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Green DM, Lahiri T, Raraigh KS, Ruiz F, Spano J, Antos N, Bonitz L, Christon L, Gregoire-Bottex M, Hale JE, Langfelder-Schwind E, La Parra Perez Á, Maguiness K, Massie J, McElroy-Barker E, McGarry ME, Mercier A, Munck A, Oliver KE, Self S, Singh K, Smiley M, Snodgrass S, Tluczek A, Tuley P, Lomas P, Wong E, Hempstead SE, Faro A, Ren CL. Cystic Fibrosis Foundation Evidence-Based Guideline for the Management of CRMS/CFSPID. Pediatrics 2024; 153:e2023064657. [PMID: 38577740 DOI: 10.1542/peds.2023-064657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/22/2024] [Indexed: 04/06/2024] Open
Abstract
A multidisciplinary committee developed evidence-based guidelines for the management of cystic fibrosis transmembrane conductance regulator-related metabolic syndrome/cystic fibrosis screen-positive, inconclusive diagnosis (CRMS/CFSPID). A total of 24 patient, intervention, comparison, and outcome questions were generated based on surveys sent to people with CRMS/CFSPID and clinicians caring for these individuals, previous recommendations, and expert committee input. Four a priori working groups (genetic testing, monitoring, treatment, and psychosocial/communication issues) were used to provide structure to the committee. A systematic review of the evidence was conducted, and found numerous case series and cohort studies, but no randomized clinical trials. A total of 30 recommendations were graded using the US Preventive Services Task Force methodology. Recommendations that received ≥80% consensus among the entire committee were approved. The resulting recommendations were of moderate to low certainty for the majority of the statements because of the low quality of the evidence. Highlights of the recommendations include thorough evaluation with genetic sequencing, deletion/duplication analysis if <2 disease-causing variants were noted in newborn screening; repeat sweat testing until at least age 8 but limiting further laboratory testing, including microbiology, radiology, and pulmonary function testing; minimal use of medications, which when suggested, should lead to shared decision-making with families; and providing communication with emphasis on social determinants of health and shared decision-making to minimize barriers which may affect processing and understanding of this complex designation. Future research will be needed regarding medication use, antibiotic therapy, and the use of chest imaging for monitoring the development of lung disease.
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Affiliation(s)
- Deanna M Green
- Johns Hopkins All Children's Hospital, St Petersburg, Florida
| | - Thomas Lahiri
- University of Vermont Children's Hospital, Burlington, Vermont
| | - Karen S Raraigh
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Jacquelyn Spano
- Stanford University School of Medicine, Stanford, California
| | - Nicholas Antos
- Medical College of Wisconsin, Children's Wisconsin, Milwaukee, Wisconsin
| | - Lynn Bonitz
- Cohen Children's Medical Center of NY/Northwell Health, New Hyde Park, New York
| | - Lillian Christon
- Medical University of South Carolina, Charleston, South Carolina
| | - Myrtha Gregoire-Bottex
- Advanced Pediatric Pulmonology, Pllc, Miramar, Florida
- Memorial Health Network, Hollywood, Florida
| | - Jaime E Hale
- University of Massachusetts Chan Medical School, Worcester, Massachusetts
| | | | - Álvaro La Parra Perez
- John B. Goddard School of Business and Economics, Weber State University, Ogden, Utah
| | - Karen Maguiness
- Riley Hospital for Children at IU Health, Indianapolis, Indiana
| | - John Massie
- University of Melbourne Murdoch Childrens Research Institute, Melbourne, Australia
| | | | - Meghan E McGarry
- University of California San Francisco, San Francisco, California
| | - Angelique Mercier
- Robert H. Lurie Children's Hospital of Chicago, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - Anne Munck
- Hospital Necker Enfants malades, AP-HP, Paris, France
| | | | - Staci Self
- University of Alabama at Birmingham, Birmingham, Alabama
| | - Kathryn Singh
- University of California, Irvine, Orange, California Miller Children's and Women's Hospital, Long Beach, California
| | | | | | | | | | - Paula Lomas
- The Cystic Fibrosis Foundation, Bethesda, Maryland
| | - Elise Wong
- The Cystic Fibrosis Foundation, Bethesda, Maryland
| | | | - Albert Faro
- The Cystic Fibrosis Foundation, Bethesda, Maryland
| | - Clement L Ren
- The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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Vaziri S, McGarry ME, Huang CY, Cuneo AA, Willen SM, Iwanaga K, Neemuchwala F, Gibb ER, Chan M, Ly NP. Time to be blunt: Substance use in cystic fibrosis. Pediatr Pulmonol 2024. [PMID: 38251844 DOI: 10.1002/ppul.26880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 01/09/2024] [Accepted: 01/10/2024] [Indexed: 01/23/2024]
Abstract
BACKGROUND As the population of people with cystic fibrosis (pwCF) continues to age, attention is shifting towards addressing the unique challenges teenagers and adults face, including substance use. Changing attitudes and legality regarding marijuana and cannabidiol (CBD) may influence their use among pwCF, but data on the rate of use, reasons for use, and administration methods are lacking. OBJECTIVE Investigate marijuana, CBD, e-cigarette, and cigarette usage among pwCF and explore differences in demographics, disease severity, and cystic fibrosis transmembrane receptor (CFTR) modulator use between recent users and nonusers. METHODS This cross-sectional study used a one-time electronic survey to assess marijuana, CBD, e-cigarette, and cigarette use in pwCF aged >13 years. Demographic and clinical characteristics were compared between recent users and nonusers. The association between recent substance use and CFTR modulator use was analyzed using logistic regressions. RESULTS Among 226 participants, 29% used marijuana, 22% used CBD, 27% used e-cigarettes, and 22% used cigarettes in the last 12 months. Users of all substances were more likely to be college-educated or aged 29-39 years than nonusers. E-cigarette users were 2.9 times more likely to use CFTR modulators (95% confidence interval [95% CI]: 0.98-11.00, p = .08) and marijuana users were 2.5 times more likely to use CFTR modulators compared to nonusers, adjusted for confounders. CBD, e-cigarettes, and cigarettes users were more likely to have an abnormal mental health screen compared to nonusers. A high proportion of never-users of marijuana and CBD expressed interest in using. CONCLUSION Substance use is more prevalent among pwCF than previously reported and needs to be addressed by healthcare providers.
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Affiliation(s)
- Sanaz Vaziri
- Department of Pediatrics, University of California San Francisco, San Francisco, California, USA
| | - Meghan E McGarry
- Department of Pediatrics, University of California San Francisco, San Francisco, California, USA
| | - Chiung-Yu Huang
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
| | - Addison A Cuneo
- Department of Pediatrics, University of California San Francisco, San Francisco, California, USA
| | - Shaina M Willen
- Department of Pediatrics, University of California Davis, Davis, California, USA
| | - Kensho Iwanaga
- Department of Pediatrics, University of California San Francisco, San Francisco, California, USA
| | - Fatima Neemuchwala
- Department of Pediatrics, University of California San Francisco, San Francisco, California, USA
| | - Elizabeth R Gibb
- Department of Pediatrics, University of California San Francisco, San Francisco, California, USA
| | - Marilynn Chan
- Department of Pediatrics, Kaiser Permanente, Oakland, California, USA
| | - Ngoc P Ly
- Department of Pediatrics, University of California San Francisco, San Francisco, California, USA
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McGarry ME, Huang CY, Ly NP. Ethnic differences in staphylococcus aureus acquisition in cystic fibrosis. J Cyst Fibros 2023; 22:909-915. [PMID: 37460380 PMCID: PMC10802839 DOI: 10.1016/j.jcf.2023.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 07/06/2023] [Accepted: 07/08/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND Hispanic people with CF (pwCF) have increased morbidity than non-Hispanic White pwCF, including increased risk of Pseudomonas aeruginosa. We aimed to determine if Staphylococcus aureus (S. aureus) acquisition varies between Hispanic and non-Hispanic White pwCF. METHODS This longitudinal cohort study of pwCF ages 0-25 years in the CF Foundation Patient Registry compared acquisition of methicillin-sensitive S. aureus (MSSA), methicillin-resistant S. aureus (MRSA), persistent MRSA between Hispanic and non-Hispanic White pwCF. Risk of acquisition was assessed by Kaplan-Meier survival curves and its association with ethnicity was evaluated using Cox regressions. Adjusted associations were evaluated using multivariate Cox models adjusting for sex, age of entry into CFFPR, CFTR variant severity, pancreatic insufficiency, CF-related diabetes, maternal education, insurance status. RESULTS Of 10,640 pwCF, 7.5% were Hispanic and 92.5% were non-Hispanic White. Hispanic pwCF had a 19% higher risk of acquiring MSSA (HR 1.19, 95% CI 1.10-1.28, p<0.001) and 13% higher risk of acquiring MRSA (HR 1.13, 95% CI 1.02-1.26, p = 0.02) than non-Hispanic White pwCF. The difference in persistent MRSA between ethnicities did not reach statistical significance. After adjusting for confounding variables, only the risk of MSSA was significantly associated with ethnicity. Compared to non-Hispanic White pwCF, Hispanic pwCF acquired MSSA and MRSA at younger median ages (4.9 vs. 3.8 years (p<0.001), 22.4 vs. 20.8 years (p = 0.02). CONCLUSION Hispanic pwCF <25 years of age have an increased risk of acquiring MSSA and acquired MSSA and MRSA at an earlier age. Differences in S. aureus acquisition may contribute to increased morbidity in Hispanic pwCF.
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Affiliation(s)
- Meghan E McGarry
- Division of Pediatric Pulmonology, Department of Pediatrics, University of California, 550 16th Ave, Box 0632, San Francisco, CA 94158, United States.
| | - Chiung-Yu Huang
- Department of Epidemiology and Biostatistics, University of California, San Francisco, United States
| | - Ngoc P Ly
- Division of Pediatric Pulmonology, Department of Pediatrics, University of California, 550 16th Ave, Box 0632, San Francisco, CA 94158, United States
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McGarry ME, Midgley KJ, Holcomb PJ, Emmorey K. How (and why) does iconicity effect lexical access: An electrophysiological study of American sign language. Neuropsychologia 2023; 183:108516. [PMID: 36796720 PMCID: PMC10576952 DOI: 10.1016/j.neuropsychologia.2023.108516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 12/17/2022] [Accepted: 02/13/2023] [Indexed: 02/16/2023]
Abstract
Prior research has found that iconicity facilitates sign production in picture-naming paradigms and has effects on ERP components. These findings may be explained by two separate hypotheses: (1) a task-specific hypothesis that suggests these effects occur because visual features of the iconic sign form can map onto the visual features of the pictures, and (2) a semantic feature hypothesis that suggests that the retrieval of iconic signs results in greater semantic activation due to the robust representation of sensory-motor semantic features compared to non-iconic signs. To test these two hypotheses, iconic and non-iconic American Sign Language (ASL) signs were elicited from deaf native/early signers using a picture-naming task and an English-to-ASL translation task, while electrophysiological recordings were made. Behavioral facilitation (faster response times) and reduced negativities were observed for iconic signs (both prior to and within the N400 time window), but only in the picture-naming task. No ERP or behavioral differences were found between iconic and non-iconic signs in the translation task. This pattern of results supports the task-specific hypothesis and provides evidence that iconicity only facilitates sign production when the eliciting stimulus and the form of the sign can visually overlap (a picture-sign alignment effect).
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Affiliation(s)
- Meghan E McGarry
- Joint Doctoral Program in Language and Communication Disorders, San Diego State University and University of California, San Diego, San Diego, CA, USA
| | | | - Phillip J Holcomb
- Department of Psychology, San Diego State University, San Diego, CA, USA
| | - Karen Emmorey
- School of Speech, Language and Hearing Sciences, San Diego State University, San Diego, CA, USA.
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McGarry ME, Gibb ER, Laguna TA, O'Sullivan BP, Sawicki GS, Zobell JT. How many billions is enough? Prioritizing profits over patients with cystic fibrosis. Pediatr Pulmonol 2023; 58:1595-1597. [PMID: 36722731 PMCID: PMC10121825 DOI: 10.1002/ppul.26335] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 01/04/2023] [Accepted: 01/26/2023] [Indexed: 02/02/2023]
Affiliation(s)
- Meghan E McGarry
- Department of Pediatrics, Division of Pediatric Pulmonary Medicine, University of California San Francisco, San Francisco, California, USA
| | - Elizabeth R Gibb
- Department of Pediatrics, Division of Pediatric Pulmonary Medicine, University of California San Francisco, San Francisco, California, USA
| | - Theresa A Laguna
- Department of Pediatrics, Division of Pulmonary Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Brian P O'Sullivan
- Department of Pediatrics, Division of Pediatric Pulmonology, Geisel School of Medicine at Dartmouth College, Hanover, New Hampshire, USA
| | - Gregory S Sawicki
- Department of Pediatrics, Division of Pulmonary Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Jeffery T Zobell
- Department of Pharmacotherapy, University of Utah, Salt Lake City, Utah, USA
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McGarry ME, Ren CL, Wu R, Farrell PM, McColley SA. Detection of disease-causing CFTR variants in state newborn screening programs. Pediatr Pulmonol 2023; 58:465-474. [PMID: 36237137 PMCID: PMC9870974 DOI: 10.1002/ppul.26209] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 09/29/2022] [Accepted: 10/12/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND Newborn screening (NBS) algorithms for cystic fibrosis (CF) vary in the United State of America and include different cystic fibrosis transmembrane conductance regulator (CFTR) variants. CFTR variant distribution varies among racial and ethnic groups. OBJECTIVE Our objectives were to identify differences in detection rate by race and ethnicity for CFTR variant panels, identify each US state detection rate for CFTR variant panels, and describe the rate of false-negative NBS and delayed diagnoses by race and ethnicity. METHODS This is a cross-sectional analysis of the detection rate of at least 1 CFTR variant for seven panels by race and ethnicity in genotyped people with CF (PwCF) or CFTR-related metabolic syndrome (CRMS)/CFTR-related disorders in CF Foundation Patient Registry (CFFPR) in 2020. We estimated the case detection rate of CFTR variant panels by applying the detection rate to Census data. Using data from CFFPR, we compared the rate of delayed diagnosis or false-negative NBS by race and ethnicity. RESULTS For all panels, detection of at least 1 CFTR variant was highest in non-Hispanic White PwCF (87.5%-97.0%), and lowest in Black, Asian, and Hispanic PwCF (41.9%-93.1%). Detection of at least 1 CFTR variant was lowest in Black and Asian people with CRMS/CFTR-related disorders (48.4%-64.8%). States with increased racial and ethnic diversity have lower detection rates for all panels. Overall, 3.8% PwCF had a false-negative NBS and 11.8% had a delayed diagnosis; Black, Hispanic, and mixed-race PwCF were overrepresented. CONCLUSION CFTR variant panels have lower detection rates in minoritized racial and ethnic groups leading to false-negative NBS, delayed diagnosis, and likely health disparities.
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Affiliation(s)
- Meghan E McGarry
- Department of Pediatrics, University of California, San Francisco, California, USA
| | - Clement L Ren
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Runyu Wu
- Cystic Fibrosis Foundation, Bethesda, Maryland, USA
| | - Philip M Farrell
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Susanna A McColley
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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Smith MA, Dinh D, Ly NP, Ward SL, McGarry ME, Zinter MS. Changes in the Use of Invasive and Noninvasive Mechanical Ventilation in Pediatric Asthma: 2009-2019. Ann Am Thorac Soc 2023; 20:245-253. [PMID: 36315585 PMCID: PMC9989865 DOI: 10.1513/annalsats.202205-461oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 10/31/2022] [Indexed: 02/04/2023] Open
Abstract
Rationale: Despite lower overall hospitalization rates for asthma in recent years, there has been an increase in the number of pediatric patients receiving intensive care management in the United States. Objectives: To investigate how the use of invasive and noninvasive mechanical ventilation for asthma has changed in the context of an evolving cohort of critically ill pediatric patients with asthma. Methods: We analyzed children admitted to intensive care units for asthma from 2009 through 2019 in the Virtual Pediatric Systems database. Regression analyses were used to evaluate how respiratory support interventions, mortality, and patient characteristics have changed over time. Odds ratios were calculated to determine how patient characteristics were associated with respiratory support needs. Stratified analyses were performed to determine how changing practice patterns may have differed between patient subgroups. Results: There were 67,614 admissions for 56,727 patients analyzed. Intubation occurred in 4.6% of admissions and decreased from 6.9% to 3.4% over time (P < 0.001), whereas noninvasive ventilation as the maximal respiratory support increased from 8.9% to 20.0% (P < 0.001). Over time, the cohort shifted to include more 2- to 6-year-olds and patients of Asian/Pacific Islander or Hispanic race/ethnicity. Although intubation decreased and noninvasive ventilation increased in all subgroups, the changes were most pronounced in the youngest patients and slightly less pronounced for obese patients. Conclusions: In pediatric asthma, use of intubation has halved, whereas use of noninvasive ventilation has more than doubled. This change in practice appears partially related to a younger patient cohort, although other factors merit exploration.
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Affiliation(s)
| | - Doantrang Dinh
- Division of Pulmonary Medicine, Department of Pediatrics, School of Medicine, Stanford University, Stanford, California
| | - Ngoc P. Ly
- Division of Pulmonology, Department of Pediatrics, School of Medicine, University of California, San Francisco, San Francisco, California; and
| | | | - Meghan E. McGarry
- Division of Pulmonology, Department of Pediatrics, School of Medicine, University of California, San Francisco, San Francisco, California; and
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McGarry ME, McColley SA, Taylor-Cousar J. In response to "who are the 10%? - Non eligibility of cystic fibrosis (CF) patients for highly effective modulator therapies". Respir Med 2022; 202:106953. [PMID: 36049345 DOI: 10.1016/j.rmed.2022.106953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 08/01/2022] [Accepted: 08/11/2022] [Indexed: 11/18/2022]
Affiliation(s)
- Meghan E McGarry
- Department of Pediatrics, University of California San Francisco, United States.
| | - Susanna A McColley
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, United States
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McGarry ME, Gibb ER, Oates GR, Schechter MS. Left behind: The potential impact of CFTR modulators on racial and ethnic disparities in cystic fibrosis. Paediatr Respir Rev 2022; 42:35-42. [PMID: 35277357 PMCID: PMC9356388 DOI: 10.1016/j.prrv.2021.12.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 12/16/2021] [Indexed: 12/16/2022]
Abstract
The advent of CFTR modulators, a genomic specific medication, revolutionized the treatment of CF for many patients. However, given that these therapeutics were only developed for specific CFTR mutations, not all people with CF have access to such disease-modifying drugs. Racial and ethnic minority groups are less likely to have CFTR mutations that are approved for CFTR modulators. This exclusion has the potential to widen existing health disparities.
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Affiliation(s)
- Meghan E. McGarry
- Division of Pulmonary Medicine, Department of Pediatrics, University of California San Francisco, San Francisco, CA
| | - Elizabeth R. Gibb
- Division of Pulmonary Medicine, Department of Pediatrics, University of California San Francisco, San Francisco, CA
| | - Gabriela R. Oates
- Division of Pulmonary and Sleep Medicine, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL
| | - Michael S. Schechter
- Division of Pulmonary and Sleep Medicine, Department of Pediatrics, Virginia Commonwealth University and Children’s Hospital of Richmond at VCU, Richmond, VA
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10
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Lim JT, Ly NP, Willen SM, Iwanaga K, Gibb ER, Chan M, Church GD, Neemuchwala F, McGarry ME. Food insecurity and mental health during the COVID-19 pandemic in cystic fibrosis households. Pediatr Pulmonol 2022; 57:1238-1244. [PMID: 35112507 DOI: 10.1002/ppul.25850] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 01/27/2022] [Accepted: 01/29/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND The COVID-19 pandemic impacted many households due to shelter-in-place orders and economic hardship. People with cystic fibrosis (CF) experienced increased food insecurity compared to the general population before the pandemic, even though adequate food access is needed to maintain nutrition goals associated with improved health-related outcomes. Little is known about the impact the pandemic had on the food insecurity of people with CF and their families. OBJECTIVE To investigate how the COVID-19 pandemic impacted food insecurity, mental health, and self-care in people with CF. METHODS Adults with CF and parents/guardians of children with CF were recruited via social media to complete online questionnaires from May 2020 to February 2021. Questionnaires in English and Spanish included USDA 2-question food insecurity screening, Patient Health Questionnaire-4 for mental health screening, and directed questions on the impact of the pandemic. RESULTS Of 372 respondents, 21.8% of the households experienced food insecurity during the pandemic compared to 18.8% prepandemic (p < .001). More food insecure patients with CF reported weight loss (32.1% vs. 13.1%, p < .001), worse airway clearance adherence (13.6% vs. 5.8%, p < .01), and worse medication adherence (12.4% vs. 1.7%, p < .01) compared to food secure patients. Food insecure subjects were more likely to have an abnormal mental health screen compared to food secure subjects (53.1% vs. 16.2%, p < .001). CONCLUSION Food insecurity increased in the CF population during the COVID-19 pandemic. Food insecure subjects reported worse mental health and self-care during the pandemic compared to food secure subjects.
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Affiliation(s)
- Janet T Lim
- Department of Pediatrics, Division of Pediatric Pulmonology, University of California, San Francisco, California, USA
| | - Ngoc P Ly
- Department of Pediatrics, Division of Pediatric Pulmonology, University of California, San Francisco, California, USA
| | - Shaina M Willen
- Department of Pediatrics, Division of Pediatric Pulmonology, University of California, San Francisco, California, USA
| | - Kensho Iwanaga
- Department of Pediatrics, Division of Pediatric Pulmonology, University of California, San Francisco, California, USA
| | - Elizabeth R Gibb
- Department of Pediatrics, Division of Pediatric Pulmonology, University of California, San Francisco, California, USA
| | - Marilynn Chan
- Department of Pediatrics, Division of Pediatric Pulmonology, University of California, San Francisco, California, USA
| | - Gwynne D Church
- Department of Pediatrics, Division of Pediatric Pulmonology, University of California, San Francisco, California, USA
| | - Fatima Neemuchwala
- Department of Pediatrics, Division of Pediatric Pulmonology, University of California, San Francisco, California, USA
| | - Meghan E McGarry
- Department of Pediatrics, Division of Pediatric Pulmonology, University of California, San Francisco, California, USA
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McGarry ME, Massa N, Mott M, Midgley KJ, Holcomb PJ, Emmorey K. Matching pictures and signs: An ERP study of the effects of iconic structural alignment in American sign language. Neuropsychologia 2021; 162:108051. [PMID: 34624260 DOI: 10.1016/j.neuropsychologia.2021.108051] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 07/28/2021] [Accepted: 10/02/2021] [Indexed: 10/20/2022]
Abstract
Event-related potentials (ERPs) were used to explore the effects of iconicity and structural visual alignment between a picture-prime and a sign-target in a picture-sign matching task in American Sign Language (ASL). Half the targets were iconic signs and were presented after a) a matching visually-aligned picture (e.g., the shape and location of the hands in the sign COW align with the depiction of a cow with visible horns), b) a matching visually-nonaligned picture (e.g., the cow's horns were not clearly shown), and c) a non-matching picture (e.g., a picture of a swing instead of a cow). The other half of the targets were filler signs. Trials in the matching condition were responded to faster than those in the non-matching condition and were associated with smaller N400 amplitudes in deaf ASL signers. These effects were also observed for hearing non-signers performing the same task with spoken-English targets. Trials where the picture-prime was aligned with the sign target were responded to faster than non-aligned trials and were associated with a reduced P3 amplitude rather than a reduced N400, suggesting that picture-sign alignment facilitated the decision process, rather than lexical access. These ERP and behavioral effects of alignment were found only for the ASL signers. The results indicate that iconicity effects on sign comprehension may reflect a task-dependent strategic use of iconicity, rather than facilitation of lexical access.
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Affiliation(s)
- Meghan E McGarry
- Joint Doctoral Program in Language and Communication Disorders, San Diego State University and University of California, San Diego, San Diego, CA, USA
| | - Natasja Massa
- School of Speech, Language and Hearing Sciences, San Diego State University, San Diego, CA, USA
| | - Megan Mott
- Department of Psychology, San Diego State University, San Diego, CA, USA
| | | | - Phillip J Holcomb
- Department of Psychology, San Diego State University, San Diego, CA, USA
| | - Karen Emmorey
- School of Speech, Language and Hearing Sciences, San Diego State University, San Diego, CA, USA.
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McGarry ME, McColley SA. Cystic fibrosis patients of minority race and ethnicity less likely eligible for CFTR modulators based on CFTR genotype. Pediatr Pulmonol 2021; 56:1496-1503. [PMID: 33470563 PMCID: PMC8137541 DOI: 10.1002/ppul.25285] [Citation(s) in RCA: 77] [Impact Index Per Article: 25.7] [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: 10/09/2020] [Revised: 12/21/2020] [Accepted: 12/31/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Cystic fibrosis transmembrane conductance regulator (CFTR) modulators are disease-modifying medications for cystic fibrosis (CF) and are shown to be efficacious for only specific CFTR mutations. CFTR mutation frequency varies by ancestry, which is different from but related to demographic racial and ethnic group. Eligibility for CFTR modulator therapy has not been previously reported by race and ethnicity. METHODS We conducted a cross-sectional study of patients in the 2018 CF Foundation Patient Registry. We analyzed the percentage of patients in each US Census defined racial and ethnic group eligible for CFTR modulators based on CFTR mutations approved by the US FDA and then based on both mutations and FDA approval by age. We compared lung function based on CFTR modulator eligibility and prescription. FINDINGS Based on CFTR mutations alone, 92.4% of non-Hispanic White patients, 69.7% of Black/African American patients, 75.6% of Hispanic patients, and 80.5% of other race patients eligible for CFTR modulators. For each CFTR modulator, Black/African American patients were least likely to have eligible mutations, and non-Hispanic White patients were most likely. There was no difference in the disparity between racial and/or ethnic groups with the addition of current FDA approval by age. The lowest pulmonary function in the cohort was seen in non-Hispanic White, Black/African American, and Hispanic patients not eligible for CFTR modulators. INTERPRETATION Patients with CF from minority groups are less likely to be eligible for CFTR modulators. Because people with CF who are racial and ethnic minorities have increased disease severity and earlier mortality, this will further contribute to health disparities.
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Affiliation(s)
- Meghan E McGarry
- Department of Pediatrics, University of California, San Francisco, California, USA
| | - Susanna A McColley
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,Department of Pediatrics, Stanley Manne Children's Research Institute, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
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13
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McGarry ME, Mott M, Midgley KJ, Holcomb PJ, Emmorey K. Picture-naming in American Sign Language: an electrophysiological study of the effects of iconicity and structured alignment. Lang Cogn Neurosci 2020; 36:199-210. [PMID: 33732747 PMCID: PMC7959108 DOI: 10.1080/23273798.2020.1804601] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 07/25/2020] [Indexed: 06/12/2023]
Abstract
A picture-naming task and ERPs were used to investigate effects of iconicity and visual alignment between signs and pictures in American Sign Language (ASL). For iconic signs, half the pictures visually overlapped with phonological features of the sign (e.g., the fingers of CAT align with a picture of a cat with prominent whiskers), while half did not (whiskers are not shown). Iconic signs were produced numerically faster than non-iconic signs and were associated with larger N400 amplitudes, akin to concreteness effects. Pictures aligned with iconic signs were named faster than non-aligned pictures, and there was a reduction in N400 amplitude. No behavioral effects were observed for the control group (English speakers). We conclude that sensory-motoric semantic features are represented more robustly for iconic than non-iconic signs (eliciting a concreteness-like N400 effect) and visual overlap between pictures and the phonological form of iconic signs facilitates lexical retrieval (eliciting a reduced N400).
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Affiliation(s)
- Meghan E. McGarry
- Joint Doctoral Program in Language and Communication Disorders, San Diego State University and University of California, San Diego, San Diego, CA USA
| | - Megan Mott
- Department of Psychology, San Diego State University, San Diego, CA USA
| | | | | | - Karen Emmorey
- School of Speech, Language and Hearing Sciences, San Diego State University, San Diego, CA USA
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14
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Zinter MS, Dvorak CC, Mayday MY, Iwanaga K, Ly NP, McGarry ME, Church GD, Faricy LE, Rowan CM, Hume JR, Steiner ME, Crawford ED, Langelier C, Kalantar K, Chow ED, Miller S, Shimano K, Melton A, Yanik GA, Sapru A, DeRisi JL. Pulmonary Metagenomic Sequencing Suggests Missed Infections in Immunocompromised Children. Clin Infect Dis 2020; 68:1847-1855. [PMID: 30239621 PMCID: PMC6784263 DOI: 10.1093/cid/ciy802] [Citation(s) in RCA: 90] [Impact Index Per Article: 22.5] [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: 05/24/2018] [Accepted: 09/13/2018] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Despite improved diagnostics, pulmonary pathogens in immunocompromised children frequently evade detection, leading to significant mortality. Therefore, we aimed to develop a highly sensitive metagenomic next-generation sequencing (mNGS) assay capable of evaluating the pulmonary microbiome and identifying diverse pathogens in the lungs of immunocompromised children. METHODS We collected 41 lower respiratory specimens from 34 immunocompromised children undergoing evaluation for pulmonary disease at 3 children's hospitals from 2014-2016. Samples underwent mechanical homogenization, parallel RNA/DNA extraction, and metagenomic sequencing. Sequencing reads were aligned to the National Center for Biotechnology Information nucleotide reference database to determine taxonomic identities. Statistical outliers were determined based on abundance within each sample and relative to other samples in the cohort. RESULTS We identified a rich cross-domain pulmonary microbiome that contained bacteria, fungi, RNA viruses, and DNA viruses in each patient. Potentially pathogenic bacteria were ubiquitous among samples but could be distinguished as possible causes of disease by parsing for outlier organisms. Samples with bacterial outliers had significantly depressed alpha-diversity (median, 0.61; interquartile range [IQR], 0.33-0.72 vs median, 0.96; IQR, 0.94-0.96; P < .001). Potential pathogens were detected in half of samples previously negative by clinical diagnostics, demonstrating increased sensitivity for missed pulmonary pathogens (P < .001). CONCLUSIONS An optimized mNGS assay for pulmonary microbes demonstrates significant inoculation of the lower airways of immunocompromised children with diverse bacteria, fungi, and viruses. Potential pathogens can be identified based on absolute and relative abundance. Ongoing investigation is needed to determine the pathogenic significance of outlier microbes in the lungs of immunocompromised children with pulmonary disease.
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Affiliation(s)
- Matt S Zinter
- Division of Critical Care, University of California, San Francisco School of Medicine
| | - Christopher C Dvorak
- Division of Allergy, Immunology, and Blood & Marrow Transplantation, University of California, San Francisco School of Medicine
| | - Madeline Y Mayday
- Division of Critical Care, University of California, San Francisco School of Medicine
| | - Kensho Iwanaga
- Division of Pulmonology, Department of Pediatrics, Benioff Children's Hospital, University of California, San Francisco School of Medicine
| | - Ngoc P Ly
- Division of Pulmonology, Department of Pediatrics, Benioff Children's Hospital, University of California, San Francisco School of Medicine
| | - Meghan E McGarry
- Division of Pulmonology, Department of Pediatrics, Benioff Children's Hospital, University of California, San Francisco School of Medicine
| | - Gwynne D Church
- Division of Pulmonology, Department of Pediatrics, Benioff Children's Hospital, University of California, San Francisco School of Medicine
| | - Lauren E Faricy
- Division of Pulmonology, Department of Pediatrics, University of Vermont School of Medicine, Burlington
| | - Courtney M Rowan
- Division of Critical Care, Department of Pediatrics, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis
| | - Janet R Hume
- Division of Critical Care, University of Minnesota School of Medicine, Minneapolis
| | - Marie E Steiner
- Division of Critical Care, University of Minnesota School of Medicine, Minneapolis.,Hematology/Oncology, Department of Pediatrics, Masonic Children's Hospital, University of Minnesota School of Medicine, Minneapolis
| | - Emily D Crawford
- Chan Zuckerberg Biohub, University of California-San Francisco School of Medicine.,Department of Biochemistry & Biophysics, University of California-San Francisco School of Medicine
| | - Charles Langelier
- Division of Infectious Diseases, Department of Internal Medicine, University of California-San Francisco School of Medicine
| | - Katrina Kalantar
- Department of Biochemistry & Biophysics, University of California-San Francisco School of Medicine
| | - Eric D Chow
- Department of Biochemistry & Biophysics, University of California-San Francisco School of Medicine
| | - Steve Miller
- Department of Laboratory Medicine, University of California-San Francisco School of Medicine
| | - Kristen Shimano
- Division of Allergy, Immunology, and Blood & Marrow Transplantation, University of California, San Francisco School of Medicine
| | - Alexis Melton
- Division of Allergy, Immunology, and Blood & Marrow Transplantation, University of California, San Francisco School of Medicine
| | - Gregory A Yanik
- Division of Oncology, Department of Pediatrics, Motts Children's Hospital, University of Michigan School of Medicine, Ann Arbor
| | - Anil Sapru
- Division of Critical Care, University of California, San Francisco School of Medicine.,Division of Critical Care, Department of Pediatrics, Mattel Children's Hospital, University of California-Los Angeles, Geffen School of Medicine
| | - Joseph L DeRisi
- Chan Zuckerberg Biohub, University of California-San Francisco School of Medicine.,Department of Biochemistry & Biophysics, University of California-San Francisco School of Medicine
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15
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Zeiger AM, McGarry ME, Mak ACY, Medina V, Salazar S, Eng C, Liu AK, Oh SS, Nuckton TJ, Jain D, Blackwell TW, Kang HM, Abecasis G, Oñate LC, Seibold MA, Burchard EG, Rodriguez-Santana J. Identification of CFTR variants in Latino patients with cystic fibrosis from the Dominican Republic and Puerto Rico. Pediatr Pulmonol 2020; 55:533-540. [PMID: 31665830 PMCID: PMC7571374 DOI: 10.1002/ppul.24549] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 09/28/2019] [Indexed: 11/09/2022]
Abstract
BACKGROUND In cystic fibrosis (CF), the spectrum and frequency of CFTR variants differ by geography and race/ethnicity. CFTR variants in White patients are well-described compared with Latino patients. No studies of CFTR variants have been done in patients with CF in the Dominican Republic or Puerto Rico. METHODS CFTR was sequenced in 61 Dominican Republican patients and 21 Puerto Rican patients with CF and greater than 60 mmol/L sweat chloride. The spectrum of CFTR variants was identified and the proportion of patients with 0, 1, or 2 CFTR variants identified was determined. The functional effects of identified CFTR variants were investigated using clinical annotation databases and computational prediction tools. RESULTS Our study found 10% of Dominican patients had two CFTR variants identified compared with 81% of Puerto Rican patients. No CFTR variants were identified in 69% of Dominican patients and 10% of Puerto Rican patients. In Dominican patients, there were 19 identified CFTR variants, accounting for 25 out of 122 disease alleles (20%). In Puerto Rican patients, there were 16 identified CFTR variants, accounting for 36 out of 42 disease alleles (86%) in Puerto Rican patients. Thirty CFTR variants were identified overall. The most frequent variants for Dominican patients were p.Phe508del and p.Ala559Thr and for Puerto Rican patients were p.Phe508del, p.Arg1066Cys, p.Arg334Trp, and p.I507del. CONCLUSIONS In this first description of the CFTR variants in patients with CF from the Dominican Republic and Puerto Rico, there was a low detection rate of two CFTR variants after full sequencing with the majority of patients from the Dominican Republic without identified variants.
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Affiliation(s)
- Andrew M Zeiger
- Department of Medicine, University of California San Francisco, San Francisco, California
| | - Meghan E McGarry
- Department of Pediatrics, University of California San Francisco, San Francisco, California
| | - Angel C Y Mak
- Department of Medicine, University of California San Francisco, San Francisco, California
| | - Vivian Medina
- Department of Pediatrics, Centro de Neumología Pediátrica, San Juan, Puerto Rico
| | - Sandra Salazar
- Department of Medicine, University of California San Francisco, San Francisco, California
| | - Celeste Eng
- Department of Medicine, University of California San Francisco, San Francisco, California
| | - Amy K Liu
- Department of Medicine, University of California San Francisco, San Francisco, California
| | - Sam S Oh
- Department of Medicine, University of California San Francisco, San Francisco, California
| | - Thomas J Nuckton
- Department of Medicine, University of California San Francisco, San Francisco, California
| | - Deepti Jain
- Department of Biostatistics, University of Washington, Seattle, Washington
| | - Thomas W Blackwell
- Department of Biostatistics, Center for Statistical Genetics, University of Michigan, Ann Arbor, Michigan
| | - Hyun Min Kang
- Department of Biostatistics, Center for Statistical Genetics, University of Michigan, Ann Arbor, Michigan
| | - Goncalo Abecasis
- Department of Biostatistics, Center for Statistical Genetics, University of Michigan, Ann Arbor, Michigan
| | - Leandra Cordero Oñate
- Department of Pediatrics, Neumología Pediátrica del Hospital Infantil Dr. Robert Reid Cabral, Santo Domingo, República Dominicana
| | - Max A Seibold
- Department of Pediatrics, National Jewish Health, Denver, Colorado
| | - Esteban G Burchard
- Department of Medicine, University of California San Francisco, San Francisco, California.,Department of Bioengineering and Therapeutic Sciences, University of California San Francisco, San Francisco, California
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16
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Abstract
Understanding variability in cystic fibrosis (CF) health outcomes requires an understanding of factors that go far beyond Cystic Fibrosis Transmembrane Receptor (CFTR) function caused by different gene mutations. Social and environmental factors that influence health have a significant influence on the trajectory of health in CF and in other chronic diseases. In this article, we review demographic factors associated with poorer health outcomes in CF, known and postulated biological mechanisms of these outcomes, and interventions that healthcare teams can implement that may reduce outcome disparities.
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Affiliation(s)
- Meghan E McGarry
- Department of Pediatrics, University of California San Francisco, San Francisco, California
| | - Wadsworth A Williams
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Susanna A McColley
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois.,Division of Pulmonary and Sleep Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.,Stanley Manne Children's Research Institute, Chicago, Illinois
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17
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McGarry ME, Neuhaus JM, Nielson DW, Ly NP. Regional variations in longitudinal pulmonary function: A comparison of Hispanic and non-Hispanic subjects with cystic fibrosis in the United States. Pediatr Pulmonol 2019; 54:1382-1390. [PMID: 31144477 PMCID: PMC6702095 DOI: 10.1002/ppul.24377] [Citation(s) in RCA: 17] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 04/23/2019] [Accepted: 05/08/2019] [Indexed: 11/11/2022]
Abstract
BACKGROUND Hispanic subjects with cystic fibrosis (CF) have increased morbidity and mortality than non-Hispanic white subjects. The ethnic disparity in mortality varies by region. Factors influencing pulmonary function vary by both ethnicity and region. OBJECTIVE To determine if the ethnic difference in pulmonary function varies by region. METHODS This retrospective cohort study compared differences in longitudinal pulmonary function (percent-predicted forced vital capacity [FVC], forced expiratory volume in 1 second [FEV1 ], forced expiratory flow at 25% to 75% [FEF25-75 ], FEV1 /FVC, and FEV1 decline) between Hispanic and non-Hispanic white subjects with CF by Census region of the United States (West, South, Midwest, and Northeast). Subjects were of ages 6 to 25 years and in the CF Foundation Patient Registry from 2008 to 2013. We used linear mixed effects models with subject-specific slopes and intercepts, adjusting for 14 demographic and clinical variables. RESULTS Of 14 932 subjects, 1433 (9.6%) were Hispanic and 13 499 (90.4%) were non-Hispanic white. Hispanic subjects' FEV1 was 9.0% (8.3%-9.8%) lower than non-Hispanic white subjects in the West, while Hispanic subjects' FEV1 was only 4.0% (3.0%-5.0%) lower in the Midwest, 4.4% (3.1%-5.7%) lower in the Northeast, and 4.4% (3.2%-5.5%) lower in the South. Similarly, FVC and FEF25-75 were lower among Hispanic subjects compared to non-Hispanic white subjects in all US regions, with the biggest differences in the West. Only in the West was FEV1 /FVC significantly lower in Hispanic subjects (-0.019; -0.022 to -0.015). FEV1 decline was not significantly different between ethnicities in any region. CONCLUSIONS In CF, Hispanic subjects have lower pulmonary function than non-Hispanic white subjects in all geographic regions with the largest difference in occurring in the West.
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Affiliation(s)
- Meghan E McGarry
- Department of Pediatrics, University of California, San Francisco, California
| | - John M Neuhaus
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California
| | - Dennis W Nielson
- Department of Pediatrics, University of California, San Francisco, California
| | - Ngoc P Ly
- Department of Pediatrics, University of California, San Francisco, California
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18
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Spear ML, Hu D, Pino-Yanes M, Huntsman S, Eng C, Levin AM, Ortega VE, White MJ, McGarry ME, Thakur N, Galanter J, Mak ACY, Oh SS, Ampleford E, Peters SP, Davis A, Kumar R, Farber HJ, Meade K, Avila PC, Serebrisky D, Lenoir MA, Brigino-Buenaventura E, Cintron WR, Thyne SM, Rodriguez-Santana JR, Ford JG, Chapela R, Estrada AM, Sandoval K, Seibold MA, Winkler CA, Bleecker ER, Myers DA, Williams LK, Hernandez RD, Torgerson DG, Burchard EG. A genome-wide association and admixture mapping study of bronchodilator drug response in African Americans with asthma. Pharmacogenomics J 2018; 19:249-259. [PMID: 30206298 PMCID: PMC6414286 DOI: 10.1038/s41397-018-0042-4] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Revised: 06/08/2018] [Accepted: 06/19/2018] [Indexed: 01/15/2023]
Abstract
Short-acting β2-adrenergic receptor agonists (SABAs) are the most commonly prescribed asthma medications worldwide. Response to SABAs is measured as bronchodilator drug response (BDR), which varies among racial/ethnic groups in the U.S1, 2. However, the genetic variation that contributes to BDR is largely undefined in African Americans with asthma3. To identify genetic variants that may contribute to differences in BDR in African Americans with asthma, we performed a genome-wide association study (GWAS) of BDR in 949 African American children with asthma, genotyped with the Axiom World Array 4 (Affymetrix, Santa Clara, CA) followed by imputation using 1000 Genomes phase III genotypes. We used linear regression models adjusting for age, sex, body mass index (BMI) and genetic ancestry to test for an association between BDR and genotype at single nucleotide polymorphisms (SNPs). To increase power and distinguish between shared vs. population-specific associations with BDR in children with asthma, we performed a meta-analysis across 949 African Americans and 1,830 Latinos (Total=2,779). Lastly, we performed genome-wide admixture mapping to identify regions whereby local African or European ancestry is associated with BDR in African Americans. We identified a population-specific association with an intergenic SNP on chromosome 9q21 that was significantly associated with BDR (rs73650726, p=7.69×10−9). A trans-ethnic meta-analysis across African Americans and Latinos identified three additional SNPs within the intron of PRKG1 that were significantly associated with BDR (rs7903366, rs7070958, and rs7081864, p≤5×10−8). Our results failed to replicate in three additional populations of 416 Latinos and 1,615 African Americans. Our findings indicate that both population specific and shared genetic variation contributes to differences in BDR in minority children with asthma, and that the genetic underpinnings of BDR may differ between racial/ethnic groups.
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Affiliation(s)
- Melissa L Spear
- Department of Bioengineering and Therapeutic Sciences, University of California, San Francisco, San Francisco, CA, USA
| | - Donglei Hu
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Maria Pino-Yanes
- Research Unit, Hospital Universitario N.S. de Candelaria, Universidad de La Laguna, Tenerife, Spain.,CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain.,Genomics and Health Group, Department of Biochemistry, Microbiology, Cell Biology and Genetics, Universidad de La Laguna, La Laguna, Tenerife, Spain
| | - Scott Huntsman
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Celeste Eng
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Albert M Levin
- Department of Public Health Sciences, Henry Ford Health System, Detroit, MI, USA
| | - Victor E Ortega
- Department of Internal Medicine, Wake Forest Baptist Medical Center, Winston Salem, NC, USA
| | - Marquitta J White
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Meghan E McGarry
- Department of Pediatrics, University of California, San Francisco, San Francisco, CA, USA
| | - Neeta Thakur
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Joshua Galanter
- Department of Bioengineering and Therapeutic Sciences, University of California, San Francisco, San Francisco, CA, USA.,Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.,Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - Angel C Y Mak
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Sam S Oh
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Elizabeth Ampleford
- Department of Internal Medicine, Wake Forest Baptist Medical Center, Winston Salem, NC, USA
| | - Stephen P Peters
- Department of Internal Medicine, Wake Forest Baptist Medical Center, Winston Salem, NC, USA
| | - Adam Davis
- UCSF Benioff Children's Hospital Oakland, Center for Community Health and Engagement, Oakland, CA, USA
| | - Rajesh Kumar
- Ann & Robert H. Lurie Children's Hospital of Chicago, Pediatrics, Chicago, IL, USA
| | - Harold J Farber
- Department of Pediatrics, Section of Pulmonology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | - Kelley Meade
- UCSF Benioff Children's Hospital Oakland, Oakland, CA, USA
| | - Pedro C Avila
- Division of Allergy-Immunology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Denise Serebrisky
- Pediatric Pulmonary Division, Jacobi Medical Center, Bronx, NY, USA.,Albert Einstein College of Medicine, Pediatrics, Bronx, NY, USA
| | | | | | | | - Shannon M Thyne
- Department of Pediatrics, David Geffen School of Medicine at ULCA, Olive View-UCLA Medical Center, Sylmar, CA, USA
| | | | | | - Rocio Chapela
- Instituto Nacional de Enfermedades Respiratorias, Mexico City, Mexico
| | - Andrés Moreno Estrada
- National Laboratory of Genomics for Biodiversity (LANGEBIO), CINVESTAV, Irapuato, Guanajuato, Mexico
| | - Karla Sandoval
- National Laboratory of Genomics for Biodiversity (LANGEBIO), CINVESTAV, Irapuato, Guanajuato, Mexico
| | - Max A Seibold
- Department of Pediatrics, National Jewish Health, Denver, CO, USA
| | - Cheryl A Winkler
- Basic Research Laboratory, National Cancer Institute, Leidos Biomedical Research, Frederick National Laboratory, Frederick, MD, USA
| | | | - Deborah A Myers
- Department of Medicine, The University of Arizona, Tucson, AZ, USA
| | - L Keoki Williams
- Center for Health Policy and Health Services Research,, Henry Ford Health System, Detroit, MI, USA.,Department of Internal Medicine, Henry Ford Health System, Detroit, MI, USA
| | - Ryan D Hernandez
- Department of Bioengineering and Therapeutic Sciences, University of California, San Francisco, San Francisco, CA, USA.,California Institute for Quantitative Biosciences (QB3), University of California, San Francisco, CA, USA.,Institute for Human Genetics, University of California, San Francisco, CA, USA
| | - Dara G Torgerson
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Esteban G Burchard
- Department of Bioengineering and Therapeutic Sciences, University of California, San Francisco, San Francisco, CA, USA. .,Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.
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19
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McGarry ME, Neuhaus JM, Nielson DW, Burchard E, Ly NP. Pulmonary function disparities exist and persist in Hispanic patients with cystic fibrosis: A longitudinal analysis. Pediatr Pulmonol 2017; 52:1550-1557. [PMID: 29082671 PMCID: PMC5693693 DOI: 10.1002/ppul.23884] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [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: 05/31/2017] [Accepted: 09/09/2017] [Indexed: 01/20/2023]
Abstract
BACKGROUND Hispanic patients with cystic fibrosis (CF) have decreased life expectancy compared to non-Hispanic white patients. Pulmonary function is a main predictor of life expectancy in CF. Ethnic differences in pulmonary function in CF have been understudied. The objective was to compare longitudinal pulmonary function between Hispanic and non-Hispanic white patients with CF. METHODS This cohort study of 15 018 6-25 years old patients in the CF Foundation Patient Registry from 2008 to 2013 compared FEV1 percent predicted and longitudinal change in FEV1 percent predicted in Hispanic to non-Hispanic white patients. We used linear mixed effects models with patient-specific slopes and intercepts, adjusting for 14 demographic and clinical variables. We did sub-analyses by CFTR class, F508del copies, and PERT use. RESULTS Hispanic patients had lower FEV1 percent predicted (79.9%) compared with non-Hispanic white patients (85.6%); (-5.8%, 95%CI -6.7% to -4.8%, P < 0.001), however, there was no difference in FEV1 decline over time. Patients on PERT had a larger difference between Hispanic and non-Hispanic white patients in FEV1 percent predicted than patients not on PERT (-6.0% vs -4.1%, P = 0.02). The ethnic difference in FEV1 percent predicted was not statistically significant between CFTR classes (Class I-III: -6.1%, Class IV-V: -5.9%, Unclassified: -5.7%, P > 0.05) or between F508del copies (None: -7.6%, Heterozygotes: -5.6%, Homozygotes: -5.3%, P > 0.05). CONCLUSIONS Disparities in pulmonary function exist in Hispanic patients with CF early in life and then persist without improving or worsening over time. It is valuable to investigate the factors contributing to pulmonary function in Hispanic patients with CF.
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Affiliation(s)
- Meghan E McGarry
- Department of Pediatrics, University of California, San Francisco, California
| | - John M Neuhaus
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
| | - Dennis W Nielson
- Department of Pediatrics, University of California, San Francisco, California
| | - Esteban Burchard
- Department of Bioengineering and Therapeutic Sciences, University of California, San Francisco, California.,Department of Medicine, University of California, San Francisco, California
| | - Ngoc P Ly
- Department of Pediatrics, University of California, San Francisco, California
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20
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Oh SS, Du R, Zeiger AM, McGarry ME, Hu D, Thakur N, Pino-Yanes M, Galanter JM, Eng C, Nishimura KK, Huntsman S, Farber HJ, Meade K, Avila P, Serebrisky D, Bibbins-Domingo K, Lenoir MA, Ford JG, Brigino-Buenaventura E, Rodriguez-Cintron W, Thyne SM, Sen S, Rodriguez-Santana JR, Williams K, Kumar R, Burchard EG. Breastfeeding associated with higher lung function in African American youths with asthma. J Asthma 2017; 54:856-865. [PMID: 27929698 PMCID: PMC6130885 DOI: 10.1080/02770903.2016.1266496] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Revised: 11/02/2016] [Accepted: 11/26/2016] [Indexed: 01/06/2023]
Abstract
OBJECTIVE In the United States, Puerto Ricans and African Americans have lower prevalence of breastfeeding and worse clinical outcomes for asthma compared with other racial/ethnic groups. We hypothesize that the history of breastfeeding is associated with increased forced expiratory volume in 1 second (FEV1) % predicted and reduced asthma exacerbations in Latino and African American youths with asthma. METHODS As part of the Genes-environments & Admixture in Latino Americans (GALA II) Study and the Study of African Americans, asthma, Genes & Environments (SAGE II), we conducted case-only analyses in children and adolescents aged 8-21 years with asthma from four different racial/ethnic groups: African Americans (n = 426), Mexican Americans (n = 424), mixed/other Latinos (n = 255), and Puerto Ricans (n = 629). We investigated the association between any breastfeeding in infancy and FEV1% predicted using multivariable linear regression; Poisson regression was used to determine the association between breastfeeding and asthma exacerbations. RESULTS Prevalence of breastfeeding was lower in African Americans (59.4%) and Puerto Ricans (54.9%) compared to Mexican Americans (76.2%) and mixed/other Latinos (66.9%; p < 0.001). After adjusting for covariates, breastfeeding was associated with a 3.58% point increase in FEV1% predicted (p = 0.01) and a 21% reduction in asthma exacerbations (p = 0.03) in African Americans only. CONCLUSION Breastfeeding was associated with higher FEV1% predicted in asthma and reduced number of asthma exacerbations in African American youths, calling attention to continued support for breastfeeding.
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Affiliation(s)
- Sam S Oh
- a Department of Medicine , University of California San Francisco , San Francisco , CA , USA
| | - Randal Du
- a Department of Medicine , University of California San Francisco , San Francisco , CA , USA
- b Department of Pharmacy , University of California San Francisco , San Francisco , CA , USA
| | - Andrew M Zeiger
- a Department of Medicine , University of California San Francisco , San Francisco , CA , USA
| | - Meghan E McGarry
- c Department of Pediatrics , University of California San Francisco , San Francisco , CA , USA
| | - Donglei Hu
- a Department of Medicine , University of California San Francisco , San Francisco , CA , USA
| | - Neeta Thakur
- a Department of Medicine , University of California San Francisco , San Francisco , CA , USA
| | - Maria Pino-Yanes
- d Research Unit , Hospital Universitario NS de Candelaria , Santa Cruz de Tenerife , Spain
| | - Joshua M Galanter
- a Department of Medicine , University of California San Francisco , San Francisco , CA , USA
- e Department of Bioengineering and Therapeutic Sciences , University of California San Franscisco , San Francisco , CA , USA
| | - Celeste Eng
- a Department of Medicine , University of California San Francisco , San Francisco , CA , USA
| | | | - Scott Huntsman
- a Department of Medicine , University of California San Francisco , San Francisco , CA , USA
| | - Harold J Farber
- f Department of Pediatrics , Baylor College of Medicine , Houston , TX , USA
- g Department of Pulmonology , Texas Children's Hospital , Houston , TX , USA
| | - Kelley Meade
- h Department of Primary Care , UCSF Benioff Children's Hospital , San Francisco , CA , USA
| | - Pedro Avila
- i Department of Medicine , Northwestern University , Evanston , IL , USA
| | - Denise Serebrisky
- j Department of Pediatric Pulmonology , Jacobi Medical Center , Bronx , NY , USA
| | - Kirsten Bibbins-Domingo
- a Department of Medicine , University of California San Francisco , San Francisco , CA , USA
| | - Michael A Lenoir
- k Department of Pediatrics , Bay Area Pediatrics , Oakland , CA , USA
| | - Jean G Ford
- l Department of Epidemiology , Johns Hopkins University Bloomberg School of Public Health , Baltimore , MD , USA
| | | | | | - Shannon M Thyne
- o Department of Medicine , University of California Los Angeles David Geffen School of Medicine , Los Angeles , CA , USA
| | - Saunak Sen
- p Department of Epidemiology and Biostatistics , University of California San Francisco , San Francisco , CA , USA
| | - Jose R Rodriguez-Santana
- q Department of Pediatric Pulmonology and Critical Care , Centro de Neumología Pediátrica , San Juan , Puerto Rico
| | - Keoki Williams
- r Center for Health Policy and Health Services Research, Henry Ford Health System , Detroit , MI , USA
- s Department of Internal Medicine , Henry Ford Health System , Detroit , MI , USA
| | - Rajesh Kumar
- i Department of Medicine , Northwestern University , Evanston , IL , USA
| | - Esteban G Burchard
- a Department of Medicine , University of California San Francisco , San Francisco , CA , USA
- e Department of Bioengineering and Therapeutic Sciences , University of California San Franscisco , San Francisco , CA , USA
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McGarry ME, Illek B, Ly NP, Zlock L, Olshansky S, Moreno C, Finkbeiner WE, Nielson DW. In vivo and in vitro ivacaftor response in cystic fibrosis patients with residual CFTR function: N-of-1 studies. Pediatr Pulmonol 2017; 52:472-479. [PMID: 28068001 PMCID: PMC5461115 DOI: 10.1002/ppul.23659] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Revised: 12/01/2016] [Accepted: 12/02/2016] [Indexed: 01/17/2023]
Abstract
RATIONALE Ivacaftor, a cystic fibrosis transmembrane conductance regulator (CFTR) potentiator, decreases sweat chloride concentration, and improves pulmonary function in 6% of cystic fibrosis (CF) patients with specific CFTR mutations. Ivacaftor increases chloride transport in many other CFTR mutations in non-human cells, if CFTR is in the epithelium. Some CF patients have CFTR in the epithelium with residual CFTR function. The effect of ivacaftor in these patients is unknown. METHODS This was a series of randomized, crossover N-of-1 trials of ivacaftor and placebo in CF patients ≥8 years old with potential residual CFTR function (intermediate sweat chloride concentration, pancreatic sufficient, or mild bronchiectasis on chest CT). Human nasal epithelium (HNE) was obtained via nasal brushing and cultured. Sweat chloride concentration change was the in vivo outcome. Chloride current change in HNE cultures with ivacaftor was the in vitro outcome. RESULTS Three subjects had decreased sweat chloride concentration (-14.8 to -40.8 mmol/L, P < 0.01). Two subjects had unchanged sweat chloride concentration. Two subjects had increased sweat chloride concentration (+23.8 and +27.3 mmol/L, P < 0.001); both were heterozygous for A455E and pancreatic sufficient. Only subjects with decreased sweat chloride concentration had increased chloride current in HNE cultures. CONCLUSIONS Some CF patients with residual CFTR function have decreased sweat chloride concentration with ivacaftor. Increased chloride current in HNE cultures among subjects with decreased sweat chloride concentrations may predict clinical response to ivacaftor. Ivacaftor can increase sweat chloride concentration in certain mutations with unclear clinical effect. Pediatr Pulmonol. 2017;52:472-479. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Meghan E McGarry
- Pediatric Pulmonology, Department of Pediatrics, University of California, San Francisco, California
| | - Beate Illek
- Children's Hospital Oakland Research Institute, Oakland, California
| | - Ngoc P Ly
- Pediatric Pulmonology, Department of Pediatrics, University of California, San Francisco, California
| | - Lorna Zlock
- Department of Pathology, University of California, San Francisco, California
| | - Sabrina Olshansky
- Children's Hospital Oakland Research Institute, Oakland, California.,College of Pharmacy, Touro University, Vallejo, California
| | - Courtney Moreno
- Pediatric Pulmonology, Department of Pediatrics, University of California, San Francisco, California
| | - Walter E Finkbeiner
- Department of Pathology, University of California, San Francisco, California
| | - Dennis W Nielson
- Pediatric Pulmonology, Department of Pediatrics, University of California, San Francisco, California
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McGarry ME, Castellanos E, Thakur N, Oh SS, Eng C, Davis A, Meade K, LeNoir MA, Avila PC, Farber HJ, Serebrisky D, Brigino-Buenaventura E, Rodriguez-Cintron W, Kumar R, Bibbins-Domingo K, Thyne SM, Sen S, Rodriguez-Santana JR, Borrell LN, Burchard EG. Obesity and bronchodilator response in black and Hispanic children and adolescents with asthma. Chest 2015; 147:1591-1598. [PMID: 25742612 DOI: 10.1378/chest.14-2689] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Obesity is associated with poor asthma control, increased asthma morbidity, and decreased response to inhaled corticosteroids. We hypothesized that obesity would be associated with decreased bronchodilator responsiveness in children and adolescents with asthma. In addition, we hypothesized that subjects who were obese and unresponsive to bronchodilator would have worse asthma control and would require more asthma controller medications. METHODS In the Study of African Americans, Asthma, Genes, and Environments (SAGE II) and the Genes-environments and Admixture in Latino Americans (GALA II) study, two identical, parallel, case-control studies of asthma, we examined the association between obesity and bronchodilator response in 2,963 black and Latino subjects enrolled from 2008 to 2013 using multivariable logistic regression. Using bronchodilator responsiveness, we compared asthma symptoms, controller medication usage, and asthma exacerbations between nonobese (< 95th% BMI) and obese (≥ 95th% BMI) subjects. RESULTS The odds of being bronchodilator unresponsive were 24% (OR, 1.24; 95% CI, 1.03-1.49) higher among obese children and adolescents compared with their not obese counterparts after adjustment for age, race/ethnicity, sex, recruitment site, baseline lung function (FEV1/FVC), and controller medication. Bronchodilator-unresponsive obese subjects were more likely to report wheezing (OR, 1.38; 95% CI, 1.13-1.70), being awakened at night (OR, 1.34; 95% CI, 1.09-1.65), using leukotriene receptor inhibitors (OR, 1.33; 95% CI, 1.05-1.70), and using inhaled corticosteroid with long-acting β2-agonist (OR, 1.37; 95% CI, 1.05-1.78) than were their nonobese counterpart. These associations were not seen in the bronchodilator-responsive group. CONCLUSIONS Obesity is associated with bronchodilator unresponsiveness among black and Latino children and adolescents with asthma. The findings on obesity and bronchodilator unresponsiveness represent a unique opportunity to identify factors affecting asthma control in blacks and Latinos.
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Affiliation(s)
- Meghan E McGarry
- Department of Pediatrics, University of California, San Francisco, CA.
| | - Elizabeth Castellanos
- Department of Bioengineering and Therapeutic Sciences, University of California, San Francisco, CA
| | - Neeta Thakur
- Department of Medicine, University of California, San Francisco, CA
| | - Sam S Oh
- Department of Bioengineering and Therapeutic Sciences, University of California, San Francisco, CA; Department of Medicine, University of California, San Francisco, CA
| | - Celeste Eng
- Department of Medicine, University of California, San Francisco, CA
| | - Adam Davis
- Children's Hospital and Research Center Oakland, Oakland, CA
| | - Kelley Meade
- Children's Hospital and Research Center Oakland, Oakland, CA
| | | | - Pedro C Avila
- Department of Allergy-Immunology, Northwestern University, Chicago, IL
| | - Harold J Farber
- Department of Pediatrics, Section of Pulmonology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX
| | | | | | | | - Rajesh Kumar
- Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | | | - Shannon M Thyne
- Department of Pediatrics, University of California, San Francisco, CA
| | - Saunak Sen
- Department of Bioengineering and Therapeutic Sciences, University of California, San Francisco, CA; Department of Epidemiology and Biostatistics, University of California, San Francisco, CA
| | | | - Luisa N Borrell
- Department of Health Sciences, Lehman College, City University of New York, Bronx, NY
| | - Esteban G Burchard
- Department of Bioengineering and Therapeutic Sciences, University of California, San Francisco, CA; Department of Medicine, University of California, San Francisco, CA
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McGarry ME, Nielson DW. Normalization of sweat chloride concentration and clinical improvement with ivacaftor in a patient with cystic fibrosis with mutation S549N. Chest 2014; 144:e1-e4. [PMID: 24081349 DOI: 10.1378/chest.13-0239] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
The cystic fibrosis (CF) protein forms an anion channel in epithelial cells, and the absence or defective function of this channel results in the clinical manifestations of CF. CF is an autosomal recessive disorder, and its many disease-causing mutations divide into five or six classes. There are 10 known class 3 gating mutations, the most common of which is G551D. Ivacaftor is a drug that in vitro increases open time and transepithelial chloride transport in all 10 gating mutations, but it is approved for use only in patients with the G551D mutation. We report complete normalization of sweat chloride concentration and rapid clinical improvement over 6 weeks of treatment with ivacaftor in a patient with CF with the gating mutation S549N. The findings suggest that ivacaftor should be considered for use in patients with any of the known gating mutations.
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Affiliation(s)
- Meghan E McGarry
- Department of Pediatrics, University of California, San Francisco, San Francisco, CA
| | - Dennis W Nielson
- Department of Pediatrics, University of California, San Francisco, San Francisco, CA.
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Grunt JA, McGarry ME, McCollum AT, Gould JB. Studies of children with ketotic hypoglycemia. Yale J Biol Med 1970; 42:420-38. [PMID: 5431864 PMCID: PMC2591674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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