Many asthma patients remain uncontrolled on inhaled corticosteroids (ICS) and long-acting beta agonists (LABAs), but guidance for selecting add-on therapies, including long-acting muscarinic antagonists (LAMAs) or biologics, is limited. We describe how prescribing practices for add-on LAMA and biologic therapy…
Arab Americans are a diverse ethnic group originating from a large geographic area in the Middle East and North Africa (MENA). We aim to characterize differences in health between Arab Americans from different geographic subgroups within MENA. We used cross-sectional…
Inhaled corticosteroids (ICS) are a cornerstone of asthma treatment. However, their efficacy is characterized by wide variability in individual responses. We investigated the association between genetic variants and risk of exacerbations in adults with asthma and how this association is…
To investigate the associations of household mold and pesticide use with risk of childhood asthma and examine the potential effect modification by child's sex at a national level in the U.S. Nationally representative data were drawn from the cross-sectional 2017…
Food insecurity is positively associated with asthma, the most common chronic childhood disease, yet directionality is unclear. The objective was to determine the association between exposure to food insecurity in early childhood and the odds of asthma later in childhood.…
For patients with diabetes, many with multiple complex chronic conditions, using a patient portal can support self-management and coordination of health care services, and may impact the frequency of in-person health care visits. To examine the impact of portal access…
The purpose of this project is to examine quality indicators for key chronic conditions such as diabetes and asthma for the Medi-Cal population served by Kaiser Permanente Northern California and to see how these indicators vary by different population definitions/denominators.…
Genetic variants in the chromosomal region 17q21 are consistently associated with asthma. However, mechanistic studies have not yet linked any of the associated variants to a function that could influence asthma, and as a result, the identity of the asthma…
Our aim was to quantify the associations of both hyperbilirubinemia and phototherapy with childhood asthma using a population-based cohort with total serum bilirubin (TSB) levels. Retrospective cohort study of infants born at ?35 weeks' gestation in the Kaiser Permanente Northern…
Some parents are concerned the childhood immunization schedule could increase risk for allergic disorders, including asthma. To inform future safety studies of this speculated association, a parent survey was conducted to examine the risk of misclassification of vaccination status in…
Nonadherence to controller and overuse of reliever asthma medications are associated with exacerbations. We aimed to determine patterns of seasonal asthma medication use and to identify time period(s) during which interventions to improve medication adherence could reduce asthma morbidity. We…
Live-attenuated influenza vaccines (LAIVs) are not licensed in children younger than 2 years of age because of a wheezing safety signal that has not been fully elucidated. In 2000, the Kaiser Permanente Vaccine Study Center conducted a placebo-controlled randomized clinical…
A recent genome-wide association study (GWAS) identified 99 loci that contain genetic risk variants shared between asthma, hay fever and eczema. Many more risk loci shared between these common allergic diseases remain to be discovered, which could point to new…
Black and Latino children experience significantly worse asthma morbidity than their white peers for multifactorial reasons. This study investigated differences in family-provider interactions for pediatric asthma, based on race/ethnicity. This was a cross-sectional study of parent surveys of asthmatic children…
To investigate whether there is a difference in the risk of asthma exacerbations between children with pre-existing asthma who receive live attenuated influenza vaccine (LAIV) compared with inactivated influenza vaccine (IIV). We identified IIV and LAIV immunizations occurring between July…
EXCELS, a postmarketing observational cohort study, was a commitment to the US Food and Drug Administration to assess the long-term safety of omalizumab in an observational setting, focusing predominantly on malignancies. The aim of this study was to examine a…
The aims of this study are to: 1) Determine the effectiveness of Long-Acting Beta Agonists (LABA) controlling therapies in comparison with other available controller regimens in persistent asthma disease management. 2) Determine if LABA-containing therapies are associated with an increased…
Our objectives are to define severe asthma phenotypes at the molecular and cellular level in order to predict prognosis, identify novel treatment targets, and guide targeted therapy. Our overarching hypothesis is that differences in clinical presentation, outcomes, and response to…
In 2009, the US Food and Drug Administration (FDA) mandated a label change for leukotriene inhibitors (LTIs) to include neuropsychiatric adverse events (eg, depression and suicidality) as a precaution. This study investigated how this label change affected the use of…
Few previous studies have evaluated primary adherence (whether a new prescription is filled within 30 d) to controller medications in individuals with persistent asthma. To compare adherence to the major controller medication regimens for asthma. This was a retrospective cohort…
The Epidemiologic Study of Xolair (omalizumab): Evaluating Clinical Effectiveness and Long-term Safety in Patients with Moderate-to-Severe Asthma (EXCELS) assessed the long-term safety of omalizumab in a clinical practice setting as part of a phase IV US Food and Drug Administration…
Based on results of clinical trials, inhaled corticosteroids (ICS) are the most-effective controller medications for preventing asthma-related exacerbations, yet few studies in real-life populations have evaluated the comparative effectiveness of ICS. To determine the likelihood of asthma exacerbations among children…
Studies comparing physical activity levels in children with and without asthma have had mixed results. Our objective was to investigate the association between asthma diagnosis and physical activity and to examine differences in these associations by race/ethnicity, weight status and…
In an analysis of data from the US Collaborative Perinatal Project, Huang et al. (Am J Epidemiol. 2013;178(12):1691-1697) report an association between neonatal total serum bilirubin levels and childhood asthma. To consider the implications of this finding, we need to…
Statins, or HMG-CoA reductase inhibitors, may aid in the treatment of asthma through their pleiotropic antiinflammatory effects. To examine the effect of statin therapy on asthma-related exacerbations using a large population-based cohort. Statin users aged 31 years or greater with…
OBJECTIVE: Medicare Part D provides formulary protections for antipsychotics but does not exempt these drugs from cost-sharing. We investigated the impact of Part D coverage on antipsychotic drug spending, adherence, and clinical outcomes among beneficiaries with varying indications for use.…
BACKGROUND: Although long-chain omega-3 (n-3) PUFAs (LComega3PUFAs) have been linked to the prevention of some inflammatory disorders, little is known about the association between these fatty acids and incidence of asthma. OBJECTIVE: The objective was to prospectively investigate the association…
Asthma has been associated with increased cardiovascular disease (CVD) risk. The authors ascertained the association of asthma with CVD and the roles that sex, concurrent allergy, and asthma medications may play in this association. They assembled a cohort of 203,595…
PURPOSE: To identify ethnic differences for risk of hospitalization for asthma and chronic obstructive pulmonary disease (COPD). METHODS: We undertook a cohort study with 126,019 participants: 55% whites, 27% blacks, 11% Asians, and 4% Hispanics. To estimate asthma and COPD…
BACKGROUND: The association between asthma and anaphylaxis remains poorly understood. OBJECTIVE: To ascertain, in a managed care organization in northern California, the association of asthma and asthma severity with future risk of anaphylactic shock and other selected allergy diagnoses. METHODS:…
OBJECTIVE: There are limited data on the risk of pulmonary disease in patients with diabetes. The aim of this study was to evaluate and compare the incidence of asthma, chronic obstructive pulmonary disease (COPD), pulmonary fibrosis, pneumonia, and lung cancer…
BACKGROUND: Mortality risk in adult asthma is poorly understood, especially the interplay among race, disease severity, and health care access. OBJECTIVE: To examine mortality risk factors in adult asthma. METHODS: In a prospective cohort study of 865 adults with severe…
BACKGROUND: Patients face increasing insurance restrictions on prescription drugs, including generic-only coverage. There are no generic inhaled corticosteroids (ICS), which are a mainstay of asthma therapy, and patients pay the full price for these drugs under generic-only policies. We examined…
BACKGROUND: Morbidity from asthma disproportionately affects black people. Whether this excess morbidity is fully explained by differences in asthma severity, access to care, or socioeconomic status (SES) is unknown. METHODS: We assessed whether there were racial disparities in asthma management…
Despite having a chronic respiratory disease, adults with asthma do not appear to selectively avoid smoking. We used data from a prospective cohort study of 865 adults, with asthma recruited from a large managed care organization after hospitalization for asthma.…
BACKGROUND: Psychosocial factors play an important role in outcomes of asthma. Perceived control, a measure of patients' beliefs about their ability to control their disease, has not been studied in association with asthma health outcomes METHODS: We used data from…
PURPOSE: We aimed to elucidate the prevalence of and risk factors for work disability in severe adult asthma and to evaluate the impact of work disability on downstream health outcomes. METHODS: We used data from a prospective cohort study of…
INTRODUCTION: The ability to conduct community-level asthma surveillance is increasingly crucial for public health programming and child health advocacy. We explored the potential and limitations of health care use records from both public and private sources for asthma surveillance in…
INTRODUCTION: As with many diseases, the epidemic of asthma among children over the past few decades has been shaped by a social and environmental context that is becoming progressively more evident. Commonly used methods for asthma surveillance, however, are based…
OBJECTIVE: To evaluate the longitudinal impact of asthma specialist care on the risk of emergency department (ED) visits and hospitalization for asthma. DATA SOURCES/STUDY SETTING: A prospective cohort study using both telephone survey and computerized utilization data. STUDY DESIGN: We…
BACKGROUND: Because they have chronic airway inflammation, adults with asthma could have symptomatic exacerbation after exposure to second hand smoke (SHS). Surprisingly, data on the effects of SHS exposure in adults with asthma are quite limited. Most previous epidemiological studies…
OBJECTIVE: The aim of this study was to evaluate the impact of introducing health information technology (HIT) on physician-patient interactions during outpatient visits. DESIGN: This was a longitudinal pre-post study: two months before and one and seven months after introduction…
BACKGROUND: There appears to be an asthma epidemic in the United States and other developed countries, with increasing prevalence and severity of asthma. Despite these trends, the understanding of severe asthma remains limited. Research has been hampered by the lack…
BACKGROUND: Psychological disorders, including depression, are common in adults with asthma. Although depression is treatable, its impact on longitudinal asthma outcomes is not clear. OBJECTIVE: To elucidate the impact of depressive symptoms on patient-centered outcomes and emergency health care use…
BACKGROUND: Inflammation plays a role in the pathogenesis of athero-thrombosis. Because of the chronic, inflammatory nature of asthma, we hypothesized a possible link asthma and prospective risk of coronary heart disease (CHD). METHODS: We performed a cohort study among 70…
OBJECTIVE: More than half of Medicaid enrollees are now in managed care. Scant information exists about which policies of practice sites improve quality of care in managed Medicaid. Children with asthma are a sentinel group for Medicaid quality monitoring because…
BACKGROUND: Regular use of inhaled anti-inflammatory (AI) medication improves outcomes for children with persistent asthma. OBJECTIVE: To relate 3 measures of asthma medication dispensing to physical health and hospital-based events among children with asthma who were enrolled in 1 of…
OBJECTIVE: Nonadherence to regular inhaled anti-inflammatory medication use is a frequent contributor to poor control of persistent asthma and may result from misunderstanding of the preventive role of such medications. This study's aims are to 1) test the hypothesis that…
OBJECTIVE: Racial/ethnic disparities in hospitalization rates among children with asthma have been documented but are not well-understood. Medicaid programs, which serve many minority children, have markedly increased their use of managed care in recent years. It is unknown whether racial/ethnic…
Although allergic diseases such as asthma and hay fever are a major cause of morbidity in industrialized countries, most studies have focused on patterns of prevalence among children and adolescents, with relatively few studies on variations in prevalence by race/ethnicity…
We tested whether asthma diagnosis is associated with weight gain and physical activity in 4,547 18 to 30-yr-old African American and white men and women, followed prospectively for up to 10 yr. Baseline asthma was most frequent in African American…
The results of this case-control study conducted at a large HMO support the notion that severe asthma may be associated with transient hepatic enzyme elevation. Conversely, we found no evidence of associations between asthma therapeutic classes and hepatic enzyme elevation.
This study developed and evaluated the performance of prediction models for asthma-related adverse outcomes based on the computerized hospital, clinic, and pharmacy utilization databases of a large health maintenance organization. Prediction models identified patients at three- to four-fold increased risk…
Effective management of populations with asthma requires methods for identifying patients at high risk for adverse outcomes. The aim of this study was to develop and validate prediction models that used computerized utilization data from a large health-maintenance organization (HMO)…
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