9 results on '"Barker, Alan"'
Search Results
2. Airway Clearance Techniques in Bronchiectasis: Analysis From the United States Bronchiectasis and Non-TB Mycobacteria Research Registry.
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Basavaraj, Ashwin, Choate, Radmila, Addrizzo-Harris, Doreen, Aksamit, Timothy R., Barker, Alan, Daley, Charles L., Anne Daniels, M. Leigh, Eden, Edward, DiMango, Angela, Fennelly, Kevin, Griffith, David E., Johnson, Margaret M., Knowles, Michael R., Metersky, Mark L., Noone, Peadar G., O'Donnell, Anne E., Olivier, Kenneth N., Salathe, Matthias A., Schmid, Andreas, and Thomashow, Byron
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BRONCHIECTASIS ,MYCOBACTERIA ,DEMOGRAPHIC characteristics ,PSEUDOMONAS aeruginosa ,LOGISTIC regression analysis ,MYCOBACTERIUM ,RESEARCH ,RESEARCH methodology ,ACQUISITION of data ,MEDICAL cooperation ,EVALUATION research ,COMPARATIVE studies ,RESPIRATORY therapy ,COUGH ,MEDICAL research ,LONGITUDINAL method - Abstract
Background: In patients with bronchiectasis, airway clearance techniques (ACTs) are important management strategies.Research Question: What are the differences in patients with bronchiectasis and a productive cough who used ACTs and those who did not? What was the assessment of bronchiectasis exacerbation frequency and change in pulmonary function at 1-year follow up?Study Design and Methods: Adult patients with bronchiectasis and a productive cough in the United States Bronchiectasis and NTM Research Registry were included in the analyses. ACTs included the use of instrumental devices and manual techniques. Stratified analyses of demographic and clinical characteristics were performed by use of ACTs at baseline and follow up. The association between ACT use and clinical outcomes was assessed with the use of unadjusted and adjusted multinomial logistic regression models.Results: Of the overall study population (n = 905), 59% used ACTs at baseline. A greater proportion of patients who used ACTs at baseline and follow up continuously had Pseudomonas aeruginosa (47% vs 36%; P = .021) and experienced an exacerbation (81% vs 59%; P < .0001) or hospitalization for pulmonary illness (32% vs 22%; P = .001) in the prior two years, compared with those patients who did not use ACTs. Fifty-eight percent of patients who used ACTs at baseline did not use ACTs at 1-year follow up. There was no significant change in pulmonary function for those who used ACTs at follow up, compared with baseline. Patients who used ACTs at baseline and follow up had greater odds for experiencing exacerbations at follow up compared with those patients who did not use ACTs.Interpretation: In patients with bronchiectasis and a productive cough, ACTs are used more often if the patients have experienced a prior exacerbation, hospitalization for pulmonary illness, or had P aeruginosa. There is a significant reduction in the use of ACTs at 1-year follow up. The odds of the development of a bronchiectasis exacerbation are higher in those patients who use ACTs continuously, which suggests more frequent use in an ill bronchiectasis population. [ABSTRACT FROM AUTHOR]- Published
- 2020
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3. Pharmacotherapy for Non-Cystic Fibrosis Bronchiectasis: Results From an NTM Info & Research Patient Survey and the Bronchiectasis and NTM Research Registry.
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Henkle, Emily, Aksamit, Timothy R, Barker, Alan F, Curtis, Jeffrey R, Daley, Charles L, Anne Daniels, M Leigh, DiMango, Angela, Eden, Edward, Fennelly, Kevin, Griffith, David E, Johnson, Margaret, Knowles, Michael R, Leitman, Amy, Leitman, Philip, Malanga, Elisha, Metersky, Mark L, Noone, Peadar G, O'Donnell, Anne E, Olivier, Kenneth N, and Prieto, Delia
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BRONCHI ,BRONCHIECTASIS ,COMPARATIVE studies ,GLUCOCORTICOIDS ,MACROLIDE antibiotics ,RESEARCH methodology ,MEDICAL cooperation ,MEDICAL research ,MYCOBACTERIAL diseases ,MYCOBACTERIUM ,RESEARCH ,RISK assessment ,SELF-evaluation ,EVALUATION research ,FIBROSIS ,DISEASE incidence ,ACQUISITION of data ,INHALATION administration ,DISEASE complications - Abstract
Background: Non-cystic fibrosis bronchiectasis ("bronchiectasis") is a chronic inflammatory lung disease often associated with nontuberculous mycobacteria (NTM) infection. Very little data exist to guide bronchiectasis management decisions. We sought to describe patterns of inhaled corticosteroid (ICS) and antibiotic therapy in the United States.Methods: We invited 2,000 patients through NTM Info & Research (NTMir) to complete an anonymous electronic survey. We separately queried baseline clinical and laboratory data from the US Bronchiectasis and NTM Research Registry (BRR).Results: Among 511 NTMir survey responders with bronchiectasis, whose median age was 67 years, 85 (17%) reported asthma and 99 (19%) reported COPD. History of ICS use was reported by 282 (55%), 171 (61%) of whom were treated 1 year or longer, and 150 (53%) were currently taking ICSs. Fewer reported ever taking azithromycin for non-NTM bronchiectasis (203 responders [40%]) or inhaled tobramycin (78 responders [15%]). The median age of 1,912 BRR patients was 69 years; 528 (28%) had asthma and 360 (19%) had COPD. Among 740 patients (42%) without NTM, 314 were taking ICSs at baseline. Among patients without NTM who were taking ICSs, only 178 (57%) had a concurrent diagnosis of COPD or asthma that could explain ICS use. Fewer were taking suppressive macrolides (96 patients [13%]), and of the 70 patients (10%) taking inhaled suppressive antibiotics, 48 (68%) had chronic Pseudomonas aeruginosa infection.Conclusions: ICS use was common in two national samples of patients with bronchiectasis, with relatively few patients taking suppressive antibiotic therapies. Further research is needed to clarify the safety and effectiveness of these therapies in patients with bronchiectasis. [ABSTRACT FROM AUTHOR]- Published
- 2017
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4. Adult Patients With Bronchiectasis: A First Look at the US Bronchiectasis Research Registry.
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Aksamit, Timothy R., O'donnell, Anne E., Barker, Alan, Olivier, Kenneth N., Winthrop, Kevin L., Daniels, M. Leigh Anne, Johnson, Margaret, Eden, Edward, Griffith, David, Knowles, Michael, Metersky, Mark, Salathe, Matthias, Thomashow, Byron, Tino, Gregory, Turino, Gerard, Carretta, Betsy, Daley, Charles L., and Bronchiectasis Research Registry Consortium
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BRONCHIECTASIS ,CYSTIC fibrosis ,CIGARETTE smokers ,GASTROESOPHAGEAL reflux ,DYSKINESIAS ,PATIENTS ,STATISTICS on Black people ,STATISTICS on Hispanic Americans ,ANIMALS ,ASTHMA ,COMPUTED tomography ,ETHNIC groups ,IMMUNOLOGICAL deficiency syndromes ,HEALTH insurance ,MEDICAL research ,MYCOBACTERIAL diseases ,MYCOBACTERIUM ,PSEUDOMONAS ,PSEUDOMONAS diseases ,RESPIRATORY measurements ,RHINITIS ,SINUSITIS ,SMOKING ,SPIROMETRY ,STAPHYLOCOCCAL diseases ,STAPHYLOCOCCUS aureus ,WHITE people ,COMORBIDITY ,OTITIS ,ACQUISITION of data ,RESPIRATORY organ abnormalities ,VITAL capacity (Respiration) - Abstract
Objectives: We sought to describe the characteristics of adult patients with bronchiectasis enrolled in the US Bronchiectasis Research Registry (BRR).Methods: The BRR is a database of patients with non-cystic-fibrosis bronchiectasis (NCFB) enrolled at 13 sites in the United States. Baseline demographic, spirometric, imaging, microbiological, and therapeutic data were entered into a central Internet-based database. Patients were subsequently analyzed by the presence of NTM.Results: We enrolled 1,826 patients between 2008 and 2014. Patients were predominantly women (79%), white (89%), and never smokers (60%), with a mean age of 64 ± 14 years. Sixty-three percent of the patients had a history of NTM disease or NTM isolated at baseline evaluation for entry into the BRR. Patients with NTM were older, predominantly women, and had bronchiectasis diagnosed at a later age than those without NTM. Gastroesophageal reflux disease (GERD) was more common in those with NTM, whereas asthma, primary immunodeficiency, and primary ciliary dyskinesia were more common in those without NTM. Fifty-one percent of patients had spirometric evidence of airflow obstruction. Patients with NTM were more likely to have diffusely dilated airways and tree-in-bud abnormalities. Pseudomonas and Staphylococcus aureus isolates were cultured less commonly in patients with NTM. Bronchial hygiene measures were used more often in those with NTM, whereas antibiotics used for exacerbations, rotating oral antibiotics, steroid use, and inhaled bronchodilators were more commonly used in those without NTM.Conclusions: Adult patients with bronchiectasis enrolled in the US BRR are described, with differences noted in demographic, radiographic, microbiological, and treatment variables based on stratification of the presence of NTM. [ABSTRACT FROM AUTHOR]- Published
- 2017
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5. Real-world treatment patterns, health care resource utilization, and costs in a US Medicare population with bronchiectasis.
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Tkacz J, Lewing B, Feliciano J, Mohanty M, Lauterio M, Fucile S, and Barker A
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- Humans, United States, Retrospective Studies, Female, Male, Aged, Aged, 80 and over, Patient Acceptance of Health Care statistics & numerical data, Hospitalization economics, Hospitalization statistics & numerical data, Health Expenditures statistics & numerical data, Health Resources economics, Health Resources statistics & numerical data, Bronchiectasis economics, Bronchiectasis therapy, Medicare economics, Health Care Costs statistics & numerical data
- Abstract
Background: Bronchiectasis carries a significant economic burden with high health care expenditures associated with frequent hospitalizations, physician visits, and treatments, including oral and intravenous antibiotics for repeated lung infections, airway-clearance therapy, and oxygen administration. Bronchiectasis exacerbations can contribute to this burden., Objective: To estimate US health care resource utilization (HCRU) and costs associated with bronchiectasis and with bronchiectasis exacerbations., Methods: This retrospective study used the 100% Medicare Fee-for-Service database (January 2014 to December 2020) to compare HCRU and costs among patients with bronchiectasis with those of patients without bronchiectasis (controls). For patients with bronchiectasis, the index date was a randomly selected bronchiectasis claim after more than 1 year of disease history and, for controls, a claim closest to their matched bronchiectasis patient's index date. All patients had continuous enrollment for at least 12 months pre-index (baseline) and at least 12 months post-index. Primary outcomes were all-cause, respiratory-related, and bronchiectasis-related HCRU and health care costs, which were presented by the overall sample and by segmented patient cohorts based on the number of exacerbations during baseline (0, 1, or ≥2)., Results: 92,529 patients with bronchiectasis (mean [SD] age, 76.7 [8.8] years; 72.3% female) and 92,529 matched controls qualified for the study. Compared with controls, patients with bronchiectasis presented greater mean (SD) all-cause physician visits (15.4 [10.0] vs 13.2 [9.7]; P < 0.001) and respiratory-related physician visits (5.2 [4.3] vs 1.9 [3.1]), pulmonologist visits (1.9 [2.2] vs 0.3 [1.0]), hospitalizations (0.4 [0.9] vs 0.3 [0.8]), emergency department visits (0.33 [1.0] vs 0.26 [1.0]), and total health care costs ($10,224 [$23,263] vs $6,704 [$19,593]). Respiratory-related HCRU was also greater in patients with more baseline exacerbations, with total health care costs of $8,506, $10,365, and $14,790 for patients with 0, 1, and at least 2 exacerbations, respectively ( P < 0.01)., Conclusions: This real-world study demonstrates the high disease burden associated with bronchiectasis and with exacerbations, highlighting the need to improve management and reduce exacerbations.
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- 2024
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6. Five-Year Outcomes among U.S. Bronchiectasis and NTM Research Registry Patients.
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Aksamit TR, Locantore N, Addrizzo-Harris D, Ali J, Barker A, Basavaraj A, Behrman M, Brunton AE, Chalmers S, Choate R, Dean NC, DiMango A, Fraulino D, Johnson MM, Lapinel NC, Maselli DJ, McShane PJ, Metersky ML, Miller BE, Naureckas ET, O'Donnell AE, Olivier KN, Prusinowski E, Restrepo MI, Richards CJ, Rhyne G, Schmid A, Solomon GM, Tal-Singer R, Thomashow B, Tino G, Tsui K, Varghese SA, Warren HE, Winthrop K, and Zha BS
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- Humans, Male, Female, Middle Aged, Aged, United States epidemiology, Hospitalization statistics & numerical data, Proportional Hazards Models, Nontuberculous Mycobacteria, Disease Progression, Bronchiectasis mortality, Bronchiectasis physiopathology, Bronchiectasis epidemiology, Registries, Mycobacterium Infections, Nontuberculous mortality, Mycobacterium Infections, Nontuberculous epidemiology
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Rationale: Nontuberculous mycobacteria (NTM) are prevalent among patients with bronchiectasis. However, the long-term natural history of patients with NTM and bronchiectasis is not well described. Objectives: To assess the impact of NTM on 5-year clinical outcomes and mortality in patients with bronchiectasis. Methods: Patients in the Bronchiectasis and NTM Research Registry with ⩾5 years of follow-up were eligible. Data were collected for all-cause mortality, lung function, exacerbations, hospitalizations, and disease severity. Outcomes were compared between patients with and without NTM at baseline. Mortality was assessed using Cox proportional hazards models and the log-rank test. Measurements and Main Results: In total, 2,634 patients were included: 1,549 (58.8%) with and 1,085 (41.2%) without NTM at baseline. All-cause mortality (95% confidence interval) at Year 5 was 12.1% (10.5%, 13.7%) overall, 12.6% (10.5%, 14.8%) in patients with NTM, and 11.5% (9.0%, 13.9%) in patients without NTM. Independent predictors of 5-year mortality were baseline FEV
1 percent predicted, age, hospitalization within 2 years before baseline, body mass index, and sex (all P < 0.01). The probabilities of acquiring NTM or Pseudomonas aeruginosa were approximately 4% and 3% per year, respectively. Spirometry, exacerbations, and hospitalizations were similar, regardless of NTM status, except that annual exacerbations were lower in patients with NTM ( P < 0.05). Conclusions: Outcomes, including exacerbations, hospitalizations, rate of loss of lung function, and mortality rate, were similar across 5 years in patients with bronchiectasis with or without NTM.- Published
- 2024
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7. The Prevalence and Significance of Staphylococcus aureus in Patients with Non-Cystic Fibrosis Bronchiectasis.
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Metersky ML, Aksamit TR, Barker A, Choate R, Daley CL, Daniels LA, DiMango A, Eden E, Griffith D, Johnson M, Knowles M, O'Donnell AE, Olivier K, Salathe M, Thomashow B, Tino G, Turino G, Winthrop KL, and Mannino D
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- Aged, Cystic Fibrosis, Female, Humans, Male, Middle Aged, Sputum microbiology, Staphylococcal Infections diagnosis, Staphylococcus aureus classification, Staphylococcus aureus isolation & purification, United States epidemiology, Bronchiectasis complications, Bronchiectasis microbiology, Staphylococcal Infections epidemiology
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Rationale: Staphylococcus aureus is commonly cultured from the sputum of patients with bronchiectasis; however, little is known about the prevalence of the organism in these patients, the characteristics of patients who have grown the organism, or its implications., Objectives: Determine the relationship between S. aureus and pulmonary function, frequency of exacerbations, and frequency of hospitalization in patients with bronchiectasis Methods: The Bronchiectasis Research Registry is a database of adults with non-cystic fibrosis bronchiectasis identified from 13 sites within the United States. Baseline and follow-up demographic, spirometric, microbiologic, and therapeutic data were entered into a central web-based database. Patients were grouped into three cohorts based on their previous respiratory cultures at the time of entry into the Registry: 1) no prior S. aureus or glucose-nonfermenting gram-negative bacilli (NF-GNB) (Pseudomonas, Stenotrophomonas, or Burkholderia spp.); 2) prior S. aureus at least once; or 3) no prior S. aureus but prior NF-GNB at least once. The association between S. aureus isolation and pulmonary function and frequency of exacerbations and hospital admissions was assessed, both at baseline and after 1 year of follow-up., Results: S. aureus was cultured from 94 of 830 patients (11.3%) included in the analysis. Patients who had grown S. aureus before entry into the Registry had a frequency of prior exacerbations and baseline pulmonary function that was between that of patients who had grown NF-GNB and those who had grown neither NF-GNB or S. aureus. Similarly, at the first follow-up visit after study entry, patients who had grown S. aureus had a frequency of exacerbations and hospitalizations that was between those of patients who had grown NF-GNB and those who had grown neither NF-GNB nor S. aureus. However, in multivariate analysis, S. aureus was not associated with pulmonary function, frequency of exacerbation, or hospital admissions. There were no significant differences in patient characteristics or outcomes between patients who had methicillin-sensitive and methicillin-resistant S. aureus., Conclusions: Staphylococcus aureus does not appear to be an independent risk factor for severe disease in patients with bronchiectasis enrolled in the Bronchiectasis Research Registry.
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- 2018
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8. An official American thoracic society statement: position statement on ATS activities for the promotion of respiratory and sleep/wake health and the care of the critically ill in the United States.
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Brown LK, Angus DC, Marin MG, Balmes JR, Barker AF, Ewart G, Halbower AC, Lutz PO, Mularski RA, Nathanson IT, Sanders MH, Stewart GL, and Upson DJ
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- Health Policy, Health Promotion, Humans, Organizational Policy, Practice Guidelines as Topic, United States, Critical Illness therapy, Respiration, Sleep physiology, Societies, Medical, Wakefulness physiology
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Background: The 1997 American Thoracic Society (ATS) statement "A Framework for Health Care Policy in the United States" outlined core principles for the Society's activities in the public health arena. In the succeeding 10 years, profound changes have taken place in the United States health care environment. In addition, the 2005 publication of the Society's Vision highlighted some differences between the original Statement and our current priorities. Therefore, the Health Policy Committee embarked on a re-analysis and re-statement of the Society's attitudes and strategies with respect to health and public policy. This Statement reflects the findings of the Committee., Purpose: To outline the key aspects of an internal ATS strategy for the promotion of respiratory and sleep/wake health and the care of the critically ill in the United States., Methods: Committee discussion and consensus-building occurred both before and after individual members performed literature searches and drafted sections of the document. Comments were solicited on the draft document from ATS committee and assembly chairs and the Executive Committee, resulting in substantive revisions of the final document., Results: Specific strategies are suggested for the ATS in the arenas of research, training and education, patient care, and advocacy so as to enhance the delivery of health care in the fields of respiratory medicine, sleep medicine, and critical care., Conclusions: The American Thoracic Society's Mission, Core Principles, and Vision provide clear guidance for the formulation of specific strategies that will serve to promote improved respiratory health and care of the critically ill in the United States.
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- 2009
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9. Asthma features in severe alpha1-antitrypsin deficiency: experience of the National Heart, Lung, and Blood Institute Registry.
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Eden E, Hammel J, Rouhani FN, Brantly ML, Barker AF, Buist AS, Fallat RJ, Stoller JK, Crystal RG, and Turino GM
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- Adult, Aged, Analysis of Variance, Asthma physiopathology, Female, Forced Expiratory Volume, Humans, Immunoglobulin E blood, Infusions, Intravenous, Linear Models, Male, Middle Aged, Multivariate Analysis, Prevalence, Prospective Studies, Risk Factors, United States epidemiology, Asthma epidemiology, alpha 1-Antitrypsin therapeutic use, alpha 1-Antitrypsin Deficiency complications, alpha 1-Antitrypsin Deficiency therapy
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Study Objectives: To describe asthma features in a cohort with alpha(1)-antitrypsin (AAT) deficiency, and determine the impact of asthma on FEV(1) decline., Background: Asthma may be common in those with AAT deficiency, and may lead to accelerated airflow obstruction., Design: Analysis of data obtained from a 5-year, prospective National Heart, Lung, and Blood Institute registry., Setting: A multicenter registry consisting of 37 clinical centers, a central phenotyping laboratory, and a data analysis center., Participants: A cohort of 1,052 subjects with AAT deficiency., Measurements and Results: Asthma was defined as reversible airflow obstruction, recurrent attacks of wheezing, and a reported diagnosis of asthma or allergy with or without an elevated serum IgE level. FEV(1) decline was calculated by least-square means with adjustments for covariables. Asthma was present in 21% of the cohort and in 12.5% of those with a normal FEV(1). Attacks of wheezing were reported in 66%, the first attack occurring at a mean +/- SD age of 31 +/- 16 years. Allergy and asthma was reported in 29% and 38%, respectively. An elevated IgE level occurred in 17% and was significantly associated with signs and symptoms of asthma and an allergy history. Unadjusted FEV(1) decline was less in the group without asthma and a normal IgE level (- 48.5 mL/yr) vs the groups with asthma features (> or = 64 mL/yr) [p = 0.002]. Multivariable analysis showed that bronchodilator response, age, and smoking were significant predictors for FEV(1) decline but not asthma., Conclusions: Symptoms and signs of asthma are common in AAT deficiency and may start at the age of most rapid FEV(1) loss. Adjusting for other risk factors such as bronchodilator response, asthma as defined does not lead to an accelerated FEV(1) decline. In AAT deficiency, augmentation therapy is not more effective in preventing the loss of lung function in those with asthma compared to those without.
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- 2003
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