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Guenther EL, McCoy KS, Eisner M, Bai S, Nemastil CJ, Novak KJ, Johnson T, Stephan EM. Impact of chronic medication de-escalation in patients with cystic fibrosis taking elexacaftor, tezacaftor, ivacaftor: A retrospective review. J Cyst Fibros 2024; 23:32-37. [PMID: 37069044 DOI: 10.1016/j.jcf.2023.03.018] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 03/06/2023] [Accepted: 03/28/2023] [Indexed: 04/19/2023]
Abstract
BACKGROUND This single-center, retrospective study evaluated the effects of de-escalating cystic fibrosis (CF) supportive therapies in patients on elexacaftor/tezacaftor/ivacaftor (ETI). For many with CF, the clinical benefit of ETI exceeds that of supportive therapies. Therefore, we anticipated patients would desire to discontinue many of their supportive therapies, leading to the creation of a de-escalation algorithm. If patients were clinically improved and stable on ETI, CF supportive therapies could be de-escalated quarterly in accordance with the algorithm. METHODS The primary objective was to assess non-inferiority of supportive therapies de-escalation by comparing the absolute change in percent predicted (ppFEV1) from baseline to month 1 versus the absolute change from baseline to month 12 after initiating ETI with patients serving as their own control. A chart review of patients initiated on ETI from September 2019 through December 2020 was conducted. Inclusion criteria included those six years and older with at least one copy of F508del. RESULTS The study included 174 patients. The mean ppFEV1 at baseline, month 1, and month 12 was 67%, 78%, and 87% respectively. The mean difference in absolute change in ppFEV1 from baseline to month 1 compared to baseline to month 12 after the initiation of ETI was 1.53% (95% CI: -0.49 to 3.55) CONCLUSION: De-escalating supportive therapies for those on ETI was non-inferior to remaining on all supportive therapies. This suggests that medications may be able to be discontinued under the context of a de-escalation algorithm, which may decrease medication burden and cost and increase quality of life.
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Affiliation(s)
- Emma L Guenther
- Department of Pharmacy, Nationwide Children's Hospital, Columbus, OH, USA
| | - Karen S McCoy
- Department of Pulmonology, Nationwide Children's Hospital, Columbus, OH, USA
| | - Mariah Eisner
- Biostatistics Resource at Nationwide Children's Hospital, Columbus, OH, USA
| | - Shasha Bai
- Pediatric Biostatistics Core, Department of Pediatrics, Emory University, Atlanta, GA, USA
| | | | - Kimberly J Novak
- Department of Pharmacy, Nationwide Children's Hospital, Columbus, OH, USA
| | - Terri Johnson
- Department of Pulmonology, Nationwide Children's Hospital, Columbus, OH, USA
| | - Emily M Stephan
- Department of Pharmacy, Nationwide Children's Hospital, Columbus, OH, USA
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Sheikh S, Ho ML, Eisner M, Gushue C, Paul G, Holtzlander M, Johnson T, McCoy KS, Lind M. Elexacaftor-Tezacaftor-Ivacaftor Therapy for Chronic Sinus Disease in Cystic Fibrosis. JAMA Otolaryngol Head Neck Surg 2023; 149:1075-1082. [PMID: 37676668 PMCID: PMC10485743 DOI: 10.1001/jamaoto.2023.2701] [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: 04/03/2023] [Accepted: 07/10/2023] [Indexed: 09/08/2023]
Abstract
Importance Cystic fibrosis (CF) is a multiorgan genetic disease with progressive upper and lower airway involvement. The effects of CF transmembrane conductance regulator (CFTR) modifier therapies on CF-related upper airway disease, specifically chronic rhinosinusitis (CRS), are not characterized. Objective To determine the outcome of elexacaftor-tezacaftor-ivacaftor (ETI) on CRS as measured by changes in sinus computed tomography (CT) metrics and on clinical parameters in individuals with CF. Design, Setting, and Participants This prospective longitudinal cohort study was conducted at the CF center of a tertiary care hospital between October 1, 2019, and July 31, 2021. A total of 64 participants with CF were included in the analysis. Intervention Sinus CT was obtained within 1 month of initiation of ETI therapy (baseline), and within 1 month of 1 year of ETI therapy. Images were independently analyzed by pulmonology, radiology, and otolaryngology physicians, using the Lund-Mackay and Sheikh-Lind scoring systems. Percent predicted forced expiratory volume in 1 second (ppFEV1), body mass index (BMI), and microbiologic data collected at initiation of ETI therapy and 3-month intervals for 1 year were also measured. Main Outcomes and Measures The study hypothesis was that ETI therapy will improve CRS as measured by changes in sinus CT at initiation and 1 year after ETI therapy and clinical parameters in individuals with CF. Results Among the 64 participants (39 [60.9%] female; median age, 18.5 [IQR, 16.0-28.5] years; 64 [100%] White), improvement in CRS was noted by improvements in sinus CT scans using both sinus CT scoring systems after 1 year of ETI therapy. The reduction in the median total score using the Lund-Mackay sinus CT scoring system (from 5.8 [IQR, 5.0-7.0] to 3.3 [IQR, 2.6-4.2]) and the Sheikh-Lind scoring system (from 3.8 [IQR, 3.0-5.0] to 2.2 [IQR, 2.0-2.5]) was noted. Increases in ppFEV1 and BMI were also observed by 3 months of ETI therapy with persistent improvement through 1 year of treatment. Similarly, after 1 year of ETI therapy, participants with CF had reductions in positivity for Pseudomonas aeruginosa and Staphylococcus aureus in oropharyngeal cultures. Conclusion and Relevance This cohort study found that use of ETI therapy was associated with improved CRS outcomes in participants with CF as quantified by improved sinus CT scans measured by 2 radiographic scoring systems and was also associated with improved clinical outcomes. Despite improvement in CT scan scores, most people with CF continue to have scores that indicate severe sinus disease.
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Affiliation(s)
- Shahid Sheikh
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus
- Division of Pulmonary Medicine, Nationwide Children’s Hospital, Columbus, Ohio
- Nationwide Children’s Hospital, Columbus, Ohio
| | - Mai-Lan Ho
- Nationwide Children’s Hospital, Columbus, Ohio
- Department of Radiology, The Ohio State University College of Medicine, Columbus
| | - Mariah Eisner
- Nationwide Children’s Hospital, Columbus, Ohio
- Biostatistics Resource, Nationwide Children’s Hospital, Columbus, Ohio
| | - Courtney Gushue
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus
- Division of Pulmonary Medicine, Nationwide Children’s Hospital, Columbus, Ohio
- Nationwide Children’s Hospital, Columbus, Ohio
| | - Grace Paul
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus
- Division of Pulmonary Medicine, Nationwide Children’s Hospital, Columbus, Ohio
- Nationwide Children’s Hospital, Columbus, Ohio
| | - Melissa Holtzlander
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus
- Division of Pulmonary Medicine, Nationwide Children’s Hospital, Columbus, Ohio
- Nationwide Children’s Hospital, Columbus, Ohio
| | - Terri Johnson
- Division of Pulmonary Medicine, Nationwide Children’s Hospital, Columbus, Ohio
- Nationwide Children’s Hospital, Columbus, Ohio
| | - Karen S. McCoy
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus
- Division of Pulmonary Medicine, Nationwide Children’s Hospital, Columbus, Ohio
- Nationwide Children’s Hospital, Columbus, Ohio
| | - Meredith Lind
- Nationwide Children’s Hospital, Columbus, Ohio
- Department of Otolaryngology, The Ohio State University College of Medicine, Columbus
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Phelan KJ, Dill-McFarland KA, Kothari A, Segnitz RM, Burkle J, Grashel B, Jenkins S, Spagna D, Martin LJ, Haslam DB, Biagini JM, Kalra M, McCoy KS, Ross KR, Jackson DJ, Mersha TB, Altman MC, Khurana Hershey GK. Airway transcriptome networks identify susceptibility to frequent asthma exacerbations in children. J Allergy Clin Immunol 2023; 152:73-83. [PMID: 36918038 PMCID: PMC10395049 DOI: 10.1016/j.jaci.2023.02.031] [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: 09/15/2022] [Revised: 01/11/2023] [Accepted: 02/01/2023] [Indexed: 03/14/2023]
Abstract
BACKGROUND Frequent asthma exacerbators, defined as those experiencing more than 1 hospitalization in a year for an asthma exacerbation, represent an important subgroup of individuals with asthma. However, this group remains poorly defined and understudied in children. OBJECTIVE Our aim was to determine the molecular mechanisms underlying asthma pathogenesis and exacerbation frequency. METHODS We performed RNA sequencing of upper airway cells from both frequent and nonfrequent exacerbators enrolled in the Ohio Pediatric Asthma Repository. RESULTS Through molecular network analysis, we found that nonfrequent exacerbators display an increase in modules enriched for immune system processes, including type 2 inflammation and response to infection. In contrast, frequent exacerbators showed expression of modules enriched for nervous system processes, such as synaptic formation and axonal outgrowth. CONCLUSION These data suggest that the upper airway of frequent exacerbators undergoes peripheral nervous system remodeling, representing a novel mechanism underlying pediatric asthma exacerbation.
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Affiliation(s)
- Kieran J Phelan
- Divison of Asthma Research, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Medical Scientist Training Program, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | | | - Arjun Kothari
- Divison of Asthma Research, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - R Max Segnitz
- Division of Allergy and Infectious Diseases, University of Washington, Seattle, Wash
| | - Jeff Burkle
- Divison of Asthma Research, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Brittany Grashel
- Divison of Asthma Research, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Seth Jenkins
- Divison of Asthma Research, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Daniel Spagna
- Divison of Asthma Research, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Lisa J Martin
- Division of Human Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - David B Haslam
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio; Division of Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Jocelyn M Biagini
- Divison of Asthma Research, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Maninder Kalra
- Department of Pediatrics, Dayton Children's Hospital, Dayton, Ohio
| | - Karen S McCoy
- Division of Pediatric Pulmonology, Nationwide Children's Hospital, Columbus; Ohio
| | - Kristie R Ross
- Department of Pediatrics-Pulmonary, Rainbow Babies and Children's Hospital, Cleveland, Ohio
| | - Daniel J Jackson
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wis
| | - Tesfaye B Mersha
- Divison of Asthma Research, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Matthew C Altman
- Division of Allergy and Infectious Diseases, University of Washington, Seattle, Wash; Systems Immunology Program, Benaroya Research Institute, Seattle, Wash
| | - Gurjit K Khurana Hershey
- Divison of Asthma Research, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio.
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Zhang S, Shrestha CL, Robledo-Avila F, Jaganathan D, Wisniewski BL, Brown N, Pham H, Carey K, Amer AO, Hall-Stoodley L, McCoy KS, Bai S, Partida-Sanchez S, Kopp BT. Cystic fibrosis macrophage function and clinical outcomes after elexacaftor/tezacaftor/ivacaftor. Eur Respir J 2023; 61:2102861. [PMID: 36265882 PMCID: PMC10066828 DOI: 10.1183/13993003.02861-2021] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [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: 11/04/2021] [Accepted: 09/16/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Abnormal macrophage function caused by dysfunctional cystic fibrosis transmembrane conductance regulator (CFTR) is a critical contributor to chronic airway infections and inflammation in people with cystic fibrosis (PWCF). Elexacaftor/tezacaftor/ivacaftor (ETI) is a new CFTR modulator therapy for PWCF. Host-pathogen and clinical responses to CFTR modulators are poorly described. We sought to determine how ETI impacts macrophage CFTR function, resulting effector functions and relationships to clinical outcome changes. METHODS Clinical information and/or biospecimens were obtained at ETI initiation and 3, 6, 9 and 12 months post-ETI in 56 PWCF and compared with non-CF controls. Peripheral blood monocyte-derived macrophages (MDMs) were isolated and functional assays performed. RESULTS ETI treatment was associated with increased CF MDM CFTR expression, function and localisation to the plasma membrane. CF MDM phagocytosis, intracellular killing of CF pathogens and efferocytosis of apoptotic neutrophils were partially restored by ETI, but inflammatory cytokine production remained unchanged. Clinical outcomes including increased forced expiratory volume in 1 s (+10%) and body mass index (+1.0 kg·m-2) showed fluctuations over time and were highly individualised. Significant correlations between post-ETI MDM CFTR function and sweat chloride levels were observed. However, MDM CFTR function correlated with clinical outcomes better than sweat chloride. CONCLUSION ETI is associated with unique changes in innate immune function and clinical outcomes.
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Affiliation(s)
- Shuzhong Zhang
- Center for Microbial Pathogenesis, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Chandra L Shrestha
- Center for Microbial Pathogenesis, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Frank Robledo-Avila
- Center for Microbial Pathogenesis, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Devi Jaganathan
- Center for Microbial Pathogenesis, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Benjamin L Wisniewski
- Center for Microbial Pathogenesis, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
- Division of Pulmonary Medicine, Nationwide Children's Hospital, Columbus, OH, USA
| | - Nevian Brown
- Center for Microbial Pathogenesis, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Hanh Pham
- Division of Pulmonary Medicine, Nationwide Children's Hospital, Columbus, OH, USA
| | - Katherine Carey
- Center for Microbial Pathogenesis, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Amal O Amer
- Department of Microbial Infection and Immunity, The Ohio State University, Columbus, OH, USA
- Infectious Disease Institute, The Ohio State University, Columbus, OH, USA
| | - Luanne Hall-Stoodley
- Department of Microbial Infection and Immunity, The Ohio State University, Columbus, OH, USA
- Infectious Disease Institute, The Ohio State University, Columbus, OH, USA
| | - Karen S McCoy
- Division of Pulmonary Medicine, Nationwide Children's Hospital, Columbus, OH, USA
| | - Shasha Bai
- Pediatric Biostatistics Core, Emory University School of Medicine, Atlanta, GA, USA
| | - Santiago Partida-Sanchez
- Center for Microbial Pathogenesis, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
- Infectious Disease Institute, The Ohio State University, Columbus, OH, USA
| | - Benjamin T Kopp
- Center for Microbial Pathogenesis, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
- Division of Pulmonary Medicine, Nationwide Children's Hospital, Columbus, OH, USA
- Infectious Disease Institute, The Ohio State University, Columbus, OH, USA
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5
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Pasley K, Krivchenia K, Dell ML, McCoy KS, Paul GR. Clinical management of pediatric patients with cystic fibrosis and autism spectrum disorder. Pediatr Pulmonol 2023; 58:1160-1168. [PMID: 36610056 DOI: 10.1002/ppul.26311] [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: 08/10/2022] [Revised: 12/19/2022] [Accepted: 01/05/2023] [Indexed: 01/09/2023]
Abstract
BACKGROUND Cystic Fibrosis (CF) and autism spectrum disorder (ASD) are life-long conditions with intense treatment burdens for patients and families. Patients with a concurrent diagnosis (CF-ASD) experience unique obstacles to CF care. This study describes the experiences of our multidisciplinary CF team in caring for patients with CF-ASD and provides insight into provider and parental perspectives on clinical management. METHODS This is a three-part qualitative study involving (1) retrospective chart review of patients with CF-ASD, (2) surveys with multidisciplinary care team members, and (3) semistructured interviews with caregivers of patients with CF-ASD. Challenges in clinical management of this specific cohort were compiled using data from chart review and care team surveys. Strategies to address these concerns were identified and rated by individual families based on relevance and practicality. RESULTS Within our CF center, 12 patients have an official diagnosis of ASD. Median age of patients with CF-ASD was 8.5 years (range 3-20 years), 67% were male, and 83% were on highly effective modulator therapy. Clinical barriers included sensory processing issues, environmental overstimulation, intolerance to procedures and to disrupted routines. Potentially impactful strategies include patient-specific coping plans, guided behavioral interventions, parental advocacy, and improved communication between the family and multidisciplinary team. CONCLUSION Children with CF-ASD face extraordinary challenges beyond the experience of neurotypical children with CF. Increased awareness of this complex dual diagnosis will help providers be sensitive to the unique needs of these patients, help build consistent and trustworthy relationships with their families and deliver effective clinical care despite limitations.
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Affiliation(s)
- Kimberly Pasley
- Division of Pulmonary Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Katelyn Krivchenia
- Division of Pulmonary Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Mary Lynn Dell
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, Charlottesville, Virginia, USA
| | - Karen S McCoy
- Division of Pulmonary Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Grace R Paul
- Division of Pulmonary Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA
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6
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McCoy KS, Blind J, Johnson T, Olson P, Raterman L, Bai S, Eisner M, Sheikh SI, Druhan S, Young C, Pasley K. Clinical change 2 years from start of elexacaftor-tezacaftor-ivacaftor in severe cystic fibrosis. Pediatr Pulmonol 2023; 58:1178-1184. [PMID: 36650567 DOI: 10.1002/ppul.26318] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 12/22/2022] [Accepted: 01/12/2023] [Indexed: 01/19/2023]
Abstract
RATIONALE Limited published research is available on the impact of elexacaftor/tezacaftor/ivacaftor (ETI) beyond the initial few months postdrug initiation, especially for those who initiated therapy via individual investigational new drug application. The experiences of patients with cystic fibrosis (CF) experiencing severe lung disease were reviewed for significant improvements in clinical symptoms and quality of life. OBJECTIVES To examine clinical outcomes 2 years post-ETI in patients with CF and advanced lung disease. METHODS This single center institutional review board-approved, retrospective chart review assessed clinical markers (percent predicted forced expiratory volume in 1 s, weight, sweat chloride), quality of life and computed tomography scans in patients with advanced lung disease who met criteria for compassionate use/expanded access program due to high risk of death or transplant need within 2 years. RESULTS Eighteen identified patients (ages 15-49 years) initiated drug between July and September 2019. Clinical markers indicated that therapy was well tolerated, not discontinued by any participant, and lab values did not indicate medical concern or discontinuation. Monitoring results indicated the safety of modulator therapy as there were no adverse clinical occurrences and all patients presented universal stabilization. There were no deaths and no transplants by the end of the study. CONCLUSIONS This study focused on patients with CF eligible for modulator therapy and were initiated due to advanced lung disease. Initiation of modulator therapy was deemed safe and resulted in objective positive changes in nutrition, cough, FEV1 , subjective reports of clinical status, level of activity, and a reduction in burden of treatment.
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Affiliation(s)
- Karen S McCoy
- Pulmonary and Sleep Medicine Division, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Jill Blind
- Investigational Pharmacy, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Terri Johnson
- Pulmonary and Sleep Medicine Division, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Patti Olson
- Pulmonary and Sleep Medicine Division, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Laura Raterman
- Pulmonary and Sleep Medicine Division, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Shasha Bai
- Department of Pediatrics at Emory University School of Medicine, Pediatric Biostatistics Core, Atlanta, Georgia, USA
| | - Mariah Eisner
- Biostatistics Resource, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Shahid I Sheikh
- Pulmonary and Sleep Medicine Division, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Stephan Druhan
- Department of Radiology, New York University Grossman School of Medicine, New York, New York, USA
| | - Cody Young
- Radiology Department, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Kimberly Pasley
- Pulmonary and Sleep Medicine Division, Nationwide Children's Hospital, Columbus, Ohio, USA
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Abstract
Biofilms are multicellular microbial aggregates that can be associated with host mucosal epithelia in the airway, gut, and genitourinary tract. The host environment plays a critical role in the establishment of these microbial communities in both health and disease. These host mucosal microenvironments however are distinct histologically, functionally, and regarding nutrient availability. This review discusses the specific mucosal epithelial microenvironments lining the airway, focusing on: i) biofilms in the human respiratory tract and the unique airway microenvironments that make it exquisitely suited to defend against infection, and ii) how airway pathophysiology and dysfunctional barrier/clearance mechanisms due to genetic mutations, damage, and inflammation contribute to biofilm infections. The host cellular responses to infection that contribute to resolution or exacerbation, and insights about evaluating and therapeutically targeting airway-associated biofilm infections are briefly discussed. Since so many studies have focused on Pseudomonas aeruginosa in the context of cystic fibrosis (CF) or on Haemophilus influenzae in the context of upper and lower respiratory diseases, these bacteria are used as examples. However, there are notable differences in diseased airway microenvironments and the unique pathophysiology specific to the bacterial pathogens themselves.
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Affiliation(s)
- Luanne Hall-Stoodley
- Department of Microbial Infection and Immunity, The Ohio State University College of Medicine, Columbus, OH, United States
- *Correspondence: Luanne Hall-Stoodley,
| | - Karen S. McCoy
- Division of Pulmonary Medicine, Nationwide Children’s Hospital, Columbus, OH, United States
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Ramsey ML, Li SS, Lara LF, Gokun Y, Akshintala VS, Conwell DL, Heintz J, Kirkby SE, McCoy KS, Papachristou GI, Patel A, Singh VK, Hart PA. Cystic fibrosis transmembrane conductance regulator modulators and the exocrine pancreas: A scoping review. J Cyst Fibros 2022; 22:193-200. [PMID: 36008229 DOI: 10.1016/j.jcf.2022.08.008] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 07/21/2022] [Accepted: 08/10/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Cystic fibrosis transmembrane conductance regulator (CFTR) modulators improve pulmonary outcomes in subjects with cystic fibrosis (CF); however, the effects on pancreatic manifestations are not well characterized. We hypothesized that CFTR modulators would improve measures of exocrine pancreatic function and outcomes. METHODS We performed a systematic search to identify studies reporting measures of the exocrine pancreas in humans treated with CFTR modulators. Only studies reporting baseline and on-treatment assessments were included. RESULTS Of 630 identified studies, 41 met inclusion criteria. CFTR modulators reduced acute pancreatitis events by 85% overall (rate ratio 0.15, 95% confidence interval (CI) 0.04, 0.52), with a greater effect seen in the subgroup with pancreas sufficient CF (PS-CF) (rate ratio 0.13 (95% CI 0.03, 0.53). Among 293 subjects with baseline and on-treatment evaluation of pancreas sufficiency, 253 were pancreas insufficient at baseline and 54 (21.3%) converted to pancreas sufficiency. Of 32 subjects with baseline FE-1 values <200 mcg/g, 16 (50%) increased to ≥200 mcg/g. Serum trypsin decreased by a mean of 565.9 ng/mL (standard deviation (SD) 311.8), amylase decreased by 38.2 U/L (SD 57.6), and lipase decreased by 232.3 U/L (SD 247.7). CONCLUSIONS CFTR modulator use reduces acute pancreatitis frequency and improves indirect measures of exocrine pancreas function. Future interventional studies that evaluate the mechanism and impact of CFTR modulators on acute pancreatitis and pancreas sufficiency in patients with CFTR dysfunction are warranted.
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Affiliation(s)
- Mitchell L Ramsey
- Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Susan S Li
- Division of General Internal Medicine, The Ohio State University Wexner Medical Center, USA
| | - Luis F Lara
- Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Yevgeniya Gokun
- Center for Biostatistics, Department of Biomedical Informatics, The Ohio State University College of Medicine, USA
| | - Venkata S Akshintala
- Pancreatitis Center, Division of Gastroenterology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Darwin L Conwell
- Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - John Heintz
- Division of Pediatric Pulmonology and Sleep Medicine, Nationwide Children's Hospital, Columbus, OH, USA
| | - Stephen E Kirkby
- Division of Pulmonary and Critical Care Medicine, The Ohio State University Wexner Medical Center, USA
| | - Karen S McCoy
- Division of Pediatric Pulmonology and Sleep Medicine, Nationwide Children's Hospital, Columbus, OH, USA
| | - Georgios I Papachristou
- Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Alpa Patel
- Division of Pediatric Pulmonology and Sleep Medicine, Nationwide Children's Hospital, Columbus, OH, USA
| | - Vikesh K Singh
- Pancreatitis Center, Division of Gastroenterology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Phil A Hart
- Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
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9
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Paul GR, Bai S, Jackson K, McCoy KS. Aquagenic wrinkling in children under two years of age: Could this be a potential clinical referral tool for cystic fibrosis among non-screened populations? J Cyst Fibros 2021; 20:e77-e83. [PMID: 34016560 DOI: 10.1016/j.jcf.2021.04.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 01/25/2021] [Revised: 03/20/2021] [Accepted: 04/07/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Early diagnosis via newborn screening is crucial to improve clinical outcomes in patients with cystic fibrosis (CF). In resource-limited areas where newborn screening is unavailable and CF-related morbidity is high, clinical tools such as palmar aquagenic wrinkling (AW) have been considered. We report the utility of AW for possible early identification of CF in children <2 years old. METHODS This pilot case-control study included 55 total children, 20 with confirmed CF, 10 CF carriers, and 25 healthy controls. The time to wrinkling (TTW) after hand immersion in water was recorded, and relationships between TTW, demographic and clinical variables, and validated diagnostic tests were analyzed. RESULTS Wrinkling was observed in children <2 years of age, and median TTW was significantly lower among those with CF (3 min) compared to carriers or healthy controls (12 and 14 min, respectively). Higher immunoreactive trypsinogen and sweat chloride levels were associated with lower TTW (p < 0.001). In this predominantly Caucasian cohort, children with F508del had the lowest TTW. Six minutes of hand immersion offered a sensitivity of 85% and a specificity of 91%, suggesting a practical and effective test duration for this age. There was no evidence that nutritional status affected TTW. CONCLUSION Our data confirm the role of AW in CF, validate test utility among young children, and analyze relationships between TTW, immunoreactive trypsinogen, sweat chloride levels, and CF-causing mutations. Despite test limitations, in children with suspected CF from non-screened populations, utility of AW in enabling early referral and diagnosis needs further exploration.
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Affiliation(s)
- Grace R Paul
- Division of Pulmonary Medicine, Nationwide Children's Hospital, Columbus, OH, USA.
| | - Shasha Bai
- Biostatistics Resource at Nationwide Children's Hospital, Columbus, OH, USA; Center for Biostatistics, The Ohio State University, Columbus, OH, USA.
| | - Kenneth Jackson
- Biostatistics Resource at Nationwide Children's Hospital, Columbus, OH, USA; Center for Biostatistics, The Ohio State University, Columbus, OH, USA.
| | - Karen S McCoy
- Division of Pulmonary Medicine, Nationwide Children's Hospital, Columbus, OH, USA.
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McCoy KS, Heijerman H, Taylor-Cousar JL, Waltz D, Sosnay PR, Ramsey BW, Rowe S, Welter J. Transparency and diversity in cystic fibrosis research - Authors' reply. Lancet 2020; 396:602. [PMID: 32861305 DOI: 10.1016/s0140-6736(20)30897-7] [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: 03/12/2020] [Accepted: 04/08/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Karen S McCoy
- Department of Pediatrics, Nationwide Children's Hospital, Ohio State University, Columbus, OH 43210, USA.
| | - Harry Heijerman
- Department of Pulmonology, University Medical Center Utrecht, Utrecht, Netherlands
| | | | | | | | - Bonnie W Ramsey
- Department of Pediatrics, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA, USA
| | - Steven Rowe
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - John Welter
- Division of Pediatric Pulmonology, Allergy, Immunology, and Sleep Medicine, New York Medical College, New York, NY, USA
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11
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Stephan EM, Nemastil CJ, Salvator A, Gemma S, Dilaveris CJ, Rice A, Sakellaris KT, Novak KJ, McCoy KS. Practitioner Due Diligence: Real-World Lumacaftor/Ivacaftor Use. J Pediatr Pharmacol Ther 2020; 25:431-436. [PMID: 32641913 DOI: 10.5863/1551-6776-25.5.431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Previous trials evaluated the efficacy of lumacaftor/ivacaftor in Phe508del homozygotes. These trials are limited by manufacturer sponsorship and were conducted under strict protocol. Additionally, this therapy is costly and does not allow for reduction in daily cystic fibrosis therapies. This study assessed the efficacy of lumacaftor/ivacaftor therapy and its effect on health care utilization in a real-world setting. METHODS Retrospective chart review comparing the first 12 months of therapy to the 24 months prior was conducted to evaluate the impact of lumacaftor/ivacaftor on pulmonary function following a streamlined process for therapy introduction. The impact on body mass index and healthcare utilization were also evaluated. The following measurements were assessed: percent predicted forced expiratory volume in 1 second, body mass index and z-scores, number of admissions, length of stay, number of emergency department visits. RESULTS Mean ppFEV1 was improved for the first 12 months on lumacaftor/ivacaftor treatment when compared with the 24 months prior: 78.8 (95% CI: 72.6, 84.9) vs 76.2 (95% CI: 70.1, 82.3) (p = 0.03). Body mass index significantly improved (patients ≥20 years), but improvement in BMI z-score (patients <20 years) was not significant. Number of admissions and LOS were significantly decreased, but ED visits were not. CONCLUSIONS Lumacaftor/ivacaftor is effective for improving ppFEV1 and BMI and for reducing health care utilization. However, this small reduction does not overcome the financial cost of treatment. Long-term outcomes and use must be studied to determine the overall effect of this therapy on cystic fibrosis interventions and their costs.
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12
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Robinson TE, Goris ML, Moss RB, Tian L, Kan P, Yilma M, McCoy KS, Newman B, de Jong PA, Long FR, Brody AS, Behrje R, Yates DP, Cornfield DN. Mucus plugging, air trapping, and bronchiectasis are important outcome measures in assessing progressive childhood cystic fibrosis lung disease. Pediatr Pulmonol 2020; 55:929-938. [PMID: 31962004 DOI: 10.1002/ppul.24646] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [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: 08/30/2019] [Accepted: 12/30/2019] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To determine which outcome measures could detect early progression of disease in school-age children with mild cystic fibrosis (CF) lung disease over a two-year time interval utilizing chest computed tomography (CT) scores, quantitative CT air trapping (QAT), and spirometric measurements. METHODS Thirty-six school-age children with mild CF lung disease (median [interquartile range] age 12 [3.7] years; percent predicted forced expiratory volume in 1 second (ppFEV1 ) 99 [12.5]) were evaluated by serial spirometer-controlled chest CT scans and spirometry at baseline, 3-month, 1- and 2-years. RESULTS No significant changes were noted at 3-month for any variable except for decreased ppFEV1 . Mucus plugging score (MPS) and QATA1andA2 increased at 1- and 2-years. The bronchiectasis score (BS), and total score (TS) were increased at 2-year. All variables tested with the exception of bronchial wall thickness score, parenchymal score (PS), and ppFEV1 , were consistent with longitudinal worsening of lung disease. Multivariate analysis revealed baseline PS, baseline TS, and 1-year changes in BS and air trapping score were predictive of 2-year changes in BS. CONCLUSIONS MPS and QATA1-A2 were the most sensitive indicators of progressive childhood CF lung disease. The 1-year change in the bronchiectasis score had the most positive predictive power for 2-year change in bronchiectasis.
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Affiliation(s)
- Terry E Robinson
- Department of Pediatrics, Center of Excellence in Pulmonary Biology, Stanford University School of Medicine, Stanford, California
| | - Michael L Goris
- Division of Nuclear Medicine/Radiology, Stanford University School of Medicine, Stanford, California
| | - Richard B Moss
- Department of Pediatrics, Center of Excellence in Pulmonary Biology, Stanford University School of Medicine, Stanford, California
| | - Lu Tian
- Department of Biomedical Data Science, Stanford University School of Medicine, Stanford, California
| | - Peiyi Kan
- Department of Pediatrics Research and Statistical Unit, Stanford University School of Medicine, Stanford, California
| | - Mignote Yilma
- Department of Pediatrics, Center of Excellence in Pulmonary Biology, Stanford University School of Medicine, Stanford, California
| | - Karen S McCoy
- Division of Pulmonary Medicine, Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio
| | - Beverley Newman
- Department of Radiology, Stanford University School of Medicine, Stanford, California
| | - Pim A de Jong
- Department of Radiology, University Medical Center Utrecht, The Netherlands
| | - Frederick R Long
- Department of Radiology, Nationwide Children's Hospital, Columbus, Ohio
| | - Alan S Brody
- Department of Radiology, Cincinnati Children's Hospital, Cincinnati, Ohio
| | - Rhett Behrje
- Department of Global Development, Takeda Pharmaceuticals, Cambridge, Massachusetts
| | - Denise P Yates
- Department of Biomarker Development, Novartis Institutes for BioMedical Research, Cambridge, Massachusetts
| | - David N Cornfield
- Department of Pediatrics, Center of Excellence in Pulmonary Biology, Stanford University School of Medicine, Stanford, California
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13
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Heijerman HGM, McKone EF, Downey DG, Van Braeckel E, Rowe SM, Tullis E, Mall MA, Welter JJ, Ramsey BW, McKee CM, Marigowda G, Moskowitz SM, Waltz D, Sosnay PR, Simard C, Ahluwalia N, Xuan F, Zhang Y, Taylor-Cousar JL, McCoy KS. Efficacy and safety of the elexacaftor plus tezacaftor plus ivacaftor combination regimen in people with cystic fibrosis homozygous for the F508del mutation: a double-blind, randomised, phase 3 trial. Lancet 2019; 394:1940-1948. [PMID: 31679946 PMCID: PMC7571408 DOI: 10.1016/s0140-6736(19)32597-8] [Citation(s) in RCA: 720] [Impact Index Per Article: 144.0] [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: 08/24/2019] [Revised: 09/06/2019] [Accepted: 09/13/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND Cystic fibrosis transmembrane conductance regulator (CFTR) modulators correct the basic defect caused by CFTR mutations. Improvements in health outcomes have been achieved with the combination of a CFTR corrector and potentiator in people with cystic fibrosis homozygous for the F508del mutation. The addition of elexacaftor (VX-445), a next-generation CFTR corrector, to tezacaftor plus ivacaftor further improved F508del-CFTR function and clinical outcomes in a phase 2 study in people with cystic fibrosis homozygous for the F508del mutation. METHODS This phase 3, multicentre, randomised, double-blind, active-controlled trial of elexacaftor in combination with tezacaftor plus ivacaftor was done at 44 sites in four countries. Eligible participants were those with cystic fibrosis homozygous for the F508del mutation, aged 12 years or older with stable disease, and with a percentage predicted forced expiratory volume in 1 s (ppFEV1) of 40-90%, inclusive. After a 4-week tezacaftor plus ivacaftor run-in period, participants were randomly assigned (1:1) to 4 weeks of elexacaftor 200 mg orally once daily plus tezacaftor 100 mg orally once daily plus ivacaftor 150 mg orally every 12 h versus tezacaftor 100 mg orally once daily plus ivacaftor 150 mg orally every 12 h alone. The primary outcome was the absolute change from baseline (measured at the end of the tezacaftor plus ivacaftor run-in) in ppFEV1 at week 4. Key secondary outcomes were absolute change in sweat chloride and Cystic Fibrosis Questionnaire-Revised respiratory domain (CFQ-R RD) score. This study is registered with ClinicalTrials.gov, NCT03525548. FINDINGS Between Aug 3 and Dec 28, 2018, 113 participants were enrolled. Following the run-in, 107 participants were randomly assigned (55 in the elexacaftor plus tezacaftor plus ivacaftor group and 52 in the tezacaftor plus ivacaftor group) and completed the 4-week treatment period. The elexacaftor plus tezacaftor plus ivacaftor group had improvements in the primary outcome of ppFEV1 (least squares mean [LSM] treatment difference of 10·0 percentage points [95% CI 7·4 to 12·6], p<0·0001) and the key secondary outcomes of sweat chloride concentration (LSM treatment difference -45·1 mmol/L [95% CI -50·1 to -40·1], p<0·0001), and CFQ-R RD score (LSM treatment difference 17·4 points [95% CI 11·8 to 23·0], p<0·0001) compared with the tezacaftor plus ivacaftor group. The triple combination regimen was well tolerated, with no discontinuations. Most adverse events were mild or moderate; serious adverse events occurred in two (4%) participants receiving elexacaftor plus tezacaftor plus ivacaftor and in one (2%) receiving tezacaftor plus ivacaftor. INTERPRETATION Elexacaftor plus tezacaftor plus ivacaftor provided clinically robust benefit compared with tezacaftor plus ivacaftor alone, with a favourable safety profile, and shows the potential to lead to transformative improvements in the lives of people with cystic fibrosis who are homozygous for the F508del mutation. FUNDING Vertex Pharmaceuticals.
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Affiliation(s)
- Harry G M Heijerman
- Department of Pulmonology, University Medical Center Utrecht, Utrecht, Netherlands.
| | - Edward F McKone
- St Vincent's University Hospital and University College Dublin School of Medicine, Dublin, Ireland
| | - Damian G Downey
- Centre for Experimental Medicine, Queen's University Belfast, Belfast, UK
| | - Eva Van Braeckel
- Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium
| | - Steven M Rowe
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Elizabeth Tullis
- Division of Respirology, St Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Marcus A Mall
- Department of Pulmonology, Immunology and Intensive Care Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany; Berlin Institute of Health, Berlin, Germany; German Center for Lung Research, Berlin, Germany
| | - John J Welter
- Division of Pediatric Pulmonology, Allergy, Immunology, and Sleep Medicine, New York Medical College, Valhalla, NY, USA
| | - Bonnie W Ramsey
- Department of Pediatrics, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA, USA
| | | | | | | | | | | | | | | | | | | | | | - Karen S McCoy
- Department of Pediatrics, Nationwide Children's Hospital, Ohio State University, Columbus, OH, USA
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14
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Schuler CL, Biagini Myers JM, Kercsmar CM, Pilipenko VV, Kroner JW, Simmons JM, Austin SR, Gunkelman SM, Ross KR, McCoy KS, Kalra M, Ruddy JR, Martin LJ, Khurana Hershey GK. Weighing in on asthma: Insights on BMI, magnesium, and hospitalizations from the Ohio Pediatric Asthma Repository. J Asthma 2019; 57:1280-1287. [PMID: 31411907 DOI: 10.1080/02770903.2019.1652639] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objective: Little is known about weight status and its effects on clinical course during hospitalization for asthma exacerbation. We sought to evaluate associations between weight status, specifically body mass index (BMI), with inpatient clinical course and clinical history.Methods: We retrospectively analyzed data from 2012 to 2013 on children hospitalized for asthma exacerbation in a state-wide longitudinal cohort, the Ohio Pediatric Asthma Repository. We examined BMI continuously (z scores) and categorically, comparing overweight and obese (Ov/Ob) to non-overweight and non-obese (nOv/nOb) children. We used linear mixed models controlling for site effects to determine if BMI was related to length of stay, as determined by physiologic readiness for discharge (PRD), defined as time to albuterol spaced every 4 h, need for nonstandard care or clinical history.Results: Across six hospitals, 874 children were included in analyses. BMI was positively associated with PRD (p=.008) but this increase was unlikely to be clinically significant. Ov/Ob children were more likely than nOv/nOb to require nonstandard care with repeat magnesium dosing in intensive care after dosing in the emergency department (OR = 3.23, 95%CI 1.39-7.78). Hospitalization in the year prior to enrollment was positively associated with BMI percentile (73.3 vs. 66.0, p=.028). Sleep disordered breathing was also associated with higher BMI percentile (78.2 vs. 65.9; p=.0013).Conclusions: Ov/Ob children had similar PRD to nOv/nOb children and were prone to repeat magnesium dosing. Previous hospitalization for exacerbation was positively associated with increasing BMI percentile. Additional research should investigate differential magnesium use by weight status, quantifying risks and benefits.
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Affiliation(s)
- Christine L Schuler
- Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Jocelyn M Biagini Myers
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.,Division of Asthma Research, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Carolyn M Kercsmar
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.,Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Valentina V Pilipenko
- Division of Human Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - John W Kroner
- Division of Asthma Research, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Jeffrey M Simmons
- Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Stephen R Austin
- Division of Asthma Research, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Samantha M Gunkelman
- Division of Pediatric Hospital Medicine, Akron Children's Hospital, Akron, OH, USA
| | - Kristie R Ross
- Department of Pediatrics-Pulmonary, Rainbow Babies and Children's Hospital, Cleveland, OH, USA
| | - Karen S McCoy
- Division of Pediatric Pulmonology, Nationwide Children's Hospital, Columbus, OH, USA
| | - Maninder Kalra
- Department of Pulmonary Medicine, Dayton Children's Hospital, Dayton, OH, USA
| | - Jennifer R Ruddy
- Department of Pediatric Pulmonary Medicine, ProMedica Toledo Children's Hospital, Toledo, OH, USA
| | - Lisa J Martin
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.,Division of Human Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Gurjit K Khurana Hershey
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.,Division of Asthma Research, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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15
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Sagel SD, Khan U, Jain R, Graff G, Daines CL, Dunitz JM, Borowitz D, Orenstein DM, Abdulhamid I, Noe J, Clancy JP, Slovis B, Rock MJ, McCoy KS, Strausbaugh S, Livingston FR, Papas KA, Shaffer ML. Effects of an Antioxidant-enriched Multivitamin in Cystic Fibrosis. A Randomized, Controlled, Multicenter Clinical Trial. Am J Respir Crit Care Med 2018; 198:639-647. [PMID: 29688760 PMCID: PMC6118015 DOI: 10.1164/rccm.201801-0105oc] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [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: 01/16/2018] [Accepted: 04/23/2018] [Indexed: 02/06/2023] Open
Abstract
RATIONALE Cystic fibrosis (CF) is characterized by dietary antioxidant deficiencies, which may contribute to an oxidant-antioxidant imbalance and oxidative stress. OBJECTIVES Evaluate the effects of an oral antioxidant-enriched multivitamin supplement on antioxidant concentrations, markers of inflammation and oxidative stress, and clinical outcomes. METHODS In this investigator-initiated, multicenter, randomized, double-blind, controlled trial, 73 pancreatic-insufficient subjects with CF 10 years of age and older with an FEV1 between 40% and 100% predicted were randomized to 16 weeks of an antioxidant-enriched multivitamin or control multivitamin without antioxidant enrichment. Endpoints included systemic antioxidant concentrations, markers of inflammation and oxidative stress, clinical outcomes (pulmonary exacerbations, anthropometric measures, pulmonary function), safety, and tolerability. MEASUREMENTS AND MAIN RESULTS Change in sputum myeloperoxidase concentration over 16 weeks, the primary efficacy endpoint, was not significantly different between the treated and control groups. Systemic antioxidant (β-carotene, coenzyme Q10, γ-tocopherol, and lutein) concentrations significantly increased in the antioxidant-treated group (P < 0.001 for each), whereas circulating calprotectin and myeloperoxidase decreased in the treated group compared with the control group at Week 4. The treated group had a lower risk of first pulmonary exacerbation requiring antibiotics than the control group (adjusted hazard ratio, 0.50; P = 0.04). Lung function and growth endpoints did not differ between groups. Adverse events and tolerability were similar between groups. CONCLUSIONS Antioxidant supplementation was safe and well tolerated, resulting in increased systemic antioxidant concentrations and modest reductions in systemic inflammation after 4 weeks. Antioxidant treatment was also associated with a lower risk of first pulmonary exacerbation. Clinical trial registered with www.clinicaltrials.gov (NCT01859390).
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Affiliation(s)
- Scott D. Sagel
- Department of Pediatrics, Children’s Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado
| | - Umer Khan
- Cystic Fibrosis Foundation Therapeutics Development Network Coordinating Center, Seattle Children’s Research Institute, Seattle, Washington
| | - Raksha Jain
- Department of Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Gavin Graff
- Department of Pediatrics, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Cori L. Daines
- Department of Pediatrics, University of Arizona, Tucson, Arizona
| | - Jordan M. Dunitz
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Drucy Borowitz
- Department of Pediatrics, Jacobs School of Medicine, University at Buffalo, Buffalo, New York
| | - David M. Orenstein
- Department of Pediatrics, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Ibrahim Abdulhamid
- Department of Pediatrics, Children’s Hospital of Michigan, Detroit, Michigan
| | - Julie Noe
- Department of Pediatrics, Children’s Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - John P. Clancy
- Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Bonnie Slovis
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Michael J. Rock
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Karen S. McCoy
- Department of Pediatrics, Nationwide Children’s Hospital, The Ohio State University College of Medicine, Columbus, Ohio
| | - Steven Strausbaugh
- Department of Medicine, Rainbow Babies and Children’s Hospital, Cleveland, Ohio
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16
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Simmons JM, Biagini Myers JM, Martin LJ, Kercsmar CM, Schuler CL, Pilipenko VV, Kroner JW, He H, Austin SR, Nguyen HT, Ross KR, McCoy KS, Alter SJ, Gunkelman SM, Vauthy PA, Khurana Hershey GK. Ohio Pediatric Asthma Repository: Opportunities to Revise Care Practices to Decrease Time to Physiologic Readiness for Discharge. Hosp Pediatr 2018; 8:305-313. [PMID: 29764909 DOI: 10.1542/hpeds.2017-0085] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Large-scale, multisite studies in which researchers evaluate patient- and systems-level factors associated with pediatric asthma exacerbation outcomes are lacking. We sought to investigate patient-level risks and system-level practices related to physiologic readiness for discharge (PRD) in the prospective Ohio Pediatric Asthma Repository. METHODS Participants were children ages 2 to 17 years admitted to an Ohio Pediatric Asthma Repository hospital for asthma exacerbation. Demographics, disease characteristics, and individual hospital practices were collected. The primary outcome was PRD timing (hours from admission or emergency department [ED] presentation until the first 4-hour albuterol spacing). RESULTS Data for 1005 participants were available (865 ED presentations). Several nonstandard care practices were associated with time to PRD (P < .001). Continuous pulse oximetry was associated with increased time to PRD (P = .004). ED dexamethasone administration was associated with decreased time to PRD (P < .001) and less ICU admittance and intravenous steroid use (P < .0001). Earlier receipt of chest radiograph, antibiotics, and intravenous steroids was associated with shorter time to PRD (P < .05). Care practices associated with shorter time to PRD varied markedly by hospital. CONCLUSIONS Substantial variation in care practices for inpatient asthma treatment exists among children's hospital systems in Ohio. We found several modifiable, system-level factors and therapies that contribute to PRD that warrant further investigation to identify the best and safest care practices. We also found that there was no standardized measure of exacerbation severity used across the hospitals. The development of such a tool is a critical gap in current practice and is needed to enable definitive comparative effectiveness studies of the management of acute asthma exacerbation.
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Affiliation(s)
- Jeffrey M Simmons
- Divisions of Hospital Medicine.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Jocelyn M Biagini Myers
- Asthma Research.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Lisa J Martin
- Human Genetics, and.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Carolyn M Kercsmar
- Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Christine L Schuler
- Divisions of Hospital Medicine.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | | | | | | | | | | | - Kristie R Ross
- Department of Pediatrics-Pulmonary, Rainbow Babies and Children's Hospital, Cleveland, Ohio
| | - Karen S McCoy
- Division of Pediatric Pulmonology, Nationwide Children's Hospital, Columbus, Ohio
| | - Sherman J Alter
- Department of Infectious Disease, Dayton Children's Hospital, Dayton, Ohio
| | | | - Pierre A Vauthy
- Department of Pediatric Pulmonary Medicine, ProMedica Toledo Children's Hospital, Toledo, Ohio; and
| | - Gurjit K Khurana Hershey
- Asthma Research, .,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
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17
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Shein SL, Farhan O, Morris N, Mahmood N, Alter SJ, Biagini Myers JM, Gunkelman SM, Kercsmar CM, Khurana Hershey GK, Martin LJ, McCoy KS, Ruddy JR, Ross KR. Adjunctive Pharmacotherapies in Children With Asthma Exacerbations Requiring Continuous Albuterol Therapy: Findings From The Ohio Pediatric Asthma Repository. Hosp Pediatr 2018; 8:hpeds.2017-0088. [PMID: 29305409 PMCID: PMC5790298 DOI: 10.1542/hpeds.2017-0088] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To identify associations between use of ipratropium and/or intravenous magnesium and outcomes of children hospitalized with acute asthma exacerbations and treated with continuous albuterol. METHODS Secondary analysis of data from children prospectively enrolled in the multicenter Ohio Pediatric Asthma Repository restricted to only children who were treated with continuous albuterol in their initial inpatient location. Children were treated with adjunctive therapies per the clinical team. RESULTS Among 242 children who received continuous albuterol, 94 (39%) received ipratropium only, 13 (5%) received magnesium alone, 42 (17%) received both, and 93 (38%) received neither. The median duration of continuous albuterol was 7.0 (interquartile range [IQR]: 2.8-12.0) hours. Ipratropium use was associated with a shorter duration of continuous albuterol (4.9 [IQR: 2.0-10.0] hours) compared with dual therapy (11.0 [IQR: 5.6-28.6] hours; P = .001), but magnesium use was not (7.5 [IQR: 2.5-16.0] hours; P = .542). In Cox proportional models (adjusted for hospital, demographics, treatment location, and respiratory failure), magnesium was associated with longer durations of continuous albuterol (hazard ratio, 0.54 [95% confidence interval: 0.37-0.77]; P < .001) and hospitalization (hazard ratio, 0.41 [95% confidence interval: 0.28-0.60]; P < .001), but ipratropium was not. CONCLUSIONS Ipratropium and magnesium were both often used in children with severe asthma hospitalizations that required continuous albuterol therapy. Magnesium use was associated with unfavorable outcomes, possibly reflecting preferential treatment to patients with more severe cases and differing practices between centers. Given the high prevalence of asthma, wide variations in practice, and the potential to improve outcomes and costs, prospective trials of these adjunctive therapies are needed.
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Affiliation(s)
| | - Obada Farhan
- Department of Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, Ohio
| | - Nathan Morris
- Department of Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, Ohio
| | | | - Sherman J Alter
- Department of Pediatrics, Dayton Children's Hospital, Dayton, Ohio
| | | | | | | | | | - Lisa J Martin
- Human Genetics, Cincinnati Children's Hospital, Cincinnati, Ohio
| | - Karen S McCoy
- Division of Pediatric Pulmonology, Nationwide Children's Hospital, Columbus, Ohio; and
| | - Jennifer R Ruddy
- Division of Pediatric Pulmonology, ProMedica Toledo Children's Hospital, Toledo, Ohio
| | - Kristie R Ross
- Pediatric Pulmonology, Rainbow Babies and Children's Hospital, Cleveland, Ohio
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18
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Krause K, Kopp BT, Tazi MF, Caution K, Hamilton K, Badr A, Shrestha C, Tumin D, Hayes D, Robledo-Avila F, Hall-Stoodley L, Klamer BG, Zhang X, Partida-Sanchez S, Parinandi NL, Kirkby SE, Dakhlallah D, McCoy KS, Cormet-Boyaka E, Amer AO. The expression of Mirc1/Mir17-92 cluster in sputum samples correlates with pulmonary exacerbations in cystic fibrosis patients. J Cyst Fibros 2017; 17:454-461. [PMID: 29241629 DOI: 10.1016/j.jcf.2017.11.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [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: 08/01/2017] [Revised: 10/27/2017] [Accepted: 11/16/2017] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Cystic fibrosis (CF) is a multi-organ disorder characterized by chronic sino-pulmonary infections and inflammation. Many patients with CF suffer from repeated pulmonary exacerbations that are predictors of worsened long-term morbidity and mortality. There are no reliable markers that associate with the onset or progression of an exacerbation or pulmonary deterioration. Previously, we found that the Mirc1/Mir17-92a cluster which is comprised of 6 microRNAs (Mirs) is highly expressed in CF mice and negatively regulates autophagy which in turn improves CF transmembrane conductance regulator (CFTR) function. Therefore, here we sought to examine the expression of individual Mirs within the Mirc1/Mir17-92 cluster in human cells and biological fluids and determine their role as biomarkers of pulmonary exacerbations and response to treatment. METHODS Mirc1/Mir17-92 cluster expression was measured in human CF and non-CF plasma, blood-derived neutrophils, and sputum samples. Values were correlated with pulmonary function, exacerbations and use of CFTR modulators. RESULTS Mirc1/Mir17-92 cluster expression was not significantly elevated in CF neutrophils nor plasma when compared to the non-CF cohort. Cluster expression in CF sputum was significantly higher than its expression in plasma. Elevated CF sputum Mirc1/Mir17-92 cluster expression positively correlated with pulmonary exacerbations and negatively correlated with lung function. Patients with CF undergoing treatment with the CFTR modulator Ivacaftor/Lumacaftor did not demonstrate significant change in the expression Mirc1/Mir17-92 cluster after six months of treatment. CONCLUSIONS Mirc1/Mir17-92 cluster expression is a promising biomarker of respiratory status in patients with CF including pulmonary exacerbation.
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Affiliation(s)
- Kathrin Krause
- Department of Microbial Infection and Immunity, Columbus, OH, USA; Dorothy M. Davis Heart and Lung Research Institute, Columbus, OH, USA; The Ohio State University College of Medicine, Columbus, OH, USA
| | - Benjamin T Kopp
- Department of Pediatrics, Columbus, OH, USA; Nationwide Children's Hospital, Columbus, OH, USA; The Ohio State University College of Medicine, Columbus, OH, USA
| | - Mia F Tazi
- Department of Microbial Infection and Immunity, Columbus, OH, USA; The Ohio State University College of Medicine, Columbus, OH, USA
| | - Kyle Caution
- Department of Microbial Infection and Immunity, Columbus, OH, USA; Dorothy M. Davis Heart and Lung Research Institute, Columbus, OH, USA; The Ohio State University College of Medicine, Columbus, OH, USA
| | - Kaitlin Hamilton
- Department of Microbial Infection and Immunity, Columbus, OH, USA; Dorothy M. Davis Heart and Lung Research Institute, Columbus, OH, USA; The Ohio State University College of Medicine, Columbus, OH, USA
| | - Asmaa Badr
- Department of Microbial Infection and Immunity, Columbus, OH, USA; Dorothy M. Davis Heart and Lung Research Institute, Columbus, OH, USA; The Ohio State University College of Medicine, Columbus, OH, USA
| | - Chandra Shrestha
- Department of Pediatrics, Columbus, OH, USA; Nationwide Children's Hospital, Columbus, OH, USA; The Ohio State University College of Medicine, Columbus, OH, USA
| | - Dmitry Tumin
- Department of Anesthesiology & Pain Medicine, Columbus, OH, USA; Nationwide Children's Hospital, Columbus, OH, USA; The Ohio State University College of Medicine, Columbus, OH, USA
| | - Don Hayes
- Department of Pediatrics, Columbus, OH, USA; Nationwide Children's Hospital, Columbus, OH, USA; The Ohio State University College of Medicine, Columbus, OH, USA
| | - Frank Robledo-Avila
- Department of Pediatrics, Columbus, OH, USA; Nationwide Children's Hospital, Columbus, OH, USA; The Ohio State University College of Medicine, Columbus, OH, USA
| | - Luanne Hall-Stoodley
- Department of Microbial Infection and Immunity, Columbus, OH, USA; The Ohio State University College of Medicine, Columbus, OH, USA
| | - Brett G Klamer
- Center for Biostatistics, Columbus, OH, USA; The Ohio State University College of Medicine, Columbus, OH, USA
| | - Xiaoli Zhang
- Center for Biostatistics, Columbus, OH, USA; The Ohio State University College of Medicine, Columbus, OH, USA
| | - Santiago Partida-Sanchez
- Department of Pediatrics, Columbus, OH, USA; Nationwide Children's Hospital, Columbus, OH, USA; The Ohio State University College of Medicine, Columbus, OH, USA
| | - Narasimham L Parinandi
- Dorothy M. Davis Heart and Lung Research Institute, Columbus, OH, USA; The Ohio State University College of Medicine, Columbus, OH, USA
| | - Stephen E Kirkby
- Department of Pediatrics, Columbus, OH, USA; Nationwide Children's Hospital, Columbus, OH, USA; The Ohio State University College of Medicine, Columbus, OH, USA
| | - Duaa Dakhlallah
- Microbiology, Immunology and Cell Biology Department, West Virginia University, Morgantown, WV, USA
| | - Karen S McCoy
- Department of Pediatrics, Columbus, OH, USA; Nationwide Children's Hospital, Columbus, OH, USA; The Ohio State University College of Medicine, Columbus, OH, USA
| | - Estelle Cormet-Boyaka
- Department of Veterinary Biosciences, Columbus, OH, USA; Dorothy M. Davis Heart and Lung Research Institute, Columbus, OH, USA
| | - Amal O Amer
- Department of Microbial Infection and Immunity, Columbus, OH, USA; Dorothy M. Davis Heart and Lung Research Institute, Columbus, OH, USA; The Ohio State University College of Medicine, Columbus, OH, USA.
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Abstract
In the article by Sheikh SI, et al, "Racial differences in pet ownership in families of children with asthma" in World Journal of Pediatrics 2016;12(3):343-346 (doi: 10.1007/s12519-016-0027-9), the last author's name was incorrectly listed as "Don Hayes". His name should have read "Don Hayes Jr".
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Affiliation(s)
- Shahid I Sheikh
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio, USA.,Section of Pulmonary Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA.,Section of Allergy/Immunology, Nationwide Children's Hospital, Columbus, Ohio, USA.,The Ohio State University, ED 444 Wolfe Education Building, Nationwide Children's Hospital, 700 Children's Drive, Columbus, 43205, OH, USA
| | - Judy Pitts
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio, USA.,Section of Pulmonary Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Nancy A Ryan-Wenger
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio, USA.,Department of Nursing Research, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Karen S McCoy
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio, USA.,Section of Pulmonary Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Don Hayes
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio, USA.,Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, Ohio, USA.,Section of Pulmonary Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA
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Sheikh SI, Pitts J, Ryan-Wenger NA, Kotha K, McCoy KS, Stukus DR. Improved quality-of-life of caregivers of children with asthma through guideline-based management. J Asthma 2016; 54:768-776. [PMID: 27831828 DOI: 10.1080/02770903.2016.1258077] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The quality of life (QOL) of caregivers of children with asthma may be related to children's responses to asthma management. AIM To evaluate change in QOL over time of caregivers of children with asthma through guideline-based management. DESIGN This was a 3-year prospective cohort study of children with asthma referred to our pediatric asthma center. Families completed Pediatric Asthma Caregiver's Quality of Life Questionnaire (PACQLQ), the Asthma Control Test™ (ACT), and reported the number of days/month of albuterol use and wheezing at each clinic visit. RESULTS We enrolled 143 children, ages 7-17 years (mean = 10.6 ± 2.9), 56.6% male, 70.6% Caucasian. Patients were managed by the same MD (n = 65,45.5%) or APN (n = 78,54.5%) over time. The mean total PACQLQ significantly increased over the 3-year period (F = 67.418, p < .001). Total scores at the first visit were 4.8 ± 1.6, which improved to 6.1 ± 1 at the 3-month follow-up visit. This improvement was sustained at the 1, 2, and 3-year clinic visits. PACQLQ emotional function (F = 60.798, p < .001) and activity limitation (F = 41.517, p < .001) domains significantly improved as well. PACQLQ scores were significantly associated with improved ACT scores (r = .37 to .47, p < .05), fewer days/month of albuterol use (r = -.25 to -.36., p < .05), and wheezing (r = -.28 to -.33, p < .05). There were no significant differences in PACQLQ, or asthma clinical outcome measures between MD and APN providers. CONCLUSION Use of National Asthma Education and Prevention Program (NAEPP) guidelines significantly improved QOL of caregivers of children with asthma and in asthma-related symptoms. Improvements over time were independent of type of providers.
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Affiliation(s)
- Shahid I Sheikh
- a Department of Pediatrics , The Ohio State University College of Medicine , Columbus , OH , USA.,b Section of Pulmonary MedicineNationwide Children's Hospital , Columbus , OH , USA.,c Section of Allergy & Immunology , Nationwide Children's Hospital , Columbus , OH , USA
| | - Judy Pitts
- b Section of Pulmonary MedicineNationwide Children's Hospital , Columbus , OH , USA
| | - Nancy A Ryan-Wenger
- b Section of Pulmonary MedicineNationwide Children's Hospital , Columbus , OH , USA
| | - Kavitha Kotha
- a Department of Pediatrics , The Ohio State University College of Medicine , Columbus , OH , USA.,b Section of Pulmonary MedicineNationwide Children's Hospital , Columbus , OH , USA
| | - Karen S McCoy
- a Department of Pediatrics , The Ohio State University College of Medicine , Columbus , OH , USA.,b Section of Pulmonary MedicineNationwide Children's Hospital , Columbus , OH , USA
| | - David R Stukus
- a Department of Pediatrics , The Ohio State University College of Medicine , Columbus , OH , USA.,c Section of Allergy & Immunology , Nationwide Children's Hospital , Columbus , OH , USA
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Sheikh SI, Pitts J, Ryan-Wenger NA, McCoy KS, Hayes D. Racial differences in pet ownership in families of children with asthma. World J Pediatr 2016; 12:343-346. [PMID: 27351569 DOI: 10.1007/s12519-016-0027-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Accepted: 01/15/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Exposure to household domestic animals such as cats and dogs in early life may have some role in pathogenesis of asthma. Racial differences exist in the prevalence of asthma. We hypothesized that there may also be racial differences in pet ownership in families with asthma. METHODS A cross sectional study was conducted from June 2011 to December 2014 on 823 of 850 (97%) families of children with asthma for pet ownership. Comparisons among racial groups were done using chi square analysis and one-way analysis of variance. RESULTS The mean age of the cohort was 6.9±4.4 years. A total of 540 (65.62%) patients were Caucasian, 195 (23.7%) African American, 42 (5.1%) hispanics, and 26 (3.2%) biracial with one Caucasian parent. Pets in the home were reported by 470 (58.5%) households. Significantly fewer African American and hispanic families had pets in the home (26.9% and 44.7%) than biracial and Caucasian families (72% and 69.9%, P<0.001). Likewise, significantly more biracial and Caucasian families were noted to have dogs (52% and 54.4%) or cats (25.4% and 40%) or both cats and dogs (28% and 18%) than African Americans families (20.3%, P<0.001; 7.1%, P<0.001) and (4.6%, P<0.001), respectively. CONCLUSIONS Among families with asthmatic children, pet ownership is significantly more likely in Caucasian families compared with African-American and Hispanic families, thus there is a racial diversity in pet ownership among families of children with asthma.
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Affiliation(s)
- Shahid I Sheikh
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio, USA.
- Section of Pulmonary Medicine, Section of Allergy/Immunology, Nationwide Children's Hospital, Columbus, Ohio, USA.
- Department of Nursing Research, Section of Allergy/Immunology, Nationwide Children's Hospital, Columbus, Ohio, USA.
| | - Judy Pitts
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio, USA
- Section of Pulmonary Medicine, Section of Allergy/Immunology, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Nancy A Ryan-Wenger
- Department of Nursing Research, Section of Allergy/Immunology, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Karen S McCoy
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio, USA
- Section of Pulmonary Medicine, Section of Allergy/Immunology, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Don Hayes
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio, USA
- Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, Ohio, USA
- Section of Pulmonary Medicine, Section of Allergy/Immunology, Nationwide Children's Hospital, Columbus, Ohio, USA
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Sheikh SI, Handly B, Ryan-Wenger NA, Hayes D, Kirkby SE, McCoy KS, Lind M. Novel Computed Tomography Scoring System for Sinus Disease in Adults With Cystic Fibrosis. Ann Otol Rhinol Laryngol 2016; 125:838-43. [PMID: 27357973 DOI: 10.1177/0003489416656645] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [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: 11/16/2022]
Abstract
OBJECTIVE There is no easy to use scoring system for computed tomography (CT) scans of the sinuses that is specific to cystic fibrosis (CF). We propose a simple and easily implemented scoring system to quantify severity of sinus disease in adults with CF. STUDY DESIGN Case series with chart review. SETTING Academic tertiary-care referral center. SUBJECTS Sixty-nine adult patients with CF and 50 age-matched controls. METHODS We validated a scoring system for CF sinus disease. The CT scans were interpreted by 3 physicians on 2 separate sittings. Parameters include maxillary opacification, nasal obstruction, lateral nasal wall displacement, uncinate process absence/demineralization, and presence/absence of mucocele. RESULTS Patients with CF aged 21 to 30 years (mean = 24.7 ± 2.49). In CF cohort (n = 69), intrarater reliability for the 10 CT categories ranged from .70 to 1.00. Twenty-six (87%) were in the excellent range, and the remaining 4 (13%) were evaluated as good. In the non-CF cohort (n = 50), reliabilities ranged from .44 to 1.00. Twenty-seven (90%) were in the excellent range. For interrater reliability, in the CF cohort, 10 CT categories across the 3 raters ranged from .55 to 1.00. Excellent reliability was achieved in 15 (50%) of the observations. In the non-CF cohort, reliabilities ranged from .44 to 1.00. CONCLUSION A novel and easy to use CT scoring system for CF sinus disease in adults was validated with inter- and intrarater reliability. This new CF sinus disease-specific scoring system can be used by clinicians, surgeons, and radiologists.
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Affiliation(s)
- Shahid I Sheikh
- Departments of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio, USA Section of Pulmonary Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Brian Handly
- Radiology, The Ohio State University College of Medicine, Columbus, Ohio, USA Radiological Institute, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Nancy A Ryan-Wenger
- Departments of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio, USA Section of Pulmonary Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Don Hayes
- Departments of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio, USA Section of Pulmonary Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA Internal Medicine, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Stephen E Kirkby
- Departments of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio, USA Section of Pulmonary Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA Internal Medicine, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Karen S McCoy
- Departments of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio, USA Section of Pulmonary Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Meredith Lind
- Otolaryngology, The Ohio State University College of Medicine, Columbus, Ohio, USA Department of Otolaryngology, Nationwide Children's Hospital, Columbus, Ohio, USA
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Sheikh SI, Chrysler M, Ryan-Wenger NA, Hayes D, McCoy KS. Improving pediatric asthma care: A partnership between pediatric primary care clinics and a free-standing Children's Hospital. J Asthma 2016; 53:622-8. [PMID: 26666448 DOI: 10.3109/02770903.2015.1126845] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Asthma is a common chronic disease of childhood. Providers' adherence to asthma guidelines is still less than optimal. OBJECTIVES To determine if an Asthma Education Program aimed at primary care practices can improve asthma care within practices and if the results vary by duration of the program. METHODS Ten practices were randomly assigned to an Early Asthma Education Intervention (EI) group or a Delayed Asthma Education Intervention (DI) group. The EI group received the intervention for 12 months and was monitored for 6 additional months. The DI group was observed without intervention for 12 months, then received the intervention for 6 months, and was monitored for 6 additional months. The program included training of asthma educators in each practice and then monitoring for improvement in medical record documentation of National Asthma Education and Prevention Program (NAEPP) asthma quality indicators by blinded random review of patient charts. RESULTS In the EI group, 6-, 12-, and 18-month data revealed significant improvement in documentation of asthma severity, education, action plan, night time symptoms, and symptoms with exercise compared to baseline and compared to DI group at baseline and at the 12-month interval. In the DI group, significant improvement in documentation in all of the above endpoints and also in documentation of NAEPP treatment guidelines was noted at 18 and 24 months. In both groups, documentation levels remained relatively stable at 6 months after the intervention, with no significant differences between groups. While improved, guideline adherence was <80% for half of the indicators. CONCLUSION In-office training of non-physician asthma providers improves the quality of asthma care.
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Affiliation(s)
- Shahid I Sheikh
- a Department of Pediatrics , The Ohio State University College of Medicine , Columbus , Ohio , USA.,c Department of Respiratory Care , Nationwide Children's Hospital , Columbus , Ohio , USA
| | - Marjorie Chrysler
- c Department of Respiratory Care , Nationwide Children's Hospital , Columbus , Ohio , USA
| | - Nancy A Ryan-Wenger
- b Section of Pulmonary Medicine, Nationwide Children's Hospital , Columbus , Ohio , USA
| | - Don Hayes
- a Department of Pediatrics , The Ohio State University College of Medicine , Columbus , Ohio , USA.,b Section of Pulmonary Medicine, Nationwide Children's Hospital , Columbus , Ohio , USA.,d Department of Internal Medicine , The Ohio State University College of Medicine , Columbus , Ohio , USA
| | - Karen S McCoy
- a Department of Pediatrics , The Ohio State University College of Medicine , Columbus , Ohio , USA.,b Section of Pulmonary Medicine, Nationwide Children's Hospital , Columbus , Ohio , USA
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Hayes D, Tumin D, Daniels CJ, McCoy KS, Mansour HM, Tobias JD, Kirkby SE. Pulmonary Artery Pressure and Benefit of Lung Transplantation in Adult Cystic Fibrosis Patients. Ann Thorac Surg 2016; 101:1104-9. [DOI: 10.1016/j.athoracsur.2015.09.086] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Revised: 09/02/2015] [Accepted: 09/28/2015] [Indexed: 10/22/2022]
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Abstract
BACKGROUND Asthma pathogenesis is a complex interaction of genetic, ethnic, environmental and social/life style risk factors. AIM The goal of this study was to identify associations, if any, in children with asthma, between environmental risk factors (exposure to second-hand tobacco smoke (STS), pet ownership, race and a family history of asthma. METHODS After IRB approval, from June 2011 to December 2014, 823 children with asthma were enrolled in this prospective cross sectional study. At the initial visit, families completed a questionnaire with information on family history of asthma, having a pet at home and exposure to STS by parents at home. Chi square analyses were calculated, with alpha level of significance ≤0.05. RESULTS History of asthma in parents, siblings or grandparents was reported by 575 (69.8%) patients including father (n = 154, 17.8%) and mother (n = 235, 26.5%). Children with family history of asthma (n = 575) were significantly more likely to have a pet at home and exposure to STS (n = 347, 60.3% and n = 198, 34.4%, respectively) compared to families without a history of asthma (n = 124, 50%, p = 0.006 and n = 44, 17.7%, p < 0.001, respectively). Similarly, asthmatic children with exposure to STS (n = 241) were significantly more likely to have a pet at home and a family history of asthma (n = 153, 63.5% and n = 197, 81.7%, respectively) compared to children with no STS exposure (n = 315, 55.5%, p = 0.034 and n = 371, 65.3%, p < 0.001 respectively). CONCLUSIONS Significantly more asthmatic children with immediate relatives with a history of asthma have a pet at home and experience STS exposure compared to children without relatives with a history of asthma, suggesting association between life style choices/environmental exposures and family history of asthma.
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Affiliation(s)
- Shahid I Sheikh
- a Department of Pediatrics , The Ohio State University College of Medicine .,b Section of Pulmonary Medicine, Nationwide Children's Hospital , and
| | - Judy Pitts
- b Section of Pulmonary Medicine, Nationwide Children's Hospital , and
| | - Nancy A Ryan-Wenger
- a Department of Pediatrics , The Ohio State University College of Medicine .,b Section of Pulmonary Medicine, Nationwide Children's Hospital , and
| | - Karen S McCoy
- a Department of Pediatrics , The Ohio State University College of Medicine .,b Section of Pulmonary Medicine, Nationwide Children's Hospital , and
| | - Don Hayes
- a Department of Pediatrics , The Ohio State University College of Medicine .,b Section of Pulmonary Medicine, Nationwide Children's Hospital , and.,c Department of Internal Medicine , The Ohio State University College of Medicine , Columbus , OH , USA
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Abstract
OBJECTIVE Many children, particularly those from inner city neighborhoods, have undiagnosed asthma. This study was done to evaluate the effectiveness of an asthma screening, referral and follow-up intervention in an inner city community setting in early identification of children at risk for undiagnosed asthma. METHODS A descriptive longitudinal cohort design was used to assess children at baseline and at a 2-year follow-up. Parents of children in a private day school and a church Sunday school (N = 103) completed a validated Asthma Screening Tool at both time periods. Children with asthma and at risk for asthma were referred to a primary care provider (PCP). RESULTS At baseline, screening of 103 children, ages 3-17 years (mean=7.7 ± 2.9), were categorized as known asthma diagnosis (n = 22), at-risk for undiagnosed asthma (n = 52) and not at-risk for asthma (n = 29). Sixty-two (60.2%) parents responded to the 2-year follow-up. Referral to PCP was kept by 61.5% from the known asthma group and by 24% of children at-risk for asthma. At 2-year follow-up, among not at-risk group, no one converted to at risk status, but majority of children among known asthma group continued to have uncontrolled asthma symptoms, and very few received daily preventive asthma medications. CONCLUSIONS The asthma screening, referral and follow-up intervention for inner city children in a community setting was successful in early identification of patients at-risk for asthma. More education for PCPs on guidelines for diagnosis and management of asthma is needed to decrease childhood asthma morbidity.
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Affiliation(s)
- Shahid I Sheikh
- a Department of Pediatrics , The Ohio State University College of Medicine , Columbus , OH , USA
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Kirkby SE, Hayes D, Parsons JP, Wisely CE, Kopp B, McCoy KS, Mastronarde JG. Eucapnic Voluntary Hyperventilation to Detect Exercise-Induced Bronchoconstriction in Cystic Fibrosis. Lung 2015; 193:733-8. [PMID: 26036953 DOI: 10.1007/s00408-015-9745-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 05/13/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Exercise-induced bronchoconstriction (EIB) has not been well studied in cystic fibrosis (CF), and eucapnic voluntary hyperventilation (EVH) testing has not been used as an objective assessment of EIB in CF to date. METHODS A prospective cohort pilot study was completed where standard EVH testing was completed by 10 CF patients with forced expiratory volume in 1 s (FEV1) ≥70% of predicted. All patients also completed a cardiopulmonary exercise test (CPET) with pre- and post-CPET spirometry as a comparative method of detecting EIB. RESULTS No adverse events occurred with EVH testing. A total of 20% (2/10) patients were diagnosed with EIB by means of EVH. Both patients had clinical symptoms consistent with EIB. No patient had a CPET-based exercise challenge consistent with EIB. CONCLUSIONS EVH testing was safe and effective in the objective assessment for EIB in patients with CF who had well-preserved lung function. It may be a more sensitive method of detecting EIB then exercise challenge.
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Affiliation(s)
- Stephen E Kirkby
- Section of Pulmonary Medicine, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA. .,Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, The Ohio State University Wexner Medical Center, The Ohio State University, Columbus, OH, USA.
| | - Don Hayes
- Section of Pulmonary Medicine, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA.,Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, The Ohio State University Wexner Medical Center, The Ohio State University, Columbus, OH, USA
| | - Jonathan P Parsons
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, The Ohio State University Wexner Medical Center, The Ohio State University, Columbus, OH, USA
| | - Clayton E Wisely
- Section of Pulmonary Medicine, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA
| | - Ben Kopp
- Section of Pulmonary Medicine, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA
| | - Karen S McCoy
- Section of Pulmonary Medicine, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA
| | - John G Mastronarde
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, The Ohio State University Wexner Medical Center, The Ohio State University, Columbus, OH, USA
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Powers SW, Stark LJ, Chamberlin LA, Filigno SS, Sullivan SM, Lemanek KL, Butcher JL, Driscoll KA, Daines CL, Brody AS, Schindler T, Konstan MW, McCoy KS, Nasr SZ, Castile RG, Acton JD, Wooldridge JL, Ksenich RA, Szczesniak RD, Rausch JR, Stallings VA, Zemel BS, Clancy JP. Behavioral and nutritional treatment for preschool-aged children with cystic fibrosis: a randomized clinical trial. JAMA Pediatr 2015; 169:e150636. [PMID: 25938655 DOI: 10.1001/jamapediatrics.2015.0636] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Evidence-based treatments that achieve optimal energy intake and improve growth in preschool-aged children with cystic fibrosis (CF) are a critical need. OBJECTIVE To test whether behavioral and nutritional treatment (intervention) was superior to an education and attention control treatment in increasing energy intake, weight z (WAZ) score, and height z (HAZ) score. DESIGN, SETTING, AND PARTICIPANTS This randomized clinical trial included 78 children aged 2 to 6 years (mean age, 3.8 years) with CF and pancreatic insufficiency (intervention, n = 36 and control, n = 42). The study was conducted at 7 CF centers between January 2006 and November 2012; all 78 participants who met intent-to-treat criteria completed through follow-up. INTERVENTIONS Behavioral intervention combined individualized nutritional counseling targeting increased energy intake and training in behavioral child management skills. The control arm provided education and served as a behavioral placebo controlling for attention and contact frequency. Both treatments were delivered in person or telehealth (via telephone). Sessions occurred weekly for 8 weeks then monthly for 4 months (6 months). Participants then returned to standard care for 1 year, with 12-month follow-up thereafter. MAIN OUTCOMES AND MEASURES Changes in energy intake and WAZ score were examined from pretreatment to posttreatment (6 months) and change in HAZ score was assessed pretreatment to follow-up (18 months). Covariates included sex, Pseudomonas aeruginosa status at baseline, and treatment modality (in person vs telehealth). RESULTS At baseline, mean (SD) energy intake was 1462 (329) kcals/d, WAZ score was -0.44 (0.81), and HAZ score was -0.55 (0.84). From pretreatment to posttreatment, the intervention increased daily energy intake by 485 calories vs 58 calories for the control group (adjusted difference, 431 calories; 95% CI, 282 to 581; P < .001) and increased the WAZ score by 0.12 units vs 0.06 for the control (adjusted difference, 0.09; 95% CI, -0.06 to 0.24; P = .25). From pretreatment to follow-up, the intervention increased the HAZ score by 0.09 units vs -0.02 for the control (adjusted difference, 0.14 units; 95% CI, 0.001 to 0.27; P = .049). Measured treatment integrity and credibility were high for both groups. CONCLUSIONS AND RELEVANCE Behavioral and nutritional intervention improved energy intake and HAZ score outcomes but not WAZ score outcomes. Our results provide evidence that behavioral and nutritional treatment may be efficacious as a nutritional intervention for preschoolers aged 2 to 6 years with CF and pancreatic insufficiency. TRIAL REGISTRATION clinicaltrials.gov Identifier:NCT00241969.
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Affiliation(s)
- Scott W Powers
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio2Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Lori J Stark
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio2Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Leigh A Chamberlin
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Stephanie S Filigno
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio2Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Stephanie M Sullivan
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Kathleen L Lemanek
- The Ohio State University College of Medicine, Columbus4Nationwide Children's Hospital, Columbus, Ohio
| | - Jennifer L Butcher
- University of Michigan Medical School, Ann Arbor6C. S. Mott Children's Hospital, Ann Arbor, Michigan
| | | | - Cori L Daines
- Department of Pediatrics, University of Arizona, Tucson
| | - Alan S Brody
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio9Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Teresa Schindler
- Case Western Reserve University School of Medicine, Cleveland, Ohio11Rainbow Babies and Children's Hospitals, Cleveland, Ohio
| | - Michael W Konstan
- Case Western Reserve University School of Medicine, Cleveland, Ohio11Rainbow Babies and Children's Hospitals, Cleveland, Ohio
| | - Karen S McCoy
- The Ohio State University College of Medicine, Columbus4Nationwide Children's Hospital, Columbus, Ohio
| | - Samya Z Nasr
- University of Michigan Medical School, Ann Arbor
| | - Robert G Castile
- The Ohio State University College of Medicine, Columbus4Nationwide Children's Hospital, Columbus, Ohio
| | - James D Acton
- Department of Child Health, University of Missouri Women and Children's Hospital, Columbia
| | - Jamie L Wooldridge
- Department of Pediatrics, St Louis University School of Medicine, St Louis, Missouri
| | - Roberta A Ksenich
- Case Western Reserve University School of Medicine, Cleveland, Ohio11Rainbow Babies and Children's Hospitals, Cleveland, Ohio
| | - Rhonda D Szczesniak
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio15Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Joseph R Rausch
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio2Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Virginia A Stallings
- Perelman School of Medicine, University of Pennsylvania, Philadelphia17Division of Gastroenterology, Hepatology, and Nutrition, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Babette S Zemel
- Perelman School of Medicine, University of Pennsylvania, Philadelphia17Division of Gastroenterology, Hepatology, and Nutrition, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - John P Clancy
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio15Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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Sheikh SI, Long FR, Flucke R, Ryan-Wenger NA, Hayes D, McCoy KS. Changes in Pulmonary Function and Controlled Ventilation-High Resolution CT of Chest After Antibiotic Therapy in Infants and Young Children with Cystic Fibrosis. Lung 2015; 193:421-8. [PMID: 25762451 DOI: 10.1007/s00408-015-9706-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Accepted: 02/27/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND Infants with cystic fibrosis (CF) develop early progressive lung disease which may be asymptomatic. Infant pulmonary function tests (IPFT) and controlled ventilation-high resolution computed tomography (CV-HRCT) of chest can detect early asymptomatic lung disease. It is not well established that these objective measures can detect changes in lung disease after clinical interventions. OBJECTIVE The purpose of this study was to evaluate usefulness of IPFT and CV-HRCT to detect changes in lung disease after intravenous (IV) antibiotic therapy in infants with early CF-related lung disease. STUDY DESIGN IPFTs and CV-HRCT done before and after 2 weeks of IV antibiotics in infants at our institution over the last 12 years were compared. CV-HRCTs were compared using the modified Brody scoring system. RESULTS The sample included 21 infants, mean age 85.2 ± 47.6 weeks. Mean change in weight was 0.4 ± 0.38 kg (p = 0.001). Significant changes in IPFT included mean % predicted FEV(0.5) (+13.5 %, p = 0.043), mean %FEF(25-75) (+30.2 %, p = 0.008), mean %RV/TLC (-11.2 %, p = 0.008), and mean %FRC/TLC (-4.5 %, p = 0.001). Total Brody scores improved from a median of 10 to 5 (p < 0.001) as did mean scores for airway wall thickening (p = 0.050), air trapping (p < 0.001), and parenchymal opacities (p = 0.003). CONCLUSION IPFT and CV-HRCT can be used as objective measures of improvement in lung disease for infants with CF treated with antibiotics.
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Affiliation(s)
- Shahid I Sheikh
- Departments of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA,
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Hayes D, McCoy KS, Whitson BA, Mansour HM, Tobias JD. High-risk age window for mortality in children with cystic fibrosis after lung transplantation. Pediatr Transplant 2015; 19:206-10. [PMID: 25430504 DOI: 10.1111/petr.12401] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [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] [Accepted: 10/29/2014] [Indexed: 11/29/2022]
Abstract
LTx in children with CF remains controversial. The UNOS database was queried from 1987 to 2013 for CF patients <18 yr of age at time of transplant. PCHR model was used to quantify hazard of mortality. 489 recipients were included in the survival analysis. The hazard function of post-transplant mortality was plotted over attained age to identify age window of highest risk, which was 16-20 yr. Unadjusted PCHR model revealed ages immediately after the high-risk window were characterized by lower hazard of mortality (HR = 0.472; 95% CI = 0.302, 0.738; p = 0.001). After adjusting for potential confounders, the decline in mortality hazard immediately after the high-risk window remained statistically significant (HR = 0.394; 95% CI: 0.211, 0.737; p = 0.004). Hazard of mortality in children with CF after LTx was highest between 16 and 20 yr of attained age and declined thereafter.
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Affiliation(s)
- Don Hayes
- Department of Pediatrics, The Ohio State University, Columbus, OH, USA; Department of Internal Medicine, The Ohio State University, Columbus, OH, USA; Section of Pulmonary Medicine, Nationwide Children's Hospital, Columbus, OH, USA
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Biagini Myers JM, Simmons JM, Kercsmar CM, Martin LJ, Pilipenko VV, Austin SR, Lindsey MA, Amalfitano KM, Guilbert TW, McCoy KS, Forbis SG, McBride JT, Ross KR, Vauthy PA, Khurana Hershey GK. Heterogeneity in asthma care in a statewide collaborative: the Ohio Pediatric Asthma Repository. Pediatrics 2015; 135:271-9. [PMID: 25601985 DOI: 10.1542/peds.2014-2230] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [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] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Asthma heterogeneity causes difficulty in studying and treating the disease. We built a comprehensive statewide repository linking questionnaire and medical record data with health outcomes to characterize the variability of clinical practices at Ohio children's hospitals for the treatment of hospitalized asthma. METHODS Children hospitalized at 6 participating Ohio children's hospitals for asthma exacerbation or reactive airway disease aged 2 to 17 were eligible. Medical, social, and environmental histories and past asthma admissions were collected from questionnaires and the medical record. RESULTS From December 2012 to September 2013, 1012 children were enrolled. There were significant differences in the population served, emergency department and inpatient practices, intensive care unit usage, discharge criteria, and length of stay across the sites (all P < .0001, total n = 1012). Public insurance was highest in Cleveland and Cincinnati (72 and 65%). In the emergency department, Cincinnati and Akron had the highest intravenous magnesium sulfate use (37% and 33%); Columbus administered the most intramuscular epinephrine (15%). Cleveland and Columbus had the highest intensive care unit admittance (44% and 41%) and proportion of long-stay patients (95% and 85%). Moderate/severe asthma severity classification was associated with discharge prescription for inhaled corticosteroids (odds ratio = 2.7; 95% confidence interval: 1.6-4.5; P = .004) but not stay length. CONCLUSIONS These data highlight the need for standardization of treatment practices for inpatient asthma care. There is considerable opportunity for personalized care plans that incorporate a patient's asthma impairment, risk, and treatment response history into hospital practices for asthma exacerbation treatment. The Ohio Pediatric Asthma Repository is a unique statewide resource in which to conduct observational, comparative effectiveness, and ultimately intervention studies for pediatric asthma.
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Affiliation(s)
| | | | | | - Lisa J Martin
- Human Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | | | | | | | | | | | - Karen S McCoy
- Division of Pediatric Pulmonology, Nationwide Children's Hospital, Columbus, Ohio
| | - Shalini G Forbis
- Department of Pediatrics, Dayton Children's Hospital, Dayton, Ohio
| | - John T McBride
- Department of Pulmonary Medicine, Akron Children's Hospital, Akron, Ohio
| | - Kristie R Ross
- Department of Pediatrics-Pulmonary, Rainbow Babies and Children's Hospital, Cleveland, Ohio; and
| | - Pierre A Vauthy
- Department of Pediatric Pulmonary Medicine, ProMedica Toledo Children's Hospital, Toledo, Ohio
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Sheikh SI, Long FR, McCoy KS, Johnson T, Ryan-Wenger NA, Hayes D. Computed tomography correlates with improvement with ivacaftor in cystic fibrosis patients with G551D mutation. J Cyst Fibros 2015; 14:84-9. [DOI: 10.1016/j.jcf.2014.06.011] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Revised: 05/29/2014] [Accepted: 06/25/2014] [Indexed: 10/25/2022]
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Affiliation(s)
- Don Hayes
- Department of Pediatrics, The Ohio State University College of Medicine, Nationwide Children's Hospital, Columbus, Ohio
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Hayes D, Tobias JD, Mansour HM, Kirkby S, McCoy KS, Daniels CJ, Whitson BA. Pulmonary Hypertension in Cystic Fibrosis with Advanced Lung Disease. Am J Respir Crit Care Med 2014; 190:898-905. [DOI: 10.1164/rccm.201407-1382oc] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Hayes D, Long FR, McCoy KS, Sheikh SI. CT imaging of pediatric patients with cystic fibrosis on ivacaftor therapy. Lung 2014; 192:823-4. [PMID: 25099273 DOI: 10.1007/s00408-014-9629-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Accepted: 07/16/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Don Hayes
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA,
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Oliver KN, Free ML, Bok C, McCoy KS, Lemanek KL, Emery CF. Stigma and optimism in adolescents and young adults with cystic fibrosis. J Cyst Fibros 2014; 13:737-44. [PMID: 24795287 DOI: 10.1016/j.jcf.2014.04.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Revised: 03/26/2014] [Accepted: 04/12/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Despite increased life expectancy among patients with cystic fibrosis (CF), few studies have examined coping among adolescents and young adults with CF. Previous research suggests that stigma associated with chronic disease is related to worse physical and psychological health, but optimism may be protective. This study examined stigma and optimism among patients with CF. METHODS Seventy-two patients with CF (ages 14 to 25) completed a self-report questionnaire assessing stigma, distress, CF-specific quality of life (QoL), and optimism. Objective health data were recorded from patient medical records. RESULTS Greater stigma was associated with lower pulmonary function, QoL, and optimism. Stigma was positively correlated with distress. Optimism moderated the relationship between stigma and anxiety (p<0.001), and between stigma and emotional functioning (p<0.01). CONCLUSIONS Stigma is related to worse lung function and psychological health in patients with CF, but higher levels of optimism may act as a protective factor.
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Affiliation(s)
- Kendea N Oliver
- Department of Psychology, The Ohio State University, 1835 Neil Ave., Room 169, Columbus, OH 43210, United States
| | - Matthew L Free
- Department of Psychology, The Ohio State University, 1835 Neil Ave., Room 169, Columbus, OH 43210, United States
| | - Cody Bok
- Department of Psychology, The Ohio State University, 1835 Neil Ave., Room 169, Columbus, OH 43210, United States
| | - Karen S McCoy
- The Research Institute, Nationwide Children's Hospital, 700 Children's Dr., Columbus, OH 43205, United States
| | - Kathleen L Lemanek
- The Research Institute, Nationwide Children's Hospital, 700 Children's Dr., Columbus, OH 43205, United States
| | - Charles F Emery
- Department of Psychology, The Ohio State University, 1835 Neil Ave., Room 169, Columbus, OH 43210, United States.
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Hayes D, Kopp BT, Kirkby S, Allen ED, McCoy KS. Attrition in Pediatric Pulmonology Fellowship. Pediatric Allergy, Immunology, and Pulmonology 2014. [DOI: 10.1089/ped.2013.0324] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Don Hayes
- Department of Pediatrics, The Ohio State University College of Medicine, Nationwide Children's Hospital, Columbus, Ohio
| | - Benjamin T. Kopp
- Department of Pediatrics, The Ohio State University College of Medicine, Nationwide Children's Hospital, Columbus, Ohio
| | - Stephen Kirkby
- Department of Pediatrics, The Ohio State University College of Medicine, Nationwide Children's Hospital, Columbus, Ohio
| | - Elizabeth D. Allen
- Department of Pediatrics, The Ohio State University College of Medicine, Nationwide Children's Hospital, Columbus, Ohio
| | - Karen S. McCoy
- Department of Pediatrics, The Ohio State University College of Medicine, Nationwide Children's Hospital, Columbus, Ohio
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Hayes Jr. D, Long FR, McCoy KS, Sheikh SI. Improvement in Bronchiectasis on CT Imaging in a Pediatric Patient with Cystic Fibrosis on Ivacaftor Therapy. Respiration 2014; 88:345-345. [DOI: 10.1159/000365999] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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Hayes D, Higgins RS, Kirkby S, McCoy KS, Wehr AM, Lehman AM, Whitson BA. Impact of pulmonary hypertension on survival in patients with cystic fibrosis undergoing lung transplantation: an analysis of the UNOS registry. J Cyst Fibros 2013; 13:416-23. [PMID: 24388063 DOI: 10.1016/j.jcf.2013.12.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [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: 09/17/2013] [Revised: 10/24/2013] [Accepted: 12/02/2013] [Indexed: 10/25/2022]
Abstract
BACKGROUND Pulmonary hypertension (PH) is a comorbidity reported in patients with cystic fibrosis (CF) with research limited to single-center studies. METHODS To assess the impact of PH in patients with CF who received a lung transplant (LTx), the United Network for Organ Sharing was queried from 1987 to 2012, restricting analysis to transplant patients 6-55 years old between 1/1/2005 and 7/6/2011. RESULTS Of 23,951 lung transplants, 1177 met inclusion criteria with 831 having mean pulmonary artery pressure (mPAP) data available. For the entire cohort, mean age was 30.3 (SD=9.2, range 12-55), and mean mPAP was 26.5 (SD = 7.8, range 5-66) mmHg. A total of 470 (57%) had PH defined as mPAP ≥ 25 mmHg. Comparing PH to non-PH groups, mean forced expiratory volume in one second (FEV1) was 24.4 (SD = 13.8) vs. 26 (SD=13.9) % of predicted, mean supplemental oxygen requirement at rest was 4.5 (SD = 4.1) vs. 3.7 (SD = 3.0) liters per minute, and mean lung allocation score was 49 (SD = 16) vs. 43 (SD = 12), respectively. For the PH group, median survival was 84.4 months compared to 67.1 months for the non-PH group (log-rank p-value = 0.326). The adjusted hazard ratio for PH vs. non-PH was 0.862 (95% CI: 0.653-1.138; p = 0.293), thus indicating no statistically significant effect of PH on survival. CONCLUSIONS A high prevalence of PH was found in CF patients prior to LTx. Based on our models despite PH being prevalent, there is no strong evidence suggesting that it significantly alters the risk of death in CF patients after LTx.
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Affiliation(s)
- Don Hayes
- Department of Pediatrics, The Ohio State University, Columbus, OH, USA; Department of Internal Medicine, The Ohio State University, Columbus, OH, USA; Nationwide Children's Hospital, Columbus, OH, USA.
| | - Robert S Higgins
- Department of Surgery, The Ohio State University, Columbus, OH, USA
| | - Stephen Kirkby
- Department of Pediatrics, The Ohio State University, Columbus, OH, USA; Department of Internal Medicine, The Ohio State University, Columbus, OH, USA; Nationwide Children's Hospital, Columbus, OH, USA
| | - Karen S McCoy
- Department of Pediatrics, The Ohio State University, Columbus, OH, USA; Nationwide Children's Hospital, Columbus, OH, USA
| | - Allison M Wehr
- Center for Biostatistics, The Ohio State University, Columbus, OH, USA
| | - Amy M Lehman
- Center for Biostatistics, The Ohio State University, Columbus, OH, USA
| | - Bryan A Whitson
- Department of Surgery, The Ohio State University, Columbus, OH, USA
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Lu XX, McCoy KS, Hu WK, Xu JL, Wang HQ, Chen P, Chen HB. Dexamethasone reduces IL-17 and Tim-3 expression in BALF of asthmatic mice. ACTA ACUST UNITED AC 2013; 33:479-484. [PMID: 23904364 DOI: 10.1007/s11596-013-1145-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2012] [Revised: 12/21/2012] [Indexed: 12/24/2022]
Abstract
This study investigated the expression of interleukin-17 (IL-17) and T cell immunoglobulin mucin and domain-containing molecule-3 (Tim-3) in bronchoalveolar lavage fluid (BALF) of asthmatic mice and the effect of dexamethasone (DEX) on these factors. Thirty-six mice were randomly divided into three groups: normal group, asthmatic group and DEX group. The mouse model of asthma was established by sensitization with ovalbumin in both the asthmatic and DEX groups. The levels of IL-6, IL-10, IL-17 and TGF-β were measured in BALF by enzyme-linked immunesorbent assay (ELISA). The mRNA expression level of Tim-3 was detected by reverse transcription polymerase chain reaction (RT-PCR). The ratio of Tim-3+CD4+ cells to total CD4+ cells in BALF was determined by flow cytometry. Differential inflammatory cells in BALF were detected. The correlations among IL-17, IL-6, IL-10, Tim-3 and inflammatory cells were analyzed. The results showed that the levels of IL-17, IL-6 and Tim-3 were substantially increased and the IL-10 level decreased in BALF in the asthmatic mice, which was significantly reversed by DEX treatment. IL-17 expression was positively correlated with IL-6 and Tim-3 expression and the number of inflammatory cells but negatively with IL-10 expression. These results indicate that the increased expression of IL-17 and Tim-3 in BALF may be implicated in the occurrence and development of asthmatic inflammation; the mechanism by which DEX suppresses asthmatic airway inflammation involves down-regulation of IL-17 and Tim-3 levels.
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Affiliation(s)
- Xiao-Xia Lu
- Department of Pulmonary Medicine, Wuhan Women and Children Health Care Center, Wuhan, 430030, China.
| | - Karen S McCoy
- Department of Pediatrics, Division of Pulmonary Medicine, Nationwide Children's Hospital and The Ohio State University School of Medicine and Public Health, Columbus, 43085, USA
| | - Wei-Kun Hu
- Department of Ophthalmology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Jia-Li Xu
- Department of Pulmonary Medicine, Wuhan Women and Children Health Care Center, Wuhan, 430030, China
| | - Hai-Qin Wang
- Department of Pulmonary Medicine, Wuhan Women and Children Health Care Center, Wuhan, 430030, China
| | - Peng Chen
- Department of Pulmonary Medicine, Wuhan Women and Children Health Care Center, Wuhan, 430030, China
| | - He-Bin Chen
- Department of Pulmonary Medicine, Wuhan Women and Children Health Care Center, Wuhan, 430030, China
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Sheikh SI, Ryan-Wenger NA, McCoy KS. Outcomes of surgical management of severe GERD in patients with cystic fibrosis. Pediatr Pulmonol 2013; 48:556-62. [PMID: 22949398 DOI: 10.1002/ppul.22630] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2011] [Accepted: 06/18/2012] [Indexed: 01/12/2023]
Abstract
BACKGROUND Patients with cystic fibrosis (CF) are at high risk for gastroesophageal reflux disease (GERD) and medical management of GERD improves pulmonary symptoms. Some patients with worsening CF and GERD symptoms undergo Nissen fundoplication, but the extent to which surgical management of GERD improves respiratory symptoms is not well studied. The purpose of this retrospective study was to evaluate the safety and efficacy of Nissen fundoplication in 48 patients with CF and uncontrolled GERD. RESULTS Patients exhibited significantly fewer pulmonary exacerbations, increased weight gain and slower decline in % predicted FEV1 at 2 years after the surgery, compared to 2 years before surgery. Mean change in % predicted FEV1 in 2 years before surgery was--13.57% and mean change in % predicted FEV1 in 2 years after the surgery was +1.5% and difference was significant P = 0.001. Better pulmonary and nutritional outcomes were noted among patients with milder lung disease compared to those with severe lung disease, and among patients who received gastrostomy tube feedings for ≥6 months compared to those with no G-tube or tube feedings for <6 months. There was no mortality associated with surgery. CONCLUSION In CF patients with worsening lung disease and uncontrolled GERD, Nissen fundoplication not only slows the decline in lung function but leads to significant improvement in weight, and decrease in CF exacerbations. Patients with milder disease and patients receiving G-tube feedings for ≥6 months after surgery benefited the most.
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Affiliation(s)
- Shahid I Sheikh
- Division of Pulmonary Medicine, Department of Pediatrics, Ohio State University College of Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA.
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Sheikh S, Khan N, Ryan-Wenger NA, McCoy KS. Demographics, clinical course, and outcomes of children with status asthmaticus treated in a pediatric intensive care unit: 8-year review. J Asthma 2013; 50:364-9. [PMID: 23379585 DOI: 10.3109/02770903.2012.757781] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE This study was done to understand the demographics, clinical course, and outcomes of children with status asthmaticus treated in a tertiary care pediatric intensive care unit (PICU). METHODS The medical charts of all patients above 5 years of age admitted to the PICU at Nationwide Children's Hospital, Columbus, OH, USA, with status asthmaticus from 2000 to 2007 were reviewed retrospectively. Data from 222 encounters by 183 children were analyzed. RESULTS The mean age at admission in years was 11 ± 3.8. The median PICU stay was 1 day (range, 1-12 days) and median hospital stay was 3 days. The ventilated group (n = 17) stayed a median of 2 days longer in the PICU and hospital. Nearly half of the children (n = 91; 50%) did not receive daily controller asthma medications. Adherence to asthma medications was reported in 125 patient charts of whom 43 (34%) were compliant. Exposure to smoking was reported in 167 of whom 70 (42%) were exposed. Among patients receiving metered dose inhaler (MDI), only 39 (18%) were using it with a spacer. Among 105 patient charts asthma severity data were available, of them 21 (20%) were labeled as mild intermittent, 29 (28%) were mild persistent, 26 (25%) were moderate persistent, and 29 (28%) were severe persistent. Compared to children with only one PICU admission during the study period (n = 161), children who had multiple PICU admissions (n = 22) experienced more prior emergency department visits and hospitalizations for asthma symptoms. There were no fatalities. CONCLUSION Asthmatics with any disease severity are at risk for life-threatening asthma exacerbations requiring PICU stay, especially those who are not adherent with their daily medications.
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Affiliation(s)
- Shahid Sheikh
- Division of Pulmonary Medicine, Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH, USA.
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Gustave JE, Jurcisek JA, McCoy KS, Goodman SD, Bakaletz LO. Targeting bacterial integration host factor to disrupt biofilms associated with cystic fibrosis. J Cyst Fibros 2012; 12:384-9. [PMID: 23168017 DOI: 10.1016/j.jcf.2012.10.011] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2012] [Revised: 10/19/2012] [Accepted: 10/26/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND This study aims to identify whether the bacterial protein, Integration Host Factor (IHF), is present within sputum solids collected from cystic fibrosis (CF) patients and thus might contribute to the structural stability of biofilms within the lungs. METHODS The presence of IHF in sputum was determined by immunohistochemistry. The role of IHF in stabilizing biofilms within sputum was tested in vitro wherein anti-IHF was used to attempt to dissolve sputum solids. RESULTS Thirty-seven of 44 sputum samples (84%) were positive for anti-IHF staining. Treatment with anti-IHF or DNase of 6 representative samples, dissolved sputum solids significantly better than treatment with normal saline in vitro, and strong synergism was observed when these agents were used in combination. CONCLUSIONS IHF was detected in the majority of sputum samples from patients with CF and in vitro treatment with anti-IHF induced dissolution of sputum solids. These data support further investigation of IHF as a potential therapeutic target for patients with CF.
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Hayes D, Kirkby S, S McCoy K, Mansour HM, Khosravi M, Strawbridge H, Tobias JD. Reduction of lipid-laden macrophage index after laparoscopic Nissen fundoplication in cystic fibrosis patients after lung transplantation. Clin Transplant 2012; 27:121-5. [PMID: 23004684 DOI: 10.1111/ctr.12020] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2012] [Indexed: 01/19/2023]
Abstract
BACKGROUND Lipid-laden macrophage (LLM) index could be potentially useful in assessing gastroesophageal (GE) reflux and aspiration after lung transplantation (LT) in patients with cystic fibrosis (CF). METHODS A retrospective review of CF patients undergoing LT and/or laparoscopic Nissen fundoplication (LNF) from January 1, 2009, to December 31, 2011, was performed. RESULTS Seventeen CF patients (nine women), mean (± SD) age 27.9 ± 7.5 yr, underwent LT with mean (± SD) pre-transplant FEV(1) of 20.9 ± 5.0% predicted. Seventy percentage (12/17) of patients underwent LNF without complications within 1-2 wk of LT. After LT, but prior to antireflux surgery, there was no significant difference in the mean (± SD) baseline LLM index (154 ± 41 vs. 146 ± 51, p = NS) between patients who were to undergo LNF and patients who did not. After LNF, a significant reduction in the mean (± SD) LLM index occurred following the procedure (154 ± 41-74 ± 54, p < 0.0001) while each patient reported resolution of symptoms of GE reflux, whereas 40% (2/5) undergoing only medical treatment reported resolution of symptoms. CONCLUSIONS Significant reduction in the LLM index occurred after LNF in CF patients after LT that correlated with resolution of clinical symptoms of GE reflux.
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Affiliation(s)
- Don Hayes
- College of Medicine, The Ohio State University, Columbus, OH 43205, USA.
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Kopp BT, Wang W, Chisolm DJ, Kelleher KJ, McCoy KS. Inpatient healthcare trends among adult cystic fibrosis patients in the U.S. Pediatr Pulmonol 2012; 47:245-51. [PMID: 21901854 PMCID: PMC3805019 DOI: 10.1002/ppul.21535] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2011] [Accepted: 07/15/2011] [Indexed: 11/10/2022]
Abstract
BACKGROUND Adult cystic fibrosis (CF) patients are an expanding cohort that is taken care of in a variety of hospital settings including adult centers located within pediatric institutions. This study compared costs and discharge rates among adult CF patient hospitalizations in terms of location of hospitalization. METHODS The 2007 Nationwide Inpatient Sample was utilized to identify adult CF patient admission data on patients aged 18-44. Data were separated into pediatric and adult facilities based on percentage discharge rate for patients >18. Primary outcomes measures were length of stay (LOS) and total hospital charges. Secondary predictors were geographic, primary payer, and co-morbidity effects on LOS and total hospital charges. RESULTS LOS was higher for adult CF patient admissions in pediatric facilities compared to adult facilities by a mean of 2.5 days. Mean total hospital charges were not significantly different. Adult hospitals in the Western U.S. had a mean total charge more than $50,000 greater than any region in the U.S. Self-pay patients had significantly fewer hospital days and charges across all hospital types. Adult facilities had 7% more CF patients discharged home with home healthcare use. Depressed CF patients had longer LOS by 1.5 days regardless of facility type. CONCLUSIONS LOS for adult CF inpatient admissions was significantly lower in adult facilities compared to pediatric facilities without a significant difference in hospital charges and is influenced by geographic hospital location. Depressed patients had longer lengths of stay regardless of facility type. Self-insured adult CF patients have a significant reduction in LOS and hospital charges when compared to all other payers regardless of hospital type.
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Affiliation(s)
- Benjamin T Kopp
- Section of Pulmonary Medicine, Nationwide Children's Hospital, Columbus, Ohio 43205, USA.
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Chisolm DJ, Hardin DS, McCoy KS, Johnson LD, McAlearney AS, Gardner W. Health literacy and willingness to use online health information by teens with asthma and diabetes. Telemed J E Health 2011; 17:676-82. [PMID: 21943161 DOI: 10.1089/tmj.2011.0037] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE This study measured health literacy in a population of teens in treatment for asthma or diabetes and tested the association between health literacy and willingness to use online health resources. MATERIALS AND METHODS About 180 patients aged 13-18 years treated for asthma or diabetes in specialty care clinics completed assessments of demographic characteristics, health literacy, and Internet access and use. Teens were provided a resource page listing selected publically available health-related Web sites and asked about perceived ease of use, perceived usefulness, and intent to use the listed Web sites. The relationship between demographic characteristics, health literacy, and online health information use was tested using chi-squared or Fisher's exact test. Predictors of intent to use resource page Web sites were assessed using bivariate and multivariate ordinal logistic regression. RESULTS About 92% of participants had adequate health literacy. Over 50% of participants had previously searched online for health information. Older age was the only significant predictor of health information search. Most teens (79%) reported intent to use at least one Web site from the resource page at least occasionally within the next 3 months. Higher health literacy (odds ratio [OR]=6.24, p<0.01) and stronger perceived usefulness (OR=1.74, p=0.01) were associated with greater intent for regular use, after controlling for demographic and Internet access variables. CONCLUSIONS Teens with lower health literacy searched online for health information as often as peers with higher literacy, but were less likely to express the intent to use recommended sites. Belief in the usefulness of a Web site is the strongest attitudinal predictor of intended future use.
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Affiliation(s)
- Deena J Chisolm
- The Research Institute at Nationwide Children's Hospital, Columbus, Ohio 43205, USA.
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Clancy JP, Rowe SM, Accurso FJ, Aitken ML, Amin RS, Ashlock MA, Ballmann M, Boyle MP, Bronsveld I, Campbell PW, De Boeck K, Donaldson SH, Dorkin HL, Dunitz JM, Durie PR, Jain M, Leonard A, McCoy KS, Moss RB, Pilewski JM, Rosenbluth DB, Rubenstein RC, Schechter MS, Botfield M, Ordoñez CL, Spencer-Green GT, Vernillet L, Wisseh S, Yen K, Konstan MW. Results of a phase IIa study of VX-809, an investigational CFTR corrector compound, in subjects with cystic fibrosis homozygous for the F508del-CFTR mutation. Thorax 2011; 67:12-8. [PMID: 21825083 DOI: 10.1136/thoraxjnl-2011-200393] [Citation(s) in RCA: 416] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND VX-809, a cystic fibrosis transmembrane conductance regulator (CFTR) modulator, has been shown to increase the cell surface density of functional F508del-CFTR in vitro. METHODS A randomised, double-blind, placebo-controlled study evaluated the safety, tolerability and pharmacodynamics of VX-809 in adult patients with cystic fibrosis (n=89) who were homozygous for the F508del-CFTR mutation. Subjects were randomised to one of four VX-809 28 day dose groups (25, 50, 100 and 200 mg) or matching placebo. RESULTS The type and incidence of adverse events were similar among VX-809- and placebo-treated subjects. Respiratory events were the most commonly reported and led to discontinuation by one subject in each active treatment arm. Pharmacokinetic data supported a once-daily oral dosing regimen. Pharmacodynamic data suggested that VX-809 improved CFTR function in at least one organ (sweat gland). VX-809 reduced elevated sweat chloride values in a dose-dependent manner (p=0.0013) that was statistically significant in the 100 and 200 mg dose groups. There was no statistically significant improvement in CFTR function in the nasal epithelium as measured by nasal potential difference, nor were there statistically significant changes in lung function or patient-reported outcomes. No maturation of immature F508del-CFTR was detected in the subgroup that provided rectal biopsy specimens. CONCLUSIONS In this study, VX-809 had a similar adverse event profile to placebo for 28 days in F508del-CFTR homozygous patients, and demonstrated biological activity with positive impact on CFTR function in the sweat gland. Additional data are needed to determine how improvements detected in CFTR function secondary to VX-809 in the sweat gland relate to those measurable in the respiratory tract and to long-term measures of clinical benefit. CLINICAL TRIAL NUMBER NCT00865904.
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Affiliation(s)
- J P Clancy
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229, USA.
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Oermann CM, Retsch-Bogart GZ, Quittner AL, Gibson RL, McCoy KS, Montgomery AB, Cooper PJ. An 18-month study of the safety and efficacy of repeated courses of inhaled aztreonam lysine in cystic fibrosis. Pediatr Pulmonol 2010; 45:1121-34. [PMID: 20672296 PMCID: PMC3867945 DOI: 10.1002/ppul.21301] [Citation(s) in RCA: 153] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Chronic airway infection with Pseudomonas aeruginosa (PA) causes morbidity and mortality in patients with cystic fibrosis (CF). Additional anti-PA therapies are needed to improve health status and health-related quality of life. AIR-CF3 was an international 18-month, open-label study to evaluate the safety and efficacy of repeated courses of aztreonam for inhalation solution (AZLI, now marketed as Cayston®) in patients aged ≥ 6 years with CF and PA infection who previously participated in one of two Phase 3 studies: AIR-CF1 or AIR-CF2. Patients received up to nine courses (28 days on/28 days off) of 75 mg AZLI two (BID) or three times daily (TID) based on randomization in the previous trials. 274 patients, mean age 28.5 years (range: 8-74 years), participated. Mean treatment adherence was high (92.0% BID group, 88.0% TID group). Hospitalization rates were low and adverse events were consistent with CF. With each course of AZLI, FEV(1) and scores on the Cystic Fibrosis Questionnaire-Revised Respiratory Symptom scale improved and bacterial density in sputum was reduced. Benefits waned in the 28 days off therapy, but weight gain was sustained over the 18 months. There were no sustained decreases in PA susceptibility. A dose response was observed; AZLI TID-treated patients demonstrated greater improvements in lung function and respiratory symptoms over 18 months. Repeated intermittent 28-day courses of AZLI treatment were well tolerated. Clinical benefits in pulmonary function, health-related quality of life, and weight were observed with each course of therapy. AZLI is a safe and effective new therapy in patients with CF and PA airway infection.
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Retsch-Bogart GZ, Quittner AL, Gibson RL, Oermann CM, McCoy KS, Montgomery AB, Cooper PJ. Efficacy and safety of inhaled aztreonam lysine for airway pseudomonas in cystic fibrosis. Chest 2009; 135:1223-1232. [PMID: 19420195 DOI: 10.1378/chest.08-1421] [Citation(s) in RCA: 212] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND We assessed the short-term efficacy and safety of aztreonam lysine for inhalation (AZLI [an aerosolized monobactam antibiotic]) in patients with cystic fibrosis (CF) and Pseudomonas aeruginosa (PA) airway infection. METHODS In this randomized, double-blind, placebo-controlled, international study (AIR-CF1 trial; June 2005 to April 2007), patients (n = 164; >or= 6 years of age) with FEV(1) >or= 25% and <or= 75% predicted values, and no recent use of antipseudomonal antibiotics or azithromycin were treated with 75 mg of AZLI (three times daily for 28 days) or placebo (1:1 randomization), then were monitored for 14 days after study drug completion. The primary efficacy end point was change in patient-reported respiratory symptoms (CF-Questionnaire-Revised [CFQ-R] Respiratory Scale). Secondary end points included changes in pulmonary function (FEV(1)), sputum PA density, and nonrespiratory CFQ-R scales. Adverse events and minimum inhibitory concentrations of aztreonam for PA were monitored. RESULTS After 28 days of treatment, AZLI improved the mean CFQ-R respiratory score (9.7 points; p < 0.001), FEV(1) (10.3% predicted; p < 0.001), and sputum PA density (- 1.453 log(10) cfu/g; p < 0.001), compared with placebo. Significant improvements in Eating, Emotional Functioning, Health Perceptions, Physical Functioning, Role Limitation/School Performance, and Vitality CFQ-R scales were observed. Adverse events were consistent with symptoms of CF lung disease and were comparable for AZLI and placebo except the incidence of "productive cough" was reduced by half in AZLI-treated patients. PA aztreonam susceptibility at baseline and end of therapy were similar. CONCLUSIONS In patients with CF, PA airway infection, moderate-to-severe lung disease, and no recent use of antipseudomonal antibiotics or azithromycin, 28-day treatment with AZLI significantly improved respiratory symptoms and pulmonary function, and was well tolerated. TRIAL REGISTRATION Clinicaltrials.gov Identifier: NCT00112359.
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Affiliation(s)
| | | | - Ronald L Gibson
- Children's Hospital and Regional Medical Center, Seattle, WA
| | | | | | | | - Peter J Cooper
- The Children's Hospital at Westmead, Sydney, NSW, Australia
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