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1دورية أكاديميةRace-specific spirometry equations may overestimate asthma control in Black children and adolescents
المؤلفون: Allison J. Burbank, Claire E. Atkinson, Andre E. Espaillat, Stephen A. Schworer, Katherine Mills, Jennifer Rooney, Ceila E. Loughlin, Wanda Phipatanakul, Michelle L. Hernandez
المصدر: Respiratory Research, Vol 24, Iss 1, Pp 1-5 (2023)
مصطلحات موضوعية: Asthma, Race, Asthma Control Test™, Spirometry, Health disparities, Diseases of the respiratory system, RC705-779
الوصف: Abstract Background A growing body of evidence suggests that use of race terms in spirometry reference equations underestimates disease burden in Black populations, which may lead to disparities in pulmonary disease outcomes. Data on asthma-specific health consequences of using race-adjusted spirometry are lacking. Methods We performed a secondary analysis of 163 children from two observational asthma studies to determine the frequencies of participants with ppFEV1 19), 87% had ppFEV1 ≥ 80% using race-specific compared to 67% using race-neutral spirometry. Children whose ppFEV1 changed to ≤ 80% with race-neutral spirometry had lower FEV1/FVC compared to those whose ppFEV1 remained ≥ 80% [0.83 (0.07) vs. 0.77 (0.05), respectively; p = 0.04], suggesting greater airway obstruction. Minimal changes in alignment of ppFEV1 with ACT score were observed for White children. Conclusions Use of race-specific reference equations in Black children may increase the risk of inappropriately labeling asthma as controlled.
وصف الملف: electronic resource
Relation: https://doaj.org/toc/1465-993X
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2دورية أكاديمية
المؤلفون: Allison J. Burbank, Krista Todoric, Pamela Steele, Jonathan Rosen, Haibo Zhou, Marcia Frye, Ceila E. Loughlin, Sally Ivins, Katherine Mills, Lauren Dembnicki Massey, Bryce B. Reeve, Michelle L. Hernandez
المصدر: Respiratory Research, Vol 19, Iss 1, Pp 1-9 (2018)
مصطلحات موضوعية: Asthma, The asthma control test (ACT), African-American, Adolescent, Questionnaire, Control, Diseases of the respiratory system, RC705-779
الوصف: Abstract Background The Asthma Control Test (ACT) is widely used to assess asthma control, yet the validity and reliability of the test have not been specifically evaluated in adolescents or African-Americans. We conducted a prospective psychometric study of the ACT in African-American (AA) and non-African-American (nAA) adolescents with persistent asthma, with emphasis on the clinical utility of the test for medical decision making. Methods Participants completed the ACT and performed spirometry. A physician conducted a guidelines-based assessment of asthma control, blinded to the ACT score. Study procedures were repeated 6–8 weeks later. The ACT-based asthma control assessment was compared to physician assessment. Results For baseline and follow-up visits, internal consistency, as measured using Cronbach’s alpha, was 0.80 and 0.81 in AA teens and 0.80 and 0.83 in nAA teens. Intraclass correlation coefficients were 0.59 and 0.76 in AA and nAA teens, respectively, with stable asthma control over time. Agreement between ACT and physician assessment was moderate in AA teens and fair in nAA teens. An ACT score of ≤19 showed reduced sensitivity for not well controlled asthma in both groups, while a score of ≤21 had the greatest area under the ROC curve. ACT scores were marginally responsive to change in control status. Conclusions Concerns for the ACT’s ability to detect uncontrolled asthma in adolescents emphasizes the need for a more comprehensive evaluation of asthma control in clinical settings. A higher threshold ACT score to define not well controlled asthma may be needed if the ACT is to be used for medical decision making. Trial registration ClinicalTrials.gov: NCT02671643, NCT02662413.
وصف الملف: electronic resource
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المؤلفون: Melissa B. Gilkey, Wei Yi Kong, Kathryn L. Kennedy, Jennifer Heisler-MacKinnon, Elena Faugno, Barbara Gwinn, Ann Chen Wu, Ceila E. Loughlin, Alison A. Galbraith
المصدر: The Journal of Allergy and Clinical Immunology: In Practice. 10:2536-2542
مصطلحات موضوعية: COVID-19, Humans, Immunology and Allergy, Financial Stress, Pandemics, Asthma, Telemedicine, United States
الوصف: One of the most compelling arguments for telemedicine is its potential to increase health care access by making care more affordable for patients and families, including those affected by asthma. This goal is critically important in the United States, where the high cost of asthma care is associated with nonadherence to preventive care regimens and suboptimal health outcomes. In this clinical commentary review, we draw from the literature and our own research to identify opportunities for and challenges to leveraging telemedicine to reduce the financial burden of asthma care. Our interviews with 42 families affected by asthma during the COVID-19 pandemic suggest that under favorable circumstances, telemedicine can meaningfully reduce costs, including those related to transportation and missed work, while offering high-quality care. However, families also identified ways in which telemedicine can increase costs. For example, some reported reduced access to support services and material resources such as medication samples, which they relied on to manage costs. In this way, our findings underscore the need for careful care coordination and communication in telemedicine. We conclude by discussing the 4Rs, a structured communication approach designed to support cost conversations, increase care coordination, and help families reduce asthma care cost burden.
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المؤلفون: Meghan E. Rebuli, Jason J. Rose, Alexandra Noël, Daniel P. Croft, Neal L. Benowitz, Alan H. Cohen, Maciej L. Goniewicz, Brandon T. Larsen, Noel Leigh, Matthew D. McGraw, Anne C. Melzer, Arthur L. Penn, Irfan Rahman, Dona Upson, Laura E. Crotty Alexander, Gary Ewart, Ilona Jaspers, Sven Eric Jordt, Seth Kligerman, Ceila E. Loughlin, Rob McConnell, Enid R. Neptune, Tran B. Nguyen, Kent E. Pinkerton, Theodore J. Witek
المصدر: Annals of the American Thoracic Society, vol 20, iss 1
مصطلحات موضوعية: Pulmonary and Respiratory Medicine, Adult, Nicotine, Tobacco Smoke and Health, Vaping, Prevention, EVALI, Lung Injury, Electronic Nicotine Delivery Systems, e-cigarette, inhalation toxicity, United States, Disease Outbreaks, Substance Misuse, Good Health and Well Being, Tobacco, vaping product, Humans, Prospective Studies, Child, Lung
الوصف: E-cigarette or vaping product use-associated lung injury (EVALI) is a severe pulmonary illness associated with the use of e-cigarettes or vaping products that was officially identified and named in 2019. This American Thoracic Society workshop was convened in 2021 to identify and prioritize research and regulatory needs to adequately respond to the EVALI outbreak and to prevent similar instances of disease associated with e-cigarette or vaping product use. An interdisciplinary group of 26 experts in adult and pediatric clinical care, public health, regulatory oversight, and toxicology were convened for the workshop. Four major topics were examined: 1) the public health and regulatory response to EVALI; 2) EVALI clinical care; 3) mechanisms contributing to EVALI; and 4) needed actions to address the health effects of EVALI. Oral presentations and group discussion were the primary modes used to identify top priorities for addressing EVALI. Initiatives including a national EVALI case registry and biorepository, integrated electronic medical record coding system, U.S. Food and Drug Administration regulation and enforcement of nicotine e-cigarette standards, regulatory authority over nontobacco-derived e-cigarettes, training in evaluating exogenous exposures, prospective clinical studies, standardized clinical follow-up assessments, ability to more readily study effects of cannabinoid e-cigarettes, and research to identify biomarkers of exposure and disease were identified as critical needs. These initiatives will require substantial federal investment as well as changes to regulatory policy. Overall, the workshop identified the need to address the root causes of EVALI to prevent future outbreaks. An integrated approach from multiple perspectives is required, including public health; clinical, basic, and translational research; regulators; and users of e-cigarettes. Improving the public health response to reduce the risk of another substantial disease-inducing event depends on coordinated actions to better understand the inhalational toxicity of these products, informing the public of the risks, anddeveloping and enforcing regulatory standards for all e-cigarettes.
وصف الملف: application/pdf
URL الوصول: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::62bd08145f00d4f087b7b81731b561a8
https://escholarship.org/uc/item/5vd162sp -
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المؤلفون: Mindy K. Ross, William A. Gower, Ceila E. Loughlin, Anil G. Jegga, Jagila Minso, Simon S. Wong, Wayne L. Furman, Lauraine H. Rivier, Lauren Bradford, Xiaoping Li, Gail H. Deutsch, Mateja Cernelc-Kohan, Timothy J. Vece, Caitlin Hurley, Dennis C. Stokes, James S. Hagood, Katayoon Shayan
المصدر: Pediatric Pulmonology. 57:264-272
مصطلحات موضوعية: Rubinstein-Taybi Syndrome, Pulmonary and Respiratory Medicine, medicine.medical_specialty, Pathology, Lung, business.industry, H&E stain, Interstitial lung disease, Surfactant protein C, Lung biopsy, respiratory system, medicine.disease, CREB-Binding Protein, Staining, medicine.anatomical_structure, Fibrosis, Mutation, Exome Sequencing, Pediatrics, Perinatology and Child Health, medicine, Humans, Histopathology, Child, Lung Diseases, Interstitial, business
الوصف: Introduction Rubinstein-Taybi syndrome (RSTS) is a rare genetic syndrome caused primarily by a mutation in the CREBBP gene found on chromosome 16. Patients with RSTS are at greater risk for a variety of medical problems, including upper airway obstruction and aspiration. Childhood interstitial lung disease (ILD) thus far has not been definitively linked to RSTS. Here we present three patients with RSTS who developed ILD and discuss possible mechanisms by which a mutation in CREBBP may be involved in the development of ILD. Methods Routine hematoxylin and eosin staining was performed on lung biopsy tissue for histological analysis. Immunofluorescent staining was performed on lung biopsy tissue for markers of fibrosis, surfactant deficiency and histone acetylation. Cases 1 and 2 had standard clinical microarray analysis. Case 3 had whole exome sequencing. Bioinformatics analyses were performed to identify possible causative genes using ToppGene. Results CT images in all cases showed consolidated densities overlying ground glass opacities. Lung histopathology revealed accumulation of proteinaceous material within alveolar spaces, evidence of fibrosis, and increased alveolar macrophages. Immunofluorescent staining showed increase in surfactant protein C staining, patchy areas of increased aSMA staining, and increased staining for acetylated histone 2 and histone 3 lysine 9. Discussion Clinical characteristics, radiographic imaging, lung histopathology, and immunofluorescent staining results shared by all cases demonstrated findings consistent with ILD. Immunofluorescent staining suggests two possible mechanisms for the development of ILD: abnormal surfactant metabolism and/or persistent activation of myofibroblasts. These two pathways could be related to dysfunctional CREBBP protein. This article is protected by copyright. All rights reserved.
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المؤلفون: Jessica K. Pepper, Robyn Sayner, Charles Lee, Scott A. Davis, Delesha M. Carpenter, Nacire Garcia, Betsy Sleath, Ceila E. Loughlin, Gail Tudor, Bethany Beznos
المصدر: Journal of Pediatric Health Care. 35:401-407
مصطلحات موضوعية: medicine.medical_specialty, Adolescent, Primary care, Electronic Nicotine Delivery Systems, 03 medical and health sciences, 0302 clinical medicine, Cigarette smoking, 030225 pediatrics, Intervention (counseling), Secondary analysis, medicine, Humans, 030212 general & internal medicine, Child, Pediatric asthma, Asthma, business.industry, Communication, Vaping, Smoking, medicine.disease, Caregivers, Family medicine, Pediatrics, Perinatology and Child Health, Usual care, Persistent asthma, business
الوصف: Introduction Although rates of cigarette smoking among U.S. adolescents have declined, rates of vaping (i.e., using e-cigarettes) have increased. We conducted a secondary analysis of 359 transcripts of medical visits of adolescents with asthma to examine communication about caregiver and adolescent smoking and vaping. Method Adolescents aged 11–17 years with persistent asthma and their parents were enrolled from four pediatric clinics in 2015–2017. Youth were randomized to the intervention or usual care groups. Intervention group adolescents watched a video and then completed an asthma question prompt list before their visits. Results Forty providers and 359 patients participated. Providers, adolescents, and caregivers discussed smoking during 38.2% of their visits. Vaping was never discussed. Discussion There is room to improve how often providers in a primary care setting discuss smoking and vaping. Further investigation might focus on how a smoking and vaping prompt list for adolescents could increase tobacco discussions during visits.
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المؤلفون: Betsy Sleath, Delesha Carpenter, Scott A. Davis, Nacire Garcia, Daniel S. Reuland, Gail Tudor, Ceila E. Loughlin
المصدر: The Journal of asthma : official journal of the Association for the Care of Asthma.
مصطلحات موضوعية: Pulmonary and Respiratory Medicine, Pediatrics, Perinatology and Child Health, Immunology and Allergy
الوصف: The purpose of this study was to investigate the extent to which adolescent asthma management self-efficacy, outcome expectations, and asthma responsibility were associated with asthma control and quality-of-life. Adolescent self-efficacy and outcome expectations are important components of social cognitive theory, which guided this research.English- and Spanish-speaking adolescents ages 11-17 with persistent asthma were recruited at four pediatric clinics. Adolescents were interviewed and parents completed questionnaires. Multiple linear regression was used to analyze the data.Three hundred and fifty-nine adolescents were recruited. Older adolescent age, male gender, and higher adolescent asthma management self-efficacy were significantly associated with higher adolescent responsibility; outcome expectations were not significantly associated with responsibility. Adolescent ratings of their own responsibility were higher than parent ratings of their child's responsibility for almost all asthma management tasks. Adolescents with higher reported asthma management self-efficacy were significantly more likely to have better quality-of-life and controlled asthma. Adolescents with more positive outcome expectations were significantly more likely to have controlled asthma. Being Native American was associated with worse quality-of-life and asthma not being controlled. Being Black was associated with asthma not being controlled.Parents and providers should work to improve adolescent self-efficacy in managing their asthma because it is associated with asthma responsibility, asthma control, and quality-of-life. Providers need to especially work with Native American and Black adolescents to improve quality-of-life and asthma control.
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المؤلفون: Gabriela Woo, Mary Crocker, David G. Parajon, Sonia Picado Fernández, Charles R. Esther, Ceila E. Loughlin, Sylvia Becker-Dreps, Terry L. Noah, Laura Parajon
المصدر: Pediatric Pulmonology. 56:1145-1154
مصطلحات موضوعية: Pulmonary and Respiratory Medicine, medicine.medical_specialty, Referral, Nicaragua, 03 medical and health sciences, 0302 clinical medicine, Surveys and Questionnaires, 030225 pediatrics, medicine, Humans, Family history, Asthma, Community Health Workers, Receiver operating characteristic, business.industry, Airways disease, Area under the curve, Respiratory infection, medicine.disease, 030228 respiratory system, Family medicine, Pediatrics, Perinatology and Child Health, Community health, Bronchial Hyperreactivity, business
الوصف: INTRODUCTION Asthma is a major cause of morbidity and mortality in children worldwide, but many cases may remain undiagnosed. Community health worker (CHW) programs have improved detection of other diseases such as childhood pneumonia, but none have been validated for detection of asthma in resource-poor settings. We hypothesized that a CHW administered questionnaire would be effective in case-detection of asthma in a poor Nicaraguan community. METHODS We enrolled children aged 2-17 from a small semiurban Nicaraguan community. A trained CHW administered a questionnaire based on a previously validated school-based screening questionnaire, which was compared to pediatric pulmonologist evaluation as a reference standard. We determined the questionnaire's sensitivity, specificity, and positive and negative likelihood ratios at different score cut-points. RESULTS A total of 199 out of 218 eligible children were enrolled. Total asthma prevalence based on physician diagnosis was 33%. Mean scores on the CHW questionnaire were 3.6 points out of 22 (SD = 4.3) for nonasthmatics and 11.0 points (SD = 5.3) for children with asthma (p
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المؤلفون: Andrew T. Barber, Ceila E. Loughlin
المصدر: Pediatric pulmonologyREFERENCES. 56(8)
مصطلحات موضوعية: Pulmonary and Respiratory Medicine, Chronic condition, medicine.medical_specialty, business.industry, Year in review, Context (language use), Disease, medicine.disease, Asthma, Aerosol delivery, Pediatrics, Perinatology and Child Health, Epidemiology, medicine, Pulmonary Medicine, Humans, Pediatric Pulmonology, Obesity, business, Intensive care medicine, Child, Exercise
الوصف: Pediatric asthma is a heterogeneous and common chronic condition with significant morbidity and burden on the healthcare system. Despite advances in the field, the disease has proven to be increasingly complex to diagnose and management strategies are constantly evolving. Studies from 2020 have advanced the field even further, particularly with regard to new methods of diagnosis and monitoring, treatment of severe asthma, modifiable risk factors like exercise and obesity, aerosol delivery, and viral respiratory infections contributing to the development of asthma. Continued studies are needed to improve our care for children with asthma and we look forward to future advances. This article is part of our 2020 "Year in Review" series, in which we summarize publications in major topic areas, in the context of selected literature from other journals relevant to our discipline.
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10Questions and reported medication problems from pediatric patients and caregivers after intervention
المؤلفون: Charles Lee, Ceila E. Loughlin, Scott A. Davis, Delesha M. Carpenter, Betsy Sleath, Robyn Sayner, Gail Tudor, Daniel S. Reuland, Nacire Garcia
المصدر: American Journal of Health-System Pharmacy. 76:366-373
مصطلحات موضوعية: Adult, Male, medicine.medical_specialty, Adolescent, Office Visits, Office visits, Video Recording, 030226 pharmacology & pharmacy, law.invention, 03 medical and health sciences, 0302 clinical medicine, Patient Education as Topic, Randomized controlled trial, law, Surveys and Questionnaires, Intervention (counseling), medicine, Humans, Anti-Asthmatic Agents, 030212 general & internal medicine, Child, Asthma, Pharmacology, Video intervention, business.industry, Communication, Health Policy, Professional-Patient Relations, Odds ratio, Middle Aged, medicine.disease, Confidence interval, Caregivers, Family medicine, Practice Research Reports, Usual care, Female, Patient Participation, business
الوصف: Purpose The effectiveness of an asthma question prompt list with video intervention to increase question-asking during pediatric office visits among youth who reported medication problems was evaluated. Methods English- or Spanish-speaking youth age 11-17 years with persistent asthma and their caregivers were enrolled from 4 pediatric clinics in a randomized controlled trial. Youth were randomized to intervention or usual care groups. Youth in the intervention group watched an educational video with their caregivers on an iPad. The youth then received a 1-page asthma question prompt list to complete before their visits. The audio of all baseline medical visits was recorded. Youth were interviewed and caregivers completed questionnaires at baseline and 6 months later. Results A total of 40 providers and 359 of their patients participated. Youth who reported at least 1 medication problem who were in the intervention group were significantly more likely to ask 1 or more questions about medications during their visits than youth in the usual care group (odds ratio = 3.1, 95% confidence interval = 2.0, 4.1). Seventy-four percent of youth and 71% caregivers who reported the youth had problems using asthma medications at baseline still reported 1 or more problems 6 months later. Conclusion Among youth who reported 1 or more problems with using their asthma medications, the intervention significantly increased youth question-asking. Many youth- and caregiver-reported problems with using asthma medications persisted over time.
URL الوصول: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::4d14834bde9c5fce64ddb2cd3c215de4
https://doi.org/10.1093/ajhp/zxy057
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