A.S.) - both in Madison; the Department of Pediatrics, Washington University in St. Louis School of Medicine and St. Louis Children's Hospital, St. Louis (L.B.B., A.B.); the Department of Public Health Sciences, Penn State University, Hershey (D.T.M., S.B.), and the University of Pittsburgh Asthma Institute at University of Pittsburgh Medical Center-University of Pittsburgh School of Medicine (F.H.) and the Department of Pediatrics, Allegheny General Hospital (D.A.G.), Pittsburgh - all in Pennsylvania; the Department of Pediatrics, Case Western Reserve University School of Medicine, Rainbow Babies and Children's Hospital, Cleveland (J.F.C., R.E.M., K.R.); the Department of Pediatrics, Emory University, Atlanta (A.M.F.); the Divisions of Respiratory Diseases (J.M.G.) and Allergy-Immunology, Boston Children's Hospital (W.P., W.J.S., S.N.B.), Harvard Medical School, and Brigham and Women's Hospital, Harvard Medical School (E.I.) - all in Boston; the Arizona Respiratory Center, University of Arizona, Tucson (W.J.M., F.D.M.); Wake Forest University School of Medicine, Winston-Salem, NC (S.P.P.); the Departments of Pediatrics (M.D.C., N.L.), Epidemiology (M.D.C.), Biostatistics (M.D.C.), and Medicine (S.C.L.), University of California, San Francisco (UCSF), and UCSF Benioff Children's Hospital (M.D.C.) - both in San Francisco; Ann and Robert H. Lurie Children's Hospital of Chicago (J.A.P., R.G.R.), University of Illinois at Chicago (J.A.K., H.V.K.), and the Department of Pediatrics, Stroger Hospital of Cook County, Rush University Medical Center (J.N.M.) - all in Chicago; UCSF Benioff Children's Hospital Oakland, Oakland (M.B., D.L., J.M.); Nemours Children's Health System, Jacksonville (K.B., J.J.L.), and Nemours Children's Hospital, University of Central Florida College of Medicine, Orlando (J.E.L.) - both in Florida; the Department of Pediatrics, National Jewish Health, Denver (R.C., J.T.O.); and the Department of Pediatrics, University of New Mexico, Albuquerque (H.H.R.)
| | - James N Moy
- From the Department of Pediatrics, University of Wisconsin School of Medicine and Public Health (D.J.J., R.F.L.J.), and the University of Wisconsin-Madison (C.A.S.) - both in Madison; the Department of Pediatrics, Washington University in St. Louis School of Medicine and St. Louis Children's Hospital, St. Louis (L.B.B., A.B.); the Department of Public Health Sciences, Penn State University, Hershey (D.T.M., S.B.), and the University of Pittsburgh Asthma Institute at University of Pittsburgh Medical Center-University of Pittsburgh School of Medicine (F.H.) and the Department of Pediatrics, Allegheny General Hospital (D.A.G.), Pittsburgh - all in Pennsylvania; the Department of Pediatrics, Case Western Reserve University School of Medicine, Rainbow Babies and Children's Hospital, Cleveland (J.F.C., R.E.M., K.R.); the Department of Pediatrics, Emory University, Atlanta (A.M.F.); the Divisions of Respiratory Diseases (J.M.G.) and Allergy-Immunology, Boston Children's Hospital (W.P., W.J.S., S.N.B.), Harvard Medical School, and Brigham and Women's Hospital, Harvard Medical School (E.I.) - all in Boston; the Arizona Respiratory Center, University of Arizona, Tucson (W.J.M., F.D.M.); Wake Forest University School of Medicine, Winston-Salem, NC (S.P.P.); the Departments of Pediatrics (M.D.C., N.L.), Epidemiology (M.D.C.), Biostatistics (M.D.C.), and Medicine (S.C.L.), University of California, San Francisco (UCSF), and UCSF Benioff Children's Hospital (M.D.C.) - both in San Francisco; Ann and Robert H. Lurie Children's Hospital of Chicago (J.A.P., R.G.R.), University of Illinois at Chicago (J.A.K., H.V.K.), and the Department of Pediatrics, Stroger Hospital of Cook County, Rush University Medical Center (J.N.M.) - all in Chicago; UCSF Benioff Children's Hospital Oakland, Oakland (M.B., D.L., J.M.); Nemours Children's Health System, Jacksonville (K.B., J.J.L.), and Nemours Children's Hospital, University of Central Florida College of Medicine, Orlando (J.E.L.) - both in Florida; the Department of Pediatrics, National Jewish Health, Denver (R.C., J.T.O.); and the Department of Pediatrics, University of New Mexico, Albuquerque (H.H.R.)
| | - Ross E Myers
- From the Department of Pediatrics, University of Wisconsin School of Medicine and Public Health (D.J.J., R.F.L.J.), and the University of Wisconsin-Madison (C.A.S.) - both in Madison; the Department of Pediatrics, Washington University in St. Louis School of Medicine and St. Louis Children's Hospital, St. Louis (L.B.B., A.B.); the Department of Public Health Sciences, Penn State University, Hershey (D.T.M., S.B.), and the University of Pittsburgh Asthma Institute at University of Pittsburgh Medical Center-University of Pittsburgh School of Medicine (F.H.) and the Department of Pediatrics, Allegheny General Hospital (D.A.G.), Pittsburgh - all in Pennsylvania; the Department of Pediatrics, Case Western Reserve University School of Medicine, Rainbow Babies and Children's Hospital, Cleveland (J.F.C., R.E.M., K.R.); the Department of Pediatrics, Emory University, Atlanta (A.M.F.); the Divisions of Respiratory Diseases (J.M.G.) and Allergy-Immunology, Boston Children's Hospital (W.P., W.J.S., S.N.B.), Harvard Medical School, and Brigham and Women's Hospital, Harvard Medical School (E.I.) - all in Boston; the Arizona Respiratory Center, University of Arizona, Tucson (W.J.M., F.D.M.); Wake Forest University School of Medicine, Winston-Salem, NC (S.P.P.); the Departments of Pediatrics (M.D.C., N.L.), Epidemiology (M.D.C.), Biostatistics (M.D.C.), and Medicine (S.C.L.), University of California, San Francisco (UCSF), and UCSF Benioff Children's Hospital (M.D.C.) - both in San Francisco; Ann and Robert H. Lurie Children's Hospital of Chicago (J.A.P., R.G.R.), University of Illinois at Chicago (J.A.K., H.V.K.), and the Department of Pediatrics, Stroger Hospital of Cook County, Rush University Medical Center (J.N.M.) - all in Chicago; UCSF Benioff Children's Hospital Oakland, Oakland (M.B., D.L., J.M.); Nemours Children's Health System, Jacksonville (K.B., J.J.L.), and Nemours Children's Hospital, University of Central Florida College of Medicine, Orlando (J.E.L.) - both in Florida; the Department of Pediatrics, National Jewish Health, Denver (R.C., J.T.O.); and the Department of Pediatrics, University of New Mexico, Albuquerque (H.H.R.)
| | - J Tod Olin
- From the Department of Pediatrics, University of Wisconsin School of Medicine and Public Health (D.J.J., R.F.L.J.), and the University of Wisconsin-Madison (C.A.S.) - both in Madison; the Department of Pediatrics, Washington University in St. Louis School of Medicine and St. Louis Children's Hospital, St. Louis (L.B.B., A.B.); the Department of Public Health Sciences, Penn State University, Hershey (D.T.M., S.B.), and the University of Pittsburgh Asthma Institute at University of Pittsburgh Medical Center-University of Pittsburgh School of Medicine (F.H.) and the Department of Pediatrics, Allegheny General Hospital (D.A.G.), Pittsburgh - all in Pennsylvania; the Department of Pediatrics, Case Western Reserve University School of Medicine, Rainbow Babies and Children's Hospital, Cleveland (J.F.C., R.E.M., K.R.); the Department of Pediatrics, Emory University, Atlanta (A.M.F.); the Divisions of Respiratory Diseases (J.M.G.) and Allergy-Immunology, Boston Children's Hospital (W.P., W.J.S., S.N.B.), Harvard Medical School, and Brigham and Women's Hospital, Harvard Medical School (E.I.) - all in Boston; the Arizona Respiratory Center, University of Arizona, Tucson (W.J.M., F.D.M.); Wake Forest University School of Medicine, Winston-Salem, NC (S.P.P.); the Departments of Pediatrics (M.D.C., N.L.), Epidemiology (M.D.C.), Biostatistics (M.D.C.), and Medicine (S.C.L.), University of California, San Francisco (UCSF), and UCSF Benioff Children's Hospital (M.D.C.) - both in San Francisco; Ann and Robert H. Lurie Children's Hospital of Chicago (J.A.P., R.G.R.), University of Illinois at Chicago (J.A.K., H.V.K.), and the Department of Pediatrics, Stroger Hospital of Cook County, Rush University Medical Center (J.N.M.) - all in Chicago; UCSF Benioff Children's Hospital Oakland, Oakland (M.B., D.L., J.M.); Nemours Children's Health System, Jacksonville (K.B., J.J.L.), and Nemours Children's Hospital, University of Central Florida College of Medicine, Orlando (J.E.L.) - both in Florida; the Department of Pediatrics, National Jewish Health, Denver (R.C., J.T.O.); and the Department of Pediatrics, University of New Mexico, Albuquerque (H.H.R.)
| | - Hengameh H Raissy
- From the Department of Pediatrics, University of Wisconsin School of Medicine and Public Health (D.J.J., R.F.L.J.), and the University of Wisconsin-Madison (C.A.S.) - both in Madison; the Department of Pediatrics, Washington University in St. Louis School of Medicine and St. Louis Children's Hospital, St. Louis (L.B.B., A.B.); the Department of Public Health Sciences, Penn State University, Hershey (D.T.M., S.B.), and the University of Pittsburgh Asthma Institute at University of Pittsburgh Medical Center-University of Pittsburgh School of Medicine (F.H.) and the Department of Pediatrics, Allegheny General Hospital (D.A.G.), Pittsburgh - all in Pennsylvania; the Department of Pediatrics, Case Western Reserve University School of Medicine, Rainbow Babies and Children's Hospital, Cleveland (J.F.C., R.E.M., K.R.); the Department of Pediatrics, Emory University, Atlanta (A.M.F.); the Divisions of Respiratory Diseases (J.M.G.) and Allergy-Immunology, Boston Children's Hospital (W.P., W.J.S., S.N.B.), Harvard Medical School, and Brigham and Women's Hospital, Harvard Medical School (E.I.) - all in Boston; the Arizona Respiratory Center, University of Arizona, Tucson (W.J.M., F.D.M.); Wake Forest University School of Medicine, Winston-Salem, NC (S.P.P.); the Departments of Pediatrics (M.D.C., N.L.), Epidemiology (M.D.C.), Biostatistics (M.D.C.), and Medicine (S.C.L.), University of California, San Francisco (UCSF), and UCSF Benioff Children's Hospital (M.D.C.) - both in San Francisco; Ann and Robert H. Lurie Children's Hospital of Chicago (J.A.P., R.G.R.), University of Illinois at Chicago (J.A.K., H.V.K.), and the Department of Pediatrics, Stroger Hospital of Cook County, Rush University Medical Center (J.N.M.) - all in Chicago; UCSF Benioff Children's Hospital Oakland, Oakland (M.B., D.L., J.M.); Nemours Children's Health System, Jacksonville (K.B., J.J.L.), and Nemours Children's Hospital, University of Central Florida College of Medicine, Orlando (J.E.L.) - both in Florida; the Department of Pediatrics, National Jewish Health, Denver (R.C., J.T.O.); and the Department of Pediatrics, University of New Mexico, Albuquerque (H.H.R.)
| | - Rachel G Robison
- From the Department of Pediatrics, University of Wisconsin School of Medicine and Public Health (D.J.J., R.F.L.J.), and the University of Wisconsin-Madison (C.A.S.) - both in Madison; the Department of Pediatrics, Washington University in St. Louis School of Medicine and St. Louis Children's Hospital, St. Louis (L.B.B., A.B.); the Department of Public Health Sciences, Penn State University, Hershey (D.T.M., S.B.), and the University of Pittsburgh Asthma Institute at University of Pittsburgh Medical Center-University of Pittsburgh School of Medicine (F.H.) and the Department of Pediatrics, Allegheny General Hospital (D.A.G.), Pittsburgh - all in Pennsylvania; the Department of Pediatrics, Case Western Reserve University School of Medicine, Rainbow Babies and Children's Hospital, Cleveland (J.F.C., R.E.M., K.R.); the Department of Pediatrics, Emory University, Atlanta (A.M.F.); the Divisions of Respiratory Diseases (J.M.G.) and Allergy-Immunology, Boston Children's Hospital (W.P., W.J.S., S.N.B.), Harvard Medical School, and Brigham and Women's Hospital, Harvard Medical School (E.I.) - all in Boston; the Arizona Respiratory Center, University of Arizona, Tucson (W.J.M., F.D.M.); Wake Forest University School of Medicine, Winston-Salem, NC (S.P.P.); the Departments of Pediatrics (M.D.C., N.L.), Epidemiology (M.D.C.), Biostatistics (M.D.C.), and Medicine (S.C.L.), University of California, San Francisco (UCSF), and UCSF Benioff Children's Hospital (M.D.C.) - both in San Francisco; Ann and Robert H. Lurie Children's Hospital of Chicago (J.A.P., R.G.R.), University of Illinois at Chicago (J.A.K., H.V.K.), and the Department of Pediatrics, Stroger Hospital of Cook County, Rush University Medical Center (J.N.M.) - all in Chicago; UCSF Benioff Children's Hospital Oakland, Oakland (M.B., D.L., J.M.); Nemours Children's Health System, Jacksonville (K.B., J.J.L.), and Nemours Children's Hospital, University of Central Florida College of Medicine, Orlando (J.E.L.) - both in Florida; the Department of Pediatrics, National Jewish Health, Denver (R.C., J.T.O.); and the Department of Pediatrics, University of New Mexico, Albuquerque (H.H.R.)
| | - Kristie Ross
- From the Department of Pediatrics, University of Wisconsin School of Medicine and Public Health (D.J.J., R.F.L.J.), and the University of Wisconsin-Madison (C.A.S.) - both in Madison; the Department of Pediatrics, Washington University in St. Louis School of Medicine and St. Louis Children's Hospital, St. Louis (L.B.B., A.B.); the Department of Public Health Sciences, Penn State University, Hershey (D.T.M., S.B.), and the University of Pittsburgh Asthma Institute at University of Pittsburgh Medical Center-University of Pittsburgh School of Medicine (F.H.) and the Department of Pediatrics, Allegheny General Hospital (D.A.G.), Pittsburgh - all in Pennsylvania; the Department of Pediatrics, Case Western Reserve University School of Medicine, Rainbow Babies and Children's Hospital, Cleveland (J.F.C., R.E.M., K.R.); the Department of Pediatrics, Emory University, Atlanta (A.M.F.); the Divisions of Respiratory Diseases (J.M.G.) and Allergy-Immunology, Boston Children's Hospital (W.P., W.J.S., S.N.B.), Harvard Medical School, and Brigham and Women's Hospital, Harvard Medical School (E.I.) - all in Boston; the Arizona Respiratory Center, University of Arizona, Tucson (W.J.M., F.D.M.); Wake Forest University School of Medicine, Winston-Salem, NC (S.P.P.); the Departments of Pediatrics (M.D.C., N.L.), Epidemiology (M.D.C.), Biostatistics (M.D.C.), and Medicine (S.C.L.), University of California, San Francisco (UCSF), and UCSF Benioff Children's Hospital (M.D.C.) - both in San Francisco; Ann and Robert H. Lurie Children's Hospital of Chicago (J.A.P., R.G.R.), University of Illinois at Chicago (J.A.K., H.V.K.), and the Department of Pediatrics, Stroger Hospital of Cook County, Rush University Medical Center (J.N.M.) - all in Chicago; UCSF Benioff Children's Hospital Oakland, Oakland (M.B., D.L., J.M.); Nemours Children's Health System, Jacksonville (K.B., J.J.L.), and Nemours Children's Hospital, University of Central Florida College of Medicine, Orlando (J.E.L.) - both in Florida; the Department of Pediatrics, National Jewish Health, Denver (R.C., J.T.O.); and the Department of Pediatrics, University of New Mexico, Albuquerque (H.H.R.)
| | - Christine A Sorkness
- From the Department of Pediatrics, University of Wisconsin School of Medicine and Public Health (D.J.J., R.F.L.J.), and the University of Wisconsin-Madison (C.A.S.) - both in Madison; the Department of Pediatrics, Washington University in St. Louis School of Medicine and St. Louis Children's Hospital, St. Louis (L.B.B., A.B.); the Department of Public Health Sciences, Penn State University, Hershey (D.T.M., S.B.), and the University of Pittsburgh Asthma Institute at University of Pittsburgh Medical Center-University of Pittsburgh School of Medicine (F.H.) and the Department of Pediatrics, Allegheny General Hospital (D.A.G.), Pittsburgh - all in Pennsylvania; the Department of Pediatrics, Case Western Reserve University School of Medicine, Rainbow Babies and Children's Hospital, Cleveland (J.F.C., R.E.M., K.R.); the Department of Pediatrics, Emory University, Atlanta (A.M.F.); the Divisions of Respiratory Diseases (J.M.G.) and Allergy-Immunology, Boston Children's Hospital (W.P., W.J.S., S.N.B.), Harvard Medical School, and Brigham and Women's Hospital, Harvard Medical School (E.I.) - all in Boston; the Arizona Respiratory Center, University of Arizona, Tucson (W.J.M., F.D.M.); Wake Forest University School of Medicine, Winston-Salem, NC (S.P.P.); the Departments of Pediatrics (M.D.C., N.L.), Epidemiology (M.D.C.), Biostatistics (M.D.C.), and Medicine (S.C.L.), University of California, San Francisco (UCSF), and UCSF Benioff Children's Hospital (M.D.C.) - both in San Francisco; Ann and Robert H. Lurie Children's Hospital of Chicago (J.A.P., R.G.R.), University of Illinois at Chicago (J.A.K., H.V.K.), and the Department of Pediatrics, Stroger Hospital of Cook County, Rush University Medical Center (J.N.M.) - all in Chicago; UCSF Benioff Children's Hospital Oakland, Oakland (M.B., D.L., J.M.); Nemours Children's Health System, Jacksonville (K.B., J.J.L.), and Nemours Children's Hospital, University of Central Florida College of Medicine, Orlando (J.E.L.) - both in Florida; the Department of Pediatrics, National Jewish Health, Denver (R.C., J.T.O.); and the Department of Pediatrics, University of New Mexico, Albuquerque (H.H.R.)
| | - Robert F Lemanske
- From the Department of Pediatrics, University of Wisconsin School of Medicine and Public Health (D.J.J., R.F.L.J.), and the University of Wisconsin-Madison (C.A.S.) - both in Madison; the Department of Pediatrics, Washington University in St. Louis School of Medicine and St. Louis Children's Hospital, St. Louis (L.B.B., A.B.); the Department of Public Health Sciences, Penn State University, Hershey (D.T.M., S.B.), and the University of Pittsburgh Asthma Institute at University of Pittsburgh Medical Center-University of Pittsburgh School of Medicine (F.H.) and the Department of Pediatrics, Allegheny General Hospital (D.A.G.), Pittsburgh - all in Pennsylvania; the Department of Pediatrics, Case Western Reserve University School of Medicine, Rainbow Babies and Children's Hospital, Cleveland (J.F.C., R.E.M., K.R.); the Department of Pediatrics, Emory University, Atlanta (A.M.F.); the Divisions of Respiratory Diseases (J.M.G.) and Allergy-Immunology, Boston Children's Hospital (W.P., W.J.S., S.N.B.), Harvard Medical School, and Brigham and Women's Hospital, Harvard Medical School (E.I.) - all in Boston; the Arizona Respiratory Center, University of Arizona, Tucson (W.J.M., F.D.M.); Wake Forest University School of Medicine, Winston-Salem, NC (S.P.P.); the Departments of Pediatrics (M.D.C., N.L.), Epidemiology (M.D.C.), Biostatistics (M.D.C.), and Medicine (S.C.L.), University of California, San Francisco (UCSF), and UCSF Benioff Children's Hospital (M.D.C.) - both in San Francisco; Ann and Robert H. Lurie Children's Hospital of Chicago (J.A.P., R.G.R.), University of Illinois at Chicago (J.A.K., H.V.K.), and the Department of Pediatrics, Stroger Hospital of Cook County, Rush University Medical Center (J.N.M.) - all in Chicago; UCSF Benioff Children's Hospital Oakland, Oakland (M.B., D.L., J.M.); Nemours Children's Health System, Jacksonville (K.B., J.J.L.), and Nemours Children's Hospital, University of Central Florida College of Medicine, Orlando (J.E.L.) - both in Florida; the Department of Pediatrics, National Jewish Health, Denver (R.C., J.T.O.); and the Department of Pediatrics, University of New Mexico, Albuquerque (H.H.R.)
| |
Collapse
|
59
|
Morris CR, Mauger DT, Suh JH, Phipatanakul W, Sheehan WJ, Moy JN, Paul IM, Szefler SJ, Jackson DJ, Fitzpatrick AM. Glutathione and arginine levels: Predictors for acetaminophen-associated asthma exacerbation? J Allergy Clin Immunol 2018. [PMID: 29518418 DOI: 10.1016/j.jaci.2018.01.045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Claudia R Morris
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Ga
| | - David T Mauger
- Department of Public Health Sciences, College of Medicine, Penn State University, Hershey, Pa
| | - Jung H Suh
- Children's Hospital Oakland Research Institute, Oakland, Calif
| | - Wanda Phipatanakul
- Division of Allergy/Immunology, Boston Children's Hospital, Harvard Medical School, Boston, Mass
| | - William J Sheehan
- Division of Allergy/Immunology, Boston Children's Hospital, Harvard Medical School, Boston, Mass
| | - James N Moy
- Stroger Hospital of Cook County, Department of Pediatrics, Rush University Medical Center, Chicago, Ill
| | - Ian M Paul
- Department of Pediatrics, College of Medicine, Penn State University, Hershey, Pa
| | - Stanley J Szefler
- Children's Hospital Colorado, the Breathing Institute, and the University of Colorado School of Medicine, Aurora, Colo
| | - Daniel J Jackson
- Pediatrics, Section of Allergy, Immunology and Rheumatology, University of Wisconsin School of Medicine and Public Health, Madison, Wis
| | - Anne M Fitzpatrick
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Ga.
| | | |
Collapse
|
60
|
Grunwell JR, Yeligar SM, Stephenson S, Ping XD, Gauthier TW, Fitzpatrick AM, Brown LAS. TGF-β1 Suppresses the Type I IFN Response and Induces Mitochondrial Dysfunction in Alveolar Macrophages. J Immunol 2018; 200:2115-2128. [PMID: 29427413 DOI: 10.4049/jimmunol.1701325] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 01/08/2018] [Indexed: 11/19/2022]
Abstract
TGF-β1 is a pleiotropic cytokine with an established role in fibrosis; however, the immunosuppressive effects of TGF-β1 are less characterized. Elevated levels of TGF-β1 are found in patients with acute and chronic lung diseases, and the underlying disease processes are exacerbated by respiratory viral infections. The alveolar macrophage is the first line of cellular defense against respiratory viral infections, and its response to infections is dependent on environmental cues. Using the mouse alveolar macrophage line, MH-S, and human CD14+ monocyte-derived macrophages, we examined the effects of TGF-β1 on the type I IFN antiviral response, macrophage polarization, and mitochondrial bioenergetics following a challenge with human respiratory syncytial virus (RSV). Our results showed that TGF-β1 treatment of macrophages decreased the antiviral and proinflammatory response, and suppressed basal, maximal, spare mitochondrial respiration, and mitochondrial ATP production. Challenge with RSV following TGF-β1 treatment further exacerbated mitochondrial dysfunction. The TGF-β1 and TGF-β1+RSV-treated macrophages had a higher frequency of apoptosis and diminished phagocytic capacity, potentially through mitochondrial stress. Disruption of TGF-β1 signaling or rescue of mitochondrial respiration may be novel therapeutically targetable pathways to improve macrophage function and prevent secondary bacterial infections that complicate viral respiratory infections.
Collapse
Affiliation(s)
- Jocelyn R Grunwell
- Division of Critical Care Medicine, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA 30322; .,Children's Healthcare of Atlanta at Egleston, Atlanta, GA 30322
| | - Samantha M Yeligar
- Division of Pulmonary, Allergy, Critical Care and Sleep, Department of Medicine, Emory University, Atlanta, GA 30322.,Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Atlanta Veterans Affairs Medical Center, Decatur, GA 30033
| | - Susan Stephenson
- Division of Pulmonary, Allergy and Sleep Medicine, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA 30322; and
| | - Xiao Du Ping
- Division of Neonatology, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA 30322
| | - Theresa W Gauthier
- Division of Neonatology, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA 30322
| | - Anne M Fitzpatrick
- Division of Pulmonary, Allergy and Sleep Medicine, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA 30322; and
| | - Lou Ann S Brown
- Division of Neonatology, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA 30322
| |
Collapse
|
61
|
Lang JE, Fitzpatrick AM, Mauger DT, Guilbert TW, Jackson DJ, Lemanske RF, Martinez FD, Strunk RC, Zeiger RS, Phipatanakul W, Bacharier LB, Pongracic JA, Holguin F, Cabana MD, Covar RA, Raissy HH, Tang M, Szefler SJ. Overweight/obesity status in preschool children associates with worse asthma but robust improvement on inhaled corticosteroids. J Allergy Clin Immunol 2017; 141:1459-1467.e2. [PMID: 29273557 PMCID: PMC6675020 DOI: 10.1016/j.jaci.2017.09.043] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 08/31/2017] [Accepted: 09/27/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Overweight/obesity (OW) is linked to worse asthma and poorer inhaled corticosteroid (ICS) response in older children and adults. OBJECTIVE We sought to describe the relationships between OW and asthma severity and response to ICS in preschool children. METHODS This post hoc study of 3 large multicenter trials involving 2- to 5-year-old children compared annualized asthma symptom days and exacerbations among normal weight (NW) (body mass index: 10th-84th percentiles) versus OW (body mass index: ≥85th percentile) participants. Participants had been randomized to daily ICS, intermittent ICS, or daily placebo. Simple and multivariable linear regression was used to compare body mass index groups. RESULTS Within the group not treated with a daily controller, OW children had more asthma symptom days (90.7 vs 53.2, P = .020) and exacerbations (1.4 vs 0.8, P = .009) thanNW children did. Within the ICS-treated groups, OW and NW children had similar asthma symptom days (daily ICS: 47.2 vs 44.0 days, P = .44; short-term ICS: 61.8 vs 52.9 days, P = .46; as-needed ICS: 53.3 vs 47.3 days, P = .53), and similar exacerbations (daily ICS: 0.6 vs 0.8, P = .10; short-term ICS: 1.1 vs 0.8 days, P = .25; as-needed ICS: 1.0 vs 1.1, P = .72). Compared with placebo, daily ICS in OW led to fewer annualized asthma symptom days (90.7 vs 41.2, P = .004) and exacerbations (1.4 vs 0.6, P = .006), while similar protective ICS effects were less apparent among NW. CONCLUSIONS In preschool children off controller therapy, OW is associated with greater asthma impairment and exacerbations. However, unlike older asthmatic patients, OW preschool children do not demonstrate reduced responsiveness to ICS therapy.
Collapse
Affiliation(s)
- Jason E Lang
- Department of Pediatrics, Duke University School of Medicine, Durham, NC.
| | | | - David T Mauger
- Department of Public Health Sciences, College of Medicine, Penn State University, Hershey, Pa
| | | | - Daniel J Jackson
- Pediatrics Section of Allergy, Immunology, and Rheumatology, University of Wisconsin School of Medicine and Public Health, Madison, Wis
| | - Robert F Lemanske
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wis
| | | | | | - Robert S Zeiger
- Kaiser Permanente Medical Center, University of California-San Diego, San Diego, Calif
| | | | | | | | - Fernando Holguin
- University of Pittsburgh School of Medicine, Pittsburgh, Pittsburgh, Pa
| | | | | | | | - Monica Tang
- Department of Pediatrics, Duke University School of Medicine, Durham, NC
| | - Stanley J Szefler
- Children's Hospital Colorado, The Breathing Institute, and University of Colorado School of Medicine, Aurora, Colo
| | | |
Collapse
|
62
|
Shams MR, Bruce AC, Fitzpatrick AM. Anxiety Contributes to Poorer Asthma Outcomes in Inner-City Black Adolescents. J Allergy Clin Immunol Pract 2017; 6:227-235. [PMID: 28803180 DOI: 10.1016/j.jaip.2017.06.034] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Revised: 06/27/2017] [Accepted: 06/30/2017] [Indexed: 12/26/2022]
Abstract
BACKGROUND The factors associated with poor asthma control, exacerbations, and health care utilization in black adolescents are complex and not well understood. Although psychological comorbidities such as anxiety are common in patients with asthma, these have not been studied in this population. OBJECTIVE This study characterized anxiety and associated asthma features in a cohort of black inner-city adolescents with persistent asthma and determined the association between anxiety symptoms, persistent uncontrolled asthma, and prospective health care utilization over 1 year. METHODS Eighty-six black adolescents were enrolled, phenotyped, and screened for anxiety symptoms with the Hospital Anxiety and Depression Scale anxiety subscale (HADS-A). Participants were telephoned every 2 months and a second study visit was completed at 1 year. Primary outcomes included persistent uncontrolled asthma, asthma exacerbations requiring systemic corticosteroids, and unscheduled health care utilization during the 1-year study period. RESULTS A total of 31% (n = 27) of adolescents had probable anxiety (ie, HADS-A score >7) and 27% (n = 23) had possible anxiety (ie, HADS-A score 5-7) at the baseline visit. Anxiety symptoms were associated with poorer asthma control, more impaired quality of life, and more insomnia symptoms. Adolescents with probable anxiety disorders also had increased odds of persistent uncontrolled asthma and emergency department utilization, with no differences in physician visits or systemic corticosteroid receipt. CONCLUSIONS Inner-city black adolescents with persistent asthma have a high prevalence of anxiety symptoms associated with poorer asthma control, impaired quality of life, insomnia, and increased prospective emergency department utilization for asthma. Routine screening for anxiety disorders may be useful in the clinical management of adolescents with asthma.
Collapse
Affiliation(s)
- Marissa R Shams
- Emory University Department of Pediatrics, Atlanta, Ga; Emory University Department of Medicine, Atlanta, Ga
| | - Alice C Bruce
- Emory University Department of Pediatrics, Atlanta, Ga
| | | |
Collapse
|
63
|
Fitzpatrick AM, Jackson DJ, Mauger D, Szefler SJ. Reply. J Allergy Clin Immunol 2017; 140:1213. [PMID: 28780972 DOI: 10.1016/j.jaci.2017.06.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 06/13/2017] [Indexed: 11/17/2022]
Affiliation(s)
| | - Daniel J Jackson
- Pediatrics Section of Allergy, Immunology and Rheumatology, University of Wisconsin School of Medicine and Public Health, Madison, Wis
| | - David Mauger
- Department of Public Health Sciences, College of Medicine, Penn State University, Hershey, Pa
| | - Stanley J Szefler
- Children's Hospital Colorado, The Breathing Institute, and University of Colorado School of Medicine, Aurora, Colo.
| |
Collapse
|
64
|
Franklin JM, Grunwell JR, Bruce AC, Smith RC, Fitzpatrick AM. Predictors of emergency department use in children with persistent asthma in metropolitan Atlanta, Georgia. Ann Allergy Asthma Immunol 2017; 119:129-136. [PMID: 28479192 PMCID: PMC5604877 DOI: 10.1016/j.anai.2017.04.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 04/07/2017] [Accepted: 04/11/2017] [Indexed: 01/29/2023]
Abstract
BACKGROUND Racial disparities are evident among children with asthma in the United States, with non-Hispanic black children at particularly high risk for poor asthma outcomes, including frequent emergency department (ED) use for asthma exacerbations. OBJECTIVE To compare asthma features in non-Hispanic black vs white children in Atlanta, Georgia, and determine what clinical features predict future ED use for asthma. METHODS Self-reported black and white children 6 to 17 years of age with persistent asthma treated with controller medications completed medical history questionnaires, lung function testing, aeroallergen sensitization testing, and venipuncture. Medical records were reviewed for asthma-related ED visits for 12 months after the initial study visit. RESULTS A total of 276 children were enrolled. Black children, compared with white children, resided in more disadvantaged zip code areas and were more likely to have public insurance. Black children also had more features of asthma severity and more ED visits during the study period. Predictors of ED use, aside from a previous ED visit, differed by race. After adjustment for socioeconomic status, predictors of ED use in white children included an ED visit in the previous year and sensitization to pets and dust; in black children, predictors included ED use in the previous year, the number of asthma controller medications, forced expiratory volume in 1 second less than 80% predicted, blood eosinophil count greater than 4%, and mold sensitization. CONCLUSION Asthma features and ED use differ between black and white children in metropolitan Atlanta. Strategies to eliminate allergen exposure in the home and improve asthma control in these children may require tailoring for different racial groups.
Collapse
Affiliation(s)
| | | | - Alice C Bruce
- Department of Pediatrics, Emory University, Atlanta, Georgia
| | - Robin C Smith
- Department of Pediatrics, Emory University, Atlanta, Georgia
| | | |
Collapse
|
65
|
Denlinger LC, Phillips BR, Ramratnam S, Ross K, Bhakta NR, Cardet JC, Castro M, Peters SP, Phipatanakul W, Aujla S, Bacharier LB, Bleecker ER, Comhair SAA, Coverstone A, DeBoer M, Erzurum SC, Fain SB, Fajt M, Fitzpatrick AM, Gaffin J, Gaston B, Hastie AT, Hawkins GA, Holguin F, Irani AM, Israel E, Levy BD, Ly N, Meyers DA, Moore WC, Myers R, Opina MTD, Peters MC, Schiebler ML, Sorkness RL, Teague WG, Wenzel SE, Woodruff PG, Mauger DT, Fahy JV, Jarjour NN. Inflammatory and Comorbid Features of Patients with Severe Asthma and Frequent Exacerbations. Am J Respir Crit Care Med 2017; 195:302-313. [PMID: 27556234 DOI: 10.1164/rccm.201602-0419oc] [Citation(s) in RCA: 295] [Impact Index Per Article: 42.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
RATIONALE Reducing asthma exacerbation frequency is an important criterion for approval of asthma therapies, but the clinical features of exacerbation-prone asthma (EPA) remain incompletely defined. OBJECTIVES To describe the clinical, physiologic, inflammatory, and comorbidity factors associated with EPA. METHODS Baseline data from the NHLBI Severe Asthma Research Program (SARP)-3 were analyzed. An exacerbation was defined as a burst of systemic corticosteroids lasting 3 days or more. Patients were classified by their number of exacerbations in the past year: none, few (one to two), or exacerbation prone (≥3). Replication of a multivariable model was performed with data from the SARP-1 + 2 cohort. MEASUREMENTS AND MAIN RESULTS Of 709 subjects in the SARP-3 cohort, 294 (41%) had no exacerbations and 173 (24%) were exacerbation prone in the prior year. Several factors normally associated with severity (asthma duration, age, sex, race, and socioeconomic status) did not associate with exacerbation frequency in SARP-3; bronchodilator responsiveness also discriminated exacerbation proneness from asthma severity. In the SARP-3 multivariable model, blood eosinophils, body mass index, and bronchodilator responsiveness were positively associated with exacerbation frequency (rate ratios [95% confidence interval], 1.6 [1.2-2.1] for every log unit of eosinophils, 1.3 [1.1-1.4] for every 10 body mass index units, and 1.2 [1.1-1.4] for every 10% increase in bronchodilatory responsiveness). Chronic sinusitis and gastroesophageal reflux were also associated with exacerbation frequency (1.7 [1.4-2.1] and 1.6 [1.3-2.0]), even after adjustment for multiple factors. These effects were replicated in the SARP-1 + 2 multivariable model. CONCLUSIONS EPA may be a distinct susceptibility phenotype with implications for the targeting of exacerbation prevention strategies. Clinical trial registered with www.clinicaltrials.gov (NCT 01760915).
Collapse
Affiliation(s)
| | - Brenda R Phillips
- 2 The Pennsylvania State University College of Medicine, Hershey, Pennsylvania
| | | | - Kristie Ross
- 3 Case Western Reserve University, Cleveland, Ohio
| | - Nirav R Bhakta
- 4 University of California San Francisco, San Francisco, California
| | | | | | | | | | - Shean Aujla
- 8 University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | | | | | | | - Mark DeBoer
- 10 University of Virginia, Charlottesville, Virginia
| | | | - Sean B Fain
- 1 University of Wisconsin, Madison, Wisconsin
| | - Merritt Fajt
- 8 University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | | | | | | | | | | | | | | | | | - Ngoc Ly
- 4 University of California San Francisco, San Francisco, California
| | | | - Wendy C Moore
- 7 Wake Forest University, Winston-Salem, North Carolina
| | - Ross Myers
- 3 Case Western Reserve University, Cleveland, Ohio
| | | | - Michael C Peters
- 4 University of California San Francisco, San Francisco, California
| | | | | | | | | | | | - David T Mauger
- 2 The Pennsylvania State University College of Medicine, Hershey, Pennsylvania
| | - John V Fahy
- 4 University of California San Francisco, San Francisco, California
| | | | | |
Collapse
|
66
|
Phipatanakul W, Mauger DT, Sorkness RL, Gaffin JM, Holguin F, Woodruff PG, Ly NP, Bacharier LB, Bhakta NR, Moore WC, Bleecker ER, Hastie AT, Meyers DA, Castro M, Fahy JV, Fitzpatrick AM, Gaston BM, Jarjour NN, Levy BD, Peters SP, Teague WG, Fajt M, Wenzel SE, Erzurum SC, Israel E. Effects of Age and Disease Severity on Systemic Corticosteroid Responses in Asthma. Am J Respir Crit Care Med 2017; 195:1439-1448. [PMID: 27967215 PMCID: PMC5470749 DOI: 10.1164/rccm.201607-1453oc] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Accepted: 12/13/2016] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Phenotypic distinctions between severe asthma (SA) and nonsevere asthma (NONSA) may be confounded by differential adherence or incorrect use of corticosteroids. OBJECTIVES To determine if there are persistent phenotypic distinctions between SA (as defined by 2014 American Thoracic Society/European Respiratory Society guidelines) and NONSA after intramuscular triamcinolone acetonide (TA), and to identify predictors of a corticosteroid response in these populations. METHODS A total of 526 adults age 18 years and older (315 SA) and 188 children age 6 to less than 18 years (107 SA) in the NHLBI Severe Asthma Research Program III were characterized before and 3 weeks after TA. The primary outcome for corticosteroid response was defined as greater than or equal to 10-point improvement in percent predicted FEV1. MEASUREMENTS AND MAIN RESULTS Adult asthma groups exhibited a small but significant mean FEV1% predicted improvement after TA (SA group mean difference, 3.4%; 95% confidence interval, 2.2-4.7%; P = 0.001), whereas children did not. Adult SA continued to manifest lower FEV1 and worse asthma control as compared with NONSA after TA. In children, after TA only prebronchodilator FEV1 distinguished SA from NONSA. A total of 21% of adults with SA and 20% of children with SA achieved greater than or equal to 10% improvement after TA. Baseline bronchodilator response and fractional exhaled nitric oxide had good sensitivity and specificity for predicting response in all groups except children with NONSA. CONCLUSIONS One in five patients with SA exhibit greater than or equal to 10% improvement in FEV1 with parenteral corticosteroid. Those likely to respond had greater bronchodilator responsiveness and fractional exhaled nitric oxide levels. In adults, differences in airflow obstruction and symptoms between SA and NONSA persist after parenteral corticosteroids, suggesting a component of corticosteroid nonresponsive pathobiology in adults with SA that may differ in children. Clinical trial registered with www.clinicaltrials.gov (NCT 01606826).
Collapse
Affiliation(s)
- Wanda Phipatanakul
- Boston Children’s Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - David T. Mauger
- Pennsylvania State University, University Park, Pennsylvania
| | | | - Jonathan M. Gaffin
- Boston Children’s Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | | | | | - Ngoc P. Ly
- University of San Francisco, San Francisco, California
| | | | | | | | | | | | | | | | - John V. Fahy
- University of San Francisco, San Francisco, California
| | | | | | | | - Bruce D. Levy
- Harvard Medical School, Boston, Massachusetts
- Brigham and Women’s Hospital, Boston, Massachusetts
| | | | | | - Merritt Fajt
- University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | | | - Elliot Israel
- Harvard Medical School, Boston, Massachusetts
- Brigham and Women’s Hospital, Boston, Massachusetts
| |
Collapse
|
67
|
Fitzpatrick AM. Severe Asthma in Children: Lessons Learned and Future Directions. J Allergy Clin Immunol Pract 2016; 4:11-9; quiz 20-1. [PMID: 26772923 DOI: 10.1016/j.jaip.2015.10.008] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Revised: 10/14/2015] [Accepted: 10/16/2015] [Indexed: 01/02/2023]
Abstract
Severe asthma in children is a complicated and heterogeneous disorder that is extremely challenging to treat. Although most children with asthma derive clinical benefit from daily administration of low-to-medium-dose inhaled corticosteroid (ICS) therapy, a small subset of children with "severe" or "refractory" asthma require high doses of ICS and even systemic corticosteroids to maintain symptom control. These children with severe asthma are at increased risk for adverse outcomes including medication-related side effects and recurrent and life-threatening exacerbations that significantly impair quality of life. This review highlights findings on severe asthma in school-age children (age 6-17 years) from the National Heart, Lung and Blood Institute's Severe Asthma Research Program (SARP) over a 10-year period, between 2001 and 2011. Although SARP has advanced knowledge of the unique clinical, biological, and molecular attributes of severe asthma in children, considerable gaps remain for which additional studies are needed.
Collapse
Affiliation(s)
- Anne M Fitzpatrick
- Department of Pediatrics, Emory University, Atlanta, Ga; Children's Healthcare of Atlanta Center for Cystic Fibrosis and Airways Disease Research, Atlanta, Ga.
| |
Collapse
|
68
|
Fitzpatrick AM, Stephenson ST, Brown MR, Nguyen K, Douglas S, Brown LAS. Systemic Corticosteroid Responses in Children with Severe Asthma: Phenotypic and Endotypic Features. J Allergy Clin Immunol Pract 2016; 5:410-419.e4. [PMID: 27665382 DOI: 10.1016/j.jaip.2016.08.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Revised: 08/11/2016] [Accepted: 08/23/2016] [Indexed: 11/18/2022]
Abstract
BACKGROUND Severe asthma in children is a heterogeneous disorder associated with variable responses to corticosteroid treatment. Criterion standards for corticosteroid responsiveness assessment in children are lacking. OBJECTIVE This study sought to characterize systemic corticosteroid responses in children with severe asthma after treatment with intramuscular triamcinolone and to identify phenotypic and molecular predictors of an intramuscular triamcinolone response. METHODS Asthma-related quality of life, exhaled nitric oxide, blood eosinophils, lung function, and inflammatory cytokine and chemokine mRNA gene expression in peripheral blood mononuclear cells were assessed in 56 children with severe asthma at baseline and 14 days after intramuscular triamcinolone injection. The Asthma Control Questionnaire was used to classify children with severe asthma into corticosteroid response groups. RESULTS Three groups of children with severe asthma were identified: controlled severe asthma, children who achieved control after triamcinolone, and children who did not achieve control. At baseline, these groups were phenotypically similar. After triamcinolone, discordance between symptoms, lung function, exhaled nitric oxide, and blood eosinophils was noted. Clinical phenotypic predictors were of limited utility in predicting the triamcinolone response, whereas systemic mRNA expression of inflammatory cytokines and chemokines related to IL-2, IL-10, and TNF signaling pathways, namely, AIMP1, CCR2, IL10RB, and IL5, strongly differentiated children who failed to achieve control with triamcinolone administration. CONCLUSIONS Systemic corticosteroid responsiveness in children with severe asthma is heterogeneous. Alternative prediction models that include molecular endotypic as well as clinical phenotypic features are needed to identify which children derive the most clinical benefit from systemic corticosteroid step-up therapy given the potential side effects.
Collapse
Affiliation(s)
- Anne M Fitzpatrick
- Department of Pediatrics, Emory University, Atlanta, Ga; Center for Cystic Fibrosis and Airways Disease Research, Children's Healthcare of Atlanta, Atlanta, Ga.
| | | | | | | | | | - Lou Ann S Brown
- Department of Pediatrics, Emory University, Atlanta, Ga; Center for Cystic Fibrosis and Airways Disease Research, Children's Healthcare of Atlanta, Atlanta, Ga
| |
Collapse
|
69
|
Park YH, Fitzpatrick AM, Medriano CA, Jones DP. High-resolution metabolomics to identify urine biomarkers in corticosteroid-resistant asthmatic children. J Allergy Clin Immunol 2016; 139:1518-1524.e4. [PMID: 27658760 DOI: 10.1016/j.jaci.2016.08.018] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 07/25/2016] [Accepted: 08/10/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Corticosteroid (CS) treatment has been established as the first anti-inflammatory treatment for adults and children with asthma. However, a subset of patients fails to respond to combined systemic and inhaled CS treatment. OBJECTIVE This study was aimed at further understanding CS resistance among children with severe asthma. METHODS High-resolution metabolomics was performed on urine samples from CS-respondent (n = 15) and CS-nonrespondent (n = 15) children to determine possible urine biomarkers related to CS resistance. The metabolic phenotypes of CS responders and CS nonresponders were analyzed using bioinformatics including Manhattan plot with false- discovery rate, hierarchical cluster analysis, Kyoto Encyclopedia Genes and Genomes, and Mummichog pathway analysis. RESULTS The 2-way hierarchical cluster analysis study determined 30 metabolites showing significantly different levels between CS responders and CS nonresponders. The important metabolites annotated were 3,6-dihydronicotinic acid (126.05 m/z, RT: 106, [M+H]+), 3-methoxy-4-hydroxyphenyl(ethylene)glycol (185.05 m/z, RT: 155, [M+H]+), 3,4-dihydroxy-phenylalanine (198.07 m/z, RT: 446, [M+H]+), γ-glutamylcysteine (236.06 m/z, RT: 528, [M+S(34)+H]+), Cys-Gly, (253.06 m/z, RT: 528, [M-NH3+H]+), and reduced Flavin mononucleotide (517.0794 m/z, RT: 533, [M+NaCl]+). Tyrosine metabolism, degradation of aromatic compounds, and glutathione metabolism are suggested to be significant pathways relating to CS resistance. CONCLUSIONS High-resolution metabolomics is a promising approach in asthma research. Five candidate markers were identified to be related to CS-resistant children with severe asthma. These compounds, upon validation, may contribute further in the understanding of CS resistance among children with severe asthma through the use of urine.
Collapse
Affiliation(s)
- Youngja H Park
- College of Pharmacy, Korea University, Sejong City, Korea.
| | | | | | - Dean P Jones
- Department of Medicine, Emory University, Atlanta, Ga
| |
Collapse
|
70
|
Sheehan WJ, Mauger DT, Paul IM, Moy JN, Boehmer SJ, Szefler SJ, Fitzpatrick AM, Jackson DJ, Bacharier LB, Cabana MD, Covar R, Holguin F, Lemanske RF, Martinez FD, Pongracic JA, Beigelman A, Baxi SN, Benson M, Blake K, Chmiel JF, Daines CL, Daines MO, Gaffin JM, Gentile DA, Gower WA, Israel E, Kumar HV, Lang JE, Lazarus SC, Lima JJ, Ly N, Marbin J, Morgan WJ, Myers RE, Olin JT, Peters SP, Raissy HH, Robison RG, Ross K, Sorkness CA, Thyne SM, Wechsler ME, Phipatanakul W. Acetaminophen versus Ibuprofen in Young Children with Mild Persistent Asthma. N Engl J Med 2016; 375:619-30. [PMID: 27532828 PMCID: PMC5085065 DOI: 10.1056/nejmoa1515990] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Studies have suggested an association between frequent acetaminophen use and asthma-related complications among children, leading some physicians to recommend that acetaminophen be avoided in children with asthma; however, appropriately designed trials evaluating this association in children are lacking. METHODS In a multicenter, prospective, randomized, double-blind, parallel-group trial, we enrolled 300 children (age range, 12 to 59 months) with mild persistent asthma and assigned them to receive either acetaminophen or ibuprofen when needed for the alleviation of fever or pain over the course of 48 weeks. The primary outcome was the number of asthma exacerbations that led to treatment with systemic glucocorticoids. Children in both groups received standardized asthma-controller therapies that were used in a simultaneous, factorially linked trial. RESULTS Participants received a median of 5.5 doses (interquartile range, 1.0 to 15.0) of trial medication; there was no significant between-group difference in the median number of doses received (P=0.47). The number of asthma exacerbations did not differ significantly between the two groups, with a mean of 0.81 per participant with acetaminophen and 0.87 per participant with ibuprofen over 46 weeks of follow-up (relative rate of asthma exacerbations in the acetaminophen group vs. the ibuprofen group, 0.94; 95% confidence interval, 0.69 to 1.28; P=0.67). In the acetaminophen group, 49% of participants had at least one asthma exacerbation and 21% had at least two, as compared with 47% and 24%, respectively, in the ibuprofen group. Similarly, no significant differences were detected between acetaminophen and ibuprofen with respect to the percentage of asthma-control days (85.8% and 86.8%, respectively; P=0.50), use of an albuterol rescue inhaler (2.8 and 3.0 inhalations per week, respectively; P=0.69), unscheduled health care utilization for asthma (0.75 and 0.76 episodes per participant, respectively; P=0.94), or adverse events. CONCLUSIONS Among young children with mild persistent asthma, as-needed use of acetaminophen was not shown to be associated with a higher incidence of asthma exacerbations or worse asthma control than was as-needed use of ibuprofen. (Funded by the National Institutes of Health; AVICA ClinicalTrials.gov number, NCT01606319.).
Collapse
Affiliation(s)
- William J Sheehan
- From the Divisions of Allergy and Immunology (W.J.S., S.N.B., W.P.) and Respiratory Diseases (J.M.G.), Boston Children's Hospital and Harvard Medical School, and the Division of Allergy and Pulmonary Medicine, Brigham and Women's Hospital and Harvard Medical School (E.I.) - all in Boston; the Departments of Public Health Sciences (D.T.M., S.J.B.) and Pediatrics (I.M.P.), Penn State College of Medicine, Hershey, and the University of Pittsburgh Asthma Institute at University of Pittsburgh Medical Center (F.H.) and the Department of Pediatrics, Allegheny General Hospital (D.A.G.), Pittsburgh - all in Pennsylvania; Stroger Hospital of Cook County and Department of Pediatrics, Rush University Medical Center (J.N.M.), Ann and Robert H. Lurie Children's Hospital of Chicago (J.A.P., R.G.R.), and University of Illinois at Chicago (H.V.K.) - all in Chicago; the Breathing Institute, Children's Hospital Colorado (S.J.S.), and the Departments of Pediatrics (S.J.S.) and Medicine (M.E.W.), University of Colorado School of Medicine, Aurora, and the Department of Pediatrics (R.C., J.T.O.) and Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine (M.E.W.), National Jewish Health, Denver - both in Colorado; the Department of Pediatrics, Emory University, Atlanta (A.M.F.); the Section of Allergy, Immunology, and Rheumatology, Department of Pediatrics, University of Wisconsin School of Medicine and Public Health (D.J.J., R.F.L.) and the School of Pharmacy, University of Wisconsin-Madison (C.A.S.) - both in Madison; Washington University School of Medicine in St. Louis and the Department of Pediatrics, St. Louis Children's Hospital (L.B.B., A.B.) - both in St. Louis; the Departments of Pediatrics (M.D.C.) and Medicine (S.C.L.) and the Airway Clinical Research Center (N.L.), University of California, San Francisco, San Francisco, Benioff Children's Hospital Oakland, Oakland (M.B., J.M.), and Olive View UCLA Medical Center and Department of Pediatrics, David Geff
| | - David T Mauger
- From the Divisions of Allergy and Immunology (W.J.S., S.N.B., W.P.) and Respiratory Diseases (J.M.G.), Boston Children's Hospital and Harvard Medical School, and the Division of Allergy and Pulmonary Medicine, Brigham and Women's Hospital and Harvard Medical School (E.I.) - all in Boston; the Departments of Public Health Sciences (D.T.M., S.J.B.) and Pediatrics (I.M.P.), Penn State College of Medicine, Hershey, and the University of Pittsburgh Asthma Institute at University of Pittsburgh Medical Center (F.H.) and the Department of Pediatrics, Allegheny General Hospital (D.A.G.), Pittsburgh - all in Pennsylvania; Stroger Hospital of Cook County and Department of Pediatrics, Rush University Medical Center (J.N.M.), Ann and Robert H. Lurie Children's Hospital of Chicago (J.A.P., R.G.R.), and University of Illinois at Chicago (H.V.K.) - all in Chicago; the Breathing Institute, Children's Hospital Colorado (S.J.S.), and the Departments of Pediatrics (S.J.S.) and Medicine (M.E.W.), University of Colorado School of Medicine, Aurora, and the Department of Pediatrics (R.C., J.T.O.) and Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine (M.E.W.), National Jewish Health, Denver - both in Colorado; the Department of Pediatrics, Emory University, Atlanta (A.M.F.); the Section of Allergy, Immunology, and Rheumatology, Department of Pediatrics, University of Wisconsin School of Medicine and Public Health (D.J.J., R.F.L.) and the School of Pharmacy, University of Wisconsin-Madison (C.A.S.) - both in Madison; Washington University School of Medicine in St. Louis and the Department of Pediatrics, St. Louis Children's Hospital (L.B.B., A.B.) - both in St. Louis; the Departments of Pediatrics (M.D.C.) and Medicine (S.C.L.) and the Airway Clinical Research Center (N.L.), University of California, San Francisco, San Francisco, Benioff Children's Hospital Oakland, Oakland (M.B., J.M.), and Olive View UCLA Medical Center and Department of Pediatrics, David Geff
| | - Ian M Paul
- From the Divisions of Allergy and Immunology (W.J.S., S.N.B., W.P.) and Respiratory Diseases (J.M.G.), Boston Children's Hospital and Harvard Medical School, and the Division of Allergy and Pulmonary Medicine, Brigham and Women's Hospital and Harvard Medical School (E.I.) - all in Boston; the Departments of Public Health Sciences (D.T.M., S.J.B.) and Pediatrics (I.M.P.), Penn State College of Medicine, Hershey, and the University of Pittsburgh Asthma Institute at University of Pittsburgh Medical Center (F.H.) and the Department of Pediatrics, Allegheny General Hospital (D.A.G.), Pittsburgh - all in Pennsylvania; Stroger Hospital of Cook County and Department of Pediatrics, Rush University Medical Center (J.N.M.), Ann and Robert H. Lurie Children's Hospital of Chicago (J.A.P., R.G.R.), and University of Illinois at Chicago (H.V.K.) - all in Chicago; the Breathing Institute, Children's Hospital Colorado (S.J.S.), and the Departments of Pediatrics (S.J.S.) and Medicine (M.E.W.), University of Colorado School of Medicine, Aurora, and the Department of Pediatrics (R.C., J.T.O.) and Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine (M.E.W.), National Jewish Health, Denver - both in Colorado; the Department of Pediatrics, Emory University, Atlanta (A.M.F.); the Section of Allergy, Immunology, and Rheumatology, Department of Pediatrics, University of Wisconsin School of Medicine and Public Health (D.J.J., R.F.L.) and the School of Pharmacy, University of Wisconsin-Madison (C.A.S.) - both in Madison; Washington University School of Medicine in St. Louis and the Department of Pediatrics, St. Louis Children's Hospital (L.B.B., A.B.) - both in St. Louis; the Departments of Pediatrics (M.D.C.) and Medicine (S.C.L.) and the Airway Clinical Research Center (N.L.), University of California, San Francisco, San Francisco, Benioff Children's Hospital Oakland, Oakland (M.B., J.M.), and Olive View UCLA Medical Center and Department of Pediatrics, David Geff
| | - James N Moy
- From the Divisions of Allergy and Immunology (W.J.S., S.N.B., W.P.) and Respiratory Diseases (J.M.G.), Boston Children's Hospital and Harvard Medical School, and the Division of Allergy and Pulmonary Medicine, Brigham and Women's Hospital and Harvard Medical School (E.I.) - all in Boston; the Departments of Public Health Sciences (D.T.M., S.J.B.) and Pediatrics (I.M.P.), Penn State College of Medicine, Hershey, and the University of Pittsburgh Asthma Institute at University of Pittsburgh Medical Center (F.H.) and the Department of Pediatrics, Allegheny General Hospital (D.A.G.), Pittsburgh - all in Pennsylvania; Stroger Hospital of Cook County and Department of Pediatrics, Rush University Medical Center (J.N.M.), Ann and Robert H. Lurie Children's Hospital of Chicago (J.A.P., R.G.R.), and University of Illinois at Chicago (H.V.K.) - all in Chicago; the Breathing Institute, Children's Hospital Colorado (S.J.S.), and the Departments of Pediatrics (S.J.S.) and Medicine (M.E.W.), University of Colorado School of Medicine, Aurora, and the Department of Pediatrics (R.C., J.T.O.) and Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine (M.E.W.), National Jewish Health, Denver - both in Colorado; the Department of Pediatrics, Emory University, Atlanta (A.M.F.); the Section of Allergy, Immunology, and Rheumatology, Department of Pediatrics, University of Wisconsin School of Medicine and Public Health (D.J.J., R.F.L.) and the School of Pharmacy, University of Wisconsin-Madison (C.A.S.) - both in Madison; Washington University School of Medicine in St. Louis and the Department of Pediatrics, St. Louis Children's Hospital (L.B.B., A.B.) - both in St. Louis; the Departments of Pediatrics (M.D.C.) and Medicine (S.C.L.) and the Airway Clinical Research Center (N.L.), University of California, San Francisco, San Francisco, Benioff Children's Hospital Oakland, Oakland (M.B., J.M.), and Olive View UCLA Medical Center and Department of Pediatrics, David Geff
| | - Susan J Boehmer
- From the Divisions of Allergy and Immunology (W.J.S., S.N.B., W.P.) and Respiratory Diseases (J.M.G.), Boston Children's Hospital and Harvard Medical School, and the Division of Allergy and Pulmonary Medicine, Brigham and Women's Hospital and Harvard Medical School (E.I.) - all in Boston; the Departments of Public Health Sciences (D.T.M., S.J.B.) and Pediatrics (I.M.P.), Penn State College of Medicine, Hershey, and the University of Pittsburgh Asthma Institute at University of Pittsburgh Medical Center (F.H.) and the Department of Pediatrics, Allegheny General Hospital (D.A.G.), Pittsburgh - all in Pennsylvania; Stroger Hospital of Cook County and Department of Pediatrics, Rush University Medical Center (J.N.M.), Ann and Robert H. Lurie Children's Hospital of Chicago (J.A.P., R.G.R.), and University of Illinois at Chicago (H.V.K.) - all in Chicago; the Breathing Institute, Children's Hospital Colorado (S.J.S.), and the Departments of Pediatrics (S.J.S.) and Medicine (M.E.W.), University of Colorado School of Medicine, Aurora, and the Department of Pediatrics (R.C., J.T.O.) and Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine (M.E.W.), National Jewish Health, Denver - both in Colorado; the Department of Pediatrics, Emory University, Atlanta (A.M.F.); the Section of Allergy, Immunology, and Rheumatology, Department of Pediatrics, University of Wisconsin School of Medicine and Public Health (D.J.J., R.F.L.) and the School of Pharmacy, University of Wisconsin-Madison (C.A.S.) - both in Madison; Washington University School of Medicine in St. Louis and the Department of Pediatrics, St. Louis Children's Hospital (L.B.B., A.B.) - both in St. Louis; the Departments of Pediatrics (M.D.C.) and Medicine (S.C.L.) and the Airway Clinical Research Center (N.L.), University of California, San Francisco, San Francisco, Benioff Children's Hospital Oakland, Oakland (M.B., J.M.), and Olive View UCLA Medical Center and Department of Pediatrics, David Geff
| | - Stanley J Szefler
- From the Divisions of Allergy and Immunology (W.J.S., S.N.B., W.P.) and Respiratory Diseases (J.M.G.), Boston Children's Hospital and Harvard Medical School, and the Division of Allergy and Pulmonary Medicine, Brigham and Women's Hospital and Harvard Medical School (E.I.) - all in Boston; the Departments of Public Health Sciences (D.T.M., S.J.B.) and Pediatrics (I.M.P.), Penn State College of Medicine, Hershey, and the University of Pittsburgh Asthma Institute at University of Pittsburgh Medical Center (F.H.) and the Department of Pediatrics, Allegheny General Hospital (D.A.G.), Pittsburgh - all in Pennsylvania; Stroger Hospital of Cook County and Department of Pediatrics, Rush University Medical Center (J.N.M.), Ann and Robert H. Lurie Children's Hospital of Chicago (J.A.P., R.G.R.), and University of Illinois at Chicago (H.V.K.) - all in Chicago; the Breathing Institute, Children's Hospital Colorado (S.J.S.), and the Departments of Pediatrics (S.J.S.) and Medicine (M.E.W.), University of Colorado School of Medicine, Aurora, and the Department of Pediatrics (R.C., J.T.O.) and Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine (M.E.W.), National Jewish Health, Denver - both in Colorado; the Department of Pediatrics, Emory University, Atlanta (A.M.F.); the Section of Allergy, Immunology, and Rheumatology, Department of Pediatrics, University of Wisconsin School of Medicine and Public Health (D.J.J., R.F.L.) and the School of Pharmacy, University of Wisconsin-Madison (C.A.S.) - both in Madison; Washington University School of Medicine in St. Louis and the Department of Pediatrics, St. Louis Children's Hospital (L.B.B., A.B.) - both in St. Louis; the Departments of Pediatrics (M.D.C.) and Medicine (S.C.L.) and the Airway Clinical Research Center (N.L.), University of California, San Francisco, San Francisco, Benioff Children's Hospital Oakland, Oakland (M.B., J.M.), and Olive View UCLA Medical Center and Department of Pediatrics, David Geff
| | - Anne M Fitzpatrick
- From the Divisions of Allergy and Immunology (W.J.S., S.N.B., W.P.) and Respiratory Diseases (J.M.G.), Boston Children's Hospital and Harvard Medical School, and the Division of Allergy and Pulmonary Medicine, Brigham and Women's Hospital and Harvard Medical School (E.I.) - all in Boston; the Departments of Public Health Sciences (D.T.M., S.J.B.) and Pediatrics (I.M.P.), Penn State College of Medicine, Hershey, and the University of Pittsburgh Asthma Institute at University of Pittsburgh Medical Center (F.H.) and the Department of Pediatrics, Allegheny General Hospital (D.A.G.), Pittsburgh - all in Pennsylvania; Stroger Hospital of Cook County and Department of Pediatrics, Rush University Medical Center (J.N.M.), Ann and Robert H. Lurie Children's Hospital of Chicago (J.A.P., R.G.R.), and University of Illinois at Chicago (H.V.K.) - all in Chicago; the Breathing Institute, Children's Hospital Colorado (S.J.S.), and the Departments of Pediatrics (S.J.S.) and Medicine (M.E.W.), University of Colorado School of Medicine, Aurora, and the Department of Pediatrics (R.C., J.T.O.) and Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine (M.E.W.), National Jewish Health, Denver - both in Colorado; the Department of Pediatrics, Emory University, Atlanta (A.M.F.); the Section of Allergy, Immunology, and Rheumatology, Department of Pediatrics, University of Wisconsin School of Medicine and Public Health (D.J.J., R.F.L.) and the School of Pharmacy, University of Wisconsin-Madison (C.A.S.) - both in Madison; Washington University School of Medicine in St. Louis and the Department of Pediatrics, St. Louis Children's Hospital (L.B.B., A.B.) - both in St. Louis; the Departments of Pediatrics (M.D.C.) and Medicine (S.C.L.) and the Airway Clinical Research Center (N.L.), University of California, San Francisco, San Francisco, Benioff Children's Hospital Oakland, Oakland (M.B., J.M.), and Olive View UCLA Medical Center and Department of Pediatrics, David Geff
| | - Daniel J Jackson
- From the Divisions of Allergy and Immunology (W.J.S., S.N.B., W.P.) and Respiratory Diseases (J.M.G.), Boston Children's Hospital and Harvard Medical School, and the Division of Allergy and Pulmonary Medicine, Brigham and Women's Hospital and Harvard Medical School (E.I.) - all in Boston; the Departments of Public Health Sciences (D.T.M., S.J.B.) and Pediatrics (I.M.P.), Penn State College of Medicine, Hershey, and the University of Pittsburgh Asthma Institute at University of Pittsburgh Medical Center (F.H.) and the Department of Pediatrics, Allegheny General Hospital (D.A.G.), Pittsburgh - all in Pennsylvania; Stroger Hospital of Cook County and Department of Pediatrics, Rush University Medical Center (J.N.M.), Ann and Robert H. Lurie Children's Hospital of Chicago (J.A.P., R.G.R.), and University of Illinois at Chicago (H.V.K.) - all in Chicago; the Breathing Institute, Children's Hospital Colorado (S.J.S.), and the Departments of Pediatrics (S.J.S.) and Medicine (M.E.W.), University of Colorado School of Medicine, Aurora, and the Department of Pediatrics (R.C., J.T.O.) and Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine (M.E.W.), National Jewish Health, Denver - both in Colorado; the Department of Pediatrics, Emory University, Atlanta (A.M.F.); the Section of Allergy, Immunology, and Rheumatology, Department of Pediatrics, University of Wisconsin School of Medicine and Public Health (D.J.J., R.F.L.) and the School of Pharmacy, University of Wisconsin-Madison (C.A.S.) - both in Madison; Washington University School of Medicine in St. Louis and the Department of Pediatrics, St. Louis Children's Hospital (L.B.B., A.B.) - both in St. Louis; the Departments of Pediatrics (M.D.C.) and Medicine (S.C.L.) and the Airway Clinical Research Center (N.L.), University of California, San Francisco, San Francisco, Benioff Children's Hospital Oakland, Oakland (M.B., J.M.), and Olive View UCLA Medical Center and Department of Pediatrics, David Geff
| | - Leonard B Bacharier
- From the Divisions of Allergy and Immunology (W.J.S., S.N.B., W.P.) and Respiratory Diseases (J.M.G.), Boston Children's Hospital and Harvard Medical School, and the Division of Allergy and Pulmonary Medicine, Brigham and Women's Hospital and Harvard Medical School (E.I.) - all in Boston; the Departments of Public Health Sciences (D.T.M., S.J.B.) and Pediatrics (I.M.P.), Penn State College of Medicine, Hershey, and the University of Pittsburgh Asthma Institute at University of Pittsburgh Medical Center (F.H.) and the Department of Pediatrics, Allegheny General Hospital (D.A.G.), Pittsburgh - all in Pennsylvania; Stroger Hospital of Cook County and Department of Pediatrics, Rush University Medical Center (J.N.M.), Ann and Robert H. Lurie Children's Hospital of Chicago (J.A.P., R.G.R.), and University of Illinois at Chicago (H.V.K.) - all in Chicago; the Breathing Institute, Children's Hospital Colorado (S.J.S.), and the Departments of Pediatrics (S.J.S.) and Medicine (M.E.W.), University of Colorado School of Medicine, Aurora, and the Department of Pediatrics (R.C., J.T.O.) and Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine (M.E.W.), National Jewish Health, Denver - both in Colorado; the Department of Pediatrics, Emory University, Atlanta (A.M.F.); the Section of Allergy, Immunology, and Rheumatology, Department of Pediatrics, University of Wisconsin School of Medicine and Public Health (D.J.J., R.F.L.) and the School of Pharmacy, University of Wisconsin-Madison (C.A.S.) - both in Madison; Washington University School of Medicine in St. Louis and the Department of Pediatrics, St. Louis Children's Hospital (L.B.B., A.B.) - both in St. Louis; the Departments of Pediatrics (M.D.C.) and Medicine (S.C.L.) and the Airway Clinical Research Center (N.L.), University of California, San Francisco, San Francisco, Benioff Children's Hospital Oakland, Oakland (M.B., J.M.), and Olive View UCLA Medical Center and Department of Pediatrics, David Geff
| | - Michael D Cabana
- From the Divisions of Allergy and Immunology (W.J.S., S.N.B., W.P.) and Respiratory Diseases (J.M.G.), Boston Children's Hospital and Harvard Medical School, and the Division of Allergy and Pulmonary Medicine, Brigham and Women's Hospital and Harvard Medical School (E.I.) - all in Boston; the Departments of Public Health Sciences (D.T.M., S.J.B.) and Pediatrics (I.M.P.), Penn State College of Medicine, Hershey, and the University of Pittsburgh Asthma Institute at University of Pittsburgh Medical Center (F.H.) and the Department of Pediatrics, Allegheny General Hospital (D.A.G.), Pittsburgh - all in Pennsylvania; Stroger Hospital of Cook County and Department of Pediatrics, Rush University Medical Center (J.N.M.), Ann and Robert H. Lurie Children's Hospital of Chicago (J.A.P., R.G.R.), and University of Illinois at Chicago (H.V.K.) - all in Chicago; the Breathing Institute, Children's Hospital Colorado (S.J.S.), and the Departments of Pediatrics (S.J.S.) and Medicine (M.E.W.), University of Colorado School of Medicine, Aurora, and the Department of Pediatrics (R.C., J.T.O.) and Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine (M.E.W.), National Jewish Health, Denver - both in Colorado; the Department of Pediatrics, Emory University, Atlanta (A.M.F.); the Section of Allergy, Immunology, and Rheumatology, Department of Pediatrics, University of Wisconsin School of Medicine and Public Health (D.J.J., R.F.L.) and the School of Pharmacy, University of Wisconsin-Madison (C.A.S.) - both in Madison; Washington University School of Medicine in St. Louis and the Department of Pediatrics, St. Louis Children's Hospital (L.B.B., A.B.) - both in St. Louis; the Departments of Pediatrics (M.D.C.) and Medicine (S.C.L.) and the Airway Clinical Research Center (N.L.), University of California, San Francisco, San Francisco, Benioff Children's Hospital Oakland, Oakland (M.B., J.M.), and Olive View UCLA Medical Center and Department of Pediatrics, David Geff
| | - Ronina Covar
- From the Divisions of Allergy and Immunology (W.J.S., S.N.B., W.P.) and Respiratory Diseases (J.M.G.), Boston Children's Hospital and Harvard Medical School, and the Division of Allergy and Pulmonary Medicine, Brigham and Women's Hospital and Harvard Medical School (E.I.) - all in Boston; the Departments of Public Health Sciences (D.T.M., S.J.B.) and Pediatrics (I.M.P.), Penn State College of Medicine, Hershey, and the University of Pittsburgh Asthma Institute at University of Pittsburgh Medical Center (F.H.) and the Department of Pediatrics, Allegheny General Hospital (D.A.G.), Pittsburgh - all in Pennsylvania; Stroger Hospital of Cook County and Department of Pediatrics, Rush University Medical Center (J.N.M.), Ann and Robert H. Lurie Children's Hospital of Chicago (J.A.P., R.G.R.), and University of Illinois at Chicago (H.V.K.) - all in Chicago; the Breathing Institute, Children's Hospital Colorado (S.J.S.), and the Departments of Pediatrics (S.J.S.) and Medicine (M.E.W.), University of Colorado School of Medicine, Aurora, and the Department of Pediatrics (R.C., J.T.O.) and Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine (M.E.W.), National Jewish Health, Denver - both in Colorado; the Department of Pediatrics, Emory University, Atlanta (A.M.F.); the Section of Allergy, Immunology, and Rheumatology, Department of Pediatrics, University of Wisconsin School of Medicine and Public Health (D.J.J., R.F.L.) and the School of Pharmacy, University of Wisconsin-Madison (C.A.S.) - both in Madison; Washington University School of Medicine in St. Louis and the Department of Pediatrics, St. Louis Children's Hospital (L.B.B., A.B.) - both in St. Louis; the Departments of Pediatrics (M.D.C.) and Medicine (S.C.L.) and the Airway Clinical Research Center (N.L.), University of California, San Francisco, San Francisco, Benioff Children's Hospital Oakland, Oakland (M.B., J.M.), and Olive View UCLA Medical Center and Department of Pediatrics, David Geff
| | - Fernando Holguin
- From the Divisions of Allergy and Immunology (W.J.S., S.N.B., W.P.) and Respiratory Diseases (J.M.G.), Boston Children's Hospital and Harvard Medical School, and the Division of Allergy and Pulmonary Medicine, Brigham and Women's Hospital and Harvard Medical School (E.I.) - all in Boston; the Departments of Public Health Sciences (D.T.M., S.J.B.) and Pediatrics (I.M.P.), Penn State College of Medicine, Hershey, and the University of Pittsburgh Asthma Institute at University of Pittsburgh Medical Center (F.H.) and the Department of Pediatrics, Allegheny General Hospital (D.A.G.), Pittsburgh - all in Pennsylvania; Stroger Hospital of Cook County and Department of Pediatrics, Rush University Medical Center (J.N.M.), Ann and Robert H. Lurie Children's Hospital of Chicago (J.A.P., R.G.R.), and University of Illinois at Chicago (H.V.K.) - all in Chicago; the Breathing Institute, Children's Hospital Colorado (S.J.S.), and the Departments of Pediatrics (S.J.S.) and Medicine (M.E.W.), University of Colorado School of Medicine, Aurora, and the Department of Pediatrics (R.C., J.T.O.) and Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine (M.E.W.), National Jewish Health, Denver - both in Colorado; the Department of Pediatrics, Emory University, Atlanta (A.M.F.); the Section of Allergy, Immunology, and Rheumatology, Department of Pediatrics, University of Wisconsin School of Medicine and Public Health (D.J.J., R.F.L.) and the School of Pharmacy, University of Wisconsin-Madison (C.A.S.) - both in Madison; Washington University School of Medicine in St. Louis and the Department of Pediatrics, St. Louis Children's Hospital (L.B.B., A.B.) - both in St. Louis; the Departments of Pediatrics (M.D.C.) and Medicine (S.C.L.) and the Airway Clinical Research Center (N.L.), University of California, San Francisco, San Francisco, Benioff Children's Hospital Oakland, Oakland (M.B., J.M.), and Olive View UCLA Medical Center and Department of Pediatrics, David Geff
| | - Robert F Lemanske
- From the Divisions of Allergy and Immunology (W.J.S., S.N.B., W.P.) and Respiratory Diseases (J.M.G.), Boston Children's Hospital and Harvard Medical School, and the Division of Allergy and Pulmonary Medicine, Brigham and Women's Hospital and Harvard Medical School (E.I.) - all in Boston; the Departments of Public Health Sciences (D.T.M., S.J.B.) and Pediatrics (I.M.P.), Penn State College of Medicine, Hershey, and the University of Pittsburgh Asthma Institute at University of Pittsburgh Medical Center (F.H.) and the Department of Pediatrics, Allegheny General Hospital (D.A.G.), Pittsburgh - all in Pennsylvania; Stroger Hospital of Cook County and Department of Pediatrics, Rush University Medical Center (J.N.M.), Ann and Robert H. Lurie Children's Hospital of Chicago (J.A.P., R.G.R.), and University of Illinois at Chicago (H.V.K.) - all in Chicago; the Breathing Institute, Children's Hospital Colorado (S.J.S.), and the Departments of Pediatrics (S.J.S.) and Medicine (M.E.W.), University of Colorado School of Medicine, Aurora, and the Department of Pediatrics (R.C., J.T.O.) and Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine (M.E.W.), National Jewish Health, Denver - both in Colorado; the Department of Pediatrics, Emory University, Atlanta (A.M.F.); the Section of Allergy, Immunology, and Rheumatology, Department of Pediatrics, University of Wisconsin School of Medicine and Public Health (D.J.J., R.F.L.) and the School of Pharmacy, University of Wisconsin-Madison (C.A.S.) - both in Madison; Washington University School of Medicine in St. Louis and the Department of Pediatrics, St. Louis Children's Hospital (L.B.B., A.B.) - both in St. Louis; the Departments of Pediatrics (M.D.C.) and Medicine (S.C.L.) and the Airway Clinical Research Center (N.L.), University of California, San Francisco, San Francisco, Benioff Children's Hospital Oakland, Oakland (M.B., J.M.), and Olive View UCLA Medical Center and Department of Pediatrics, David Geff
| | - Fernando D Martinez
- From the Divisions of Allergy and Immunology (W.J.S., S.N.B., W.P.) and Respiratory Diseases (J.M.G.), Boston Children's Hospital and Harvard Medical School, and the Division of Allergy and Pulmonary Medicine, Brigham and Women's Hospital and Harvard Medical School (E.I.) - all in Boston; the Departments of Public Health Sciences (D.T.M., S.J.B.) and Pediatrics (I.M.P.), Penn State College of Medicine, Hershey, and the University of Pittsburgh Asthma Institute at University of Pittsburgh Medical Center (F.H.) and the Department of Pediatrics, Allegheny General Hospital (D.A.G.), Pittsburgh - all in Pennsylvania; Stroger Hospital of Cook County and Department of Pediatrics, Rush University Medical Center (J.N.M.), Ann and Robert H. Lurie Children's Hospital of Chicago (J.A.P., R.G.R.), and University of Illinois at Chicago (H.V.K.) - all in Chicago; the Breathing Institute, Children's Hospital Colorado (S.J.S.), and the Departments of Pediatrics (S.J.S.) and Medicine (M.E.W.), University of Colorado School of Medicine, Aurora, and the Department of Pediatrics (R.C., J.T.O.) and Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine (M.E.W.), National Jewish Health, Denver - both in Colorado; the Department of Pediatrics, Emory University, Atlanta (A.M.F.); the Section of Allergy, Immunology, and Rheumatology, Department of Pediatrics, University of Wisconsin School of Medicine and Public Health (D.J.J., R.F.L.) and the School of Pharmacy, University of Wisconsin-Madison (C.A.S.) - both in Madison; Washington University School of Medicine in St. Louis and the Department of Pediatrics, St. Louis Children's Hospital (L.B.B., A.B.) - both in St. Louis; the Departments of Pediatrics (M.D.C.) and Medicine (S.C.L.) and the Airway Clinical Research Center (N.L.), University of California, San Francisco, San Francisco, Benioff Children's Hospital Oakland, Oakland (M.B., J.M.), and Olive View UCLA Medical Center and Department of Pediatrics, David Geff
| | - Jacqueline A Pongracic
- From the Divisions of Allergy and Immunology (W.J.S., S.N.B., W.P.) and Respiratory Diseases (J.M.G.), Boston Children's Hospital and Harvard Medical School, and the Division of Allergy and Pulmonary Medicine, Brigham and Women's Hospital and Harvard Medical School (E.I.) - all in Boston; the Departments of Public Health Sciences (D.T.M., S.J.B.) and Pediatrics (I.M.P.), Penn State College of Medicine, Hershey, and the University of Pittsburgh Asthma Institute at University of Pittsburgh Medical Center (F.H.) and the Department of Pediatrics, Allegheny General Hospital (D.A.G.), Pittsburgh - all in Pennsylvania; Stroger Hospital of Cook County and Department of Pediatrics, Rush University Medical Center (J.N.M.), Ann and Robert H. Lurie Children's Hospital of Chicago (J.A.P., R.G.R.), and University of Illinois at Chicago (H.V.K.) - all in Chicago; the Breathing Institute, Children's Hospital Colorado (S.J.S.), and the Departments of Pediatrics (S.J.S.) and Medicine (M.E.W.), University of Colorado School of Medicine, Aurora, and the Department of Pediatrics (R.C., J.T.O.) and Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine (M.E.W.), National Jewish Health, Denver - both in Colorado; the Department of Pediatrics, Emory University, Atlanta (A.M.F.); the Section of Allergy, Immunology, and Rheumatology, Department of Pediatrics, University of Wisconsin School of Medicine and Public Health (D.J.J., R.F.L.) and the School of Pharmacy, University of Wisconsin-Madison (C.A.S.) - both in Madison; Washington University School of Medicine in St. Louis and the Department of Pediatrics, St. Louis Children's Hospital (L.B.B., A.B.) - both in St. Louis; the Departments of Pediatrics (M.D.C.) and Medicine (S.C.L.) and the Airway Clinical Research Center (N.L.), University of California, San Francisco, San Francisco, Benioff Children's Hospital Oakland, Oakland (M.B., J.M.), and Olive View UCLA Medical Center and Department of Pediatrics, David Geff
| | - Avraham Beigelman
- From the Divisions of Allergy and Immunology (W.J.S., S.N.B., W.P.) and Respiratory Diseases (J.M.G.), Boston Children's Hospital and Harvard Medical School, and the Division of Allergy and Pulmonary Medicine, Brigham and Women's Hospital and Harvard Medical School (E.I.) - all in Boston; the Departments of Public Health Sciences (D.T.M., S.J.B.) and Pediatrics (I.M.P.), Penn State College of Medicine, Hershey, and the University of Pittsburgh Asthma Institute at University of Pittsburgh Medical Center (F.H.) and the Department of Pediatrics, Allegheny General Hospital (D.A.G.), Pittsburgh - all in Pennsylvania; Stroger Hospital of Cook County and Department of Pediatrics, Rush University Medical Center (J.N.M.), Ann and Robert H. Lurie Children's Hospital of Chicago (J.A.P., R.G.R.), and University of Illinois at Chicago (H.V.K.) - all in Chicago; the Breathing Institute, Children's Hospital Colorado (S.J.S.), and the Departments of Pediatrics (S.J.S.) and Medicine (M.E.W.), University of Colorado School of Medicine, Aurora, and the Department of Pediatrics (R.C., J.T.O.) and Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine (M.E.W.), National Jewish Health, Denver - both in Colorado; the Department of Pediatrics, Emory University, Atlanta (A.M.F.); the Section of Allergy, Immunology, and Rheumatology, Department of Pediatrics, University of Wisconsin School of Medicine and Public Health (D.J.J., R.F.L.) and the School of Pharmacy, University of Wisconsin-Madison (C.A.S.) - both in Madison; Washington University School of Medicine in St. Louis and the Department of Pediatrics, St. Louis Children's Hospital (L.B.B., A.B.) - both in St. Louis; the Departments of Pediatrics (M.D.C.) and Medicine (S.C.L.) and the Airway Clinical Research Center (N.L.), University of California, San Francisco, San Francisco, Benioff Children's Hospital Oakland, Oakland (M.B., J.M.), and Olive View UCLA Medical Center and Department of Pediatrics, David Geff
| | - Sachin N Baxi
- From the Divisions of Allergy and Immunology (W.J.S., S.N.B., W.P.) and Respiratory Diseases (J.M.G.), Boston Children's Hospital and Harvard Medical School, and the Division of Allergy and Pulmonary Medicine, Brigham and Women's Hospital and Harvard Medical School (E.I.) - all in Boston; the Departments of Public Health Sciences (D.T.M., S.J.B.) and Pediatrics (I.M.P.), Penn State College of Medicine, Hershey, and the University of Pittsburgh Asthma Institute at University of Pittsburgh Medical Center (F.H.) and the Department of Pediatrics, Allegheny General Hospital (D.A.G.), Pittsburgh - all in Pennsylvania; Stroger Hospital of Cook County and Department of Pediatrics, Rush University Medical Center (J.N.M.), Ann and Robert H. Lurie Children's Hospital of Chicago (J.A.P., R.G.R.), and University of Illinois at Chicago (H.V.K.) - all in Chicago; the Breathing Institute, Children's Hospital Colorado (S.J.S.), and the Departments of Pediatrics (S.J.S.) and Medicine (M.E.W.), University of Colorado School of Medicine, Aurora, and the Department of Pediatrics (R.C., J.T.O.) and Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine (M.E.W.), National Jewish Health, Denver - both in Colorado; the Department of Pediatrics, Emory University, Atlanta (A.M.F.); the Section of Allergy, Immunology, and Rheumatology, Department of Pediatrics, University of Wisconsin School of Medicine and Public Health (D.J.J., R.F.L.) and the School of Pharmacy, University of Wisconsin-Madison (C.A.S.) - both in Madison; Washington University School of Medicine in St. Louis and the Department of Pediatrics, St. Louis Children's Hospital (L.B.B., A.B.) - both in St. Louis; the Departments of Pediatrics (M.D.C.) and Medicine (S.C.L.) and the Airway Clinical Research Center (N.L.), University of California, San Francisco, San Francisco, Benioff Children's Hospital Oakland, Oakland (M.B., J.M.), and Olive View UCLA Medical Center and Department of Pediatrics, David Geff
| | - Mindy Benson
- From the Divisions of Allergy and Immunology (W.J.S., S.N.B., W.P.) and Respiratory Diseases (J.M.G.), Boston Children's Hospital and Harvard Medical School, and the Division of Allergy and Pulmonary Medicine, Brigham and Women's Hospital and Harvard Medical School (E.I.) - all in Boston; the Departments of Public Health Sciences (D.T.M., S.J.B.) and Pediatrics (I.M.P.), Penn State College of Medicine, Hershey, and the University of Pittsburgh Asthma Institute at University of Pittsburgh Medical Center (F.H.) and the Department of Pediatrics, Allegheny General Hospital (D.A.G.), Pittsburgh - all in Pennsylvania; Stroger Hospital of Cook County and Department of Pediatrics, Rush University Medical Center (J.N.M.), Ann and Robert H. Lurie Children's Hospital of Chicago (J.A.P., R.G.R.), and University of Illinois at Chicago (H.V.K.) - all in Chicago; the Breathing Institute, Children's Hospital Colorado (S.J.S.), and the Departments of Pediatrics (S.J.S.) and Medicine (M.E.W.), University of Colorado School of Medicine, Aurora, and the Department of Pediatrics (R.C., J.T.O.) and Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine (M.E.W.), National Jewish Health, Denver - both in Colorado; the Department of Pediatrics, Emory University, Atlanta (A.M.F.); the Section of Allergy, Immunology, and Rheumatology, Department of Pediatrics, University of Wisconsin School of Medicine and Public Health (D.J.J., R.F.L.) and the School of Pharmacy, University of Wisconsin-Madison (C.A.S.) - both in Madison; Washington University School of Medicine in St. Louis and the Department of Pediatrics, St. Louis Children's Hospital (L.B.B., A.B.) - both in St. Louis; the Departments of Pediatrics (M.D.C.) and Medicine (S.C.L.) and the Airway Clinical Research Center (N.L.), University of California, San Francisco, San Francisco, Benioff Children's Hospital Oakland, Oakland (M.B., J.M.), and Olive View UCLA Medical Center and Department of Pediatrics, David Geff
| | - Kathryn Blake
- From the Divisions of Allergy and Immunology (W.J.S., S.N.B., W.P.) and Respiratory Diseases (J.M.G.), Boston Children's Hospital and Harvard Medical School, and the Division of Allergy and Pulmonary Medicine, Brigham and Women's Hospital and Harvard Medical School (E.I.) - all in Boston; the Departments of Public Health Sciences (D.T.M., S.J.B.) and Pediatrics (I.M.P.), Penn State College of Medicine, Hershey, and the University of Pittsburgh Asthma Institute at University of Pittsburgh Medical Center (F.H.) and the Department of Pediatrics, Allegheny General Hospital (D.A.G.), Pittsburgh - all in Pennsylvania; Stroger Hospital of Cook County and Department of Pediatrics, Rush University Medical Center (J.N.M.), Ann and Robert H. Lurie Children's Hospital of Chicago (J.A.P., R.G.R.), and University of Illinois at Chicago (H.V.K.) - all in Chicago; the Breathing Institute, Children's Hospital Colorado (S.J.S.), and the Departments of Pediatrics (S.J.S.) and Medicine (M.E.W.), University of Colorado School of Medicine, Aurora, and the Department of Pediatrics (R.C., J.T.O.) and Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine (M.E.W.), National Jewish Health, Denver - both in Colorado; the Department of Pediatrics, Emory University, Atlanta (A.M.F.); the Section of Allergy, Immunology, and Rheumatology, Department of Pediatrics, University of Wisconsin School of Medicine and Public Health (D.J.J., R.F.L.) and the School of Pharmacy, University of Wisconsin-Madison (C.A.S.) - both in Madison; Washington University School of Medicine in St. Louis and the Department of Pediatrics, St. Louis Children's Hospital (L.B.B., A.B.) - both in St. Louis; the Departments of Pediatrics (M.D.C.) and Medicine (S.C.L.) and the Airway Clinical Research Center (N.L.), University of California, San Francisco, San Francisco, Benioff Children's Hospital Oakland, Oakland (M.B., J.M.), and Olive View UCLA Medical Center and Department of Pediatrics, David Geff
| | - James F Chmiel
- From the Divisions of Allergy and Immunology (W.J.S., S.N.B., W.P.) and Respiratory Diseases (J.M.G.), Boston Children's Hospital and Harvard Medical School, and the Division of Allergy and Pulmonary Medicine, Brigham and Women's Hospital and Harvard Medical School (E.I.) - all in Boston; the Departments of Public Health Sciences (D.T.M., S.J.B.) and Pediatrics (I.M.P.), Penn State College of Medicine, Hershey, and the University of Pittsburgh Asthma Institute at University of Pittsburgh Medical Center (F.H.) and the Department of Pediatrics, Allegheny General Hospital (D.A.G.), Pittsburgh - all in Pennsylvania; Stroger Hospital of Cook County and Department of Pediatrics, Rush University Medical Center (J.N.M.), Ann and Robert H. Lurie Children's Hospital of Chicago (J.A.P., R.G.R.), and University of Illinois at Chicago (H.V.K.) - all in Chicago; the Breathing Institute, Children's Hospital Colorado (S.J.S.), and the Departments of Pediatrics (S.J.S.) and Medicine (M.E.W.), University of Colorado School of Medicine, Aurora, and the Department of Pediatrics (R.C., J.T.O.) and Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine (M.E.W.), National Jewish Health, Denver - both in Colorado; the Department of Pediatrics, Emory University, Atlanta (A.M.F.); the Section of Allergy, Immunology, and Rheumatology, Department of Pediatrics, University of Wisconsin School of Medicine and Public Health (D.J.J., R.F.L.) and the School of Pharmacy, University of Wisconsin-Madison (C.A.S.) - both in Madison; Washington University School of Medicine in St. Louis and the Department of Pediatrics, St. Louis Children's Hospital (L.B.B., A.B.) - both in St. Louis; the Departments of Pediatrics (M.D.C.) and Medicine (S.C.L.) and the Airway Clinical Research Center (N.L.), University of California, San Francisco, San Francisco, Benioff Children's Hospital Oakland, Oakland (M.B., J.M.), and Olive View UCLA Medical Center and Department of Pediatrics, David Geff
| | - Cori L Daines
- From the Divisions of Allergy and Immunology (W.J.S., S.N.B., W.P.) and Respiratory Diseases (J.M.G.), Boston Children's Hospital and Harvard Medical School, and the Division of Allergy and Pulmonary Medicine, Brigham and Women's Hospital and Harvard Medical School (E.I.) - all in Boston; the Departments of Public Health Sciences (D.T.M., S.J.B.) and Pediatrics (I.M.P.), Penn State College of Medicine, Hershey, and the University of Pittsburgh Asthma Institute at University of Pittsburgh Medical Center (F.H.) and the Department of Pediatrics, Allegheny General Hospital (D.A.G.), Pittsburgh - all in Pennsylvania; Stroger Hospital of Cook County and Department of Pediatrics, Rush University Medical Center (J.N.M.), Ann and Robert H. Lurie Children's Hospital of Chicago (J.A.P., R.G.R.), and University of Illinois at Chicago (H.V.K.) - all in Chicago; the Breathing Institute, Children's Hospital Colorado (S.J.S.), and the Departments of Pediatrics (S.J.S.) and Medicine (M.E.W.), University of Colorado School of Medicine, Aurora, and the Department of Pediatrics (R.C., J.T.O.) and Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine (M.E.W.), National Jewish Health, Denver - both in Colorado; the Department of Pediatrics, Emory University, Atlanta (A.M.F.); the Section of Allergy, Immunology, and Rheumatology, Department of Pediatrics, University of Wisconsin School of Medicine and Public Health (D.J.J., R.F.L.) and the School of Pharmacy, University of Wisconsin-Madison (C.A.S.) - both in Madison; Washington University School of Medicine in St. Louis and the Department of Pediatrics, St. Louis Children's Hospital (L.B.B., A.B.) - both in St. Louis; the Departments of Pediatrics (M.D.C.) and Medicine (S.C.L.) and the Airway Clinical Research Center (N.L.), University of California, San Francisco, San Francisco, Benioff Children's Hospital Oakland, Oakland (M.B., J.M.), and Olive View UCLA Medical Center and Department of Pediatrics, David Geff
| | - Michael O Daines
- From the Divisions of Allergy and Immunology (W.J.S., S.N.B., W.P.) and Respiratory Diseases (J.M.G.), Boston Children's Hospital and Harvard Medical School, and the Division of Allergy and Pulmonary Medicine, Brigham and Women's Hospital and Harvard Medical School (E.I.) - all in Boston; the Departments of Public Health Sciences (D.T.M., S.J.B.) and Pediatrics (I.M.P.), Penn State College of Medicine, Hershey, and the University of Pittsburgh Asthma Institute at University of Pittsburgh Medical Center (F.H.) and the Department of Pediatrics, Allegheny General Hospital (D.A.G.), Pittsburgh - all in Pennsylvania; Stroger Hospital of Cook County and Department of Pediatrics, Rush University Medical Center (J.N.M.), Ann and Robert H. Lurie Children's Hospital of Chicago (J.A.P., R.G.R.), and University of Illinois at Chicago (H.V.K.) - all in Chicago; the Breathing Institute, Children's Hospital Colorado (S.J.S.), and the Departments of Pediatrics (S.J.S.) and Medicine (M.E.W.), University of Colorado School of Medicine, Aurora, and the Department of Pediatrics (R.C., J.T.O.) and Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine (M.E.W.), National Jewish Health, Denver - both in Colorado; the Department of Pediatrics, Emory University, Atlanta (A.M.F.); the Section of Allergy, Immunology, and Rheumatology, Department of Pediatrics, University of Wisconsin School of Medicine and Public Health (D.J.J., R.F.L.) and the School of Pharmacy, University of Wisconsin-Madison (C.A.S.) - both in Madison; Washington University School of Medicine in St. Louis and the Department of Pediatrics, St. Louis Children's Hospital (L.B.B., A.B.) - both in St. Louis; the Departments of Pediatrics (M.D.C.) and Medicine (S.C.L.) and the Airway Clinical Research Center (N.L.), University of California, San Francisco, San Francisco, Benioff Children's Hospital Oakland, Oakland (M.B., J.M.), and Olive View UCLA Medical Center and Department of Pediatrics, David Geff
| | - Jonathan M Gaffin
- From the Divisions of Allergy and Immunology (W.J.S., S.N.B., W.P.) and Respiratory Diseases (J.M.G.), Boston Children's Hospital and Harvard Medical School, and the Division of Allergy and Pulmonary Medicine, Brigham and Women's Hospital and Harvard Medical School (E.I.) - all in Boston; the Departments of Public Health Sciences (D.T.M., S.J.B.) and Pediatrics (I.M.P.), Penn State College of Medicine, Hershey, and the University of Pittsburgh Asthma Institute at University of Pittsburgh Medical Center (F.H.) and the Department of Pediatrics, Allegheny General Hospital (D.A.G.), Pittsburgh - all in Pennsylvania; Stroger Hospital of Cook County and Department of Pediatrics, Rush University Medical Center (J.N.M.), Ann and Robert H. Lurie Children's Hospital of Chicago (J.A.P., R.G.R.), and University of Illinois at Chicago (H.V.K.) - all in Chicago; the Breathing Institute, Children's Hospital Colorado (S.J.S.), and the Departments of Pediatrics (S.J.S.) and Medicine (M.E.W.), University of Colorado School of Medicine, Aurora, and the Department of Pediatrics (R.C., J.T.O.) and Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine (M.E.W.), National Jewish Health, Denver - both in Colorado; the Department of Pediatrics, Emory University, Atlanta (A.M.F.); the Section of Allergy, Immunology, and Rheumatology, Department of Pediatrics, University of Wisconsin School of Medicine and Public Health (D.J.J., R.F.L.) and the School of Pharmacy, University of Wisconsin-Madison (C.A.S.) - both in Madison; Washington University School of Medicine in St. Louis and the Department of Pediatrics, St. Louis Children's Hospital (L.B.B., A.B.) - both in St. Louis; the Departments of Pediatrics (M.D.C.) and Medicine (S.C.L.) and the Airway Clinical Research Center (N.L.), University of California, San Francisco, San Francisco, Benioff Children's Hospital Oakland, Oakland (M.B., J.M.), and Olive View UCLA Medical Center and Department of Pediatrics, David Geff
| | - Deborah A Gentile
- From the Divisions of Allergy and Immunology (W.J.S., S.N.B., W.P.) and Respiratory Diseases (J.M.G.), Boston Children's Hospital and Harvard Medical School, and the Division of Allergy and Pulmonary Medicine, Brigham and Women's Hospital and Harvard Medical School (E.I.) - all in Boston; the Departments of Public Health Sciences (D.T.M., S.J.B.) and Pediatrics (I.M.P.), Penn State College of Medicine, Hershey, and the University of Pittsburgh Asthma Institute at University of Pittsburgh Medical Center (F.H.) and the Department of Pediatrics, Allegheny General Hospital (D.A.G.), Pittsburgh - all in Pennsylvania; Stroger Hospital of Cook County and Department of Pediatrics, Rush University Medical Center (J.N.M.), Ann and Robert H. Lurie Children's Hospital of Chicago (J.A.P., R.G.R.), and University of Illinois at Chicago (H.V.K.) - all in Chicago; the Breathing Institute, Children's Hospital Colorado (S.J.S.), and the Departments of Pediatrics (S.J.S.) and Medicine (M.E.W.), University of Colorado School of Medicine, Aurora, and the Department of Pediatrics (R.C., J.T.O.) and Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine (M.E.W.), National Jewish Health, Denver - both in Colorado; the Department of Pediatrics, Emory University, Atlanta (A.M.F.); the Section of Allergy, Immunology, and Rheumatology, Department of Pediatrics, University of Wisconsin School of Medicine and Public Health (D.J.J., R.F.L.) and the School of Pharmacy, University of Wisconsin-Madison (C.A.S.) - both in Madison; Washington University School of Medicine in St. Louis and the Department of Pediatrics, St. Louis Children's Hospital (L.B.B., A.B.) - both in St. Louis; the Departments of Pediatrics (M.D.C.) and Medicine (S.C.L.) and the Airway Clinical Research Center (N.L.), University of California, San Francisco, San Francisco, Benioff Children's Hospital Oakland, Oakland (M.B., J.M.), and Olive View UCLA Medical Center and Department of Pediatrics, David Geff
| | - W Adam Gower
- From the Divisions of Allergy and Immunology (W.J.S., S.N.B., W.P.) and Respiratory Diseases (J.M.G.), Boston Children's Hospital and Harvard Medical School, and the Division of Allergy and Pulmonary Medicine, Brigham and Women's Hospital and Harvard Medical School (E.I.) - all in Boston; the Departments of Public Health Sciences (D.T.M., S.J.B.) and Pediatrics (I.M.P.), Penn State College of Medicine, Hershey, and the University of Pittsburgh Asthma Institute at University of Pittsburgh Medical Center (F.H.) and the Department of Pediatrics, Allegheny General Hospital (D.A.G.), Pittsburgh - all in Pennsylvania; Stroger Hospital of Cook County and Department of Pediatrics, Rush University Medical Center (J.N.M.), Ann and Robert H. Lurie Children's Hospital of Chicago (J.A.P., R.G.R.), and University of Illinois at Chicago (H.V.K.) - all in Chicago; the Breathing Institute, Children's Hospital Colorado (S.J.S.), and the Departments of Pediatrics (S.J.S.) and Medicine (M.E.W.), University of Colorado School of Medicine, Aurora, and the Department of Pediatrics (R.C., J.T.O.) and Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine (M.E.W.), National Jewish Health, Denver - both in Colorado; the Department of Pediatrics, Emory University, Atlanta (A.M.F.); the Section of Allergy, Immunology, and Rheumatology, Department of Pediatrics, University of Wisconsin School of Medicine and Public Health (D.J.J., R.F.L.) and the School of Pharmacy, University of Wisconsin-Madison (C.A.S.) - both in Madison; Washington University School of Medicine in St. Louis and the Department of Pediatrics, St. Louis Children's Hospital (L.B.B., A.B.) - both in St. Louis; the Departments of Pediatrics (M.D.C.) and Medicine (S.C.L.) and the Airway Clinical Research Center (N.L.), University of California, San Francisco, San Francisco, Benioff Children's Hospital Oakland, Oakland (M.B., J.M.), and Olive View UCLA Medical Center and Department of Pediatrics, David Geff
| | - Elliot Israel
- From the Divisions of Allergy and Immunology (W.J.S., S.N.B., W.P.) and Respiratory Diseases (J.M.G.), Boston Children's Hospital and Harvard Medical School, and the Division of Allergy and Pulmonary Medicine, Brigham and Women's Hospital and Harvard Medical School (E.I.) - all in Boston; the Departments of Public Health Sciences (D.T.M., S.J.B.) and Pediatrics (I.M.P.), Penn State College of Medicine, Hershey, and the University of Pittsburgh Asthma Institute at University of Pittsburgh Medical Center (F.H.) and the Department of Pediatrics, Allegheny General Hospital (D.A.G.), Pittsburgh - all in Pennsylvania; Stroger Hospital of Cook County and Department of Pediatrics, Rush University Medical Center (J.N.M.), Ann and Robert H. Lurie Children's Hospital of Chicago (J.A.P., R.G.R.), and University of Illinois at Chicago (H.V.K.) - all in Chicago; the Breathing Institute, Children's Hospital Colorado (S.J.S.), and the Departments of Pediatrics (S.J.S.) and Medicine (M.E.W.), University of Colorado School of Medicine, Aurora, and the Department of Pediatrics (R.C., J.T.O.) and Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine (M.E.W.), National Jewish Health, Denver - both in Colorado; the Department of Pediatrics, Emory University, Atlanta (A.M.F.); the Section of Allergy, Immunology, and Rheumatology, Department of Pediatrics, University of Wisconsin School of Medicine and Public Health (D.J.J., R.F.L.) and the School of Pharmacy, University of Wisconsin-Madison (C.A.S.) - both in Madison; Washington University School of Medicine in St. Louis and the Department of Pediatrics, St. Louis Children's Hospital (L.B.B., A.B.) - both in St. Louis; the Departments of Pediatrics (M.D.C.) and Medicine (S.C.L.) and the Airway Clinical Research Center (N.L.), University of California, San Francisco, San Francisco, Benioff Children's Hospital Oakland, Oakland (M.B., J.M.), and Olive View UCLA Medical Center and Department of Pediatrics, David Geff
| | - Harsha V Kumar
- From the Divisions of Allergy and Immunology (W.J.S., S.N.B., W.P.) and Respiratory Diseases (J.M.G.), Boston Children's Hospital and Harvard Medical School, and the Division of Allergy and Pulmonary Medicine, Brigham and Women's Hospital and Harvard Medical School (E.I.) - all in Boston; the Departments of Public Health Sciences (D.T.M., S.J.B.) and Pediatrics (I.M.P.), Penn State College of Medicine, Hershey, and the University of Pittsburgh Asthma Institute at University of Pittsburgh Medical Center (F.H.) and the Department of Pediatrics, Allegheny General Hospital (D.A.G.), Pittsburgh - all in Pennsylvania; Stroger Hospital of Cook County and Department of Pediatrics, Rush University Medical Center (J.N.M.), Ann and Robert H. Lurie Children's Hospital of Chicago (J.A.P., R.G.R.), and University of Illinois at Chicago (H.V.K.) - all in Chicago; the Breathing Institute, Children's Hospital Colorado (S.J.S.), and the Departments of Pediatrics (S.J.S.) and Medicine (M.E.W.), University of Colorado School of Medicine, Aurora, and the Department of Pediatrics (R.C., J.T.O.) and Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine (M.E.W.), National Jewish Health, Denver - both in Colorado; the Department of Pediatrics, Emory University, Atlanta (A.M.F.); the Section of Allergy, Immunology, and Rheumatology, Department of Pediatrics, University of Wisconsin School of Medicine and Public Health (D.J.J., R.F.L.) and the School of Pharmacy, University of Wisconsin-Madison (C.A.S.) - both in Madison; Washington University School of Medicine in St. Louis and the Department of Pediatrics, St. Louis Children's Hospital (L.B.B., A.B.) - both in St. Louis; the Departments of Pediatrics (M.D.C.) and Medicine (S.C.L.) and the Airway Clinical Research Center (N.L.), University of California, San Francisco, San Francisco, Benioff Children's Hospital Oakland, Oakland (M.B., J.M.), and Olive View UCLA Medical Center and Department of Pediatrics, David Geff
| | - Jason E Lang
- From the Divisions of Allergy and Immunology (W.J.S., S.N.B., W.P.) and Respiratory Diseases (J.M.G.), Boston Children's Hospital and Harvard Medical School, and the Division of Allergy and Pulmonary Medicine, Brigham and Women's Hospital and Harvard Medical School (E.I.) - all in Boston; the Departments of Public Health Sciences (D.T.M., S.J.B.) and Pediatrics (I.M.P.), Penn State College of Medicine, Hershey, and the University of Pittsburgh Asthma Institute at University of Pittsburgh Medical Center (F.H.) and the Department of Pediatrics, Allegheny General Hospital (D.A.G.), Pittsburgh - all in Pennsylvania; Stroger Hospital of Cook County and Department of Pediatrics, Rush University Medical Center (J.N.M.), Ann and Robert H. Lurie Children's Hospital of Chicago (J.A.P., R.G.R.), and University of Illinois at Chicago (H.V.K.) - all in Chicago; the Breathing Institute, Children's Hospital Colorado (S.J.S.), and the Departments of Pediatrics (S.J.S.) and Medicine (M.E.W.), University of Colorado School of Medicine, Aurora, and the Department of Pediatrics (R.C., J.T.O.) and Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine (M.E.W.), National Jewish Health, Denver - both in Colorado; the Department of Pediatrics, Emory University, Atlanta (A.M.F.); the Section of Allergy, Immunology, and Rheumatology, Department of Pediatrics, University of Wisconsin School of Medicine and Public Health (D.J.J., R.F.L.) and the School of Pharmacy, University of Wisconsin-Madison (C.A.S.) - both in Madison; Washington University School of Medicine in St. Louis and the Department of Pediatrics, St. Louis Children's Hospital (L.B.B., A.B.) - both in St. Louis; the Departments of Pediatrics (M.D.C.) and Medicine (S.C.L.) and the Airway Clinical Research Center (N.L.), University of California, San Francisco, San Francisco, Benioff Children's Hospital Oakland, Oakland (M.B., J.M.), and Olive View UCLA Medical Center and Department of Pediatrics, David Geff
| | - Stephen C Lazarus
- From the Divisions of Allergy and Immunology (W.J.S., S.N.B., W.P.) and Respiratory Diseases (J.M.G.), Boston Children's Hospital and Harvard Medical School, and the Division of Allergy and Pulmonary Medicine, Brigham and Women's Hospital and Harvard Medical School (E.I.) - all in Boston; the Departments of Public Health Sciences (D.T.M., S.J.B.) and Pediatrics (I.M.P.), Penn State College of Medicine, Hershey, and the University of Pittsburgh Asthma Institute at University of Pittsburgh Medical Center (F.H.) and the Department of Pediatrics, Allegheny General Hospital (D.A.G.), Pittsburgh - all in Pennsylvania; Stroger Hospital of Cook County and Department of Pediatrics, Rush University Medical Center (J.N.M.), Ann and Robert H. Lurie Children's Hospital of Chicago (J.A.P., R.G.R.), and University of Illinois at Chicago (H.V.K.) - all in Chicago; the Breathing Institute, Children's Hospital Colorado (S.J.S.), and the Departments of Pediatrics (S.J.S.) and Medicine (M.E.W.), University of Colorado School of Medicine, Aurora, and the Department of Pediatrics (R.C., J.T.O.) and Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine (M.E.W.), National Jewish Health, Denver - both in Colorado; the Department of Pediatrics, Emory University, Atlanta (A.M.F.); the Section of Allergy, Immunology, and Rheumatology, Department of Pediatrics, University of Wisconsin School of Medicine and Public Health (D.J.J., R.F.L.) and the School of Pharmacy, University of Wisconsin-Madison (C.A.S.) - both in Madison; Washington University School of Medicine in St. Louis and the Department of Pediatrics, St. Louis Children's Hospital (L.B.B., A.B.) - both in St. Louis; the Departments of Pediatrics (M.D.C.) and Medicine (S.C.L.) and the Airway Clinical Research Center (N.L.), University of California, San Francisco, San Francisco, Benioff Children's Hospital Oakland, Oakland (M.B., J.M.), and Olive View UCLA Medical Center and Department of Pediatrics, David Geff
| | - John J Lima
- From the Divisions of Allergy and Immunology (W.J.S., S.N.B., W.P.) and Respiratory Diseases (J.M.G.), Boston Children's Hospital and Harvard Medical School, and the Division of Allergy and Pulmonary Medicine, Brigham and Women's Hospital and Harvard Medical School (E.I.) - all in Boston; the Departments of Public Health Sciences (D.T.M., S.J.B.) and Pediatrics (I.M.P.), Penn State College of Medicine, Hershey, and the University of Pittsburgh Asthma Institute at University of Pittsburgh Medical Center (F.H.) and the Department of Pediatrics, Allegheny General Hospital (D.A.G.), Pittsburgh - all in Pennsylvania; Stroger Hospital of Cook County and Department of Pediatrics, Rush University Medical Center (J.N.M.), Ann and Robert H. Lurie Children's Hospital of Chicago (J.A.P., R.G.R.), and University of Illinois at Chicago (H.V.K.) - all in Chicago; the Breathing Institute, Children's Hospital Colorado (S.J.S.), and the Departments of Pediatrics (S.J.S.) and Medicine (M.E.W.), University of Colorado School of Medicine, Aurora, and the Department of Pediatrics (R.C., J.T.O.) and Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine (M.E.W.), National Jewish Health, Denver - both in Colorado; the Department of Pediatrics, Emory University, Atlanta (A.M.F.); the Section of Allergy, Immunology, and Rheumatology, Department of Pediatrics, University of Wisconsin School of Medicine and Public Health (D.J.J., R.F.L.) and the School of Pharmacy, University of Wisconsin-Madison (C.A.S.) - both in Madison; Washington University School of Medicine in St. Louis and the Department of Pediatrics, St. Louis Children's Hospital (L.B.B., A.B.) - both in St. Louis; the Departments of Pediatrics (M.D.C.) and Medicine (S.C.L.) and the Airway Clinical Research Center (N.L.), University of California, San Francisco, San Francisco, Benioff Children's Hospital Oakland, Oakland (M.B., J.M.), and Olive View UCLA Medical Center and Department of Pediatrics, David Geff
| | - Ngoc Ly
- From the Divisions of Allergy and Immunology (W.J.S., S.N.B., W.P.) and Respiratory Diseases (J.M.G.), Boston Children's Hospital and Harvard Medical School, and the Division of Allergy and Pulmonary Medicine, Brigham and Women's Hospital and Harvard Medical School (E.I.) - all in Boston; the Departments of Public Health Sciences (D.T.M., S.J.B.) and Pediatrics (I.M.P.), Penn State College of Medicine, Hershey, and the University of Pittsburgh Asthma Institute at University of Pittsburgh Medical Center (F.H.) and the Department of Pediatrics, Allegheny General Hospital (D.A.G.), Pittsburgh - all in Pennsylvania; Stroger Hospital of Cook County and Department of Pediatrics, Rush University Medical Center (J.N.M.), Ann and Robert H. Lurie Children's Hospital of Chicago (J.A.P., R.G.R.), and University of Illinois at Chicago (H.V.K.) - all in Chicago; the Breathing Institute, Children's Hospital Colorado (S.J.S.), and the Departments of Pediatrics (S.J.S.) and Medicine (M.E.W.), University of Colorado School of Medicine, Aurora, and the Department of Pediatrics (R.C., J.T.O.) and Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine (M.E.W.), National Jewish Health, Denver - both in Colorado; the Department of Pediatrics, Emory University, Atlanta (A.M.F.); the Section of Allergy, Immunology, and Rheumatology, Department of Pediatrics, University of Wisconsin School of Medicine and Public Health (D.J.J., R.F.L.) and the School of Pharmacy, University of Wisconsin-Madison (C.A.S.) - both in Madison; Washington University School of Medicine in St. Louis and the Department of Pediatrics, St. Louis Children's Hospital (L.B.B., A.B.) - both in St. Louis; the Departments of Pediatrics (M.D.C.) and Medicine (S.C.L.) and the Airway Clinical Research Center (N.L.), University of California, San Francisco, San Francisco, Benioff Children's Hospital Oakland, Oakland (M.B., J.M.), and Olive View UCLA Medical Center and Department of Pediatrics, David Geff
| | - Jyothi Marbin
- From the Divisions of Allergy and Immunology (W.J.S., S.N.B., W.P.) and Respiratory Diseases (J.M.G.), Boston Children's Hospital and Harvard Medical School, and the Division of Allergy and Pulmonary Medicine, Brigham and Women's Hospital and Harvard Medical School (E.I.) - all in Boston; the Departments of Public Health Sciences (D.T.M., S.J.B.) and Pediatrics (I.M.P.), Penn State College of Medicine, Hershey, and the University of Pittsburgh Asthma Institute at University of Pittsburgh Medical Center (F.H.) and the Department of Pediatrics, Allegheny General Hospital (D.A.G.), Pittsburgh - all in Pennsylvania; Stroger Hospital of Cook County and Department of Pediatrics, Rush University Medical Center (J.N.M.), Ann and Robert H. Lurie Children's Hospital of Chicago (J.A.P., R.G.R.), and University of Illinois at Chicago (H.V.K.) - all in Chicago; the Breathing Institute, Children's Hospital Colorado (S.J.S.), and the Departments of Pediatrics (S.J.S.) and Medicine (M.E.W.), University of Colorado School of Medicine, Aurora, and the Department of Pediatrics (R.C., J.T.O.) and Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine (M.E.W.), National Jewish Health, Denver - both in Colorado; the Department of Pediatrics, Emory University, Atlanta (A.M.F.); the Section of Allergy, Immunology, and Rheumatology, Department of Pediatrics, University of Wisconsin School of Medicine and Public Health (D.J.J., R.F.L.) and the School of Pharmacy, University of Wisconsin-Madison (C.A.S.) - both in Madison; Washington University School of Medicine in St. Louis and the Department of Pediatrics, St. Louis Children's Hospital (L.B.B., A.B.) - both in St. Louis; the Departments of Pediatrics (M.D.C.) and Medicine (S.C.L.) and the Airway Clinical Research Center (N.L.), University of California, San Francisco, San Francisco, Benioff Children's Hospital Oakland, Oakland (M.B., J.M.), and Olive View UCLA Medical Center and Department of Pediatrics, David Geff
| | - Wayne J Morgan
- From the Divisions of Allergy and Immunology (W.J.S., S.N.B., W.P.) and Respiratory Diseases (J.M.G.), Boston Children's Hospital and Harvard Medical School, and the Division of Allergy and Pulmonary Medicine, Brigham and Women's Hospital and Harvard Medical School (E.I.) - all in Boston; the Departments of Public Health Sciences (D.T.M., S.J.B.) and Pediatrics (I.M.P.), Penn State College of Medicine, Hershey, and the University of Pittsburgh Asthma Institute at University of Pittsburgh Medical Center (F.H.) and the Department of Pediatrics, Allegheny General Hospital (D.A.G.), Pittsburgh - all in Pennsylvania; Stroger Hospital of Cook County and Department of Pediatrics, Rush University Medical Center (J.N.M.), Ann and Robert H. Lurie Children's Hospital of Chicago (J.A.P., R.G.R.), and University of Illinois at Chicago (H.V.K.) - all in Chicago; the Breathing Institute, Children's Hospital Colorado (S.J.S.), and the Departments of Pediatrics (S.J.S.) and Medicine (M.E.W.), University of Colorado School of Medicine, Aurora, and the Department of Pediatrics (R.C., J.T.O.) and Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine (M.E.W.), National Jewish Health, Denver - both in Colorado; the Department of Pediatrics, Emory University, Atlanta (A.M.F.); the Section of Allergy, Immunology, and Rheumatology, Department of Pediatrics, University of Wisconsin School of Medicine and Public Health (D.J.J., R.F.L.) and the School of Pharmacy, University of Wisconsin-Madison (C.A.S.) - both in Madison; Washington University School of Medicine in St. Louis and the Department of Pediatrics, St. Louis Children's Hospital (L.B.B., A.B.) - both in St. Louis; the Departments of Pediatrics (M.D.C.) and Medicine (S.C.L.) and the Airway Clinical Research Center (N.L.), University of California, San Francisco, San Francisco, Benioff Children's Hospital Oakland, Oakland (M.B., J.M.), and Olive View UCLA Medical Center and Department of Pediatrics, David Geff
| | - Ross E Myers
- From the Divisions of Allergy and Immunology (W.J.S., S.N.B., W.P.) and Respiratory Diseases (J.M.G.), Boston Children's Hospital and Harvard Medical School, and the Division of Allergy and Pulmonary Medicine, Brigham and Women's Hospital and Harvard Medical School (E.I.) - all in Boston; the Departments of Public Health Sciences (D.T.M., S.J.B.) and Pediatrics (I.M.P.), Penn State College of Medicine, Hershey, and the University of Pittsburgh Asthma Institute at University of Pittsburgh Medical Center (F.H.) and the Department of Pediatrics, Allegheny General Hospital (D.A.G.), Pittsburgh - all in Pennsylvania; Stroger Hospital of Cook County and Department of Pediatrics, Rush University Medical Center (J.N.M.), Ann and Robert H. Lurie Children's Hospital of Chicago (J.A.P., R.G.R.), and University of Illinois at Chicago (H.V.K.) - all in Chicago; the Breathing Institute, Children's Hospital Colorado (S.J.S.), and the Departments of Pediatrics (S.J.S.) and Medicine (M.E.W.), University of Colorado School of Medicine, Aurora, and the Department of Pediatrics (R.C., J.T.O.) and Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine (M.E.W.), National Jewish Health, Denver - both in Colorado; the Department of Pediatrics, Emory University, Atlanta (A.M.F.); the Section of Allergy, Immunology, and Rheumatology, Department of Pediatrics, University of Wisconsin School of Medicine and Public Health (D.J.J., R.F.L.) and the School of Pharmacy, University of Wisconsin-Madison (C.A.S.) - both in Madison; Washington University School of Medicine in St. Louis and the Department of Pediatrics, St. Louis Children's Hospital (L.B.B., A.B.) - both in St. Louis; the Departments of Pediatrics (M.D.C.) and Medicine (S.C.L.) and the Airway Clinical Research Center (N.L.), University of California, San Francisco, San Francisco, Benioff Children's Hospital Oakland, Oakland (M.B., J.M.), and Olive View UCLA Medical Center and Department of Pediatrics, David Geff
| | - J Tod Olin
- From the Divisions of Allergy and Immunology (W.J.S., S.N.B., W.P.) and Respiratory Diseases (J.M.G.), Boston Children's Hospital and Harvard Medical School, and the Division of Allergy and Pulmonary Medicine, Brigham and Women's Hospital and Harvard Medical School (E.I.) - all in Boston; the Departments of Public Health Sciences (D.T.M., S.J.B.) and Pediatrics (I.M.P.), Penn State College of Medicine, Hershey, and the University of Pittsburgh Asthma Institute at University of Pittsburgh Medical Center (F.H.) and the Department of Pediatrics, Allegheny General Hospital (D.A.G.), Pittsburgh - all in Pennsylvania; Stroger Hospital of Cook County and Department of Pediatrics, Rush University Medical Center (J.N.M.), Ann and Robert H. Lurie Children's Hospital of Chicago (J.A.P., R.G.R.), and University of Illinois at Chicago (H.V.K.) - all in Chicago; the Breathing Institute, Children's Hospital Colorado (S.J.S.), and the Departments of Pediatrics (S.J.S.) and Medicine (M.E.W.), University of Colorado School of Medicine, Aurora, and the Department of Pediatrics (R.C., J.T.O.) and Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine (M.E.W.), National Jewish Health, Denver - both in Colorado; the Department of Pediatrics, Emory University, Atlanta (A.M.F.); the Section of Allergy, Immunology, and Rheumatology, Department of Pediatrics, University of Wisconsin School of Medicine and Public Health (D.J.J., R.F.L.) and the School of Pharmacy, University of Wisconsin-Madison (C.A.S.) - both in Madison; Washington University School of Medicine in St. Louis and the Department of Pediatrics, St. Louis Children's Hospital (L.B.B., A.B.) - both in St. Louis; the Departments of Pediatrics (M.D.C.) and Medicine (S.C.L.) and the Airway Clinical Research Center (N.L.), University of California, San Francisco, San Francisco, Benioff Children's Hospital Oakland, Oakland (M.B., J.M.), and Olive View UCLA Medical Center and Department of Pediatrics, David Geff
| | - Stephen P Peters
- From the Divisions of Allergy and Immunology (W.J.S., S.N.B., W.P.) and Respiratory Diseases (J.M.G.), Boston Children's Hospital and Harvard Medical School, and the Division of Allergy and Pulmonary Medicine, Brigham and Women's Hospital and Harvard Medical School (E.I.) - all in Boston; the Departments of Public Health Sciences (D.T.M., S.J.B.) and Pediatrics (I.M.P.), Penn State College of Medicine, Hershey, and the University of Pittsburgh Asthma Institute at University of Pittsburgh Medical Center (F.H.) and the Department of Pediatrics, Allegheny General Hospital (D.A.G.), Pittsburgh - all in Pennsylvania; Stroger Hospital of Cook County and Department of Pediatrics, Rush University Medical Center (J.N.M.), Ann and Robert H. Lurie Children's Hospital of Chicago (J.A.P., R.G.R.), and University of Illinois at Chicago (H.V.K.) - all in Chicago; the Breathing Institute, Children's Hospital Colorado (S.J.S.), and the Departments of Pediatrics (S.J.S.) and Medicine (M.E.W.), University of Colorado School of Medicine, Aurora, and the Department of Pediatrics (R.C., J.T.O.) and Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine (M.E.W.), National Jewish Health, Denver - both in Colorado; the Department of Pediatrics, Emory University, Atlanta (A.M.F.); the Section of Allergy, Immunology, and Rheumatology, Department of Pediatrics, University of Wisconsin School of Medicine and Public Health (D.J.J., R.F.L.) and the School of Pharmacy, University of Wisconsin-Madison (C.A.S.) - both in Madison; Washington University School of Medicine in St. Louis and the Department of Pediatrics, St. Louis Children's Hospital (L.B.B., A.B.) - both in St. Louis; the Departments of Pediatrics (M.D.C.) and Medicine (S.C.L.) and the Airway Clinical Research Center (N.L.), University of California, San Francisco, San Francisco, Benioff Children's Hospital Oakland, Oakland (M.B., J.M.), and Olive View UCLA Medical Center and Department of Pediatrics, David Geff
| | - Hengameh H Raissy
- From the Divisions of Allergy and Immunology (W.J.S., S.N.B., W.P.) and Respiratory Diseases (J.M.G.), Boston Children's Hospital and Harvard Medical School, and the Division of Allergy and Pulmonary Medicine, Brigham and Women's Hospital and Harvard Medical School (E.I.) - all in Boston; the Departments of Public Health Sciences (D.T.M., S.J.B.) and Pediatrics (I.M.P.), Penn State College of Medicine, Hershey, and the University of Pittsburgh Asthma Institute at University of Pittsburgh Medical Center (F.H.) and the Department of Pediatrics, Allegheny General Hospital (D.A.G.), Pittsburgh - all in Pennsylvania; Stroger Hospital of Cook County and Department of Pediatrics, Rush University Medical Center (J.N.M.), Ann and Robert H. Lurie Children's Hospital of Chicago (J.A.P., R.G.R.), and University of Illinois at Chicago (H.V.K.) - all in Chicago; the Breathing Institute, Children's Hospital Colorado (S.J.S.), and the Departments of Pediatrics (S.J.S.) and Medicine (M.E.W.), University of Colorado School of Medicine, Aurora, and the Department of Pediatrics (R.C., J.T.O.) and Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine (M.E.W.), National Jewish Health, Denver - both in Colorado; the Department of Pediatrics, Emory University, Atlanta (A.M.F.); the Section of Allergy, Immunology, and Rheumatology, Department of Pediatrics, University of Wisconsin School of Medicine and Public Health (D.J.J., R.F.L.) and the School of Pharmacy, University of Wisconsin-Madison (C.A.S.) - both in Madison; Washington University School of Medicine in St. Louis and the Department of Pediatrics, St. Louis Children's Hospital (L.B.B., A.B.) - both in St. Louis; the Departments of Pediatrics (M.D.C.) and Medicine (S.C.L.) and the Airway Clinical Research Center (N.L.), University of California, San Francisco, San Francisco, Benioff Children's Hospital Oakland, Oakland (M.B., J.M.), and Olive View UCLA Medical Center and Department of Pediatrics, David Geff
| | - Rachel G Robison
- From the Divisions of Allergy and Immunology (W.J.S., S.N.B., W.P.) and Respiratory Diseases (J.M.G.), Boston Children's Hospital and Harvard Medical School, and the Division of Allergy and Pulmonary Medicine, Brigham and Women's Hospital and Harvard Medical School (E.I.) - all in Boston; the Departments of Public Health Sciences (D.T.M., S.J.B.) and Pediatrics (I.M.P.), Penn State College of Medicine, Hershey, and the University of Pittsburgh Asthma Institute at University of Pittsburgh Medical Center (F.H.) and the Department of Pediatrics, Allegheny General Hospital (D.A.G.), Pittsburgh - all in Pennsylvania; Stroger Hospital of Cook County and Department of Pediatrics, Rush University Medical Center (J.N.M.), Ann and Robert H. Lurie Children's Hospital of Chicago (J.A.P., R.G.R.), and University of Illinois at Chicago (H.V.K.) - all in Chicago; the Breathing Institute, Children's Hospital Colorado (S.J.S.), and the Departments of Pediatrics (S.J.S.) and Medicine (M.E.W.), University of Colorado School of Medicine, Aurora, and the Department of Pediatrics (R.C., J.T.O.) and Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine (M.E.W.), National Jewish Health, Denver - both in Colorado; the Department of Pediatrics, Emory University, Atlanta (A.M.F.); the Section of Allergy, Immunology, and Rheumatology, Department of Pediatrics, University of Wisconsin School of Medicine and Public Health (D.J.J., R.F.L.) and the School of Pharmacy, University of Wisconsin-Madison (C.A.S.) - both in Madison; Washington University School of Medicine in St. Louis and the Department of Pediatrics, St. Louis Children's Hospital (L.B.B., A.B.) - both in St. Louis; the Departments of Pediatrics (M.D.C.) and Medicine (S.C.L.) and the Airway Clinical Research Center (N.L.), University of California, San Francisco, San Francisco, Benioff Children's Hospital Oakland, Oakland (M.B., J.M.), and Olive View UCLA Medical Center and Department of Pediatrics, David Geff
| | - Kristie Ross
- From the Divisions of Allergy and Immunology (W.J.S., S.N.B., W.P.) and Respiratory Diseases (J.M.G.), Boston Children's Hospital and Harvard Medical School, and the Division of Allergy and Pulmonary Medicine, Brigham and Women's Hospital and Harvard Medical School (E.I.) - all in Boston; the Departments of Public Health Sciences (D.T.M., S.J.B.) and Pediatrics (I.M.P.), Penn State College of Medicine, Hershey, and the University of Pittsburgh Asthma Institute at University of Pittsburgh Medical Center (F.H.) and the Department of Pediatrics, Allegheny General Hospital (D.A.G.), Pittsburgh - all in Pennsylvania; Stroger Hospital of Cook County and Department of Pediatrics, Rush University Medical Center (J.N.M.), Ann and Robert H. Lurie Children's Hospital of Chicago (J.A.P., R.G.R.), and University of Illinois at Chicago (H.V.K.) - all in Chicago; the Breathing Institute, Children's Hospital Colorado (S.J.S.), and the Departments of Pediatrics (S.J.S.) and Medicine (M.E.W.), University of Colorado School of Medicine, Aurora, and the Department of Pediatrics (R.C., J.T.O.) and Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine (M.E.W.), National Jewish Health, Denver - both in Colorado; the Department of Pediatrics, Emory University, Atlanta (A.M.F.); the Section of Allergy, Immunology, and Rheumatology, Department of Pediatrics, University of Wisconsin School of Medicine and Public Health (D.J.J., R.F.L.) and the School of Pharmacy, University of Wisconsin-Madison (C.A.S.) - both in Madison; Washington University School of Medicine in St. Louis and the Department of Pediatrics, St. Louis Children's Hospital (L.B.B., A.B.) - both in St. Louis; the Departments of Pediatrics (M.D.C.) and Medicine (S.C.L.) and the Airway Clinical Research Center (N.L.), University of California, San Francisco, San Francisco, Benioff Children's Hospital Oakland, Oakland (M.B., J.M.), and Olive View UCLA Medical Center and Department of Pediatrics, David Geff
| | - Christine A Sorkness
- From the Divisions of Allergy and Immunology (W.J.S., S.N.B., W.P.) and Respiratory Diseases (J.M.G.), Boston Children's Hospital and Harvard Medical School, and the Division of Allergy and Pulmonary Medicine, Brigham and Women's Hospital and Harvard Medical School (E.I.) - all in Boston; the Departments of Public Health Sciences (D.T.M., S.J.B.) and Pediatrics (I.M.P.), Penn State College of Medicine, Hershey, and the University of Pittsburgh Asthma Institute at University of Pittsburgh Medical Center (F.H.) and the Department of Pediatrics, Allegheny General Hospital (D.A.G.), Pittsburgh - all in Pennsylvania; Stroger Hospital of Cook County and Department of Pediatrics, Rush University Medical Center (J.N.M.), Ann and Robert H. Lurie Children's Hospital of Chicago (J.A.P., R.G.R.), and University of Illinois at Chicago (H.V.K.) - all in Chicago; the Breathing Institute, Children's Hospital Colorado (S.J.S.), and the Departments of Pediatrics (S.J.S.) and Medicine (M.E.W.), University of Colorado School of Medicine, Aurora, and the Department of Pediatrics (R.C., J.T.O.) and Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine (M.E.W.), National Jewish Health, Denver - both in Colorado; the Department of Pediatrics, Emory University, Atlanta (A.M.F.); the Section of Allergy, Immunology, and Rheumatology, Department of Pediatrics, University of Wisconsin School of Medicine and Public Health (D.J.J., R.F.L.) and the School of Pharmacy, University of Wisconsin-Madison (C.A.S.) - both in Madison; Washington University School of Medicine in St. Louis and the Department of Pediatrics, St. Louis Children's Hospital (L.B.B., A.B.) - both in St. Louis; the Departments of Pediatrics (M.D.C.) and Medicine (S.C.L.) and the Airway Clinical Research Center (N.L.), University of California, San Francisco, San Francisco, Benioff Children's Hospital Oakland, Oakland (M.B., J.M.), and Olive View UCLA Medical Center and Department of Pediatrics, David Geff
| | - Shannon M Thyne
- From the Divisions of Allergy and Immunology (W.J.S., S.N.B., W.P.) and Respiratory Diseases (J.M.G.), Boston Children's Hospital and Harvard Medical School, and the Division of Allergy and Pulmonary Medicine, Brigham and Women's Hospital and Harvard Medical School (E.I.) - all in Boston; the Departments of Public Health Sciences (D.T.M., S.J.B.) and Pediatrics (I.M.P.), Penn State College of Medicine, Hershey, and the University of Pittsburgh Asthma Institute at University of Pittsburgh Medical Center (F.H.) and the Department of Pediatrics, Allegheny General Hospital (D.A.G.), Pittsburgh - all in Pennsylvania; Stroger Hospital of Cook County and Department of Pediatrics, Rush University Medical Center (J.N.M.), Ann and Robert H. Lurie Children's Hospital of Chicago (J.A.P., R.G.R.), and University of Illinois at Chicago (H.V.K.) - all in Chicago; the Breathing Institute, Children's Hospital Colorado (S.J.S.), and the Departments of Pediatrics (S.J.S.) and Medicine (M.E.W.), University of Colorado School of Medicine, Aurora, and the Department of Pediatrics (R.C., J.T.O.) and Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine (M.E.W.), National Jewish Health, Denver - both in Colorado; the Department of Pediatrics, Emory University, Atlanta (A.M.F.); the Section of Allergy, Immunology, and Rheumatology, Department of Pediatrics, University of Wisconsin School of Medicine and Public Health (D.J.J., R.F.L.) and the School of Pharmacy, University of Wisconsin-Madison (C.A.S.) - both in Madison; Washington University School of Medicine in St. Louis and the Department of Pediatrics, St. Louis Children's Hospital (L.B.B., A.B.) - both in St. Louis; the Departments of Pediatrics (M.D.C.) and Medicine (S.C.L.) and the Airway Clinical Research Center (N.L.), University of California, San Francisco, San Francisco, Benioff Children's Hospital Oakland, Oakland (M.B., J.M.), and Olive View UCLA Medical Center and Department of Pediatrics, David Geff
| | - Michael E Wechsler
- From the Divisions of Allergy and Immunology (W.J.S., S.N.B., W.P.) and Respiratory Diseases (J.M.G.), Boston Children's Hospital and Harvard Medical School, and the Division of Allergy and Pulmonary Medicine, Brigham and Women's Hospital and Harvard Medical School (E.I.) - all in Boston; the Departments of Public Health Sciences (D.T.M., S.J.B.) and Pediatrics (I.M.P.), Penn State College of Medicine, Hershey, and the University of Pittsburgh Asthma Institute at University of Pittsburgh Medical Center (F.H.) and the Department of Pediatrics, Allegheny General Hospital (D.A.G.), Pittsburgh - all in Pennsylvania; Stroger Hospital of Cook County and Department of Pediatrics, Rush University Medical Center (J.N.M.), Ann and Robert H. Lurie Children's Hospital of Chicago (J.A.P., R.G.R.), and University of Illinois at Chicago (H.V.K.) - all in Chicago; the Breathing Institute, Children's Hospital Colorado (S.J.S.), and the Departments of Pediatrics (S.J.S.) and Medicine (M.E.W.), University of Colorado School of Medicine, Aurora, and the Department of Pediatrics (R.C., J.T.O.) and Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine (M.E.W.), National Jewish Health, Denver - both in Colorado; the Department of Pediatrics, Emory University, Atlanta (A.M.F.); the Section of Allergy, Immunology, and Rheumatology, Department of Pediatrics, University of Wisconsin School of Medicine and Public Health (D.J.J., R.F.L.) and the School of Pharmacy, University of Wisconsin-Madison (C.A.S.) - both in Madison; Washington University School of Medicine in St. Louis and the Department of Pediatrics, St. Louis Children's Hospital (L.B.B., A.B.) - both in St. Louis; the Departments of Pediatrics (M.D.C.) and Medicine (S.C.L.) and the Airway Clinical Research Center (N.L.), University of California, San Francisco, San Francisco, Benioff Children's Hospital Oakland, Oakland (M.B., J.M.), and Olive View UCLA Medical Center and Department of Pediatrics, David Geff
| | - Wanda Phipatanakul
- From the Divisions of Allergy and Immunology (W.J.S., S.N.B., W.P.) and Respiratory Diseases (J.M.G.), Boston Children's Hospital and Harvard Medical School, and the Division of Allergy and Pulmonary Medicine, Brigham and Women's Hospital and Harvard Medical School (E.I.) - all in Boston; the Departments of Public Health Sciences (D.T.M., S.J.B.) and Pediatrics (I.M.P.), Penn State College of Medicine, Hershey, and the University of Pittsburgh Asthma Institute at University of Pittsburgh Medical Center (F.H.) and the Department of Pediatrics, Allegheny General Hospital (D.A.G.), Pittsburgh - all in Pennsylvania; Stroger Hospital of Cook County and Department of Pediatrics, Rush University Medical Center (J.N.M.), Ann and Robert H. Lurie Children's Hospital of Chicago (J.A.P., R.G.R.), and University of Illinois at Chicago (H.V.K.) - all in Chicago; the Breathing Institute, Children's Hospital Colorado (S.J.S.), and the Departments of Pediatrics (S.J.S.) and Medicine (M.E.W.), University of Colorado School of Medicine, Aurora, and the Department of Pediatrics (R.C., J.T.O.) and Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine (M.E.W.), National Jewish Health, Denver - both in Colorado; the Department of Pediatrics, Emory University, Atlanta (A.M.F.); the Section of Allergy, Immunology, and Rheumatology, Department of Pediatrics, University of Wisconsin School of Medicine and Public Health (D.J.J., R.F.L.) and the School of Pharmacy, University of Wisconsin-Madison (C.A.S.) - both in Madison; Washington University School of Medicine in St. Louis and the Department of Pediatrics, St. Louis Children's Hospital (L.B.B., A.B.) - both in St. Louis; the Departments of Pediatrics (M.D.C.) and Medicine (S.C.L.) and the Airway Clinical Research Center (N.L.), University of California, San Francisco, San Francisco, Benioff Children's Hospital Oakland, Oakland (M.B., J.M.), and Olive View UCLA Medical Center and Department of Pediatrics, David Geff
| |
Collapse
|
71
|
Zein JG, Udeh BL, Teague WG, Koroukian SM, Schlitz NK, Bleecker ER, Busse WB, Calhoun WJ, Castro M, Comhair SA, Fitzpatrick AM, Israel E, Wenzel SE, Holguin F, Gaston BM, Erzurum SC. Impact of Age and Sex on Outcomes and Hospital Cost of Acute Asthma in the United States, 2011-2012. PLoS One 2016; 11:e0157301. [PMID: 27294365 PMCID: PMC4905648 DOI: 10.1371/journal.pone.0157301] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 05/26/2016] [Indexed: 12/20/2022] Open
Abstract
Background Worldwide, asthma is a leading cause of morbidity, mortality and economic burden, with significant gender and racial disparities. However, little attention has been given to the independent role of age on lifetime asthma severity and hospitalization. We aimed to assess the effect of age, gender, race and ethnicity on indicators of asthma severity including asthma related hospitalization, mortality, hospital cost, and the rate of respiratory failure. Methods We analyzed the 2011 and 2012 Healthcare Cost and Utilization Project- National Inpatient Sample (NIS). We validated and extended those results using the National Heart, Lung, and Blood Institute-Severe Asthma Research Program (SARP; 2002–2011) database. Severe asthma was prospectively defined using the stringent American Thoracic Society (ATS) definition. Results Hospitalization for asthma was reported in 372,685 encounters in 2012 and 368,528 in 2011. The yearly aggregate cost exceeded $2 billion. There were distinct bimodal distributions for hospitalization age, with an initial peak at 5 years and a second at 50 years. Likewise, this bimodal age distribution of patients with severe asthma was identified using SARP. Males comprised the majority of individuals in the first peak, but women in the second. Aggregate hospital cost mirrored the bimodal peak distribution. The probability of respiratory failure increased with age until the age of 60, after which it continued to increase in men, but not in women. Conclusions Severe asthma is primarily a disease of young boys and middle age women. Greater understanding of the biology of lung aging and influence of sex hormones will allow us to plan for targeted interventions during these times in order to reduce the personal and societal burdens of asthma.
Collapse
Affiliation(s)
- Joe G. Zein
- Department of Pathobiology, Lerner Research Institute, and Respiratory Institute, Cleveland Clinic, Cleveland, Ohio, United States of America
- * E-mail:
| | - Belinda L. Udeh
- Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio, United States of America
| | - W. Gerald Teague
- Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, Virginia, United States of America
| | - Siran M. Koroukian
- Department of Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, Ohio, United States of America
| | - Nicholas K. Schlitz
- Department of Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, Ohio, United States of America
| | - Eugene R. Bleecker
- Center for Genomics and Personalized Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, United States of America
| | - William B. Busse
- Department of Medicine, the University of Wisconsin, School of Medicine and Public Health, Madison, Wisconsin, United States of America
| | - William J. Calhoun
- Department of Medicine, University of Texas Medical Branch, Galveston, Texas, United States of America
| | - Mario Castro
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, United States of America
| | - Suzy A. Comhair
- Department of Pathobiology, Lerner Research Institute, and Respiratory Institute, Cleveland Clinic, Cleveland, Ohio, United States of America
| | - Anne M. Fitzpatrick
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - Elliot Israel
- Pulmonary Division, Harvard Medical School, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
| | - Sally E. Wenzel
- The Asthma Institute, the University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Fernando Holguin
- The Asthma Institute, the University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Benjamin M. Gaston
- Department of Pediatric, Rainbow Babies & Children’s Hospital, Cleveland, Ohio, United States of America
| | - Serpil C. Erzurum
- Department of Pathobiology, Lerner Research Institute, and Respiratory Institute, Cleveland Clinic, Cleveland, Ohio, United States of America
| | | |
Collapse
|
72
|
Levy BD, Noel PJ, Freemer MM, Cloutier MM, Georas SN, Jarjour NN, Ober C, Woodruff PG, Barnes KC, Bender BG, Camargo CA, Chupp GL, Denlinger LC, Fahy JV, Fitzpatrick AM, Fuhlbrigge A, Gaston BM, Hartert TV, Kolls JK, Lynch SV, Moore WC, Morgan WJ, Nadeau KC, Ownby DR, Solway J, Szefler SJ, Wenzel SE, Wright RJ, Smith RA, Erzurum SC. Future Research Directions in Asthma. An NHLBI Working Group Report. Am J Respir Crit Care Med 2016; 192:1366-72. [PMID: 26305520 DOI: 10.1164/rccm.201505-0963ws] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Asthma is a common chronic disease without cure. Our understanding of asthma onset, pathobiology, classification, and management has evolved substantially over the past decade; however, significant asthma-related morbidity and excess healthcare use and costs persist. To address this important clinical condition, the NHLBI convened a group of extramural investigators for an Asthma Research Strategic Planning workshop on September 18-19, 2014, to accelerate discoveries and their translation to patients. The workshop focused on (1) in utero and early-life origins of asthma, (2) the use of phenotypes and endotypes to classify disease, (3) defining disease modification, (4) disease management, and (5) implementation research. This report summarizes the workshop and produces recommendations to guide future research in asthma.
Collapse
Affiliation(s)
- Bruce D Levy
- 1 Brigham and Women's Hospital, Boston, Massachusetts
| | - Patricia J Noel
- 2 National Heart, Lung, and Blood Institute, Bethesda, Maryland
| | | | | | | | - Nizar N Jarjour
- 5 University of Wisconsin Hospital and Clinics, Madison, Wisconsin
| | - Carole Ober
- 6 The University of Chicago, Chicago, Illinois
| | | | | | | | | | - Geoff L Chupp
- 11 Yale University School of Medicine, New Haven, Connecticut
| | | | - John V Fahy
- 7 University of California at San Francisco, San Francisco, California
| | | | | | - Ben M Gaston
- 13 Case Western Reserve University, Cleveland, Ohio
| | - Tina V Hartert
- 14 Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Jay K Kolls
- 15 University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Susan V Lynch
- 7 University of California at San Francisco, San Francisco, California
| | - Wendy C Moore
- 16 Wake Forest School of Medicine, Winston Salem, North Carolina
| | | | - Kari C Nadeau
- 18 Stanford School of Medicine, Stanford, California
| | | | | | - Stanley J Szefler
- 20 Children's Hospital Colorado and the University of Colorado School of Medicine, Denver, Colorado
| | - Sally E Wenzel
- 15 University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | | | - Robert A Smith
- 2 National Heart, Lung, and Blood Institute, Bethesda, Maryland
| | | |
Collapse
|
73
|
Fitzpatrick AM. Biomarkers of asthma and allergic airway diseases. Ann Allergy Asthma Immunol 2016; 115:335-40. [PMID: 26505931 DOI: 10.1016/j.anai.2015.09.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Revised: 09/04/2015] [Accepted: 09/04/2015] [Indexed: 01/29/2023]
|
74
|
Riley CM, Wenzel SE, Castro M, Erzurum SC, Chung KF, Fitzpatrick AM, Gaston B, Israel E, Moore WC, Bleecker ER, Calhoun WJ, Jarjour NN, Busse WW, Peters SP, Teague WG, Sorkness R, Holguin F. Clinical Implications of Having Reduced Mid Forced Expiratory Flow Rates (FEF25-75), Independently of FEV1, in Adult Patients with Asthma. PLoS One 2015; 10:e0145476. [PMID: 26717486 PMCID: PMC4696666 DOI: 10.1371/journal.pone.0145476] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Accepted: 11/12/2015] [Indexed: 01/23/2023] Open
Abstract
INTRODUCTION FEF25-75 is one of the standard results provided in spirometry reports; however, in adult asthmatics there is limited information on how this physiological measure relates to clinical or biological outcomes independently of the FEV1 or the FEV1/FVC ratio. PURPOSE To determine the association between Hankinson's percent-predicted FEF25-75 (FEF25-75%) levels with changes in healthcare utilization, respiratory symptom frequency, and biomarkers of distal airway inflammation. METHODS In participants enrolled in the Severe Asthma Research Program 1-2, we compared outcomes across FEF25-75% quartiles. Multivariable analyses were done to avoid confounding by demographic characteristics, FEV1, and the FEV1/FVC ratio. In a sensitivity analysis, we also compared outcomes across participants with FEF25-75% below the lower limit of normal (LLN) and FEV1/FVC above LLN. RESULTS Subjects in the lowest FEF25-75% quartile had greater rates of healthcare utilization and higher exhaled nitric oxide and sputum eosinophils. In multivariable analysis, being in the lowest FEF25-75% quartile remained significantly associated with nocturnal symptoms (OR 3.0 [95%CI 1.3-6.9]), persistent symptoms (OR 3.3 [95%CI 1-11], ICU admission for asthma (3.7 [1.3-10.8]) and blood eosinophil % (0.18 [0.07, 0.29]). In the sensitivity analysis, those with FEF25-75% CONCLUSIONS After controlling for demographic variables, FEV1 and FEV1/FVC, a reduced FEF25-75% is independently associated with previous ICU admission, persistent symptoms, nocturnal symptoms, blood eosinophilia and bronchial hyperreactivity. This suggests that in some asthmatics, a reduced FEF25-75% is an independent biomarker for more severe asthma.
Collapse
Affiliation(s)
- Craig M. Riley
- Department of Medicine, Division of Internal Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States of America
| | - Sally E. Wenzel
- Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States of America
| | - Mario Castro
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine in St. Louis, St. Louis, Missouri, United States of America
| | - Serpil C. Erzurum
- Department of Pathobiology, Cleveland Clinic Foundation, Cleveland, Ohio, United States of America
| | - Kian Fan Chung
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Anne M. Fitzpatrick
- Department of Pediatrics, Emory University School of Medicine, Atlanta, George, United States of America
| | - Benjamin Gaston
- Department of Pediatrics, Division of Pediatric Pulmonary Medicine, University Hospitals, Cleveland, Ohio, United States of America
| | - Elliot Israel
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
| | - Wendy C. Moore
- Department of Medicine, Division of Pulmonary, Critical Care, Allergy and Immunologic Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, United States of America
| | - Eugene R. Bleecker
- Department of Medicine, Division of Pulmonary, Critical Care, Allergy and Immunologic Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, United States of America
| | - William J. Calhoun
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, University of Texas Medical Branch, Galveston, Texas, United States of America
| | - Nizar N. Jarjour
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States of America
| | - William W. Busse
- Department of Medicine, Division of Allergy and Immunology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States of America
| | - Stephen P. Peters
- Department of Medicine, Division of Pulmonary, Critical Care, Allergy and Immunologic Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, United States of America
| | - W. Gerald Teague
- Department of Pediatrics, Division of Respiratory Medicine, University of Virginia Children’s Hospital, Charlottesville, Virginia, United States of America
| | - Ronald Sorkness
- School of Pharmacy, University of Wisconsin at Madison, Madison, Wisconsin, United States of America
| | - Fernando Holguin
- Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States of America
| |
Collapse
|
75
|
Bacharier LB, Guilbert TW, Mauger DT, Boehmer S, Beigelman A, Fitzpatrick AM, Jackson DJ, Baxi SN, Benson M, Burnham CAD, Cabana M, Castro M, Chmiel JF, Covar R, Daines M, Gaffin JM, Gentile DA, Holguin F, Israel E, Kelly HW, Lazarus SC, Lemanske RF, Ly N, Meade K, Morgan W, Moy J, Olin T, Peters SP, Phipatanakul W, Pongracic JA, Raissy HH, Ross K, Sheehan WJ, Sorkness C, Szefler SJ, Teague WG, Thyne S, Martinez FD. Early Administration of Azithromycin and Prevention of Severe Lower Respiratory Tract Illnesses in Preschool Children With a History of Such Illnesses: A Randomized Clinical Trial. JAMA 2015; 314:2034-2044. [PMID: 26575060 PMCID: PMC4757487 DOI: 10.1001/jama.2015.13896] [Citation(s) in RCA: 181] [Impact Index Per Article: 20.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
IMPORTANCE Many preschool children develop recurrent, severe episodes of lower respiratory tract illness (LRTI). Although viral infections are often present, bacteria may also contribute to illness pathogenesis. Strategies that effectively attenuate such episodes are needed. OBJECTIVE To evaluate if early administration of azithromycin, started prior to the onset of severe LRTI symptoms, in preschool children with recurrent severe LRTIs can prevent the progression of these episodes. DESIGN, SETTING, AND PARTICIPANTS A randomized, double-blind, placebo-controlled, parallel-group trial conducted across 9 academic US medical centers in the National Heart, Lung, and Blood Institute's AsthmaNet network, with enrollment starting in April 2011 and follow-up complete by December 2014. Participants were 607 children aged 12 through 71 months with histories of recurrent, severe LRTIs and minimal day-to-day impairment. INTERVENTION Participants were randomly assigned to receive azithromycin (12 mg/kg/d for 5 days; n = 307) or matching placebo (n = 300), started early during each predefined RTI (child's signs or symptoms prior to development of LRTI), based on individualized action plans, over a 12- through 18-month period. MAIN OUTCOMES AND MEASURES The primary outcome measure was the number of RTIs not progressing to a severe LRTI, measured at the level of the RTI, that would in clinical practice trigger the prescription of oral corticosteroids. Presence of azithromycin-resistant organisms in oropharyngeal samples, along with adverse events, were among the secondary outcome measures. RESULTS A total of 937 treated RTIs (azithromycin group, 473; placebo group, 464) were experienced by 443 children (azithromycin group, 223; placebo group, 220), including 92 severe LRTIs (azithromycin group, 35; placebo group, 57). Azithromycin significantly reduced the risk of progressing to severe LRTI relative to placebo (hazard ratio, 0.64 [95% CI, 0.41-0.98], P = .04; absolute risk for first RTI: 0.05 for azithromycin, 0.08 for placebo; risk difference, 0.03 [95% CI, 0.00-0.06]). Induction of azithromycin-resistant organisms and adverse events were infrequently observed. CONCLUSIONS AND RELEVANCE Among young children with histories of recurrent severe LRTIs, the use of azithromycin early during an apparent RTI compared with placebo reduced the likelihood of severe LRTI. More information is needed on the development of antibiotic-resistant pathogens with this strategy. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01272635.
Collapse
Affiliation(s)
- Leonard B Bacharier
- Department of Pediatrics, Washington University in St Louis School of Medicine, St Louis, Missouri (Bacharier, Beigelman, Castro); Cincinnati Children's Hospital and Medical Center, Cincinnati, Ohio (Guilbert); Department of Public Health Sciences, Pennsylvania State University, Hershey (Mauger, Boehmer); Department of Pediatrics, Emory University, Atlanta, Georgia (Fitzpatrick); Pediatrics Section of Allergy, Immunology, and Rheumatology, University of Wisconsin School of Medicine and Public Health, Madison (Jackson); Division of Allergy/Immunology, Boston Children's Hospital, Boston, Massachusetts (Baxi, Phipatanakul, Sheehan); Benioff Children's Hospital, Oakland, California (Benson, Meade); Department of Pathology and Immunology, Washington University in St Louis School of Medicine, St Louis, Missouri (Burnham); University of California, San Francisco, Medicine, San Francisco (Cabana, Lazarus); Rainbow Babies and Children's Hospital, Cleveland, Ohio (Chmiel, Ross); Department of Pediatrics, National Jewish Health, Denver, Colorado (Covar, Olin); University of Arizona, Arizona Respiratory Center, Tucson (Daines, Morgan); Division of Respiratory Diseases, Boston Children's Hospital, Boston, Massachusetts (Gaffin); Department of Pediatrics, Allegheny General Hospital, Pittsburgh, Pennsylvania (Gentile); The University of Pittsburgh Asthma Institute, Pittsburgh, Pennsylvania (Holguin); Brigham and Women's Hospital, Boston, Massachusetts (Israel); Department of Pediatrics, University of New Mexico School of Medicine, Albuquerque, New Mexico (Kelly); Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison (Lemanske); Airway Clinical Research Center, University of California, San Francisco, San Francisco, California (Ly); Stroger Hospital of Cook County Pediatric Services, Chicago, Illinois (Moy); Wake Forest University School of Medicine, Winston-Salem, North Carolina (Peters); Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois (Pongracic); Department of Pediatrics/Pulmonary, University of New Mexico, Albuquerque (Raissy); University of Wisconsin-Madison, Madison (Sorkness); The Breathing Institute, Children's Hospital Colorado, Denver (Szefler); University of Virginia School of Medicine, Charlottesville (Teague); Department of Pediatrics, San Francisco General Hospital, San Francisco, California (Thyne); Arizona Respiratory Center, University of Arizona, Tucson, Arizona (Martinez)
| | - Theresa W Guilbert
- Department of Pediatrics, Washington University in St Louis School of Medicine, St Louis, Missouri (Bacharier, Beigelman, Castro); Cincinnati Children's Hospital and Medical Center, Cincinnati, Ohio (Guilbert); Department of Public Health Sciences, Pennsylvania State University, Hershey (Mauger, Boehmer); Department of Pediatrics, Emory University, Atlanta, Georgia (Fitzpatrick); Pediatrics Section of Allergy, Immunology, and Rheumatology, University of Wisconsin School of Medicine and Public Health, Madison (Jackson); Division of Allergy/Immunology, Boston Children's Hospital, Boston, Massachusetts (Baxi, Phipatanakul, Sheehan); Benioff Children's Hospital, Oakland, California (Benson, Meade); Department of Pathology and Immunology, Washington University in St Louis School of Medicine, St Louis, Missouri (Burnham); University of California, San Francisco, Medicine, San Francisco (Cabana, Lazarus); Rainbow Babies and Children's Hospital, Cleveland, Ohio (Chmiel, Ross); Department of Pediatrics, National Jewish Health, Denver, Colorado (Covar, Olin); University of Arizona, Arizona Respiratory Center, Tucson (Daines, Morgan); Division of Respiratory Diseases, Boston Children's Hospital, Boston, Massachusetts (Gaffin); Department of Pediatrics, Allegheny General Hospital, Pittsburgh, Pennsylvania (Gentile); The University of Pittsburgh Asthma Institute, Pittsburgh, Pennsylvania (Holguin); Brigham and Women's Hospital, Boston, Massachusetts (Israel); Department of Pediatrics, University of New Mexico School of Medicine, Albuquerque, New Mexico (Kelly); Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison (Lemanske); Airway Clinical Research Center, University of California, San Francisco, San Francisco, California (Ly); Stroger Hospital of Cook County Pediatric Services, Chicago, Illinois (Moy); Wake Forest University School of Medicine, Winston-Salem, North Carolina (Peters); Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois (Pongracic); Department of Pediatrics/Pulmonary, University of New Mexico, Albuquerque (Raissy); University of Wisconsin-Madison, Madison (Sorkness); The Breathing Institute, Children's Hospital Colorado, Denver (Szefler); University of Virginia School of Medicine, Charlottesville (Teague); Department of Pediatrics, San Francisco General Hospital, San Francisco, California (Thyne); Arizona Respiratory Center, University of Arizona, Tucson, Arizona (Martinez)
| | - David T Mauger
- Department of Pediatrics, Washington University in St Louis School of Medicine, St Louis, Missouri (Bacharier, Beigelman, Castro); Cincinnati Children's Hospital and Medical Center, Cincinnati, Ohio (Guilbert); Department of Public Health Sciences, Pennsylvania State University, Hershey (Mauger, Boehmer); Department of Pediatrics, Emory University, Atlanta, Georgia (Fitzpatrick); Pediatrics Section of Allergy, Immunology, and Rheumatology, University of Wisconsin School of Medicine and Public Health, Madison (Jackson); Division of Allergy/Immunology, Boston Children's Hospital, Boston, Massachusetts (Baxi, Phipatanakul, Sheehan); Benioff Children's Hospital, Oakland, California (Benson, Meade); Department of Pathology and Immunology, Washington University in St Louis School of Medicine, St Louis, Missouri (Burnham); University of California, San Francisco, Medicine, San Francisco (Cabana, Lazarus); Rainbow Babies and Children's Hospital, Cleveland, Ohio (Chmiel, Ross); Department of Pediatrics, National Jewish Health, Denver, Colorado (Covar, Olin); University of Arizona, Arizona Respiratory Center, Tucson (Daines, Morgan); Division of Respiratory Diseases, Boston Children's Hospital, Boston, Massachusetts (Gaffin); Department of Pediatrics, Allegheny General Hospital, Pittsburgh, Pennsylvania (Gentile); The University of Pittsburgh Asthma Institute, Pittsburgh, Pennsylvania (Holguin); Brigham and Women's Hospital, Boston, Massachusetts (Israel); Department of Pediatrics, University of New Mexico School of Medicine, Albuquerque, New Mexico (Kelly); Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison (Lemanske); Airway Clinical Research Center, University of California, San Francisco, San Francisco, California (Ly); Stroger Hospital of Cook County Pediatric Services, Chicago, Illinois (Moy); Wake Forest University School of Medicine, Winston-Salem, North Carolina (Peters); Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois (Pongracic); Department of Pediatrics/Pulmonary, University of New Mexico, Albuquerque (Raissy); University of Wisconsin-Madison, Madison (Sorkness); The Breathing Institute, Children's Hospital Colorado, Denver (Szefler); University of Virginia School of Medicine, Charlottesville (Teague); Department of Pediatrics, San Francisco General Hospital, San Francisco, California (Thyne); Arizona Respiratory Center, University of Arizona, Tucson, Arizona (Martinez)
| | - Susan Boehmer
- Department of Pediatrics, Washington University in St Louis School of Medicine, St Louis, Missouri (Bacharier, Beigelman, Castro); Cincinnati Children's Hospital and Medical Center, Cincinnati, Ohio (Guilbert); Department of Public Health Sciences, Pennsylvania State University, Hershey (Mauger, Boehmer); Department of Pediatrics, Emory University, Atlanta, Georgia (Fitzpatrick); Pediatrics Section of Allergy, Immunology, and Rheumatology, University of Wisconsin School of Medicine and Public Health, Madison (Jackson); Division of Allergy/Immunology, Boston Children's Hospital, Boston, Massachusetts (Baxi, Phipatanakul, Sheehan); Benioff Children's Hospital, Oakland, California (Benson, Meade); Department of Pathology and Immunology, Washington University in St Louis School of Medicine, St Louis, Missouri (Burnham); University of California, San Francisco, Medicine, San Francisco (Cabana, Lazarus); Rainbow Babies and Children's Hospital, Cleveland, Ohio (Chmiel, Ross); Department of Pediatrics, National Jewish Health, Denver, Colorado (Covar, Olin); University of Arizona, Arizona Respiratory Center, Tucson (Daines, Morgan); Division of Respiratory Diseases, Boston Children's Hospital, Boston, Massachusetts (Gaffin); Department of Pediatrics, Allegheny General Hospital, Pittsburgh, Pennsylvania (Gentile); The University of Pittsburgh Asthma Institute, Pittsburgh, Pennsylvania (Holguin); Brigham and Women's Hospital, Boston, Massachusetts (Israel); Department of Pediatrics, University of New Mexico School of Medicine, Albuquerque, New Mexico (Kelly); Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison (Lemanske); Airway Clinical Research Center, University of California, San Francisco, San Francisco, California (Ly); Stroger Hospital of Cook County Pediatric Services, Chicago, Illinois (Moy); Wake Forest University School of Medicine, Winston-Salem, North Carolina (Peters); Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois (Pongracic); Department of Pediatrics/Pulmonary, University of New Mexico, Albuquerque (Raissy); University of Wisconsin-Madison, Madison (Sorkness); The Breathing Institute, Children's Hospital Colorado, Denver (Szefler); University of Virginia School of Medicine, Charlottesville (Teague); Department of Pediatrics, San Francisco General Hospital, San Francisco, California (Thyne); Arizona Respiratory Center, University of Arizona, Tucson, Arizona (Martinez)
| | - Avraham Beigelman
- Department of Pediatrics, Washington University in St Louis School of Medicine, St Louis, Missouri (Bacharier, Beigelman, Castro); Cincinnati Children's Hospital and Medical Center, Cincinnati, Ohio (Guilbert); Department of Public Health Sciences, Pennsylvania State University, Hershey (Mauger, Boehmer); Department of Pediatrics, Emory University, Atlanta, Georgia (Fitzpatrick); Pediatrics Section of Allergy, Immunology, and Rheumatology, University of Wisconsin School of Medicine and Public Health, Madison (Jackson); Division of Allergy/Immunology, Boston Children's Hospital, Boston, Massachusetts (Baxi, Phipatanakul, Sheehan); Benioff Children's Hospital, Oakland, California (Benson, Meade); Department of Pathology and Immunology, Washington University in St Louis School of Medicine, St Louis, Missouri (Burnham); University of California, San Francisco, Medicine, San Francisco (Cabana, Lazarus); Rainbow Babies and Children's Hospital, Cleveland, Ohio (Chmiel, Ross); Department of Pediatrics, National Jewish Health, Denver, Colorado (Covar, Olin); University of Arizona, Arizona Respiratory Center, Tucson (Daines, Morgan); Division of Respiratory Diseases, Boston Children's Hospital, Boston, Massachusetts (Gaffin); Department of Pediatrics, Allegheny General Hospital, Pittsburgh, Pennsylvania (Gentile); The University of Pittsburgh Asthma Institute, Pittsburgh, Pennsylvania (Holguin); Brigham and Women's Hospital, Boston, Massachusetts (Israel); Department of Pediatrics, University of New Mexico School of Medicine, Albuquerque, New Mexico (Kelly); Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison (Lemanske); Airway Clinical Research Center, University of California, San Francisco, San Francisco, California (Ly); Stroger Hospital of Cook County Pediatric Services, Chicago, Illinois (Moy); Wake Forest University School of Medicine, Winston-Salem, North Carolina (Peters); Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois (Pongracic); Department of Pediatrics/Pulmonary, University of New Mexico, Albuquerque (Raissy); University of Wisconsin-Madison, Madison (Sorkness); The Breathing Institute, Children's Hospital Colorado, Denver (Szefler); University of Virginia School of Medicine, Charlottesville (Teague); Department of Pediatrics, San Francisco General Hospital, San Francisco, California (Thyne); Arizona Respiratory Center, University of Arizona, Tucson, Arizona (Martinez)
| | - Anne M Fitzpatrick
- Department of Pediatrics, Washington University in St Louis School of Medicine, St Louis, Missouri (Bacharier, Beigelman, Castro); Cincinnati Children's Hospital and Medical Center, Cincinnati, Ohio (Guilbert); Department of Public Health Sciences, Pennsylvania State University, Hershey (Mauger, Boehmer); Department of Pediatrics, Emory University, Atlanta, Georgia (Fitzpatrick); Pediatrics Section of Allergy, Immunology, and Rheumatology, University of Wisconsin School of Medicine and Public Health, Madison (Jackson); Division of Allergy/Immunology, Boston Children's Hospital, Boston, Massachusetts (Baxi, Phipatanakul, Sheehan); Benioff Children's Hospital, Oakland, California (Benson, Meade); Department of Pathology and Immunology, Washington University in St Louis School of Medicine, St Louis, Missouri (Burnham); University of California, San Francisco, Medicine, San Francisco (Cabana, Lazarus); Rainbow Babies and Children's Hospital, Cleveland, Ohio (Chmiel, Ross); Department of Pediatrics, National Jewish Health, Denver, Colorado (Covar, Olin); University of Arizona, Arizona Respiratory Center, Tucson (Daines, Morgan); Division of Respiratory Diseases, Boston Children's Hospital, Boston, Massachusetts (Gaffin); Department of Pediatrics, Allegheny General Hospital, Pittsburgh, Pennsylvania (Gentile); The University of Pittsburgh Asthma Institute, Pittsburgh, Pennsylvania (Holguin); Brigham and Women's Hospital, Boston, Massachusetts (Israel); Department of Pediatrics, University of New Mexico School of Medicine, Albuquerque, New Mexico (Kelly); Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison (Lemanske); Airway Clinical Research Center, University of California, San Francisco, San Francisco, California (Ly); Stroger Hospital of Cook County Pediatric Services, Chicago, Illinois (Moy); Wake Forest University School of Medicine, Winston-Salem, North Carolina (Peters); Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois (Pongracic); Department of Pediatrics/Pulmonary, University of New Mexico, Albuquerque (Raissy); University of Wisconsin-Madison, Madison (Sorkness); The Breathing Institute, Children's Hospital Colorado, Denver (Szefler); University of Virginia School of Medicine, Charlottesville (Teague); Department of Pediatrics, San Francisco General Hospital, San Francisco, California (Thyne); Arizona Respiratory Center, University of Arizona, Tucson, Arizona (Martinez)
| | - Daniel J Jackson
- Department of Pediatrics, Washington University in St Louis School of Medicine, St Louis, Missouri (Bacharier, Beigelman, Castro); Cincinnati Children's Hospital and Medical Center, Cincinnati, Ohio (Guilbert); Department of Public Health Sciences, Pennsylvania State University, Hershey (Mauger, Boehmer); Department of Pediatrics, Emory University, Atlanta, Georgia (Fitzpatrick); Pediatrics Section of Allergy, Immunology, and Rheumatology, University of Wisconsin School of Medicine and Public Health, Madison (Jackson); Division of Allergy/Immunology, Boston Children's Hospital, Boston, Massachusetts (Baxi, Phipatanakul, Sheehan); Benioff Children's Hospital, Oakland, California (Benson, Meade); Department of Pathology and Immunology, Washington University in St Louis School of Medicine, St Louis, Missouri (Burnham); University of California, San Francisco, Medicine, San Francisco (Cabana, Lazarus); Rainbow Babies and Children's Hospital, Cleveland, Ohio (Chmiel, Ross); Department of Pediatrics, National Jewish Health, Denver, Colorado (Covar, Olin); University of Arizona, Arizona Respiratory Center, Tucson (Daines, Morgan); Division of Respiratory Diseases, Boston Children's Hospital, Boston, Massachusetts (Gaffin); Department of Pediatrics, Allegheny General Hospital, Pittsburgh, Pennsylvania (Gentile); The University of Pittsburgh Asthma Institute, Pittsburgh, Pennsylvania (Holguin); Brigham and Women's Hospital, Boston, Massachusetts (Israel); Department of Pediatrics, University of New Mexico School of Medicine, Albuquerque, New Mexico (Kelly); Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison (Lemanske); Airway Clinical Research Center, University of California, San Francisco, San Francisco, California (Ly); Stroger Hospital of Cook County Pediatric Services, Chicago, Illinois (Moy); Wake Forest University School of Medicine, Winston-Salem, North Carolina (Peters); Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois (Pongracic); Department of Pediatrics/Pulmonary, University of New Mexico, Albuquerque (Raissy); University of Wisconsin-Madison, Madison (Sorkness); The Breathing Institute, Children's Hospital Colorado, Denver (Szefler); University of Virginia School of Medicine, Charlottesville (Teague); Department of Pediatrics, San Francisco General Hospital, San Francisco, California (Thyne); Arizona Respiratory Center, University of Arizona, Tucson, Arizona (Martinez)
| | - Sachin N Baxi
- Department of Pediatrics, Washington University in St Louis School of Medicine, St Louis, Missouri (Bacharier, Beigelman, Castro); Cincinnati Children's Hospital and Medical Center, Cincinnati, Ohio (Guilbert); Department of Public Health Sciences, Pennsylvania State University, Hershey (Mauger, Boehmer); Department of Pediatrics, Emory University, Atlanta, Georgia (Fitzpatrick); Pediatrics Section of Allergy, Immunology, and Rheumatology, University of Wisconsin School of Medicine and Public Health, Madison (Jackson); Division of Allergy/Immunology, Boston Children's Hospital, Boston, Massachusetts (Baxi, Phipatanakul, Sheehan); Benioff Children's Hospital, Oakland, California (Benson, Meade); Department of Pathology and Immunology, Washington University in St Louis School of Medicine, St Louis, Missouri (Burnham); University of California, San Francisco, Medicine, San Francisco (Cabana, Lazarus); Rainbow Babies and Children's Hospital, Cleveland, Ohio (Chmiel, Ross); Department of Pediatrics, National Jewish Health, Denver, Colorado (Covar, Olin); University of Arizona, Arizona Respiratory Center, Tucson (Daines, Morgan); Division of Respiratory Diseases, Boston Children's Hospital, Boston, Massachusetts (Gaffin); Department of Pediatrics, Allegheny General Hospital, Pittsburgh, Pennsylvania (Gentile); The University of Pittsburgh Asthma Institute, Pittsburgh, Pennsylvania (Holguin); Brigham and Women's Hospital, Boston, Massachusetts (Israel); Department of Pediatrics, University of New Mexico School of Medicine, Albuquerque, New Mexico (Kelly); Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison (Lemanske); Airway Clinical Research Center, University of California, San Francisco, San Francisco, California (Ly); Stroger Hospital of Cook County Pediatric Services, Chicago, Illinois (Moy); Wake Forest University School of Medicine, Winston-Salem, North Carolina (Peters); Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois (Pongracic); Department of Pediatrics/Pulmonary, University of New Mexico, Albuquerque (Raissy); University of Wisconsin-Madison, Madison (Sorkness); The Breathing Institute, Children's Hospital Colorado, Denver (Szefler); University of Virginia School of Medicine, Charlottesville (Teague); Department of Pediatrics, San Francisco General Hospital, San Francisco, California (Thyne); Arizona Respiratory Center, University of Arizona, Tucson, Arizona (Martinez)
| | - Mindy Benson
- Department of Pediatrics, Washington University in St Louis School of Medicine, St Louis, Missouri (Bacharier, Beigelman, Castro); Cincinnati Children's Hospital and Medical Center, Cincinnati, Ohio (Guilbert); Department of Public Health Sciences, Pennsylvania State University, Hershey (Mauger, Boehmer); Department of Pediatrics, Emory University, Atlanta, Georgia (Fitzpatrick); Pediatrics Section of Allergy, Immunology, and Rheumatology, University of Wisconsin School of Medicine and Public Health, Madison (Jackson); Division of Allergy/Immunology, Boston Children's Hospital, Boston, Massachusetts (Baxi, Phipatanakul, Sheehan); Benioff Children's Hospital, Oakland, California (Benson, Meade); Department of Pathology and Immunology, Washington University in St Louis School of Medicine, St Louis, Missouri (Burnham); University of California, San Francisco, Medicine, San Francisco (Cabana, Lazarus); Rainbow Babies and Children's Hospital, Cleveland, Ohio (Chmiel, Ross); Department of Pediatrics, National Jewish Health, Denver, Colorado (Covar, Olin); University of Arizona, Arizona Respiratory Center, Tucson (Daines, Morgan); Division of Respiratory Diseases, Boston Children's Hospital, Boston, Massachusetts (Gaffin); Department of Pediatrics, Allegheny General Hospital, Pittsburgh, Pennsylvania (Gentile); The University of Pittsburgh Asthma Institute, Pittsburgh, Pennsylvania (Holguin); Brigham and Women's Hospital, Boston, Massachusetts (Israel); Department of Pediatrics, University of New Mexico School of Medicine, Albuquerque, New Mexico (Kelly); Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison (Lemanske); Airway Clinical Research Center, University of California, San Francisco, San Francisco, California (Ly); Stroger Hospital of Cook County Pediatric Services, Chicago, Illinois (Moy); Wake Forest University School of Medicine, Winston-Salem, North Carolina (Peters); Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois (Pongracic); Department of Pediatrics/Pulmonary, University of New Mexico, Albuquerque (Raissy); University of Wisconsin-Madison, Madison (Sorkness); The Breathing Institute, Children's Hospital Colorado, Denver (Szefler); University of Virginia School of Medicine, Charlottesville (Teague); Department of Pediatrics, San Francisco General Hospital, San Francisco, California (Thyne); Arizona Respiratory Center, University of Arizona, Tucson, Arizona (Martinez)
| | - Carey-Ann D Burnham
- Department of Pediatrics, Washington University in St Louis School of Medicine, St Louis, Missouri (Bacharier, Beigelman, Castro); Cincinnati Children's Hospital and Medical Center, Cincinnati, Ohio (Guilbert); Department of Public Health Sciences, Pennsylvania State University, Hershey (Mauger, Boehmer); Department of Pediatrics, Emory University, Atlanta, Georgia (Fitzpatrick); Pediatrics Section of Allergy, Immunology, and Rheumatology, University of Wisconsin School of Medicine and Public Health, Madison (Jackson); Division of Allergy/Immunology, Boston Children's Hospital, Boston, Massachusetts (Baxi, Phipatanakul, Sheehan); Benioff Children's Hospital, Oakland, California (Benson, Meade); Department of Pathology and Immunology, Washington University in St Louis School of Medicine, St Louis, Missouri (Burnham); University of California, San Francisco, Medicine, San Francisco (Cabana, Lazarus); Rainbow Babies and Children's Hospital, Cleveland, Ohio (Chmiel, Ross); Department of Pediatrics, National Jewish Health, Denver, Colorado (Covar, Olin); University of Arizona, Arizona Respiratory Center, Tucson (Daines, Morgan); Division of Respiratory Diseases, Boston Children's Hospital, Boston, Massachusetts (Gaffin); Department of Pediatrics, Allegheny General Hospital, Pittsburgh, Pennsylvania (Gentile); The University of Pittsburgh Asthma Institute, Pittsburgh, Pennsylvania (Holguin); Brigham and Women's Hospital, Boston, Massachusetts (Israel); Department of Pediatrics, University of New Mexico School of Medicine, Albuquerque, New Mexico (Kelly); Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison (Lemanske); Airway Clinical Research Center, University of California, San Francisco, San Francisco, California (Ly); Stroger Hospital of Cook County Pediatric Services, Chicago, Illinois (Moy); Wake Forest University School of Medicine, Winston-Salem, North Carolina (Peters); Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois (Pongracic); Department of Pediatrics/Pulmonary, University of New Mexico, Albuquerque (Raissy); University of Wisconsin-Madison, Madison (Sorkness); The Breathing Institute, Children's Hospital Colorado, Denver (Szefler); University of Virginia School of Medicine, Charlottesville (Teague); Department of Pediatrics, San Francisco General Hospital, San Francisco, California (Thyne); Arizona Respiratory Center, University of Arizona, Tucson, Arizona (Martinez)
| | - Michael Cabana
- Department of Pediatrics, Washington University in St Louis School of Medicine, St Louis, Missouri (Bacharier, Beigelman, Castro); Cincinnati Children's Hospital and Medical Center, Cincinnati, Ohio (Guilbert); Department of Public Health Sciences, Pennsylvania State University, Hershey (Mauger, Boehmer); Department of Pediatrics, Emory University, Atlanta, Georgia (Fitzpatrick); Pediatrics Section of Allergy, Immunology, and Rheumatology, University of Wisconsin School of Medicine and Public Health, Madison (Jackson); Division of Allergy/Immunology, Boston Children's Hospital, Boston, Massachusetts (Baxi, Phipatanakul, Sheehan); Benioff Children's Hospital, Oakland, California (Benson, Meade); Department of Pathology and Immunology, Washington University in St Louis School of Medicine, St Louis, Missouri (Burnham); University of California, San Francisco, Medicine, San Francisco (Cabana, Lazarus); Rainbow Babies and Children's Hospital, Cleveland, Ohio (Chmiel, Ross); Department of Pediatrics, National Jewish Health, Denver, Colorado (Covar, Olin); University of Arizona, Arizona Respiratory Center, Tucson (Daines, Morgan); Division of Respiratory Diseases, Boston Children's Hospital, Boston, Massachusetts (Gaffin); Department of Pediatrics, Allegheny General Hospital, Pittsburgh, Pennsylvania (Gentile); The University of Pittsburgh Asthma Institute, Pittsburgh, Pennsylvania (Holguin); Brigham and Women's Hospital, Boston, Massachusetts (Israel); Department of Pediatrics, University of New Mexico School of Medicine, Albuquerque, New Mexico (Kelly); Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison (Lemanske); Airway Clinical Research Center, University of California, San Francisco, San Francisco, California (Ly); Stroger Hospital of Cook County Pediatric Services, Chicago, Illinois (Moy); Wake Forest University School of Medicine, Winston-Salem, North Carolina (Peters); Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois (Pongracic); Department of Pediatrics/Pulmonary, University of New Mexico, Albuquerque (Raissy); University of Wisconsin-Madison, Madison (Sorkness); The Breathing Institute, Children's Hospital Colorado, Denver (Szefler); University of Virginia School of Medicine, Charlottesville (Teague); Department of Pediatrics, San Francisco General Hospital, San Francisco, California (Thyne); Arizona Respiratory Center, University of Arizona, Tucson, Arizona (Martinez)
| | - Mario Castro
- Department of Pediatrics, Washington University in St Louis School of Medicine, St Louis, Missouri (Bacharier, Beigelman, Castro); Cincinnati Children's Hospital and Medical Center, Cincinnati, Ohio (Guilbert); Department of Public Health Sciences, Pennsylvania State University, Hershey (Mauger, Boehmer); Department of Pediatrics, Emory University, Atlanta, Georgia (Fitzpatrick); Pediatrics Section of Allergy, Immunology, and Rheumatology, University of Wisconsin School of Medicine and Public Health, Madison (Jackson); Division of Allergy/Immunology, Boston Children's Hospital, Boston, Massachusetts (Baxi, Phipatanakul, Sheehan); Benioff Children's Hospital, Oakland, California (Benson, Meade); Department of Pathology and Immunology, Washington University in St Louis School of Medicine, St Louis, Missouri (Burnham); University of California, San Francisco, Medicine, San Francisco (Cabana, Lazarus); Rainbow Babies and Children's Hospital, Cleveland, Ohio (Chmiel, Ross); Department of Pediatrics, National Jewish Health, Denver, Colorado (Covar, Olin); University of Arizona, Arizona Respiratory Center, Tucson (Daines, Morgan); Division of Respiratory Diseases, Boston Children's Hospital, Boston, Massachusetts (Gaffin); Department of Pediatrics, Allegheny General Hospital, Pittsburgh, Pennsylvania (Gentile); The University of Pittsburgh Asthma Institute, Pittsburgh, Pennsylvania (Holguin); Brigham and Women's Hospital, Boston, Massachusetts (Israel); Department of Pediatrics, University of New Mexico School of Medicine, Albuquerque, New Mexico (Kelly); Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison (Lemanske); Airway Clinical Research Center, University of California, San Francisco, San Francisco, California (Ly); Stroger Hospital of Cook County Pediatric Services, Chicago, Illinois (Moy); Wake Forest University School of Medicine, Winston-Salem, North Carolina (Peters); Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois (Pongracic); Department of Pediatrics/Pulmonary, University of New Mexico, Albuquerque (Raissy); University of Wisconsin-Madison, Madison (Sorkness); The Breathing Institute, Children's Hospital Colorado, Denver (Szefler); University of Virginia School of Medicine, Charlottesville (Teague); Department of Pediatrics, San Francisco General Hospital, San Francisco, California (Thyne); Arizona Respiratory Center, University of Arizona, Tucson, Arizona (Martinez)
| | - James F Chmiel
- Department of Pediatrics, Washington University in St Louis School of Medicine, St Louis, Missouri (Bacharier, Beigelman, Castro); Cincinnati Children's Hospital and Medical Center, Cincinnati, Ohio (Guilbert); Department of Public Health Sciences, Pennsylvania State University, Hershey (Mauger, Boehmer); Department of Pediatrics, Emory University, Atlanta, Georgia (Fitzpatrick); Pediatrics Section of Allergy, Immunology, and Rheumatology, University of Wisconsin School of Medicine and Public Health, Madison (Jackson); Division of Allergy/Immunology, Boston Children's Hospital, Boston, Massachusetts (Baxi, Phipatanakul, Sheehan); Benioff Children's Hospital, Oakland, California (Benson, Meade); Department of Pathology and Immunology, Washington University in St Louis School of Medicine, St Louis, Missouri (Burnham); University of California, San Francisco, Medicine, San Francisco (Cabana, Lazarus); Rainbow Babies and Children's Hospital, Cleveland, Ohio (Chmiel, Ross); Department of Pediatrics, National Jewish Health, Denver, Colorado (Covar, Olin); University of Arizona, Arizona Respiratory Center, Tucson (Daines, Morgan); Division of Respiratory Diseases, Boston Children's Hospital, Boston, Massachusetts (Gaffin); Department of Pediatrics, Allegheny General Hospital, Pittsburgh, Pennsylvania (Gentile); The University of Pittsburgh Asthma Institute, Pittsburgh, Pennsylvania (Holguin); Brigham and Women's Hospital, Boston, Massachusetts (Israel); Department of Pediatrics, University of New Mexico School of Medicine, Albuquerque, New Mexico (Kelly); Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison (Lemanske); Airway Clinical Research Center, University of California, San Francisco, San Francisco, California (Ly); Stroger Hospital of Cook County Pediatric Services, Chicago, Illinois (Moy); Wake Forest University School of Medicine, Winston-Salem, North Carolina (Peters); Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois (Pongracic); Department of Pediatrics/Pulmonary, University of New Mexico, Albuquerque (Raissy); University of Wisconsin-Madison, Madison (Sorkness); The Breathing Institute, Children's Hospital Colorado, Denver (Szefler); University of Virginia School of Medicine, Charlottesville (Teague); Department of Pediatrics, San Francisco General Hospital, San Francisco, California (Thyne); Arizona Respiratory Center, University of Arizona, Tucson, Arizona (Martinez)
| | - Ronina Covar
- Department of Pediatrics, Washington University in St Louis School of Medicine, St Louis, Missouri (Bacharier, Beigelman, Castro); Cincinnati Children's Hospital and Medical Center, Cincinnati, Ohio (Guilbert); Department of Public Health Sciences, Pennsylvania State University, Hershey (Mauger, Boehmer); Department of Pediatrics, Emory University, Atlanta, Georgia (Fitzpatrick); Pediatrics Section of Allergy, Immunology, and Rheumatology, University of Wisconsin School of Medicine and Public Health, Madison (Jackson); Division of Allergy/Immunology, Boston Children's Hospital, Boston, Massachusetts (Baxi, Phipatanakul, Sheehan); Benioff Children's Hospital, Oakland, California (Benson, Meade); Department of Pathology and Immunology, Washington University in St Louis School of Medicine, St Louis, Missouri (Burnham); University of California, San Francisco, Medicine, San Francisco (Cabana, Lazarus); Rainbow Babies and Children's Hospital, Cleveland, Ohio (Chmiel, Ross); Department of Pediatrics, National Jewish Health, Denver, Colorado (Covar, Olin); University of Arizona, Arizona Respiratory Center, Tucson (Daines, Morgan); Division of Respiratory Diseases, Boston Children's Hospital, Boston, Massachusetts (Gaffin); Department of Pediatrics, Allegheny General Hospital, Pittsburgh, Pennsylvania (Gentile); The University of Pittsburgh Asthma Institute, Pittsburgh, Pennsylvania (Holguin); Brigham and Women's Hospital, Boston, Massachusetts (Israel); Department of Pediatrics, University of New Mexico School of Medicine, Albuquerque, New Mexico (Kelly); Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison (Lemanske); Airway Clinical Research Center, University of California, San Francisco, San Francisco, California (Ly); Stroger Hospital of Cook County Pediatric Services, Chicago, Illinois (Moy); Wake Forest University School of Medicine, Winston-Salem, North Carolina (Peters); Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois (Pongracic); Department of Pediatrics/Pulmonary, University of New Mexico, Albuquerque (Raissy); University of Wisconsin-Madison, Madison (Sorkness); The Breathing Institute, Children's Hospital Colorado, Denver (Szefler); University of Virginia School of Medicine, Charlottesville (Teague); Department of Pediatrics, San Francisco General Hospital, San Francisco, California (Thyne); Arizona Respiratory Center, University of Arizona, Tucson, Arizona (Martinez)
| | - Michael Daines
- Department of Pediatrics, Washington University in St Louis School of Medicine, St Louis, Missouri (Bacharier, Beigelman, Castro); Cincinnati Children's Hospital and Medical Center, Cincinnati, Ohio (Guilbert); Department of Public Health Sciences, Pennsylvania State University, Hershey (Mauger, Boehmer); Department of Pediatrics, Emory University, Atlanta, Georgia (Fitzpatrick); Pediatrics Section of Allergy, Immunology, and Rheumatology, University of Wisconsin School of Medicine and Public Health, Madison (Jackson); Division of Allergy/Immunology, Boston Children's Hospital, Boston, Massachusetts (Baxi, Phipatanakul, Sheehan); Benioff Children's Hospital, Oakland, California (Benson, Meade); Department of Pathology and Immunology, Washington University in St Louis School of Medicine, St Louis, Missouri (Burnham); University of California, San Francisco, Medicine, San Francisco (Cabana, Lazarus); Rainbow Babies and Children's Hospital, Cleveland, Ohio (Chmiel, Ross); Department of Pediatrics, National Jewish Health, Denver, Colorado (Covar, Olin); University of Arizona, Arizona Respiratory Center, Tucson (Daines, Morgan); Division of Respiratory Diseases, Boston Children's Hospital, Boston, Massachusetts (Gaffin); Department of Pediatrics, Allegheny General Hospital, Pittsburgh, Pennsylvania (Gentile); The University of Pittsburgh Asthma Institute, Pittsburgh, Pennsylvania (Holguin); Brigham and Women's Hospital, Boston, Massachusetts (Israel); Department of Pediatrics, University of New Mexico School of Medicine, Albuquerque, New Mexico (Kelly); Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison (Lemanske); Airway Clinical Research Center, University of California, San Francisco, San Francisco, California (Ly); Stroger Hospital of Cook County Pediatric Services, Chicago, Illinois (Moy); Wake Forest University School of Medicine, Winston-Salem, North Carolina (Peters); Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois (Pongracic); Department of Pediatrics/Pulmonary, University of New Mexico, Albuquerque (Raissy); University of Wisconsin-Madison, Madison (Sorkness); The Breathing Institute, Children's Hospital Colorado, Denver (Szefler); University of Virginia School of Medicine, Charlottesville (Teague); Department of Pediatrics, San Francisco General Hospital, San Francisco, California (Thyne); Arizona Respiratory Center, University of Arizona, Tucson, Arizona (Martinez)
| | - Jonathan M Gaffin
- Department of Pediatrics, Washington University in St Louis School of Medicine, St Louis, Missouri (Bacharier, Beigelman, Castro); Cincinnati Children's Hospital and Medical Center, Cincinnati, Ohio (Guilbert); Department of Public Health Sciences, Pennsylvania State University, Hershey (Mauger, Boehmer); Department of Pediatrics, Emory University, Atlanta, Georgia (Fitzpatrick); Pediatrics Section of Allergy, Immunology, and Rheumatology, University of Wisconsin School of Medicine and Public Health, Madison (Jackson); Division of Allergy/Immunology, Boston Children's Hospital, Boston, Massachusetts (Baxi, Phipatanakul, Sheehan); Benioff Children's Hospital, Oakland, California (Benson, Meade); Department of Pathology and Immunology, Washington University in St Louis School of Medicine, St Louis, Missouri (Burnham); University of California, San Francisco, Medicine, San Francisco (Cabana, Lazarus); Rainbow Babies and Children's Hospital, Cleveland, Ohio (Chmiel, Ross); Department of Pediatrics, National Jewish Health, Denver, Colorado (Covar, Olin); University of Arizona, Arizona Respiratory Center, Tucson (Daines, Morgan); Division of Respiratory Diseases, Boston Children's Hospital, Boston, Massachusetts (Gaffin); Department of Pediatrics, Allegheny General Hospital, Pittsburgh, Pennsylvania (Gentile); The University of Pittsburgh Asthma Institute, Pittsburgh, Pennsylvania (Holguin); Brigham and Women's Hospital, Boston, Massachusetts (Israel); Department of Pediatrics, University of New Mexico School of Medicine, Albuquerque, New Mexico (Kelly); Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison (Lemanske); Airway Clinical Research Center, University of California, San Francisco, San Francisco, California (Ly); Stroger Hospital of Cook County Pediatric Services, Chicago, Illinois (Moy); Wake Forest University School of Medicine, Winston-Salem, North Carolina (Peters); Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois (Pongracic); Department of Pediatrics/Pulmonary, University of New Mexico, Albuquerque (Raissy); University of Wisconsin-Madison, Madison (Sorkness); The Breathing Institute, Children's Hospital Colorado, Denver (Szefler); University of Virginia School of Medicine, Charlottesville (Teague); Department of Pediatrics, San Francisco General Hospital, San Francisco, California (Thyne); Arizona Respiratory Center, University of Arizona, Tucson, Arizona (Martinez)
| | - Deborah Ann Gentile
- Department of Pediatrics, Washington University in St Louis School of Medicine, St Louis, Missouri (Bacharier, Beigelman, Castro); Cincinnati Children's Hospital and Medical Center, Cincinnati, Ohio (Guilbert); Department of Public Health Sciences, Pennsylvania State University, Hershey (Mauger, Boehmer); Department of Pediatrics, Emory University, Atlanta, Georgia (Fitzpatrick); Pediatrics Section of Allergy, Immunology, and Rheumatology, University of Wisconsin School of Medicine and Public Health, Madison (Jackson); Division of Allergy/Immunology, Boston Children's Hospital, Boston, Massachusetts (Baxi, Phipatanakul, Sheehan); Benioff Children's Hospital, Oakland, California (Benson, Meade); Department of Pathology and Immunology, Washington University in St Louis School of Medicine, St Louis, Missouri (Burnham); University of California, San Francisco, Medicine, San Francisco (Cabana, Lazarus); Rainbow Babies and Children's Hospital, Cleveland, Ohio (Chmiel, Ross); Department of Pediatrics, National Jewish Health, Denver, Colorado (Covar, Olin); University of Arizona, Arizona Respiratory Center, Tucson (Daines, Morgan); Division of Respiratory Diseases, Boston Children's Hospital, Boston, Massachusetts (Gaffin); Department of Pediatrics, Allegheny General Hospital, Pittsburgh, Pennsylvania (Gentile); The University of Pittsburgh Asthma Institute, Pittsburgh, Pennsylvania (Holguin); Brigham and Women's Hospital, Boston, Massachusetts (Israel); Department of Pediatrics, University of New Mexico School of Medicine, Albuquerque, New Mexico (Kelly); Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison (Lemanske); Airway Clinical Research Center, University of California, San Francisco, San Francisco, California (Ly); Stroger Hospital of Cook County Pediatric Services, Chicago, Illinois (Moy); Wake Forest University School of Medicine, Winston-Salem, North Carolina (Peters); Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois (Pongracic); Department of Pediatrics/Pulmonary, University of New Mexico, Albuquerque (Raissy); University of Wisconsin-Madison, Madison (Sorkness); The Breathing Institute, Children's Hospital Colorado, Denver (Szefler); University of Virginia School of Medicine, Charlottesville (Teague); Department of Pediatrics, San Francisco General Hospital, San Francisco, California (Thyne); Arizona Respiratory Center, University of Arizona, Tucson, Arizona (Martinez)
| | - Fernando Holguin
- Department of Pediatrics, Washington University in St Louis School of Medicine, St Louis, Missouri (Bacharier, Beigelman, Castro); Cincinnati Children's Hospital and Medical Center, Cincinnati, Ohio (Guilbert); Department of Public Health Sciences, Pennsylvania State University, Hershey (Mauger, Boehmer); Department of Pediatrics, Emory University, Atlanta, Georgia (Fitzpatrick); Pediatrics Section of Allergy, Immunology, and Rheumatology, University of Wisconsin School of Medicine and Public Health, Madison (Jackson); Division of Allergy/Immunology, Boston Children's Hospital, Boston, Massachusetts (Baxi, Phipatanakul, Sheehan); Benioff Children's Hospital, Oakland, California (Benson, Meade); Department of Pathology and Immunology, Washington University in St Louis School of Medicine, St Louis, Missouri (Burnham); University of California, San Francisco, Medicine, San Francisco (Cabana, Lazarus); Rainbow Babies and Children's Hospital, Cleveland, Ohio (Chmiel, Ross); Department of Pediatrics, National Jewish Health, Denver, Colorado (Covar, Olin); University of Arizona, Arizona Respiratory Center, Tucson (Daines, Morgan); Division of Respiratory Diseases, Boston Children's Hospital, Boston, Massachusetts (Gaffin); Department of Pediatrics, Allegheny General Hospital, Pittsburgh, Pennsylvania (Gentile); The University of Pittsburgh Asthma Institute, Pittsburgh, Pennsylvania (Holguin); Brigham and Women's Hospital, Boston, Massachusetts (Israel); Department of Pediatrics, University of New Mexico School of Medicine, Albuquerque, New Mexico (Kelly); Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison (Lemanske); Airway Clinical Research Center, University of California, San Francisco, San Francisco, California (Ly); Stroger Hospital of Cook County Pediatric Services, Chicago, Illinois (Moy); Wake Forest University School of Medicine, Winston-Salem, North Carolina (Peters); Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois (Pongracic); Department of Pediatrics/Pulmonary, University of New Mexico, Albuquerque (Raissy); University of Wisconsin-Madison, Madison (Sorkness); The Breathing Institute, Children's Hospital Colorado, Denver (Szefler); University of Virginia School of Medicine, Charlottesville (Teague); Department of Pediatrics, San Francisco General Hospital, San Francisco, California (Thyne); Arizona Respiratory Center, University of Arizona, Tucson, Arizona (Martinez)
| | - Elliot Israel
- Department of Pediatrics, Washington University in St Louis School of Medicine, St Louis, Missouri (Bacharier, Beigelman, Castro); Cincinnati Children's Hospital and Medical Center, Cincinnati, Ohio (Guilbert); Department of Public Health Sciences, Pennsylvania State University, Hershey (Mauger, Boehmer); Department of Pediatrics, Emory University, Atlanta, Georgia (Fitzpatrick); Pediatrics Section of Allergy, Immunology, and Rheumatology, University of Wisconsin School of Medicine and Public Health, Madison (Jackson); Division of Allergy/Immunology, Boston Children's Hospital, Boston, Massachusetts (Baxi, Phipatanakul, Sheehan); Benioff Children's Hospital, Oakland, California (Benson, Meade); Department of Pathology and Immunology, Washington University in St Louis School of Medicine, St Louis, Missouri (Burnham); University of California, San Francisco, Medicine, San Francisco (Cabana, Lazarus); Rainbow Babies and Children's Hospital, Cleveland, Ohio (Chmiel, Ross); Department of Pediatrics, National Jewish Health, Denver, Colorado (Covar, Olin); University of Arizona, Arizona Respiratory Center, Tucson (Daines, Morgan); Division of Respiratory Diseases, Boston Children's Hospital, Boston, Massachusetts (Gaffin); Department of Pediatrics, Allegheny General Hospital, Pittsburgh, Pennsylvania (Gentile); The University of Pittsburgh Asthma Institute, Pittsburgh, Pennsylvania (Holguin); Brigham and Women's Hospital, Boston, Massachusetts (Israel); Department of Pediatrics, University of New Mexico School of Medicine, Albuquerque, New Mexico (Kelly); Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison (Lemanske); Airway Clinical Research Center, University of California, San Francisco, San Francisco, California (Ly); Stroger Hospital of Cook County Pediatric Services, Chicago, Illinois (Moy); Wake Forest University School of Medicine, Winston-Salem, North Carolina (Peters); Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois (Pongracic); Department of Pediatrics/Pulmonary, University of New Mexico, Albuquerque (Raissy); University of Wisconsin-Madison, Madison (Sorkness); The Breathing Institute, Children's Hospital Colorado, Denver (Szefler); University of Virginia School of Medicine, Charlottesville (Teague); Department of Pediatrics, San Francisco General Hospital, San Francisco, California (Thyne); Arizona Respiratory Center, University of Arizona, Tucson, Arizona (Martinez)
| | - H William Kelly
- Department of Pediatrics, Washington University in St Louis School of Medicine, St Louis, Missouri (Bacharier, Beigelman, Castro); Cincinnati Children's Hospital and Medical Center, Cincinnati, Ohio (Guilbert); Department of Public Health Sciences, Pennsylvania State University, Hershey (Mauger, Boehmer); Department of Pediatrics, Emory University, Atlanta, Georgia (Fitzpatrick); Pediatrics Section of Allergy, Immunology, and Rheumatology, University of Wisconsin School of Medicine and Public Health, Madison (Jackson); Division of Allergy/Immunology, Boston Children's Hospital, Boston, Massachusetts (Baxi, Phipatanakul, Sheehan); Benioff Children's Hospital, Oakland, California (Benson, Meade); Department of Pathology and Immunology, Washington University in St Louis School of Medicine, St Louis, Missouri (Burnham); University of California, San Francisco, Medicine, San Francisco (Cabana, Lazarus); Rainbow Babies and Children's Hospital, Cleveland, Ohio (Chmiel, Ross); Department of Pediatrics, National Jewish Health, Denver, Colorado (Covar, Olin); University of Arizona, Arizona Respiratory Center, Tucson (Daines, Morgan); Division of Respiratory Diseases, Boston Children's Hospital, Boston, Massachusetts (Gaffin); Department of Pediatrics, Allegheny General Hospital, Pittsburgh, Pennsylvania (Gentile); The University of Pittsburgh Asthma Institute, Pittsburgh, Pennsylvania (Holguin); Brigham and Women's Hospital, Boston, Massachusetts (Israel); Department of Pediatrics, University of New Mexico School of Medicine, Albuquerque, New Mexico (Kelly); Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison (Lemanske); Airway Clinical Research Center, University of California, San Francisco, San Francisco, California (Ly); Stroger Hospital of Cook County Pediatric Services, Chicago, Illinois (Moy); Wake Forest University School of Medicine, Winston-Salem, North Carolina (Peters); Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois (Pongracic); Department of Pediatrics/Pulmonary, University of New Mexico, Albuquerque (Raissy); University of Wisconsin-Madison, Madison (Sorkness); The Breathing Institute, Children's Hospital Colorado, Denver (Szefler); University of Virginia School of Medicine, Charlottesville (Teague); Department of Pediatrics, San Francisco General Hospital, San Francisco, California (Thyne); Arizona Respiratory Center, University of Arizona, Tucson, Arizona (Martinez)
| | - Stephen C Lazarus
- Department of Pediatrics, Washington University in St Louis School of Medicine, St Louis, Missouri (Bacharier, Beigelman, Castro); Cincinnati Children's Hospital and Medical Center, Cincinnati, Ohio (Guilbert); Department of Public Health Sciences, Pennsylvania State University, Hershey (Mauger, Boehmer); Department of Pediatrics, Emory University, Atlanta, Georgia (Fitzpatrick); Pediatrics Section of Allergy, Immunology, and Rheumatology, University of Wisconsin School of Medicine and Public Health, Madison (Jackson); Division of Allergy/Immunology, Boston Children's Hospital, Boston, Massachusetts (Baxi, Phipatanakul, Sheehan); Benioff Children's Hospital, Oakland, California (Benson, Meade); Department of Pathology and Immunology, Washington University in St Louis School of Medicine, St Louis, Missouri (Burnham); University of California, San Francisco, Medicine, San Francisco (Cabana, Lazarus); Rainbow Babies and Children's Hospital, Cleveland, Ohio (Chmiel, Ross); Department of Pediatrics, National Jewish Health, Denver, Colorado (Covar, Olin); University of Arizona, Arizona Respiratory Center, Tucson (Daines, Morgan); Division of Respiratory Diseases, Boston Children's Hospital, Boston, Massachusetts (Gaffin); Department of Pediatrics, Allegheny General Hospital, Pittsburgh, Pennsylvania (Gentile); The University of Pittsburgh Asthma Institute, Pittsburgh, Pennsylvania (Holguin); Brigham and Women's Hospital, Boston, Massachusetts (Israel); Department of Pediatrics, University of New Mexico School of Medicine, Albuquerque, New Mexico (Kelly); Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison (Lemanske); Airway Clinical Research Center, University of California, San Francisco, San Francisco, California (Ly); Stroger Hospital of Cook County Pediatric Services, Chicago, Illinois (Moy); Wake Forest University School of Medicine, Winston-Salem, North Carolina (Peters); Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois (Pongracic); Department of Pediatrics/Pulmonary, University of New Mexico, Albuquerque (Raissy); University of Wisconsin-Madison, Madison (Sorkness); The Breathing Institute, Children's Hospital Colorado, Denver (Szefler); University of Virginia School of Medicine, Charlottesville (Teague); Department of Pediatrics, San Francisco General Hospital, San Francisco, California (Thyne); Arizona Respiratory Center, University of Arizona, Tucson, Arizona (Martinez)
| | - Robert F Lemanske
- Department of Pediatrics, Washington University in St Louis School of Medicine, St Louis, Missouri (Bacharier, Beigelman, Castro); Cincinnati Children's Hospital and Medical Center, Cincinnati, Ohio (Guilbert); Department of Public Health Sciences, Pennsylvania State University, Hershey (Mauger, Boehmer); Department of Pediatrics, Emory University, Atlanta, Georgia (Fitzpatrick); Pediatrics Section of Allergy, Immunology, and Rheumatology, University of Wisconsin School of Medicine and Public Health, Madison (Jackson); Division of Allergy/Immunology, Boston Children's Hospital, Boston, Massachusetts (Baxi, Phipatanakul, Sheehan); Benioff Children's Hospital, Oakland, California (Benson, Meade); Department of Pathology and Immunology, Washington University in St Louis School of Medicine, St Louis, Missouri (Burnham); University of California, San Francisco, Medicine, San Francisco (Cabana, Lazarus); Rainbow Babies and Children's Hospital, Cleveland, Ohio (Chmiel, Ross); Department of Pediatrics, National Jewish Health, Denver, Colorado (Covar, Olin); University of Arizona, Arizona Respiratory Center, Tucson (Daines, Morgan); Division of Respiratory Diseases, Boston Children's Hospital, Boston, Massachusetts (Gaffin); Department of Pediatrics, Allegheny General Hospital, Pittsburgh, Pennsylvania (Gentile); The University of Pittsburgh Asthma Institute, Pittsburgh, Pennsylvania (Holguin); Brigham and Women's Hospital, Boston, Massachusetts (Israel); Department of Pediatrics, University of New Mexico School of Medicine, Albuquerque, New Mexico (Kelly); Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison (Lemanske); Airway Clinical Research Center, University of California, San Francisco, San Francisco, California (Ly); Stroger Hospital of Cook County Pediatric Services, Chicago, Illinois (Moy); Wake Forest University School of Medicine, Winston-Salem, North Carolina (Peters); Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois (Pongracic); Department of Pediatrics/Pulmonary, University of New Mexico, Albuquerque (Raissy); University of Wisconsin-Madison, Madison (Sorkness); The Breathing Institute, Children's Hospital Colorado, Denver (Szefler); University of Virginia School of Medicine, Charlottesville (Teague); Department of Pediatrics, San Francisco General Hospital, San Francisco, California (Thyne); Arizona Respiratory Center, University of Arizona, Tucson, Arizona (Martinez)
| | - Ngoc Ly
- Department of Pediatrics, Washington University in St Louis School of Medicine, St Louis, Missouri (Bacharier, Beigelman, Castro); Cincinnati Children's Hospital and Medical Center, Cincinnati, Ohio (Guilbert); Department of Public Health Sciences, Pennsylvania State University, Hershey (Mauger, Boehmer); Department of Pediatrics, Emory University, Atlanta, Georgia (Fitzpatrick); Pediatrics Section of Allergy, Immunology, and Rheumatology, University of Wisconsin School of Medicine and Public Health, Madison (Jackson); Division of Allergy/Immunology, Boston Children's Hospital, Boston, Massachusetts (Baxi, Phipatanakul, Sheehan); Benioff Children's Hospital, Oakland, California (Benson, Meade); Department of Pathology and Immunology, Washington University in St Louis School of Medicine, St Louis, Missouri (Burnham); University of California, San Francisco, Medicine, San Francisco (Cabana, Lazarus); Rainbow Babies and Children's Hospital, Cleveland, Ohio (Chmiel, Ross); Department of Pediatrics, National Jewish Health, Denver, Colorado (Covar, Olin); University of Arizona, Arizona Respiratory Center, Tucson (Daines, Morgan); Division of Respiratory Diseases, Boston Children's Hospital, Boston, Massachusetts (Gaffin); Department of Pediatrics, Allegheny General Hospital, Pittsburgh, Pennsylvania (Gentile); The University of Pittsburgh Asthma Institute, Pittsburgh, Pennsylvania (Holguin); Brigham and Women's Hospital, Boston, Massachusetts (Israel); Department of Pediatrics, University of New Mexico School of Medicine, Albuquerque, New Mexico (Kelly); Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison (Lemanske); Airway Clinical Research Center, University of California, San Francisco, San Francisco, California (Ly); Stroger Hospital of Cook County Pediatric Services, Chicago, Illinois (Moy); Wake Forest University School of Medicine, Winston-Salem, North Carolina (Peters); Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois (Pongracic); Department of Pediatrics/Pulmonary, University of New Mexico, Albuquerque (Raissy); University of Wisconsin-Madison, Madison (Sorkness); The Breathing Institute, Children's Hospital Colorado, Denver (Szefler); University of Virginia School of Medicine, Charlottesville (Teague); Department of Pediatrics, San Francisco General Hospital, San Francisco, California (Thyne); Arizona Respiratory Center, University of Arizona, Tucson, Arizona (Martinez)
| | - Kelley Meade
- Department of Pediatrics, Washington University in St Louis School of Medicine, St Louis, Missouri (Bacharier, Beigelman, Castro); Cincinnati Children's Hospital and Medical Center, Cincinnati, Ohio (Guilbert); Department of Public Health Sciences, Pennsylvania State University, Hershey (Mauger, Boehmer); Department of Pediatrics, Emory University, Atlanta, Georgia (Fitzpatrick); Pediatrics Section of Allergy, Immunology, and Rheumatology, University of Wisconsin School of Medicine and Public Health, Madison (Jackson); Division of Allergy/Immunology, Boston Children's Hospital, Boston, Massachusetts (Baxi, Phipatanakul, Sheehan); Benioff Children's Hospital, Oakland, California (Benson, Meade); Department of Pathology and Immunology, Washington University in St Louis School of Medicine, St Louis, Missouri (Burnham); University of California, San Francisco, Medicine, San Francisco (Cabana, Lazarus); Rainbow Babies and Children's Hospital, Cleveland, Ohio (Chmiel, Ross); Department of Pediatrics, National Jewish Health, Denver, Colorado (Covar, Olin); University of Arizona, Arizona Respiratory Center, Tucson (Daines, Morgan); Division of Respiratory Diseases, Boston Children's Hospital, Boston, Massachusetts (Gaffin); Department of Pediatrics, Allegheny General Hospital, Pittsburgh, Pennsylvania (Gentile); The University of Pittsburgh Asthma Institute, Pittsburgh, Pennsylvania (Holguin); Brigham and Women's Hospital, Boston, Massachusetts (Israel); Department of Pediatrics, University of New Mexico School of Medicine, Albuquerque, New Mexico (Kelly); Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison (Lemanske); Airway Clinical Research Center, University of California, San Francisco, San Francisco, California (Ly); Stroger Hospital of Cook County Pediatric Services, Chicago, Illinois (Moy); Wake Forest University School of Medicine, Winston-Salem, North Carolina (Peters); Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois (Pongracic); Department of Pediatrics/Pulmonary, University of New Mexico, Albuquerque (Raissy); University of Wisconsin-Madison, Madison (Sorkness); The Breathing Institute, Children's Hospital Colorado, Denver (Szefler); University of Virginia School of Medicine, Charlottesville (Teague); Department of Pediatrics, San Francisco General Hospital, San Francisco, California (Thyne); Arizona Respiratory Center, University of Arizona, Tucson, Arizona (Martinez)
| | - Wayne Morgan
- Department of Pediatrics, Washington University in St Louis School of Medicine, St Louis, Missouri (Bacharier, Beigelman, Castro); Cincinnati Children's Hospital and Medical Center, Cincinnati, Ohio (Guilbert); Department of Public Health Sciences, Pennsylvania State University, Hershey (Mauger, Boehmer); Department of Pediatrics, Emory University, Atlanta, Georgia (Fitzpatrick); Pediatrics Section of Allergy, Immunology, and Rheumatology, University of Wisconsin School of Medicine and Public Health, Madison (Jackson); Division of Allergy/Immunology, Boston Children's Hospital, Boston, Massachusetts (Baxi, Phipatanakul, Sheehan); Benioff Children's Hospital, Oakland, California (Benson, Meade); Department of Pathology and Immunology, Washington University in St Louis School of Medicine, St Louis, Missouri (Burnham); University of California, San Francisco, Medicine, San Francisco (Cabana, Lazarus); Rainbow Babies and Children's Hospital, Cleveland, Ohio (Chmiel, Ross); Department of Pediatrics, National Jewish Health, Denver, Colorado (Covar, Olin); University of Arizona, Arizona Respiratory Center, Tucson (Daines, Morgan); Division of Respiratory Diseases, Boston Children's Hospital, Boston, Massachusetts (Gaffin); Department of Pediatrics, Allegheny General Hospital, Pittsburgh, Pennsylvania (Gentile); The University of Pittsburgh Asthma Institute, Pittsburgh, Pennsylvania (Holguin); Brigham and Women's Hospital, Boston, Massachusetts (Israel); Department of Pediatrics, University of New Mexico School of Medicine, Albuquerque, New Mexico (Kelly); Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison (Lemanske); Airway Clinical Research Center, University of California, San Francisco, San Francisco, California (Ly); Stroger Hospital of Cook County Pediatric Services, Chicago, Illinois (Moy); Wake Forest University School of Medicine, Winston-Salem, North Carolina (Peters); Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois (Pongracic); Department of Pediatrics/Pulmonary, University of New Mexico, Albuquerque (Raissy); University of Wisconsin-Madison, Madison (Sorkness); The Breathing Institute, Children's Hospital Colorado, Denver (Szefler); University of Virginia School of Medicine, Charlottesville (Teague); Department of Pediatrics, San Francisco General Hospital, San Francisco, California (Thyne); Arizona Respiratory Center, University of Arizona, Tucson, Arizona (Martinez)
| | - James Moy
- Department of Pediatrics, Washington University in St Louis School of Medicine, St Louis, Missouri (Bacharier, Beigelman, Castro); Cincinnati Children's Hospital and Medical Center, Cincinnati, Ohio (Guilbert); Department of Public Health Sciences, Pennsylvania State University, Hershey (Mauger, Boehmer); Department of Pediatrics, Emory University, Atlanta, Georgia (Fitzpatrick); Pediatrics Section of Allergy, Immunology, and Rheumatology, University of Wisconsin School of Medicine and Public Health, Madison (Jackson); Division of Allergy/Immunology, Boston Children's Hospital, Boston, Massachusetts (Baxi, Phipatanakul, Sheehan); Benioff Children's Hospital, Oakland, California (Benson, Meade); Department of Pathology and Immunology, Washington University in St Louis School of Medicine, St Louis, Missouri (Burnham); University of California, San Francisco, Medicine, San Francisco (Cabana, Lazarus); Rainbow Babies and Children's Hospital, Cleveland, Ohio (Chmiel, Ross); Department of Pediatrics, National Jewish Health, Denver, Colorado (Covar, Olin); University of Arizona, Arizona Respiratory Center, Tucson (Daines, Morgan); Division of Respiratory Diseases, Boston Children's Hospital, Boston, Massachusetts (Gaffin); Department of Pediatrics, Allegheny General Hospital, Pittsburgh, Pennsylvania (Gentile); The University of Pittsburgh Asthma Institute, Pittsburgh, Pennsylvania (Holguin); Brigham and Women's Hospital, Boston, Massachusetts (Israel); Department of Pediatrics, University of New Mexico School of Medicine, Albuquerque, New Mexico (Kelly); Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison (Lemanske); Airway Clinical Research Center, University of California, San Francisco, San Francisco, California (Ly); Stroger Hospital of Cook County Pediatric Services, Chicago, Illinois (Moy); Wake Forest University School of Medicine, Winston-Salem, North Carolina (Peters); Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois (Pongracic); Department of Pediatrics/Pulmonary, University of New Mexico, Albuquerque (Raissy); University of Wisconsin-Madison, Madison (Sorkness); The Breathing Institute, Children's Hospital Colorado, Denver (Szefler); University of Virginia School of Medicine, Charlottesville (Teague); Department of Pediatrics, San Francisco General Hospital, San Francisco, California (Thyne); Arizona Respiratory Center, University of Arizona, Tucson, Arizona (Martinez)
| | - Tod Olin
- Department of Pediatrics, Washington University in St Louis School of Medicine, St Louis, Missouri (Bacharier, Beigelman, Castro); Cincinnati Children's Hospital and Medical Center, Cincinnati, Ohio (Guilbert); Department of Public Health Sciences, Pennsylvania State University, Hershey (Mauger, Boehmer); Department of Pediatrics, Emory University, Atlanta, Georgia (Fitzpatrick); Pediatrics Section of Allergy, Immunology, and Rheumatology, University of Wisconsin School of Medicine and Public Health, Madison (Jackson); Division of Allergy/Immunology, Boston Children's Hospital, Boston, Massachusetts (Baxi, Phipatanakul, Sheehan); Benioff Children's Hospital, Oakland, California (Benson, Meade); Department of Pathology and Immunology, Washington University in St Louis School of Medicine, St Louis, Missouri (Burnham); University of California, San Francisco, Medicine, San Francisco (Cabana, Lazarus); Rainbow Babies and Children's Hospital, Cleveland, Ohio (Chmiel, Ross); Department of Pediatrics, National Jewish Health, Denver, Colorado (Covar, Olin); University of Arizona, Arizona Respiratory Center, Tucson (Daines, Morgan); Division of Respiratory Diseases, Boston Children's Hospital, Boston, Massachusetts (Gaffin); Department of Pediatrics, Allegheny General Hospital, Pittsburgh, Pennsylvania (Gentile); The University of Pittsburgh Asthma Institute, Pittsburgh, Pennsylvania (Holguin); Brigham and Women's Hospital, Boston, Massachusetts (Israel); Department of Pediatrics, University of New Mexico School of Medicine, Albuquerque, New Mexico (Kelly); Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison (Lemanske); Airway Clinical Research Center, University of California, San Francisco, San Francisco, California (Ly); Stroger Hospital of Cook County Pediatric Services, Chicago, Illinois (Moy); Wake Forest University School of Medicine, Winston-Salem, North Carolina (Peters); Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois (Pongracic); Department of Pediatrics/Pulmonary, University of New Mexico, Albuquerque (Raissy); University of Wisconsin-Madison, Madison (Sorkness); The Breathing Institute, Children's Hospital Colorado, Denver (Szefler); University of Virginia School of Medicine, Charlottesville (Teague); Department of Pediatrics, San Francisco General Hospital, San Francisco, California (Thyne); Arizona Respiratory Center, University of Arizona, Tucson, Arizona (Martinez)
| | - Stephen P Peters
- Department of Pediatrics, Washington University in St Louis School of Medicine, St Louis, Missouri (Bacharier, Beigelman, Castro); Cincinnati Children's Hospital and Medical Center, Cincinnati, Ohio (Guilbert); Department of Public Health Sciences, Pennsylvania State University, Hershey (Mauger, Boehmer); Department of Pediatrics, Emory University, Atlanta, Georgia (Fitzpatrick); Pediatrics Section of Allergy, Immunology, and Rheumatology, University of Wisconsin School of Medicine and Public Health, Madison (Jackson); Division of Allergy/Immunology, Boston Children's Hospital, Boston, Massachusetts (Baxi, Phipatanakul, Sheehan); Benioff Children's Hospital, Oakland, California (Benson, Meade); Department of Pathology and Immunology, Washington University in St Louis School of Medicine, St Louis, Missouri (Burnham); University of California, San Francisco, Medicine, San Francisco (Cabana, Lazarus); Rainbow Babies and Children's Hospital, Cleveland, Ohio (Chmiel, Ross); Department of Pediatrics, National Jewish Health, Denver, Colorado (Covar, Olin); University of Arizona, Arizona Respiratory Center, Tucson (Daines, Morgan); Division of Respiratory Diseases, Boston Children's Hospital, Boston, Massachusetts (Gaffin); Department of Pediatrics, Allegheny General Hospital, Pittsburgh, Pennsylvania (Gentile); The University of Pittsburgh Asthma Institute, Pittsburgh, Pennsylvania (Holguin); Brigham and Women's Hospital, Boston, Massachusetts (Israel); Department of Pediatrics, University of New Mexico School of Medicine, Albuquerque, New Mexico (Kelly); Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison (Lemanske); Airway Clinical Research Center, University of California, San Francisco, San Francisco, California (Ly); Stroger Hospital of Cook County Pediatric Services, Chicago, Illinois (Moy); Wake Forest University School of Medicine, Winston-Salem, North Carolina (Peters); Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois (Pongracic); Department of Pediatrics/Pulmonary, University of New Mexico, Albuquerque (Raissy); University of Wisconsin-Madison, Madison (Sorkness); The Breathing Institute, Children's Hospital Colorado, Denver (Szefler); University of Virginia School of Medicine, Charlottesville (Teague); Department of Pediatrics, San Francisco General Hospital, San Francisco, California (Thyne); Arizona Respiratory Center, University of Arizona, Tucson, Arizona (Martinez)
| | - Wanda Phipatanakul
- Department of Pediatrics, Washington University in St Louis School of Medicine, St Louis, Missouri (Bacharier, Beigelman, Castro); Cincinnati Children's Hospital and Medical Center, Cincinnati, Ohio (Guilbert); Department of Public Health Sciences, Pennsylvania State University, Hershey (Mauger, Boehmer); Department of Pediatrics, Emory University, Atlanta, Georgia (Fitzpatrick); Pediatrics Section of Allergy, Immunology, and Rheumatology, University of Wisconsin School of Medicine and Public Health, Madison (Jackson); Division of Allergy/Immunology, Boston Children's Hospital, Boston, Massachusetts (Baxi, Phipatanakul, Sheehan); Benioff Children's Hospital, Oakland, California (Benson, Meade); Department of Pathology and Immunology, Washington University in St Louis School of Medicine, St Louis, Missouri (Burnham); University of California, San Francisco, Medicine, San Francisco (Cabana, Lazarus); Rainbow Babies and Children's Hospital, Cleveland, Ohio (Chmiel, Ross); Department of Pediatrics, National Jewish Health, Denver, Colorado (Covar, Olin); University of Arizona, Arizona Respiratory Center, Tucson (Daines, Morgan); Division of Respiratory Diseases, Boston Children's Hospital, Boston, Massachusetts (Gaffin); Department of Pediatrics, Allegheny General Hospital, Pittsburgh, Pennsylvania (Gentile); The University of Pittsburgh Asthma Institute, Pittsburgh, Pennsylvania (Holguin); Brigham and Women's Hospital, Boston, Massachusetts (Israel); Department of Pediatrics, University of New Mexico School of Medicine, Albuquerque, New Mexico (Kelly); Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison (Lemanske); Airway Clinical Research Center, University of California, San Francisco, San Francisco, California (Ly); Stroger Hospital of Cook County Pediatric Services, Chicago, Illinois (Moy); Wake Forest University School of Medicine, Winston-Salem, North Carolina (Peters); Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois (Pongracic); Department of Pediatrics/Pulmonary, University of New Mexico, Albuquerque (Raissy); University of Wisconsin-Madison, Madison (Sorkness); The Breathing Institute, Children's Hospital Colorado, Denver (Szefler); University of Virginia School of Medicine, Charlottesville (Teague); Department of Pediatrics, San Francisco General Hospital, San Francisco, California (Thyne); Arizona Respiratory Center, University of Arizona, Tucson, Arizona (Martinez)
| | - Jacqueline A Pongracic
- Department of Pediatrics, Washington University in St Louis School of Medicine, St Louis, Missouri (Bacharier, Beigelman, Castro); Cincinnati Children's Hospital and Medical Center, Cincinnati, Ohio (Guilbert); Department of Public Health Sciences, Pennsylvania State University, Hershey (Mauger, Boehmer); Department of Pediatrics, Emory University, Atlanta, Georgia (Fitzpatrick); Pediatrics Section of Allergy, Immunology, and Rheumatology, University of Wisconsin School of Medicine and Public Health, Madison (Jackson); Division of Allergy/Immunology, Boston Children's Hospital, Boston, Massachusetts (Baxi, Phipatanakul, Sheehan); Benioff Children's Hospital, Oakland, California (Benson, Meade); Department of Pathology and Immunology, Washington University in St Louis School of Medicine, St Louis, Missouri (Burnham); University of California, San Francisco, Medicine, San Francisco (Cabana, Lazarus); Rainbow Babies and Children's Hospital, Cleveland, Ohio (Chmiel, Ross); Department of Pediatrics, National Jewish Health, Denver, Colorado (Covar, Olin); University of Arizona, Arizona Respiratory Center, Tucson (Daines, Morgan); Division of Respiratory Diseases, Boston Children's Hospital, Boston, Massachusetts (Gaffin); Department of Pediatrics, Allegheny General Hospital, Pittsburgh, Pennsylvania (Gentile); The University of Pittsburgh Asthma Institute, Pittsburgh, Pennsylvania (Holguin); Brigham and Women's Hospital, Boston, Massachusetts (Israel); Department of Pediatrics, University of New Mexico School of Medicine, Albuquerque, New Mexico (Kelly); Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison (Lemanske); Airway Clinical Research Center, University of California, San Francisco, San Francisco, California (Ly); Stroger Hospital of Cook County Pediatric Services, Chicago, Illinois (Moy); Wake Forest University School of Medicine, Winston-Salem, North Carolina (Peters); Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois (Pongracic); Department of Pediatrics/Pulmonary, University of New Mexico, Albuquerque (Raissy); University of Wisconsin-Madison, Madison (Sorkness); The Breathing Institute, Children's Hospital Colorado, Denver (Szefler); University of Virginia School of Medicine, Charlottesville (Teague); Department of Pediatrics, San Francisco General Hospital, San Francisco, California (Thyne); Arizona Respiratory Center, University of Arizona, Tucson, Arizona (Martinez)
| | - Hengameh H Raissy
- Department of Pediatrics, Washington University in St Louis School of Medicine, St Louis, Missouri (Bacharier, Beigelman, Castro); Cincinnati Children's Hospital and Medical Center, Cincinnati, Ohio (Guilbert); Department of Public Health Sciences, Pennsylvania State University, Hershey (Mauger, Boehmer); Department of Pediatrics, Emory University, Atlanta, Georgia (Fitzpatrick); Pediatrics Section of Allergy, Immunology, and Rheumatology, University of Wisconsin School of Medicine and Public Health, Madison (Jackson); Division of Allergy/Immunology, Boston Children's Hospital, Boston, Massachusetts (Baxi, Phipatanakul, Sheehan); Benioff Children's Hospital, Oakland, California (Benson, Meade); Department of Pathology and Immunology, Washington University in St Louis School of Medicine, St Louis, Missouri (Burnham); University of California, San Francisco, Medicine, San Francisco (Cabana, Lazarus); Rainbow Babies and Children's Hospital, Cleveland, Ohio (Chmiel, Ross); Department of Pediatrics, National Jewish Health, Denver, Colorado (Covar, Olin); University of Arizona, Arizona Respiratory Center, Tucson (Daines, Morgan); Division of Respiratory Diseases, Boston Children's Hospital, Boston, Massachusetts (Gaffin); Department of Pediatrics, Allegheny General Hospital, Pittsburgh, Pennsylvania (Gentile); The University of Pittsburgh Asthma Institute, Pittsburgh, Pennsylvania (Holguin); Brigham and Women's Hospital, Boston, Massachusetts (Israel); Department of Pediatrics, University of New Mexico School of Medicine, Albuquerque, New Mexico (Kelly); Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison (Lemanske); Airway Clinical Research Center, University of California, San Francisco, San Francisco, California (Ly); Stroger Hospital of Cook County Pediatric Services, Chicago, Illinois (Moy); Wake Forest University School of Medicine, Winston-Salem, North Carolina (Peters); Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois (Pongracic); Department of Pediatrics/Pulmonary, University of New Mexico, Albuquerque (Raissy); University of Wisconsin-Madison, Madison (Sorkness); The Breathing Institute, Children's Hospital Colorado, Denver (Szefler); University of Virginia School of Medicine, Charlottesville (Teague); Department of Pediatrics, San Francisco General Hospital, San Francisco, California (Thyne); Arizona Respiratory Center, University of Arizona, Tucson, Arizona (Martinez)
| | - Kristie Ross
- Department of Pediatrics, Washington University in St Louis School of Medicine, St Louis, Missouri (Bacharier, Beigelman, Castro); Cincinnati Children's Hospital and Medical Center, Cincinnati, Ohio (Guilbert); Department of Public Health Sciences, Pennsylvania State University, Hershey (Mauger, Boehmer); Department of Pediatrics, Emory University, Atlanta, Georgia (Fitzpatrick); Pediatrics Section of Allergy, Immunology, and Rheumatology, University of Wisconsin School of Medicine and Public Health, Madison (Jackson); Division of Allergy/Immunology, Boston Children's Hospital, Boston, Massachusetts (Baxi, Phipatanakul, Sheehan); Benioff Children's Hospital, Oakland, California (Benson, Meade); Department of Pathology and Immunology, Washington University in St Louis School of Medicine, St Louis, Missouri (Burnham); University of California, San Francisco, Medicine, San Francisco (Cabana, Lazarus); Rainbow Babies and Children's Hospital, Cleveland, Ohio (Chmiel, Ross); Department of Pediatrics, National Jewish Health, Denver, Colorado (Covar, Olin); University of Arizona, Arizona Respiratory Center, Tucson (Daines, Morgan); Division of Respiratory Diseases, Boston Children's Hospital, Boston, Massachusetts (Gaffin); Department of Pediatrics, Allegheny General Hospital, Pittsburgh, Pennsylvania (Gentile); The University of Pittsburgh Asthma Institute, Pittsburgh, Pennsylvania (Holguin); Brigham and Women's Hospital, Boston, Massachusetts (Israel); Department of Pediatrics, University of New Mexico School of Medicine, Albuquerque, New Mexico (Kelly); Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison (Lemanske); Airway Clinical Research Center, University of California, San Francisco, San Francisco, California (Ly); Stroger Hospital of Cook County Pediatric Services, Chicago, Illinois (Moy); Wake Forest University School of Medicine, Winston-Salem, North Carolina (Peters); Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois (Pongracic); Department of Pediatrics/Pulmonary, University of New Mexico, Albuquerque (Raissy); University of Wisconsin-Madison, Madison (Sorkness); The Breathing Institute, Children's Hospital Colorado, Denver (Szefler); University of Virginia School of Medicine, Charlottesville (Teague); Department of Pediatrics, San Francisco General Hospital, San Francisco, California (Thyne); Arizona Respiratory Center, University of Arizona, Tucson, Arizona (Martinez)
| | - William J Sheehan
- Department of Pediatrics, Washington University in St Louis School of Medicine, St Louis, Missouri (Bacharier, Beigelman, Castro); Cincinnati Children's Hospital and Medical Center, Cincinnati, Ohio (Guilbert); Department of Public Health Sciences, Pennsylvania State University, Hershey (Mauger, Boehmer); Department of Pediatrics, Emory University, Atlanta, Georgia (Fitzpatrick); Pediatrics Section of Allergy, Immunology, and Rheumatology, University of Wisconsin School of Medicine and Public Health, Madison (Jackson); Division of Allergy/Immunology, Boston Children's Hospital, Boston, Massachusetts (Baxi, Phipatanakul, Sheehan); Benioff Children's Hospital, Oakland, California (Benson, Meade); Department of Pathology and Immunology, Washington University in St Louis School of Medicine, St Louis, Missouri (Burnham); University of California, San Francisco, Medicine, San Francisco (Cabana, Lazarus); Rainbow Babies and Children's Hospital, Cleveland, Ohio (Chmiel, Ross); Department of Pediatrics, National Jewish Health, Denver, Colorado (Covar, Olin); University of Arizona, Arizona Respiratory Center, Tucson (Daines, Morgan); Division of Respiratory Diseases, Boston Children's Hospital, Boston, Massachusetts (Gaffin); Department of Pediatrics, Allegheny General Hospital, Pittsburgh, Pennsylvania (Gentile); The University of Pittsburgh Asthma Institute, Pittsburgh, Pennsylvania (Holguin); Brigham and Women's Hospital, Boston, Massachusetts (Israel); Department of Pediatrics, University of New Mexico School of Medicine, Albuquerque, New Mexico (Kelly); Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison (Lemanske); Airway Clinical Research Center, University of California, San Francisco, San Francisco, California (Ly); Stroger Hospital of Cook County Pediatric Services, Chicago, Illinois (Moy); Wake Forest University School of Medicine, Winston-Salem, North Carolina (Peters); Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois (Pongracic); Department of Pediatrics/Pulmonary, University of New Mexico, Albuquerque (Raissy); University of Wisconsin-Madison, Madison (Sorkness); The Breathing Institute, Children's Hospital Colorado, Denver (Szefler); University of Virginia School of Medicine, Charlottesville (Teague); Department of Pediatrics, San Francisco General Hospital, San Francisco, California (Thyne); Arizona Respiratory Center, University of Arizona, Tucson, Arizona (Martinez)
| | - Christine Sorkness
- Department of Pediatrics, Washington University in St Louis School of Medicine, St Louis, Missouri (Bacharier, Beigelman, Castro); Cincinnati Children's Hospital and Medical Center, Cincinnati, Ohio (Guilbert); Department of Public Health Sciences, Pennsylvania State University, Hershey (Mauger, Boehmer); Department of Pediatrics, Emory University, Atlanta, Georgia (Fitzpatrick); Pediatrics Section of Allergy, Immunology, and Rheumatology, University of Wisconsin School of Medicine and Public Health, Madison (Jackson); Division of Allergy/Immunology, Boston Children's Hospital, Boston, Massachusetts (Baxi, Phipatanakul, Sheehan); Benioff Children's Hospital, Oakland, California (Benson, Meade); Department of Pathology and Immunology, Washington University in St Louis School of Medicine, St Louis, Missouri (Burnham); University of California, San Francisco, Medicine, San Francisco (Cabana, Lazarus); Rainbow Babies and Children's Hospital, Cleveland, Ohio (Chmiel, Ross); Department of Pediatrics, National Jewish Health, Denver, Colorado (Covar, Olin); University of Arizona, Arizona Respiratory Center, Tucson (Daines, Morgan); Division of Respiratory Diseases, Boston Children's Hospital, Boston, Massachusetts (Gaffin); Department of Pediatrics, Allegheny General Hospital, Pittsburgh, Pennsylvania (Gentile); The University of Pittsburgh Asthma Institute, Pittsburgh, Pennsylvania (Holguin); Brigham and Women's Hospital, Boston, Massachusetts (Israel); Department of Pediatrics, University of New Mexico School of Medicine, Albuquerque, New Mexico (Kelly); Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison (Lemanske); Airway Clinical Research Center, University of California, San Francisco, San Francisco, California (Ly); Stroger Hospital of Cook County Pediatric Services, Chicago, Illinois (Moy); Wake Forest University School of Medicine, Winston-Salem, North Carolina (Peters); Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois (Pongracic); Department of Pediatrics/Pulmonary, University of New Mexico, Albuquerque (Raissy); University of Wisconsin-Madison, Madison (Sorkness); The Breathing Institute, Children's Hospital Colorado, Denver (Szefler); University of Virginia School of Medicine, Charlottesville (Teague); Department of Pediatrics, San Francisco General Hospital, San Francisco, California (Thyne); Arizona Respiratory Center, University of Arizona, Tucson, Arizona (Martinez)
| | - Stanley J Szefler
- Department of Pediatrics, Washington University in St Louis School of Medicine, St Louis, Missouri (Bacharier, Beigelman, Castro); Cincinnati Children's Hospital and Medical Center, Cincinnati, Ohio (Guilbert); Department of Public Health Sciences, Pennsylvania State University, Hershey (Mauger, Boehmer); Department of Pediatrics, Emory University, Atlanta, Georgia (Fitzpatrick); Pediatrics Section of Allergy, Immunology, and Rheumatology, University of Wisconsin School of Medicine and Public Health, Madison (Jackson); Division of Allergy/Immunology, Boston Children's Hospital, Boston, Massachusetts (Baxi, Phipatanakul, Sheehan); Benioff Children's Hospital, Oakland, California (Benson, Meade); Department of Pathology and Immunology, Washington University in St Louis School of Medicine, St Louis, Missouri (Burnham); University of California, San Francisco, Medicine, San Francisco (Cabana, Lazarus); Rainbow Babies and Children's Hospital, Cleveland, Ohio (Chmiel, Ross); Department of Pediatrics, National Jewish Health, Denver, Colorado (Covar, Olin); University of Arizona, Arizona Respiratory Center, Tucson (Daines, Morgan); Division of Respiratory Diseases, Boston Children's Hospital, Boston, Massachusetts (Gaffin); Department of Pediatrics, Allegheny General Hospital, Pittsburgh, Pennsylvania (Gentile); The University of Pittsburgh Asthma Institute, Pittsburgh, Pennsylvania (Holguin); Brigham and Women's Hospital, Boston, Massachusetts (Israel); Department of Pediatrics, University of New Mexico School of Medicine, Albuquerque, New Mexico (Kelly); Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison (Lemanske); Airway Clinical Research Center, University of California, San Francisco, San Francisco, California (Ly); Stroger Hospital of Cook County Pediatric Services, Chicago, Illinois (Moy); Wake Forest University School of Medicine, Winston-Salem, North Carolina (Peters); Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois (Pongracic); Department of Pediatrics/Pulmonary, University of New Mexico, Albuquerque (Raissy); University of Wisconsin-Madison, Madison (Sorkness); The Breathing Institute, Children's Hospital Colorado, Denver (Szefler); University of Virginia School of Medicine, Charlottesville (Teague); Department of Pediatrics, San Francisco General Hospital, San Francisco, California (Thyne); Arizona Respiratory Center, University of Arizona, Tucson, Arizona (Martinez)
| | - W Gerald Teague
- Department of Pediatrics, Washington University in St Louis School of Medicine, St Louis, Missouri (Bacharier, Beigelman, Castro); Cincinnati Children's Hospital and Medical Center, Cincinnati, Ohio (Guilbert); Department of Public Health Sciences, Pennsylvania State University, Hershey (Mauger, Boehmer); Department of Pediatrics, Emory University, Atlanta, Georgia (Fitzpatrick); Pediatrics Section of Allergy, Immunology, and Rheumatology, University of Wisconsin School of Medicine and Public Health, Madison (Jackson); Division of Allergy/Immunology, Boston Children's Hospital, Boston, Massachusetts (Baxi, Phipatanakul, Sheehan); Benioff Children's Hospital, Oakland, California (Benson, Meade); Department of Pathology and Immunology, Washington University in St Louis School of Medicine, St Louis, Missouri (Burnham); University of California, San Francisco, Medicine, San Francisco (Cabana, Lazarus); Rainbow Babies and Children's Hospital, Cleveland, Ohio (Chmiel, Ross); Department of Pediatrics, National Jewish Health, Denver, Colorado (Covar, Olin); University of Arizona, Arizona Respiratory Center, Tucson (Daines, Morgan); Division of Respiratory Diseases, Boston Children's Hospital, Boston, Massachusetts (Gaffin); Department of Pediatrics, Allegheny General Hospital, Pittsburgh, Pennsylvania (Gentile); The University of Pittsburgh Asthma Institute, Pittsburgh, Pennsylvania (Holguin); Brigham and Women's Hospital, Boston, Massachusetts (Israel); Department of Pediatrics, University of New Mexico School of Medicine, Albuquerque, New Mexico (Kelly); Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison (Lemanske); Airway Clinical Research Center, University of California, San Francisco, San Francisco, California (Ly); Stroger Hospital of Cook County Pediatric Services, Chicago, Illinois (Moy); Wake Forest University School of Medicine, Winston-Salem, North Carolina (Peters); Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois (Pongracic); Department of Pediatrics/Pulmonary, University of New Mexico, Albuquerque (Raissy); University of Wisconsin-Madison, Madison (Sorkness); The Breathing Institute, Children's Hospital Colorado, Denver (Szefler); University of Virginia School of Medicine, Charlottesville (Teague); Department of Pediatrics, San Francisco General Hospital, San Francisco, California (Thyne); Arizona Respiratory Center, University of Arizona, Tucson, Arizona (Martinez)
| | - Shannon Thyne
- Department of Pediatrics, Washington University in St Louis School of Medicine, St Louis, Missouri (Bacharier, Beigelman, Castro); Cincinnati Children's Hospital and Medical Center, Cincinnati, Ohio (Guilbert); Department of Public Health Sciences, Pennsylvania State University, Hershey (Mauger, Boehmer); Department of Pediatrics, Emory University, Atlanta, Georgia (Fitzpatrick); Pediatrics Section of Allergy, Immunology, and Rheumatology, University of Wisconsin School of Medicine and Public Health, Madison (Jackson); Division of Allergy/Immunology, Boston Children's Hospital, Boston, Massachusetts (Baxi, Phipatanakul, Sheehan); Benioff Children's Hospital, Oakland, California (Benson, Meade); Department of Pathology and Immunology, Washington University in St Louis School of Medicine, St Louis, Missouri (Burnham); University of California, San Francisco, Medicine, San Francisco (Cabana, Lazarus); Rainbow Babies and Children's Hospital, Cleveland, Ohio (Chmiel, Ross); Department of Pediatrics, National Jewish Health, Denver, Colorado (Covar, Olin); University of Arizona, Arizona Respiratory Center, Tucson (Daines, Morgan); Division of Respiratory Diseases, Boston Children's Hospital, Boston, Massachusetts (Gaffin); Department of Pediatrics, Allegheny General Hospital, Pittsburgh, Pennsylvania (Gentile); The University of Pittsburgh Asthma Institute, Pittsburgh, Pennsylvania (Holguin); Brigham and Women's Hospital, Boston, Massachusetts (Israel); Department of Pediatrics, University of New Mexico School of Medicine, Albuquerque, New Mexico (Kelly); Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison (Lemanske); Airway Clinical Research Center, University of California, San Francisco, San Francisco, California (Ly); Stroger Hospital of Cook County Pediatric Services, Chicago, Illinois (Moy); Wake Forest University School of Medicine, Winston-Salem, North Carolina (Peters); Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois (Pongracic); Department of Pediatrics/Pulmonary, University of New Mexico, Albuquerque (Raissy); University of Wisconsin-Madison, Madison (Sorkness); The Breathing Institute, Children's Hospital Colorado, Denver (Szefler); University of Virginia School of Medicine, Charlottesville (Teague); Department of Pediatrics, San Francisco General Hospital, San Francisco, California (Thyne); Arizona Respiratory Center, University of Arizona, Tucson, Arizona (Martinez)
| | - Fernando D Martinez
- Department of Pediatrics, Washington University in St Louis School of Medicine, St Louis, Missouri (Bacharier, Beigelman, Castro); Cincinnati Children's Hospital and Medical Center, Cincinnati, Ohio (Guilbert); Department of Public Health Sciences, Pennsylvania State University, Hershey (Mauger, Boehmer); Department of Pediatrics, Emory University, Atlanta, Georgia (Fitzpatrick); Pediatrics Section of Allergy, Immunology, and Rheumatology, University of Wisconsin School of Medicine and Public Health, Madison (Jackson); Division of Allergy/Immunology, Boston Children's Hospital, Boston, Massachusetts (Baxi, Phipatanakul, Sheehan); Benioff Children's Hospital, Oakland, California (Benson, Meade); Department of Pathology and Immunology, Washington University in St Louis School of Medicine, St Louis, Missouri (Burnham); University of California, San Francisco, Medicine, San Francisco (Cabana, Lazarus); Rainbow Babies and Children's Hospital, Cleveland, Ohio (Chmiel, Ross); Department of Pediatrics, National Jewish Health, Denver, Colorado (Covar, Olin); University of Arizona, Arizona Respiratory Center, Tucson (Daines, Morgan); Division of Respiratory Diseases, Boston Children's Hospital, Boston, Massachusetts (Gaffin); Department of Pediatrics, Allegheny General Hospital, Pittsburgh, Pennsylvania (Gentile); The University of Pittsburgh Asthma Institute, Pittsburgh, Pennsylvania (Holguin); Brigham and Women's Hospital, Boston, Massachusetts (Israel); Department of Pediatrics, University of New Mexico School of Medicine, Albuquerque, New Mexico (Kelly); Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison (Lemanske); Airway Clinical Research Center, University of California, San Francisco, San Francisco, California (Ly); Stroger Hospital of Cook County Pediatric Services, Chicago, Illinois (Moy); Wake Forest University School of Medicine, Winston-Salem, North Carolina (Peters); Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois (Pongracic); Department of Pediatrics/Pulmonary, University of New Mexico, Albuquerque (Raissy); University of Wisconsin-Madison, Madison (Sorkness); The Breathing Institute, Children's Hospital Colorado, Denver (Szefler); University of Virginia School of Medicine, Charlottesville (Teague); Department of Pediatrics, San Francisco General Hospital, San Francisco, California (Thyne); Arizona Respiratory Center, University of Arizona, Tucson, Arizona (Martinez)
| |
Collapse
|
76
|
Guilbert TW, Bacharier LB, Fitzpatrick AM. Severe asthma in children. J Allergy Clin Immunol Pract 2015; 2:489-500. [PMID: 25213041 DOI: 10.1016/j.jaip.2014.06.022] [Citation(s) in RCA: 96] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Revised: 06/27/2014] [Accepted: 06/30/2014] [Indexed: 11/19/2022]
Abstract
Severe asthma in children is characterized by sustained symptoms despite treatment with high doses of inhaled corticosteroids or oral corticosteroids. Children with severe asthma may fall into 2 categories, difficult-to-treat asthma or severe therapy-resistant asthma. Difficult-to-treat asthma is defined as poor control due to an incorrect diagnosis or comorbidities, or poor adherence due to adverse psychological or environmental factors. In contrast, treatment resistant is defined as difficult asthma despite management of these factors. It is increasingly recognized that severe asthma is a highly heterogeneous disorder associated with a number of clinical and inflammatory phenotypes that have been described in children with severe asthma. Guideline-based drug therapy of severe childhood asthma is based primarily on extrapolated data from adult studies. The recommendation is that children with severe asthma be treated with higher-dose inhaled or oral corticosteroids combined with long-acting β-agonists and other add-on therapies, such as antileukotrienes and methylxanthines. It is important to identify and address the influences that make asthma difficult to control, including reviewing the diagnosis and removing causal or aggravating factors. Better definition of the phenotypes and better targeting of therapy based upon individual patient phenotypes is likely to improve asthma treatment in the future.
Collapse
Affiliation(s)
- Theresa W Guilbert
- Division of Pulmonology Medicine, Department of Pediatrics, Cincinnati Children's Hospital, Cincinnati, Ohio.
| | - Leonard B Bacharier
- Division of Allergy, Immunology and Pulmonary Medicine, Department of Pediatrics, Washington University School of Medicine and St Louis Children's Hospital, St Louis, Mo
| | - Anne M Fitzpatrick
- Division of Pulmonary, Allergy & Immunology, Cystic Fibrosis, and Sleep, Department of Pediatrics, Emory University, Atlanta, Ga
| |
Collapse
|
77
|
Stephenson ST, Brown LAS, Helms MN, Qu H, Brown SD, Brown MR, Fitzpatrick AM. Cysteine oxidation impairs systemic glucocorticoid responsiveness in children with difficult-to-treat asthma. J Allergy Clin Immunol 2015; 136:454-61.e9. [PMID: 25748343 DOI: 10.1016/j.jaci.2015.01.023] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Revised: 01/12/2015] [Accepted: 01/21/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND The mechanisms underlying glucocorticoid responsiveness are largely unknown. Although redox regulation of the glucocorticoid receptor (GR) has been reported, it has not been studied in asthmatic patients. OBJECTIVE We characterized systemic cysteine oxidation and its association with inflammatory and clinical features in healthy children and children with difficult-to-treat asthma. We hypothesized that cysteine oxidation would be associated with increased markers of oxidative stress and inflammation, increased features of asthma severity, decreased clinically defined glucocorticoid responsiveness, and impaired GR function. METHODS PBMCs were collected from healthy children (n = 16) and children with asthma (n = 118) aged 6 to 17 years. Children with difficult-to-treat asthma underwent glucocorticoid responsiveness testing with intramuscular triamcinolone. Cysteine, cystine, and inflammatory chemokines and reactive oxygen species generation were quantified, and expression and activity of the GR were assessed. RESULTS Cysteine oxidation was present in children with difficult-to-treat asthma and accompanied by increased reactive oxygen species generation and increased CCL3 and CXCL1 mRNA expression. Children with the greatest extent of cysteine oxidation had more features of asthma severity, including poorer symptom control, greater medication use, and less glucocorticoid responsiveness despite inhaled glucocorticoid therapy. Cysteine oxidation also modified the GR protein by decreasing available sulfhydryl groups and decreasing nuclear GR expression and activity. CONCLUSIONS A highly oxidized cysteine redox state promotes a posttranslational modification of the GR that might inhibit its function. Given that cysteine oxidation is prevalent in children with difficult-to-treat asthma, the cysteine redox state might represent a potential therapeutic target for restoration of glucocorticoid responsiveness in this population.
Collapse
Affiliation(s)
| | - Lou Ann S Brown
- Emory University Department of Pediatrics, Atlanta, Ga; Children's Healthcare of Atlanta Center for Cystic Fibrosis and Airways Disease Research, Atlanta, Ga
| | - My N Helms
- Emory University Department of Pediatrics, Atlanta, Ga; Children's Healthcare of Atlanta Center for Cystic Fibrosis and Airways Disease Research, Atlanta, Ga
| | - Hongyan Qu
- Emory University Department of Pediatrics, Atlanta, Ga
| | | | - Milton R Brown
- Emory University Department of Pediatrics, Atlanta, Ga; Children's Healthcare of Atlanta Center for Cystic Fibrosis and Airways Disease Research, Atlanta, Ga
| | - Anne M Fitzpatrick
- Emory University Department of Pediatrics, Atlanta, Ga; Children's Healthcare of Atlanta Center for Cystic Fibrosis and Airways Disease Research, Atlanta, Ga.
| |
Collapse
|
78
|
Brown SD, Brown LA, Stephenson S, Dodds JC, Douglas SL, Qu H, Fitzpatrick AM. Characterization of a high TNF-α phenotype in children with moderate-to-severe asthma. J Allergy Clin Immunol 2015; 135:1651-4. [PMID: 25725987 DOI: 10.1016/j.jaci.2014.08.054] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Revised: 07/28/2014] [Accepted: 08/01/2014] [Indexed: 11/17/2022]
Affiliation(s)
- Sheena D Brown
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Ga
| | - Lou Ann Brown
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Ga; Children's Healthcare of Atlanta Center for Cystic Fibrosis and Airways Disease Research, Atlanta, Ga
| | - Susan Stephenson
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Ga
| | - Jennifer C Dodds
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Ga
| | - Shaneka L Douglas
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Ga
| | - Hongyan Qu
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Ga
| | - Anne M Fitzpatrick
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Ga; Children's Healthcare of Atlanta Center for Cystic Fibrosis and Airways Disease Research, Atlanta, Ga.
| |
Collapse
|
79
|
Grunwell JR, Gillespie SE, Ward JM, Fitzpatrick AM, Brown LA, Gauthier TW, Hebbar KB. Comparison of Glutathione, Cysteine, and Their Redox Potentials in the Plasma of Critically Ill and Healthy Children. Front Pediatr 2015; 3:46. [PMID: 26075191 PMCID: PMC4443718 DOI: 10.3389/fped.2015.00046] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2015] [Accepted: 05/10/2015] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Oxidative stress is known to play a role in critical illness due to an imbalance in reactive oxygen species and reactive nitrogen species, and the body's ability to detoxify pro-oxidants using small molecule anti-oxidants and anti-oxidant enzymes. OBJECTIVE To compare the concentrations of plasma redox metabolites and redox potentials for the Cys/CySS and GSH/GSSG thiol/disulfide pairs in critically ill children with healthy control children. METHODS We performed a prospective clinical observational study of children ages ≤18 years and weight ≥6 kg, who were hospitalized between January 2010 and April 2012 in a 30-bed multidisciplinary medical-surgical pediatric intensive care unit (PICU). We measured the plasma concentrations of Cys, CySS, GSH, and GSSG within the first 24 h of PICU arrival, and we calculated the redox potential for the Cys/CySS (Eh Cys/CySS) and GSH/GSSG (Eh GSH/GSSG) thiol/disulfide pairs in the plasma of 61 critically ill children and 16 healthy control children. RESULTS Critically ill children have less Cys (p = 0.009), less CySS (p = 0.011), less Total Cys ([Cys] + 2[CySS], p = 0.01), more GSSG (p < 0.001), and more oxidized Eh GSH/GSSG (p < 0.001) compared to healthy children. CONCLUSION Our results demonstrate that in the presence of pediatric critical illness, the Total Cys/CySS thiol pool decreases while GSH is likely one component of the cellular redox system that reduces CySS back to Cys, thus maintaining Eh Cys/CySS. The Total Cys pool is more abundant than the Total GSH pool in the plasma of children. Further investigation is needed to elucidate the differences in redox potentials in subgroups of critically ill children, and to determine whether differences in redox metabolite concentrations and redox potentials correlate with severity of critical illness and clinical outcomes.
Collapse
Affiliation(s)
- Jocelyn R Grunwell
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Children's Healthcare of Atlanta, Emory University School of Medicine , Atlanta, GA , USA
| | - Scott E Gillespie
- Division of Infectious Disease, Department of Pediatrics, Emory University School of Medicine , Atlanta, GA , USA
| | - Janine M Ward
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Emory University School of Medicine , Atlanta, GA , USA
| | - Anne M Fitzpatrick
- Division of Pulmonology, Allergy & Immunology, Cystic Fibrosis, and Sleep, Department of Pediatrics, Emory University School of Medicine , Atlanta, GA , USA
| | - Lou Ann Brown
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Emory University School of Medicine , Atlanta, GA , USA
| | - Theresa W Gauthier
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Emory University School of Medicine , Atlanta, GA , USA
| | - Kiran B Hebbar
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Children's Healthcare of Atlanta, Emory University School of Medicine , Atlanta, GA , USA
| |
Collapse
|
80
|
Tangpricha V, Judd SE, Ziegler TR, Hao L, Alvarez JA, Fitzpatrick AM, McComsey GA, Eckard AR. LL-37 concentrations and the relationship to vitamin D, immune status, and inflammation in HIV-infected children and young adults. AIDS Res Hum Retroviruses 2014; 30:670-6. [PMID: 24798231 DOI: 10.1089/aid.2013.0279] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Antimicrobial peptide LL-37 is produced in response to active vitamin D to exert immunomodulatory effects and inhibits HIV replication in vitro. To date, no studies have investigated LL-37 in HIV-infected patients. This study sought to investigate LL-37 and the relationship to 25-hydroxyvitamin D [25(OH)D] and HIV-related variables in this population. HIV-infected subjects and healthy controls ages 1-25 years old were prospectively enrolled in this cross-sectional study. Fasting plasma LL-37 and 25(OH)D concentrations were measured in duplicate with ELISA. HIV(+) subjects (36 antiretroviral therapy (ART)-experienced subjects; 27 ART-naïve subjects) and 31 healthy controls were enrolled. Overall, 93% were black and the median age was 20 years. There was no difference in median (interquartile range) LL-37 between the HIV-infected group and controls [58.3 (46.4,69.5) vs. 51.3 (40.8,98.2) ng/ml, respectively; p=0.57]; however, the ART-experienced group had higher concentrations than the ART-naive group [66.2 (55.4,77.0) vs. 48.9 (38.9,57.9) ng/ml, respectively; p<0.001]. LL-37 was positively correlated with 25(OH)D in controls, but not in HIV-infected groups, and was positively correlated with current CD4 and ΔCD4 (current-nadir) in the ART-experienced group. After adjustment for age, race, sex, and HIV duration, the association between LL-37 and CD4 remained significant. These findings suggest that HIV and/or HIV-related variables may alter the expected positive relationship between vitamin D and LL-37 and should be further investigated.
Collapse
Affiliation(s)
| | | | | | - Li Hao
- Emory University School of Medicine, Atlanta, Georgia
| | | | - Anne M. Fitzpatrick
- Emory University School of Medicine, Atlanta, Georgia
- Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Grace A. McComsey
- Rainbow Babies and Children's Hospital and Case Western Reserve University/Case Medical Center, Cleveland, Ohio
| | - Allison Ross Eckard
- Emory University School of Medicine, Atlanta, Georgia
- Children's Healthcare of Atlanta, Atlanta, Georgia
| |
Collapse
|
81
|
Fitzpatrick AM, Holbrook JT, Wei CY, Brown MS, Wise RA, Teague WG. Exhaled breath condensate pH does not discriminate asymptomatic gastroesophageal reflux or the response to lansoprazole treatment in children with poorly controlled asthma. J Allergy Clin Immunol Pract 2014; 2:579-86.e7. [PMID: 25213052 DOI: 10.1016/j.jaip.2014.04.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Revised: 04/07/2014] [Accepted: 04/10/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Although exhaled breath condensate (EBC) pH has been identified as an "emerging" biomarker of interest for asthma clinical trials, the clinical determinants of EBC pH remain poorly understood. Other studies have associated acid reflux-induced respiratory symptoms, for example, cough, with transient acidification of EBC. OBJECTIVE We sought to determine the clinical and physiologic correlates of EBC acidification in a highly characterized sample of children with poorly controlled asthma. We hypothesized that (1) children with asymptomatic gastroesophageal reflux determined by 24-hour esophageal pH monitoring would have a lower EBC pH than children without gastroesophageal reflux, (2) treatment with lansoprazole would alter EBC pH in those children, and (3) EBC acidification would be associated with increased asthma symptoms, poorer asthma control and quality of life, and increased formation of breath nitrogen oxides (NOx). METHODS A total of 110 children, age range 6 to 17 years, with poor asthma control and esophageal pH data enrolled in the Study of Acid Reflux in Children with Asthma (NCT00442013) were included. Children submitted EBC samples for pH and NOx measurement at randomization and at study weeks 8, 16, and 24. RESULTS Serial EBC pH measurements failed to distinguish asymptomatic gastroesophageal reflux and was not associated with breath NOx formation. EBC pH also did not discriminate asthma characteristics such as medication and health care utilization, pulmonary function, and asthma control and quality of life both at baseline and across the study period. CONCLUSION Despite the relative ease of EBC collection, EBC pH as a biomarker does not provide useful information of children with asthma who were enrolled in asthma clinical trials.
Collapse
Affiliation(s)
- Anne M Fitzpatrick
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Ga; Center for Developmental Lung Biology, Children's Healthcare of Atlanta, Atlanta, Ga.
| | - Janet T Holbrook
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Md
| | - Christine Y Wei
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Md
| | - Meredith S Brown
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Ga
| | - Robert A Wise
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Md
| | - W Gerald Teague
- Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, Va
| | | |
Collapse
|
82
|
Castro M, King TS, Kunselman SJ, Cabana MD, Denlinger L, Holguin F, Kazani SD, Moore WC, Moy J, Sorkness CA, Avila P, Bacharier LB, Bleecker E, Boushey HA, Chmiel J, Fitzpatrick AM, Gentile D, Hundal M, Israel E, Kraft M, Krishnan JA, LaForce C, Lazarus SC, Lemanske R, Lugogo N, Martin RJ, Mauger DT, Naureckas E, Peters SP, Phipatanakul W, Que LG, Sheshadri A, Smith L, Solway J, Sullivan-Vedder L, Sumino K, Wechsler ME, Wenzel S, White SR, Sutherland ER. Effect of vitamin D3 on asthma treatment failures in adults with symptomatic asthma and lower vitamin D levels: the VIDA randomized clinical trial. JAMA 2014; 311:2083-91. [PMID: 24838406 PMCID: PMC4217655 DOI: 10.1001/jama.2014.5052] [Citation(s) in RCA: 193] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
IMPORTANCE In asthma and other diseases, vitamin D insufficiency is associated with adverse outcomes. It is not known if supplementing inhaled corticosteroids with oral vitamin D3 improves outcomes in patients with asthma and vitamin D insufficiency. OBJECTIVE To evaluate if vitamin D supplementation would improve the clinical efficacy of inhaled corticosteroids in patients with symptomatic asthma and lower vitamin D levels. DESIGN, SETTING, AND PARTICIPANTS The VIDA (Vitamin D Add-on Therapy Enhances Corticosteroid Responsiveness in Asthma) randomized, double-blind, parallel, placebo-controlled trial studying adult patients with symptomatic asthma and a serum 25-hydroxyvitamin D level of less than 30 ng/mL was conducted across 9 academic US medical centers in the National Heart, Lung, and Blood Institute's AsthmaNet network, with enrollment starting in April 2011 and follow-up complete by January 2014. After a run-in period that included treatment with an inhaled corticosteroid, 408 patients were randomized. INTERVENTIONS Oral vitamin D3 (100,000 IU once, then 4000 IU/d for 28 weeks; n = 201) or placebo (n = 207) was added to inhaled ciclesonide (320 µg/d). If asthma control was achieved after 12 weeks, ciclesonide was tapered to 160 µg/d for 8 weeks, then to 80 µg/d for 8 weeks if asthma control was maintained. MAIN OUTCOMES AND MEASURES The primary outcome was time to first asthma treatment failure (a composite outcome of decline in lung function and increases in use of β-agonists, systemic corticosteroids, and health care). RESULTS Treatment with vitamin D3 did not alter the rate of first treatment failure during 28 weeks (28% [95% CI, 21%-34%] with vitamin D3 vs 29% [95% CI, 23%-35%] with placebo; adjusted hazard ratio, 0.9 [95% CI, 0.6-1.3]). Of 14 prespecified secondary outcomes, 9 were analyzed, including asthma exacerbation; of those 9, the only statistically significant outcome was a small difference in the overall dose of ciclesonide required to maintain asthma control (111.3 µg/d [95% CI, 102.2-120.4 µg/d] in the vitamin D3 group vs 126.2 µg/d [95% CI, 117.2-135.3 µg/d] in the placebo group; difference of 14.9 µg/d [95% CI, 2.1-27.7 µg/d]). CONCLUSIONS AND RELEVANCE Vitamin D3 did not reduce the rate of first treatment failure or exacerbation in adults with persistent asthma and vitamin D insufficiency. These findings do not support a strategy of therapeutic vitamin D3 supplementation in patients with symptomatic asthma. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01248065.
Collapse
Affiliation(s)
- Mario Castro
- Washington University School of Medicine, St Louis, Missouri
| | | | | | | | | | - Fernando Holguin
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | | | - Wendy C Moore
- Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - James Moy
- Stroger Hospital of Cook County, Chicago, Illinois
| | | | | | | | - Eugene Bleecker
- Wake Forest School of Medicine, Winston-Salem, North Carolina
| | | | - James Chmiel
- Rainbow Babies and Children's Hospital, Cleveland, Ohio
| | | | | | - Mandeep Hundal
- Duke University School of Medicine, Durham, North Carolina
| | | | - Monica Kraft
- Duke University School of Medicine, Durham, North Carolina
| | | | | | | | | | - Njira Lugogo
- Duke University School of Medicine, Durham, North Carolina
| | | | | | | | | | | | - Loretta G Que
- Duke University School of Medicine, Durham, North Carolina
| | - Ajay Sheshadri
- Washington University School of Medicine, St Louis, Missouri
| | | | | | | | - Kaharu Sumino
- Washington University School of Medicine, St Louis, Missouri
| | | | - Sally Wenzel
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | | | - E Rand Sutherland
- National Jewish Health, Denver, Colorado20Dr Sutherland is now with sanofi
| | | |
Collapse
|
83
|
Szefler SJ, Chmiel JF, Fitzpatrick AM, Giacoia G, Green TP, Jackson DJ, Nielsen HC, Phipatanakul W, Raissy HH. Reply: To PMID 24290281. J Allergy Clin Immunol 2014; 133:1776-7. [PMID: 24786239 DOI: 10.1016/j.jaci.2014.03.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Accepted: 03/05/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Stanley J Szefler
- Department of Pediatrics and Pharmacology, National Jewish Health, and the University of Colorado School of Medicine, Denver, Colo.
| | - James F Chmiel
- University Hospitals Rainbow Babies and Children's Hospital and Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Anne M Fitzpatrick
- Emory University Department of Pediatrics and Children's Healthcare of Atlanta Center for Developmental Lung Biology, Atlanta, Ga
| | - George Giacoia
- National Institute of Child Health and Development, Bethesda, Md
| | - Thomas P Green
- Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Daniel J Jackson
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wis
| | - Heber C Nielsen
- Floating Hospital for Children at Tufts Medical Center, Tufts University School of Medicine, Boston, Mass
| | | | - Hengameh H Raissy
- Department of Pediatrics, University of New Mexico School of Medicine, Albuquerque, NM
| |
Collapse
|
84
|
Fitzpatrick AM, Park Y, Brown LAS, Jones DP. Children with severe asthma have unique oxidative stress-associated metabolomic profiles. J Allergy Clin Immunol 2014; 133:258-61.e1-8. [PMID: 24369802 DOI: 10.1016/j.jaci.2013.10.012] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Revised: 10/08/2013] [Accepted: 10/09/2013] [Indexed: 10/25/2022]
Affiliation(s)
- Anne M Fitzpatrick
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Ga; Children's Healthcare of Atlanta Center for Developmental Lung Biology, Atlanta, Ga.
| | - Youngja Park
- Department of Medicine, Emory University School of Medicine, Atlanta, Ga; College of Pharmacy, Korea University, Seong, Korea
| | - Lou Ann S Brown
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Ga; Children's Healthcare of Atlanta Center for Developmental Lung Biology, Atlanta, Ga
| | - Dean P Jones
- Department of Medicine, Emory University School of Medicine, Atlanta, Ga
| |
Collapse
|
85
|
Chang TS, Lemanske RF, Mauger DT, Fitzpatrick AM, Sorkness CA, Szefler SJ, Gangnon RE, Page CD, Jackson DJ. Childhood asthma clusters and response to therapy in clinical trials. J Allergy Clin Immunol 2014; 133:363-9. [PMID: 24139497 PMCID: PMC3960405 DOI: 10.1016/j.jaci.2013.09.002] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Revised: 08/31/2013] [Accepted: 09/06/2013] [Indexed: 12/28/2022]
Abstract
BACKGROUND Childhood asthma clusters, or subclasses, have been developed by computational methods without evaluation of clinical utility. OBJECTIVE To replicate and determine whether childhood asthma clusters previously identified computationally in the Severe Asthma Research Program (SARP) are associated with treatment responses in Childhood Asthma Research and Education (CARE) Network clinical trials. METHODS A cluster assignment model was determined by using SARP participant data. A total of 611 participants 6 to 18 years old from 3 CARE trials were assigned to SARP pediatric clusters. Primary and secondary outcomes were analyzed by cluster in each trial. RESULTS CARE participants were assigned to SARP clusters with high accuracy. Baseline characteristics were similar between SARP and CARE children of the same cluster. Treatment response in CARE trials was generally similar across clusters. However, with the caveat of a smaller sample size, children in the early-onset/severe-lung function cluster had best response with fluticasone/salmeterol (64% vs 23% 2.5× fluticasone and 13% fluticasone/montelukast in the Best ADd-on Therapy Giving Effective Responses trial; P = .011) and children in the early-onset/comorbidity cluster had the least clinical efficacy to treatments (eg, -0.076% change in FEV1 in the Characterizing Response to Leukotriene Receptor Antagonist and Inhaled Corticosteroid trial). CONCLUSIONS In this study, we replicated SARP pediatric asthma clusters by using a separate, large clinical trials network. Early-onset/severe-lung function and early-onset/comorbidity clusters were associated with differential and limited response to therapy, respectively. Further prospective study of therapeutic response by cluster could provide new insights into childhood asthma treatment.
Collapse
Affiliation(s)
- Timothy S Chang
- Department of Biostatistics and Medical Informatics, University of Wisconsin School of Medicine and Public Health, Madison, Wis
| | - Robert F Lemanske
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wis; Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wis
| | - David T Mauger
- Department of Health Evaluation Sciences, Pennsylvania State University, Hershey, Pa
| | - Anne M Fitzpatrick
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Ga
| | - Christine A Sorkness
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wis
| | - Stanley J Szefler
- Department of Pediatrics, National Jewish Health and University of Colorado School of Medicine, Denver, Colo
| | - Ronald E Gangnon
- Department of Biostatistics and Medical Informatics, University of Wisconsin School of Medicine and Public Health, Madison, Wis
| | - C David Page
- Department of Biostatistics and Medical Informatics, University of Wisconsin School of Medicine and Public Health, Madison, Wis
| | - Daniel J Jackson
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wis.
| |
Collapse
|
86
|
Sah PK, Gerald Teague W, Demuth KA, Whitlock DR, Brown SD, Fitzpatrick AM. Poor asthma control in obese children may be overestimated because of enhanced perception of dyspnea. J Allergy Clin Immunol Pract 2014; 1:39-45. [PMID: 23646295 DOI: 10.1016/j.jaip.2012.10.006] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Although studies in adults have shown a non-TH2 obese asthma phenotype, whether a similar phenotype exists in children is unclear. OBJECTIVE We hypothesized that asthmatic children with obesity, defined as a body mass index above the 95th percentile for age and sex, would have poorer asthma control as well as decreased quality of life, increased health care utilization, and decreased pulmonary function measures as a function of increased TH1 versus TH2 polarization. METHODS This study involved a post hoc analysis of cross sectional data from 269 children 6 to 17 years of age enrolled in the National Heart, Lung, and Blood Institute Severe Asthma Research Program. Children answered questionnaires and underwent spirometry, plethysmography, exhaled nitric oxide determination, and venipuncture for TH1/TH2 cytokine determination. Asthma control was defined according to national asthma treatment guidelines that are based on prespecified thresholds for lung function and symptom frequency. RESULTS Fifty-eight children (22%) were overweight and 67(25%) were obese. Obese children did not have poorer asthma control but were more likely to report nonspecific symptoms such as dyspnea and nocturnal awakenings. Obese children did have decreased asthma-related quality of life and increased health care utilization, but this was not associated with airflow limitation. Instead, obese children had decreased functional residual capacity. A unique pattern of TH1 or TH2 polarization was not observed. CONCLUSIONS Poor asthma control in obese children with asthma may be overestimated because of enhanced perception of nonspecific symptoms such as dyspnea that results from altered mechanical properties of the chest wall. Careful assessment of physiologic as well as symptom-based measures is needed in the evaluation of obese children with respiratory symptoms.
Collapse
|
87
|
Szefler SJ, Chmiel JF, Fitzpatrick AM, Giacoia G, Green TP, Jackson DJ, Nielsen HC, Phipatanakul W, Raissy HH. Asthma across the ages: knowledge gaps in childhood asthma. J Allergy Clin Immunol 2014; 133:3-13; quiz 14. [PMID: 24290281 PMCID: PMC3925634 DOI: 10.1016/j.jaci.2013.10.018] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2013] [Revised: 10/17/2013] [Accepted: 10/21/2013] [Indexed: 01/01/2023]
Abstract
The Eunice Kennedy Shriver National Institute of Child Health and Human Development convened an Asthma Group in response to the Best Pharmaceuticals for Children Act. The overall goal of the Best Pharmaceuticals for Children Act Program is to improve pediatric therapeutics through preclinical and clinical drug trials that lead to drug-labeling changes. Although significant advances have been made in the understanding and management of asthma in adults with appropriately labeled medications, less information is available on the management of asthma in children. Indeed, many medications are inadequately labeled for use in children. In general, the younger the child, the less information there is available to guide clinicians. Because asthma often begins in early childhood, it is incumbent on us to continue to address the primary questions raised in this review and carefully evaluate the medications used to manage asthma in children. Meanwhile, continued efforts should be made in defining effective strategies that reduce the risk of exacerbations. If the areas of defined need are addressed in the coming years, namely prevention of exacerbations and progression of disease, as well as primary intervention, we will see continuing reduction in asthma mortality and morbidity along with improved quality of life for children with asthma.
Collapse
Affiliation(s)
- Stanley J Szefler
- Department of Pediatrics and Pharmacology, National Jewish Health, and the University of Colorado School of Medicine, Denver, Colo.
| | - James F Chmiel
- University Hospitals Rainbow Babies and Children's Hospital and Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Anne M Fitzpatrick
- Emory University Department of Pediatrics and Children's Healthcare of Atlanta Center for Developmental Lung Biology, Atlanta, Ga
| | - George Giacoia
- National Institute of Child Health and Development, Bethesda, Md
| | - Thomas P Green
- Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Daniel J Jackson
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wis
| | - Heber C Nielsen
- Floating Hospital for Children at Tufts Medical Center, Tufts University School of Medicine, Boston, Mass
| | | | - Hengameh H Raissy
- Department of Pediatrics, University of New Mexico School of Medicine, Albuquerque, NM
| |
Collapse
|
88
|
Schneibel KR, Fitzpatrick AM, Ping XD, Brown LAS, Gauthier TW. Inflammatory mediator patterns in tracheal aspirate and their association with bronchopulmonary dysplasia in very low birth weight neonates. J Perinatol 2013; 33:383-7. [PMID: 23047424 PMCID: PMC3625688 DOI: 10.1038/jp.2012.125] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Alterations in inflammatory mediators are an important finding in neonates who develop bronchopulmonary dysplasia (BPD); however, there is a lack of research examining the relationship between multiple inflammatory mediators in premature neonates and the development of BPD. This study investigated whether the distribution of 12 inflammatory mediators detected in the tracheal aspirate (TA) of neonates within 24 h of birth could differentiate between neonates who did and who did not develop BPD. STUDY DESIGN TA samples were collected from 27 very low birth weight neonates (BPD+=11), and the concentrations of 12 biomarkers associated with BPD were determined. Linear discriminant analysis (LDA) was used to classify neonates into two outcome groups. RESULT LDA based on the 12 measured biomarkers displayed a significant level of discriminant function (P=0.007). CONCLUSION Using linear discriminant analysis, predictive models of BPD can be generated. Our results suggest that multiple inflammatory mediators collected within 24 h of birth may be used to classify neonates into who will and who will not develop BPD.
Collapse
|
89
|
Lee GB, Brandt EB, Xiao C, Gibson AM, Le Cras TD, Brown LAS, Fitzpatrick AM, Khurana Hershey GK. Diesel exhaust particles induce cysteine oxidation and s-glutathionylation in house dust mite induced murine asthma. PLoS One 2013; 8:e60632. [PMID: 23555996 PMCID: PMC3612047 DOI: 10.1371/journal.pone.0060632] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2012] [Accepted: 03/01/2013] [Indexed: 02/07/2023] Open
Abstract
Background Diesel exhaust particle (DEP) exposure enhances allergic inflammation and has been linked to the incidence of asthma. Oxidative stress on the thiol molecules cysteine (Cys) and glutathione (GSH) can promote inflammatory host responses. The effect of DEP on the thiol oxidation/reduction (redox) state in the asthmatic lung is unknown. Objective To determine if DEP exposure alters the Cys or GSH redox state in the asthmatic airway. Methods Bronchoalveolar lavage fluid was obtained from a house dust mite (HDM) induced murine asthma model exposed to DEP. GSH, glutathione disulfide (GSSG), Cys, cystine (CySS), and s-glutathionylated cysteine (CySSG) were determined by high pressure liquid chromatography. Results DEP co-administered with HDM, but not DEP or HDM alone, decreased total Cys, increased CySS, and increased CySSG without significantly altering GSH or GSSG. Conclusions DEP exposure promotes oxidation and S-glutathionylation of cysteine amino acids in the asthmatic airway, suggesting a novel mechanism by which DEP may enhance allergic inflammatory responses.
Collapse
Affiliation(s)
- Gerald B. Lee
- Division of Asthma Research, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, United States of America
- Division of Allergy and Immunology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, United States of America
| | - Eric B. Brandt
- Division of Asthma Research, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, United States of America
| | - Chang Xiao
- Division of Asthma Research, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, United States of America
| | - Aaron M. Gibson
- Division of Asthma Research, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, United States of America
| | - Timothy D. Le Cras
- Division of Pulmonary Biology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, United States of America
| | - Lou Ann S. Brown
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - Anne M. Fitzpatrick
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - Gurjit K. Khurana Hershey
- Division of Asthma Research, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, United States of America
- Division of Allergy and Immunology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, United States of America
- * E-mail:
| |
Collapse
|
90
|
Holguin F, Comhair SAA, Hazen SL, Powers RW, Khatri SS, Bleecker ER, Busse WW, Calhoun WJ, Castro M, Fitzpatrick AM, Gaston B, Israel E, Jarjour NN, Moore WC, Peters SP, Teague WG, Chung KF, Erzurum SC, Wenzel SE. An association between L-arginine/asymmetric dimethyl arginine balance, obesity, and the age of asthma onset phenotype. Am J Respir Crit Care Med 2012. [PMID: 23204252 DOI: 10.1164/rccm.201207-1270oc] [Citation(s) in RCA: 123] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
RATIONALE Increasing body mass index (BMI) has been associated with less fractional exhaled nitric oxide (Fe(NO)). This may be explained by an increase in the concentration of asymmetric dimethyl arginine (ADMA) relative to L-arginine, which can lead to greater nitric oxide synthase uncoupling. OBJECTIVES To compare this mechanism across age of asthma onset groups and determine its association with asthma morbidity and lung function. METHODS Cross-sectional study of participants from the Severe Asthma Research Program, across early- (<12 yr) and late- (>12 yr) onset asthma phenotypes. MEASUREMENTS AND MAIN RESULTS Subjects with late-onset asthma had a higher median plasma ADMA level (0.48 μM, [interquartile range (IQR), 0.35-0.7] compared with early onset, 0.37 μM [IQR, 0.29-0.59], P = 0.01) and lower median plasma l-arginine (late onset, 52.3 [IQR, 43-61] compared with early onset, 51 μM [IQR 39-66]; P = 0.02). The log of plasma L-arginine/ADMA was inversely correlated with BMI in the late- (r = -0.4, P = 0.0006) in contrast to the early-onset phenotype (r = -0.2, P = 0.07). Although Fe(NO) was inversely associated with BMI in the late-onset phenotype (P = 0.02), the relationship was lost after adjusting for L-arginine/ADMA. Also in this phenotype, a reduced L-arginine/ADMA was associated with less IgE, increased respiratory symptoms, lower lung volumes, and worse asthma quality of life. CONCLUSIONS In late-onset asthma phenotype, plasma ratios of L-arginine to ADMA may explain the inverse relationship of BMI to Fe(NO). In addition, these lower L-arginine/ADMA ratios are associated with reduced lung function and increased respiratory symptom frequency, suggesting a role in the pathobiology of the late-onset phenotype.
Collapse
Affiliation(s)
- Fernando Holguin
- Asthma Institute, Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh, MUH 628, 3459 Fifth Avenue, Pittsburgh, PA 15213, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
91
|
Abstract
Asthma, one of the most prevalent diseases affecting people worldwide, is a chronic respiratory disease characterized by heightened airway inflammation, airway hyperresponsiveness and airflow obstruction in response to specific triggers. While the specific mechanisms responsible for asthma are not well understood, changing environmental factors associated with urban lifestyles may underlie the increased prevalence of the disorder. Vitamin D is of particular interest in asthma since vitamin D concentrations decrease with increased time spent indoors, decreased exposure to sunlight, less exercise, obesity, and inadequate calcium intake. Additionally, a growing body of literature suggests that there is a relationship between vitamin D status and respiratory symptoms, presumably through immunomodulatory effects of vitamin D. This review discusses vitamin D as it relates to asthma across the age spectrum, with a focus on human studies.
Collapse
|
92
|
Eckard AR, Judd SE, Ziegler TR, Camacho-Gonzalez AF, Fitzpatrick AM, Hadley GR, Grossmann RE, Seaton L, Seydafkan S, Mulligan MJ, Rimann N, Tangpricha V, McComsey GA. Risk factors for vitamin D deficiency and relationship with cardiac biomarkers, inflammation and immune restoration in HIV-infected youth. Antivir Ther 2012; 17:1069-78. [PMID: 22894927 DOI: 10.3851/imp2318] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2012] [Indexed: 02/07/2023]
Abstract
BACKGROUND Vitamin D deficiency is common in HIV-infected individuals. In adults, traditional and HIV-related factors play a role in vitamin D status, and deficiency appears to impair immune restoration and exacerbate HIV complications, like cardiovascular disease (CVD). This study sought to determine factors contributing to vitamin D status in HIV-infected youth and investigate the relationship with CVD risk, inflammation and immune restoration. METHODS HIV-infected subjects (1-25 years old) were enrolled prospectively along with healthy controls that were group-matched by age, sex and race. HIV data were collected for the HIV-infected group, while traditional risk factors, including vitamin D intake, sun exposure, skin pigmentation, physical activity level and body mass index (BMI) were collected for both groups. Fasting lipids, plasma 25-hydroxyvitamin D (25[OH]D), and inflammation markers were measured. RESULTS In total, 200 HIV-infected subjects and 50 controls were enrolled. HIV group had 53% male, 95% Black and a mean age of 17.2 ±4.6 years. There was no difference in 25(OH)D between groups; 77% of HIV+ and 74% of controls had 25(OH)D<20 ng/ml. Only Fitzpatrick skin type was independently associated with 25(OH)D. No HIV variables were associated with 25(OH)D, even when HIV sub-populations were examined. Inflammation, CVD risk factors and immune restoration were not independently associated with 25(OH)D. CONCLUSIONS Vitamin D deficiency is common among HIV-infected youth. However, HIV factors, CVD risk, inflammation and immune restoration do not appear to have the same relationship with vitamin D as has been shown in adults. Supplementation trials are needed to determine if increasing 25(OH)D concentrations could better elucidate these relationships.
Collapse
|
93
|
Fitzpatrick AM, Jones DP, Brown LAS. Glutathione redox control of asthma: from molecular mechanisms to therapeutic opportunities. Antioxid Redox Signal 2012; 17:375-408. [PMID: 22304503 PMCID: PMC3353819 DOI: 10.1089/ars.2011.4198] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2011] [Revised: 01/22/2012] [Accepted: 01/22/2012] [Indexed: 12/11/2022]
Abstract
Asthma is a chronic inflammatory disorder of the airways associated with airway hyper-responsiveness and airflow limitation in response to specific triggers. Whereas inflammation is important for tissue regeneration and wound healing, the profound and sustained inflammatory response associated with asthma may result in airway remodeling that involves smooth muscle hypertrophy, epithelial goblet-cell hyperplasia, and permanent deposition of airway extracellular matrix proteins. Although the specific mechanisms responsible for asthma are still being unraveled, free radicals such as reactive oxygen species and reactive nitrogen species are important mediators of airway tissue damage that are increased in subjects with asthma. There is also a growing body of literature implicating disturbances in oxidation/reduction (redox) reactions and impaired antioxidant defenses as a risk factor for asthma development and asthma severity. Ultimately, these redox-related perturbations result in a vicious cycle of airway inflammation and injury that is not always amenable to current asthma therapy, particularly in cases of severe asthma. This review will discuss disruptions of redox signaling and control in asthma with a focus on the thiol, glutathione, and reduced (thiol) form (GSH). First, GSH synthesis, GSH distribution, and GSH function and homeostasis are discussed. We then review the literature related to GSH redox balance in health and asthma, with an emphasis on human studies. Finally, therapeutic opportunities to restore the GSH redox balance in subjects with asthma are discussed.
Collapse
Affiliation(s)
- Anne M Fitzpatrick
- Department of Pediatrics, Emory University, Atlanta, Georgia 30322, USA.
| | | | | |
Collapse
|
94
|
Galban-Horcajo F, Fitzpatrick AM, Hutton AJ, Dunn SM, Kalna G, Brennan KM, Rinaldi S, Yu RK, Goodyear CS, Willison HJ. Antibodies to heteromeric glycolipid complexes in multifocal motor neuropathy. Eur J Neurol 2012; 20:62-70. [PMID: 22727042 DOI: 10.1111/j.1468-1331.2012.03767.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2012] [Accepted: 04/24/2012] [Indexed: 11/29/2022]
Abstract
BACKGROUND Measurement of anti-GM1 IgM antibodies in multifocal motor neuropathy (MMN) sera is confounded by relatively low sensitivity that limits clinical usefulness. Combinatorial assay methods, in which antibodies react to heteromeric complexes of two or more glycolipids, are being increasingly applied to this area of diagnostic testing. METHODS A newly developed combinatorial glycoarray able to identify antibodies to 45 different heteromeric glycolipid complexes and their 10 individual glycolipid components was applied to a randomly selected population of 33 MMN cases and 57 normal or disease controls. Comparison with an enzyme-linked immunosorbent assay (ELISA) was conducted for selected single glycolipids and their complexes. RESULTS By ELISA, 22/33 MMN cases had detectable anti-GM1 IgM antibodies, whereas 19/33 MMN samples were positive for anti-GM1 antibodies by glycoarray. Analysis of variance (anova) revealed that of the 55 possible single glycolipids and their 1:1 complexes, antibodies to the GM1:galactocerebroside (GM1:GalC) complex were most significantly associated with MMN, returning 33/33 MMN samples as positive by glycoarray and 29/33 positive by ELISA. Regression analysis revealed a high correlation in absolute values between ELISA and glycoarray. Receiver operator characteristic analysis revealed insignificantly different diagnostic performance between the two methods. However, the glycoarray appeared to offer slightly improved sensitivity by identifying antibodies in four ELISA-negative samples. CONCLUSIONS The use of combinatorial glycoarray or ELISA increased the diagnostic sensitivity of anti-glycolipid antibody testing in this cohort of MMN cases, without significantly affecting specificity, and may be a useful assay modification for routine clinical screening.
Collapse
Affiliation(s)
- F Galban-Horcajo
- Glasgow Biomedical Research Centre, College of Medical, Veterinary and Life Science, Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
| | | | | | | | | | | | | | | | | | | |
Collapse
|
95
|
Torgerson DG, Capurso D, Ampleford EJ, Li X, Moore WC, Gignoux CR, Hu D, Eng C, Mathias RA, Busse WW, Castro M, Erzurum SC, Fitzpatrick AM, Gaston B, Israel E, Jarjour NN, Teague WG, Wenzel SE, Rodríguez-Santana JR, Rodríguez-Cintrón W, Avila PC, Ford JG, Barnes KC, Burchard EG, Howard TD, Bleecker ER, Meyers DA, Cox NJ, Ober C, Nicolae DL. Genome-wide ancestry association testing identifies a common European variant on 6q14.1 as a risk factor for asthma in African American subjects. J Allergy Clin Immunol 2012; 130:622-629.e9. [PMID: 22607992 DOI: 10.1016/j.jaci.2012.03.045] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2011] [Revised: 02/22/2012] [Accepted: 03/06/2012] [Indexed: 12/14/2022]
Abstract
BACKGROUND Genetic variants that contribute to asthma susceptibility might be present at varying frequencies in different populations, which is an important consideration and advantage for performing genetic association studies in admixed populations. OBJECTIVE We sought to identify asthma-associated loci in African American subjects. METHODS We compared local African and European ancestry estimated from dense single nucleotide polymorphism genotype data in African American adults with asthma and nonasthmatic control subjects. Allelic tests of association were performed within the candidate regions identified, correcting for local European admixture. RESULTS We identified a significant ancestry association peak on chromosome 6q. Allelic tests for association within this region identified a single nucleotide polymorphism (rs1361549) on 6q14.1 that was associated with asthma exclusively in African American subjects with local European admixture (odds ratio, 2.2). The risk allele is common in Europe (42% in the HapMap population of Utah residents with Northern and Western European ancestry from the Centre d'Etude du Polymorphisme Humain collection) but absent in West Africa (0% in the HapMap population of Yorubans in Ibadan, Nigeria), suggesting the allele is present in African American subjects because of recent European admixture. We replicated our findings in Puerto Rican subjects and similarly found that the signal of association is largely specific to subjects who are heterozygous for African and non-African ancestry at 6q14.1. However, we found no evidence for association in European American or Puerto Rican subjects in the absence of local African ancestry, suggesting that the association with asthma at rs1361549 is due to an environmental or genetic interaction. CONCLUSION We identified a novel asthma-associated locus that is relevant to admixed populations with African ancestry and highlight the importance of considering local ancestry in genetic association studies of admixed populations.
Collapse
Affiliation(s)
- Dara G Torgerson
- Department of Human Genetics, University of Chicago, Chicago, Il 60637, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
96
|
Brown SD, Baxter KM, Stephenson ST, Esper AM, Brown LAS, Fitzpatrick AM. Airway TGF-β1 and oxidant stress in children with severe asthma: association with airflow limitation. J Allergy Clin Immunol 2011; 129:388-96, 396.e1-8. [PMID: 22206775 DOI: 10.1016/j.jaci.2011.11.037] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2011] [Revised: 11/27/2011] [Accepted: 11/29/2011] [Indexed: 01/14/2023]
Abstract
BACKGROUND TGF-β1 is thought to play a role in airway remodeling in asthmatic subjects. TGF-β1 expression might be mediated by an excessive burden of reactive oxygen species and oxidant stress. OBJECTIVE Given the profound airway oxidant stress we have previously observed in children with severe asthma, we sought to (1) quantify TGF-β1 protein and mRNA gene expression in the airways of children with mild-to-moderate and severe atopic asthma and (2) determine the relationship of airway TGF-β1 concentrations to oxidant burden (ie, lipid peroxidation), T(H)2-mediated eosinophilic inflammation, and airflow limitation. METHODS Bronchoalveolar lavage fluid was collected from 68 atopic children with asthma (severe asthma, n = 28) and 12 atopic adult control subjects. Airway TGF-β1 expression and activation were assessed in relation to airway IL-13, 8-isoprostane, and malondialdehyde concentrations. The relationship of airway TGF-β1 expression to airflow limitation in children with asthma was also assessed. RESULTS Children with severe asthma had higher total airway concentrations of TGF-β1 that were associated with increased protein and mRNA expression of TGF-β1 in airway macrophages and an increase in concentrations of the lipid peroxidation biomarkers 8-isoprostanes and malondialdehyde. TGF-β1 activation was also greater in children with severe asthma and was associated with higher airway 8-isoprostane, malondialdehyde, and IL-13 concentrations. Total airway TGF-β1 concentrations were further associated with airflow limitation. CONCLUSIONS Children with severe asthma have increased airway TGF-β1 expression and activation associated with an increased airway oxidant burden. Oxidant stress might mediate the effects of TGF-β1 and promote airway remodeling in children with severe asthma.
Collapse
Affiliation(s)
- Sheena D Brown
- Department of Pediatrics, Emory University, Atlanta, GA, USA
| | | | | | | | | | | |
Collapse
|
97
|
Stephenson ST, Hadley G, Brown LAS, Fitzpatrick AM. Decreased expression of acetaminophen-metabolizing enzymes and glutathione in asthmatic children after acetaminophen exposure. J Allergy Clin Immunol 2011; 129:867-9. [PMID: 22130424 DOI: 10.1016/j.jaci.2011.10.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2011] [Revised: 10/15/2011] [Accepted: 10/20/2011] [Indexed: 10/15/2022]
|
98
|
Jarjour NN, Erzurum SC, Bleecker ER, Calhoun WJ, Castro M, Comhair SAA, Chung KF, Curran-Everett D, Dweik RA, Fain SB, Fitzpatrick AM, Gaston BM, Israel E, Hastie A, Hoffman EA, Holguin F, Levy BD, Meyers DA, Moore WC, Peters SP, Sorkness RL, Teague WG, Wenzel SE, Busse WW. Severe asthma: lessons learned from the National Heart, Lung, and Blood Institute Severe Asthma Research Program. Am J Respir Crit Care Med 2011; 185:356-62. [PMID: 22095547 DOI: 10.1164/rccm.201107-1317pp] [Citation(s) in RCA: 193] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
The National Heart, Lung, and Blood Institute Severe Asthma Research Program (SARP) has characterized over the past 10 years 1,644 patients with asthma, including 583 individuals with severe asthma. SARP collaboration has led to a rapid recruitment of subjects and efficient sharing of samples among participating sites to conduct independent mechanistic investigations of severe asthma. Enrolled SARP subjects underwent detailed clinical, physiologic, genomic, and radiological evaluations. In addition, SARP investigators developed safe procedures for bronchoscopy in participants with asthma, including those with severe disease. SARP studies revealed that severe asthma is a heterogeneous disease with varying molecular, biochemical, and cellular inflammatory features and unique structure-function abnormalities. Priorities for future studies include recruitment of a larger number of subjects with severe asthma, including children, to allow further characterization of anatomic, physiologic, biochemical, and genetic factors related to severe disease in a longitudinal assessment to identify factors that modulate the natural history of severe asthma and provide mechanistic rationale for management strategies.
Collapse
|
99
|
Li X, Ampleford EJ, Howard TD, Moore WC, Li H, Busse WW, Castro M, Erzurum SC, Fitzpatrick AM, Gaston B, Israel E, Jarjour NN, Teague WG, Wenzel SE, Hawkins GA, Bleecker ER, Meyers DA. The C11orf30-LRRC32 region is associated with total serum IgE levels in asthmatic patients. J Allergy Clin Immunol 2011; 129:575-8, 578.e1-9. [PMID: 22070912 DOI: 10.1016/j.jaci.2011.09.040] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2011] [Revised: 09/13/2011] [Accepted: 09/21/2011] [Indexed: 01/05/2023]
|
100
|
Abstract
Epinephrine is the treatment of choice for anaphylaxis. Delay in administration of epinephrine is a known risk factor for food allergy reaction-related mortality; however, individuals with food allergy may not have epinephrine readily available. This study was designed to determine the percent of food-allergic children that have an epinephrine autoinjector readily available and factors associated with epinephrine autoinjector carriage rates. Parents completed a questionnaire on food allergy and food allergy preparedness. Staff recorded whether an epinephrine autoinjector and medical alert bracelet was immediately available in clinic. Parental responses from 63 food-allergic children were included. Fifty-nine percent (37/63) had an epinephrine autoinjector present in the clinic, and 79% (50/63) reported receiving training in epinephrine autoinjector use. There was no correlation between epinephrine autoinjector presence in the clinic and parental report of having an epinephrine autoinjector available at all times (phi = 0.21). Epinephrine autoinjector training was associated with increased odds of having an epinephrine autoinjector immediately available (adjusted odds ratio, 8.74 [1.69, 45.04]). Fewer school aged children (≥5 years old) reportedly had their epinephrine autoinjector with them when eating lunch (25% [8/32] versus 42% [13/31]; p = 0.002) or snacks (28% [9/32] versus 37% [13/31]; p = 0.005) when compared with those <5 years old. Many children do not have their epinephrine autoinjectors readily available despite parental report. Epinephrine autoinjector training improved the odds of having an epinephrine autoinjector readily available. Continued patient education on the importance of having an epinephrine autoinjector easily accessible, especially when eating, is important.
Collapse
Affiliation(s)
- Karen A. DeMuth
- Department of Pediatrics, Division of Pulmonary, Allergy, Cystic Fibrosis, and Sleep Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | | |
Collapse
|