Carin Lamm - Academia.edu (original) (raw)

Papers by Carin Lamm

Research paper thumbnail of Childhood Asthma Incidence, Early and Persistent Wheeze, and Neighborhood Socioeconomic Factors in the ECHO/CREW Consortium

Research paper thumbnail of Associations between Early Life Environmental Exposures and Rhinitis Trajectories in an Urban Birth Cohort

Journal of Allergy and Clinical Immunology

Research paper thumbnail of Cheyne-Stokes Respiration in a 17-Year-Old Boy Awaiting Heart Transplantation

Texas Heart Institute Journal

Cheyne-Stokes respiration is a pattern of alternating central apnea and hyperpnea. It is well des... more Cheyne-Stokes respiration is a pattern of alternating central apnea and hyperpnea. It is well described in adults with congestive heart failure, but not in children. We report the case of a 17-year-old boy whose systolic heart failure was complicated by Cheyne-Stokes respiration. He was given supportive therapy until heart transplant, after which his Cheyne-Stokes respiration clinically resolved. Clinicians should be aware of this uncommon condition in pediatric and adolescent patients who have advanced heart failure and irregular breathing.

Research paper thumbnail of Aeroallergen Sensitization, Serum IgE, and Eosinophilia as Predictors of Response to Omalizumab Therapy during the Fall Season among Children with Persistent Asthma

The Journal of Allergy and Clinical Immunology: In Practice

BACKGROUND Perennial aeroallergen sensitization is associated with greater asthma morbidity and i... more BACKGROUND Perennial aeroallergen sensitization is associated with greater asthma morbidity and is required for treatment with omalizumab. OBJECTIVE To investigate the predictive relationship between the number of aeroallergen sensitizations, total serum IgE, and serum eosinophil count, and response to omalizumab in children and adolescents with asthma treated during the fall season. METHODS This analysis includes inner-city patients with persistent asthma and recent exacerbations aged 6-20 years comprising the placebo and omalizumab-treated groups in two completed randomized clinical trials, the Inner-City Anti-IgE Therapy for Asthma (ICATA) study and the Preventative Omalizumab or Step-Up Therapy for Fall Exacerbations (PROSE) study. Logistic regression modeled the relationship between greater degrees of markers of allergic inflammation and the primary outcome of fall season asthma exacerbations. RESULTS The analysis included 761 participants who were 62% male and 59% African American with a median age of 10 years. Fall asthma exacerbations were significantly higher in children with greater numbers of aeroallergen-specific sensitizations in the placebo group (OR 1.33, 95% CI 1.11-1.60, p<0.01), but not in the omalizumab-treated children (OR 1.08, 95% CI 0.91-1.28, p=0.37) indicating a significant differential effect (p<0.01). Likewise, there was a differential effect of omalizumab treatment in children with greater baseline total serum IgE levels (p<0.01) or greater baseline serum eosinophil counts (p<0.01). Multiple aeroallergen sensitization was the best predictor of response to omalizumab; treated participants sensitized to ≥4 different groups of aeroallergens had a 51% reduction in the odds of a fall exacerbation (OR 0.49, 95% CI 0.30-0.81, p<0.01). CONCLUSIONS In preventing fall season asthma exacerbations, treatment with omalizumab was most beneficial in children with a greater degree of allergic inflammation.

Research paper thumbnail of Best Practice Guide for the Treatment of Nightmare Disorder in Adults

Journal of Clinical Sleep Medicine

Research paper thumbnail of Rhinitis in Children and Adolescents with Asthma: Ubiquitous, Difficult to Control, and Associated with Asthma Outcomes

The Journal of allergy and clinical immunology, Jan 10, 2018

Rhinitis and asthma are linked, but substantial knowledge gaps in this relationship exist. To det... more Rhinitis and asthma are linked, but substantial knowledge gaps in this relationship exist. To determine the prevalence of rhinitis and its phenotypes in children and adolescents with asthma, assess symptom severity and medication requirements for rhinitis control, and investigate associations between rhinitis and asthma. 749 children with asthma participating in the Asthma Phenotypes in the Inner-City study received baseline evaluations and were managed for 1 year with algorithm-based treatments for rhinitis and asthma. Rhinitis was diagnosed by questionnaire focusing on individual symptoms, and pre-defined phenotypes were determined by combining symptom patterns with skin testing and serum specific IgE. Analyses were done on 619 children with asthma who completed at least 4 of 6 visits. Rhinitis was present in 93.5%, and phenotypes identified at baseline were confirmed during the observation/management year. Perennial allergic rhinitis with seasonal exacerbations (PARSE) was most c...

Research paper thumbnail of Practice Parameters for the Surgical Modifications of the Upper Airway for Obstructive Sleep Apnea in Adults

Sleep

Practice Parameters-Aurora et al 1.0 INTRODUCTION Obstructive sleep apnea (OSA) is a syndrome cha... more Practice Parameters-Aurora et al 1.0 INTRODUCTION Obstructive sleep apnea (OSA) is a syndrome characterized by repetitive upper airway collapse or narrowing. Sequelae include adverse cardiovascular and metabolic outcomes, decline in quality of life, and neurocognitive impairment. 1-4 In addition to lifestyle modifications such as weight loss, avoidance of alcohol or other agents that can decrease upper airway patency, and implementation of positional therapy, the main therapeutic options include positive airway pressure therapy (PAP), oral appliances, and surgical procedures. 5 For most individuals, PAP therapy remains the preferable first-line treatment for OSA. However, a significant proportion of patients are unable to tolerate PAP therapy and seek alternate treatment. 6 Practice parameters for the treatment of OSA in adults by surgical modification of the upper airway were first published in 1996 by the AASM (formerly ASDA). 7 The 1996 practice parameters were based on a systematic review that accompanied the publication. 8 Recently a series of clinical guidelines for the compre-PRACTICE PARAMETERS FOR SURGERY FOR OSA IN ADULTS

Research paper thumbnail of Practice Parameters for the Respiratory Indications for Polysomnography in Children

Sleep

Practice Parameters-Aurora et al Background: There has been marked expansion in the literature an... more Practice Parameters-Aurora et al Background: There has been marked expansion in the literature and practice of pediatric sleep medicine; however, no recent evidencebased practice parameters have been reported. These practice parameters are the first of 2 papers that assess indications for polysomnography in children. This paper addresses indications for polysomnography in children with suspected sleep related breathing disorders. These recommendations were reviewed and approved by the Board of Directors of the American Academy of Sleep Medicine. Methods: A systematic review of the literature was performed, and the American Academy of Neurology grading system was used to assess the quality of evidence. Recommendations for PSG Use: 1. Polysomnography in children should be performed and interpreted in accordance with the recommendations of the AASM Manual for the Scoring of Sleep and Associated Events. (Standard) 2. Polysomnography is indicated when the clinical assessment suggests the diagnosis of obstructive sleep apnea syndrome (OSAS) in children. (Standard) 3. Children with mild OSAS preoperatively should have clinical evaluation following adenotonsillectomy to assess for residual symptoms. If there are residual symptoms of OSAS, polysomnography should be performed. (Standard) 4. Polysomnography is indicated following adenotonsillectomy to assess for residual OSAS in children with preoperative evidence for moderate to severe OSAS, obesity, craniofacial anomalies that obstruct the upper airway, and neurologic disorders (e.g., Down syndrome, Prader-Willi syndrome, and myelomeningocele). (Standard) 5. Polysomnography is indicated for positive airway pressure (PAP) titration in children with obstructive sleep apnea syndrome. (Standard) 6. Polysomnography is indicated when the clinical assessment suggests the diagnosis of congenital central alveolar hypoventilation syndrome or sleep related hypoventilation due to neuromuscular disorders or chest wall deformities. It is indicated in selected cases of primary sleep apnea of infancy. (Guideline) 7. Polysomnography is indicated when there is clinical evidence of a sleep related breathing disorder in infants who have experienced an apparent life-threatening event (ALTE). (Guideline) 8. Polysomnography is indicated in children being considered for adenotonsillectomy to treat obstructive sleep apnea syndrome.

Research paper thumbnail of Can We Predict Fall Asthma Exacerbations? Validation Of The Seasonal Asthma Exacerbation Index

The Journal of allergy and clinical immunology, Jan 23, 2017

A Seasonal Asthma Exacerbation Predictive Index (saEPI) was previously reported based on two prio... more A Seasonal Asthma Exacerbation Predictive Index (saEPI) was previously reported based on two prior NIAID Inner City Asthma Consortium trials. We sought to validate the saEPI in a separate trial designed to prevent fall exacerbations with omalizumab therapy. The saEPI and its components were analyzed to characterize those who had an asthma exacerbation during the PROSE (Preventative Omalizumab or Step-Up Therapy for Fall Exacerbations) study. We characterized those inner-city children with and without asthma exacerbations in the fall periods treated with guidelines based therapy (GBT) in the absence and presence of omalizumab. A higher saEPI was associated with an exacerbation in both the GBT alone (p<0.001, AUC 0.76) and the GBT + omalizumab group (p<0.01, AUC 0.65). In the GBT group, younger age at recruitment, higher total IgE, higher blood eosinophil percent and number, and higher treatment step were associated with those who had an exacerbation compared to those who did no...

Research paper thumbnail of Pathways through which asthma risk factors contribute to asthma severity in inner-city children

The Journal of allergy and clinical immunology, Oct 1, 2016

Pathway analyses can be used to determine how host and environmental factors contribute to asthma... more Pathway analyses can be used to determine how host and environmental factors contribute to asthma severity. To investigate pathways explaining asthma severity in inner-city children. On the basis of medical evidence in the published literature, we developed a conceptual model to describe how 8 risk-factor domains (allergen sensitization, allergic inflammation, pulmonary physiology, stress, obesity, vitamin D, environmental tobacco smoke [ETS] exposure, and rhinitis severity) are linked to asthma severity. To estimate the relative magnitude and significance of hypothesized relationships among these domains and asthma severity, we applied a causal network analysis to test our model in an Inner-City Asthma Consortium study. Participants comprised 6- to 17-year-old children (n = 561) with asthma and rhinitis from 9 US inner cities who were evaluated every 2 months for 1 year. Asthma severity was measured by a longitudinal composite assessment of day and night symptoms, exacerbations, an...

Research paper thumbnail of Interstitial Lung Disease And Atypical Adenomatous Hyperplasia In An Adolescent With Scleromyositis Overlap Syndrome

A3. FELLOWS CASE CONFERENCE, 2012

Research paper thumbnail of An otherwise healthy 9-year-old boy who falls asleep in school

Case Studies in Polysomnography Interpretation, 2012

Research paper thumbnail of Nocardia farcinica isolated from bronchoalveolar lavage fluid of a child with cystic fibrosis

The Pediatric infectious disease journal, 2007

Nocardia spp. can cause pulmonary infection, usually in the setting of immunosuppression or under... more Nocardia spp. can cause pulmonary infection, usually in the setting of immunosuppression or underlying lung disease. There have been a few reports of these organisms isolated from cystic fibrosis patients and, when recovered, the isolates were almost always Nocardia asteroides. We present the first reported case of a child with cystic fibrosis harboring Nocardia farcinica.

Research paper thumbnail of Sleep Problems In Urban Minority Children May Be More Prevalent Than Previously Recognized

B73. PEDIATRIC SLEEP, 2011

Research paper thumbnail of Wegener Granulomatosis Presenting With Cystic Cavitary Lung Lesions

D56. PEDIATRIC CASE REPORTS: DIAGNOSTIC AND MANAGEMENT DILEMMAS, 2010

Research paper thumbnail of The Natural History of Type B Niemann-Pick Disease: Results From a 10-Year Longitudinal Study

PEDIATRICS, 2004

Objectives. Type B Niemann-Pick disease (NPD-B) caused by acid sphingomyelinase deficiency is a r... more Objectives. Type B Niemann-Pick disease (NPD-B) caused by acid sphingomyelinase deficiency is a rare, autosomal recessive, lysosomal storage disorder with a broad range of disease severity. The objectives of this study were to document the natural history of the disease in a large, clinically heterogeneous patient population that was followed for a period of 10 years and to determine how genotype influences phenotype. Methods. Twenty-nine patients with NPD-B had serial evaluations at least 9 months apart. Organ volumes, hematologic indices, lipid concentrations, pulmonary function, and hepatic activity were studied, and individual phenotypic severity was compared with genotype. Results. All patients with intact spleens had splenomegaly (mean value: 12.7 multiples of normal [MN]; range: 4.5–27.3 MN), and all but 1 had hepatomegaly (mean volume: 1.91 MN; range: 0.93–3.21 MN). At initial visit, 39% had thrombocytopenia and 3% had leukopenia. At final visit, the percentages increased to...

Research paper thumbnail of Evaluation of home audiotapes as an abbreviated test for obstructive sleep apnea syndrome (OSAS) in children

Pediatric Pulmonology, 1999

Snoring occurs commonly in children and is sometimes associated with obstructive sleep apnea synd... more Snoring occurs commonly in children and is sometimes associated with obstructive sleep apnea syndrome (OSAS). Based on clinical history alone, it is difficult to distinguish primary snoring, characterized by noisy breathing during sleep without apnea or hypoventilation, from snoring indicative of OSAS. An overnight polysomnogram (PSG) is required to establish a definitive diagnosis of OSAS. Because sleep evaluations are costly and resources are limited, we evaluated whether a home audiotape recording could accurately identify children with OSAS. We studied 36 children referred by pediatricians and otolaryngologists for possible OSAS. Parents completed a questionnaire about their child's sleep and breathing and made a 15-min audiotape of the child's breath sounds during sleep. Overnight PSGs were performed on all patients. There were 29 patients who completed the study: 15 patients in the Primary Snoring group (apnea/hypopnea index <5) and 14 patients in the OSAS group (apnea/hypopnea index ജ5). No significant statistical differences existed between the two groups for physical characteristics or questionnaire responses. Seven observers analyzed the audiotapes for the presence of a struggle sound and respiratory pauses. The median sensitivity of the audiotape as a predictor of OSAS was 71% (range 43-86%), and the median specificity was 80% (range 67-80%). The presence of a struggle sound on the audiotape was the parameter most predictive of OSAS. There was a good level of agreement among the seven audiotape observers, as demonstrated by a mean and range kappa statistic of 0.70 (0.50-0.93) for the 21 pairs of observers. Using a clinical score to predict OSAS, the sensitivity was 46%, and the specificity was 83%. We conclude that findings on a home audiotape can be suggestive of OSAS, but are not sufficiently specific to reliably distinguish primary snoring from OSAS.

Research paper thumbnail of Assessment of inspiratory flow limitation in children with sleep-disordered breathing by a nasal cannula pressure transducer system

Pediatric Pulmonology, 2002

A nasal cannula pressure transducer system identifies inspiratory flow limitation and increased u... more A nasal cannula pressure transducer system identifies inspiratory flow limitation and increased upper airway resistance in adults with sleep-disordered breathing (SDB). The purpose of this study was to evaluate whether nasal cannula pressure (NCP) detects apneas and hypopneas as well as additional flow-limited events associated with increased airway resistance in children. We studied NCP in 47 patients (ages 2-14 years) referred for SDB to a university-based sleep disorders program during nocturnal polysomnography (NPSG). During NPSG, airflow was assessed simultaneously by thermistor and NCP. There was a high correlation between apneas assessed by thermistor (T) and NCP (r = 0.90, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.0001), and for hypopneas using these two methods (r = 0.94, P = 0.0001). Respiratory driving pressure was indirectly measured with an esophageal pressure catheter. Flow-limited (flattened) NCP waves were associated with significantly higher driving pressure, indicating elevated upper airway resistance, compared to nonflow-limited (rounded) waves during nonrapid eye movement (NREM) (P = 0.05) and rapid eye movement (REM) (P = 0.01) sleep. Patients were classified as either having obstructive sleep apnea syndrome (OSAS) or primary snoring, based on standard NPSG criteria. NCP identified additional respiratory events with a flattened contour (FC) not detected by thermistor. NCP is a noninvasive device that identifies obstructive apneas and hypopneas as well as additional respiratory events associated with flow limitation in children.

Research paper thumbnail of Polysomnographic findings in a patient with the mitochondrial encephalomyopathy NARP

Neurology, 1997

A 23-year-old woman with the mitochondrial encephalomyopathy NARP (neurogenic muscle weakness, at... more A 23-year-old woman with the mitochondrial encephalomyopathy NARP (neurogenic muscle weakness, ataxia, and retinitis pigmentosa) presented with symptoms of obstructive sleep apnea (OSA). An overnight polysomnogram (PSG) showed apnea, EEG slowing, and a paucity of sleep spindles. The patient had a tracheostomy for OSA, and 5 months later she had normal EEG patterns and marked clinical improvement. We propose that patients with mitochondrial encephalomyopathies should have sleep evaluations if the history suggests OSA.

Research paper thumbnail of Congenital rickets associated with magnesium sulfate infusion for tocolysis

The Journal of Pediatrics, 1988

Research paper thumbnail of Childhood Asthma Incidence, Early and Persistent Wheeze, and Neighborhood Socioeconomic Factors in the ECHO/CREW Consortium

Research paper thumbnail of Associations between Early Life Environmental Exposures and Rhinitis Trajectories in an Urban Birth Cohort

Journal of Allergy and Clinical Immunology

Research paper thumbnail of Cheyne-Stokes Respiration in a 17-Year-Old Boy Awaiting Heart Transplantation

Texas Heart Institute Journal

Cheyne-Stokes respiration is a pattern of alternating central apnea and hyperpnea. It is well des... more Cheyne-Stokes respiration is a pattern of alternating central apnea and hyperpnea. It is well described in adults with congestive heart failure, but not in children. We report the case of a 17-year-old boy whose systolic heart failure was complicated by Cheyne-Stokes respiration. He was given supportive therapy until heart transplant, after which his Cheyne-Stokes respiration clinically resolved. Clinicians should be aware of this uncommon condition in pediatric and adolescent patients who have advanced heart failure and irregular breathing.

Research paper thumbnail of Aeroallergen Sensitization, Serum IgE, and Eosinophilia as Predictors of Response to Omalizumab Therapy during the Fall Season among Children with Persistent Asthma

The Journal of Allergy and Clinical Immunology: In Practice

BACKGROUND Perennial aeroallergen sensitization is associated with greater asthma morbidity and i... more BACKGROUND Perennial aeroallergen sensitization is associated with greater asthma morbidity and is required for treatment with omalizumab. OBJECTIVE To investigate the predictive relationship between the number of aeroallergen sensitizations, total serum IgE, and serum eosinophil count, and response to omalizumab in children and adolescents with asthma treated during the fall season. METHODS This analysis includes inner-city patients with persistent asthma and recent exacerbations aged 6-20 years comprising the placebo and omalizumab-treated groups in two completed randomized clinical trials, the Inner-City Anti-IgE Therapy for Asthma (ICATA) study and the Preventative Omalizumab or Step-Up Therapy for Fall Exacerbations (PROSE) study. Logistic regression modeled the relationship between greater degrees of markers of allergic inflammation and the primary outcome of fall season asthma exacerbations. RESULTS The analysis included 761 participants who were 62% male and 59% African American with a median age of 10 years. Fall asthma exacerbations were significantly higher in children with greater numbers of aeroallergen-specific sensitizations in the placebo group (OR 1.33, 95% CI 1.11-1.60, p<0.01), but not in the omalizumab-treated children (OR 1.08, 95% CI 0.91-1.28, p=0.37) indicating a significant differential effect (p<0.01). Likewise, there was a differential effect of omalizumab treatment in children with greater baseline total serum IgE levels (p<0.01) or greater baseline serum eosinophil counts (p<0.01). Multiple aeroallergen sensitization was the best predictor of response to omalizumab; treated participants sensitized to ≥4 different groups of aeroallergens had a 51% reduction in the odds of a fall exacerbation (OR 0.49, 95% CI 0.30-0.81, p<0.01). CONCLUSIONS In preventing fall season asthma exacerbations, treatment with omalizumab was most beneficial in children with a greater degree of allergic inflammation.

Research paper thumbnail of Best Practice Guide for the Treatment of Nightmare Disorder in Adults

Journal of Clinical Sleep Medicine

Research paper thumbnail of Rhinitis in Children and Adolescents with Asthma: Ubiquitous, Difficult to Control, and Associated with Asthma Outcomes

The Journal of allergy and clinical immunology, Jan 10, 2018

Rhinitis and asthma are linked, but substantial knowledge gaps in this relationship exist. To det... more Rhinitis and asthma are linked, but substantial knowledge gaps in this relationship exist. To determine the prevalence of rhinitis and its phenotypes in children and adolescents with asthma, assess symptom severity and medication requirements for rhinitis control, and investigate associations between rhinitis and asthma. 749 children with asthma participating in the Asthma Phenotypes in the Inner-City study received baseline evaluations and were managed for 1 year with algorithm-based treatments for rhinitis and asthma. Rhinitis was diagnosed by questionnaire focusing on individual symptoms, and pre-defined phenotypes were determined by combining symptom patterns with skin testing and serum specific IgE. Analyses were done on 619 children with asthma who completed at least 4 of 6 visits. Rhinitis was present in 93.5%, and phenotypes identified at baseline were confirmed during the observation/management year. Perennial allergic rhinitis with seasonal exacerbations (PARSE) was most c...

Research paper thumbnail of Practice Parameters for the Surgical Modifications of the Upper Airway for Obstructive Sleep Apnea in Adults

Sleep

Practice Parameters-Aurora et al 1.0 INTRODUCTION Obstructive sleep apnea (OSA) is a syndrome cha... more Practice Parameters-Aurora et al 1.0 INTRODUCTION Obstructive sleep apnea (OSA) is a syndrome characterized by repetitive upper airway collapse or narrowing. Sequelae include adverse cardiovascular and metabolic outcomes, decline in quality of life, and neurocognitive impairment. 1-4 In addition to lifestyle modifications such as weight loss, avoidance of alcohol or other agents that can decrease upper airway patency, and implementation of positional therapy, the main therapeutic options include positive airway pressure therapy (PAP), oral appliances, and surgical procedures. 5 For most individuals, PAP therapy remains the preferable first-line treatment for OSA. However, a significant proportion of patients are unable to tolerate PAP therapy and seek alternate treatment. 6 Practice parameters for the treatment of OSA in adults by surgical modification of the upper airway were first published in 1996 by the AASM (formerly ASDA). 7 The 1996 practice parameters were based on a systematic review that accompanied the publication. 8 Recently a series of clinical guidelines for the compre-PRACTICE PARAMETERS FOR SURGERY FOR OSA IN ADULTS

Research paper thumbnail of Practice Parameters for the Respiratory Indications for Polysomnography in Children

Sleep

Practice Parameters-Aurora et al Background: There has been marked expansion in the literature an... more Practice Parameters-Aurora et al Background: There has been marked expansion in the literature and practice of pediatric sleep medicine; however, no recent evidencebased practice parameters have been reported. These practice parameters are the first of 2 papers that assess indications for polysomnography in children. This paper addresses indications for polysomnography in children with suspected sleep related breathing disorders. These recommendations were reviewed and approved by the Board of Directors of the American Academy of Sleep Medicine. Methods: A systematic review of the literature was performed, and the American Academy of Neurology grading system was used to assess the quality of evidence. Recommendations for PSG Use: 1. Polysomnography in children should be performed and interpreted in accordance with the recommendations of the AASM Manual for the Scoring of Sleep and Associated Events. (Standard) 2. Polysomnography is indicated when the clinical assessment suggests the diagnosis of obstructive sleep apnea syndrome (OSAS) in children. (Standard) 3. Children with mild OSAS preoperatively should have clinical evaluation following adenotonsillectomy to assess for residual symptoms. If there are residual symptoms of OSAS, polysomnography should be performed. (Standard) 4. Polysomnography is indicated following adenotonsillectomy to assess for residual OSAS in children with preoperative evidence for moderate to severe OSAS, obesity, craniofacial anomalies that obstruct the upper airway, and neurologic disorders (e.g., Down syndrome, Prader-Willi syndrome, and myelomeningocele). (Standard) 5. Polysomnography is indicated for positive airway pressure (PAP) titration in children with obstructive sleep apnea syndrome. (Standard) 6. Polysomnography is indicated when the clinical assessment suggests the diagnosis of congenital central alveolar hypoventilation syndrome or sleep related hypoventilation due to neuromuscular disorders or chest wall deformities. It is indicated in selected cases of primary sleep apnea of infancy. (Guideline) 7. Polysomnography is indicated when there is clinical evidence of a sleep related breathing disorder in infants who have experienced an apparent life-threatening event (ALTE). (Guideline) 8. Polysomnography is indicated in children being considered for adenotonsillectomy to treat obstructive sleep apnea syndrome.

Research paper thumbnail of Can We Predict Fall Asthma Exacerbations? Validation Of The Seasonal Asthma Exacerbation Index

The Journal of allergy and clinical immunology, Jan 23, 2017

A Seasonal Asthma Exacerbation Predictive Index (saEPI) was previously reported based on two prio... more A Seasonal Asthma Exacerbation Predictive Index (saEPI) was previously reported based on two prior NIAID Inner City Asthma Consortium trials. We sought to validate the saEPI in a separate trial designed to prevent fall exacerbations with omalizumab therapy. The saEPI and its components were analyzed to characterize those who had an asthma exacerbation during the PROSE (Preventative Omalizumab or Step-Up Therapy for Fall Exacerbations) study. We characterized those inner-city children with and without asthma exacerbations in the fall periods treated with guidelines based therapy (GBT) in the absence and presence of omalizumab. A higher saEPI was associated with an exacerbation in both the GBT alone (p<0.001, AUC 0.76) and the GBT + omalizumab group (p<0.01, AUC 0.65). In the GBT group, younger age at recruitment, higher total IgE, higher blood eosinophil percent and number, and higher treatment step were associated with those who had an exacerbation compared to those who did no...

Research paper thumbnail of Pathways through which asthma risk factors contribute to asthma severity in inner-city children

The Journal of allergy and clinical immunology, Oct 1, 2016

Pathway analyses can be used to determine how host and environmental factors contribute to asthma... more Pathway analyses can be used to determine how host and environmental factors contribute to asthma severity. To investigate pathways explaining asthma severity in inner-city children. On the basis of medical evidence in the published literature, we developed a conceptual model to describe how 8 risk-factor domains (allergen sensitization, allergic inflammation, pulmonary physiology, stress, obesity, vitamin D, environmental tobacco smoke [ETS] exposure, and rhinitis severity) are linked to asthma severity. To estimate the relative magnitude and significance of hypothesized relationships among these domains and asthma severity, we applied a causal network analysis to test our model in an Inner-City Asthma Consortium study. Participants comprised 6- to 17-year-old children (n = 561) with asthma and rhinitis from 9 US inner cities who were evaluated every 2 months for 1 year. Asthma severity was measured by a longitudinal composite assessment of day and night symptoms, exacerbations, an...

Research paper thumbnail of Interstitial Lung Disease And Atypical Adenomatous Hyperplasia In An Adolescent With Scleromyositis Overlap Syndrome

A3. FELLOWS CASE CONFERENCE, 2012

Research paper thumbnail of An otherwise healthy 9-year-old boy who falls asleep in school

Case Studies in Polysomnography Interpretation, 2012

Research paper thumbnail of Nocardia farcinica isolated from bronchoalveolar lavage fluid of a child with cystic fibrosis

The Pediatric infectious disease journal, 2007

Nocardia spp. can cause pulmonary infection, usually in the setting of immunosuppression or under... more Nocardia spp. can cause pulmonary infection, usually in the setting of immunosuppression or underlying lung disease. There have been a few reports of these organisms isolated from cystic fibrosis patients and, when recovered, the isolates were almost always Nocardia asteroides. We present the first reported case of a child with cystic fibrosis harboring Nocardia farcinica.

Research paper thumbnail of Sleep Problems In Urban Minority Children May Be More Prevalent Than Previously Recognized

B73. PEDIATRIC SLEEP, 2011

Research paper thumbnail of Wegener Granulomatosis Presenting With Cystic Cavitary Lung Lesions

D56. PEDIATRIC CASE REPORTS: DIAGNOSTIC AND MANAGEMENT DILEMMAS, 2010

Research paper thumbnail of The Natural History of Type B Niemann-Pick Disease: Results From a 10-Year Longitudinal Study

PEDIATRICS, 2004

Objectives. Type B Niemann-Pick disease (NPD-B) caused by acid sphingomyelinase deficiency is a r... more Objectives. Type B Niemann-Pick disease (NPD-B) caused by acid sphingomyelinase deficiency is a rare, autosomal recessive, lysosomal storage disorder with a broad range of disease severity. The objectives of this study were to document the natural history of the disease in a large, clinically heterogeneous patient population that was followed for a period of 10 years and to determine how genotype influences phenotype. Methods. Twenty-nine patients with NPD-B had serial evaluations at least 9 months apart. Organ volumes, hematologic indices, lipid concentrations, pulmonary function, and hepatic activity were studied, and individual phenotypic severity was compared with genotype. Results. All patients with intact spleens had splenomegaly (mean value: 12.7 multiples of normal [MN]; range: 4.5–27.3 MN), and all but 1 had hepatomegaly (mean volume: 1.91 MN; range: 0.93–3.21 MN). At initial visit, 39% had thrombocytopenia and 3% had leukopenia. At final visit, the percentages increased to...

Research paper thumbnail of Evaluation of home audiotapes as an abbreviated test for obstructive sleep apnea syndrome (OSAS) in children

Pediatric Pulmonology, 1999

Snoring occurs commonly in children and is sometimes associated with obstructive sleep apnea synd... more Snoring occurs commonly in children and is sometimes associated with obstructive sleep apnea syndrome (OSAS). Based on clinical history alone, it is difficult to distinguish primary snoring, characterized by noisy breathing during sleep without apnea or hypoventilation, from snoring indicative of OSAS. An overnight polysomnogram (PSG) is required to establish a definitive diagnosis of OSAS. Because sleep evaluations are costly and resources are limited, we evaluated whether a home audiotape recording could accurately identify children with OSAS. We studied 36 children referred by pediatricians and otolaryngologists for possible OSAS. Parents completed a questionnaire about their child's sleep and breathing and made a 15-min audiotape of the child's breath sounds during sleep. Overnight PSGs were performed on all patients. There were 29 patients who completed the study: 15 patients in the Primary Snoring group (apnea/hypopnea index <5) and 14 patients in the OSAS group (apnea/hypopnea index ജ5). No significant statistical differences existed between the two groups for physical characteristics or questionnaire responses. Seven observers analyzed the audiotapes for the presence of a struggle sound and respiratory pauses. The median sensitivity of the audiotape as a predictor of OSAS was 71% (range 43-86%), and the median specificity was 80% (range 67-80%). The presence of a struggle sound on the audiotape was the parameter most predictive of OSAS. There was a good level of agreement among the seven audiotape observers, as demonstrated by a mean and range kappa statistic of 0.70 (0.50-0.93) for the 21 pairs of observers. Using a clinical score to predict OSAS, the sensitivity was 46%, and the specificity was 83%. We conclude that findings on a home audiotape can be suggestive of OSAS, but are not sufficiently specific to reliably distinguish primary snoring from OSAS.

Research paper thumbnail of Assessment of inspiratory flow limitation in children with sleep-disordered breathing by a nasal cannula pressure transducer system

Pediatric Pulmonology, 2002

A nasal cannula pressure transducer system identifies inspiratory flow limitation and increased u... more A nasal cannula pressure transducer system identifies inspiratory flow limitation and increased upper airway resistance in adults with sleep-disordered breathing (SDB). The purpose of this study was to evaluate whether nasal cannula pressure (NCP) detects apneas and hypopneas as well as additional flow-limited events associated with increased airway resistance in children. We studied NCP in 47 patients (ages 2-14 years) referred for SDB to a university-based sleep disorders program during nocturnal polysomnography (NPSG). During NPSG, airflow was assessed simultaneously by thermistor and NCP. There was a high correlation between apneas assessed by thermistor (T) and NCP (r = 0.90, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.0001), and for hypopneas using these two methods (r = 0.94, P = 0.0001). Respiratory driving pressure was indirectly measured with an esophageal pressure catheter. Flow-limited (flattened) NCP waves were associated with significantly higher driving pressure, indicating elevated upper airway resistance, compared to nonflow-limited (rounded) waves during nonrapid eye movement (NREM) (P = 0.05) and rapid eye movement (REM) (P = 0.01) sleep. Patients were classified as either having obstructive sleep apnea syndrome (OSAS) or primary snoring, based on standard NPSG criteria. NCP identified additional respiratory events with a flattened contour (FC) not detected by thermistor. NCP is a noninvasive device that identifies obstructive apneas and hypopneas as well as additional respiratory events associated with flow limitation in children.

Research paper thumbnail of Polysomnographic findings in a patient with the mitochondrial encephalomyopathy NARP

Neurology, 1997

A 23-year-old woman with the mitochondrial encephalomyopathy NARP (neurogenic muscle weakness, at... more A 23-year-old woman with the mitochondrial encephalomyopathy NARP (neurogenic muscle weakness, ataxia, and retinitis pigmentosa) presented with symptoms of obstructive sleep apnea (OSA). An overnight polysomnogram (PSG) showed apnea, EEG slowing, and a paucity of sleep spindles. The patient had a tracheostomy for OSA, and 5 months later she had normal EEG patterns and marked clinical improvement. We propose that patients with mitochondrial encephalomyopathies should have sleep evaluations if the history suggests OSA.

Research paper thumbnail of Congenital rickets associated with magnesium sulfate infusion for tocolysis

The Journal of Pediatrics, 1988