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Krishnan JA, Buhl R. As-needed ICS/formoterol or as-needed SABA in mild asthma? Eur Respir J 2024; 63:2302308. [PMID: 38575166 DOI: 10.1183/13993003.02308-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 01/03/2024] [Indexed: 04/06/2024]
Affiliation(s)
| | - Roland Buhl
- Johannes Gutenberg University of Mainz, Mainz, Germany
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Covar R, Lazarus SC, Krishnan JA, Blake KV, Sorkness CA, Dyer AM, Lang JE, Lugogo NL, Mauger DT, Wechsler ME, Wenzel SE, Cardet JC, Castro M, Israel E, Phipatanakul W, King TS. Association of Sputum Eosinophilia With Easily Measured Type-2 Inflammatory Biomarkers in Untreated Mild Persistent Asthma. J Allergy Clin Immunol Pract 2024; 12:960-969.e6. [PMID: 38097180 DOI: 10.1016/j.jaip.2023.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 09/26/2023] [Accepted: 12/05/2023] [Indexed: 02/12/2024]
Abstract
BACKGROUND A multicenter clinical trial in patients with mild persistent asthma indicated that response to inhaled corticosteroids (ICS) is limited to those with sputum eosinophilia. However, testing for sputum eosinophilia is impractical in most clinical settings. OBJECTIVE We examined associations between sputum eosinophilia and type 2 inflammatory biomarkers in untreated mild persistent asthma. METHODS Induced sputum, blood eosinophil count (BEC), fractional exhaled nitric oxide (FeNO), and serum periostin were obtained twice during the 6-week run-in period in a clinical trial that enrolled patients 12 years and older with symptomatic, mild persistent asthma without controller therapy. The optimal threshold for each biomarker was based on achieving 80% or greater sensitivity. Performance of biomarkers (area under the receiver operating characteristics curve [AUC], range 0.0-1.0) in predicting sputum eosinophilia 2% or greater was determined; AUCs of 0.8 to 0.9 and more than 0.9 define excellent and outstanding discrimination, respectively. RESULTS Of 564 participants, 27% were sputum eosinophilic, 83% were atopic, 70% had BEC of 200/uL or higher or FeNO of 25 ppb or greater; 64% of participants without sputum eosinophilia had elevated BEC or FeNO. The AUCs for BEC, FeNO, and both together in predicting sputum eosinophilia were all below the threshold for excellent discrimination (AUC 0.75, 0.78, and 0.79, respectively). Periostin (in adults) had poor discrimination (AUC 0.59; P = .02). CONCLUSIONS In untreated mild persistent asthma, there is substantial discordance between sputum eosinophilia, BEC, and FeNO. Until prospective trials test the ability of alternative biomarkers to predict ICS response, BEC or FeNO phenotyping may be an option to consider ICS through a shared decision-making process with consideration of other clinical features.
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Affiliation(s)
- Ronina Covar
- Department of Pediatrics, National Jewish Health, Denver, Colo.
| | - Stephen C Lazarus
- Department of Medicine, University of California, San Francisco, Calif
| | - Jerry A Krishnan
- Departments of Medicine and Public Health, University of Illinois Chicago, Chicago, Ill
| | - Kathryn V Blake
- Center for Pharmacogenomics and Translational Research, Nemours Children's Health, Jacksonville, Fla
| | - Christine A Sorkness
- Department of Medicine and School of Pharmacy, University of Wisconsin, Madison, Wis
| | - Anne-Marie Dyer
- Department of Public Health Sciences, Pennsylvania State University, Hershey, Pa
| | - Jason E Lang
- Department of Pediatrics, Duke University School of Medicine, Durham, NC
| | - Njira L Lugogo
- Department of Medicine, University of Michigan, Ann Arbor, Mich
| | - David T Mauger
- Department of Public Health Sciences, Pennsylvania State University, Hershey, Pa
| | | | - Sally E Wenzel
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pa
| | | | - Mario Castro
- Department of Medicine, University of Kansas School of Medicine, Kansas City, Kan
| | - Elliot Israel
- Department of Medicine, Harvard Medical School Brigham & Women's Hospital, Boston, Mass
| | | | - Tonya S King
- Department of Public Health Sciences, Pennsylvania State University, Hershey, Pa
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3
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Goff SL, Shieh MS, Lindenauer PK, Ash AS, Krishnan JA, Geissler KH. Differences in Health Care Utilization for Asthma by Children with Medicaid versus Private Insurance. Popul Health Manag 2024; 27:105-113. [PMID: 38574325 PMCID: PMC11001504 DOI: 10.1089/pop.2023.0244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024] Open
Abstract
Asthma is the most common chronic disease in children, disproportionately affects families with lower incomes, and is a leading reason for acute care visits and hospitalizations. This retrospective cohort study used the Massachusetts All Payer Claims Database (2014-2018) to examine differences in acute care utilization and quality of care for asthma between Medicaid- and privately insured children in Massachusetts. Outcomes included acute care use (emergency department [ED] or hospitalization), ED visits with asthma, routine asthma visits, and filled prescriptions for asthma medications. Multivariable logistic regression was used to account for differences in demographics, ZIP codes, health status, and asthma severity. Overall, 10.0% of Medicaid-insured children and 5.6% of privately insured were classified as having asthma. Among 317,596 child-year observations for children with asthma, 64.4% were insured by Medicaid. Medicaid-insured children had higher rates of any acute care use (50.4% vs. 30.0%) and ED visits with an asthma diagnosis (27.2% vs. 13.3%) compared to privately insured children. Only 65.4% of Medicaid enrollees had at least one routine asthma visit compared to 74.3% of privately insured children. Most children received at least one asthma medication (88.6% Medicaid vs. 83.3% privately insured), but a higher percentage of Medicaid-insured children received at least one rescue medication (84.0% vs. 73.7%), and a lower percentage of Medicaid-insured (46.1% vs. 49.2%) received a controller medication. These results suggest that opportunities for improvement in childhood asthma persist, particularly for children insured by Medicaid.
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Affiliation(s)
- Sarah L. Goff
- Department of Health Promotion and Policy, School of Public Health & Health Sciences, University of Massachusetts Amherst, Amherst, Massachusetts, USA
| | - Meng-Shiou Shieh
- Department of Healthcare Delivery and Population Sciences, University of Massachusetts-Chan Medical School—Baystate, Springfield, Massachusetts, USA
| | - Peter K. Lindenauer
- Department of Healthcare Delivery and Population Sciences, University of Massachusetts-Chan Medical School—Baystate, Springfield, Massachusetts, USA
- Department of Medicine, University of Massachusetts Chan Medical School-Baystate, Springfield, Massachusetts, USA
| | - Arlene S. Ash
- Department of Population and Quantitative Health Sciences, UMass Chan Medical School, Worcester, Massachusetts, USA
| | - Jerry A. Krishnan
- Department of Epidemiology and Biostatistics, School of Public Health, University of Illinois Chicago, Chicago, Illinois, USA
- Division of Pulmonary, Critical Care, Sleep and Allergy, University of Illinois Chicago, Chicago, Illinois, USA
- Institute for Healthcare Delivery Design, University of Illinois Chicago, Chicago, Illinois, USA
| | - Kimberley H. Geissler
- Department of Healthcare Delivery and Population Sciences, University of Massachusetts-Chan Medical School—Baystate, Springfield, Massachusetts, USA
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4
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Suri R, Markovic D, Woo H, Arjomandi M, Barr RG, Bowler RP, Criner G, Curtis JL, Dransfield MT, Drummond MB, Fortis S, Han MK, Hoffman EA, Kaner RJ, Kaufman JD, Krishnan JA, Martinez FJ, Ohar J, Ortega VE, Paine Iii R, Soler X, Woodruff PG, Hansel NN, Cooper CB, Tashkin DP, Buhr RG, Barjaktarevic IZ. The Effect of Chronic Altitude Exposure on COPD Outcomes in the SPIROMICS Cohort. Am J Respir Crit Care Med 2024. [PMID: 38507607 DOI: 10.1164/rccm.202310-1965oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 03/20/2024] [Indexed: 03/22/2024] Open
Abstract
RATIONALE Individuals with COPD have airflow obstruction and maldistribution of ventilation. For those living at high altitude, any gas exchange abnormality is compounded by reduced partial pressures of inspired oxygen. OBJECTIVES Does residence at higher-altitude exposure affect COPD outcomes, including lung function, imaging characteristics, symptoms, health status, functional exercise capacity, exacerbations, or mortality? METHODS From the SPIROMICS cohort, we identified individuals with COPD living below 1,000 ft (305 m) elevation (n= 1,367) versus above 4,000 ft (1,219 m) elevation (n= 288). Multivariable regression models were used to evaluate associations of exposure to high altitude with COPD-related outcomes. MEASUREMENTS AND MAIN RESULTS Living at higher altitude was associated with reduced functional exercise capacity as defined by 6MWD (-32.3 m, (-55.7 to -28.6)). There were no differences in patient-reported outcomes as defined by symptoms (CAT, mMRC), or health status (SGRQ). Higher altitude was not associated with a different rate of FEV1 decline. Higher altitude was associated with lower odds of severe exacerbations (IRR 0.65, (0.46 to 0.90)). There were no differences in small airway disease, air trapping, or emphysema. In longitudinal analyses, higher altitude was associated with increased mortality (HR 1.25, (1.0 to 1.55)); however, this association was no longer significant when accounting for air pollution. CONCLUSIONS Chronic altitude exposure is associated with reduced functional exercise capacity in individuals with COPD, but this did not translate into differences in symptoms or health status. Additionally, chronic high-altitude exposure did not affect progression of disease as defined by longitudinal changes in spirometry.
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Affiliation(s)
- Rajat Suri
- University of California San Diego, 8784, Pulmonary, Critical Care, and Sleep Medicine, La Jolla, California, United States;
| | - Daniela Markovic
- Ronald Reagan UCLA Medical Center, 21767, Medicine Statistics Core, Los Angeles, California, United States
| | - Han Woo
- Johns Hopkins University, 1466, Medicine, Baltimore, Maryland, United States
| | - Mehrdad Arjomandi
- UCSF Lung Biology Center, Medicine, San Francisco, California, United States
| | - R Graham Barr
- Columbia University, 5798, New York, New York, United States
| | - Russell P Bowler
- National Jewish Medical and Research Center, Department of Medicine, Denver, Colorado, United States
| | - Gerard Criner
- Temple University Hospital, Pulm & Crit Care Medicine, Philadelphia, Pennsylvania, United States
- Lewis Katz School of Medicine at Temple University, 12314, Philadelphia, Pennsylvania, United States
| | - Jeffrey L Curtis
- University of Michigan-Ann Arbor, 1259, Division of Pulmonary and Critical Care Medicine, Ann Arbor, Michigan, United States
- VA Ann Arbor Healthcare System, 20034, Medical Service, Ann Arbor, Michigan, United States
| | - Mark T Dransfield
- University of Alabama at Birmingham and the Birmingham VA Medical Center, Medicine/Pulmonary, Allergy and Critical Care, Birmingham, Alabama, United States
| | - M Bradley Drummond
- University of North Carolina at Chapel Hill, 2331, Chapel Hill, North Carolina, United States
| | - Spyridon Fortis
- University of Iowa Hospitals and Clinics, 21782, Division of Pulmonary, Critical Care and Occupation Medicine, Iowa City, Iowa, United States
| | - MeiLan K Han
- University of Michigan, Pulmonary & Critical Care, Ann Arbor, Michigan, United States
| | - Eric A Hoffman
- University of Iowa Carver College of Medicine, Radiology, Iowa City, Iowa, United States
| | - Robert J Kaner
- Weill Cornell Medical College, Pulmonary and Critical Care Medicine; Genetic Medicine, New York, New York, United States
| | - Joel D Kaufman
- University of Washington, 7284, Department of Environmental and Occupational Health Sciences, Seattle, Washington, United States
| | - Jerry A Krishnan
- University of Illinois at Chicago, 14681, Chicago, Illinois, United States
| | | | - Jill Ohar
- Wake Forest School of Medicine, Internal Medicine, Division of Pulmonary, Critical Care, Allergy and Immunologic Diseases, Winston-Salem, North Carolina, United States
| | - Victor E Ortega
- Mayo Clinic, 6915, Internal Medicine, Division of Respiratory Medicine, Scottsdale, Arizona, United States
| | | | - Xavier Soler
- Regeneron Pharmaceuticals Inc, 7845, Tarrytown, New York, United States
| | - Prescott G Woodruff
- UCSF, Division of Pulmonary and Critical Care Medicine, Department of Medicine and CVRI, San Francisco, California, United States
| | - Nadia N Hansel
- Johns Hopkins University, Medicine, Baltimore, Maryland, United States
| | | | | | - Russell G Buhr
- University of California, Los Angeles, Division of Pulmonary & Critical Care, Department of Medicine, 90095, California, United States
| | - Igor Z Barjaktarevic
- University of California Los Angeles David Geffen School of Medicine, 12222, Medicine, Los Angeles, California, United States
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5
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Freedman MB, Kim YJ, Kaur R, Jain BV, Adegunsoye AO, Chung YC, DeLisa JA, Gardner JM, Gordon HS, Greenberg JA, Kaul M, Khouzam N, Labedz SL, Mokhlesi B, Rintz J, Rubinstein I, Taylor A, Vines DL, Ziauddin L, Gerald LB, Krishnan JA. Home Oxygen After Hospitalization for COVID-19: Results From the Multi-Center OXFORD Study. Respir Care 2024; 69:281-289. [PMID: 38176902 PMCID: PMC10984596 DOI: 10.4187/respcare.11436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 11/16/2023] [Indexed: 01/06/2024]
Abstract
BACKGROUND In the first months of the pandemic, prior to the introduction of proven-effective treatments, 15-37% of patients hospitalized with COVID-19 were discharged on home oxygen. After proven-effective treatments for acute COVID-19 were established by evidence-based guidelines, little remains known about home oxygen requirements following hospitalization for COVID-19. METHODS This was a retrospective, multi-center cohort study of subjects hospitalized for COVID-19 between October 2020-September 2021 at 3 academic health centers. Information was abstracted from electronic health records at the index hospitalization and for 60 d after discharge. The World Health Organization COVID-19 Clinical Progression Scale score was used to identify patients with severe COVID-19. RESULTS Of 517 subjects (mean age 58 y, 47% female, 42% Black, 36% Hispanic, 22% with severe COVID-19), 81% were treated with systemic corticosteroids, 61% with remdesivir, and 2.5% with tocilizumab. About one quarter of subjects were discharged on home oxygen (26% [95% CI 22-29]). Older age (adjusted odds ratio [aOR] 1.02 per 5 y [95% CI 1.02-1.02]), higher body mass index (aOR 1.02 per kg/m2 [1.00-1.04]), diabetes (yes vs no, aOR 1.73 [1.46-2.02]), severe COVID-19 (vs moderate, aOR 3.19 [2.19-4.64]), and treatment with systemic corticosteroids (yes vs no, aOR 30.63 [4.51-208.17]) were associated with an increased odds of discharge on home oxygen. Comorbid hypertension (yes vs no, aOR 0.71 [0.66-0.77) was associated with a decreased odds of home oxygen. Within 60 d of hospital discharge, 50% had documentation of pulse oximetry; in this group, home oxygen was discontinued in 46%. CONCLUSIONS About one in 41 subjects were prescribed home oxygen after hospitalization for COVID-19, even after guidelines established proven-effective treatments for acute illness. Evidence-based strategies to reduce the requirement for home oxygen in patients hospitalized for COVID-19 are needed.
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Affiliation(s)
- Michael B Freedman
- Drs Freedman and Kaul are affiliated with Division of Pulmonary, Critical Care, Sleep, and Allergy, Department of Medicine, University of Illinois Chicago, Chicago, Illinois; and Medical Service, Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois. Drs Kim, Labedz, and Taylor and Ms Ziauddin are affiliated with Division of Pulmonary, Critical Care, Sleep, and Allergy, Department of Medicine, University of Illinois Chicago, Chicago, Illinois. Drs Kaur and Vines and Mr Rintz are affiliated with Division of Respiratory Care, Department of Cardiopulmonary Sciences, Rush University, Chicago, Illinois. Dr Jain is affiliated with Medical Service, Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois; and Division of Hospital Medicine, Department of Medicine, Northwestern University, Chicago, Illinois. Dr Adegunsoye is affiliated with Section of Pulmonary Critical and Critical Care, Department of Medicine, University of Chicago, Chicago, Illinois. Dr Chung and Ms DeLisa are affiliated with Office of Population Health Sciences, University of Illinois Hospital and Health Sciences System, Chicago, Illinois. Ms Gardner is affiliated with Research Service, Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois. Drs Gordon and Khouzam are affiliated with Medical Service, Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois; and Academic Internal Medicine and Geriatrics, Department of Medicine, University of Illinois Chicago, Chicago, Illinois. Drs Greenberg and Mokhlesi are affiliated with Division Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Rush University, Chicago, Illinois. Dr Rubinstein is affiliated with Division of Pulmonary, Critical Care, Sleep, and Allergy, Department of Medicine, University of Illinois Chicago, Chicago, Illinois; Medical Service, Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois; and Research Service, Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois. Drs Gerald and Krishnan are affiliated with Division of Pulmonary, Critical Care, Sleep, and Allergy, Department of Medicine, University of Illinois Chicago, Chicago, Illinois; and Office of Population Health Sciences, University of Illinois Hospital and Health Sciences System, Chicago, Illinois.
| | - Yoo Jin Kim
- Drs Freedman and Kaul are affiliated with Division of Pulmonary, Critical Care, Sleep, and Allergy, Department of Medicine, University of Illinois Chicago, Chicago, Illinois; and Medical Service, Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois. Drs Kim, Labedz, and Taylor and Ms Ziauddin are affiliated with Division of Pulmonary, Critical Care, Sleep, and Allergy, Department of Medicine, University of Illinois Chicago, Chicago, Illinois. Drs Kaur and Vines and Mr Rintz are affiliated with Division of Respiratory Care, Department of Cardiopulmonary Sciences, Rush University, Chicago, Illinois. Dr Jain is affiliated with Medical Service, Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois; and Division of Hospital Medicine, Department of Medicine, Northwestern University, Chicago, Illinois. Dr Adegunsoye is affiliated with Section of Pulmonary Critical and Critical Care, Department of Medicine, University of Chicago, Chicago, Illinois. Dr Chung and Ms DeLisa are affiliated with Office of Population Health Sciences, University of Illinois Hospital and Health Sciences System, Chicago, Illinois. Ms Gardner is affiliated with Research Service, Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois. Drs Gordon and Khouzam are affiliated with Medical Service, Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois; and Academic Internal Medicine and Geriatrics, Department of Medicine, University of Illinois Chicago, Chicago, Illinois. Drs Greenberg and Mokhlesi are affiliated with Division Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Rush University, Chicago, Illinois. Dr Rubinstein is affiliated with Division of Pulmonary, Critical Care, Sleep, and Allergy, Department of Medicine, University of Illinois Chicago, Chicago, Illinois; Medical Service, Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois; and Research Service, Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois. Drs Gerald and Krishnan are affiliated with Division of Pulmonary, Critical Care, Sleep, and Allergy, Department of Medicine, University of Illinois Chicago, Chicago, Illinois; and Office of Population Health Sciences, University of Illinois Hospital and Health Sciences System, Chicago, Illinois
| | - Ramandeep Kaur
- Drs Freedman and Kaul are affiliated with Division of Pulmonary, Critical Care, Sleep, and Allergy, Department of Medicine, University of Illinois Chicago, Chicago, Illinois; and Medical Service, Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois. Drs Kim, Labedz, and Taylor and Ms Ziauddin are affiliated with Division of Pulmonary, Critical Care, Sleep, and Allergy, Department of Medicine, University of Illinois Chicago, Chicago, Illinois. Drs Kaur and Vines and Mr Rintz are affiliated with Division of Respiratory Care, Department of Cardiopulmonary Sciences, Rush University, Chicago, Illinois. Dr Jain is affiliated with Medical Service, Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois; and Division of Hospital Medicine, Department of Medicine, Northwestern University, Chicago, Illinois. Dr Adegunsoye is affiliated with Section of Pulmonary Critical and Critical Care, Department of Medicine, University of Chicago, Chicago, Illinois. Dr Chung and Ms DeLisa are affiliated with Office of Population Health Sciences, University of Illinois Hospital and Health Sciences System, Chicago, Illinois. Ms Gardner is affiliated with Research Service, Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois. Drs Gordon and Khouzam are affiliated with Medical Service, Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois; and Academic Internal Medicine and Geriatrics, Department of Medicine, University of Illinois Chicago, Chicago, Illinois. Drs Greenberg and Mokhlesi are affiliated with Division Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Rush University, Chicago, Illinois. Dr Rubinstein is affiliated with Division of Pulmonary, Critical Care, Sleep, and Allergy, Department of Medicine, University of Illinois Chicago, Chicago, Illinois; Medical Service, Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois; and Research Service, Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois. Drs Gerald and Krishnan are affiliated with Division of Pulmonary, Critical Care, Sleep, and Allergy, Department of Medicine, University of Illinois Chicago, Chicago, Illinois; and Office of Population Health Sciences, University of Illinois Hospital and Health Sciences System, Chicago, Illinois
| | - Bijal V Jain
- Drs Freedman and Kaul are affiliated with Division of Pulmonary, Critical Care, Sleep, and Allergy, Department of Medicine, University of Illinois Chicago, Chicago, Illinois; and Medical Service, Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois. Drs Kim, Labedz, and Taylor and Ms Ziauddin are affiliated with Division of Pulmonary, Critical Care, Sleep, and Allergy, Department of Medicine, University of Illinois Chicago, Chicago, Illinois. Drs Kaur and Vines and Mr Rintz are affiliated with Division of Respiratory Care, Department of Cardiopulmonary Sciences, Rush University, Chicago, Illinois. Dr Jain is affiliated with Medical Service, Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois; and Division of Hospital Medicine, Department of Medicine, Northwestern University, Chicago, Illinois. Dr Adegunsoye is affiliated with Section of Pulmonary Critical and Critical Care, Department of Medicine, University of Chicago, Chicago, Illinois. Dr Chung and Ms DeLisa are affiliated with Office of Population Health Sciences, University of Illinois Hospital and Health Sciences System, Chicago, Illinois. Ms Gardner is affiliated with Research Service, Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois. Drs Gordon and Khouzam are affiliated with Medical Service, Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois; and Academic Internal Medicine and Geriatrics, Department of Medicine, University of Illinois Chicago, Chicago, Illinois. Drs Greenberg and Mokhlesi are affiliated with Division Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Rush University, Chicago, Illinois. Dr Rubinstein is affiliated with Division of Pulmonary, Critical Care, Sleep, and Allergy, Department of Medicine, University of Illinois Chicago, Chicago, Illinois; Medical Service, Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois; and Research Service, Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois. Drs Gerald and Krishnan are affiliated with Division of Pulmonary, Critical Care, Sleep, and Allergy, Department of Medicine, University of Illinois Chicago, Chicago, Illinois; and Office of Population Health Sciences, University of Illinois Hospital and Health Sciences System, Chicago, Illinois
| | - Ayodeji O Adegunsoye
- Drs Freedman and Kaul are affiliated with Division of Pulmonary, Critical Care, Sleep, and Allergy, Department of Medicine, University of Illinois Chicago, Chicago, Illinois; and Medical Service, Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois. Drs Kim, Labedz, and Taylor and Ms Ziauddin are affiliated with Division of Pulmonary, Critical Care, Sleep, and Allergy, Department of Medicine, University of Illinois Chicago, Chicago, Illinois. Drs Kaur and Vines and Mr Rintz are affiliated with Division of Respiratory Care, Department of Cardiopulmonary Sciences, Rush University, Chicago, Illinois. Dr Jain is affiliated with Medical Service, Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois; and Division of Hospital Medicine, Department of Medicine, Northwestern University, Chicago, Illinois. Dr Adegunsoye is affiliated with Section of Pulmonary Critical and Critical Care, Department of Medicine, University of Chicago, Chicago, Illinois. Dr Chung and Ms DeLisa are affiliated with Office of Population Health Sciences, University of Illinois Hospital and Health Sciences System, Chicago, Illinois. Ms Gardner is affiliated with Research Service, Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois. Drs Gordon and Khouzam are affiliated with Medical Service, Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois; and Academic Internal Medicine and Geriatrics, Department of Medicine, University of Illinois Chicago, Chicago, Illinois. Drs Greenberg and Mokhlesi are affiliated with Division Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Rush University, Chicago, Illinois. Dr Rubinstein is affiliated with Division of Pulmonary, Critical Care, Sleep, and Allergy, Department of Medicine, University of Illinois Chicago, Chicago, Illinois; Medical Service, Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois; and Research Service, Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois. Drs Gerald and Krishnan are affiliated with Division of Pulmonary, Critical Care, Sleep, and Allergy, Department of Medicine, University of Illinois Chicago, Chicago, Illinois; and Office of Population Health Sciences, University of Illinois Hospital and Health Sciences System, Chicago, Illinois
| | - Yu-Che Chung
- Drs Freedman and Kaul are affiliated with Division of Pulmonary, Critical Care, Sleep, and Allergy, Department of Medicine, University of Illinois Chicago, Chicago, Illinois; and Medical Service, Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois. Drs Kim, Labedz, and Taylor and Ms Ziauddin are affiliated with Division of Pulmonary, Critical Care, Sleep, and Allergy, Department of Medicine, University of Illinois Chicago, Chicago, Illinois. Drs Kaur and Vines and Mr Rintz are affiliated with Division of Respiratory Care, Department of Cardiopulmonary Sciences, Rush University, Chicago, Illinois. Dr Jain is affiliated with Medical Service, Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois; and Division of Hospital Medicine, Department of Medicine, Northwestern University, Chicago, Illinois. Dr Adegunsoye is affiliated with Section of Pulmonary Critical and Critical Care, Department of Medicine, University of Chicago, Chicago, Illinois. Dr Chung and Ms DeLisa are affiliated with Office of Population Health Sciences, University of Illinois Hospital and Health Sciences System, Chicago, Illinois. Ms Gardner is affiliated with Research Service, Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois. Drs Gordon and Khouzam are affiliated with Medical Service, Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois; and Academic Internal Medicine and Geriatrics, Department of Medicine, University of Illinois Chicago, Chicago, Illinois. Drs Greenberg and Mokhlesi are affiliated with Division Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Rush University, Chicago, Illinois. Dr Rubinstein is affiliated with Division of Pulmonary, Critical Care, Sleep, and Allergy, Department of Medicine, University of Illinois Chicago, Chicago, Illinois; Medical Service, Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois; and Research Service, Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois. Drs Gerald and Krishnan are affiliated with Division of Pulmonary, Critical Care, Sleep, and Allergy, Department of Medicine, University of Illinois Chicago, Chicago, Illinois; and Office of Population Health Sciences, University of Illinois Hospital and Health Sciences System, Chicago, Illinois
| | - Julie A DeLisa
- Drs Freedman and Kaul are affiliated with Division of Pulmonary, Critical Care, Sleep, and Allergy, Department of Medicine, University of Illinois Chicago, Chicago, Illinois; and Medical Service, Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois. Drs Kim, Labedz, and Taylor and Ms Ziauddin are affiliated with Division of Pulmonary, Critical Care, Sleep, and Allergy, Department of Medicine, University of Illinois Chicago, Chicago, Illinois. Drs Kaur and Vines and Mr Rintz are affiliated with Division of Respiratory Care, Department of Cardiopulmonary Sciences, Rush University, Chicago, Illinois. Dr Jain is affiliated with Medical Service, Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois; and Division of Hospital Medicine, Department of Medicine, Northwestern University, Chicago, Illinois. Dr Adegunsoye is affiliated with Section of Pulmonary Critical and Critical Care, Department of Medicine, University of Chicago, Chicago, Illinois. Dr Chung and Ms DeLisa are affiliated with Office of Population Health Sciences, University of Illinois Hospital and Health Sciences System, Chicago, Illinois. Ms Gardner is affiliated with Research Service, Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois. Drs Gordon and Khouzam are affiliated with Medical Service, Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois; and Academic Internal Medicine and Geriatrics, Department of Medicine, University of Illinois Chicago, Chicago, Illinois. Drs Greenberg and Mokhlesi are affiliated with Division Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Rush University, Chicago, Illinois. Dr Rubinstein is affiliated with Division of Pulmonary, Critical Care, Sleep, and Allergy, Department of Medicine, University of Illinois Chicago, Chicago, Illinois; Medical Service, Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois; and Research Service, Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois. Drs Gerald and Krishnan are affiliated with Division of Pulmonary, Critical Care, Sleep, and Allergy, Department of Medicine, University of Illinois Chicago, Chicago, Illinois; and Office of Population Health Sciences, University of Illinois Hospital and Health Sciences System, Chicago, Illinois
| | - Jessica M Gardner
- Drs Freedman and Kaul are affiliated with Division of Pulmonary, Critical Care, Sleep, and Allergy, Department of Medicine, University of Illinois Chicago, Chicago, Illinois; and Medical Service, Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois. Drs Kim, Labedz, and Taylor and Ms Ziauddin are affiliated with Division of Pulmonary, Critical Care, Sleep, and Allergy, Department of Medicine, University of Illinois Chicago, Chicago, Illinois. Drs Kaur and Vines and Mr Rintz are affiliated with Division of Respiratory Care, Department of Cardiopulmonary Sciences, Rush University, Chicago, Illinois. Dr Jain is affiliated with Medical Service, Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois; and Division of Hospital Medicine, Department of Medicine, Northwestern University, Chicago, Illinois. Dr Adegunsoye is affiliated with Section of Pulmonary Critical and Critical Care, Department of Medicine, University of Chicago, Chicago, Illinois. Dr Chung and Ms DeLisa are affiliated with Office of Population Health Sciences, University of Illinois Hospital and Health Sciences System, Chicago, Illinois. Ms Gardner is affiliated with Research Service, Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois. Drs Gordon and Khouzam are affiliated with Medical Service, Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois; and Academic Internal Medicine and Geriatrics, Department of Medicine, University of Illinois Chicago, Chicago, Illinois. Drs Greenberg and Mokhlesi are affiliated with Division Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Rush University, Chicago, Illinois. Dr Rubinstein is affiliated with Division of Pulmonary, Critical Care, Sleep, and Allergy, Department of Medicine, University of Illinois Chicago, Chicago, Illinois; Medical Service, Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois; and Research Service, Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois. Drs Gerald and Krishnan are affiliated with Division of Pulmonary, Critical Care, Sleep, and Allergy, Department of Medicine, University of Illinois Chicago, Chicago, Illinois; and Office of Population Health Sciences, University of Illinois Hospital and Health Sciences System, Chicago, Illinois
| | - Howard S Gordon
- Drs Freedman and Kaul are affiliated with Division of Pulmonary, Critical Care, Sleep, and Allergy, Department of Medicine, University of Illinois Chicago, Chicago, Illinois; and Medical Service, Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois. Drs Kim, Labedz, and Taylor and Ms Ziauddin are affiliated with Division of Pulmonary, Critical Care, Sleep, and Allergy, Department of Medicine, University of Illinois Chicago, Chicago, Illinois. Drs Kaur and Vines and Mr Rintz are affiliated with Division of Respiratory Care, Department of Cardiopulmonary Sciences, Rush University, Chicago, Illinois. Dr Jain is affiliated with Medical Service, Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois; and Division of Hospital Medicine, Department of Medicine, Northwestern University, Chicago, Illinois. Dr Adegunsoye is affiliated with Section of Pulmonary Critical and Critical Care, Department of Medicine, University of Chicago, Chicago, Illinois. Dr Chung and Ms DeLisa are affiliated with Office of Population Health Sciences, University of Illinois Hospital and Health Sciences System, Chicago, Illinois. Ms Gardner is affiliated with Research Service, Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois. Drs Gordon and Khouzam are affiliated with Medical Service, Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois; and Academic Internal Medicine and Geriatrics, Department of Medicine, University of Illinois Chicago, Chicago, Illinois. Drs Greenberg and Mokhlesi are affiliated with Division Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Rush University, Chicago, Illinois. Dr Rubinstein is affiliated with Division of Pulmonary, Critical Care, Sleep, and Allergy, Department of Medicine, University of Illinois Chicago, Chicago, Illinois; Medical Service, Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois; and Research Service, Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois. Drs Gerald and Krishnan are affiliated with Division of Pulmonary, Critical Care, Sleep, and Allergy, Department of Medicine, University of Illinois Chicago, Chicago, Illinois; and Office of Population Health Sciences, University of Illinois Hospital and Health Sciences System, Chicago, Illinois
| | - Jared A Greenberg
- Drs Freedman and Kaul are affiliated with Division of Pulmonary, Critical Care, Sleep, and Allergy, Department of Medicine, University of Illinois Chicago, Chicago, Illinois; and Medical Service, Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois. Drs Kim, Labedz, and Taylor and Ms Ziauddin are affiliated with Division of Pulmonary, Critical Care, Sleep, and Allergy, Department of Medicine, University of Illinois Chicago, Chicago, Illinois. Drs Kaur and Vines and Mr Rintz are affiliated with Division of Respiratory Care, Department of Cardiopulmonary Sciences, Rush University, Chicago, Illinois. Dr Jain is affiliated with Medical Service, Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois; and Division of Hospital Medicine, Department of Medicine, Northwestern University, Chicago, Illinois. Dr Adegunsoye is affiliated with Section of Pulmonary Critical and Critical Care, Department of Medicine, University of Chicago, Chicago, Illinois. Dr Chung and Ms DeLisa are affiliated with Office of Population Health Sciences, University of Illinois Hospital and Health Sciences System, Chicago, Illinois. Ms Gardner is affiliated with Research Service, Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois. Drs Gordon and Khouzam are affiliated with Medical Service, Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois; and Academic Internal Medicine and Geriatrics, Department of Medicine, University of Illinois Chicago, Chicago, Illinois. Drs Greenberg and Mokhlesi are affiliated with Division Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Rush University, Chicago, Illinois. Dr Rubinstein is affiliated with Division of Pulmonary, Critical Care, Sleep, and Allergy, Department of Medicine, University of Illinois Chicago, Chicago, Illinois; Medical Service, Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois; and Research Service, Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois. Drs Gerald and Krishnan are affiliated with Division of Pulmonary, Critical Care, Sleep, and Allergy, Department of Medicine, University of Illinois Chicago, Chicago, Illinois; and Office of Population Health Sciences, University of Illinois Hospital and Health Sciences System, Chicago, Illinois
| | - Malvika Kaul
- Drs Freedman and Kaul are affiliated with Division of Pulmonary, Critical Care, Sleep, and Allergy, Department of Medicine, University of Illinois Chicago, Chicago, Illinois; and Medical Service, Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois. Drs Kim, Labedz, and Taylor and Ms Ziauddin are affiliated with Division of Pulmonary, Critical Care, Sleep, and Allergy, Department of Medicine, University of Illinois Chicago, Chicago, Illinois. Drs Kaur and Vines and Mr Rintz are affiliated with Division of Respiratory Care, Department of Cardiopulmonary Sciences, Rush University, Chicago, Illinois. Dr Jain is affiliated with Medical Service, Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois; and Division of Hospital Medicine, Department of Medicine, Northwestern University, Chicago, Illinois. Dr Adegunsoye is affiliated with Section of Pulmonary Critical and Critical Care, Department of Medicine, University of Chicago, Chicago, Illinois. Dr Chung and Ms DeLisa are affiliated with Office of Population Health Sciences, University of Illinois Hospital and Health Sciences System, Chicago, Illinois. Ms Gardner is affiliated with Research Service, Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois. Drs Gordon and Khouzam are affiliated with Medical Service, Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois; and Academic Internal Medicine and Geriatrics, Department of Medicine, University of Illinois Chicago, Chicago, Illinois. Drs Greenberg and Mokhlesi are affiliated with Division Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Rush University, Chicago, Illinois. Dr Rubinstein is affiliated with Division of Pulmonary, Critical Care, Sleep, and Allergy, Department of Medicine, University of Illinois Chicago, Chicago, Illinois; Medical Service, Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois; and Research Service, Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois. Drs Gerald and Krishnan are affiliated with Division of Pulmonary, Critical Care, Sleep, and Allergy, Department of Medicine, University of Illinois Chicago, Chicago, Illinois; and Office of Population Health Sciences, University of Illinois Hospital and Health Sciences System, Chicago, Illinois
| | - Nader Khouzam
- Drs Freedman and Kaul are affiliated with Division of Pulmonary, Critical Care, Sleep, and Allergy, Department of Medicine, University of Illinois Chicago, Chicago, Illinois; and Medical Service, Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois. Drs Kim, Labedz, and Taylor and Ms Ziauddin are affiliated with Division of Pulmonary, Critical Care, Sleep, and Allergy, Department of Medicine, University of Illinois Chicago, Chicago, Illinois. Drs Kaur and Vines and Mr Rintz are affiliated with Division of Respiratory Care, Department of Cardiopulmonary Sciences, Rush University, Chicago, Illinois. Dr Jain is affiliated with Medical Service, Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois; and Division of Hospital Medicine, Department of Medicine, Northwestern University, Chicago, Illinois. Dr Adegunsoye is affiliated with Section of Pulmonary Critical and Critical Care, Department of Medicine, University of Chicago, Chicago, Illinois. Dr Chung and Ms DeLisa are affiliated with Office of Population Health Sciences, University of Illinois Hospital and Health Sciences System, Chicago, Illinois. Ms Gardner is affiliated with Research Service, Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois. Drs Gordon and Khouzam are affiliated with Medical Service, Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois; and Academic Internal Medicine and Geriatrics, Department of Medicine, University of Illinois Chicago, Chicago, Illinois. Drs Greenberg and Mokhlesi are affiliated with Division Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Rush University, Chicago, Illinois. Dr Rubinstein is affiliated with Division of Pulmonary, Critical Care, Sleep, and Allergy, Department of Medicine, University of Illinois Chicago, Chicago, Illinois; Medical Service, Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois; and Research Service, Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois. Drs Gerald and Krishnan are affiliated with Division of Pulmonary, Critical Care, Sleep, and Allergy, Department of Medicine, University of Illinois Chicago, Chicago, Illinois; and Office of Population Health Sciences, University of Illinois Hospital and Health Sciences System, Chicago, Illinois
| | - Stephanie L Labedz
- Drs Freedman and Kaul are affiliated with Division of Pulmonary, Critical Care, Sleep, and Allergy, Department of Medicine, University of Illinois Chicago, Chicago, Illinois; and Medical Service, Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois. Drs Kim, Labedz, and Taylor and Ms Ziauddin are affiliated with Division of Pulmonary, Critical Care, Sleep, and Allergy, Department of Medicine, University of Illinois Chicago, Chicago, Illinois. Drs Kaur and Vines and Mr Rintz are affiliated with Division of Respiratory Care, Department of Cardiopulmonary Sciences, Rush University, Chicago, Illinois. Dr Jain is affiliated with Medical Service, Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois; and Division of Hospital Medicine, Department of Medicine, Northwestern University, Chicago, Illinois. Dr Adegunsoye is affiliated with Section of Pulmonary Critical and Critical Care, Department of Medicine, University of Chicago, Chicago, Illinois. Dr Chung and Ms DeLisa are affiliated with Office of Population Health Sciences, University of Illinois Hospital and Health Sciences System, Chicago, Illinois. Ms Gardner is affiliated with Research Service, Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois. Drs Gordon and Khouzam are affiliated with Medical Service, Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois; and Academic Internal Medicine and Geriatrics, Department of Medicine, University of Illinois Chicago, Chicago, Illinois. Drs Greenberg and Mokhlesi are affiliated with Division Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Rush University, Chicago, Illinois. Dr Rubinstein is affiliated with Division of Pulmonary, Critical Care, Sleep, and Allergy, Department of Medicine, University of Illinois Chicago, Chicago, Illinois; Medical Service, Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois; and Research Service, Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois. Drs Gerald and Krishnan are affiliated with Division of Pulmonary, Critical Care, Sleep, and Allergy, Department of Medicine, University of Illinois Chicago, Chicago, Illinois; and Office of Population Health Sciences, University of Illinois Hospital and Health Sciences System, Chicago, Illinois
| | - Babak Mokhlesi
- Drs Freedman and Kaul are affiliated with Division of Pulmonary, Critical Care, Sleep, and Allergy, Department of Medicine, University of Illinois Chicago, Chicago, Illinois; and Medical Service, Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois. Drs Kim, Labedz, and Taylor and Ms Ziauddin are affiliated with Division of Pulmonary, Critical Care, Sleep, and Allergy, Department of Medicine, University of Illinois Chicago, Chicago, Illinois. Drs Kaur and Vines and Mr Rintz are affiliated with Division of Respiratory Care, Department of Cardiopulmonary Sciences, Rush University, Chicago, Illinois. Dr Jain is affiliated with Medical Service, Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois; and Division of Hospital Medicine, Department of Medicine, Northwestern University, Chicago, Illinois. Dr Adegunsoye is affiliated with Section of Pulmonary Critical and Critical Care, Department of Medicine, University of Chicago, Chicago, Illinois. Dr Chung and Ms DeLisa are affiliated with Office of Population Health Sciences, University of Illinois Hospital and Health Sciences System, Chicago, Illinois. Ms Gardner is affiliated with Research Service, Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois. Drs Gordon and Khouzam are affiliated with Medical Service, Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois; and Academic Internal Medicine and Geriatrics, Department of Medicine, University of Illinois Chicago, Chicago, Illinois. Drs Greenberg and Mokhlesi are affiliated with Division Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Rush University, Chicago, Illinois. Dr Rubinstein is affiliated with Division of Pulmonary, Critical Care, Sleep, and Allergy, Department of Medicine, University of Illinois Chicago, Chicago, Illinois; Medical Service, Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois; and Research Service, Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois. Drs Gerald and Krishnan are affiliated with Division of Pulmonary, Critical Care, Sleep, and Allergy, Department of Medicine, University of Illinois Chicago, Chicago, Illinois; and Office of Population Health Sciences, University of Illinois Hospital and Health Sciences System, Chicago, Illinois
| | - Jacob Rintz
- Drs Freedman and Kaul are affiliated with Division of Pulmonary, Critical Care, Sleep, and Allergy, Department of Medicine, University of Illinois Chicago, Chicago, Illinois; and Medical Service, Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois. Drs Kim, Labedz, and Taylor and Ms Ziauddin are affiliated with Division of Pulmonary, Critical Care, Sleep, and Allergy, Department of Medicine, University of Illinois Chicago, Chicago, Illinois. Drs Kaur and Vines and Mr Rintz are affiliated with Division of Respiratory Care, Department of Cardiopulmonary Sciences, Rush University, Chicago, Illinois. Dr Jain is affiliated with Medical Service, Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois; and Division of Hospital Medicine, Department of Medicine, Northwestern University, Chicago, Illinois. Dr Adegunsoye is affiliated with Section of Pulmonary Critical and Critical Care, Department of Medicine, University of Chicago, Chicago, Illinois. Dr Chung and Ms DeLisa are affiliated with Office of Population Health Sciences, University of Illinois Hospital and Health Sciences System, Chicago, Illinois. Ms Gardner is affiliated with Research Service, Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois. Drs Gordon and Khouzam are affiliated with Medical Service, Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois; and Academic Internal Medicine and Geriatrics, Department of Medicine, University of Illinois Chicago, Chicago, Illinois. Drs Greenberg and Mokhlesi are affiliated with Division Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Rush University, Chicago, Illinois. Dr Rubinstein is affiliated with Division of Pulmonary, Critical Care, Sleep, and Allergy, Department of Medicine, University of Illinois Chicago, Chicago, Illinois; Medical Service, Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois; and Research Service, Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois. Drs Gerald and Krishnan are affiliated with Division of Pulmonary, Critical Care, Sleep, and Allergy, Department of Medicine, University of Illinois Chicago, Chicago, Illinois; and Office of Population Health Sciences, University of Illinois Hospital and Health Sciences System, Chicago, Illinois
| | - Israel Rubinstein
- Drs Freedman and Kaul are affiliated with Division of Pulmonary, Critical Care, Sleep, and Allergy, Department of Medicine, University of Illinois Chicago, Chicago, Illinois; and Medical Service, Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois. Drs Kim, Labedz, and Taylor and Ms Ziauddin are affiliated with Division of Pulmonary, Critical Care, Sleep, and Allergy, Department of Medicine, University of Illinois Chicago, Chicago, Illinois. Drs Kaur and Vines and Mr Rintz are affiliated with Division of Respiratory Care, Department of Cardiopulmonary Sciences, Rush University, Chicago, Illinois. Dr Jain is affiliated with Medical Service, Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois; and Division of Hospital Medicine, Department of Medicine, Northwestern University, Chicago, Illinois. Dr Adegunsoye is affiliated with Section of Pulmonary Critical and Critical Care, Department of Medicine, University of Chicago, Chicago, Illinois. Dr Chung and Ms DeLisa are affiliated with Office of Population Health Sciences, University of Illinois Hospital and Health Sciences System, Chicago, Illinois. Ms Gardner is affiliated with Research Service, Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois. Drs Gordon and Khouzam are affiliated with Medical Service, Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois; and Academic Internal Medicine and Geriatrics, Department of Medicine, University of Illinois Chicago, Chicago, Illinois. Drs Greenberg and Mokhlesi are affiliated with Division Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Rush University, Chicago, Illinois. Dr Rubinstein is affiliated with Division of Pulmonary, Critical Care, Sleep, and Allergy, Department of Medicine, University of Illinois Chicago, Chicago, Illinois; Medical Service, Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois; and Research Service, Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois. Drs Gerald and Krishnan are affiliated with Division of Pulmonary, Critical Care, Sleep, and Allergy, Department of Medicine, University of Illinois Chicago, Chicago, Illinois; and Office of Population Health Sciences, University of Illinois Hospital and Health Sciences System, Chicago, Illinois
| | - Analisa Taylor
- Drs Freedman and Kaul are affiliated with Division of Pulmonary, Critical Care, Sleep, and Allergy, Department of Medicine, University of Illinois Chicago, Chicago, Illinois; and Medical Service, Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois. Drs Kim, Labedz, and Taylor and Ms Ziauddin are affiliated with Division of Pulmonary, Critical Care, Sleep, and Allergy, Department of Medicine, University of Illinois Chicago, Chicago, Illinois. Drs Kaur and Vines and Mr Rintz are affiliated with Division of Respiratory Care, Department of Cardiopulmonary Sciences, Rush University, Chicago, Illinois. Dr Jain is affiliated with Medical Service, Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois; and Division of Hospital Medicine, Department of Medicine, Northwestern University, Chicago, Illinois. Dr Adegunsoye is affiliated with Section of Pulmonary Critical and Critical Care, Department of Medicine, University of Chicago, Chicago, Illinois. Dr Chung and Ms DeLisa are affiliated with Office of Population Health Sciences, University of Illinois Hospital and Health Sciences System, Chicago, Illinois. Ms Gardner is affiliated with Research Service, Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois. Drs Gordon and Khouzam are affiliated with Medical Service, Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois; and Academic Internal Medicine and Geriatrics, Department of Medicine, University of Illinois Chicago, Chicago, Illinois. Drs Greenberg and Mokhlesi are affiliated with Division Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Rush University, Chicago, Illinois. Dr Rubinstein is affiliated with Division of Pulmonary, Critical Care, Sleep, and Allergy, Department of Medicine, University of Illinois Chicago, Chicago, Illinois; Medical Service, Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois; and Research Service, Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois. Drs Gerald and Krishnan are affiliated with Division of Pulmonary, Critical Care, Sleep, and Allergy, Department of Medicine, University of Illinois Chicago, Chicago, Illinois; and Office of Population Health Sciences, University of Illinois Hospital and Health Sciences System, Chicago, Illinois
| | - David L Vines
- Drs Freedman and Kaul are affiliated with Division of Pulmonary, Critical Care, Sleep, and Allergy, Department of Medicine, University of Illinois Chicago, Chicago, Illinois; and Medical Service, Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois. Drs Kim, Labedz, and Taylor and Ms Ziauddin are affiliated with Division of Pulmonary, Critical Care, Sleep, and Allergy, Department of Medicine, University of Illinois Chicago, Chicago, Illinois. Drs Kaur and Vines and Mr Rintz are affiliated with Division of Respiratory Care, Department of Cardiopulmonary Sciences, Rush University, Chicago, Illinois. Dr Jain is affiliated with Medical Service, Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois; and Division of Hospital Medicine, Department of Medicine, Northwestern University, Chicago, Illinois. Dr Adegunsoye is affiliated with Section of Pulmonary Critical and Critical Care, Department of Medicine, University of Chicago, Chicago, Illinois. Dr Chung and Ms DeLisa are affiliated with Office of Population Health Sciences, University of Illinois Hospital and Health Sciences System, Chicago, Illinois. Ms Gardner is affiliated with Research Service, Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois. Drs Gordon and Khouzam are affiliated with Medical Service, Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois; and Academic Internal Medicine and Geriatrics, Department of Medicine, University of Illinois Chicago, Chicago, Illinois. Drs Greenberg and Mokhlesi are affiliated with Division Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Rush University, Chicago, Illinois. Dr Rubinstein is affiliated with Division of Pulmonary, Critical Care, Sleep, and Allergy, Department of Medicine, University of Illinois Chicago, Chicago, Illinois; Medical Service, Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois; and Research Service, Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois. Drs Gerald and Krishnan are affiliated with Division of Pulmonary, Critical Care, Sleep, and Allergy, Department of Medicine, University of Illinois Chicago, Chicago, Illinois; and Office of Population Health Sciences, University of Illinois Hospital and Health Sciences System, Chicago, Illinois
| | - Lubna Ziauddin
- Drs Freedman and Kaul are affiliated with Division of Pulmonary, Critical Care, Sleep, and Allergy, Department of Medicine, University of Illinois Chicago, Chicago, Illinois; and Medical Service, Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois. Drs Kim, Labedz, and Taylor and Ms Ziauddin are affiliated with Division of Pulmonary, Critical Care, Sleep, and Allergy, Department of Medicine, University of Illinois Chicago, Chicago, Illinois. Drs Kaur and Vines and Mr Rintz are affiliated with Division of Respiratory Care, Department of Cardiopulmonary Sciences, Rush University, Chicago, Illinois. Dr Jain is affiliated with Medical Service, Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois; and Division of Hospital Medicine, Department of Medicine, Northwestern University, Chicago, Illinois. Dr Adegunsoye is affiliated with Section of Pulmonary Critical and Critical Care, Department of Medicine, University of Chicago, Chicago, Illinois. Dr Chung and Ms DeLisa are affiliated with Office of Population Health Sciences, University of Illinois Hospital and Health Sciences System, Chicago, Illinois. Ms Gardner is affiliated with Research Service, Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois. Drs Gordon and Khouzam are affiliated with Medical Service, Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois; and Academic Internal Medicine and Geriatrics, Department of Medicine, University of Illinois Chicago, Chicago, Illinois. Drs Greenberg and Mokhlesi are affiliated with Division Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Rush University, Chicago, Illinois. Dr Rubinstein is affiliated with Division of Pulmonary, Critical Care, Sleep, and Allergy, Department of Medicine, University of Illinois Chicago, Chicago, Illinois; Medical Service, Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois; and Research Service, Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois. Drs Gerald and Krishnan are affiliated with Division of Pulmonary, Critical Care, Sleep, and Allergy, Department of Medicine, University of Illinois Chicago, Chicago, Illinois; and Office of Population Health Sciences, University of Illinois Hospital and Health Sciences System, Chicago, Illinois
| | - Lynn B Gerald
- Drs Freedman and Kaul are affiliated with Division of Pulmonary, Critical Care, Sleep, and Allergy, Department of Medicine, University of Illinois Chicago, Chicago, Illinois; and Medical Service, Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois. Drs Kim, Labedz, and Taylor and Ms Ziauddin are affiliated with Division of Pulmonary, Critical Care, Sleep, and Allergy, Department of Medicine, University of Illinois Chicago, Chicago, Illinois. Drs Kaur and Vines and Mr Rintz are affiliated with Division of Respiratory Care, Department of Cardiopulmonary Sciences, Rush University, Chicago, Illinois. Dr Jain is affiliated with Medical Service, Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois; and Division of Hospital Medicine, Department of Medicine, Northwestern University, Chicago, Illinois. Dr Adegunsoye is affiliated with Section of Pulmonary Critical and Critical Care, Department of Medicine, University of Chicago, Chicago, Illinois. Dr Chung and Ms DeLisa are affiliated with Office of Population Health Sciences, University of Illinois Hospital and Health Sciences System, Chicago, Illinois. Ms Gardner is affiliated with Research Service, Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois. Drs Gordon and Khouzam are affiliated with Medical Service, Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois; and Academic Internal Medicine and Geriatrics, Department of Medicine, University of Illinois Chicago, Chicago, Illinois. Drs Greenberg and Mokhlesi are affiliated with Division Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Rush University, Chicago, Illinois. Dr Rubinstein is affiliated with Division of Pulmonary, Critical Care, Sleep, and Allergy, Department of Medicine, University of Illinois Chicago, Chicago, Illinois; Medical Service, Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois; and Research Service, Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois. Drs Gerald and Krishnan are affiliated with Division of Pulmonary, Critical Care, Sleep, and Allergy, Department of Medicine, University of Illinois Chicago, Chicago, Illinois; and Office of Population Health Sciences, University of Illinois Hospital and Health Sciences System, Chicago, Illinois
| | - Jerry A Krishnan
- Drs Freedman and Kaul are affiliated with Division of Pulmonary, Critical Care, Sleep, and Allergy, Department of Medicine, University of Illinois Chicago, Chicago, Illinois; and Medical Service, Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois. Drs Kim, Labedz, and Taylor and Ms Ziauddin are affiliated with Division of Pulmonary, Critical Care, Sleep, and Allergy, Department of Medicine, University of Illinois Chicago, Chicago, Illinois. Drs Kaur and Vines and Mr Rintz are affiliated with Division of Respiratory Care, Department of Cardiopulmonary Sciences, Rush University, Chicago, Illinois. Dr Jain is affiliated with Medical Service, Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois; and Division of Hospital Medicine, Department of Medicine, Northwestern University, Chicago, Illinois. Dr Adegunsoye is affiliated with Section of Pulmonary Critical and Critical Care, Department of Medicine, University of Chicago, Chicago, Illinois. Dr Chung and Ms DeLisa are affiliated with Office of Population Health Sciences, University of Illinois Hospital and Health Sciences System, Chicago, Illinois. Ms Gardner is affiliated with Research Service, Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois. Drs Gordon and Khouzam are affiliated with Medical Service, Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois; and Academic Internal Medicine and Geriatrics, Department of Medicine, University of Illinois Chicago, Chicago, Illinois. Drs Greenberg and Mokhlesi are affiliated with Division Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Rush University, Chicago, Illinois. Dr Rubinstein is affiliated with Division of Pulmonary, Critical Care, Sleep, and Allergy, Department of Medicine, University of Illinois Chicago, Chicago, Illinois; Medical Service, Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois; and Research Service, Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois. Drs Gerald and Krishnan are affiliated with Division of Pulmonary, Critical Care, Sleep, and Allergy, Department of Medicine, University of Illinois Chicago, Chicago, Illinois; and Office of Population Health Sciences, University of Illinois Hospital and Health Sciences System, Chicago, Illinois
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Markus AF, Rijnbeek PR, Kors JA, Burn E, Duarte-Salles T, Haug M, Kim C, Kolde R, Lee Y, Park HS, Park RW, Prieto-Alhambra D, Reyes C, Krishnan JA, Brusselle GG, Verhamme KM. Real-world treatment trajectories of adults with newly diagnosed asthma or COPD. BMJ Open Respir Res 2024; 11:e002127. [PMID: 38413124 PMCID: PMC10900306 DOI: 10.1136/bmjresp-2023-002127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 02/09/2024] [Indexed: 02/29/2024] Open
Abstract
BACKGROUND There is a lack of knowledge on how patients with asthma or chronic obstructive pulmonary disease (COPD) are globally treated in the real world, especially with regard to the initial pharmacological treatment of newly diagnosed patients and the different treatment trajectories. This knowledge is important to monitor and improve clinical practice. METHODS This retrospective cohort study aims to characterise treatments using data from four claims (drug dispensing) and four electronic health record (EHR; drug prescriptions) databases across six countries and three continents, encompassing 1.3 million patients with asthma or COPD. We analysed treatment trajectories at drug class level from first diagnosis and visualised these in sunburst plots. RESULTS In four countries (USA, UK, Spain and the Netherlands), most adults with asthma initiate treatment with short-acting ß2 agonists monotherapy (20.8%-47.4% of first-line treatments). For COPD, the most frequent first-line treatment varies by country. The largest percentages of untreated patients (for asthma and COPD) were found in claims databases (14.5%-33.2% for asthma and 27.0%-52.2% for COPD) from the USA as compared with EHR databases (6.9%-15.2% for asthma and 4.4%-17.5% for COPD) from European countries. The treatment trajectories showed step-up as well as step-down in treatments. CONCLUSION Real-world data from claims and EHRs indicate that first-line treatments of asthma and COPD vary widely across countries. We found evidence of a stepwise approach in the pharmacological treatment of asthma and COPD, suggesting that treatments may be tailored to patients' needs.
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Affiliation(s)
- Aniek F Markus
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Peter R Rijnbeek
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Jan A Kors
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Edward Burn
- Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- Centre for Statistics in Medicine (CSM), Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDROMS), University of Oxford, Oxford, UK
| | - Talita Duarte-Salles
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, The Netherlands
- Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - Markus Haug
- Institute of Computer Science, University of Tartu, Tartu, Estonia
| | - Chungsoo Kim
- Department of Biomedical Sciences, Ajou University Graduate School of Medicine, Suwon, Republic of Korea
| | - Raivo Kolde
- Institute of Computer Science, University of Tartu, Tartu, Estonia
| | - Youngsoo Lee
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Hae-Sim Park
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Rae Woong Park
- Department of Biomedical Sciences, Ajou University Graduate School of Medicine, Suwon, Republic of Korea
| | - Daniel Prieto-Alhambra
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, The Netherlands
- Centre for Statistics in Medicine (CSM), Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDROMS), University of Oxford, Oxford, UK
| | - Carlen Reyes
- Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - Jerry A Krishnan
- Breathe Chicago Center, Division of Pulmonary, Critical Care, Sleep, and Allergy, University of Illinois Chicago, Chicago, Illinois, USA
| | - Guy G Brusselle
- Departments of Clinical Epidemiology and Respiratory Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium
| | - Katia Mc Verhamme
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of Infection Control & Epidemiology, OLV Hospital, Aalst, Belgium
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Scanzera AC, Kravets S, Hallak JA, Musick H, Krishnan JA, Chan RP, Kim SJ. Evaluating the Relationship between Neighborhood-Level Social Vulnerability and Patient Adherence to Ophthalmology Appointments. Ophthalmic Epidemiol 2024; 31:11-20. [PMID: 36820490 PMCID: PMC10444903 DOI: 10.1080/09286586.2023.2180806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 01/28/2023] [Accepted: 02/10/2023] [Indexed: 02/24/2023]
Abstract
PURPOSE To examine the association between neighborhood-level social vulnerability and adherence to scheduled ophthalmology appointments. METHODS In this retrospective cohort study, records of all patients ≥18 years scheduled for an ophthalmology appointment between September 12, 2020, and February 8, 2021, were reviewed. Primary exposure is neighborhood-level Social Vulnerability Index (SVI) based on the patient's residential location. SVI is a rank score of 15 social factors into four themes (socioeconomic status, household composition/disability, minority status/language, and housing type/transportation), ranging from 0 to 1.0, with higher ranks indicating greater social vulnerability. The overall SVI score and each theme were analyzed separately as the primary exposure of interest in multivariable logistic regression models that controlled for age, sex, appointment status (new or established), race, and distance from clinic. The primary outcome, non-adherence, was defined as missing more than 25% of scheduled appointments. RESULTS Of 8,322 patients (41% non-Hispanic Black, 24% Hispanic, 22% non-Hispanic White) with scheduled appointments, 28% were non-adherent. Non-adherence was associated with greater social vulnerability (adjusted odds ratio [aOR] per 0.01 increase in overall SVI = 2.46 [95% confidence interval, 1.99, 3.06]) and each SVI theme (socioeconomic status: aOR = 2.38 [1.94, 2.91]; household composition/disability: aOR = = 1.51 [1.26, 1.81]; minority status/language: aOR = 2.03 [1.55, 2.68]; housing type/transportation: aOR = 1.41 [1.16, 1.73]). CONCLUSION Neighborhood-level social vulnerability is associated with greater risk of non-adherence to scheduled ophthalmology appointments, controlling for individual characteristics. Multi-level intervention strategies that incorporate neighborhood-level vulnerabilities are needed to reduce disparities in access to ophthalmology care.
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Affiliation(s)
- Angelica C. Scanzera
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois Chicago, 1855 W. Taylor Street, Chicago, IL 60612, United States
| | - Sasha Kravets
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois Chicago, 1855 W. Taylor Street, Chicago, IL 60612, United States
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois Chicago, 1603 W. Taylor Street, Chicago, IL 60612, United States
| | - Joelle A. Hallak
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois Chicago, 1855 W. Taylor Street, Chicago, IL 60612, United States
| | - Hugh Musick
- Institute for Healthcare Delivery Design, Population Health Sciences Program, University of Illinois Chicago, 1220 S. Wood Street, Chicago, IL 60657, United States
| | - Jerry A. Krishnan
- Institute for Healthcare Delivery Design, Population Health Sciences Program, University of Illinois Chicago, 1220 S. Wood Street, Chicago, IL 60657, United States
| | - R.V. Paul Chan
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois Chicago, 1855 W. Taylor Street, Chicago, IL 60612, United States
| | - Sage J. Kim
- Division of Health Policy & Administration, School of Public Health, University of Illinois Chicago, 1603 W. Taylor Street, Chicago, IL 60612, United States
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8
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Koch AL, Shing TL, Namen A, Couper D, Smith B, Barr RG, Bhatt S, Putcha N, Baugh A, Saha AK, Zeidler M, Comellas A, Cooper CB, Barjaktarevic I, Bowler RP, Han MK, Kim V, Paine, III R, Kanner RE, Krishnan JA, Martinez FJ, Woodruff PG, Hansel NN, Hoffman EA, Peters SP, Ortega VE. Lung Structure and Risk of Sleep Apnea in SPIROMICS. Chronic Obstr Pulm Dis 2024; 11:26-36. [PMID: 37931592 PMCID: PMC10913931 DOI: 10.15326/jcopdf.2023.0411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/23/2023] [Indexed: 11/08/2023]
Abstract
Rationale The SubPopulations and InteRmediate Outcome Measures in COPD Study (SPIROMICS) is a prospective cohort study that enrolled 2981 participants with the goal of identifying new chronic obstructive pulmonary disease (COPD) subgroups and intermediate markers of disease progression. Individuals with COPD and obstructive sleep apnea (OSA) experience impaired quality of life and more frequent exacerbations. COPD severity also associates with computed tomography scan-based emphysema and alterations in airway dimensions. Objectives The objective was to determine whether the combination of lung function and structure influences the risk of OSA among current and former smokers. Methods Using 2 OSA risk scores, the Berlin Sleep Questionnaire (BSQ), and the DOISNORE50 (Diseases, Observed apnea, Insomnia, Snoring, Neck circumference > 18 inches, Obesity with body mass index [BMI] > 32, R = are you male, Excessive daytime sleepiness, 50 = age ≥ 50) (DIS), 1767 current and former smokers were evaluated for an association of lung structure and function with OSA risk. Measurements and Main Results The study cohort's mean age was 63 years, BMI was 28 kg/m2, and forced expiratory volume in 1 second (FEV1) was 74.8% predicted. The majority were male (55%), White (77%), former smokers (59%), and had COPD (63%). A high-risk OSA score was reported in 36% and 61% using DIS and BSQ respectively. There was a 9% increased odds of a high-risk DIS score (odds ratio [OR]=1.09, 95% confidence interval [CI]:1.03-1.14) and nominally increased odds of a high-risk BSQ score for every 10% decrease in FEV1 %predicted (OR=1.04, 95%CI: 0.998-1.09). Lung function-OSA risk associations persisted after additionally adjusting for lung structure measurements (%emphysema, %air trapping, parametric response mapping for functional small airways disease, , mean segmental wall area, tracheal %wall area, dysanapsis) for DIS (OR=1.12, 95%CI:1.03-1.22) and BSQ (OR=1.09, 95%CI:1.01-1.18). Conclusions Lower lung function independently associates with having high risk for OSA in current and former smokers. Lung structural elements, especially dysanapsis, functional small airways disease, and tracheal %wall area strengthened the effects on OSA risk.
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Affiliation(s)
- Abigail L. Koch
- Leonard M. Miller School of Medicine, University of Miami, Miami, Florida, United States
| | - Tracie L. Shing
- Collaborative Studies Coordinating Center, Department of Biostatistics, Gilling’s School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, United States
| | - Andrew Namen
- Section on Pulmonary, Critical Care, Allergy and Immunological Diseases, Wake Forest School of Medicine, Wake Forest, North Carolina, United States
| | - David Couper
- Collaborative Studies Coordinating Center, Department of Biostatistics, Gilling’s School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, United States
| | - Benjamin Smith
- Department of Medicine, Columbia University Medical Center, New York, New York, United States
| | - R. Graham Barr
- Department of Medicine, Columbia University Medical Center, New York, New York, United States
| | - Surya Bhatt
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Nirupama Putcha
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland, United States
| | - Aaron Baugh
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of California, San Francisco, California, United States
| | - Amit K. Saha
- Section on Pulmonary, Critical Care, Allergy and Immunological Diseases, Wake Forest School of Medicine, Wake Forest, North Carolina, United States
| | - Michelle Zeidler
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California, United States
| | - Alejandro Comellas
- Departments of Radiology, Medicine, and Bioengineering, University of Iowa, Iowa City, Iowa, United States
| | - Christopher B. Cooper
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California, United States
| | - Igor Barjaktarevic
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California, United States
| | - Russell P. Bowler
- Division of Pulmonary, Critical Care, and Sleep Medicine, National Jewish Health, Denver, Colorado, United States
| | - MeiLan K. Han
- Division of Pulmonary and Critical Care Medicine, School of Medicine, University of Michigan, Ann Arbor, Michigan, United States
| | - Victor Kim
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Temple University School of Medicine, Philadelphia, Pennsylvania, United States
| | - Robert Paine, III
- Division of Respiratory, Critical Care, and Occupational Pulmonary Medicine, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, Utah, United States
| | - Richard E. Kanner
- Division of Respiratory, Critical Care, and Occupational Pulmonary Medicine, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, Utah, United States
| | - Jerry A. Krishnan
- Division of Pulmonary, Critical Care, Sleep, and Allergy, University of Illinois at Chicago, Chicago, Illinois, United States
| | - Fernando J. Martinez
- Division of Pulmonary and Critical Care Medicine, Weill Cornell Medical College, New York, New York, United States
| | - Prescott G Woodruff
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of California, San Francisco, California, United States
| | - Nadia N. Hansel
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland, United States
| | - Eric A. Hoffman
- Departments of Radiology, Medicine, and Bioengineering, University of Iowa, Iowa City, Iowa, United States
| | - Stephen P. Peters
- Section on Pulmonary, Critical Care, Allergy and Immunological Diseases, Wake Forest School of Medicine, Wake Forest, North Carolina, United States
| | - Victor E. Ortega
- Department of Internal Medicine, Division of Respiratory Diseases, Center for Individualized Medicine, Mayo Clinic, Scottsdale, Arizona, United States
| | - for the SubPopulations and InteRmediate Outcome Measures in COPD Study (SPIROMICS) Investigators
- Leonard M. Miller School of Medicine, University of Miami, Miami, Florida, United States
- Collaborative Studies Coordinating Center, Department of Biostatistics, Gilling’s School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, United States
- Section on Pulmonary, Critical Care, Allergy and Immunological Diseases, Wake Forest School of Medicine, Wake Forest, North Carolina, United States
- Department of Medicine, Columbia University Medical Center, New York, New York, United States
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland, United States
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of California, San Francisco, California, United States
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California, United States
- Departments of Radiology, Medicine, and Bioengineering, University of Iowa, Iowa City, Iowa, United States
- Division of Pulmonary, Critical Care, and Sleep Medicine, National Jewish Health, Denver, Colorado, United States
- Division of Pulmonary and Critical Care Medicine, School of Medicine, University of Michigan, Ann Arbor, Michigan, United States
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Temple University School of Medicine, Philadelphia, Pennsylvania, United States
- Division of Respiratory, Critical Care, and Occupational Pulmonary Medicine, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, Utah, United States
- Division of Pulmonary, Critical Care, Sleep, and Allergy, University of Illinois at Chicago, Chicago, Illinois, United States
- Division of Pulmonary and Critical Care Medicine, Weill Cornell Medical College, New York, New York, United States
- Department of Internal Medicine, Division of Respiratory Diseases, Center for Individualized Medicine, Mayo Clinic, Scottsdale, Arizona, United States
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9
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Opron K, Begley LA, Erb-Downward JR, Li G, Alexis NE, Barjaktarevic I, Barr RG, Bleecker ER, Boucher R, Bowler RP, Christenson SA, Comellas AP, Criner G, Cooper CB, Couper D, Galban CJ, Han MK, Hastie A, Hatt C, Hoffman EA, Kaner RJ, Kesimer M, Krishnan JA, LaFon DC, Martinez FJ, Ortega VE, Peters SP, Paine Iii R, Putcha N, Woodruff PG, Huffnagle GB, Kozik AJ, Curtis JL, Huang YJ. Loss of Airway Phylogenetic Diversity Is Associated with Clinical and Pathobiological Markers of Disease Development in COPD. Am J Respir Crit Care Med 2024. [PMID: 38261629 DOI: 10.1164/rccm.202303-0489oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 01/19/2024] [Indexed: 01/25/2024] Open
Abstract
RATIONALE The airway microbiome has the potential to shape COPD pathogenesis, but its relationship to outcomes in milder disease is unestablished. OBJECTIVES Identify sputum microbiome characteristics associated with markers of COPD in participants of the SubPopulations and InteRmediate Outcome Measures of COPD Study (SPIROMICS). METHODS Sputum DNA from 877 participants were analyzed using 16S rRNA gene sequencing. Relationships between baseline airway microbiota composition and clinical, radiographic and muco-inflammatory markers, including longitudinal lung function trajectory, were examined. MEASUREMENTS AND MAIN RESULTS Participant data represented predominantly milder disease (GOLD 0-2: N=732/877). Phylogenetic diversity (range of different species within a sample) correlated positively with baseline lung function, declined with higher GOLD stage, and correlated negatively with symptom burden, radiographic markers of airway disease, and total mucin concentrations (p<0.001). In co-variate adjusted regression models, organisms robustly associated with better lung function included members of Alloprevotella, Oribacterium, and Veillonella. Conversely, lower lung function, greater symptoms and radiographic measures of small airway disease associated with enrichment in members of Streptococcus, Actinobacillus, Actinomyces, and other genera. Baseline sputum microbiota features also associated with lung function trajectory during SPIROMICS follow up (stable/improved, decliner, or rapid decliner). The 'stable/improved' group (slope of FEV1 regression ≥ 66th percentile) had higher bacterial diversity at baseline, associated with enrichment in Prevotella, Leptotrichia, and Neisseria. In contrast, the 'rapid decliner' group (FEV1 slope ≤ 33rd percentile) had significantly lower baseline diversity, associated with enrichment in Streptococcus. CONCLUSIONS In SPIROMICS baseline airway microbiota features demonstrate divergent associations with better or worse COPD-related outcomes.
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Affiliation(s)
- Kristopher Opron
- University of Michigan Medical School, 12266, Internal Medicine, Ann Arbor, Michigan, United States
| | - Lesa A Begley
- University of Michigan, 1259, Ann Arbor, Michigan, United States
| | - John R Erb-Downward
- University of Michigan, Internal Medicine, Ann Arbor, Michigan, United States
| | - Gen Li
- University of Michigan School of Public Health, 51329, Department of Biostatistics, Ann Arbor, Michigan, United States
| | - Neil E Alexis
- UNC Chapel Hill, Pediatrics, Chapel Hill, North Carolina, United States
| | - Igor Barjaktarevic
- University of California Los Angeles David Geffen School of Medicine, 12222, Medicine, Los Angeles, California, United States
| | - R Graham Barr
- Columbia University, 5798, New York, New York, United States
| | - Eugene R Bleecker
- The University of Arizona Arizona Health Sciences Center, 12217, Division of Genetics, Genomics and Precision Medicine, Tucson, Arizona, United States
| | - Richard Boucher
- University of North Carolina, Cystic Fibrosis/Pulmonary Research and Treatment Center, Chapel Hill,, North Carolina, United States
| | - Russell P Bowler
- National Jewish Medical and Research Center, Department of Medicine, Denver, Colorado, United States
| | - Stephanie A Christenson
- University of California, San Francisco, Pulmonary & Critical Care, San Francisco, California, United States
| | - Alejandro P Comellas
- University of Iowa, 4083, Internal Medicine, Iowa City, Iowa, United States
- United States
| | - Gerard Criner
- Temple University Hospital, Pulm & Crit Care Medicine, Philadelphia, Pennsylvania, United States
| | | | - David Couper
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
| | - Craig J Galban
- Center for Molecular Imaging, Ann Arbor, Michigan, United States
| | - MeiLan K Han
- University of Michigan, Pulmonary & Critical Care, Ann Arbor, Michigan, United States
| | - Annette Hastie
- Wake Forest University, Center for Genomics and Personalized Medicine Research, School of Medicine, Winston-Salem, North Carolina, United States
| | | | - Eric A Hoffman
- University of Iowa Carver College of Medicine, Radiology, Iowa City, Iowa, United States
| | - Robert J Kaner
- Weill Cornell Medical College, Pulmonary and Critical Care Medicine; Genetic Medicine, New York, New York, United States
| | - Mehmet Kesimer
- University of North Carolina, Biochemistry and Biophysics, Chapel Hill, North Carolina, United States
| | - Jerry A Krishnan
- University of Illinois at Chicago, 14681, Chicago, Illinois, United States
| | - David C LaFon
- University of Alabama at Birmingham, 9968, Medicine-Pulmonary, Allergy, & Critical Care, Birmingham, Alabama, United States
| | | | - Victor E Ortega
- Mayo Clinic, 6915, Internal Medicine, Division of Respiratory Medicine, Scottsdale, Arizona, United States
| | - Stephen P Peters
- Wake Forest School of Medicine Medical Center, Section on Pulmonary, Critical Care, Allergy & Immunological Diseases, Winston-Salem, North Carolina, United States
| | | | - Nirupama Putcha
- Johns Hopkins University School of Medicine, Pulmonary and Critical Care Medicine, Baltimore, Maryland, United States
- Silver Spring, Maryland, United States
| | - Prescott G Woodruff
- UCSF, Division of Pulmonary and Critical Care Medicine, Department of Medicine and CVRI, San Francisco, California, United States
| | - Gary B Huffnagle
- University of Michigan , Internal Medicine, Ann Arbor, Michigan, United States
| | - Ariangela J Kozik
- University of Michigan-Ann Arbor, 1259, Molecular, Cellular, and Developmental Biology, Ann Arbor, Michigan, United States
- Michigan Medicine, 21614, Internal Medicine - Pulmonary and Critical Care Medicine, Ann Arbor, Michigan, United States
| | - Jeffrey L Curtis
- University of Michigan Health System, 21614, Internal Medicine, Ann Arbor, Michigan, United States
- VA Ann Arbor Healthcare System, 20034, Medical Service, Ann Arbor, Michigan, United States
| | - Yvonne J Huang
- University of Michigan, 1259, Dept of Internal Medicine-Pulmonary/Critical Care and Dept of Microbiology/Immunology, Ann Arbor, Michigan, United States;
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10
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Leung JM, Wu MJ, Kheradpour P, Chen C, Drake KA, Tong G, Ridaura VK, Zisser HC, Conrad WA, Hudson N, Allen J, Welberry C, Parsy-Kowalska C, Macdonald I, Tapson VF, Moy JN, deFilippi CR, Rosas IO, Basit M, Krishnan JA, Parthasarathy S, Prabhakar BS, Salvatore M, Kim CC. Early immune factors associated with the development of post-acute sequelae of SARS-CoV-2 infection in hospitalized and non-hospitalized individuals. Front Immunol 2024; 15:1348041. [PMID: 38318183 PMCID: PMC10838987 DOI: 10.3389/fimmu.2024.1348041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 01/02/2024] [Indexed: 02/07/2024] Open
Abstract
Background Infection by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can lead to post-acute sequelae of SARS-CoV-2 (PASC) that can persist for weeks to years following initial viral infection. Clinical manifestations of PASC are heterogeneous and often involve multiple organs. While many hypotheses have been made on the mechanisms of PASC and its associated symptoms, the acute biological drivers of PASC are still unknown. Methods We enrolled 494 patients with COVID-19 at their initial presentation to a hospital or clinic and followed them longitudinally to determine their development of PASC. From 341 patients, we conducted multi-omic profiling on peripheral blood samples collected shortly after study enrollment to investigate early immune signatures associated with the development of PASC. Results During the first week of COVID-19, we observed a large number of differences in the immune profile of individuals who were hospitalized for COVID-19 compared to those individuals with COVID-19 who were not hospitalized. Differences between individuals who did or did not later develop PASC were, in comparison, more limited, but included significant differences in autoantibodies and in epigenetic and transcriptional signatures in double-negative 1 B cells, in particular. Conclusions We found that early immune indicators of incident PASC were nuanced, with significant molecular signals manifesting predominantly in double-negative B cells, compared with the robust differences associated with hospitalization during acute COVID-19. The emerging acute differences in B cell phenotypes, especially in double-negative 1 B cells, in PASC patients highlight a potentially important role of these cells in the development of PASC.
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Affiliation(s)
| | - Michelle J. Wu
- Verily Life Sciences, South San Francisco, CA, United States
| | | | - Chen Chen
- Verily Life Sciences, South San Francisco, CA, United States
| | | | - Gary Tong
- Verily Life Sciences, South San Francisco, CA, United States
| | | | | | - William A. Conrad
- Providence Little Company of Mary Medical Center Torrance, Torrance, CA, United States
| | | | - Jared Allen
- Oncimmune Limited, Nottingham, United Kingdom
| | | | | | | | - Victor F. Tapson
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - James N. Moy
- Department of Internal Medicine, Rush University Medical Center, Chicago, IL, United States
| | | | - Ivan O. Rosas
- Department of Medicine, Baylor College of Medicine, Houston, TX, United States
| | - Mujeeb Basit
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Jerry A. Krishnan
- Breathe Chicago Center, University of Illinois Chicago, Chicago, IL, United States
| | - Sairam Parthasarathy
- Division of Pulmonary, Allergy, Critical Care & Sleep Medicine, University of Arizona, Tucson, AZ, United States
| | - Bellur S. Prabhakar
- Department of Microbiology and Immunology, University of Illinois - College of Medicine, Chicago, IL, United States
| | - Mirella Salvatore
- Department of Medicine and Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, United States
| | - Charles C. Kim
- Verily Life Sciences, South San Francisco, CA, United States
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11
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Au DH, Gleason E, Hunter-Merrill R, Barón AE, Collins M, Ronneberg C, Lv N, Rise P, Wai TH, Plumley R, Wisniewski SR, Sciurba FC, Kim DY, Simonelli P, Krishnan JA, Wendt CH, Feemster LC, Criner GJ, Maddipati V, Mohan A, Ma J. Lifestyle Intervention and Excess Weight in Chronic Obstructive Pulmonary Disease (COPD): INSIGHT COPD Randomized Clinical Trial. Ann Am Thorac Soc 2023; 20:1743-1751. [PMID: 37769182 PMCID: PMC10704228 DOI: 10.1513/annalsats.202305-458oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 09/26/2023] [Indexed: 09/30/2023] Open
Abstract
Rationale: Being overweight or obese is common among patients with chronic obstructive pulmonary disease (COPD), but whether interventions targeted at weight loss improve functional impairments is unknown. Objectives: INSIGHT (Intervention Study in Overweight Patients with COPD) tested whether a pragmatic low-intensity lifestyle intervention would lead to better physical functional status among overweight or obese participants with COPD. Methods: The trial was a 12-month, multicenter, patient-level pragmatic clinical trial. Participants were recruited from April 2017 to August 2019 from 38 sites across the United States and randomized to receive usual care or usual care plus lifestyle intervention. The intervention was a self-directed video program delivering the Diabetes Prevention Program's Group Lifestyle Balance curriculum. Results: The primary outcome was 6-minute-walk test distance at 12 months. Priority secondary outcomes were postwalk modified Borg dyspnea at 12 months and weight at 12 months. Participants (N = 684; mean age, 67.0 ± 8.0 yr [standard deviation]; 41.2% female) on average were obese (body mass index, 33.0 ± 4.6 kg/m2) with moderate COPD (forced expiratory volume in 1 second % predicted, 58.1 ± 15.7%). At 12 months, participants randomized to the intervention arm walked farther (adjusted difference, 42.3 ft [95% confidence interval (CI), 7.9-76.7 ft]; P = 0.02), had less dyspnea at the end of the 6-minute-walk test (adjusted difference, -0.36 [95% CI, -0.63 to -0.09]; P = 0.008), and had greater weight loss (adjusted difference, -1.34 kg [95% CI, -2.33 to -0.34 kg]; P = 0.008) than control participants. The intervention did not improve the odds of achieving clinically meaningful thresholds of walk distance (98.4 ft) or dyspnea (1 unit) but did achieve meaningful thresholds of weight loss (3% and 5%). Conclusions: Among participants with COPD who were overweight or obese, a self-guided low-intensity video-based lifestyle intervention led to modest weight loss but did not lead to clinically important improvements in physical functional status and dyspnea. Clinical trial registered with www.clinicaltrials.gov (NCT02634268).
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Affiliation(s)
- David H. Au
- Health Services Research and Development, Veterans Affairs Puget Sound Healthcare System, Seattle Division, Seattle, Washington
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle, Washington
| | - Emily Gleason
- Health Services Research and Development, Veterans Affairs Puget Sound Healthcare System, Seattle Division, Seattle, Washington
| | - Rachel Hunter-Merrill
- Health Services Research and Development, Veterans Affairs Puget Sound Healthcare System, Seattle Division, Seattle, Washington
| | - Anna E. Barón
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Margaret Collins
- Health Services Research and Development, Veterans Affairs Puget Sound Healthcare System, Seattle Division, Seattle, Washington
| | | | - Nan Lv
- Department of Medicine and
| | - Peter Rise
- Health Services Research and Development, Veterans Affairs Puget Sound Healthcare System, Seattle Division, Seattle, Washington
| | - Travis Hee Wai
- Health Services Research and Development, Veterans Affairs Puget Sound Healthcare System, Seattle Division, Seattle, Washington
| | - Robert Plumley
- Health Services Research and Development, Veterans Affairs Puget Sound Healthcare System, Seattle Division, Seattle, Washington
| | | | - Frank C. Sciurba
- Department of Medicine, Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Dong-Yun Kim
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Paul Simonelli
- Department of Pulmonary and Critical Care Medicine, Geisinger Medical Center, Danville, Pennsylvania
| | | | - Christine H. Wendt
- Department of Medicine, Division of Pulmonary, Allergy, Critical Care, and Sleep, Minneapolis Veterans Affairs Healthcare System, Minneapolis, Minnesota
| | - Laura C. Feemster
- Health Services Research and Development, Veterans Affairs Puget Sound Healthcare System, Seattle Division, Seattle, Washington
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle, Washington
| | - Gerard J. Criner
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Veeranna Maddipati
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, East Carolina University, Greenville, North Carolina
| | - Arjun Mohan
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, East Carolina University, Greenville, North Carolina
| | - Jun Ma
- Division of Academic Internal Medicine and Geriatrics, University of Illinois Chicago, Chicago, Illinois
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12
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Prieto-Centurion V, Holm KE, Casaburi R, Porszasz J, Basu S, Bracken NE, Gallardo R, Gonzalez V, Illendula SD, Sandhaus RA, Sullivan JL, Walsh LJ, Gerald LB, Krishnan JA. A Hybrid Effectiveness/Implementation Clinical Trial of Adherence to Long-Term Oxygen Therapy for Chronic Obstructive Pulmonary Disease. Ann Am Thorac Soc 2023; 20:1561-1570. [PMID: 37683098 PMCID: PMC10632931 DOI: 10.1513/annalsats.202302-104oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 09/07/2023] [Indexed: 09/10/2023] Open
Abstract
Rationale: Interventions to promote adherence to long-term oxygen therapy (LTOT) in chronic obstructive pulmonary disease (COPD) are needed. Objectives: To examine the real-world effectiveness of phone-based peer coaching on LTOT adherence and other outcomes in a pragmatic trial of patients with COPD. Methods: In a hybrid effectiveness/implementation pragmatic trial, patients were randomized to receive phone-based proactive coaching (educational materials, five phone-based peer coaching sessions over 60 d), reactive coaching (educational materials, peer coaching when requested), or usual care. Study staff members collected baseline and outcome data via phone at 30, 60, and 90 days after randomization. Adherence to LTOT over 60 days, the primary effectiveness outcome, was defined as mean LTOT use ⩾17.7 h/d. LTOT use was calculated using information about home oxygen equipment use in worksheets completed by study participants. Comparisons of adherence to LTOT between each coaching group and the usual care group using multivariable logistic regression models were prespecified as the primary analyses. Secondary effectiveness outcomes included Patient Reported Outcome Management Information System measures for physical, emotional, and social health. We assessed early implementation domains in the reach, adoption, and implementation framework. Results: In 444 participants, the proportions who were adherent to LTOT at 60 days were 74% in usual care, 84% in reactive coaching, and 70% in proactive coaching groups. Although reach, adoption by stakeholder partners, and intervention fidelity were acceptable, complete LTOT adherence data were available in only 73% of participants. Reactive coaching (adjusted odds ratio, 1.77; 97.5% confidence interval, 0.80-3.90) and proactive coaching (adjusted odds ratio, 0.70; 97.5% confidence interval, 0.34-1.46) did not improve adherence to LTOT compared with usual care. However, proactive coaching significantly reduced depressive symptoms and sleep disturbance compared with usual care and reduced depressive symptoms compared with reactive coaching. Unexpectedly, LTOT adherence was significantly lower in the proactive compared with the reactive coaching group. Conclusions: The results were inconclusive about whether a phone-based peer coaching strategy changed LTOT adherence compared with usual care. Further studies are needed to confirm the potential benefits of proactive peer coaching on secondary effectiveness outcomes and differences in LTOT adherence between proactive and reactive peer coaching. Clinical trial registered with ClinicalTrials.gov (NCT02098369).
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Affiliation(s)
| | - Kristen E. Holm
- Department of Medicine, National Jewish Health, Denver, Colorado
- Department of Community and Behavioral Health, Colorado School of Public Health, Aurora, Colorado
| | - Richard Casaburi
- Lindquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, California
| | - Janos Porszasz
- Lindquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, California
| | | | - Nina E. Bracken
- Breathe Chicago Center, Division of Pulmonary, Critical Care, Sleep and Allergy
- Office of Population Health Sciences, Office of the Vice Chancellor for Health Affairs, University of Illinois Chicago, Chicago, Illinois
| | - Richard Gallardo
- Alzheimer’s Therapeutic Research Institute, San Diego, California
| | - Vanessa Gonzalez
- School of Public Health, and
- American Academy of Sleep Medicine Foundation, Darien, Illinois; and
| | - Sai D. Illendula
- Breathe Chicago Center, Division of Pulmonary, Critical Care, Sleep and Allergy
- Office of Population Health Sciences, Office of the Vice Chancellor for Health Affairs, University of Illinois Chicago, Chicago, Illinois
| | | | | | | | - Lynn B. Gerald
- Breathe Chicago Center, Division of Pulmonary, Critical Care, Sleep and Allergy
- Office of Population Health Sciences, Office of the Vice Chancellor for Health Affairs, University of Illinois Chicago, Chicago, Illinois
| | - Jerry A. Krishnan
- Breathe Chicago Center, Division of Pulmonary, Critical Care, Sleep and Allergy
- Office of Population Health Sciences, Office of the Vice Chancellor for Health Affairs, University of Illinois Chicago, Chicago, Illinois
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13
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Zaeh SE, Case M, Au DH, DaSilva M, Deitemeyer K, DeLisa J, Feemster LC, Gerald LB, Krishnan JA, Sculley J, Woodruff A, Eakin MN. Clinical Practices Surrounding the Prescription of Home Oxygen in Patients With COPD and Desaturation. Chronic Obstr Pulm Dis 2023; 10:343-354. [PMID: 37433062 PMCID: PMC10699490 DOI: 10.15326/jcopdf.2023.0402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/09/2023] [Indexed: 07/13/2023]
Abstract
Purpose While home oxygen therapy increases survival in patients with chronic obstructive pulmonary disease (COPD) who have severe resting hypoxemia, recent evidence suggests that there is no survival benefit of home oxygen for patients with COPD who have isolated exertional desaturation. We aimed to understand clinician practice patterns surrounding the prescription of home oxygen for patients with COPD. Methods We conducted semi-structured qualitative interviews via videoconference with 15 physicians and 3 nurse practitioners who provide care for patients with COPD. Clinicians were recruited through the American Lung Association Airways Clinical Research Centers. Interview guides were created with the assistance of patient investigators and included questions regarding clinician practices surrounding the prescription of oxygen for patients with COPD and the use of clinical guidelines. Interviews were recorded, transcribed, and coded for themes. Results Of the 18 clinician interviewees, one-third were women, with most participants (n=11) being < 50 years old. Results of the semi-structured interviews suggested research evidence, clinical experience, and patient preferences contributed to clinician decision-making. Most clinicians described a shared decision-making process for prescribing home oxygen for patients, including discussion of risks and benefits, and developing an understanding of patient values and preferences. Clinicians did not use a structured tool to conduct these conversations. Conclusions Clinicians consider a number of patient and clinical factors when prescribing home oxygen therapy, often using a shared decision-making process. Tools to support shared decision-making about the use of home oxygen are needed.
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Affiliation(s)
- Sandra E. Zaeh
- Division of Pulmonary, Critical Care, and Sleep Medicine, Yale University School of Medicine, New Haven, Connecticut, United States
| | - Meredith Case
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, United States
| | - David H. Au
- Veterans Affairs Puget Sound Health Services Research and Development, Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, Washington, United States
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle, Washington, United States
| | - Michele DaSilva
- Patient Advisory Board, American Lung Association, Chicago, Illinois, United States
| | - Karen Deitemeyer
- Patient Advisory Board, American Lung Association, Chicago, Illinois, United States
| | - Julie DeLisa
- Division of Pulmonary, Critical Care, Sleep, and Allergy, Department of Medicine, University of Illinois Chicago, Chicago, Illinois, United States
| | - Laura C. Feemster
- Veterans Affairs Puget Sound Health Services Research and Development, Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, Washington, United States
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle, Washington, United States
| | - Lynn B. Gerald
- Division of Pulmonary, Critical Care, Sleep, and Allergy, Department of Medicine, University of Illinois Chicago, Chicago, Illinois, United States
- Office of Population Health Sciences, University of Illinois-Chicago, Chicago, Illinois, United States
| | - Jerry A. Krishnan
- Division of Pulmonary, Critical Care, Sleep, and Allergy, Department of Medicine, University of Illinois Chicago, Chicago, Illinois, United States
- Office of Population Health Sciences, University of Illinois-Chicago, Chicago, Illinois, United States
| | - Jennifer Sculley
- Office of Population Health Sciences, University of Illinois-Chicago, Chicago, Illinois, United States
| | - Annette Woodruff
- Patient Advisory Board, American Lung Association, Chicago, Illinois, United States
| | - Michelle N. Eakin
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, United States
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14
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Chen C, Parthasarathy S, Leung JM, Wu MJ, Drake KA, Ridaura VK, Zisser HC, Conrad WA, Tapson VF, Moy JN, deFilippi CR, Rosas IO, Prabhakar BS, Basit M, Salvatore M, Krishnan JA, Kim CC. Distinct temporal trajectories and risk factors for Post-acute sequelae of SARS-CoV-2 infection. Front Med (Lausanne) 2023; 10:1227883. [PMID: 37908849 PMCID: PMC10614284 DOI: 10.3389/fmed.2023.1227883] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 09/19/2023] [Indexed: 11/02/2023] Open
Abstract
Background The understanding of Post-acute sequelae of SARS-CoV-2 infection (PASC) can be improved by longitudinal assessment of symptoms encompassing the acute illness period. To gain insight into the various disease trajectories of PASC, we assessed symptom evolution and clinical factors associated with the development of PASC over 3 months, starting with the acute illness period. Methods We conducted a prospective cohort study to identify parameters associated with PASC. We performed cluster and case control analyses of clinical data, including symptomatology collected over 3 months following infection. Results We identified three phenotypic clusters associated with PASC that could be characterized as remittent, persistent, or incident based on the 3-month change in symptom number compared to study entry: remittent (median; min, max: -4; -17, 3), persistent (-2; -14, 7), or incident (4.5; -5, 17) (p = 0.041 remittent vs. persistent, p < 0.001 remittent vs. incident, p < 0.001 persistent vs. incident). Despite younger age and lower hospitalization rates, the incident phenotype had a greater number of symptoms (15; 8, 24) and a higher proportion of participants with PASC (63.2%) than the persistent (6; 2, 9 and 52.2%) or remittent clusters (1; 0, 6 and 18.7%). Systemic corticosteroid administration during acute infection was also associated with PASC at 3 months [OR (95% CI): 2.23 (1.14, 4.36)]. Conclusion An incident disease phenotype characterized by symptoms that were absent during acute illness and the observed association with high dose steroids during acute illness have potential critical implications for preventing PASC.
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Affiliation(s)
- Chen Chen
- Verily Life Sciences, South San Francisco, CA, United States
| | - Sairam Parthasarathy
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, University of Arizona, Tucson, AZ, United States
| | | | - Michelle J. Wu
- Verily Life Sciences, South San Francisco, CA, United States
| | | | | | | | - William A. Conrad
- Providence Little Company of Mary Medical Center Torrance, Torrance, CA, United States
| | - Victor F. Tapson
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - James N. Moy
- Department of Internal Medicine, Rush University Medical Center, Chicago, IL, United States
| | | | - Ivan O. Rosas
- Department of Medicine, Baylor College of Medicine, Houston, TX, United States
| | - Bellur S. Prabhakar
- Department of Microbiology and Immunology, University of Illinois–College of Medicine, Chicago, IL, United States
| | - Mujeeb Basit
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Mirella Salvatore
- Department of Medicine, Weill Cornell Medicine, New York, NY, United States
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, United States
| | - Jerry A. Krishnan
- Breathe Chicago Center, University of Illinois Chicago, Chicago, IL, United States
| | - Charles C. Kim
- Verily Life Sciences, South San Francisco, CA, United States
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15
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Scanzera AC, Sherrod RM, Potharazu AV, Nguyen D, Beversluis C, Karnik NS, Chan RVP, Kim SJ, Krishnan JA, Musick H. Barriers and Facilitators to Ophthalmology Visit Adherence in an Urban Hospital Setting. Transl Vis Sci Technol 2023; 12:11. [PMID: 37831446 PMCID: PMC10587857 DOI: 10.1167/tvst.12.10.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 09/12/2023] [Indexed: 10/14/2023] Open
Abstract
Purpose To explore barriers and facilitators to completing scheduled outpatient appointments at an urban academic hospital-based ophthalmology department. Methods Potential participants were stratified by neighborhood Social Vulnerability Index (SVI) (range, 0-1.0, higher scores indicate greater vulnerability), and semistructured interviews were conducted with individuals 18 years and older with an SVI of greater than 0.61 (n = 17) and providers delivering care in the General Eye Clinic of the University of Illinois Chicago (n = 8). Qualitative analysis informed by human-centered design methods was conducted to classify barriers and facilitators into three domains of the Consolidated Framework for Implementation Research: outer setting, inner setting, and characteristics of individuals. Results There were four main themes-transportation, time burden, social support, and economic situation-all of which were within the outer setting of the Consolidated Framework for Implementation Research; transportation was most salient. Although providers perceived health literacy as a barrier affecting motivation, patients expressed a high motivation to attend visits and felt well-educated about their condition. Conclusions A lack of resources outside of the health system presents significant barriers for patients from neighborhoods with high SVI. Future efforts to improve adherence should focus on resource-related interventions in the outer setting. Improving access to eye care will require community-level interventions, particularly transportation. Translational Relevance Understanding the barriers and facilitators within the Consolidated Framework for Implementation Research provides useful guidance for future interventions, specifically to focus future efforts to improve adherence on resource-related interventions.
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Affiliation(s)
- Angelica C. Scanzera
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois Chicago, Chicago, Illinois, USA
| | - R. McKinley Sherrod
- Institute for Healthcare Delivery Design, Office of Population Health Sciences, University of Illinois Chicago, Chicago, Illinois, USA
| | - Archit V. Potharazu
- Institute for Healthcare Delivery Design, Office of Population Health Sciences, University of Illinois Chicago, Chicago, Illinois, USA
- College of Medicine, University of Illinois Chicago, Chicago, Illinois, USA
| | - Diana Nguyen
- Institute of Design, Illinois Institute of Technology, Chicago, Illinois, USA
| | - Cameron Beversluis
- Institute for Healthcare Delivery Design, Office of Population Health Sciences, University of Illinois Chicago, Chicago, Illinois, USA
| | - Niranjan S. Karnik
- Institute for Juvenile Research, University of Illinois Chicago, Chicago, Illinois, USA
| | - Robison V. P. Chan
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois Chicago, Chicago, Illinois, USA
| | - Sage J. Kim
- Division of Health Policy, School of Public Health, University of Illinois Chicago, Chicago, Illinois, USA
| | - Jerry A. Krishnan
- Institute for Healthcare Delivery Design, Office of Population Health Sciences, University of Illinois Chicago, Chicago, Illinois, USA
| | - Hugh Musick
- Institute for Healthcare Delivery Design, Office of Population Health Sciences, University of Illinois Chicago, Chicago, Illinois, USA
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16
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Levy ML, Bateman ED, Allan K, Bacharier LB, Bonini M, Boulet LP, Bourdin A, Brightling C, Brusselle G, Buhl R, Chakaya MJ, Cruz AA, Drazen J, Ducharme FM, Duijts L, Fleming L, Inoue H, Ko FWS, Krishnan JA, Masekela R, Mortimer K, Pitrez P, Salvi S, Sheikh A, Reddel HK, Yorgancıoğlu A. Global access and patient safety in the transition to environmentally friendly respiratory inhalers: the Global Initiative for Asthma perspective. Lancet 2023; 402:1012-1016. [PMID: 37480934 DOI: 10.1016/s0140-6736(23)01358-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 06/12/2023] [Accepted: 06/27/2023] [Indexed: 07/24/2023]
Affiliation(s)
| | - Eric D Bateman
- Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Keith Allan
- Department of Patient and Community Engagement, University Hospitals of Leicester, Leicester, UK
| | - Leonard B Bacharier
- Department of Pediatrics, Monroe Carell Jr Children's Hospital at Vanderbilt University Medical Center, Nashville, TN, USA
| | - Matteo Bonini
- Department of Cardiovascular and Pulmonary Sciences, Università Cattolica del Sacro Cuore, Fondazione Policlinico A Gemelli-IRCCS, Rome, Italy
| | | | - Arnaud Bourdin
- Department of Respiratory Diseases, University of Montpellier, Montpellier, France
| | - Chris Brightling
- Institute for Lung Health, Leicester NIHR BRC, University of Leicester, Leicester, UK
| | - Guy Brusselle
- Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium; Departments of Epidemiology and Respiratory Medicine, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Roland Buhl
- Pulmonary Department, Mainz University Hospital, Mainz, Germany
| | | | - Alvaro A Cruz
- ProAR Foundation and School of Medicine, Federal University of Bahia, Salvador, Brazil
| | - Jeffrey Drazen
- Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Francine M Ducharme
- Departments of Pediatrics and of Social and Preventive Medicine, Sainte-Justine University Health Centre, University of Montreal, Montreal, QC, Canada
| | - Liesbeth Duijts
- Department of Pediatrics, Divisions of Respiratory Medicine and Allergology and Neonatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Louise Fleming
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Hiromasa Inoue
- Department of Pulmonary Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Fanny W S Ko
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Jerry A Krishnan
- Breathe Chicago Center, University of Illinois Chicago, Chicago, IL, USA
| | - Refiloe Masekela
- Department of Paediatrics and Child Health, University of KwaZulu Natal, Durban, South Africa
| | - Kevin Mortimer
- Department of Paediatrics and Child Health, University of KwaZulu Natal, Durban, South Africa; Department of Respiratory Medicine, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK; Cambridge Africa Department, University of Cambridge, Cambridge, UK
| | - Paulo Pitrez
- Pulmonology Department, Hospital Santa Casa de Porto Alegre, Porto Alegre, Brazil
| | - Sundeep Salvi
- Pulmocare Research and Education (PURE) Foundation, Pune, India
| | - Aziz Sheikh
- Primary Care Research & Development and Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Helen K Reddel
- Woolcock Institute of Medical Research and The University of Sydney, Sydney, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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17
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Geissler KH, Shieh MS, Evans V, Lindenauer PK, Ash AS, Krishnan JA, Goff SL. Influenza Vaccinations Among Privately and Publicly Insured Children With Asthma. Acad Pediatr 2023; 23:1368-1375. [PMID: 36870447 PMCID: PMC10474246 DOI: 10.1016/j.acap.2023.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 02/20/2023] [Accepted: 02/24/2023] [Indexed: 03/06/2023]
Abstract
OBJECTIVE Annual influenza vaccination rates for children remain well below the Healthy People 2030 target of 70%. We aimed to compare influenza vaccination rates for children with asthma by insurance type and to identify associated factors. METHODS This cross-sectional study examined influenza vaccination rates for children with asthma by insurance type, age, year, and disease status using the Massachusetts All Payer Claims Database (2014-2018). We used multivariable logistic regression to estimate the probability of vaccination accounting for child and insurance characteristics. RESULTS The sample included 317,596 child-year observations for children with asthma in 2015-18. Fewer than half of children with asthma received influenza vaccinations; 51.3% among privately insured and 45.1% among Medicaid insured. Risk modeling reduced, but did not eliminate, this gap; privately insured children were 3.7 percentage points (pp) more likely to receive an influenza vaccination than Medicaid-insured children (95% confidence interval [CI]: 2.9-4.5pp). Risk modeling also found persistent asthma was associated with more vaccinations (6.7pp higher; 95% CI: 6.2-7.2pp), as was younger age. The regression-adjusted probability of influenza vaccination in a non-office setting was 3.2pp higher in 2018 than 2015 (95% CI: 2.2-4.2pp), and significantly lower for children with Medicaid. CONCLUSIONS Despite clear recommendations for annual influenza vaccinations for children with asthma, low rates persist, particularly for children with Medicaid. Offering vaccines in non-office settings such as retail pharmacies may reduce barriers, but we did not observe increased vaccination rates in the first years after this policy change.
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Affiliation(s)
- Kimberley H Geissler
- Department of Health Promotion and Policy (KH Geissler, V Evans, and SL Goff), School of Public Health & Health Sciences, University of Massachusetts Amherst.
| | - Meng-Shiou Shieh
- Department of Healthcare Delivery and Population Sciences (M-S Shieh and PK Lindenauer), University of Massachusetts Chan Medical School-Baystate, Springfield, MA
| | - Valerie Evans
- Department of Health Promotion and Policy (KH Geissler, V Evans, and SL Goff), School of Public Health & Health Sciences, University of Massachusetts Amherst
| | - Peter K Lindenauer
- Department of Healthcare Delivery and Population Sciences (M-S Shieh and PK Lindenauer), University of Massachusetts Chan Medical School-Baystate, Springfield, MA; Department of Medicine (PK Lindenauer), University of Massachusetts Chan Medical School-Baystate, Springfield, MA
| | - Arlene S Ash
- Department of Population and Quantitative Health Sciences (AS Ash), UMass Chan Medical School, Worcester, MA
| | - Jerry A Krishnan
- Division of Epidemiology and Biostatistics (JA Krishnan), School of Public Health, University of Illinois Chicago; Division of Pulmonary, Critical Care, Sleep and Allergy (JA Krishnan), College of Medicine, University of Illinois Chicago; Institute for Healthcare Delivery Design (JA Krishnan), University of Illinois Chicago
| | - Sarah L Goff
- Department of Health Promotion and Policy (KH Geissler, V Evans, and SL Goff), School of Public Health & Health Sciences, University of Massachusetts Amherst
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18
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Krishnan JA, Margellos-Anast H, Kumar R, Africk JJ, Berbaum M, Bracken N, Chen YF, DeLisa J, Erwin K, Ignoffo S, Illendula SD, Kim H, Lohff C, MacTavish T, Martin MA, Mosnaim GS, Nguyen H, Norell S, Nyenhuis SM, Paik SM, Pittsenbarger Z, Press VG, Sculley J, Thompson TM, Zun L, Gerald LB, McDermott M. Coordinated Health Care Interventions for Childhood Asthma Gaps in Outcomes (CHICAGO) plan. J Allergy Clin Immunol Glob 2023; 2:100100. [PMID: 37641662 PMCID: PMC10461791 DOI: 10.1016/j.jacig.2023.100100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
Background Evidence-based strategies to improve outcomes in minority children with uncontrolled asthma discharged from the emergency department (ED) are needed. Objectives This multicenter pragmatic clinical trial was designed to compare an ED-only intervention (decision support tool), an ED-only intervention and home visits by community health workers for 6 months (ED-plus-home), and enhanced usual care (UC). Methods Children aged 5 to 11 years with uncontrolled asthma were enrolled. The change over 6 months in the Patient-Reported Outcomes Measurement Information System Asthma Impact Scale score in children and Satisfaction with Participation in Social Roles score in caregivers were the primary outcomes. The secondary outcomes included guideline-recommended ED discharge care and self-management. Results Recruitment was significantly lower than expected (373 vs 640 expected). Of the 373 children (64% Black and 31% Latino children), only 63% completed the 6-month follow-up visit. In multivariable analyses that accounted for missing data, the adjusted odds ratios and 98% CIs for differences in Asthma Impact Scores or caregivers' Satisfaction with Participation in Social Roles scores were not significant. However, guideline-recommended ED discharge care was significantly improved in the intervention groups versus in the UC group, and self-management behaviors were significantly improved in the ED-plus-home group versus in the ED-only and UC groups. Conclusions The ED-based interventions did not significantly improve the primary clinical outcomes, although the study was likely underpowered. Although guideline-recommended ED discharge care and self-management did improve, their effect on clinical outcomes needs further study.
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Affiliation(s)
- Jerry A. Krishnan
- Office of the Vice Chancellor for Health Affairs, University of Illinois Chicago
- Department of Medicine, University of Illinois Chicago
| | | | - Rajesh Kumar
- Department of Pediatrics, Northwestern University and Ann and Robert H. Lurie Children’s Hospital of Chicago
| | | | - Michael Berbaum
- Center for Clinical and Translational Science, University of Illinois Chicago
| | - Nina Bracken
- Department of Medicine, University of Illinois Chicago
| | - Yi-Fan Chen
- Center for Clinical and Translational Science, University of Illinois Chicago
| | - Julie DeLisa
- Department of Medicine, University of Illinois Chicago
| | - Kim Erwin
- Office of the Vice Chancellor for Health Affairs, University of Illinois Chicago
| | - Stacy Ignoffo
- Sinai Urban Health Institute, Sinai Health System, Chicago
| | | | - Hajwa Kim
- Center for Clinical and Translational Science, University of Illinois Chicago
| | | | - Tom MacTavish
- Institute of Design, Illinois Institute of Technology, Chicago
| | | | | | - Hannah Nguyen
- Department of Medicine, University of Illinois Chicago
| | - Sarah Norell
- Office of the Vice Chancellor for Health Affairs, University of Illinois Chicago
| | | | - S. Margaret Paik
- Department of Pediatrics, University of Chicago Medicine Comer Children’s Hospital
| | - Zachary Pittsenbarger
- Department of Pediatrics, Northwestern University and Ann and Robert H. Lurie Children’s Hospital of Chicago
| | - Valerie G. Press
- Department of Pediatrics, University of Chicago Medicine Comer Children’s Hospital
- Department of Medicine, University of Chicago Medicine
| | - Jennifer Sculley
- Office of the Vice Chancellor for Health Affairs, University of Illinois Chicago
| | - Trevonne M. Thompson
- Department of Emergency Medicine, Cook County Health and Hospitals System, Chicago
- Department of Emergency Medicine, University of Illinois Chicago
| | - Leslie Zun
- Department of Emergency Medicine and Psychiatry, Rosalind Franklin University of Medicine and Science, Chicago Medical School
| | - Lynn B. Gerald
- Office of the Vice Chancellor for Health Affairs, University of Illinois Chicago
- Department of Medicine, University of Illinois Chicago
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19
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Scanzera AC, Nyenhuis SM, Rudd BN, Ramaswamy M, Mazzucca S, Castro M, Kennedy DJ, Mermelstein RJ, Chambers DA, Dudek SM, Krishnan JA. Building a new regional home for implementation science: Annual Midwest Clinical & Translational Research Meetings. J Investig Med 2023; 71:567-576. [PMID: 37002618 DOI: 10.1177/10815589231166102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
The vision of the Central Society for Clinical and Translational Research (CSCTR) is to "promote a vibrant, supportive community of multidisciplinary, clinical, and translational medical research to benefit humanity." Together with the Midwestern Section of the American Federation for Medical Research, CSCTR hosts an Annual Midwest Clinical & Translational Research Meeting, a regional multispecialty meeting that provides the opportunity for trainees and early-stage investigators to present their research to leaders in their fields. There is an increasing national and global interest in implementation science (IS), the systematic study of activities (or strategies) to facilitate the successful uptake of evidence-based health interventions in clinical and community settings. Given the growing importance of this field and its relevance to the goals of the CSCTR, in 2022, the Midwest Clinical & Translational Research Meeting incorporated new initiatives and sessions in IS. In this report, we describe the role of IS in the translational research spectrum, provide a summary of sessions from the 2022 Midwest Clinical & Translational Research Meeting, and highlight initiatives to complement national efforts to build capacity for IS through the annual meetings.
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Affiliation(s)
- Angelica C Scanzera
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois Chicago, Chicago, IL, USA
| | | | - Brittany N Rudd
- Institute for Juvenile Research, University of Illinois Chicago, Chicago, IL, USA
| | - Megha Ramaswamy
- KU Medical Center, University of Kansas, Kansas City, KS, USA
| | | | - Mario Castro
- KU Medical Center, University of Kansas, Kansas City, KS, USA
| | - David J Kennedy
- Department of Medicine, University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA
| | - Robin J Mermelstein
- Institute for Health Research and Policy, University of Illinois Chicago, Chicago, IL, USA
| | - David A Chambers
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA
| | - Steven M Dudek
- Department of Medicine, University of Illinois Chicago, Chicago, IL, USA
| | - Jerry A Krishnan
- Department of Medicine, University of Illinois Chicago, Chicago, IL, USA
- Population Health Sciences Program, University of Illinois Chicago, Chicago, IL, USA
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20
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McKleroy W, Shing T, Anderson WH, Arjomandi M, Awan HA, Barjaktarevic I, Barr RG, Bleecker ER, Boscardin J, Bowler RP, Buhr RG, Criner GJ, Comellas AP, Curtis JL, Dransfield M, Doerschuk CM, Dolezal BA, Drummond MB, Han MK, Hansel NN, Helton K, Hoffman EA, Kaner RJ, Kanner RE, Krishnan JA, Lazarus SC, Martinez FJ, Ohar J, Ortega VE, Paine R, Peters SP, Reinhardt JM, Rennard S, Smith BM, Tashkin DP, Couper D, Cooper CB, Woodruff PG. Longitudinal Follow-Up of Participants With Tobacco Exposure and Preserved Spirometry. JAMA 2023; 330:442-453. [PMID: 37526720 PMCID: PMC10394572 DOI: 10.1001/jama.2023.11676] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 06/20/2023] [Indexed: 08/02/2023]
Abstract
Importance People who smoked cigarettes may experience respiratory symptoms without spirometric airflow obstruction. These individuals are typically excluded from chronic obstructive pulmonary disease (COPD) trials and lack evidence-based therapies. Objective To define the natural history of persons with tobacco exposure and preserved spirometry (TEPS) and symptoms (symptomatic TEPS). Design, Setting, and Participants SPIROMICS II was an extension of SPIROMICS I, a multicenter study of persons aged 40 to 80 years who smoked cigarettes (>20 pack-years) with or without COPD and controls without tobacco exposure or airflow obstruction. Participants were enrolled in SPIROMICS I and II from November 10, 2010, through July 31, 2015, and followed up through July 31, 2021. Exposures Participants in SPIROMICS I underwent spirometry, 6-minute walk distance testing, assessment of respiratory symptoms, and computed tomography of the chest at yearly visits for 3 to 4 years. Participants in SPIROMICS II had 1 additional in-person visit 5 to 7 years after enrollment in SPIROMICS I. Respiratory symptoms were assessed with the COPD Assessment Test (range, 0 to 40; higher scores indicate more severe symptoms). Participants with symptomatic TEPS had normal spirometry (postbronchodilator ratio of forced expiratory volume in the first second [FEV1] to forced vital capacity >0.70) and COPD Assessment Test scores of 10 or greater. Participants with asymptomatic TEPS had normal spirometry and COPD Assessment Test scores of less than 10. Patient-reported respiratory symptoms and exacerbations were assessed every 4 months via phone calls. Main Outcomes and Measures The primary outcome was assessment for accelerated decline in lung function (FEV1) in participants with symptomatic TEPS vs asymptomatic TEPS. Secondary outcomes included development of COPD defined by spirometry, respiratory symptoms, rates of respiratory exacerbations, and progression of computed tomographic-defined airway wall thickening or emphysema. Results Of 1397 study participants, 226 had symptomatic TEPS (mean age, 60.1 [SD, 9.8] years; 134 were women [59%]) and 269 had asymptomatic TEPS (mean age, 63.1 [SD, 9.1] years; 134 were women [50%]). At a median follow-up of 5.76 years, the decline in FEV1 was -31.3 mL/y for participants with symptomatic TEPS vs -38.8 mL/y for those with asymptomatic TEPS (between-group difference, -7.5 mL/y [95% CI, -16.6 to 1.6 mL/y]). The cumulative incidence of COPD was 33.0% among participants with symptomatic TEPS vs 31.6% among those with asymptomatic TEPS (hazard ratio, 1.05 [95% CI, 0.76 to 1.46]). Participants with symptomatic TEPS had significantly more respiratory exacerbations than those with asymptomatic TEPS (0.23 vs 0.08 exacerbations per person-year, respectively; rate ratio, 2.38 [95% CI, 1.71 to 3.31], P < .001). Conclusions and Relevance Participants with symptomatic TEPS did not have accelerated rates of decline in FEV1 or increased incidence of COPD vs those with asymptomatic TEPS, but participants with symptomatic TEPS did experience significantly more respiratory exacerbations over a median follow-up of 5.8 years.
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Affiliation(s)
- William McKleroy
- Division of Pulmonary, Critical Care, Sleep, and Allergy, Department of Medicine, School of Medicine, University of California, San Francisco
- Now with Department of Pulmonary and Critical Care Medicine, Kaiser Permanente San Francisco Medical Center, San Francisco, California
| | - Tracie Shing
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill
| | - Wayne H Anderson
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, School of Medicine, University of North Carolina, Chapel Hill
| | - Mehrdad Arjomandi
- Division of Pulmonary, Critical Care, Sleep, and Allergy, Department of Medicine, School of Medicine, University of California, San Francisco
- Division of Pulmonary and Critical Care Medicine, Medical Service, San Francisco VA Medical Center, San Francisco, California
| | - Hira Anees Awan
- Roy J. Carver Department of Biomedical Engineering, University of Iowa, Iowa City
| | - Igor Barjaktarevic
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles
| | - R Graham Barr
- Divisions of General Medicine and Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Columbia University Medical Center, New York, New York
- Department of Epidemiology, Columbia University Medical Center, New York, New York
| | - Eugene R Bleecker
- Division of Genetics, Genomics, and Precision Medicine, Department of Medicine, College of Medicine, University of Arizona, Tucson
- Division of Pharmacogenomics, Center for Applied Genetics and Genomic Medicine, University of Arizona, Tucson
| | - John Boscardin
- Department of Medicine and Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco
| | - Russell P Bowler
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, National Jewish Health, Denver, Colorado
| | - Russell G Buhr
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles
| | - Gerard J Criner
- Division of Thoracic Medicine and Surgery, Department of Medicine, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | - Alejandro P Comellas
- Division of Pulmonary, Critical Care, and Occupational Medicine, Department of Medicine, Carver College of Medicine, University of Iowa, Iowa City
| | - Jeffrey L Curtis
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, School of Medicine, University of Michigan, Ann Arbor
- Medical Service, VA Ann Arbor Healthcare System, Ann Arbor, Michigan
| | - Mark Dransfield
- Division of Pulmonary, Allergy, and Critical Care, Department of Medicine, University of Alabama, Birmingham
| | - Claire M Doerschuk
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, School of Medicine, University of North Carolina, Chapel Hill
| | - Brett A Dolezal
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles
| | - M Bradley Drummond
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, School of Medicine, University of North Carolina, Chapel Hill
| | - MeiLan K Han
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, School of Medicine, University of Michigan, Ann Arbor
| | - Nadia N Hansel
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Kinsey Helton
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill
| | - Eric A Hoffman
- Roy J. Carver Department of Biomedical Engineering, University of Iowa, Iowa City
- Division of Pulmonary, Critical Care, and Occupational Medicine, Department of Medicine, Carver College of Medicine, University of Iowa, Iowa City
- Department of Radiology, Carver College of Medicine, University of Iowa, Iowa City
| | - Robert J Kaner
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Richard E Kanner
- Division of Respiratory, Critical Care, and Occupational Pulmonary Medicine, Department of Medicine, School of Medicine, University of Utah, Salt Lake City
| | - Jerry A Krishnan
- Breathe Chicago Center, Division of Pulmonary, Critical Care, Sleep, and Allergy, University of Illinois, Chicago
| | - Stephen C Lazarus
- Division of Pulmonary, Critical Care, Sleep, and Allergy, Department of Medicine, School of Medicine, University of California, San Francisco
- Cardiovascular Research Institute, University of California, San Francisco
| | - Fernando J Martinez
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Jill Ohar
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Wake Forest University, Winston-Salem, North Carolina
| | - Victor E Ortega
- Division of Pulmonary Medicine, Department of Medicine, Mayo Clinic, Phoenix, Arizona
| | - Robert Paine
- Division of Respiratory, Critical Care, and Occupational Pulmonary Medicine, Department of Medicine, School of Medicine, University of Utah, Salt Lake City
| | - Stephen P Peters
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Wake Forest University, Winston-Salem, North Carolina
| | - Joseph M Reinhardt
- Roy J. Carver Department of Biomedical Engineering, University of Iowa, Iowa City
| | - Stephen Rennard
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, College of Medicine, University of Nebraska, Omaha
| | - Benjamin M Smith
- Divisions of General Medicine and Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Columbia University Medical Center, New York, New York
- Division of Experimental Medicine, McGill University, Montreal, Quebec, Canada
| | - Donald P Tashkin
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles
| | - David Couper
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill
| | - Christopher B Cooper
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles
- Department of Physiology, David Geffen School of Medicine, University of California, Los Angeles
| | - Prescott G Woodruff
- Division of Pulmonary, Critical Care, Sleep, and Allergy, Department of Medicine, School of Medicine, University of California, San Francisco
- Cardiovascular Research Institute, University of California, San Francisco
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21
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Arjomandi M, Zeng S, Chen J, Bhatt SP, Abtin F, Barjaktarevic I, Barr RG, Bleecker ER, Buhr RG, Criner GJ, Comellas AP, Couper DJ, Curtis JL, Dransfield MT, Fortis S, Han MK, Hansel NN, Hoffman EA, Hokanson JE, Kaner RJ, Kanner RE, Krishnan JA, Labaki WW, Lynch DA, Ortega VE, Peters SP, Woodruff PG, Cooper CB, Bowler RP, Paine III R, Rennard SI, Tashkin DP. Changes in Lung Volumes with Spirometric Disease Progression in COPD. Chronic Obstr Pulm Dis 2023; 10:270-285. [PMID: 37199719 PMCID: PMC10484496 DOI: 10.15326/jcopdf.2022.0363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/12/2023] [Indexed: 05/19/2023]
Abstract
Background Abnormal lung volumes representing air trapping identify the subset of smokers with preserved spirometry who develop spirometric chronic obstructive pulmonary disease (COPD) and adverse outcomes. However, how lung volumes evolve in early COPD as airflow obstruction develops remains unclear. Methods To establish how lung volumes change with the development of spirometric COPD, we examined lung volumes from the pulmonary function data (seated posture) available in the U.S. Department of Veterans Affairs electronic health records (n=71,356) and lung volumes measured by computed tomography (supine posture) available from the COPD Genetic Epidemiology (COPDGene®) study (n=7969) and the SubPopulations and InterMediate Outcome Measures In COPD Study (SPIROMICS) (n=2552) cohorts, and studied their cross-sectional distributions and longitudinal changes across the airflow obstruction spectrum. Patients with preserved ratio-impaired spirometry (PRISm) were excluded from this analysis. Results Lung volumes from all 3 cohorts showed similar patterns of distributions and longitudinal changes with worsening airflow obstruction. The distributions for total lung capacity (TLC), vital capacity (VC), and inspiratory capacity (IC) and their patterns of change were nonlinear and included different phases. When stratified by airflow obstruction using Global initiative for chronic Obstructive Lung Disease (GOLD) stages, patients with GOLD 1 (mild) COPD had larger lung volumes (TLC, VC, IC) compared to patients with GOLD 0 (smokers with preserved spirometry) or GOLD 2 (moderate) disease. In longitudinal follow-up of baseline GOLD 0 patients who progressed to spirometric COPD, those with an initially higher TLC and VC developed mild obstruction (GOLD 1) while those with an initially lower TLC and VC developed moderate obstruction (GOLD 2). Conclusions In COPD, TLC, and VC have biphasic distributions, change in nonlinear fashions as obstruction worsens, and could differentiate those GOLD 0 patients at risk for more rapid spirometric disease progression.
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Affiliation(s)
- Mehrdad Arjomandi
- San Francisco Veterans Affairs Healthcare System, San Francisco, California, United States
- Department of Medicine, University of California, San Francisco, California, United States
| | - Siyang Zeng
- San Francisco Veterans Affairs Healthcare System, San Francisco, California, United States
- Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, Washington, United States
| | - Jianhong Chen
- San Francisco Veterans Affairs Healthcare System, San Francisco, California, United States
- Department of Medicine, University of California, San Francisco, California, United States
| | - Surya P. Bhatt
- University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Fereidoun Abtin
- Department of Medicine, University of California, Los Angeles, California, United States
| | - Igor Barjaktarevic
- Department of Medicine, University of California, Los Angeles, California, United States
| | - R. Graham Barr
- Columbia-Presbyterian Medical Center, New York, New York, United States
| | - Eugene R. Bleecker
- University of Arizona, College of Medicine, Tucson, Arizona, United States
| | - Russell G. Buhr
- Department of Medicine, University of California, Los Angeles, California, United States
| | | | | | - David J. Couper
- University of North Carolina, Chapel Hill, North Carolina, United States
| | - Jeffrey L. Curtis
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, United States
- Medical Service, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, United States
| | | | | | - MeiLan K. Han
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, United States
| | - Nadia N. Hansel
- Department of Medicine, Johns Hopkins University, Baltimore, United States
| | | | - John E. Hokanson
- Department of Epidemiology, School of Public Health, University of Colorado, United States
| | - Robert J. Kaner
- Weill Cornell Medical Center, New York, New York, United States
| | | | | | - Wassim W. Labaki
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, United States
| | - David A. Lynch
- Department of Radiology, National Jewish Health Systems, Denver, Colorado, United States
| | | | - Stephen P. Peters
- Wake Forest School of Medicine, Winston-Salem, North Carolina, United States
| | - Prescott G. Woodruff
- Department of Medicine, University of California, San Francisco, California, United States
| | - Christopher B. Cooper
- Department of Medicine, University of California, Los Angeles, California, United States
| | - Russell P. Bowler
- Department of Medicine, National Jewish Health Systems, Denver, Colorado, United States
| | - Robert Paine III
- University of Utah, Salt Lake City, Utah, United States
- Department of Medicine, National Jewish Health Systems, Denver, Colorado, United States
| | | | - Donald P. Tashkin
- Columbia-Presbyterian Medical Center, New York, New York, United States
| | - the COPDGene and SPIROMICS Investigators.
- San Francisco Veterans Affairs Healthcare System, San Francisco, California, United States
- Department of Medicine, University of California, San Francisco, California, United States
- Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, Washington, United States
- University of Alabama at Birmingham, Birmingham, Alabama, United States
- Department of Medicine, University of California, Los Angeles, California, United States
- Columbia-Presbyterian Medical Center, New York, New York, United States
- University of Arizona, College of Medicine, Tucson, Arizona, United States
- Temple University, Philadelphia, Pennsylvania, United States
- University of Iowa, Iowa City, Iowa, United States
- University of North Carolina, Chapel Hill, North Carolina, United States
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, United States
- Medical Service, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, United States
- Department of Medicine, Johns Hopkins University, Baltimore, United States
- Department of Epidemiology, School of Public Health, University of Colorado, United States
- Weill Cornell Medical Center, New York, New York, United States
- University of Utah, Salt Lake City, Utah, United States
- University of Illinois at Chicago, Chicago, Illinois, United States
- Department of Radiology, National Jewish Health Systems, Denver, Colorado, United States
- Mayo Clinic, Scottsdale, Arizona, United States
- Wake Forest School of Medicine, Winston-Salem, North Carolina, United States
- Department of Medicine, National Jewish Health Systems, Denver, Colorado, United States
- University of Nebraska Medical Center, Omaha, Nebraska, United States
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22
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Horwitz LI, Thaweethai T, Brosnahan SB, Cicek MS, Fitzgerald ML, Goldman JD, Hess R, Hodder SL, Jacoby VL, Jordan MR, Krishnan JA, Laiyemo AO, Metz TD, Nichols L, Patzer RE, Sekar A, Singer NG, Stiles LE, Taylor BS, Ahmed S, Algren HA, Anglin K, Aponte-Soto L, Ashktorab H, Bassett IV, Bedi B, Bhadelia N, Bime C, Bind MAC, Black LJ, Blomkalns AL, Brim H, Castro M, Chan J, Charney AW, Chen BK, Chen LQ, Chen P, Chestek D, Chibnik LB, Chow DC, Chu HY, Clifton RG, Collins S, Costantine MM, Cribbs SK, Deeks SG, Dickinson JD, Donohue SE, Durstenfeld MS, Emery IF, Erlandson KM, Facelli JC, Farah-Abraham R, Finn AV, Fischer MS, Flaherman VJ, Fleurimont J, Fonseca V, Gallagher EJ, Gander JC, Gennaro ML, Gibson KS, Go M, Goodman SN, Granger JP, Greenway FL, Hafner JW, Han JE, Harkins MS, Hauser KSP, Heath JR, Hernandez CR, Ho O, Hoffman MK, Hoover SE, Horowitz CR, Hsu H, Hsue PY, Hughes BL, Jagannathan P, James JA, John J, Jolley S, Judd SE, Juskowich JJ, Kanjilal DG, Karlson EW, Katz SD, Kelly JD, Kelly SW, Kim AY, Kirwan JP, Knox KS, Kumar A, Lamendola-Essel MF, Lanca M, Lee-lannotti JK, Lefebvre RC, Levy BD, Lin JY, Logarbo BP, Logue JK, Longo MT, Luciano CA, Lutrick K, Malakooti SK, Mallett G, Maranga G, Marathe JG, Marconi VC, Marshall GD, Martin CF, Martin JN, May HT, McComsey GA, McDonald D, Mendez-Figueroa H, Miele L, Mittleman MA, Mohandas S, Mouchati C, Mullington JM, Nadkarni GN, Nahin ER, Neuman RB, Newman LT, Nguyen A, Nikolich JZ, Ofotokun I, Ogbogu PU, Palatnik A, Palomares KTS, Parimon T, Parry S, Parthasarathy S, Patterson TF, Pearman A, Peluso MJ, Pemu P, Pettker CM, Plunkett BA, Pogreba-Brown K, Poppas A, Porterfield JZ, Quigley JG, Quinn DK, Raissy H, Rebello CJ, Reddy UM, Reece R, Reeder HT, Rischard FP, Rosas JM, Rosen CJ, Rouphael NG, Rouse DJ, Ruff AM, Saint Jean C, Sandoval GJ, Santana JL, Schlater SM, Sciurba FC, Selvaggi C, Seshadri S, Sesso HD, Shah DP, Shemesh E, Sherif ZA, Shinnick DJ, Simhan HN, Singh U, Sowles A, Subbian V, Sun J, Suthar MS, Teunis LJ, Thorp JM, Ticotsky A, Tita ATN, Tragus R, Tuttle KR, Urdaneta AE, Utz PJ, VanWagoner TM, Vasey A, Vernon SD, Vidal C, Walker T, Ward HD, Warren DE, Weeks RM, Weiner SJ, Weyer JC, Wheeler JL, Whiteheart SW, Wiley Z, Williams NJ, Wisnivesky JP, Wood JC, Yee LM, Young NM, Zisis SN, Foulkes AS. Researching COVID to Enhance Recovery (RECOVER) adult study protocol: Rationale, objectives, and design. PLoS One 2023; 18:e0286297. [PMID: 37352211 PMCID: PMC10289397 DOI: 10.1371/journal.pone.0286297] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 05/12/2023] [Indexed: 06/25/2023] Open
Abstract
IMPORTANCE SARS-CoV-2 infection can result in ongoing, relapsing, or new symptoms or other health effects after the acute phase of infection; termed post-acute sequelae of SARS-CoV-2 infection (PASC), or long COVID. The characteristics, prevalence, trajectory and mechanisms of PASC are ill-defined. The objectives of the Researching COVID to Enhance Recovery (RECOVER) Multi-site Observational Study of PASC in Adults (RECOVER-Adult) are to: (1) characterize PASC prevalence; (2) characterize the symptoms, organ dysfunction, natural history, and distinct phenotypes of PASC; (3) identify demographic, social and clinical risk factors for PASC onset and recovery; and (4) define the biological mechanisms underlying PASC pathogenesis. METHODS RECOVER-Adult is a combined prospective/retrospective cohort currently planned to enroll 14,880 adults aged ≥18 years. Eligible participants either must meet WHO criteria for suspected, probable, or confirmed infection; or must have evidence of no prior infection. Recruitment occurs at 86 sites in 33 U.S. states, Washington, DC and Puerto Rico, via facility- and community-based outreach. Participants complete quarterly questionnaires about symptoms, social determinants, vaccination status, and interim SARS-CoV-2 infections. In addition, participants contribute biospecimens and undergo physical and laboratory examinations at approximately 0, 90 and 180 days from infection or negative test date, and yearly thereafter. Some participants undergo additional testing based on specific criteria or random sampling. Patient representatives provide input on all study processes. The primary study outcome is onset of PASC, measured by signs and symptoms. A paradigm for identifying PASC cases will be defined and updated using supervised and unsupervised learning approaches with cross-validation. Logistic regression and proportional hazards regression will be conducted to investigate associations between risk factors, onset, and resolution of PASC symptoms. DISCUSSION RECOVER-Adult is the first national, prospective, longitudinal cohort of PASC among US adults. Results of this study are intended to inform public health, spur clinical trials, and expand treatment options. REGISTRATION NCT05172024.
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Affiliation(s)
- Leora I. Horwitz
- Department of Population Health, NYU Grossman School of Medicine, New York, New York, United States of America
| | - Tanayott Thaweethai
- Department of Biostatistics, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Shari B. Brosnahan
- Division of Pulmonary Critical Care and Sleep Medicine, NYU Langone Health, New York, New York, United States of America
| | - Mine S. Cicek
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Megan L. Fitzgerald
- Patient Led Research Collaboration on COVID-19, Washington, DC, United States of America
| | - Jason D. Goldman
- Division of Infectious Diseases, Providence Swedish Medical Center, Seattle, Washington, United States of America
| | - Rachel Hess
- Department of Population Health Sciences and Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, United States of America
| | - S. L. Hodder
- Department of Medicine, West Virginia University, Morgantown, West Virginia, United States of America
| | - Vanessa L. Jacoby
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, California, United States of America
| | - Michael R. Jordan
- Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Medford, Massachusetts, United States of America
| | - Jerry A. Krishnan
- Department of Medicine, University of Illinois Chicago, Chicago, Illinois, United States of America
| | - Adeyinka O. Laiyemo
- Department of Medicine, Howard University, Washington, DC, United States of America
| | - Torri D. Metz
- Department of Obstetrics and Gynecology, University of Utah Health, Salt Lake City, Utah, United States of America
| | - Lauren Nichols
- Body Politic COVID-19 Support Group, Boston, Massachusetts, United States of America
| | - Rachel E. Patzer
- Department of Medicine and Surgery, Health Services Research Center, Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - Anisha Sekar
- Patient Led Research Collaboration on COVID-19, Washington, DC, United States of America
| | - Nora G. Singer
- Department of Medicine and Rheumatology, The MetroHealth Medical Center, Cleveland, Ohio, United States of America
| | - Lauren E. Stiles
- Department of Neurology, Stony Brook University Renaissance School of Medicine, Stony Brook, New York, United States of America
| | - Barbara S. Taylor
- Department of Medicine, Division of Infectious Diseases and Infectious Diseases, Long School of Medicine, University of Texas Health Science Center San Antonio, San Antonio, Texas, United States of America
| | - Shifa Ahmed
- Department of Biostatistics, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Heather A. Algren
- Swedish Center for Research and Innovation, Providence Swedish Medical Center, Seattle, Washington, United States of America
| | - Khamal Anglin
- Department of Epidemiology and Biostatistics, University of California at San Francisco Institute of Global Health Sciences, San Francisco, San Francisco, California, United States of America
| | - Lisa Aponte-Soto
- College of Science and Health, Department of Health Sciences, DePaul University, Chicago, Illinois, United States of America
| | - Hassan Ashktorab
- Department of Medicine, Howard University, Washington, DC, United States of America
| | - Ingrid V. Bassett
- Medical Practice Evaluation Center, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Brahmchetna Bedi
- Department of Medicine, Emory University, Atlanta, Georgia, United States of America
| | - Nahid Bhadelia
- Center for Emerging Infectious Diseases Policy and Research, Boston University School of Medicine, Boston, Massachusetts, United States of America
| | - Christian Bime
- Department of Medicine, University of Arizona, Tucson, Arizona, United States of America
| | - Marie-Abele C. Bind
- Department of Biostatistics, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Lora J. Black
- Department of Clinical Research, Sanford Research, Sioux Falls, South Dakota, United States of America
| | - Andra L. Blomkalns
- Department of Emergency Medicine, Stanford University, Stanford, California, United States of America
| | - Hassan Brim
- Department of Pathology, Howard University, Washington, DC, United States of America
| | - Mario Castro
- Division of Pulmonary and Critical Care, University of Kansas Medical Center, Kansas City, Kansas City, United States of America
| | - James Chan
- Department of Biostatistics, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Alexander W. Charney
- Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Benjamin K. Chen
- Division of Infectious Disease, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Li Qing Chen
- Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
| | - Peter Chen
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, United States of America
| | - David Chestek
- Department of Emergency Medicine, University of Illinois Chicago, Chicago, Illinois, United States of America
| | - Lori B. Chibnik
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Dominic C. Chow
- Department of Medicine, University of Hawaii at Manoa John A. Burns School of Medicine, Honolulu, Hawaii, United States of America
| | - Helen Y. Chu
- Department of Allergy & Infectious Diseases, University of Washington, Seattle, Washington, United States of America
| | - Rebecca G. Clifton
- Department of Biostatistics, George Washington University, Washington, DC, United States of America
| | - Shelby Collins
- Department of Medicine, Emory University, Atlanta, Georgia, United States of America
| | - Maged M. Costantine
- Department of Obstetrics and Gynecology, The Ohio State University Hospital, Columbus, Ohio, United States of America
| | - Sushma K. Cribbs
- Department of Medicine, Emory University, Atlanta, Georgia, United States of America
| | - Steven G. Deeks
- Department of Medicine, University of California, San Francisco, San Francisco, California, United States of America
| | - John D. Dickinson
- Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska, United States of America
| | - Sarah E. Donohue
- Department of Research Services, University of Illinois College of Medicine, Peoria, Illinois, United States of America
| | - Matthew S. Durstenfeld
- Department of Medicine, Division of Cardiology at Zuckerberg San Francisco General, University of California San Francisco, San Francisco, California, United States of America
| | - Ivette F. Emery
- MaineHealth Institute for Research, MaineHealth, Scarborough, Maine, United States of America
| | - Kristine M. Erlandson
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States of America
| | - Julio C. Facelli
- Department of Biomedical Informatics and Clinical and Translational Science Institute, University of Utah, Salt Lake City, Utah, United States of America
| | - Rachael Farah-Abraham
- Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - Aloke V. Finn
- Department of Pathology, CVPath Institute, Gaithersburg, Maryland, United States of America
| | - Melinda S. Fischer
- Department of Medicine, Division of Infectious Diseases and Infectious Diseases, Long School of Medicine, University of Texas Health Science Center San Antonio, San Antonio, Texas, United States of America
| | - Valerie J. Flaherman
- Department of Pediatrics, University of California, San Francisco, San Francisco, California, United States of America
| | - Judes Fleurimont
- Mile Square Health Center, University of Illinois Chicago, University of Illinois Chicago, Chicago, Illinois, United States of America
| | - Vivian Fonseca
- Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana, United States of America
| | - Emily J. Gallagher
- Department of Endocrinology, Diabetes and Bone Disease, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Jennifer C. Gander
- Center for Research and Evaluation, Kaiser Permanente of Georgia, Atlanta, Georgia, United States of America
| | - Maria Laura Gennaro
- Public Health Research Institute and Department of Medicine, Rutgers New Jersey Medical School, Newark, New Jersey, United States of America
| | - Kelly S. Gibson
- Department of Obstetrics and Gynecology, MetroHealth System, Cleveland, Ohio, United States of America
| | - Minjoung Go
- Department of Medicine, Stanford University, Stanford, California, United States of America
| | - Steven N. Goodman
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, California, United States of America
| | - Joey P. Granger
- Department of Physiology & Biophysics, University of Mississippi Medical Center, Jackson, Mississippi, United States of America
| | - Frank L. Greenway
- Clinical Trials, Pennington Biomedical Research Center, Baton Rouge, Louisiana, United States of America
| | - John W. Hafner
- Department of Emergency Medicine, OSF Saint Francis Medical Center, Peoria, Illinois, United States of America
| | - Jenny E. Han
- Department of Pulmonary and Critical Care, Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - Michelle S. Harkins
- Department of Internal Medicine University of New Mexico, Health Science Center, Albuquerque, New Mexico, United States of America
| | - Kristine S. P. Hauser
- Clinical Research Center, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America
| | - James R. Heath
- Department of Bioengineering, Institute for Systems Biology, Seattle, Washington, United States of America
| | - Carla R. Hernandez
- Clinical Research Center, University Hospitals Cleveland Medical Center, Cleveland, Ohio, United States of America
| | - On Ho
- Seattle Children’s Therapeutics, Seattle, Washington, United States of America
| | - Matthew K. Hoffman
- Department of Obstetrics and Gynecology, Christiana Care Health Services, Newark, Delaware, United States of America
| | - Susan E. Hoover
- Department of Clinical Research, Sanford Research, Sioux Falls, South Dakota, United States of America
| | - Carol R. Horowitz
- Institute for Health Equity Research, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Harvey Hsu
- Department of Internal Medicine, University of Arizona, Phoenix, Arizona, United States of America
| | - Priscilla Y. Hsue
- Department of Medicine, University of California, San Francisco, San Francisco, California, United States of America
| | - Brenna L. Hughes
- Department of Obstetrics and Gynecology, Duke University, Durham, North Carolina, United States of America
| | - Prasanna Jagannathan
- Department of Medicine, Stanford University, Stanford, California, United States of America
| | - Judith A. James
- Department of Arthritis & Clinical Immunology, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma, United States of America
| | - Janice John
- Department of Family Medicine, Cambridge Health Alliance, Cambridge, Massachusetts, United States of America
| | - Sarah Jolley
- Department of Pulmonary and Critical Care Medicine, University of Colorado, Aurora, Colorado, United States of America
| | - S. E. Judd
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Joy J. Juskowich
- Department of Medicine, Division of Infectious Diseases, West Virginia School of Medicine, Morgantown, West Virginia, United States of America
| | - Diane G. Kanjilal
- Department of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Elizabeth W. Karlson
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Stuart D. Katz
- Department of Medicine, NYU Langone Health, New York, New York, United States of America
| | - J. Daniel Kelly
- Department of Medicine, University of California, San Francisco, San Francisco, California, United States of America
| | - Sara W. Kelly
- Department of Pediatrics & Department of Research Services, University of Illinois College of Medicine, Peoria, Illinois, United States of America
| | - Arthur Y. Kim
- Department of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - John P. Kirwan
- Department Integrated Physiology and Molecular Medicine, Pennington Biomedical Research Center, Baton Rouge, Louisiana, United States of America
| | - Kenneth S. Knox
- Department of Internal Medicine, University of Arizona, Phoenix, Arizona, United States of America
| | - Andre Kumar
- Department of Medicine, Stanford University, Stanford, California, United States of America
| | | | - Margaret Lanca
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Joyce K. Lee-lannotti
- Department of Internal Medicine and Neurology, University of Arizona College of Medicine Phoenix, Phoenix, Arizona, United States of America
| | - R. Craig Lefebvre
- Communications Practice Area, RTI International, Research Triangle Park, North Carolina, United States of America
| | - Bruce D. Levy
- Department of Internal Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
| | - Janet Y. Lin
- Department of Emergency Medicine, University of Illinois Chicago, Chicago, Illinois, United States of America
| | - Brian P. Logarbo
- Tulane Center for Clinical Research, Tulane University School of Medicine, New Orleans, Louisiana, United States of America
| | - Jennifer K. Logue
- Department of Medicine, University of Washington, Seattle, Washington, United States of America
| | - Michele T. Longo
- Tulane Center for Clinical Neurosciences, Tulane School of Medicine, New Orleans, Louisiana, United States of America
| | - Carlos A. Luciano
- Department of Neurology, University of Puerto Rico School of Medicine, San Juan, Puerto Rico, United States of America
| | - Karen Lutrick
- Department of Family & Community Medicine, University of Arizona, College of Medicine – Tucson, Tucson, Arizona, United States of America
| | - Shahdi K. Malakooti
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio, United States of America
| | - Gail Mallett
- Department of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois, United States of America
| | - Gabrielle Maranga
- Department of Population Health, NYU Grossman School of Medicine, New York, New York, United States of America
| | - Jai G. Marathe
- Department of Medicine, Section of Infectious Diseases, Boston University Medical Center, Boston, Massachusetts, United States of America
| | - Vincent C. Marconi
- Department of Medicine, Infectious Diseases and Department of Global Health, Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - Gailen D. Marshall
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, United States of America
| | - Christopher F. Martin
- Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - Jeffrey N. Martin
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, United States of America
| | - Heidi T. May
- Department of Cardiology, Intermountain Medical Center, Salt Lake City, Utah, United States of America
| | - Grace A. McComsey
- Department of Medicine, Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, Ohio, United States of America
| | - Dylan McDonald
- Department of Allergy & Infectious Diseases, University of Washington, Seattle, Washington, United States of America
| | - Hector Mendez-Figueroa
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Texas Health Science Center at Houston, Houston, Texas, United States of America
| | - Lucio Miele
- Department of Genetics, Louisiana State University Health Sciences Center, New Orleans, Louisiana, United States of America
| | - Murray A. Mittleman
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Sindhu Mohandas
- Department of Infectious Diseases, Children’s Hospital Los Angeles, University of Southern California, Los Angeles, California, United States of America
| | - Christian Mouchati
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio, United States of America
| | - Janet M. Mullington
- Department of Neurology and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America
| | - Girish N. Nadkarni
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Erica R. Nahin
- Department of Medicine, NYU Langone Health, New York, New York, United States of America
| | - Robert B. Neuman
- Division of Cardiology, Kaiser Permanente of Georgia, Atlanta, Georgia, United States of America
| | - Lisa T. Newman
- Department of Social, Statistical and Environmental Sciences, RTI International, Research Triangle Park, North Carolina, United States of America
| | - Amber Nguyen
- Department of Biostatistics, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Janko Z. Nikolich
- Department of Immunobiology, University of Arizona College of Medicine, Tucson, Arizona, United States of America
| | - Igho Ofotokun
- Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - Princess U. Ogbogu
- Division of Pediatric Allergy, Immunology, and Rheumatology, University Hospitals Rainbow Babies and Children’s Hospital, Cleveland, Ohio, United States of America
| | - Anna Palatnik
- Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, Wisconsin, United States of America
| | - Kristy T. S. Palomares
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Saint Peter’s University Hospital, New Brunswick, New Jersey, United States of America
| | - Tanyalak Parimon
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, United States of America
| | - Samuel Parry
- Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Sairam Parthasarathy
- Department of Medicine, University of Arizona, Tucson, Arizona, United States of America
| | - Thomas F. Patterson
- Department of Medicine, Department of Infectious Disease, University of Texas Health, San Antonio, Texas, United States of America
| | - Ann Pearman
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio, United States of America
| | - Michael J. Peluso
- Division of HIV, Infectious Disease, and Global Medicine, University of California, San Francisco, California, United States of America
| | - Priscilla Pemu
- Department of Medicine, Morehouse School of Medicine, Atlanta, Georgia, United States of America
| | - Christian M. Pettker
- Department of Obstetrics, Gynecology & Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut, United States of America
| | - Beth A. Plunkett
- Department of Obstetrics and Gynecology, NorthShore University Health System, Evanston, Illinois, United States of America
| | - Kristen Pogreba-Brown
- Department of Epidemiology and Biostatistics, University of Arizona, Tucson, Arizona, United States of America
| | - Athena Poppas
- Division of Cardiology, Warren Alpert Medical School of Brown University, Providence, Rhode Island, United States of America
| | - J. Zachary Porterfield
- Department of Internal Medicine, Division of Infectious Diseases, University of Kentucky, Lexington, Kentucky, United States of America
| | - John G. Quigley
- Department of Medicine, Division of Hematology/Oncology, University of Illinois Chicago, Chicago, Illinois, United States of America
| | - Davin K. Quinn
- Department of Psychiatry and Behavioral Sciences, University of New Mexico School of Medicine, Albuquerque, New Mexico, United States of America
| | - Hengameh Raissy
- Department of Pediatrics, University of New Mexico, Health Sciences Center, Albuquerque, New Mexico, United States of America
| | - Candida J. Rebello
- Department of Nutrition and Chronic Disease, Pennington Biomedical Research Center, Baton Rouge, Louisiana, United States of America
| | - Uma M. Reddy
- Department of Obstetrics and Gynecology, Columbia University, New York, New York, United States of America
| | - Rebecca Reece
- Department of Medicine, Division of Infectious Diseases, West Virginia School of Medicine, Morgantown, West Virginia, United States of America
| | - Harrison T. Reeder
- Department of Biostatistics, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Franz P. Rischard
- Department of Pulmonary and Critical Care, University of Arizona, Tucson, Arizona, United States of America
| | - Johana M. Rosas
- Department of Medicine, NYU Langone Health, New York, New York, United States of America
| | - Clifford J. Rosen
- MaineHealth Institute for Research, MaineHealth, Scarborough, Maine, United States of America
| | - Nadine G. Rouphael
- Department of Medicine, Emory University, Atlanta, Georgia, United States of America
| | - Dwight J. Rouse
- Department of Obstetrics and Gynecology, Brown University, Providence, Rhode Island, United States of America
| | - Adam M. Ruff
- Division of Pulmonary and Critical Care, University of Kansas Medical Center, Kansas City, Kansas City, United States of America
| | - Christina Saint Jean
- Department of Population Health, NYU Grossman School of Medicine, New York, New York, United States of America
| | - Grecio J. Sandoval
- Department of Biostatistics, George Washington University, Washington, DC, United States of America
| | - Jorge L. Santana
- Department of Medicine, University of Puerto Rico, San Juan, Puerto Rico, United States of America
| | - Shannon M. Schlater
- Department of Internal Medicine, University of Utah, Salt Lake City, Utah, United States of America
| | - Frank C. Sciurba
- Department of Medicine, Division of Pulmonary Allergy and Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Caitlin Selvaggi
- Department of Biostatistics, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Sudha Seshadri
- Glenn Biggs Institute for Alzheimer’s and Neurodegenerative Diseases, University of Texas Health Sciences Center San Antonio, San Antonio, Texas, United States of America
| | - Howard D. Sesso
- Division of Preventive Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
| | - Dimpy P. Shah
- Department of Population Health Sciences, Mays Cancer Center, University of Texas Health, San Antonio, Texas, United States of America
| | - Eyal Shemesh
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Zaki A. Sherif
- Department of Biochemistry & Molecular Biology, Howard University College of Medicine, Washington, DC, United States of America
| | - Daniel J. Shinnick
- Department of Biostatistics, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Hyagriv N. Simhan
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States of America
| | - Upinder Singh
- Department of Internal Medicine, Stanford University, Stanford, California, United States of America
| | - Amber Sowles
- Department of Obstetrics and Gynecology, University of Utah Health, Salt Lake City, Utah, United States of America
| | - Vignesh Subbian
- Department of Biomedical Engineering, Department of Systems and Industrial Engineering, University of Arizona College of Engineering, Tucson, Arizona, United States of America
| | - Jun Sun
- Department of Medicine, University of Illinois Chicago, Chicago, Illinois, United States of America
| | - Mehul S. Suthar
- Department of Pediatrics, Emory Vaccine Center, Emory University, Atlanta, Georgia, United States of America
| | - Larissa J. Teunis
- Health Services Research Center, Emory University, Atlanta, Georgia, United States of America
| | - John M. Thorp
- Department of Obstetrics and Gynecology, University of North Carolina Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Amberly Ticotsky
- Department of Family Medicine, Cambridge Health Alliance, Cambridge, Massachusetts, United States of America
| | - Alan T. N. Tita
- Department of Obstetrics and Gynecology and Center for Women’s Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Robin Tragus
- Department of Medicine, University of Texas Health Science Center, San Antonio, Texas, United States of America
| | - Katherine R. Tuttle
- Department of Medicine, Division of Nephrology, University of Washington School of Medicine, Spokane, Washington, United States of America
| | - Alfredo E. Urdaneta
- Department of Emergency Medicine, Stanford University, Stanford, California, United States of America
| | - P. J. Utz
- Department of Internal Medicine, Stanford University, Stanford, California, United States of America
| | - Timothy M. VanWagoner
- Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States of America
| | - Andrew Vasey
- Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska, United States of America
| | - Suzanne D. Vernon
- Department of Research, Bateman Horne Center, Salt Lake City, Utah, United States of America
| | - Crystal Vidal
- Department of Population Health, NYU Grossman School of Medicine, New York, New York, United States of America
| | - Tiffany Walker
- Department of Medicine, Emory University, Atlanta, Georgia, United States of America
| | - Honorine D. Ward
- Department of Medicine, Tufts Medical Center, Boston, Massachusetts, United States of America
| | - David E. Warren
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, Nebraska, United States of America
| | - Ryan M. Weeks
- Department of Microbiology, Immunology, and Molecular Genetics, University of Kentucky, Lexington, Kentucky, United States of America
| | - Steven J. Weiner
- Department of Biostatistics, George Washington University, Washington, DC, United States of America
| | - Jordan C. Weyer
- Center for Individualized Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Jennifer L. Wheeler
- Center for Individualized Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Sidney W. Whiteheart
- Department of Molecular and Cellular Biochemistry, University of Kentucky, Lexington, Kentucky, United States of America
| | - Zanthia Wiley
- Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - Natasha J. Williams
- Institute for Excellence in Health Equity, NYU Grossman School of Medicine, New York, New York, United States of America
| | - Juan P. Wisnivesky
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - John C. Wood
- Department of Pediatrics and Radiology, Children’s Hospital of Los Angeles, Los Angeles, California, United States of America
| | - Lynn M. Yee
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
| | - Natalie M. Young
- Swedish Center for Research and Innovation, Providence Swedish Medical Center, Seattle, Washington, United States of America
| | - Sokratis N. Zisis
- Department of Medicine, Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, Ohio, United States of America
| | - Andrea S. Foulkes
- Department of Biostatistics, Massachusetts General Hospital, Boston, Massachusetts, United States of America
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Thaweethai T, Jolley SE, Karlson EW, Levitan EB, Levy B, McComsey GA, McCorkell L, Nadkarni GN, Parthasarathy S, Singh U, Walker TA, Selvaggi CA, Shinnick DJ, Schulte CCM, Atchley-Challenner R, Alba GA, Alicic R, Altman N, Anglin K, Argueta U, Ashktorab H, Baslet G, Bassett IV, Bateman L, Bedi B, Bhattacharyya S, Bind MA, Blomkalns AL, Bonilla H, Bush PA, Castro M, Chan J, Charney AW, Chen P, Chibnik LB, Chu HY, Clifton RG, Costantine MM, Cribbs SK, Davila Nieves SI, Deeks SG, Duven A, Emery IF, Erdmann N, Erlandson KM, Ernst KC, Farah-Abraham R, Farner CE, Feuerriegel EM, Fleurimont J, Fonseca V, Franko N, Gainer V, Gander JC, Gardner EM, Geng LN, Gibson KS, Go M, Goldman JD, Grebe H, Greenway FL, Habli M, Hafner J, Han JE, Hanson KA, Heath J, Hernandez C, Hess R, Hodder SL, Hoffman MK, Hoover SE, Huang B, Hughes BL, Jagannathan P, John J, Jordan MR, Katz SD, Kaufman ES, Kelly JD, Kelly SW, Kemp MM, Kirwan JP, Klein JD, Knox KS, Krishnan JA, Kumar A, Laiyemo AO, Lambert AA, Lanca M, Lee-Iannotti JK, Logarbo BP, Longo MT, Luciano CA, Lutrick K, Maley JH, Marathe JG, Marconi V, Marshall GD, Martin CF, Matusov Y, Mehari A, Mendez-Figueroa H, Mermelstein R, Metz TD, Morse R, Mosier J, Mouchati C, Mullington J, Murphy SN, Neuman RB, Nikolich JZ, Ofotokun I, Ojemakinde E, Palatnik A, Palomares K, Parimon T, Parry S, Patterson JE, Patterson TF, Patzer RE, Peluso MJ, Pemu P, Pettker CM, Plunkett BA, Pogreba-Brown K, Poppas A, Quigley JG, Reddy U, Reece R, Reeder H, Reeves WB, Reiman EM, Rischard F, Rosand J, Rouse DJ, Ruff A, Saade G, Sandoval GJ, Schlater SM, Shepherd F, Sherif ZA, Simhan H, Singer NG, Skupski DW, Sowles A, Sparks JA, Sukhera FI, Taylor BS, Teunis L, Thomas RJ, Thorp JM, Thuluvath P, Ticotsky A, Tita AT, Tuttle KR, Urdaneta AE, Valdivieso D, VanWagoner TM, Vasey A, Verduzco-Gutierrez M, Wallace ZS, Ward HD, Warren DE, Weiner SJ, Welch S, Whiteheart SW, Wiley Z, Wisnivesky JP, Yee LM, Zisis S, Horwitz LI, Foulkes AS. Development of a Definition of Postacute Sequelae of SARS-CoV-2 Infection. JAMA 2023; 329:1934-1946. [PMID: 37278994 PMCID: PMC10214179 DOI: 10.1001/jama.2023.8823] [Citation(s) in RCA: 152] [Impact Index Per Article: 152.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 05/01/2023] [Indexed: 06/07/2023]
Abstract
Importance SARS-CoV-2 infection is associated with persistent, relapsing, or new symptoms or other health effects occurring after acute infection, termed postacute sequelae of SARS-CoV-2 infection (PASC), also known as long COVID. Characterizing PASC requires analysis of prospectively and uniformly collected data from diverse uninfected and infected individuals. Objective To develop a definition of PASC using self-reported symptoms and describe PASC frequencies across cohorts, vaccination status, and number of infections. Design, Setting, and Participants Prospective observational cohort study of adults with and without SARS-CoV-2 infection at 85 enrolling sites (hospitals, health centers, community organizations) located in 33 states plus Washington, DC, and Puerto Rico. Participants who were enrolled in the RECOVER adult cohort before April 10, 2023, completed a symptom survey 6 months or more after acute symptom onset or test date. Selection included population-based, volunteer, and convenience sampling. Exposure SARS-CoV-2 infection. Main Outcomes and Measures PASC and 44 participant-reported symptoms (with severity thresholds). Results A total of 9764 participants (89% SARS-CoV-2 infected; 71% female; 16% Hispanic/Latino; 15% non-Hispanic Black; median age, 47 years [IQR, 35-60]) met selection criteria. Adjusted odds ratios were 1.5 or greater (infected vs uninfected participants) for 37 symptoms. Symptoms contributing to PASC score included postexertional malaise, fatigue, brain fog, dizziness, gastrointestinal symptoms, palpitations, changes in sexual desire or capacity, loss of or change in smell or taste, thirst, chronic cough, chest pain, and abnormal movements. Among 2231 participants first infected on or after December 1, 2021, and enrolled within 30 days of infection, 224 (10% [95% CI, 8.8%-11%]) were PASC positive at 6 months. Conclusions and Relevance A definition of PASC was developed based on symptoms in a prospective cohort study. As a first step to providing a framework for other investigations, iterative refinement that further incorporates other clinical features is needed to support actionable definitions of PASC.
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Affiliation(s)
- Tanayott Thaweethai
- Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
| | | | | | | | - Bruce Levy
- Harvard Medical School, Boston, Massachusetts
- Brigham and Women's Hospital, Boston, Massachusetts
| | | | - Lisa McCorkell
- Patient-Led Research Collaborative, Calabasas, California
| | | | | | - Upinder Singh
- Stanford University School of Medicine, Stanford, California
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Mario Castro
- University of Kansas Medical Center, Kansas City
| | | | | | - Peter Chen
- Cedars-Sinai Medical Center, Los Angeles, California
| | | | - Helen Y Chu
- University of Washington School of Medicine, Seattle
| | | | | | | | | | | | | | | | | | | | | | | | - Cheryl E Farner
- The University of Texas Health Science Center at San Antonio
| | | | | | - Vivian Fonseca
- Tulane University Health Sciences Center, New Orleans, Louisiana
| | | | | | | | | | | | | | - Minjoung Go
- Stanford University School of Medicine, Stanford, California
| | | | | | | | | | - John Hafner
- University of Illinois Chicago College of Medicine
| | - Jenny E Han
- Emory University School of Medicine, Atlanta, Georgia
| | | | - James Heath
- Institute for Systems Biology, Seattle, Washington
| | | | - Rachel Hess
- University of Utah Schools of the Health Sciences, Salt Lake City
| | - Sally L Hodder
- West Virginia Clinical and Translational Science Institute, Morgantown
| | | | | | | | | | | | - Janice John
- Cambridge Health Alliance, Cambridge, Massachusetts
| | | | - Stuart D Katz
- New York University Grossman School of Medicine, New York
| | | | | | - Sara W Kelly
- University of Illinois College of Medicine at Peoria
| | | | - John P Kirwan
- Pennington Biomedical Research Center, Baton Rouge, Louisiana
| | | | | | - Jerry A Krishnan
- University of Illinois Hospital and Health Sciences System, Chicago
| | - Andre Kumar
- Stanford University School of Medicine, Stanford, California
| | | | | | | | | | | | | | | | | | - Jason H Maley
- Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | | | | | | | | | - Yuri Matusov
- Cedars-Sinai Medical Center, Los Angeles, California
| | - Alem Mehari
- Howard University College of Medicine, Washington, DC
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Jan E Patterson
- The University of Texas Health Science Center at San Antonio
| | | | | | | | | | | | - Beth A Plunkett
- Harvard Medical School, Boston, Massachusetts
- NorthShore University HealthSystem, Evanston, Illinois
| | | | - Athena Poppas
- Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | | | - Uma Reddy
- Columbia University Irving Medical Center, New York, New York
| | - Rebecca Reece
- West Virginia University School of Medicine, Morgantown
| | | | - W B Reeves
- Department of Medicine, The University of Texas Health Science Center at San Antonio
| | | | | | | | | | - Adam Ruff
- The University of Kansas Medical Center, Kansas City
| | | | - Grecio J Sandoval
- Milken Institute of Public Health, The George Washington University, Washington, DC
| | | | | | - Zaki A Sherif
- Howard University College of Medicine, Washington, DC
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Steven J Weiner
- The George Washington University Biostatistics Center, Rockville, Maryland
| | | | | | | | | | - Lynn M Yee
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | | | | | - Andrea S Foulkes
- Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
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24
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Van Buren E, Radicioni G, Lester S, O’Neal WK, Dang H, Kasela S, Garudadri S, Curtis JL, Han MK, Krishnan JA, Wan ES, Silverman EK, Hastie A, Ortega VE, Lappalainen T, Nawijn MC, van den Berge M, Christenson SA, Li Y, Cho MH, Kesimer M, Kelada SNP. Genetic regulators of sputum mucin concentration and their associations with COPD phenotypes. PLoS Genet 2023; 19:e1010445. [PMID: 37352370 PMCID: PMC10325042 DOI: 10.1371/journal.pgen.1010445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 07/06/2023] [Accepted: 04/26/2023] [Indexed: 06/25/2023] Open
Abstract
Hyper-secretion and/or hyper-concentration of mucus is a defining feature of multiple obstructive lung diseases, including chronic obstructive pulmonary disease (COPD). Mucus itself is composed of a mixture of water, ions, salt and proteins, of which the gel-forming mucins, MUC5AC and MUC5B, are the most abundant. Recent studies have linked the concentrations of these proteins in sputum to COPD phenotypes, including chronic bronchitis (CB) and acute exacerbations (AE). We sought to determine whether common genetic variants influence sputum mucin concentrations and whether these variants are also associated with COPD phenotypes, specifically CB and AE. We performed a GWAS to identify quantitative trait loci for sputum mucin protein concentration (pQTL) in the Sub-Populations and InteRmediate Outcome Measures in COPD Study (SPIROMICS, n = 708 for total mucin, n = 215 for MUC5AC, MUC5B). Subsequently, we tested for associations of mucin pQTL with CB and AE using regression modeling (n = 822-1300). Replication analysis was conducted using data from COPDGene (n = 5740) and by examining results from the UK Biobank. We identified one genome-wide significant pQTL for MUC5AC (rs75401036) and two for MUC5B (rs140324259, rs10001928). The strongest association for MUC5B, with rs140324259 on chromosome 11, explained 14% of variation in sputum MUC5B. Despite being associated with lower MUC5B, the C allele of rs140324259 conferred increased risk of CB (odds ratio (OR) = 1.42; 95% confidence interval (CI): 1.10-1.80) as well as AE ascertained over three years of follow up (OR = 1.41; 95% CI: 1.02-1.94). Associations between rs140324259 and CB or AE did not replicate in COPDGene. However, in the UK Biobank, rs140324259 was associated with phenotypes that define CB, namely chronic mucus production and cough, again with the C allele conferring increased risk. We conclude that sputum MUC5AC and MUC5B concentrations are associated with common genetic variants, and the top locus for MUC5B may influence COPD phenotypes, in particular CB.
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Affiliation(s)
- Eric Van Buren
- Department of Biostatistics, University of North Carolina, Chapel Hill, North Carolina, United States of America
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Giorgia Radicioni
- Marsico Lung Institute, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Sarah Lester
- Department of Genetics, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Wanda K. O’Neal
- Marsico Lung Institute, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Hong Dang
- Marsico Lung Institute, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Silva Kasela
- New York Genome Center, New York, New York, United States of America
- Department of Systems Biology, Columbia University, New York, New York, United States of America
| | - Suresh Garudadri
- Division of Pulmonary, Critical Care, Allergy, & Sleep Medicine, Department of Medicine, University of California San Francisco, San Francisco, California, United States of America
| | - Jeffrey L. Curtis
- Pulmonary & Critical Care Medicine Division, University of Michigan, Ann Arbor, Michigan, United States of America
- Medical Service, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, United States of America
| | - MeiLan K. Han
- Pulmonary & Critical Care Medicine Division, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Jerry A. Krishnan
- Breathe Chicago Center, University of Illinois, Chicago, Illinois, United States of America
| | - Emily S. Wan
- Channing Division of Network Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
- VA Boston Healthcare System, Jamaica Plain, Massachusetts, United States of America
| | - Edwin K. Silverman
- Channing Division of Network Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
| | - Annette Hastie
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, United States of America
| | - Victor E. Ortega
- Department of Internal Medicine, Division of Respiratory Medicine, Mayo Clinic, Scottsdale, Arizona, United States of America
| | - Tuuli Lappalainen
- New York Genome Center, New York, New York, United States of America
- Department of Systems Biology, Columbia University, New York, New York, United States of America
| | - Martijn C. Nawijn
- Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Groningen Research Institute for Asthma and COPD, University Medical Center Groningen, Groningen, the Netherlands
| | - Maarten van den Berge
- Groningen Research Institute for Asthma and COPD, University Medical Center Groningen, Groningen, the Netherlands
- Department of Pulmonary Diseases, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Stephanie A. Christenson
- Division of Pulmonary, Critical Care, Allergy, & Sleep Medicine, Department of Medicine, University of California San Francisco, San Francisco, California, United States of America
| | - Yun Li
- Department of Biostatistics, University of North Carolina, Chapel Hill, North Carolina, United States of America
- Department of Genetics, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Michael H. Cho
- Channing Division of Network Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
| | - Mehmet Kesimer
- Marsico Lung Institute, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Samir N. P. Kelada
- Marsico Lung Institute, University of North Carolina, Chapel Hill, North Carolina, United States of America
- Department of Genetics, University of North Carolina, Chapel Hill, North Carolina, United States of America
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25
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DiLillo KM, Norman KC, Freeman CM, Christenson SA, Alexis NE, Anderson WH, Barjaktarevic IZ, Barr RG, Comellas AP, Bleecker ER, Boucher RC, Couper DJ, Criner GJ, Doerschuk CM, Wells JM, Han MK, Hoffman EA, Hansel NN, Hastie AT, Kaner RJ, Krishnan JA, Labaki WW, Martinez FJ, Meyers DA, O'Neal WK, Ortega VE, Paine R, Peters SP, Woodruff PG, Cooper CB, Bowler RP, Curtis JL, Arnold KB. A blood and bronchoalveolar lavage protein signature of rapid FEV 1 decline in smoking-associated COPD. Sci Rep 2023; 13:8228. [PMID: 37217548 PMCID: PMC10203309 DOI: 10.1038/s41598-023-32216-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 03/24/2023] [Indexed: 05/24/2023] Open
Abstract
Accelerated progression of chronic obstructive pulmonary disease (COPD) is associated with increased risks of hospitalization and death. Prognostic insights into mechanisms and markers of progression could facilitate development of disease-modifying therapies. Although individual biomarkers exhibit some predictive value, performance is modest and their univariate nature limits network-level insights. To overcome these limitations and gain insights into early pathways associated with rapid progression, we measured 1305 peripheral blood and 48 bronchoalveolar lavage proteins in individuals with COPD [n = 45, mean initial forced expiratory volume in one second (FEV1) 75.6 ± 17.4% predicted]. We applied a data-driven analysis pipeline, which enabled identification of protein signatures that predicted individuals at-risk for accelerated lung function decline (FEV1 decline ≥ 70 mL/year) ~ 6 years later, with high accuracy. Progression signatures suggested that early dysregulation in elements of the complement cascade is associated with accelerated decline. Our results propose potential biomarkers and early aberrant signaling mechanisms driving rapid progression in COPD.
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Affiliation(s)
- Katarina M DiLillo
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
| | - Katy C Norman
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
| | - Christine M Freeman
- Research Service, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
- Division of Pulmonary & Critical Care Medicine, University of Michigan, Ann Arbor, MI, USA
- Graduate Program in Immunology, University of Michigan, Ann Arbor, MI, USA
| | - Stephanie A Christenson
- Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Neil E Alexis
- Center for Environmental Medicine, Asthma, and Lung Biology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Wayne H Anderson
- Marsico Lung Institute/Pulmonary and Critical Care Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Igor Z Barjaktarevic
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - R Graham Barr
- Department of Medicine, Columbia University Medical Center, New York, NY, USA
| | - Alejandro P Comellas
- Division of Pulmonary, Critical Care and Occupational Medicine, University of Iowa, Iowa City, IA, USA
| | - Eugene R Bleecker
- Division of Genetics, Genomics and Precision Medicine, University of Arizona Health Sciences, Tucson, AZ, USA
| | - Richard C Boucher
- Marsico Lung Institute/Cystic Fibrosis Research Center, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - David J Couper
- Collaborative Studies Coordinating Center, Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Gerard J Criner
- Department of Thoracic Medicine and Surgery, Temple University, Philadelphia, PA, USA
| | - Claire M Doerschuk
- Marsico Lung Institute/Cystic Fibrosis Research Center, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - J Michael Wells
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - MeiLan K Han
- Division of Pulmonary & Critical Care Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Eric A Hoffman
- Department of Radiology, University of Iowa, Iowa City, IA, USA
| | - Nadia N Hansel
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Annette T Hastie
- Department of Internal Medicine, Wake Forest School of Medicine, Atrium Health, Wake Forest Baptist, Winston Salem, NC, USA
| | - Robert J Kaner
- Department of Medicine, Weill Cornell Medical Center, New York, NY, USA
| | - Jerry A Krishnan
- Division of Pulmonary, Critical Care, Sleep and Allergy, University of Illinois at Chicago, Chicago, IL, USA
| | - Wassim W Labaki
- Division of Pulmonary & Critical Care Medicine, University of Michigan, Ann Arbor, MI, USA
| | | | - Deborah A Meyers
- Division of Genetics, Genomics and Precision Medicine, University of Arizona Health Sciences, Tucson, AZ, USA
| | - Wanda K O'Neal
- Marsico Lung Institute/Cystic Fibrosis Research Center, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Victor E Ortega
- Department of Internal Medicine, Division of Respiratory Medicine, Mayo Clinic, Scottsdale, AZ, USA
| | - Robert Paine
- Division of Respiratory, Critical Care, and Occupational Pulmonary Medicine, University of Utah, Salt Lake City, UT, USA
| | - Stephen P Peters
- Department of Internal Medicine, Wake Forest School of Medicine, Atrium Health, Wake Forest Baptist, Winston Salem, NC, USA
| | - Prescott G Woodruff
- Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Christopher B Cooper
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Russell P Bowler
- Division of Pulmonary and Critical Care, National Jewish Health, Denver, CO, USA
| | - Jeffrey L Curtis
- Division of Pulmonary & Critical Care Medicine, University of Michigan, Ann Arbor, MI, USA
- Graduate Program in Immunology, University of Michigan, Ann Arbor, MI, USA
- Medical Service, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Kelly B Arnold
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA.
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Bledsoe J, Woller SC, Brooks M, Sciurba FC, Krishnan JA, Martin D, Hou P, Lin JY, Kindzelski A, Handberg E, Kirwan BA, Zaharris E, Castro L, Shapiro NL, Pepine CJ, Majercik S, Fu Z, Zhong Y, Venugopal V, Lai YH, Ridker PM, Connors JM. Clinically stable covid-19 patients presenting to acute unscheduled episodic care venues have increased risk of hospitalization: secondary analysis of a randomized control trial. BMC Infect Dis 2023; 23:325. [PMID: 37189091 PMCID: PMC10184108 DOI: 10.1186/s12879-023-08295-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 04/30/2023] [Indexed: 05/17/2023] Open
Abstract
BACKGROUND Assessment for risks associated with acute stable COVID-19 is important to optimize clinical trial enrollment and target patients for scarce therapeutics. To assess whether healthcare system engagement location is an independent predictor of outcomes we performed a secondary analysis of the ACTIV-4B Outpatient Thrombosis Prevention trial. METHODS A secondary analysis of the ACTIV-4B trial that was conducted at 52 US sites between September 2020 and August 2021. Participants were enrolled through acute unscheduled episodic care (AUEC) enrollment location (emergency department, or urgent care clinic visit) compared to minimal contact (MC) enrollment (electronic contact from test center lists of positive patients).We report the primary composite outcome of cardiopulmonary hospitalizations, symptomatic venous thromboembolism, myocardial infarction, stroke, transient ischemic attack, systemic arterial thromboembolism, or death among stable outpatients stratified by enrollment setting, AUEC versus MC. A propensity score for AUEC enrollment was created, and Cox proportional hazards regression with inverse probability weighting (IPW) was used to compare the primary outcome by enrollment location. RESULTS Among the 657 ACTIV-4B patients randomized, 533 (81.1%) with known enrollment setting data were included in this analysis, 227 from AUEC settings and 306 from MC settings. In a multivariate logistic regression model, time from COVID test, age, Black race, Hispanic ethnicity, and body mass index were associated with AUEC enrollment. Irrespective of trial treatment allocation, patients enrolled at an AUEC setting were 10-times more likely to suffer from the adjudicated primary outcome, 7.9% vs. 0.7%; p < 0.001, compared with patients enrolled at a MC setting. Upon Cox regression analysis adjustment patients enrolled at an AUEC setting remained at significant risk of the primary composite outcome, HR 3.40 (95% CI 1.46, 7.94). CONCLUSIONS Patients with clinically stable COVID-19 presenting to an AUEC enrollment setting represent a population at increased risk of arterial and venous thrombosis complications, hospitalization for cardiopulmonary events, or death, when adjusted for other risk factors, compared with patients enrolled at a MC setting. Future outpatient therapeutic trials and clinical therapeutic delivery programs of clinically stable COVID-19 patients may focus on inclusion of higher-risk patient populations from AUEC engagement locations. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04498273.
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Affiliation(s)
- Joseph Bledsoe
- Intermountain Healthcare, Emergency Medicine and Trauma, Salt Lake City, UT, USA.
- Intermountain Medical Center, Department of Medicine, 5121 S. Cottonwood Drive, Murray, UT, 84157, USA.
| | - Scott C Woller
- Intermountain Medical Center, Department of Medicine, 5121 S. Cottonwood Drive, Murray, UT, 84157, USA
| | - Maria Brooks
- School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Frank C Sciurba
- School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jerry A Krishnan
- Division of Pulmonary, Critical Care, Sleep, and Allergy, University of Illinois, Chicago, IL, USA
| | - Deborah Martin
- School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Peter Hou
- Brigham and Women's Hospital, Boston, MA, USA
| | - Janet Y Lin
- Department of Emergency Medicine, University of Illinois, Chicago, IL, USA
| | | | - Eileen Handberg
- School of Medicine, University of Florida, Gainesville, FL, USA
| | | | | | - Lauren Castro
- Division of Pulmonary, Critical Care, Sleep, and Allergy, University of Illinois, Chicago, IL, USA
| | - Nancy L Shapiro
- Department of Pharmacy Practice, College of Pharmacy, University of Illinois, Chicago, IL, USA
| | - Carl J Pepine
- School of Medicine, University of Florida, Gainesville, FL, USA
| | - Sarah Majercik
- Intermountain Healthcare, Emergency Medicine and Trauma, Salt Lake City, UT, USA
| | - Zhuxuan Fu
- School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Yongqi Zhong
- School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Vidya Venugopal
- School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Yu-Hsuan Lai
- School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
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27
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LaFon DC, Woo H, Fedarko N, Azar A, Hill H, Tebo AE, Martins TB, Han MK, Krishnan JA, Ortega VE, Barjaktarevic I, Kaner RJ, Hastie A, O'Neal WK, Couper D, Woodruff PG, Curtis JL, Hansel NN, Nahm MH, Dransfield MT, Putcha N. Reduced quantity and function of pneumococcal antibodies are associated with exacerbations of COPD in SPIROMICS. Clin Immunol 2023; 250:109324. [PMID: 37030524 PMCID: PMC10171244 DOI: 10.1016/j.clim.2023.109324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 03/24/2023] [Accepted: 04/04/2023] [Indexed: 04/10/2023]
Abstract
While hypogammaglobulinemia is associated with COPD exacerbations, it is unknown whether frequent exacerbators have specific defects in antibody production/function. We hypothesized that reduced quantity/function of serum pneumococcal antibodies correlate with exacerbation risk in the SPIROMICS cohort. We measured total pneumococcal IgG in n = 764 previously vaccinated participants with COPD. In a propensity-matched subset of n = 200 with vaccination within five years (n = 50 without exacerbations in the previous year; n = 75 with one, n = 75 with ≥2), we measured pneumococcal IgG for 23 individual serotypes, and pneumococcal antibody function for 4 serotypes. Higher total pneumococcal IgG, serotype-specific IgG (17/23 serotypes), and antibody function (3/4 serotypes) were independently associated with fewer prior exacerbations. Higher pneumococcal IgG (5/23 serotypes) predicted lower exacerbation risk in the following year. Pneumococcal antibodies are inversely associated with exacerbations, supporting the presence of immune defects in frequent exacerbators. With further study, pneumococcal antibodies may be useful biomarkers for immune dysfunction in COPD.
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Affiliation(s)
- David C LaFon
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, United States; UAB Lung Health Center, Birmingham, AL, United States.
| | - Han Woo
- Johns Hopkins University, Baltimore, MD, United States
| | - Neal Fedarko
- Johns Hopkins University, Baltimore, MD, United States
| | - Antoine Azar
- Johns Hopkins University, Baltimore, MD, United States
| | - Harry Hill
- Department of Pathology, University of Utah Health and ARUP Laboratories, Salt Lake City, UT, United States
| | - Anne E Tebo
- Department of Pathology, University of Utah Health and ARUP Laboratories, Salt Lake City, UT, United States; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States
| | - Thomas B Martins
- Department of Pathology, University of Utah Health and ARUP Laboratories, Salt Lake City, UT, United States
| | - MeiLan K Han
- Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI, United States
| | | | | | - Igor Barjaktarevic
- Pulmonary and Critical Care, University of California Los Angeles, Los Angeles, CA, United States
| | | | - Annette Hastie
- Wake Forest University School of Medicine, Winston-Salem, NC, United States
| | - Wanda K O'Neal
- Marisco Lung Institute, University of North Carolina School of Medicine, Chapel Hill, NC, United States
| | - David Couper
- University of North Carolina Department of Biostatistics, Chapel Hill, NC, United States
| | | | - Jeffrey L Curtis
- Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI, United States; VA Ann Arbor Healthcare System, Ann Arbor, MI, United States
| | | | - Moon H Nahm
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, United States; Department of Microbiology, University of Alabama at Birmingham, United States
| | - Mark T Dransfield
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, United States; UAB Lung Health Center, Birmingham, AL, United States; Birmingham VA Medical Center, Birmingham, AL, United States
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28
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Wang TY, Wahed AS, Morris A, Kreuziger LB, Quigley JG, Lamas GA, Weissman AJ, Lopez-Sendon J, Knudson MM, Siegal DM, Kasthuri RS, Alexander AJ, Wahid L, Atassi B, Miller PJ, Lawson JW, Patel B, Krishnan JA, Shapiro NL, Martin DE, Kindzelski AL, Leifer ES, Joo J, Lyu L, Pennella A, Everett BM, Geraci MW, Anstrom KJ, Ortel TL. Effect of Thromboprophylaxis on Clinical Outcomes After COVID-19 Hospitalization. Ann Intern Med 2023; 176:515-523. [PMID: 36940444 PMCID: PMC10064277 DOI: 10.7326/m22-3350] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/22/2023] Open
Abstract
BACKGROUND Patients hospitalized with COVID-19 have an increased incidence of thromboembolism. The role of extended thromboprophylaxis after hospital discharge is unclear. OBJECTIVE To determine whether anticoagulation is superior to placebo in reducing death and thromboembolic complications among patients discharged after COVID-19 hospitalization. DESIGN Prospective, randomized, double-blind, placebo-controlled clinical trial. (ClinicalTrials.gov: NCT04650087). SETTING Done during 2021 to 2022 among 127 U.S. hospitals. PARTICIPANTS Adults aged 18 years or older hospitalized with COVID-19 for 48 hours or more and ready for discharge, excluding those with a requirement for, or contraindication to, anticoagulation. INTERVENTION 2.5 mg of apixaban versus placebo twice daily for 30 days. MEASUREMENTS The primary efficacy end point was a 30-day composite of death, arterial thromboembolism, and venous thromboembolism. The primary safety end points were 30-day major bleeding and clinically relevant nonmajor bleeding. RESULTS Enrollment was terminated early, after 1217 participants were randomly assigned, because of a lower than anticipated event rate and a declining rate of COVID-19 hospitalizations. Median age was 54 years, 50.4% were women, 26.5% were Black, and 16.7% were Hispanic; 30.7% had a World Health Organization severity score of 5 or greater, and 11.0% had an International Medical Prevention Registry on Venous Thromboembolism risk prediction score of greater than 4. Incidence of the primary end point was 2.13% (95% CI, 1.14 to 3.62) in the apixaban group and 2.31% (CI, 1.27 to 3.84) in the placebo group. Major bleeding occurred in 2 (0.4%) and 1 (0.2%) and clinically relevant nonmajor bleeding occurred in 3 (0.6%) and 6 (1.1%) apixaban-treated and placebo-treated participants, respectively. By day 30, thirty-six (3.0%) participants were lost to follow-up, and 8.5% of apixaban and 11.9% of placebo participants permanently discontinued the study drug treatment. LIMITATIONS The introduction of SARS-CoV-2 vaccines decreased the risk for hospitalization and death. Study enrollment spanned the peaks of the Delta and Omicron variants in the United States, which influenced illness severity. CONCLUSION The incidence of death or thromboembolism was low in this cohort of patients discharged after hospitalization with COVID-19. Because of early enrollment termination, the results were imprecise and the study was inconclusive. PRIMARY FUNDING SOURCE National Institutes of Health.
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Affiliation(s)
- Tracy Y Wang
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina (T.Y.W., A.P.)
| | - Abdus S Wahed
- Departments of Biostatistics, Epidemiology, and Statistics, University of Pittsburgh, Pittsburgh, Pennsylvania (A.S.W.)
| | - Alison Morris
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania (A.M.)
| | - Lisa Baumann Kreuziger
- Versiti Blood Research Institute, Versiti, and Medical College of Wisconsin, Milwaukee, Wisconsin (L.B.K.)
| | - John G Quigley
- Division of Hematology and Oncology, Department of Medicine, University of Illinois Chicago, Chicago, Illinois (J.G.Q.)
| | - Gervasio A Lamas
- Division of Cardiology, Department of Medicine, Mount Sinai Medical Center, Miami Beach, Florida (G.A.L.)
| | - Alexandra J Weissman
- Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania (A.J.W.)
| | - Jose Lopez-Sendon
- IdiPaz Research Institute, Universidad Autonoma de Madrid, Madrid, Spain (J.L.)
| | - M Margaret Knudson
- Department of Surgery, University of California San Francisco, San Francisco, California (M.M.K.)
| | - Deborah M Siegal
- Department of Medicine, University of Ottawa, Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Ontario, Canada (D.M.S.)
| | - Raj S Kasthuri
- Division of Hematology, UNC Blood Research Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (R.S.K.)
| | | | - Lana Wahid
- Division of Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, North Carolina (L.W.)
| | - Bassel Atassi
- OSF Little Company of Mary Medical Center, Evergreen Park, Illinois (B.A.)
| | - Peter J Miller
- Wake Forest School of Medicine, Winston-Salem, North Carolina (P.J.M.)
| | - Janice W Lawson
- Tallahassee Memorial HealthCare, Tallahassee, Florida (J.W.L.)
| | - Bela Patel
- University of Texas Health Science Center Houston, Houston, Texas (B.P.)
| | | | - Nancy L Shapiro
- College of Pharmacy, University of Illinois Chicago, Chicago, Illinois (N.L.S.)
| | - Deborah E Martin
- School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania (D.E.M.)
| | - Andrei L Kindzelski
- Division of Blood Diseases and Resources, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland (A.L.K.)
| | - Eric S Leifer
- Office of Biostatistics Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland (E.S.L., J.J.)
| | - Jungnam Joo
- Office of Biostatistics Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland (E.S.L., J.J.)
| | - Lingyun Lyu
- Department of Biostatistics, University of Pittsburgh, Pittsburgh, Pennsylvania (L.L.)
| | - Annie Pennella
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina (T.Y.W., A.P.)
| | - Brendan M Everett
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts (B.M.E.)
| | - Mark W Geraci
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania (M.W.G.)
| | - Kevin J Anstrom
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (K.J.A.)
| | - Thomas L Ortel
- Division of Hematology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina (T.L.O.)
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29
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Balmes JR, Holm SM, McCormack MC, Hansel NN, Gerald LB, Krishnan JA. Cooking with Natural Gas: Just the Facts Please. Am J Respir Crit Care Med 2023; 207:996-997. [PMID: 36867430 PMCID: PMC10112436 DOI: 10.1164/rccm.202302-0278vp] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023] Open
Affiliation(s)
- John R Balmes
- University of California, Berkeley, Environmental Health Sciences, School of Public Health, Berkeley, California, United States.,University of California, San Francisco, Department of Medicine, San Francisco, California, United States;
| | - Stephanie M Holm
- University of California Berkeley School of Public Health, 40289, Berkeley, California, United States.,University of California San Francisco Division of Occupational and Environmental Medicine, 227316, San Francisco, California, United States
| | - Meredith C McCormack
- Johns Hopkins University, Pulmonary and Critical Care, Baltimore, Maryland, United States
| | - Nadia N Hansel
- Johns Hopkins University, Medicine, Baltimore, Maryland, United States
| | - Lynn B Gerald
- University of Illinois Chicago, 14681, Breathe Chicago Center, Chicago, Illinois, United States
| | - Jerry A Krishnan
- University of Illinois at Chicago, 14681, Chicago, Illinois, United States
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Fortis S, Quibrera PM, Comellas AP, Bhatt SP, Tashkin DP, Hoffman EA, Criner GJ, Han MK, Barr RG, Arjomandi M, Dransfield MB, Peters SP, Dolezal BA, Kim V, Putcha N, Rennard SI, Paine R, Kanner RE, Curtis JL, Bowler RP, Martinez FJ, Hansel NN, Krishnan JA, Woodruff PG, Barjaktarevic IZ, Couper D, Anderson WH, Cooper CB. Bronchodilator Responsiveness in Tobacco-Exposed People With or Without COPD. Chest 2023; 163:502-514. [PMID: 36395858 PMCID: PMC9993341 DOI: 10.1016/j.chest.2022.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 11/04/2022] [Accepted: 11/10/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Bronchodilator responsiveness (BDR) in obstructive lung disease varies over time and may be associated with distinct clinical features. RESEARCH QUESTION Is consistent BDR over time (always present) differentially associated with obstructive lung disease features relative to inconsistent (sometimes present) or never (never present) BDR in tobacco-exposed people with or without COPD? STUDY DESIGN AND METHODS We retrospectively analyzed data from 2,269 tobacco-exposed participants in the Subpopulations and Intermediate Outcome Measures in COPD Study with or without COPD. We used various BDR definitions: change of ≥ 200 mL and ≥ 12% in FEV1 (FEV1-BDR), change in FVC (FVC-BDR), and change in in FEV1, FVC or both (ATS-BDR). Using generalized linear models adjusted for demographics, smoking history, FEV1 % predicted after bronchodilator administration, and number of visits that the participant completed, we assessed the association of BDR group: (1) consistent BDR, (2) inconsistent BDR, and (3) never BDR with asthma, CT scan features, blood eosinophil levels, and FEV1 decline in participants without COPD (Global Initiative for Chronic Obstructive Lung Disease [GOLD] stage 0) and the entire cohort (participants with or without COPD). RESULTS Both consistent and inconsistent ATS-BDR were associated with asthma history and greater small airways disease (%parametric response mapping functional small airways disease) relative to never ATS-BDR in participants with GOLD stage 0 disease and the entire cohort. We observed similar findings using FEV1-BDR and FVC-BDR definitions. Eosinophils did not vary consistently among BDR groups. Consistent BDR was associated with FEV1 decline over time relative to never BDR in the entire cohort. In participants with GOLD stage 0 disease, both the inconsistent ATS-BDR group (OR, 3.20; 95% CI, 2.21-4.66; P < .001) and consistent ATS-BDR group (OR, 9.48; 95% CI, 3.77-29.12; P < .001) were associated with progression to COPD relative to the never ATS-BDR group. INTERPRETATION Demonstration of BDR, even once, describes an obstructive lung disease phenotype with a history of asthma and greater small airways disease. Consistent demonstration of BDR indicated a high risk of lung function decline over time in the entire cohort and was associated with higher risk of progression to COPD in patients with GOLD stage 0 disease.
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Affiliation(s)
- Spyridon Fortis
- Center for Access & Delivery Research & Evaluation, Iowa City VA Health Care System, Iowa City, IA; Division of Pulmonary, Critical Care and Occupational Medicine, Department of Internal Medicine, University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City, IA.
| | - Pedro M Quibrera
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Alejandro P Comellas
- Division of Pulmonary, Critical Care and Occupational Medicine, Department of Internal Medicine, University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City, IA
| | - Surya P Bhatt
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Alabama at Birmingham, Birmingham VA Medical Center, Birmingham, AL
| | - Donald P Tashkin
- Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine at the University of California, Los Angeles, CA
| | - Eric A Hoffman
- Departments of Radiology, Biomedical Engineering and Medicine, University of Iowa, Iowa City, IA
| | - Gerard J Criner
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, PA
| | - MeiLan K Han
- Division of Pulmonary and Critical Care Medicine, University of Michigan Health System, Ann Arbor, MI
| | - R Graham Barr
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY
| | - Mehrdad Arjomandi
- Department of Medicine, University of California, San Francisco, CA; San Francisco Veterans Affairs Healthcare System, San Francisco, CA
| | - Mark B Dransfield
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Alabama at Birmingham, Birmingham VA Medical Center, Birmingham, AL; Division of Pulmonary and Critical Care Medicine, Birmingham VA Medical Center, Birmingham, AL
| | - Stephen P Peters
- Section on Pulmonary, Critical Care, Allergy, and Immunologic Diseases, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC
| | - Brett A Dolezal
- Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine at the University of California, Los Angeles, CA
| | - Victor Kim
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, PA
| | - Nirupama Putcha
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD
| | - Stephen I Rennard
- Division of Pulmonary and Critical Care Medicine, University of Nebraska Medical Center, Omaha, NE
| | - Robert Paine
- Division of Respiratory, Critical Care and Occupational Medicine, Department of Internal Medicine, University of Utah, Salt Lake City, UT
| | - Richard E Kanner
- Division of Respiratory, Critical Care and Occupational Medicine, Department of Internal Medicine, University of Utah, Salt Lake City, UT
| | - Jeffrey L Curtis
- Division of Pulmonary and Critical Care Medicine, University of Michigan Health System, Ann Arbor, MI; Medicine Service, VA Ann Arbor Healthcare System, Ann Arbor, MI
| | - Russell P Bowler
- Department of Medicine, National Jewish Medical and Research Center, Denver, CO
| | - Fernando J Martinez
- Departments of Medicine and Genetic Medicine, Weill Cornell Medicine, New York, NY
| | - Nadia N Hansel
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD
| | - Jerry A Krishnan
- Division of Pulmonary, Critical Care, Sleep, and Allergy, University of Illinois at Chicago, Chicago, IL
| | | | - Igor Z Barjaktarevic
- Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine at the University of California, Los Angeles, CA
| | - David Couper
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Wayne H Anderson
- Division of Pulmonary and Critical Care Medicine, Marsico Lung Institute, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Christopher B Cooper
- Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine at the University of California, Los Angeles, CA
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Krings JG, Gerald JK, Blake KV, Krishnan JA, Reddel HK, Bacharier LB, Dixon AE, Sumino K, Gerald LB, Brownson RC, Persell SD, Clemens CJ, Hiller KM, Castro M, Martinez FD. A Call for the United States to Accelerate the Implementation of Reliever Combination Inhaled Corticosteroid-Formoterol Inhalers in Asthma. Am J Respir Crit Care Med 2023; 207:390-405. [PMID: 36538711 PMCID: PMC9940146 DOI: 10.1164/rccm.202209-1729pp] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022] Open
Affiliation(s)
- James G. Krings
- Division of Pulmonary and Critical Care Medicine, Department of Medicine
| | - Joe K. Gerald
- Department of Community Environment and Policy, Mel and Enid Zuckerman College of Public Health
- Asthma & Airway Disease Research Center, University of Arizona, Tucson, Arizona
| | - Kathryn V. Blake
- Center for Pharmacogenomics and Translational Research, Nemours Children’s Health, Jacksonville, Florida
| | | | - Helen K. Reddel
- The Woolcock Institute of Medical Research and The University of Sydney, Sydney, Australia
| | - Leonard B. Bacharier
- Monroe Carell Jr. Children’s Hospital at Vanderbilt, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Anne E. Dixon
- Division of Pulmonary Critical Care, Department of Medicine, University of Vermont, Burlington, Vermont
| | - Kaharu Sumino
- Division of Pulmonary and Critical Care Medicine, Department of Medicine
| | - Lynn B. Gerald
- Population Health Sciences Program, University of Illinois Chicago, Chicago, Illinois
| | - Ross C. Brownson
- Department of Surgery, School of Medicine, and
- Prevention Research Center, Brown School, Washington University in Saint Louis, St. Louis, Missouri
| | - Stephen D. Persell
- Division of General Internal Medicine, Department of Medicine, and
- Center for Primary Care Innovation, Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | | | - Katherine M. Hiller
- Department of Emergency Medicine, School of Medicine, Indiana University, Bloomington, Indiana; and
| | - Mario Castro
- Division of Pulmonary Critical Care and Sleep Medicine, Department of Medicine, University of Kansas, Kansas City, Kansas
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32
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Levy ML, Bacharier LB, Bateman E, Boulet LP, Brightling C, Buhl R, Brusselle G, Cruz AA, Drazen JM, Duijts L, Fleming L, Inoue H, Ko FWS, Krishnan JA, Mortimer K, Pitrez PM, Sheikh A, Yorgancıoğlu A, Reddel HK. Key recommendations for primary care from the 2022 Global Initiative for Asthma (GINA) update. NPJ Prim Care Respir Med 2023; 33:7. [PMID: 36754956 PMCID: PMC9907191 DOI: 10.1038/s41533-023-00330-1] [Citation(s) in RCA: 64] [Impact Index Per Article: 64.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Accepted: 01/17/2023] [Indexed: 02/10/2023] Open
Abstract
The Global Initiative for Asthma (GINA) was established in 1993 by the World Health Organization and the US National Heart Lung and Blood Institute to improve asthma awareness, prevention and management worldwide. GINA develops and publishes evidence-based, annually updated resources for clinicians. GINA guidance is adopted by national asthma guidelines in many countries, adapted to fit local healthcare systems, practices, and resource availability. GINA is independent of industry, funded by the sale and licensing of its materials. This review summarizes key practical guidance for primary care from the 2022 GINA strategy report. It provides guidance on confirming the diagnosis of asthma using spirometry or peak expiratory flow. GINA recommends that all adults, adolescents and most children with asthma should receive inhaled corticosteroid (ICS)-containing therapy to reduce the risk of severe exacerbations, either taken regularly, or (for adults and adolescents with "mild" asthma) as combination ICS-formoterol taken as needed for symptom relief. For patients with moderate-severe asthma, the preferred regimen is maintenance-and-reliever therapy (MART) with ICS-formoterol. Asthma treatment is not "one size fits all"; GINA recommends individualized assessment, adjustment, and review of treatment. As many patients with difficult-to-treat or severe asthma are not referred early for specialist review, we provide updated guidance for primary care on diagnosis, further investigation, optimization and treatment of severe asthma across secondary and tertiary care. While the GINA strategy has global relevance, we recognize that there are special considerations for its adoption in low- and middle-income countries, particularly the current poor access to inhaled medications.
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Affiliation(s)
| | - Leonard B. Bacharier
- grid.412807.80000 0004 1936 9916Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN USA
| | - Eric Bateman
- grid.7836.a0000 0004 1937 1151Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Louis-Philippe Boulet
- grid.23856.3a0000 0004 1936 8390Québec Heart and Lung Institute, Université Laval, Québec City, QC Canada
| | - Chris Brightling
- grid.9918.90000 0004 1936 8411Institute for Lung Health, Leicester NIHR BRC, University of Leicester, Leicester, UK
| | - Roland Buhl
- grid.410607.4Pulmonary Department, Mainz University Hospital, Mainz, Germany
| | - Guy Brusselle
- grid.410566.00000 0004 0626 3303Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium ,grid.5645.2000000040459992XDepartments of Epidemiology and Respiratory Medicine, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Alvaro A. Cruz
- grid.8399.b0000 0004 0372 8259ProAR Foundation and Federal University of Bahia, Salvador, Bahia Brazil
| | - Jeffrey M. Drazen
- grid.38142.3c000000041936754XBrigham and Women’s Hospital and Department of Medicine, Harvard Medical School, Boston, MA USA
| | - Liesbeth Duijts
- grid.5645.2000000040459992XDivisions of Respiratory Medicine and Allergology and Neonatology, Department of Pediatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Louise Fleming
- grid.7445.20000 0001 2113 8111National Heart and Lung Institute, Imperial College, London, UK
| | - Hiromasa Inoue
- grid.258333.c0000 0001 1167 1801Department of Pulmonary Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Fanny W. S. Ko
- grid.10784.3a0000 0004 1937 0482Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Jerry A. Krishnan
- grid.185648.60000 0001 2175 0319Breathe Chicago Center, University of Illinois Chicago, Chicago, IL USA
| | - Kevin Mortimer
- grid.513149.bLiverpool University Hospitals NHS Foundation Trust, Liverpool, UK ,grid.5335.00000000121885934University of Cambridge, Cambridge, UK ,grid.16463.360000 0001 0723 4123Department of Paediatrics and Child Health, College of Health Sciences, School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Paulo M. Pitrez
- grid.415169.e0000 0001 2198 9354Hospital Santa Casa de Porto Alegre, Porto Alegre, Brazil
| | - Aziz Sheikh
- grid.4305.20000 0004 1936 7988Department of Primary Care Research & Development, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Arzu Yorgancıoğlu
- grid.411688.20000 0004 0595 6052Department of Pulmonology, Celal Bayar University, Manisa, Turkey
| | - Helen K. Reddel
- grid.1013.30000 0004 1936 834XThe Woolcock Institute of Medical Research and The University of Sydney, Sydney, NSW Australia
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Dixon AE, Que LG, Kalhan R, Dransfield MT, Rogers L, Gerald LB, Kraft M, Krishnan JA, Johnson O, Hazucha H, Roy G, Holbrook JT, Wise RA. Roflumilast May Increase Risk of Exacerbations When Used to Treat Poorly Controlled Asthma in People with Obesity. Ann Am Thorac Soc 2023; 20:206-214. [PMID: 36170654 PMCID: PMC9989863 DOI: 10.1513/annalsats.202204-368oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 09/28/2022] [Indexed: 02/04/2023] Open
Abstract
Rationale: People with obesity often have severe, difficult-to-control asthma. There is a need to develop better treatments for this population. One potential treatment is roflumilast, a phosphodiesterase 4 inhibitor, as it is reported to have efficacy for the treatment of asthma and can promote weight loss. Objectives: To investigate the potential efficacy of roflumilast for the treatment of poorly controlled asthma in people with obesity. Methods: A randomized, double-masked, placebo-controlled trial of 24 weeks of roflumilast versus placebo for the treatment of poorly controlled asthma in people with obesity (body mass index of 30 kg/m2 or higher). The primary outcome was a change in ACT (Asthma Control Test) score. Results: Twenty-two people were randomized to roflumilast and 16 to placebo. Roflumilast had no effect on change in the ACT (increased by 2.6 [interquartile range (IQR), 0.5-4.4] in those on roflumilast vs. 2.0 [IQR, 0.7-3.3] in those on placebo). Participants assigned to roflumilast had a 3.5-fold (relative risk [RR] 95% confidence interval [CI], 1.3-9.4) increased risk of an episode of poor asthma control and an 8.1-fold (RR 95% CI, 1.01-65.0) increased risk of an urgent care visit for asthma. Ten participants (56%) assigned to roflumilast required a course of oral corticosteroids for asthma exacerbations, and none in the placebo group. Participants losing 5% or more of their body weight experienced a clinically and statistically significant improvement in asthma control (ACT increased by 4.4 [IQR, 2.5-6.3] vs. 1.5 [IQR, 0.0-3.0] in those who lost less than 5%). Conclusions: Roflumilast had no effect on asthma control. Of concern, roflumilast was associated with an increased risk of exacerbation in obese individuals with poorly controlled asthma. These results highlight the importance of studying interventions in different subpopulations of people with asthma, particularly people with obesity and asthma who may respond differently to medications than lean people with asthma. Weight loss of at least 5% was associated with improved asthma control, indicating that interventions other than roflumilast promoting weight loss may have efficacy for the treatment of poorly controlled asthma in people with obesity. Clinical trial registered with www.clinicaltrials.gov (NCT03532490).
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Affiliation(s)
- Anne E. Dixon
- Department of Medicine, Larner College of Medicine, University of Vermont, Burlington, Vermont
| | - Loretta G. Que
- Department of Medicine, Duke University Health System, Durham, North Carolina
| | - Ravi Kalhan
- Division of Pulmonary and Critical Care Medicine, Northwestern University, Chicago, Illinois
| | - Mark T. Dransfield
- Department of Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Linda Rogers
- Mount Sinai-National Jewish Health Respiratory Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | | | - Monica Kraft
- Department of Medicine, College of Medicine, Mel and Enid Zuckerman College of Public Health & Asthma and Airway Disease Research Center, University of Arizona, Tucson, Arizona
| | - Jerry A. Krishnan
- Breathe Chicago Center, University of Illinois Chicago, Chicago, Illinois; and
| | - Olivia Johnson
- Department of Medicine, Larner College of Medicine, University of Vermont, Burlington, Vermont
| | | | - Gem Roy
- Bloomberg School of Public Health and
| | | | - Robert A. Wise
- Bloomberg School of Public Health and
- Depatment of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland
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34
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Sowho MO, Koch AL, Putcha N, Woo H, Gassett A, Paulin LM, Koehler K, Barr RG, Comellas AP, Cooper CB, Barjaktarevic I, Zeidler MR, Billings ME, Bowler RP, Han MK, Kim V, Paine Iii R, Parekh TM, Krishnan JA, Peters SP, Woodruff PG, Baugh AM, Kaufman JD, Couper D, Hansel NN. Ambient Air Pollution Exposure and Sleep Quality in COPD. Chronic Obstr Pulm Dis 2023; 10:102-111. [PMID: 36599095 PMCID: PMC9995229 DOI: 10.15326/jcopdf.2022.0350] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/22/2022] [Indexed: 01/05/2023]
Abstract
Rationale Ambient air pollution exposure is associated with respiratory morbidity among individuals with chronic obstructive pulmonary disease (COPD), particularly among those with concomitant obesity. Although people with COPD report high incidence of poor sleep quality, no studies have evaluated the association between air pollution exposure, obesity, and sleep disturbances in COPD. Methods We analyzed data collected from current and former smokers with COPD enrolled in the Subpopulations and Intermediate Outcome Measures in COPD -Air Pollution ancillary study (SPIROMICS AIR). Socio-demographics and anthropometric measurements were collected, and 1-year mean historical ambient particulate matter (PM2.5) and ozone concentrations at participants' residences were estimated by cohort-specific spatiotemporal modeling. Sleep quality was assessed with the Pittsburgh Sleep Quality Index (PSQI), and regression models were constructed to determine the association of 1-year PM2.5 (1Yr-PM2.5) and 1-year ozone (1Yr-ozone) with the PSQI score, and whether obesity modified the association. Results In 1308 participants (age: 65.8±7.8 years, 42% women), results of regression analyses suggest that each 10µg/m3 increase in 1Yr-PM2.5 was associated with a 2.1-point increase in PSQI (P=0.03). Obesity modified the association between 1Yr-PM2.5 and PSQI (P=0.03). In obese and overweight participants, a 10µg/m3 increase in 1Yr-PM2.5 was associated with a higher PSQI (4.0 points, P<0.01, and 3.4 points, P<0.01, respectively); but no association in lean-normal weight participants (P=0.51). There was no association between 1 Yr-ozone and PSQI. Conclusions Overweight and obese individuals with COPD appear to be susceptible to the effects of ambient PM2.5 on sleep quality. In COPD, weight and ambient PM2.5 may be modifiable risk factors to improve sleep quality.
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Affiliation(s)
- Mudiaga O Sowho
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland, United States
| | - Abigail L Koch
- Leonard M. Miller School of Medicine, University of Miami, Miami, Florida, United States
| | - Nirupama Putcha
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland, United States
| | - Han Woo
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland, United States
| | - Amanda Gassett
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of Washington School of Medicine, Seattle, Washington, United States
| | - Laura M Paulin
- Department of Medicine, Dartmouth-Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, United States
| | - Kirsten Koehler
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States
| | - R Graham Barr
- Department of Medicine, Columbia University Medical Center, New York, New York, United States
| | - Alejandro P Comellas
- Division of Pulmonary, Critical Care, and Occupational Medicine, College of Medicine, University of Iowa, Iowa City, Iowa, United States
| | - Christopher B Cooper
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of California Los Angeles, Los Angeles, California, United States
| | - Igor Barjaktarevic
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of California Los Angeles, Los Angeles, California, United States
| | - Michelle R Zeidler
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of California Los Angeles, Los Angeles, California, United States
| | - Martha E Billings
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of Washington School of Medicine, Seattle, Washington, United States
| | - Russell P Bowler
- Division of Pulmonary, Critical Care and Sleep Medicine, National Jewish Health, Denver, Colorado, United States
| | - MeiLan K Han
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, Michigan, United States
| | - Victor Kim
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Temple University School of Medicine, Philadelphia, Pennsylvania, United States
| | - Robert Paine Iii
- Division of Respiratory, Critical Care and Occupational Medicine, University of Utah, Salt Lake City, Utah, United States
| | - Trisha M Parekh
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Jerry A Krishnan
- Division of Pulmonary, Critical Care, Sleep, and Allergy, University of Illinois at Chicago, Chicago, Illinois, United States
| | - Stephen P Peters
- Section on Pulmonary, Critical Care, Allergy and Immunologic Diseases, Wake Forest University, Winston-Salem, North Carolina, United States
| | - Prescott G Woodruff
- Division of Pulmonary, Critical Care and Sleep Medicine, University of California San Francisco, San Francisco, California, United States
| | - Aaron M Baugh
- Division of Pulmonary, Critical Care and Sleep Medicine, University of California San Francisco, San Francisco, California, United States
| | - Joel D Kaufman
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of Washington School of Medicine, Seattle, Washington, United States
| | - David Couper
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
| | - Nadia N Hansel
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland, United States
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35
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Weiss JR, Serdenes R, Madtha U, Zhao H, Kim V, Lopez-Pastrana J, Eakin MN, O'Toole J, Cooper CB, Woodruff P, Kanner RE, Krishnan JA, Iyer AS, Couper D, Morrison MF. Association Among Chronic Obstructive Pulmonary Disease Severity, Exacerbation Risk, and Anxiety and Depression Symptoms in the SPIROMICS Cohort. J Acad Consult Liaison Psychiatry 2023; 64:45-57. [PMID: 35948252 DOI: 10.1016/j.jaclp.2022.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 07/22/2022] [Accepted: 07/29/2022] [Indexed: 01/23/2023]
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is a common, progressive lung disease that often manifests with psychiatric symptoms. Despite this, patients with COPD are not routinely screened for anxiety and depression, which substantially contribute to COPD-related morbidity. OBJECTIVE To determine the relationship among COPD symptom severity, exacerbation risk, and clinically significant anxiety and depression symptoms in ever smokers with COPD. METHODS We used baseline data from the Subpopulations and Intermediate Outcome Measures In COPD Study (SPIROMICS) cohort to examine ever smokers with COPD across Global Initiative for Obstructive Lung Disease (GOLD) disease severity groups. Multivariable logistic regression models were used to calculate odds ratios for clinically significant anxiety and depression for each GOLD group, which was compared to the control group of ever smokers without COPD. Odds ratios were adjusted for subject demographics, medical comorbidities, and substance use covariates, and comparisons were completed using 2-tailed tests. RESULTS Of the 2664 subjects studied, 784 (29.4%) had clinically significant anxiety, and 497 (18.7%) had clinically significant depression. In the multivariable analysis, high pulmonary symptom groups, groups B and D, had increased adjusted odds of clinically significant anxiety (group B: adjusted odds ratios [AOR] 1.28, P = 0.03; group D: AOR 1.95, P < 0.0001) and depression (group B: AOR 2.09, P < 0.0001; group D: AOR 3.04, P < 0.0001). GOLD group D, the group with high pulmonary symptoms and high COPD exacerbation risk, had the greatest risk of both anxiety and depression among the GOLD groups. CONCLUSIONS High COPD symptom severity, even in the absence of elevated COPD exacerbation risk, is associated with clinically significant anxiety and depression. Our separate analyses of anxiety and depression symptoms in a large, multisite, national cohort are unique within the literature and have important treatment implications for COPD patients. Our findings also highlight the utility of screening patients with high COPD symptom severity for anxiety and depression.
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Affiliation(s)
- Jacob R Weiss
- Department of Psychiatry and Behavioral Science, Temple University Hospital, Philadelphia, PA.
| | - Ryan Serdenes
- Department of Psychiatry and Behavioral Science, Temple University Hospital, Philadelphia, PA
| | - Uchechukwu Madtha
- Department of Psychiatry and Behavioral Science, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Huaqing Zhao
- Department of Biomedical Education and Data Science, Lewis Katz School of Medicine, Philadelphia, PA
| | - Victor Kim
- Department of Thoracic Medicine and Surgery, Temple University Hospital, Philadelphia, PA
| | - Jahaira Lopez-Pastrana
- Department of Psychiatry and Human Behavior, Thomas Jefferson University Hospital, Philadelphia, PA
| | - Michelle N Eakin
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Jacqueline O'Toole
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Christopher B Cooper
- Departments of Medicine and Physiology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
| | - Prescott Woodruff
- Division of Pulmonary, Critical Care and Sleep, University of California San Francisco, San Francisco, CA
| | - Richard E Kanner
- Division of Pulmonary and Critical Care, University of Utah School of Medicine, Salt Lake City, UT
| | - Jerry A Krishnan
- Division of Pulmonary, Critical Care, Sleep and Allergy, University of Illinois at Chicago, Chicago, IL
| | - Anand S Iyer
- Lung Health Center, Division of Pulmonary, Allergy and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - David Couper
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Mary F Morrison
- Department of Psychiatry and Behavioral Science, Temple University Hospital, Philadelphia, PA
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Buhr RG, Krishnan JA. Yet Another Crack in the Facade of the Centers for Medicare and Medicaid Services Hospital Readmissions Reduction Program for Chronic Obstructive Pulmonary Disease. Am J Respir Crit Care Med 2023; 207:2-4. [PMID: 36018579 PMCID: PMC9952858 DOI: 10.1164/rccm.202208-1551ed] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Affiliation(s)
- Russell G. Buhr
- David Geffen School of MedicineUniversity of California Los AngelesLos Angeles, California,Health Services Research and DevelopmentGreater Los Angeles Veterans Affairs Healthcare SystemLos Angeles, California
| | - Jerry A. Krishnan
- Division of Pulmonary, Critical Care, Sleep, and AllergyUniversity of Illinois ChicagoChicago, Illinois,Population Health Sciences ProgramUniversity of Illinois ChicagoChicago, Illinois
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Graboyes EM, Chaiyachati KH, Sisto Gall J, Johnson W, Krishnan JA, McManus SS, Thompson L, Shulman LN, Yabroff KR. Addressing Transportation Insecurity Among Patients With Cancer. J Natl Cancer Inst 2022; 114:1593-1600. [PMID: 36130286 PMCID: PMC9745432 DOI: 10.1093/jnci/djac134] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 04/18/2022] [Accepted: 05/04/2022] [Indexed: 01/11/2023] Open
Abstract
Health-care-related transportation insecurity is common in the United States. Patients with cancer are especially vulnerable because cancer care is episodic in nature, occurs over a prolonged period, is marked by frequent clinical encounters, requires intense treatments, and results in substantial financial hardship. As a result of transportation insecurity, patients with cancer may forego, miss, delay, alter, and/or prematurely terminate necessary care. Limited data suggest that these alterations in care have the potential to increase the rates of cancer recurrence and mortality and exacerbate disparities in cancer incidence, severity, and outcomes. Transportation insecurity also negatively impacts at the informal caregiver, provider, health system, and societal levels. Recognizing that transportation is a critical determinant of outcomes for patients with cancer, there are ongoing efforts to develop evidence-based protocols to identify at-risk patients and address transportation insecurity at federal policy, health system, not-for-profit, and industry levels. In 2021, the National Cancer Policy Forum of the National Academies of Science, Engineering, and Medicine sponsored a series of webinars addressing key social determinants of health including food, housing, and transportation among patients with cancer. This commentary summarizes the formal presentations and discussions related to transportation insecurity and will 1) discuss the heterogeneous nature of transportation insecurity among patients with cancer; 2) characterize its prevalence along the cancer continuum; 3) examine its multilevel consequences; 4) discuss measurement and screening tools; 5) highlight ongoing efforts to address transportation insecurity; 6) suggest policy levers; and 7) outline a research agenda to address critical knowledge gaps.
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Affiliation(s)
- Evan M Graboyes
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Krisda H Chaiyachati
- Department of Medicine, Division of General Internal Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
| | | | | | - Jerry A Krishnan
- Population Health Sciences Program, University of Illinois Chicago, Chicago, IL, USA
| | - Sapna S McManus
- Chief Diversity Office, Genentech Inc, San Francisco, CA, USA
| | | | - Lawrence N Shulman
- Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
| | - K Robin Yabroff
- Surveillance and Health Equity Science, American Cancer Society, Kennesaw, GA, USA
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38
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Connors JM, Brooks MM, Sciurba FC, Krishnan JA, Bledsoe JR, Castro L, Eng H, Handberg E, Hou PC, Hulbert J, Kirwan BA, Lin JY, Martin D, Samuelson H, Shapiro NL, Zaharris E, Wisniewski SR, Ridker PM. Outpatient Randomized Controlled Trials in the Covid-19 Era and Beyond. NEJM Evid 2022; 1:EVIDctcs2200149. [PMID: 38319835 DOI: 10.1056/evidctcs2200149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
Outpatient Trials in the Covid-19 Era and BeyondA group of investigators had a meeting at the National Heart, Lung, and Blood Institute in May 2020 to discuss ways to decrease thrombotic complications among symptomatic outpatients with Covid-19. The investigators discuss their approach to three specific challenges: conducting a trial remotely, working through regulatory hurdles, and recruiting a diverse population of participants.
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LaBedz SL, Prieto-Centurion V, Mutso A, Basu S, Bracken NE, Calhoun EA, DiDomenico RJ, Joo M, Pickard AS, Pittendrigh B, Williams MV, Illendula S, Krishnan JA. Pragmatic Clinical Trial to Improve Patient Experience Among Adults During Transitions from Hospital to Home: the PArTNER study. J Gen Intern Med 2022; 37:4103-4111. [PMID: 35260961 PMCID: PMC9708982 DOI: 10.1007/s11606-022-07461-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 02/04/2022] [Indexed: 01/04/2023]
Abstract
INTRODUCTION Minority-serving hospitals (MSHs) need evidence-based strategies tailored to the populations they serve to improve patient-centered outcomes after hospitalization. METHODS We conducted a pragmatic randomized clinical trial (RCT) from October 2014 to January 2017 at a MSH comparing the effectiveness of a stakeholder-supported Navigator intervention vs. Usual care on post-hospital patient experience, outcomes, and healthcare utilization. Community health workers and peer coaches delivered the intervention which included (1) in-hospital visits to assess barriers to health/healthcare and to develop a personalized Discharge Patient Education Tool (DPET); (2) a home visit to review the DPET; and (3) telephone-based peer coaching. The co-primary outcomes were between-group comparisons of 30-day changes in Patient-Reported Outcomes Measurement Information System (PROMIS) measures of anxiety and informational support (minimum important difference is 2 to 5 units change); a p-value <0.025 was considered significant using intention-to-treat analysis. Secondary outcomes included death, ED visits, or readmissions and measures of emotional, social, and physical health at 30 and 60 days. RESULTS We enrolled 1029 adults hospitalized with heart failure (28%), pneumonia (22%), MI (10%), COPD (11%), or sickle cell disease (29%). Over 80% were non-Hispanic Black. Overall, there were no significant between-group differences in the 30-day change in anxiety (adjusted difference: -1.6, 97.5% CI -3.3 to 0.1, p=0.03), informational support (adjusted difference: -0.01, 97.5% CI -2.0 to 1.9, p=0.99), or any secondary outcomes. Exploratory analyses suggested the Navigator intervention improved anxiety among participants with COPD, a primary care provider, a hospitalization in the past 12 months, or higher baseline anxiety; among participants without health insurance, the intervention improved informational support (all p-values <0.05). CONCLUSIONS In this pragmatic RCT at a MSH, the Navigator intervention did not improve post-hospital anxiety, informational support, or other outcomes compared to Usual care. Benefits observed in participant subgroups should be confirmed in future studies. TRIAL REGISTRATION Clinicaltrials.gov identifier: NCT02114515.
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Affiliation(s)
- Stephanie L LaBedz
- Breathe Chicago Center, Division of Pulmonary, Critical Care, Sleep, and Allergy, University of Illinois at Chicago, Chicago, IL, USA.
| | - Valentin Prieto-Centurion
- Breathe Chicago Center, Division of Pulmonary, Critical Care, Sleep, and Allergy, University of Illinois at Chicago, Chicago, IL, USA
| | - Amelia Mutso
- Department of Pharmacology & Regenerative Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - Sanjib Basu
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, IL, USA
| | - Nina E Bracken
- Breathe Chicago Center, Division of Pulmonary, Critical Care, Sleep, and Allergy, University of Illinois at Chicago, Chicago, IL, USA
| | - Elizabeth A Calhoun
- Department of Population Health, University of Kansas Medical Center, Kansas City, KS, USA
| | - Robert J DiDomenico
- Department of Pharmacy Practice, College of Pharmacy, University of Illinois at Chicago, Chicago, IL, USA
| | - Min Joo
- Division of Pulmonary, Critical Care, Sleep, and Allergy, University of Illinois at Chicago, Chicago, IL, USA
| | - A Simon Pickard
- Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois at Chicago, Chicago, IL, USA
| | | | - Mark V Williams
- Division of Hospital Medicine, Department of Internal Medicine, Washington University, St. Louis, MO, USA
| | - Sai Illendula
- Breathe Chicago Center, Division of Pulmonary, Critical Care, Sleep, and Allergy, University of Illinois at Chicago, Chicago, IL, USA
| | - Jerry A Krishnan
- Breathe Chicago Center, Division of Pulmonary, Critical Care, Sleep, and Allergy, University of Illinois at Chicago, Chicago, IL, USA
- Population Health Sciences Program, University of Illinois Hospital & Health Sciences System, University of Illinois at Chicago, Chicago, IL, USA
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Dy T, Hamilton WJ, Kramer CB, Apter A, Krishnan JA, Stout JW, Teach SJ, Federman A, Elder J, Bryant-Stephens T, Bruhl RJ, Jackson S, Sumino K. Stakeholder engagement in eight comparative effectiveness trials in African Americans and Latinos with asthma. Res Involv Engagem 2022; 8:63. [PMID: 36434672 PMCID: PMC9694541 DOI: 10.1186/s40900-022-00399-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 11/04/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND The effects of stakeholder engagement, particularly in comparative effectiveness trials, have not been widely reported. In 2014, eight comparative effectiveness studies targeting African Americans and Hispanics/Latinos with uncontrolled asthma were funded by the Patient-Centered Outcomes Research Institute (PCORI) as part of its Addressing Disparities Program. Awardees were required to meaningfully involve patients and other stakeholders. Using specific examples, we describe how these stakeholders substantially changed the research protocols and in other ways participated meaningfully as full partners in the development and conduct of the eight studies. METHODS Using the method content analysis of cases, we identified themes regarding the types of stakeholders, methods of engagement, input from the stakeholders, changes made to the research protocols and processes, and perceived benefits and challenges of the engagement process. We used summaries from meetings of the eight teams, results from an engagement survey, and the final research reports as our data source to obtain detailed information. The descriptive data were assessed by multiple reviewers using inductive and deductive qualitative methods and discussed in the context of engagement literature. RESULTS Stakeholders participated in the planning, conduct, and dissemination phases of all eight asthma studies. All the studies included clinicians and community representatives as stakeholders. Other stakeholders included patients with asthma, their caregivers, advocacy organizations, and health-system representatives. Engagement was primarily by participation in advisory boards, although six of the eight studies (75%) also utilized focus groups and one-on-one interviews. Difficulty finding a time and location to meet was the most reported challenge to engagement, noted by four of the eight teams (50%). Other reported challenges and barriers to engagement included recruitment of stakeholders, varying levels of enthusiasm among stakeholders, controlling power dynamics, and ensuring that stakeholder involvement was reflected and had true influence on the project. CONCLUSION Engagement-driven modifications led to specific changes in study design and conduct that were felt to have increased enrollment and the general level of trust and support of the targeted communities. The level of interaction described, between investigators and stakeholders in each study and between investigator-stakeholder groups, is-we believe-unprecedented and may provide useful guidance for other studies seeking to improve the effectiveness of community-driven research.
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Affiliation(s)
- Tiffany Dy
- Division of Allergy and Immunology, Department of Internal Medicine, Washington University School of Medicine in St. Louis, 660 S. Euclid Ave, CB 8122, St. Louis, MO, 63110, USA.
| | - Winifred J Hamilton
- Environmental Health Service, Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX, USA
| | | | - Andrea Apter
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Jerry A Krishnan
- Division of Pulmonary, Critical Care, Sleep, and Allergy, Department of Medicine, University of Illinois Chicago and Population Health Sciences Program, University of Illinois Hospital and Health Sciences System, Chicago, IL, USA
| | - James W Stout
- Department of Pediatrics and Health Services, University of Washington, Seattle, WA, USA
| | - Stephen J Teach
- Division of Emergency Medicine and the Department of Pediatrics, Children's National Hospital, Washington, DC, USA
| | - Alex Federman
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - John Elder
- Institute for Behavioral and Community Health, School of Public Health, San Diego State University, San Diego, CA, USA
| | - Tyra Bryant-Stephens
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Rebecca J Bruhl
- Environmental Health Service, Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Shawni Jackson
- Division of General Medical Sciences, Department of Medicine, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Kaharu Sumino
- Division of Pulmonary and Critical Care, Department of Internal Medicine, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
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Tejwani V, Woo H, Liu C, Tillery AK, Gassett AJ, Kanner RE, Hoffman EA, Martinez FJ, Woodruff PG, Barr RG, Fawzy A, Koehler K, Curtis JL, Freeman CM, Cooper CB, Comellas AP, Pirozzi C, Paine R, Tashkin D, Krishnan JA, Sack C, Putcha N, Paulin LM, Zusman M, Kaufman JD, Alexis NE, Hansel NN. Black carbon content in airway macrophages is associated with increased severe exacerbations and worse COPD morbidity in SPIROMICS. Respir Res 2022; 23:310. [PMID: 36376879 PMCID: PMC9664618 DOI: 10.1186/s12931-022-02225-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 10/19/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Airway macrophages (AM), crucial for the immune response in chronic obstructive pulmonary disease (COPD), are exposed to environmental particulate matter (PM), which they retain in their cytoplasm as black carbon (BC). However, whether AM BC accurately reflects environmental PM2.5 exposure, and can serve as a biomarker of COPD outcomes, is unknown. METHODS We analyzed induced sputum from participants at 7 of 12 sites SPIROMICS sites for AM BC content, which we related to exposures and to lung function and respiratory outcomes. Models were adjusted for batch (first vs. second), age, race (white vs. non-white), income (<$35,000, $35,000~$74,999, ≥$75,000, decline to answer), BMI, and use of long-acting beta-agonist/long-acting muscarinic antagonists, with sensitivity analysis performed with inclusion of urinary cotinine and lung function as covariates. RESULTS Of 324 participants, 143 were current smokers and 201 had spirometric-confirmed COPD. Modeled indoor fine (< 2.5 μm in aerodynamic diameter) particulate matter (PM2.5) and urinary cotinine were associated with higher AM BC. Other assessed indoor and ambient pollutant exposures were not associated with higher AM BC. Higher AM BC was associated with worse lung function and odds of severe exacerbation, as well as worse functional status, respiratory symptoms and quality of life. CONCLUSION Indoor PM2.5 and cigarette smoke exposure may lead to increased AM BC deposition. Black carbon content in AMs is associated with worse COPD morbidity in current and former smokers, which remained after sensitivity analysis adjusting for cigarette smoke burden. Airway macrophage BC, which may alter macrophage function, could serve as a predictor of experiencing worse respiratory symptoms and impaired lung function.
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Affiliation(s)
- Vickram Tejwani
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA.
- Respiratory Institute, Cleveland Clinic, 9500 Euclid Avenue, A90, 44195, Cleveland, OH, USA.
| | - Han Woo
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Chen Liu
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Anna K Tillery
- Center for Environmental Medicine, Asthma, and Lung Biology, Division of Allergy and Immunology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Amanda J Gassett
- Division of Pulmonary and Critical Care Medicine, University of Washington, Seattle, WA, USA
| | - Richard E Kanner
- Division of Respiratory, Critical Care and Occupational Medicine, University of Utah, Salt Lake City, UT, USA
| | - Eric A Hoffman
- Department of Radiology, Medicine and Biomedical Engineering, University of Iowa, Iowa City, IA, USA
| | - Fernando J Martinez
- Division of Pulmonology and Critical Care Medicine, Weill-Cornell Medical Center, Cornell University, New York, NY, USA
| | - Prescott G Woodruff
- Division of Pulmonary, Critical Care and Sleep Medicine, University of California San Francisco, San Francisco, CA, USA
| | - R Graham Barr
- Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - Ashraf Fawzy
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Kirsten Koehler
- Environmental Health and Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Jeffrey L Curtis
- Pulmonary and Critical Care Medicine Division, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, MI, USA
- Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Christine M Freeman
- Pulmonary and Critical Care Medicine Division, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, MI, USA
- Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Christopher B Cooper
- Division of Pulmonary and Critical Care Medicine, University of California Los Angeles Medical Center, Los Angeles, CA, USA
| | - Alejandro P Comellas
- Division of Pulmonary, Critical Care, and Occupational Medicine, College of Medicine, University of Iowa, Iowa City, IA, USA
| | | | - Robert Paine
- University of Utah Hospital, Salt Lake City, UT, USA
| | - Donald Tashkin
- Division of Pulmonary and Critical Care Medicine, University of California Los Angeles Medical Center, Los Angeles, CA, USA
| | - Jerry A Krishnan
- Department of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - Coralynn Sack
- Division of Pulmonary and Critical Care Medicine, University of Washington, Seattle, WA, USA
| | - Nirupama Putcha
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Laura M Paulin
- Pulmonary/Critical Care, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA
| | - Marina Zusman
- Division of Pulmonary and Critical Care Medicine, University of Washington, Seattle, WA, USA
| | - Joel D Kaufman
- Division of Pulmonary and Critical Care Medicine, University of Washington, Seattle, WA, USA
| | - Neil E Alexis
- Center for Environmental Medicine, Asthma, and Lung Biology, Division of Allergy and Immunology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Nadia N Hansel
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA
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Han MK, Ye W, Wang D, White E, Arjomandi M, Barjaktarevic IZ, Brown SA, Buhr RG, Comellas AP, Cooper CB, Criner GJ, Dransfield MT, Drescher F, Folz RJ, Hansel NN, Kalhan R, Kaner RJ, Kanner RE, Krishnan JA, Lazarus SC, Maddipati V, Martinez FJ, Mathews A, Meldrum C, McEvoy C, Nyunoya T, Rogers L, Stringer WW, Wendt CH, Wise RA, Wisniewski SR, Sciurba FC, Woodruff PG. Bronchodilators in Tobacco-Exposed Persons with Symptoms and Preserved Lung Function. N Engl J Med 2022; 387:1173-1184. [PMID: 36066078 PMCID: PMC9741866 DOI: 10.1056/nejmoa2204752] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Many persons with a history of smoking tobacco have clinically significant respiratory symptoms despite an absence of airflow obstruction as assessed by spirometry. They are often treated with medications for chronic obstructive pulmonary disease (COPD), but supporting evidence for this treatment is lacking. METHODS We randomly assigned persons who had a tobacco-smoking history of at least 10 pack-years, respiratory symptoms as defined by a COPD Assessment Test score of at least 10 (scores range from 0 to 40, with higher scores indicating worse symptoms), and preserved lung function on spirometry (ratio of forced expiratory volume in 1 second [FEV1] to forced vital capacity [FVC] ≥0.70 and FVC ≥70% of the predicted value after bronchodilator use) to receive either indacaterol (27.5 μg) plus glycopyrrolate (15.6 μg) or placebo twice daily for 12 weeks. The primary outcome was at least a 4-point decrease (i.e., improvement) in the St. George's Respiratory Questionnaire (SGRQ) score (scores range from 0 to 100, with higher scores indicating worse health status) after 12 weeks without treatment failure (defined as an increase in lower respiratory symptoms treated with a long-acting inhaled bronchodilator, glucocorticoid, or antibiotic agent). RESULTS A total of 535 participants underwent randomization. In the modified intention-to-treat population (471 participants), 128 of 227 participants (56.4%) in the treatment group and 144 of 244 (59.0%) in the placebo group had at least a 4-point decrease in the SGRQ score (difference, -2.6 percentage points; 95% confidence interval [CI], -11.6 to 6.3; adjusted odds ratio, 0.91; 95% CI, 0.60 to 1.37; P = 0.65). The mean change in the percent of predicted FEV1 was 2.48 percentage points (95% CI, 1.49 to 3.47) in the treatment group and -0.09 percentage points (95% CI, -1.06 to 0.89) in the placebo group, and the mean change in the inspiratory capacity was 0.12 liters (95% CI, 0.07 to 0.18) in the treatment group and 0.02 liters (95% CI, -0.03 to 0.08) in the placebo group. Four serious adverse events occurred in the treatment group, and 11 occurred in the placebo group; none were deemed potentially related to the treatment or placebo. CONCLUSIONS Inhaled dual bronchodilator therapy did not decrease respiratory symptoms in symptomatic, tobacco-exposed persons with preserved lung function as assessed by spirometry. (Funded by the National Heart, Lung, and Blood Institute and others; RETHINC ClinicalTrials.gov number, NCT02867761.).
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Affiliation(s)
- MeiLan K Han
- From the Division of Pulmonary and Critical Care (M.K.H., C. Meldrum) and the School of Public Health (W.Y., D.W., E.W.), University of Michigan, Ann Arbor; the Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine (M.A., S.C.L., P.G.W.) and the Cardiovascular Research Institute (S.C.L., P.G.W.), University of California San Francisco, and the San Francisco Veterans Affairs (VA) Healthcare System (M.A.) - both in San Francisco; the Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine at UCLA (I.Z.B., R.G.B., C.B.C.), and the Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center (W.W.S.) - both in Los Angeles; the Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore (S.-A.B., N.N.H., R.A.W.); the Division of Pulmonary, Critical Care, and Occupational Medicine, University of Iowa, Iowa City (A.P.C.); the Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia (G.J.C.); the Division of Pulmonary, Allergy, and Critical Care Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham (M.T.D.); Geisel School of Medicine at Dartmouth and Pulmonary and Critical Care Medicine, VA Medical Center, White River Junction, VT (F.D.); the Division of Pulmonary, Critical Care, and Sleep Medicine, Houston Methodist Academic Medicine Associates, Houston (R.J.F.); the Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine (R.K.), and the Breathe Chicago Center, Division of Pulmonary, Critical Care, Sleep, and Allergy, University of Illinois Chicago (J.A.K.) - both in Chicago; the Department of Genetic Medicine (R.J.K.) and Joan and Sanford I. Weill Department of Medicine (R.J.K., F.J.M.), Weill Cornell Medicine and New York-Presbyterian Hospital, and the Division of Pulmonary, Critical Care, and Sleep Medicine, Icahn School of Medicine at Mount Sinai (L.R.) - both in New York; the Division of Respiratory, Critical Care, and Occupational Pulmonary Medicine, University of Utah School of Medicine, Salt Lake City (R.E.K.); East Carolina University, Greenville (V.M.), and Duke University School of Medicine, Durham (A.M.) - both in North Carolina; HealthPartners Institute, Bloomington (C. McEvoy), and Minneapolis VA Healthcare System, Minneapolis (C.H.W.) - both in Minnesota; and the Division of Pulmonary, Allergy, and Critical Care Medicine (T.N., F.C.S.) and Epidemiology Data Center (S.R.W.), University of Pittsburgh, Pittsburgh
| | - Wen Ye
- From the Division of Pulmonary and Critical Care (M.K.H., C. Meldrum) and the School of Public Health (W.Y., D.W., E.W.), University of Michigan, Ann Arbor; the Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine (M.A., S.C.L., P.G.W.) and the Cardiovascular Research Institute (S.C.L., P.G.W.), University of California San Francisco, and the San Francisco Veterans Affairs (VA) Healthcare System (M.A.) - both in San Francisco; the Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine at UCLA (I.Z.B., R.G.B., C.B.C.), and the Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center (W.W.S.) - both in Los Angeles; the Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore (S.-A.B., N.N.H., R.A.W.); the Division of Pulmonary, Critical Care, and Occupational Medicine, University of Iowa, Iowa City (A.P.C.); the Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia (G.J.C.); the Division of Pulmonary, Allergy, and Critical Care Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham (M.T.D.); Geisel School of Medicine at Dartmouth and Pulmonary and Critical Care Medicine, VA Medical Center, White River Junction, VT (F.D.); the Division of Pulmonary, Critical Care, and Sleep Medicine, Houston Methodist Academic Medicine Associates, Houston (R.J.F.); the Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine (R.K.), and the Breathe Chicago Center, Division of Pulmonary, Critical Care, Sleep, and Allergy, University of Illinois Chicago (J.A.K.) - both in Chicago; the Department of Genetic Medicine (R.J.K.) and Joan and Sanford I. Weill Department of Medicine (R.J.K., F.J.M.), Weill Cornell Medicine and New York-Presbyterian Hospital, and the Division of Pulmonary, Critical Care, and Sleep Medicine, Icahn School of Medicine at Mount Sinai (L.R.) - both in New York; the Division of Respiratory, Critical Care, and Occupational Pulmonary Medicine, University of Utah School of Medicine, Salt Lake City (R.E.K.); East Carolina University, Greenville (V.M.), and Duke University School of Medicine, Durham (A.M.) - both in North Carolina; HealthPartners Institute, Bloomington (C. McEvoy), and Minneapolis VA Healthcare System, Minneapolis (C.H.W.) - both in Minnesota; and the Division of Pulmonary, Allergy, and Critical Care Medicine (T.N., F.C.S.) and Epidemiology Data Center (S.R.W.), University of Pittsburgh, Pittsburgh
| | - Di Wang
- From the Division of Pulmonary and Critical Care (M.K.H., C. Meldrum) and the School of Public Health (W.Y., D.W., E.W.), University of Michigan, Ann Arbor; the Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine (M.A., S.C.L., P.G.W.) and the Cardiovascular Research Institute (S.C.L., P.G.W.), University of California San Francisco, and the San Francisco Veterans Affairs (VA) Healthcare System (M.A.) - both in San Francisco; the Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine at UCLA (I.Z.B., R.G.B., C.B.C.), and the Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center (W.W.S.) - both in Los Angeles; the Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore (S.-A.B., N.N.H., R.A.W.); the Division of Pulmonary, Critical Care, and Occupational Medicine, University of Iowa, Iowa City (A.P.C.); the Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia (G.J.C.); the Division of Pulmonary, Allergy, and Critical Care Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham (M.T.D.); Geisel School of Medicine at Dartmouth and Pulmonary and Critical Care Medicine, VA Medical Center, White River Junction, VT (F.D.); the Division of Pulmonary, Critical Care, and Sleep Medicine, Houston Methodist Academic Medicine Associates, Houston (R.J.F.); the Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine (R.K.), and the Breathe Chicago Center, Division of Pulmonary, Critical Care, Sleep, and Allergy, University of Illinois Chicago (J.A.K.) - both in Chicago; the Department of Genetic Medicine (R.J.K.) and Joan and Sanford I. Weill Department of Medicine (R.J.K., F.J.M.), Weill Cornell Medicine and New York-Presbyterian Hospital, and the Division of Pulmonary, Critical Care, and Sleep Medicine, Icahn School of Medicine at Mount Sinai (L.R.) - both in New York; the Division of Respiratory, Critical Care, and Occupational Pulmonary Medicine, University of Utah School of Medicine, Salt Lake City (R.E.K.); East Carolina University, Greenville (V.M.), and Duke University School of Medicine, Durham (A.M.) - both in North Carolina; HealthPartners Institute, Bloomington (C. McEvoy), and Minneapolis VA Healthcare System, Minneapolis (C.H.W.) - both in Minnesota; and the Division of Pulmonary, Allergy, and Critical Care Medicine (T.N., F.C.S.) and Epidemiology Data Center (S.R.W.), University of Pittsburgh, Pittsburgh
| | - Emily White
- From the Division of Pulmonary and Critical Care (M.K.H., C. Meldrum) and the School of Public Health (W.Y., D.W., E.W.), University of Michigan, Ann Arbor; the Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine (M.A., S.C.L., P.G.W.) and the Cardiovascular Research Institute (S.C.L., P.G.W.), University of California San Francisco, and the San Francisco Veterans Affairs (VA) Healthcare System (M.A.) - both in San Francisco; the Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine at UCLA (I.Z.B., R.G.B., C.B.C.), and the Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center (W.W.S.) - both in Los Angeles; the Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore (S.-A.B., N.N.H., R.A.W.); the Division of Pulmonary, Critical Care, and Occupational Medicine, University of Iowa, Iowa City (A.P.C.); the Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia (G.J.C.); the Division of Pulmonary, Allergy, and Critical Care Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham (M.T.D.); Geisel School of Medicine at Dartmouth and Pulmonary and Critical Care Medicine, VA Medical Center, White River Junction, VT (F.D.); the Division of Pulmonary, Critical Care, and Sleep Medicine, Houston Methodist Academic Medicine Associates, Houston (R.J.F.); the Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine (R.K.), and the Breathe Chicago Center, Division of Pulmonary, Critical Care, Sleep, and Allergy, University of Illinois Chicago (J.A.K.) - both in Chicago; the Department of Genetic Medicine (R.J.K.) and Joan and Sanford I. Weill Department of Medicine (R.J.K., F.J.M.), Weill Cornell Medicine and New York-Presbyterian Hospital, and the Division of Pulmonary, Critical Care, and Sleep Medicine, Icahn School of Medicine at Mount Sinai (L.R.) - both in New York; the Division of Respiratory, Critical Care, and Occupational Pulmonary Medicine, University of Utah School of Medicine, Salt Lake City (R.E.K.); East Carolina University, Greenville (V.M.), and Duke University School of Medicine, Durham (A.M.) - both in North Carolina; HealthPartners Institute, Bloomington (C. McEvoy), and Minneapolis VA Healthcare System, Minneapolis (C.H.W.) - both in Minnesota; and the Division of Pulmonary, Allergy, and Critical Care Medicine (T.N., F.C.S.) and Epidemiology Data Center (S.R.W.), University of Pittsburgh, Pittsburgh
| | - Mehrdad Arjomandi
- From the Division of Pulmonary and Critical Care (M.K.H., C. Meldrum) and the School of Public Health (W.Y., D.W., E.W.), University of Michigan, Ann Arbor; the Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine (M.A., S.C.L., P.G.W.) and the Cardiovascular Research Institute (S.C.L., P.G.W.), University of California San Francisco, and the San Francisco Veterans Affairs (VA) Healthcare System (M.A.) - both in San Francisco; the Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine at UCLA (I.Z.B., R.G.B., C.B.C.), and the Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center (W.W.S.) - both in Los Angeles; the Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore (S.-A.B., N.N.H., R.A.W.); the Division of Pulmonary, Critical Care, and Occupational Medicine, University of Iowa, Iowa City (A.P.C.); the Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia (G.J.C.); the Division of Pulmonary, Allergy, and Critical Care Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham (M.T.D.); Geisel School of Medicine at Dartmouth and Pulmonary and Critical Care Medicine, VA Medical Center, White River Junction, VT (F.D.); the Division of Pulmonary, Critical Care, and Sleep Medicine, Houston Methodist Academic Medicine Associates, Houston (R.J.F.); the Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine (R.K.), and the Breathe Chicago Center, Division of Pulmonary, Critical Care, Sleep, and Allergy, University of Illinois Chicago (J.A.K.) - both in Chicago; the Department of Genetic Medicine (R.J.K.) and Joan and Sanford I. Weill Department of Medicine (R.J.K., F.J.M.), Weill Cornell Medicine and New York-Presbyterian Hospital, and the Division of Pulmonary, Critical Care, and Sleep Medicine, Icahn School of Medicine at Mount Sinai (L.R.) - both in New York; the Division of Respiratory, Critical Care, and Occupational Pulmonary Medicine, University of Utah School of Medicine, Salt Lake City (R.E.K.); East Carolina University, Greenville (V.M.), and Duke University School of Medicine, Durham (A.M.) - both in North Carolina; HealthPartners Institute, Bloomington (C. McEvoy), and Minneapolis VA Healthcare System, Minneapolis (C.H.W.) - both in Minnesota; and the Division of Pulmonary, Allergy, and Critical Care Medicine (T.N., F.C.S.) and Epidemiology Data Center (S.R.W.), University of Pittsburgh, Pittsburgh
| | - Igor Z Barjaktarevic
- From the Division of Pulmonary and Critical Care (M.K.H., C. Meldrum) and the School of Public Health (W.Y., D.W., E.W.), University of Michigan, Ann Arbor; the Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine (M.A., S.C.L., P.G.W.) and the Cardiovascular Research Institute (S.C.L., P.G.W.), University of California San Francisco, and the San Francisco Veterans Affairs (VA) Healthcare System (M.A.) - both in San Francisco; the Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine at UCLA (I.Z.B., R.G.B., C.B.C.), and the Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center (W.W.S.) - both in Los Angeles; the Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore (S.-A.B., N.N.H., R.A.W.); the Division of Pulmonary, Critical Care, and Occupational Medicine, University of Iowa, Iowa City (A.P.C.); the Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia (G.J.C.); the Division of Pulmonary, Allergy, and Critical Care Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham (M.T.D.); Geisel School of Medicine at Dartmouth and Pulmonary and Critical Care Medicine, VA Medical Center, White River Junction, VT (F.D.); the Division of Pulmonary, Critical Care, and Sleep Medicine, Houston Methodist Academic Medicine Associates, Houston (R.J.F.); the Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine (R.K.), and the Breathe Chicago Center, Division of Pulmonary, Critical Care, Sleep, and Allergy, University of Illinois Chicago (J.A.K.) - both in Chicago; the Department of Genetic Medicine (R.J.K.) and Joan and Sanford I. Weill Department of Medicine (R.J.K., F.J.M.), Weill Cornell Medicine and New York-Presbyterian Hospital, and the Division of Pulmonary, Critical Care, and Sleep Medicine, Icahn School of Medicine at Mount Sinai (L.R.) - both in New York; the Division of Respiratory, Critical Care, and Occupational Pulmonary Medicine, University of Utah School of Medicine, Salt Lake City (R.E.K.); East Carolina University, Greenville (V.M.), and Duke University School of Medicine, Durham (A.M.) - both in North Carolina; HealthPartners Institute, Bloomington (C. McEvoy), and Minneapolis VA Healthcare System, Minneapolis (C.H.W.) - both in Minnesota; and the Division of Pulmonary, Allergy, and Critical Care Medicine (T.N., F.C.S.) and Epidemiology Data Center (S.R.W.), University of Pittsburgh, Pittsburgh
| | - Stacey-Ann Brown
- From the Division of Pulmonary and Critical Care (M.K.H., C. Meldrum) and the School of Public Health (W.Y., D.W., E.W.), University of Michigan, Ann Arbor; the Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine (M.A., S.C.L., P.G.W.) and the Cardiovascular Research Institute (S.C.L., P.G.W.), University of California San Francisco, and the San Francisco Veterans Affairs (VA) Healthcare System (M.A.) - both in San Francisco; the Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine at UCLA (I.Z.B., R.G.B., C.B.C.), and the Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center (W.W.S.) - both in Los Angeles; the Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore (S.-A.B., N.N.H., R.A.W.); the Division of Pulmonary, Critical Care, and Occupational Medicine, University of Iowa, Iowa City (A.P.C.); the Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia (G.J.C.); the Division of Pulmonary, Allergy, and Critical Care Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham (M.T.D.); Geisel School of Medicine at Dartmouth and Pulmonary and Critical Care Medicine, VA Medical Center, White River Junction, VT (F.D.); the Division of Pulmonary, Critical Care, and Sleep Medicine, Houston Methodist Academic Medicine Associates, Houston (R.J.F.); the Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine (R.K.), and the Breathe Chicago Center, Division of Pulmonary, Critical Care, Sleep, and Allergy, University of Illinois Chicago (J.A.K.) - both in Chicago; the Department of Genetic Medicine (R.J.K.) and Joan and Sanford I. Weill Department of Medicine (R.J.K., F.J.M.), Weill Cornell Medicine and New York-Presbyterian Hospital, and the Division of Pulmonary, Critical Care, and Sleep Medicine, Icahn School of Medicine at Mount Sinai (L.R.) - both in New York; the Division of Respiratory, Critical Care, and Occupational Pulmonary Medicine, University of Utah School of Medicine, Salt Lake City (R.E.K.); East Carolina University, Greenville (V.M.), and Duke University School of Medicine, Durham (A.M.) - both in North Carolina; HealthPartners Institute, Bloomington (C. McEvoy), and Minneapolis VA Healthcare System, Minneapolis (C.H.W.) - both in Minnesota; and the Division of Pulmonary, Allergy, and Critical Care Medicine (T.N., F.C.S.) and Epidemiology Data Center (S.R.W.), University of Pittsburgh, Pittsburgh
| | - Russell G Buhr
- From the Division of Pulmonary and Critical Care (M.K.H., C. Meldrum) and the School of Public Health (W.Y., D.W., E.W.), University of Michigan, Ann Arbor; the Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine (M.A., S.C.L., P.G.W.) and the Cardiovascular Research Institute (S.C.L., P.G.W.), University of California San Francisco, and the San Francisco Veterans Affairs (VA) Healthcare System (M.A.) - both in San Francisco; the Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine at UCLA (I.Z.B., R.G.B., C.B.C.), and the Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center (W.W.S.) - both in Los Angeles; the Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore (S.-A.B., N.N.H., R.A.W.); the Division of Pulmonary, Critical Care, and Occupational Medicine, University of Iowa, Iowa City (A.P.C.); the Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia (G.J.C.); the Division of Pulmonary, Allergy, and Critical Care Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham (M.T.D.); Geisel School of Medicine at Dartmouth and Pulmonary and Critical Care Medicine, VA Medical Center, White River Junction, VT (F.D.); the Division of Pulmonary, Critical Care, and Sleep Medicine, Houston Methodist Academic Medicine Associates, Houston (R.J.F.); the Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine (R.K.), and the Breathe Chicago Center, Division of Pulmonary, Critical Care, Sleep, and Allergy, University of Illinois Chicago (J.A.K.) - both in Chicago; the Department of Genetic Medicine (R.J.K.) and Joan and Sanford I. Weill Department of Medicine (R.J.K., F.J.M.), Weill Cornell Medicine and New York-Presbyterian Hospital, and the Division of Pulmonary, Critical Care, and Sleep Medicine, Icahn School of Medicine at Mount Sinai (L.R.) - both in New York; the Division of Respiratory, Critical Care, and Occupational Pulmonary Medicine, University of Utah School of Medicine, Salt Lake City (R.E.K.); East Carolina University, Greenville (V.M.), and Duke University School of Medicine, Durham (A.M.) - both in North Carolina; HealthPartners Institute, Bloomington (C. McEvoy), and Minneapolis VA Healthcare System, Minneapolis (C.H.W.) - both in Minnesota; and the Division of Pulmonary, Allergy, and Critical Care Medicine (T.N., F.C.S.) and Epidemiology Data Center (S.R.W.), University of Pittsburgh, Pittsburgh
| | - Alejandro P Comellas
- From the Division of Pulmonary and Critical Care (M.K.H., C. Meldrum) and the School of Public Health (W.Y., D.W., E.W.), University of Michigan, Ann Arbor; the Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine (M.A., S.C.L., P.G.W.) and the Cardiovascular Research Institute (S.C.L., P.G.W.), University of California San Francisco, and the San Francisco Veterans Affairs (VA) Healthcare System (M.A.) - both in San Francisco; the Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine at UCLA (I.Z.B., R.G.B., C.B.C.), and the Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center (W.W.S.) - both in Los Angeles; the Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore (S.-A.B., N.N.H., R.A.W.); the Division of Pulmonary, Critical Care, and Occupational Medicine, University of Iowa, Iowa City (A.P.C.); the Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia (G.J.C.); the Division of Pulmonary, Allergy, and Critical Care Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham (M.T.D.); Geisel School of Medicine at Dartmouth and Pulmonary and Critical Care Medicine, VA Medical Center, White River Junction, VT (F.D.); the Division of Pulmonary, Critical Care, and Sleep Medicine, Houston Methodist Academic Medicine Associates, Houston (R.J.F.); the Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine (R.K.), and the Breathe Chicago Center, Division of Pulmonary, Critical Care, Sleep, and Allergy, University of Illinois Chicago (J.A.K.) - both in Chicago; the Department of Genetic Medicine (R.J.K.) and Joan and Sanford I. Weill Department of Medicine (R.J.K., F.J.M.), Weill Cornell Medicine and New York-Presbyterian Hospital, and the Division of Pulmonary, Critical Care, and Sleep Medicine, Icahn School of Medicine at Mount Sinai (L.R.) - both in New York; the Division of Respiratory, Critical Care, and Occupational Pulmonary Medicine, University of Utah School of Medicine, Salt Lake City (R.E.K.); East Carolina University, Greenville (V.M.), and Duke University School of Medicine, Durham (A.M.) - both in North Carolina; HealthPartners Institute, Bloomington (C. McEvoy), and Minneapolis VA Healthcare System, Minneapolis (C.H.W.) - both in Minnesota; and the Division of Pulmonary, Allergy, and Critical Care Medicine (T.N., F.C.S.) and Epidemiology Data Center (S.R.W.), University of Pittsburgh, Pittsburgh
| | - Christopher B Cooper
- From the Division of Pulmonary and Critical Care (M.K.H., C. Meldrum) and the School of Public Health (W.Y., D.W., E.W.), University of Michigan, Ann Arbor; the Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine (M.A., S.C.L., P.G.W.) and the Cardiovascular Research Institute (S.C.L., P.G.W.), University of California San Francisco, and the San Francisco Veterans Affairs (VA) Healthcare System (M.A.) - both in San Francisco; the Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine at UCLA (I.Z.B., R.G.B., C.B.C.), and the Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center (W.W.S.) - both in Los Angeles; the Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore (S.-A.B., N.N.H., R.A.W.); the Division of Pulmonary, Critical Care, and Occupational Medicine, University of Iowa, Iowa City (A.P.C.); the Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia (G.J.C.); the Division of Pulmonary, Allergy, and Critical Care Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham (M.T.D.); Geisel School of Medicine at Dartmouth and Pulmonary and Critical Care Medicine, VA Medical Center, White River Junction, VT (F.D.); the Division of Pulmonary, Critical Care, and Sleep Medicine, Houston Methodist Academic Medicine Associates, Houston (R.J.F.); the Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine (R.K.), and the Breathe Chicago Center, Division of Pulmonary, Critical Care, Sleep, and Allergy, University of Illinois Chicago (J.A.K.) - both in Chicago; the Department of Genetic Medicine (R.J.K.) and Joan and Sanford I. Weill Department of Medicine (R.J.K., F.J.M.), Weill Cornell Medicine and New York-Presbyterian Hospital, and the Division of Pulmonary, Critical Care, and Sleep Medicine, Icahn School of Medicine at Mount Sinai (L.R.) - both in New York; the Division of Respiratory, Critical Care, and Occupational Pulmonary Medicine, University of Utah School of Medicine, Salt Lake City (R.E.K.); East Carolina University, Greenville (V.M.), and Duke University School of Medicine, Durham (A.M.) - both in North Carolina; HealthPartners Institute, Bloomington (C. McEvoy), and Minneapolis VA Healthcare System, Minneapolis (C.H.W.) - both in Minnesota; and the Division of Pulmonary, Allergy, and Critical Care Medicine (T.N., F.C.S.) and Epidemiology Data Center (S.R.W.), University of Pittsburgh, Pittsburgh
| | - Gerard J Criner
- From the Division of Pulmonary and Critical Care (M.K.H., C. Meldrum) and the School of Public Health (W.Y., D.W., E.W.), University of Michigan, Ann Arbor; the Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine (M.A., S.C.L., P.G.W.) and the Cardiovascular Research Institute (S.C.L., P.G.W.), University of California San Francisco, and the San Francisco Veterans Affairs (VA) Healthcare System (M.A.) - both in San Francisco; the Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine at UCLA (I.Z.B., R.G.B., C.B.C.), and the Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center (W.W.S.) - both in Los Angeles; the Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore (S.-A.B., N.N.H., R.A.W.); the Division of Pulmonary, Critical Care, and Occupational Medicine, University of Iowa, Iowa City (A.P.C.); the Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia (G.J.C.); the Division of Pulmonary, Allergy, and Critical Care Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham (M.T.D.); Geisel School of Medicine at Dartmouth and Pulmonary and Critical Care Medicine, VA Medical Center, White River Junction, VT (F.D.); the Division of Pulmonary, Critical Care, and Sleep Medicine, Houston Methodist Academic Medicine Associates, Houston (R.J.F.); the Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine (R.K.), and the Breathe Chicago Center, Division of Pulmonary, Critical Care, Sleep, and Allergy, University of Illinois Chicago (J.A.K.) - both in Chicago; the Department of Genetic Medicine (R.J.K.) and Joan and Sanford I. Weill Department of Medicine (R.J.K., F.J.M.), Weill Cornell Medicine and New York-Presbyterian Hospital, and the Division of Pulmonary, Critical Care, and Sleep Medicine, Icahn School of Medicine at Mount Sinai (L.R.) - both in New York; the Division of Respiratory, Critical Care, and Occupational Pulmonary Medicine, University of Utah School of Medicine, Salt Lake City (R.E.K.); East Carolina University, Greenville (V.M.), and Duke University School of Medicine, Durham (A.M.) - both in North Carolina; HealthPartners Institute, Bloomington (C. McEvoy), and Minneapolis VA Healthcare System, Minneapolis (C.H.W.) - both in Minnesota; and the Division of Pulmonary, Allergy, and Critical Care Medicine (T.N., F.C.S.) and Epidemiology Data Center (S.R.W.), University of Pittsburgh, Pittsburgh
| | - Mark T Dransfield
- From the Division of Pulmonary and Critical Care (M.K.H., C. Meldrum) and the School of Public Health (W.Y., D.W., E.W.), University of Michigan, Ann Arbor; the Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine (M.A., S.C.L., P.G.W.) and the Cardiovascular Research Institute (S.C.L., P.G.W.), University of California San Francisco, and the San Francisco Veterans Affairs (VA) Healthcare System (M.A.) - both in San Francisco; the Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine at UCLA (I.Z.B., R.G.B., C.B.C.), and the Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center (W.W.S.) - both in Los Angeles; the Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore (S.-A.B., N.N.H., R.A.W.); the Division of Pulmonary, Critical Care, and Occupational Medicine, University of Iowa, Iowa City (A.P.C.); the Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia (G.J.C.); the Division of Pulmonary, Allergy, and Critical Care Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham (M.T.D.); Geisel School of Medicine at Dartmouth and Pulmonary and Critical Care Medicine, VA Medical Center, White River Junction, VT (F.D.); the Division of Pulmonary, Critical Care, and Sleep Medicine, Houston Methodist Academic Medicine Associates, Houston (R.J.F.); the Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine (R.K.), and the Breathe Chicago Center, Division of Pulmonary, Critical Care, Sleep, and Allergy, University of Illinois Chicago (J.A.K.) - both in Chicago; the Department of Genetic Medicine (R.J.K.) and Joan and Sanford I. Weill Department of Medicine (R.J.K., F.J.M.), Weill Cornell Medicine and New York-Presbyterian Hospital, and the Division of Pulmonary, Critical Care, and Sleep Medicine, Icahn School of Medicine at Mount Sinai (L.R.) - both in New York; the Division of Respiratory, Critical Care, and Occupational Pulmonary Medicine, University of Utah School of Medicine, Salt Lake City (R.E.K.); East Carolina University, Greenville (V.M.), and Duke University School of Medicine, Durham (A.M.) - both in North Carolina; HealthPartners Institute, Bloomington (C. McEvoy), and Minneapolis VA Healthcare System, Minneapolis (C.H.W.) - both in Minnesota; and the Division of Pulmonary, Allergy, and Critical Care Medicine (T.N., F.C.S.) and Epidemiology Data Center (S.R.W.), University of Pittsburgh, Pittsburgh
| | - Frank Drescher
- From the Division of Pulmonary and Critical Care (M.K.H., C. Meldrum) and the School of Public Health (W.Y., D.W., E.W.), University of Michigan, Ann Arbor; the Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine (M.A., S.C.L., P.G.W.) and the Cardiovascular Research Institute (S.C.L., P.G.W.), University of California San Francisco, and the San Francisco Veterans Affairs (VA) Healthcare System (M.A.) - both in San Francisco; the Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine at UCLA (I.Z.B., R.G.B., C.B.C.), and the Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center (W.W.S.) - both in Los Angeles; the Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore (S.-A.B., N.N.H., R.A.W.); the Division of Pulmonary, Critical Care, and Occupational Medicine, University of Iowa, Iowa City (A.P.C.); the Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia (G.J.C.); the Division of Pulmonary, Allergy, and Critical Care Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham (M.T.D.); Geisel School of Medicine at Dartmouth and Pulmonary and Critical Care Medicine, VA Medical Center, White River Junction, VT (F.D.); the Division of Pulmonary, Critical Care, and Sleep Medicine, Houston Methodist Academic Medicine Associates, Houston (R.J.F.); the Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine (R.K.), and the Breathe Chicago Center, Division of Pulmonary, Critical Care, Sleep, and Allergy, University of Illinois Chicago (J.A.K.) - both in Chicago; the Department of Genetic Medicine (R.J.K.) and Joan and Sanford I. Weill Department of Medicine (R.J.K., F.J.M.), Weill Cornell Medicine and New York-Presbyterian Hospital, and the Division of Pulmonary, Critical Care, and Sleep Medicine, Icahn School of Medicine at Mount Sinai (L.R.) - both in New York; the Division of Respiratory, Critical Care, and Occupational Pulmonary Medicine, University of Utah School of Medicine, Salt Lake City (R.E.K.); East Carolina University, Greenville (V.M.), and Duke University School of Medicine, Durham (A.M.) - both in North Carolina; HealthPartners Institute, Bloomington (C. McEvoy), and Minneapolis VA Healthcare System, Minneapolis (C.H.W.) - both in Minnesota; and the Division of Pulmonary, Allergy, and Critical Care Medicine (T.N., F.C.S.) and Epidemiology Data Center (S.R.W.), University of Pittsburgh, Pittsburgh
| | - Rodney J Folz
- From the Division of Pulmonary and Critical Care (M.K.H., C. Meldrum) and the School of Public Health (W.Y., D.W., E.W.), University of Michigan, Ann Arbor; the Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine (M.A., S.C.L., P.G.W.) and the Cardiovascular Research Institute (S.C.L., P.G.W.), University of California San Francisco, and the San Francisco Veterans Affairs (VA) Healthcare System (M.A.) - both in San Francisco; the Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine at UCLA (I.Z.B., R.G.B., C.B.C.), and the Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center (W.W.S.) - both in Los Angeles; the Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore (S.-A.B., N.N.H., R.A.W.); the Division of Pulmonary, Critical Care, and Occupational Medicine, University of Iowa, Iowa City (A.P.C.); the Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia (G.J.C.); the Division of Pulmonary, Allergy, and Critical Care Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham (M.T.D.); Geisel School of Medicine at Dartmouth and Pulmonary and Critical Care Medicine, VA Medical Center, White River Junction, VT (F.D.); the Division of Pulmonary, Critical Care, and Sleep Medicine, Houston Methodist Academic Medicine Associates, Houston (R.J.F.); the Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine (R.K.), and the Breathe Chicago Center, Division of Pulmonary, Critical Care, Sleep, and Allergy, University of Illinois Chicago (J.A.K.) - both in Chicago; the Department of Genetic Medicine (R.J.K.) and Joan and Sanford I. Weill Department of Medicine (R.J.K., F.J.M.), Weill Cornell Medicine and New York-Presbyterian Hospital, and the Division of Pulmonary, Critical Care, and Sleep Medicine, Icahn School of Medicine at Mount Sinai (L.R.) - both in New York; the Division of Respiratory, Critical Care, and Occupational Pulmonary Medicine, University of Utah School of Medicine, Salt Lake City (R.E.K.); East Carolina University, Greenville (V.M.), and Duke University School of Medicine, Durham (A.M.) - both in North Carolina; HealthPartners Institute, Bloomington (C. McEvoy), and Minneapolis VA Healthcare System, Minneapolis (C.H.W.) - both in Minnesota; and the Division of Pulmonary, Allergy, and Critical Care Medicine (T.N., F.C.S.) and Epidemiology Data Center (S.R.W.), University of Pittsburgh, Pittsburgh
| | - Nadia N Hansel
- From the Division of Pulmonary and Critical Care (M.K.H., C. Meldrum) and the School of Public Health (W.Y., D.W., E.W.), University of Michigan, Ann Arbor; the Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine (M.A., S.C.L., P.G.W.) and the Cardiovascular Research Institute (S.C.L., P.G.W.), University of California San Francisco, and the San Francisco Veterans Affairs (VA) Healthcare System (M.A.) - both in San Francisco; the Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine at UCLA (I.Z.B., R.G.B., C.B.C.), and the Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center (W.W.S.) - both in Los Angeles; the Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore (S.-A.B., N.N.H., R.A.W.); the Division of Pulmonary, Critical Care, and Occupational Medicine, University of Iowa, Iowa City (A.P.C.); the Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia (G.J.C.); the Division of Pulmonary, Allergy, and Critical Care Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham (M.T.D.); Geisel School of Medicine at Dartmouth and Pulmonary and Critical Care Medicine, VA Medical Center, White River Junction, VT (F.D.); the Division of Pulmonary, Critical Care, and Sleep Medicine, Houston Methodist Academic Medicine Associates, Houston (R.J.F.); the Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine (R.K.), and the Breathe Chicago Center, Division of Pulmonary, Critical Care, Sleep, and Allergy, University of Illinois Chicago (J.A.K.) - both in Chicago; the Department of Genetic Medicine (R.J.K.) and Joan and Sanford I. Weill Department of Medicine (R.J.K., F.J.M.), Weill Cornell Medicine and New York-Presbyterian Hospital, and the Division of Pulmonary, Critical Care, and Sleep Medicine, Icahn School of Medicine at Mount Sinai (L.R.) - both in New York; the Division of Respiratory, Critical Care, and Occupational Pulmonary Medicine, University of Utah School of Medicine, Salt Lake City (R.E.K.); East Carolina University, Greenville (V.M.), and Duke University School of Medicine, Durham (A.M.) - both in North Carolina; HealthPartners Institute, Bloomington (C. McEvoy), and Minneapolis VA Healthcare System, Minneapolis (C.H.W.) - both in Minnesota; and the Division of Pulmonary, Allergy, and Critical Care Medicine (T.N., F.C.S.) and Epidemiology Data Center (S.R.W.), University of Pittsburgh, Pittsburgh
| | - Ravi Kalhan
- From the Division of Pulmonary and Critical Care (M.K.H., C. Meldrum) and the School of Public Health (W.Y., D.W., E.W.), University of Michigan, Ann Arbor; the Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine (M.A., S.C.L., P.G.W.) and the Cardiovascular Research Institute (S.C.L., P.G.W.), University of California San Francisco, and the San Francisco Veterans Affairs (VA) Healthcare System (M.A.) - both in San Francisco; the Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine at UCLA (I.Z.B., R.G.B., C.B.C.), and the Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center (W.W.S.) - both in Los Angeles; the Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore (S.-A.B., N.N.H., R.A.W.); the Division of Pulmonary, Critical Care, and Occupational Medicine, University of Iowa, Iowa City (A.P.C.); the Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia (G.J.C.); the Division of Pulmonary, Allergy, and Critical Care Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham (M.T.D.); Geisel School of Medicine at Dartmouth and Pulmonary and Critical Care Medicine, VA Medical Center, White River Junction, VT (F.D.); the Division of Pulmonary, Critical Care, and Sleep Medicine, Houston Methodist Academic Medicine Associates, Houston (R.J.F.); the Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine (R.K.), and the Breathe Chicago Center, Division of Pulmonary, Critical Care, Sleep, and Allergy, University of Illinois Chicago (J.A.K.) - both in Chicago; the Department of Genetic Medicine (R.J.K.) and Joan and Sanford I. Weill Department of Medicine (R.J.K., F.J.M.), Weill Cornell Medicine and New York-Presbyterian Hospital, and the Division of Pulmonary, Critical Care, and Sleep Medicine, Icahn School of Medicine at Mount Sinai (L.R.) - both in New York; the Division of Respiratory, Critical Care, and Occupational Pulmonary Medicine, University of Utah School of Medicine, Salt Lake City (R.E.K.); East Carolina University, Greenville (V.M.), and Duke University School of Medicine, Durham (A.M.) - both in North Carolina; HealthPartners Institute, Bloomington (C. McEvoy), and Minneapolis VA Healthcare System, Minneapolis (C.H.W.) - both in Minnesota; and the Division of Pulmonary, Allergy, and Critical Care Medicine (T.N., F.C.S.) and Epidemiology Data Center (S.R.W.), University of Pittsburgh, Pittsburgh
| | - Robert J Kaner
- From the Division of Pulmonary and Critical Care (M.K.H., C. Meldrum) and the School of Public Health (W.Y., D.W., E.W.), University of Michigan, Ann Arbor; the Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine (M.A., S.C.L., P.G.W.) and the Cardiovascular Research Institute (S.C.L., P.G.W.), University of California San Francisco, and the San Francisco Veterans Affairs (VA) Healthcare System (M.A.) - both in San Francisco; the Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine at UCLA (I.Z.B., R.G.B., C.B.C.), and the Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center (W.W.S.) - both in Los Angeles; the Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore (S.-A.B., N.N.H., R.A.W.); the Division of Pulmonary, Critical Care, and Occupational Medicine, University of Iowa, Iowa City (A.P.C.); the Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia (G.J.C.); the Division of Pulmonary, Allergy, and Critical Care Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham (M.T.D.); Geisel School of Medicine at Dartmouth and Pulmonary and Critical Care Medicine, VA Medical Center, White River Junction, VT (F.D.); the Division of Pulmonary, Critical Care, and Sleep Medicine, Houston Methodist Academic Medicine Associates, Houston (R.J.F.); the Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine (R.K.), and the Breathe Chicago Center, Division of Pulmonary, Critical Care, Sleep, and Allergy, University of Illinois Chicago (J.A.K.) - both in Chicago; the Department of Genetic Medicine (R.J.K.) and Joan and Sanford I. Weill Department of Medicine (R.J.K., F.J.M.), Weill Cornell Medicine and New York-Presbyterian Hospital, and the Division of Pulmonary, Critical Care, and Sleep Medicine, Icahn School of Medicine at Mount Sinai (L.R.) - both in New York; the Division of Respiratory, Critical Care, and Occupational Pulmonary Medicine, University of Utah School of Medicine, Salt Lake City (R.E.K.); East Carolina University, Greenville (V.M.), and Duke University School of Medicine, Durham (A.M.) - both in North Carolina; HealthPartners Institute, Bloomington (C. McEvoy), and Minneapolis VA Healthcare System, Minneapolis (C.H.W.) - both in Minnesota; and the Division of Pulmonary, Allergy, and Critical Care Medicine (T.N., F.C.S.) and Epidemiology Data Center (S.R.W.), University of Pittsburgh, Pittsburgh
| | - Richard E Kanner
- From the Division of Pulmonary and Critical Care (M.K.H., C. Meldrum) and the School of Public Health (W.Y., D.W., E.W.), University of Michigan, Ann Arbor; the Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine (M.A., S.C.L., P.G.W.) and the Cardiovascular Research Institute (S.C.L., P.G.W.), University of California San Francisco, and the San Francisco Veterans Affairs (VA) Healthcare System (M.A.) - both in San Francisco; the Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine at UCLA (I.Z.B., R.G.B., C.B.C.), and the Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center (W.W.S.) - both in Los Angeles; the Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore (S.-A.B., N.N.H., R.A.W.); the Division of Pulmonary, Critical Care, and Occupational Medicine, University of Iowa, Iowa City (A.P.C.); the Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia (G.J.C.); the Division of Pulmonary, Allergy, and Critical Care Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham (M.T.D.); Geisel School of Medicine at Dartmouth and Pulmonary and Critical Care Medicine, VA Medical Center, White River Junction, VT (F.D.); the Division of Pulmonary, Critical Care, and Sleep Medicine, Houston Methodist Academic Medicine Associates, Houston (R.J.F.); the Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine (R.K.), and the Breathe Chicago Center, Division of Pulmonary, Critical Care, Sleep, and Allergy, University of Illinois Chicago (J.A.K.) - both in Chicago; the Department of Genetic Medicine (R.J.K.) and Joan and Sanford I. Weill Department of Medicine (R.J.K., F.J.M.), Weill Cornell Medicine and New York-Presbyterian Hospital, and the Division of Pulmonary, Critical Care, and Sleep Medicine, Icahn School of Medicine at Mount Sinai (L.R.) - both in New York; the Division of Respiratory, Critical Care, and Occupational Pulmonary Medicine, University of Utah School of Medicine, Salt Lake City (R.E.K.); East Carolina University, Greenville (V.M.), and Duke University School of Medicine, Durham (A.M.) - both in North Carolina; HealthPartners Institute, Bloomington (C. McEvoy), and Minneapolis VA Healthcare System, Minneapolis (C.H.W.) - both in Minnesota; and the Division of Pulmonary, Allergy, and Critical Care Medicine (T.N., F.C.S.) and Epidemiology Data Center (S.R.W.), University of Pittsburgh, Pittsburgh
| | - Jerry A Krishnan
- From the Division of Pulmonary and Critical Care (M.K.H., C. Meldrum) and the School of Public Health (W.Y., D.W., E.W.), University of Michigan, Ann Arbor; the Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine (M.A., S.C.L., P.G.W.) and the Cardiovascular Research Institute (S.C.L., P.G.W.), University of California San Francisco, and the San Francisco Veterans Affairs (VA) Healthcare System (M.A.) - both in San Francisco; the Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine at UCLA (I.Z.B., R.G.B., C.B.C.), and the Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center (W.W.S.) - both in Los Angeles; the Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore (S.-A.B., N.N.H., R.A.W.); the Division of Pulmonary, Critical Care, and Occupational Medicine, University of Iowa, Iowa City (A.P.C.); the Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia (G.J.C.); the Division of Pulmonary, Allergy, and Critical Care Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham (M.T.D.); Geisel School of Medicine at Dartmouth and Pulmonary and Critical Care Medicine, VA Medical Center, White River Junction, VT (F.D.); the Division of Pulmonary, Critical Care, and Sleep Medicine, Houston Methodist Academic Medicine Associates, Houston (R.J.F.); the Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine (R.K.), and the Breathe Chicago Center, Division of Pulmonary, Critical Care, Sleep, and Allergy, University of Illinois Chicago (J.A.K.) - both in Chicago; the Department of Genetic Medicine (R.J.K.) and Joan and Sanford I. Weill Department of Medicine (R.J.K., F.J.M.), Weill Cornell Medicine and New York-Presbyterian Hospital, and the Division of Pulmonary, Critical Care, and Sleep Medicine, Icahn School of Medicine at Mount Sinai (L.R.) - both in New York; the Division of Respiratory, Critical Care, and Occupational Pulmonary Medicine, University of Utah School of Medicine, Salt Lake City (R.E.K.); East Carolina University, Greenville (V.M.), and Duke University School of Medicine, Durham (A.M.) - both in North Carolina; HealthPartners Institute, Bloomington (C. McEvoy), and Minneapolis VA Healthcare System, Minneapolis (C.H.W.) - both in Minnesota; and the Division of Pulmonary, Allergy, and Critical Care Medicine (T.N., F.C.S.) and Epidemiology Data Center (S.R.W.), University of Pittsburgh, Pittsburgh
| | - Stephen C Lazarus
- From the Division of Pulmonary and Critical Care (M.K.H., C. Meldrum) and the School of Public Health (W.Y., D.W., E.W.), University of Michigan, Ann Arbor; the Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine (M.A., S.C.L., P.G.W.) and the Cardiovascular Research Institute (S.C.L., P.G.W.), University of California San Francisco, and the San Francisco Veterans Affairs (VA) Healthcare System (M.A.) - both in San Francisco; the Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine at UCLA (I.Z.B., R.G.B., C.B.C.), and the Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center (W.W.S.) - both in Los Angeles; the Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore (S.-A.B., N.N.H., R.A.W.); the Division of Pulmonary, Critical Care, and Occupational Medicine, University of Iowa, Iowa City (A.P.C.); the Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia (G.J.C.); the Division of Pulmonary, Allergy, and Critical Care Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham (M.T.D.); Geisel School of Medicine at Dartmouth and Pulmonary and Critical Care Medicine, VA Medical Center, White River Junction, VT (F.D.); the Division of Pulmonary, Critical Care, and Sleep Medicine, Houston Methodist Academic Medicine Associates, Houston (R.J.F.); the Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine (R.K.), and the Breathe Chicago Center, Division of Pulmonary, Critical Care, Sleep, and Allergy, University of Illinois Chicago (J.A.K.) - both in Chicago; the Department of Genetic Medicine (R.J.K.) and Joan and Sanford I. Weill Department of Medicine (R.J.K., F.J.M.), Weill Cornell Medicine and New York-Presbyterian Hospital, and the Division of Pulmonary, Critical Care, and Sleep Medicine, Icahn School of Medicine at Mount Sinai (L.R.) - both in New York; the Division of Respiratory, Critical Care, and Occupational Pulmonary Medicine, University of Utah School of Medicine, Salt Lake City (R.E.K.); East Carolina University, Greenville (V.M.), and Duke University School of Medicine, Durham (A.M.) - both in North Carolina; HealthPartners Institute, Bloomington (C. McEvoy), and Minneapolis VA Healthcare System, Minneapolis (C.H.W.) - both in Minnesota; and the Division of Pulmonary, Allergy, and Critical Care Medicine (T.N., F.C.S.) and Epidemiology Data Center (S.R.W.), University of Pittsburgh, Pittsburgh
| | - Veeranna Maddipati
- From the Division of Pulmonary and Critical Care (M.K.H., C. Meldrum) and the School of Public Health (W.Y., D.W., E.W.), University of Michigan, Ann Arbor; the Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine (M.A., S.C.L., P.G.W.) and the Cardiovascular Research Institute (S.C.L., P.G.W.), University of California San Francisco, and the San Francisco Veterans Affairs (VA) Healthcare System (M.A.) - both in San Francisco; the Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine at UCLA (I.Z.B., R.G.B., C.B.C.), and the Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center (W.W.S.) - both in Los Angeles; the Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore (S.-A.B., N.N.H., R.A.W.); the Division of Pulmonary, Critical Care, and Occupational Medicine, University of Iowa, Iowa City (A.P.C.); the Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia (G.J.C.); the Division of Pulmonary, Allergy, and Critical Care Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham (M.T.D.); Geisel School of Medicine at Dartmouth and Pulmonary and Critical Care Medicine, VA Medical Center, White River Junction, VT (F.D.); the Division of Pulmonary, Critical Care, and Sleep Medicine, Houston Methodist Academic Medicine Associates, Houston (R.J.F.); the Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine (R.K.), and the Breathe Chicago Center, Division of Pulmonary, Critical Care, Sleep, and Allergy, University of Illinois Chicago (J.A.K.) - both in Chicago; the Department of Genetic Medicine (R.J.K.) and Joan and Sanford I. Weill Department of Medicine (R.J.K., F.J.M.), Weill Cornell Medicine and New York-Presbyterian Hospital, and the Division of Pulmonary, Critical Care, and Sleep Medicine, Icahn School of Medicine at Mount Sinai (L.R.) - both in New York; the Division of Respiratory, Critical Care, and Occupational Pulmonary Medicine, University of Utah School of Medicine, Salt Lake City (R.E.K.); East Carolina University, Greenville (V.M.), and Duke University School of Medicine, Durham (A.M.) - both in North Carolina; HealthPartners Institute, Bloomington (C. McEvoy), and Minneapolis VA Healthcare System, Minneapolis (C.H.W.) - both in Minnesota; and the Division of Pulmonary, Allergy, and Critical Care Medicine (T.N., F.C.S.) and Epidemiology Data Center (S.R.W.), University of Pittsburgh, Pittsburgh
| | - Fernando J Martinez
- From the Division of Pulmonary and Critical Care (M.K.H., C. Meldrum) and the School of Public Health (W.Y., D.W., E.W.), University of Michigan, Ann Arbor; the Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine (M.A., S.C.L., P.G.W.) and the Cardiovascular Research Institute (S.C.L., P.G.W.), University of California San Francisco, and the San Francisco Veterans Affairs (VA) Healthcare System (M.A.) - both in San Francisco; the Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine at UCLA (I.Z.B., R.G.B., C.B.C.), and the Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center (W.W.S.) - both in Los Angeles; the Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore (S.-A.B., N.N.H., R.A.W.); the Division of Pulmonary, Critical Care, and Occupational Medicine, University of Iowa, Iowa City (A.P.C.); the Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia (G.J.C.); the Division of Pulmonary, Allergy, and Critical Care Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham (M.T.D.); Geisel School of Medicine at Dartmouth and Pulmonary and Critical Care Medicine, VA Medical Center, White River Junction, VT (F.D.); the Division of Pulmonary, Critical Care, and Sleep Medicine, Houston Methodist Academic Medicine Associates, Houston (R.J.F.); the Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine (R.K.), and the Breathe Chicago Center, Division of Pulmonary, Critical Care, Sleep, and Allergy, University of Illinois Chicago (J.A.K.) - both in Chicago; the Department of Genetic Medicine (R.J.K.) and Joan and Sanford I. Weill Department of Medicine (R.J.K., F.J.M.), Weill Cornell Medicine and New York-Presbyterian Hospital, and the Division of Pulmonary, Critical Care, and Sleep Medicine, Icahn School of Medicine at Mount Sinai (L.R.) - both in New York; the Division of Respiratory, Critical Care, and Occupational Pulmonary Medicine, University of Utah School of Medicine, Salt Lake City (R.E.K.); East Carolina University, Greenville (V.M.), and Duke University School of Medicine, Durham (A.M.) - both in North Carolina; HealthPartners Institute, Bloomington (C. McEvoy), and Minneapolis VA Healthcare System, Minneapolis (C.H.W.) - both in Minnesota; and the Division of Pulmonary, Allergy, and Critical Care Medicine (T.N., F.C.S.) and Epidemiology Data Center (S.R.W.), University of Pittsburgh, Pittsburgh
| | - Anne Mathews
- From the Division of Pulmonary and Critical Care (M.K.H., C. Meldrum) and the School of Public Health (W.Y., D.W., E.W.), University of Michigan, Ann Arbor; the Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine (M.A., S.C.L., P.G.W.) and the Cardiovascular Research Institute (S.C.L., P.G.W.), University of California San Francisco, and the San Francisco Veterans Affairs (VA) Healthcare System (M.A.) - both in San Francisco; the Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine at UCLA (I.Z.B., R.G.B., C.B.C.), and the Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center (W.W.S.) - both in Los Angeles; the Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore (S.-A.B., N.N.H., R.A.W.); the Division of Pulmonary, Critical Care, and Occupational Medicine, University of Iowa, Iowa City (A.P.C.); the Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia (G.J.C.); the Division of Pulmonary, Allergy, and Critical Care Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham (M.T.D.); Geisel School of Medicine at Dartmouth and Pulmonary and Critical Care Medicine, VA Medical Center, White River Junction, VT (F.D.); the Division of Pulmonary, Critical Care, and Sleep Medicine, Houston Methodist Academic Medicine Associates, Houston (R.J.F.); the Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine (R.K.), and the Breathe Chicago Center, Division of Pulmonary, Critical Care, Sleep, and Allergy, University of Illinois Chicago (J.A.K.) - both in Chicago; the Department of Genetic Medicine (R.J.K.) and Joan and Sanford I. Weill Department of Medicine (R.J.K., F.J.M.), Weill Cornell Medicine and New York-Presbyterian Hospital, and the Division of Pulmonary, Critical Care, and Sleep Medicine, Icahn School of Medicine at Mount Sinai (L.R.) - both in New York; the Division of Respiratory, Critical Care, and Occupational Pulmonary Medicine, University of Utah School of Medicine, Salt Lake City (R.E.K.); East Carolina University, Greenville (V.M.), and Duke University School of Medicine, Durham (A.M.) - both in North Carolina; HealthPartners Institute, Bloomington (C. McEvoy), and Minneapolis VA Healthcare System, Minneapolis (C.H.W.) - both in Minnesota; and the Division of Pulmonary, Allergy, and Critical Care Medicine (T.N., F.C.S.) and Epidemiology Data Center (S.R.W.), University of Pittsburgh, Pittsburgh
| | - Catherine Meldrum
- From the Division of Pulmonary and Critical Care (M.K.H., C. Meldrum) and the School of Public Health (W.Y., D.W., E.W.), University of Michigan, Ann Arbor; the Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine (M.A., S.C.L., P.G.W.) and the Cardiovascular Research Institute (S.C.L., P.G.W.), University of California San Francisco, and the San Francisco Veterans Affairs (VA) Healthcare System (M.A.) - both in San Francisco; the Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine at UCLA (I.Z.B., R.G.B., C.B.C.), and the Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center (W.W.S.) - both in Los Angeles; the Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore (S.-A.B., N.N.H., R.A.W.); the Division of Pulmonary, Critical Care, and Occupational Medicine, University of Iowa, Iowa City (A.P.C.); the Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia (G.J.C.); the Division of Pulmonary, Allergy, and Critical Care Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham (M.T.D.); Geisel School of Medicine at Dartmouth and Pulmonary and Critical Care Medicine, VA Medical Center, White River Junction, VT (F.D.); the Division of Pulmonary, Critical Care, and Sleep Medicine, Houston Methodist Academic Medicine Associates, Houston (R.J.F.); the Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine (R.K.), and the Breathe Chicago Center, Division of Pulmonary, Critical Care, Sleep, and Allergy, University of Illinois Chicago (J.A.K.) - both in Chicago; the Department of Genetic Medicine (R.J.K.) and Joan and Sanford I. Weill Department of Medicine (R.J.K., F.J.M.), Weill Cornell Medicine and New York-Presbyterian Hospital, and the Division of Pulmonary, Critical Care, and Sleep Medicine, Icahn School of Medicine at Mount Sinai (L.R.) - both in New York; the Division of Respiratory, Critical Care, and Occupational Pulmonary Medicine, University of Utah School of Medicine, Salt Lake City (R.E.K.); East Carolina University, Greenville (V.M.), and Duke University School of Medicine, Durham (A.M.) - both in North Carolina; HealthPartners Institute, Bloomington (C. McEvoy), and Minneapolis VA Healthcare System, Minneapolis (C.H.W.) - both in Minnesota; and the Division of Pulmonary, Allergy, and Critical Care Medicine (T.N., F.C.S.) and Epidemiology Data Center (S.R.W.), University of Pittsburgh, Pittsburgh
| | - Charlene McEvoy
- From the Division of Pulmonary and Critical Care (M.K.H., C. Meldrum) and the School of Public Health (W.Y., D.W., E.W.), University of Michigan, Ann Arbor; the Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine (M.A., S.C.L., P.G.W.) and the Cardiovascular Research Institute (S.C.L., P.G.W.), University of California San Francisco, and the San Francisco Veterans Affairs (VA) Healthcare System (M.A.) - both in San Francisco; the Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine at UCLA (I.Z.B., R.G.B., C.B.C.), and the Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center (W.W.S.) - both in Los Angeles; the Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore (S.-A.B., N.N.H., R.A.W.); the Division of Pulmonary, Critical Care, and Occupational Medicine, University of Iowa, Iowa City (A.P.C.); the Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia (G.J.C.); the Division of Pulmonary, Allergy, and Critical Care Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham (M.T.D.); Geisel School of Medicine at Dartmouth and Pulmonary and Critical Care Medicine, VA Medical Center, White River Junction, VT (F.D.); the Division of Pulmonary, Critical Care, and Sleep Medicine, Houston Methodist Academic Medicine Associates, Houston (R.J.F.); the Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine (R.K.), and the Breathe Chicago Center, Division of Pulmonary, Critical Care, Sleep, and Allergy, University of Illinois Chicago (J.A.K.) - both in Chicago; the Department of Genetic Medicine (R.J.K.) and Joan and Sanford I. Weill Department of Medicine (R.J.K., F.J.M.), Weill Cornell Medicine and New York-Presbyterian Hospital, and the Division of Pulmonary, Critical Care, and Sleep Medicine, Icahn School of Medicine at Mount Sinai (L.R.) - both in New York; the Division of Respiratory, Critical Care, and Occupational Pulmonary Medicine, University of Utah School of Medicine, Salt Lake City (R.E.K.); East Carolina University, Greenville (V.M.), and Duke University School of Medicine, Durham (A.M.) - both in North Carolina; HealthPartners Institute, Bloomington (C. McEvoy), and Minneapolis VA Healthcare System, Minneapolis (C.H.W.) - both in Minnesota; and the Division of Pulmonary, Allergy, and Critical Care Medicine (T.N., F.C.S.) and Epidemiology Data Center (S.R.W.), University of Pittsburgh, Pittsburgh
| | - Toru Nyunoya
- From the Division of Pulmonary and Critical Care (M.K.H., C. Meldrum) and the School of Public Health (W.Y., D.W., E.W.), University of Michigan, Ann Arbor; the Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine (M.A., S.C.L., P.G.W.) and the Cardiovascular Research Institute (S.C.L., P.G.W.), University of California San Francisco, and the San Francisco Veterans Affairs (VA) Healthcare System (M.A.) - both in San Francisco; the Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine at UCLA (I.Z.B., R.G.B., C.B.C.), and the Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center (W.W.S.) - both in Los Angeles; the Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore (S.-A.B., N.N.H., R.A.W.); the Division of Pulmonary, Critical Care, and Occupational Medicine, University of Iowa, Iowa City (A.P.C.); the Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia (G.J.C.); the Division of Pulmonary, Allergy, and Critical Care Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham (M.T.D.); Geisel School of Medicine at Dartmouth and Pulmonary and Critical Care Medicine, VA Medical Center, White River Junction, VT (F.D.); the Division of Pulmonary, Critical Care, and Sleep Medicine, Houston Methodist Academic Medicine Associates, Houston (R.J.F.); the Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine (R.K.), and the Breathe Chicago Center, Division of Pulmonary, Critical Care, Sleep, and Allergy, University of Illinois Chicago (J.A.K.) - both in Chicago; the Department of Genetic Medicine (R.J.K.) and Joan and Sanford I. Weill Department of Medicine (R.J.K., F.J.M.), Weill Cornell Medicine and New York-Presbyterian Hospital, and the Division of Pulmonary, Critical Care, and Sleep Medicine, Icahn School of Medicine at Mount Sinai (L.R.) - both in New York; the Division of Respiratory, Critical Care, and Occupational Pulmonary Medicine, University of Utah School of Medicine, Salt Lake City (R.E.K.); East Carolina University, Greenville (V.M.), and Duke University School of Medicine, Durham (A.M.) - both in North Carolina; HealthPartners Institute, Bloomington (C. McEvoy), and Minneapolis VA Healthcare System, Minneapolis (C.H.W.) - both in Minnesota; and the Division of Pulmonary, Allergy, and Critical Care Medicine (T.N., F.C.S.) and Epidemiology Data Center (S.R.W.), University of Pittsburgh, Pittsburgh
| | - Linda Rogers
- From the Division of Pulmonary and Critical Care (M.K.H., C. Meldrum) and the School of Public Health (W.Y., D.W., E.W.), University of Michigan, Ann Arbor; the Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine (M.A., S.C.L., P.G.W.) and the Cardiovascular Research Institute (S.C.L., P.G.W.), University of California San Francisco, and the San Francisco Veterans Affairs (VA) Healthcare System (M.A.) - both in San Francisco; the Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine at UCLA (I.Z.B., R.G.B., C.B.C.), and the Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center (W.W.S.) - both in Los Angeles; the Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore (S.-A.B., N.N.H., R.A.W.); the Division of Pulmonary, Critical Care, and Occupational Medicine, University of Iowa, Iowa City (A.P.C.); the Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia (G.J.C.); the Division of Pulmonary, Allergy, and Critical Care Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham (M.T.D.); Geisel School of Medicine at Dartmouth and Pulmonary and Critical Care Medicine, VA Medical Center, White River Junction, VT (F.D.); the Division of Pulmonary, Critical Care, and Sleep Medicine, Houston Methodist Academic Medicine Associates, Houston (R.J.F.); the Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine (R.K.), and the Breathe Chicago Center, Division of Pulmonary, Critical Care, Sleep, and Allergy, University of Illinois Chicago (J.A.K.) - both in Chicago; the Department of Genetic Medicine (R.J.K.) and Joan and Sanford I. Weill Department of Medicine (R.J.K., F.J.M.), Weill Cornell Medicine and New York-Presbyterian Hospital, and the Division of Pulmonary, Critical Care, and Sleep Medicine, Icahn School of Medicine at Mount Sinai (L.R.) - both in New York; the Division of Respiratory, Critical Care, and Occupational Pulmonary Medicine, University of Utah School of Medicine, Salt Lake City (R.E.K.); East Carolina University, Greenville (V.M.), and Duke University School of Medicine, Durham (A.M.) - both in North Carolina; HealthPartners Institute, Bloomington (C. McEvoy), and Minneapolis VA Healthcare System, Minneapolis (C.H.W.) - both in Minnesota; and the Division of Pulmonary, Allergy, and Critical Care Medicine (T.N., F.C.S.) and Epidemiology Data Center (S.R.W.), University of Pittsburgh, Pittsburgh
| | - William W Stringer
- From the Division of Pulmonary and Critical Care (M.K.H., C. Meldrum) and the School of Public Health (W.Y., D.W., E.W.), University of Michigan, Ann Arbor; the Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine (M.A., S.C.L., P.G.W.) and the Cardiovascular Research Institute (S.C.L., P.G.W.), University of California San Francisco, and the San Francisco Veterans Affairs (VA) Healthcare System (M.A.) - both in San Francisco; the Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine at UCLA (I.Z.B., R.G.B., C.B.C.), and the Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center (W.W.S.) - both in Los Angeles; the Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore (S.-A.B., N.N.H., R.A.W.); the Division of Pulmonary, Critical Care, and Occupational Medicine, University of Iowa, Iowa City (A.P.C.); the Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia (G.J.C.); the Division of Pulmonary, Allergy, and Critical Care Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham (M.T.D.); Geisel School of Medicine at Dartmouth and Pulmonary and Critical Care Medicine, VA Medical Center, White River Junction, VT (F.D.); the Division of Pulmonary, Critical Care, and Sleep Medicine, Houston Methodist Academic Medicine Associates, Houston (R.J.F.); the Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine (R.K.), and the Breathe Chicago Center, Division of Pulmonary, Critical Care, Sleep, and Allergy, University of Illinois Chicago (J.A.K.) - both in Chicago; the Department of Genetic Medicine (R.J.K.) and Joan and Sanford I. Weill Department of Medicine (R.J.K., F.J.M.), Weill Cornell Medicine and New York-Presbyterian Hospital, and the Division of Pulmonary, Critical Care, and Sleep Medicine, Icahn School of Medicine at Mount Sinai (L.R.) - both in New York; the Division of Respiratory, Critical Care, and Occupational Pulmonary Medicine, University of Utah School of Medicine, Salt Lake City (R.E.K.); East Carolina University, Greenville (V.M.), and Duke University School of Medicine, Durham (A.M.) - both in North Carolina; HealthPartners Institute, Bloomington (C. McEvoy), and Minneapolis VA Healthcare System, Minneapolis (C.H.W.) - both in Minnesota; and the Division of Pulmonary, Allergy, and Critical Care Medicine (T.N., F.C.S.) and Epidemiology Data Center (S.R.W.), University of Pittsburgh, Pittsburgh
| | - Christine H Wendt
- From the Division of Pulmonary and Critical Care (M.K.H., C. Meldrum) and the School of Public Health (W.Y., D.W., E.W.), University of Michigan, Ann Arbor; the Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine (M.A., S.C.L., P.G.W.) and the Cardiovascular Research Institute (S.C.L., P.G.W.), University of California San Francisco, and the San Francisco Veterans Affairs (VA) Healthcare System (M.A.) - both in San Francisco; the Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine at UCLA (I.Z.B., R.G.B., C.B.C.), and the Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center (W.W.S.) - both in Los Angeles; the Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore (S.-A.B., N.N.H., R.A.W.); the Division of Pulmonary, Critical Care, and Occupational Medicine, University of Iowa, Iowa City (A.P.C.); the Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia (G.J.C.); the Division of Pulmonary, Allergy, and Critical Care Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham (M.T.D.); Geisel School of Medicine at Dartmouth and Pulmonary and Critical Care Medicine, VA Medical Center, White River Junction, VT (F.D.); the Division of Pulmonary, Critical Care, and Sleep Medicine, Houston Methodist Academic Medicine Associates, Houston (R.J.F.); the Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine (R.K.), and the Breathe Chicago Center, Division of Pulmonary, Critical Care, Sleep, and Allergy, University of Illinois Chicago (J.A.K.) - both in Chicago; the Department of Genetic Medicine (R.J.K.) and Joan and Sanford I. Weill Department of Medicine (R.J.K., F.J.M.), Weill Cornell Medicine and New York-Presbyterian Hospital, and the Division of Pulmonary, Critical Care, and Sleep Medicine, Icahn School of Medicine at Mount Sinai (L.R.) - both in New York; the Division of Respiratory, Critical Care, and Occupational Pulmonary Medicine, University of Utah School of Medicine, Salt Lake City (R.E.K.); East Carolina University, Greenville (V.M.), and Duke University School of Medicine, Durham (A.M.) - both in North Carolina; HealthPartners Institute, Bloomington (C. McEvoy), and Minneapolis VA Healthcare System, Minneapolis (C.H.W.) - both in Minnesota; and the Division of Pulmonary, Allergy, and Critical Care Medicine (T.N., F.C.S.) and Epidemiology Data Center (S.R.W.), University of Pittsburgh, Pittsburgh
| | - Robert A Wise
- From the Division of Pulmonary and Critical Care (M.K.H., C. Meldrum) and the School of Public Health (W.Y., D.W., E.W.), University of Michigan, Ann Arbor; the Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine (M.A., S.C.L., P.G.W.) and the Cardiovascular Research Institute (S.C.L., P.G.W.), University of California San Francisco, and the San Francisco Veterans Affairs (VA) Healthcare System (M.A.) - both in San Francisco; the Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine at UCLA (I.Z.B., R.G.B., C.B.C.), and the Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center (W.W.S.) - both in Los Angeles; the Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore (S.-A.B., N.N.H., R.A.W.); the Division of Pulmonary, Critical Care, and Occupational Medicine, University of Iowa, Iowa City (A.P.C.); the Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia (G.J.C.); the Division of Pulmonary, Allergy, and Critical Care Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham (M.T.D.); Geisel School of Medicine at Dartmouth and Pulmonary and Critical Care Medicine, VA Medical Center, White River Junction, VT (F.D.); the Division of Pulmonary, Critical Care, and Sleep Medicine, Houston Methodist Academic Medicine Associates, Houston (R.J.F.); the Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine (R.K.), and the Breathe Chicago Center, Division of Pulmonary, Critical Care, Sleep, and Allergy, University of Illinois Chicago (J.A.K.) - both in Chicago; the Department of Genetic Medicine (R.J.K.) and Joan and Sanford I. Weill Department of Medicine (R.J.K., F.J.M.), Weill Cornell Medicine and New York-Presbyterian Hospital, and the Division of Pulmonary, Critical Care, and Sleep Medicine, Icahn School of Medicine at Mount Sinai (L.R.) - both in New York; the Division of Respiratory, Critical Care, and Occupational Pulmonary Medicine, University of Utah School of Medicine, Salt Lake City (R.E.K.); East Carolina University, Greenville (V.M.), and Duke University School of Medicine, Durham (A.M.) - both in North Carolina; HealthPartners Institute, Bloomington (C. McEvoy), and Minneapolis VA Healthcare System, Minneapolis (C.H.W.) - both in Minnesota; and the Division of Pulmonary, Allergy, and Critical Care Medicine (T.N., F.C.S.) and Epidemiology Data Center (S.R.W.), University of Pittsburgh, Pittsburgh
| | - Stephen R Wisniewski
- From the Division of Pulmonary and Critical Care (M.K.H., C. Meldrum) and the School of Public Health (W.Y., D.W., E.W.), University of Michigan, Ann Arbor; the Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine (M.A., S.C.L., P.G.W.) and the Cardiovascular Research Institute (S.C.L., P.G.W.), University of California San Francisco, and the San Francisco Veterans Affairs (VA) Healthcare System (M.A.) - both in San Francisco; the Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine at UCLA (I.Z.B., R.G.B., C.B.C.), and the Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center (W.W.S.) - both in Los Angeles; the Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore (S.-A.B., N.N.H., R.A.W.); the Division of Pulmonary, Critical Care, and Occupational Medicine, University of Iowa, Iowa City (A.P.C.); the Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia (G.J.C.); the Division of Pulmonary, Allergy, and Critical Care Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham (M.T.D.); Geisel School of Medicine at Dartmouth and Pulmonary and Critical Care Medicine, VA Medical Center, White River Junction, VT (F.D.); the Division of Pulmonary, Critical Care, and Sleep Medicine, Houston Methodist Academic Medicine Associates, Houston (R.J.F.); the Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine (R.K.), and the Breathe Chicago Center, Division of Pulmonary, Critical Care, Sleep, and Allergy, University of Illinois Chicago (J.A.K.) - both in Chicago; the Department of Genetic Medicine (R.J.K.) and Joan and Sanford I. Weill Department of Medicine (R.J.K., F.J.M.), Weill Cornell Medicine and New York-Presbyterian Hospital, and the Division of Pulmonary, Critical Care, and Sleep Medicine, Icahn School of Medicine at Mount Sinai (L.R.) - both in New York; the Division of Respiratory, Critical Care, and Occupational Pulmonary Medicine, University of Utah School of Medicine, Salt Lake City (R.E.K.); East Carolina University, Greenville (V.M.), and Duke University School of Medicine, Durham (A.M.) - both in North Carolina; HealthPartners Institute, Bloomington (C. McEvoy), and Minneapolis VA Healthcare System, Minneapolis (C.H.W.) - both in Minnesota; and the Division of Pulmonary, Allergy, and Critical Care Medicine (T.N., F.C.S.) and Epidemiology Data Center (S.R.W.), University of Pittsburgh, Pittsburgh
| | - Frank C Sciurba
- From the Division of Pulmonary and Critical Care (M.K.H., C. Meldrum) and the School of Public Health (W.Y., D.W., E.W.), University of Michigan, Ann Arbor; the Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine (M.A., S.C.L., P.G.W.) and the Cardiovascular Research Institute (S.C.L., P.G.W.), University of California San Francisco, and the San Francisco Veterans Affairs (VA) Healthcare System (M.A.) - both in San Francisco; the Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine at UCLA (I.Z.B., R.G.B., C.B.C.), and the Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center (W.W.S.) - both in Los Angeles; the Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore (S.-A.B., N.N.H., R.A.W.); the Division of Pulmonary, Critical Care, and Occupational Medicine, University of Iowa, Iowa City (A.P.C.); the Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia (G.J.C.); the Division of Pulmonary, Allergy, and Critical Care Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham (M.T.D.); Geisel School of Medicine at Dartmouth and Pulmonary and Critical Care Medicine, VA Medical Center, White River Junction, VT (F.D.); the Division of Pulmonary, Critical Care, and Sleep Medicine, Houston Methodist Academic Medicine Associates, Houston (R.J.F.); the Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine (R.K.), and the Breathe Chicago Center, Division of Pulmonary, Critical Care, Sleep, and Allergy, University of Illinois Chicago (J.A.K.) - both in Chicago; the Department of Genetic Medicine (R.J.K.) and Joan and Sanford I. Weill Department of Medicine (R.J.K., F.J.M.), Weill Cornell Medicine and New York-Presbyterian Hospital, and the Division of Pulmonary, Critical Care, and Sleep Medicine, Icahn School of Medicine at Mount Sinai (L.R.) - both in New York; the Division of Respiratory, Critical Care, and Occupational Pulmonary Medicine, University of Utah School of Medicine, Salt Lake City (R.E.K.); East Carolina University, Greenville (V.M.), and Duke University School of Medicine, Durham (A.M.) - both in North Carolina; HealthPartners Institute, Bloomington (C. McEvoy), and Minneapolis VA Healthcare System, Minneapolis (C.H.W.) - both in Minnesota; and the Division of Pulmonary, Allergy, and Critical Care Medicine (T.N., F.C.S.) and Epidemiology Data Center (S.R.W.), University of Pittsburgh, Pittsburgh
| | - Prescott G Woodruff
- From the Division of Pulmonary and Critical Care (M.K.H., C. Meldrum) and the School of Public Health (W.Y., D.W., E.W.), University of Michigan, Ann Arbor; the Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine (M.A., S.C.L., P.G.W.) and the Cardiovascular Research Institute (S.C.L., P.G.W.), University of California San Francisco, and the San Francisco Veterans Affairs (VA) Healthcare System (M.A.) - both in San Francisco; the Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine at UCLA (I.Z.B., R.G.B., C.B.C.), and the Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center (W.W.S.) - both in Los Angeles; the Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore (S.-A.B., N.N.H., R.A.W.); the Division of Pulmonary, Critical Care, and Occupational Medicine, University of Iowa, Iowa City (A.P.C.); the Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia (G.J.C.); the Division of Pulmonary, Allergy, and Critical Care Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham (M.T.D.); Geisel School of Medicine at Dartmouth and Pulmonary and Critical Care Medicine, VA Medical Center, White River Junction, VT (F.D.); the Division of Pulmonary, Critical Care, and Sleep Medicine, Houston Methodist Academic Medicine Associates, Houston (R.J.F.); the Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine (R.K.), and the Breathe Chicago Center, Division of Pulmonary, Critical Care, Sleep, and Allergy, University of Illinois Chicago (J.A.K.) - both in Chicago; the Department of Genetic Medicine (R.J.K.) and Joan and Sanford I. Weill Department of Medicine (R.J.K., F.J.M.), Weill Cornell Medicine and New York-Presbyterian Hospital, and the Division of Pulmonary, Critical Care, and Sleep Medicine, Icahn School of Medicine at Mount Sinai (L.R.) - both in New York; the Division of Respiratory, Critical Care, and Occupational Pulmonary Medicine, University of Utah School of Medicine, Salt Lake City (R.E.K.); East Carolina University, Greenville (V.M.), and Duke University School of Medicine, Durham (A.M.) - both in North Carolina; HealthPartners Institute, Bloomington (C. McEvoy), and Minneapolis VA Healthcare System, Minneapolis (C.H.W.) - both in Minnesota; and the Division of Pulmonary, Allergy, and Critical Care Medicine (T.N., F.C.S.) and Epidemiology Data Center (S.R.W.), University of Pittsburgh, Pittsburgh
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Buhr RG, Barjaktarevic IZ, Quibrera PM, Bateman LA, Bleecker ER, Couper DJ, Curtis JL, Dolezal BA, Han MK, Hansel NN, Krishnan JA, Martinez FJ, McKleroy W, Paine R, Rennard SI, Tashkin DP, Woodruff PG, Kanner RE, Cooper CB. Reversible Airflow Obstruction Predicts Future Chronic Obstructive Pulmonary Disease Development in the SPIROMICS Cohort: An Observational Cohort Study. Am J Respir Crit Care Med 2022; 206:554-562. [PMID: 35549640 PMCID: PMC9716898 DOI: 10.1164/rccm.202201-0094oc] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 05/10/2022] [Indexed: 12/14/2022] Open
Abstract
Rationale: Chronic obstructive pulmonary disease (COPD) is defined by fixed spirometric ratio, FEV1/FVC < 0.70 after inhaled bronchodilators. However, the implications of variable obstruction (VO), in which the prebronchodilator FEV1/FVC ratio is less than 0.70 but increases to 0.70 or more after inhaled bronchodilators, have not been determined. Objectives: We explored differences in physiology, exacerbations, and health status in participants with VO compared with reference participants without obstruction. Methods: Data from the SPIROMICS (Subpopulations and Intermediate Outcome Measures in COPD Study) cohort were obtained. Participants with VO were compared with reference participants without obstruction. Measurements and Main Results: We assessed differences in baseline radiographic emphysema and small airway disease at study entry, baseline, and change in lung function by spirometry, functional capacity by 6-minute walk, health status using standard questionnaires, exacerbation rates, and progression to COPD between the two groups. All models were adjusted for participant characteristics, asthma history, and tobacco exposure. We assessed 175 participants with VO and 603 reference participants without obstruction. Participants with VO had 6.2 times the hazard of future development of COPD controlling for other factors (95% confidence interval, 4.6-8.3; P < 0.001). Compared with reference participants, the VO group had significantly lower baseline pre- and post-bronchodilator (BD) FEV1, and greater decline over time in post-BD FEV1, and pre- and post-BD FVC. There were no significant differences in exacerbations between groups. Conclusions: Significant risk for future COPD development exists for those with pre- but not post-BD airflow obstruction. These findings support consideration of expanding spirometric criteria defining COPD to include pre-BD obstruction. Clinical trial registered with www.clinicaltrials.gov (NCT01969344).
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Affiliation(s)
- Russell G. Buhr
- Division of Pulmonary and Critical Care Medicine, and
- Center for the Study of Healthcare Innovation, Implementation, and Policy, Health Services Research and Development, Greater Los Angeles Veterans Affairs Healthcare System, Los Angeles, California
| | | | - P. Miguel Quibrera
- Collaborative Studies Coordinating Center, Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
| | - Lori A. Bateman
- Collaborative Studies Coordinating Center, Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
| | - Eugene R. Bleecker
- Division of Genetics, Genomics, and Precision Medicine, University of Arizona, Tucson, Arizona
| | - David J. Couper
- Collaborative Studies Coordinating Center, Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
| | - Jeffrey L. Curtis
- Division of Pulmonary and Critical Care Medicine, University of Michigan School of Medicine, Ann Arbor, Michigan
- Medical Service, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan
| | | | - MeiLan K. Han
- Division of Pulmonary and Critical Care Medicine, University of Michigan School of Medicine, Ann Arbor, Michigan
| | - Nadia N. Hansel
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jerry A. Krishnan
- Breathe Chicago Center, Division of Pulmonary and Critical Care Medicine, University of Illinois at Chicago College of Medicine, Chicago, Illinois
| | - Fernando J. Martinez
- Division of Pulmonary and Critical Care Medicine, Columbia University College of Physicians and Surgeons, New York, New York
| | - William McKleroy
- Division of Pulmonary and Critical Care Medicine, University of California, San Francisco, California
| | - Robert Paine
- Division of Respiratory, Critical Care, and Occupational Medicine, University of Utah School of Medicine, Salt Lake City, Utah
- Veterans Affairs Salt Lake City Healthcare System, Salt Lake City, Utah; and
| | - Stephen I. Rennard
- Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska
| | | | - Prescott G. Woodruff
- Division of Pulmonary and Critical Care Medicine, University of California, San Francisco, California
| | - Richard E. Kanner
- Division of Respiratory, Critical Care, and Occupational Medicine, University of Utah School of Medicine, Salt Lake City, Utah
| | - Christopher B. Cooper
- Division of Pulmonary and Critical Care Medicine, and
- Department of Physiology, David Geffen School of Medicine, University of California, Los Angeles, California
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Dommaraju SR, Rivera SG, Rocha EG, Bicknell S, Loizzo D, Mohammad A, Rajan P, Seballos A, Datta A, Ahmed R, Krishnan JA, Keehn MT. Health professional students at the University of Illinois Chicago (HOLISTIC) Cohort Study: A protocol. PLoS One 2022; 17:e0269964. [PMID: 36040905 PMCID: PMC9426903 DOI: 10.1371/journal.pone.0269964] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 05/14/2022] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES The objectives of the HOLISTIC Cohort Study are to establish a prospective cohort study covering a period of three years that characterizes the health of students within and across health professional education programs at the University of Illinois Chicago (UIC) during the coronavirus disease 2019 (COVID-19) pandemic, implement an interprofessional student research team, and generate a meaningful dataset that is used to inform initiatives that improve student health. This report describes the protocol of the HOLISTIC Cohort Study, including survey development, recruitment strategy, and data management and analysis. METHODS An interprofessional student research team has been organized with the goal of providing continuous assessment of study design and implementation across the seven health science colleges (applied health sciences, dentistry, medicine, nursing, pharmacy, public health, and social work) at the University of Illinois Chicago in Chicago, IL. To be eligible to participate in the HOLISTIC Cohort Study, students are required to be 1) age 18 years or older; 2) enrolled full- or part-time in one or more of UIC's seven health science colleges; and 3) enrolled in a program that prepares its graduates to enter a healthcare profession. The study protocol includes a series of three recruitment waves (Spring 2021 [April 14, 2021, to May 5, 2021; completed], Spring 2022, Spring 2023). In the first recruitment wave, eligible students were sent an invitation via electronic mail (e-mail) to complete an online survey. The online survey was based on the U.S. Centers for Disease Control and Prevention's Behavioral Risk Factor Surveillance System 2019 survey and the 2014 World Health Organization Report of the Strategic Advisory Group of Experts Working Group Vaccine Hesitancy Scale. Electronic informed consent and study data are collected and managed using Research Electronic Data Capture (REDCap) tools. This study utilizes convenience sampling from all seven health science colleges at UIC with a target recruitment total of 2,000 participants. DISCUSSION AND FUTURE DIRECTIONS A total of 555 students across all seven health science colleges (10.8% of 5,118 students who were invited; 27.6% of target sample size) enrolled in the cohort during the first recruitment wave. The pilot data establishes the feasibility of the study during the COVID-19 pandemic. Adaptations to overcome barriers to study implementation, including the use of remote, rather than in-person, study meetings, staff training, and participant recruitment are discussed. For the second and third waves of recruitment, the student research team will seek institutional review board (IRB) approval to implement additional enrollment strategies that are tailored to each health science college, such as online newsletters, virtual townhalls, flyers on bulletin boards near classrooms tailored to each health science college.
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Affiliation(s)
- Sunil R. Dommaraju
- College of Medicine, University of Illinois Chicago, Chicago, Illinois, United States of America
| | - Stephanie Gordon Rivera
- School of Public Health, University of Illinois Chicago, Chicago, Illinois, United States of America
| | - Ethan G. Rocha
- College of Applied Health Sciences, University of Illinois Chicago, Chicago, Illinois, United States of America
| | - Scott Bicknell
- College of Dentistry, University of Illinois Chicago, Chicago, Illinois, United States of America
| | - Daniel Loizzo
- College of Medicine, University of Illinois Chicago, Chicago, Illinois, United States of America
| | - Ayesha Mohammad
- College of Applied Health Sciences, University of Illinois Chicago, Chicago, Illinois, United States of America
| | - Priya Rajan
- College of Nursing, University of Illinois Chicago, Chicago, Illinois, United States of America
| | - Alexandria Seballos
- College of Applied Health Sciences, University of Illinois Chicago, Chicago, Illinois, United States of America
| | - Avisek Datta
- School of Public Health, University of Illinois Chicago, Chicago, Illinois, United States of America
| | - Rashid Ahmed
- School of Public Health, University of Illinois Chicago, Chicago, Illinois, United States of America
| | - Jerry A. Krishnan
- College of Medicine, University of Illinois Chicago, Chicago, Illinois, United States of America
- Population Health Sciences Program, Office of the Vice Chancellor for Health Affairs, University of Illinois Chicago, Chicago, Illinois, United States of America
| | - Mary T. Keehn
- College of Applied Health Sciences, University of Illinois Chicago, Chicago, Illinois, United States of America
- Interprofessional Practice and Education, Office of the Vice Chancellor for Health Affairs, University of Illinois Chicago, Chicago, Illinois, United States of America
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Belz DC, Woo H, Putcha N, Paulin LM, Koehler K, Fawzy A, Alexis NE, Barr RG, Comellas AP, Cooper CB, Couper D, Dransfield M, Gassett AJ, Han M, Hoffman EA, Kanner RE, Krishnan JA, Martinez FJ, Paine R, Peng RD, Peters S, Pirozzi CS, Woodruff PG, Kaufman JD, Hansel NN. Ambient ozone effects on respiratory outcomes among smokers modified by neighborhood poverty: An analysis of SPIROMICS AIR. Sci Total Environ 2022; 829:154694. [PMID: 35318050 PMCID: PMC9117415 DOI: 10.1016/j.scitotenv.2022.154694] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Revised: 03/15/2022] [Accepted: 03/16/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Neighborhood poverty has been associated with poor health outcomes. Previous studies have also identified adverse respiratory effects of long-term ambient ozone. Factors associated with neighborhood poverty may accentuate the adverse impact of ozone on respiratory health. OBJECTIVES To evaluate whether neighborhood poverty modifies the association between ambient ozone exposure and respiratory morbidity including symptoms, exacerbation risk, and radiologic parameters, among participants of the SPIROMICS AIR cohort study. METHODS Spatiotemporal models incorporating cohort-specific monitoring estimated 10-year average outdoor ozone concentrations at participants' homes. Adjusted regression models were used to determine the association of ozone exposure with respiratory outcomes, accounting for demographic factors, education, individual income, body mass index (BMI), and study site. Neighborhood poverty rate was defined by percentage of families living below federal poverty level per census tract. Interaction terms for neighborhood poverty rate with ozone were included in covariate-adjusted models to evaluate for effect modification. RESULTS 1874 participants were included in the analysis, with mean (± SD) age 64 (± 8.8) years and FEV1 (forced expiratory volume in one second) 74.7% (±25.8) predicted. Participants resided in neighborhoods with mean poverty rate of 9.9% (±10.3) of families below the federal poverty level and mean 10-year ambient ozone concentration of 24.7 (±5.2) ppb. There was an interaction between neighborhood poverty rate and ozone concentration for numerous respiratory outcomes, including COPD Assessment Test score, modified Medical Research Council Dyspnea Scale, six-minute walk test, and odds of COPD exacerbation in the year prior to enrollment, such that adverse effects of ozone were greater among participants in higher poverty neighborhoods. CONCLUSION Individuals with COPD in high poverty neighborhoods have higher susceptibility to adverse respiratory effects of ambient ozone exposure, after adjusting for individual factors. These findings highlight the interaction between exposures associated with poverty and their effect on respiratory health.
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Affiliation(s)
- Daniel C Belz
- Department of Medicine, Johns Hopkins University, 1830 E. Monument, 5th Floor, Baltimore, MD 21205, USA.
| | - Han Woo
- Department of Medicine, Johns Hopkins University, 1830 E. Monument, 5th Floor, Baltimore, MD 21205, USA.
| | - Nirupama Putcha
- Department of Medicine, Johns Hopkins University, 1830 E. Monument, 5th Floor, Baltimore, MD 21205, USA.
| | - Laura M Paulin
- Dartmouth-Hitchcock Medical Center/Geisel School of Medicine at Dartmouth, 1 Medical Center Dr, Pulmonary 5C Ste, Lebanon, NH 03756, USA.
| | - Kirsten Koehler
- Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA.
| | - Ashraf Fawzy
- Department of Medicine, Johns Hopkins University, 1830 E. Monument, 5th Floor, Baltimore, MD 21205, USA.
| | - Neil E Alexis
- University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
| | - R Graham Barr
- Columbia University Medical Center, 630 W. 168th St., New York, NY 10032, USA.
| | - Alejandro P Comellas
- University of Iowa Department of Internal Medicine, 200 Hawkins Drive, Iowa City, IA 52242, USA.
| | - Christopher B Cooper
- University of California, Los Angeles, 10833 Le Conte Ave, Los Angeles, CA 90095, USA.
| | - David Couper
- University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
| | - Mark Dransfield
- University of Alabama, Birmingham, 1720 2nd Ave South, Birmingham, AL 35294, USA.
| | - Amanda J Gassett
- University of Washington, 1959 NE Pacific St, Seattle, WA 98195, USA.
| | - MeiLan Han
- University of Michigan, 1500 E Medical Center Dr, Ann Arbor, MI 48109, USA.
| | - Eric A Hoffman
- University of Iowa Department of Internal Medicine, 200 Hawkins Drive, Iowa City, IA 52242, USA.
| | - Richard E Kanner
- University of Utah, 50 North Medical Drive, Salt Lake City, UT 84132, USA.
| | - Jerry A Krishnan
- University of Illinois at Chicago, 1853 West Polk Street, Chicago, IL 60612, USA.
| | | | - Robert Paine
- University of Utah, 50 North Medical Drive, Salt Lake City, UT 84132, USA.
| | - Roger D Peng
- Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA.
| | - Stephen Peters
- Wake Forest University, 475 Vine St, Winston-Salem, NC 27101, USA.
| | - Cheryl S Pirozzi
- University of Utah, 50 North Medical Drive, Salt Lake City, UT 84132, USA.
| | - Prescott G Woodruff
- University of California, San Francisco, 513 Parnassus Ave, HSE, San Francisco, CA 94143, USA.
| | - Joel D Kaufman
- University of Washington, 1959 NE Pacific St, Seattle, WA 98195, USA.
| | - Nadia N Hansel
- Department of Medicine, Johns Hopkins University, 1830 E. Monument, 5th Floor, Baltimore, MD 21205, USA.
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Forrest CB, Schuchard J, Bruno C, Amaral S, Cox ED, Flynn KE, Hinds PS, Huang IC, Kappelman MD, Krishnan JA, Kumar RB, Lai JS, Paller AS, Phipatanakul W, Schanberg LE, Sumino K, Weitzman ER, Reeve BB. Self-Reported Health Outcomes of Children and Youth with 10 Chronic Diseases. J Pediatr 2022; 246:207-212.e1. [PMID: 35247394 PMCID: PMC9232908 DOI: 10.1016/j.jpeds.2022.02.052] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 02/22/2022] [Accepted: 02/24/2022] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To identify pediatric patient-reported outcomes (PROs) that are associated with chronic conditions and to evaluate the effects of chronic disease activity on PROs. STUDY DESIGN Participants (8-24 years old) and their parents were enrolled into 14 studies that evaluated Patient-Reported Outcome Measurement Information System PROs across 10 chronic conditions-asthma, atopic dermatitis, cancer, cancer survivors, chronic kidney disease, Crohn's disease, juvenile idiopathic arthritis, lupus, sickle cell disease, and type 1 diabetes mellitus. PRO scores were contrasted with the US general population of children using nationally representative percentiles. PRO-specific coefficients of variation were computed to illustrate the degree of variation in scores within vs between conditions. Condition-specific measures of disease severity and Cohen d effect sizes were used to examine PRO scores by disease activity. RESULTS Participants included 2975 child respondents and 2392 parent respondents who provided data for 3409 unique children: 52% were 5-12 years old, 52% female, 25% African American/Black, and 14% Hispanic. Across all 10 chronic conditions, children reported more anxiety, fatigue, pain, and mobility restrictions than the general pediatric population. Variation in PRO scores within chronic disease cohorts was equivalent to variation within the general population, exceeding between-cohort variation by factors of 1.9 (mobility) to 5.7 (anxiety). Disease activity was consistently associated with poorer self-reported health, and these effects were weakest for peer relationships. CONCLUSIONS Chronic conditions are associated with symptoms and functional status in children and adolescents across 10 different disorders. These findings highlight the need to complement conventional clinical evaluations with those obtained directly from patients themselves using PROs.
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Affiliation(s)
| | | | - Cortney Bruno
- Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Sandra Amaral
- Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Elizabeth D. Cox
- University of Wisconsin-Madison Schools of Medicine and Public Health, Madison, WI
| | | | | | - I-Chan Huang
- St. Jude Children’s Research Hospital, Memphis, TN
| | | | | | - Rajesh B. Kumar
- Northwestern University Feinberg School of Medicine and the Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL
| | - Jin-Shei Lai
- Northwestern University Feinberg School of Medicine
| | | | | | | | - Kaharu Sumino
- Washington University School of Medicine, St. Louis, MO
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Gater A, Nelsen L, Coon CD, Eremenco S, O'Quinn S, Khan AH, Eckert L, Staunton H, Bonner N, Hall R, Krishnan JA, Stoloff S, Schatz M, Haughney J, Coons SJ. Asthma Daytime Symptom Diary (ADSD) and Asthma Nighttime Symptom Diary (ANSD): Measurement Properties of Novel Patient-Reported Symptom Measures. J Allergy Clin Immunol Pract 2022; 10:1249-1259. [PMID: 34896298 DOI: 10.1016/j.jaip.2021.11.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 10/27/2021] [Accepted: 11/17/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND The Asthma Daytime Symptom Diary (ADSD) and the Asthma Nighttime Symptom Diary (ANSD) were developed to meet the need for standardized patient-reported measures of asthma symptoms to assess treatment trial outcomes in adults and adolescents. OBJECTIVE To determine scoring and evaluate the measurement properties of the ADSD/ANSD. METHODS Adolescents (12-17 years) and adults (18+ years) with asthma completed draft 8-item electronic versions of the ADSD/ANSD for 10 days alongside the Adult Asthma Symptom Daily Scales (AASDS) and a Patient Global Impression of Severity (PGIS). Using classical and modern psychometric methods, initial analyses evaluated the performance of ADSD/ANSD items to inform scoring. Subsequent analyses evaluated the reliability and validity of ADSD/ANSD scores. RESULTS A demographically and clinically diverse sample (n = 130 adolescents; n = 89 adults) was recruited. Item performance was generally strong. However, items assessing chest pressure and mucus/phlegm demonstrated redundancy and poorer performance and were removed. Principal-components analysis, confirmatory factor analysis, and item response theory supported combining items to form 6-item total ADSD/ANSD scores. Internal consistency (α = 0.94-0.95) and test-retest reliability (intraclass correlation coefficient = 0.86-0.95) were strong. Strong correlations (r = 0.72-0.80) were observed between ADSD scores and AASDS items assessing asthma symptom frequency, bother, and impact on activities. Significant differences (P < .001) in mean ADSD/ANSD scores were observed between groups categorized by asthma severity (PGIS), asthma control, inhaler use, nebulizer use, activity limitations, and nighttime awakenings. CONCLUSIONS The ADSD/ANSD items and scores demonstrated strong reliability and validity. Implementation of the measures in interventional studies will enable the evaluation of responsiveness and meaningful within-patient change.
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Affiliation(s)
- Adam Gater
- Adelphi Values Ltd, Bollington, Cheshire, United Kingdom.
| | | | | | - Sonya Eremenco
- Patient-Reported Outcome Consortium, Critical Path Institute, Tucson, Ariz
| | | | | | | | - Hannah Staunton
- Roche Products Limited, Welwyn Garden City, Hertfordshire, United Kingdom
| | - Nicola Bonner
- Adelphi Values Ltd, Bollington, Cheshire, United Kingdom
| | - Rebecca Hall
- Adelphi Values Ltd, Bollington, Cheshire, United Kingdom
| | | | | | - Michael Schatz
- Kaiser Permanente Medical Center/Kaiser Foundation Hospital, San Diego, Calif
| | - John Haughney
- Queen Elizabeth University Hospital, Glasgow, United Kingdom
| | - Stephen Joel Coons
- Patient-Reported Outcome Consortium, Critical Path Institute, Tucson, Ariz
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48
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Baugh AD, Shiboski S, Hansel NN, Ortega V, Barjaktarevic I, Barr RG, Bowler R, Comellas AP, Cooper CB, Couper D, Criner G, Curtis JL, Dransfield M, Ejike C, Han MK, Hoffman E, Krishnan J, Krishnan JA, Mannino D, Paine R, Parekh T, Peters S, Putcha N, Rennard S, Thakur N, Woodruff PG. Reconsidering the Utility of Race-Specific Lung Function Prediction Equations. Am J Respir Crit Care Med 2022; 205:819-829. [PMID: 34913855 PMCID: PMC9836221 DOI: 10.1164/rccm.202105-1246oc] [Citation(s) in RCA: 57] [Impact Index Per Article: 28.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Rationale: African American individuals have worse outcomes in chronic obstructive pulmonary disease (COPD). Objectives: To assess whether race-specific approaches for estimating lung function contribute to racial inequities by failing to recognize pathological decrements and considering them normal. Methods: In a cohort with and at risk for COPD, we assessed whether lung function prediction equations applied in a race-specific versus universal manner better modeled the relationship between FEV1, FVC, and other COPD outcomes, including the COPD Assessment Test, St. George's Respiratory Questionnaire, computed tomography percent emphysema, airway wall thickness, and 6-minute-walk test. We related these outcomes to differences in FEV1 using multiple linear regression and compared predictive performance between fitted models using root mean squared error and Alpaydin's paired F test. Measurements and Main Results: Using race-specific equations, African American individuals were calculated to have better lung function than non-Hispanic White individuals (FEV1, 76.8% vs. 71.8% predicted; P = 0.02). Using universally applied equations, African American individuals were calculated to have worse lung function. Using Hankinson's Non-Hispanic White equation, FEV1 was 64.7% versus 71.8% (P < 0.001). Using the Global Lung Initiative's Other race equation, FEV1 was 70.0% versus 77.9% (P < 0.001). Prediction errors from linear regression were less for universally applied equations compared with race-specific equations when examining FEV1% predicted with the COPD Assessment Test (P < 0.01), St. George's Respiratory Questionnaire (P < 0.01), and airway wall thickness (P < 0.01). Although African American participants had greater adversity (P < 0.001), less adversity was only associated with better FEV1 in non-Hispanic White participants (P for interaction = 0.041). Conclusions: Race-specific equations may underestimate COPD severity in African American individuals.Clinical trial registered with www.clinicaltrials.gov (NCT01969344).
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Affiliation(s)
- Aaron D. Baugh
- University of California San Francisco, San Francisco, California
| | - Stephen Shiboski
- University of California San Francisco, San Francisco, California
| | | | - Victor Ortega
- Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Igor Barjaktarevic
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - R. Graham Barr
- Columbia University Medical Center, Columbia University, New York, New York
| | | | | | | | - David Couper
- Department of Biostatistics, University of North Carolina, Chapel Hill, North Carolina
| | - Gerard Criner
- Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | - Jeffrey L. Curtis
- University of Michigan, Ann Arbor, Michigan;,Veterans Administration Ann Arbor Healthcare System, Ann Arbor, Michigan
| | | | | | | | - Eric Hoffman
- Carver College of Medicine, University of Iowa, Iowa City, Iowa
| | | | | | | | | | | | - Stephen Peters
- Wake Forest School of Medicine, Winston-Salem, North Carolina
| | | | | | - Neeta Thakur
- University of California San Francisco, San Francisco, California
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Abstract
PURPOSE OF REVIEW Many healthcare systems rapidly implemented telehealth as a substitute for in-person care during the coronavirus disease 2019 (COVID-19) pandemic. The purpose of this review is to describe the evidence base supporting the use of telehealth for chronic obstructive pulmonary disease (COPD) prior to the COVID-19 pandemic, discuss the barriers to implementing telehealth during the pandemic, and share our opinion about the future of telehealth in COPD. RECENT FINDINGS The evidence from randomized clinical trials in COPD completed prior to the COVID-19 pandemic indicate that the effectiveness of telehealth interventions compared to in-person usual care on clinical outcomes is inconclusive. Recent experience during the COVID-19 pandemic indicates that telehealth may increase access to healthcare and satisfaction with care when delivered in addition to usual in-person care. While some reimbursement-related barriers to telehealth have been alleviated during the COVID-19 pandemic, several patient, provider, and health-system barriers to implementation remain. SUMMARY There is a need to further evaluate the delivery of telehealth services as an adjunct to traditional in-person models of COPD care. Standardization and reporting of core clinical, satisfaction, accessibility, and quality of care outcomes are needed to promote cross-study learning and more rapid translation of research evidence into practice.
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50
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Martinez FJ, Agusti A, Celli BR, Han MK, Allinson JP, Bhatt SP, Calverley P, Chotirmall SH, Chowdhury B, Darken P, Da Silva CA, Donaldson G, Dorinsky P, Dransfield M, Faner R, Halpin DM, Jones P, Krishnan JA, Locantore N, Martinez FD, Mullerova H, Price D, Rabe KF, Reisner C, Singh D, Vestbo J, Vogelmeier CF, Wise RA, Tal-Singer R, Wedzicha JA. Treatment Trials in Young Patients with Chronic Obstructive Pulmonary Disease and Pre-Chronic Obstructive Pulmonary Disease Patients: Time to Move Forward. Am J Respir Crit Care Med 2022; 205:275-287. [PMID: 34672872 PMCID: PMC8886994 DOI: 10.1164/rccm.202107-1663so] [Citation(s) in RCA: 57] [Impact Index Per Article: 28.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is the end result of a series of dynamic and cumulative gene-environment interactions over a lifetime. The evolving understanding of COPD biology provides novel opportunities for prevention, early diagnosis, and intervention. To advance these concepts, we propose therapeutic trials in two major groups of subjects: "young" individuals with COPD and those with pre-COPD. Given that lungs grow to about 20 years of age and begin to age at approximately 50 years, we consider "young" patients with COPD those patients in the age range of 20-50 years. Pre-COPD relates to individuals of any age who have respiratory symptoms with or without structural and/or functional abnormalities, in the absence of airflow limitation, and who may develop persistent airflow limitation over time. We exclude from the current discussion infants and adolescents because of their unique physiological context and COPD in older adults given their representation in prior randomized controlled trials (RCTs). We highlight the need of RCTs focused on COPD in young patients or pre-COPD to reduce disease progression, providing innovative approaches to identifying and engaging potential study subjects. We detail approaches to RCT design, including potential outcomes such as lung function, patient-reported outcomes, exacerbations, lung imaging, mortality, and composite endpoints. We critically review study design components such as statistical powering and analysis, duration of study treatment, and formats to trial structure, including platform, basket, and umbrella trials. We provide a call to action for treatment RCTs in 1) young adults with COPD and 2) those with pre-COPD at any age.
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Affiliation(s)
| | - Alvar Agusti
- Catedra Salut Respiratoria and,Institut Respiratorio, Hospital Clinic, Barcelona, Spain;,Institut d’investigacions biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain;,Centro de Investigacion Biomedica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Bartolome R. Celli
- Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - MeiLan K. Han
- University of Michigan Health System, Ann Arbor, Michigan
| | - James P. Allinson
- National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Surya P. Bhatt
- Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Peter Calverley
- Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, United Kingdom
| | | | | | | | - Carla A. Da Silva
- Clinical Development, Research and Early Development, Respiratory and Immunology, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - Gavin Donaldson
- National Heart and Lung Institute, Imperial College, London, United Kingdom
| | | | - Mark Dransfield
- Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Rosa Faner
- Department of Biomedical Sciences, University of Barcelona, Barcelona, Spain
| | | | - Paul Jones
- St. George’s University of London, London, United Kingdom
| | | | | | | | | | - David Price
- Observational and Pragmatic Research Institute, Singapore;,Centre of Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom
| | - Klaus F. Rabe
- LungenClinic Grosshansdorf, Member of the German Center for Lung Research, Grosshansdorf, Germany;,Department of Medicine, Christian Albrechts University Kiel, Member of the German Center for Lung Research Kiel, Germany
| | | | | | - Jørgen Vestbo
- Manchester University NHS Trust, Manchester, United Kingdom
| | - Claus F. Vogelmeier
- Department of Medicine, Pulmonary and Critical Care Medicine, University of Marburg, Member of the German Center for Lung Research, Marburg, Germany
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