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Ishmael L, Apter A, Busse PJ, Calderon-Candelario R, Carroll JK, Casale T, Celedón JC, Cohen R, Coyne-Beasley T, Cui J, Ericson B, Hernandez P, Kaelber DC, Maher N, Merriman C, Mosnaim G, Nazario S, Phipatanakul W, Pinto-Plata V, Riley I, Shenoy K, Wisnivesky J, Yawn B, Israel E, Cardet JC. Asthma morbidity measures across Black ethnic subgroups. J Allergy Clin Immunol 2024; 153:408-417. [PMID: 38000696 PMCID: PMC10922293 DOI: 10.1016/j.jaci.2023.10.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 10/04/2023] [Accepted: 10/31/2023] [Indexed: 11/26/2023]
Abstract
BACKGROUND Black adults are disproportionately affected by asthma and are often considered a homogeneous group in research studies despite cultural and ancestral differences. OBJECTIVE We sought to determine if asthma morbidity differs across adults in Black ethnic subgroups. METHODS Adults with moderate-severe asthma were recruited across the continental United States and Puerto Rico for the PREPARE (PeRson EmPowered Asthma RElief) trial. Using self-identifications, we categorized multiethnic Black (ME/B) participants (n = 226) as Black Latinx participants (n = 146) or Caribbean, continental African, or other Black participants (n = 80). African American (AA/B) participants (n = 518) were categorized as Black participants who identified their ethnicity as being American. Baseline characteristics and retrospective asthma morbidity measures (self-reported exacerbations requiring systemic corticosteroids [SCs], emergency department/urgent care [ED/UC] visits, hospitalizations) were compared across subgroups using multivariable regression. RESULTS Compared with AA/B participants, ME/B participants were more likely to be younger, residing in the US Northeast, and Spanish speaking and to have lower body mass index, health literacy, and <1 comorbidity, but higher blood eosinophil counts. In a multivariable analysis, ME/B participants were significantly more likely to have ED/UC visits (incidence rate ratio [IRR] = 1.34, 95% CI = 1.04-1.72) and SC use (IRR = 1.27, 95% CI = 1.00-1.62) for asthma than AA/B participants. Of the ME/B subgroups, Puerto Rican Black Latinx participants (n = 120) were significantly more likely to have ED/UC visits (IRR = 1.64, 95% CI = 1.22-2.21) and SC use for asthma (IRR = 1.43, 95% CI = 1.06-1.92) than AA/B participants. There were no significant differences in hospitalizations for asthma among subgroups. CONCLUSIONS ME/B adults, specifically Puerto Rican Black Latinx adults, have higher risk of ED/UC visits and SC use for asthma than other Black subgroups.
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Affiliation(s)
- Leah Ishmael
- Division of Allergy and Immunology, Department of Internal Medicine, University of South Florida Morsani College of Medicine, Tampa, Fla
| | - Andrea Apter
- Division of Pulmonary, Allergy and Critical Care, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa
| | - Paula J Busse
- Division of Clinical Immunology, Icahn School of Medicine at Mount Sinai, New York, NY
| | | | - Jennifer K Carroll
- American Academy of Family Physicians National Research Network, Leawood, Kan; Department of Family Medicine, University of Colorado School of Medicine, Aurora, Colo
| | - Thomas Casale
- Division of Allergy and Immunology, Department of Internal Medicine, University of South Florida Morsani College of Medicine, Tampa, Fla
| | - Juan C Celedón
- Division of Pediatric Pulmonary Medicine, University of Pittsburgh, Pittsburgh, Pa
| | - Rubin Cohen
- Division of Pulmonary Critical Care and Sleep Medicine, Syracuse VA Medical Center, SUNY Upstate Medical University, Syracuse, NY
| | - Tamera Coyne-Beasley
- Department of Adolescent Medicine, University of North Carolina, Chapel Hill, NC
| | - Jing Cui
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, Mass
| | - Brianna Ericson
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, Mass
| | - Paulina Hernandez
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, Mass
| | - David C Kaelber
- Center for Clinical Informatics Research and Education, MetroHealth System, Cleveland, Ohio; Departments of Medicine, Pediatrics, and Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, Ohio
| | - Nancy Maher
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, Mass
| | - Conner Merriman
- Division of Allergy and Immunology, Department of Internal Medicine, University of South Florida Morsani College of Medicine, Tampa, Fla
| | - Giselle Mosnaim
- Division of Allergy, Asthma, and Immunology, Northshore University Health System, Evanston, Ill
| | - Sylvette Nazario
- Allergy and Immunology Section, University of Puerto Rico School of Medicine, San Juan, Puerto Rico
| | - Wanda Phipatanakul
- Departments of Allergy and Immunology and Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, Mass
| | - Victor Pinto-Plata
- Division of Pulmonary and Critical Care, Lahey Hospital and Medical Center, Burlington, Mass
| | - Isaretta Riley
- Division of Pulmonary and Critical Care Medicine, Duke University School of Medicine, Durham, NC
| | - Kartik Shenoy
- Temple Lung Center, Lewis Katz School of Medicine at Temple University, Philadelphia, Pa
| | - Juan Wisnivesky
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Barbara Yawn
- Department of Family and Community Health, University of Minnesota, Minneapolis, Minn
| | - Elliot Israel
- Divisions of Pulmonary and Critical Care Medicine and Allergy and Clinical Immunology, Brigham and Women's Hospital, Boston, Mass
| | - Juan Carlos Cardet
- Division of Allergy and Immunology, Department of Internal Medicine, University of South Florida Morsani College of Medicine, Tampa, Fla.
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Mabelane T, Masekela R, Dandara C, Hadebe S. Immunogenetics and pharmacogenetics of allergic asthma in Africa. FRONTIERS IN ALLERGY 2023; 4:1165311. [PMID: 37228580 PMCID: PMC10203899 DOI: 10.3389/falgy.2023.1165311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 04/20/2023] [Indexed: 05/27/2023] Open
Abstract
Asthma is a common chronic condition in children and in an African setting is often highly prevalent in urban areas as compared to rural areas. Asthma is a heritable disease and the genetic risk is often exacerbated by unique localised environmental factors. The Global Initiative for Asthma (GINA) recommendation for the control of asthma includes inhaled corticosteroids (ICS) alone or together with short-acting β2-agonists (SABA) or long-acting β2-agonists (LABA). While these drugs can relieve asthma symptoms, there is evidence of reduced efficacy in people of African ancestry. Whether this is due to immunogenetics, genomic variability in drug metabolising genes (pharmacogenetics) or genetics of asthma-related traits is not well defined. Pharmacogenetic evidence of first-line asthma drugs in people of African ancestry is lacking and is further compounded by the lack of representative genetic association studies in the continent. In this review, we will discuss the paucity of data related to the pharmacogenetics of asthma drugs in people of African ancestry, mainly drawing from African American data. We will further discuss how this gap can be bridged to improve asthma health outcomes in Africa.
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Affiliation(s)
- Tshegofatso Mabelane
- Department of Medicine, Sefako Makgatho Health Science University, Ga-Rankuwa, South Africa
| | - Refiloe Masekela
- Department of Paediatrics, Nelson Mandela School of Medicine, Inkosi Albert Luthuli Hospital, University of KwaZulu-Natal, Durban, South Africa
| | - Collet Dandara
- Division of Human Genetics, Department of Pathology, Faculty of Health Sciences and Institute of Infectious Diseases Molecular Medicine, University of Cape Town, Cape Town, South Africa
- Platform for Pharmacogenomics Research and Translation, South African Medical Research Council, Cape Town, South Africa
| | - Sabelo Hadebe
- Division of Immunology, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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Cardet JC, Shenoy K, Baydur A, Carroll JK, Celedón JC, Cui J, Dara P, Ericson B, Forth VE, Fagan M, Fuhlbrigge AL, Gupta R, Hart MK, Hernandez ML, Hernandez PA, Kruse J, Maher NE, Manning BK, Pinto-Plata VM, Robles J, Rodriguez-Louis J, Shields JB, Telon Sosa BS, Wechsler ME, Israel E. Caribbean Latinx with moderate-severe asthma bear greater asthma morbidity than other Latinx. J Allergy Clin Immunol 2022; 150:1106-1113.e10. [PMID: 35779669 PMCID: PMC9643605 DOI: 10.1016/j.jaci.2022.05.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 05/08/2022] [Accepted: 05/17/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Hispanic/Latinx (HL) ethnicity encompasses racially and culturally diverse subgroups. Studies suggest that Puerto Ricans (PR) may bear greater asthma-related morbidity than Mexicans, but these were conducted in children or had limited clinical characterization. OBJECTIVES This study sought to determine whether disparities in asthma morbidity exist among HL adult subgroups. METHODS Adults with moderate-severe asthma were recruited from US clinics, including from Puerto Rico, for the Person Empowered Asthma Relief (PREPARE) trial. Considering the shared heritage between PR and other Caribbean HL (Cubans and Dominicans [C&D]), the investigators compared baseline self-reported clinical characteristics between Caribbean HL (CHL) (PR and C&D: n = 457) and other HLs (OHL) (Mexicans, Spaniards, Central/South Americans; n = 141), and between CHL subgroups (C&D [n = 56] and PR [n = 401]). This study compared asthma morbidity measures (self-reported exacerbations requiring systemic corticosteroids, emergency department/urgent care (ED/UC) visits, hospitalizations, health care utilization) through negative binomial regression. RESULTS CHL compared to OHL were similar in age, body mass index, poverty status, blood eosinophils, and fractional exhaled nitric oxide but were prescribed more asthma controller therapies. Relative to OHL, CHL had significantly increased odds of asthma exacerbations (odds ratio [OR]: 1.84; 95% CI: 1.4-2.4), ED/UC visits (OR: 1.88; 95% CI: 1.4-2.5), hospitalization (OR: 1.98; 95% CI: 1.06-3.7), and health care utilization (OR: 1.91; 95% CI: 1.44-2.53). Of the CHL subgroups, PR had significantly increased odds of asthma exacerbations, ED/UC visits, hospitalizations, and health care utilization compared to OHL, whereas C&D only had increased odds of exacerbations compared to OHL. PR compared to C&D had greater odds of ED/UC and health care utilization. CONCLUSIONS CHL adults, compared with OHL, adults reported nearly twice the asthma morbidity; these differences are primarily driven by PR. Novel interventions are needed to reduce morbidity in this highly impacted population.
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Affiliation(s)
- Juan Carlos Cardet
- Division of Allergy and Immunology, Department of Internal Medicine, University of South Florida, Morsani College of Medicine, Tampa, Fla
| | - Kartik Shenoy
- Temple Lung Center, Lewis Katz School of Medicine at Temple University, Philadelphia, Pa
| | - Ahmet Baydur
- Division of Pulmonary, Critical Care and Sleep Medicine, Keck School of Medicine, University of Southern California, Los Angeles, Calif
| | - Jennifer K Carroll
- American Academy of Family Physicians National Research Network, Leawood, Kan; Department of Family Medicine, University of Colorado School of Medicine, University of Colorado, Aurora, Colo
| | - Juan Carlos Celedón
- Division of Pediatric Pulmonary Medicine, University of Pittsburgh, Pittsburgh, Pa
| | - Jing Cui
- Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital, Boston, Mass
| | - Prajwal Dara
- Department of Internal Medicine, University of South Florida, Morsani College of Medicine, Tampa, Fla
| | - Brianna Ericson
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, Mass
| | - Victoria E Forth
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, Mass
| | | | - Anne L Fuhlbrigge
- Department of Medicine, Pulmonary Science and Critical Care Medicine, University of Colorado School of Medicine, University of Colorado, Aurora, Colo
| | - Rohit Gupta
- Temple Lung Center, Lewis Katz School of Medicine at Temple University, Philadelphia, Pa
| | | | - Michelle L Hernandez
- Division of Allergy and Immunology, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Paulina Arias Hernandez
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, Mass
| | - Jean Kruse
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, Mass
| | - Nancy E Maher
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, Mass
| | - Brian K Manning
- American Academy of Family Physicians National Research Network, Leawood, Kan
| | - Victor M Pinto-Plata
- Division of Pulmonary and Critical Care Medicine, Lahey Hospital and Medical Center, Burlington, Mass
| | | | | | - Joel B Shields
- American Academy of Family Physicians National Research Network, Leawood, Kan
| | - Bonnie S Telon Sosa
- Department of Internal Medicine, Allergy/Immunology Section, University of Puerto Rico: Medical Sciences Campus, San Juan, Puerto Rico
| | - Michael E Wechsler
- Department of Medicine, NJH Cohen Family Asthma Institute, National Jewish Health, Denver, Colo
| | - Elliot Israel
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, Mass.
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Okelo SO. Racial Inequities in Asthma Care. Semin Respir Crit Care Med 2022; 43:684-708. [DOI: 10.1055/s-0042-1756492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractRacial inequities in asthma care are evolving as a recognized factor in long-standing inequities in asthma outcomes (e.g., hospitalization and mortality). Little research has been conducted regarding the presence or absence of racial inequities among patients seen in asthma specialist settings, this is an important area of future research given that asthma specialist care is recommended for patients experiencing the poor asthma outcomes disproportionately experienced by Black and Hispanic patients. This study provides a systematic review of racial asthma care inequities in asthma epidemiology, clinical assessment, medication prescription, and asthma specialist referral practices.
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Affiliation(s)
- Sande O. Okelo
- Division of Pediatric Pulmonology and Sleep Medicine, The David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California
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Cardet JC, Chang KL, Rooks BJ, Carroll JK, Celedón JC, Coyne-Beasley T, Cui J, Ericson B, Forth VE, Fagan M, Fuhlbrigge AL, Hernandez PA, Kruse J, Louisias M, Maher NE, Manning B, Pace WD, Phipatanakul W, Rodriguez-Louis J, Shields JB, Israel E, Wisnivesky JP. Socioeconomic status associates with worse asthma morbidity among Black and Latinx adults. J Allergy Clin Immunol 2022; 150:841-849.e4. [PMID: 35597370 PMCID: PMC9724153 DOI: 10.1016/j.jaci.2022.04.030] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 03/11/2022] [Accepted: 04/21/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Asthma disproportionately affects African American/Black (AA/B) and Hispanic/Latinx (H/L) patients and individuals with low socioeconomic status (SES), but the relationship between SES and asthma morbidity within these racial/ethnic groups is inadequately understood. OBJECTIVE To determine the relationship between SES and asthma morbidity among AA/B and H/L adults with moderate to severe asthma using multidomain SES frameworks and mediation analyses. METHODS We analyzed enrollment data from the PeRson EmPowered Asthma RElief randomized trial, evaluating inhaled corticosteroid supplementation to rescue therapy. We tested for direct and indirect relationships between SES and asthma morbidity using structural equation models. For SES, we used a latent variable defined by poverty, education, and unemployment. For asthma morbidity, we used self-reported asthma exacerbations in the year before enrollment (corticosteroid bursts, emergency room/urgent care visits, or hospitalizations), and Asthma Control Test scores. We tested for mediation via health literacy, perceived stress, and self-reported discrimination. All models adjusted for age, sex, body mass index, ethnicity, and comorbidities. RESULTS Among 990 AA/B and H/L adults, low SES (latent variable) was directly associated with hospitalizations (β = 0.24) and worse Asthma Control Test scores (β = 0.20). Stress partially mediated the relationship between SES and increased emergency room/urgent care visits and worse asthma control (β = 0.03 and = 0.05, respectively). Individual SES domains were directly associated with asthma morbidity. Stress mediated indirect associations between low educational attainment and unemployment with worse asthma control (β = 0.05 and = 0.06, respectively). CONCLUSIONS Lower SES is directly, and indirectly through stress, associated with asthma morbidity among AA/B and H/L adults. Identification of stressors and relevant management strategies may lessen asthma-related morbidity among these populations.
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Affiliation(s)
- Juan Carlos Cardet
- Division of Allergy and Immunology, Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa, Fla
| | - Ku-Lang Chang
- Department of Community Health and Family Medicine, University of Florida College of Medicine, Gainesville, Fla
| | - Benjamin J Rooks
- Department of Community Health and Family Medicine, University of Florida College of Medicine, Gainesville, Fla
| | - Jennifer K Carroll
- American Academy of Family Physicians, National Research Network, Leawood, Kan; CU Anschutz Department of Family Medicine, University of Colorado, Aurora, Colo
| | - Juan Carlos Celedón
- Division of Pediatric Pulmonary Medicine, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, Pa
| | - Tamera Coyne-Beasley
- Department of Medicine, University of Alabama at Birmingham, Children's of Alabama, Birmingham
| | - Jing Cui
- Divisions of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital, Boston, Mass
| | - Brianna Ericson
- Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, Mass
| | - Victoria E Forth
- Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, Mass
| | | | - Anne L Fuhlbrigge
- Department of Medicine, Pulmonary Science and Critical Care Medicine, University of Colorado School of Medicine, Aurora, Colo
| | - Paulina Arias Hernandez
- Divisions of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital, Boston, Mass
| | - Jean Kruse
- Divisions of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital, Boston, Mass
| | - Margee Louisias
- Division of Allergy and Clinical Immunology, Brigham and Women's Hospital, Boston, Mass
| | - Nancy E Maher
- Divisions of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital, Boston, Mass
| | - Brian Manning
- American Academy of Family Physicians, National Research Network, Leawood, Kan
| | - Wilson D Pace
- American Academy of Family Physicians, National Research Network, Leawood, Kan; DARTNet Institute, Aurora, Colo
| | | | | | - Joel B Shields
- American Academy of Family Physicians, National Research Network, Leawood, Kan
| | - Elliot Israel
- Divisions of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital, Boston, Mass; Division of Allergy and Clinical Immunology, Brigham and Women's Hospital, Boston, Mass.
| | - Juan P Wisnivesky
- Divisions of General Internal Medicine and Pulmonary and Critical Care Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
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Israel E, Cardet JC, Carroll JK, Fuhlbrigge AL, She L, Rockhold FW, Maher NE, Fagan M, Forth VE, Yawn BP, Arias Hernandez P, Kruse JM, Manning BK, Rodriguez-Louis J, Shields JB, Ericson B, Colon-Moya AD, Madison S, Coyne-Beasley T, Hammer GM, Kaplan BM, Rand CS, Robles J, Thompson O, Wechsler ME, Wisnivesky JP, McKee MD, Jariwala SP, Jerschow E, Busse PJ, Kaelber DC, Nazario S, Hernandez ML, Apter AJ, Chang KL, Pinto-Plata V, Stranges PM, Hurley LP, Trevor J, Casale TB, Chupp G, Riley IL, Shenoy K, Pasarica M, Calderon-Candelario RA, Tapp H, Baydur A, Pace WD. Reliever-Triggered Inhaled Glucocorticoid in Black and Latinx Adults with Asthma. N Engl J Med 2022; 386:1505-1518. [PMID: 35213105 PMCID: PMC10367430 DOI: 10.1056/nejmoa2118813] [Citation(s) in RCA: 39] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Black and Latinx patients bear a disproportionate burden of asthma. Efforts to reduce the disproportionate morbidity have been mostly unsuccessful, and guideline recommendations have not been based on studies in these populations. METHODS In this pragmatic, open-label trial, we randomly assigned Black and Latinx adults with moderate-to-severe asthma to use a patient-activated, reliever-triggered inhaled glucocorticoid strategy (beclomethasone dipropionate, 80 μg) plus usual care (intervention) or to continue usual care. Participants had one instructional visit followed by 15 monthly questionnaires. The primary end point was the annualized rate of severe asthma exacerbations. Secondary end points included monthly asthma control as measured with the Asthma Control Test (ACT; range, 5 [poor] to 25 [complete control]), quality of life as measured with the Asthma Symptom Utility Index (ASUI; range, 0 to 1, with lower scores indicating greater impairment), and participant-reported missed days of work, school, or usual activities. Safety was also assessed. RESULTS Of 1201 adults (603 Black and 598 Latinx), 600 were assigned to the intervention group and 601 to the usual-care group. The annualized rate of severe asthma exacerbations was 0.69 (95% confidence interval [CI], 0.61 to 0.78) in the intervention group and 0.82 (95% CI, 0.73 to 0.92) in the usual-care group (hazard ratio, 0.85; 95% CI, 0.72 to 0.999; P = 0.048). ACT scores increased by 3.4 points (95% CI, 3.1 to 3.6) in the intervention group and by 2.5 points (95% CI, 2.3 to 2.8) in the usual-care group (difference, 0.9; 95% CI, 0.5 to 1.2); ASUI scores increased by 0.12 points (95% CI, 0.11 to 0.13) and 0.08 points (95% CI, 0.07 to 0.09), respectively (difference, 0.04; 95% CI, 0.02 to 0.05). The annualized rate of missed days was 13.4 in the intervention group and 16.8 in the usual-care group (rate ratio, 0.80; 95% CI, 0.67 to 0.95). Serious adverse events occurred in 12.2% of the participants, with an even distribution between the groups. CONCLUSIONS Among Black and Latinx adults with moderate-to-severe asthma, provision of an inhaled glucocorticoid and one-time instruction on its use, added to usual care, led to a lower rate of severe asthma exacerbations. (Funded by the Patient-Centered Outcomes Research Institute and others; PREPARE ClinicalTrials.gov number, NCT02995733.).
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Affiliation(s)
- Elliot Israel
- From the Divisions of Pulmonary and Critical Care Medicine and Allergy and Immunology, Brigham and Women's Hospital, Harvard Medical School (E.I., N.E.M., V.E.F., P.A.H., J.M.K., J.R.L., B.E.), and patient partner (O.T.), Boston, and the Lahey Hospital and Medical Center, Burlington (V.P.P.) - all in Massachusetts; the Division of Allergy and Immunology, Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa (J.-C.C., T.B.C.), the Department of Nursing, University of Miami Health System (M.F.), and Miller School of Medicine, University of Miami (R.A.C.C.), Miami, the Department of Community Health and Family Medicine, University of Florida College of Medicine, Gainesville (K.L.C.), and the University of Central Florida College of Medicine, Orlando (M.P.) - all in Florida; the Department of Family Medicine (J.K.C., W.D.P.) and the Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine (A.L.F.), University of Colorado, Aurora, the Public Leadership Group (G.M.H.), the Department of Medicine, National Jewish Health (M.E.W.), and the Denver Health and Hospital Authority (L.P.H.), Denver - all in Colorado; the American Academy of Family Physicians National Research Network, Leawood, KS (J.K.C., B.K.M., J.B.S.); Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (L.S., F.W.R.); the Department of Family and Community Health, University of Minnesota, Minneapolis (B.P.Y.), and patient partner, St. Paul (S.M.) - both in Minnesota; patient partner, South Jordan, UT (A.D.C.M.); the Division of Adolescent Medicine (T.C.B.) and the Lung Health Center, Department of Medicine, University of Alabama, Birmingham (J.T.); the American Lung Association, Washington, DC (B.M.K.); the Department of Medicine, Johns Hopkins School of Medicine, Baltimore (C.S.R.); patient partner (J.R.), the Divisions of General Internal Medicine and Pulmonary and Critical Care Medicine (J.P.W.) and Clinical Immunology and Allergy (P.J.B.), Icahn School of Medicine at Mount Sinai, and Montefiore Medical Center, (E.J.), Albert Einstein College of Medicine (M.D.M., S.P.J.) - all in New York; the Center for Clinical Informatics Research and Education, the MetroHealth System, and the Departments of Internal Medicine, Pediatrics, and Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland (D.C.K.); the Department of Internal Medicine, Section of Allergy and Immunology, University of Puerto Rico, San Juan (S.N.); the Division of Allergy and Immunology, University of North Carolina School of Medicine, Chapel Hill (M.L.H.), the Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University School of Medicine, Durham (I.L.R.), and the Department of Family Medicine, Atrium Health, Charlotte (H.T.) - all in North Carolina; the Division of Pulmonary, Allergy, and Critical Care Medicine, Perelman School of Medicine, University of Pennsylvania (A.J.A.), and the Temple Lung Center, Lewis Katz School of Medicine at Temple University (K.S.) - both in Philadelphia; the University of Illinois at Chicago College of Pharmacy, Chicago (P.M.S.); the Section of Pulmonary, Critical Care, and Sleep Medicine, Yale School of Medicine, New Haven, CT (G.C.); and the Division of Pulmonary, Critical Care, and Sleep Medicine, Keck School of Medicine, University of Southern California, Los Angeles (A.B.)
| | - Juan-Carlos Cardet
- From the Divisions of Pulmonary and Critical Care Medicine and Allergy and Immunology, Brigham and Women's Hospital, Harvard Medical School (E.I., N.E.M., V.E.F., P.A.H., J.M.K., J.R.L., B.E.), and patient partner (O.T.), Boston, and the Lahey Hospital and Medical Center, Burlington (V.P.P.) - all in Massachusetts; the Division of Allergy and Immunology, Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa (J.-C.C., T.B.C.), the Department of Nursing, University of Miami Health System (M.F.), and Miller School of Medicine, University of Miami (R.A.C.C.), Miami, the Department of Community Health and Family Medicine, University of Florida College of Medicine, Gainesville (K.L.C.), and the University of Central Florida College of Medicine, Orlando (M.P.) - all in Florida; the Department of Family Medicine (J.K.C., W.D.P.) and the Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine (A.L.F.), University of Colorado, Aurora, the Public Leadership Group (G.M.H.), the Department of Medicine, National Jewish Health (M.E.W.), and the Denver Health and Hospital Authority (L.P.H.), Denver - all in Colorado; the American Academy of Family Physicians National Research Network, Leawood, KS (J.K.C., B.K.M., J.B.S.); Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (L.S., F.W.R.); the Department of Family and Community Health, University of Minnesota, Minneapolis (B.P.Y.), and patient partner, St. Paul (S.M.) - both in Minnesota; patient partner, South Jordan, UT (A.D.C.M.); the Division of Adolescent Medicine (T.C.B.) and the Lung Health Center, Department of Medicine, University of Alabama, Birmingham (J.T.); the American Lung Association, Washington, DC (B.M.K.); the Department of Medicine, Johns Hopkins School of Medicine, Baltimore (C.S.R.); patient partner (J.R.), the Divisions of General Internal Medicine and Pulmonary and Critical Care Medicine (J.P.W.) and Clinical Immunology and Allergy (P.J.B.), Icahn School of Medicine at Mount Sinai, and Montefiore Medical Center, (E.J.), Albert Einstein College of Medicine (M.D.M., S.P.J.) - all in New York; the Center for Clinical Informatics Research and Education, the MetroHealth System, and the Departments of Internal Medicine, Pediatrics, and Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland (D.C.K.); the Department of Internal Medicine, Section of Allergy and Immunology, University of Puerto Rico, San Juan (S.N.); the Division of Allergy and Immunology, University of North Carolina School of Medicine, Chapel Hill (M.L.H.), the Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University School of Medicine, Durham (I.L.R.), and the Department of Family Medicine, Atrium Health, Charlotte (H.T.) - all in North Carolina; the Division of Pulmonary, Allergy, and Critical Care Medicine, Perelman School of Medicine, University of Pennsylvania (A.J.A.), and the Temple Lung Center, Lewis Katz School of Medicine at Temple University (K.S.) - both in Philadelphia; the University of Illinois at Chicago College of Pharmacy, Chicago (P.M.S.); the Section of Pulmonary, Critical Care, and Sleep Medicine, Yale School of Medicine, New Haven, CT (G.C.); and the Division of Pulmonary, Critical Care, and Sleep Medicine, Keck School of Medicine, University of Southern California, Los Angeles (A.B.)
| | - Jennifer K Carroll
- From the Divisions of Pulmonary and Critical Care Medicine and Allergy and Immunology, Brigham and Women's Hospital, Harvard Medical School (E.I., N.E.M., V.E.F., P.A.H., J.M.K., J.R.L., B.E.), and patient partner (O.T.), Boston, and the Lahey Hospital and Medical Center, Burlington (V.P.P.) - all in Massachusetts; the Division of Allergy and Immunology, Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa (J.-C.C., T.B.C.), the Department of Nursing, University of Miami Health System (M.F.), and Miller School of Medicine, University of Miami (R.A.C.C.), Miami, the Department of Community Health and Family Medicine, University of Florida College of Medicine, Gainesville (K.L.C.), and the University of Central Florida College of Medicine, Orlando (M.P.) - all in Florida; the Department of Family Medicine (J.K.C., W.D.P.) and the Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine (A.L.F.), University of Colorado, Aurora, the Public Leadership Group (G.M.H.), the Department of Medicine, National Jewish Health (M.E.W.), and the Denver Health and Hospital Authority (L.P.H.), Denver - all in Colorado; the American Academy of Family Physicians National Research Network, Leawood, KS (J.K.C., B.K.M., J.B.S.); Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (L.S., F.W.R.); the Department of Family and Community Health, University of Minnesota, Minneapolis (B.P.Y.), and patient partner, St. Paul (S.M.) - both in Minnesota; patient partner, South Jordan, UT (A.D.C.M.); the Division of Adolescent Medicine (T.C.B.) and the Lung Health Center, Department of Medicine, University of Alabama, Birmingham (J.T.); the American Lung Association, Washington, DC (B.M.K.); the Department of Medicine, Johns Hopkins School of Medicine, Baltimore (C.S.R.); patient partner (J.R.), the Divisions of General Internal Medicine and Pulmonary and Critical Care Medicine (J.P.W.) and Clinical Immunology and Allergy (P.J.B.), Icahn School of Medicine at Mount Sinai, and Montefiore Medical Center, (E.J.), Albert Einstein College of Medicine (M.D.M., S.P.J.) - all in New York; the Center for Clinical Informatics Research and Education, the MetroHealth System, and the Departments of Internal Medicine, Pediatrics, and Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland (D.C.K.); the Department of Internal Medicine, Section of Allergy and Immunology, University of Puerto Rico, San Juan (S.N.); the Division of Allergy and Immunology, University of North Carolina School of Medicine, Chapel Hill (M.L.H.), the Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University School of Medicine, Durham (I.L.R.), and the Department of Family Medicine, Atrium Health, Charlotte (H.T.) - all in North Carolina; the Division of Pulmonary, Allergy, and Critical Care Medicine, Perelman School of Medicine, University of Pennsylvania (A.J.A.), and the Temple Lung Center, Lewis Katz School of Medicine at Temple University (K.S.) - both in Philadelphia; the University of Illinois at Chicago College of Pharmacy, Chicago (P.M.S.); the Section of Pulmonary, Critical Care, and Sleep Medicine, Yale School of Medicine, New Haven, CT (G.C.); and the Division of Pulmonary, Critical Care, and Sleep Medicine, Keck School of Medicine, University of Southern California, Los Angeles (A.B.)
| | - Anne L Fuhlbrigge
- From the Divisions of Pulmonary and Critical Care Medicine and Allergy and Immunology, Brigham and Women's Hospital, Harvard Medical School (E.I., N.E.M., V.E.F., P.A.H., J.M.K., J.R.L., B.E.), and patient partner (O.T.), Boston, and the Lahey Hospital and Medical Center, Burlington (V.P.P.) - all in Massachusetts; the Division of Allergy and Immunology, Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa (J.-C.C., T.B.C.), the Department of Nursing, University of Miami Health System (M.F.), and Miller School of Medicine, University of Miami (R.A.C.C.), Miami, the Department of Community Health and Family Medicine, University of Florida College of Medicine, Gainesville (K.L.C.), and the University of Central Florida College of Medicine, Orlando (M.P.) - all in Florida; the Department of Family Medicine (J.K.C., W.D.P.) and the Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine (A.L.F.), University of Colorado, Aurora, the Public Leadership Group (G.M.H.), the Department of Medicine, National Jewish Health (M.E.W.), and the Denver Health and Hospital Authority (L.P.H.), Denver - all in Colorado; the American Academy of Family Physicians National Research Network, Leawood, KS (J.K.C., B.K.M., J.B.S.); Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (L.S., F.W.R.); the Department of Family and Community Health, University of Minnesota, Minneapolis (B.P.Y.), and patient partner, St. Paul (S.M.) - both in Minnesota; patient partner, South Jordan, UT (A.D.C.M.); the Division of Adolescent Medicine (T.C.B.) and the Lung Health Center, Department of Medicine, University of Alabama, Birmingham (J.T.); the American Lung Association, Washington, DC (B.M.K.); the Department of Medicine, Johns Hopkins School of Medicine, Baltimore (C.S.R.); patient partner (J.R.), the Divisions of General Internal Medicine and Pulmonary and Critical Care Medicine (J.P.W.) and Clinical Immunology and Allergy (P.J.B.), Icahn School of Medicine at Mount Sinai, and Montefiore Medical Center, (E.J.), Albert Einstein College of Medicine (M.D.M., S.P.J.) - all in New York; the Center for Clinical Informatics Research and Education, the MetroHealth System, and the Departments of Internal Medicine, Pediatrics, and Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland (D.C.K.); the Department of Internal Medicine, Section of Allergy and Immunology, University of Puerto Rico, San Juan (S.N.); the Division of Allergy and Immunology, University of North Carolina School of Medicine, Chapel Hill (M.L.H.), the Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University School of Medicine, Durham (I.L.R.), and the Department of Family Medicine, Atrium Health, Charlotte (H.T.) - all in North Carolina; the Division of Pulmonary, Allergy, and Critical Care Medicine, Perelman School of Medicine, University of Pennsylvania (A.J.A.), and the Temple Lung Center, Lewis Katz School of Medicine at Temple University (K.S.) - both in Philadelphia; the University of Illinois at Chicago College of Pharmacy, Chicago (P.M.S.); the Section of Pulmonary, Critical Care, and Sleep Medicine, Yale School of Medicine, New Haven, CT (G.C.); and the Division of Pulmonary, Critical Care, and Sleep Medicine, Keck School of Medicine, University of Southern California, Los Angeles (A.B.)
| | - Lilin She
- From the Divisions of Pulmonary and Critical Care Medicine and Allergy and Immunology, Brigham and Women's Hospital, Harvard Medical School (E.I., N.E.M., V.E.F., P.A.H., J.M.K., J.R.L., B.E.), and patient partner (O.T.), Boston, and the Lahey Hospital and Medical Center, Burlington (V.P.P.) - all in Massachusetts; the Division of Allergy and Immunology, Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa (J.-C.C., T.B.C.), the Department of Nursing, University of Miami Health System (M.F.), and Miller School of Medicine, University of Miami (R.A.C.C.), Miami, the Department of Community Health and Family Medicine, University of Florida College of Medicine, Gainesville (K.L.C.), and the University of Central Florida College of Medicine, Orlando (M.P.) - all in Florida; the Department of Family Medicine (J.K.C., W.D.P.) and the Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine (A.L.F.), University of Colorado, Aurora, the Public Leadership Group (G.M.H.), the Department of Medicine, National Jewish Health (M.E.W.), and the Denver Health and Hospital Authority (L.P.H.), Denver - all in Colorado; the American Academy of Family Physicians National Research Network, Leawood, KS (J.K.C., B.K.M., J.B.S.); Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (L.S., F.W.R.); the Department of Family and Community Health, University of Minnesota, Minneapolis (B.P.Y.), and patient partner, St. Paul (S.M.) - both in Minnesota; patient partner, South Jordan, UT (A.D.C.M.); the Division of Adolescent Medicine (T.C.B.) and the Lung Health Center, Department of Medicine, University of Alabama, Birmingham (J.T.); the American Lung Association, Washington, DC (B.M.K.); the Department of Medicine, Johns Hopkins School of Medicine, Baltimore (C.S.R.); patient partner (J.R.), the Divisions of General Internal Medicine and Pulmonary and Critical Care Medicine (J.P.W.) and Clinical Immunology and Allergy (P.J.B.), Icahn School of Medicine at Mount Sinai, and Montefiore Medical Center, (E.J.), Albert Einstein College of Medicine (M.D.M., S.P.J.) - all in New York; the Center for Clinical Informatics Research and Education, the MetroHealth System, and the Departments of Internal Medicine, Pediatrics, and Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland (D.C.K.); the Department of Internal Medicine, Section of Allergy and Immunology, University of Puerto Rico, San Juan (S.N.); the Division of Allergy and Immunology, University of North Carolina School of Medicine, Chapel Hill (M.L.H.), the Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University School of Medicine, Durham (I.L.R.), and the Department of Family Medicine, Atrium Health, Charlotte (H.T.) - all in North Carolina; the Division of Pulmonary, Allergy, and Critical Care Medicine, Perelman School of Medicine, University of Pennsylvania (A.J.A.), and the Temple Lung Center, Lewis Katz School of Medicine at Temple University (K.S.) - both in Philadelphia; the University of Illinois at Chicago College of Pharmacy, Chicago (P.M.S.); the Section of Pulmonary, Critical Care, and Sleep Medicine, Yale School of Medicine, New Haven, CT (G.C.); and the Division of Pulmonary, Critical Care, and Sleep Medicine, Keck School of Medicine, University of Southern California, Los Angeles (A.B.)
| | - Frank W Rockhold
- From the Divisions of Pulmonary and Critical Care Medicine and Allergy and Immunology, Brigham and Women's Hospital, Harvard Medical School (E.I., N.E.M., V.E.F., P.A.H., J.M.K., J.R.L., B.E.), and patient partner (O.T.), Boston, and the Lahey Hospital and Medical Center, Burlington (V.P.P.) - all in Massachusetts; the Division of Allergy and Immunology, Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa (J.-C.C., T.B.C.), the Department of Nursing, University of Miami Health System (M.F.), and Miller School of Medicine, University of Miami (R.A.C.C.), Miami, the Department of Community Health and Family Medicine, University of Florida College of Medicine, Gainesville (K.L.C.), and the University of Central Florida College of Medicine, Orlando (M.P.) - all in Florida; the Department of Family Medicine (J.K.C., W.D.P.) and the Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine (A.L.F.), University of Colorado, Aurora, the Public Leadership Group (G.M.H.), the Department of Medicine, National Jewish Health (M.E.W.), and the Denver Health and Hospital Authority (L.P.H.), Denver - all in Colorado; the American Academy of Family Physicians National Research Network, Leawood, KS (J.K.C., B.K.M., J.B.S.); Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (L.S., F.W.R.); the Department of Family and Community Health, University of Minnesota, Minneapolis (B.P.Y.), and patient partner, St. Paul (S.M.) - both in Minnesota; patient partner, South Jordan, UT (A.D.C.M.); the Division of Adolescent Medicine (T.C.B.) and the Lung Health Center, Department of Medicine, University of Alabama, Birmingham (J.T.); the American Lung Association, Washington, DC (B.M.K.); the Department of Medicine, Johns Hopkins School of Medicine, Baltimore (C.S.R.); patient partner (J.R.), the Divisions of General Internal Medicine and Pulmonary and Critical Care Medicine (J.P.W.) and Clinical Immunology and Allergy (P.J.B.), Icahn School of Medicine at Mount Sinai, and Montefiore Medical Center, (E.J.), Albert Einstein College of Medicine (M.D.M., S.P.J.) - all in New York; the Center for Clinical Informatics Research and Education, the MetroHealth System, and the Departments of Internal Medicine, Pediatrics, and Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland (D.C.K.); the Department of Internal Medicine, Section of Allergy and Immunology, University of Puerto Rico, San Juan (S.N.); the Division of Allergy and Immunology, University of North Carolina School of Medicine, Chapel Hill (M.L.H.), the Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University School of Medicine, Durham (I.L.R.), and the Department of Family Medicine, Atrium Health, Charlotte (H.T.) - all in North Carolina; the Division of Pulmonary, Allergy, and Critical Care Medicine, Perelman School of Medicine, University of Pennsylvania (A.J.A.), and the Temple Lung Center, Lewis Katz School of Medicine at Temple University (K.S.) - both in Philadelphia; the University of Illinois at Chicago College of Pharmacy, Chicago (P.M.S.); the Section of Pulmonary, Critical Care, and Sleep Medicine, Yale School of Medicine, New Haven, CT (G.C.); and the Division of Pulmonary, Critical Care, and Sleep Medicine, Keck School of Medicine, University of Southern California, Los Angeles (A.B.)
| | - Nancy E Maher
- From the Divisions of Pulmonary and Critical Care Medicine and Allergy and Immunology, Brigham and Women's Hospital, Harvard Medical School (E.I., N.E.M., V.E.F., P.A.H., J.M.K., J.R.L., B.E.), and patient partner (O.T.), Boston, and the Lahey Hospital and Medical Center, Burlington (V.P.P.) - all in Massachusetts; the Division of Allergy and Immunology, Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa (J.-C.C., T.B.C.), the Department of Nursing, University of Miami Health System (M.F.), and Miller School of Medicine, University of Miami (R.A.C.C.), Miami, the Department of Community Health and Family Medicine, University of Florida College of Medicine, Gainesville (K.L.C.), and the University of Central Florida College of Medicine, Orlando (M.P.) - all in Florida; the Department of Family Medicine (J.K.C., W.D.P.) and the Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine (A.L.F.), University of Colorado, Aurora, the Public Leadership Group (G.M.H.), the Department of Medicine, National Jewish Health (M.E.W.), and the Denver Health and Hospital Authority (L.P.H.), Denver - all in Colorado; the American Academy of Family Physicians National Research Network, Leawood, KS (J.K.C., B.K.M., J.B.S.); Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (L.S., F.W.R.); the Department of Family and Community Health, University of Minnesota, Minneapolis (B.P.Y.), and patient partner, St. Paul (S.M.) - both in Minnesota; patient partner, South Jordan, UT (A.D.C.M.); the Division of Adolescent Medicine (T.C.B.) and the Lung Health Center, Department of Medicine, University of Alabama, Birmingham (J.T.); the American Lung Association, Washington, DC (B.M.K.); the Department of Medicine, Johns Hopkins School of Medicine, Baltimore (C.S.R.); patient partner (J.R.), the Divisions of General Internal Medicine and Pulmonary and Critical Care Medicine (J.P.W.) and Clinical Immunology and Allergy (P.J.B.), Icahn School of Medicine at Mount Sinai, and Montefiore Medical Center, (E.J.), Albert Einstein College of Medicine (M.D.M., S.P.J.) - all in New York; the Center for Clinical Informatics Research and Education, the MetroHealth System, and the Departments of Internal Medicine, Pediatrics, and Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland (D.C.K.); the Department of Internal Medicine, Section of Allergy and Immunology, University of Puerto Rico, San Juan (S.N.); the Division of Allergy and Immunology, University of North Carolina School of Medicine, Chapel Hill (M.L.H.), the Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University School of Medicine, Durham (I.L.R.), and the Department of Family Medicine, Atrium Health, Charlotte (H.T.) - all in North Carolina; the Division of Pulmonary, Allergy, and Critical Care Medicine, Perelman School of Medicine, University of Pennsylvania (A.J.A.), and the Temple Lung Center, Lewis Katz School of Medicine at Temple University (K.S.) - both in Philadelphia; the University of Illinois at Chicago College of Pharmacy, Chicago (P.M.S.); the Section of Pulmonary, Critical Care, and Sleep Medicine, Yale School of Medicine, New Haven, CT (G.C.); and the Division of Pulmonary, Critical Care, and Sleep Medicine, Keck School of Medicine, University of Southern California, Los Angeles (A.B.)
| | - Maureen Fagan
- From the Divisions of Pulmonary and Critical Care Medicine and Allergy and Immunology, Brigham and Women's Hospital, Harvard Medical School (E.I., N.E.M., V.E.F., P.A.H., J.M.K., J.R.L., B.E.), and patient partner (O.T.), Boston, and the Lahey Hospital and Medical Center, Burlington (V.P.P.) - all in Massachusetts; the Division of Allergy and Immunology, Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa (J.-C.C., T.B.C.), the Department of Nursing, University of Miami Health System (M.F.), and Miller School of Medicine, University of Miami (R.A.C.C.), Miami, the Department of Community Health and Family Medicine, University of Florida College of Medicine, Gainesville (K.L.C.), and the University of Central Florida College of Medicine, Orlando (M.P.) - all in Florida; the Department of Family Medicine (J.K.C., W.D.P.) and the Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine (A.L.F.), University of Colorado, Aurora, the Public Leadership Group (G.M.H.), the Department of Medicine, National Jewish Health (M.E.W.), and the Denver Health and Hospital Authority (L.P.H.), Denver - all in Colorado; the American Academy of Family Physicians National Research Network, Leawood, KS (J.K.C., B.K.M., J.B.S.); Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (L.S., F.W.R.); the Department of Family and Community Health, University of Minnesota, Minneapolis (B.P.Y.), and patient partner, St. Paul (S.M.) - both in Minnesota; patient partner, South Jordan, UT (A.D.C.M.); the Division of Adolescent Medicine (T.C.B.) and the Lung Health Center, Department of Medicine, University of Alabama, Birmingham (J.T.); the American Lung Association, Washington, DC (B.M.K.); the Department of Medicine, Johns Hopkins School of Medicine, Baltimore (C.S.R.); patient partner (J.R.), the Divisions of General Internal Medicine and Pulmonary and Critical Care Medicine (J.P.W.) and Clinical Immunology and Allergy (P.J.B.), Icahn School of Medicine at Mount Sinai, and Montefiore Medical Center, (E.J.), Albert Einstein College of Medicine (M.D.M., S.P.J.) - all in New York; the Center for Clinical Informatics Research and Education, the MetroHealth System, and the Departments of Internal Medicine, Pediatrics, and Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland (D.C.K.); the Department of Internal Medicine, Section of Allergy and Immunology, University of Puerto Rico, San Juan (S.N.); the Division of Allergy and Immunology, University of North Carolina School of Medicine, Chapel Hill (M.L.H.), the Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University School of Medicine, Durham (I.L.R.), and the Department of Family Medicine, Atrium Health, Charlotte (H.T.) - all in North Carolina; the Division of Pulmonary, Allergy, and Critical Care Medicine, Perelman School of Medicine, University of Pennsylvania (A.J.A.), and the Temple Lung Center, Lewis Katz School of Medicine at Temple University (K.S.) - both in Philadelphia; the University of Illinois at Chicago College of Pharmacy, Chicago (P.M.S.); the Section of Pulmonary, Critical Care, and Sleep Medicine, Yale School of Medicine, New Haven, CT (G.C.); and the Division of Pulmonary, Critical Care, and Sleep Medicine, Keck School of Medicine, University of Southern California, Los Angeles (A.B.)
| | - Victoria E Forth
- From the Divisions of Pulmonary and Critical Care Medicine and Allergy and Immunology, Brigham and Women's Hospital, Harvard Medical School (E.I., N.E.M., V.E.F., P.A.H., J.M.K., J.R.L., B.E.), and patient partner (O.T.), Boston, and the Lahey Hospital and Medical Center, Burlington (V.P.P.) - all in Massachusetts; the Division of Allergy and Immunology, Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa (J.-C.C., T.B.C.), the Department of Nursing, University of Miami Health System (M.F.), and Miller School of Medicine, University of Miami (R.A.C.C.), Miami, the Department of Community Health and Family Medicine, University of Florida College of Medicine, Gainesville (K.L.C.), and the University of Central Florida College of Medicine, Orlando (M.P.) - all in Florida; the Department of Family Medicine (J.K.C., W.D.P.) and the Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine (A.L.F.), University of Colorado, Aurora, the Public Leadership Group (G.M.H.), the Department of Medicine, National Jewish Health (M.E.W.), and the Denver Health and Hospital Authority (L.P.H.), Denver - all in Colorado; the American Academy of Family Physicians National Research Network, Leawood, KS (J.K.C., B.K.M., J.B.S.); Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (L.S., F.W.R.); the Department of Family and Community Health, University of Minnesota, Minneapolis (B.P.Y.), and patient partner, St. Paul (S.M.) - both in Minnesota; patient partner, South Jordan, UT (A.D.C.M.); the Division of Adolescent Medicine (T.C.B.) and the Lung Health Center, Department of Medicine, University of Alabama, Birmingham (J.T.); the American Lung Association, Washington, DC (B.M.K.); the Department of Medicine, Johns Hopkins School of Medicine, Baltimore (C.S.R.); patient partner (J.R.), the Divisions of General Internal Medicine and Pulmonary and Critical Care Medicine (J.P.W.) and Clinical Immunology and Allergy (P.J.B.), Icahn School of Medicine at Mount Sinai, and Montefiore Medical Center, (E.J.), Albert Einstein College of Medicine (M.D.M., S.P.J.) - all in New York; the Center for Clinical Informatics Research and Education, the MetroHealth System, and the Departments of Internal Medicine, Pediatrics, and Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland (D.C.K.); the Department of Internal Medicine, Section of Allergy and Immunology, University of Puerto Rico, San Juan (S.N.); the Division of Allergy and Immunology, University of North Carolina School of Medicine, Chapel Hill (M.L.H.), the Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University School of Medicine, Durham (I.L.R.), and the Department of Family Medicine, Atrium Health, Charlotte (H.T.) - all in North Carolina; the Division of Pulmonary, Allergy, and Critical Care Medicine, Perelman School of Medicine, University of Pennsylvania (A.J.A.), and the Temple Lung Center, Lewis Katz School of Medicine at Temple University (K.S.) - both in Philadelphia; the University of Illinois at Chicago College of Pharmacy, Chicago (P.M.S.); the Section of Pulmonary, Critical Care, and Sleep Medicine, Yale School of Medicine, New Haven, CT (G.C.); and the Division of Pulmonary, Critical Care, and Sleep Medicine, Keck School of Medicine, University of Southern California, Los Angeles (A.B.)
| | - Barbara P Yawn
- From the Divisions of Pulmonary and Critical Care Medicine and Allergy and Immunology, Brigham and Women's Hospital, Harvard Medical School (E.I., N.E.M., V.E.F., P.A.H., J.M.K., J.R.L., B.E.), and patient partner (O.T.), Boston, and the Lahey Hospital and Medical Center, Burlington (V.P.P.) - all in Massachusetts; the Division of Allergy and Immunology, Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa (J.-C.C., T.B.C.), the Department of Nursing, University of Miami Health System (M.F.), and Miller School of Medicine, University of Miami (R.A.C.C.), Miami, the Department of Community Health and Family Medicine, University of Florida College of Medicine, Gainesville (K.L.C.), and the University of Central Florida College of Medicine, Orlando (M.P.) - all in Florida; the Department of Family Medicine (J.K.C., W.D.P.) and the Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine (A.L.F.), University of Colorado, Aurora, the Public Leadership Group (G.M.H.), the Department of Medicine, National Jewish Health (M.E.W.), and the Denver Health and Hospital Authority (L.P.H.), Denver - all in Colorado; the American Academy of Family Physicians National Research Network, Leawood, KS (J.K.C., B.K.M., J.B.S.); Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (L.S., F.W.R.); the Department of Family and Community Health, University of Minnesota, Minneapolis (B.P.Y.), and patient partner, St. Paul (S.M.) - both in Minnesota; patient partner, South Jordan, UT (A.D.C.M.); the Division of Adolescent Medicine (T.C.B.) and the Lung Health Center, Department of Medicine, University of Alabama, Birmingham (J.T.); the American Lung Association, Washington, DC (B.M.K.); the Department of Medicine, Johns Hopkins School of Medicine, Baltimore (C.S.R.); patient partner (J.R.), the Divisions of General Internal Medicine and Pulmonary and Critical Care Medicine (J.P.W.) and Clinical Immunology and Allergy (P.J.B.), Icahn School of Medicine at Mount Sinai, and Montefiore Medical Center, (E.J.), Albert Einstein College of Medicine (M.D.M., S.P.J.) - all in New York; the Center for Clinical Informatics Research and Education, the MetroHealth System, and the Departments of Internal Medicine, Pediatrics, and Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland (D.C.K.); the Department of Internal Medicine, Section of Allergy and Immunology, University of Puerto Rico, San Juan (S.N.); the Division of Allergy and Immunology, University of North Carolina School of Medicine, Chapel Hill (M.L.H.), the Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University School of Medicine, Durham (I.L.R.), and the Department of Family Medicine, Atrium Health, Charlotte (H.T.) - all in North Carolina; the Division of Pulmonary, Allergy, and Critical Care Medicine, Perelman School of Medicine, University of Pennsylvania (A.J.A.), and the Temple Lung Center, Lewis Katz School of Medicine at Temple University (K.S.) - both in Philadelphia; the University of Illinois at Chicago College of Pharmacy, Chicago (P.M.S.); the Section of Pulmonary, Critical Care, and Sleep Medicine, Yale School of Medicine, New Haven, CT (G.C.); and the Division of Pulmonary, Critical Care, and Sleep Medicine, Keck School of Medicine, University of Southern California, Los Angeles (A.B.)
| | - Paulina Arias Hernandez
- From the Divisions of Pulmonary and Critical Care Medicine and Allergy and Immunology, Brigham and Women's Hospital, Harvard Medical School (E.I., N.E.M., V.E.F., P.A.H., J.M.K., J.R.L., B.E.), and patient partner (O.T.), Boston, and the Lahey Hospital and Medical Center, Burlington (V.P.P.) - all in Massachusetts; the Division of Allergy and Immunology, Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa (J.-C.C., T.B.C.), the Department of Nursing, University of Miami Health System (M.F.), and Miller School of Medicine, University of Miami (R.A.C.C.), Miami, the Department of Community Health and Family Medicine, University of Florida College of Medicine, Gainesville (K.L.C.), and the University of Central Florida College of Medicine, Orlando (M.P.) - all in Florida; the Department of Family Medicine (J.K.C., W.D.P.) and the Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine (A.L.F.), University of Colorado, Aurora, the Public Leadership Group (G.M.H.), the Department of Medicine, National Jewish Health (M.E.W.), and the Denver Health and Hospital Authority (L.P.H.), Denver - all in Colorado; the American Academy of Family Physicians National Research Network, Leawood, KS (J.K.C., B.K.M., J.B.S.); Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (L.S., F.W.R.); the Department of Family and Community Health, University of Minnesota, Minneapolis (B.P.Y.), and patient partner, St. Paul (S.M.) - both in Minnesota; patient partner, South Jordan, UT (A.D.C.M.); the Division of Adolescent Medicine (T.C.B.) and the Lung Health Center, Department of Medicine, University of Alabama, Birmingham (J.T.); the American Lung Association, Washington, DC (B.M.K.); the Department of Medicine, Johns Hopkins School of Medicine, Baltimore (C.S.R.); patient partner (J.R.), the Divisions of General Internal Medicine and Pulmonary and Critical Care Medicine (J.P.W.) and Clinical Immunology and Allergy (P.J.B.), Icahn School of Medicine at Mount Sinai, and Montefiore Medical Center, (E.J.), Albert Einstein College of Medicine (M.D.M., S.P.J.) - all in New York; the Center for Clinical Informatics Research and Education, the MetroHealth System, and the Departments of Internal Medicine, Pediatrics, and Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland (D.C.K.); the Department of Internal Medicine, Section of Allergy and Immunology, University of Puerto Rico, San Juan (S.N.); the Division of Allergy and Immunology, University of North Carolina School of Medicine, Chapel Hill (M.L.H.), the Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University School of Medicine, Durham (I.L.R.), and the Department of Family Medicine, Atrium Health, Charlotte (H.T.) - all in North Carolina; the Division of Pulmonary, Allergy, and Critical Care Medicine, Perelman School of Medicine, University of Pennsylvania (A.J.A.), and the Temple Lung Center, Lewis Katz School of Medicine at Temple University (K.S.) - both in Philadelphia; the University of Illinois at Chicago College of Pharmacy, Chicago (P.M.S.); the Section of Pulmonary, Critical Care, and Sleep Medicine, Yale School of Medicine, New Haven, CT (G.C.); and the Division of Pulmonary, Critical Care, and Sleep Medicine, Keck School of Medicine, University of Southern California, Los Angeles (A.B.)
| | - Jean M Kruse
- From the Divisions of Pulmonary and Critical Care Medicine and Allergy and Immunology, Brigham and Women's Hospital, Harvard Medical School (E.I., N.E.M., V.E.F., P.A.H., J.M.K., J.R.L., B.E.), and patient partner (O.T.), Boston, and the Lahey Hospital and Medical Center, Burlington (V.P.P.) - all in Massachusetts; the Division of Allergy and Immunology, Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa (J.-C.C., T.B.C.), the Department of Nursing, University of Miami Health System (M.F.), and Miller School of Medicine, University of Miami (R.A.C.C.), Miami, the Department of Community Health and Family Medicine, University of Florida College of Medicine, Gainesville (K.L.C.), and the University of Central Florida College of Medicine, Orlando (M.P.) - all in Florida; the Department of Family Medicine (J.K.C., W.D.P.) and the Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine (A.L.F.), University of Colorado, Aurora, the Public Leadership Group (G.M.H.), the Department of Medicine, National Jewish Health (M.E.W.), and the Denver Health and Hospital Authority (L.P.H.), Denver - all in Colorado; the American Academy of Family Physicians National Research Network, Leawood, KS (J.K.C., B.K.M., J.B.S.); Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (L.S., F.W.R.); the Department of Family and Community Health, University of Minnesota, Minneapolis (B.P.Y.), and patient partner, St. Paul (S.M.) - both in Minnesota; patient partner, South Jordan, UT (A.D.C.M.); the Division of Adolescent Medicine (T.C.B.) and the Lung Health Center, Department of Medicine, University of Alabama, Birmingham (J.T.); the American Lung Association, Washington, DC (B.M.K.); the Department of Medicine, Johns Hopkins School of Medicine, Baltimore (C.S.R.); patient partner (J.R.), the Divisions of General Internal Medicine and Pulmonary and Critical Care Medicine (J.P.W.) and Clinical Immunology and Allergy (P.J.B.), Icahn School of Medicine at Mount Sinai, and Montefiore Medical Center, (E.J.), Albert Einstein College of Medicine (M.D.M., S.P.J.) - all in New York; the Center for Clinical Informatics Research and Education, the MetroHealth System, and the Departments of Internal Medicine, Pediatrics, and Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland (D.C.K.); the Department of Internal Medicine, Section of Allergy and Immunology, University of Puerto Rico, San Juan (S.N.); the Division of Allergy and Immunology, University of North Carolina School of Medicine, Chapel Hill (M.L.H.), the Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University School of Medicine, Durham (I.L.R.), and the Department of Family Medicine, Atrium Health, Charlotte (H.T.) - all in North Carolina; the Division of Pulmonary, Allergy, and Critical Care Medicine, Perelman School of Medicine, University of Pennsylvania (A.J.A.), and the Temple Lung Center, Lewis Katz School of Medicine at Temple University (K.S.) - both in Philadelphia; the University of Illinois at Chicago College of Pharmacy, Chicago (P.M.S.); the Section of Pulmonary, Critical Care, and Sleep Medicine, Yale School of Medicine, New Haven, CT (G.C.); and the Division of Pulmonary, Critical Care, and Sleep Medicine, Keck School of Medicine, University of Southern California, Los Angeles (A.B.)
| | - Brian K Manning
- From the Divisions of Pulmonary and Critical Care Medicine and Allergy and Immunology, Brigham and Women's Hospital, Harvard Medical School (E.I., N.E.M., V.E.F., P.A.H., J.M.K., J.R.L., B.E.), and patient partner (O.T.), Boston, and the Lahey Hospital and Medical Center, Burlington (V.P.P.) - all in Massachusetts; the Division of Allergy and Immunology, Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa (J.-C.C., T.B.C.), the Department of Nursing, University of Miami Health System (M.F.), and Miller School of Medicine, University of Miami (R.A.C.C.), Miami, the Department of Community Health and Family Medicine, University of Florida College of Medicine, Gainesville (K.L.C.), and the University of Central Florida College of Medicine, Orlando (M.P.) - all in Florida; the Department of Family Medicine (J.K.C., W.D.P.) and the Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine (A.L.F.), University of Colorado, Aurora, the Public Leadership Group (G.M.H.), the Department of Medicine, National Jewish Health (M.E.W.), and the Denver Health and Hospital Authority (L.P.H.), Denver - all in Colorado; the American Academy of Family Physicians National Research Network, Leawood, KS (J.K.C., B.K.M., J.B.S.); Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (L.S., F.W.R.); the Department of Family and Community Health, University of Minnesota, Minneapolis (B.P.Y.), and patient partner, St. Paul (S.M.) - both in Minnesota; patient partner, South Jordan, UT (A.D.C.M.); the Division of Adolescent Medicine (T.C.B.) and the Lung Health Center, Department of Medicine, University of Alabama, Birmingham (J.T.); the American Lung Association, Washington, DC (B.M.K.); the Department of Medicine, Johns Hopkins School of Medicine, Baltimore (C.S.R.); patient partner (J.R.), the Divisions of General Internal Medicine and Pulmonary and Critical Care Medicine (J.P.W.) and Clinical Immunology and Allergy (P.J.B.), Icahn School of Medicine at Mount Sinai, and Montefiore Medical Center, (E.J.), Albert Einstein College of Medicine (M.D.M., S.P.J.) - all in New York; the Center for Clinical Informatics Research and Education, the MetroHealth System, and the Departments of Internal Medicine, Pediatrics, and Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland (D.C.K.); the Department of Internal Medicine, Section of Allergy and Immunology, University of Puerto Rico, San Juan (S.N.); the Division of Allergy and Immunology, University of North Carolina School of Medicine, Chapel Hill (M.L.H.), the Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University School of Medicine, Durham (I.L.R.), and the Department of Family Medicine, Atrium Health, Charlotte (H.T.) - all in North Carolina; the Division of Pulmonary, Allergy, and Critical Care Medicine, Perelman School of Medicine, University of Pennsylvania (A.J.A.), and the Temple Lung Center, Lewis Katz School of Medicine at Temple University (K.S.) - both in Philadelphia; the University of Illinois at Chicago College of Pharmacy, Chicago (P.M.S.); the Section of Pulmonary, Critical Care, and Sleep Medicine, Yale School of Medicine, New Haven, CT (G.C.); and the Division of Pulmonary, Critical Care, and Sleep Medicine, Keck School of Medicine, University of Southern California, Los Angeles (A.B.)
| | - Jacqueline Rodriguez-Louis
- From the Divisions of Pulmonary and Critical Care Medicine and Allergy and Immunology, Brigham and Women's Hospital, Harvard Medical School (E.I., N.E.M., V.E.F., P.A.H., J.M.K., J.R.L., B.E.), and patient partner (O.T.), Boston, and the Lahey Hospital and Medical Center, Burlington (V.P.P.) - all in Massachusetts; the Division of Allergy and Immunology, Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa (J.-C.C., T.B.C.), the Department of Nursing, University of Miami Health System (M.F.), and Miller School of Medicine, University of Miami (R.A.C.C.), Miami, the Department of Community Health and Family Medicine, University of Florida College of Medicine, Gainesville (K.L.C.), and the University of Central Florida College of Medicine, Orlando (M.P.) - all in Florida; the Department of Family Medicine (J.K.C., W.D.P.) and the Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine (A.L.F.), University of Colorado, Aurora, the Public Leadership Group (G.M.H.), the Department of Medicine, National Jewish Health (M.E.W.), and the Denver Health and Hospital Authority (L.P.H.), Denver - all in Colorado; the American Academy of Family Physicians National Research Network, Leawood, KS (J.K.C., B.K.M., J.B.S.); Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (L.S., F.W.R.); the Department of Family and Community Health, University of Minnesota, Minneapolis (B.P.Y.), and patient partner, St. Paul (S.M.) - both in Minnesota; patient partner, South Jordan, UT (A.D.C.M.); the Division of Adolescent Medicine (T.C.B.) and the Lung Health Center, Department of Medicine, University of Alabama, Birmingham (J.T.); the American Lung Association, Washington, DC (B.M.K.); the Department of Medicine, Johns Hopkins School of Medicine, Baltimore (C.S.R.); patient partner (J.R.), the Divisions of General Internal Medicine and Pulmonary and Critical Care Medicine (J.P.W.) and Clinical Immunology and Allergy (P.J.B.), Icahn School of Medicine at Mount Sinai, and Montefiore Medical Center, (E.J.), Albert Einstein College of Medicine (M.D.M., S.P.J.) - all in New York; the Center for Clinical Informatics Research and Education, the MetroHealth System, and the Departments of Internal Medicine, Pediatrics, and Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland (D.C.K.); the Department of Internal Medicine, Section of Allergy and Immunology, University of Puerto Rico, San Juan (S.N.); the Division of Allergy and Immunology, University of North Carolina School of Medicine, Chapel Hill (M.L.H.), the Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University School of Medicine, Durham (I.L.R.), and the Department of Family Medicine, Atrium Health, Charlotte (H.T.) - all in North Carolina; the Division of Pulmonary, Allergy, and Critical Care Medicine, Perelman School of Medicine, University of Pennsylvania (A.J.A.), and the Temple Lung Center, Lewis Katz School of Medicine at Temple University (K.S.) - both in Philadelphia; the University of Illinois at Chicago College of Pharmacy, Chicago (P.M.S.); the Section of Pulmonary, Critical Care, and Sleep Medicine, Yale School of Medicine, New Haven, CT (G.C.); and the Division of Pulmonary, Critical Care, and Sleep Medicine, Keck School of Medicine, University of Southern California, Los Angeles (A.B.)
| | - Joel B Shields
- From the Divisions of Pulmonary and Critical Care Medicine and Allergy and Immunology, Brigham and Women's Hospital, Harvard Medical School (E.I., N.E.M., V.E.F., P.A.H., J.M.K., J.R.L., B.E.), and patient partner (O.T.), Boston, and the Lahey Hospital and Medical Center, Burlington (V.P.P.) - all in Massachusetts; the Division of Allergy and Immunology, Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa (J.-C.C., T.B.C.), the Department of Nursing, University of Miami Health System (M.F.), and Miller School of Medicine, University of Miami (R.A.C.C.), Miami, the Department of Community Health and Family Medicine, University of Florida College of Medicine, Gainesville (K.L.C.), and the University of Central Florida College of Medicine, Orlando (M.P.) - all in Florida; the Department of Family Medicine (J.K.C., W.D.P.) and the Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine (A.L.F.), University of Colorado, Aurora, the Public Leadership Group (G.M.H.), the Department of Medicine, National Jewish Health (M.E.W.), and the Denver Health and Hospital Authority (L.P.H.), Denver - all in Colorado; the American Academy of Family Physicians National Research Network, Leawood, KS (J.K.C., B.K.M., J.B.S.); Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (L.S., F.W.R.); the Department of Family and Community Health, University of Minnesota, Minneapolis (B.P.Y.), and patient partner, St. Paul (S.M.) - both in Minnesota; patient partner, South Jordan, UT (A.D.C.M.); the Division of Adolescent Medicine (T.C.B.) and the Lung Health Center, Department of Medicine, University of Alabama, Birmingham (J.T.); the American Lung Association, Washington, DC (B.M.K.); the Department of Medicine, Johns Hopkins School of Medicine, Baltimore (C.S.R.); patient partner (J.R.), the Divisions of General Internal Medicine and Pulmonary and Critical Care Medicine (J.P.W.) and Clinical Immunology and Allergy (P.J.B.), Icahn School of Medicine at Mount Sinai, and Montefiore Medical Center, (E.J.), Albert Einstein College of Medicine (M.D.M., S.P.J.) - all in New York; the Center for Clinical Informatics Research and Education, the MetroHealth System, and the Departments of Internal Medicine, Pediatrics, and Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland (D.C.K.); the Department of Internal Medicine, Section of Allergy and Immunology, University of Puerto Rico, San Juan (S.N.); the Division of Allergy and Immunology, University of North Carolina School of Medicine, Chapel Hill (M.L.H.), the Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University School of Medicine, Durham (I.L.R.), and the Department of Family Medicine, Atrium Health, Charlotte (H.T.) - all in North Carolina; the Division of Pulmonary, Allergy, and Critical Care Medicine, Perelman School of Medicine, University of Pennsylvania (A.J.A.), and the Temple Lung Center, Lewis Katz School of Medicine at Temple University (K.S.) - both in Philadelphia; the University of Illinois at Chicago College of Pharmacy, Chicago (P.M.S.); the Section of Pulmonary, Critical Care, and Sleep Medicine, Yale School of Medicine, New Haven, CT (G.C.); and the Division of Pulmonary, Critical Care, and Sleep Medicine, Keck School of Medicine, University of Southern California, Los Angeles (A.B.)
| | - Brianna Ericson
- From the Divisions of Pulmonary and Critical Care Medicine and Allergy and Immunology, Brigham and Women's Hospital, Harvard Medical School (E.I., N.E.M., V.E.F., P.A.H., J.M.K., J.R.L., B.E.), and patient partner (O.T.), Boston, and the Lahey Hospital and Medical Center, Burlington (V.P.P.) - all in Massachusetts; the Division of Allergy and Immunology, Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa (J.-C.C., T.B.C.), the Department of Nursing, University of Miami Health System (M.F.), and Miller School of Medicine, University of Miami (R.A.C.C.), Miami, the Department of Community Health and Family Medicine, University of Florida College of Medicine, Gainesville (K.L.C.), and the University of Central Florida College of Medicine, Orlando (M.P.) - all in Florida; the Department of Family Medicine (J.K.C., W.D.P.) and the Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine (A.L.F.), University of Colorado, Aurora, the Public Leadership Group (G.M.H.), the Department of Medicine, National Jewish Health (M.E.W.), and the Denver Health and Hospital Authority (L.P.H.), Denver - all in Colorado; the American Academy of Family Physicians National Research Network, Leawood, KS (J.K.C., B.K.M., J.B.S.); Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (L.S., F.W.R.); the Department of Family and Community Health, University of Minnesota, Minneapolis (B.P.Y.), and patient partner, St. Paul (S.M.) - both in Minnesota; patient partner, South Jordan, UT (A.D.C.M.); the Division of Adolescent Medicine (T.C.B.) and the Lung Health Center, Department of Medicine, University of Alabama, Birmingham (J.T.); the American Lung Association, Washington, DC (B.M.K.); the Department of Medicine, Johns Hopkins School of Medicine, Baltimore (C.S.R.); patient partner (J.R.), the Divisions of General Internal Medicine and Pulmonary and Critical Care Medicine (J.P.W.) and Clinical Immunology and Allergy (P.J.B.), Icahn School of Medicine at Mount Sinai, and Montefiore Medical Center, (E.J.), Albert Einstein College of Medicine (M.D.M., S.P.J.) - all in New York; the Center for Clinical Informatics Research and Education, the MetroHealth System, and the Departments of Internal Medicine, Pediatrics, and Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland (D.C.K.); the Department of Internal Medicine, Section of Allergy and Immunology, University of Puerto Rico, San Juan (S.N.); the Division of Allergy and Immunology, University of North Carolina School of Medicine, Chapel Hill (M.L.H.), the Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University School of Medicine, Durham (I.L.R.), and the Department of Family Medicine, Atrium Health, Charlotte (H.T.) - all in North Carolina; the Division of Pulmonary, Allergy, and Critical Care Medicine, Perelman School of Medicine, University of Pennsylvania (A.J.A.), and the Temple Lung Center, Lewis Katz School of Medicine at Temple University (K.S.) - both in Philadelphia; the University of Illinois at Chicago College of Pharmacy, Chicago (P.M.S.); the Section of Pulmonary, Critical Care, and Sleep Medicine, Yale School of Medicine, New Haven, CT (G.C.); and the Division of Pulmonary, Critical Care, and Sleep Medicine, Keck School of Medicine, University of Southern California, Los Angeles (A.B.)
| | - Alex D Colon-Moya
- From the Divisions of Pulmonary and Critical Care Medicine and Allergy and Immunology, Brigham and Women's Hospital, Harvard Medical School (E.I., N.E.M., V.E.F., P.A.H., J.M.K., J.R.L., B.E.), and patient partner (O.T.), Boston, and the Lahey Hospital and Medical Center, Burlington (V.P.P.) - all in Massachusetts; the Division of Allergy and Immunology, Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa (J.-C.C., T.B.C.), the Department of Nursing, University of Miami Health System (M.F.), and Miller School of Medicine, University of Miami (R.A.C.C.), Miami, the Department of Community Health and Family Medicine, University of Florida College of Medicine, Gainesville (K.L.C.), and the University of Central Florida College of Medicine, Orlando (M.P.) - all in Florida; the Department of Family Medicine (J.K.C., W.D.P.) and the Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine (A.L.F.), University of Colorado, Aurora, the Public Leadership Group (G.M.H.), the Department of Medicine, National Jewish Health (M.E.W.), and the Denver Health and Hospital Authority (L.P.H.), Denver - all in Colorado; the American Academy of Family Physicians National Research Network, Leawood, KS (J.K.C., B.K.M., J.B.S.); Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (L.S., F.W.R.); the Department of Family and Community Health, University of Minnesota, Minneapolis (B.P.Y.), and patient partner, St. Paul (S.M.) - both in Minnesota; patient partner, South Jordan, UT (A.D.C.M.); the Division of Adolescent Medicine (T.C.B.) and the Lung Health Center, Department of Medicine, University of Alabama, Birmingham (J.T.); the American Lung Association, Washington, DC (B.M.K.); the Department of Medicine, Johns Hopkins School of Medicine, Baltimore (C.S.R.); patient partner (J.R.), the Divisions of General Internal Medicine and Pulmonary and Critical Care Medicine (J.P.W.) and Clinical Immunology and Allergy (P.J.B.), Icahn School of Medicine at Mount Sinai, and Montefiore Medical Center, (E.J.), Albert Einstein College of Medicine (M.D.M., S.P.J.) - all in New York; the Center for Clinical Informatics Research and Education, the MetroHealth System, and the Departments of Internal Medicine, Pediatrics, and Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland (D.C.K.); the Department of Internal Medicine, Section of Allergy and Immunology, University of Puerto Rico, San Juan (S.N.); the Division of Allergy and Immunology, University of North Carolina School of Medicine, Chapel Hill (M.L.H.), the Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University School of Medicine, Durham (I.L.R.), and the Department of Family Medicine, Atrium Health, Charlotte (H.T.) - all in North Carolina; the Division of Pulmonary, Allergy, and Critical Care Medicine, Perelman School of Medicine, University of Pennsylvania (A.J.A.), and the Temple Lung Center, Lewis Katz School of Medicine at Temple University (K.S.) - both in Philadelphia; the University of Illinois at Chicago College of Pharmacy, Chicago (P.M.S.); the Section of Pulmonary, Critical Care, and Sleep Medicine, Yale School of Medicine, New Haven, CT (G.C.); and the Division of Pulmonary, Critical Care, and Sleep Medicine, Keck School of Medicine, University of Southern California, Los Angeles (A.B.)
| | - Suzanne Madison
- From the Divisions of Pulmonary and Critical Care Medicine and Allergy and Immunology, Brigham and Women's Hospital, Harvard Medical School (E.I., N.E.M., V.E.F., P.A.H., J.M.K., J.R.L., B.E.), and patient partner (O.T.), Boston, and the Lahey Hospital and Medical Center, Burlington (V.P.P.) - all in Massachusetts; the Division of Allergy and Immunology, Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa (J.-C.C., T.B.C.), the Department of Nursing, University of Miami Health System (M.F.), and Miller School of Medicine, University of Miami (R.A.C.C.), Miami, the Department of Community Health and Family Medicine, University of Florida College of Medicine, Gainesville (K.L.C.), and the University of Central Florida College of Medicine, Orlando (M.P.) - all in Florida; the Department of Family Medicine (J.K.C., W.D.P.) and the Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine (A.L.F.), University of Colorado, Aurora, the Public Leadership Group (G.M.H.), the Department of Medicine, National Jewish Health (M.E.W.), and the Denver Health and Hospital Authority (L.P.H.), Denver - all in Colorado; the American Academy of Family Physicians National Research Network, Leawood, KS (J.K.C., B.K.M., J.B.S.); Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (L.S., F.W.R.); the Department of Family and Community Health, University of Minnesota, Minneapolis (B.P.Y.), and patient partner, St. Paul (S.M.) - both in Minnesota; patient partner, South Jordan, UT (A.D.C.M.); the Division of Adolescent Medicine (T.C.B.) and the Lung Health Center, Department of Medicine, University of Alabama, Birmingham (J.T.); the American Lung Association, Washington, DC (B.M.K.); the Department of Medicine, Johns Hopkins School of Medicine, Baltimore (C.S.R.); patient partner (J.R.), the Divisions of General Internal Medicine and Pulmonary and Critical Care Medicine (J.P.W.) and Clinical Immunology and Allergy (P.J.B.), Icahn School of Medicine at Mount Sinai, and Montefiore Medical Center, (E.J.), Albert Einstein College of Medicine (M.D.M., S.P.J.) - all in New York; the Center for Clinical Informatics Research and Education, the MetroHealth System, and the Departments of Internal Medicine, Pediatrics, and Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland (D.C.K.); the Department of Internal Medicine, Section of Allergy and Immunology, University of Puerto Rico, San Juan (S.N.); the Division of Allergy and Immunology, University of North Carolina School of Medicine, Chapel Hill (M.L.H.), the Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University School of Medicine, Durham (I.L.R.), and the Department of Family Medicine, Atrium Health, Charlotte (H.T.) - all in North Carolina; the Division of Pulmonary, Allergy, and Critical Care Medicine, Perelman School of Medicine, University of Pennsylvania (A.J.A.), and the Temple Lung Center, Lewis Katz School of Medicine at Temple University (K.S.) - both in Philadelphia; the University of Illinois at Chicago College of Pharmacy, Chicago (P.M.S.); the Section of Pulmonary, Critical Care, and Sleep Medicine, Yale School of Medicine, New Haven, CT (G.C.); and the Division of Pulmonary, Critical Care, and Sleep Medicine, Keck School of Medicine, University of Southern California, Los Angeles (A.B.)
| | - Tamera Coyne-Beasley
- From the Divisions of Pulmonary and Critical Care Medicine and Allergy and Immunology, Brigham and Women's Hospital, Harvard Medical School (E.I., N.E.M., V.E.F., P.A.H., J.M.K., J.R.L., B.E.), and patient partner (O.T.), Boston, and the Lahey Hospital and Medical Center, Burlington (V.P.P.) - all in Massachusetts; the Division of Allergy and Immunology, Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa (J.-C.C., T.B.C.), the Department of Nursing, University of Miami Health System (M.F.), and Miller School of Medicine, University of Miami (R.A.C.C.), Miami, the Department of Community Health and Family Medicine, University of Florida College of Medicine, Gainesville (K.L.C.), and the University of Central Florida College of Medicine, Orlando (M.P.) - all in Florida; the Department of Family Medicine (J.K.C., W.D.P.) and the Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine (A.L.F.), University of Colorado, Aurora, the Public Leadership Group (G.M.H.), the Department of Medicine, National Jewish Health (M.E.W.), and the Denver Health and Hospital Authority (L.P.H.), Denver - all in Colorado; the American Academy of Family Physicians National Research Network, Leawood, KS (J.K.C., B.K.M., J.B.S.); Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (L.S., F.W.R.); the Department of Family and Community Health, University of Minnesota, Minneapolis (B.P.Y.), and patient partner, St. Paul (S.M.) - both in Minnesota; patient partner, South Jordan, UT (A.D.C.M.); the Division of Adolescent Medicine (T.C.B.) and the Lung Health Center, Department of Medicine, University of Alabama, Birmingham (J.T.); the American Lung Association, Washington, DC (B.M.K.); the Department of Medicine, Johns Hopkins School of Medicine, Baltimore (C.S.R.); patient partner (J.R.), the Divisions of General Internal Medicine and Pulmonary and Critical Care Medicine (J.P.W.) and Clinical Immunology and Allergy (P.J.B.), Icahn School of Medicine at Mount Sinai, and Montefiore Medical Center, (E.J.), Albert Einstein College of Medicine (M.D.M., S.P.J.) - all in New York; the Center for Clinical Informatics Research and Education, the MetroHealth System, and the Departments of Internal Medicine, Pediatrics, and Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland (D.C.K.); the Department of Internal Medicine, Section of Allergy and Immunology, University of Puerto Rico, San Juan (S.N.); the Division of Allergy and Immunology, University of North Carolina School of Medicine, Chapel Hill (M.L.H.), the Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University School of Medicine, Durham (I.L.R.), and the Department of Family Medicine, Atrium Health, Charlotte (H.T.) - all in North Carolina; the Division of Pulmonary, Allergy, and Critical Care Medicine, Perelman School of Medicine, University of Pennsylvania (A.J.A.), and the Temple Lung Center, Lewis Katz School of Medicine at Temple University (K.S.) - both in Philadelphia; the University of Illinois at Chicago College of Pharmacy, Chicago (P.M.S.); the Section of Pulmonary, Critical Care, and Sleep Medicine, Yale School of Medicine, New Haven, CT (G.C.); and the Division of Pulmonary, Critical Care, and Sleep Medicine, Keck School of Medicine, University of Southern California, Los Angeles (A.B.)
| | - Gretchen M Hammer
- From the Divisions of Pulmonary and Critical Care Medicine and Allergy and Immunology, Brigham and Women's Hospital, Harvard Medical School (E.I., N.E.M., V.E.F., P.A.H., J.M.K., J.R.L., B.E.), and patient partner (O.T.), Boston, and the Lahey Hospital and Medical Center, Burlington (V.P.P.) - all in Massachusetts; the Division of Allergy and Immunology, Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa (J.-C.C., T.B.C.), the Department of Nursing, University of Miami Health System (M.F.), and Miller School of Medicine, University of Miami (R.A.C.C.), Miami, the Department of Community Health and Family Medicine, University of Florida College of Medicine, Gainesville (K.L.C.), and the University of Central Florida College of Medicine, Orlando (M.P.) - all in Florida; the Department of Family Medicine (J.K.C., W.D.P.) and the Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine (A.L.F.), University of Colorado, Aurora, the Public Leadership Group (G.M.H.), the Department of Medicine, National Jewish Health (M.E.W.), and the Denver Health and Hospital Authority (L.P.H.), Denver - all in Colorado; the American Academy of Family Physicians National Research Network, Leawood, KS (J.K.C., B.K.M., J.B.S.); Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (L.S., F.W.R.); the Department of Family and Community Health, University of Minnesota, Minneapolis (B.P.Y.), and patient partner, St. Paul (S.M.) - both in Minnesota; patient partner, South Jordan, UT (A.D.C.M.); the Division of Adolescent Medicine (T.C.B.) and the Lung Health Center, Department of Medicine, University of Alabama, Birmingham (J.T.); the American Lung Association, Washington, DC (B.M.K.); the Department of Medicine, Johns Hopkins School of Medicine, Baltimore (C.S.R.); patient partner (J.R.), the Divisions of General Internal Medicine and Pulmonary and Critical Care Medicine (J.P.W.) and Clinical Immunology and Allergy (P.J.B.), Icahn School of Medicine at Mount Sinai, and Montefiore Medical Center, (E.J.), Albert Einstein College of Medicine (M.D.M., S.P.J.) - all in New York; the Center for Clinical Informatics Research and Education, the MetroHealth System, and the Departments of Internal Medicine, Pediatrics, and Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland (D.C.K.); the Department of Internal Medicine, Section of Allergy and Immunology, University of Puerto Rico, San Juan (S.N.); the Division of Allergy and Immunology, University of North Carolina School of Medicine, Chapel Hill (M.L.H.), the Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University School of Medicine, Durham (I.L.R.), and the Department of Family Medicine, Atrium Health, Charlotte (H.T.) - all in North Carolina; the Division of Pulmonary, Allergy, and Critical Care Medicine, Perelman School of Medicine, University of Pennsylvania (A.J.A.), and the Temple Lung Center, Lewis Katz School of Medicine at Temple University (K.S.) - both in Philadelphia; the University of Illinois at Chicago College of Pharmacy, Chicago (P.M.S.); the Section of Pulmonary, Critical Care, and Sleep Medicine, Yale School of Medicine, New Haven, CT (G.C.); and the Division of Pulmonary, Critical Care, and Sleep Medicine, Keck School of Medicine, University of Southern California, Los Angeles (A.B.)
| | - Barbara M Kaplan
- From the Divisions of Pulmonary and Critical Care Medicine and Allergy and Immunology, Brigham and Women's Hospital, Harvard Medical School (E.I., N.E.M., V.E.F., P.A.H., J.M.K., J.R.L., B.E.), and patient partner (O.T.), Boston, and the Lahey Hospital and Medical Center, Burlington (V.P.P.) - all in Massachusetts; the Division of Allergy and Immunology, Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa (J.-C.C., T.B.C.), the Department of Nursing, University of Miami Health System (M.F.), and Miller School of Medicine, University of Miami (R.A.C.C.), Miami, the Department of Community Health and Family Medicine, University of Florida College of Medicine, Gainesville (K.L.C.), and the University of Central Florida College of Medicine, Orlando (M.P.) - all in Florida; the Department of Family Medicine (J.K.C., W.D.P.) and the Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine (A.L.F.), University of Colorado, Aurora, the Public Leadership Group (G.M.H.), the Department of Medicine, National Jewish Health (M.E.W.), and the Denver Health and Hospital Authority (L.P.H.), Denver - all in Colorado; the American Academy of Family Physicians National Research Network, Leawood, KS (J.K.C., B.K.M., J.B.S.); Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (L.S., F.W.R.); the Department of Family and Community Health, University of Minnesota, Minneapolis (B.P.Y.), and patient partner, St. Paul (S.M.) - both in Minnesota; patient partner, South Jordan, UT (A.D.C.M.); the Division of Adolescent Medicine (T.C.B.) and the Lung Health Center, Department of Medicine, University of Alabama, Birmingham (J.T.); the American Lung Association, Washington, DC (B.M.K.); the Department of Medicine, Johns Hopkins School of Medicine, Baltimore (C.S.R.); patient partner (J.R.), the Divisions of General Internal Medicine and Pulmonary and Critical Care Medicine (J.P.W.) and Clinical Immunology and Allergy (P.J.B.), Icahn School of Medicine at Mount Sinai, and Montefiore Medical Center, (E.J.), Albert Einstein College of Medicine (M.D.M., S.P.J.) - all in New York; the Center for Clinical Informatics Research and Education, the MetroHealth System, and the Departments of Internal Medicine, Pediatrics, and Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland (D.C.K.); the Department of Internal Medicine, Section of Allergy and Immunology, University of Puerto Rico, San Juan (S.N.); the Division of Allergy and Immunology, University of North Carolina School of Medicine, Chapel Hill (M.L.H.), the Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University School of Medicine, Durham (I.L.R.), and the Department of Family Medicine, Atrium Health, Charlotte (H.T.) - all in North Carolina; the Division of Pulmonary, Allergy, and Critical Care Medicine, Perelman School of Medicine, University of Pennsylvania (A.J.A.), and the Temple Lung Center, Lewis Katz School of Medicine at Temple University (K.S.) - both in Philadelphia; the University of Illinois at Chicago College of Pharmacy, Chicago (P.M.S.); the Section of Pulmonary, Critical Care, and Sleep Medicine, Yale School of Medicine, New Haven, CT (G.C.); and the Division of Pulmonary, Critical Care, and Sleep Medicine, Keck School of Medicine, University of Southern California, Los Angeles (A.B.)
| | - Cynthia S Rand
- From the Divisions of Pulmonary and Critical Care Medicine and Allergy and Immunology, Brigham and Women's Hospital, Harvard Medical School (E.I., N.E.M., V.E.F., P.A.H., J.M.K., J.R.L., B.E.), and patient partner (O.T.), Boston, and the Lahey Hospital and Medical Center, Burlington (V.P.P.) - all in Massachusetts; the Division of Allergy and Immunology, Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa (J.-C.C., T.B.C.), the Department of Nursing, University of Miami Health System (M.F.), and Miller School of Medicine, University of Miami (R.A.C.C.), Miami, the Department of Community Health and Family Medicine, University of Florida College of Medicine, Gainesville (K.L.C.), and the University of Central Florida College of Medicine, Orlando (M.P.) - all in Florida; the Department of Family Medicine (J.K.C., W.D.P.) and the Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine (A.L.F.), University of Colorado, Aurora, the Public Leadership Group (G.M.H.), the Department of Medicine, National Jewish Health (M.E.W.), and the Denver Health and Hospital Authority (L.P.H.), Denver - all in Colorado; the American Academy of Family Physicians National Research Network, Leawood, KS (J.K.C., B.K.M., J.B.S.); Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (L.S., F.W.R.); the Department of Family and Community Health, University of Minnesota, Minneapolis (B.P.Y.), and patient partner, St. Paul (S.M.) - both in Minnesota; patient partner, South Jordan, UT (A.D.C.M.); the Division of Adolescent Medicine (T.C.B.) and the Lung Health Center, Department of Medicine, University of Alabama, Birmingham (J.T.); the American Lung Association, Washington, DC (B.M.K.); the Department of Medicine, Johns Hopkins School of Medicine, Baltimore (C.S.R.); patient partner (J.R.), the Divisions of General Internal Medicine and Pulmonary and Critical Care Medicine (J.P.W.) and Clinical Immunology and Allergy (P.J.B.), Icahn School of Medicine at Mount Sinai, and Montefiore Medical Center, (E.J.), Albert Einstein College of Medicine (M.D.M., S.P.J.) - all in New York; the Center for Clinical Informatics Research and Education, the MetroHealth System, and the Departments of Internal Medicine, Pediatrics, and Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland (D.C.K.); the Department of Internal Medicine, Section of Allergy and Immunology, University of Puerto Rico, San Juan (S.N.); the Division of Allergy and Immunology, University of North Carolina School of Medicine, Chapel Hill (M.L.H.), the Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University School of Medicine, Durham (I.L.R.), and the Department of Family Medicine, Atrium Health, Charlotte (H.T.) - all in North Carolina; the Division of Pulmonary, Allergy, and Critical Care Medicine, Perelman School of Medicine, University of Pennsylvania (A.J.A.), and the Temple Lung Center, Lewis Katz School of Medicine at Temple University (K.S.) - both in Philadelphia; the University of Illinois at Chicago College of Pharmacy, Chicago (P.M.S.); the Section of Pulmonary, Critical Care, and Sleep Medicine, Yale School of Medicine, New Haven, CT (G.C.); and the Division of Pulmonary, Critical Care, and Sleep Medicine, Keck School of Medicine, University of Southern California, Los Angeles (A.B.)
| | - Janet Robles
- From the Divisions of Pulmonary and Critical Care Medicine and Allergy and Immunology, Brigham and Women's Hospital, Harvard Medical School (E.I., N.E.M., V.E.F., P.A.H., J.M.K., J.R.L., B.E.), and patient partner (O.T.), Boston, and the Lahey Hospital and Medical Center, Burlington (V.P.P.) - all in Massachusetts; the Division of Allergy and Immunology, Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa (J.-C.C., T.B.C.), the Department of Nursing, University of Miami Health System (M.F.), and Miller School of Medicine, University of Miami (R.A.C.C.), Miami, the Department of Community Health and Family Medicine, University of Florida College of Medicine, Gainesville (K.L.C.), and the University of Central Florida College of Medicine, Orlando (M.P.) - all in Florida; the Department of Family Medicine (J.K.C., W.D.P.) and the Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine (A.L.F.), University of Colorado, Aurora, the Public Leadership Group (G.M.H.), the Department of Medicine, National Jewish Health (M.E.W.), and the Denver Health and Hospital Authority (L.P.H.), Denver - all in Colorado; the American Academy of Family Physicians National Research Network, Leawood, KS (J.K.C., B.K.M., J.B.S.); Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (L.S., F.W.R.); the Department of Family and Community Health, University of Minnesota, Minneapolis (B.P.Y.), and patient partner, St. Paul (S.M.) - both in Minnesota; patient partner, South Jordan, UT (A.D.C.M.); the Division of Adolescent Medicine (T.C.B.) and the Lung Health Center, Department of Medicine, University of Alabama, Birmingham (J.T.); the American Lung Association, Washington, DC (B.M.K.); the Department of Medicine, Johns Hopkins School of Medicine, Baltimore (C.S.R.); patient partner (J.R.), the Divisions of General Internal Medicine and Pulmonary and Critical Care Medicine (J.P.W.) and Clinical Immunology and Allergy (P.J.B.), Icahn School of Medicine at Mount Sinai, and Montefiore Medical Center, (E.J.), Albert Einstein College of Medicine (M.D.M., S.P.J.) - all in New York; the Center for Clinical Informatics Research and Education, the MetroHealth System, and the Departments of Internal Medicine, Pediatrics, and Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland (D.C.K.); the Department of Internal Medicine, Section of Allergy and Immunology, University of Puerto Rico, San Juan (S.N.); the Division of Allergy and Immunology, University of North Carolina School of Medicine, Chapel Hill (M.L.H.), the Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University School of Medicine, Durham (I.L.R.), and the Department of Family Medicine, Atrium Health, Charlotte (H.T.) - all in North Carolina; the Division of Pulmonary, Allergy, and Critical Care Medicine, Perelman School of Medicine, University of Pennsylvania (A.J.A.), and the Temple Lung Center, Lewis Katz School of Medicine at Temple University (K.S.) - both in Philadelphia; the University of Illinois at Chicago College of Pharmacy, Chicago (P.M.S.); the Section of Pulmonary, Critical Care, and Sleep Medicine, Yale School of Medicine, New Haven, CT (G.C.); and the Division of Pulmonary, Critical Care, and Sleep Medicine, Keck School of Medicine, University of Southern California, Los Angeles (A.B.)
| | - Opal Thompson
- From the Divisions of Pulmonary and Critical Care Medicine and Allergy and Immunology, Brigham and Women's Hospital, Harvard Medical School (E.I., N.E.M., V.E.F., P.A.H., J.M.K., J.R.L., B.E.), and patient partner (O.T.), Boston, and the Lahey Hospital and Medical Center, Burlington (V.P.P.) - all in Massachusetts; the Division of Allergy and Immunology, Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa (J.-C.C., T.B.C.), the Department of Nursing, University of Miami Health System (M.F.), and Miller School of Medicine, University of Miami (R.A.C.C.), Miami, the Department of Community Health and Family Medicine, University of Florida College of Medicine, Gainesville (K.L.C.), and the University of Central Florida College of Medicine, Orlando (M.P.) - all in Florida; the Department of Family Medicine (J.K.C., W.D.P.) and the Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine (A.L.F.), University of Colorado, Aurora, the Public Leadership Group (G.M.H.), the Department of Medicine, National Jewish Health (M.E.W.), and the Denver Health and Hospital Authority (L.P.H.), Denver - all in Colorado; the American Academy of Family Physicians National Research Network, Leawood, KS (J.K.C., B.K.M., J.B.S.); Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (L.S., F.W.R.); the Department of Family and Community Health, University of Minnesota, Minneapolis (B.P.Y.), and patient partner, St. Paul (S.M.) - both in Minnesota; patient partner, South Jordan, UT (A.D.C.M.); the Division of Adolescent Medicine (T.C.B.) and the Lung Health Center, Department of Medicine, University of Alabama, Birmingham (J.T.); the American Lung Association, Washington, DC (B.M.K.); the Department of Medicine, Johns Hopkins School of Medicine, Baltimore (C.S.R.); patient partner (J.R.), the Divisions of General Internal Medicine and Pulmonary and Critical Care Medicine (J.P.W.) and Clinical Immunology and Allergy (P.J.B.), Icahn School of Medicine at Mount Sinai, and Montefiore Medical Center, (E.J.), Albert Einstein College of Medicine (M.D.M., S.P.J.) - all in New York; the Center for Clinical Informatics Research and Education, the MetroHealth System, and the Departments of Internal Medicine, Pediatrics, and Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland (D.C.K.); the Department of Internal Medicine, Section of Allergy and Immunology, University of Puerto Rico, San Juan (S.N.); the Division of Allergy and Immunology, University of North Carolina School of Medicine, Chapel Hill (M.L.H.), the Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University School of Medicine, Durham (I.L.R.), and the Department of Family Medicine, Atrium Health, Charlotte (H.T.) - all in North Carolina; the Division of Pulmonary, Allergy, and Critical Care Medicine, Perelman School of Medicine, University of Pennsylvania (A.J.A.), and the Temple Lung Center, Lewis Katz School of Medicine at Temple University (K.S.) - both in Philadelphia; the University of Illinois at Chicago College of Pharmacy, Chicago (P.M.S.); the Section of Pulmonary, Critical Care, and Sleep Medicine, Yale School of Medicine, New Haven, CT (G.C.); and the Division of Pulmonary, Critical Care, and Sleep Medicine, Keck School of Medicine, University of Southern California, Los Angeles (A.B.)
| | - Michael E Wechsler
- From the Divisions of Pulmonary and Critical Care Medicine and Allergy and Immunology, Brigham and Women's Hospital, Harvard Medical School (E.I., N.E.M., V.E.F., P.A.H., J.M.K., J.R.L., B.E.), and patient partner (O.T.), Boston, and the Lahey Hospital and Medical Center, Burlington (V.P.P.) - all in Massachusetts; the Division of Allergy and Immunology, Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa (J.-C.C., T.B.C.), the Department of Nursing, University of Miami Health System (M.F.), and Miller School of Medicine, University of Miami (R.A.C.C.), Miami, the Department of Community Health and Family Medicine, University of Florida College of Medicine, Gainesville (K.L.C.), and the University of Central Florida College of Medicine, Orlando (M.P.) - all in Florida; the Department of Family Medicine (J.K.C., W.D.P.) and the Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine (A.L.F.), University of Colorado, Aurora, the Public Leadership Group (G.M.H.), the Department of Medicine, National Jewish Health (M.E.W.), and the Denver Health and Hospital Authority (L.P.H.), Denver - all in Colorado; the American Academy of Family Physicians National Research Network, Leawood, KS (J.K.C., B.K.M., J.B.S.); Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (L.S., F.W.R.); the Department of Family and Community Health, University of Minnesota, Minneapolis (B.P.Y.), and patient partner, St. Paul (S.M.) - both in Minnesota; patient partner, South Jordan, UT (A.D.C.M.); the Division of Adolescent Medicine (T.C.B.) and the Lung Health Center, Department of Medicine, University of Alabama, Birmingham (J.T.); the American Lung Association, Washington, DC (B.M.K.); the Department of Medicine, Johns Hopkins School of Medicine, Baltimore (C.S.R.); patient partner (J.R.), the Divisions of General Internal Medicine and Pulmonary and Critical Care Medicine (J.P.W.) and Clinical Immunology and Allergy (P.J.B.), Icahn School of Medicine at Mount Sinai, and Montefiore Medical Center, (E.J.), Albert Einstein College of Medicine (M.D.M., S.P.J.) - all in New York; the Center for Clinical Informatics Research and Education, the MetroHealth System, and the Departments of Internal Medicine, Pediatrics, and Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland (D.C.K.); the Department of Internal Medicine, Section of Allergy and Immunology, University of Puerto Rico, San Juan (S.N.); the Division of Allergy and Immunology, University of North Carolina School of Medicine, Chapel Hill (M.L.H.), the Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University School of Medicine, Durham (I.L.R.), and the Department of Family Medicine, Atrium Health, Charlotte (H.T.) - all in North Carolina; the Division of Pulmonary, Allergy, and Critical Care Medicine, Perelman School of Medicine, University of Pennsylvania (A.J.A.), and the Temple Lung Center, Lewis Katz School of Medicine at Temple University (K.S.) - both in Philadelphia; the University of Illinois at Chicago College of Pharmacy, Chicago (P.M.S.); the Section of Pulmonary, Critical Care, and Sleep Medicine, Yale School of Medicine, New Haven, CT (G.C.); and the Division of Pulmonary, Critical Care, and Sleep Medicine, Keck School of Medicine, University of Southern California, Los Angeles (A.B.)
| | - Juan P Wisnivesky
- From the Divisions of Pulmonary and Critical Care Medicine and Allergy and Immunology, Brigham and Women's Hospital, Harvard Medical School (E.I., N.E.M., V.E.F., P.A.H., J.M.K., J.R.L., B.E.), and patient partner (O.T.), Boston, and the Lahey Hospital and Medical Center, Burlington (V.P.P.) - all in Massachusetts; the Division of Allergy and Immunology, Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa (J.-C.C., T.B.C.), the Department of Nursing, University of Miami Health System (M.F.), and Miller School of Medicine, University of Miami (R.A.C.C.), Miami, the Department of Community Health and Family Medicine, University of Florida College of Medicine, Gainesville (K.L.C.), and the University of Central Florida College of Medicine, Orlando (M.P.) - all in Florida; the Department of Family Medicine (J.K.C., W.D.P.) and the Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine (A.L.F.), University of Colorado, Aurora, the Public Leadership Group (G.M.H.), the Department of Medicine, National Jewish Health (M.E.W.), and the Denver Health and Hospital Authority (L.P.H.), Denver - all in Colorado; the American Academy of Family Physicians National Research Network, Leawood, KS (J.K.C., B.K.M., J.B.S.); Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (L.S., F.W.R.); the Department of Family and Community Health, University of Minnesota, Minneapolis (B.P.Y.), and patient partner, St. Paul (S.M.) - both in Minnesota; patient partner, South Jordan, UT (A.D.C.M.); the Division of Adolescent Medicine (T.C.B.) and the Lung Health Center, Department of Medicine, University of Alabama, Birmingham (J.T.); the American Lung Association, Washington, DC (B.M.K.); the Department of Medicine, Johns Hopkins School of Medicine, Baltimore (C.S.R.); patient partner (J.R.), the Divisions of General Internal Medicine and Pulmonary and Critical Care Medicine (J.P.W.) and Clinical Immunology and Allergy (P.J.B.), Icahn School of Medicine at Mount Sinai, and Montefiore Medical Center, (E.J.), Albert Einstein College of Medicine (M.D.M., S.P.J.) - all in New York; the Center for Clinical Informatics Research and Education, the MetroHealth System, and the Departments of Internal Medicine, Pediatrics, and Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland (D.C.K.); the Department of Internal Medicine, Section of Allergy and Immunology, University of Puerto Rico, San Juan (S.N.); the Division of Allergy and Immunology, University of North Carolina School of Medicine, Chapel Hill (M.L.H.), the Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University School of Medicine, Durham (I.L.R.), and the Department of Family Medicine, Atrium Health, Charlotte (H.T.) - all in North Carolina; the Division of Pulmonary, Allergy, and Critical Care Medicine, Perelman School of Medicine, University of Pennsylvania (A.J.A.), and the Temple Lung Center, Lewis Katz School of Medicine at Temple University (K.S.) - both in Philadelphia; the University of Illinois at Chicago College of Pharmacy, Chicago (P.M.S.); the Section of Pulmonary, Critical Care, and Sleep Medicine, Yale School of Medicine, New Haven, CT (G.C.); and the Division of Pulmonary, Critical Care, and Sleep Medicine, Keck School of Medicine, University of Southern California, Los Angeles (A.B.)
| | - M Diane McKee
- From the Divisions of Pulmonary and Critical Care Medicine and Allergy and Immunology, Brigham and Women's Hospital, Harvard Medical School (E.I., N.E.M., V.E.F., P.A.H., J.M.K., J.R.L., B.E.), and patient partner (O.T.), Boston, and the Lahey Hospital and Medical Center, Burlington (V.P.P.) - all in Massachusetts; the Division of Allergy and Immunology, Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa (J.-C.C., T.B.C.), the Department of Nursing, University of Miami Health System (M.F.), and Miller School of Medicine, University of Miami (R.A.C.C.), Miami, the Department of Community Health and Family Medicine, University of Florida College of Medicine, Gainesville (K.L.C.), and the University of Central Florida College of Medicine, Orlando (M.P.) - all in Florida; the Department of Family Medicine (J.K.C., W.D.P.) and the Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine (A.L.F.), University of Colorado, Aurora, the Public Leadership Group (G.M.H.), the Department of Medicine, National Jewish Health (M.E.W.), and the Denver Health and Hospital Authority (L.P.H.), Denver - all in Colorado; the American Academy of Family Physicians National Research Network, Leawood, KS (J.K.C., B.K.M., J.B.S.); Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (L.S., F.W.R.); the Department of Family and Community Health, University of Minnesota, Minneapolis (B.P.Y.), and patient partner, St. Paul (S.M.) - both in Minnesota; patient partner, South Jordan, UT (A.D.C.M.); the Division of Adolescent Medicine (T.C.B.) and the Lung Health Center, Department of Medicine, University of Alabama, Birmingham (J.T.); the American Lung Association, Washington, DC (B.M.K.); the Department of Medicine, Johns Hopkins School of Medicine, Baltimore (C.S.R.); patient partner (J.R.), the Divisions of General Internal Medicine and Pulmonary and Critical Care Medicine (J.P.W.) and Clinical Immunology and Allergy (P.J.B.), Icahn School of Medicine at Mount Sinai, and Montefiore Medical Center, (E.J.), Albert Einstein College of Medicine (M.D.M., S.P.J.) - all in New York; the Center for Clinical Informatics Research and Education, the MetroHealth System, and the Departments of Internal Medicine, Pediatrics, and Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland (D.C.K.); the Department of Internal Medicine, Section of Allergy and Immunology, University of Puerto Rico, San Juan (S.N.); the Division of Allergy and Immunology, University of North Carolina School of Medicine, Chapel Hill (M.L.H.), the Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University School of Medicine, Durham (I.L.R.), and the Department of Family Medicine, Atrium Health, Charlotte (H.T.) - all in North Carolina; the Division of Pulmonary, Allergy, and Critical Care Medicine, Perelman School of Medicine, University of Pennsylvania (A.J.A.), and the Temple Lung Center, Lewis Katz School of Medicine at Temple University (K.S.) - both in Philadelphia; the University of Illinois at Chicago College of Pharmacy, Chicago (P.M.S.); the Section of Pulmonary, Critical Care, and Sleep Medicine, Yale School of Medicine, New Haven, CT (G.C.); and the Division of Pulmonary, Critical Care, and Sleep Medicine, Keck School of Medicine, University of Southern California, Los Angeles (A.B.)
| | - Sunit P Jariwala
- From the Divisions of Pulmonary and Critical Care Medicine and Allergy and Immunology, Brigham and Women's Hospital, Harvard Medical School (E.I., N.E.M., V.E.F., P.A.H., J.M.K., J.R.L., B.E.), and patient partner (O.T.), Boston, and the Lahey Hospital and Medical Center, Burlington (V.P.P.) - all in Massachusetts; the Division of Allergy and Immunology, Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa (J.-C.C., T.B.C.), the Department of Nursing, University of Miami Health System (M.F.), and Miller School of Medicine, University of Miami (R.A.C.C.), Miami, the Department of Community Health and Family Medicine, University of Florida College of Medicine, Gainesville (K.L.C.), and the University of Central Florida College of Medicine, Orlando (M.P.) - all in Florida; the Department of Family Medicine (J.K.C., W.D.P.) and the Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine (A.L.F.), University of Colorado, Aurora, the Public Leadership Group (G.M.H.), the Department of Medicine, National Jewish Health (M.E.W.), and the Denver Health and Hospital Authority (L.P.H.), Denver - all in Colorado; the American Academy of Family Physicians National Research Network, Leawood, KS (J.K.C., B.K.M., J.B.S.); Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (L.S., F.W.R.); the Department of Family and Community Health, University of Minnesota, Minneapolis (B.P.Y.), and patient partner, St. Paul (S.M.) - both in Minnesota; patient partner, South Jordan, UT (A.D.C.M.); the Division of Adolescent Medicine (T.C.B.) and the Lung Health Center, Department of Medicine, University of Alabama, Birmingham (J.T.); the American Lung Association, Washington, DC (B.M.K.); the Department of Medicine, Johns Hopkins School of Medicine, Baltimore (C.S.R.); patient partner (J.R.), the Divisions of General Internal Medicine and Pulmonary and Critical Care Medicine (J.P.W.) and Clinical Immunology and Allergy (P.J.B.), Icahn School of Medicine at Mount Sinai, and Montefiore Medical Center, (E.J.), Albert Einstein College of Medicine (M.D.M., S.P.J.) - all in New York; the Center for Clinical Informatics Research and Education, the MetroHealth System, and the Departments of Internal Medicine, Pediatrics, and Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland (D.C.K.); the Department of Internal Medicine, Section of Allergy and Immunology, University of Puerto Rico, San Juan (S.N.); the Division of Allergy and Immunology, University of North Carolina School of Medicine, Chapel Hill (M.L.H.), the Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University School of Medicine, Durham (I.L.R.), and the Department of Family Medicine, Atrium Health, Charlotte (H.T.) - all in North Carolina; the Division of Pulmonary, Allergy, and Critical Care Medicine, Perelman School of Medicine, University of Pennsylvania (A.J.A.), and the Temple Lung Center, Lewis Katz School of Medicine at Temple University (K.S.) - both in Philadelphia; the University of Illinois at Chicago College of Pharmacy, Chicago (P.M.S.); the Section of Pulmonary, Critical Care, and Sleep Medicine, Yale School of Medicine, New Haven, CT (G.C.); and the Division of Pulmonary, Critical Care, and Sleep Medicine, Keck School of Medicine, University of Southern California, Los Angeles (A.B.)
| | - Elina Jerschow
- From the Divisions of Pulmonary and Critical Care Medicine and Allergy and Immunology, Brigham and Women's Hospital, Harvard Medical School (E.I., N.E.M., V.E.F., P.A.H., J.M.K., J.R.L., B.E.), and patient partner (O.T.), Boston, and the Lahey Hospital and Medical Center, Burlington (V.P.P.) - all in Massachusetts; the Division of Allergy and Immunology, Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa (J.-C.C., T.B.C.), the Department of Nursing, University of Miami Health System (M.F.), and Miller School of Medicine, University of Miami (R.A.C.C.), Miami, the Department of Community Health and Family Medicine, University of Florida College of Medicine, Gainesville (K.L.C.), and the University of Central Florida College of Medicine, Orlando (M.P.) - all in Florida; the Department of Family Medicine (J.K.C., W.D.P.) and the Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine (A.L.F.), University of Colorado, Aurora, the Public Leadership Group (G.M.H.), the Department of Medicine, National Jewish Health (M.E.W.), and the Denver Health and Hospital Authority (L.P.H.), Denver - all in Colorado; the American Academy of Family Physicians National Research Network, Leawood, KS (J.K.C., B.K.M., J.B.S.); Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (L.S., F.W.R.); the Department of Family and Community Health, University of Minnesota, Minneapolis (B.P.Y.), and patient partner, St. Paul (S.M.) - both in Minnesota; patient partner, South Jordan, UT (A.D.C.M.); the Division of Adolescent Medicine (T.C.B.) and the Lung Health Center, Department of Medicine, University of Alabama, Birmingham (J.T.); the American Lung Association, Washington, DC (B.M.K.); the Department of Medicine, Johns Hopkins School of Medicine, Baltimore (C.S.R.); patient partner (J.R.), the Divisions of General Internal Medicine and Pulmonary and Critical Care Medicine (J.P.W.) and Clinical Immunology and Allergy (P.J.B.), Icahn School of Medicine at Mount Sinai, and Montefiore Medical Center, (E.J.), Albert Einstein College of Medicine (M.D.M., S.P.J.) - all in New York; the Center for Clinical Informatics Research and Education, the MetroHealth System, and the Departments of Internal Medicine, Pediatrics, and Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland (D.C.K.); the Department of Internal Medicine, Section of Allergy and Immunology, University of Puerto Rico, San Juan (S.N.); the Division of Allergy and Immunology, University of North Carolina School of Medicine, Chapel Hill (M.L.H.), the Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University School of Medicine, Durham (I.L.R.), and the Department of Family Medicine, Atrium Health, Charlotte (H.T.) - all in North Carolina; the Division of Pulmonary, Allergy, and Critical Care Medicine, Perelman School of Medicine, University of Pennsylvania (A.J.A.), and the Temple Lung Center, Lewis Katz School of Medicine at Temple University (K.S.) - both in Philadelphia; the University of Illinois at Chicago College of Pharmacy, Chicago (P.M.S.); the Section of Pulmonary, Critical Care, and Sleep Medicine, Yale School of Medicine, New Haven, CT (G.C.); and the Division of Pulmonary, Critical Care, and Sleep Medicine, Keck School of Medicine, University of Southern California, Los Angeles (A.B.)
| | - Paula J Busse
- From the Divisions of Pulmonary and Critical Care Medicine and Allergy and Immunology, Brigham and Women's Hospital, Harvard Medical School (E.I., N.E.M., V.E.F., P.A.H., J.M.K., J.R.L., B.E.), and patient partner (O.T.), Boston, and the Lahey Hospital and Medical Center, Burlington (V.P.P.) - all in Massachusetts; the Division of Allergy and Immunology, Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa (J.-C.C., T.B.C.), the Department of Nursing, University of Miami Health System (M.F.), and Miller School of Medicine, University of Miami (R.A.C.C.), Miami, the Department of Community Health and Family Medicine, University of Florida College of Medicine, Gainesville (K.L.C.), and the University of Central Florida College of Medicine, Orlando (M.P.) - all in Florida; the Department of Family Medicine (J.K.C., W.D.P.) and the Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine (A.L.F.), University of Colorado, Aurora, the Public Leadership Group (G.M.H.), the Department of Medicine, National Jewish Health (M.E.W.), and the Denver Health and Hospital Authority (L.P.H.), Denver - all in Colorado; the American Academy of Family Physicians National Research Network, Leawood, KS (J.K.C., B.K.M., J.B.S.); Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (L.S., F.W.R.); the Department of Family and Community Health, University of Minnesota, Minneapolis (B.P.Y.), and patient partner, St. Paul (S.M.) - both in Minnesota; patient partner, South Jordan, UT (A.D.C.M.); the Division of Adolescent Medicine (T.C.B.) and the Lung Health Center, Department of Medicine, University of Alabama, Birmingham (J.T.); the American Lung Association, Washington, DC (B.M.K.); the Department of Medicine, Johns Hopkins School of Medicine, Baltimore (C.S.R.); patient partner (J.R.), the Divisions of General Internal Medicine and Pulmonary and Critical Care Medicine (J.P.W.) and Clinical Immunology and Allergy (P.J.B.), Icahn School of Medicine at Mount Sinai, and Montefiore Medical Center, (E.J.), Albert Einstein College of Medicine (M.D.M., S.P.J.) - all in New York; the Center for Clinical Informatics Research and Education, the MetroHealth System, and the Departments of Internal Medicine, Pediatrics, and Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland (D.C.K.); the Department of Internal Medicine, Section of Allergy and Immunology, University of Puerto Rico, San Juan (S.N.); the Division of Allergy and Immunology, University of North Carolina School of Medicine, Chapel Hill (M.L.H.), the Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University School of Medicine, Durham (I.L.R.), and the Department of Family Medicine, Atrium Health, Charlotte (H.T.) - all in North Carolina; the Division of Pulmonary, Allergy, and Critical Care Medicine, Perelman School of Medicine, University of Pennsylvania (A.J.A.), and the Temple Lung Center, Lewis Katz School of Medicine at Temple University (K.S.) - both in Philadelphia; the University of Illinois at Chicago College of Pharmacy, Chicago (P.M.S.); the Section of Pulmonary, Critical Care, and Sleep Medicine, Yale School of Medicine, New Haven, CT (G.C.); and the Division of Pulmonary, Critical Care, and Sleep Medicine, Keck School of Medicine, University of Southern California, Los Angeles (A.B.)
| | - David C Kaelber
- From the Divisions of Pulmonary and Critical Care Medicine and Allergy and Immunology, Brigham and Women's Hospital, Harvard Medical School (E.I., N.E.M., V.E.F., P.A.H., J.M.K., J.R.L., B.E.), and patient partner (O.T.), Boston, and the Lahey Hospital and Medical Center, Burlington (V.P.P.) - all in Massachusetts; the Division of Allergy and Immunology, Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa (J.-C.C., T.B.C.), the Department of Nursing, University of Miami Health System (M.F.), and Miller School of Medicine, University of Miami (R.A.C.C.), Miami, the Department of Community Health and Family Medicine, University of Florida College of Medicine, Gainesville (K.L.C.), and the University of Central Florida College of Medicine, Orlando (M.P.) - all in Florida; the Department of Family Medicine (J.K.C., W.D.P.) and the Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine (A.L.F.), University of Colorado, Aurora, the Public Leadership Group (G.M.H.), the Department of Medicine, National Jewish Health (M.E.W.), and the Denver Health and Hospital Authority (L.P.H.), Denver - all in Colorado; the American Academy of Family Physicians National Research Network, Leawood, KS (J.K.C., B.K.M., J.B.S.); Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (L.S., F.W.R.); the Department of Family and Community Health, University of Minnesota, Minneapolis (B.P.Y.), and patient partner, St. Paul (S.M.) - both in Minnesota; patient partner, South Jordan, UT (A.D.C.M.); the Division of Adolescent Medicine (T.C.B.) and the Lung Health Center, Department of Medicine, University of Alabama, Birmingham (J.T.); the American Lung Association, Washington, DC (B.M.K.); the Department of Medicine, Johns Hopkins School of Medicine, Baltimore (C.S.R.); patient partner (J.R.), the Divisions of General Internal Medicine and Pulmonary and Critical Care Medicine (J.P.W.) and Clinical Immunology and Allergy (P.J.B.), Icahn School of Medicine at Mount Sinai, and Montefiore Medical Center, (E.J.), Albert Einstein College of Medicine (M.D.M., S.P.J.) - all in New York; the Center for Clinical Informatics Research and Education, the MetroHealth System, and the Departments of Internal Medicine, Pediatrics, and Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland (D.C.K.); the Department of Internal Medicine, Section of Allergy and Immunology, University of Puerto Rico, San Juan (S.N.); the Division of Allergy and Immunology, University of North Carolina School of Medicine, Chapel Hill (M.L.H.), the Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University School of Medicine, Durham (I.L.R.), and the Department of Family Medicine, Atrium Health, Charlotte (H.T.) - all in North Carolina; the Division of Pulmonary, Allergy, and Critical Care Medicine, Perelman School of Medicine, University of Pennsylvania (A.J.A.), and the Temple Lung Center, Lewis Katz School of Medicine at Temple University (K.S.) - both in Philadelphia; the University of Illinois at Chicago College of Pharmacy, Chicago (P.M.S.); the Section of Pulmonary, Critical Care, and Sleep Medicine, Yale School of Medicine, New Haven, CT (G.C.); and the Division of Pulmonary, Critical Care, and Sleep Medicine, Keck School of Medicine, University of Southern California, Los Angeles (A.B.)
| | - Sylvette Nazario
- From the Divisions of Pulmonary and Critical Care Medicine and Allergy and Immunology, Brigham and Women's Hospital, Harvard Medical School (E.I., N.E.M., V.E.F., P.A.H., J.M.K., J.R.L., B.E.), and patient partner (O.T.), Boston, and the Lahey Hospital and Medical Center, Burlington (V.P.P.) - all in Massachusetts; the Division of Allergy and Immunology, Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa (J.-C.C., T.B.C.), the Department of Nursing, University of Miami Health System (M.F.), and Miller School of Medicine, University of Miami (R.A.C.C.), Miami, the Department of Community Health and Family Medicine, University of Florida College of Medicine, Gainesville (K.L.C.), and the University of Central Florida College of Medicine, Orlando (M.P.) - all in Florida; the Department of Family Medicine (J.K.C., W.D.P.) and the Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine (A.L.F.), University of Colorado, Aurora, the Public Leadership Group (G.M.H.), the Department of Medicine, National Jewish Health (M.E.W.), and the Denver Health and Hospital Authority (L.P.H.), Denver - all in Colorado; the American Academy of Family Physicians National Research Network, Leawood, KS (J.K.C., B.K.M., J.B.S.); Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (L.S., F.W.R.); the Department of Family and Community Health, University of Minnesota, Minneapolis (B.P.Y.), and patient partner, St. Paul (S.M.) - both in Minnesota; patient partner, South Jordan, UT (A.D.C.M.); the Division of Adolescent Medicine (T.C.B.) and the Lung Health Center, Department of Medicine, University of Alabama, Birmingham (J.T.); the American Lung Association, Washington, DC (B.M.K.); the Department of Medicine, Johns Hopkins School of Medicine, Baltimore (C.S.R.); patient partner (J.R.), the Divisions of General Internal Medicine and Pulmonary and Critical Care Medicine (J.P.W.) and Clinical Immunology and Allergy (P.J.B.), Icahn School of Medicine at Mount Sinai, and Montefiore Medical Center, (E.J.), Albert Einstein College of Medicine (M.D.M., S.P.J.) - all in New York; the Center for Clinical Informatics Research and Education, the MetroHealth System, and the Departments of Internal Medicine, Pediatrics, and Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland (D.C.K.); the Department of Internal Medicine, Section of Allergy and Immunology, University of Puerto Rico, San Juan (S.N.); the Division of Allergy and Immunology, University of North Carolina School of Medicine, Chapel Hill (M.L.H.), the Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University School of Medicine, Durham (I.L.R.), and the Department of Family Medicine, Atrium Health, Charlotte (H.T.) - all in North Carolina; the Division of Pulmonary, Allergy, and Critical Care Medicine, Perelman School of Medicine, University of Pennsylvania (A.J.A.), and the Temple Lung Center, Lewis Katz School of Medicine at Temple University (K.S.) - both in Philadelphia; the University of Illinois at Chicago College of Pharmacy, Chicago (P.M.S.); the Section of Pulmonary, Critical Care, and Sleep Medicine, Yale School of Medicine, New Haven, CT (G.C.); and the Division of Pulmonary, Critical Care, and Sleep Medicine, Keck School of Medicine, University of Southern California, Los Angeles (A.B.)
| | - Michelle L Hernandez
- From the Divisions of Pulmonary and Critical Care Medicine and Allergy and Immunology, Brigham and Women's Hospital, Harvard Medical School (E.I., N.E.M., V.E.F., P.A.H., J.M.K., J.R.L., B.E.), and patient partner (O.T.), Boston, and the Lahey Hospital and Medical Center, Burlington (V.P.P.) - all in Massachusetts; the Division of Allergy and Immunology, Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa (J.-C.C., T.B.C.), the Department of Nursing, University of Miami Health System (M.F.), and Miller School of Medicine, University of Miami (R.A.C.C.), Miami, the Department of Community Health and Family Medicine, University of Florida College of Medicine, Gainesville (K.L.C.), and the University of Central Florida College of Medicine, Orlando (M.P.) - all in Florida; the Department of Family Medicine (J.K.C., W.D.P.) and the Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine (A.L.F.), University of Colorado, Aurora, the Public Leadership Group (G.M.H.), the Department of Medicine, National Jewish Health (M.E.W.), and the Denver Health and Hospital Authority (L.P.H.), Denver - all in Colorado; the American Academy of Family Physicians National Research Network, Leawood, KS (J.K.C., B.K.M., J.B.S.); Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (L.S., F.W.R.); the Department of Family and Community Health, University of Minnesota, Minneapolis (B.P.Y.), and patient partner, St. Paul (S.M.) - both in Minnesota; patient partner, South Jordan, UT (A.D.C.M.); the Division of Adolescent Medicine (T.C.B.) and the Lung Health Center, Department of Medicine, University of Alabama, Birmingham (J.T.); the American Lung Association, Washington, DC (B.M.K.); the Department of Medicine, Johns Hopkins School of Medicine, Baltimore (C.S.R.); patient partner (J.R.), the Divisions of General Internal Medicine and Pulmonary and Critical Care Medicine (J.P.W.) and Clinical Immunology and Allergy (P.J.B.), Icahn School of Medicine at Mount Sinai, and Montefiore Medical Center, (E.J.), Albert Einstein College of Medicine (M.D.M., S.P.J.) - all in New York; the Center for Clinical Informatics Research and Education, the MetroHealth System, and the Departments of Internal Medicine, Pediatrics, and Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland (D.C.K.); the Department of Internal Medicine, Section of Allergy and Immunology, University of Puerto Rico, San Juan (S.N.); the Division of Allergy and Immunology, University of North Carolina School of Medicine, Chapel Hill (M.L.H.), the Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University School of Medicine, Durham (I.L.R.), and the Department of Family Medicine, Atrium Health, Charlotte (H.T.) - all in North Carolina; the Division of Pulmonary, Allergy, and Critical Care Medicine, Perelman School of Medicine, University of Pennsylvania (A.J.A.), and the Temple Lung Center, Lewis Katz School of Medicine at Temple University (K.S.) - both in Philadelphia; the University of Illinois at Chicago College of Pharmacy, Chicago (P.M.S.); the Section of Pulmonary, Critical Care, and Sleep Medicine, Yale School of Medicine, New Haven, CT (G.C.); and the Division of Pulmonary, Critical Care, and Sleep Medicine, Keck School of Medicine, University of Southern California, Los Angeles (A.B.)
| | - Andrea J Apter
- From the Divisions of Pulmonary and Critical Care Medicine and Allergy and Immunology, Brigham and Women's Hospital, Harvard Medical School (E.I., N.E.M., V.E.F., P.A.H., J.M.K., J.R.L., B.E.), and patient partner (O.T.), Boston, and the Lahey Hospital and Medical Center, Burlington (V.P.P.) - all in Massachusetts; the Division of Allergy and Immunology, Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa (J.-C.C., T.B.C.), the Department of Nursing, University of Miami Health System (M.F.), and Miller School of Medicine, University of Miami (R.A.C.C.), Miami, the Department of Community Health and Family Medicine, University of Florida College of Medicine, Gainesville (K.L.C.), and the University of Central Florida College of Medicine, Orlando (M.P.) - all in Florida; the Department of Family Medicine (J.K.C., W.D.P.) and the Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine (A.L.F.), University of Colorado, Aurora, the Public Leadership Group (G.M.H.), the Department of Medicine, National Jewish Health (M.E.W.), and the Denver Health and Hospital Authority (L.P.H.), Denver - all in Colorado; the American Academy of Family Physicians National Research Network, Leawood, KS (J.K.C., B.K.M., J.B.S.); Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (L.S., F.W.R.); the Department of Family and Community Health, University of Minnesota, Minneapolis (B.P.Y.), and patient partner, St. Paul (S.M.) - both in Minnesota; patient partner, South Jordan, UT (A.D.C.M.); the Division of Adolescent Medicine (T.C.B.) and the Lung Health Center, Department of Medicine, University of Alabama, Birmingham (J.T.); the American Lung Association, Washington, DC (B.M.K.); the Department of Medicine, Johns Hopkins School of Medicine, Baltimore (C.S.R.); patient partner (J.R.), the Divisions of General Internal Medicine and Pulmonary and Critical Care Medicine (J.P.W.) and Clinical Immunology and Allergy (P.J.B.), Icahn School of Medicine at Mount Sinai, and Montefiore Medical Center, (E.J.), Albert Einstein College of Medicine (M.D.M., S.P.J.) - all in New York; the Center for Clinical Informatics Research and Education, the MetroHealth System, and the Departments of Internal Medicine, Pediatrics, and Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland (D.C.K.); the Department of Internal Medicine, Section of Allergy and Immunology, University of Puerto Rico, San Juan (S.N.); the Division of Allergy and Immunology, University of North Carolina School of Medicine, Chapel Hill (M.L.H.), the Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University School of Medicine, Durham (I.L.R.), and the Department of Family Medicine, Atrium Health, Charlotte (H.T.) - all in North Carolina; the Division of Pulmonary, Allergy, and Critical Care Medicine, Perelman School of Medicine, University of Pennsylvania (A.J.A.), and the Temple Lung Center, Lewis Katz School of Medicine at Temple University (K.S.) - both in Philadelphia; the University of Illinois at Chicago College of Pharmacy, Chicago (P.M.S.); the Section of Pulmonary, Critical Care, and Sleep Medicine, Yale School of Medicine, New Haven, CT (G.C.); and the Division of Pulmonary, Critical Care, and Sleep Medicine, Keck School of Medicine, University of Southern California, Los Angeles (A.B.)
| | - Ku-Lang Chang
- From the Divisions of Pulmonary and Critical Care Medicine and Allergy and Immunology, Brigham and Women's Hospital, Harvard Medical School (E.I., N.E.M., V.E.F., P.A.H., J.M.K., J.R.L., B.E.), and patient partner (O.T.), Boston, and the Lahey Hospital and Medical Center, Burlington (V.P.P.) - all in Massachusetts; the Division of Allergy and Immunology, Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa (J.-C.C., T.B.C.), the Department of Nursing, University of Miami Health System (M.F.), and Miller School of Medicine, University of Miami (R.A.C.C.), Miami, the Department of Community Health and Family Medicine, University of Florida College of Medicine, Gainesville (K.L.C.), and the University of Central Florida College of Medicine, Orlando (M.P.) - all in Florida; the Department of Family Medicine (J.K.C., W.D.P.) and the Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine (A.L.F.), University of Colorado, Aurora, the Public Leadership Group (G.M.H.), the Department of Medicine, National Jewish Health (M.E.W.), and the Denver Health and Hospital Authority (L.P.H.), Denver - all in Colorado; the American Academy of Family Physicians National Research Network, Leawood, KS (J.K.C., B.K.M., J.B.S.); Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (L.S., F.W.R.); the Department of Family and Community Health, University of Minnesota, Minneapolis (B.P.Y.), and patient partner, St. Paul (S.M.) - both in Minnesota; patient partner, South Jordan, UT (A.D.C.M.); the Division of Adolescent Medicine (T.C.B.) and the Lung Health Center, Department of Medicine, University of Alabama, Birmingham (J.T.); the American Lung Association, Washington, DC (B.M.K.); the Department of Medicine, Johns Hopkins School of Medicine, Baltimore (C.S.R.); patient partner (J.R.), the Divisions of General Internal Medicine and Pulmonary and Critical Care Medicine (J.P.W.) and Clinical Immunology and Allergy (P.J.B.), Icahn School of Medicine at Mount Sinai, and Montefiore Medical Center, (E.J.), Albert Einstein College of Medicine (M.D.M., S.P.J.) - all in New York; the Center for Clinical Informatics Research and Education, the MetroHealth System, and the Departments of Internal Medicine, Pediatrics, and Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland (D.C.K.); the Department of Internal Medicine, Section of Allergy and Immunology, University of Puerto Rico, San Juan (S.N.); the Division of Allergy and Immunology, University of North Carolina School of Medicine, Chapel Hill (M.L.H.), the Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University School of Medicine, Durham (I.L.R.), and the Department of Family Medicine, Atrium Health, Charlotte (H.T.) - all in North Carolina; the Division of Pulmonary, Allergy, and Critical Care Medicine, Perelman School of Medicine, University of Pennsylvania (A.J.A.), and the Temple Lung Center, Lewis Katz School of Medicine at Temple University (K.S.) - both in Philadelphia; the University of Illinois at Chicago College of Pharmacy, Chicago (P.M.S.); the Section of Pulmonary, Critical Care, and Sleep Medicine, Yale School of Medicine, New Haven, CT (G.C.); and the Division of Pulmonary, Critical Care, and Sleep Medicine, Keck School of Medicine, University of Southern California, Los Angeles (A.B.)
| | - Victor Pinto-Plata
- From the Divisions of Pulmonary and Critical Care Medicine and Allergy and Immunology, Brigham and Women's Hospital, Harvard Medical School (E.I., N.E.M., V.E.F., P.A.H., J.M.K., J.R.L., B.E.), and patient partner (O.T.), Boston, and the Lahey Hospital and Medical Center, Burlington (V.P.P.) - all in Massachusetts; the Division of Allergy and Immunology, Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa (J.-C.C., T.B.C.), the Department of Nursing, University of Miami Health System (M.F.), and Miller School of Medicine, University of Miami (R.A.C.C.), Miami, the Department of Community Health and Family Medicine, University of Florida College of Medicine, Gainesville (K.L.C.), and the University of Central Florida College of Medicine, Orlando (M.P.) - all in Florida; the Department of Family Medicine (J.K.C., W.D.P.) and the Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine (A.L.F.), University of Colorado, Aurora, the Public Leadership Group (G.M.H.), the Department of Medicine, National Jewish Health (M.E.W.), and the Denver Health and Hospital Authority (L.P.H.), Denver - all in Colorado; the American Academy of Family Physicians National Research Network, Leawood, KS (J.K.C., B.K.M., J.B.S.); Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (L.S., F.W.R.); the Department of Family and Community Health, University of Minnesota, Minneapolis (B.P.Y.), and patient partner, St. Paul (S.M.) - both in Minnesota; patient partner, South Jordan, UT (A.D.C.M.); the Division of Adolescent Medicine (T.C.B.) and the Lung Health Center, Department of Medicine, University of Alabama, Birmingham (J.T.); the American Lung Association, Washington, DC (B.M.K.); the Department of Medicine, Johns Hopkins School of Medicine, Baltimore (C.S.R.); patient partner (J.R.), the Divisions of General Internal Medicine and Pulmonary and Critical Care Medicine (J.P.W.) and Clinical Immunology and Allergy (P.J.B.), Icahn School of Medicine at Mount Sinai, and Montefiore Medical Center, (E.J.), Albert Einstein College of Medicine (M.D.M., S.P.J.) - all in New York; the Center for Clinical Informatics Research and Education, the MetroHealth System, and the Departments of Internal Medicine, Pediatrics, and Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland (D.C.K.); the Department of Internal Medicine, Section of Allergy and Immunology, University of Puerto Rico, San Juan (S.N.); the Division of Allergy and Immunology, University of North Carolina School of Medicine, Chapel Hill (M.L.H.), the Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University School of Medicine, Durham (I.L.R.), and the Department of Family Medicine, Atrium Health, Charlotte (H.T.) - all in North Carolina; the Division of Pulmonary, Allergy, and Critical Care Medicine, Perelman School of Medicine, University of Pennsylvania (A.J.A.), and the Temple Lung Center, Lewis Katz School of Medicine at Temple University (K.S.) - both in Philadelphia; the University of Illinois at Chicago College of Pharmacy, Chicago (P.M.S.); the Section of Pulmonary, Critical Care, and Sleep Medicine, Yale School of Medicine, New Haven, CT (G.C.); and the Division of Pulmonary, Critical Care, and Sleep Medicine, Keck School of Medicine, University of Southern California, Los Angeles (A.B.)
| | - Paul M Stranges
- From the Divisions of Pulmonary and Critical Care Medicine and Allergy and Immunology, Brigham and Women's Hospital, Harvard Medical School (E.I., N.E.M., V.E.F., P.A.H., J.M.K., J.R.L., B.E.), and patient partner (O.T.), Boston, and the Lahey Hospital and Medical Center, Burlington (V.P.P.) - all in Massachusetts; the Division of Allergy and Immunology, Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa (J.-C.C., T.B.C.), the Department of Nursing, University of Miami Health System (M.F.), and Miller School of Medicine, University of Miami (R.A.C.C.), Miami, the Department of Community Health and Family Medicine, University of Florida College of Medicine, Gainesville (K.L.C.), and the University of Central Florida College of Medicine, Orlando (M.P.) - all in Florida; the Department of Family Medicine (J.K.C., W.D.P.) and the Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine (A.L.F.), University of Colorado, Aurora, the Public Leadership Group (G.M.H.), the Department of Medicine, National Jewish Health (M.E.W.), and the Denver Health and Hospital Authority (L.P.H.), Denver - all in Colorado; the American Academy of Family Physicians National Research Network, Leawood, KS (J.K.C., B.K.M., J.B.S.); Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (L.S., F.W.R.); the Department of Family and Community Health, University of Minnesota, Minneapolis (B.P.Y.), and patient partner, St. Paul (S.M.) - both in Minnesota; patient partner, South Jordan, UT (A.D.C.M.); the Division of Adolescent Medicine (T.C.B.) and the Lung Health Center, Department of Medicine, University of Alabama, Birmingham (J.T.); the American Lung Association, Washington, DC (B.M.K.); the Department of Medicine, Johns Hopkins School of Medicine, Baltimore (C.S.R.); patient partner (J.R.), the Divisions of General Internal Medicine and Pulmonary and Critical Care Medicine (J.P.W.) and Clinical Immunology and Allergy (P.J.B.), Icahn School of Medicine at Mount Sinai, and Montefiore Medical Center, (E.J.), Albert Einstein College of Medicine (M.D.M., S.P.J.) - all in New York; the Center for Clinical Informatics Research and Education, the MetroHealth System, and the Departments of Internal Medicine, Pediatrics, and Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland (D.C.K.); the Department of Internal Medicine, Section of Allergy and Immunology, University of Puerto Rico, San Juan (S.N.); the Division of Allergy and Immunology, University of North Carolina School of Medicine, Chapel Hill (M.L.H.), the Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University School of Medicine, Durham (I.L.R.), and the Department of Family Medicine, Atrium Health, Charlotte (H.T.) - all in North Carolina; the Division of Pulmonary, Allergy, and Critical Care Medicine, Perelman School of Medicine, University of Pennsylvania (A.J.A.), and the Temple Lung Center, Lewis Katz School of Medicine at Temple University (K.S.) - both in Philadelphia; the University of Illinois at Chicago College of Pharmacy, Chicago (P.M.S.); the Section of Pulmonary, Critical Care, and Sleep Medicine, Yale School of Medicine, New Haven, CT (G.C.); and the Division of Pulmonary, Critical Care, and Sleep Medicine, Keck School of Medicine, University of Southern California, Los Angeles (A.B.)
| | - Laura P Hurley
- From the Divisions of Pulmonary and Critical Care Medicine and Allergy and Immunology, Brigham and Women's Hospital, Harvard Medical School (E.I., N.E.M., V.E.F., P.A.H., J.M.K., J.R.L., B.E.), and patient partner (O.T.), Boston, and the Lahey Hospital and Medical Center, Burlington (V.P.P.) - all in Massachusetts; the Division of Allergy and Immunology, Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa (J.-C.C., T.B.C.), the Department of Nursing, University of Miami Health System (M.F.), and Miller School of Medicine, University of Miami (R.A.C.C.), Miami, the Department of Community Health and Family Medicine, University of Florida College of Medicine, Gainesville (K.L.C.), and the University of Central Florida College of Medicine, Orlando (M.P.) - all in Florida; the Department of Family Medicine (J.K.C., W.D.P.) and the Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine (A.L.F.), University of Colorado, Aurora, the Public Leadership Group (G.M.H.), the Department of Medicine, National Jewish Health (M.E.W.), and the Denver Health and Hospital Authority (L.P.H.), Denver - all in Colorado; the American Academy of Family Physicians National Research Network, Leawood, KS (J.K.C., B.K.M., J.B.S.); Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (L.S., F.W.R.); the Department of Family and Community Health, University of Minnesota, Minneapolis (B.P.Y.), and patient partner, St. Paul (S.M.) - both in Minnesota; patient partner, South Jordan, UT (A.D.C.M.); the Division of Adolescent Medicine (T.C.B.) and the Lung Health Center, Department of Medicine, University of Alabama, Birmingham (J.T.); the American Lung Association, Washington, DC (B.M.K.); the Department of Medicine, Johns Hopkins School of Medicine, Baltimore (C.S.R.); patient partner (J.R.), the Divisions of General Internal Medicine and Pulmonary and Critical Care Medicine (J.P.W.) and Clinical Immunology and Allergy (P.J.B.), Icahn School of Medicine at Mount Sinai, and Montefiore Medical Center, (E.J.), Albert Einstein College of Medicine (M.D.M., S.P.J.) - all in New York; the Center for Clinical Informatics Research and Education, the MetroHealth System, and the Departments of Internal Medicine, Pediatrics, and Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland (D.C.K.); the Department of Internal Medicine, Section of Allergy and Immunology, University of Puerto Rico, San Juan (S.N.); the Division of Allergy and Immunology, University of North Carolina School of Medicine, Chapel Hill (M.L.H.), the Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University School of Medicine, Durham (I.L.R.), and the Department of Family Medicine, Atrium Health, Charlotte (H.T.) - all in North Carolina; the Division of Pulmonary, Allergy, and Critical Care Medicine, Perelman School of Medicine, University of Pennsylvania (A.J.A.), and the Temple Lung Center, Lewis Katz School of Medicine at Temple University (K.S.) - both in Philadelphia; the University of Illinois at Chicago College of Pharmacy, Chicago (P.M.S.); the Section of Pulmonary, Critical Care, and Sleep Medicine, Yale School of Medicine, New Haven, CT (G.C.); and the Division of Pulmonary, Critical Care, and Sleep Medicine, Keck School of Medicine, University of Southern California, Los Angeles (A.B.)
| | - Jennifer Trevor
- From the Divisions of Pulmonary and Critical Care Medicine and Allergy and Immunology, Brigham and Women's Hospital, Harvard Medical School (E.I., N.E.M., V.E.F., P.A.H., J.M.K., J.R.L., B.E.), and patient partner (O.T.), Boston, and the Lahey Hospital and Medical Center, Burlington (V.P.P.) - all in Massachusetts; the Division of Allergy and Immunology, Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa (J.-C.C., T.B.C.), the Department of Nursing, University of Miami Health System (M.F.), and Miller School of Medicine, University of Miami (R.A.C.C.), Miami, the Department of Community Health and Family Medicine, University of Florida College of Medicine, Gainesville (K.L.C.), and the University of Central Florida College of Medicine, Orlando (M.P.) - all in Florida; the Department of Family Medicine (J.K.C., W.D.P.) and the Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine (A.L.F.), University of Colorado, Aurora, the Public Leadership Group (G.M.H.), the Department of Medicine, National Jewish Health (M.E.W.), and the Denver Health and Hospital Authority (L.P.H.), Denver - all in Colorado; the American Academy of Family Physicians National Research Network, Leawood, KS (J.K.C., B.K.M., J.B.S.); Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (L.S., F.W.R.); the Department of Family and Community Health, University of Minnesota, Minneapolis (B.P.Y.), and patient partner, St. Paul (S.M.) - both in Minnesota; patient partner, South Jordan, UT (A.D.C.M.); the Division of Adolescent Medicine (T.C.B.) and the Lung Health Center, Department of Medicine, University of Alabama, Birmingham (J.T.); the American Lung Association, Washington, DC (B.M.K.); the Department of Medicine, Johns Hopkins School of Medicine, Baltimore (C.S.R.); patient partner (J.R.), the Divisions of General Internal Medicine and Pulmonary and Critical Care Medicine (J.P.W.) and Clinical Immunology and Allergy (P.J.B.), Icahn School of Medicine at Mount Sinai, and Montefiore Medical Center, (E.J.), Albert Einstein College of Medicine (M.D.M., S.P.J.) - all in New York; the Center for Clinical Informatics Research and Education, the MetroHealth System, and the Departments of Internal Medicine, Pediatrics, and Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland (D.C.K.); the Department of Internal Medicine, Section of Allergy and Immunology, University of Puerto Rico, San Juan (S.N.); the Division of Allergy and Immunology, University of North Carolina School of Medicine, Chapel Hill (M.L.H.), the Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University School of Medicine, Durham (I.L.R.), and the Department of Family Medicine, Atrium Health, Charlotte (H.T.) - all in North Carolina; the Division of Pulmonary, Allergy, and Critical Care Medicine, Perelman School of Medicine, University of Pennsylvania (A.J.A.), and the Temple Lung Center, Lewis Katz School of Medicine at Temple University (K.S.) - both in Philadelphia; the University of Illinois at Chicago College of Pharmacy, Chicago (P.M.S.); the Section of Pulmonary, Critical Care, and Sleep Medicine, Yale School of Medicine, New Haven, CT (G.C.); and the Division of Pulmonary, Critical Care, and Sleep Medicine, Keck School of Medicine, University of Southern California, Los Angeles (A.B.)
| | - Thomas B Casale
- From the Divisions of Pulmonary and Critical Care Medicine and Allergy and Immunology, Brigham and Women's Hospital, Harvard Medical School (E.I., N.E.M., V.E.F., P.A.H., J.M.K., J.R.L., B.E.), and patient partner (O.T.), Boston, and the Lahey Hospital and Medical Center, Burlington (V.P.P.) - all in Massachusetts; the Division of Allergy and Immunology, Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa (J.-C.C., T.B.C.), the Department of Nursing, University of Miami Health System (M.F.), and Miller School of Medicine, University of Miami (R.A.C.C.), Miami, the Department of Community Health and Family Medicine, University of Florida College of Medicine, Gainesville (K.L.C.), and the University of Central Florida College of Medicine, Orlando (M.P.) - all in Florida; the Department of Family Medicine (J.K.C., W.D.P.) and the Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine (A.L.F.), University of Colorado, Aurora, the Public Leadership Group (G.M.H.), the Department of Medicine, National Jewish Health (M.E.W.), and the Denver Health and Hospital Authority (L.P.H.), Denver - all in Colorado; the American Academy of Family Physicians National Research Network, Leawood, KS (J.K.C., B.K.M., J.B.S.); Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (L.S., F.W.R.); the Department of Family and Community Health, University of Minnesota, Minneapolis (B.P.Y.), and patient partner, St. Paul (S.M.) - both in Minnesota; patient partner, South Jordan, UT (A.D.C.M.); the Division of Adolescent Medicine (T.C.B.) and the Lung Health Center, Department of Medicine, University of Alabama, Birmingham (J.T.); the American Lung Association, Washington, DC (B.M.K.); the Department of Medicine, Johns Hopkins School of Medicine, Baltimore (C.S.R.); patient partner (J.R.), the Divisions of General Internal Medicine and Pulmonary and Critical Care Medicine (J.P.W.) and Clinical Immunology and Allergy (P.J.B.), Icahn School of Medicine at Mount Sinai, and Montefiore Medical Center, (E.J.), Albert Einstein College of Medicine (M.D.M., S.P.J.) - all in New York; the Center for Clinical Informatics Research and Education, the MetroHealth System, and the Departments of Internal Medicine, Pediatrics, and Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland (D.C.K.); the Department of Internal Medicine, Section of Allergy and Immunology, University of Puerto Rico, San Juan (S.N.); the Division of Allergy and Immunology, University of North Carolina School of Medicine, Chapel Hill (M.L.H.), the Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University School of Medicine, Durham (I.L.R.), and the Department of Family Medicine, Atrium Health, Charlotte (H.T.) - all in North Carolina; the Division of Pulmonary, Allergy, and Critical Care Medicine, Perelman School of Medicine, University of Pennsylvania (A.J.A.), and the Temple Lung Center, Lewis Katz School of Medicine at Temple University (K.S.) - both in Philadelphia; the University of Illinois at Chicago College of Pharmacy, Chicago (P.M.S.); the Section of Pulmonary, Critical Care, and Sleep Medicine, Yale School of Medicine, New Haven, CT (G.C.); and the Division of Pulmonary, Critical Care, and Sleep Medicine, Keck School of Medicine, University of Southern California, Los Angeles (A.B.)
| | - Geoffrey Chupp
- From the Divisions of Pulmonary and Critical Care Medicine and Allergy and Immunology, Brigham and Women's Hospital, Harvard Medical School (E.I., N.E.M., V.E.F., P.A.H., J.M.K., J.R.L., B.E.), and patient partner (O.T.), Boston, and the Lahey Hospital and Medical Center, Burlington (V.P.P.) - all in Massachusetts; the Division of Allergy and Immunology, Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa (J.-C.C., T.B.C.), the Department of Nursing, University of Miami Health System (M.F.), and Miller School of Medicine, University of Miami (R.A.C.C.), Miami, the Department of Community Health and Family Medicine, University of Florida College of Medicine, Gainesville (K.L.C.), and the University of Central Florida College of Medicine, Orlando (M.P.) - all in Florida; the Department of Family Medicine (J.K.C., W.D.P.) and the Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine (A.L.F.), University of Colorado, Aurora, the Public Leadership Group (G.M.H.), the Department of Medicine, National Jewish Health (M.E.W.), and the Denver Health and Hospital Authority (L.P.H.), Denver - all in Colorado; the American Academy of Family Physicians National Research Network, Leawood, KS (J.K.C., B.K.M., J.B.S.); Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (L.S., F.W.R.); the Department of Family and Community Health, University of Minnesota, Minneapolis (B.P.Y.), and patient partner, St. Paul (S.M.) - both in Minnesota; patient partner, South Jordan, UT (A.D.C.M.); the Division of Adolescent Medicine (T.C.B.) and the Lung Health Center, Department of Medicine, University of Alabama, Birmingham (J.T.); the American Lung Association, Washington, DC (B.M.K.); the Department of Medicine, Johns Hopkins School of Medicine, Baltimore (C.S.R.); patient partner (J.R.), the Divisions of General Internal Medicine and Pulmonary and Critical Care Medicine (J.P.W.) and Clinical Immunology and Allergy (P.J.B.), Icahn School of Medicine at Mount Sinai, and Montefiore Medical Center, (E.J.), Albert Einstein College of Medicine (M.D.M., S.P.J.) - all in New York; the Center for Clinical Informatics Research and Education, the MetroHealth System, and the Departments of Internal Medicine, Pediatrics, and Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland (D.C.K.); the Department of Internal Medicine, Section of Allergy and Immunology, University of Puerto Rico, San Juan (S.N.); the Division of Allergy and Immunology, University of North Carolina School of Medicine, Chapel Hill (M.L.H.), the Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University School of Medicine, Durham (I.L.R.), and the Department of Family Medicine, Atrium Health, Charlotte (H.T.) - all in North Carolina; the Division of Pulmonary, Allergy, and Critical Care Medicine, Perelman School of Medicine, University of Pennsylvania (A.J.A.), and the Temple Lung Center, Lewis Katz School of Medicine at Temple University (K.S.) - both in Philadelphia; the University of Illinois at Chicago College of Pharmacy, Chicago (P.M.S.); the Section of Pulmonary, Critical Care, and Sleep Medicine, Yale School of Medicine, New Haven, CT (G.C.); and the Division of Pulmonary, Critical Care, and Sleep Medicine, Keck School of Medicine, University of Southern California, Los Angeles (A.B.)
| | - Isaretta L Riley
- From the Divisions of Pulmonary and Critical Care Medicine and Allergy and Immunology, Brigham and Women's Hospital, Harvard Medical School (E.I., N.E.M., V.E.F., P.A.H., J.M.K., J.R.L., B.E.), and patient partner (O.T.), Boston, and the Lahey Hospital and Medical Center, Burlington (V.P.P.) - all in Massachusetts; the Division of Allergy and Immunology, Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa (J.-C.C., T.B.C.), the Department of Nursing, University of Miami Health System (M.F.), and Miller School of Medicine, University of Miami (R.A.C.C.), Miami, the Department of Community Health and Family Medicine, University of Florida College of Medicine, Gainesville (K.L.C.), and the University of Central Florida College of Medicine, Orlando (M.P.) - all in Florida; the Department of Family Medicine (J.K.C., W.D.P.) and the Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine (A.L.F.), University of Colorado, Aurora, the Public Leadership Group (G.M.H.), the Department of Medicine, National Jewish Health (M.E.W.), and the Denver Health and Hospital Authority (L.P.H.), Denver - all in Colorado; the American Academy of Family Physicians National Research Network, Leawood, KS (J.K.C., B.K.M., J.B.S.); Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (L.S., F.W.R.); the Department of Family and Community Health, University of Minnesota, Minneapolis (B.P.Y.), and patient partner, St. Paul (S.M.) - both in Minnesota; patient partner, South Jordan, UT (A.D.C.M.); the Division of Adolescent Medicine (T.C.B.) and the Lung Health Center, Department of Medicine, University of Alabama, Birmingham (J.T.); the American Lung Association, Washington, DC (B.M.K.); the Department of Medicine, Johns Hopkins School of Medicine, Baltimore (C.S.R.); patient partner (J.R.), the Divisions of General Internal Medicine and Pulmonary and Critical Care Medicine (J.P.W.) and Clinical Immunology and Allergy (P.J.B.), Icahn School of Medicine at Mount Sinai, and Montefiore Medical Center, (E.J.), Albert Einstein College of Medicine (M.D.M., S.P.J.) - all in New York; the Center for Clinical Informatics Research and Education, the MetroHealth System, and the Departments of Internal Medicine, Pediatrics, and Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland (D.C.K.); the Department of Internal Medicine, Section of Allergy and Immunology, University of Puerto Rico, San Juan (S.N.); the Division of Allergy and Immunology, University of North Carolina School of Medicine, Chapel Hill (M.L.H.), the Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University School of Medicine, Durham (I.L.R.), and the Department of Family Medicine, Atrium Health, Charlotte (H.T.) - all in North Carolina; the Division of Pulmonary, Allergy, and Critical Care Medicine, Perelman School of Medicine, University of Pennsylvania (A.J.A.), and the Temple Lung Center, Lewis Katz School of Medicine at Temple University (K.S.) - both in Philadelphia; the University of Illinois at Chicago College of Pharmacy, Chicago (P.M.S.); the Section of Pulmonary, Critical Care, and Sleep Medicine, Yale School of Medicine, New Haven, CT (G.C.); and the Division of Pulmonary, Critical Care, and Sleep Medicine, Keck School of Medicine, University of Southern California, Los Angeles (A.B.)
| | - Kartik Shenoy
- From the Divisions of Pulmonary and Critical Care Medicine and Allergy and Immunology, Brigham and Women's Hospital, Harvard Medical School (E.I., N.E.M., V.E.F., P.A.H., J.M.K., J.R.L., B.E.), and patient partner (O.T.), Boston, and the Lahey Hospital and Medical Center, Burlington (V.P.P.) - all in Massachusetts; the Division of Allergy and Immunology, Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa (J.-C.C., T.B.C.), the Department of Nursing, University of Miami Health System (M.F.), and Miller School of Medicine, University of Miami (R.A.C.C.), Miami, the Department of Community Health and Family Medicine, University of Florida College of Medicine, Gainesville (K.L.C.), and the University of Central Florida College of Medicine, Orlando (M.P.) - all in Florida; the Department of Family Medicine (J.K.C., W.D.P.) and the Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine (A.L.F.), University of Colorado, Aurora, the Public Leadership Group (G.M.H.), the Department of Medicine, National Jewish Health (M.E.W.), and the Denver Health and Hospital Authority (L.P.H.), Denver - all in Colorado; the American Academy of Family Physicians National Research Network, Leawood, KS (J.K.C., B.K.M., J.B.S.); Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (L.S., F.W.R.); the Department of Family and Community Health, University of Minnesota, Minneapolis (B.P.Y.), and patient partner, St. Paul (S.M.) - both in Minnesota; patient partner, South Jordan, UT (A.D.C.M.); the Division of Adolescent Medicine (T.C.B.) and the Lung Health Center, Department of Medicine, University of Alabama, Birmingham (J.T.); the American Lung Association, Washington, DC (B.M.K.); the Department of Medicine, Johns Hopkins School of Medicine, Baltimore (C.S.R.); patient partner (J.R.), the Divisions of General Internal Medicine and Pulmonary and Critical Care Medicine (J.P.W.) and Clinical Immunology and Allergy (P.J.B.), Icahn School of Medicine at Mount Sinai, and Montefiore Medical Center, (E.J.), Albert Einstein College of Medicine (M.D.M., S.P.J.) - all in New York; the Center for Clinical Informatics Research and Education, the MetroHealth System, and the Departments of Internal Medicine, Pediatrics, and Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland (D.C.K.); the Department of Internal Medicine, Section of Allergy and Immunology, University of Puerto Rico, San Juan (S.N.); the Division of Allergy and Immunology, University of North Carolina School of Medicine, Chapel Hill (M.L.H.), the Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University School of Medicine, Durham (I.L.R.), and the Department of Family Medicine, Atrium Health, Charlotte (H.T.) - all in North Carolina; the Division of Pulmonary, Allergy, and Critical Care Medicine, Perelman School of Medicine, University of Pennsylvania (A.J.A.), and the Temple Lung Center, Lewis Katz School of Medicine at Temple University (K.S.) - both in Philadelphia; the University of Illinois at Chicago College of Pharmacy, Chicago (P.M.S.); the Section of Pulmonary, Critical Care, and Sleep Medicine, Yale School of Medicine, New Haven, CT (G.C.); and the Division of Pulmonary, Critical Care, and Sleep Medicine, Keck School of Medicine, University of Southern California, Los Angeles (A.B.)
| | - Magdalena Pasarica
- From the Divisions of Pulmonary and Critical Care Medicine and Allergy and Immunology, Brigham and Women's Hospital, Harvard Medical School (E.I., N.E.M., V.E.F., P.A.H., J.M.K., J.R.L., B.E.), and patient partner (O.T.), Boston, and the Lahey Hospital and Medical Center, Burlington (V.P.P.) - all in Massachusetts; the Division of Allergy and Immunology, Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa (J.-C.C., T.B.C.), the Department of Nursing, University of Miami Health System (M.F.), and Miller School of Medicine, University of Miami (R.A.C.C.), Miami, the Department of Community Health and Family Medicine, University of Florida College of Medicine, Gainesville (K.L.C.), and the University of Central Florida College of Medicine, Orlando (M.P.) - all in Florida; the Department of Family Medicine (J.K.C., W.D.P.) and the Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine (A.L.F.), University of Colorado, Aurora, the Public Leadership Group (G.M.H.), the Department of Medicine, National Jewish Health (M.E.W.), and the Denver Health and Hospital Authority (L.P.H.), Denver - all in Colorado; the American Academy of Family Physicians National Research Network, Leawood, KS (J.K.C., B.K.M., J.B.S.); Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (L.S., F.W.R.); the Department of Family and Community Health, University of Minnesota, Minneapolis (B.P.Y.), and patient partner, St. Paul (S.M.) - both in Minnesota; patient partner, South Jordan, UT (A.D.C.M.); the Division of Adolescent Medicine (T.C.B.) and the Lung Health Center, Department of Medicine, University of Alabama, Birmingham (J.T.); the American Lung Association, Washington, DC (B.M.K.); the Department of Medicine, Johns Hopkins School of Medicine, Baltimore (C.S.R.); patient partner (J.R.), the Divisions of General Internal Medicine and Pulmonary and Critical Care Medicine (J.P.W.) and Clinical Immunology and Allergy (P.J.B.), Icahn School of Medicine at Mount Sinai, and Montefiore Medical Center, (E.J.), Albert Einstein College of Medicine (M.D.M., S.P.J.) - all in New York; the Center for Clinical Informatics Research and Education, the MetroHealth System, and the Departments of Internal Medicine, Pediatrics, and Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland (D.C.K.); the Department of Internal Medicine, Section of Allergy and Immunology, University of Puerto Rico, San Juan (S.N.); the Division of Allergy and Immunology, University of North Carolina School of Medicine, Chapel Hill (M.L.H.), the Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University School of Medicine, Durham (I.L.R.), and the Department of Family Medicine, Atrium Health, Charlotte (H.T.) - all in North Carolina; the Division of Pulmonary, Allergy, and Critical Care Medicine, Perelman School of Medicine, University of Pennsylvania (A.J.A.), and the Temple Lung Center, Lewis Katz School of Medicine at Temple University (K.S.) - both in Philadelphia; the University of Illinois at Chicago College of Pharmacy, Chicago (P.M.S.); the Section of Pulmonary, Critical Care, and Sleep Medicine, Yale School of Medicine, New Haven, CT (G.C.); and the Division of Pulmonary, Critical Care, and Sleep Medicine, Keck School of Medicine, University of Southern California, Los Angeles (A.B.)
| | - Rafael A Calderon-Candelario
- From the Divisions of Pulmonary and Critical Care Medicine and Allergy and Immunology, Brigham and Women's Hospital, Harvard Medical School (E.I., N.E.M., V.E.F., P.A.H., J.M.K., J.R.L., B.E.), and patient partner (O.T.), Boston, and the Lahey Hospital and Medical Center, Burlington (V.P.P.) - all in Massachusetts; the Division of Allergy and Immunology, Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa (J.-C.C., T.B.C.), the Department of Nursing, University of Miami Health System (M.F.), and Miller School of Medicine, University of Miami (R.A.C.C.), Miami, the Department of Community Health and Family Medicine, University of Florida College of Medicine, Gainesville (K.L.C.), and the University of Central Florida College of Medicine, Orlando (M.P.) - all in Florida; the Department of Family Medicine (J.K.C., W.D.P.) and the Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine (A.L.F.), University of Colorado, Aurora, the Public Leadership Group (G.M.H.), the Department of Medicine, National Jewish Health (M.E.W.), and the Denver Health and Hospital Authority (L.P.H.), Denver - all in Colorado; the American Academy of Family Physicians National Research Network, Leawood, KS (J.K.C., B.K.M., J.B.S.); Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (L.S., F.W.R.); the Department of Family and Community Health, University of Minnesota, Minneapolis (B.P.Y.), and patient partner, St. Paul (S.M.) - both in Minnesota; patient partner, South Jordan, UT (A.D.C.M.); the Division of Adolescent Medicine (T.C.B.) and the Lung Health Center, Department of Medicine, University of Alabama, Birmingham (J.T.); the American Lung Association, Washington, DC (B.M.K.); the Department of Medicine, Johns Hopkins School of Medicine, Baltimore (C.S.R.); patient partner (J.R.), the Divisions of General Internal Medicine and Pulmonary and Critical Care Medicine (J.P.W.) and Clinical Immunology and Allergy (P.J.B.), Icahn School of Medicine at Mount Sinai, and Montefiore Medical Center, (E.J.), Albert Einstein College of Medicine (M.D.M., S.P.J.) - all in New York; the Center for Clinical Informatics Research and Education, the MetroHealth System, and the Departments of Internal Medicine, Pediatrics, and Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland (D.C.K.); the Department of Internal Medicine, Section of Allergy and Immunology, University of Puerto Rico, San Juan (S.N.); the Division of Allergy and Immunology, University of North Carolina School of Medicine, Chapel Hill (M.L.H.), the Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University School of Medicine, Durham (I.L.R.), and the Department of Family Medicine, Atrium Health, Charlotte (H.T.) - all in North Carolina; the Division of Pulmonary, Allergy, and Critical Care Medicine, Perelman School of Medicine, University of Pennsylvania (A.J.A.), and the Temple Lung Center, Lewis Katz School of Medicine at Temple University (K.S.) - both in Philadelphia; the University of Illinois at Chicago College of Pharmacy, Chicago (P.M.S.); the Section of Pulmonary, Critical Care, and Sleep Medicine, Yale School of Medicine, New Haven, CT (G.C.); and the Division of Pulmonary, Critical Care, and Sleep Medicine, Keck School of Medicine, University of Southern California, Los Angeles (A.B.)
| | - Hazel Tapp
- From the Divisions of Pulmonary and Critical Care Medicine and Allergy and Immunology, Brigham and Women's Hospital, Harvard Medical School (E.I., N.E.M., V.E.F., P.A.H., J.M.K., J.R.L., B.E.), and patient partner (O.T.), Boston, and the Lahey Hospital and Medical Center, Burlington (V.P.P.) - all in Massachusetts; the Division of Allergy and Immunology, Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa (J.-C.C., T.B.C.), the Department of Nursing, University of Miami Health System (M.F.), and Miller School of Medicine, University of Miami (R.A.C.C.), Miami, the Department of Community Health and Family Medicine, University of Florida College of Medicine, Gainesville (K.L.C.), and the University of Central Florida College of Medicine, Orlando (M.P.) - all in Florida; the Department of Family Medicine (J.K.C., W.D.P.) and the Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine (A.L.F.), University of Colorado, Aurora, the Public Leadership Group (G.M.H.), the Department of Medicine, National Jewish Health (M.E.W.), and the Denver Health and Hospital Authority (L.P.H.), Denver - all in Colorado; the American Academy of Family Physicians National Research Network, Leawood, KS (J.K.C., B.K.M., J.B.S.); Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (L.S., F.W.R.); the Department of Family and Community Health, University of Minnesota, Minneapolis (B.P.Y.), and patient partner, St. Paul (S.M.) - both in Minnesota; patient partner, South Jordan, UT (A.D.C.M.); the Division of Adolescent Medicine (T.C.B.) and the Lung Health Center, Department of Medicine, University of Alabama, Birmingham (J.T.); the American Lung Association, Washington, DC (B.M.K.); the Department of Medicine, Johns Hopkins School of Medicine, Baltimore (C.S.R.); patient partner (J.R.), the Divisions of General Internal Medicine and Pulmonary and Critical Care Medicine (J.P.W.) and Clinical Immunology and Allergy (P.J.B.), Icahn School of Medicine at Mount Sinai, and Montefiore Medical Center, (E.J.), Albert Einstein College of Medicine (M.D.M., S.P.J.) - all in New York; the Center for Clinical Informatics Research and Education, the MetroHealth System, and the Departments of Internal Medicine, Pediatrics, and Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland (D.C.K.); the Department of Internal Medicine, Section of Allergy and Immunology, University of Puerto Rico, San Juan (S.N.); the Division of Allergy and Immunology, University of North Carolina School of Medicine, Chapel Hill (M.L.H.), the Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University School of Medicine, Durham (I.L.R.), and the Department of Family Medicine, Atrium Health, Charlotte (H.T.) - all in North Carolina; the Division of Pulmonary, Allergy, and Critical Care Medicine, Perelman School of Medicine, University of Pennsylvania (A.J.A.), and the Temple Lung Center, Lewis Katz School of Medicine at Temple University (K.S.) - both in Philadelphia; the University of Illinois at Chicago College of Pharmacy, Chicago (P.M.S.); the Section of Pulmonary, Critical Care, and Sleep Medicine, Yale School of Medicine, New Haven, CT (G.C.); and the Division of Pulmonary, Critical Care, and Sleep Medicine, Keck School of Medicine, University of Southern California, Los Angeles (A.B.)
| | - Ahmet Baydur
- From the Divisions of Pulmonary and Critical Care Medicine and Allergy and Immunology, Brigham and Women's Hospital, Harvard Medical School (E.I., N.E.M., V.E.F., P.A.H., J.M.K., J.R.L., B.E.), and patient partner (O.T.), Boston, and the Lahey Hospital and Medical Center, Burlington (V.P.P.) - all in Massachusetts; the Division of Allergy and Immunology, Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa (J.-C.C., T.B.C.), the Department of Nursing, University of Miami Health System (M.F.), and Miller School of Medicine, University of Miami (R.A.C.C.), Miami, the Department of Community Health and Family Medicine, University of Florida College of Medicine, Gainesville (K.L.C.), and the University of Central Florida College of Medicine, Orlando (M.P.) - all in Florida; the Department of Family Medicine (J.K.C., W.D.P.) and the Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine (A.L.F.), University of Colorado, Aurora, the Public Leadership Group (G.M.H.), the Department of Medicine, National Jewish Health (M.E.W.), and the Denver Health and Hospital Authority (L.P.H.), Denver - all in Colorado; the American Academy of Family Physicians National Research Network, Leawood, KS (J.K.C., B.K.M., J.B.S.); Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (L.S., F.W.R.); the Department of Family and Community Health, University of Minnesota, Minneapolis (B.P.Y.), and patient partner, St. Paul (S.M.) - both in Minnesota; patient partner, South Jordan, UT (A.D.C.M.); the Division of Adolescent Medicine (T.C.B.) and the Lung Health Center, Department of Medicine, University of Alabama, Birmingham (J.T.); the American Lung Association, Washington, DC (B.M.K.); the Department of Medicine, Johns Hopkins School of Medicine, Baltimore (C.S.R.); patient partner (J.R.), the Divisions of General Internal Medicine and Pulmonary and Critical Care Medicine (J.P.W.) and Clinical Immunology and Allergy (P.J.B.), Icahn School of Medicine at Mount Sinai, and Montefiore Medical Center, (E.J.), Albert Einstein College of Medicine (M.D.M., S.P.J.) - all in New York; the Center for Clinical Informatics Research and Education, the MetroHealth System, and the Departments of Internal Medicine, Pediatrics, and Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland (D.C.K.); the Department of Internal Medicine, Section of Allergy and Immunology, University of Puerto Rico, San Juan (S.N.); the Division of Allergy and Immunology, University of North Carolina School of Medicine, Chapel Hill (M.L.H.), the Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University School of Medicine, Durham (I.L.R.), and the Department of Family Medicine, Atrium Health, Charlotte (H.T.) - all in North Carolina; the Division of Pulmonary, Allergy, and Critical Care Medicine, Perelman School of Medicine, University of Pennsylvania (A.J.A.), and the Temple Lung Center, Lewis Katz School of Medicine at Temple University (K.S.) - both in Philadelphia; the University of Illinois at Chicago College of Pharmacy, Chicago (P.M.S.); the Section of Pulmonary, Critical Care, and Sleep Medicine, Yale School of Medicine, New Haven, CT (G.C.); and the Division of Pulmonary, Critical Care, and Sleep Medicine, Keck School of Medicine, University of Southern California, Los Angeles (A.B.)
| | - Wilson D Pace
- From the Divisions of Pulmonary and Critical Care Medicine and Allergy and Immunology, Brigham and Women's Hospital, Harvard Medical School (E.I., N.E.M., V.E.F., P.A.H., J.M.K., J.R.L., B.E.), and patient partner (O.T.), Boston, and the Lahey Hospital and Medical Center, Burlington (V.P.P.) - all in Massachusetts; the Division of Allergy and Immunology, Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa (J.-C.C., T.B.C.), the Department of Nursing, University of Miami Health System (M.F.), and Miller School of Medicine, University of Miami (R.A.C.C.), Miami, the Department of Community Health and Family Medicine, University of Florida College of Medicine, Gainesville (K.L.C.), and the University of Central Florida College of Medicine, Orlando (M.P.) - all in Florida; the Department of Family Medicine (J.K.C., W.D.P.) and the Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine (A.L.F.), University of Colorado, Aurora, the Public Leadership Group (G.M.H.), the Department of Medicine, National Jewish Health (M.E.W.), and the Denver Health and Hospital Authority (L.P.H.), Denver - all in Colorado; the American Academy of Family Physicians National Research Network, Leawood, KS (J.K.C., B.K.M., J.B.S.); Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (L.S., F.W.R.); the Department of Family and Community Health, University of Minnesota, Minneapolis (B.P.Y.), and patient partner, St. Paul (S.M.) - both in Minnesota; patient partner, South Jordan, UT (A.D.C.M.); the Division of Adolescent Medicine (T.C.B.) and the Lung Health Center, Department of Medicine, University of Alabama, Birmingham (J.T.); the American Lung Association, Washington, DC (B.M.K.); the Department of Medicine, Johns Hopkins School of Medicine, Baltimore (C.S.R.); patient partner (J.R.), the Divisions of General Internal Medicine and Pulmonary and Critical Care Medicine (J.P.W.) and Clinical Immunology and Allergy (P.J.B.), Icahn School of Medicine at Mount Sinai, and Montefiore Medical Center, (E.J.), Albert Einstein College of Medicine (M.D.M., S.P.J.) - all in New York; the Center for Clinical Informatics Research and Education, the MetroHealth System, and the Departments of Internal Medicine, Pediatrics, and Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland (D.C.K.); the Department of Internal Medicine, Section of Allergy and Immunology, University of Puerto Rico, San Juan (S.N.); the Division of Allergy and Immunology, University of North Carolina School of Medicine, Chapel Hill (M.L.H.), the Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University School of Medicine, Durham (I.L.R.), and the Department of Family Medicine, Atrium Health, Charlotte (H.T.) - all in North Carolina; the Division of Pulmonary, Allergy, and Critical Care Medicine, Perelman School of Medicine, University of Pennsylvania (A.J.A.), and the Temple Lung Center, Lewis Katz School of Medicine at Temple University (K.S.) - both in Philadelphia; the University of Illinois at Chicago College of Pharmacy, Chicago (P.M.S.); the Section of Pulmonary, Critical Care, and Sleep Medicine, Yale School of Medicine, New Haven, CT (G.C.); and the Division of Pulmonary, Critical Care, and Sleep Medicine, Keck School of Medicine, University of Southern California, Los Angeles (A.B.)
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Lee Y, Chen H, Chen W, Qi Q, Afshar M, Cai J, Daviglus ML, Thyagarajan B, North KE, London SJ, Boerwinkle E, Celedón JC, Kaplan RC, Yu B. Metabolomic Associations of Asthma in the Hispanic Community Health Study/Study of Latinos. Metabolites 2022; 12:metabo12040359. [PMID: 35448546 PMCID: PMC9028429 DOI: 10.3390/metabo12040359] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 04/02/2022] [Accepted: 04/12/2022] [Indexed: 12/17/2022] Open
Abstract
Asthma disproportionally affects Hispanic and/or Latino backgrounds; however, the relation between circulating metabolites and asthma remains unclear. We conducted a cross-sectional study associating 640 individual serum metabolites, as well as twelve metabolite modules, with asthma in 3347 Hispanic/Latino background participants (514 asthmatics, 15.36%) from the Hispanic/Latino Community Health Study/Study of Latinos. Using survey logistic regression, per standard deviation (SD) increase in 1-arachidonoyl-GPA (20:4) was significantly associated with 32% high odds of asthma after accounting for clinical risk factors (p = 6.27 × 10−5), and per SD of the green module, constructed using weighted gene co-expression network, was suggestively associated with 25% high odds of asthma (p = 0.006). In the stratified analyses by sex and Hispanic and/or Latino backgrounds, the effect of 1-arachidonoyl-GPA (20:4) and the green module was predominantly observed in women (OR = 1.24 and 1.37, p < 0.001) and people of Cuban and Puerto-Rican backgrounds (OR = 1.25 and 1.27, p < 0.01). Mutations in Fatty Acid Desaturase 2 (FADS2) affected the levels of 1-arachidonoyl-GPA (20:4), and Mendelian Randomization analyses revealed that high genetically regulated 1-arachidonoyl-GPA (20:4) levels were associated with increased odds of asthma (p < 0.001). The findings reinforce a molecular basis for asthma etiology, and the potential causal effect of 1-arachidonoyl-GPA (20:4) on asthma provides an opportunity for future intervention.
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Affiliation(s)
- Yura Lee
- Department of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA; (Y.L.); (H.C.); (E.B.)
| | - Han Chen
- Department of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA; (Y.L.); (H.C.); (E.B.)
| | - Wei Chen
- Department of Pediatrics, School of Medicine, University of Pittsburgh, Pittsburgh, PA 15224, USA; (W.C.); (J.C.C.)
| | - Qibin Qi
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY 10461, USA;
| | - Majid Afshar
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI 53726, USA; (M.A.); (R.C.K.)
| | - Jianwen Cai
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC 27516, USA;
| | - Martha L. Daviglus
- Institute of Minority Health Research, University of Illinois College of Medicine, Chicago, IL 60612, USA;
| | - Bharat Thyagarajan
- Department of Laboratory Medicine and Pathology, University of Minnesota, MMC 609, 420 Delaware Street, Minneapolis, MN 55455, USA;
| | - Kari E. North
- Department of Epidemiology and Carolina Center for Genome Sciences, School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27514, USA;
| | - Stephanie J. London
- Department of Health and Human Services, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC 27709, USA;
| | - Eric Boerwinkle
- Department of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA; (Y.L.); (H.C.); (E.B.)
| | - Juan C. Celedón
- Department of Pediatrics, School of Medicine, University of Pittsburgh, Pittsburgh, PA 15224, USA; (W.C.); (J.C.C.)
- Division of Pulmonary Medicine, Children’s Hospital of Pittsburgh of UPMC, Pittsburgh, PA 15224, USA
| | - Robert C. Kaplan
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI 53726, USA; (M.A.); (R.C.K.)
| | - Bing Yu
- Department of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA; (Y.L.); (H.C.); (E.B.)
- Correspondence:
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8
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Belbin GM, Cullina S, Wenric S, Soper ER, Glicksberg BS, Torre D, Moscati A, Wojcik GL, Shemirani R, Beckmann ND, Cohain A, Sorokin EP, Park DS, Ambite JL, Ellis S, Auton A, Bottinger EP, Cho JH, Loos RJF, Abul-Husn NS, Zaitlen NA, Gignoux CR, Kenny EE. Toward a fine-scale population health monitoring system. Cell 2021; 184:2068-2083.e11. [PMID: 33861964 DOI: 10.1016/j.cell.2021.03.034] [Citation(s) in RCA: 69] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 11/18/2020] [Accepted: 03/12/2021] [Indexed: 12/22/2022]
Abstract
Understanding population health disparities is an essential component of equitable precision health efforts. Epidemiology research often relies on definitions of race and ethnicity, but these population labels may not adequately capture disease burdens and environmental factors impacting specific sub-populations. Here, we propose a framework for repurposing data from electronic health records (EHRs) in concert with genomic data to explore the demographic ties that can impact disease burdens. Using data from a diverse biobank in New York City, we identified 17 communities sharing recent genetic ancestry. We observed 1,177 health outcomes that were statistically associated with a specific group and demonstrated significant differences in the segregation of genetic variants contributing to Mendelian diseases. We also demonstrated that fine-scale population structure can impact the prediction of complex disease risk within groups. This work reinforces the utility of linking genomic data to EHRs and provides a framework toward fine-scale monitoring of population health.
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Affiliation(s)
- Gillian M Belbin
- Institute for Genomic Health, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; The Charles Bronfman Institute of Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Sinead Cullina
- Institute for Genomic Health, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; The Charles Bronfman Institute of Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Stephane Wenric
- Institute for Genomic Health, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; The Charles Bronfman Institute of Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Emily R Soper
- Institute for Genomic Health, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Benjamin S Glicksberg
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; Hasso Plattner Institute for Digital Health at Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Denis Torre
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Arden Moscati
- The Charles Bronfman Institute of Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Genevieve L Wojcik
- Department of Biomedical Data Science, Stanford University, Stanford, CA 94305, USA
| | - Ruhollah Shemirani
- Information Science Institute, University of Southern California, Marina del Rey, CA 90089, USA
| | - Noam D Beckmann
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Ariella Cohain
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Elena P Sorokin
- Department of Biomedical Data Science, Stanford University, Stanford, CA 94305, USA
| | - Danny S Park
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; Department of Bioengineering and Therapeutic Sciences, University of California, San Francisco, San Francisco, CA 94158, USA
| | - Jose-Luis Ambite
- Information Science Institute, University of Southern California, Marina del Rey, CA 90089, USA
| | - Steve Ellis
- The Charles Bronfman Institute of Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Adam Auton
- Department of Genetics, Albert Einstein College of Medicine, New York, NY 10461, USA
| | - Erwin P Bottinger
- Hasso Plattner Institute for Digital Health at Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Judy H Cho
- The Charles Bronfman Institute of Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Ruth J F Loos
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; The Charles Bronfman Institute of Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Noura S Abul-Husn
- Institute for Genomic Health, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Noah A Zaitlen
- Department of Neurology, University of California, Los Angeles, Los Angeles, CA 90033, USA
| | - Christopher R Gignoux
- Colorado Center for Personalized Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Eimear E Kenny
- Institute for Genomic Health, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA.
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9
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Israel E, Cardet JC, Carroll JK, Fuhlbrigge AL, Pace WD, Maher NE, She L, Rockhold FW, Fagan M, Forth VE, Hernandez PA, Manning BK, Rodriguez-Louis J, Shields JB, Coyne-Beasley T, Kaplan BM, Rand CS, Morales-Cosme W, Wechsler ME, Wisnivesky JP, White M, Yawn BP, McKee MD, Busse PJ, Kaelber DC, Nazario S, Hernandez ML, Apter AJ, Chang KL, Pinto-Plata V, Stranges PM, Hurley LP, Trevor J, Casale TB, Chupp G, Riley IL, Shenoy K, Pasarica M, Calderon-Candelario RA, Tapp H, Baydur A. A randomized, open-label, pragmatic study to assess reliever-triggered inhaled corticosteroid in African American/Black and Hispanic/Latinx adults with asthma: Design and methods of the PREPARE trial. Contemp Clin Trials 2021; 101:106246. [PMID: 33316456 PMCID: PMC8130188 DOI: 10.1016/j.cct.2020.106246] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 12/05/2020] [Accepted: 12/07/2020] [Indexed: 01/15/2023]
Abstract
BACKGROUND Asthma prevalence, morbidity, and mortality disproportionately impact African American/Black (AA/B) and Hispanic/Latinx (H/L) communities. Adherence to daily inhaled corticosteroid (ICS), recommended by asthma guidelines in all but the mildest cases of asthma, is generally poor. As-needed ICS has shown promise as a patient-empowering asthma management strategy, but it has not been rigorously studied in AA/B or H/L patients or in a real-world setting. Design and Aim The PeRson EmPowered Asthma RElief (PREPARE) Study is a randomized, open-label, pragmatic study which aims to assess whether a patient-guided, reliever-triggered ICS strategy called PARTICS (Patient-Activated Reliever-Triggered Inhaled CorticoSteroid) can improve asthma outcomes in AA/B and H/L adult patient populations. In designing and implementing the study, the PREPARE research team has relied heavily on advice from AA/B and H/L Patient Partners and other stakeholders. Methods PREPARE is enrolling 1200 adult participants (600 AA/Bs, 600H/Ls) with asthma. Participants are randomized to PARTICS + Usual Care (intervention) versus Usual Care (control). Following a single in-person enrollment visit, participants complete monthly questionnaires for 15 months. The primary endpoint is annualized asthma exacerbation rate. Secondary endpoints include asthma control; preference-based quality of life; and days lost from work, school, or usual activities. Discussion The PREPARE study features a pragmatic design allowing for the real-world assessment of a patient-centered, reliever-triggered ICS strategy in AA/B and H/L patients. Outcomes of this study have the potential to offer powerful evidence supporting PARTICS as an effective asthma management strategy in patient populations that suffer disproportionately from asthma morbidity and mortality.
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Affiliation(s)
- Elliot Israel
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, United States of America.
| | - Juan Carlos Cardet
- Division of Allergy and Immunology, Morsani College of Medicine, University of South Florida, 12908 Bruce B Downs Boulevard, Suite 4128, Tampa, FL, United States of America.
| | - Jennifer K Carroll
- American Academy of Family Physicians National Research Network, 11400 Tomahawk Creek Parkway, Leawood, KS 66211, United States of America; CU Anschutz Department of Family Medicine, University of Colorado, 12631 East 17th Avenue, Box F496, Aurora, CO 80045, United States of America.
| | - Anne L Fuhlbrigge
- Department of Medicine, Pulmonary Science and Critical Care Medicine, University of Colorado School of Medicine, Fitzsimons Building, 13001 E 17th Place, Box C290, Aurora, CO, United States of America.
| | - Wilson D Pace
- American Academy of Family Physicians National Research Network, 11400 Tomahawk Creek Parkway, Leawood, KS 66211, United States of America; DARTNet Institute, 12635 East Montview Boulevard, Mail Stop 3, Suite 129, Aurora, CO, United States of America.
| | - Nancy E Maher
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, United States of America.
| | - Lilin She
- Duke Clinical Research Institute, Duke University Medical Center, P.O. Box 17969, Durham, NC, United States of America.
| | - Frank W Rockhold
- Duke Clinical Research Institute, Duke University Medical Center, 200 Morris Street, Office 6428, Durham, NC, United States of America.
| | - Maureen Fagan
- University of Miami Health System, 1150 NW 14th Street, Don Soffer Clinical Research Building, Suite 360-H, Miami, FL, United States of America.
| | - Victoria E Forth
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, United States of America
| | - Paulina Arias Hernandez
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, United States of America
| | - Brian K Manning
- American Academy of Family Physicians National Research Network, 11400 Tomahawk Creek Parkway, Leawood, KS, United States of America.
| | - Jacqueline Rodriguez-Louis
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, United States of America.
| | - Joel B Shields
- American Academy of Family Physicians National Research Network, 11400 Tomahawk Creek Parkway, Leawood, KS, United States of America.
| | - Tamera Coyne-Beasley
- Division of Adolescent Medicine, University of Alabama at Birmingham, Children's of Alabama, 1600 7th Avenue South, Birmingham, AL, United States of America.
| | - Barbara M Kaplan
- American Lung Association, 1331 Pennsylvania Avenue NW, 1425N, Washington, DC, United States of America.
| | - Cynthia S Rand
- Department of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, 1830 Building, 1830 E Monument Street, Baltimore, MD, United States of America.
| | - Wilfredo Morales-Cosme
- University of Puerto Rico: Medical Sciences Campus, P.O. Box 365067, San Juan, Puerto Rico.
| | - Michael E Wechsler
- Department of Medicine, NJH Cohen Family Asthma Institute, National Jewish Health, 1400 Jackson Street, Denver, CO 80206, United States of America.
| | - Juan P Wisnivesky
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, United States of America; Division of Pulmonary and Critical Care Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, United States of America.
| | - Mary White
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, United States of America
| | - Barbara P Yawn
- Department of Family and Community Health, University of Minnesota, 516 Delaware Street SE, Minneapolis, MN, United States of America
| | - M Diane McKee
- Albert Einstein College of Medicine, 1300 Morris Park Avenue, The Bronx, NY 10461, United States of America; Department of Family Medicine and Community Health, University of Massachusetts Medical School, UMass Memorial Health Care, 55 Lake Avenue North, Worcester, MA, United States of America.
| | - Paula J Busse
- Division of Clinical Immunology and Allergy, Icahn School of Medicine at Mount Sinai, 1425 Madison Avenue, Room 11-20, New York, NY, United States of America.
| | - David C Kaelber
- Center for Clinical Informatics Research and Education, Departments of Internal Medicine, Pediatrics, and Population and Quantitative Health Sciences, The MetroHealth System, Case Western Reserve University, 2500 MetroHealth Drive, Cleveland, OH, United States of America.
| | - Sylvette Nazario
- Department of Internal Medicine, Allergy/Immunology Section, University of Puerto Rico: Medical Sciences Campus, P.O. Box 365067, San Juan, Puerto Rico.
| | - Michelle L Hernandez
- Division of Allergy, Immunology, & Rheumatology, University of North Carolina School of Medicine, 5008C Mary Ellen Jones Building, 116 Manning Drive, CB #7231, Chapel Hill, NC, United States of America.
| | - Andrea J Apter
- Division of Pulmonary, Allergy, Critical Care Medicine, Perelman School of Medicine, University of Pennsylvania, 829 Gates Building, Hospital of the University of Pennsylvania, 3600 Spruce Street, Philadelphia, PA, United States of America.
| | - Ku-Lang Chang
- Department of Community Health and Family Medicine, University of Florida College of Medicine, 4197 NW 86th Terrace, Gainesville, FL, United States of America.
| | - Victor Pinto-Plata
- Division of Critical Care/Pulmonary, Baystate Health, Tolosky Center, 3300 Main Street, Suite 2B, Springfield, MA, United States of America.
| | - Paul M Stranges
- University of Illinois at Chicago College of Pharmacy, 833 S Wood Street, Chicago, IL, United States of America.
| | - Laura P Hurley
- Denver Health and Hospital Authority, 301 W 6th Avenue, MC 3251, Denver, CO, United States of America.
| | - Jennifer Trevor
- Department of Medicine, UAB Lung Health Center, University of Alabama, 526 20th Street South, Birmingham, AL, United States of America.
| | - Thomas B Casale
- Division of Allergy and Immunology, Morsani College of Medicine, University of South Florida, 12901 Bruce B Downs Boulevard, MDC 19, Tampa, FL, United States of America.
| | - Geoffrey Chupp
- Pulmonary, Critical Care & Sleep Medicine, Yale School of Medicine, PO Box 208057, 300 Cedar Street, New Haven, CT, United States of America.
| | - Isaretta L Riley
- Division of Pulmonary, Allergy & Critical Care Medicine, Duke University School of Medicine, Box 102355, 247 Hanes House, Durham, NC, United States of America.
| | - Kartik Shenoy
- Temple Lung Center, Lewis Katz School of Medicine at Temple University, 3401 N. Broad Street, Suite 710C, Philadelphia, PA, United States of America.
| | - Magdalena Pasarica
- University of Central Florida, College of Medicine, 6850 Lake Nona Boulevard, Orlando, FL, United States of America.
| | - Rafael A Calderon-Candelario
- Miller School of Medicine, University of Miami, 1600 NW 10 Ave (Loc# R-47), 7th floor, Room 7052, Miami, FL, United States of America.
| | - Hazel Tapp
- Department of Family Medicine, Atrium Health, 2001 Vail Street, Suite 400B, Charlotte, NC, United States of America.
| | - Ahmet Baydur
- Division of Pulmonary, Critical Care and Sleep Medicine, Keck School of Medicine, University of Southern California, 2020 Zonal Avenue, IRD 725, Los Angeles, CA, United States of America.
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10
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Wechsler ME, Szefler SJ, Ortega VE, Pongracic JA, Chinchilli V, Lima JJ, Krishnan JA, Kunselman SJ, Mauger D, Bleecker ER, Bacharier LB, Beigelman A, Benson M, Blake KV, Cabana MD, Cardet JC, Castro M, Chmiel JF, Covar R, Denlinger L, DiMango E, Fitzpatrick AM, Gentile D, Grossman N, Holguin F, Jackson DJ, Kumar H, Kraft M, LaForce CF, Lang J, Lazarus SC, Lemanske RF, Long D, Lugogo N, Martinez F, Meyers DA, Moore WC, Moy J, Naureckas E, Olin JT, Peters SP, Phipatanakul W, Que L, Raissy H, Robison RG, Ross K, Sheehan W, Smith LJ, Solway J, Sorkness CA, Sullivan-Vedder L, Wenzel S, White S, Israel E. Step-Up Therapy in Black Children and Adults with Poorly Controlled Asthma. N Engl J Med 2019; 381:1227-1239. [PMID: 31553835 PMCID: PMC7026584 DOI: 10.1056/nejmoa1905560] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Morbidity from asthma is disproportionately higher among black patients than among white patients, and black patients constitute the minority of participants in trials informing treatment. Data indicate that patients with inadequately controlled asthma benefit more from addition of a long-acting beta-agonist (LABA) than from increased glucocorticoids; however, these data may not be informative for treatment in black patients. METHODS We conducted two prospective, randomized, double-blind trials: one involving children and the other involving adolescents and adults. In both trials, the patients had at least one grandparent who identified as black and had asthma that was inadequately controlled with low-dose inhaled glucocorticoids. We compared combinations of therapy, which included the addition of a LABA (salmeterol) to an inhaled glucocorticoid (fluticasone propionate), a step-up to double to quintuple the dose of fluticasone, or both. The treatments were compared with the use of a composite measure that evaluated asthma exacerbations, asthma-control days, and lung function; data were stratified according to genotypic African ancestry. RESULTS When quintupling the dose of fluticasone (to 250 μg twice a day) was compared with adding salmeterol (50 μg twice a day) and doubling the fluticasone (to 100 μg twice a day), a superior response occurred in 46% of the children with quintupling the fluticasone and in 46% of the children with doubling the fluticasone and adding salmeterol (P = 0.99). In contrast, more adolescents and adults had a superior response to added salmeterol than to an increase in fluticasone (salmeterol-low-dose fluticasone vs. medium-dose fluticasone, 49% vs. 28% [P = 0.003]; salmeterol-medium-dose fluticasone vs. high-dose fluticasone, 49% vs. 31% [P = 0.02]). Neither the degree of African ancestry nor baseline biomarkers predicted a superior response to specific treatments. The increased dose of inhaled glucocorticoids was associated with a decrease in the ratio of urinary cortisol to creatinine in children younger than 8 years of age. CONCLUSIONS In contrast to black adolescents and adults, almost half the black children with poorly controlled asthma had a superior response to an increase in the dose of an inhaled glucocorticoid and almost half had a superior response to the addition of a LABA. (Funded by the National Heart, Lung, and Blood Institute; BARD ClinicalTrials.gov number, NCT01967173.).
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Affiliation(s)
- Michael E Wechsler
- From National Jewish Health (M.E.W., R.C., J.T.O.), Denver, and University of Colorado School of Medicine (M.E.W., S.J.S., R.C., F.H., J.T.O.) and Children's Hospital Colorado (S.J.S.), Aurora - all in Colorado; Wake Forest School of Medicine (V.E.O., W.C.M., S.P.P.), Winston-Salem, North Carolina Clinical Research (C.F.L.), Raleigh, and Duke University Medical Center (N.L., L.Q.), Durham - all in North Carolina; 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.K.), Rush University Medical Center (J.M.), University of Chicago (E.N., J.S., S. White), and Northwestern University Feinberg School of Medicine (L.J.S.) - all in Chicago; Penn State University (V.C., S.J.K., D.M.), Hershey, and Allegheny General Hospital (D.G.) and University of Pittsburgh Medical Center (S. Wenzel), Pittsburgh - all in Pennsylvania; Nemours Children's Health System, Jacksonville (J.J.L., K.V.B., J.L.), and University of South Florida Morsani College of Medicine, Tampa (J.-C.C.) - both in Florida; University of Arizona Health Sciences, Tucson (E.R.B., M.K., F.M., D.A.M.); Washington University School of Medicine, St. Louis (L.B.B., A.B., M.C.); University of California, San Francisco (UCSF), San Francisco (M.B., M.D.C., S.C.L., D.L.) and UCSF Benioff Children's Hospital, Oakland (M.B., D.L.) - both in California; Brigham and Women's Hospital and Harvard Medical School (J.-C.C., N.G., E.I.) and Boston Children's Hospital (W.P., W.S.) - all in Boston; University Hospitals Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland (J.F.C., K.R.); University of Wisconsin-Madison, Madison (L.D., D.J.J., R.F.L., C.A.S.) and Aurora Sinai Medical Center, Milwaukee (L.S.-V.) - both in Wisconsin; Columbia University Irving Medical Center, New York, (E.D.); Emory University, Atlanta (A.M.F.); and University of New Mexico, Albuquerque (H.R.)
| | - Stanley J Szefler
- From National Jewish Health (M.E.W., R.C., J.T.O.), Denver, and University of Colorado School of Medicine (M.E.W., S.J.S., R.C., F.H., J.T.O.) and Children's Hospital Colorado (S.J.S.), Aurora - all in Colorado; Wake Forest School of Medicine (V.E.O., W.C.M., S.P.P.), Winston-Salem, North Carolina Clinical Research (C.F.L.), Raleigh, and Duke University Medical Center (N.L., L.Q.), Durham - all in North Carolina; 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.K.), Rush University Medical Center (J.M.), University of Chicago (E.N., J.S., S. White), and Northwestern University Feinberg School of Medicine (L.J.S.) - all in Chicago; Penn State University (V.C., S.J.K., D.M.), Hershey, and Allegheny General Hospital (D.G.) and University of Pittsburgh Medical Center (S. Wenzel), Pittsburgh - all in Pennsylvania; Nemours Children's Health System, Jacksonville (J.J.L., K.V.B., J.L.), and University of South Florida Morsani College of Medicine, Tampa (J.-C.C.) - both in Florida; University of Arizona Health Sciences, Tucson (E.R.B., M.K., F.M., D.A.M.); Washington University School of Medicine, St. Louis (L.B.B., A.B., M.C.); University of California, San Francisco (UCSF), San Francisco (M.B., M.D.C., S.C.L., D.L.) and UCSF Benioff Children's Hospital, Oakland (M.B., D.L.) - both in California; Brigham and Women's Hospital and Harvard Medical School (J.-C.C., N.G., E.I.) and Boston Children's Hospital (W.P., W.S.) - all in Boston; University Hospitals Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland (J.F.C., K.R.); University of Wisconsin-Madison, Madison (L.D., D.J.J., R.F.L., C.A.S.) and Aurora Sinai Medical Center, Milwaukee (L.S.-V.) - both in Wisconsin; Columbia University Irving Medical Center, New York, (E.D.); Emory University, Atlanta (A.M.F.); and University of New Mexico, Albuquerque (H.R.)
| | - Victor E Ortega
- From National Jewish Health (M.E.W., R.C., J.T.O.), Denver, and University of Colorado School of Medicine (M.E.W., S.J.S., R.C., F.H., J.T.O.) and Children's Hospital Colorado (S.J.S.), Aurora - all in Colorado; Wake Forest School of Medicine (V.E.O., W.C.M., S.P.P.), Winston-Salem, North Carolina Clinical Research (C.F.L.), Raleigh, and Duke University Medical Center (N.L., L.Q.), Durham - all in North Carolina; 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.K.), Rush University Medical Center (J.M.), University of Chicago (E.N., J.S., S. White), and Northwestern University Feinberg School of Medicine (L.J.S.) - all in Chicago; Penn State University (V.C., S.J.K., D.M.), Hershey, and Allegheny General Hospital (D.G.) and University of Pittsburgh Medical Center (S. Wenzel), Pittsburgh - all in Pennsylvania; Nemours Children's Health System, Jacksonville (J.J.L., K.V.B., J.L.), and University of South Florida Morsani College of Medicine, Tampa (J.-C.C.) - both in Florida; University of Arizona Health Sciences, Tucson (E.R.B., M.K., F.M., D.A.M.); Washington University School of Medicine, St. Louis (L.B.B., A.B., M.C.); University of California, San Francisco (UCSF), San Francisco (M.B., M.D.C., S.C.L., D.L.) and UCSF Benioff Children's Hospital, Oakland (M.B., D.L.) - both in California; Brigham and Women's Hospital and Harvard Medical School (J.-C.C., N.G., E.I.) and Boston Children's Hospital (W.P., W.S.) - all in Boston; University Hospitals Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland (J.F.C., K.R.); University of Wisconsin-Madison, Madison (L.D., D.J.J., R.F.L., C.A.S.) and Aurora Sinai Medical Center, Milwaukee (L.S.-V.) - both in Wisconsin; Columbia University Irving Medical Center, New York, (E.D.); Emory University, Atlanta (A.M.F.); and University of New Mexico, Albuquerque (H.R.)
| | - Jacqueline A Pongracic
- From National Jewish Health (M.E.W., R.C., J.T.O.), Denver, and University of Colorado School of Medicine (M.E.W., S.J.S., R.C., F.H., J.T.O.) and Children's Hospital Colorado (S.J.S.), Aurora - all in Colorado; Wake Forest School of Medicine (V.E.O., W.C.M., S.P.P.), Winston-Salem, North Carolina Clinical Research (C.F.L.), Raleigh, and Duke University Medical Center (N.L., L.Q.), Durham - all in North Carolina; 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.K.), Rush University Medical Center (J.M.), University of Chicago (E.N., J.S., S. White), and Northwestern University Feinberg School of Medicine (L.J.S.) - all in Chicago; Penn State University (V.C., S.J.K., D.M.), Hershey, and Allegheny General Hospital (D.G.) and University of Pittsburgh Medical Center (S. Wenzel), Pittsburgh - all in Pennsylvania; Nemours Children's Health System, Jacksonville (J.J.L., K.V.B., J.L.), and University of South Florida Morsani College of Medicine, Tampa (J.-C.C.) - both in Florida; University of Arizona Health Sciences, Tucson (E.R.B., M.K., F.M., D.A.M.); Washington University School of Medicine, St. Louis (L.B.B., A.B., M.C.); University of California, San Francisco (UCSF), San Francisco (M.B., M.D.C., S.C.L., D.L.) and UCSF Benioff Children's Hospital, Oakland (M.B., D.L.) - both in California; Brigham and Women's Hospital and Harvard Medical School (J.-C.C., N.G., E.I.) and Boston Children's Hospital (W.P., W.S.) - all in Boston; University Hospitals Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland (J.F.C., K.R.); University of Wisconsin-Madison, Madison (L.D., D.J.J., R.F.L., C.A.S.) and Aurora Sinai Medical Center, Milwaukee (L.S.-V.) - both in Wisconsin; Columbia University Irving Medical Center, New York, (E.D.); Emory University, Atlanta (A.M.F.); and University of New Mexico, Albuquerque (H.R.)
| | - Vernon Chinchilli
- From National Jewish Health (M.E.W., R.C., J.T.O.), Denver, and University of Colorado School of Medicine (M.E.W., S.J.S., R.C., F.H., J.T.O.) and Children's Hospital Colorado (S.J.S.), Aurora - all in Colorado; Wake Forest School of Medicine (V.E.O., W.C.M., S.P.P.), Winston-Salem, North Carolina Clinical Research (C.F.L.), Raleigh, and Duke University Medical Center (N.L., L.Q.), Durham - all in North Carolina; 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.K.), Rush University Medical Center (J.M.), University of Chicago (E.N., J.S., S. White), and Northwestern University Feinberg School of Medicine (L.J.S.) - all in Chicago; Penn State University (V.C., S.J.K., D.M.), Hershey, and Allegheny General Hospital (D.G.) and University of Pittsburgh Medical Center (S. Wenzel), Pittsburgh - all in Pennsylvania; Nemours Children's Health System, Jacksonville (J.J.L., K.V.B., J.L.), and University of South Florida Morsani College of Medicine, Tampa (J.-C.C.) - both in Florida; University of Arizona Health Sciences, Tucson (E.R.B., M.K., F.M., D.A.M.); Washington University School of Medicine, St. Louis (L.B.B., A.B., M.C.); University of California, San Francisco (UCSF), San Francisco (M.B., M.D.C., S.C.L., D.L.) and UCSF Benioff Children's Hospital, Oakland (M.B., D.L.) - both in California; Brigham and Women's Hospital and Harvard Medical School (J.-C.C., N.G., E.I.) and Boston Children's Hospital (W.P., W.S.) - all in Boston; University Hospitals Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland (J.F.C., K.R.); University of Wisconsin-Madison, Madison (L.D., D.J.J., R.F.L., C.A.S.) and Aurora Sinai Medical Center, Milwaukee (L.S.-V.) - both in Wisconsin; Columbia University Irving Medical Center, New York, (E.D.); Emory University, Atlanta (A.M.F.); and University of New Mexico, Albuquerque (H.R.)
| | - John J Lima
- From National Jewish Health (M.E.W., R.C., J.T.O.), Denver, and University of Colorado School of Medicine (M.E.W., S.J.S., R.C., F.H., J.T.O.) and Children's Hospital Colorado (S.J.S.), Aurora - all in Colorado; Wake Forest School of Medicine (V.E.O., W.C.M., S.P.P.), Winston-Salem, North Carolina Clinical Research (C.F.L.), Raleigh, and Duke University Medical Center (N.L., L.Q.), Durham - all in North Carolina; 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.K.), Rush University Medical Center (J.M.), University of Chicago (E.N., J.S., S. White), and Northwestern University Feinberg School of Medicine (L.J.S.) - all in Chicago; Penn State University (V.C., S.J.K., D.M.), Hershey, and Allegheny General Hospital (D.G.) and University of Pittsburgh Medical Center (S. Wenzel), Pittsburgh - all in Pennsylvania; Nemours Children's Health System, Jacksonville (J.J.L., K.V.B., J.L.), and University of South Florida Morsani College of Medicine, Tampa (J.-C.C.) - both in Florida; University of Arizona Health Sciences, Tucson (E.R.B., M.K., F.M., D.A.M.); Washington University School of Medicine, St. Louis (L.B.B., A.B., M.C.); University of California, San Francisco (UCSF), San Francisco (M.B., M.D.C., S.C.L., D.L.) and UCSF Benioff Children's Hospital, Oakland (M.B., D.L.) - both in California; Brigham and Women's Hospital and Harvard Medical School (J.-C.C., N.G., E.I.) and Boston Children's Hospital (W.P., W.S.) - all in Boston; University Hospitals Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland (J.F.C., K.R.); University of Wisconsin-Madison, Madison (L.D., D.J.J., R.F.L., C.A.S.) and Aurora Sinai Medical Center, Milwaukee (L.S.-V.) - both in Wisconsin; Columbia University Irving Medical Center, New York, (E.D.); Emory University, Atlanta (A.M.F.); and University of New Mexico, Albuquerque (H.R.)
| | - Jerry A Krishnan
- From National Jewish Health (M.E.W., R.C., J.T.O.), Denver, and University of Colorado School of Medicine (M.E.W., S.J.S., R.C., F.H., J.T.O.) and Children's Hospital Colorado (S.J.S.), Aurora - all in Colorado; Wake Forest School of Medicine (V.E.O., W.C.M., S.P.P.), Winston-Salem, North Carolina Clinical Research (C.F.L.), Raleigh, and Duke University Medical Center (N.L., L.Q.), Durham - all in North Carolina; 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.K.), Rush University Medical Center (J.M.), University of Chicago (E.N., J.S., S. White), and Northwestern University Feinberg School of Medicine (L.J.S.) - all in Chicago; Penn State University (V.C., S.J.K., D.M.), Hershey, and Allegheny General Hospital (D.G.) and University of Pittsburgh Medical Center (S. Wenzel), Pittsburgh - all in Pennsylvania; Nemours Children's Health System, Jacksonville (J.J.L., K.V.B., J.L.), and University of South Florida Morsani College of Medicine, Tampa (J.-C.C.) - both in Florida; University of Arizona Health Sciences, Tucson (E.R.B., M.K., F.M., D.A.M.); Washington University School of Medicine, St. Louis (L.B.B., A.B., M.C.); University of California, San Francisco (UCSF), San Francisco (M.B., M.D.C., S.C.L., D.L.) and UCSF Benioff Children's Hospital, Oakland (M.B., D.L.) - both in California; Brigham and Women's Hospital and Harvard Medical School (J.-C.C., N.G., E.I.) and Boston Children's Hospital (W.P., W.S.) - all in Boston; University Hospitals Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland (J.F.C., K.R.); University of Wisconsin-Madison, Madison (L.D., D.J.J., R.F.L., C.A.S.) and Aurora Sinai Medical Center, Milwaukee (L.S.-V.) - both in Wisconsin; Columbia University Irving Medical Center, New York, (E.D.); Emory University, Atlanta (A.M.F.); and University of New Mexico, Albuquerque (H.R.)
| | - Susan J Kunselman
- From National Jewish Health (M.E.W., R.C., J.T.O.), Denver, and University of Colorado School of Medicine (M.E.W., S.J.S., R.C., F.H., J.T.O.) and Children's Hospital Colorado (S.J.S.), Aurora - all in Colorado; Wake Forest School of Medicine (V.E.O., W.C.M., S.P.P.), Winston-Salem, North Carolina Clinical Research (C.F.L.), Raleigh, and Duke University Medical Center (N.L., L.Q.), Durham - all in North Carolina; 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.K.), Rush University Medical Center (J.M.), University of Chicago (E.N., J.S., S. White), and Northwestern University Feinberg School of Medicine (L.J.S.) - all in Chicago; Penn State University (V.C., S.J.K., D.M.), Hershey, and Allegheny General Hospital (D.G.) and University of Pittsburgh Medical Center (S. Wenzel), Pittsburgh - all in Pennsylvania; Nemours Children's Health System, Jacksonville (J.J.L., K.V.B., J.L.), and University of South Florida Morsani College of Medicine, Tampa (J.-C.C.) - both in Florida; University of Arizona Health Sciences, Tucson (E.R.B., M.K., F.M., D.A.M.); Washington University School of Medicine, St. Louis (L.B.B., A.B., M.C.); University of California, San Francisco (UCSF), San Francisco (M.B., M.D.C., S.C.L., D.L.) and UCSF Benioff Children's Hospital, Oakland (M.B., D.L.) - both in California; Brigham and Women's Hospital and Harvard Medical School (J.-C.C., N.G., E.I.) and Boston Children's Hospital (W.P., W.S.) - all in Boston; University Hospitals Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland (J.F.C., K.R.); University of Wisconsin-Madison, Madison (L.D., D.J.J., R.F.L., C.A.S.) and Aurora Sinai Medical Center, Milwaukee (L.S.-V.) - both in Wisconsin; Columbia University Irving Medical Center, New York, (E.D.); Emory University, Atlanta (A.M.F.); and University of New Mexico, Albuquerque (H.R.)
| | - David Mauger
- From National Jewish Health (M.E.W., R.C., J.T.O.), Denver, and University of Colorado School of Medicine (M.E.W., S.J.S., R.C., F.H., J.T.O.) and Children's Hospital Colorado (S.J.S.), Aurora - all in Colorado; Wake Forest School of Medicine (V.E.O., W.C.M., S.P.P.), Winston-Salem, North Carolina Clinical Research (C.F.L.), Raleigh, and Duke University Medical Center (N.L., L.Q.), Durham - all in North Carolina; 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.K.), Rush University Medical Center (J.M.), University of Chicago (E.N., J.S., S. White), and Northwestern University Feinberg School of Medicine (L.J.S.) - all in Chicago; Penn State University (V.C., S.J.K., D.M.), Hershey, and Allegheny General Hospital (D.G.) and University of Pittsburgh Medical Center (S. Wenzel), Pittsburgh - all in Pennsylvania; Nemours Children's Health System, Jacksonville (J.J.L., K.V.B., J.L.), and University of South Florida Morsani College of Medicine, Tampa (J.-C.C.) - both in Florida; University of Arizona Health Sciences, Tucson (E.R.B., M.K., F.M., D.A.M.); Washington University School of Medicine, St. Louis (L.B.B., A.B., M.C.); University of California, San Francisco (UCSF), San Francisco (M.B., M.D.C., S.C.L., D.L.) and UCSF Benioff Children's Hospital, Oakland (M.B., D.L.) - both in California; Brigham and Women's Hospital and Harvard Medical School (J.-C.C., N.G., E.I.) and Boston Children's Hospital (W.P., W.S.) - all in Boston; University Hospitals Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland (J.F.C., K.R.); University of Wisconsin-Madison, Madison (L.D., D.J.J., R.F.L., C.A.S.) and Aurora Sinai Medical Center, Milwaukee (L.S.-V.) - both in Wisconsin; Columbia University Irving Medical Center, New York, (E.D.); Emory University, Atlanta (A.M.F.); and University of New Mexico, Albuquerque (H.R.)
| | - Eugene R Bleecker
- From National Jewish Health (M.E.W., R.C., J.T.O.), Denver, and University of Colorado School of Medicine (M.E.W., S.J.S., R.C., F.H., J.T.O.) and Children's Hospital Colorado (S.J.S.), Aurora - all in Colorado; Wake Forest School of Medicine (V.E.O., W.C.M., S.P.P.), Winston-Salem, North Carolina Clinical Research (C.F.L.), Raleigh, and Duke University Medical Center (N.L., L.Q.), Durham - all in North Carolina; 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.K.), Rush University Medical Center (J.M.), University of Chicago (E.N., J.S., S. White), and Northwestern University Feinberg School of Medicine (L.J.S.) - all in Chicago; Penn State University (V.C., S.J.K., D.M.), Hershey, and Allegheny General Hospital (D.G.) and University of Pittsburgh Medical Center (S. Wenzel), Pittsburgh - all in Pennsylvania; Nemours Children's Health System, Jacksonville (J.J.L., K.V.B., J.L.), and University of South Florida Morsani College of Medicine, Tampa (J.-C.C.) - both in Florida; University of Arizona Health Sciences, Tucson (E.R.B., M.K., F.M., D.A.M.); Washington University School of Medicine, St. Louis (L.B.B., A.B., M.C.); University of California, San Francisco (UCSF), San Francisco (M.B., M.D.C., S.C.L., D.L.) and UCSF Benioff Children's Hospital, Oakland (M.B., D.L.) - both in California; Brigham and Women's Hospital and Harvard Medical School (J.-C.C., N.G., E.I.) and Boston Children's Hospital (W.P., W.S.) - all in Boston; University Hospitals Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland (J.F.C., K.R.); University of Wisconsin-Madison, Madison (L.D., D.J.J., R.F.L., C.A.S.) and Aurora Sinai Medical Center, Milwaukee (L.S.-V.) - both in Wisconsin; Columbia University Irving Medical Center, New York, (E.D.); Emory University, Atlanta (A.M.F.); and University of New Mexico, Albuquerque (H.R.)
| | - Leonard B Bacharier
- From National Jewish Health (M.E.W., R.C., J.T.O.), Denver, and University of Colorado School of Medicine (M.E.W., S.J.S., R.C., F.H., J.T.O.) and Children's Hospital Colorado (S.J.S.), Aurora - all in Colorado; Wake Forest School of Medicine (V.E.O., W.C.M., S.P.P.), Winston-Salem, North Carolina Clinical Research (C.F.L.), Raleigh, and Duke University Medical Center (N.L., L.Q.), Durham - all in North Carolina; 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.K.), Rush University Medical Center (J.M.), University of Chicago (E.N., J.S., S. White), and Northwestern University Feinberg School of Medicine (L.J.S.) - all in Chicago; Penn State University (V.C., S.J.K., D.M.), Hershey, and Allegheny General Hospital (D.G.) and University of Pittsburgh Medical Center (S. Wenzel), Pittsburgh - all in Pennsylvania; Nemours Children's Health System, Jacksonville (J.J.L., K.V.B., J.L.), and University of South Florida Morsani College of Medicine, Tampa (J.-C.C.) - both in Florida; University of Arizona Health Sciences, Tucson (E.R.B., M.K., F.M., D.A.M.); Washington University School of Medicine, St. Louis (L.B.B., A.B., M.C.); University of California, San Francisco (UCSF), San Francisco (M.B., M.D.C., S.C.L., D.L.) and UCSF Benioff Children's Hospital, Oakland (M.B., D.L.) - both in California; Brigham and Women's Hospital and Harvard Medical School (J.-C.C., N.G., E.I.) and Boston Children's Hospital (W.P., W.S.) - all in Boston; University Hospitals Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland (J.F.C., K.R.); University of Wisconsin-Madison, Madison (L.D., D.J.J., R.F.L., C.A.S.) and Aurora Sinai Medical Center, Milwaukee (L.S.-V.) - both in Wisconsin; Columbia University Irving Medical Center, New York, (E.D.); Emory University, Atlanta (A.M.F.); and University of New Mexico, Albuquerque (H.R.)
| | - Avraham Beigelman
- From National Jewish Health (M.E.W., R.C., J.T.O.), Denver, and University of Colorado School of Medicine (M.E.W., S.J.S., R.C., F.H., J.T.O.) and Children's Hospital Colorado (S.J.S.), Aurora - all in Colorado; Wake Forest School of Medicine (V.E.O., W.C.M., S.P.P.), Winston-Salem, North Carolina Clinical Research (C.F.L.), Raleigh, and Duke University Medical Center (N.L., L.Q.), Durham - all in North Carolina; 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.K.), Rush University Medical Center (J.M.), University of Chicago (E.N., J.S., S. White), and Northwestern University Feinberg School of Medicine (L.J.S.) - all in Chicago; Penn State University (V.C., S.J.K., D.M.), Hershey, and Allegheny General Hospital (D.G.) and University of Pittsburgh Medical Center (S. Wenzel), Pittsburgh - all in Pennsylvania; Nemours Children's Health System, Jacksonville (J.J.L., K.V.B., J.L.), and University of South Florida Morsani College of Medicine, Tampa (J.-C.C.) - both in Florida; University of Arizona Health Sciences, Tucson (E.R.B., M.K., F.M., D.A.M.); Washington University School of Medicine, St. Louis (L.B.B., A.B., M.C.); University of California, San Francisco (UCSF), San Francisco (M.B., M.D.C., S.C.L., D.L.) and UCSF Benioff Children's Hospital, Oakland (M.B., D.L.) - both in California; Brigham and Women's Hospital and Harvard Medical School (J.-C.C., N.G., E.I.) and Boston Children's Hospital (W.P., W.S.) - all in Boston; University Hospitals Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland (J.F.C., K.R.); University of Wisconsin-Madison, Madison (L.D., D.J.J., R.F.L., C.A.S.) and Aurora Sinai Medical Center, Milwaukee (L.S.-V.) - both in Wisconsin; Columbia University Irving Medical Center, New York, (E.D.); Emory University, Atlanta (A.M.F.); and University of New Mexico, Albuquerque (H.R.)
| | - Mindy Benson
- From National Jewish Health (M.E.W., R.C., J.T.O.), Denver, and University of Colorado School of Medicine (M.E.W., S.J.S., R.C., F.H., J.T.O.) and Children's Hospital Colorado (S.J.S.), Aurora - all in Colorado; Wake Forest School of Medicine (V.E.O., W.C.M., S.P.P.), Winston-Salem, North Carolina Clinical Research (C.F.L.), Raleigh, and Duke University Medical Center (N.L., L.Q.), Durham - all in North Carolina; 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.K.), Rush University Medical Center (J.M.), University of Chicago (E.N., J.S., S. White), and Northwestern University Feinberg School of Medicine (L.J.S.) - all in Chicago; Penn State University (V.C., S.J.K., D.M.), Hershey, and Allegheny General Hospital (D.G.) and University of Pittsburgh Medical Center (S. Wenzel), Pittsburgh - all in Pennsylvania; Nemours Children's Health System, Jacksonville (J.J.L., K.V.B., J.L.), and University of South Florida Morsani College of Medicine, Tampa (J.-C.C.) - both in Florida; University of Arizona Health Sciences, Tucson (E.R.B., M.K., F.M., D.A.M.); Washington University School of Medicine, St. Louis (L.B.B., A.B., M.C.); University of California, San Francisco (UCSF), San Francisco (M.B., M.D.C., S.C.L., D.L.) and UCSF Benioff Children's Hospital, Oakland (M.B., D.L.) - both in California; Brigham and Women's Hospital and Harvard Medical School (J.-C.C., N.G., E.I.) and Boston Children's Hospital (W.P., W.S.) - all in Boston; University Hospitals Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland (J.F.C., K.R.); University of Wisconsin-Madison, Madison (L.D., D.J.J., R.F.L., C.A.S.) and Aurora Sinai Medical Center, Milwaukee (L.S.-V.) - both in Wisconsin; Columbia University Irving Medical Center, New York, (E.D.); Emory University, Atlanta (A.M.F.); and University of New Mexico, Albuquerque (H.R.)
| | - Kathryn V Blake
- From National Jewish Health (M.E.W., R.C., J.T.O.), Denver, and University of Colorado School of Medicine (M.E.W., S.J.S., R.C., F.H., J.T.O.) and Children's Hospital Colorado (S.J.S.), Aurora - all in Colorado; Wake Forest School of Medicine (V.E.O., W.C.M., S.P.P.), Winston-Salem, North Carolina Clinical Research (C.F.L.), Raleigh, and Duke University Medical Center (N.L., L.Q.), Durham - all in North Carolina; 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.K.), Rush University Medical Center (J.M.), University of Chicago (E.N., J.S., S. White), and Northwestern University Feinberg School of Medicine (L.J.S.) - all in Chicago; Penn State University (V.C., S.J.K., D.M.), Hershey, and Allegheny General Hospital (D.G.) and University of Pittsburgh Medical Center (S. Wenzel), Pittsburgh - all in Pennsylvania; Nemours Children's Health System, Jacksonville (J.J.L., K.V.B., J.L.), and University of South Florida Morsani College of Medicine, Tampa (J.-C.C.) - both in Florida; University of Arizona Health Sciences, Tucson (E.R.B., M.K., F.M., D.A.M.); Washington University School of Medicine, St. Louis (L.B.B., A.B., M.C.); University of California, San Francisco (UCSF), San Francisco (M.B., M.D.C., S.C.L., D.L.) and UCSF Benioff Children's Hospital, Oakland (M.B., D.L.) - both in California; Brigham and Women's Hospital and Harvard Medical School (J.-C.C., N.G., E.I.) and Boston Children's Hospital (W.P., W.S.) - all in Boston; University Hospitals Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland (J.F.C., K.R.); University of Wisconsin-Madison, Madison (L.D., D.J.J., R.F.L., C.A.S.) and Aurora Sinai Medical Center, Milwaukee (L.S.-V.) - both in Wisconsin; Columbia University Irving Medical Center, New York, (E.D.); Emory University, Atlanta (A.M.F.); and University of New Mexico, Albuquerque (H.R.)
| | - Michael D Cabana
- From National Jewish Health (M.E.W., R.C., J.T.O.), Denver, and University of Colorado School of Medicine (M.E.W., S.J.S., R.C., F.H., J.T.O.) and Children's Hospital Colorado (S.J.S.), Aurora - all in Colorado; Wake Forest School of Medicine (V.E.O., W.C.M., S.P.P.), Winston-Salem, North Carolina Clinical Research (C.F.L.), Raleigh, and Duke University Medical Center (N.L., L.Q.), Durham - all in North Carolina; 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.K.), Rush University Medical Center (J.M.), University of Chicago (E.N., J.S., S. White), and Northwestern University Feinberg School of Medicine (L.J.S.) - all in Chicago; Penn State University (V.C., S.J.K., D.M.), Hershey, and Allegheny General Hospital (D.G.) and University of Pittsburgh Medical Center (S. Wenzel), Pittsburgh - all in Pennsylvania; Nemours Children's Health System, Jacksonville (J.J.L., K.V.B., J.L.), and University of South Florida Morsani College of Medicine, Tampa (J.-C.C.) - both in Florida; University of Arizona Health Sciences, Tucson (E.R.B., M.K., F.M., D.A.M.); Washington University School of Medicine, St. Louis (L.B.B., A.B., M.C.); University of California, San Francisco (UCSF), San Francisco (M.B., M.D.C., S.C.L., D.L.) and UCSF Benioff Children's Hospital, Oakland (M.B., D.L.) - both in California; Brigham and Women's Hospital and Harvard Medical School (J.-C.C., N.G., E.I.) and Boston Children's Hospital (W.P., W.S.) - all in Boston; University Hospitals Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland (J.F.C., K.R.); University of Wisconsin-Madison, Madison (L.D., D.J.J., R.F.L., C.A.S.) and Aurora Sinai Medical Center, Milwaukee (L.S.-V.) - both in Wisconsin; Columbia University Irving Medical Center, New York, (E.D.); Emory University, Atlanta (A.M.F.); and University of New Mexico, Albuquerque (H.R.)
| | - Juan-Carlos Cardet
- From National Jewish Health (M.E.W., R.C., J.T.O.), Denver, and University of Colorado School of Medicine (M.E.W., S.J.S., R.C., F.H., J.T.O.) and Children's Hospital Colorado (S.J.S.), Aurora - all in Colorado; Wake Forest School of Medicine (V.E.O., W.C.M., S.P.P.), Winston-Salem, North Carolina Clinical Research (C.F.L.), Raleigh, and Duke University Medical Center (N.L., L.Q.), Durham - all in North Carolina; 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.K.), Rush University Medical Center (J.M.), University of Chicago (E.N., J.S., S. White), and Northwestern University Feinberg School of Medicine (L.J.S.) - all in Chicago; Penn State University (V.C., S.J.K., D.M.), Hershey, and Allegheny General Hospital (D.G.) and University of Pittsburgh Medical Center (S. Wenzel), Pittsburgh - all in Pennsylvania; Nemours Children's Health System, Jacksonville (J.J.L., K.V.B., J.L.), and University of South Florida Morsani College of Medicine, Tampa (J.-C.C.) - both in Florida; University of Arizona Health Sciences, Tucson (E.R.B., M.K., F.M., D.A.M.); Washington University School of Medicine, St. Louis (L.B.B., A.B., M.C.); University of California, San Francisco (UCSF), San Francisco (M.B., M.D.C., S.C.L., D.L.) and UCSF Benioff Children's Hospital, Oakland (M.B., D.L.) - both in California; Brigham and Women's Hospital and Harvard Medical School (J.-C.C., N.G., E.I.) and Boston Children's Hospital (W.P., W.S.) - all in Boston; University Hospitals Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland (J.F.C., K.R.); University of Wisconsin-Madison, Madison (L.D., D.J.J., R.F.L., C.A.S.) and Aurora Sinai Medical Center, Milwaukee (L.S.-V.) - both in Wisconsin; Columbia University Irving Medical Center, New York, (E.D.); Emory University, Atlanta (A.M.F.); and University of New Mexico, Albuquerque (H.R.)
| | - Mario Castro
- From National Jewish Health (M.E.W., R.C., J.T.O.), Denver, and University of Colorado School of Medicine (M.E.W., S.J.S., R.C., F.H., J.T.O.) and Children's Hospital Colorado (S.J.S.), Aurora - all in Colorado; Wake Forest School of Medicine (V.E.O., W.C.M., S.P.P.), Winston-Salem, North Carolina Clinical Research (C.F.L.), Raleigh, and Duke University Medical Center (N.L., L.Q.), Durham - all in North Carolina; 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.K.), Rush University Medical Center (J.M.), University of Chicago (E.N., J.S., S. White), and Northwestern University Feinberg School of Medicine (L.J.S.) - all in Chicago; Penn State University (V.C., S.J.K., D.M.), Hershey, and Allegheny General Hospital (D.G.) and University of Pittsburgh Medical Center (S. Wenzel), Pittsburgh - all in Pennsylvania; Nemours Children's Health System, Jacksonville (J.J.L., K.V.B., J.L.), and University of South Florida Morsani College of Medicine, Tampa (J.-C.C.) - both in Florida; University of Arizona Health Sciences, Tucson (E.R.B., M.K., F.M., D.A.M.); Washington University School of Medicine, St. Louis (L.B.B., A.B., M.C.); University of California, San Francisco (UCSF), San Francisco (M.B., M.D.C., S.C.L., D.L.) and UCSF Benioff Children's Hospital, Oakland (M.B., D.L.) - both in California; Brigham and Women's Hospital and Harvard Medical School (J.-C.C., N.G., E.I.) and Boston Children's Hospital (W.P., W.S.) - all in Boston; University Hospitals Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland (J.F.C., K.R.); University of Wisconsin-Madison, Madison (L.D., D.J.J., R.F.L., C.A.S.) and Aurora Sinai Medical Center, Milwaukee (L.S.-V.) - both in Wisconsin; Columbia University Irving Medical Center, New York, (E.D.); Emory University, Atlanta (A.M.F.); and University of New Mexico, Albuquerque (H.R.)
| | - James F Chmiel
- From National Jewish Health (M.E.W., R.C., J.T.O.), Denver, and University of Colorado School of Medicine (M.E.W., S.J.S., R.C., F.H., J.T.O.) and Children's Hospital Colorado (S.J.S.), Aurora - all in Colorado; Wake Forest School of Medicine (V.E.O., W.C.M., S.P.P.), Winston-Salem, North Carolina Clinical Research (C.F.L.), Raleigh, and Duke University Medical Center (N.L., L.Q.), Durham - all in North Carolina; 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.K.), Rush University Medical Center (J.M.), University of Chicago (E.N., J.S., S. White), and Northwestern University Feinberg School of Medicine (L.J.S.) - all in Chicago; Penn State University (V.C., S.J.K., D.M.), Hershey, and Allegheny General Hospital (D.G.) and University of Pittsburgh Medical Center (S. Wenzel), Pittsburgh - all in Pennsylvania; Nemours Children's Health System, Jacksonville (J.J.L., K.V.B., J.L.), and University of South Florida Morsani College of Medicine, Tampa (J.-C.C.) - both in Florida; University of Arizona Health Sciences, Tucson (E.R.B., M.K., F.M., D.A.M.); Washington University School of Medicine, St. Louis (L.B.B., A.B., M.C.); University of California, San Francisco (UCSF), San Francisco (M.B., M.D.C., S.C.L., D.L.) and UCSF Benioff Children's Hospital, Oakland (M.B., D.L.) - both in California; Brigham and Women's Hospital and Harvard Medical School (J.-C.C., N.G., E.I.) and Boston Children's Hospital (W.P., W.S.) - all in Boston; University Hospitals Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland (J.F.C., K.R.); University of Wisconsin-Madison, Madison (L.D., D.J.J., R.F.L., C.A.S.) and Aurora Sinai Medical Center, Milwaukee (L.S.-V.) - both in Wisconsin; Columbia University Irving Medical Center, New York, (E.D.); Emory University, Atlanta (A.M.F.); and University of New Mexico, Albuquerque (H.R.)
| | - Ronina Covar
- From National Jewish Health (M.E.W., R.C., J.T.O.), Denver, and University of Colorado School of Medicine (M.E.W., S.J.S., R.C., F.H., J.T.O.) and Children's Hospital Colorado (S.J.S.), Aurora - all in Colorado; Wake Forest School of Medicine (V.E.O., W.C.M., S.P.P.), Winston-Salem, North Carolina Clinical Research (C.F.L.), Raleigh, and Duke University Medical Center (N.L., L.Q.), Durham - all in North Carolina; 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.K.), Rush University Medical Center (J.M.), University of Chicago (E.N., J.S., S. White), and Northwestern University Feinberg School of Medicine (L.J.S.) - all in Chicago; Penn State University (V.C., S.J.K., D.M.), Hershey, and Allegheny General Hospital (D.G.) and University of Pittsburgh Medical Center (S. Wenzel), Pittsburgh - all in Pennsylvania; Nemours Children's Health System, Jacksonville (J.J.L., K.V.B., J.L.), and University of South Florida Morsani College of Medicine, Tampa (J.-C.C.) - both in Florida; University of Arizona Health Sciences, Tucson (E.R.B., M.K., F.M., D.A.M.); Washington University School of Medicine, St. Louis (L.B.B., A.B., M.C.); University of California, San Francisco (UCSF), San Francisco (M.B., M.D.C., S.C.L., D.L.) and UCSF Benioff Children's Hospital, Oakland (M.B., D.L.) - both in California; Brigham and Women's Hospital and Harvard Medical School (J.-C.C., N.G., E.I.) and Boston Children's Hospital (W.P., W.S.) - all in Boston; University Hospitals Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland (J.F.C., K.R.); University of Wisconsin-Madison, Madison (L.D., D.J.J., R.F.L., C.A.S.) and Aurora Sinai Medical Center, Milwaukee (L.S.-V.) - both in Wisconsin; Columbia University Irving Medical Center, New York, (E.D.); Emory University, Atlanta (A.M.F.); and University of New Mexico, Albuquerque (H.R.)
| | - Loren Denlinger
- From National Jewish Health (M.E.W., R.C., J.T.O.), Denver, and University of Colorado School of Medicine (M.E.W., S.J.S., R.C., F.H., J.T.O.) and Children's Hospital Colorado (S.J.S.), Aurora - all in Colorado; Wake Forest School of Medicine (V.E.O., W.C.M., S.P.P.), Winston-Salem, North Carolina Clinical Research (C.F.L.), Raleigh, and Duke University Medical Center (N.L., L.Q.), Durham - all in North Carolina; 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.K.), Rush University Medical Center (J.M.), University of Chicago (E.N., J.S., S. White), and Northwestern University Feinberg School of Medicine (L.J.S.) - all in Chicago; Penn State University (V.C., S.J.K., D.M.), Hershey, and Allegheny General Hospital (D.G.) and University of Pittsburgh Medical Center (S. Wenzel), Pittsburgh - all in Pennsylvania; Nemours Children's Health System, Jacksonville (J.J.L., K.V.B., J.L.), and University of South Florida Morsani College of Medicine, Tampa (J.-C.C.) - both in Florida; University of Arizona Health Sciences, Tucson (E.R.B., M.K., F.M., D.A.M.); Washington University School of Medicine, St. Louis (L.B.B., A.B., M.C.); University of California, San Francisco (UCSF), San Francisco (M.B., M.D.C., S.C.L., D.L.) and UCSF Benioff Children's Hospital, Oakland (M.B., D.L.) - both in California; Brigham and Women's Hospital and Harvard Medical School (J.-C.C., N.G., E.I.) and Boston Children's Hospital (W.P., W.S.) - all in Boston; University Hospitals Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland (J.F.C., K.R.); University of Wisconsin-Madison, Madison (L.D., D.J.J., R.F.L., C.A.S.) and Aurora Sinai Medical Center, Milwaukee (L.S.-V.) - both in Wisconsin; Columbia University Irving Medical Center, New York, (E.D.); Emory University, Atlanta (A.M.F.); and University of New Mexico, Albuquerque (H.R.)
| | - Emily DiMango
- From National Jewish Health (M.E.W., R.C., J.T.O.), Denver, and University of Colorado School of Medicine (M.E.W., S.J.S., R.C., F.H., J.T.O.) and Children's Hospital Colorado (S.J.S.), Aurora - all in Colorado; Wake Forest School of Medicine (V.E.O., W.C.M., S.P.P.), Winston-Salem, North Carolina Clinical Research (C.F.L.), Raleigh, and Duke University Medical Center (N.L., L.Q.), Durham - all in North Carolina; 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.K.), Rush University Medical Center (J.M.), University of Chicago (E.N., J.S., S. White), and Northwestern University Feinberg School of Medicine (L.J.S.) - all in Chicago; Penn State University (V.C., S.J.K., D.M.), Hershey, and Allegheny General Hospital (D.G.) and University of Pittsburgh Medical Center (S. Wenzel), Pittsburgh - all in Pennsylvania; Nemours Children's Health System, Jacksonville (J.J.L., K.V.B., J.L.), and University of South Florida Morsani College of Medicine, Tampa (J.-C.C.) - both in Florida; University of Arizona Health Sciences, Tucson (E.R.B., M.K., F.M., D.A.M.); Washington University School of Medicine, St. Louis (L.B.B., A.B., M.C.); University of California, San Francisco (UCSF), San Francisco (M.B., M.D.C., S.C.L., D.L.) and UCSF Benioff Children's Hospital, Oakland (M.B., D.L.) - both in California; Brigham and Women's Hospital and Harvard Medical School (J.-C.C., N.G., E.I.) and Boston Children's Hospital (W.P., W.S.) - all in Boston; University Hospitals Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland (J.F.C., K.R.); University of Wisconsin-Madison, Madison (L.D., D.J.J., R.F.L., C.A.S.) and Aurora Sinai Medical Center, Milwaukee (L.S.-V.) - both in Wisconsin; Columbia University Irving Medical Center, New York, (E.D.); Emory University, Atlanta (A.M.F.); and University of New Mexico, Albuquerque (H.R.)
| | - Anne M Fitzpatrick
- From National Jewish Health (M.E.W., R.C., J.T.O.), Denver, and University of Colorado School of Medicine (M.E.W., S.J.S., R.C., F.H., J.T.O.) and Children's Hospital Colorado (S.J.S.), Aurora - all in Colorado; Wake Forest School of Medicine (V.E.O., W.C.M., S.P.P.), Winston-Salem, North Carolina Clinical Research (C.F.L.), Raleigh, and Duke University Medical Center (N.L., L.Q.), Durham - all in North Carolina; 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.K.), Rush University Medical Center (J.M.), University of Chicago (E.N., J.S., S. White), and Northwestern University Feinberg School of Medicine (L.J.S.) - all in Chicago; Penn State University (V.C., S.J.K., D.M.), Hershey, and Allegheny General Hospital (D.G.) and University of Pittsburgh Medical Center (S. Wenzel), Pittsburgh - all in Pennsylvania; Nemours Children's Health System, Jacksonville (J.J.L., K.V.B., J.L.), and University of South Florida Morsani College of Medicine, Tampa (J.-C.C.) - both in Florida; University of Arizona Health Sciences, Tucson (E.R.B., M.K., F.M., D.A.M.); Washington University School of Medicine, St. Louis (L.B.B., A.B., M.C.); University of California, San Francisco (UCSF), San Francisco (M.B., M.D.C., S.C.L., D.L.) and UCSF Benioff Children's Hospital, Oakland (M.B., D.L.) - both in California; Brigham and Women's Hospital and Harvard Medical School (J.-C.C., N.G., E.I.) and Boston Children's Hospital (W.P., W.S.) - all in Boston; University Hospitals Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland (J.F.C., K.R.); University of Wisconsin-Madison, Madison (L.D., D.J.J., R.F.L., C.A.S.) and Aurora Sinai Medical Center, Milwaukee (L.S.-V.) - both in Wisconsin; Columbia University Irving Medical Center, New York, (E.D.); Emory University, Atlanta (A.M.F.); and University of New Mexico, Albuquerque (H.R.)
| | - Deborah Gentile
- From National Jewish Health (M.E.W., R.C., J.T.O.), Denver, and University of Colorado School of Medicine (M.E.W., S.J.S., R.C., F.H., J.T.O.) and Children's Hospital Colorado (S.J.S.), Aurora - all in Colorado; Wake Forest School of Medicine (V.E.O., W.C.M., S.P.P.), Winston-Salem, North Carolina Clinical Research (C.F.L.), Raleigh, and Duke University Medical Center (N.L., L.Q.), Durham - all in North Carolina; 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.K.), Rush University Medical Center (J.M.), University of Chicago (E.N., J.S., S. White), and Northwestern University Feinberg School of Medicine (L.J.S.) - all in Chicago; Penn State University (V.C., S.J.K., D.M.), Hershey, and Allegheny General Hospital (D.G.) and University of Pittsburgh Medical Center (S. Wenzel), Pittsburgh - all in Pennsylvania; Nemours Children's Health System, Jacksonville (J.J.L., K.V.B., J.L.), and University of South Florida Morsani College of Medicine, Tampa (J.-C.C.) - both in Florida; University of Arizona Health Sciences, Tucson (E.R.B., M.K., F.M., D.A.M.); Washington University School of Medicine, St. Louis (L.B.B., A.B., M.C.); University of California, San Francisco (UCSF), San Francisco (M.B., M.D.C., S.C.L., D.L.) and UCSF Benioff Children's Hospital, Oakland (M.B., D.L.) - both in California; Brigham and Women's Hospital and Harvard Medical School (J.-C.C., N.G., E.I.) and Boston Children's Hospital (W.P., W.S.) - all in Boston; University Hospitals Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland (J.F.C., K.R.); University of Wisconsin-Madison, Madison (L.D., D.J.J., R.F.L., C.A.S.) and Aurora Sinai Medical Center, Milwaukee (L.S.-V.) - both in Wisconsin; Columbia University Irving Medical Center, New York, (E.D.); Emory University, Atlanta (A.M.F.); and University of New Mexico, Albuquerque (H.R.)
| | - Nicole Grossman
- From National Jewish Health (M.E.W., R.C., J.T.O.), Denver, and University of Colorado School of Medicine (M.E.W., S.J.S., R.C., F.H., J.T.O.) and Children's Hospital Colorado (S.J.S.), Aurora - all in Colorado; Wake Forest School of Medicine (V.E.O., W.C.M., S.P.P.), Winston-Salem, North Carolina Clinical Research (C.F.L.), Raleigh, and Duke University Medical Center (N.L., L.Q.), Durham - all in North Carolina; 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.K.), Rush University Medical Center (J.M.), University of Chicago (E.N., J.S., S. White), and Northwestern University Feinberg School of Medicine (L.J.S.) - all in Chicago; Penn State University (V.C., S.J.K., D.M.), Hershey, and Allegheny General Hospital (D.G.) and University of Pittsburgh Medical Center (S. Wenzel), Pittsburgh - all in Pennsylvania; Nemours Children's Health System, Jacksonville (J.J.L., K.V.B., J.L.), and University of South Florida Morsani College of Medicine, Tampa (J.-C.C.) - both in Florida; University of Arizona Health Sciences, Tucson (E.R.B., M.K., F.M., D.A.M.); Washington University School of Medicine, St. Louis (L.B.B., A.B., M.C.); University of California, San Francisco (UCSF), San Francisco (M.B., M.D.C., S.C.L., D.L.) and UCSF Benioff Children's Hospital, Oakland (M.B., D.L.) - both in California; Brigham and Women's Hospital and Harvard Medical School (J.-C.C., N.G., E.I.) and Boston Children's Hospital (W.P., W.S.) - all in Boston; University Hospitals Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland (J.F.C., K.R.); University of Wisconsin-Madison, Madison (L.D., D.J.J., R.F.L., C.A.S.) and Aurora Sinai Medical Center, Milwaukee (L.S.-V.) - both in Wisconsin; Columbia University Irving Medical Center, New York, (E.D.); Emory University, Atlanta (A.M.F.); and University of New Mexico, Albuquerque (H.R.)
| | - Fernando Holguin
- From National Jewish Health (M.E.W., R.C., J.T.O.), Denver, and University of Colorado School of Medicine (M.E.W., S.J.S., R.C., F.H., J.T.O.) and Children's Hospital Colorado (S.J.S.), Aurora - all in Colorado; Wake Forest School of Medicine (V.E.O., W.C.M., S.P.P.), Winston-Salem, North Carolina Clinical Research (C.F.L.), Raleigh, and Duke University Medical Center (N.L., L.Q.), Durham - all in North Carolina; 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.K.), Rush University Medical Center (J.M.), University of Chicago (E.N., J.S., S. White), and Northwestern University Feinberg School of Medicine (L.J.S.) - all in Chicago; Penn State University (V.C., S.J.K., D.M.), Hershey, and Allegheny General Hospital (D.G.) and University of Pittsburgh Medical Center (S. Wenzel), Pittsburgh - all in Pennsylvania; Nemours Children's Health System, Jacksonville (J.J.L., K.V.B., J.L.), and University of South Florida Morsani College of Medicine, Tampa (J.-C.C.) - both in Florida; University of Arizona Health Sciences, Tucson (E.R.B., M.K., F.M., D.A.M.); Washington University School of Medicine, St. Louis (L.B.B., A.B., M.C.); University of California, San Francisco (UCSF), San Francisco (M.B., M.D.C., S.C.L., D.L.) and UCSF Benioff Children's Hospital, Oakland (M.B., D.L.) - both in California; Brigham and Women's Hospital and Harvard Medical School (J.-C.C., N.G., E.I.) and Boston Children's Hospital (W.P., W.S.) - all in Boston; University Hospitals Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland (J.F.C., K.R.); University of Wisconsin-Madison, Madison (L.D., D.J.J., R.F.L., C.A.S.) and Aurora Sinai Medical Center, Milwaukee (L.S.-V.) - both in Wisconsin; Columbia University Irving Medical Center, New York, (E.D.); Emory University, Atlanta (A.M.F.); and University of New Mexico, Albuquerque (H.R.)
| | - Daniel J Jackson
- From National Jewish Health (M.E.W., R.C., J.T.O.), Denver, and University of Colorado School of Medicine (M.E.W., S.J.S., R.C., F.H., J.T.O.) and Children's Hospital Colorado (S.J.S.), Aurora - all in Colorado; Wake Forest School of Medicine (V.E.O., W.C.M., S.P.P.), Winston-Salem, North Carolina Clinical Research (C.F.L.), Raleigh, and Duke University Medical Center (N.L., L.Q.), Durham - all in North Carolina; 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.K.), Rush University Medical Center (J.M.), University of Chicago (E.N., J.S., S. White), and Northwestern University Feinberg School of Medicine (L.J.S.) - all in Chicago; Penn State University (V.C., S.J.K., D.M.), Hershey, and Allegheny General Hospital (D.G.) and University of Pittsburgh Medical Center (S. Wenzel), Pittsburgh - all in Pennsylvania; Nemours Children's Health System, Jacksonville (J.J.L., K.V.B., J.L.), and University of South Florida Morsani College of Medicine, Tampa (J.-C.C.) - both in Florida; University of Arizona Health Sciences, Tucson (E.R.B., M.K., F.M., D.A.M.); Washington University School of Medicine, St. Louis (L.B.B., A.B., M.C.); University of California, San Francisco (UCSF), San Francisco (M.B., M.D.C., S.C.L., D.L.) and UCSF Benioff Children's Hospital, Oakland (M.B., D.L.) - both in California; Brigham and Women's Hospital and Harvard Medical School (J.-C.C., N.G., E.I.) and Boston Children's Hospital (W.P., W.S.) - all in Boston; University Hospitals Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland (J.F.C., K.R.); University of Wisconsin-Madison, Madison (L.D., D.J.J., R.F.L., C.A.S.) and Aurora Sinai Medical Center, Milwaukee (L.S.-V.) - both in Wisconsin; Columbia University Irving Medical Center, New York, (E.D.); Emory University, Atlanta (A.M.F.); and University of New Mexico, Albuquerque (H.R.)
| | - Harsha Kumar
- From National Jewish Health (M.E.W., R.C., J.T.O.), Denver, and University of Colorado School of Medicine (M.E.W., S.J.S., R.C., F.H., J.T.O.) and Children's Hospital Colorado (S.J.S.), Aurora - all in Colorado; Wake Forest School of Medicine (V.E.O., W.C.M., S.P.P.), Winston-Salem, North Carolina Clinical Research (C.F.L.), Raleigh, and Duke University Medical Center (N.L., L.Q.), Durham - all in North Carolina; 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.K.), Rush University Medical Center (J.M.), University of Chicago (E.N., J.S., S. White), and Northwestern University Feinberg School of Medicine (L.J.S.) - all in Chicago; Penn State University (V.C., S.J.K., D.M.), Hershey, and Allegheny General Hospital (D.G.) and University of Pittsburgh Medical Center (S. Wenzel), Pittsburgh - all in Pennsylvania; Nemours Children's Health System, Jacksonville (J.J.L., K.V.B., J.L.), and University of South Florida Morsani College of Medicine, Tampa (J.-C.C.) - both in Florida; University of Arizona Health Sciences, Tucson (E.R.B., M.K., F.M., D.A.M.); Washington University School of Medicine, St. Louis (L.B.B., A.B., M.C.); University of California, San Francisco (UCSF), San Francisco (M.B., M.D.C., S.C.L., D.L.) and UCSF Benioff Children's Hospital, Oakland (M.B., D.L.) - both in California; Brigham and Women's Hospital and Harvard Medical School (J.-C.C., N.G., E.I.) and Boston Children's Hospital (W.P., W.S.) - all in Boston; University Hospitals Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland (J.F.C., K.R.); University of Wisconsin-Madison, Madison (L.D., D.J.J., R.F.L., C.A.S.) and Aurora Sinai Medical Center, Milwaukee (L.S.-V.) - both in Wisconsin; Columbia University Irving Medical Center, New York, (E.D.); Emory University, Atlanta (A.M.F.); and University of New Mexico, Albuquerque (H.R.)
| | - Monica Kraft
- From National Jewish Health (M.E.W., R.C., J.T.O.), Denver, and University of Colorado School of Medicine (M.E.W., S.J.S., R.C., F.H., J.T.O.) and Children's Hospital Colorado (S.J.S.), Aurora - all in Colorado; Wake Forest School of Medicine (V.E.O., W.C.M., S.P.P.), Winston-Salem, North Carolina Clinical Research (C.F.L.), Raleigh, and Duke University Medical Center (N.L., L.Q.), Durham - all in North Carolina; 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.K.), Rush University Medical Center (J.M.), University of Chicago (E.N., J.S., S. White), and Northwestern University Feinberg School of Medicine (L.J.S.) - all in Chicago; Penn State University (V.C., S.J.K., D.M.), Hershey, and Allegheny General Hospital (D.G.) and University of Pittsburgh Medical Center (S. Wenzel), Pittsburgh - all in Pennsylvania; Nemours Children's Health System, Jacksonville (J.J.L., K.V.B., J.L.), and University of South Florida Morsani College of Medicine, Tampa (J.-C.C.) - both in Florida; University of Arizona Health Sciences, Tucson (E.R.B., M.K., F.M., D.A.M.); Washington University School of Medicine, St. Louis (L.B.B., A.B., M.C.); University of California, San Francisco (UCSF), San Francisco (M.B., M.D.C., S.C.L., D.L.) and UCSF Benioff Children's Hospital, Oakland (M.B., D.L.) - both in California; Brigham and Women's Hospital and Harvard Medical School (J.-C.C., N.G., E.I.) and Boston Children's Hospital (W.P., W.S.) - all in Boston; University Hospitals Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland (J.F.C., K.R.); University of Wisconsin-Madison, Madison (L.D., D.J.J., R.F.L., C.A.S.) and Aurora Sinai Medical Center, Milwaukee (L.S.-V.) - both in Wisconsin; Columbia University Irving Medical Center, New York, (E.D.); Emory University, Atlanta (A.M.F.); and University of New Mexico, Albuquerque (H.R.)
| | - Craig F LaForce
- From National Jewish Health (M.E.W., R.C., J.T.O.), Denver, and University of Colorado School of Medicine (M.E.W., S.J.S., R.C., F.H., J.T.O.) and Children's Hospital Colorado (S.J.S.), Aurora - all in Colorado; Wake Forest School of Medicine (V.E.O., W.C.M., S.P.P.), Winston-Salem, North Carolina Clinical Research (C.F.L.), Raleigh, and Duke University Medical Center (N.L., L.Q.), Durham - all in North Carolina; 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.K.), Rush University Medical Center (J.M.), University of Chicago (E.N., J.S., S. White), and Northwestern University Feinberg School of Medicine (L.J.S.) - all in Chicago; Penn State University (V.C., S.J.K., D.M.), Hershey, and Allegheny General Hospital (D.G.) and University of Pittsburgh Medical Center (S. Wenzel), Pittsburgh - all in Pennsylvania; Nemours Children's Health System, Jacksonville (J.J.L., K.V.B., J.L.), and University of South Florida Morsani College of Medicine, Tampa (J.-C.C.) - both in Florida; University of Arizona Health Sciences, Tucson (E.R.B., M.K., F.M., D.A.M.); Washington University School of Medicine, St. Louis (L.B.B., A.B., M.C.); University of California, San Francisco (UCSF), San Francisco (M.B., M.D.C., S.C.L., D.L.) and UCSF Benioff Children's Hospital, Oakland (M.B., D.L.) - both in California; Brigham and Women's Hospital and Harvard Medical School (J.-C.C., N.G., E.I.) and Boston Children's Hospital (W.P., W.S.) - all in Boston; University Hospitals Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland (J.F.C., K.R.); University of Wisconsin-Madison, Madison (L.D., D.J.J., R.F.L., C.A.S.) and Aurora Sinai Medical Center, Milwaukee (L.S.-V.) - both in Wisconsin; Columbia University Irving Medical Center, New York, (E.D.); Emory University, Atlanta (A.M.F.); and University of New Mexico, Albuquerque (H.R.)
| | - Jason Lang
- From National Jewish Health (M.E.W., R.C., J.T.O.), Denver, and University of Colorado School of Medicine (M.E.W., S.J.S., R.C., F.H., J.T.O.) and Children's Hospital Colorado (S.J.S.), Aurora - all in Colorado; Wake Forest School of Medicine (V.E.O., W.C.M., S.P.P.), Winston-Salem, North Carolina Clinical Research (C.F.L.), Raleigh, and Duke University Medical Center (N.L., L.Q.), Durham - all in North Carolina; 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.K.), Rush University Medical Center (J.M.), University of Chicago (E.N., J.S., S. White), and Northwestern University Feinberg School of Medicine (L.J.S.) - all in Chicago; Penn State University (V.C., S.J.K., D.M.), Hershey, and Allegheny General Hospital (D.G.) and University of Pittsburgh Medical Center (S. Wenzel), Pittsburgh - all in Pennsylvania; Nemours Children's Health System, Jacksonville (J.J.L., K.V.B., J.L.), and University of South Florida Morsani College of Medicine, Tampa (J.-C.C.) - both in Florida; University of Arizona Health Sciences, Tucson (E.R.B., M.K., F.M., D.A.M.); Washington University School of Medicine, St. Louis (L.B.B., A.B., M.C.); University of California, San Francisco (UCSF), San Francisco (M.B., M.D.C., S.C.L., D.L.) and UCSF Benioff Children's Hospital, Oakland (M.B., D.L.) - both in California; Brigham and Women's Hospital and Harvard Medical School (J.-C.C., N.G., E.I.) and Boston Children's Hospital (W.P., W.S.) - all in Boston; University Hospitals Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland (J.F.C., K.R.); University of Wisconsin-Madison, Madison (L.D., D.J.J., R.F.L., C.A.S.) and Aurora Sinai Medical Center, Milwaukee (L.S.-V.) - both in Wisconsin; Columbia University Irving Medical Center, New York, (E.D.); Emory University, Atlanta (A.M.F.); and University of New Mexico, Albuquerque (H.R.)
| | - Stephen C Lazarus
- From National Jewish Health (M.E.W., R.C., J.T.O.), Denver, and University of Colorado School of Medicine (M.E.W., S.J.S., R.C., F.H., J.T.O.) and Children's Hospital Colorado (S.J.S.), Aurora - all in Colorado; Wake Forest School of Medicine (V.E.O., W.C.M., S.P.P.), Winston-Salem, North Carolina Clinical Research (C.F.L.), Raleigh, and Duke University Medical Center (N.L., L.Q.), Durham - all in North Carolina; 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.K.), Rush University Medical Center (J.M.), University of Chicago (E.N., J.S., S. White), and Northwestern University Feinberg School of Medicine (L.J.S.) - all in Chicago; Penn State University (V.C., S.J.K., D.M.), Hershey, and Allegheny General Hospital (D.G.) and University of Pittsburgh Medical Center (S. Wenzel), Pittsburgh - all in Pennsylvania; Nemours Children's Health System, Jacksonville (J.J.L., K.V.B., J.L.), and University of South Florida Morsani College of Medicine, Tampa (J.-C.C.) - both in Florida; University of Arizona Health Sciences, Tucson (E.R.B., M.K., F.M., D.A.M.); Washington University School of Medicine, St. Louis (L.B.B., A.B., M.C.); University of California, San Francisco (UCSF), San Francisco (M.B., M.D.C., S.C.L., D.L.) and UCSF Benioff Children's Hospital, Oakland (M.B., D.L.) - both in California; Brigham and Women's Hospital and Harvard Medical School (J.-C.C., N.G., E.I.) and Boston Children's Hospital (W.P., W.S.) - all in Boston; University Hospitals Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland (J.F.C., K.R.); University of Wisconsin-Madison, Madison (L.D., D.J.J., R.F.L., C.A.S.) and Aurora Sinai Medical Center, Milwaukee (L.S.-V.) - both in Wisconsin; Columbia University Irving Medical Center, New York, (E.D.); Emory University, Atlanta (A.M.F.); and University of New Mexico, Albuquerque (H.R.)
| | - Robert F Lemanske
- From National Jewish Health (M.E.W., R.C., J.T.O.), Denver, and University of Colorado School of Medicine (M.E.W., S.J.S., R.C., F.H., J.T.O.) and Children's Hospital Colorado (S.J.S.), Aurora - all in Colorado; Wake Forest School of Medicine (V.E.O., W.C.M., S.P.P.), Winston-Salem, North Carolina Clinical Research (C.F.L.), Raleigh, and Duke University Medical Center (N.L., L.Q.), Durham - all in North Carolina; 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.K.), Rush University Medical Center (J.M.), University of Chicago (E.N., J.S., S. White), and Northwestern University Feinberg School of Medicine (L.J.S.) - all in Chicago; Penn State University (V.C., S.J.K., D.M.), Hershey, and Allegheny General Hospital (D.G.) and University of Pittsburgh Medical Center (S. Wenzel), Pittsburgh - all in Pennsylvania; Nemours Children's Health System, Jacksonville (J.J.L., K.V.B., J.L.), and University of South Florida Morsani College of Medicine, Tampa (J.-C.C.) - both in Florida; University of Arizona Health Sciences, Tucson (E.R.B., M.K., F.M., D.A.M.); Washington University School of Medicine, St. Louis (L.B.B., A.B., M.C.); University of California, San Francisco (UCSF), San Francisco (M.B., M.D.C., S.C.L., D.L.) and UCSF Benioff Children's Hospital, Oakland (M.B., D.L.) - both in California; Brigham and Women's Hospital and Harvard Medical School (J.-C.C., N.G., E.I.) and Boston Children's Hospital (W.P., W.S.) - all in Boston; University Hospitals Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland (J.F.C., K.R.); University of Wisconsin-Madison, Madison (L.D., D.J.J., R.F.L., C.A.S.) and Aurora Sinai Medical Center, Milwaukee (L.S.-V.) - both in Wisconsin; Columbia University Irving Medical Center, New York, (E.D.); Emory University, Atlanta (A.M.F.); and University of New Mexico, Albuquerque (H.R.)
| | - Dayna Long
- From National Jewish Health (M.E.W., R.C., J.T.O.), Denver, and University of Colorado School of Medicine (M.E.W., S.J.S., R.C., F.H., J.T.O.) and Children's Hospital Colorado (S.J.S.), Aurora - all in Colorado; Wake Forest School of Medicine (V.E.O., W.C.M., S.P.P.), Winston-Salem, North Carolina Clinical Research (C.F.L.), Raleigh, and Duke University Medical Center (N.L., L.Q.), Durham - all in North Carolina; 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.K.), Rush University Medical Center (J.M.), University of Chicago (E.N., J.S., S. White), and Northwestern University Feinberg School of Medicine (L.J.S.) - all in Chicago; Penn State University (V.C., S.J.K., D.M.), Hershey, and Allegheny General Hospital (D.G.) and University of Pittsburgh Medical Center (S. Wenzel), Pittsburgh - all in Pennsylvania; Nemours Children's Health System, Jacksonville (J.J.L., K.V.B., J.L.), and University of South Florida Morsani College of Medicine, Tampa (J.-C.C.) - both in Florida; University of Arizona Health Sciences, Tucson (E.R.B., M.K., F.M., D.A.M.); Washington University School of Medicine, St. Louis (L.B.B., A.B., M.C.); University of California, San Francisco (UCSF), San Francisco (M.B., M.D.C., S.C.L., D.L.) and UCSF Benioff Children's Hospital, Oakland (M.B., D.L.) - both in California; Brigham and Women's Hospital and Harvard Medical School (J.-C.C., N.G., E.I.) and Boston Children's Hospital (W.P., W.S.) - all in Boston; University Hospitals Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland (J.F.C., K.R.); University of Wisconsin-Madison, Madison (L.D., D.J.J., R.F.L., C.A.S.) and Aurora Sinai Medical Center, Milwaukee (L.S.-V.) - both in Wisconsin; Columbia University Irving Medical Center, New York, (E.D.); Emory University, Atlanta (A.M.F.); and University of New Mexico, Albuquerque (H.R.)
| | - Njira Lugogo
- From National Jewish Health (M.E.W., R.C., J.T.O.), Denver, and University of Colorado School of Medicine (M.E.W., S.J.S., R.C., F.H., J.T.O.) and Children's Hospital Colorado (S.J.S.), Aurora - all in Colorado; Wake Forest School of Medicine (V.E.O., W.C.M., S.P.P.), Winston-Salem, North Carolina Clinical Research (C.F.L.), Raleigh, and Duke University Medical Center (N.L., L.Q.), Durham - all in North Carolina; 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.K.), Rush University Medical Center (J.M.), University of Chicago (E.N., J.S., S. White), and Northwestern University Feinberg School of Medicine (L.J.S.) - all in Chicago; Penn State University (V.C., S.J.K., D.M.), Hershey, and Allegheny General Hospital (D.G.) and University of Pittsburgh Medical Center (S. Wenzel), Pittsburgh - all in Pennsylvania; Nemours Children's Health System, Jacksonville (J.J.L., K.V.B., J.L.), and University of South Florida Morsani College of Medicine, Tampa (J.-C.C.) - both in Florida; University of Arizona Health Sciences, Tucson (E.R.B., M.K., F.M., D.A.M.); Washington University School of Medicine, St. Louis (L.B.B., A.B., M.C.); University of California, San Francisco (UCSF), San Francisco (M.B., M.D.C., S.C.L., D.L.) and UCSF Benioff Children's Hospital, Oakland (M.B., D.L.) - both in California; Brigham and Women's Hospital and Harvard Medical School (J.-C.C., N.G., E.I.) and Boston Children's Hospital (W.P., W.S.) - all in Boston; University Hospitals Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland (J.F.C., K.R.); University of Wisconsin-Madison, Madison (L.D., D.J.J., R.F.L., C.A.S.) and Aurora Sinai Medical Center, Milwaukee (L.S.-V.) - both in Wisconsin; Columbia University Irving Medical Center, New York, (E.D.); Emory University, Atlanta (A.M.F.); and University of New Mexico, Albuquerque (H.R.)
| | - Fernando Martinez
- From National Jewish Health (M.E.W., R.C., J.T.O.), Denver, and University of Colorado School of Medicine (M.E.W., S.J.S., R.C., F.H., J.T.O.) and Children's Hospital Colorado (S.J.S.), Aurora - all in Colorado; Wake Forest School of Medicine (V.E.O., W.C.M., S.P.P.), Winston-Salem, North Carolina Clinical Research (C.F.L.), Raleigh, and Duke University Medical Center (N.L., L.Q.), Durham - all in North Carolina; 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.K.), Rush University Medical Center (J.M.), University of Chicago (E.N., J.S., S. White), and Northwestern University Feinberg School of Medicine (L.J.S.) - all in Chicago; Penn State University (V.C., S.J.K., D.M.), Hershey, and Allegheny General Hospital (D.G.) and University of Pittsburgh Medical Center (S. Wenzel), Pittsburgh - all in Pennsylvania; Nemours Children's Health System, Jacksonville (J.J.L., K.V.B., J.L.), and University of South Florida Morsani College of Medicine, Tampa (J.-C.C.) - both in Florida; University of Arizona Health Sciences, Tucson (E.R.B., M.K., F.M., D.A.M.); Washington University School of Medicine, St. Louis (L.B.B., A.B., M.C.); University of California, San Francisco (UCSF), San Francisco (M.B., M.D.C., S.C.L., D.L.) and UCSF Benioff Children's Hospital, Oakland (M.B., D.L.) - both in California; Brigham and Women's Hospital and Harvard Medical School (J.-C.C., N.G., E.I.) and Boston Children's Hospital (W.P., W.S.) - all in Boston; University Hospitals Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland (J.F.C., K.R.); University of Wisconsin-Madison, Madison (L.D., D.J.J., R.F.L., C.A.S.) and Aurora Sinai Medical Center, Milwaukee (L.S.-V.) - both in Wisconsin; Columbia University Irving Medical Center, New York, (E.D.); Emory University, Atlanta (A.M.F.); and University of New Mexico, Albuquerque (H.R.)
| | - Deborah A Meyers
- From National Jewish Health (M.E.W., R.C., J.T.O.), Denver, and University of Colorado School of Medicine (M.E.W., S.J.S., R.C., F.H., J.T.O.) and Children's Hospital Colorado (S.J.S.), Aurora - all in Colorado; Wake Forest School of Medicine (V.E.O., W.C.M., S.P.P.), Winston-Salem, North Carolina Clinical Research (C.F.L.), Raleigh, and Duke University Medical Center (N.L., L.Q.), Durham - all in North Carolina; 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.K.), Rush University Medical Center (J.M.), University of Chicago (E.N., J.S., S. White), and Northwestern University Feinberg School of Medicine (L.J.S.) - all in Chicago; Penn State University (V.C., S.J.K., D.M.), Hershey, and Allegheny General Hospital (D.G.) and University of Pittsburgh Medical Center (S. Wenzel), Pittsburgh - all in Pennsylvania; Nemours Children's Health System, Jacksonville (J.J.L., K.V.B., J.L.), and University of South Florida Morsani College of Medicine, Tampa (J.-C.C.) - both in Florida; University of Arizona Health Sciences, Tucson (E.R.B., M.K., F.M., D.A.M.); Washington University School of Medicine, St. Louis (L.B.B., A.B., M.C.); University of California, San Francisco (UCSF), San Francisco (M.B., M.D.C., S.C.L., D.L.) and UCSF Benioff Children's Hospital, Oakland (M.B., D.L.) - both in California; Brigham and Women's Hospital and Harvard Medical School (J.-C.C., N.G., E.I.) and Boston Children's Hospital (W.P., W.S.) - all in Boston; University Hospitals Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland (J.F.C., K.R.); University of Wisconsin-Madison, Madison (L.D., D.J.J., R.F.L., C.A.S.) and Aurora Sinai Medical Center, Milwaukee (L.S.-V.) - both in Wisconsin; Columbia University Irving Medical Center, New York, (E.D.); Emory University, Atlanta (A.M.F.); and University of New Mexico, Albuquerque (H.R.)
| | - Wendy C Moore
- From National Jewish Health (M.E.W., R.C., J.T.O.), Denver, and University of Colorado School of Medicine (M.E.W., S.J.S., R.C., F.H., J.T.O.) and Children's Hospital Colorado (S.J.S.), Aurora - all in Colorado; Wake Forest School of Medicine (V.E.O., W.C.M., S.P.P.), Winston-Salem, North Carolina Clinical Research (C.F.L.), Raleigh, and Duke University Medical Center (N.L., L.Q.), Durham - all in North Carolina; 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.K.), Rush University Medical Center (J.M.), University of Chicago (E.N., J.S., S. White), and Northwestern University Feinberg School of Medicine (L.J.S.) - all in Chicago; Penn State University (V.C., S.J.K., D.M.), Hershey, and Allegheny General Hospital (D.G.) and University of Pittsburgh Medical Center (S. Wenzel), Pittsburgh - all in Pennsylvania; Nemours Children's Health System, Jacksonville (J.J.L., K.V.B., J.L.), and University of South Florida Morsani College of Medicine, Tampa (J.-C.C.) - both in Florida; University of Arizona Health Sciences, Tucson (E.R.B., M.K., F.M., D.A.M.); Washington University School of Medicine, St. Louis (L.B.B., A.B., M.C.); University of California, San Francisco (UCSF), San Francisco (M.B., M.D.C., S.C.L., D.L.) and UCSF Benioff Children's Hospital, Oakland (M.B., D.L.) - both in California; Brigham and Women's Hospital and Harvard Medical School (J.-C.C., N.G., E.I.) and Boston Children's Hospital (W.P., W.S.) - all in Boston; University Hospitals Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland (J.F.C., K.R.); University of Wisconsin-Madison, Madison (L.D., D.J.J., R.F.L., C.A.S.) and Aurora Sinai Medical Center, Milwaukee (L.S.-V.) - both in Wisconsin; Columbia University Irving Medical Center, New York, (E.D.); Emory University, Atlanta (A.M.F.); and University of New Mexico, Albuquerque (H.R.)
| | - James Moy
- From National Jewish Health (M.E.W., R.C., J.T.O.), Denver, and University of Colorado School of Medicine (M.E.W., S.J.S., R.C., F.H., J.T.O.) and Children's Hospital Colorado (S.J.S.), Aurora - all in Colorado; Wake Forest School of Medicine (V.E.O., W.C.M., S.P.P.), Winston-Salem, North Carolina Clinical Research (C.F.L.), Raleigh, and Duke University Medical Center (N.L., L.Q.), Durham - all in North Carolina; 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.K.), Rush University Medical Center (J.M.), University of Chicago (E.N., J.S., S. White), and Northwestern University Feinberg School of Medicine (L.J.S.) - all in Chicago; Penn State University (V.C., S.J.K., D.M.), Hershey, and Allegheny General Hospital (D.G.) and University of Pittsburgh Medical Center (S. Wenzel), Pittsburgh - all in Pennsylvania; Nemours Children's Health System, Jacksonville (J.J.L., K.V.B., J.L.), and University of South Florida Morsani College of Medicine, Tampa (J.-C.C.) - both in Florida; University of Arizona Health Sciences, Tucson (E.R.B., M.K., F.M., D.A.M.); Washington University School of Medicine, St. Louis (L.B.B., A.B., M.C.); University of California, San Francisco (UCSF), San Francisco (M.B., M.D.C., S.C.L., D.L.) and UCSF Benioff Children's Hospital, Oakland (M.B., D.L.) - both in California; Brigham and Women's Hospital and Harvard Medical School (J.-C.C., N.G., E.I.) and Boston Children's Hospital (W.P., W.S.) - all in Boston; University Hospitals Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland (J.F.C., K.R.); University of Wisconsin-Madison, Madison (L.D., D.J.J., R.F.L., C.A.S.) and Aurora Sinai Medical Center, Milwaukee (L.S.-V.) - both in Wisconsin; Columbia University Irving Medical Center, New York, (E.D.); Emory University, Atlanta (A.M.F.); and University of New Mexico, Albuquerque (H.R.)
| | - Edward Naureckas
- From National Jewish Health (M.E.W., R.C., J.T.O.), Denver, and University of Colorado School of Medicine (M.E.W., S.J.S., R.C., F.H., J.T.O.) and Children's Hospital Colorado (S.J.S.), Aurora - all in Colorado; Wake Forest School of Medicine (V.E.O., W.C.M., S.P.P.), Winston-Salem, North Carolina Clinical Research (C.F.L.), Raleigh, and Duke University Medical Center (N.L., L.Q.), Durham - all in North Carolina; 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.K.), Rush University Medical Center (J.M.), University of Chicago (E.N., J.S., S. White), and Northwestern University Feinberg School of Medicine (L.J.S.) - all in Chicago; Penn State University (V.C., S.J.K., D.M.), Hershey, and Allegheny General Hospital (D.G.) and University of Pittsburgh Medical Center (S. Wenzel), Pittsburgh - all in Pennsylvania; Nemours Children's Health System, Jacksonville (J.J.L., K.V.B., J.L.), and University of South Florida Morsani College of Medicine, Tampa (J.-C.C.) - both in Florida; University of Arizona Health Sciences, Tucson (E.R.B., M.K., F.M., D.A.M.); Washington University School of Medicine, St. Louis (L.B.B., A.B., M.C.); University of California, San Francisco (UCSF), San Francisco (M.B., M.D.C., S.C.L., D.L.) and UCSF Benioff Children's Hospital, Oakland (M.B., D.L.) - both in California; Brigham and Women's Hospital and Harvard Medical School (J.-C.C., N.G., E.I.) and Boston Children's Hospital (W.P., W.S.) - all in Boston; University Hospitals Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland (J.F.C., K.R.); University of Wisconsin-Madison, Madison (L.D., D.J.J., R.F.L., C.A.S.) and Aurora Sinai Medical Center, Milwaukee (L.S.-V.) - both in Wisconsin; Columbia University Irving Medical Center, New York, (E.D.); Emory University, Atlanta (A.M.F.); and University of New Mexico, Albuquerque (H.R.)
| | - J Tod Olin
- From National Jewish Health (M.E.W., R.C., J.T.O.), Denver, and University of Colorado School of Medicine (M.E.W., S.J.S., R.C., F.H., J.T.O.) and Children's Hospital Colorado (S.J.S.), Aurora - all in Colorado; Wake Forest School of Medicine (V.E.O., W.C.M., S.P.P.), Winston-Salem, North Carolina Clinical Research (C.F.L.), Raleigh, and Duke University Medical Center (N.L., L.Q.), Durham - all in North Carolina; 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.K.), Rush University Medical Center (J.M.), University of Chicago (E.N., J.S., S. White), and Northwestern University Feinberg School of Medicine (L.J.S.) - all in Chicago; Penn State University (V.C., S.J.K., D.M.), Hershey, and Allegheny General Hospital (D.G.) and University of Pittsburgh Medical Center (S. Wenzel), Pittsburgh - all in Pennsylvania; Nemours Children's Health System, Jacksonville (J.J.L., K.V.B., J.L.), and University of South Florida Morsani College of Medicine, Tampa (J.-C.C.) - both in Florida; University of Arizona Health Sciences, Tucson (E.R.B., M.K., F.M., D.A.M.); Washington University School of Medicine, St. Louis (L.B.B., A.B., M.C.); University of California, San Francisco (UCSF), San Francisco (M.B., M.D.C., S.C.L., D.L.) and UCSF Benioff Children's Hospital, Oakland (M.B., D.L.) - both in California; Brigham and Women's Hospital and Harvard Medical School (J.-C.C., N.G., E.I.) and Boston Children's Hospital (W.P., W.S.) - all in Boston; University Hospitals Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland (J.F.C., K.R.); University of Wisconsin-Madison, Madison (L.D., D.J.J., R.F.L., C.A.S.) and Aurora Sinai Medical Center, Milwaukee (L.S.-V.) - both in Wisconsin; Columbia University Irving Medical Center, New York, (E.D.); Emory University, Atlanta (A.M.F.); and University of New Mexico, Albuquerque (H.R.)
| | - Stephen P Peters
- From National Jewish Health (M.E.W., R.C., J.T.O.), Denver, and University of Colorado School of Medicine (M.E.W., S.J.S., R.C., F.H., J.T.O.) and Children's Hospital Colorado (S.J.S.), Aurora - all in Colorado; Wake Forest School of Medicine (V.E.O., W.C.M., S.P.P.), Winston-Salem, North Carolina Clinical Research (C.F.L.), Raleigh, and Duke University Medical Center (N.L., L.Q.), Durham - all in North Carolina; 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.K.), Rush University Medical Center (J.M.), University of Chicago (E.N., J.S., S. White), and Northwestern University Feinberg School of Medicine (L.J.S.) - all in Chicago; Penn State University (V.C., S.J.K., D.M.), Hershey, and Allegheny General Hospital (D.G.) and University of Pittsburgh Medical Center (S. Wenzel), Pittsburgh - all in Pennsylvania; Nemours Children's Health System, Jacksonville (J.J.L., K.V.B., J.L.), and University of South Florida Morsani College of Medicine, Tampa (J.-C.C.) - both in Florida; University of Arizona Health Sciences, Tucson (E.R.B., M.K., F.M., D.A.M.); Washington University School of Medicine, St. Louis (L.B.B., A.B., M.C.); University of California, San Francisco (UCSF), San Francisco (M.B., M.D.C., S.C.L., D.L.) and UCSF Benioff Children's Hospital, Oakland (M.B., D.L.) - both in California; Brigham and Women's Hospital and Harvard Medical School (J.-C.C., N.G., E.I.) and Boston Children's Hospital (W.P., W.S.) - all in Boston; University Hospitals Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland (J.F.C., K.R.); University of Wisconsin-Madison, Madison (L.D., D.J.J., R.F.L., C.A.S.) and Aurora Sinai Medical Center, Milwaukee (L.S.-V.) - both in Wisconsin; Columbia University Irving Medical Center, New York, (E.D.); Emory University, Atlanta (A.M.F.); and University of New Mexico, Albuquerque (H.R.)
| | - Wanda Phipatanakul
- From National Jewish Health (M.E.W., R.C., J.T.O.), Denver, and University of Colorado School of Medicine (M.E.W., S.J.S., R.C., F.H., J.T.O.) and Children's Hospital Colorado (S.J.S.), Aurora - all in Colorado; Wake Forest School of Medicine (V.E.O., W.C.M., S.P.P.), Winston-Salem, North Carolina Clinical Research (C.F.L.), Raleigh, and Duke University Medical Center (N.L., L.Q.), Durham - all in North Carolina; 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.K.), Rush University Medical Center (J.M.), University of Chicago (E.N., J.S., S. White), and Northwestern University Feinberg School of Medicine (L.J.S.) - all in Chicago; Penn State University (V.C., S.J.K., D.M.), Hershey, and Allegheny General Hospital (D.G.) and University of Pittsburgh Medical Center (S. Wenzel), Pittsburgh - all in Pennsylvania; Nemours Children's Health System, Jacksonville (J.J.L., K.V.B., J.L.), and University of South Florida Morsani College of Medicine, Tampa (J.-C.C.) - both in Florida; University of Arizona Health Sciences, Tucson (E.R.B., M.K., F.M., D.A.M.); Washington University School of Medicine, St. Louis (L.B.B., A.B., M.C.); University of California, San Francisco (UCSF), San Francisco (M.B., M.D.C., S.C.L., D.L.) and UCSF Benioff Children's Hospital, Oakland (M.B., D.L.) - both in California; Brigham and Women's Hospital and Harvard Medical School (J.-C.C., N.G., E.I.) and Boston Children's Hospital (W.P., W.S.) - all in Boston; University Hospitals Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland (J.F.C., K.R.); University of Wisconsin-Madison, Madison (L.D., D.J.J., R.F.L., C.A.S.) and Aurora Sinai Medical Center, Milwaukee (L.S.-V.) - both in Wisconsin; Columbia University Irving Medical Center, New York, (E.D.); Emory University, Atlanta (A.M.F.); and University of New Mexico, Albuquerque (H.R.)
| | - Loretta Que
- From National Jewish Health (M.E.W., R.C., J.T.O.), Denver, and University of Colorado School of Medicine (M.E.W., S.J.S., R.C., F.H., J.T.O.) and Children's Hospital Colorado (S.J.S.), Aurora - all in Colorado; Wake Forest School of Medicine (V.E.O., W.C.M., S.P.P.), Winston-Salem, North Carolina Clinical Research (C.F.L.), Raleigh, and Duke University Medical Center (N.L., L.Q.), Durham - all in North Carolina; 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.K.), Rush University Medical Center (J.M.), University of Chicago (E.N., J.S., S. White), and Northwestern University Feinberg School of Medicine (L.J.S.) - all in Chicago; Penn State University (V.C., S.J.K., D.M.), Hershey, and Allegheny General Hospital (D.G.) and University of Pittsburgh Medical Center (S. Wenzel), Pittsburgh - all in Pennsylvania; Nemours Children's Health System, Jacksonville (J.J.L., K.V.B., J.L.), and University of South Florida Morsani College of Medicine, Tampa (J.-C.C.) - both in Florida; University of Arizona Health Sciences, Tucson (E.R.B., M.K., F.M., D.A.M.); Washington University School of Medicine, St. Louis (L.B.B., A.B., M.C.); University of California, San Francisco (UCSF), San Francisco (M.B., M.D.C., S.C.L., D.L.) and UCSF Benioff Children's Hospital, Oakland (M.B., D.L.) - both in California; Brigham and Women's Hospital and Harvard Medical School (J.-C.C., N.G., E.I.) and Boston Children's Hospital (W.P., W.S.) - all in Boston; University Hospitals Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland (J.F.C., K.R.); University of Wisconsin-Madison, Madison (L.D., D.J.J., R.F.L., C.A.S.) and Aurora Sinai Medical Center, Milwaukee (L.S.-V.) - both in Wisconsin; Columbia University Irving Medical Center, New York, (E.D.); Emory University, Atlanta (A.M.F.); and University of New Mexico, Albuquerque (H.R.)
| | - Hengameh Raissy
- From National Jewish Health (M.E.W., R.C., J.T.O.), Denver, and University of Colorado School of Medicine (M.E.W., S.J.S., R.C., F.H., J.T.O.) and Children's Hospital Colorado (S.J.S.), Aurora - all in Colorado; Wake Forest School of Medicine (V.E.O., W.C.M., S.P.P.), Winston-Salem, North Carolina Clinical Research (C.F.L.), Raleigh, and Duke University Medical Center (N.L., L.Q.), Durham - all in North Carolina; 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.K.), Rush University Medical Center (J.M.), University of Chicago (E.N., J.S., S. White), and Northwestern University Feinberg School of Medicine (L.J.S.) - all in Chicago; Penn State University (V.C., S.J.K., D.M.), Hershey, and Allegheny General Hospital (D.G.) and University of Pittsburgh Medical Center (S. Wenzel), Pittsburgh - all in Pennsylvania; Nemours Children's Health System, Jacksonville (J.J.L., K.V.B., J.L.), and University of South Florida Morsani College of Medicine, Tampa (J.-C.C.) - both in Florida; University of Arizona Health Sciences, Tucson (E.R.B., M.K., F.M., D.A.M.); Washington University School of Medicine, St. Louis (L.B.B., A.B., M.C.); University of California, San Francisco (UCSF), San Francisco (M.B., M.D.C., S.C.L., D.L.) and UCSF Benioff Children's Hospital, Oakland (M.B., D.L.) - both in California; Brigham and Women's Hospital and Harvard Medical School (J.-C.C., N.G., E.I.) and Boston Children's Hospital (W.P., W.S.) - all in Boston; University Hospitals Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland (J.F.C., K.R.); University of Wisconsin-Madison, Madison (L.D., D.J.J., R.F.L., C.A.S.) and Aurora Sinai Medical Center, Milwaukee (L.S.-V.) - both in Wisconsin; Columbia University Irving Medical Center, New York, (E.D.); Emory University, Atlanta (A.M.F.); and University of New Mexico, Albuquerque (H.R.)
| | - Rachel G Robison
- From National Jewish Health (M.E.W., R.C., J.T.O.), Denver, and University of Colorado School of Medicine (M.E.W., S.J.S., R.C., F.H., J.T.O.) and Children's Hospital Colorado (S.J.S.), Aurora - all in Colorado; Wake Forest School of Medicine (V.E.O., W.C.M., S.P.P.), Winston-Salem, North Carolina Clinical Research (C.F.L.), Raleigh, and Duke University Medical Center (N.L., L.Q.), Durham - all in North Carolina; 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.K.), Rush University Medical Center (J.M.), University of Chicago (E.N., J.S., S. White), and Northwestern University Feinberg School of Medicine (L.J.S.) - all in Chicago; Penn State University (V.C., S.J.K., D.M.), Hershey, and Allegheny General Hospital (D.G.) and University of Pittsburgh Medical Center (S. Wenzel), Pittsburgh - all in Pennsylvania; Nemours Children's Health System, Jacksonville (J.J.L., K.V.B., J.L.), and University of South Florida Morsani College of Medicine, Tampa (J.-C.C.) - both in Florida; University of Arizona Health Sciences, Tucson (E.R.B., M.K., F.M., D.A.M.); Washington University School of Medicine, St. Louis (L.B.B., A.B., M.C.); University of California, San Francisco (UCSF), San Francisco (M.B., M.D.C., S.C.L., D.L.) and UCSF Benioff Children's Hospital, Oakland (M.B., D.L.) - both in California; Brigham and Women's Hospital and Harvard Medical School (J.-C.C., N.G., E.I.) and Boston Children's Hospital (W.P., W.S.) - all in Boston; University Hospitals Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland (J.F.C., K.R.); University of Wisconsin-Madison, Madison (L.D., D.J.J., R.F.L., C.A.S.) and Aurora Sinai Medical Center, Milwaukee (L.S.-V.) - both in Wisconsin; Columbia University Irving Medical Center, New York, (E.D.); Emory University, Atlanta (A.M.F.); and University of New Mexico, Albuquerque (H.R.)
| | - Kristie Ross
- From National Jewish Health (M.E.W., R.C., J.T.O.), Denver, and University of Colorado School of Medicine (M.E.W., S.J.S., R.C., F.H., J.T.O.) and Children's Hospital Colorado (S.J.S.), Aurora - all in Colorado; Wake Forest School of Medicine (V.E.O., W.C.M., S.P.P.), Winston-Salem, North Carolina Clinical Research (C.F.L.), Raleigh, and Duke University Medical Center (N.L., L.Q.), Durham - all in North Carolina; 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.K.), Rush University Medical Center (J.M.), University of Chicago (E.N., J.S., S. White), and Northwestern University Feinberg School of Medicine (L.J.S.) - all in Chicago; Penn State University (V.C., S.J.K., D.M.), Hershey, and Allegheny General Hospital (D.G.) and University of Pittsburgh Medical Center (S. Wenzel), Pittsburgh - all in Pennsylvania; Nemours Children's Health System, Jacksonville (J.J.L., K.V.B., J.L.), and University of South Florida Morsani College of Medicine, Tampa (J.-C.C.) - both in Florida; University of Arizona Health Sciences, Tucson (E.R.B., M.K., F.M., D.A.M.); Washington University School of Medicine, St. Louis (L.B.B., A.B., M.C.); University of California, San Francisco (UCSF), San Francisco (M.B., M.D.C., S.C.L., D.L.) and UCSF Benioff Children's Hospital, Oakland (M.B., D.L.) - both in California; Brigham and Women's Hospital and Harvard Medical School (J.-C.C., N.G., E.I.) and Boston Children's Hospital (W.P., W.S.) - all in Boston; University Hospitals Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland (J.F.C., K.R.); University of Wisconsin-Madison, Madison (L.D., D.J.J., R.F.L., C.A.S.) and Aurora Sinai Medical Center, Milwaukee (L.S.-V.) - both in Wisconsin; Columbia University Irving Medical Center, New York, (E.D.); Emory University, Atlanta (A.M.F.); and University of New Mexico, Albuquerque (H.R.)
| | - William Sheehan
- From National Jewish Health (M.E.W., R.C., J.T.O.), Denver, and University of Colorado School of Medicine (M.E.W., S.J.S., R.C., F.H., J.T.O.) and Children's Hospital Colorado (S.J.S.), Aurora - all in Colorado; Wake Forest School of Medicine (V.E.O., W.C.M., S.P.P.), Winston-Salem, North Carolina Clinical Research (C.F.L.), Raleigh, and Duke University Medical Center (N.L., L.Q.), Durham - all in North Carolina; 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.K.), Rush University Medical Center (J.M.), University of Chicago (E.N., J.S., S. White), and Northwestern University Feinberg School of Medicine (L.J.S.) - all in Chicago; Penn State University (V.C., S.J.K., D.M.), Hershey, and Allegheny General Hospital (D.G.) and University of Pittsburgh Medical Center (S. Wenzel), Pittsburgh - all in Pennsylvania; Nemours Children's Health System, Jacksonville (J.J.L., K.V.B., J.L.), and University of South Florida Morsani College of Medicine, Tampa (J.-C.C.) - both in Florida; University of Arizona Health Sciences, Tucson (E.R.B., M.K., F.M., D.A.M.); Washington University School of Medicine, St. Louis (L.B.B., A.B., M.C.); University of California, San Francisco (UCSF), San Francisco (M.B., M.D.C., S.C.L., D.L.) and UCSF Benioff Children's Hospital, Oakland (M.B., D.L.) - both in California; Brigham and Women's Hospital and Harvard Medical School (J.-C.C., N.G., E.I.) and Boston Children's Hospital (W.P., W.S.) - all in Boston; University Hospitals Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland (J.F.C., K.R.); University of Wisconsin-Madison, Madison (L.D., D.J.J., R.F.L., C.A.S.) and Aurora Sinai Medical Center, Milwaukee (L.S.-V.) - both in Wisconsin; Columbia University Irving Medical Center, New York, (E.D.); Emory University, Atlanta (A.M.F.); and University of New Mexico, Albuquerque (H.R.)
| | - Lewis J Smith
- From National Jewish Health (M.E.W., R.C., J.T.O.), Denver, and University of Colorado School of Medicine (M.E.W., S.J.S., R.C., F.H., J.T.O.) and Children's Hospital Colorado (S.J.S.), Aurora - all in Colorado; Wake Forest School of Medicine (V.E.O., W.C.M., S.P.P.), Winston-Salem, North Carolina Clinical Research (C.F.L.), Raleigh, and Duke University Medical Center (N.L., L.Q.), Durham - all in North Carolina; 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.K.), Rush University Medical Center (J.M.), University of Chicago (E.N., J.S., S. White), and Northwestern University Feinberg School of Medicine (L.J.S.) - all in Chicago; Penn State University (V.C., S.J.K., D.M.), Hershey, and Allegheny General Hospital (D.G.) and University of Pittsburgh Medical Center (S. Wenzel), Pittsburgh - all in Pennsylvania; Nemours Children's Health System, Jacksonville (J.J.L., K.V.B., J.L.), and University of South Florida Morsani College of Medicine, Tampa (J.-C.C.) - both in Florida; University of Arizona Health Sciences, Tucson (E.R.B., M.K., F.M., D.A.M.); Washington University School of Medicine, St. Louis (L.B.B., A.B., M.C.); University of California, San Francisco (UCSF), San Francisco (M.B., M.D.C., S.C.L., D.L.) and UCSF Benioff Children's Hospital, Oakland (M.B., D.L.) - both in California; Brigham and Women's Hospital and Harvard Medical School (J.-C.C., N.G., E.I.) and Boston Children's Hospital (W.P., W.S.) - all in Boston; University Hospitals Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland (J.F.C., K.R.); University of Wisconsin-Madison, Madison (L.D., D.J.J., R.F.L., C.A.S.) and Aurora Sinai Medical Center, Milwaukee (L.S.-V.) - both in Wisconsin; Columbia University Irving Medical Center, New York, (E.D.); Emory University, Atlanta (A.M.F.); and University of New Mexico, Albuquerque (H.R.)
| | - Julian Solway
- From National Jewish Health (M.E.W., R.C., J.T.O.), Denver, and University of Colorado School of Medicine (M.E.W., S.J.S., R.C., F.H., J.T.O.) and Children's Hospital Colorado (S.J.S.), Aurora - all in Colorado; Wake Forest School of Medicine (V.E.O., W.C.M., S.P.P.), Winston-Salem, North Carolina Clinical Research (C.F.L.), Raleigh, and Duke University Medical Center (N.L., L.Q.), Durham - all in North Carolina; 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.K.), Rush University Medical Center (J.M.), University of Chicago (E.N., J.S., S. White), and Northwestern University Feinberg School of Medicine (L.J.S.) - all in Chicago; Penn State University (V.C., S.J.K., D.M.), Hershey, and Allegheny General Hospital (D.G.) and University of Pittsburgh Medical Center (S. Wenzel), Pittsburgh - all in Pennsylvania; Nemours Children's Health System, Jacksonville (J.J.L., K.V.B., J.L.), and University of South Florida Morsani College of Medicine, Tampa (J.-C.C.) - both in Florida; University of Arizona Health Sciences, Tucson (E.R.B., M.K., F.M., D.A.M.); Washington University School of Medicine, St. Louis (L.B.B., A.B., M.C.); University of California, San Francisco (UCSF), San Francisco (M.B., M.D.C., S.C.L., D.L.) and UCSF Benioff Children's Hospital, Oakland (M.B., D.L.) - both in California; Brigham and Women's Hospital and Harvard Medical School (J.-C.C., N.G., E.I.) and Boston Children's Hospital (W.P., W.S.) - all in Boston; University Hospitals Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland (J.F.C., K.R.); University of Wisconsin-Madison, Madison (L.D., D.J.J., R.F.L., C.A.S.) and Aurora Sinai Medical Center, Milwaukee (L.S.-V.) - both in Wisconsin; Columbia University Irving Medical Center, New York, (E.D.); Emory University, Atlanta (A.M.F.); and University of New Mexico, Albuquerque (H.R.)
| | - Christine A Sorkness
- From National Jewish Health (M.E.W., R.C., J.T.O.), Denver, and University of Colorado School of Medicine (M.E.W., S.J.S., R.C., F.H., J.T.O.) and Children's Hospital Colorado (S.J.S.), Aurora - all in Colorado; Wake Forest School of Medicine (V.E.O., W.C.M., S.P.P.), Winston-Salem, North Carolina Clinical Research (C.F.L.), Raleigh, and Duke University Medical Center (N.L., L.Q.), Durham - all in North Carolina; 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.K.), Rush University Medical Center (J.M.), University of Chicago (E.N., J.S., S. White), and Northwestern University Feinberg School of Medicine (L.J.S.) - all in Chicago; Penn State University (V.C., S.J.K., D.M.), Hershey, and Allegheny General Hospital (D.G.) and University of Pittsburgh Medical Center (S. Wenzel), Pittsburgh - all in Pennsylvania; Nemours Children's Health System, Jacksonville (J.J.L., K.V.B., J.L.), and University of South Florida Morsani College of Medicine, Tampa (J.-C.C.) - both in Florida; University of Arizona Health Sciences, Tucson (E.R.B., M.K., F.M., D.A.M.); Washington University School of Medicine, St. Louis (L.B.B., A.B., M.C.); University of California, San Francisco (UCSF), San Francisco (M.B., M.D.C., S.C.L., D.L.) and UCSF Benioff Children's Hospital, Oakland (M.B., D.L.) - both in California; Brigham and Women's Hospital and Harvard Medical School (J.-C.C., N.G., E.I.) and Boston Children's Hospital (W.P., W.S.) - all in Boston; University Hospitals Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland (J.F.C., K.R.); University of Wisconsin-Madison, Madison (L.D., D.J.J., R.F.L., C.A.S.) and Aurora Sinai Medical Center, Milwaukee (L.S.-V.) - both in Wisconsin; Columbia University Irving Medical Center, New York, (E.D.); Emory University, Atlanta (A.M.F.); and University of New Mexico, Albuquerque (H.R.)
| | - Lisa Sullivan-Vedder
- From National Jewish Health (M.E.W., R.C., J.T.O.), Denver, and University of Colorado School of Medicine (M.E.W., S.J.S., R.C., F.H., J.T.O.) and Children's Hospital Colorado (S.J.S.), Aurora - all in Colorado; Wake Forest School of Medicine (V.E.O., W.C.M., S.P.P.), Winston-Salem, North Carolina Clinical Research (C.F.L.), Raleigh, and Duke University Medical Center (N.L., L.Q.), Durham - all in North Carolina; 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.K.), Rush University Medical Center (J.M.), University of Chicago (E.N., J.S., S. White), and Northwestern University Feinberg School of Medicine (L.J.S.) - all in Chicago; Penn State University (V.C., S.J.K., D.M.), Hershey, and Allegheny General Hospital (D.G.) and University of Pittsburgh Medical Center (S. Wenzel), Pittsburgh - all in Pennsylvania; Nemours Children's Health System, Jacksonville (J.J.L., K.V.B., J.L.), and University of South Florida Morsani College of Medicine, Tampa (J.-C.C.) - both in Florida; University of Arizona Health Sciences, Tucson (E.R.B., M.K., F.M., D.A.M.); Washington University School of Medicine, St. Louis (L.B.B., A.B., M.C.); University of California, San Francisco (UCSF), San Francisco (M.B., M.D.C., S.C.L., D.L.) and UCSF Benioff Children's Hospital, Oakland (M.B., D.L.) - both in California; Brigham and Women's Hospital and Harvard Medical School (J.-C.C., N.G., E.I.) and Boston Children's Hospital (W.P., W.S.) - all in Boston; University Hospitals Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland (J.F.C., K.R.); University of Wisconsin-Madison, Madison (L.D., D.J.J., R.F.L., C.A.S.) and Aurora Sinai Medical Center, Milwaukee (L.S.-V.) - both in Wisconsin; Columbia University Irving Medical Center, New York, (E.D.); Emory University, Atlanta (A.M.F.); and University of New Mexico, Albuquerque (H.R.)
| | - Sally Wenzel
- From National Jewish Health (M.E.W., R.C., J.T.O.), Denver, and University of Colorado School of Medicine (M.E.W., S.J.S., R.C., F.H., J.T.O.) and Children's Hospital Colorado (S.J.S.), Aurora - all in Colorado; Wake Forest School of Medicine (V.E.O., W.C.M., S.P.P.), Winston-Salem, North Carolina Clinical Research (C.F.L.), Raleigh, and Duke University Medical Center (N.L., L.Q.), Durham - all in North Carolina; 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.K.), Rush University Medical Center (J.M.), University of Chicago (E.N., J.S., S. White), and Northwestern University Feinberg School of Medicine (L.J.S.) - all in Chicago; Penn State University (V.C., S.J.K., D.M.), Hershey, and Allegheny General Hospital (D.G.) and University of Pittsburgh Medical Center (S. Wenzel), Pittsburgh - all in Pennsylvania; Nemours Children's Health System, Jacksonville (J.J.L., K.V.B., J.L.), and University of South Florida Morsani College of Medicine, Tampa (J.-C.C.) - both in Florida; University of Arizona Health Sciences, Tucson (E.R.B., M.K., F.M., D.A.M.); Washington University School of Medicine, St. Louis (L.B.B., A.B., M.C.); University of California, San Francisco (UCSF), San Francisco (M.B., M.D.C., S.C.L., D.L.) and UCSF Benioff Children's Hospital, Oakland (M.B., D.L.) - both in California; Brigham and Women's Hospital and Harvard Medical School (J.-C.C., N.G., E.I.) and Boston Children's Hospital (W.P., W.S.) - all in Boston; University Hospitals Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland (J.F.C., K.R.); University of Wisconsin-Madison, Madison (L.D., D.J.J., R.F.L., C.A.S.) and Aurora Sinai Medical Center, Milwaukee (L.S.-V.) - both in Wisconsin; Columbia University Irving Medical Center, New York, (E.D.); Emory University, Atlanta (A.M.F.); and University of New Mexico, Albuquerque (H.R.)
| | - Steven White
- From National Jewish Health (M.E.W., R.C., J.T.O.), Denver, and University of Colorado School of Medicine (M.E.W., S.J.S., R.C., F.H., J.T.O.) and Children's Hospital Colorado (S.J.S.), Aurora - all in Colorado; Wake Forest School of Medicine (V.E.O., W.C.M., S.P.P.), Winston-Salem, North Carolina Clinical Research (C.F.L.), Raleigh, and Duke University Medical Center (N.L., L.Q.), Durham - all in North Carolina; 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.K.), Rush University Medical Center (J.M.), University of Chicago (E.N., J.S., S. White), and Northwestern University Feinberg School of Medicine (L.J.S.) - all in Chicago; Penn State University (V.C., S.J.K., D.M.), Hershey, and Allegheny General Hospital (D.G.) and University of Pittsburgh Medical Center (S. Wenzel), Pittsburgh - all in Pennsylvania; Nemours Children's Health System, Jacksonville (J.J.L., K.V.B., J.L.), and University of South Florida Morsani College of Medicine, Tampa (J.-C.C.) - both in Florida; University of Arizona Health Sciences, Tucson (E.R.B., M.K., F.M., D.A.M.); Washington University School of Medicine, St. Louis (L.B.B., A.B., M.C.); University of California, San Francisco (UCSF), San Francisco (M.B., M.D.C., S.C.L., D.L.) and UCSF Benioff Children's Hospital, Oakland (M.B., D.L.) - both in California; Brigham and Women's Hospital and Harvard Medical School (J.-C.C., N.G., E.I.) and Boston Children's Hospital (W.P., W.S.) - all in Boston; University Hospitals Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland (J.F.C., K.R.); University of Wisconsin-Madison, Madison (L.D., D.J.J., R.F.L., C.A.S.) and Aurora Sinai Medical Center, Milwaukee (L.S.-V.) - both in Wisconsin; Columbia University Irving Medical Center, New York, (E.D.); Emory University, Atlanta (A.M.F.); and University of New Mexico, Albuquerque (H.R.)
| | - Elliot Israel
- From National Jewish Health (M.E.W., R.C., J.T.O.), Denver, and University of Colorado School of Medicine (M.E.W., S.J.S., R.C., F.H., J.T.O.) and Children's Hospital Colorado (S.J.S.), Aurora - all in Colorado; Wake Forest School of Medicine (V.E.O., W.C.M., S.P.P.), Winston-Salem, North Carolina Clinical Research (C.F.L.), Raleigh, and Duke University Medical Center (N.L., L.Q.), Durham - all in North Carolina; 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.K.), Rush University Medical Center (J.M.), University of Chicago (E.N., J.S., S. White), and Northwestern University Feinberg School of Medicine (L.J.S.) - all in Chicago; Penn State University (V.C., S.J.K., D.M.), Hershey, and Allegheny General Hospital (D.G.) and University of Pittsburgh Medical Center (S. Wenzel), Pittsburgh - all in Pennsylvania; Nemours Children's Health System, Jacksonville (J.J.L., K.V.B., J.L.), and University of South Florida Morsani College of Medicine, Tampa (J.-C.C.) - both in Florida; University of Arizona Health Sciences, Tucson (E.R.B., M.K., F.M., D.A.M.); Washington University School of Medicine, St. Louis (L.B.B., A.B., M.C.); University of California, San Francisco (UCSF), San Francisco (M.B., M.D.C., S.C.L., D.L.) and UCSF Benioff Children's Hospital, Oakland (M.B., D.L.) - both in California; Brigham and Women's Hospital and Harvard Medical School (J.-C.C., N.G., E.I.) and Boston Children's Hospital (W.P., W.S.) - all in Boston; University Hospitals Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland (J.F.C., K.R.); University of Wisconsin-Madison, Madison (L.D., D.J.J., R.F.L., C.A.S.) and Aurora Sinai Medical Center, Milwaukee (L.S.-V.) - both in Wisconsin; Columbia University Irving Medical Center, New York, (E.D.); Emory University, Atlanta (A.M.F.); and University of New Mexico, Albuquerque (H.R.)
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11
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Rho J, Ahn C, Gao A, Sawicki GS, Keller A, Jain R. Disparities in Mortality of Hispanic Patients with Cystic Fibrosis in the United States. A National and Regional Cohort Study. Am J Respir Crit Care Med 2019; 198:1055-1063. [PMID: 29742360 DOI: 10.1164/rccm.201711-2357oc] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Patients of Hispanic origin with cystic fibrosis (CF) are the largest growing minority, representing 8.5% of patients with CF in the United States. No national survival analysis of this group has ever been undertaken. OBJECTIVES We aimed to determine whether Hispanic ethnicity within the CF population is associated with worse outcomes and whether any geographic differences exist. METHODS Using U.S. Cystic Fibrosis Foundation Patient Registry data from 2010 to 2014, we performed a retrospective cohort analysis comparing survival rates between Hispanics and non-Hispanics using Kaplan-Meier and Cox regression analysis. A subject's residence was categorized into geographic regions based on U.S. Census Bureau data: Northeast, Midwest, West, and South. MEASUREMENTS AND MAIN RESULTS A total of 29,637 patients were included in the study; 2,493 identified themselves as Hispanic. Hispanics had a lower survival probability overall, with a mean age of death of 22.4 ± 9.9 years compared with non-Hispanics of 28.1 ± 10.0 years (P < 0.0001). Multivariate Cox proportional hazards modeling revealed that Hispanic patients with CF had a 1.27 times higher rate of death compared with non-Hispanics (95% confidence interval, 1.05-1.53) after adjusting for covariates including age, sex, genetic mutations, bacterial cultures, lung function, body mass index, use of CF respiratory therapies, low socioeconomic status, pancreatic enzyme use, and CF-related diabetes. When analyzed by region, Hispanics in the Midwest, Northeast, and West had shorter median survivals compared with non-Hispanics, which was not demonstrated in the South. CONCLUSIONS Patients with CF of Hispanic origin have a higher mortality rate than non-Hispanic patients with CF. This pattern was seen in the Midwest, Northeast, and West but not in the South.
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Affiliation(s)
- Jason Rho
- 1 Department of Internal Medicine and
| | - Chul Ahn
- 2 Department of Biostatistics, University of Texas Southwestern Medical Center, Dallas, Texas; and
| | - Ang Gao
- 2 Department of Biostatistics, University of Texas Southwestern Medical Center, Dallas, Texas; and
| | - Gregory S Sawicki
- 3 Department of Respiratory Diseases, Boston Children's Hospital, Boston, Massachusetts
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12
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Grossman NL, Ortega VE, King TS, Bleecker ER, Ampleford EA, Bacharier LB, Cabana MD, Cardet JC, Carr TF, Castro M, Denlinger LC, Denson JL, Fandino N, Fitzpatrick AM, Hawkins GA, Holguin F, Krishnan JA, Lazarus SC, Nyenhuis SM, Phipatanakul W, Ramratnam SK, Wenzel S, Peters SP, Meyers DA, Wechsler ME, Israel E. Exacerbation-prone asthma in the context of race and ancestry in Asthma Clinical Research Network trials. J Allergy Clin Immunol 2019; 144:1524-1533. [PMID: 31520679 DOI: 10.1016/j.jaci.2019.08.033] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 07/27/2019] [Accepted: 08/16/2019] [Indexed: 01/07/2023]
Abstract
BACKGROUND Minority groups of African descent experience disproportionately greater asthma morbidity compared with other racial groups, suggesting that genetic variation from a common ancestry could influence exacerbation risk. OBJECTIVE We evaluated clinical trial measures in the context of self-reported race and genetic ancestry to identify risk factors for asthma exacerbations. METHODS One thousand eight hundred forty multiethnic subjects from 12 Asthma Clinical Research Network and AsthmaNet trials were analyzed for incident asthma exacerbations with Poisson regression models that included clinical measures, self-reported race (black, non-Hispanic white, and other), and estimates of global genetic African ancestry in a subgroup (n = 760). RESULTS Twenty-four percent of 1840 subjects self-identified as black. Black and white subjects had common risk factors for exacerbations, including a history of 2 or more exacerbations in the previous year and FEV1 percent predicted values, whereas chronic sinusitis, allergic rhinitis, and gastroesophageal reflux disease were only associated with increased exacerbation risk in black subjects. In the combined multiethnic cohort, neither race (P = .30) nor percentage of genetic African ancestry as a continuous variable associated with exacerbation risk (adjusted rate ratio [RR], 1.26 [95% CI, 0.94-1.70; P = .13]; RR per 1-SD change [32% ancestry], 0.97 [95% CI, 0.78-1.19; P = .74]). However, in 161 black subjects with genetic data, those with African ancestry greater than the median (≥82%) had a significantly greater risk of exacerbation (RR, 3.06 [95% CI, 1.09-8.6; P = .03]). CONCLUSION Black subjects have unique risk factors for asthma exacerbations, of which global African genetic ancestry had the strongest effect.
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Affiliation(s)
- Nicole L Grossman
- Department of Internal Medicine, Division of Pulmonary and Critical Care, Lahey Hospital and Medical Center, Burlington, Mass
| | - Victor E Ortega
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC.
| | - Tonya S King
- Department of Public Health Sciences, Pennsylvania State University School of Medicine, Hershey, Pa
| | - Eugene R Bleecker
- Department of Medicine, Division of Genetics, Genomics, and Precision Medicine, University of Arizona College of Medicine, Tucson, Ariz
| | | | - Leonard B Bacharier
- Department of Pediatrics, Division of Allergy, Immunology, and Pulmonary Medicine, Washington University School of Medicine, St Louis, Mo
| | - Michael D Cabana
- Department of Pediatrics, University of California San Francisco, San Francisco, Calif
| | - Juan C Cardet
- Deparment of Internal Medicine, Divison of Allergy and Immunology, Morsani College of Medicine, University of South Florida, Tampa, Fla
| | - Tara F Carr
- Department of Medicine, Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, University of Arizona, Tucson, AZ
| | - Mario Castro
- Department of Internal Medicine, Division of Pulmonary Diseases and Critical Care Medicine, University of Kansas, Kansas City, Kan
| | - Loren C Denlinger
- Department of Medicine, University of Wisconsin School of Medicine, Madison, Wis
| | - Joshua L Denson
- Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, National Jewish Health, Denver, Colo
| | - Nicolas Fandino
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass
| | | | - Gregory A Hawkins
- Department of Biochemistry, Wake Forest School of Medicine, Winston-Salem, NC
| | - Fernando Holguin
- Department of Medicine, University of Colorado Anschutz Medical Campus, Denver, Colo
| | - Jerry A Krishnan
- Department of Medicine, University of Illinois Hospital & Health Sciences System, Chicago, Ill
| | - Stephen C Lazarus
- Department of Medicine, University of California San Francisco, San Francisco, Calif
| | - Sharmilee M Nyenhuis
- Department of Medicine, University of Illinois Hospital & Health Sciences System, Chicago, Ill
| | - Wanda Phipatanakul
- Division of Pediatric Allergy and Immunology, Boston Children's Hospital, Harvard Medical School, Boston, Mass
| | - Sima K Ramratnam
- Department of Pediatrics, University of Wisconsin School of Medicine, Madison, Wis
| | - Sally Wenzel
- Department of Environmental and Occupational Health, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pa
| | - Stephen P Peters
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC
| | - Deborah A Meyers
- Department of Medicine, Division of Genetics, Genomics, and Precision Medicine, University of Arizona College of Medicine, Tucson, Ariz
| | - Michael E Wechsler
- Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, National Jewish Health, Denver, Colo
| | - Elliot Israel
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass
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13
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Kim EJ, Simonson J, Jacome S, Conigliaro J, Hanchate AD, Hajizadeh N. Disparities in complementary alternative medicine use and asthma exacerbation in the United States. J Asthma 2019; 57:866-874. [PMID: 31045459 DOI: 10.1080/02770903.2019.1614615] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: Complementary and alternative medicines (CAM) are associated with poor asthma medication adherence, a major risk factor for asthma exacerbation. However, previous studies showed inconsistent relationships between CAM use and asthma control due to small sample sizes, demographic differences across populations studied, and poor differentiation of CAM types.Methods: We examined associations between CAM use and asthma exacerbation using a cross-sectional analysis of the 2012 National Health Interview Survey. We included adults ≥18 years with current asthma (n = 2,736) to analyze racial/ethnic differences in CAM use as well as the association between CAM use and both asthma exacerbation and emergency department (ED) visit for asthma exacerbation across racial/ethnic groups. We ran descriptive statistics and multivariable logistic regressions.Result: Blacks (OR = 0.63 [0.49-0.81]) and Hispanics (OR = 0.66 [0.48-0.92]) had decreased odds of using CAM compared to Whites. Overall, there was no association between CAM use and asthma exacerbation (OR = 0.99 [0.79-1.25]) but the subgroup of 'other complementary approaches' was associated with increased odds of asthma exacerbation among all survey respondents (1.90 [1.21-2.97]), Whites (OR = 1.90 [1.21-2.97]), and Hispanics (OR = 1.43 [0.98-2.09). CAM use was associated with decreased odds of an ED visit for asthma exacerbation (OR = 0.65 [0.45-0.93]). These associations were different among racial/ethnic groups with decreased odds of ED visit among Whites (OR = 0.50 [0.32-0.78]) but no association among Blacks and Hispanics.Conclusion: We found that both CAM use and the association between CAM use and asthma exacerbation varied by racial/ethnic group. The different relationship may arise from how CAM is used to complement or to substitute for conventional asthma management.
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Affiliation(s)
- Eun Ji Kim
- Division of General Internal Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Lake Success, New York, USA.,Center for Health Innovations and Outcomes Research Feinstein, Institute for Medical Research, Manhasset, New York, USA
| | - Joseph Simonson
- Department of Internal Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York, USA
| | - Sonia Jacome
- Center for Health Innovations and Outcomes Research Feinstein, Institute for Medical Research, Manhasset, New York, USA
| | - Joseph Conigliaro
- Division of General Internal Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Lake Success, New York, USA.,Center for Health Innovations and Outcomes Research Feinstein, Institute for Medical Research, Manhasset, New York, USA
| | - Amresh D Hanchate
- Section of General Internal Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Negin Hajizadeh
- Center for Health Innovations and Outcomes Research Feinstein, Institute for Medical Research, Manhasset, New York, USA.,Department of Internal Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York, USA
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14
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Measuring Micrometers of Matter and Inventing Indices: Entangling Social Perception within Discrete and Continuous Measurements of Air Quality. SOCIAL SCIENCES 2019. [DOI: 10.3390/socsci8020048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Environmental protection agencies around the globe are establishing different methods for measuring particulates, and then integrating those measurements into a single air quality index with other pollutants. At the same time, scientific inquiry has also shifted to a theory of measurement that incorporates discrete and continuous measurement. This article reviews the relationship between discrete measurements and indices, while also speculating on the way that the continuous measurement of air pollution could stimulate awareness and action. The paper argues that continuous measurement must include the way people of different backgrounds perceive air pollution in their lives. After reviewing the methods of measuring particulates and their inclusion into various indices, the article argues that in order to take action to mitigate the health impacts of air pollution, we must allow for the social perception of air pollution to become entangled within our scientific measurements.
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Abstract
PURPOSE OF REVIEW Although asthma is a common disease worldwide, its pathogenesis remains to be fully elucidated. There is increasing evidence of the interaction between epigenetics, DNA-damage, and environmental allergens in the development of asthma. In this review, we will focus on the role of epigenetics and DNA-damage in asthma. RECENT FINDINGS There is growing evidence of environmental allergens, particularly house dust mite, stimulating oxidative DNA damage in airway epithelial cells. The repair of this DNA damage has been implicated in the secretion of Th2 cytokines and the induction of allergic inflammation. SUMMARY Studies of the role of epigenetics, DNA-damage, and environmental allergens have begun to reveal the their complex interactions and their roles in the development of asthma. Further study in these areas may lead to novel prevention and treatment approaches.
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16
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Han YY, Forno E, Canino G, Celedón JC. Psychosocial risk factors and asthma among adults in Puerto Rico. J Asthma 2018; 56:653-661. [PMID: 29738276 DOI: 10.1080/02770903.2018.1474366] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Asthma and psychosocial stressors are common among Puerto Rican adults living in the United States. We estimated the prevalence of current asthma, and examined potential psychosocial risk factors and current asthma, among adults in Puerto Rico. METHODS Cross-sectional study of 3,049 Puerto Ricans aged 18-64 years living in Puerto Rico between May 2014 and June 2016. A structured interview was conducted to obtain information on demographics, lifestyle, mental disorders, and respiratory health. Current asthma was defined as self-reported physician-diagnosed asthma and still having asthma. Multivariable logistic regression was used to examine psychosocial risk factors and current asthma. RESULTS The estimated prevalence of current asthma was 10.2%. In a multivariable analysis, exposure to violence (odds ratio [OR] for each 1-point increment in a validated scale = 1.14, 95% confidence interval [CI] = 1.07 to 1.21) and a lifetime history of at least one suicide attempt (OR = 3.01, 95% CI = 1.80 to 5.01) were significantly associated with current asthma, independently of major depressive disorder. Moreover, a lifetime history of at least one suicide attempt was associated with co-existing asthma and chronic obstructive pulmonary disease (i.e., asthma-COPD overlap syndrome or ACOS (OR = 9.05, 95% CI = 3.32-24.67). CONCLUSIONS Our findings suggest that asthma is a major health problem among adults in Puerto Rico, with psychosocial risk factors playing a significant role in asthma and ACOS. Addressing chronic stressors and mental illness should be part of comprehensive strategies to reduce asthma burden in this population.
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Affiliation(s)
- Yueh-Ying Han
- a Division of Pediatric Pulmonary Medicine, Allergy, and Immunology, Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh , Pittsburgh , Pennsylvania
| | - Erick Forno
- a Division of Pediatric Pulmonary Medicine, Allergy, and Immunology, Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh , Pittsburgh , Pennsylvania
| | - Glorisa Canino
- b Behavioral Sciences Research Institute, University of Puerto Rico , San Juan , Puerto Rico
| | - Juan C Celedón
- a Division of Pediatric Pulmonary Medicine, Allergy, and Immunology, Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh , Pittsburgh , Pennsylvania
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17
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Cazzola M, Calzetta L, Matera MG, Hanania NA, Rogliani P. How does race/ethnicity influence pharmacological response to asthma therapies? Expert Opin Drug Metab Toxicol 2018. [DOI: 10.1080/17425255.2018.1449833] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Mario Cazzola
- Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy
| | - Luigino Calzetta
- Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy
| | - Maria Gabriella Matera
- Department of Experimental Medicine, Unit of Pharmacology, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Nicola A Hanania
- Section of Pulmonary, Critical Care and Sleep Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Paola Rogliani
- Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy
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18
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Alcala E, Cisneros R, Capitman JA. Health care access, concentrated poverty, and pediatric asthma hospital care use in California's San Joaquin Valley: A multilevel approach. J Asthma 2017; 55:1253-1261. [PMID: 29261336 DOI: 10.1080/02770903.2017.1409234] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND California's San Joaquin Valley is a region with a history of poverty, low health care access, and high rates of pediatric asthma. It is important to understand the potential barriers to care that challenge vulnerable populations. OBJECTIVE The objective was to describe pediatric asthma-related utilization patterns in the emergency department (ED) and hospital by insurance coverage as well as to identify contributing individual-level indicators (age, sex, race/ethnicity, and insurance coverage) and neighborhood-level indicators of health care access. METHODS This was a retrospective study based on secondary data from California hospital and ED records 2007-2012. Children who used services for asthma-related conditions, were aged 0-14 years, Hispanic or non-Hispanic white, and resided in the San Joaquin Valley were included in the analysis. Poisson multilevel modeling was used to control for individual- and neighborhood-level factors. RESULTS The effect of insurance coverage on asthma ED visits and hospitalizations was modified by the neighborhood-level percentage of concentrated poverty (RR = 1.01, 95% CI = 1.01-1.02; RR = 1.03, 95% CI = 1.02-1.04, respectively). The effect of insurance coverage on asthma hospitalizations was completely explained by the neighborhood-level percentage of concentrated poverty. CONCLUSIONS Observed effects of insurance coverage on hospital care use were significantly modified by neighborhood-level measures of health care access and concentrated poverty. This suggests not only an overall greater risk for poor children on Medi-Cal, but also a greater vulnerability or response to neighborhood social factors such as socioeconomic status, community cohesiveness, crime, and racial/ethnic segregation.
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Affiliation(s)
- Emanuel Alcala
- a Department of Public Health, School of Social Sciences, Humanities, and Arts , University of California, Merced , California , USA.,b College of Health and Human Services , Central Valley Health Policy Institute, California State University , Fresno , California , USA
| | - Ricardo Cisneros
- a Department of Public Health, School of Social Sciences, Humanities, and Arts , University of California, Merced , California , USA
| | - John A Capitman
- b College of Health and Human Services , Central Valley Health Policy Institute, California State University , Fresno , California , USA
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19
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Hellwege J, Keaton J, Giri A, Gao X, Velez Edwards DR, Edwards TL. Population Stratification in Genetic Association Studies. CURRENT PROTOCOLS IN HUMAN GENETICS 2017; 95:1.22.1-1.22.23. [PMID: 29044472 PMCID: PMC6007879 DOI: 10.1002/cphg.48] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Population stratification (PS) is a primary consideration in studies of genetic determinants of human traits. Failure to control for PS may lead to confounding, causing a study to fail for lack of significant results, or resources to be wasted following false-positive signals. Here, historical and current approaches for addressing PS when performing genetic association studies in human populations are reviewed. Methods for detecting the presence of PS, including global and local ancestry methods, are described. Also described are approaches for accounting for PS when calculating association statistics, such that measures of association are not confounded. Many traits are being examined for the first time in minority populations, which may inherently feature PS. © 2017 by John Wiley & Sons, Inc.
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Affiliation(s)
- Jacklyn Hellwege
- Vanderbilt Genetics Institute, Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center,
Nashville, TN 37203, USA
| | - Jacob Keaton
- Vanderbilt Genetics Institute, Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center,
Nashville, TN 37203, USA
| | - Ayush Giri
- Vanderbilt Genetics Institute, Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center,
Nashville, TN 37203, USA
| | - Xiaoyi Gao
- Department of Ophthalmology and Preventive Medicine, Keck School of Medicine, University of Southern California, Los
Angeles, CA 90033, USA
| | - Digna R. Velez Edwards
- Vanderbilt Genetics Institute, Department of Obstetrics and Gynecology, Vanderbilt University Medical Center,
Nashville, TN 37203, USA
| | - Todd L. Edwards
- Vanderbilt Genetics Institute, Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center,
Nashville, TN 37203, USA
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Oh SS, Du R, Zeiger AM, McGarry ME, Hu D, Thakur N, Pino-Yanes M, Galanter JM, Eng C, Nishimura KK, Huntsman S, Farber HJ, Meade K, Avila P, Serebrisky D, Bibbins-Domingo K, Lenoir MA, Ford JG, Brigino-Buenaventura E, Rodriguez-Cintron W, Thyne SM, Sen S, Rodriguez-Santana JR, Williams K, Kumar R, Burchard EG. Breastfeeding associated with higher lung function in African American youths with asthma. J Asthma 2017; 54:856-865. [PMID: 27929698 PMCID: PMC6130885 DOI: 10.1080/02770903.2016.1266496] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Revised: 11/02/2016] [Accepted: 11/26/2016] [Indexed: 01/06/2023]
Abstract
OBJECTIVE In the United States, Puerto Ricans and African Americans have lower prevalence of breastfeeding and worse clinical outcomes for asthma compared with other racial/ethnic groups. We hypothesize that the history of breastfeeding is associated with increased forced expiratory volume in 1 second (FEV1) % predicted and reduced asthma exacerbations in Latino and African American youths with asthma. METHODS As part of the Genes-environments & Admixture in Latino Americans (GALA II) Study and the Study of African Americans, asthma, Genes & Environments (SAGE II), we conducted case-only analyses in children and adolescents aged 8-21 years with asthma from four different racial/ethnic groups: African Americans (n = 426), Mexican Americans (n = 424), mixed/other Latinos (n = 255), and Puerto Ricans (n = 629). We investigated the association between any breastfeeding in infancy and FEV1% predicted using multivariable linear regression; Poisson regression was used to determine the association between breastfeeding and asthma exacerbations. RESULTS Prevalence of breastfeeding was lower in African Americans (59.4%) and Puerto Ricans (54.9%) compared to Mexican Americans (76.2%) and mixed/other Latinos (66.9%; p < 0.001). After adjusting for covariates, breastfeeding was associated with a 3.58% point increase in FEV1% predicted (p = 0.01) and a 21% reduction in asthma exacerbations (p = 0.03) in African Americans only. CONCLUSION Breastfeeding was associated with higher FEV1% predicted in asthma and reduced number of asthma exacerbations in African American youths, calling attention to continued support for breastfeeding.
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Affiliation(s)
- Sam S Oh
- a Department of Medicine , University of California San Francisco , San Francisco , CA , USA
| | - Randal Du
- a Department of Medicine , University of California San Francisco , San Francisco , CA , USA
- b Department of Pharmacy , University of California San Francisco , San Francisco , CA , USA
| | - Andrew M Zeiger
- a Department of Medicine , University of California San Francisco , San Francisco , CA , USA
| | - Meghan E McGarry
- c Department of Pediatrics , University of California San Francisco , San Francisco , CA , USA
| | - Donglei Hu
- a Department of Medicine , University of California San Francisco , San Francisco , CA , USA
| | - Neeta Thakur
- a Department of Medicine , University of California San Francisco , San Francisco , CA , USA
| | - Maria Pino-Yanes
- d Research Unit , Hospital Universitario NS de Candelaria , Santa Cruz de Tenerife , Spain
| | - Joshua M Galanter
- a Department of Medicine , University of California San Francisco , San Francisco , CA , USA
- e Department of Bioengineering and Therapeutic Sciences , University of California San Franscisco , San Francisco , CA , USA
| | - Celeste Eng
- a Department of Medicine , University of California San Francisco , San Francisco , CA , USA
| | | | - Scott Huntsman
- a Department of Medicine , University of California San Francisco , San Francisco , CA , USA
| | - Harold J Farber
- f Department of Pediatrics , Baylor College of Medicine , Houston , TX , USA
- g Department of Pulmonology , Texas Children's Hospital , Houston , TX , USA
| | - Kelley Meade
- h Department of Primary Care , UCSF Benioff Children's Hospital , San Francisco , CA , USA
| | - Pedro Avila
- i Department of Medicine , Northwestern University , Evanston , IL , USA
| | - Denise Serebrisky
- j Department of Pediatric Pulmonology , Jacobi Medical Center , Bronx , NY , USA
| | - Kirsten Bibbins-Domingo
- a Department of Medicine , University of California San Francisco , San Francisco , CA , USA
| | - Michael A Lenoir
- k Department of Pediatrics , Bay Area Pediatrics , Oakland , CA , USA
| | - Jean G Ford
- l Department of Epidemiology , Johns Hopkins University Bloomberg School of Public Health , Baltimore , MD , USA
| | | | | | - Shannon M Thyne
- o Department of Medicine , University of California Los Angeles David Geffen School of Medicine , Los Angeles , CA , USA
| | - Saunak Sen
- p Department of Epidemiology and Biostatistics , University of California San Francisco , San Francisco , CA , USA
| | - Jose R Rodriguez-Santana
- q Department of Pediatric Pulmonology and Critical Care , Centro de Neumología Pediátrica , San Juan , Puerto Rico
| | - Keoki Williams
- r Center for Health Policy and Health Services Research, Henry Ford Health System , Detroit , MI , USA
- s Department of Internal Medicine , Henry Ford Health System , Detroit , MI , USA
| | - Rajesh Kumar
- i Department of Medicine , Northwestern University , Evanston , IL , USA
| | - Esteban G Burchard
- a Department of Medicine , University of California San Francisco , San Francisco , CA , USA
- e Department of Bioengineering and Therapeutic Sciences , University of California San Franscisco , San Francisco , CA , USA
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What Ancestry Can Tell Us About the Genetic Origins of Inter-Ethnic Differences in Asthma Expression. Curr Allergy Asthma Rep 2017; 16:53. [PMID: 27393700 DOI: 10.1007/s11882-016-0635-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Differences in asthma prevalence have been described across different populations, suggesting that genetic ancestry can play an important role in this disease. In fact, several studies have demonstrated an association between African ancestry with increased asthma susceptibility and severity, higher immunoglobulin E levels, and lower lung function. In contrast, Native American ancestry has been shown to have a protective role for this disease. Genome-wide association studies have allowed the identification of population-specific genetic variants with varying allele frequency among populations. Additionally, the correlation of genetic ancestry at the chromosomal level with asthma and related traits by means of admixture mapping has revealed regions of the genome where ancestry is correlated with the disease. In this review, we discuss the evidence supporting the association of genetic ancestry with asthma susceptibility and asthma-related traits, and highlight the regions of the genome harboring ancestry-specific genetic risk factors.
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Himes BE, Ortega VE. Making progress toward understanding the genetic architecture of asthma in the most affected US ethnic group. Eur Respir J 2017; 49:49/5/1700329. [PMID: 28461304 DOI: 10.1183/13993003.00329-2017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 02/16/2017] [Indexed: 11/05/2022]
Affiliation(s)
- Blanca E Himes
- Dept of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, PA, USA
| | - Victor E Ortega
- Center for Genomics and Personalized Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
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Personalized Medicine. Respir Med 2017. [DOI: 10.1007/978-3-319-43447-6_13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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24
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Aguerrevere LE, Castillo YA, Nicks RC, Juan R, Curtis KL. Pain-Related Symptom Reporting Among Hispanics: Implications for Forensic Psychological Evaluations. PSYCHOLOGICAL INJURY & LAW 2016. [DOI: 10.1007/s12207-016-9271-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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25
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Ortega VE, Kumar R. The Effect of Ancestry and Genetic Variation on Lung Function Predictions: What Is "Normal" Lung Function in Diverse Human Populations? Curr Allergy Asthma Rep 2015; 15:16. [PMID: 26130473 DOI: 10.1007/s11882-015-0516-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Lung function measures are an invaluable screening test for respiratory health and have been associated with the morbidity and mortality related to different airway disease as well as all-cause mortality. Currently, reference values for spirometric measurements are obtained using equations derived from individual ethnic or racial groups. The rapid expansion of more racially and ethnically diverse populations will challenge current race-based lung function reference equations. Recent international general population studies and ancestry-based genetic studies have found that ancestry and genetic variation are determinants of lung function and have suggested a role for genetic ancestry or gene variants in future lung function reference equations. In this review, we discuss the potential limitations of current lung function reference equations in a global society which is becoming more ethnically, racially, and, thus, genetically diverse. We also focus on how an individual's ancestral background or genetic profile could provide the basis for more accurate, personalized predictions of an individual's baseline lung function.
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Affiliation(s)
- Victor E Ortega
- Center for Genomics and Personalized Medicine Research, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157, USA,
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26
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Scheckner B, Arcoleo K, Feldman JM. The effect of parental social support and acculturation on childhood asthma control. J Asthma 2015; 52:606-13. [PMID: 25428771 PMCID: PMC4662868 DOI: 10.3109/02770903.2014.991969] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Revised: 10/23/2014] [Accepted: 11/22/2014] [Indexed: 11/13/2022]
Abstract
OBJECTIVE There exists large ethnic disparities in asthma among Latino children; Puerto Ricans (PRs) are disproportionately affected, while Mexicans have the lowest prevalence and morbidity. Disparities are poorly understood, however, acculturation and social support are suggested to influence asthma control among children. This study investigated the relationship between acculturation, social support and asthma control among PR and Mexican children and their caregivers. METHODS Primary caregiver-child dyads (n = 267) of PR (n = 79) and Mexican (n = 188) descent were recruited from clinics at two inner-city hospitals in Bronx, NY and three clinics in Phoenix, AZ. Children were 5-12 years of age and had a confirmed asthma diagnosis. Dyads completed measures of social support, acculturation and asthma control; logistic regression was used for analysis. RESULTS Mexican children had better asthma control than PR children (p < 0.001). PR caregivers were more acculturated than Mexican caregivers (p < 0.05); however, acculturation did not predict control. Across Latino subgroups caregivers' total level of social support predicted better asthma control among children (p < 0.05), and support received from family and friends each independently predicted better control (p < 0.05). CONCLUSIONS Results suggest that social support reduces some of the burden associated with asthma management enabling caretakers to better control their children's asthma.
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Affiliation(s)
- Bari Scheckner
- Ferkauf Graduate School of Psychology, Yeshiva University, NY
| | | | - Jonathan M. Feldman
- Ferkauf Graduate School of Psychology, Yeshiva University, NY
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, NY
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Implications of population structure and ancestry on asthma genetic studies. Curr Opin Allergy Clin Immunol 2015; 14:381-9. [PMID: 25153337 DOI: 10.1097/aci.0000000000000102] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE OF REVIEW The frequency and severity of asthma differ between different racial and ethnic groups. An understanding of the genetic basis for these differences could constitute future genetic biomarker panels for predicting asthma risk and progression in individuals from different ethnic groups. RECENT THEMES The recent mixing of different ancestries during the European colonization of the Americas and the African slave trade has resulted in the complex population structures identified in different ethnic groups. These population structures represent varying degrees of genetic diversity which impacts the allele frequency of individual variants and, thus, how the gene variation is utilized in genetic association studies. In this review, we will discuss the basis for the complex population structures of modern human genomes and the impact of genetic diversity on genetic studies in different ethnic groups. We will also highlight the potential for admixture and rare variant-based genetic studies to identify novel genetic loci for asthma susceptibility and severity. SUMMARY The ability to account for the consequences of genetic diversity in different racial and ethnic groups will be critical in developing genetic profiles for personalized or precision medicine approaches tailored to asthmatic patients from different ethnic groups.
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Bunyavanich S, Celedón JC. Use of inhaled corticosteroids among Hispanics in the United States. Ann Am Thorac Soc 2015; 12:241-2. [PMID: 25706490 PMCID: PMC4342837 DOI: 10.1513/annalsats.201501-008ed] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 01/07/2015] [Indexed: 11/20/2022] Open
Affiliation(s)
- Supinda Bunyavanich
- 1 Division of Allergy and Immunology, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York; and
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29
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El Burai Félix S, Bailey CM, Zahran HS. Asthma prevalence among Hispanic adults in Puerto Rico and Hispanic adults of Puerto Rican descent in the United States - results from two national surveys. J Asthma 2015; 52:3-9. [PMID: 25137343 PMCID: PMC4554327 DOI: 10.3109/02770903.2014.950427] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
UNLABELLED Abstract Objective: To assess whether asthma prevalence differs between Hispanic adults living in Puerto Rico and Hispanic adults of Puerto Rican descent living in the United States. METHODS We used 2008-2010 Behavioral Risk Factor Surveillance System data, administered in Puerto Rico for Hispanic adults living in Puerto Rico (Hispanics in Puerto Rico), and 2008-2010 National Health Interview Survey data for Hispanic adults of Puerto Rican descent living in the United States (Puerto Rican Americans). We used 95% confidence intervals (CIs) to compare asthma prevalence between corresponding subgroups; non-overlapping CIs indicate statistical significance. Chi-square test and multivariate logistic regression were used to assess the association between current asthma status and socio-demographic factors and health risk behaviors within each Puerto Rican population. RESULTS Current asthma prevalence among Hispanics in Puerto Rico (7.0% [6.4%-7.7%]) was significantly lower than the prevalence among Puerto Rican Americans (15.6% [13.0%-18.1%]). The prevalence among almost all socio-demographic and health risk subgroups of Hispanics in Puerto Rico was significantly lower than the prevalence among the corresponding subgroups of Puerto Rican Americans. Adjusting for potential confounders did not alter the results. Asthma prevalence was significantly associated with obesity among Puerto Rican Americans (adjusted prevalence ratios [aPR]=1.5 [1.1-2.0]), and among Hispanics in Puerto Rico was associated with obesity (aPR=1.6 [1.3-1.9]), smoking (aPR=1.4 [1.1-1.9]) and being female (aPR=1.9 [1.5-2.4]). CONCLUSION Asthma was more prevalent among Puerto Rican Americans than Hispanics in Puerto Rico. Although the observed associations did not explain all variations in asthma prevalence between these two populations, they may lay the foundation for future research.
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Affiliation(s)
- Suad El Burai Félix
- Division of Environmental Hazards and Health Effects, National Center for Environmental Health, Centers for Disease Control and Prevention , Atlanta , Georgia
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30
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Pino-Yanes M, Thakur N, Gignoux CR, Galanter JM, Roth LA, Eng C, Nishimura KK, Oh SS, Vora H, Huntsman S, Nguyen EA, Hu D, Drake KA, Conti DV, Moreno-Estrada A, Sandoval K, Winkler CA, Borrell LN, Lurmann F, Islam TS, Davis A, Farber HJ, Meade K, Avila PC, Serebrisky D, Bibbins-Domingo K, Lenoir MA, Ford JG, Brigino-Buenaventura E, Rodriguez-Cintron W, Thyne SM, Sen S, Rodriguez-Santana JR, Bustamante CD, Williams LK, Gilliland FD, Gauderman WJ, Kumar R, Torgerson DG, Burchard EG. Genetic ancestry influences asthma susceptibility and lung function among Latinos. J Allergy Clin Immunol 2015; 135:228-35. [PMID: 25301036 PMCID: PMC4289103 DOI: 10.1016/j.jaci.2014.07.053] [Citation(s) in RCA: 93] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Revised: 07/18/2014] [Accepted: 07/22/2014] [Indexed: 01/01/2023]
Abstract
BACKGROUND Childhood asthma prevalence and morbidity varies among Latinos in the United States, with Puerto Ricans having the highest and Mexicans the lowest. OBJECTIVE To determine whether genetic ancestry is associated with the odds of asthma among Latinos, and secondarily whether genetic ancestry is associated with lung function among Latino children. METHODS We analyzed 5493 Latinos with and without asthma from 3 independent studies. For each participant, we estimated the proportion of African, European, and Native American ancestry using genome-wide data. We tested whether genetic ancestry was associated with the presence of asthma and lung function among subjects with and without asthma. Odds ratios (OR) and effect sizes were assessed for every 20% increase in each ancestry. RESULTS Native American ancestry was associated with lower odds of asthma (OR = 0.72, 95% CI: 0.66-0.78, P = 8.0 × 10(-15)), while African ancestry was associated with higher odds of asthma (OR = 1.40, 95% CI: 1.14-1.72, P = .001). These associations were robust to adjustment for covariates related to early life exposures, air pollution, and socioeconomic status. Among children with asthma, African ancestry was associated with lower lung function, including both pre- and post-bronchodilator measures of FEV1 (-77 ± 19 mL; P = 5.8 × 10(-5) and -83 ± 19 mL; P = 1.1 x 10(-5), respectively) and forced vital capacity (-100 ± 21 mL; P = 2.7 × 10(-6) and -107 ± 22 mL; P = 1.0 x 10(-6), respectively). CONCLUSION Differences in the proportions of genetic ancestry can partially explain disparities in asthma susceptibility and lung function among Latinos.
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Affiliation(s)
- Maria Pino-Yanes
- Department of Medicine, University of California, San Francisco (UCSF), San Francisco, Calif; CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain.
| | - Neeta Thakur
- Department of Medicine, University of California, San Francisco (UCSF), San Francisco, Calif
| | | | - Joshua M Galanter
- Department of Medicine, University of California, San Francisco (UCSF), San Francisco, Calif; Department of Bioengineering and Therapeutic Sciences, UCSF, San Francisco, Calif
| | - Lindsey A Roth
- Department of Medicine, University of California, San Francisco (UCSF), San Francisco, Calif
| | - Celeste Eng
- Department of Medicine, University of California, San Francisco (UCSF), San Francisco, Calif
| | - Katherine K Nishimura
- Department of Medicine, University of California, San Francisco (UCSF), San Francisco, Calif
| | - Sam S Oh
- Department of Medicine, University of California, San Francisco (UCSF), San Francisco, Calif
| | - Hita Vora
- Department of Preventative Medicine, University of Southern California, Los Angeles, Calif
| | - Scott Huntsman
- Department of Medicine, University of California, San Francisco (UCSF), San Francisco, Calif
| | - Elizabeth A Nguyen
- Department of Medicine, University of California, San Francisco (UCSF), San Francisco, Calif
| | - Donglei Hu
- Department of Medicine, University of California, San Francisco (UCSF), San Francisco, Calif
| | - Katherine A Drake
- Department of Bioengineering and Therapeutic Sciences, UCSF, San Francisco, Calif
| | - David V Conti
- Department of Preventative Medicine, University of Southern California, Los Angeles, Calif
| | | | - Karla Sandoval
- Department of Genetics, Stanford University, Palo Alto, Calif
| | - Cheryl A Winkler
- Basic Research Laboratory, SAIC-Frederick, Inc, Center for Cancer Research, National Cancer Institute, Frederick, Md
| | - Luisa N Borrell
- Department of Health Sciences, Graduate Program in Public Health, City University of New York, Bronx, NY
| | | | - Talat S Islam
- Department of Preventative Medicine, University of Southern California, Los Angeles, Calif
| | - Adam Davis
- Children's Hospital and Research Center Oakland, Oakland, Calif
| | - Harold J Farber
- Department of Pediatrics, Section of Pulmonology, Baylor College of Medicine and Texas Children's Hospital, Houston, Tex
| | - Kelley Meade
- Children's Hospital and Research Center Oakland, Oakland, Calif
| | - Pedro C Avila
- Department of Medicine, Northwestern University, Chicago, Ill
| | | | | | | | - Jean G Ford
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md
| | | | | | - Shannon M Thyne
- Department of Pediatrics, UCSF, San Francisco General Hospital, San Francisco, Calif
| | - Saunak Sen
- Department of Epidemiology and Biostatistics, UCSF, San Francisco, Calif
| | | | | | - L Keoki Williams
- Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit, Mich; Department of Internal Medicine, Henry Ford Health System, Detroit, Mich
| | - Frank D Gilliland
- Department of Preventative Medicine, University of Southern California, Los Angeles, Calif
| | - W James Gauderman
- Department of Preventative Medicine, University of Southern California, Los Angeles, Calif
| | - Rajesh Kumar
- Children's Memorial Hospital and the Feinberg School of Medicine, Northwestern University, Chicago, Ill
| | - Dara G Torgerson
- Department of Medicine, University of California, San Francisco (UCSF), San Francisco, Calif
| | - Esteban G Burchard
- Department of Medicine, University of California, San Francisco (UCSF), San Francisco, Calif; Department of Bioengineering and Therapeutic Sciences, UCSF, San Francisco, Calif
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Rashid S, Carcel C, Morphew T, Amaro S, Galant S. Effectiveness of a promotora home visitation program for underserved Hispanic children with asthma. J Asthma 2014; 52:478-84. [PMID: 25405362 DOI: 10.3109/02770903.2014.986738] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Retention in a mobile asthma clinic, the Breathmobile™, of ≥3 visits has previously been shown to be essential for attaining asthma control in underserved children. The objective of this study in primarily Hispanic-American children was to determine the difference in retention between those seen in the Breathmobile™ compared to those receiving an additional promotora-based home visit (HV). METHODS Children with asthma in the Breathmobile™ program were evaluated for asthma status and aeroallergen sensitivity. Indication for HV included poor asthma control, educational and environmental control needs. An initial visit consisted of environmental assessment as well as a 3-h interactive educational session covering asthma basics. A follow-up visit 1 month later assessed implementation. The primary outcome measure of retention was ≥6 months in the Breathmobile™ program. RESULTS Of the 1007 asthmatic children seen between April 2002 and June of 2005, 136 received HV. These children showed significantly greater retention compared to those without HV with a median number of visits (5 visits versus 2 visits), ≥3 Breathmobile™ visits (86.0% versus 38.8%), median number of days in the program (299 versus 63 days) and percentage of patients in the program ≥6 months (67.8% versus 31.3%) p < 0.001. HV and asthma severity were each independent predictors of retention. CONCLUSIONS The addition of a promotora HV program proved effective in providing greater retention in the Breathmobile™ program essential for asthma control. Randomized clinical trials will be needed to show the impact on health care utilization and asthma control.
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Affiliation(s)
- Shumyla Rashid
- Children's Hospital of Orange County , Breathmobile, Orange, CA , USA and
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Pai S, Boutin-Foster C, Mancuso CA, Loganathan R, Basir R, Kanna B. "Looking out for each other": a qualitative study on the role of social network interactions in asthma management among adult Latino patients presenting to an emergency department. J Asthma 2014; 51:714-9. [PMID: 24628522 PMCID: PMC4167065 DOI: 10.3109/02770903.2014.903967] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE The objective of this study was to identify the types of interactions between asthma patients and their social networks such as close family and friends that influence the management of asthma. METHODS Participants were Latino adults presenting for a repeat visit to the emergency department for asthma treatment. Qualitative interviews were conducted with 76 participants. They were asked to describe the experiences of their social networks that have asthma and how interactions with these individuals influenced their own asthma management. Responses were transcribed and analyzed using Grounded Theory as a qualitative analytic approach. Responses were assigned codes; similar codes were grouped into concepts and then categorized to form overarching themes. RESULTS Four themes emerged: (1) Perceptions of severity of asthma may be based on the experiences of social networks; (2) Economic factors may contribute to the sharing and borrowing of asthma medications between patients and their social networks; (3) Economic factors may contribute to using home remedies instead of prescribed medications; (4) Social network members may be unaware of the factors that trigger asthma and therefore, contribute to asthma exacerbations. CONCLUSION This study identified important social network interactions that may impact asthma management in Latino adults. These results can be used to broaden the current focus of asthma self-management programs to incorporate discussions on the role of social networks. A focus on social network interactions addresses the social epidemiology of asthma and advances our understanding of root causes that may underlie the high prevalence of asthma in many Latino communities.
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Affiliation(s)
- Sucheta Pai
- Department of Internal medicine, Weill Cornell Medical College , NY , USA
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Campbell CD, Mohajeri K, Malig M, Hormozdiari F, Nelson B, Du G, Patterson KM, Eng C, Torgerson DG, Hu D, Herman C, Chong JX, Ko A, O'Roak BJ, Krumm N, Vives L, Lee C, Roth LA, Rodriguez-Cintron W, Rodriguez-Santana J, Brigino-Buenaventura E, Davis A, Meade K, LeNoir MA, Thyne S, Jackson DJ, Gern JE, Lemanske RF, Shendure J, Abney M, Burchard EG, Ober C, Eichler EE. Whole-genome sequencing of individuals from a founder population identifies candidate genes for asthma. PLoS One 2014; 9:e104396. [PMID: 25116239 PMCID: PMC4130548 DOI: 10.1371/journal.pone.0104396] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Accepted: 07/12/2014] [Indexed: 12/30/2022] Open
Abstract
Asthma is a complex genetic disease caused by a combination of genetic and environmental risk factors. We sought to test classes of genetic variants largely missed by genome-wide association studies (GWAS), including copy number variants (CNVs) and low-frequency variants, by performing whole-genome sequencing (WGS) on 16 individuals from asthma-enriched and asthma-depleted families. The samples were obtained from an extended 13-generation Hutterite pedigree with reduced genetic heterogeneity due to a small founding gene pool and reduced environmental heterogeneity as a result of a communal lifestyle. We sequenced each individual to an average depth of 13-fold, generated a comprehensive catalog of genetic variants, and tested the most severe mutations for association with asthma. We identified and validated 1960 CNVs, 19 nonsense or splice-site single nucleotide variants (SNVs), and 18 insertions or deletions that were out of frame. As follow-up, we performed targeted sequencing of 16 genes in 837 cases and 540 controls of Puerto Rican ancestry and found that controls carry a significantly higher burden of mutations in IL27RA (2.0% of controls; 0.23% of cases; nominal p = 0.004; Bonferroni p = 0.21). We also genotyped 593 CNVs in 1199 Hutterite individuals. We identified a nominally significant association (p = 0.03; Odds ratio (OR) = 3.13) between a 6 kbp deletion in an intron of NEDD4L and increased risk of asthma. We genotyped this deletion in an additional 4787 non-Hutterite individuals (nominal p = 0.056; OR = 1.69). NEDD4L is expressed in bronchial epithelial cells, and conditional knockout of this gene in the lung in mice leads to severe inflammation and mucus accumulation. Our study represents one of the early instances of applying WGS to complex disease with a large environmental component and demonstrates how WGS can identify risk variants, including CNVs and low-frequency variants, largely untested in GWAS.
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Affiliation(s)
- Catarina D. Campbell
- Department of Genome Sciences, University of Washington, Seattle, Washington, United States of America
| | - Kiana Mohajeri
- Department of Genome Sciences, University of Washington, Seattle, Washington, United States of America
| | - Maika Malig
- Department of Genome Sciences, University of Washington, Seattle, Washington, United States of America
| | - Fereydoun Hormozdiari
- Department of Genome Sciences, University of Washington, Seattle, Washington, United States of America
| | - Benjamin Nelson
- Department of Genome Sciences, University of Washington, Seattle, Washington, United States of America
| | - Gaixin Du
- Department of Human Genetics, The University of Chicago, Chicago, Illinois, United States of America
| | - Kristen M. Patterson
- Department of Human Genetics, The University of Chicago, Chicago, Illinois, United States of America
| | - Celeste Eng
- Department of Medicine, University of California San Francisco, San Francisco, California, United States of America
| | - Dara G. Torgerson
- Department of Medicine, University of California San Francisco, San Francisco, California, United States of America
| | - Donglei Hu
- Department of Medicine, University of California San Francisco, San Francisco, California, United States of America
| | - Catherine Herman
- Department of Human Genetics, The University of Chicago, Chicago, Illinois, United States of America
| | - Jessica X. Chong
- Department of Human Genetics, The University of Chicago, Chicago, Illinois, United States of America
| | - Arthur Ko
- Department of Genome Sciences, University of Washington, Seattle, Washington, United States of America
| | - Brian J. O'Roak
- Department of Genome Sciences, University of Washington, Seattle, Washington, United States of America
| | - Niklas Krumm
- Department of Genome Sciences, University of Washington, Seattle, Washington, United States of America
| | - Laura Vives
- Department of Genome Sciences, University of Washington, Seattle, Washington, United States of America
| | - Choli Lee
- Department of Genome Sciences, University of Washington, Seattle, Washington, United States of America
| | - Lindsey A. Roth
- Department of Medicine, University of California San Francisco, San Francisco, California, United States of America
| | | | | | - Emerita Brigino-Buenaventura
- Department of Allergy & Immunology, Kaiser Permanente-Vallejo Medical Center, Vallejo, California, United States of America
| | - Adam Davis
- Children's Hospital and Research Center Oakland, Oakland, California, United States of America
| | - Kelley Meade
- Children's Hospital and Research Center Oakland, Oakland, California, United States of America
| | | | - Shannon Thyne
- San Francisco General Hospital, San Francisco, California, and the Department of Pediatrics, University of California San Francisco, San Francisco, California, United States of America
| | - Daniel J. Jackson
- Department of Pediatrics, University of Wisconsin, Madison, Wisconsin, United States of America
| | - James E. Gern
- Department of Pediatrics, University of Wisconsin, Madison, Wisconsin, United States of America
| | - Robert F. Lemanske
- Department of Pediatrics, University of Wisconsin, Madison, Wisconsin, United States of America
- Department of Medicine, University of Wisconsin, Madison, Wisconsin, United States of America
| | - Jay Shendure
- Department of Genome Sciences, University of Washington, Seattle, Washington, United States of America
| | - Mark Abney
- Department of Human Genetics, The University of Chicago, Chicago, Illinois, United States of America
| | - Esteban G. Burchard
- Department of Medicine, University of California San Francisco, San Francisco, California, United States of America
- Department of Bioengineering and Therapeutic Sciences, University of California San Francisco, San Francisco, California, United States of America
| | - Carole Ober
- Department of Human Genetics, The University of Chicago, Chicago, Illinois, United States of America
| | - Evan E. Eichler
- Department of Genome Sciences, University of Washington, Seattle, Washington, United States of America
- Howard Hughes Medical Institute, Seattle, Washington, United States of America
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Molina E, Haas R, del Rincon I, Battafarano DF, Restrepo JF, Escalante A. Does the "Hispanic paradox" occur in rheumatoid arthritis? Survival data from a multiethnic cohort. Arthritis Care Res (Hoboken) 2014; 66:972-9. [PMID: 24339449 PMCID: PMC4051868 DOI: 10.1002/acr.22254] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2013] [Accepted: 12/03/2013] [Indexed: 01/26/2023]
Abstract
OBJECTIVE Despite lower socioeconomic status (SES) and higher disease burden, Hispanics in the US paradoxically display equal or lower mortality on average than non-Hispanic whites. Our objective was to determine if the "Hispanic paradox" occurs among patients with rheumatoid arthritis (RA). METHODS In a cohort of 706 RA patients, we compared differences in RA severity and comorbidity between Hispanic and non-Hispanic white ethnic groups at baseline. Cox proportional hazards models were used to estimate and compare mortality risk between Hispanics and non-Hispanic whites. RESULTS We studied 706 patients with RA, of whom 434 were Hispanic and 272 were non-Hispanic white. Hispanics had significantly lower SES, greater inflammation, as well as higher tender and swollen joint counts. Patients were observed for 6,639 patient-years, during which time 229 deaths occurred by the censoring date (rate 3.4 per 100 person-years; 95% confidence interval 3.0, 3.9). Age- and sex-adjusted mortality was not significantly different between the 2 ethnic groups (hazard ratio [HR] 0.96). After adjustment for comorbidities, RA severity, and level of acculturation, mortality among Hispanics was lower (HR 0.56, P = 0.004). CONCLUSION Despite greater severity in most clinical manifestations and lower SES among Hispanics, paradoxically, their mortality was not increased. Further research is needed to understand the mechanisms underlying this survival paradox.
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Affiliation(s)
- Emily Molina
- University of Texas Health Science Center at San Antonio, Texas
| | - Roy Haas
- University of Texas Health Science Center at San Antonio, Texas
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Rosser FJ, Forno E, Cooper PJ, Celedón JC. Asthma in Hispanics. An 8-year update. Am J Respir Crit Care Med 2014; 189:1316-27. [PMID: 24881937 PMCID: PMC4098086 DOI: 10.1164/rccm.201401-0186pp] [Citation(s) in RCA: 107] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Accepted: 04/05/2014] [Indexed: 01/25/2023] Open
Abstract
This review provides an update on asthma in Hispanics, a diverse group tracing their ancestry to countries previously under Spanish rule. A marked variability in the prevalence and morbidity from asthma remains among Hispanic subgroups in the United States and Hispanic America. In the United States, Puerto Ricans and Mexican Americans have high and low burdens of asthma, respectively (the "Hispanic Paradox"). This wide divergence in asthma morbidity among Hispanic subgroups is multifactorial, likely reflecting the effects of known (secondhand tobacco smoke, air pollution, psychosocial stress, obesity, inadequate treatment) and potential (genetic variants, urbanization, vitamin D insufficiency, and eradication of parasitic infections) risk factors. Barriers to adequate asthma management in Hispanics include economic and educational disadvantages, lack of health insurance, and no access to or poor adherence with controller medications such as inhaled corticosteroids. Although considerable progress has been made in our understanding of asthma in Hispanic subgroups, many questions remain. Studies of asthma in Hispanic America should focus on environmental or lifestyle factors that are more relevant to asthma in this region (e.g., urbanization, air pollution, parasitism, and stress). In the United States, research studies should focus on risk factors that are known to or may diverge among Hispanic subgroups, including but not limited to epigenetic variation, prematurity, vitamin D level, diet, and stress. Clinical trials of culturally appropriate interventions that address multiple aspects of asthma management in Hispanic subgroups should be prioritized for funding. Ensuring high-quality healthcare for all remains a pillar of eliminating asthma disparities.
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Affiliation(s)
- Franziska J. Rosser
- Division of Pediatric Pulmonary Medicine, Allergy and Immunology, Children’s Hospital of Pittsburgh of UPMC, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Erick Forno
- Division of Pediatric Pulmonary Medicine, Allergy and Immunology, Children’s Hospital of Pittsburgh of UPMC, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Philip J. Cooper
- Laboratorio de Investigaciones FEPIS, Quinindé, Esmeraldas Province, Ecuador; and
- Institute of Infection and Immunity, St. George’s University of London, London, United Kingdom
| | - Juan C. Celedón
- Division of Pediatric Pulmonary Medicine, Allergy and Immunology, Children’s Hospital of Pittsburgh of UPMC, University of Pittsburgh, Pittsburgh, Pennsylvania
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Forno E, Acosta-Pérez E, Brehm JM, Han YY, Alvarez M, Colón-Semidey A, Canino G, Celedón JC. Obesity and adiposity indicators, asthma, and atopy in Puerto Rican children. J Allergy Clin Immunol 2014; 133:1308-14, 1314.e1-5. [PMID: 24290290 PMCID: PMC4013276 DOI: 10.1016/j.jaci.2013.09.041] [Citation(s) in RCA: 82] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2013] [Revised: 09/18/2013] [Accepted: 09/20/2013] [Indexed: 12/12/2022]
Abstract
BACKGROUND Whether adiposity indicators other than body mass index (BMI) should be used in studies of childhood asthma is largely unknown. The role of atopy in "obese asthma" is also unclear. OBJECTIVES To examine the relationship among adiposity indicators, asthma, and atopy in Puerto Rican children, and to assess whether atopy mediates the obesity-asthma association. METHODS In a study of Puerto Rican children with (n = 351) and without (n = 327) asthma, we measured BMI, percent of body fat, waist circumference, and waist-to-hip ratio. The outcomes studied included asthma, lung function, measures of atopy, and, among cases, indicators of asthma severity or control. We performed mediation analysis to assess the contribution of atopy to the relationship between adiposity and asthma. RESULTS BMI, percent of body fat, and waist circumference were associated with increased odds of asthma. Among cases, all 3 measures were generally associated with lung function, asthma severity/control, and atopy; however, there were differences depending on the adiposity indicator analyzed. Atopy considerably mediated the adiposity-asthma association in this population: allergic rhinitis accounted for 22% to 53% of the association with asthma, and sensitization to cockroach mediated 13% to 20% of the association with forced vital capacity and 29% to 42% of the association with emergency department visits for asthma. CONCLUSIONS Adiposity indicators are associated with asthma, asthma severity/control, and atopy in Puerto Rican children. Atopy significantly mediates the effect of adiposity on asthma outcomes. Longitudinal studies are needed to further investigate the causal role, if any, of adiposity distribution and atopy on "obese asthma" in childhood.
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Affiliation(s)
- Erick Forno
- Division of Pediatric Pulmonary Medicine, Allergy, and Immunology, Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh, Pittsburgh, Pa
| | - Edna Acosta-Pérez
- Department of Pediatrics, Behavioral Sciences Research Institute, University of Puerto Rico, San Juan, Puerto Rico
| | - John M Brehm
- Division of Pediatric Pulmonary Medicine, Allergy, and Immunology, Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh, Pittsburgh, Pa
| | - Yueh-Ying Han
- Division of Pediatric Pulmonary Medicine, Allergy, and Immunology, Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh, Pittsburgh, Pa
| | - María Alvarez
- Department of Pediatrics, Behavioral Sciences Research Institute, University of Puerto Rico, San Juan, Puerto Rico
| | - Angel Colón-Semidey
- Department of Pediatrics, Behavioral Sciences Research Institute, University of Puerto Rico, San Juan, Puerto Rico
| | - Glorisa Canino
- Department of Pediatrics, Behavioral Sciences Research Institute, University of Puerto Rico, San Juan, Puerto Rico
| | - Juan C Celedón
- Division of Pediatric Pulmonary Medicine, Allergy, and Immunology, Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh, Pittsburgh, Pa.
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Carlin C, Yee AB, Fagnano M, Halterman JS. The influence of Hispanic ethnicity on parent-provider communication about asthma. Clin Pediatr (Phila) 2014; 53:380-6. [PMID: 24281159 PMCID: PMC3949158 DOI: 10.1177/0009922813510598] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Research has shown that minority caregivers of children with asthma report poorer communication with health care providers than nonminority caregivers. Less is known about the specific influence of Hispanic ethnicity on parent-provider communication. Our objective was to evaluate the influence of Hispanic ethnicity on parent-provider communication regarding their child's asthma and on caregiver confidence in communicating with their child's provider at a primary care visit. Data were obtained from 166 caregivers of children (2-12 years) with persistent asthma. Caregiver perceptions of provider communication and confidence were evaluated. We found that Hispanic compared to non-Hispanic caregivers reported better communication with providers on several items. Hispanic caregivers also were more likely to indicate full confidence in their ability to communicate with providers. These findings suggest Hispanic caregivers may experience better parent-provider communication than non-Hispanics. Further investigation is needed to assess provider- and clinic-specific factors that may influence communication between minority caregivers and providers.
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Affiliation(s)
- Courtney Carlin
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States
| | - Alison B Yee
- Department of Psychiatry Washington University in St. Louis School of Medicine, St. Louis, MO
| | - Maria Fagnano
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States
| | - Jill S. Halterman
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States
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Ortega VE, Meyers DA. Pharmacogenetics: implications of race and ethnicity on defining genetic profiles for personalized medicine. J Allergy Clin Immunol 2014; 133:16-26. [PMID: 24369795 DOI: 10.1016/j.jaci.2013.10.040] [Citation(s) in RCA: 139] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Revised: 10/22/2013] [Accepted: 10/23/2013] [Indexed: 01/06/2023]
Abstract
Pharmacogenetics is being used to develop personalized therapies specific to subjects from different ethnic or racial groups. To date, pharmacogenetic studies have been primarily performed in trial cohorts consisting of non-Hispanic white subjects of European descent. A "bottleneck" or collapse of genetic diversity associated with the first human colonization of Europe during the Upper Paleolithic period, followed by the recent mixing of African, European, and Native American ancestries, has resulted in different ethnic groups with varying degrees of genetic diversity. Differences in genetic ancestry might introduce genetic variation, which has the potential to alter the therapeutic efficacy of commonly used asthma therapies, such as β2-adrenergic receptor agonists (β-agonists). Pharmacogenetic studies of admixed ethnic groups have been limited to small candidate gene association studies, of which the best example is the gene coding for the receptor target of β-agonist therapy, the β2-adrenergic receptor (ADRB2). Large consortium-based sequencing studies are using next-generation whole-genome sequencing to provide a diverse genome map of different admixed populations, which can be used for future pharmacogenetic studies. These studies will include candidate gene studies, genome-wide association studies, and whole-genome admixture-based approaches that account for ancestral genetic structure, complex haplotypes, gene-gene interactions, and rare variants to detect and replicate novel pharmacogenetic loci.
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Affiliation(s)
- Victor E Ortega
- Center for Genomics and Personalized Medicine, Wake Forest School of Medicine, Winston-Salem, NC
| | - Deborah A Meyers
- Center for Genomics and Personalized Medicine, Wake Forest School of Medicine, Winston-Salem, NC.
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Iqbal S, Oraka E, Chew GL, Flanders WD. Association between birthplace and current asthma: the role of environment and acculturation. Am J Public Health 2013; 104 Suppl 1:S175-82. [PMID: 24354818 DOI: 10.2105/ajph.2013.301509] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We evaluated associations between current asthma and birthplace among major racial/ethnic groups in the United States. METHODS We used multivariate logistic regression methods to analyze data on 102,524 children and adolescents and 255,156 adults in the National Health Interview Survey (2001-2009). RESULTS We found significantly higher prevalence (P < .05) of current asthma among children and adolescents (9.3% vs 5.1%) and adults (7.6% vs 4.7%) born in the 50 states and Washington, DC (US-born), than among those born elsewhere. These differences were among all age groups of non-Hispanic Whites, non-Hispanic Blacks, and Hispanics (excluding Puerto Ricans) and among Chinese adults. Non-US-born adults with 10 or more years of residency in the United States had higher odds of current asthma (odds ratio = 1.55; 95% confidence interval = 1.25, 1.93) than did those who arrived more recently. Findings suggested a similar trend among non-US-born children. CONCLUSIONS Current asthma status was positively associated with being born in the United States and with duration of residency in the United States. Among other contributing factors, changes in environment and acculturation may explain some of the differences in asthma prevalence.
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Affiliation(s)
- Shahed Iqbal
- Shahed Iqbal, Emeka Oraka, and Ginger L. Chew are with the Air Pollution and Respiratory Health Branch, and W. Dana Flanders is with the Division of Environmental Hazards and Health Effects, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA. W. Dana Flanders is also with the Rollins School of Public Health, Emory University, Atlanta
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Pur Ozyigit L, Ozcelik B, Ozcan Ciloglu S, Erkan F. The effectiveness of a pictorial asthma action plan for improving asthma control and the quality of life in illiterate women. J Asthma 2013; 51:423-8. [PMID: 24200510 DOI: 10.3109/02770903.2013.863331] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Written asthma action plans are an important part of asthma management, but cannot be used for illiterate people. OBJECTIVE The aim of this study was to establish the effectiveness of a pictorial asthma action plan on asthma control, health-related quality of life (HRQoL), and asthma morbidity in a population of illiterate women with asthma. METHODS Forty illiterate women with moderate-severe persistent asthma were assigned alternatively to receive either asthma education alone (control group) or asthma education and a pictorial asthma action plan (study group). Asthma control was assessed using the asthma control test (ACT), HRQoL was assessed using the St George's Respiratory Questionnaire (SGRQ), and the frequency of non-scheduled hospital or emergency visits was monitored. RESULTS Thirty-four patients completed the study. The ACT and SGRQ scores of both groups improved at every follow-up time point compared with baseline (p < 0.001). The ACT scores at 1 month (22.44 versus 20.75, p = 0.034) and 2 months (23.28 versus 21.81, p = 0.010) were higher in the study group than in the control group, but this was not maintained at 6 months (24.00 versus 23.25, p = 0.069). The SGRQ scores at 6 months were better in the study group (18.12) than in the control group (23.96, p = 0.033). No hospital admissions were recorded for either group. CONCLUSION Education provides a significant improvement in asthma control and HRQoL while managing illiterate asthma patients, additionally the pictorial asthma action plan can be a helpful tool for self-medication.
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Affiliation(s)
- Leyla Pur Ozyigit
- Department of Allergy and Immunology, American Hospital , Istanbul , Turkey
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Jariwala S, Toh J, Shum M, de Vos G, Zou K, Sindher S, Patel P, Geevarghese A, Tavdy A, Rosenstreich D. The association between asthma-related emergency department visits and pollen and mold spore concentrations in the Bronx, 2001-2008. J Asthma 2013; 51:79-83. [PMID: 24131032 DOI: 10.3109/02770903.2013.853779] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The incidence of asthma morbidity and mortality is highest among minority inner-city populations. Among New York City's five boroughs, the Bronx has the highest rate of asthma-related hospitalizations and mortality. Outdoor air pollutants have been associated with increased asthma-related ED visits (AREDV) in this borough. OBJECTIVE To better understand the contribution of pollen and mold to asthma severity in the Bronx. METHODS The numbers of daily adult and pediatric AREDV and asthma-related hospitalizations (ARH) from 2001 to 2008 were obtained from two Bronx hospitals. AREDV and ARH data were acquired retrospectively through the Clinical Looking Glass data analysis software. Daily counts for tree, grass and weed pollen and mold spore counts from March 2001 to October 2008 were obtained from the Armonk counting station. All data were statistically analyzed and graphed as daily values. RESULTS There were a total of 42 065 AREDV and 10 132 ARH at both Bronx hospitals. There were spring and winter peaks of increased AREDV. Tree pollen counts significantly correlated with total AREDV (rho = 0.3639, p < 0.001), and pediatric (rho = 0.33, p < 0.001) and adult AREDV (rho = 0.28, p < 0.001). ARH positively correlated with tree pollen counts (Spearman rho = 0.2389, p < 0.001). CONCLUSIONS There exists a significant association between spring AREDV and ARH and tree pollen concentrations in a highly urbanized area such as the Bronx. Early anticipation of spring pollen peaks based on ongoing surveillance could potentially guide clinical practice and minimize asthma-related ED visits in the Bronx.
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Alicea-Alvarez N, Swanson-Biearman B, Kelsen SG. A review of barriers to effective asthma management in Puerto Ricans: cultural, healthcare system and pharmacogenomic issues. J Asthma 2013; 51:97-105. [PMID: 24040906 DOI: 10.3109/02770903.2013.845205] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Among the Hispanic community, Puerto Ricans have the highest prevalence of asthma and manifest the worst outcomes. The expected growth of the Hispanic population in the USA in the next several decades make elimination of disparate care in Puerto Rican asthmatics a matter of national importance. The purpose of this review of the literature (ROL) is to examine a variety of health system, genetic and cultural barriers in the Puerto Rican community which have created disparities in asthma care and outcomes among adult and pediatric Hispanic populations. In addition, this ROL describes several culturally sensitive, community-based educational interventions which can be used as a framework for future projects to improved asthma outcomes. METHODS Databases searched included Medline, PubMED, EBSCOhost, PsycINFO, CINAHL, Google Scholar and ERIC. Papers published in English from January 1990 to January 2012 were reviewed. RESULTS Health system policies, insurer compensation patterns, clinician attitudes and cultural values/folk remedies in the Puerto Rican community represent barriers to effective asthma management, the use of controller medication and the implementation of educational interventions. In addition, genetic factors involving the beta-2 adrenergic receptor gene, which impair the response to albuterol, appear to contribute to poorer outcomes in Puerto Rican asthmatics. In contrast, several comprehensive, community-based, culturally sensitive educational interventions such as Controlling Asthma in American Cities Project (CAACP), the Racial and Ethnic Approach to Community Health in the US Program and Healthy Hoops programs (REACH) have been described. CONCLUSIONS We believe that culturally sensitive community-based asthma education programs can serve as models for programs targeted toward Puerto Ricans to help decrease asthma morbidity. Moreover, greater sensitivity to Puerto Rican mores and folk remedies on the part of healthcare providers may improve the patient-clinician rapport and, hence, asthma outcomes. Finally, given ethnically based differences in pharmacogenomics, clinical trials targeting the Puerto Rican population may help to better define optimal asthma medication regimens in this ethnic group.
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Affiliation(s)
- Norma Alicea-Alvarez
- Center for Bioethics, Urban Health and Policy, Temple University School of Medicine , Philadelphia, PA , USA
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Kumar R, Nguyen EA, Roth LA, Oh SS, Gignoux CR, Huntsman S, Eng C, Moreno-Estrada A, Sandoval K, Peñaloza-Espinosa RI, López-López M, Avila PC, Farber HJ, Tcheurekdjian H, Rodriguez-Cintron W, Rodriguez-Santana JR, Serebrisky D, Thyne SM, Williams LK, Winkler C, Bustamante CD, Pérez-Stable EJ, Borrell LN, Burchard EG. Factors associated with degree of atopy in Latino children in a nationwide pediatric sample: the Genes-environments and Admixture in Latino Asthmatics (GALA II) study. J Allergy Clin Immunol 2013; 132:896-905.e1. [PMID: 23684070 PMCID: PMC3788073 DOI: 10.1016/j.jaci.2013.02.046] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2012] [Revised: 12/05/2012] [Accepted: 02/07/2013] [Indexed: 11/16/2022]
Abstract
BACKGROUND Atopy varies by ethnicity, even within Latino groups. This variation might be due to environmental, sociocultural, or genetic factors. OBJECTIVE We sought to examine risk factors for atopy within a nationwide study of US Latino children with and without asthma. METHODS Aeroallergen skin test responses were analyzed in 1830 US Latino subjects. Key determinants of atopy included country/region of origin, generation in the United States, acculturation, genetic ancestry, and site to which subjects migrated. Serial multivariate zero-inflated negative binomial regressions stratified by asthma status examined the association of each key determinant variable with the number of positive skin test responses. In addition, the independent effect of each key variable was determined by including all key variables in the final models. RESULTS In baseline analyses African ancestry was associated with 3 times (95% CI, 1.62-5.57) as many positive skin test responses in asthmatic participants and 3.26 times (95% CI, 1.02-10.39) as many positive skin test responses in control participants. Generation and recruitment site were also associated with atopy in crude models. In final models adjusted for key variables, asthmatic patients of Puerto Rican (exp[β] [95% CI], 1.31 [1.02-1.69]) and mixed (exp[β] [95% CI], 1.27 [1.03-1.56]) ethnicity had a greater probability of positive skin test responses compared with Mexican asthmatic patients. Ancestry associations were abrogated by recruitment site but not region of origin. CONCLUSIONS Puerto Rican ethnicity and mixed origin were associated with degree of atopy within US Latino children with asthma. African ancestry was not associated with degree of atopy after adjusting for recruitment site. Local environment variation, represented by site, was associated with degree of sensitization.
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Affiliation(s)
- Rajesh Kumar
- Division of Allergy and Immunology, Children's Memorial Hospital, and the Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, Ill.
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Kannan S, Acosta LM, Acevedo-Garcia D, Divjan A, Bracero LA, Perzanowski MS, Chew GL. Sociocultural characteristics, obesity and inflammatory biomarkers in Puerto Rican toddlers born in New York City. Pediatr Allergy Immunol 2013; 24:487-92. [PMID: 23773017 DOI: 10.1111/pai.12084] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/16/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND In the USA, Puerto Rican children have a higher prevalence of asthma than other Latino ethnicities, and acculturation is one of hypothesized reasons for this difference. We examined associations between sociocultural characteristics and serum leptin, high-sensitivity C-reactive protein (hsCRP), and body mass index (BMI), and further, among hsCRP, leptin levels, BMI percentiles, and allergic sensitization in 2-year-old children. METHODS IgE antibodies, leptin, and hsCRP concentrations were measured in serum from Puerto Rican toddlers (n = 143) born in New York City with a maternal history of allergy and/or asthma. Demographic and home characteristics questionnaires were administered to the mother, postpartum and two years later. Children's weight and height were measured to determine BMI percentiles. RESULTS More girls (60%) had leptin levels above the median compared with boys (37%) (p = 0.0063). Leptin was positively correlated with BMI (r = 0.25; p = 0.0042). Children in daycare were more likely to be obese (40% vs. 24% p < 0.06). Maternal birthplace was significantly associated with children's leptin but not with hsCRP. Leptin levels were lower for children whose mothers were born on the US mainland (GM = 2.5 ng/ml, 95% CI [2.2-2.7]) compared with those whose mothers were born in Puerto Rico or another country (GM = 3.2 ng/ml, 95% CI [2.2-3.9], t-test p = 0.01). Mothers born in another country were more likely than those born in the US mainland or Puerto Rico to have obese children (60% vs. 26% p < 0.02). Leptin, hsCRP, and BMI percentile were not associated with sensitization to any of the measured inhalant allergens or total IgE. CONCLUSION Even at a very young age, some acculturation factors were associated with biomarkers and anthropometric measures of obesity among this Puerto Rican pediatric population. To our knowledge, this is the first study demonstrating the association of mother's birth place with child BMI and leptin as early as 24 months.
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Affiliation(s)
- Srimathi Kannan
- Department of Animal Science, Food and Nutrition, College of Agricultural Sciences, Southern Illinois University, Carbondale, IL 62901, USA.
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Dahlin A, Tantisira KG. Integrative systems biology approaches in asthma pharmacogenomics. Pharmacogenomics 2013; 13:1387-404. [PMID: 22966888 DOI: 10.2217/pgs.12.126] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
In order to improve therapeutic outcomes, there is a tremendous need to identify patients who are likely to respond to a given asthma treatment. Pharmacogenomic studies have explained a portion of the variability in drug response and provided an increasing list of candidate genes and SNPs. However, as phenotypic variation arises from a network of complex interactions among genetic and environmental factors, rather than individual genes or SNPs, a multidisciplinary, systems-level approach is required in order to understand the inter-relationships among these factors. Systems biology, which seeks to capture interactions between genetic factors and other variables, offers a promising approach to improved therapeutic outcomes in asthma. This aritcle will review and update progress in the pharmacogenomics of asthma and then discuss the application of systems biology approaches to asthma pharmacogenomics.
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Affiliation(s)
- Amber Dahlin
- Channing Laboratory, Brigham & Women's Hospital & Harvard Medical School, 181 Longwood Avenue, Boston, MA 02115, USA
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Tsai CL, Delclos GL, Huang JS, Hanania NA, Camargo CA. Age-related differences in asthma outcomes in the United States, 1988-2006. Ann Allergy Asthma Immunol 2013; 110:240-6, 246.e1. [PMID: 23535086 DOI: 10.1016/j.anai.2013.01.002] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2012] [Revised: 01/07/2013] [Accepted: 01/08/2013] [Indexed: 12/31/2022]
Abstract
BACKGROUND Relatively little is known about the effect of age on asthma outcomes in adults, particularly at a national level. OBJECTIVE To investigate age-related differences in asthma outcomes in a nationally representative, longitudinal study. METHODS We analyzed data from the Third National Health and Nutrition Examination Survey (1988-1994) with linked mortality files through 2006. Adults with physician-diagnosed asthma were identified and were divided into 2 age groups: younger adults (17-54 years of age) and older adults (55 years or older). The outcome measures were both cross-sectional (health care use, comorbidity, and lung function) and longitudinal (all-cause mortality). RESULTS There were an estimated 9,566,000 adults with current asthma. Of these, 73% were younger adults and 27% older adults. Compared with younger adults, older adults had more hospitalizations in the past year, more comorbidities, and poorer lung function (eg, lower forced expiratory volume in 1 second) (P < .05 for all). During a median follow-up of 15 years, significant baseline predictors of higher all-cause mortality included older age (≥55 vs <55 years old: adjusted hazard ratio [HR], 6.77; 95% confidence interval [CI], 3.15-14.54), poor health status (fair and poor vs excellent health status: adjusted HR, 10.07; 95% CI, 3.75-27.01), and vitamin D deficiency (vitamin D level <30 vs ≥50 nmol/L: adjusted HR, 2.19; 95% CI, 1.05-4.58), whereas Mexican American ethnicity (adjusted HR, 0.31; 95% CI, 0.14-0.65) was associated with lower mortality. Controlling for age, asthma was not associated with increased all-cause mortality (adjusted HR, 1.28; 95% CI, 0.99-1.65). CONCLUSION Older adults with asthma have a substantial burden of morbidity and increased mortality. The ethnic differences in asthma mortality and the vitamin D-mortality link merit further investigation.
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Affiliation(s)
- Chu-Lin Tsai
- Division of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas School of Public Health, Houston, Texas 77030, USA.
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Nguyen EA, Burchard EG. Asthma Research for All of the United States. PEDIATRIC ALLERGY IMMUNOLOGY AND PULMONOLOGY 2012; 25:128-131. [PMID: 22970422 DOI: 10.1089/ped.2012.0173] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 06/08/2012] [Accepted: 07/12/2012] [Indexed: 01/08/2023]
Abstract
Asthma disproportionally affects different ethnic/racial groups, with Puerto Ricans and African Americans suffering the highest asthma prevalence and morbidity, Mexicans the lowest, and non-Hispanic whites in between. Genome-wide association studies of asthma have found both shared and race/ethnic-specific genetic risks factors for asthma. However, the majority of genetic asthma research is performed in populations of European descent, which limits the benefits of genetic research to European populations. It is important to biomedical and clinical research to include more diverse and underrepresented populations. The rich genetic diversity of all populations can be leveraged to scientific advantage. For example, admixture mapping provides a more powerful approach than traditional genome-wide allelic association studies in discovering genetic associations for complex diseases. By being more inclusive we can achieve a better understanding of the genetics of asthma, address health disparities, and ensure that scientific advances will benefit populations worldwide.
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Effect of secondhand smoke on asthma control among black and Latino children. J Allergy Clin Immunol 2012; 129:1478-83.e7. [PMID: 22552109 DOI: 10.1016/j.jaci.2012.03.017] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2011] [Revised: 03/05/2012] [Accepted: 03/06/2012] [Indexed: 11/20/2022]
Abstract
BACKGROUND Among patients with asthma, the clinical effect and relative contribution of maternal smoking during pregnancy (in utero smoking) and current secondhand smoke (SHS) exposure on asthma control is poorly documented, and there is a paucity of research involving minority populations. OBJECTIVES We sought to examine the association between poor asthma control and in utero smoking and current SHS exposure among Latino and black children with asthma. METHODS We performed a case-only analysis of 2 multicenter case-control studies conducted from 2008-2010 with similar protocols. We recruited 2481 Latino and black subjects with asthma (ages 8-17 years) from the mainland United States and Puerto Rico. Ordinal logistic regression was used to estimate the effect of in utero smoking and current SHS exposures on National Heart, Lung, and Blood Institute-defined asthma control. RESULTS Poor asthma control among children 8 to 17 years of age was independently associated with in utero smoking (odds ratio [OR], 1.5; 95% CI, 1.1-2.0). In utero smoking through the mother was also associated with secondary asthma outcomes, including early-onset asthma (OR, 1.7; 95% CI, 1.1-2.4), daytime symptoms (OR, 1.6; 95% CI, 1.1-2.1), and asthma-related limitation of activities (OR, 1.6; 95% CI, 1.2-2.2). CONCLUSIONS Maternal smoking while in utero is associated with poor asthma control in black and Latino subjects assessed at 8-17 years of age.
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Schauberger EM, Ewart SL, Arshad SH, Huebner M, Karmaus W, Holloway JW, Friderici KH, Ziegler JT, Zhang H, Rose-Zerilli MJ, Barton SJ, Holgate ST, Kilpatrick JR, Harley JB, Lajoie-Kadoch S, Harley ITW, Hamid Q, Kurukulaaratchy RJ, Seibold MA, Avila PC, Rodriguez-Cintrón W, Rodriguez-Santana JR, Hu D, Gignoux C, Romieu I, London SJ, Burchard EG, Langefeld CD, Wills-Karp M. Identification of ATPAF1 as a novel candidate gene for asthma in children. J Allergy Clin Immunol 2011; 128:753-760.e11. [PMID: 21696813 PMCID: PMC3185108 DOI: 10.1016/j.jaci.2011.04.058] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2010] [Revised: 04/19/2011] [Accepted: 04/27/2011] [Indexed: 10/18/2022]
Abstract
BACKGROUND Asthma is a common disease of children with a complex genetic origin. Understanding the genetic basis of asthma susceptibility will allow disease prediction and risk stratification. OBJECTIVE We sought to identify asthma susceptibility genes in children. METHODS A nested case-control genetic association study of children of Caucasian European ancestry from a birth cohort was conducted. Single nucleotide polymorphisms (SNPs, n = 116,024) were genotyped in pools of DNA samples from cohort children with physician-diagnosed asthma (n = 112) and normal controls (n = 165). A genomic region containing the ATPAF1 gene was found to be significantly associated with asthma. Additional SNPs within this region were genotyped in individual samples from the same children and in 8 independent study populations of Caucasian, African American, Hispanic, or other ancestries. SNPs were also genotyped or imputed in 2 consortia control populations. ATPAF1 expression was measured in bronchial biopsies from asthmatic patients and controls. RESULTS Asthma was found to be associated with a cluster of SNPs and SNP haplotypes containing the ATPAF1 gene, with 2 SNPs achieving significance at a genome-wide level (P = 2.26 × 10(-5) to 2.2 × 10(-8)). Asthma severity was also found to be associated with SNPs and SNP haplotypes in the primary population. SNP and/or gene-level associations were confirmed in the 4 non-Hispanic populations. Haplotype associations were also confirmed in the non-Hispanic populations (P = .045-.0009). ATPAF1 total RNA expression was significantly (P < .01) higher in bronchial biopsies from asthmatic patients than from controls. CONCLUSION Genetic variation in the ATPAF1 gene predisposes children of different ancestries to asthma.
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Akuete K, Oh SS, Thyne S, Rodriguez-Santana JR, Chapela R, Meade K, Rodriguez-Cintron W, LeNoir M, Ford JG, Williams LK, Avila PC, Burchard EG, Tcheurekdjian H. Ethnic variability in persistent asthma after in utero tobacco exposure. Pediatrics 2011; 128:e623-30. [PMID: 21859918 PMCID: PMC3164096 DOI: 10.1542/peds.2011-0640] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The effects of in utero tobacco smoke exposure on childhood respiratory health have been investigated, and outcomes have been inconsistent. OBJECTIVE To determine if in utero tobacco smoke exposure is associated with childhood persistent asthma in Mexican, Puerto Rican, and black children. PATIENTS AND METHODS There were 295 Mexican, Puerto Rican, and black asthmatic children, aged 8 to 16 years, who underwent spirometry, and clinical data were collected from the parents during a standardized interview. The effect of in utero tobacco smoke exposure on the development of persistent asthma and related clinical outcomes was evaluated by logistic regression. RESULTS Children with persistent asthma had a higher odds of exposure to in utero tobacco smoke, but not current tobacco smoke, than did children with intermittent asthma (odds ratio [OR]: 3.57; P = .029). Tobacco smoke exposure from parents in the first 2 years of life did not alter this association. Furthermore, there were higher odds of in utero tobacco smoke exposure in children experiencing nocturnal symptoms (OR: 2.77; P = .048), daily asthma symptoms (OR: 2.73; P = .046), and emergency department visits (OR: 3.85; P = .015) within the year. CONCLUSIONS Exposure to tobacco smoke in utero was significantly associated with persistent asthma among Mexican, Puerto Rican, and black children compared with those with intermittent asthma. These results suggest that smoking cessation during pregnancy may lead to a decrease in the incidence of persistent asthma in these populations.
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Affiliation(s)
- Kwei Akuete
- Departments of Medicine and Pediatrics, Case Western Reserve University, Cleveland Ohio
| | - Sam S. Oh
- Center for Tobacco Control Research and Education, ,Department of Medicine and Cardiovascular Research Institute
| | - Shannon Thyne
- Department of Pediatrics, San Francisco General Hospital, San Francisco, California
| | | | - Rocio Chapela
- Instituto Nacional de Enfermedades Respiratorias, Mexico City, Mexico
| | - Kelley Meade
- Children's Hospital and Research Institute, Oakland, California
| | | | | | - Jean G. Ford
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - L. Keoki Williams
- Center for Health Services Research, Department of Internal Medicine, Henry Ford Health System, Detroit, Michigan
| | - Pedro C. Avila
- Division of Allergy-Immunology, Northwestern University, Chicago, Illinois; and
| | - Esteban González Burchard
- Department of Bioengineering and Therapeutic Sciences, ,Lung Biology Center, and ,Institute for Human Genetics, University of California, San Francisco, California
| | - Haig Tcheurekdjian
- Departments of Medicine and Pediatrics, Case Western Reserve University, Cleveland Ohio; ,Allergy/Immunology Associates Inc, Cleveland, Ohio
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