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Wang S, Laageide L, Phan V, Rosenbach M, Gerke AK, Wanat KA. Use of registry surveys in cutaneous sarcoidosis. J Am Acad Dermatol 2024:S0190-9622(24)00387-6. [PMID: 38395226 DOI: 10.1016/j.jaad.2024.02.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 01/21/2024] [Accepted: 02/09/2024] [Indexed: 02/25/2024]
Affiliation(s)
- Sonia Wang
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Leah Laageide
- Department of Dermatology, University of Rochester Medical Center, Rochester, New York
| | - Van Phan
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins Hospital, Baltimore, Maryland
| | - Misha Rosenbach
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Alicia K Gerke
- Department of Pulmonology, University of Iowa Hospital and Clinics, Iowa City, Iowa
| | - Karolyn A Wanat
- Department of Dermatology and Pathology, Medical College of Wisconsin, Milwaukee, Wisconsin.
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Gerke AK. Treatment of Granulomatous Inflammation in Pulmonary Sarcoidosis. J Clin Med 2024; 13:738. [PMID: 38337432 PMCID: PMC10856377 DOI: 10.3390/jcm13030738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Revised: 01/24/2024] [Accepted: 01/25/2024] [Indexed: 02/12/2024] Open
Abstract
The management of pulmonary sarcoidosis is a complex interplay of disease characteristics, the impact of medications, and patient preferences. Foremost, it is important to weigh the risk of anti-granulomatous treatment with the benefits of lung preservation and improvement in quality of life. Because of its high spontaneous resolution rate, pulmonary sarcoidosis should only be treated in cases of significant symptoms due to granulomatous inflammation, lung function decline, or substantial inflammation on imaging that can lead to irreversible fibrosis. The longstanding basis of treatment has historically been corticosteroid therapy for the control of granulomatous inflammation. However, several corticosteroid-sparing options have increasing evidence for use in refractory disease, inability to taper steroids to an acceptable dose, or in those with toxicity to corticosteroids. Treatment of sarcoidosis should be individualized for each patient due to the heterogeneity of the clinical course, comorbid conditions, response to therapy, and tolerance of medication side effects.
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Affiliation(s)
- Alicia K Gerke
- Pulmonary and Critical Care Medicine, University of Iowa, 200 Hawkins Drive, Iowa City, IA 52242, USA
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Chung H, Hanken K, Gerke AK, Lund BC. Montelukast and risk for antidepressant treatment failure. J Psychosom Res 2023; 164:111075. [PMID: 36368225 DOI: 10.1016/j.jpsychores.2022.111075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 10/24/2022] [Accepted: 10/29/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVE While implicated in causing depression, no studies have examined the impact of montelukast on antidepressant effectiveness. We examined whether existing montelukast therapy was associated with acute antidepressant treatment failure (objective 1), and whether montelukast initiation was associated with depression relapse during maintenance antidepressant therapy (objective 2), relative to inhaled corticosteroid (ICS). METHODS Patients with asthma and depression were identified using national Veterans Health Administration data from 2007 to 2019. Objective 1: 12,109 patients initiated an antidepressant after receiving montelukast or ICS for 6 months. The primary outcome was acute antidepressant treatment failure, defined as subsequent initiation of a new antidepressant or augmenting agent within 6 months. Objective 2: 14,673 patients initiated montelukast or ICS after receiving stable antidepressant monotherapy for 6 months. The primary outcome of depression relapse was defined by a subsequent change in the pre-existing maintenance antidepressant regimen within 6 months. Both objectives employed a retrospective cohort design with log-binomial regression. RESULTS Objective 1: Acute antidepressant failure was observed in 21.3% (628/2943) and 22.3% (2044/9166) of patients receiving montelukast versus ICS, respectively. Relative risk in adjusted analyses was 0.98 (95% CI: 0.90, 1.07). Objective 2: Depression relapse was observed in 24.4% (288/1182) and 22.4% (3027/13,491) of patients initiating montelukast versus ICS, respectively. Relative risk in adjusted analyses was 1.08 (95% CI: 0.96, 1.20) within 6 months and 1.50 (95% CI: 1.16, 1.93) within 45 days. CONCLUSION Discontinuation of existing montelukast therapy is unnecessary when initiating antidepressants. However, potential evidence for depression relapse following montelukast initiation warrants additional investigation.
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Affiliation(s)
- Haemy Chung
- Department of Pharmacy, Iowa City Veterans Affairs Health Care System, Iowa City, IA, United States of America
| | - Kaitlin Hanken
- Department of Pharmacy, Iowa City Veterans Affairs Health Care System, Iowa City, IA, United States of America
| | - Alicia K Gerke
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, United States of America
| | - Brian C Lund
- Center for Access & Delivery Research and Evaluation, Iowa City Veterans Affairs Health Care System, Iowa City, IA, United States of America; Department of Epidemiology, University of Iowa College of Public Health, Iowa City, IA, United States of America.
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Abstract
OBJECTIVES Neuropsychiatric events (NEs) reported with montelukast during post-marketing surveillance by the US Food & Drug Administration resulted in a 2008 safety alert and a black box warning in 2020. Our objective was to evaluate montelukast exposure and NEs risk using sequence symmetry analysis. METHODS National Veterans Health Administration (VHA) administrative data were used to identify 11 840 patients prescribed incident montelukast during fiscal year 2014. Incident prescribing of neuropsychiatric medication was used as a proxy marker for incident NEs and included antidepressants, benzodiazepines, hypnotics, antipsychotics, mood stabilizers, and buspirone. Symmetry ratios were calculated as the ratio of patients with an incident neuropsychiatric event in the year following montelukast initiation to the year preceding initiation. Exposure counterfactual analyses were used to examine the relationship between potential therapeutic alternatives to montelukast and risk for NEs. RESULTS Incident NEs were observed in 2305 patients following montelukast initiation and 2734 patients preceding montelukast initiation (SR 0.84, 95% CI 0.80-0.89). Sensitivity analyses examining each of the 6 sub-types of psychiatric medications also failed to show increased risk of NEs following montelukast initiation. Therapeutic alternatives to montelukast, such as inhaled corticosteroids, were also not associated increased NE risk. CONCLUSIONS Initiation of montelukast was not associated with increased risk of a variety of NEs in this sequence symmetry analysis involving adult patients in the VHA. Our findings do not support the hypothesis that NEs are associated with montelukast initiation.
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Affiliation(s)
- Christopher W Fox
- Department of Pharmacy, Iowa City Veterans Affairs Health Care System, Iowa City, IA, USA
| | - Chelsea L Khaw
- Department of Pharmacy, Iowa City Veterans Affairs Health Care System, Iowa City, IA, USA
| | - Alicia K Gerke
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Brian C Lund
- Center for Access & Delivery Research and Evaluation and Department of Pharmacy Practice, Iowa City Veterans Affairs Health Care System, Iowa City, IA, USA
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Simmering J, Stapleton EM, Polgreen PM, Kuntz J, Gerke AK. Patterns of medication use and imaging following initial diagnosis of sarcoidosis. Respir Med 2021; 189:106622. [PMID: 34600163 PMCID: PMC10918686 DOI: 10.1016/j.rmed.2021.106622] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 08/31/2021] [Accepted: 09/14/2021] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Sarcoidosis is a rare inflammatory disease with unclear natural history. Using a large, retrospective, longitudinal, population-based cohort, we sought to define its natural history in order to guide future clinical studies. METHODS We identified 722 newly diagnosed cases of sarcoidosis within Kaiser Permanente Northwest health care records between 1995 and 2015. We investigated immunosuppressive medication use in the two years following diagnosis, analyzed demographic and clinical characteristics, and quantified chest imaging and pulmonary function testing (PFTs) across the clinical course. RESULTS Over two years of follow-up, 41% of patients were treated with prednisone. Of those, 75% tapered off their first course within 100 days, although half of those patients required recurrent therapy. Five percent of the entire cohort remained on prednisone for longer than one year, with an average daily dose of 10-20 mg. Chest imaging was associated with early prednisone use, and chest CT was associated with changes in prednisone dose. PFTs or demographics were not associated with prednisone use. Cumulative prednisone doses were significantly higher in African Americans (1,845 mg additional) and those who had a chest CT (2,015 mg additional). Overall, PFTs were less frequently obtained than chest imaging and had no significant change over disease course. DISCUSSION The natural history of sarcoidosis varies greatly. For those requiring therapy, corticosteroid burden is high. Chest imaging drives medication dose changes as compared to PFTs, but neither outcome fully captures the entire history of disease. Prospective cohorts are needed with purposefully collected, repeated measures that include objective clinical assessments and symptoms.
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Affiliation(s)
- J Simmering
- University of Iowa, Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, 200 Hawkins Dr., C33GH, Iowa City, IA, 52242, USA
| | - E M Stapleton
- University of Iowa, Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, 200 Hawkins Dr., C33GH, Iowa City, IA, 52242, USA
| | - P M Polgreen
- University of Iowa, Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, 200 Hawkins Dr., C33GH, Iowa City, IA, 52242, USA
| | - J Kuntz
- Kaiser Permanente Northwest Center for Health Research, 3800 N. Interstate Ave., Portland, OR, 97227, USA
| | - A K Gerke
- University of Iowa, Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, 200 Hawkins Dr., C33GH, Iowa City, IA, 52242, USA.
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Zhou Y, Gerke AK, Lower EE, Vizel A, Talwar D, Strambu I, Francesqui J, Sellares J, Sawahata M, Obi ON, Nagai S, Tanizawa K, Judson MA, Jeny F, Valeyre D, Cunha Castro MD, Pereira C, Balter M, Baughman RP. The impact of demographic disparities in the presentation of sarcoidosis: A multicenter prospective study. Respir Med 2021; 187:106564. [PMID: 34391118 PMCID: PMC9999732 DOI: 10.1016/j.rmed.2021.106564] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 07/31/2021] [Accepted: 08/04/2021] [Indexed: 01/04/2023]
Abstract
OBJECTIVE To study how demographic differences impact disease manifestation of sarcoidosis using the WASOG tool in a large multicentric study. METHODS Clinical data regarding 1445 patients with sarcoidosis from 14 clinical sites in 10 countries were prospectively reviewed from Feb 1, 2020 to Sep 30, 2020. Organ involvement was evaluated for the whole group and for subgroups differentiated by sex, race, and age. RESULTS The median age of the patients at diagnosis was 46 years old; 60.8% of the patients were female. The most commonly involved organ was lung (96%), followed by skin (24%) and eye (22%). Black patients had more multiple organ involvement than White patients (OR = 3.227, 95% CI: 2.243-4.643) and females had more multiple organ involvement than males (OR = 1.238, 95% CI: 1.083-1.415). Black patients had more frequent involvement of neurologic, skin, eye, extra thoracic lymph node, liver and spleen than White and Asian patients. Women were more likely to have eye (OR = 1.522, 95%CI: 1.259-1.838) or skin involvement (OR = 1.369, 95%CI: 1.152-1.628). Men were more likely to have cardiac involvement (OR = 1.326, 95%CI: 1.096-1.605). A total of 262 (18.1%) patients did not receive systemic treatment for sarcoidosis. Therapy was more common in Black patients than in other races. CONCLUSION The initial presentation and treatment of sarcoidosis was related to sex, race, and age. Black and female individuals are found to have multiple organ involvement more frequently. Age at diagnosis<45, Black patients and multiple organ involvement were independent predictors of treatment.
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Affiliation(s)
- Ying Zhou
- Department of Respiratory Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, 200433, China.
| | - Alicia K Gerke
- Department of Internal Medicine, Pulmonary and Critical Care, University of Iowa, 200 Hawkins Dr, Iowa City, IA, 52246, USA
| | - Elyse E Lower
- Internal Medicine, University of Cincinnati, University of Cincinnati Medical Center, Cincinnati, OH, 45267-0565, USA
| | - Alexander Vizel
- Kazan State Medical University, Department of Phthisiopulmonology. Butlerov Str., 49. Kazan, Tatarsan Republic. 420012, Russian Federation
| | - Deepak Talwar
- Department of Pulmonary and Sleep Care Medicine, Metro Multispeciality Hospital, Noida, Uttar Pradesh, India
| | - Irina Strambu
- Pulmonology Department, University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania
| | - Joel Francesqui
- Servei de Pneumologia, Respiratory Institute, Hospital Clínic, IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - Jacobo Sellares
- Servei de Pneumologia, Respiratory Institute, Hospital Clínic, IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - Michiru Sawahata
- Division of Pulmonary Medicine, Department of Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, 329-0498, Japan
| | - Ogugua Ndili Obi
- Division of Pulmonary, Critical Care and Sleep Medicine, Brody School of Medicine, East Carolina University, Greenville, NC, USA
| | - Sonoko Nagai
- Kyoto Central Clinic, Clinical Research Center, Kyoto, Japan
| | - Kiminobu Tanizawa
- Kyoto Central Clinic, Clinical Research Center, Kyoto, Japan; Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Marc A Judson
- Department of Medicine, Albany Medical College, Albany, NY, USA
| | - Florence Jeny
- Service de Pneumologie, Assistance Publique-Hôpitaux de Paris, Hôpital Avicenne, Bobigny, France
| | - Dominique Valeyre
- Service de Pneumologie, Assistance Publique-Hôpitaux de Paris, Hôpital Avicenne, Bobigny, France
| | - Marina Dornfeld Cunha Castro
- Department of Medicine, Division of Respiratory Diseases, Interstitial Lung Diseases Center, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Carlos Pereira
- Department of Medicine, Division of Respiratory Diseases, Interstitial Lung Diseases Center, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Meyer Balter
- Division of Respirology, Dept of Medicine, Mount Sinai Hospital, Toronto, ON, Canada
| | - Robert P Baughman
- Internal Medicine, University of Cincinnati, University of Cincinnati Medical Center, Cincinnati, OH, 45267-0565, USA
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Miller AC, Arakkal AT, Koeneman S, Cavanaugh JE, Gerke AK, Hornick DB, Polgreen PM. Incidence, duration and risk factors associated with delayed and missed diagnostic opportunities related to tuberculosis: a population-based longitudinal study. BMJ Open 2021; 11:e045605. [PMID: 33602715 PMCID: PMC7896623 DOI: 10.1136/bmjopen-2020-045605] [Citation(s) in RCA: 6] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVES Missed opportunities to diagnose tuberculosis are costly to patients and society. In this study, we (1) estimate the frequency and duration of diagnostic delays among patients with active pulmonary tuberculosis and (2) determine the risk factors for experiencing a diagnostic delay. DESIGN A retrospective cohort study of patients with tuberculosis using longitudinal healthcare encounters prior to diagnosis. SETTING Commercially insured enrollees from the Commercial Claims and Encounters or Medicare Supplemental IBM Marketscan Research Databases, 2001-2017. PARTICIPANTS All patients diagnosed with, and receiving treatment for, pulmonary tuberculosis, enrolled at least 365 days prior to diagnosis. PRIMARY AND SECONDARY OUTCOME MEASURES We estimated the number of visits with tuberculosis-related symptoms prior to diagnosis that would be expected to occur in the absence of delays and compared this estimate to the observed pattern. We computed the number of visits representing a delay and used a simulation-based approach to estimate the number of patients experiencing a delay, number of missed opportunities per patient and duration of delays (ie, time between diagnosis and earliest missed opportunity). We also explored risk factors for missed opportunities. RESULTS We identified 3371 patients diagnosed and treated for active tuberculosis that could be followed up for 1 year prior to diagnosis. We estimated 77.2% (95% CI 75.6% to 78.7%) of patients experienced at least one missed opportunity; of these patients, an average of 3.89 (95% CI 3.65 to 4.14) visits represented a missed opportunity, and the mean duration of delay was 31.66 days (95% CI 28.51 to 35.11). Risk factors for delays included outpatient or emergency department settings, weekend visits, patient age, influenza season presentation, history of chronic respiratory symptoms and prior fluoroquinolone use. CONCLUSIONS Many patients with tuberculosis experience multiple missed diagnostic opportunities prior to diagnosis. Missed opportunities occur most commonly in outpatient settings and numerous patient-specific, environment-specific and setting-specific factors increase risk for delays.
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Affiliation(s)
| | | | - Scott Koeneman
- Biostatistics, The University of Iowa, Iowa City, Iowa, USA
| | | | - Alicia K Gerke
- Internal Medicine, The University of Iowa, Iowa City, Iowa, USA
| | | | - Philip M Polgreen
- Epidemiology, University of Iowa, Iowa City, Iowa, USA
- Internal Medicine, The University of Iowa, Iowa City, Iowa, USA
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Abstract
Sarcoidosis is a systemic disease of unknown etiology defined by the presence of noncaseating granulomatous inflammation that can cause organ damage and diminished quality of life. Treatment is indicated to protect organ function and decrease symptomatic burden. Current treatment options focus on interruption of granuloma formation and propagation. Clinical trials guiding evidence for treatment are lacking due to the rarity of disease, heterogeneous clinical course, and lack of prognostic biomarkers, all of which contribute to difficulty in clinical trial design and implementation. In this review, a multidisciplinary treatment approach is summarized, addressing immunuosuppressive drugs, managing complications of chronic granulomatous inflammation, and assessing treatment toxicity. Discovery of new therapies will depend on research into pathogenesis of antigen presentation and granulomatous inflammation. Future treatment approaches may also include personalized decisions based on pharmacogenomics and sarcoidosis phenotype, as well as patient-centered approaches to manage immunosuppression, symptom control, and treatment of comorbid conditions.
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Affiliation(s)
- Alicia K Gerke
- Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Iowa, Iowa City, IA, United States
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Harper LJ, Gerke AK, Wang XF, Ribeiro Neto ML, Baughman RP, Beyer K, Drent M, Judson MA, Maier LA, Serchuck L, Singh N, Culver DA. Income and Other Contributors to Poor Outcomes in U.S. Patients with Sarcoidosis. Am J Respir Crit Care Med 2020; 201:955-964. [PMID: 31825646 DOI: 10.1164/rccm.201906-1250oc] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Rationale: Socioeconomic factors are associated with worse disease severity at presentation in sarcoidosis, but the relative importance of socioeconomic variables on morbidity and disease burden has not been fully elucidated.Objectives: To determine the association between income and sarcoidosis outcomes after controlling for socioeconomic and disease-related factors.Methods: Using the Sarcoidosis Advanced Registry for Cures database, we analyzed data from 2,318 patients with sarcoidosis in the United States to determine the effect of income and other variables on outcomes. We divided comorbidities arising after diagnosis into those likely related to steroid use and those likely related to sarcoidosis. We assessed the development of health-related, functional, and socioeconomic outcomes following the diagnosis of sarcoidosis.Measurements and Main Results: In multivariate analysis, low-income patients had significantly higher rates of new sarcoidosis-related comorbidities (<$35,000, odds ratio [OR], 2.4 [1.7-3.3]; $35,000-84,999, OR, 1.4 [1.1-1.9]; and ≥$85,000 [reference (Ref)]) and new steroid-related comorbidities (<$35,000, OR, 1.3 [0.9-2.0]; $35,000-84,999, OR, 1.5 [1.1-2.1]; and ≥$85,000 [Ref]), had lower health-related quality of life as assessed by the Sarcoidosis Health Questionnaire (P < 0.001), and experienced more impact on family finances (<$35,000, OR, 7.9 [4.9-12.7]; $35,000-84,999, OR, 2.7 [1.9-3.9]; and ≥$85,000 [Ref]). The use of supplemental oxygen, need for assistive devices, and job loss were more common in lower income patients. Development of comorbidities after diagnosis of sarcoidosis occurred in 63% of patients and were strong independent predictors of poor outcomes. In random forest modeling, income was consistently a leading predictor of outcome.Conclusions: These results suggest the burden from sarcoidosis preferentially impacts the economically disadvantaged.
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Affiliation(s)
- Logan J Harper
- Department of Pulmonary Medicine, Respiratory Institute and
| | - Alicia K Gerke
- Department of Internal Medicine, University of Iowa, Iowa City, Iowa
| | - Xiao-Feng Wang
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio
| | | | - Robert P Baughman
- Department of Medicine, University of Cincinnati Health, Cincinnati, Ohio
| | - Kelli Beyer
- Foundation for Sarcoidosis Research, Chicago, Illinois
| | - Marjolein Drent
- ILD Center of Excellence, Department of Pulmonology, St. Antonius Hospital, Nieuwegein, the Netherlands.,Department of Pharmacology and Toxicology, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands.,ILD Care Foundation Research Team, Ede, the Netherlands
| | - Marc A Judson
- Division of Pulmonary and Critical Care Medicine, Albany Medical College, Albany, New York
| | - Lisa A Maier
- Division of Environmental and Occupational Health Sciences, National Jewish Health, Denver, Colorado.,Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, School of Medicine, and.,Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado Anschutz Campus, Aurora, Colorado; and
| | - Leslie Serchuck
- Foundation for Sarcoidosis Research Sarcoidosis Advanced Registry for Cures Registry, Foundation for Sarcoidosis Research, Chicago, Illinois
| | - Noopur Singh
- Foundation for Sarcoidosis Research, Chicago, Illinois
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Crouser ED, Maier LA, Wilson KC, Bonham CA, Morgenthau AS, Patterson KC, Abston E, Bernstein RC, Blankstein R, Chen ES, Culver DA, Drake W, Drent M, Gerke AK, Ghobrial M, Govender P, Hamzeh N, James WE, Judson MA, Kellermeyer L, Knight S, Koth LL, Poletti V, Raman SV, Tukey MH, Westney GE. Diagnosis and Detection of Sarcoidosis. An Official American Thoracic Society Clinical Practice Guideline. Am J Respir Crit Care Med 2020; 201:e26-e51. [PMID: 32293205 PMCID: PMC7159433 DOI: 10.1164/rccm.202002-0251st] [Citation(s) in RCA: 425] [Impact Index Per Article: 106.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background: The diagnosis of sarcoidosis is not standardized but is based on three major criteria: a compatible clinical presentation, finding nonnecrotizing granulomatous inflammation in one or more tissue samples, and the exclusion of alternative causes of granulomatous disease. There are no universally accepted measures to determine if each diagnostic criterion has been satisfied; therefore, the diagnosis of sarcoidosis is never fully secure. Methods: Systematic reviews and, when appropriate, meta-analyses were performed to summarize the best available evidence. The evidence was appraised using the Grading of Recommendations, Assessment, Development, and Evaluation approach and then discussed by a multidisciplinary panel. Recommendations for or against various diagnostic tests were formulated and graded after the expert panel weighed desirable and undesirable consequences, certainty of estimates, feasibility, and acceptability. Results: The clinical presentation, histopathology, and exclusion of alternative diagnoses were summarized. On the basis of the available evidence, the expert committee made 1 strong recommendation for baseline serum calcium testing, 13 conditional recommendations, and 1 best practice statement. All evidence was very low quality. Conclusions: The panel used systematic reviews of the evidence to inform clinical recommendations in favor of or against various diagnostic tests in patients with suspected or known sarcoidosis. The evidence and recommendations should be revisited as new evidence becomes available.
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Rahaghi FF, Sweiss NJ, Saketkoo LA, Scholand MB, Barney JB, Gerke AK, Lower EE, Mirsaeidi M, O'Hare L, Rumbak MJ, Samavati L, Baughman RP. Management of repository corticotrophin injection therapy for pulmonary sarcoidosis: a Delphi study. Eur Respir Rev 2020; 29:29/155/190147. [PMID: 32198219 PMCID: PMC9489143 DOI: 10.1183/16000617.0147-2019] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 02/19/2020] [Indexed: 12/14/2022] Open
Abstract
In patients treated with repository corticotrophin injection (RCI) for pulmonary sarcoidosis, effective management of adverse events may improve adherence. However, management of adverse events may be challenging due to limitations in real-world clinical experience with RCI and available published guidelines. We surveyed 12 physicians with a modified Delphi process using three questionnaires. Questionnaire 1 consisted of open-ended questions. Panellists' answers were developed into a series of statements for Questionnaires 2 and 3. In these, physicians rated their agreement with the statements using a Likert scale. Key consensus recommendations included a starting dose of 40 units twice a week for patients with less severe disease, continued at a maintenance dose for patients who responded, particularly those with chronic refractory sarcoidosis. Panellists reached consensus that concomitant steroids should be quickly tapered in patients receiving RCI, but that concomitant use of immunosuppressive medications should be continued. Panellists developed consensus recommendations for adverse event management, and reached consensus that RCI should be down-titrated or discontinued if other interventions for the adverse effects fail or if the adverse effect is severe. In the absence of clinical evidence, our Delphi consensus opinions may provide practical guidance to physicians on the management of RCI to treat pulmonary sarcoidosis. In this paper, a modified Delphi method was used to develop an expert consensus on the use of repository corticotrophin injection therapy for pulmonary sarcoidosis, including dosing, concomitant medications, contraindications and adverse event management.http://bit.ly/2TyauZp
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Affiliation(s)
| | - Nadera J Sweiss
- University of Illinois at Chicago College of Medicine, Chicago, IL, USA
| | | | | | | | - Alicia K Gerke
- University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Elyse E Lower
- University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - Mehdi Mirsaeidi
- University of Miami Miller School of Medicine, Miami, FL, USA
| | - Lanier O'Hare
- University of Alabama at Birmingham, Birmingham, AL, USA
| | - Mark J Rumbak
- University of South Florida College of Medicine, Tampa, FL, USA
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12
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Rahaghi FF, Baughman RP, Saketkoo LA, Sweiss NJ, Barney JB, Birring SS, Costabel U, Crouser ED, Drent M, Gerke AK, Grutters JC, Hamzeh NY, Huizar I, Ennis James W, Kalra S, Kullberg S, Li H, Lower EE, Maier LA, Mirsaeidi M, Müller-Quernheim J, Carmona Porquera EM, Samavati L, Valeyre D, Scholand MB. Delphi consensus recommendations for a treatment algorithm in pulmonary sarcoidosis. Eur Respir Rev 2020; 29:29/155/190146. [PMID: 32198218 PMCID: PMC9488897 DOI: 10.1183/16000617.0146-2019] [Citation(s) in RCA: 70] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 02/07/2020] [Indexed: 12/27/2022] Open
Abstract
Pulmonary sarcoidosis presents substantial management challenges, with limited evidence on effective therapies and phenotypes. In the absence of definitive evidence, expert consensus can supply clinically useful guidance in medicine. An international panel of 26 experts participated in a Delphi process to identify consensus on pharmacological management in sarcoidosis with the development of preliminary recommendations. The modified Delphi process used three rounds. The first round focused on qualitative data collection with open-ended questions to ensure comprehensive inclusion of expert concepts. Rounds 2 and 3 applied quantitative assessments using an 11-point Likert scale to identify consensus. Key consensus points included glucocorticoids as initial therapy for most patients, with non-biologics (immunomodulators), usually methotrexate, considered in severe or extrapulmonary disease requiring prolonged treatment, or as a steroid-sparing intervention in cases with high risk of steroid toxicity. Biologic therapies might be considered as additive therapy if non-biologics are insufficiently effective or are not tolerated with initial biologic therapy, usually with a tumour necrosis factor-α inhibitor, typically infliximab. The Delphi methodology provided a platform to gain potentially valuable insight and interim guidance while awaiting evidenced-based contributions. Expert consensus recommendations for a pulmonary sarcoidosis treatment algorithm from a modified Delphi process include corticosteroids as initial therapy, immunomodulators for steroid-sparing or severe disease, and biologics for very severe diseasehttp://bit.ly/2SmP3uG
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Ussavarungsi K, Nugent K, Gerke AK, Krasowski MD, Tuetken RS, Lenert PS. Interstitial lung disease associated with anti-PM-Scl antibody: A single center experience. Autoimmun Rev 2019; 18:102355. [DOI: 10.1016/j.autrev.2019.102355] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 04/13/2019] [Indexed: 02/06/2023]
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Ussavarungsi K, Gerke AK. Approach to tapering antisarcoidosis therapy. Curr Opin Pulm Med 2019; 25:526-532. [PMID: 31365387 DOI: 10.1097/mcp.0000000000000607] [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] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Sarcoidosis is a multisystemic granulomatous disease, which commonly affects the lung. The natural course of the disease and prognosis are variable from asymptomatic, spontaneous remission to progressive disease, which requires treatment. Once treatment is initiated, tapering therapy can be problematic. RECENT FINDINGS Corticosteroids are recommended as first-line therapy, but optimal regimen and duration of treatment is not well established. Treatment may differ based on severity of disease, extrapulmonary involvement, physician and patient preferences. We reviewed currently recommended regimens, particularly, in pulmonary sarcoidosis and the use of alternative treatments as corticosteroid-sparing agents. SUMMARY Corticosteroid use is quite effective as initial therapy but is associated with significant side effects. An approach to tapering sarcoidosis therapy is not standardized, given the lack of evidence-based data. This review provides guidance based on the current literature.
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Affiliation(s)
- Kamonpun Ussavarungsi
- Division of Pulmonary and Critical Care, Department of Internal Medicine, University of Iowa, Iowa City, Iowa, USA
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Affiliation(s)
- Alicia K Gerke
- University of Iowa, Pulmonary and Critical Care Medicine, 200 Hawkins Dr. C33-GH, Iowa City, IA, 52242, USA.
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Vargas Buonfiglio LG, Borcherding JA, Frommelt M, Parker GJ, Duchman B, Vanegas Calderón OG, Fernandez-Ruiz R, Noriega JE, Stone EA, Gerke AK, Zabner J, Comellas AP. Airway surface liquid from smokers promotes bacterial growth and biofilm formation via iron-lactoferrin imbalance. Respir Res 2018. [PMID: 29524964 PMCID: PMC5845328 DOI: 10.1186/s12931-018-0743-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background Smoking is a leading cause of respiratory infections worldwide. Tobacco particulate matter disrupts iron homeostasis in the lungs and increases the iron content in the airways of smokers. The airway epithelia secrete lactoferrin to quench iron required for bacteria to proliferate and cause lung infections. We hypothesized that smokers would have increased bacterial growth and biofilm formation via iron lactoferrin imbalance. Methods We collected bronchoalveolar lavage (BAL) samples from non-smokers and smokers. We challenged these samples using a standard inoculum of Staphylococcus aureus and Pseudomonas aeruginosa and quantified bacterial growth and biofilm formation. We measured both iron and lactoferrin in the samples. We investigated the effect of supplementing non-smoker BAL with cigarette smoke extract (CSE) or ferric chloride and the effect of supplementing smoker BAL with lactoferrin on bacterial growth and biofilm formation. Results BAL from smokers had increased bacterial growth and biofilm formation compared to non-smokers after both S. aureus and P. aeruginosa challenge. In addition, we found that samples from smokers had a higher iron to lactoferrin ratio. Supplementing the BAL of non-smokers with cigarette smoke extract and ferric chloride increased bacterial growth. Conversely, supplementing the BAL of smokers with lactoferrin had a concentration-dependent decrease in bacterial growth and biofilm formation. Conclusion Cigarette smoking produces factors which increase bacterial growth and biofilm formation in the BAL. We propose that smoking disrupts the iron-to-lactoferrin in the airways. This finding offers a new avenue for potential therapeutic interventions to prevent respiratory infections in smokers. Electronic supplementary material The online version of this article (10.1186/s12931-018-0743-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Luis G Vargas Buonfiglio
- Department of Internal Medicine, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, 6312 Pappajohn Biomedical Discovery Building. Newton Road, Iowa City, IA, 52242, USA
| | - Jennifer A Borcherding
- Department of Internal Medicine, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, 6312 Pappajohn Biomedical Discovery Building. Newton Road, Iowa City, IA, 52242, USA
| | - Mark Frommelt
- Department of Internal Medicine, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, 6312 Pappajohn Biomedical Discovery Building. Newton Road, Iowa City, IA, 52242, USA
| | - Gavin J Parker
- Department of Chemistry, College of Liberal Arts & Sciences, University of Iowa, Iowa City, IA, USA
| | - Bryce Duchman
- Department of Internal Medicine, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, 6312 Pappajohn Biomedical Discovery Building. Newton Road, Iowa City, IA, 52242, USA
| | - Oriana G Vanegas Calderón
- Department of Pediatrics, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Ruth Fernandez-Ruiz
- Department of Internal Medicine, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, 6312 Pappajohn Biomedical Discovery Building. Newton Road, Iowa City, IA, 52242, USA
| | - Julio E Noriega
- Department of Internal Medicine, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, 6312 Pappajohn Biomedical Discovery Building. Newton Road, Iowa City, IA, 52242, USA
| | - Elizabeth A Stone
- Department of Chemistry, College of Liberal Arts & Sciences, University of Iowa, Iowa City, IA, USA
| | - Alicia K Gerke
- Department of Internal Medicine, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, 6312 Pappajohn Biomedical Discovery Building. Newton Road, Iowa City, IA, 52242, USA
| | - Joseph Zabner
- Department of Internal Medicine, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, 6312 Pappajohn Biomedical Discovery Building. Newton Road, Iowa City, IA, 52242, USA
| | - Alejandro P Comellas
- Department of Internal Medicine, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, 6312 Pappajohn Biomedical Discovery Building. Newton Road, Iowa City, IA, 52242, USA.
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Abstract
Sarcoidosis is a systemic inflammatory disease with substantial morbidity and increasing mortality. As part of the National Heart, Lung, and Blood Institute's workshop to better understand this disease and improve the outcomes of patients with sarcoidosis, we reviewed the available data on health care burden and outcomes of this disease in the United States. Disparities in outcomes exist by race, ethnicity, sex, and socioeconomic groups, with African Americans having disproportionately more severe disease. Mortality rates are highest in African Americans, but may be increasing in white individuals. The health care burden of sarcoidosis is defined not only by its somatic manifestations, but is also greatly impacted by psychosocial, economic, and comorbid conditions associated with this disease. Fatigue, depression, cognitive dysfunction, treatment side effects, and pain syndromes are highly prevalent in this population and contribute to poor outcomes. The direct and indirect economic costs to patients and society are likely also substantial, although not well defined. We recommend leveraging existing and future technology and infrastructure to more accurately define and monitor the overall total sarcoidosis-attributable health care burden and patient outcomes in the United States.
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Affiliation(s)
- Alicia K. Gerke
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Iowa, Iowa City, Iowa
| | - Marc A. Judson
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Albany Medical College, Albany, New York
| | - Yvette C. Cozier
- Slone Epidemiology Center at Boston University, Boston, Massachusetts
| | - Daniel A. Culver
- Department of Pulmonary Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, Ohio; and
| | - Laura L. Koth
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California
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Vargas Buonfiglio LG, Mudunkotuwa IA, Abou Alaiwa MH, Vanegas Calderón OG, Borcherding JA, Gerke AK, Zabner J, Grassian VH, Comellas AP. Effects of Coal Fly Ash Particulate Matter on the Antimicrobial Activity of Airway Surface Liquid. Environ Health Perspect 2017; 125:077003. [PMID: 28696208 PMCID: PMC5744695 DOI: 10.1289/ehp876] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Revised: 12/30/2016] [Accepted: 01/19/2017] [Indexed: 05/21/2023]
Abstract
BACKGROUND Sustained exposure to ambient particulate matter (PM) is a global cause of mortality. Coal fly ash (CFA) is a byproduct of coal combustion and is a source of anthropogenic PM with worldwide health relevance. The airway epithelia are lined with fluid called airway surface liquid (ASL), which contains antimicrobial proteins and peptides (AMPs). Cationic AMPs bind negatively charged bacteria to exert their antimicrobial activity. PM arriving in the airways could potentially interact with AMPs in the ASL to affect their antimicrobial activity. OBJECTIVES We hypothesized that PM can interact with ASL AMPs to impair their antimicrobial activity. METHODS We exposed pig and human airway explants, pig and human ASL, and the human cationic AMPs β-defensin-3, LL-37, and lysozyme to CFA or control. Thereafter, we assessed the antimicrobial activity of exposed airway samples using both bioluminescence and standard colony-forming unit assays. We investigated PM-AMP electrostatic interaction by attenuated total reflection Fourier-transform infrared spectroscopy and measuring the zeta potential. We also studied the adsorption of AMPs on PM. RESULTS We found increased bacterial survival in CFA-exposed airway explants, ASL, and AMPs. In addition, we report that PM with a negative surface charge can adsorb cationic AMPs and form negative particle-protein complexes. CONCLUSION We propose that when CFA arrives at the airway, it rapidly adsorbs AMPs and creates negative complexes, thereby decreasing the functional amount of AMPs capable of killing pathogens. These results provide a novel translational insight into an early mechanism for how ambient PM increases the susceptibility of the airways to bacterial infection. https://doi.org/10.1289/EHP876.
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Affiliation(s)
| | | | | | - Oriana G Vanegas Calderón
- Department of Pediatrics, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA
| | | | - Alicia K Gerke
- Department of Internal Medicine, Roy J. and Lucille A. Carver College of Medicine
| | - Joseph Zabner
- Department of Internal Medicine, Roy J. and Lucille A. Carver College of Medicine
| | - Vicki H Grassian
- Department of Chemistry and Biochemistry
- Department of Nanoengineering, and
- Scripps Institution of Oceanography, University of California San Diego, La Jolla, California, USA
| | - Alejandro P Comellas
- Department of Internal Medicine, Roy J. and Lucille A. Carver College of Medicine
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Vargas Buonfiglio LG, Cano M, Pezzulo AA, Vanegas Calderon OG, Zabner J, Gerke AK, Comellas AP. Effect of vitamin D 3 on the antimicrobial activity of human airway surface liquid: preliminary results of a randomised placebo-controlled double-blind trial. BMJ Open Respir Res 2017; 4:e000211. [PMID: 28883932 PMCID: PMC5531307 DOI: 10.1136/bmjresp-2017-000211] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [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: 05/06/2017] [Indexed: 12/21/2022] Open
Abstract
Introduction Vitamin D3 supplementation has been reported to prevent lung infections and increase the gene expression of antimicrobial peptides such as cathelicidin. We investigated the effect of vitamin D3 supplementation on the antimicrobial activity of airway surface liquid (ASL) in human subjects. Since smoking can increase the risk of respiratory infections, we also investigated the effect of smoking in the cathelicidin response to vitamin D3 in human airway epithelia in vitro. Methods This study is a subanalysis of single-centre community-based randomised placebo-controlled double-blind trial. Participants were randomised to receive 1000 international units per day of oral vitamin D3 or identical placebo for 90 days. Blood and ASL samples were collected preintervention and postintervention. 105 participants were originally enrolled, 86 completed the trial, and due to low protein concentration in the samples, 40 participants were finally analysed. Our primary outcome was ASL antimicrobial activity. We also considered secondary outcomes including changes in serum concentration of 25-hydroxyvitamin D3 (25(OH)D3), 1,25-hydroxyvitamin D3, calcium and parathyroid hormone (PTH). In addition, we studied the effect of cigarette smoke extract (CSE) exposure to primary human airway epithelial cell cultures on the gene expression of cathelicidin in response to vitamin D3 and expression of CYP27B1 (1-alpha hydroxylase), responsible for vitamin D3 activation. Results Vitamin D3 supplementation significantly increased both ASL antimicrobial activity and serum concentration of 25(OH)D3. In a subgroup analysis, we found that smokers did not increase their baseline antimicrobial activity in response to vitamin D3. Exposure to CSE on human airway epithelia decreased baseline CYP27B1 gene expression and cathelicidin response to 25(OH)D3. Conclusion Vitamin D3 supplementation for 90 days increases ASL antimicrobial activity. Data from this preliminary study suggest that smoking may alter the ability of airway epithelia to activate vitamin D3 and increase the gene expression of cathelicidin antimicrobial peptide. Trial registration number NCT01967628; Post-results.
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Affiliation(s)
- Luis G Vargas Buonfiglio
- Department of Internal Medicine, Roy J and Lucille A Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Marlene Cano
- Department of Internal Medicine, Roy J and Lucille A Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Alejandro A Pezzulo
- Department of Internal Medicine, Roy J and Lucille A Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Oriana G Vanegas Calderon
- Department of Pediatrics, Roy J and Lucille A Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Joseph Zabner
- Department of Internal Medicine, Roy J and Lucille A Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Alicia K Gerke
- Department of Internal Medicine, Roy J and Lucille A Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Alejandro P Comellas
- Department of Internal Medicine, Roy J and Lucille A Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA
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Gerke AK, Tang F, Cozier YC, Lash MT, Schappet J, Phillips E, Polgreen PM. A web-based registry for patients with sarcoidosis. Sarcoidosis Vasc Diffuse Lung Dis 2017. [PMID: 30613131 PMCID: PMC6319670 DOI: 10.36141/svdld.v34i1.5129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND/OBJECTIVE The objective is to present the development of a novel web-based patient registry for sarcoidosis. We describe recruitment efforts and assess efficacy of internet-based advertising on recruitment. METHODS "Worldwide Sarcoidosis Research Study (WISE)" started in 2011 under the domain www.sarcoidstudy.org. The registry includes thirteen patient-reported surveys about patient characteristics, diagnosis, and treatment. Effects of two internet-based advertising methods (geographically-broad versus geographically-targeted to high sarcoidosis search areas) on recruitment were analyzed with time series regression. RESULTS Since 2011, over 1500 participants have registered (82% whites, 9% African Americans, 5% mixed, 4% other), with 23% of participants providing saliva samples for DNA. Median age is 43 years (range 21-80). African Americans were more frequently recruited via support groups, while whites had a higher frequency of finding the registry via internet. Generalized internet-based advertising significantly improved recruitment in all demographic groups (p<0.001). However, a higher response rate to internet-based advertising was seen in whites compared to African Americans(p<0.001), females versus males(p=0.043), higher income categories(p=0.048), and increased education level(p<0.001). Targeting advertising campaigns to geographical areas with high internet-search patterns for sarcoidosis, with different demographics, was not effective in raising registry recruitment above baseline or increasing diversity. CONCLUSIONS A web-based registry is an effective method for establishing a cohort of patients with sarcoidosis invested in clinical research with DNA specimens. Despite limitations, opportunities for research in patient-oriented outcomes and broad internet-based research methodology are possible. Our results demonstrate that web-based approaches to recruit study subjects need to be focused to match different target populations.
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Affiliation(s)
- Alicia K. Gerke
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Iowa, Iowa City,Correspondence: Alicia K. Gerke, MD Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Iowa, 200 Hawkins Dr., Iowa City, Iowa 52242, USA Tel. 319-356-1616 E-mail:
| | - Fan Tang
- University of Iowa Department of Biostatistics Iowa City
| | | | - Michael T. Lash
- University of Iowa, Department of Computer Science, Iowa City
| | - James Schappet
- Institute for Clinical and Translational Science, University of Iowa, Iowa City
| | - Emily Phillips
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Iowa, Iowa City
| | - Philip M. Polgreen
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Iowa, Iowa City
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Mikulski MA, Gerke AK, Newell JD, Murray AM, Smith CJ, Fuortes LJ. Lower limit of normal based spirometric abnormalities associated with radiographic abnormality in an elderly cohort at low risk for exposure. Int J Occup Environ Health 2016; 22:121-7. [PMID: 27142581 DOI: 10.1080/10773525.2016.1176328] [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] [Indexed: 10/21/2022]
Abstract
BACKGROUND Although the relation between radiographic abnormalities and spirometric impairment in people with asbestosis has been studied extensively, the extent of spirometric impairment associated with milder radiographic abnormalities is not established. OBJECTIVE To test associations between mild radiographic abnormalities and Lower Limit of Normal (LLN)-based spirometry interpretation. METHODS Spirometry and CXRs were collected for 1,026 at low risk of exposure to pneumoconiotic agents participants in a medical screening program. RESULTS Individuals with each type of isolated or combined International Labour Organization (ILO) abnormalities had up to over sixfold statistically significant increase in odds of LLN-based restrictive pattern physiology (OR = 1.96, 95%CI 1.03-3.73 for parenchymal to OR = 6.09, 95%CI 1.94-19.10 for parenchymal and pleural) compared to those with normal films. CONCLUSIONS The findings from this study confirm the association of mild profusion abnormalities with clinically relevant, LLN-based lung function abnormalities.
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Affiliation(s)
- Marek A Mikulski
- a Department of Occupational and Environmental Health, College of Public Health , The University of Iowa , 2213 Westlawn, Iowa City , IA 52242 , USA
| | - Alicia K Gerke
- b Department of Internal Medicine , The University of Iowa Hospitals and Clinics , Iowa City , IA , USA
| | - John D Newell
- c Department of Radiology , The University of Iowa Hospitals and Clinics , Iowa City , IA , USA
| | - Ann M Murray
- d Roy J. and Lucille Carver College of Medicine, The University of Iowa , Iowa City , IA , USA
| | - Carmen J Smith
- e Department of Biostatistics , College of Public Health, The University of Iowa , Iowa City , IA , USA
| | - Laurence J Fuortes
- a Department of Occupational and Environmental Health, College of Public Health , The University of Iowa , 2213 Westlawn, Iowa City , IA 52242 , USA
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Gerke AK, Tang F, Cavanaugh JE, Doerschug KC, Polgreen PM. Increased trend in extracorporeal membrane oxygenation use by adults in the United States since 2007. BMC Res Notes 2015; 8:686. [PMID: 26581610 PMCID: PMC4650500 DOI: 10.1186/s13104-015-1678-7] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Accepted: 11/05/2015] [Indexed: 12/02/2022] Open
Abstract
Background Extracorporeal membrane oxygenation (ECMO) has been increasingly studied as a life support modality, but it is unclear if its use has changed over time. Recent publication shows no significant trend in use of ECMO over time; however, this report does not include more recent data. We performed trend analysis to determine if and when the use of ECMO changed in the past decade. Results We identified hospitalizations (2000–2011) in the Nationwide Inpatient Sample during which ECMO was recorded. We used a segmented linear regression model to determine trend and to identify a temporal change point when rate of ECMO use increased. ECMO use gradually grew until 2007, at which time there was a dramatic increase in the rate (p = 0.0003). There was no difference in mortality after 2007 (p = 0.3374), but there was longer length of stay (p = 0.0001) and smaller percentage of women (p = 0.005). Conclusions There has been a marked increase in ECMO use since 2007. As ECMO use becomes more common, further study regarding indications, cost-effectiveness, and outcomes is warranted to guide optimal use.
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Affiliation(s)
- Alicia K Gerke
- Department of Internal Medicine, University of Iowa, 200 Hawkins Dr., Iowa, IA, 52242, USA.
| | - Fan Tang
- Department of Biostatistics, University of Iowa, 105 River Street, Iowa, IA, 52242, USA.
| | - Joseph E Cavanaugh
- Department of Biostatistics, University of Iowa, 105 River Street, Iowa, IA, 52242, USA.
| | - Kevin C Doerschug
- Department of Internal Medicine, University of Iowa, 200 Hawkins Dr., Iowa, IA, 52242, USA.
| | - Philip M Polgreen
- Department of Internal Medicine, University of Iowa, 200 Hawkins Dr., Iowa, IA, 52242, USA.
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Gerke AK, Tang F, Pendergast J, Cavanaugh JE, Polgreen PM. The high frequency of healthcare use in patients one year prior to a sarcoidosis diagnosis. Sarcoidosis Vasc Diffuse Lung Dis 2014; 31:256-261. [PMID: 25363229 PMCID: PMC4315308] [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] [Subscribe] [Scholar Register] [Received: 09/23/2013] [Revised: 10/08/2014] [Accepted: 04/16/2014] [Indexed: 06/04/2023]
Abstract
BACKGROUND The clinical presentation of sarcoidosis can be varied. Prior investigations have shown that diagnosis is often delayed over six months, particularly in patients with pulmonary symptoms. Delays may lead to high healthcare use prior to diagnosis. OBJECTIVE To investigate healthcare use prior to diagnosis of sarcoidosis for a cohort of insured patients. METHODS We conducted a case-control study using a de-identified limited dataset of private health insurance claims. Cases were identified as persons with sarcoidosis from 2003-2009. Controls with other respiratory-related diagnoses (asthma, chronic obstructive pulmonary disease, pneumonia) were matched by age, gender, and diagnosis date. We compared frequencies of doctor visits, prescriptions, and imaging in the year prior to established diagnosis. RESULTS We identified 206 cases and 2060 controls and compared healthcare use patterns in the year prior to diagnosis. Among those receiving prescriptions, a larger proportion of cases received two or more antibiotic courses (69% vs. 55%, p=0.0020) or two or more corticosteroid prescriptions (63% vs. 50%, p=0.0137). On average, cases had more doctor visits (14.7 vs. 7.8, p<0.0001), saw more specialties (3.9 vs. 2.1, p<0.0001), and underwent more chest x-rays (2.0 vs. 1.5, p<0.0001). A larger proportion of cases underwent two or more chest x-rays (54% vs. 24%, p<0.0001). CONCLUSIONS Patients with sarcoidosis undergo a large amount of healthcare prior to diagnosis, some of which may not be necessary, compared to controls with respiratory-related disease. These results highlight the need for improved diagnostic algorithms to identify patients with sarcoidosis and avoid potentially excessive delays in diagnosis.
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Affiliation(s)
- Alicia K Gerke
- Department of Internal Medicine: Pulmonary and Critical Care University of Iowa Hospitals and Clinics Iowa City, IA - 52242.
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Gerke AK, Yang M, Tang F, Foster ED, Cavanaugh JE, Polgreen PM. Association of hospitalizations for asthma with seasonal and pandemic influenza. Respirology 2014; 19:116-21. [PMID: 23931674 DOI: 10.1111/resp.12165] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Revised: 06/04/2013] [Accepted: 07/17/2013] [Indexed: 01/17/2023]
Abstract
BACKGROUND AND OBJECTIVE Although influenza has been associated with asthma exacerbations, it is not clear the extent to which this association affects health care use in the United States. The first goal of this project was to determine whether, and to what extent, the incidence of asthma hospitalizations is associated with seasonal variation in influenza. Second, we used influenza trends (2000-2008) to help predict asthma admissions during the 2009 H1N1 influenza pandemic. METHODS We identified all hospitalizations between 1998 and 2008 in the Nationwide Inpatient Sample from the Healthcare Cost and Utilization Project during which a primary diagnosis of asthma was recorded. Separately, we identified all hospitalizations during which a diagnosis of influenza was recorded. We performed time series regression analyses to investigate the association of monthly asthma admissions with influenza incidence. Finally, we applied these time series regression models using 1998-2008 data, to forecast monthly asthma admissions during the 2009 influenza pandemic. RESULTS Based on time series regression models, a strong, significant association exists between concurrent influenza activity and incidence of asthma hospitalizations (P-value < 0.0001). Use of influenza data to predict asthma admissions during the 2009 H1N1 pandemic improved the mean squared prediction error by 60.2%. CONCLUSIONS Influenza activity in the population is significantly associated with asthma hospitalizations in the United States, and this association can be exploited to more accurately forecast asthma admissions. Our results suggest that improvements in influenza surveillance, prevention and treatment may decrease hospitalizations of asthma patients.
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Affiliation(s)
- Alicia K Gerke
- Department of Internal Medicine, University of Iowa, Iowa City, Iowa, USA
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Gross TJ, Powers LS, Boudreau RL, Brink B, Reisetter A, Goel K, Gerke AK, Hassan IH, Monick MM. A microRNA processing defect in smokers' macrophages is linked to SUMOylation of the endonuclease DICER. J Biol Chem 2014; 289:12823-34. [PMID: 24668803 PMCID: PMC4007470 DOI: 10.1074/jbc.m114.565473] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [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: 03/13/2014] [Revised: 03/24/2014] [Indexed: 11/06/2022] Open
Abstract
Despite the fact that alveolar macrophages play an important role in smoking-related disease, little is known about what regulates their pathophysiologic phenotype. Evaluating smoker macrophages, we found significant down-regulation of multiple microRNAs (miRNAs). This work investigates the hypothesis that cigarette smoke alters mature miRNA expression in lung macrophages by inhibiting processing of primary miRNA transcripts. Studies on smoker alveolar macrophages showed a defect in miRNA maturation. Studies on the miRNA biogenesis machinery led us to focus on the cytosolic RNA endonuclease, DICER. DICER cleaves the stem-loop structure from pre-miRNAs, allowing them to dissociate into their mature 20-22-nucleotide single-stranded form. DICER activity assays confirmed impaired DICER activity following cigarette smoke exposure. Further protein studies demonstrated a decreased expression of the native 217-kDa form of DICER and an accumulation of high molecular weight forms with cigarette smoke exposure. This molecular mass shift was shown to contain SUMO moieties and could be blocked by silencing RNA directed at the primary SUMOylating ligase, Ubc9. In determining the cigarette smoke components responsible for changes in DICER, we found that N-acetylcysteine, an antioxidant and anti-aldehyde, protected DICER protein and activity from cigarette smoke extract. This massive down-regulation of miRNAs (driven in part by alterations in DICER) may be an important regulator of the disease-promoting macrophage phenotype found in the lungs of smokers.
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Affiliation(s)
- Thomas J. Gross
- From the Department of Medicine, Carver College of Medicine, University of Iowa, Iowa City, Iowa 52242
| | - Linda S. Powers
- From the Department of Medicine, Carver College of Medicine, University of Iowa, Iowa City, Iowa 52242
| | - Ryan L. Boudreau
- From the Department of Medicine, Carver College of Medicine, University of Iowa, Iowa City, Iowa 52242
| | - Brandi Brink
- From the Department of Medicine, Carver College of Medicine, University of Iowa, Iowa City, Iowa 52242
| | - Anna Reisetter
- From the Department of Medicine, Carver College of Medicine, University of Iowa, Iowa City, Iowa 52242
| | - Khushboo Goel
- From the Department of Medicine, Carver College of Medicine, University of Iowa, Iowa City, Iowa 52242
| | - Alicia K. Gerke
- From the Department of Medicine, Carver College of Medicine, University of Iowa, Iowa City, Iowa 52242
| | - Ihab H. Hassan
- From the Department of Medicine, Carver College of Medicine, University of Iowa, Iowa City, Iowa 52242
| | - Martha M. Monick
- From the Department of Medicine, Carver College of Medicine, University of Iowa, Iowa City, Iowa 52242
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Gerke AK, Pezzulo AA, Tang F, Cavanaugh JE, Bair TB, Phillips E, Powers LS, Monick MM. Effects of vitamin D supplementation on alveolar macrophage gene expression: preliminary results of a randomized, controlled trial. Multidiscip Respir Med 2014; 9:18. [PMID: 24669961 PMCID: PMC3986866 DOI: 10.1186/2049-6958-9-18] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Accepted: 03/13/2014] [Indexed: 12/04/2022] Open
Abstract
Background Vitamin D deficiency has been implicated as a factor in a number of infectious and inflammatory lung diseases. In the lung, alveolar macrophages play a key role in inflammation and defense of infection, but there are little data exploring the immunomodulatory effects of vitamin D on innate lung immunity in humans. The objective of this study was to determine the effects of vitamin D supplementation on gene expression of alveolar macrophages. Methods We performed a parallel, double-blind, placebo-controlled, randomized trial to determine the effects of vitamin D on alveolar macrophage gene expression. Vitamin D3 (1000 international units/day) or placebo was administered to adults for three months. Bronchoscopy was performed pre- and post-intervention to obtain alveolar macrophages. Messenger RNA was isolated from the macrophages and subjected to whole genome exon array analysis. The primary outcome was differential gene expression of the alveolar macrophage in response to vitamin D supplementation. Specific genes underwent validation by polymerase chain reaction methods. Results Fifty-eight subjects were randomized to vitamin D (n = 28) or placebo (n = 30). There was a marginal overall difference between treatment group and placebo group in the change of 25-hydroxyvitaminD levels (4.43 ng/ml vs. 0.2 ng/ml, p = 0.10). Whole genome exon array analysis revealed differential gene expression associated with change in serum vitamin D levels in the treated group. CCL8/MCP-2 was the top-regulated cytokine gene and was further validated. Conclusions Although only a non-significant increased trend was seen in serum vitamin D levels, subjects treated with vitamin D supplementation had immune-related differential gene expression in alveolar macrophages. Trial registration ClinicalTrials.org: NCT01967628.
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Affiliation(s)
- Alicia K Gerke
- Department of Internal Medicine, University of Iowa, 200 Hawkins Dr, Iowa City 52242, IA, USA.
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Gerke AK, Pezzulo AA, Tang F, Cavanaugh JE, Bair TB, Phillips E, Powers LS, Monick MM. Effects of vitamin D supplementation on alveolar macrophage gene expression: preliminary results of a randomized, controlled trial. Multidiscip Respir Med 2014. [DOI: 10.4081/mrm.2014.417] [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] [Indexed: 11/22/2022] Open
Abstract
Background: Vitamin D deficiency has been implicated as a factor in a number of infectious and inflammatory lung diseases. In the lung, alveolar macrophages play a key role in inflammation and defense of infection, but there are little data exploring the immunomodulatory effects of vitamin D on innate lung immunity in humans. The objective of this study was to determine the effects of vitamin D supplementation on gene expression of alveolar macrophages.
Methods: We performed a parallel, double-blind, placebo-controlled, randomized trial to determine the effects of vitamin D on alveolar macrophage gene expression. Vitamin D3 (1000 international units/day) or placebo was administered to adults for three months. Bronchoscopy was performed pre- and post-intervention to obtain alveolar macrophages. Messenger RNA was isolated from the macrophages and subjected to whole genome exon array analysis. The primary outcome was differential gene expression of the alveolar macrophage in response to vitamin D supplementation. Specific genes underwent validation by polymerase chain reaction methods.
Results: Fifty-eight subjects were randomized to vitamin D (n = 28) or placebo (n = 30). There was a marginal overall difference between treatment group and placebo group in the change of 25-hydroxyvitaminD levels(4.43 ng/ml vs. 0.2 ng/ml, p = 0.10). Whole genome exon array analysis revealed differential gene expression associated with change in serum vitamin D levels in the treated group. CCL8/MCP-2 was the top-regulated cytokine gene and was further validated.
Conclusions: Although only a non-significant increased trend was seen in serum vitamin D levels, subjects treated with vitamin D supplementation had immune-related differential gene expression in alveolar macrophages.
Trial registration: ClinicalTrials.org: NCT01967628.
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Gerke AK, Tang F, Yang M, Foster ED, Cavanaugh JE, Polgreen PM. Predicting chronic obstructive pulmonary disease hospitalizations based on concurrent influenza activity. COPD 2013; 10:573-80. [PMID: 23819753 DOI: 10.3109/15412555.2013.777400] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Although influenza has been associated with chronic obstructive pulmonary disease (COPD) exacerbations, it is not clear the extent to which this association affects healthcare use in the United States. The first goal of this project was to determine to what extent the incidence of COPD hospitalizations is associated with seasonal influenza. Second, as a natural experiment, we used influenza activity to help predict COPD admissions during the 2009 H1N1 influenza pandemic. To do this, we identified all hospitalizations between 1998 and 2010 in the Nationwide Inpatient Sample from the Healthcare Cost and Utilization Project (HCUP) during which a primary diagnosis of COPD was recorded. Separately, we identified all hospitalizations during which a diagnosis of influenza was recorded. We formulated time series regression models to investigate the association of monthly COPD admissions with influenza incidence. Finally, we applied these models, fit using 1998-2008 data, to forecast monthly COPD admissions during the 2009 pandemic. Based on time series regression models, a strong, significant association exists between concurrent influenza activity and incidence of COPD hospitalizations (p-value < 0.0001). The association is especially strong among older patients requiring mechanical ventilation. Use of influenza data to predict COPD admissions during the 2009 H1N1 pandemic reduced the mean-squared prediction error by 29.9%. We conclude that influenza activity is significantly associated with COPD hospitalizations in the United States and influenza activity can be exploited to more accurately forecast COPD admissions. Our results suggest that improvements in influenza surveillance, prevention, and treatment may decrease hospitalizations of patients diagnosed with COPD.
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Affiliation(s)
- Alicia K Gerke
- 1Department of Internal Medicine, University of Iowa , Iowa City, IA , USA
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Gerke AK, Tang F, Yang M, Cavanaugh JE, Polgreen PM. An analysis of seasonality of sarcoidosis in the United States veteran population: 2000-2007. Sarcoidosis Vasc Diffuse Lung Dis 2012; 29:155-158. [PMID: 23461080 PMCID: PMC4321897] [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] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND The onset of sarcoidosis is thought to be seasonal, particularly Lofgren's syndrome. However, there are conflicting data on seasonality by country and by radiographic stage. OBJECTIVE The objective of this study was to determine if there is seasonality of the diagnosis of sarcoidosis in outpatients in the United States. METHODS AND RESULTS Using time series methods, we performed a retrospective analysis of 3791 incident cases of sarcoidosis in the Veteran's Health Administration national outpatient claims database (2000-2007). We did not find overall seasonality in the occurrence of new sarcoidosis in United States Veterans (p = 0.9860), even after we subdivided the United States by northern (p = 0.6824) and southern regions (p = 0.4588). CONCLUSION The lack of seasonality in this study indicates that season is not a dominant factor in complex gene-environment-host interaction that precedes presentation of new sarcoidosis cases in the United States Veteran population.
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Affiliation(s)
- Alicia K. Gerke
- University of Iowa Department of Internal Medicine: 200 Hawkins Dr. Iowa City, Iowa 52242
| | - Fan Tang
- University of Iowa Department of Biostatistics: 200 Hawkins Dr. Iowa City, Iowa 52242
| | - Ming Yang
- University of Iowa Department of Biostatistics: 200 Hawkins Dr. Iowa City, Iowa 52242
| | - Joseph E. Cavanaugh
- University of Iowa Department of Biostatistics: 200 Hawkins Dr. Iowa City, Iowa 52242
| | - Philip M. Polgreen
- University of Iowa Department of Internal Medicine: 200 Hawkins Dr. Iowa City, Iowa 52242
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Gerke AK, Yang M, Tang F, Cavanaugh JE, Polgreen PM. Increased hospitalizations among sarcoidosis patients from 1998 to 2008: a population-based cohort study. BMC Pulm Med 2012; 12:19. [PMID: 22584044 PMCID: PMC3391973 DOI: 10.1186/1471-2466-12-19] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2011] [Accepted: 05/14/2012] [Indexed: 11/10/2022] Open
Abstract
Background Diagnostic and treatment approaches for sarcoidosis have changed dramatically over the past decade. Yet, the most recent reports of trends in hospitalizations of sarcoidosis patients are over ten years old. The objectives of this study were to determine the incidence of sarcoidosis among hospitalized patients and to analyze recent trends and seasonality of hospitalizations in sarcoidosis patients. Methods We performed a retrospective cohort study of the Nationwide Inpatient Sample from 1998 through 2008. We identified all hospitalizations with a primary or secondary diagnosis of sarcoidosis (ICD-9-CM code 135). Incidence was modeled as a seasonal time series about a linear trend. Results Time series analysis of the monthly number of hospitalizations revealed a distinct positive linear trend. Over the study period, the number of hospitalized patients with sarcoidosis increased from 37,516 to 70,947 cases. Trends were most pronounced in patients older than 55 years (p < 0.0001), African Americans (p < 0.0001), females (p = 0.0289), and non-Medicaid populations (p < 0.0001). Hospitalizations are seasonal with highest incidence in January through March. Conclusions Hospitalizations among sarcoidosis patients have almost doubled during the past decade, with disproportionate rate increases in African Americans, women, and older patients. The rate also increases among patients with insurance other than Medicaid. This study indicates the need for heightened surveillance of sarcoidosis patients given the unknown consequences of evolving treatment approaches. Our results point to a need for research investigating risk factors for hospitalization, including medications, co-morbidities, demographics, and socioeconomic status.
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Affiliation(s)
- Alicia K Gerke
- Department of Internal Medicine, University of Iowa, 200 Hawkins Drive, Iowa City, IA 52242, USA.
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Philibert RA, Sears RA, Powers LS, Nash E, Bair T, Gerke AK, Hassan I, Thomas CP, Gross TJ, Monick MM. Coordinated DNA methylation and gene expression changes in smoker alveolar macrophages: specific effects on VEGF receptor 1 expression. J Leukoc Biol 2012; 92:621-31. [PMID: 22427682 DOI: 10.1189/jlb.1211632] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Cigarette smoking is implicated in numerous diseases, including emphysema and lung cancer. The clinical expression of lung disease in smokers is not well explained by currently defined variations in gene expression or simple differences in smoking exposure. Alveolar macrophages play a critical role in the inflammation and remodeling of the lung parenchyma in smoking-related lung disease. Significant gene expression changes in alveolar macrophages from smokers have been identified. However, the mechanism for these changes remains unknown. One potential mechanism for smoking-altered gene expression is via changes in cytosine methylation in DNA regions proximal to gene-coding sequences. In this study, alveolar macrophage DNA from heavy smokers and never smokers was isolated and methylation status at 25,000 loci determined. We found differential methylation in genes from immune-system and inflammatory pathways. Analysis of matching gene expression data demonstrated a parallel enrichment for changes in immune-system and inflammatory pathways. A significant number of genes with smoking-altered mRNA expression had inverse changes in methylation status. One gene highlighted by this data was the FLT1, and further studies found particular up-regulation of a splice variant encoding a soluble inhibitory form of the receptor. In conclusion, chronic cigarette smoke exposure altered DNA methylation in specific gene promoter regions in human alveolar macrophages.
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Gerke AK, van Beek E, Hunninghake GW. Smoking inhibits the frequency of bronchovascular bundle thickening in sarcoidosis. Acad Radiol 2011; 18:885-91. [PMID: 21530329 DOI: 10.1016/j.acra.2011.02.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2011] [Revised: 02/01/2011] [Accepted: 02/03/2011] [Indexed: 10/18/2022]
Abstract
RATIONALE/OBJECTIVES Smoking has been associated with decreased incidence and prevalence of sarcoidosis, but few studies have evaluated effects of smoking on clinical parameters of the disease. The objectives were to determine the association of smoking with radiographic patterns and to evaluate the associations of these smoking-related radiographic patterns on airflow obstruction in sarcoidosis. MATERIALS AND METHODS Clinical data and computed tomography (CT) scans of 124 patients with sarcoidosis were reviewed. CT scans were assessed for lymph nodes, nodules, bronchiectasis, bronchovascular bundle thickening, displaced hilum, fibrosis, ground glass, emphysema, pleural changes, and alveolar opacities. CT patterns were compared between patients with and without a history of smoking. The effect of smoking on the associations between radiographic patterns and airflow obstruction was assessed with multivariable analysis. RESULTS Smokers had less frequency of bronchovascular bundle thickening than nonsmokers (11/38 subjects [29%] vs 50/86 subjects [58%], P = .003) and more emphysema (7/38 subjects [18%] vs 1/86 subjects [1%], P = .001). Patients who had bronchovascular bundle thickening were less likely to have ever smoked (11/61 subjects [18%] vs 27/63 subjects [43%], P = .003) or be current smokers (4/61 subjects [7%] vs 15/63 subjects [24%], P = .008). Age (P = .003) and bronchovascular bundle thickening (P = .02) were independent predictors of airflow obstruction. There were no differences in smoking history between patients with airflow obstruction versus those without (10/37 subjects [27%] vs 28/87 subjects [32%], P = .63). CONCLUSIONS In patients with sarcoidosis, smoking is associated with decreased frequency of bronchovascular bundle thickening, an important clinical manifestation of the lung disease. Further, bronchovascular bundle thickening and age are the only independent predictors of airflow obstruction, and smoking does not confound these associations.
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Gerke AK, Hunninghake GW. Survival With Pulmonary Fibrosis Related to Age, Race, and Gender. Chest 2010. [DOI: 10.1378/chest.10749] [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] [Indexed: 11/01/2022] Open
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Gerke AK, Hunninghake GW. BRONCHOVASCULAR BUNDLE THICKENING PREDICTS AIRFLOW OBSTRUCTION IN PATIENTS WITH SARCOIDOSIS: THE ROLE OF SMOKING. Chest 2009. [DOI: 10.1378/chest.136.4_meetingabstracts.65s-h] [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] [Indexed: 11/01/2022] Open
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Abstract
Sarcoidosis continues to be a disease of research interest because of its complicated immune mechanisms and elusive etiology. So far, it has been established that granulomatous inflammation in sarcoidosis is predominantly a T-helper 1 immune response mediated by a complex network of lymphocytes, macrophages, and cytokines. The cause of progression to a chronic and potentially fibrotic form is unclear but may involve loss of apoptotic mechanisms, loss of regulatory response, or a persistent antigen that cannot be cleared. Recent genomic and proteomic technology has emphasized the importance of host susceptibility and gene-environment interaction in the expression of the disease.
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Affiliation(s)
- Alicia K Gerke
- Division of Pulmonary, Critical Care, and Occupational Medicine, University of Iowa College of Medicine, 200 Hawkins Drive, Iowa City, IA 52242, USA.
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Gerke AK, Wilson J. COMPLETE RESOLUTION OF SEVERE HIGH OUTPUT HEART FAILURE AND PULMONARY HYPERTENSION AFTER REPAIR OF LONGSTANDING ARTERIOVENOUS FISTULA. Chest 2007. [DOI: 10.1378/chest.132.4_meetingabstracts.729a] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Hargett CW, Gerke AK, Fortin TA, Tapson VF. CORRELATION OF NT-PROBNP WITH OTHER NONINVASIVE PARAMETERS IN PATIENTS WITH PULMONARY ARTERIAL HYPERTENSION. Chest 2005. [DOI: 10.1378/chest.128.4_meetingabstracts.201s-b] [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] [Indexed: 11/01/2022] Open
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Gerke AK, Tapson V. Brain Natriuretic Peptide Levels Correlate With Hemodynamic and Functional Parameters in Patients With Pulmonary Arterial Hypertension. Chest 2004. [DOI: 10.1378/chest.126.4_meetingabstracts.760s-a] [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] [Indexed: 11/01/2022] Open
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