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Chipps BE, Zeiger RS, Beuther DA, Wise RA, McCann W, Reibman J, George M, Gilbert I, Eudicone JM, Coyne KS, Harding G, Murphy KR. Advancing assessment of asthma control with a composite tool: The Asthma Impairment and Risk Questionnaire. Ann Allergy Asthma Immunol 2024:S1081-1206(24)00153-4. [PMID: 38494113 DOI: 10.1016/j.anai.2024.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 02/20/2024] [Accepted: 03/13/2024] [Indexed: 03/19/2024]
Abstract
BACKGROUND National and international asthma guidelines and reports do not include control tools that combine impairment assessment with exacerbation history in one instrument. OBJECTIVE To analyze the performance of the composite Asthma Impairment and Risk Questionnaire (AIRQ) in assessing both domains of control and predicting exacerbation risk compared with the Global Initiative for Asthma (GINA) 4-question symptom control tool (GINA SCT), Asthma Control Test (ACT), and physician expert opinion (EO) informed by GINA SCT responses and appraisal of GINA-identified risk factors for poor asthma outcomes. METHODS Multivariable logistic regressions evaluated AIRQ and GINA SCT as predictors of ACT. McNemar's test compared the proportion of patients categorized at baseline as completely or well-controlled by each assessment but with current impairment or previous-year and subsequent-year exacerbations. RESULTS The analysis included 1064 patients aged 12 years or older; mean (SD) age 43.8 years (19.3); 70% female; 79% White; and 6% Hispanic or Latino. AIRQ and GINA SCT were highly predictive of ACT well-controlled vs not well-controlled and very poorly controlled (receiver operator characteristic area under curve AIRQ = 0.90, GINA SCT = 0.86, P = .03 AIRQ vs GINA SCT) and ACT very poorly controlled vs well-controlled and not well-controlled asthma (receiver operator characteristic area under curve AIRQ = 0.91, GINA SCT = 0.87, P = .01 AIRQ vs GINA SCT). AIRQ rated fewer patients as having completely or well-controlled asthma who had current impairment (P < .01) or with previous-year and subsequent-year exacerbations (P < .001) than did GINA SCT, ACT, and EO. CONCLUSION AIRQ performs better in assessing both domains of current control and predicting exacerbation risk than do control tools and EO informed by GINA SCT and risk factors for poor asthma outcomes.
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Affiliation(s)
- Bradley E Chipps
- Capital Allergy & Respiratory Disease Center, Sacramento, California.
| | - Robert S Zeiger
- Department of Clinical Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California
| | | | - Robert A Wise
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Joan Reibman
- New York University School of Medicine, New York, New York
| | - Maureen George
- Columbia University School of Nursing, New York, New York
| | - Ileen Gilbert
- BioPharmaceuticals Medical, AstraZeneca, Wilmington, Delaware
| | | | | | | | - Kevin R Murphy
- Boys Town National Research Hospital, Boys Town, Nebraska
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McCann W, Murphy KR, Zeiger RS, Beuther DA, Wise RA, Reibman J, George M, Gilbert I, Eudicone JM, Gandhi HN, Cutts K, Coyne KS, Chipps B. Assessing meaningful change in the Asthma Impairment and Risk Questionnaire. Ann Allergy Asthma Immunol 2024:S1081-1206(24)00085-1. [PMID: 38369256 DOI: 10.1016/j.anai.2024.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 02/08/2024] [Accepted: 02/08/2024] [Indexed: 02/20/2024]
Abstract
BACKGROUND The Asthma Impairment and Risk Questionnaire (AIRQ) is a 10-item, yes/no, equally weighted control tool. Lower scores indicate better control. Moreover, 7 impairment items reflect previous 2-week symptoms, and 3 risk items assess previous 12-month exacerbations. The Follow-up AIRQ for use between annual assessments has a 3-month recall period for exacerbation items. OBJECTIVE To evaluate the responsiveness of the AIRQ over time and identify a minimal important difference (MID). METHODS The AIRQ longitudinal study data were analyzed from patients with asthma aged 12 years and older. Anchor-based methods assessed differences in AIRQ scores relative to Patient Global Impression of Change, the accepted MIDs for St. George's Respiratory Questionnaire and Asthma Control Test, and exacerbation occurrence over 12 months. Baseline and 12-month data reflected 12-month recall AIRQ scores; Follow-up AIRQ scores were used for 3-, 6-, and 9-month analyses. RESULTS A total of 1070 patients were included. The Patient Global Impression of Change rating of "much improved" was associated with AIRQ mean score changes from baseline to months 3, 6, 9, and 12 of -2.0, -1.9, -1.9, and -1.8, respectively. The mean AIRQ score change among patients who met the St. George's Respiratory Questionnaire MID (≥4-point decrease) was -1.8 at 6 and 12 months. The AIRQ mean scores decreased from baseline by -2.2 to -2.5 points at months 3, 6, 9, and 12 for patients who met the Asthma Control Test MID (≥ 3-point increase). A 2-point higher baseline AIRQ score was associated with a 1.7 odds ratio of 12-month exacerbation occurrence (95% CI, 1.53-1.89). CONCLUSION A change score of 2 is recommended as the AIRQ MID.
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Affiliation(s)
| | - Kevin R Murphy
- Division of Allergy, Asthma and Immunology, Boys Town National Research Hospital, Boys Town, Nebraska
| | - Robert S Zeiger
- Departments of Allergy and Research and Evaluation, Kaiser Permanente Southern California, San Diego and Pasadena, California
| | - David A Beuther
- Division of Pulmonary, Critical Care and Sleep Medicine, National Jewish Health, Denver, Colorado
| | - Robert A Wise
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Joan Reibman
- Department of Medicine, New York University (NYU) Grossman School of Medicine, New York, New York
| | - Maureen George
- Department of Nursing, Columbia University School of Nursing, New York, New York
| | - Ileen Gilbert
- BioPharmaceuticals Medical, AstraZeneca, Wilmington, Delaware
| | | | - Hitesh N Gandhi
- BioPharmaceuticals Medical, AstraZeneca, Wilmington, Delaware
| | - Katelyn Cutts
- Patient-Centered Research, Evidera, Bethesda, Maryland
| | - Karin S Coyne
- Patient-Centered Research, Evidera, Bethesda, Maryland
| | - Bradley Chipps
- Capital Allergy and Respiratory Disease Center, Sacramento, California
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Weiss ST, Mirzakhani H, Carey VJ, O'Connor GT, Zeiger RS, Bacharier LB, Stokes J, Litonjua AA. Prenatal vitamin D supplementation to prevent childhood asthma: 15-year results from the Vitamin D Antenatal Asthma Reduction Trial (VDAART). J Allergy Clin Immunol 2024; 153:378-388. [PMID: 37852328 DOI: 10.1016/j.jaci.2023.10.003] [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: 07/24/2023] [Revised: 09/13/2023] [Accepted: 10/06/2023] [Indexed: 10/20/2023]
Abstract
This article provides an overview of the findings obtained from the Vitamin D Antenatal Asthma Reduction Trial (VDAART) spanning a period of 15 years. The review covers various aspects, including the trial's rationale, study design, and initial intent-to-treat analyses, as well as an explanation of why those analyses did not achieve statistical significance. Additionally, the article delves into the post hoc results obtained from stratified intent-to-treat analyses based on maternal vitamin D baseline levels and genotype-stratified analyses. These results demonstrate a statistically significant reduction in asthma among offspring aged 3 and 6 years when comparing vitamin D supplementation (4400 IU/d) to the standard prenatal multivitamin with vitamin D (400 IU/d). Furthermore, these post hoc analyses found that vitamin D supplementation led to a decrease in total serum IgE levels and improved lung function in children compared to those whose mothers received a placebo alongside the standard prenatal multivitamin with vitamin D. Last, the article concludes with recommendations regarding the optimal dosing of vitamin D for pregnant women to prevent childhood asthma as well as suggestions for future trials in this field.
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Affiliation(s)
- Scott T Weiss
- Department of Medicine, Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass.
| | - Hooman Mirzakhani
- Department of Medicine, Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Vincent J Carey
- Department of Medicine, Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - George T O'Connor
- Department of Medicine, Pulmonary Centre, Boston Medical Centre, Boston University, Boston, Mass
| | - Robert S Zeiger
- Department of Clinical Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, Calif
| | - Leonard B Bacharier
- Department of Pediatrics, Division of Pediatric Allergy, Immunology and Pulmonary Medicine, Monroe Carell Jr Children's Hospital at Vanderbilt, Nashville, Tenn
| | - Jeffrey Stokes
- Department of Pediatrics, Division of Pediatric Allergy, Immunology and Pulmonary Medicine, Washington University, St Louis, Mo
| | - Augusto A Litonjua
- Department of Pediatrics Golisano Children's Hospital, Pediatric Pulmonary Division, University of Rochester Medical School, Rochester, NY
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Knihtilä HM, Stubbs BJ, Carey VJ, Laranjo N, Zeiger RS, Bacharier LB, O'Connor GT, Weiss ST, Litonjua AA. Preschool Impulse Oscillometry Predicts Active Asthma and Impaired Lung Function at School Age. J Allergy Clin Immunol 2024:S0091-6749(24)00034-4. [PMID: 38244724 DOI: 10.1016/j.jaci.2023.12.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 11/16/2023] [Accepted: 12/29/2023] [Indexed: 01/22/2024]
Abstract
BACKGROUND Asthmatic symptoms often start during early childhood. Impulse oscillometry (IOS) is feasible in preschool children who may be unable to reliably perform spirometry measurements. OBJECTIVE We evaluated the utility of IOS in a multicenter multiethnic high-risk asthma cohort entitled the Vitamin D Antenatal Asthma Reduction Trial (VDAART). METHODS The VDAART recruited pregnant women whose children were followed from birth to age 8 years. Lung function was assessed with IOS at ages 4, 5, and 6 years and spirometry at ages 5, 6, 7, and 8 years. Asthma status, respiratory symptoms, and medication use were assessed with repeated questionnaires from birth to age 8 years. RESULTS In total 220 children were included in this secondary analysis. Recent respiratory symptoms and short-acting β2-agonist (SABA) use were associated with increased respiratory resistance at 5 Hz (R5) at age 4 years (β 2.6; 95% CI 1.0, 4.4; P=0.002 and β 3.4; 95% CI 0.7, 6.2; P=0.015, respectively). Increased R5 at age 4 years was also associated with decreased lung function from ages 5 to 8 years (β -0.3; 95% CI -0.5, -0.1; P<0.001 for FEV1 at 8 years) and active asthma at age 8 years (β 2.0; 95% CI 0.2, 3.8; P=0.029). CONCLUSION Increased respiratory resistance in preschool IOS is associated with frequent respiratory symptoms as well as school-age asthma and lung function impairment. Our findings suggest that IOS may serve as a potential objective measure for early identification of children who are at high risk of respiratory morbidity.
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Affiliation(s)
- Hanna M Knihtilä
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School; Department of Pediatrics, Stanford University School of Medicine.
| | - Benjamin J Stubbs
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School
| | - Vincent J Carey
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School
| | - Nancy Laranjo
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School
| | - Robert S Zeiger
- Department of Clinical Science, Kaiser Permanente Bernard J Tyson School of Medicine
| | | | - George T O'Connor
- The Pulmonary Center, Department of Medicine, Boston University School of Medicine
| | - Scott T Weiss
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School
| | - Augusto A Litonjua
- Division of Pediatric Pulmonary Medicine, Golisano Children's Hospital, University of Rochester Medical Center
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Shadid IL, Lee-Sarwar K, Lu Z, Yadama A, Laranjo N, Carey V, O’Connor GT, Zeiger RS, Bacharier L, Guchelaar HJ, Liu YY, Litonjua AA, Weiss ST, Mirzakhani H. Early life gut microbiome in children following spontaneous preterm birth and maternal preeclampsia. iScience 2023; 26:108311. [PMID: 38025771 PMCID: PMC10679898 DOI: 10.1016/j.isci.2023.108311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 08/25/2023] [Accepted: 10/20/2023] [Indexed: 12/01/2023] Open
Abstract
The early life microbiome plays an important role in developmental and long-term health outcomes. However, it is unknown whether adverse pregnancy complications affect the offspring's gut microbiome postnatally and in early years. In a longitudinal cohort with a five-year follow-up of mother-child pairs affected by preeclampsia (PE) or spontaneous preterm birth (sPTB), we evaluated offspring gut alpha and beta diversity as well as taxa abundances considering factors like breastfeeding and mode of delivery. Our study highlights a trend where microbiome diversity exhibits comparable development across adverse and normal pregnancies. However, specific taxa at genus level emerge with distinctive abundances, showing enrichment and/or depletion over time in relation to PE or sPTB. These findings underscore the potential for certain adverse pregnancy complications to induce alterations in the offspring's microbiome over the course of early life. The implications of these findings on the immediate and long-term health of offspring should be investigated in future studies.
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Affiliation(s)
- Iskander L.C. Shadid
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
- Department of Clinical Pharmacy & Toxicology, Leiden University Medical Center, Leiden, the Netherlands
| | - Kathleen Lee-Sarwar
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Zheng Lu
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Arya Yadama
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
- System Dynamics at MIT Sloan School of Management, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Nancy Laranjo
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Vincent Carey
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - George T. O’Connor
- Pulmonary Center and Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Robert S. Zeiger
- Department of Clinical Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, USA
| | - Leonard Bacharier
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Henk-Jan Guchelaar
- Department of Clinical Pharmacy & Toxicology, Leiden University Medical Center, Leiden, the Netherlands
| | - Yang-Yu Liu
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
- Center for Artificial Intelligence and Modeling, The Carl R. Woese Institute for Genomic Biology, University of Illinois at Urbana-Champaign, Champaign, IL, USA
| | - Augusto A. Litonjua
- Division of Pediatric Pulmonary Medicine, Golisano Children’s Hospital at University of Rochester Medical Center, Rochester, NY, USA
| | - Scott T. Weiss
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Hooman Mirzakhani
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
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Wise RA, Chipps B, Murphy KR, Beuther DA, Reibman J, McCann W, Gilbert I, Eudicone JM, Gandhi HN, Harding G, Cutts K, George M, Zeiger RS. Confirmatory cross-sectional validation of the Asthma Impairment and Risk Questionnaire. J Allergy Clin Immunol Pract 2023; 11:3531-3533.e1. [PMID: 37474101 DOI: 10.1016/j.jaip.2023.07.018] [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] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 07/10/2023] [Accepted: 07/13/2023] [Indexed: 07/22/2023]
Affiliation(s)
- Robert A Wise
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Md.
| | - Bradley Chipps
- Capital Allergy and Respiratory Disease Center, Sacramento, Calif
| | | | | | - Joan Reibman
- New York University School of Medicine, New York, NY
| | | | | | | | | | | | | | | | - Robert S Zeiger
- Department of Allergy, Kaiser Permanente Southern California, San Diego, Calif; Department of Research and Evaluation, Kaiser Permanente Southern California, San Diego, Calif; Department of Clinical Science, Bernard J. Tyson School of Medicine, Pasadena, Calif
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Fiocchi AG, Phipatanakul W, Zeiger RS, Durrani SR, Cole J, Msihid J, Gall R, Jacob-Nara JA, Deniz Y, Rowe PJ, Lederer DJ, Hardin M, Zhang Y, Khan AH. Dupilumab leads to better-controlled asthma and quality of life in children: the VOYAGE study. Eur Respir J 2023; 62:2300558. [PMID: 37734856 PMCID: PMC10620476 DOI: 10.1183/13993003.00558-2023] [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: 03/31/2023] [Accepted: 09/13/2023] [Indexed: 09/23/2023]
Abstract
BACKGROUND Dupilumab has shown long-term treatment benefits in children with uncontrolled asthma. We assessed in more detail the impact of dupilumab on asthma control and health-related quality of life (HRQoL) in children and their caregivers. METHODS Children aged 6-11 years with uncontrolled moderate-to-severe type 2 asthma (baseline blood eosinophils ≥150 cells·µL-1 or fractional exhaled nitric oxide ≥20 ppb; n=350) were treated with dupilumab or placebo for 52 weeks in the VOYAGE study. Primary outcomes of these analyses were asthma control (change from baseline in Asthma Control Questionnaire 7 Interviewer-Administered (ACQ-7-IA) and achieving a clinically meaningful response of ≥0.5 points); proportion of patients achieving well-controlled asthma or better (ACQ-7-IA ≤0.75 points); effect on patients' (Standardised Paediatric Asthma Quality of Life Questionnaire Interviewer-Administered (PAQLQ(S)-IA)) and caregivers' (Paediatric Asthma Caregiver's Quality of Life Questionnaire (PACQLQ)) HRQoL; and allergic rhinitis-related QoL. RESULTS Dupilumab versus placebo significantly improved children's ACQ-7-IA scores by week 4 with sustained improvements through week 52 (least squares mean difference at week 52: -0.44, 95% CI -0.59- -0.30; p<0.0001); a higher proportion achieved a clinically meaningful response (week 52: 86% versus 75%; p=0.0051). At weeks 24 and 52, more children who received dupilumab achieved well-controlled asthma (ACQ-7-IA ≤0.75 points: 61% versus 43%; p=0.0001 and 70% versus 46%; p<0.0001, respectively). Significant improvements in PAQLQ(S)-IA and PACQLQ scores were observed by week 52. CONCLUSIONS In children aged 6-11 years with moderate-to-severe type 2 asthma, dupilumab treatment was associated with rapid, sustained improvements in asthma control. HRQoL was significantly improved for children and their caregivers.
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Affiliation(s)
- Alessandro G Fiocchi
- Translational Research in Paediatric Specialities Area, Division of Allergy, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Wanda Phipatanakul
- Department of Allergy and Immunology, Boston Children's Hospital and Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Robert S Zeiger
- Department of Clinical Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, USA
| | | | | | | | - Rebecca Gall
- Regeneron Pharmaceuticals Inc., Tarrytown, NY, USA
| | | | - Yamo Deniz
- Regeneron Pharmaceuticals Inc., Tarrytown, NY, USA
| | | | | | | | - Yi Zhang
- Regeneron Pharmaceuticals Inc., Tarrytown, NY, USA
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Chipps B, Zeiger RS, Beuther DA, Reibman J, Wise RA, McCann W, Gilbert I, Eudicone JM, Gandhi HN, Harding G, Cutts K, George M, Murphy KR. The Asthma Impairment and Risk Questionnaire enhances the assessment of asthma control. Ann Allergy Asthma Immunol 2023; 131:436-443.e1. [PMID: 37105501 DOI: 10.1016/j.anai.2023.04.024] [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: 11/03/2022] [Revised: 03/29/2023] [Accepted: 04/13/2023] [Indexed: 04/29/2023]
Abstract
BACKGROUND Asthma control is often overestimated in routine practice, and despite advances in the understanding of immunopathology and the availability of new precision therapies, the burden of disease remains unacceptably high. OBJECTIVE To compare the performance of the Asthma Impairment and Risk Questionnaire (AIRQ) with patient and physician assessments and the Asthma Control Test (ACT) in identifying asthma control. METHODS Baseline data from a longitudinal study of the AIRQ were analyzed. Patients with asthma in the United States aged 12 years and older followed in 24 specialty practices and 1 specialty-affiliated primary care clinic were enrolled between May and November 2019. At entry, participants completed AIRQ and ACT, and participants and physicians completed 5-point Likert scale assessments of control. RESULTS A total of 1112 participants were enrolled (mean [SD] age = 43.9 [19.3] years, 70% of the female sex, 78% White). Overall, 62% of participants rated themselves as well- or completely controlled, and 54% were rated comparably by physicians. The ACT classified 49% of participants as well-controlled, with 35% similarly categorized by AIRQ. Previous-year exacerbations were experienced by 32% of participants who self-rated as well- or completely controlled, 30% who were rated as well- or completely controlled by physicians, and 29% assessed as well-controlled by ACT, but only 15% of those classified as well-controlled by AIRQ. CONCLUSION The burden of asthma is substantial in patients cared for by asthma specialists, and asthma control is overestimated by patients, physicians, and the symptom-based ACT. The AIRQ assesses risk in addition to symptom control and may serve to improve asthma control determination by assessing previous exacerbations.
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Affiliation(s)
- Bradley Chipps
- Capital Allergy and Respiratory Disease Center, Sacramento, California.
| | - Robert S Zeiger
- Department of Clinical Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California
| | - David A Beuther
- Division of Pulmonary, Critical Care and Sleep Medicine, National Jewish Health, Denver, Colorado
| | - Joan Reibman
- Department of Medicine, New York University (NYU) Grossman School of Medicine, New York, New York
| | - Robert A Wise
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Ileen Gilbert
- BioPharmaceuticals Medical, AstraZeneca, Wilmington, Delaware
| | | | - Hitesh N Gandhi
- BioPharmaceuticals Medical, AstraZeneca, Wilmington, Delaware
| | - Gale Harding
- Patient-Centered Research, Evidera, Bethesda, Maryland
| | - Katelyn Cutts
- Patient-Centered Research, Evidera, Bethesda, Maryland
| | - Maureen George
- Department of Nursing, Columbia University School of Nursing, New York, New York
| | - Kevin R Murphy
- Division of Allergy, Asthma and Immunology, Boys Town National Research Hospital, Boys Town, Nebraska
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Jha A, Baumann N, Shadid I, Shah J, Chen YCS, Lee-Sarwar KA, Zeiger RS, O'Connor GT, Bacharier LB, Carey VJ, Laranjo N, Fichorova RN, Litonjua AA, Weiss ST, Mirzakhani H. The relationship of fetal sex and maternal race and ethnicity with early and late pregnancy C-reactive protein and interleukin-8. Am J Reprod Immunol 2023; 90:e13746. [PMID: 37491932 DOI: 10.1111/aji.13746] [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: 09/05/2022] [Revised: 03/11/2023] [Accepted: 06/22/2023] [Indexed: 07/27/2023] Open
Abstract
PROBLEM Promotion of a healthy pregnancy is dependent on a coordinated immune response that minimizes inflammation at the maternal-fetal interface. Few studies investigated the effect of fetal sex on proinflammatory biomarkers during pregnancy and whether maternal race could impact this association. We aimed to examine whether fetal sex could, independently of maternal race/ethnicity and the condition of pregnancy (normal vs. complicated), impact inflammatory markers (C-reactive protein [CRP] and interleukin-8 [IL-8] levels) in early and late pregnancy. METHODS OF STUDY This study was a cohort analysis using prospectively collected data from pregnant women who participated in the Vitamin Antenatal Asthma Reduction Trial (VDAART, N = 816). Maternal serum CRP and IL-8 levels were measured in early and late pregnancy (10-18 and 32-38 weeks of gestation, respectively). Five hundred and twenty-eight out of 816 pregnant women who participated in the trial had available CRP and IL-8 measurements at both study time points. We examined the association of fetal sex with early and late CRP and IL-8 levels and their paired sample difference. We further investigated whether maternal race/ethnicity, pregnancy complications (i.e., preeclampsia and gestational diabetes), and early pregnancy body mass index (BMI) could affect the association between these two biomarkers and fetal sex adjusting for potential confounders. For this purpose, we used generalized linear and logistic regression models on log-normalized early and late CRP and IL-8 levels as well as their split at median to form high and low groups. RESULTS Women pregnant with male fetuses (266/528 = 56.5%) had higher CRP levels in early to mid-pregnancy (β = .18: 95% confidence interval [CI]: CI = 0.03-0.32; p = .02). Twenty-seven percent (143/528) of the study subjects were Hispanic. Hispanic African American [AA] women and women of races other than White and AA had higher levels of CRP at early to mid-pregnancy compared with White women (β = .57; 95% CI: 0.17-0.97; p < .01 and β = .27; 95% CI: 0.05-0.48; p = .02, respectively). IL-8 levels were not associated with fetal sex in early and late pregnancy (p's > .05). Other factors such as gestational diabetes and early pregnancy BMI were associated with higher CRP levels and higher CRP and IL-8 levels, respectively. Dichotomizing log-normalized cytokine levels at the median in a sensitivity analysis, women with male fetuses had lower odds of high (above-median) IL-8 levels at early pregnancy. Also, women with races other than AA and White carrying male fetuses had higher odds of having high (above-median) late-pregnancy CRP and early-pregnancy IL-8 levels (adjusted odds ratio [aOR] = 3.80, 95% CI: 0.24-1.23; p = .02 and aOR = 3.57; 95% CI: 0.23-1.03; p = .02, respectively). Of the pregnancy complications, women with gestational diabetes mellitus had a higher paired difference of early and late pregnancy CRP levels (β = .38; 95% CI: 0.09-0.68; p = .01), but no difference in IL-8 levels (p's > .05). No associations between the inflammatory markers and preeclampsia were found. CONCLUSION Fetal sex is associated with CRP in early pregnancy and an association with IL-8 in early pregnancy is implied. Our study further indicates that maternal race/ethnicity could be a contributing factor in the relationship between fetal sex and inflammatory responses during pregnancy. However, the specificity and level of the contribution might vary by type of cytokine, pregnancy stage, and other confounding factors such as BMI that may impact these associations.
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Affiliation(s)
- Anjali Jha
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Noah Baumann
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Iskander Shadid
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
- Department of Clinical Pharmacy and Toxicology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jhill Shah
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
- Division of Pediatric Pulmonary Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Yih-Chieh S Chen
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
- Division of Allergy and Clinical Immunology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Kathleen A Lee-Sarwar
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
- Division of Allergy and Clinical Immunology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Robert S Zeiger
- Department of Clinical Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California, USA
| | - George T O'Connor
- Pulmonary Center and Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Leonard B Bacharier
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Vincent J Carey
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Nancy Laranjo
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Raina N Fichorova
- Laboratory of Genital Tract Biology, Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Augusto A Litonjua
- Division of Pediatric Pulmonary Medicine, Golisano Children's Hospital at Strong, University of Rochester Medical Center, Rochester, New York, USA
| | - Scott T Weiss
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Hooman Mirzakhani
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
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10
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Shah J, Shadid ILC, Carey VJ, Laranjo N, O'Connor GT, Zeiger RS, Bacharier L, Litonjua AA, Weiss ST, Mirzakhani H. Early-Life Weight Status and Risk of Childhood Asthma or Recurrent Wheeze in Preterm and Term Offspring. J Allergy Clin Immunol Pract 2023; 11:2125-2132.e1. [PMID: 37088369 PMCID: PMC10330365 DOI: 10.1016/j.jaip.2023.03.059] [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] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 03/16/2023] [Accepted: 03/28/2023] [Indexed: 04/25/2023]
Abstract
BACKGROUND Excessive weight is associated with the development of childhood asthma. However, trends among preterm and term offspring may differ. OBJECTIVE To assess whether the association of longitudinal weight for age (WFA) and odds of asthma/recurrent wheeze in early life differs between children born preterm and those born at term. METHODS This study used prospectively collected data from the Vitamin D Antenatal Asthma Reduction Trial. Children (n = 804) were followed-up and anthropometric measurements, including WFA, were taken at birth and annually until the age of 6 years. The primary outcome was asthma/recurrent wheeze by age 3 and 6 years. RESULTS Among the offspring, 71 (8.8%) were premature. In all the children, the odds of asthma/recurrent wheeze increased by 15% (adjusted odds ratio [aOR], 1.15; 95% CI, 1.10-1.20; P < .001) by age 3 years and 9% (aOR, 1.09; 95% CI, 1.07-1.11; P < .001) by age 6 years for each unit increase in WFA z score. Odds were different between term and preterm offspring (Pinteraction < .001). In term offspring, the odds of having asthma/recurrent wheeze by age 3 and 6 years increased by 22% and 15%, respectively (aOR, 1.22, 95% CI, 1.16-1.27, P < .001, and aOR, 1.15, 95% CI, 1.11-1.18, P < .001). In preterm offspring, by age 3 years, odds of asthma/recurrent wheeze decreased by 10% for each unit increase in WFA z score (aOR, 0.90; 95% CI, 0.81-0.99; P = .030) and decreased by 27% by age 6 years (aOR, .73; 95% CI, 0.61-0.86; P < .001). CONCLUSIONS During early life, increasing standardized WFA is associated with higher odds of asthma/recurrent wheeze in term children. In contrast, in preterm children, a higher standardized WFA during catch-up growth may decrease the odds of asthma/recurrent wheeze associated with prematurity.
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Affiliation(s)
- Jhill Shah
- Division of Paediatric Pulmonary Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Mass; Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Iskander L C Shadid
- Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass; Department of Clinical Pharmacy & Toxicology, Leiden University Medical Center, Leiden, The Netherlands
| | - Vincent J Carey
- Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Nancy Laranjo
- Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - George T O'Connor
- Pulmonary Centre, Department of Medicine, Boston Medical Centre, Boston University, Boston, Mass
| | - Robert S Zeiger
- Department of Clinical Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, Calif
| | - Leonard Bacharier
- Division of Paediatric Allergy, Immunology and Pulmonary Medicine, Department of Paediatrics, Washington University, St Louis, Mo
| | - Augusto A Litonjua
- Division of Paediatric Pulmonary Medicine, Golisano Children's Hospital at University of Rochester Medical Centre, Rochester, NY
| | - Scott T Weiss
- Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Hooman Mirzakhani
- Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass.
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11
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Shadid IL, Brustad N, Lu M, Chawes BL, Bisgaard H, Zeiger RS, O'Connor GT, Bacharier LB, Guchelaar HJ, Litonjua AA, Weiss ST, Mirzakhani H. The Impact of Baseline 25-Hydroxyvitamin D Level and Gestational Age on Prenatal Vitamin D Supplementation to Prevent Offspring Asthma or Recurrent Wheezing. Am J Clin Nutr 2023; 117:1342-1352. [PMID: 37075847 PMCID: PMC10447477 DOI: 10.1016/j.ajcnut.2023.04.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 02/28/2023] [Accepted: 04/14/2023] [Indexed: 04/21/2023] Open
Abstract
BACKGROUND Prenatal vitamin D deficiency is associated with asthma or recurrent wheezing in offspring. However, evidence from randomized trials on the efficacy of vitamin D supplementation is inconclusive. OBJECTIVES We aimed to examine the differential efficacy of prenatal vitamin D supplementation based on the maternal baseline vitamin D status and the starting time of supplementation to prevent early life asthma or recurrent wheezing. METHODS We conducted a secondary analysis of the Vitamin D Antenatal Asthma Reduction Trial (VDAART), a randomized double-blind trial of prenatal vitamin D supplementation initiated at 10-18 weeks (wks) of gestation (4400 IU of intervention/day compared with 400 IU of placebo/day) to prevent offspring asthma or recurrent wheezing by the age of 6 years. We assessed the effect of modification of supplementation by maternal baseline vitamin D status at enrollment and the timing of initiation of supplementation. RESULTS An inverse relationship was observed between maternal 25-hydroxyvitamin D (25(OH)D) levels at trial entry and 25(OH)D levels during late pregnancy (32-38 wks of gestation) in both supplementation arms (P < 0.001). Overall, supplementation efficacy was not dependent on the maternal baseline 25(OH)D status. However, a trend toward the reduction of asthma or recurrent wheezing was observed across the baseline groups in the intervention arm (P = 0.01), with the greatest reduction observed in the most severely vitamin D-deficient women (25(OH)D < 12 ng/mL; adjusted odds ratio [aOR] = 0.48; confidence interval [CI]: 0.17, 1.34). Gestational age at trial enrollment modified supplementation efficacy, showing a greater reduction of offspring asthma or recurrent wheezing with earlier intervention during pregnancy (aOR = 0.85; CI = 0.76, 0.95), particularly in women who were 9-12 wk pregnant (aOR = 0.45; CI = 0.24, 0.82). CONCLUSIONS Pregnant women with severe vitamin D deficiency show the greatest 25(OH)D improvement because of supplementation. In these women, a vitamin D dose of 4400 IU might have a preventive role in the development of early life offspring asthma or recurrent wheezing. Gestational age is suggested to modify the efficacy of prenatal vitamin D supplementation, showing the highest beneficial effect if supplementation is started during the first trimester of pregnancy. This study is an ancillary analysis from the VDAART, which is registered in ClinicalTrials.gov as NCT00902621.
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Affiliation(s)
- Iskander Lc Shadid
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States; Department of Clinical Pharmacy and Toxicology, Leiden University Medical Center, Leiden, The Netherlands
| | - Nicklas Brustad
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Mengdi Lu
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States
| | - Bo L Chawes
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Hans Bisgaard
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Robert S Zeiger
- Department of Clinical Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, United States
| | - George T O'Connor
- Pulmonary Center and Department of Medicine, Boston University School of Medicine, Boston, MA, United States
| | - Leonard B Bacharier
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Henk-Jan Guchelaar
- Department of Clinical Pharmacy and Toxicology, Leiden University Medical Center, Leiden, The Netherlands
| | - Augusto A Litonjua
- Division of Pediatric Pulmonary Medicine, Golisano Children's Hospital at University of Rochester Medical Center, Rochester, NY, United States
| | - Scott T Weiss
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States
| | - Hooman Mirzakhani
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States.
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12
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Lee-Sarwar KA, Fischer-Rasmussen K, Bønnelykke K, Bisgaard H, Chawes B, Kelly RS, Lasky-Su J, Zeiger RS, O’Connor GT, Bacharier LB, Carey VJ, Laranjo N, Litonjua AA, Weiss ST. Omega-3 Fatty Acids Interact with DPP10 Region Genotype in Association with Childhood Atopy. Nutrients 2023; 15:2416. [PMID: 37242299 PMCID: PMC10223962 DOI: 10.3390/nu15102416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 04/27/2023] [Accepted: 05/02/2023] [Indexed: 05/28/2023] Open
Abstract
Associations of omega-3 fatty acids (n-3) with allergic diseases are inconsistent, perhaps in part due to genetic variation. We sought to identify and validate genetic variants that modify associations of n-3 with childhood asthma or atopy in participants in the Vitamin D Antenatal Asthma Reduction Trial (VDAART) and the Copenhagen Prospective Studies on Asthma in Childhood 2010 (COPSAC). Dietary n-3 was derived from food frequency questionnaires and plasma n-3 was measured via untargeted mass spectrometry in early childhood and children aged 6 years old. Interactions of genotype with n-3 in association with asthma or atopy at age 6 years were sought for six candidate genes/gene regions and genome-wide. Two SNPs in the region of DPP10 (rs958457 and rs1516311) interacted with plasma n-3 at age 3 years in VDAART (p = 0.007 and 0.003, respectively) and with plasma n-3 at age 18 months in COPSAC (p = 0.01 and 0.02, respectively) in associationwith atopy. Another DPP10 region SNP, rs1367180, interacted with dietary n-3 at age 6 years in VDAART (p = 0.009) and with plasma n-3 at age 6 years in COPSAC (p = 0.004) in association with atopy. No replicated interactions were identified for asthma. The effect of n-3 on reducing childhood allergic disease may differ by individual factors, including genetic variation in the DPP10 region.
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Affiliation(s)
- Kathleen A. Lee-Sarwar
- Channing Division of Network Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA 02115, USA
- Division of Allergy and Clinical Immunology, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA 02115, USA
| | - Kasper Fischer-Rasmussen
- Copenhagen Prospective Studies on Asthma in Childhood (COPSAC), Herlev and Gentofte Hospital, University of Copenhagen, 2820 Gentofte, Denmark
| | - Klaus Bønnelykke
- Copenhagen Prospective Studies on Asthma in Childhood (COPSAC), Herlev and Gentofte Hospital, University of Copenhagen, 2820 Gentofte, Denmark
| | - Hans Bisgaard
- Copenhagen Prospective Studies on Asthma in Childhood (COPSAC), Herlev and Gentofte Hospital, University of Copenhagen, 2820 Gentofte, Denmark
| | - Bo Chawes
- Copenhagen Prospective Studies on Asthma in Childhood (COPSAC), Herlev and Gentofte Hospital, University of Copenhagen, 2820 Gentofte, Denmark
| | - Rachel S. Kelly
- Channing Division of Network Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA 02115, USA
| | - Jessica Lasky-Su
- Channing Division of Network Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA 02115, USA
| | - Robert S. Zeiger
- Department of Clinical Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA 91101, USA
| | - George T. O’Connor
- Pulmonary Center and Department of Medicine, Boston University School of Medicine, Boston, MA 02118, USA
| | - Leonard B. Bacharier
- Division of Pediatric Allergy, Immunology and Pulmonary Medicine, Department of Pediatrics, Monroe Carell Jr. Children’s Hospital at Vanderbilt, Vanderbilt University Medical Center, Nashville, TN 37212, USA
| | - Vincent J. Carey
- Channing Division of Network Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA 02115, USA
| | - Nancy Laranjo
- Channing Division of Network Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA 02115, USA
| | - Augusto A. Litonjua
- Division of Pediatric Pulmonary Medicine, Golisano Children’s Hospital at Strong, University of Rochester Medical Center, Rochester, NY 14612, USA
| | - Scott T. Weiss
- Channing Division of Network Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA 02115, USA
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13
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Lee-Sarwar KA, Chen YC, Lasky-Su J, Kelly RS, Zeiger RS, O’Connor GT, Bacharier LB, Jia X, Beigelman A, Gold DR, Laranjo N, Bunyavanich S, Weiss ST, Litonjua AA, Brennan PJ. Early-life fecal metabolomics of food allergy. Allergy 2023; 78:512-521. [PMID: 36448508 PMCID: PMC10590492 DOI: 10.1111/all.15602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 11/14/2022] [Accepted: 11/21/2022] [Indexed: 12/05/2022]
Abstract
BACKGROUND Intestinal microenvironmental perturbations may increase food allergy risk. We hypothesize that children with clinical food allergy, those with food sensitization, and healthy children can be differentiated by intestinal metabolites in the first years of life. METHODS In this ancillary analysis of the Vitamin D Antenatal Asthma Reduction Trial (VDAART), we performed untargeted metabolomic profiling in 824 stool samples collected at ages 3-6 months, 1 year and 3 years. Subjects included 23 with clinical food allergy at age 3 and/or 6 years, 151 with food sensitization but no clinical food allergy, and 220 controls. We identified modules of correlated, functionally related metabolites and sought associations of metabolite modules and individual metabolites with food allergy/sensitization using regression models. RESULTS Several modules of functionally related intestinal metabolites were reduced among subjects with food allergy, including bile acids at ages 3-6 months and 1 year, amino acids at age 3-6 months, steroid hormones at 1 year, and sphingolipids at age 3 years. One module primarily containing diacylglycerols was increased in those with food allergy at age 3-6 months. Fecal caffeine metabolites at age 3-6 months, likely derived from breast milk, were increased in those with food allergy and/or sensitization (beta = 5.9, 95% CI 1.0-10.8, p = .02) and were inversely correlated with fecal bile acids and bilirubin metabolites, though maternal plasma caffeine levels were not associated with food allergy and/or sensitization. CONCLUSIONS Several classes of bioactive fecal metabolites are associated with food allergy and/or sensitization including bile acids, steroid hormones, sphingolipids, and caffeine metabolites.
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Affiliation(s)
- Kathleen A. Lee-Sarwar
- Channing Division of Network Medicine, Brigham and Women’s Hospital and Harvard Medical School; Boston, MA, USA
- Division of Allergy & Clinical Immunology, Brigham and Women’s Hospital and Harvard Medical School; Boston, MA, USA
| | - Yih-Chieh Chen
- Channing Division of Network Medicine, Brigham and Women’s Hospital and Harvard Medical School; Boston, MA, USA
- Division of Allergy & Clinical Immunology, Brigham and Women’s Hospital and Harvard Medical School; Boston, MA, USA
| | - Jessica Lasky-Su
- Channing Division of Network Medicine, Brigham and Women’s Hospital and Harvard Medical School; Boston, MA, USA
| | - Rachel S. Kelly
- Channing Division of Network Medicine, Brigham and Women’s Hospital and Harvard Medical School; Boston, MA, USA
| | - Robert S. Zeiger
- Department of Clinical Science Kaiser Permanente Bernard J. Tyson School of Medicine; Pasadena, CA, USA
| | - George T. O’Connor
- Pulmonary Center and Department of Medicine, Boston University School of Medicine; Boston, MA, USA
| | - Leonard B. Bacharier
- Department of Pediatric Allergy, Immunology, and Pulmonary, Vanderbilt Children’s Hospital, Vanderbilt University Medical Center; Nashville, TN, USA
| | - Xiaojiong Jia
- Division of Allergy & Clinical Immunology, Brigham and Women’s Hospital and Harvard Medical School; Boston, MA, USA
| | - Avraham Beigelman
- Schneider Children’s Medical Center of Israel, Tel Aviv University; Tel Aviv, Israel; Division of Pediatric Allergy, Immunology & Pulmonary Medicine, Department of Pediatrics, Washington University School of Medicine; St. Louis, MO, USA
| | - Diane R. Gold
- Channing Division of Network Medicine, Brigham and Women’s Hospital and Harvard Medical School; Boston, MA, USA
- Department of Environmental Health, Harvard T.H. Chan School of Public Health; Boston, MA, USA
| | - Nancy Laranjo
- Channing Division of Network Medicine, Brigham and Women’s Hospital and Harvard Medical School; Boston, MA, USA
| | - Supinda Bunyavanich
- Division of Allergy and Immunology, Department of Pediatrics, Icahn School of Medicine at Mount Sinai; New York, NY, USA; Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai; New York, NY, USA
| | - Scott T. Weiss
- Division of Allergy & Clinical Immunology, Brigham and Women’s Hospital and Harvard Medical School; Boston, MA, USA
| | - Augusto A. Litonjua
- Division of Pediatric Pulmonary Medicine, Golisano Children’s Hospital at Strong, University of Rochester Medical Center; Rochester, NY, USA
| | - Patrick J. Brennan
- Division of Allergy & Clinical Immunology, Brigham and Women’s Hospital and Harvard Medical School; Boston, MA, USA
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14
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Knihtilä HM, Huang M, Prince N, Stubbs BJ, Carey VJ, Laranjo N, Mirzakhani H, Zeiger RS, Bacharier LB, O'Connor GT, Litonjua AA, Weiss ST, Lasky-Su J. Maternal vitamin D status modifies the effects of early life tobacco exposure on child lung function. J Allergy Clin Immunol 2023; 151:556-564. [PMID: 36400177 PMCID: PMC9905288 DOI: 10.1016/j.jaci.2022.10.030] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 10/03/2022] [Accepted: 10/19/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Prior studies suggest that vitamin D may modify the effects of environmental exposures; however, none have investigated gestational vitamin D and cumulative tobacco smoke exposure (TSE) throughout pregnancy and early life. OBJECTIVES This study investigated the effects of early life TSE on child lung function and the modulatory effects of gestational vitamin D on this association. METHODS The VDAART (Vitamin D Antenatal Asthma Reduction Trial) recruited nonsmoking pregnant women and followed the mother-child pairs to age 6 years. TSE was assessed with questionnaires and plasma cotinine measurements in the mothers (10-18 and 32-38 gestational weeks) and children (1, 3, and 6 years). Cumulative TSE was calculated from the repeated cotinine measurements. 25-hydroxyvitamin D (25[OH]D) levels were measured at 10-18 and 32-38 gestational weeks. Lung function was assessed at 6 years with spirometry and impulse oscillometry. RESULTS Of the 476 mother-child pairs, 205 (43%) had increased cotinine levels at ≥1 time point. Cumulative TSE was associated with decreased FEV1 (β = -0.043 L, P = .018) and increased respiratory resistance at 5 Hz (R5; β = 0.060 kPa/L/s, P = .002). This association persisted in subjects with insufficient (<30 ng/mL) 25(OH)D levels throughout pregnancy (β = 0.077 kPa/L/s, P = .016 for R5) but not among those with sufficient levels throughout pregnancy. CONCLUSIONS Cumulative TSE from pregnancy to childhood is associated with dose- and duration-dependent decreases in child lung function at 6 years even in the absence of reported maternal smoking. Gestational vitamin D may modulate this effect and have therapeutic potential for minimizing the adverse effect of TSE on lung throughout early life. RANDOMIZED TRIAL Maternal Vitamin D Supplementation to Prevent Childhood Asthma (VDAART); clinicaltrials.gov identifier: NCT00920621.
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Affiliation(s)
- Hanna M Knihtilä
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass; Department of Pediatrics, Stanford University School of Medicine, Stanford, Calif.
| | - Mengna Huang
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass
| | - Nicole Prince
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass
| | - Benjamin J Stubbs
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass
| | - Vincent J Carey
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass
| | - Nancy Laranjo
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass
| | - Hooman Mirzakhani
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass
| | - Robert S Zeiger
- Departments of Allergy Research and Evaluation, Kaiser Permanente Southern California Region, San Diego, Calif; Research and Evaluation, Kaiser Permanente Southern California Region, San Diego and Pasadena, Calif
| | - Leonard B Bacharier
- Division of Allergy, Immunology, and Pulmonary Medicine, Department of Pediatrics, St Louis Children's Hospital, Washington University School of Medicine, St Louis, Mo
| | - George T O'Connor
- Pulmonary Center, Department of Medicine, Boston University School of Medicine, Boston, Mass
| | - Augusto A Litonjua
- Division of Pediatric Pulmonary Medicine, Golisano Children's Hospital, University of Rochester Medical Center, Rochester, NY
| | - Scott T Weiss
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass
| | - Jessica Lasky-Su
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass.
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15
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Lee-Sarwar KA, Chen YC, Yao Chen Y, Kozyrskyj AL, Mandhane PJ, Turvey SE, Subbarao P, Bisgaard H, Stokholm J, Chawes B, Sørensen SJ, Kelly RS, Lasky-Su J, Zeiger RS, O’Connor GT, Sandel MT, Bacharier LB, Beigelman A, Carey VJ, Harshfield BJ, Laranjo N, Gold DR, Weiss ST, Litonjua AA. The maternal prenatal and offspring early-life gut microbiome of childhood asthma phenotypes. Allergy 2023; 78:418-428. [PMID: 36107703 PMCID: PMC9892205 DOI: 10.1111/all.15516] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 08/06/2022] [Accepted: 08/17/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND The infant fecal microbiome is known to impact subsequent asthma risk, but the environmental exposures impacting this association, the role of the maternal microbiome, and how the microbiome impacts different childhood asthma phenotypes are unknown. METHODS Our objective was to identify associations between features of the prenatal and early-life fecal microbiomes and child asthma phenotypes. We analyzed fecal 16 s rRNA microbiome profiling and fecal metabolomic profiling from stool samples collected from mothers during the third trimester of pregnancy (n = 120) and offspring at ages 3-6 months (n = 265), 1 (n = 436) and 3 years (n = 506) in a total of 657 mother-child pairs participating in the Vitamin D Antenatal Asthma Reduction Trial. We used clinical data from birth to age 6 years to characterize subjects with asthma as having early, transient or active asthma phenotypes. In addition to identifying specific genera that were robustly associated with asthma phenotypes in multiple covariate-adjusted models, we clustered subjects by their longitudinal microbiome composition and sought associations between fecal metabolites and relevant microbiome and clinical features. RESULTS Seven maternal and two infant fecal microbial taxa were robustly associated with at least one asthma phenotype, and a longitudinal gut microenvironment profile was associated with early asthma (Fisher exact test p = .03). Though mode of delivery was not directly associated with asthma, we found substantial evidence for a pathway whereby cesarean section reduces fecal Bacteroides and microbial sphingolipids, increasing susceptibility to early asthma. CONCLUSION Overall, our results suggest that the early-life, including prenatal, fecal microbiome modifies risk of asthma, especially asthma with onset by age 3 years.
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Affiliation(s)
- Kathleen A. Lee-Sarwar
- Channing Division of Network Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
- Division of Allergy and Clinical Immunology, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Yih-Chieh Chen
- Channing Division of Network Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
- Division of Allergy and Clinical Immunology, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Yuan Yao Chen
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | | | - Piush J. Mandhane
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Stuart E. Turvey
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Padmaja Subbarao
- Department of Pediatrics & Physiology, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Hans Bisgaard
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Gentofte, Denmark
| | - Jakob Stokholm
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Gentofte, Denmark
| | - Bo Chawes
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Gentofte, Denmark
| | - Søren J. Sørensen
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Gentofte, Denmark
| | - Rachel S. Kelly
- Channing Division of Network Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Jessica Lasky-Su
- Channing Division of Network Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Robert S. Zeiger
- Department of Clinical Science Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, USA
| | - George T. O’Connor
- Pulmonary Center and Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Megan T. Sandel
- Department of Pediatrics, Boston Medical Center, Boston, MA, USA
| | - Leonard B. Bacharier
- Division of Pediatric Allergy, Immunology and Pulmonary Medicine, Department of Pediatrics, Monroe Carell Jr Children’s Hospital at Vanderbilt University Medical Center, Nashville, TN, USA
| | - Avraham Beigelman
- Division of Pediatric Allergy, Immunology and Pulmonary Medicine, Department of Pediatrics, Washington University School of Medicine, St Louis, MO and St Louis Children’s Hospital, St Louis, MO, USA
- The Kipper Institute of Allergy and Immunology, Schneider Children’s Medical Center of Israel, Tel Aviv University, Israel
| | - Vincent J. Carey
- Channing Division of Network Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Benjamin J. Harshfield
- Channing Division of Network Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Nancy Laranjo
- Channing Division of Network Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Diane R. Gold
- Channing Division of Network Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Scott T. Weiss
- Channing Division of Network Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Augusto A. Litonjua
- Division of Pediatric Pulmonary Medicine, Golisano Children’s Hospital at Strong, University of Rochester Medical Center, Rochester, NY, USA
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Chen W, Schatz M, Zhou Y, Xie F, Bali V, Das A, Schelfhout J, Stern JA, Zeiger RS. Prediction of Persistent Chronic Cough in Patients with Chronic Cough Using Machine Learning. ERJ Open Res 2023; 9:00471-2022. [PMID: 37009024 PMCID: PMC10052506 DOI: 10.1183/23120541.00471-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 12/11/2022] [Indexed: 01/27/2023] Open
Abstract
IntroductionTo develop and validate prediction models for risk of persistent chronic cough (PCC) in patients with chronic cough.Study DesignRetrospective cohort studyMethodsTwo retrospective cohorts of patients 18–85 years of age were identified for years 2011–2016: aspecialist cohort whichincluded CC patients diagnosed by specialists, and anevent cohortwhich comprised of CC patients identified by at least three cough events. A cough event could be a cough diagnosis, dispensing of cough medication, or any indication of cough in clinical notes. Model training and validation were conducted using two machine learning approaches and 400+ features. Sensitivity analyses were also conducted. PCC was defined as a CC diagnosis or any two (specialist cohort) or three (event cohort) cough events in year 2 and again in year 3 after the index date.Results8581/52 010 patients met eligibility criteria for the specialist/event cohorts (mean age 60.0/55.5 years), respectively. 38.2% and 12.4% patients in the specialist and event cohorts, respectively, developed PCC. The utilization-based models were mainly based on baseline health care utilizations associated with CC or respiratory diseases, while the diagnosis-based models incorporated traditional parameters including age, asthma, pulmonary fibrosis, obstructive pulmonary disease, gastroesophageal reflux, hypertension, and bronchiectasis. All final models were parsimonious (5–7 predictors) and moderately accurate (AUC: 0.74–0.76 for utilization-based models and 0.71 for diagnosis-based models).ConclusionsThe application of our risk prediction models may be used to identify high-risk PCC patients at any stage of the clinical testing/evaluation to facilitate decision making.
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Reibman J, Chipps BE, Zeiger RS, Beuther DA, Wise RA, McCann W, Gilbert I, Eudicone JM, Gandhi HN, Harding G, Cutts K, Coyne KS, Murphy KR, George M. Relationship Between Asthma Control as Measured by the Asthma Impairment and Risk Questionnaire (AIRQ) and Patient Perception of Disease Status, Health-Related Quality of Life, and Treatment Adherence. J Asthma Allergy 2023; 16:59-72. [PMID: 36636702 PMCID: PMC9829987 DOI: 10.2147/jaa.s373184] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 11/11/2022] [Indexed: 01/05/2023] Open
Abstract
Purpose Critical asthma outcomes highlighted in clinical guidelines include asthma-related quality of life, asthma exacerbations, and asthma control. An easy-to-implement measure of asthma control that assesses both symptom impairment and exacerbation risk and reflects the impact of asthma on patients' lives is lacking. Hence, the objective of this study was to assess the Asthma Impairment and Risk Questionnaire (AIRQ®) construct validity relative to patient self-perception of asthma status and validated disease-specific patient-reported outcome (PRO) measures. Patients and methods Baseline data were analyzed from patients (aged ≥ 12 years) with asthma participating in a 12-month observational study assessing the ability of AIRQ to predict exacerbations. At entry, patients completed a sociodemographic questionnaire, AIRQ, 3 questions addressing self-perceived asthma status, Saint George's Respiratory Questionnaire (SGRQ), mini-Asthma Quality of Life Questionnaire (AQLQ), and Adult Asthma Adherence Questionnaire (AAAQ). Descriptive statistics were calculated for demographic and clinical characteristics. AIRQ construct validity was evaluated by assessing correlations between total AIRQ score and patient self-assessments, SGRQ, mini-AQLQ, and AAAQ scores. Comparisons of SGRQ, mini-AQLQ, and AAAQ total and component/domain scores by AIRQ control category were performed using general linear models and Scheffe's post hoc adjustments for pairwise comparisons. Results A total of 1112 patients were enrolled: 70% female, 78% White, mean (standard deviation) age 43.9 (19.5) years. There were highly significant correlations between AIRQ score and patient self-perception of overall control (r = 0.69; p < 0.001), total SGRQ (r = 0.74, p < 0.001), and mini-AQLQ (r = -0.78, p < 0.001) scores. As AIRQ control category worsened, so did total and domain SGRQ, mini-AQLQ, and AAAQ impediment-to-inhaled-corticosteroid-adherence scores (all pairwise comparisons p < 0.001). Conclusion Findings demonstrate the construct validity of AIRQ relative to patient self-perception of asthma status, disease-specific PRO measures, and treatment adherence barriers. AIRQ can be a useful instrument to raise awareness of the unrecognized impacts of asthma on patients' lives.
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Affiliation(s)
- Joan Reibman
- New York University School of Medicine, New York, NY, USA,Correspondence: Joan Reibman, New York University School of Medicine, 550 1st Avenue, Room NB7N24, New York, NY, 10016, USA, Tel +1 212-263-6479, Fax +1 212-263-8442, Email
| | - Bradley E Chipps
- Capital Allergy & Respiratory Disease Center, Sacramento, CA, USA
| | - Robert S Zeiger
- Department of Clinical Science Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, USA
| | | | - Robert A Wise
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Ileen Gilbert
- BioPharmaceuticals Medical, AstraZeneca, Wilmington, DE, USA
| | | | - Hitesh N Gandhi
- BioPharmaceuticals Medical, AstraZeneca, Wilmington, DE, USA
| | | | | | | | - Kevin R Murphy
- Boys Town National Research Hospital, Boys Town, NE, USA
| | - Maureen George
- Office of Research & Scholarship, Columbia University School of Nursing, New York, NY, USA
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18
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Angel DM, Schatz M, Zeiger RS, Sicherer SH, Khan DA. What a Difference 10 Years Can Make. J Allergy Clin Immunol Pract 2023; 11:140-144.e2. [PMID: 36610756 DOI: 10.1016/j.jaip.2022.10.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 10/25/2022] [Indexed: 01/06/2023]
Affiliation(s)
- Dawn M Angel
- American Academy of Allergy and Clinical Immunology, Denver, Colo.
| | - Michael Schatz
- Department of Allergy, Kaiser Permanente Medical Care Program, San Diego, Calif
| | - Robert S Zeiger
- Kaiser Permanente Bernard J. Tyson School of Medicine, Department of Clinical Science, Pasadena, Calif
| | - Scott H Sicherer
- Division of Pediatric Allergy and Immunology, Jaffe Food Allergy Institute, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY
| | - David A Khan
- Division of Allergy and Immunology, Department of Internal Medicine, University of Texas Southwestern, Dallas, Texas
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19
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Chen YCS, Lee-Sarwar KA, Mirzakhani H, O'Connor GT, Bacharier LB, Zeiger RS, Knihtilä HM, Jha A, Kelly RS, Laranjo N, Fichorova RN, Luu N, Weiss ST, Litonjua AA. The Association of Prenatal C-Reactive Protein Levels With Childhood Asthma and Atopy. J Allergy Clin Immunol Pract 2022; 10:3213-3219.e11. [PMID: 36108928 PMCID: PMC10088546 DOI: 10.1016/j.jaip.2022.08.044] [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] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 08/08/2022] [Accepted: 08/20/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND The pathogenesis of childhood asthma is complex, and determinants of risk may begin in utero. OBJECTIVE To describe the association of systemic prenatal inflammation, measured by plasma C-reactive protein (CRP), with childhood asthma, eczema, and allergic rhinitis. METHODS A total of 522 maternal-offspring pairs from the Vitamin D Antenatal Asthma Reduction Trial were included. Prenatal plasma CRP level was measured between 10 and 18 weeks of gestation and between 32 and 38 weeks of gestation. Offspring asthma, eczema, and allergic rhinitis were assessed quarterly between birth and age 6 years. We performed mediation analyses of prenatal CRP on the association between several maternal characteristics and offspring asthma. RESULTS Elevated early and late prenatal CRP and an increase in CRP from early to late pregnancy were associated with asthma by age 6 years (early: adjusted odds ratio [aOR], 1.76, 95% CI, 1.12-2.82, P = .02; late: aOR, 2.45, 95% CI, 1.47-4.18, P < .001; CRP increase: aOR, 2.06, 95% CI, 1.26-3.39, P < .004). Prenatal CRP and childhood asthma associations were strengthened among offspring with atopic asthma (early: aOR, 3.78, 95% CI, 1.49-10.64, P = .008; late: aOR, 4.84, 95% CI, 1.68-15.50, P = .005; CRP increase: aOR, 3.01, 95% CI, 1.06-9.16, P = .04). Early and late prenatal CRP mediated 96% and 86% of the association between maternal prepregnancy body mass index and offspring asthma, respectively. CONCLUSIONS Higher prenatal CRP and an increase in CRP from early to late pregnancy are associated with childhood asthma. Systemic inflammation during pregnancy associated with modifiable maternal characteristics may be an important determinant of childhood asthma risk.
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Affiliation(s)
- Yih-Chieh S Chen
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass; Division of Allergy and Clinical Immunology, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass
| | - Kathleen A Lee-Sarwar
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass; Division of Allergy and Clinical Immunology, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass
| | - Hooman Mirzakhani
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass
| | - George T O'Connor
- The Pulmonary Center, Department of Medicine, Boston University School of Medicine, Boston, Mass
| | - Leonard B Bacharier
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tenn
| | - Robert S Zeiger
- Departments of Allergy and Research and Evaluation, Kaiser Permanente Southern California, San Diego and Pasadena, Calif; Department of Clinical Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, Calif
| | - Hanna M Knihtilä
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass; Department of Pediatrics, Stanford University School of Medicine, Stanford, Calif
| | - Anjali Jha
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass
| | - Rachel S Kelly
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass
| | - Nancy Laranjo
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass
| | - Raina N Fichorova
- Laboratory of Genital Tract Biology, Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass
| | - Ngan Luu
- Laboratory of Genital Tract Biology, Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass
| | - Scott T Weiss
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass
| | - Augusto A Litonjua
- Division of Pediatric Pulmonary Medicine, Golisano Children's Hospital at Strong, University of Rochester Medical Center, Rochester, NY.
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20
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Beuther DA, Murphy KR, Zeiger RS, Wise RA, McCann W, Reibman J, George M, Gilbert I, Eudicone JM, Gandhi HN, Ross M, Coyne KS, Chipps B. The Asthma Impairment and Risk Questionnaire (AIRQ) Control Level Predicts Future Risk of Asthma Exacerbations. J Allergy Clin Immunol Pract 2022; 10:3204-3212.e2. [PMID: 35998877 DOI: 10.1016/j.jaip.2022.08.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 07/01/2022] [Accepted: 08/03/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND The Asthma Impairment and Risk Questionnaire (AIRQ) is a 10-item, equally weighted, yes/no control tool validated in patients with asthma aged 12 years and older. OBJECTIVE To evaluate AIRQ's ability to predict patient-reported exacerbations over 12 months. METHODS Patients completed a baseline AIRQ during an in-person enrollment visit and reported exacerbations (ie, asthma-related courses of oral corticosteroids, emergency department/urgent care visits, and hospitalizations) via monthly online surveys. Logistic regressions were performed using AIRQ control level (well-controlled [WC], not well-controlled [NWC], very poorly controlled [VPC]), age, sex, race, and body mass index as covariates and 1 or more and 2 or more exacerbations as the dependent variables (adjusted odds ratios [OR] and 95% Wald CIs). Kaplan-Meier analyses of time to first exacerbation by AIRQ control level were performed. RESULTS A total of 1,112 patients were enrolled; 1,070 completed 1 or more surveys over 12 months (mean ± SD 10.5 ± 2.8 months); 70.5% female; age 43.9 ± 19.3 years; 20.4% non-White; body mass index 30.6 ± 8.7 kg/m2; AIRQ: WC 35.2%, NWC 38.1%, VPC 26.6%. A total of 45.7% of patients reported 1 or more exacerbations and 26.7% 2 or more exacerbations (WC 28.4% ≥ 1, 11.1% ≥ 2; NWC 46.3% ≥ 1, 27.9% ≥ 2; VPC 67.7% ≥ 1, 45.6% ≥ 2). The ORs for 1 or more exacerbations NWC versus WC were 2.1 (CI 1.6-2.9), and VPC versus WC were 4.6 (CI 3.3-6.5). The ORs for 2 or more exacerbations NWC versus WC were 3.1 (CI 2.1-4.6), and VPC versus WC were 6.1 (CI 4.0-9.1). Kaplan-Meier curves demonstrated clear differentiation of time to first exacerbation by AIRQ control level (P < .001). CONCLUSIONS The AIRQ control level predicts exacerbation risk over 12 months and probability of time to first exacerbation.
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Affiliation(s)
- David A Beuther
- Department of Medicine, National Jewish Health, Denver, Colo.
| | - Kevin R Murphy
- Department of Pediatrics, Boys Town National Research Hospital, Boys Town, Neb
| | - Robert S Zeiger
- Department of Clinical Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, Calif
| | - Robert A Wise
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Md
| | | | - Joan Reibman
- Department of Medicine, New York University School of Medicine, New York, NY
| | - Maureen George
- Department of Nursing, Columbia University, New York, NY
| | | | | | | | | | | | - Bradley Chipps
- Capital Allergy & Respiratory Disease Center, Sacramento, CA
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21
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Zeiger JS, Silvers WS, Naimi DR, Skypala IJ, Ellis AK, Connors L, Jeimy S, Nayak AP, Bernstein JA, Zeiger RS. Impact of cannabis knowledge and attitudes on real-world practice. Ann Allergy Asthma Immunol 2022; 129:441-450. [PMID: 35472594 PMCID: PMC9869714 DOI: 10.1016/j.anai.2022.04.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 03/18/2022] [Accepted: 04/12/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND Increased cannabis consumption worldwide challenges allergists because of an upsurge in cannabis allergy and need to discuss cannabis with patients. OBJECTIVE To determine the knowledge, attitudes, and practices regarding cannabis among allergists and their approach to recognizing and diagnosing suspected cannabis allergy. METHODS The International Allergist Canna Knowledge, Attitudes, and Practices Survey was completed by members from 3 International Allergy Societies. Survey questions included the following: 13 on cannabis attitudes, 7 on cannabis knowledge, and 4 on real-world allergy practices. Knowledge level was dichotomized and Statistical Package for the Social Sciences TwoStep Cluster Analysis grouped participants by attitudes. Multivariate analysis determined the relationship of knowledge and attitude to practice delivery. RESULTS Of 570 eligible surveys started, 445 (78.1%) were completed. Participants were 49.7% of female sex, 65.9% aged 24 to 56 years, approximately 70% in practice for more than or equal to 10 years, and 29.2% practicing in an area where cannabis use is illegal. Of the respondents, 43.1% reported consulting on patients with suspected cannabis allergy and 54.7% had undertaken skin prick testing, in vitro cannabis testing, or both. Statistically significant differences were found between the 3 societies for most variables analyzed. Analysis of attitudes revealed 3 clusters named Traditional, Progressive, and Unsure. Those with more progressive attitudes toward cannabis and who had more knowledge were more comfortable speaking to patients about cannabis and more often asked patients on how often and how they used cannabis (all P < .001). CONCLUSION Varying knowledge and attitudes toward cannabis affecting comfort communicating with patients about cannabis were found in members of 3 allergy societies supporting the need for more cannabis research and education.
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Affiliation(s)
| | - William S Silvers
- Canna Research Foundation, Boulder, Colorado; University of Colorado School of Medicine, Denver, Colorado
| | - David R Naimi
- Naval Hospital Camp Pendleton, Oceanside, California
| | - Isabel J Skypala
- Royal Brompton & Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - Anne K Ellis
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Lori Connors
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Samira Jeimy
- Division of Clinical Immunology and Allergy, Department of Medicine, Western University, London, Ontario, Canada
| | - Ajay P Nayak
- Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Jonathan A Bernstein
- University of Cincinnati College of Medicine, Bernstein Allergy Group, Cincinnati, Ohio
| | - Robert S Zeiger
- Canna Research Foundation, Boulder, Colorado; Department of Clinical Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California
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22
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Davis GE, Zeiger RS, Emmanuel B, Chung Y, Tran TN, Evans KA, Chen S, Katial R, Kreindler JL, Tkacz J. Systemic Corticosteroid–related Adverse Outcomes and Health Care Resource Utilization and Costs Among Patients with Chronic Rhinosinusitis with Nasal Polyposis. Clin Ther 2022; 44:1187-1202. [DOI: 10.1016/j.clinthera.2022.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 07/15/2022] [Accepted: 08/08/2022] [Indexed: 11/03/2022]
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Zeiger RS, Schatz M, Zhou Y, Xie F, Bali V, Schelfhout J, Das A, Stern JA, Chen W. Risk Factors for Persistent Chronic Cough During Consecutive Years: A Retrospective Database Analysis. J Allergy Clin Immunol Pract 2022; 10:1587-1597. [PMID: 35272071 DOI: 10.1016/j.jaip.2022.02.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 02/01/2022] [Accepted: 02/08/2022] [Indexed: 12/22/2022]
Abstract
BACKGROUND The identification of patients at high risk for diseases provides clinicians essential information to better manage such patients. Persistent chronic cough (PCC) is a condition with high clinical burden and limited knowledge of the risk factors that drive the persistent symptoms. OBJECTIVE To understand the risk factors of PCC in patients with CC diagnosed by specialists. METHODS In this retrospective study, adults aged 18 to 85 years diagnosed with CC by a pulmonologist, allergist, otolaryngologist, or gastroenterologist in the period 2011 to 2016 were identified. PCC was defined by another CC code or at least 2 cough events at least 8 weeks but no more than 4 months apart in each of the 2 consecutive years beginning 1 year after the original CC diagnosis. Unadjusted and adjusted risk ratios with 95% CI for patient characteristics at baseline in relationship to PCC were estimated by Poisson regression models with robust error variance. RESULTS Of the adults with CC, 3270 (27.4%) had PCC and 5302 (44.5%) did not have CC during follow-up; 3341 (28.1%) had CC in only 1 follow-up year and were excluded from the analysis. Compared with patients without PCC, patients with PCC were noted to have significantly increased adjusted risk ratios for the following baseline features: (1) demographic characteristics (elderly, females, and less educated); (2) comorbidities (chronic obstructive pulmonary disease, chronic sinusitis, bronchiectasis, pulmonary fibrosis, hypertension, depression, and cough complications); (3) medication dispensed (inhaled corticosteroids/long-acting beta-agonists, leukotriene modifiers, nasal corticosteroids, nasal short-acting muscarinic antagonists, proton pump inhibitors, antitussives with narcotics, and neuromodulators); and (4) specialist care, particularly with pulmonologists. CONCLUSIONS Knowledge of the independent risk factors associated with PCC should aid clinicians in identifying such patients and improve their management.
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Affiliation(s)
- Robert S Zeiger
- Department of Allergy, Kaiser Permanente Southern California, San Diego, Calif; Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, Calif; Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, Calif.
| | - Michael Schatz
- Department of Allergy, Kaiser Permanente Southern California, San Diego, Calif; Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, Calif
| | | | - Fagen Xie
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, Calif
| | - Vishal Bali
- Center for Observational and Real-World Evidence (CORE), Merck & Co, Inc, Kenilworth, NJ
| | - Jonathan Schelfhout
- Center for Observational and Real-World Evidence (CORE), Merck & Co, Inc, Kenilworth, NJ
| | - Amar Das
- Center for Observational and Real-World Evidence (CORE), Merck & Co, Inc, Kenilworth, NJ
| | - Julie A Stern
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, Calif
| | - Wansu Chen
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, Calif
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Chipps BE, Murphy KR, Wise RA, McCann WA, Beuther DA, Reibman J, George M, Gilbert I, Eudicone JM, Gandhi HN, Harding G, Ross M, Zeiger RS. Evaluating construct validity of the Asthma Impairment and Risk Questionnaire using a 3-month exacerbation recall. Ann Allergy Asthma Immunol 2022; 128:544-552.e3. [PMID: 35123077 DOI: 10.1016/j.anai.2022.01.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 12/23/2021] [Accepted: 01/19/2022] [Indexed: 10/19/2022]
Abstract
BACKGROUND Recurrent assessment of asthma control is essential to evaluating disease stability and intervention impacts. An assessment that can be administered between annual clinic visits is needed. The Asthma Impairment and Risk Questionnaire (AIRQ) is a cross-sectionally validated, 10-item, yes or no, composite control tool evaluating previous 2-week symptoms and previous 12-month exacerbations. OBJECTIVE To evaluate the construct validity of the AIRQ using a 3-month recall period for exacerbation-based risk questions and retaining the 2-week recall for symptom-based impairment items. METHODS At baseline, patients completed the AIRQ with 12-month recall exacerbation items, Asthma Control Test (ACT), St. George's Respiratory Questionnaire (SGRQ), and global self-assessments of asthma risk, control, and symptom severity. Patient-reported exacerbations were captured monthly. The AIRQ with 3-month recall exacerbation items, ACT, and global self-assessments was administered at months 3, 6, and 9, and SGRQ at month 6. RESULTS A total of 1112 patients aged 12 years or older were enrolled (mean [SD] age, 43.9 [19.5] years). The AIRQ and each administration of the AIRQ with 3-month recall exacerbation items classified asthma control similarly to an ACT plus exacerbation validation standard. For both AIRQ versions, SGRQ scores were higher with worsening asthma control (P < .001). At months 3, 6, and 9, worse AIRQ control levels were associated with higher proportions of patients with 1 or more and 2 or more exacerbations in the previous 3 months and patient global self-assessments indicating greater asthma morbidity (all P < .001). CONCLUSION The AIRQ using exacerbation risk items with a 3-month recall period exhibits construct validity for classifying current asthma control and can be administered between annual AIRQ assessments.
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Affiliation(s)
- Bradley E Chipps
- Capital Allergy & Respiratory Disease Center, Sacramento, California.
| | - Kevin R Murphy
- Division of Allergy, Asthma and Immunology, Boys Town National Research Hospital, Boys Town, Nebraska
| | - Robert A Wise
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - David A Beuther
- Division of Pulmonary, Critical Care and Sleep Medicine, National Jewish Health, Denver, Colorado
| | - Joan Reibman
- Department of Medicine, New York University School of Medicine, New York, New York
| | - Maureen George
- Department of Nursing, Columbia University School of Nursing, New York, New York
| | - Ileen Gilbert
- BioPharmaceuticals Medical, AstraZeneca, Wilmington, Delaware
| | | | - Hitesh N Gandhi
- BioPharmaceuticals Medical, AstraZeneca, Wilmington, Delaware
| | | | | | - Robert S Zeiger
- Departments of Allergy and Research and Evaluation, Kaiser Permanente Southern California, San Diego and Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California
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Schatz M, Zeiger RS. Asthma Guidance: Options for Individualized Care. J Allergy Clin Immunol Pract 2022; 10:S39-S40. [PMID: 34949333 DOI: 10.1016/j.jaip.2021.10.047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 10/22/2021] [Indexed: 10/19/2022]
Affiliation(s)
- Michael Schatz
- Department of Allergy, Kaiser Permanente Southern California, San Diego, Calif.
| | - Robert S Zeiger
- Department of Allergy, Kaiser Permanente Southern California, San Diego, Calif; Department of Clinical Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, Calif
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Angel DM, Schatz M, Zeiger RS, Sicherer SH, Khan DA. Diversity, Equity, and Inclusion: What Can a Journal Do? J Allergy Clin Immunol Pract 2021; 9:3853-3856. [PMID: 34563739 DOI: 10.1016/j.jaip.2021.09.019] [Citation(s) in RCA: 1] [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] [Received: 09/17/2021] [Accepted: 09/17/2021] [Indexed: 11/25/2022]
Affiliation(s)
- Dawn M Angel
- American Academy of Allergy and Clinical Immunology, Denver, Colo.
| | - Michael Schatz
- Department of Allergy, Kaiser Permanente Medical Care Program, San Diego, Calif
| | - Robert S Zeiger
- Kaiser Permanente Bernard J. Tyson School of Medicine, Department of Clinical Science, Pasadena, Calif
| | - Scott H Sicherer
- Division of Pediatric Allergy and Immunology, Jaffe Food Allergy Institute, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY
| | - David A Khan
- Division of Allergy and Immunology, Department of Internal Medicine, University of Texas Southwestern, Dallas, Texas
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Meltzer EO, Zeiger RS, Dicpinigaitis P, Bernstein JA, Oppenheimer JJ, Way NA, Li VW, Boggs R, Doane MJ, Urdaneta E, Weaver JP, Schelfhout J, Fonseca E. Prevalence and Burden of Chronic Cough in the United States. J Allergy Clin Immunol Pract 2021; 9:4037-4044.e2. [PMID: 34333189 DOI: 10.1016/j.jaip.2021.07.022] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 06/14/2021] [Accepted: 07/06/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND Chronic cough is a common complaint but there are little population-based data on its burden in the United States. OBJECTIVE To determine the prevalence of chronic cough and its burden on individuals and the health care system. METHODS This was a survey of respondents who completed the 2018 National Health and Wellness Survey and questions about sleep and health care resource use. Chronic cough was defined as having a daily cough for 8 or more weeks. Respondents without chronic cough were selected through propensity score matching. Chronic cough prevalence was estimated using poststratification sampling weights calculated using U.S. Census data and post-data Horvitz-Thompson sampling weights to adjust for sampling bias. RESULTS Of 74,977 National Health and Wellness Survey respondents, 3,654 had experienced chronic cough in the previous 12 months, for a weighted prevalence of 5.0%. Respondents with chronic cough were older and more predominantly female than respondents without chronic cough (both P < .001). Compared with matched respondents without chronic cough, those with chronic cough had lower mean scores on the Medical Outcomes Study 36-item Short Form Survey v2 physical (P < .001) and mental (P < .001) component summary scores. More respondents with chronic cough than matched controls experienced severe anxiety and severe depression in the past 2 weeks, work productivity impairment, impaired sleep quality and daytime sleepiness, as well as more emergency department visits and hospitalizations in the past 6 months (P < .001 for all comparisons). CONCLUSIONS The burden of chronic cough manifests itself as reduced health-related quality of life, increased anxiety and depression, impaired sleep and work productivity, and greater health care utilization.
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Affiliation(s)
- Eli O Meltzer
- Department of Pediatrics, University of California, San Diego, Calif.
| | - Robert S Zeiger
- Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, Calif
| | | | - Jonathan A Bernstein
- Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio
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Chen YCS, Mirzakhani H, Lu M, Zeiger RS, O'Connor GT, Sandel MT, Bacharier LB, Beigelman A, Carey VJ, Harshfield BJ, Laranjo N, Litonjua AA, Weiss ST, Lee-Sarwar KA. The Association of Prenatal Vitamin D Sufficiency With Aeroallergen Sensitization and Allergic Rhinitis in Early Childhood. J Allergy Clin Immunol Pract 2021; 9:3788-3796.e3. [PMID: 34166843 DOI: 10.1016/j.jaip.2021.06.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 05/11/2021] [Accepted: 06/02/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND The role of prenatal vitamin D sufficiency and supplementation in the development of childhood aeroallergen sensitization and allergic rhinitis remains uncertain. OBJECTIVE To describe the association of prenatal vitamin D sufficiency with childhood allergic outcomes in participants of the Vitamin D Antenatal Asthma Reduction Trial, a randomized controlled trial of prenatal vitamin D supplementation. METHODS We included 414 mother-offspring pairs with offspring aeroallergen sensitization data available at age 6 years in this analysis. We examined the association between prenatal vitamin D sufficiency status, based on vitamin D levels measured in the first and third trimesters, or vitamin D supplementation treatment assignment with the outcomes of aeroallergen sensitization, parent-reported clinical allergic rhinitis, parent-reported clinical allergic rhinitis with aeroallergen sensitization, food sensitization, any sensitization, eczema, and total IgE at ages 3 and 6 years. RESULTS Compared with early and late insufficiency, early prenatal vitamin D insufficiency with late sufficiency was associated with reduced development of clinical allergic rhinitis with aeroallergen sensitization at 3 years (adjusted odds ratio [aOR] = 0.34; 95% confidence interval [CI], 0.13-0.82; P = .02) and 6 years (aOR = 0.54; 95% CI, 0.29-0.98; P = .05). At 6 years, clinical allergic rhinitis with sensitization was significantly decreased in offspring whose mothers received high-dose vitamin D (aOR = 0.54; 95% CI, 0.32-0.91; P = .02) compared with offspring whose mothers who received low-dose vitamin D. Associations of prenatal vitamin D with aeroallergen sensitization were strengthened among children who also developed asthma or who had a maternal history of atopy. CONCLUSIONS Among mothers with first-trimester vitamin D insufficiency, we detected a protective effect of third-trimester prenatal vitamin D sufficiency on the development of clinical allergic rhinitis with aeroallergen sensitization at ages 3 and 6 years.
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Affiliation(s)
- Yih-Chieh S Chen
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass; Division of Allergy and Clinical Immunology, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass.
| | - Hooman Mirzakhani
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass
| | - Mengdi Lu
- Division of Pediatric Pulmonary Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Mass
| | - Robert S Zeiger
- Department of Allergy Research, Kaiser Permanente Medical Center, San Diego, Calif
| | - George T O'Connor
- Pulmonary Center and Department of Medicine, Boston University School of Medicine, Boston, Mass
| | - Megan T Sandel
- Department of Pediatrics, Boston Medical Center, Boston, Mass
| | - Leonard B Bacharier
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tenn
| | - Avraham Beigelman
- Division of Pediatric Allergy, Immunology, and Pulmonary Medicine, Department of Pediatrics, Washington University School of Medicine, St Louis, Mo; The Kipper Institute of Allergy and Immunology, Schneider Children's Medical Center of Israel, Tel Aviv University, Tel Aviv, Israel
| | - Vincent J Carey
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass
| | - Benjamin J Harshfield
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass
| | - Nancy Laranjo
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass
| | - Augusto A Litonjua
- Division of Pediatric Pulmonary Medicine, Golisano Children's Hospital at Strong, University of Rochester Medical Center, Rochester, NY
| | - Scott T Weiss
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass
| | - Kathleen A Lee-Sarwar
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass; Division of Allergy and Clinical Immunology, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass
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Izadi N, Baraghoshi D, Curran-Everett D, Zeiger RS, Szefler SJ, Covar RA. Factors Associated with Persistence of Severe Asthma from Late Adolescence to Early Adulthood. Am J Respir Crit Care Med 2021; 204:776-787. [PMID: 34029510 PMCID: PMC8528529 DOI: 10.1164/rccm.202010-3763oc] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 05/10/2021] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Asthma severity in children generally starts mild but may progress and stay severe for unknown reasons. OBJECTIVES Identify factors in childhood that predict persistence of severe asthma in late adolescence and early adulthood. METHODS The Childhood Asthma Management Program is the largest and longest asthma trial in 1041 children aged 5-12 years with mild to moderate asthma. We evaluated 682 participants from the program with analyzable data in late adolescence (age 17-19) and early adulthood (age 21-23). MEASUREMENTS Severe asthma was defined using criteria from the American Thoracic Society and the National Asthma Education and Prevention Program to best capture severe asthma. Logistic regression with stepwise elimination was used to analyze clinical features, biomarkers, and lung function predictive of persistence of severe asthma. MAIN RESULTS In late adolescence and early adulthood 12% and 19% of the patents had severe asthma, respectively; only 6% were severe at both time periods. For every 5% decrease in post bronchodilator FEV1/FVC in childhood, the odds of persistence of severe asthma increased 2.36-fold (95% CI: 1.70-3.28; p <0.0001), for participants with maternal smoking during pregnancy odds of persistence of severe asthma increased 3.17-fold (95% CI: 1.18-8.53, p=0.02). Reduced growth lung function trajectory was significantly associated with persistence of severe asthma compared to normal growth. CONCLUSIONS Lung function and maternal smoking during pregnancy were significant predictors of severe asthma from late adolescence to early adulthood. Interventions to preserve lung function early may prevent disease progression.
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Affiliation(s)
- Neema Izadi
- Children's Hospital Los Angeles Department of Pediatrics, 337885, Division of Clinical Immunology & Allergy, Los Angeles, California, United States;
| | | | | | | | - Stanley J Szefler
- University of Colorado Denver School of Medicine, 12225, Pediatrics, Aurora, Colorado, United States
| | - Ronina A Covar
- National Jewish Health, 2930, Pediatrics, Denver, Colorado, United States
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Decuyper II, Green BJ, Sussman GL, Ebo DG, Silvers WS, Pacheco K, King BS, Cohn JR, Zeiger RS, Zeiger JS, Naimi DR, Beezhold DH, Nayak AP. Occupational Allergies to Cannabis. J Allergy Clin Immunol Pract 2021; 8:3331-3338. [PMID: 33161961 DOI: 10.1016/j.jaip.2020.09.003] [Citation(s) in RCA: 5] [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] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 09/02/2020] [Accepted: 09/02/2020] [Indexed: 10/23/2022]
Abstract
Within the last decade there has been a significant expansion in access to cannabis for medicinal and adult nonmedical use in the United States and abroad. This has resulted in a rapidly growing and diverse workforce that is involved with the growth, cultivation, handling, and dispensing of the cannabis plant and its products. The objective of this review was to educate physicians on the complexities associated with the health effects of cannabis exposure, the nature of these exposures, and the future practical challenges of managing these in the context of allergic disease. We will detail the biological hazards related to typical modern cannabis industry operations that may potentially drive allergic sensitization in workers. We will highlight the limitations that have hindered the development of objective diagnostic measures that are essential in separating "true" cannabis allergies from nonspecific reactions/irritations that "mimic" allergy-like symptoms. Finally, we will discuss recent advances in the basic and translational scientific research that will aid the development of diagnostic tools and therapeutic standards to serve optimal management of cannabis allergies across the occupational spectrum.
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Affiliation(s)
- Ine I Decuyper
- Department of Immunology-Allergology-Rheumatology, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium; Infla-Med Centre of Excellence University of Antwerp, Antwerp, Belgium
| | - Brett J Green
- Office of the Director, Health Effects Laboratory Division, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Morgantown, Wv
| | - Gordon L Sussman
- Division of Allergy and Clinical Immunology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Didier G Ebo
- Department of Immunology-Allergology-Rheumatology, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium; Infla-Med Centre of Excellence University of Antwerp, Antwerp, Belgium
| | | | - Karin Pacheco
- Division of Environmental and Occupational Health Sciences, Department of Medicine, National Jewish Health, Denver, Colo
| | - Bradley S King
- Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Western States Division, Denver, Colo
| | - John R Cohn
- Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, Philadelphia, Pa; Jane & Leonard Korman Respiratory Institute, Thomas Jefferson University, Philadelphia, Pa
| | | | | | | | - Donald H Beezhold
- Office of the Director, Health Effects Laboratory Division, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Morgantown, Wv
| | - Ajay P Nayak
- Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, Philadelphia, Pa; Jane & Leonard Korman Respiratory Institute, Thomas Jefferson University, Philadelphia, Pa; Center for Translational Medicine, Thomas Jefferson University, Philadelphia, Pa.
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Luo G, Nau CL, Crawford WW, Schatz M, Zeiger RS, Koebnick C. Generalizability of an Automatic Explanation Method for Machine Learning Prediction Results on Asthma-Related Hospital Visits in Patients With Asthma: Quantitative Analysis. J Med Internet Res 2021; 23:e24153. [PMID: 33856359 PMCID: PMC8085752 DOI: 10.2196/24153] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 12/07/2020] [Accepted: 03/22/2021] [Indexed: 12/21/2022] Open
Abstract
Background Asthma exerts a substantial burden on patients and health care systems. To facilitate preventive care for asthma management and improve patient outcomes, we recently developed two machine learning models, one on Intermountain Healthcare data and the other on Kaiser Permanente Southern California (KPSC) data, to forecast asthma-related hospital visits, including emergency department visits and hospitalizations, in the succeeding 12 months among patients with asthma. As is typical for machine learning approaches, these two models do not explain their forecasting results. To address the interpretability issue of black-box models, we designed an automatic method to offer rule format explanations for the forecasting results of any machine learning model on imbalanced tabular data and to suggest customized interventions with no accuracy loss. Our method worked well for explaining the forecasting results of our Intermountain Healthcare model, but its generalizability to other health care systems remains unknown. Objective The objective of this study is to evaluate the generalizability of our automatic explanation method to KPSC for forecasting asthma-related hospital visits. Methods Through a secondary analysis of 987,506 data instances from 2012 to 2017 at KPSC, we used our method to explain the forecasting results of our KPSC model and to suggest customized interventions. The patient cohort covered a random sample of 70% of patients with asthma who had a KPSC health plan for any period between 2015 and 2018. Results Our method explained the forecasting results for 97.57% (2204/2259) of the patients with asthma who were correctly forecasted to undergo asthma-related hospital visits in the succeeding 12 months. Conclusions For forecasting asthma-related hospital visits, our automatic explanation method exhibited an acceptable generalizability to KPSC. International Registered Report Identifier (IRRID) RR2-10.2196/resprot.5039
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Affiliation(s)
- Gang Luo
- Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, WA, United States
| | - Claudia L Nau
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, United States
| | - William W Crawford
- Department of Allergy and Immunology, Kaiser Permanente South Bay Medical Center, Harbor City, CA, United States
| | - Michael Schatz
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, United States.,Department of Allergy, Kaiser Permanente Southern California, San Diego, CA, United States
| | - Robert S Zeiger
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, United States.,Department of Allergy, Kaiser Permanente Southern California, San Diego, CA, United States
| | - Corinna Koebnick
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, United States
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Lu M, Litonjua AA, O'Connor GT, Zeiger RS, Bacharier L, Schatz M, Carey VJ, Weiss ST, Mirzakhani H. Effect of early and late prenatal vitamin D and maternal asthma status on offspring asthma or recurrent wheeze. J Allergy Clin Immunol 2021; 147:1234-1241.e3. [PMID: 32822692 PMCID: PMC7892633 DOI: 10.1016/j.jaci.2020.06.041] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 05/24/2020] [Accepted: 06/24/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND Childhood asthma developmental programming is complex. Maternal asthma is a strong risk factor for childhood asthma, whereas vitamin D (VD) has emerged as a modifiable prenatal exposure. OBJECTIVE Our aim was to examine the combined effect of early and late prenatal VD status in during pregnancies in women with and without asthma on childhood asthma or recurrent wheeze development. METHODS We conducted a cohort study using prospectively collected data from the Vitamin D Antenatal Asthma Reduction Trial, a randomized, double-blinded, placebo-controlled VD supplementation trial in pregnant women at high risk of offspring asthma (N = 806 mother-offspring pairs). 25-Hydroxyvitamin-D (25(OH)D) level was measured in early and late pregnancy. Our main exposure was an ordered variable representing early and late prenatal VD sufficiency (25(OH)D level ≥ 30 ng/mL) status during pregnancy in women with and without asthma. The primary outcome was offspring with asthma or recurrent wheeze by age 3 years. We also examined the effect of prenatal VD level on early life asthma or recurrent wheeze progression to active asthma at age 6 years. RESULTS Among mothers with asthma versus among mothers with early and late prenatal VD insufficiency, those with early or late VD sufficiency (adjusted odds ratio = 0.56; 95% CI = 0.31-1.00) or early and late VD sufficiency (adjusted odds ratio = 0.36; 95% CI = 0.15-0.81) had a lower risk of offspring with asthma or recurrent wheeze by age 3 years (Pfor trend = .008). This protective trend was reiterated in asthma or recurrent wheeze progression to active asthma from age 3 to 6 years (Pfor trend = .04). CONCLUSION This study implies a protective role for VD sufficiency throughout pregnancy, particularly in attenuating the risk conferred by maternal asthma on childhood asthma or recurrent wheeze development.
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Affiliation(s)
- Mengdi Lu
- Division of Pediatric Pulmonary Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Mass; Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass
| | - Augusto A Litonjua
- Division of Pediatric Pulmonary Medicine, Golisano Children's Hospital at University of Rochester Medical Center, Rochester, NY
| | - George T O'Connor
- Pulmonary Center, Department of Medicine, Boston Medical Center, Boston University, Boston, Mass
| | - Robert S Zeiger
- Department of Allergy and Research and Evaluation, Kaiser Permanente Southern California Region, San Diego and Pasadena, Calif
| | - Leonard Bacharier
- Division of Pediatric Allergy, Immunology and Pulmonary Medicine, Department of Pediatrics, Washington University, St Louis, Mo
| | - Michael Schatz
- Division of Pediatric Allergy, Immunology and Pulmonary Medicine, Department of Pediatrics, Washington University, St Louis, Mo
| | - Vincent J Carey
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass
| | - Scott T Weiss
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass
| | - Hooman Mirzakhani
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass.
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Knihtilä HM, Stubbs BJ, Carey VJ, Laranjo N, Chu SH, Kelly RS, Zeiger RS, Bacharier LB, O'Connor GT, Lasky-Su J, Weiss ST, Litonjua AA. Low gestational vitamin D level and childhood asthma are related to impaired lung function in high-risk children. J Allergy Clin Immunol 2021; 148:110-119.e9. [PMID: 33485958 DOI: 10.1016/j.jaci.2020.12.647] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 12/01/2020] [Accepted: 12/31/2020] [Indexed: 01/21/2023]
Abstract
BACKGROUND Lung function impairment in early life often persists into adulthood. Therefore, identifying risk factors for low childhood lung function is crucial. OBJECTIVE We examined the effect of 25-hydroxyvitamin D (25[OH]D) level and childhood asthma phenotype on childhood lung function in the Vitamin D Antenatal Asthma Reduction Trial (VDAART). METHODS The 25(OH)D level was measured at set time points in mothers during pregnancy and in children during early life. On the basis of parental reports, children were categorized into 3 clinical phenotypes: asymptomatic/infrequent wheeze, early transient wheeze, and asthma at age 6 years. Lung function was assessed with impulse oscillometry at ages 4, 5, and 6 years and with spirometry at ages 5 and 6 years. RESULTS A total of 570 mother-child pairs were included in this post hoc analysis. Mean gestational 25(OH)D-level quartiles were negatively associated with child respiratory resistance at 5 Hz (R5) from age 4 to 6 years (β, -0.021 kPa/L/s; 95% CI, -0.035 to -0.007; P = .003) and positively associated with FEV1 (β, 0.018 L; 95% CI, 0.005-0.031; P = .008) and forced vital capacity (β, 0.022 L; 95% CI, 0.009-0.036; P = .002) from age 5 to 6 years. Children with asthma at age 6 years had lower lung function from age 4 to 6 years than the asymptomatic/infrequent wheeze group (β, 0.065 kPa/L/s; 95% CI, 0.028 to 0.102; P < .001 for R5 and β, -0.063 L; 95% CI, -0.099 to -0.028; P < .001 for FEV1). CONCLUSIONS Low gestational 25(OH)D level and childhood asthma are important risk factors for decreased lung function in early childhood.
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Affiliation(s)
- Hanna M Knihtilä
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass
| | - Benjamin J Stubbs
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass
| | - Vincent J Carey
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass
| | - Nancy Laranjo
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass
| | - Su H Chu
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass
| | - Rachel S Kelly
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass
| | - Robert S Zeiger
- Departments of Allergy and Research and Evaluation, Kaiser Permanente Southern California Region, San Diego and Pasadena, Calif
| | - Leonard B Bacharier
- Division of Allergy, Immunology, and Pulmonary Medicine, Department of Pediatrics, St Louis Children's Hospital, Washington University School of Medicine, St Louis, Mo
| | - George T O'Connor
- Pulmonary Center, Department of Medicine, Boston University School of Medicine, Boston, Mass
| | - Jessica Lasky-Su
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass
| | - Scott T Weiss
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass.
| | - Augusto A Litonjua
- Division of Pediatric Pulmonary Medicine, Golisano Children's Hospital, University of Rochester Medical Center, Rochester, NY
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Zeiger JS, Silvers WS, Winders TA, Hart MK, Zeiger RS. Cannabis attitudes and patterns of use among followers of the Allergy & Asthma Network. Ann Allergy Asthma Immunol 2021; 126:401-410.e1. [PMID: 33465453 DOI: 10.1016/j.anai.2021.01.014] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 12/14/2020] [Accepted: 01/10/2021] [Indexed: 01/27/2023]
Abstract
BACKGROUND Cannabis use in patients with allergy/asthma, a high-risk group for adverse effects to cannabis, is unknown. OBJECTIVE To determine the patterns of use and attitudes toward cannabis in patients with allergy/asthma. METHODS An anonymous online survey on cannabis attitudes and use was conducted through the Adult Allergy & Asthma Network. The Asthma Control Test assessed asthma burden. Cluster analyses determined group phenotypes and factor analyses condensed cannabis subjective effects into similar response patterns. RESULTS A total of 88 of 489 respondents (18.0%) currently use cannabis with most at the age of less than 50 years old, of female sex, and of White race. Of the noncannabis users (N = 401), 2.5% reported cannabis allergy. Cluster analysis revealed that a liberal attitude toward cannabis was associated with current cannabis use (P < .001). Among current cannabis users, 40.9% of their physicians inquired on cannabis use; only 37.5% of users wanted to discuss cannabis. In addition, 65.9% used cannabis for medical or medical/recreational purposes. Cannabinoids used were tetrahydrocannabinol (33.0%), cannabidiol (19.3%), or both (47.7%). Smoked and vaped cannabis were reported by 53.4% and 35.2%, respectively. Furthermore, 51 cannabis users (58.0%) reported current asthma with 39.2% uncontrolled; of these, 50% smoked cannabis. Compared with current participants with asthma not using cannabis, those currently using cannabis experienced similar levels of asthma control, quality of life, and frequency of asthma exacerbations. Positive effects were endorsed more than negative effects to cannabis (P < .001). Moreover, 19.3% of cannabis users reported coughing that was associated with smoking cannabis (P < .001). CONCLUSION Cannabis was used by less than 20% of the respondents with positive effects more frequent than negative effects. Half of cannabis users with uncontrolled asthma smoke cannabis, but only a minority of the physicians inquire about its use.
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Affiliation(s)
| | - William S Silvers
- Canna Research Foundation, Boulder, Colorado; Department of Medicine, University of Colorado School of Medicine, Denver, Colorado
| | | | | | - Robert S Zeiger
- Department of Allergy, Kaiser Permanente Southern California, San Diego, California
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Sullivan PW, Ghushchyan VH, Skoner DP, LeCocq J, Park S, Zeiger RS. Complications and Health Care Resource Utilization Associated with Systemic Corticosteroids in Children and Adolescents with Persistent Asthma. J Allergy Clin Immunol Pract 2020; 9:1541-1551.e9. [PMID: 33290914 PMCID: PMC8393544 DOI: 10.1016/j.jaip.2020.11.049] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 10/22/2020] [Accepted: 11/20/2020] [Indexed: 01/30/2023]
Abstract
BACKGROUND: Limited comparative data are available on the impact of systemic corticosteroid (SCS) use in children and adolescents. OBJECTIVE: To determine if asthmatic children and adolescents treated with SCS have a higher likelihood of developing complications versus those not receiving SCS and to examine health care resource utilization (HCRU) in this population. METHODS: A retrospective study of data from children and adolescents with persistent asthma retrieved from the MarketScan database, a large US health claims data set, for the period 2000 to 2017 was performed. Propensity score matching was used to pair patients in the SCS and control cohorts. For complications, SCS subgroups (≥4 or 1-3 annual prescriptions) were compared with asthmatic controls without SCS using logistic regression, and for HCRU, cohorts were compared using negative binomial regression. RESULTS: A total of 67,081 patients were included (SCS: 23,898; control: 43,183). The odds of having a complication were 2.9 (95% confidence interval [CI], 2.5-3.2; P < .001) and 1.6 (95% CI, 1.6-1.7; P < .001) times higher in the ≥4 and 1 to 3 SCS groups, respectively, in the first year of follow-up versus controls. For asthma-related hospitalizations, the incidence rate ratio (IRR) was 6.9 (95% CI, 5.6-8.6) and 3.1 (95% CI, 2.8-3.4) times greater in the ≥4 SCS and 1 to 3 SCS groups, respectively, versus controls; for asthma-related emergency department visits, IRR was 5.0 (95% CI, 4.4-5.6) and 2.9 (95% CI, 2.7-3.0) times greater, respectively, versus controls (all P < .01). CONCLUSION: Children and adolescents receiving SCS for persistent asthma have an increased risk of developing complications and have greater HCRU in the first year of follow-up versus those without SCS exposure.
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Affiliation(s)
- Patrick W Sullivan
- Department of Pharmacy Practice, Regis University School of Pharmacy, Denver, Colo.
| | - Vahram H Ghushchyan
- Center for Pharmaceutical Outcomes Research, University of Colorado, Aurora, Colo; American University of Armenia, Yerevan, Armenia
| | - David P Skoner
- Department of Pediatrics, West Virginia University, Morgantown, WV
| | - Jason LeCocq
- Novartis Pharmaceuticals Corporation, East Hanover, NJ
| | - Siyeon Park
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, Md
| | - Robert S Zeiger
- Department of Allergy, Kaiser Permanente, Southern California Region, San Diego, Calif
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Zeiger RS, Schatz M, Hong B, Li Q, Stern JA, Takhar HS, Weaver JP, Bali V, Schelfhout J, Chen W. Patient-Reported Burden of Chronic Cough in a Managed Care Organization. J Allergy Clin Immunol Pract 2020; 9:1624-1637.e10. [PMID: 33227523 DOI: 10.1016/j.jaip.2020.11.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 11/04/2020] [Accepted: 11/08/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND The burden of chronic cough (CC) requires better understanding. OBJECTIVE To determine the severity, health status, and health care resource utilization among patients with CC identified by electronic health records on 2 visits separated by ≥1 year. METHODS Information on cough-related burden was collected through survey from patients with CC, including validated questionnaires (the cough health status Leicester Cough Questionnaire [LCQ], the cough hypersensitivity Hull Airway Reflux Questionnaire [HARQ], and the Cough Quality of Life Questionnaire [CQLQ]), CC-associated respiratory and gastrointestinal comorbidities, and treatment responses. Spearman correlation coefficients were reported to examine the associations among the LCQ, HARQ, and CQLQ. Patient demographics and patient-reported CC features were compared between males and females, and among ethnic groups using Robust Poisson regression models. RESULTS The survey was completed by 565 patients who were 64.8 ± 12.6 years, 75.8% female, and 60.4% white. CC duration was 8.6 ± 10.5 years with an average weekly severity of 5.3 ± 2.3 (maximum 10). The LCQ score was 11.3 ± 3.9 (maximum 21). The HARQ score was 33.3 ± 13.6 (normal ≤13). The CQLQ score was 56.9 ± 17.5 (maximum 112, worse with higher scores). The Spearman rank correlations were high between the LCQ and HARQ (-0.65), the LCQ and CQLQ (-0.80), and the HARQ and CQLQ (0.69). Patients with CC-associated respiratory and gastrointestinal comorbidities generally showed similar results regarding the above questionnaires. Treatment responses were suboptimal. Women compared with men and non-whites compared with whites reported significantly worse cough severity and poorer LCQ, HARQ, and CQLQ scores. CONCLUSIONS CC is self-reported as a burdensome condition, particularly in women and non-white minorities, which markedly affects daily living with inadequate response to treatments.
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Affiliation(s)
- Robert S Zeiger
- Department of Allergy, Kaiser Permanente Southern California, San Diego, Calif; Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, Calif.
| | - Michael Schatz
- Department of Allergy, Kaiser Permanente Southern California, San Diego, Calif
| | - Benjamin Hong
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, Calif
| | - Qiaowu Li
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, Calif
| | - Julie A Stern
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, Calif
| | - Harpreet S Takhar
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, Calif
| | - Jessica P Weaver
- Center for Observational and Real-World Evidence (CORE), Merck & Co., Inc., Kenilworth, NJ
| | - Vishal Bali
- Center for Observational and Real-World Evidence (CORE), Merck & Co., Inc., Kenilworth, NJ
| | - Jonathan Schelfhout
- Center for Observational and Real-World Evidence (CORE), Merck & Co., Inc., Kenilworth, NJ
| | - Wansu Chen
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, Calif
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Luo G, Nau CL, Crawford WW, Schatz M, Zeiger RS, Rozema E, Koebnick C. Developing a Predictive Model for Asthma-Related Hospital Encounters in Patients With Asthma in a Large, Integrated Health Care System: Secondary Analysis. JMIR Med Inform 2020; 8:e22689. [PMID: 33164906 PMCID: PMC7683251 DOI: 10.2196/22689] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 09/15/2020] [Accepted: 10/18/2020] [Indexed: 12/22/2022] Open
Abstract
Background Asthma causes numerous hospital encounters annually, including emergency department visits and hospitalizations. To improve patient outcomes and reduce the number of these encounters, predictive models are widely used to prospectively pinpoint high-risk patients with asthma for preventive care via care management. However, previous models do not have adequate accuracy to achieve this goal well. Adopting the modeling guideline for checking extensive candidate features, we recently constructed a machine learning model on Intermountain Healthcare data to predict asthma-related hospital encounters in patients with asthma. Although this model is more accurate than the previous models, whether our modeling guideline is generalizable to other health care systems remains unknown. Objective This study aims to assess the generalizability of our modeling guideline to Kaiser Permanente Southern California (KPSC). Methods The patient cohort included a random sample of 70.00% (397,858/568,369) of patients with asthma who were enrolled in a KPSC health plan for any duration between 2015 and 2018. We produced a machine learning model via a secondary analysis of 987,506 KPSC data instances from 2012 to 2017 and by checking 337 candidate features to project asthma-related hospital encounters in the following 12-month period in patients with asthma. Results Our model reached an area under the receiver operating characteristic curve of 0.820. When the cutoff point for binary classification was placed at the top 10.00% (20,474/204,744) of patients with asthma having the largest predicted risk, our model achieved an accuracy of 90.08% (184,435/204,744), a sensitivity of 51.90% (2259/4353), and a specificity of 90.91% (182,176/200,391). Conclusions Our modeling guideline exhibited acceptable generalizability to KPSC and resulted in a model that is more accurate than those formerly built by others. After further enhancement, our model could be used to guide asthma care management. International Registered Report Identifier (IRRID) RR2-10.2196/resprot.5039
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Affiliation(s)
- Gang Luo
- Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, WA, United States
| | - Claudia L Nau
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, United States
| | - William W Crawford
- Department of Allergy and Immunology, Kaiser Permanente South Bay Medical Center, Harbor City, CA, United States
| | - Michael Schatz
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, United States.,Department of Allergy, Kaiser Permanente Southern California, San Diego, CA, United States
| | - Robert S Zeiger
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, United States.,Department of Allergy, Kaiser Permanente Southern California, San Diego, CA, United States
| | - Emily Rozema
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, United States
| | - Corinna Koebnick
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, United States
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Zeiger JS, Silvers WS, Fleegler EM, Zeiger RS. Attitudes about cannabis mediate the relationship between cannabis knowledge and use in active adult athletes. J Cannabis Res 2020; 2:18. [PMID: 33526137 PMCID: PMC7819330 DOI: 10.1186/s42238-020-00023-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 04/02/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Little is known about how cannabis knowledge and attitudes impact cannabis use behavior. OBJECTIVE To test the knowledge-attitudes-behavior paradigm in active adult athletes. DESIGN The Athlete Pain, Exercise, and Cannabis Experience (PEACE) Survey, a cross-sectional survey study, used social media and email blasts to recruit participants and SurveyGizmo to collect data. PARTICIPANTS Self-defined active adult athletes (n = 1161). MAIN MEASURES Knowledge about cannabis was evaluated with four questions. Attitudes toward cannabis was evaluated with 11 questions. The attitudes questions were used in a TwoStep Cluster analysis in SPSS to assign group membership by attitudes. Chi-square was used to determine if there were differences in cluster membership by demographic factors and if knowledge about cannabis differed by cluster membership. Regression analysis was performed to determine if cannabis attitudes mediated the relationship between cannabis knowledge and cannabis use. KEY RESULTS A three-cluster solution was the best fit to the data. The clusters were named Conservative (n = 374, 32.2%), Unsure (n = 533, 45.9%), and Liberal (n = 254, 21.9). There was a significant difference among the clusters for all 11 attitudes items (all p < 0.001). Attitude cluster membership was significantly different by age (p < 0.001), primary sport (p < 0.05), and knowledge about cannabis (p < 0.001). Athletes in the liberal cluster answered the knowledge questions correctly most often. Attitudes mediated the relationship between cannabis knowledge and cannabis use [Never (32.4%), Past (41.6%), Current (26.0%)] with athletes in the liberal cluster showing more knowledge and greater likelihood to be a current cannabis user (p < 0.001). Among current cannabis users there were differential patterns of cannabis use depending on their attitudes and knowledge; liberal athletes tended to co-use THC and CBD and used cannabis longer. (p < 0.001). CONCLUSIONS Cannabis education needs to consider attitudes about cannabis, especially among those who might benefit from medical cannabis.
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Affiliation(s)
- Joanna S Zeiger
- Canna Research Group, 3996 Savannah Ct, Boulder, CO, 80301, USA.
| | - William S Silvers
- Canna Research Group, 3996 Savannah Ct, Boulder, CO, 80301, USA
- Division of Allergy and Clinical Immunology, University of Colorado Denver School of Medicine, 12700 E. 19th Ave., Room 10C03, Aurora, CO, 80045, USA
| | - Edward M Fleegler
- Canna Research Group, 3996 Savannah Ct, Boulder, CO, 80301, USA
- To-Life in Peace, LLC, 3812 Taft Court, Wheat Ridge, CO, 80033, USA
| | - Robert S Zeiger
- Canna Research Group, 3996 Savannah Ct, Boulder, CO, 80301, USA
- Kaiser Permanente Southern California, 7060 Clairemont Mesa Blvd, San Diego, CA, 92111, USA
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Angel DM, Zeiger RS, Sicherer SH, Khan DA, Schatz M. JACI: In Practice Response to COVID-19 Pandemic. J Allergy Clin Immunol Pract 2020; 8:1475-1476. [PMID: 32272283 PMCID: PMC7194788 DOI: 10.1016/j.jaip.2020.03.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 03/31/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Dawn M Angel
- American Academy of Allergy, Asthma & Immunology, Denver, Colo
| | - Robert S Zeiger
- Department of Allergy, Kaiser Permanente Southern California, San Diego, Calif; Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, Calif
| | - Scott H Sicherer
- Jaffe Food Allergy Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - David A Khan
- Department of Internal Medicine, Division of Allergy & Immunology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Michael Schatz
- Department of Allergy, Kaiser Permanente Southern California, San Diego, Calif.
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Haselkorn T, Szefler SJ, Chipps BE, Bleecker ER, Harkins MS, Paknis B, Kianifard F, Ortiz B, Zeiger RS. Disease Burden and Long-Term Risk of Persistent Very Poorly Controlled Asthma: TENOR II. J Allergy Clin Immunol Pract 2020; 8:2243-2253. [PMID: 32173511 DOI: 10.1016/j.jaip.2020.02.040] [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] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 01/30/2020] [Accepted: 02/26/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Severe/difficult-to-treat disease occurs in 5% to 10% of patients with asthma, but accounts for more than 50% of related economic costs. Understanding factors associated with persistent very poorly controlled (VPC) asthma may improve outcomes. OBJECTIVE To characterize persistent VPC asthma after more than 10 years of standard of care. METHODS The Epidemiology and Natural history of asthma: Outcomes and treatment Regimens (TENOR) II (N = 341) was a multicenter, observational study of patients with severe/difficult-to-treat asthma with a single, cross-sectional visit more than 10 years after TENOR I. Persistent VPC asthma was defined as VPC asthma at TENOR I and TENOR II enrollment; without VPC asthma was defined as well- or not well-controlled asthma at either or both visits. Multivariable logistic regression assessed long-term predictors of persistent VPC asthma using TENOR I baseline variables. RESULTS Of 327 patients, nearly half (48.0%, n = 157) had persistent VPC asthma. Comorbidities and asthma triggers were more frequent in patients with persistent VPC asthma than in patients without VPC asthma. Total geometric mean IgE was higher in patients with persistent VPC asthma (89.3 IU/mL vs 55.7 IU/mL); there was no difference in eosinophil levels. Lung function was lower in patients with persistent VPC asthma (mean % predicted pre- and postbronchodilator FEV1, 63.0% vs 82.8% and 69.6% vs 87.2%, respectively). Exacerbations in the previous year were more likely in patients with persistent VPC asthma (29.7% vs 9.0%, respectively). Predictors of persistent VPC asthma were black versus white race/ethnicity, allergic trigger count (4 vs 0), systemic corticosteroid use, and postbronchodilator FEV1 (per 10% decrease). CONCLUSIONS The burden of persistent VPC asthma is high in severe/difficult-to-treat disease; management of modifiable risk factors, maximization of lung function, and trigger avoidance may improve outcomes.
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Affiliation(s)
| | - Stanley J Szefler
- The Breathing Institute, Children's Hospital Colorado, Aurora, Colo; Department of Pediatrics, Section of Pediatric Pulmonary and Sleep Medicine, University of Colorado School of Medicine, Aurora, Colo
| | - Bradley E Chipps
- Capital Allergy and Respiratory Disease Center, Sacramento, Calif
| | - Eugene R Bleecker
- Department of Medicine, Division of Pharmacogenomics, Center for Applied Genetics and Genomics Medicine, University of Arizona Health Sciences, Tucson, Ariz
| | - Michelle S Harkins
- Division of Pulmonary, Critical Care and Sleep Medicine, University of New Mexico, Albuquerque, NM
| | | | | | | | - Robert S Zeiger
- Departments of Allergy and Research and Evaluation, Kaiser Permanente Southern California, San Diego and Pasadena, Calif
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Fitzpatrick AM, Bacharier LB, Jackson DJ, Szefler SJ, Beigelman A, Cabana M, Covar R, Guilbert T, Holguin F, Lemanske RF, Martinez FD, Morgan W, Phipatanakul W, Pongracic JA, Raissy HH, Zeiger RS, Mauger DT. Heterogeneity of Mild to Moderate Persistent Asthma in Children: Confirmation by Latent Class Analysis and Association with 1-Year Outcomes. J Allergy Clin Immunol Pract 2020; 8:2617-2627.e4. [PMID: 32156610 DOI: 10.1016/j.jaip.2020.02.032] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 02/17/2020] [Indexed: 01/04/2023]
Abstract
BACKGROUND Compared with adults, phenotypic characterization of children with asthma is still limited and it remains difficult to predict which children with asthma are at highest risk for poor outcomes. OBJECTIVE To identify latent classes in a large population of treatment-adherent children with mild to moderate asthma enrolled in clinical trials and determine whether latent class assignment predicts future lung function abnormalities and exacerbation rate. METHODS Latent class analysis was performed on 2593 children with mild to moderate asthma aged 5 18 years, with 19 variables encompassing demographic characteristics, medical history, symptoms, lung function, allergic sensitization, and type 2 inflammation. Outcomes included lung function and the annualized exacerbation rate at 12 months of follow-up. RESULTS Five latent classes were identified with differing demographic features, asthma control, sensitization, type 2 inflammatory markers, and lung function. Exacerbation rates were 1.30 ± 0.12 for class 1 (multiple sensitization with partially reversible airflow limitation), 0.90 ± 0.05 for class 2 (multiple sensitization with reversible airflow limitation), 0.87 ± 0.08 for class 3 (lesser sensitization with reversible airflow limitation), 0.87 ± 0.05 for class 4 (multiple sensitization with normal lung function), and 0.71 ± 0.06 for class 5 (lesser sensitization with normal lung function). Lung function abnormalities persisted in class 1 at 12 months. CONCLUSIONS Children with mild to moderate asthma are a heterogeneous group. Allergic sensitization and lung function may be particularly useful in identifying children at the greatest risk for future exacerbation. Additional studies are needed to determine whether latent classes correspond to meaningful phenotypes for the purpose of personalized treatment.
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Affiliation(s)
- Anne M Fitzpatrick
- Department of Pediatrics, Emory University and Children's Healthcare of Atlanta, Atlanta, Ga.
| | - Leonard B Bacharier
- Department of Pediatrics, Washington University and St Louis Children's Hospital, St Louis, Mo
| | - Daniel J Jackson
- Departments of Pediatrics and Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wis
| | - Stanley J Szefler
- Children's Hospital Colorado and Department of Pediatrics, University of Colorado, Aurora, Colo
| | - Avraham Beigelman
- Department of Pediatrics, Washington University and St Louis Children's Hospital, St Louis, Mo
| | - Michael Cabana
- Department of Pediatrics, Albert Einstein College of Medicine and Montefiore Health System, Bronx, New York, NY
| | - Ronina Covar
- Department of Pediatrics, National Jewish Health, Denver, Colo
| | - Theresa Guilbert
- Department of Pediatrics, University of Cincinnati and Cincinnati Children's Hospital and Medical Center, Cincinnati, Ohio
| | | | - Robert F Lemanske
- Departments of Pediatrics and Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wis
| | | | - Wayne Morgan
- Department of Pediatrics, The University of Arizona, Tucson, Ariz
| | - Wanda Phipatanakul
- Division of Allergy and Immunology, Boston Children's Hospital and Harvard Medical School Department of Pediatrics, Boston, Mass
| | | | | | - Robert S Zeiger
- Kaiser Permanente, Southern California Region and Department of Pediatrics, University of California San Diego, San Diego, Calif
| | - David T Mauger
- Department of Public Health Sciences, Penn State University, Hershey, Pa
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Zeiger RS, Schatz M, Butler RK, Weaver JP, Bali V, Chen W. Burden of Specialist-Diagnosed Chronic Cough in Adults. J Allergy Clin Immunol Pract 2020; 8:1645-1657.e7. [PMID: 32059869 DOI: 10.1016/j.jaip.2020.01.054] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 12/31/2019] [Accepted: 01/26/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND The burden of chronic cough (CC) in patients seeking specialist care is infrequently researched. OBJECTIVE To describe patient characteristics and disease burden associated with specialist-diagnosed CC. METHODS Using administrative pharmacy and medical data, we identified patients aged 18 to 85 years with CC diagnosed by pulmonologists, allergists, otolaryngologists, or gastroenterologists. Patients were stratified into 4 subgroups on the basis of the presence or absence of common respiratory diseases or gastroesophageal reflux disease (GERD). Clinical features and health care resource utilization (HCRU) in the baseline and outcome years were compared between the CC subgroups. The baseline factors associated with persistence of CC and a comparison of the CC cohort to a matched noncough cohort were also determined. RESULTS The 11,290 patients with specialist-diagnosed CC were aged about 61 years and 66.7% were females. The CC cohort experienced frequent GERD (44.1%), asthma (31.2%), obesity (24.3%), upper airway cough syndrome (20.4%), common cough complications (19.4%), and hospitalizations (9.8%). The patients with CC with both respiratory disease and GERD exhibited at baseline and follow-up the most common cough comorbidities, higher HCRU, specialist care, and dispensed respiratory and nonrespiratory medications including proton pump inhibitors, antitussives, psychotherapeutics, oral corticosteroids, and antibiotics compared with the other subgroups. A 40.6% persistence of CC occurred similarly between CC subgroups. In addition, patients with CC in the matched analysis experienced significantly more comorbidities, laboratory evaluations, HCRU, and antitussives than patients without cough. CONCLUSIONS Specialist-diagnosed CC was associated with considerable disease burden, particularly among those with both respiratory disease and GERD. In addition, CC burden was more pronounced than in matched patients without cough.
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Affiliation(s)
- Robert S Zeiger
- Department of Allergy, Kaiser Permanente Southern California, San Diego, Calif; Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, Calif.
| | - Michael Schatz
- Department of Allergy, Kaiser Permanente Southern California, San Diego, Calif
| | - Rebecca K Butler
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, Calif
| | - Jessica P Weaver
- Center for Observational and Real-World Evidence (CORE), Merck & Co, Inc, Kenilworth, NJ
| | - Vishal Bali
- Center for Observational and Real-World Evidence (CORE), Merck & Co, Inc, Kenilworth, NJ
| | - Wansu Chen
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, Calif
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Litonjua AA, Carey VJ, Laranjo N, Stubbs BJ, Mirzakhani H, O'Connor GT, Sandel M, Beigelman A, Bacharier LB, Zeiger RS, Schatz M, Hollis BW, Weiss ST. Six-Year Follow-up of a Trial of Antenatal Vitamin D for Asthma Reduction. N Engl J Med 2020; 382:525-533. [PMID: 32023372 PMCID: PMC7444088 DOI: 10.1056/nejmoa1906137] [Citation(s) in RCA: 71] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND We previously reported the results of a trial of prenatal vitamin D supplementation to prevent asthma and recurrent wheeze in young children, which suggested that supplementation provided a protective effect at the age of 3 years. We followed the children through the age of 6 years to determine the course of asthma and recurrent wheeze. METHODS In this follow-up study, investigators and participants remained unaware of the treatment assignments through the children's sixth birthday. We aimed to determine whether, when maternal levels of 25-hydroxyvitamin D were taken into account, children born to mothers who had received 4400 IU of vitamin D3 per day during pregnancy (vitamin D group) would have a lower incidence of asthma and recurrent wheeze at the age of 6 years than would those born to mothers who had received 400 IU of vitamin D3 per day (control group). Time-to-event methods were used to compare the treatment groups with respect to time to the onset of asthma or recurrent wheeze. Multivariate methods were used to compare longitudinal measures of lung function between the treatment groups. RESULTS There was no effect of maternal vitamin D supplementation on asthma and recurrent wheeze in either an intention-to-treat analysis or an analysis with stratification according to the maternal 25-hydroxyvitamin D level during pregnancy. There was no effect of prenatal vitamin D supplementation on most of the prespecified secondary outcomes. We found no effects of prenatal supplementation on spirometric indexes. Although there was a very small effect on airway resistance as measured by impulse oscillometry, this finding was of uncertain significance. CONCLUSIONS Vitamin D supplementation during the prenatal period alone did not influence the 6-year incidence of asthma and recurrent wheeze among children who were at risk for asthma. (Funded by the National Heart, Lung, and Blood Institute; VDAART ClinicalTrials.gov number, NCT00920621.).
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Affiliation(s)
- Augusto A Litonjua
- From the Division of Pulmonary Medicine, Department of Pediatrics, Golisano Children's Hospital at Strong, University of Rochester Medical Center, Rochester, NY (A.A.L.); the Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital (V.J.C., N.L., B.J.S., H.M., S.T.W.), Harvard Medical School (V.J.C., H.M., S.T.W.), the Pulmonary Center, Department of Medicine, Boston University School of Medicine (G.T.O.), and the Department of Pediatrics, Boston Medical Center (M. Sandel) - all in Boston; the Division of Allergy, Immunology, and Pulmonary Medicine, Department of Pediatrics, St. Louis Children's Hospital, Washington University School of Medicine, St. Louis (A.B., L.B.B.); Kaiser Permanente Southern California, San Diego (R.S.Z., M. Schatz); and the Department of Pediatrics, Medical University of South Carolina, Charleston (B.W.H.)
| | - Vincent J Carey
- From the Division of Pulmonary Medicine, Department of Pediatrics, Golisano Children's Hospital at Strong, University of Rochester Medical Center, Rochester, NY (A.A.L.); the Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital (V.J.C., N.L., B.J.S., H.M., S.T.W.), Harvard Medical School (V.J.C., H.M., S.T.W.), the Pulmonary Center, Department of Medicine, Boston University School of Medicine (G.T.O.), and the Department of Pediatrics, Boston Medical Center (M. Sandel) - all in Boston; the Division of Allergy, Immunology, and Pulmonary Medicine, Department of Pediatrics, St. Louis Children's Hospital, Washington University School of Medicine, St. Louis (A.B., L.B.B.); Kaiser Permanente Southern California, San Diego (R.S.Z., M. Schatz); and the Department of Pediatrics, Medical University of South Carolina, Charleston (B.W.H.)
| | - Nancy Laranjo
- From the Division of Pulmonary Medicine, Department of Pediatrics, Golisano Children's Hospital at Strong, University of Rochester Medical Center, Rochester, NY (A.A.L.); the Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital (V.J.C., N.L., B.J.S., H.M., S.T.W.), Harvard Medical School (V.J.C., H.M., S.T.W.), the Pulmonary Center, Department of Medicine, Boston University School of Medicine (G.T.O.), and the Department of Pediatrics, Boston Medical Center (M. Sandel) - all in Boston; the Division of Allergy, Immunology, and Pulmonary Medicine, Department of Pediatrics, St. Louis Children's Hospital, Washington University School of Medicine, St. Louis (A.B., L.B.B.); Kaiser Permanente Southern California, San Diego (R.S.Z., M. Schatz); and the Department of Pediatrics, Medical University of South Carolina, Charleston (B.W.H.)
| | - Benjamin J Stubbs
- From the Division of Pulmonary Medicine, Department of Pediatrics, Golisano Children's Hospital at Strong, University of Rochester Medical Center, Rochester, NY (A.A.L.); the Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital (V.J.C., N.L., B.J.S., H.M., S.T.W.), Harvard Medical School (V.J.C., H.M., S.T.W.), the Pulmonary Center, Department of Medicine, Boston University School of Medicine (G.T.O.), and the Department of Pediatrics, Boston Medical Center (M. Sandel) - all in Boston; the Division of Allergy, Immunology, and Pulmonary Medicine, Department of Pediatrics, St. Louis Children's Hospital, Washington University School of Medicine, St. Louis (A.B., L.B.B.); Kaiser Permanente Southern California, San Diego (R.S.Z., M. Schatz); and the Department of Pediatrics, Medical University of South Carolina, Charleston (B.W.H.)
| | - Hooman Mirzakhani
- From the Division of Pulmonary Medicine, Department of Pediatrics, Golisano Children's Hospital at Strong, University of Rochester Medical Center, Rochester, NY (A.A.L.); the Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital (V.J.C., N.L., B.J.S., H.M., S.T.W.), Harvard Medical School (V.J.C., H.M., S.T.W.), the Pulmonary Center, Department of Medicine, Boston University School of Medicine (G.T.O.), and the Department of Pediatrics, Boston Medical Center (M. Sandel) - all in Boston; the Division of Allergy, Immunology, and Pulmonary Medicine, Department of Pediatrics, St. Louis Children's Hospital, Washington University School of Medicine, St. Louis (A.B., L.B.B.); Kaiser Permanente Southern California, San Diego (R.S.Z., M. Schatz); and the Department of Pediatrics, Medical University of South Carolina, Charleston (B.W.H.)
| | - George T O'Connor
- From the Division of Pulmonary Medicine, Department of Pediatrics, Golisano Children's Hospital at Strong, University of Rochester Medical Center, Rochester, NY (A.A.L.); the Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital (V.J.C., N.L., B.J.S., H.M., S.T.W.), Harvard Medical School (V.J.C., H.M., S.T.W.), the Pulmonary Center, Department of Medicine, Boston University School of Medicine (G.T.O.), and the Department of Pediatrics, Boston Medical Center (M. Sandel) - all in Boston; the Division of Allergy, Immunology, and Pulmonary Medicine, Department of Pediatrics, St. Louis Children's Hospital, Washington University School of Medicine, St. Louis (A.B., L.B.B.); Kaiser Permanente Southern California, San Diego (R.S.Z., M. Schatz); and the Department of Pediatrics, Medical University of South Carolina, Charleston (B.W.H.)
| | - Megan Sandel
- From the Division of Pulmonary Medicine, Department of Pediatrics, Golisano Children's Hospital at Strong, University of Rochester Medical Center, Rochester, NY (A.A.L.); the Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital (V.J.C., N.L., B.J.S., H.M., S.T.W.), Harvard Medical School (V.J.C., H.M., S.T.W.), the Pulmonary Center, Department of Medicine, Boston University School of Medicine (G.T.O.), and the Department of Pediatrics, Boston Medical Center (M. Sandel) - all in Boston; the Division of Allergy, Immunology, and Pulmonary Medicine, Department of Pediatrics, St. Louis Children's Hospital, Washington University School of Medicine, St. Louis (A.B., L.B.B.); Kaiser Permanente Southern California, San Diego (R.S.Z., M. Schatz); and the Department of Pediatrics, Medical University of South Carolina, Charleston (B.W.H.)
| | - Avraham Beigelman
- From the Division of Pulmonary Medicine, Department of Pediatrics, Golisano Children's Hospital at Strong, University of Rochester Medical Center, Rochester, NY (A.A.L.); the Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital (V.J.C., N.L., B.J.S., H.M., S.T.W.), Harvard Medical School (V.J.C., H.M., S.T.W.), the Pulmonary Center, Department of Medicine, Boston University School of Medicine (G.T.O.), and the Department of Pediatrics, Boston Medical Center (M. Sandel) - all in Boston; the Division of Allergy, Immunology, and Pulmonary Medicine, Department of Pediatrics, St. Louis Children's Hospital, Washington University School of Medicine, St. Louis (A.B., L.B.B.); Kaiser Permanente Southern California, San Diego (R.S.Z., M. Schatz); and the Department of Pediatrics, Medical University of South Carolina, Charleston (B.W.H.)
| | - Leonard B Bacharier
- From the Division of Pulmonary Medicine, Department of Pediatrics, Golisano Children's Hospital at Strong, University of Rochester Medical Center, Rochester, NY (A.A.L.); the Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital (V.J.C., N.L., B.J.S., H.M., S.T.W.), Harvard Medical School (V.J.C., H.M., S.T.W.), the Pulmonary Center, Department of Medicine, Boston University School of Medicine (G.T.O.), and the Department of Pediatrics, Boston Medical Center (M. Sandel) - all in Boston; the Division of Allergy, Immunology, and Pulmonary Medicine, Department of Pediatrics, St. Louis Children's Hospital, Washington University School of Medicine, St. Louis (A.B., L.B.B.); Kaiser Permanente Southern California, San Diego (R.S.Z., M. Schatz); and the Department of Pediatrics, Medical University of South Carolina, Charleston (B.W.H.)
| | - Robert S Zeiger
- From the Division of Pulmonary Medicine, Department of Pediatrics, Golisano Children's Hospital at Strong, University of Rochester Medical Center, Rochester, NY (A.A.L.); the Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital (V.J.C., N.L., B.J.S., H.M., S.T.W.), Harvard Medical School (V.J.C., H.M., S.T.W.), the Pulmonary Center, Department of Medicine, Boston University School of Medicine (G.T.O.), and the Department of Pediatrics, Boston Medical Center (M. Sandel) - all in Boston; the Division of Allergy, Immunology, and Pulmonary Medicine, Department of Pediatrics, St. Louis Children's Hospital, Washington University School of Medicine, St. Louis (A.B., L.B.B.); Kaiser Permanente Southern California, San Diego (R.S.Z., M. Schatz); and the Department of Pediatrics, Medical University of South Carolina, Charleston (B.W.H.)
| | - Michael Schatz
- From the Division of Pulmonary Medicine, Department of Pediatrics, Golisano Children's Hospital at Strong, University of Rochester Medical Center, Rochester, NY (A.A.L.); the Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital (V.J.C., N.L., B.J.S., H.M., S.T.W.), Harvard Medical School (V.J.C., H.M., S.T.W.), the Pulmonary Center, Department of Medicine, Boston University School of Medicine (G.T.O.), and the Department of Pediatrics, Boston Medical Center (M. Sandel) - all in Boston; the Division of Allergy, Immunology, and Pulmonary Medicine, Department of Pediatrics, St. Louis Children's Hospital, Washington University School of Medicine, St. Louis (A.B., L.B.B.); Kaiser Permanente Southern California, San Diego (R.S.Z., M. Schatz); and the Department of Pediatrics, Medical University of South Carolina, Charleston (B.W.H.)
| | - Bruce W Hollis
- From the Division of Pulmonary Medicine, Department of Pediatrics, Golisano Children's Hospital at Strong, University of Rochester Medical Center, Rochester, NY (A.A.L.); the Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital (V.J.C., N.L., B.J.S., H.M., S.T.W.), Harvard Medical School (V.J.C., H.M., S.T.W.), the Pulmonary Center, Department of Medicine, Boston University School of Medicine (G.T.O.), and the Department of Pediatrics, Boston Medical Center (M. Sandel) - all in Boston; the Division of Allergy, Immunology, and Pulmonary Medicine, Department of Pediatrics, St. Louis Children's Hospital, Washington University School of Medicine, St. Louis (A.B., L.B.B.); Kaiser Permanente Southern California, San Diego (R.S.Z., M. Schatz); and the Department of Pediatrics, Medical University of South Carolina, Charleston (B.W.H.)
| | - Scott T Weiss
- From the Division of Pulmonary Medicine, Department of Pediatrics, Golisano Children's Hospital at Strong, University of Rochester Medical Center, Rochester, NY (A.A.L.); the Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital (V.J.C., N.L., B.J.S., H.M., S.T.W.), Harvard Medical School (V.J.C., H.M., S.T.W.), the Pulmonary Center, Department of Medicine, Boston University School of Medicine (G.T.O.), and the Department of Pediatrics, Boston Medical Center (M. Sandel) - all in Boston; the Division of Allergy, Immunology, and Pulmonary Medicine, Department of Pediatrics, St. Louis Children's Hospital, Washington University School of Medicine, St. Louis (A.B., L.B.B.); Kaiser Permanente Southern California, San Diego (R.S.Z., M. Schatz); and the Department of Pediatrics, Medical University of South Carolina, Charleston (B.W.H.)
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Schatz M, Sicherer SH, Khan DA, Zeiger RS. The Journal of Allergy and Clinical Immunology: In Practice 2019 Highlights. J Allergy Clin Immunol Pract 2020; 8:912-936. [PMID: 31980411 DOI: 10.1016/j.jaip.2020.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 01/03/2020] [Indexed: 10/25/2022]
Abstract
This article provides highlights of the clinically impactful original studies and reviews published in The Journal of Allergy and Clinical Immunology: In Practice in 2019 on the subjects of anaphylaxis, asthma, dermatitis, drug allergy, food allergy, immunodeficiency, immunotherapy, rhinitis/sinusitis, and urticaria/angioedema/mast cell disorders. Within each topic, practical aspects of diagnosis and management are emphasized. Treatments discussed include lifestyle modifications, allergen avoidance therapy, positive and negative effects of pharmacologic therapy, and various forms of immunologic and desensitization management. We designed this review to help readers consolidate and use this extensive and practical knowledge for the benefit of their patients.
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Affiliation(s)
- Michael Schatz
- Department of Allergy, Kaiser Permanente Southern California, San Diego, Calif.
| | - Scott H Sicherer
- Jaffe Food Allergy Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - David A Khan
- Department of Internal Medicine, Division of Allergy & Immunology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Robert S Zeiger
- Department of Allergy, Kaiser Permanente Southern California, San Diego, Calif; Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, Calif
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Zeiger RS, Xie F, Schatz M, Hong BD, Weaver JP, Bali V, Schelfhout J, Chen W. Prevalence and Characteristics of Chronic Cough in Adults Identified by Administrative Data. Perm J 2020; 24:1-3. [PMID: 33482968 DOI: 10.7812/tpp/20.022] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
CONTEXT International Classification of Diseases-9/10 codes for chronic cough (CC) do not exist, limiting investigation. OBJECTIVE To develop a computerized algorithm to determine CC prevalence and its characteristics. DESIGN This observational study using administrative data identified hierarchically patients aged 18 to 85 years with CC from 2013 to 2016. First, a specialist-diagnosed CC group was identified using an internal CC encounter code during an outpatient visit to a pulmonologist, allergist, otolaryngologist, or gastroenterologist. Subsequently, an event-diagnosed CC group was identified based on clinical notes through natural language processing, ICD-9/ICD-10 cough codes, and dispensed antitussives. MAIN OUTCOME MEASURES Prevalence of CC and comparison of clinical characteristics between specialist-diagnosed and event-diagnosed CC subgroups. RESULTS A total of 50,163 patients with CC of more than 8 weeks were identified. Of these, 11,290 (22.5%) were specialist diagnosed, and 38,873 (77.5%) were event diagnosed. The CC cohort was 57.4 ± 16.5 years of age; 67.6% were female. The overall prevalence was 1.04% (95% confidence interval = 1.03-1.06) in 2016. Prevalence in 2016 was higher in female patients (1.21%) than in male patients (0.81%), higher in patients aged 65 to 85 years (2.2%) than in patients aged 18 to 44 years (0.43%), and higher in Blacks (1.38%) than in Whites (1.21%). Compared with patients with event-diagnosed CC, patients with specialist-diagnosed CC exhibited significantly higher frequencies of laboratory tests and respiratory and nonrespiratory comorbidities and dispensed medication and lower frequency of pneumonia, all-cause and respiratory-cause emergency department visits and hospitalizations, and dispensed antitussives. CONCLUSIONS We identified a CC cohort using electronic data in a managed care organization. Prevalences varied by sex, age, and ethnicity. Clinical characteristics varied between specialist-diagnosed and event-diagnosed CC.
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Affiliation(s)
- Robert S Zeiger
- Departments of Allergy and Research and Evaluation, Kaiser Permanente Southern California, San Diego and Pasadena, CA
| | - Fagen Xie
- Departments of Allergy and Research and Evaluation, Kaiser Permanente Southern California, San Diego and Pasadena, CA
| | - Michael Schatz
- Departments of Allergy and Research and Evaluation, Kaiser Permanente Southern California, San Diego and Pasadena, CA
| | - Benjamin D Hong
- Departments of Allergy and Research and Evaluation, Kaiser Permanente Southern California, San Diego and Pasadena, CA
| | - Jessica P Weaver
- Center for Observational and Real-World Evidence (CORE), Merck & Co, Inc, Kenilworth, NJ
| | - Vishal Bali
- Center for Observational and Real-World Evidence (CORE), Merck & Co, Inc, Kenilworth, NJ
| | - Jonathan Schelfhout
- Center for Observational and Real-World Evidence (CORE), Merck & Co, Inc, Kenilworth, NJ
| | - Wansu Chen
- Departments of Allergy and Research and Evaluation, Kaiser Permanente Southern California, San Diego and Pasadena, CA
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Chen W, Schatz M, Liang Z, Li Q, Sadikova E, Zhang Z, Bagga S, Zeiger RS. Controller therapy in Asians and whites with persistent Asthma. Asian Pac J Allergy Immunol 2019; 37:73-86. [PMID: 29888928 DOI: 10.12932/ap-210617-0105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Little is known concerning the relative effectiveness of LTRAs compared to ICSs as monotherapy or LABA as add-on therapy in the Asian population. OBJECTIVES In this retrospective cohort study, we examined the comparative effectiveness of montelukast to ICS as a first-line monotherapy and as an add-on in comparison with LABA on asthma exacerbations among Asian and non -Hispanic white persistent asthma patients in a large managed care organization. METHODS The three add-on comparisons were montelukast plus low-dose ICS versus LABA plus low-dose ICS, montelukast plus low-dose ICS versus medium-dose ICS, and montelukast plus medium-dose ICS versus LABA plus medium-dose ICS. Patients were identified based on ICD-9 diagnosis codes and administrative pharmacy dispensing. Exacerbations were defined as asthma emergency department visit or hospitalization, or asthma outpatient visits requiring systemic corticosteroid dispensing. Patient demographic and clinical characteristics were balanced by using inverse probability treatment weighting. Multivariable robust Poisson and Cox-proportional hazards regression models were applied to estimate rate ratios and hazard ratios. RESULTS Compared with low-dose ICS monotherapy, montelukast monotherapy evidenced a lower incidence rate (RR 0.89, CI 0.79-0.99, p = 0.03) but similar hazard rate (HR 0.96, CI 0.86-1.06, p = 0.43) of asthma exacerbation in white patients 12 years of age or older. No difference was observed in Asian patients or in white children 4-11 years of age. All other comparisons did not reveal a statistically significant difference in incidence or hazard rate. CONCLUSION In a real-world comparative effectiveness study, asthma exacerbation rates were similar among guideline alternative controller regimens in Asians and whites.
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Affiliation(s)
- Wansu Chen
- Departments of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | - Michael Schatz
- Departments of Allergy, Kaiser Permanente Southern California, San Diego, CA
| | - Zhi Liang
- Departments of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | - Qiaowu Li
- Departments of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | | | - Zilu Zhang
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute
| | | | - Robert S Zeiger
- Departments of Allergy, Kaiser Permanente Southern California, San Diego, CA
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Lee-Sarwar KA, Kelly RS, Lasky-Su J, Zeiger RS, O'Connor GT, Sandel MT, Bacharier LB, Beigelman A, Rifas-Shiman SL, Carey VJ, Harshfield BJ, Laranjo N, Gold DR, Weiss ST, Litonjua AA. Fecal short-chain fatty acids in pregnancy and offspring asthma and allergic outcomes. J Allergy Clin Immunol Pract 2019; 8:1100-1102.e13. [PMID: 31494295 DOI: 10.1016/j.jaip.2019.08.036] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 08/07/2019] [Accepted: 08/08/2019] [Indexed: 12/26/2022]
Affiliation(s)
- Kathleen A Lee-Sarwar
- Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass; Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass.
| | - Rachel S Kelly
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass
| | - Jessica Lasky-Su
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass
| | - Robert S Zeiger
- Departments of Allergy and Research and Evaluation, Kaiser Permanente Southern California, San Diego and Pasadena, Calif
| | - George T O'Connor
- Pulmonary Center and Department of Medicine, Boston University School of Medicine, Boston, Mass
| | - Megan T Sandel
- Department of Pediatrics, Boston Medical Center, Boston, Mass
| | - Leonard B Bacharier
- Division of Pediatric Allergy, Immunology and Pulmonary Medicine, Department of Pediatrics, Washington University School of Medicine, St Louis, Mo; St Louis Children's Hospital, St Louis, Mo
| | - Avraham Beigelman
- Division of Pediatric Allergy, Immunology and Pulmonary Medicine, Department of Pediatrics, Washington University School of Medicine, St Louis, Mo; St Louis Children's Hospital, St Louis, Mo
| | - Sheryl L Rifas-Shiman
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Mass
| | - Vincent J Carey
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass
| | - Benjamin J Harshfield
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass
| | - Nancy Laranjo
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass
| | - Diane R Gold
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass; Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Mass
| | - Scott T Weiss
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass
| | - Augusto A Litonjua
- Division of Pediatric Pulmonary Medicine, Golisano Children's Hospital at Strong, University of Rochester Medical Center, Rochester, NY
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Mirzakhani H, Carey VJ, McElrath TF, Hollis BW, O’Connor GT, Zeiger RS, Bacharier L, Litonjua AA, Weiss ST. Maternal Asthma, Preeclampsia, and Risk for Childhood Asthma at Age Six. Am J Respir Crit Care Med 2019; 200:638-642. [PMID: 31059286 PMCID: PMC6727151 DOI: 10.1164/rccm.201901-0081le] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Affiliation(s)
- Hooman Mirzakhani
- Harvard Medical SchoolBoston, Massachusetts
- Brigham and Women’s HospitalBoston, Massachusetts
| | - Vincent J. Carey
- Harvard Medical SchoolBoston, Massachusetts
- Brigham and Women’s HospitalBoston, Massachusetts
| | | | | | | | | | | | | | - Scott T. Weiss
- Harvard Medical SchoolBoston, Massachusetts
- Partners Health CareBoston, Massachusetts
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Zeiger JS, Silvers WS, Fleegler EM, Zeiger RS. Age related differences in cannabis use and subjective effects in a large population-based survey of adult athletes. J Cannabis Res 2019; 1:7. [PMID: 33526101 PMCID: PMC7819305 DOI: 10.1186/s42238-019-0006-9] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 06/20/2019] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND There is a paucity of information regarding cannabis use behaviors in adult community-based athletes as most research in athletes has focused on misuse of cannabis in elite, adolescent, university-based athletes. We aimed to determine whether age related differences exist in patterns of cannabis use and subjective effects to cannabis in adult athletes. METHODS The Athlete PEACE Survey used mainly social media and email blasts to recruit and SurveyGizmo to collect data. Cannabis patterns of use (duration of use, frequency of use, routes of administration, cannabinoid used, concurrent use with exercise), benefits, and adverse effects were reported. Age was reported by decade from 21 to ≥60. Age trends in cannabis use patterns and subjective effects were assessed using linear trend analysis. RESULTS Of the 1161 participants, 301 (26%) athletes currently used cannabis. Younger athletes compared to older athletes reported significantly more positive and adverse subjective effects to cannabis, used cannabis longer, and used both tetrahydrocannabinol and cannabidiol for medical and recreational purposes. Younger athletes used cannabis concurrently with exercise more often than older athletes and consumed edibles, vaporized, and smoked more than older athletes. CONCLUSIONS We found age-related cannabis patterns of use and subjective effects to cannabis. Concerns about cannabis mis-use and abuse in athletes maybe overstated with the potential benefits (improved sleep, decreased anxiety, less pain) outweighing the adverse effects (increased anxiety, increased appetite, difficulty concentrating).
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Affiliation(s)
- Joanna S Zeiger
- Canna Research Group, 3996 Savannah Ct., Boulder, CO, 80301, USA.
| | - William S Silvers
- Canna Research Group, 3996 Savannah Ct., Boulder, CO, 80301, USA
- Division of Allergy and Clinical Immunology, University of Colorado Denver School of Medicine, 12700 E. 19th Ave., Room 10C03, Aurora, CO, 80045, USA
| | - Edward M Fleegler
- Canna Research Group, 3996 Savannah Ct., Boulder, CO, 80301, USA
- To-Life in Peace, LLC, 3812 Taft Court, Wheat Ridge, Colorado, 80033, USA
| | - Robert S Zeiger
- Canna Research Group, 3996 Savannah Ct., Boulder, CO, 80301, USA
- Kaiser Permanente Southern California, 7060 Clairemont Mesa Blvd, San Diego, CA, 92111, USA
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Zeiger JS, Silvers WS, Fleegler EM, Zeiger RS. Cannabis use in active athletes: Behaviors related to subjective effects. PLoS One 2019; 14:e0218998. [PMID: 31251769 PMCID: PMC6598761 DOI: 10.1371/journal.pone.0218998] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 05/29/2019] [Indexed: 12/20/2022] Open
Abstract
Cannabis use has not been well characterized in athletes. Studies primarily examine problematic use or its categorization by anti-doping bodies as a banned substance. Patterns of use, reasons for use, and responses to cannabis consumption have not been studied in a community-based sample of adult athletes. The Athlete PEACE Survey examined cannabis use patterns and subjective effects to cannabis in a community-based cohort of adult athletes. We used mainly social media and email blasts to recruit and SurveyGizmo to collect data. 1,161 (91.1%) of the 1,274 athletes taking the survey completed it. Current cannabis use was evaluated by asking "In the past two weeks, have you used marijuana (including THC and/or CBD)?" and cannabis type used was assessed by asking "What do you primarily use THC, CBD, or both?". Cannabis benefits and adverse effects (i.e. subjective effects) and patterns of use were reported. 302 athletes (26%) currently use cannabis of whom 301 had complete data for cluster analysis. Cluster analysis was used to determine cannabis user phenotypes and exploratory factor analysis (EFA) was used to create subjective effects factors. Associations between cannabis user phenotype clusters and the subjective effects factors were explored using multivariate analysis. Cluster analysis identified three statistically distinct cannabis user phenotypes: (1) older athletes who primarily use medical CBD, (2) mixed age athletes who use cannabis mainly recreationally with both THC and CBD use, and (3) mixed age athletes who used cannabis the longest with primary THC and CBD use. EFA showed three subjective effects factors: (1) Well-being, (2) Calm, and (3) Adverse. Mean positive subjective were higher than mean adverse subjective effects (p<0.001). The cluster using THC and CBD showed the highest mean scores for all three subjective effects factors (p<0.001). Athletes who use a combination of THC and CBD exhibited the most benefit to well-being and calm with minimal adverse effects. Our methodology can be used to develop real-world evidence to inform future use of medical cannabis products.
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Affiliation(s)
| | - William S. Silvers
- Canna Research Group, Boulder, CO, United States of America
- University of Colorado School of Medicine, Aurora, CO, United States of America
| | - Edward M. Fleegler
- Canna Research Group, Boulder, CO, United States of America
- To-Life in Peace, LLC, Wheat Ridge, CO, United States of America
| | - Robert S. Zeiger
- Canna Research Group, Boulder, CO, United States of America
- Kaiser Permanente Southern California, San Diego, CA, United States of America
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