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2. Returning incidentally discovered Hepatitis C RNA-seq results to COPDGene study participants.

Author

Silverman, Edwin, Kim, Arthur, Make, Barry, Regan, Elizabeth, Morrow, Jarrett, Hersh, Craig, OBrien, James, Crapo, James, Hansel, Nadia, Criner, Gerard, Flenaugh, Eric, Conrad, Douglas, Casaburi, Richard, Bowler, Russell, Hanania, Nicola, Barr, R, Bhatt, Surya, Sciurba, Frank, Anzueto, Antonio, Han, MeiLan, McEvoy, Charlene, Comellas, Alejandro, DeMeo, Dawn, Rosiello, Richard, Curtis, Jeffrey, Uchida, Tricia, Wilson, Carla, and ORourke, P

Abstract

The consequences of returning infectious pathogen test results identified incidentally in research studies have not been well-studied. Concerns include identification of an important health issue for individuals, accuracy of research test results, public health impact, potential emotional distress for participants, and need for IRB permissions. Blood RNA-sequencing analysis for non-human RNA in 3984 participants from the COPDGene study identified 228 participants with evidence suggestive for hepatitis C virus (HCV) infection. We hypothesized that incidentally discovered HCV results could be effectively returned to COPDGene participants with attention to the identified concerns. In conjunction with a COPDGene Participant Advisory Panel, we developed and obtained IRB approval for a process of returning HCV research results and an HCV Follow-Up Study questionnaire to capture information about previous HCV diagnosis and treatment information and participant reactions to return of HCV results. During phone calls following the initial HCV notification letter, 84 of 124 participants who could be contacted (67.7%) volunteered that they had been previously diagnosed with HCV infection. Thirty-one of these 124 COPDGene participants were enrolled in the HCV Follow-Up Study. Five of the 31 HCV Follow-Up Study participants did not report a previous diagnosis of HCV. For four of these participants, subsequent clinical HCV testing confirmed HCV infection. Thus, 30/31 Follow-Up Study participants had confirmed HCV diagnoses, supporting the accuracy of the HCV research test results. However, the limited number of participants in the Follow-Up Study precludes an accurate assessment of the false-positive and false-negative rates of the research RNA sequencing evidence for HCV. Most HCV Follow-Up Study participants (29/31) were supportive of returning HCV research results, and most participants found the process for returning HCV results to be informative and not upsetting. Newly diagnosed participants were more likely to be pleased to learn about a potentially curable infection (p = 0.027) and showed a trend toward being more frightened by the potential health risks of HCV (p = 0.11). We conclude that HCV results identified incidentally during transcriptomic research studies can be successfully returned to research study participants with a carefully designed process.

Published
2023

4. Prevalence of abnormal spirometry in individuals with a smoking history and no known obstructive lung disease.

Author

Tran, Thuonghien, Kinney, Gregory, Comellas, Alejandro, Hoth, Karin, Baldomero, Arianne, Mamary, A, Curtis, Jeffrey, Hanania, Nicola, Casaburi, Richard, Young, Kendra, Kim, Victor, Make, Barry, Wan, Emily, Diaz, Alejandro, Hokanson, John, Crapo, James, Silverman, Edwin, Bhatt, Surya, Regan, Elizabeth, and Fortis, Spyridon

Subjects
Chronic obstructive pulmonary disease, Diagnosis, Humans, Female, Prevalence, Pulmonary Disease, Chronic Obstructive, Lung, Smoking, Risk Factors, Spirometry
Abstract

INTRODUCTION: Recent evidence suggests a high prevalence of undiagnosed chronic obstructive pulmonary disease (COPD). These individuals are at risk of exacerbations and delayed treatment. We analyzed an at-risk population for the prevalence of abnormal spirometry to provide clarity into who should undergo early spirometry. METHODS: We analyzed data from the COPDGene study. Participants with ≥10 pack-years of smoking were included. Individuals with self-reported or physician-diagnosed COPD, asthma, chronic bronchitis, emphysema and/or were on inhalers were excluded. Parsimonious multivariable logistic regression models identified factors associated with abnormal spirometry, defined as either airflow obstruction (AFO) or preserved ratio impaired spirometry. Variables were selected for the final model using a stepwise backward variable elimination process which minimized Akaike information criterion (AIC). Similarly, during the 5-year follow-up period, we assessed factors associated with incident diagnosis of COPD. RESULTS: Of 5055 individuals, 1064 (21%) had undiagnosed AFO. Age, pack-years, current smoking and a history of acute bronchitis were associated with AFO while body mass index, female sex, and Black race were inversely associated. Among 2800 participants with 5-year follow-up, 532 (19%) had an incident diagnosis of COPD. Associated risk factors included mMRC ≥2, chronic productive cough, respiratory exacerbations during the follow-up period, and abnormal spirometry. Age was inversely associated. CONCLUSIONS: The prevalence of undiagnosed COPD is high in at-risk populations. We found multiple factors associated with undiagnosed COPD and incident diagnosis of COPD at follow up. These results can be used to identify those at risk for undiagnosed COPD to facilitate earlier diagnosis and treatment.

Published
2023

5. Clinical Markers Associated With Risk of Suicide or Drug Overdose Among Individuals With Smoking Exposure: A Longitudinal Follow-up Study of the COPDGene Cohort.

Author

Adviento, Brigid, Regan, Elizabeth, Make, Barry, Han, MeiLan, Foreman, Marilyn, Iyer, Anand, Bhatt, Surya, Kim, Victor, Bon, Jessica, Soler, Xavier, Kinney, Gregory, Hanania, Nicola, Lowe, Katherine, Holm, Kristen, Yohannes, Abebaw, Shinozaki, Gen, Hoth, Karin, and Fiedorowicz, Jess

Subjects
COPD, overdose, prospective cohort study, suicide deaths, tobacco smoking, Humans, Female, Middle Aged, Aged, Male, Follow-Up Studies, Pulmonary Disease, Chronic Obstructive, Prospective Studies, Smoking, Risk Factors, Dyspnea, Biomarkers, Drug Overdose, Forced Expiratory Volume
Abstract

BACKGROUND: Studies have shown that COPD and smoking are associated with increased suicide risk. To date, there are no prospective studies examining suicide risk among individuals with smoking exposure along a spectrum of pulmonary diseases ranging from normal spirometry to severe COPD. RESEARCH QUESTION: Which clinical variables predict death by suicide or overdose of indeterminate intent in a large cohort of individuals with smoking exposure within the Genetic Epidemiology of COPD (COPDGene) study? STUDY DESIGN AND METHODS: We studied data from 9,930 participants involved in COPDGene, a multisite, prospective cohort study of individuals with smoking exposure. Primary cause of adjudicated deaths was identified by using death certificates, family reports, and medical records. Time to death by suicide/overdose was examined as the primary outcome in Cox regression models including age, sex, race, BMI, pack-years, current smoking status, airflow limitation (FEV1 % predicted), dyspnea (modified Medical Research Council scale score ≥ 2), 6-min walk distance, supplemental oxygen use, and severe exacerbations in the prior year with time-varying covariates and other causes of death as a competing risk. RESULTS: The cohort was 47% female and 33% Black (67% White); they had a mean ± SD age of 59.6 ± 9.0 years and a mean FEV1 % predicted of 76.1 ± 25.5. Sixty-three individuals died by suicide/overdose. Factors associated with risk of suicide/overdose were current smoking (hazard ratio [HR], 6.44; 95% CI, 2.64-15.67), use of sedative/hypnotics (HR, 2.33; 95% CI, 1.24-4.38), and dyspnea (HR, 2.23; 95% CI, 1.34-3.70). Lower risk was associated with older age (per-decade HR, 0.45; 95% CI, 0.31-0.67), higher BMI (HR, 0.95; 95% CI, 0.91-0.99), and African-American race (HR, 0.41; 95% CI, 0.23-0.74). Severity of airflow limitation (FEV % predicted) was not associated with suicide risk. INTERPRETATION: In this well-characterized cohort of individuals with smoking exposure with and without COPD, risk factors for suicide/overdose were identified that emphasize the subjective experience of illness over objective assessments of lung function.

Published
2023

7. Use of the Spirometric “Fixed-Ratio” Underdiagnoses COPD in African-Americans in a Longitudinal Cohort Study

Author

Regan, Elizabeth A., Lowe, Melissa E., Make, Barry J., Curtis, Jeffrey L., Chen, Quan (Grace), Cho, Michael H., Crooks, James L., Lowe, Katherine E., Wilson, Carla, O’Brien, James K., Oates, Gabriela R., Baldomero, Arianne K., Kinney, Gregory L., Young, Kendra A., Diaz, Alejandro A., Bhatt, Surya P., McCormack, Meredith C., Hansel, Nadia N., Kim, Victor, Richmond, Nicole E., Westney, Gloria E., Foreman, Marilyn G., Conrad, Douglas J., DeMeo, Dawn L., Hoth, Karin F., Amaza, Hannatu, Balasubramanian, Aparna, Kallet, Julia, Watts, Shandi, Hanania, Nicola A., Hokanson, John, Beaty, Terri H., Crapo, James D., Silverman, Edwin K., Casaburi, Richard, and Wise, Robert

Published
2023
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12. Alpha-1 Antitrypsin MZ Heterozygosity Is an Endotype of Chronic Obstructive Pulmonary Disease.

Author

Ghosh, Auyon J, Hobbs, Brian D, Moll, Matthew, Saferali, Aabida, Boueiz, Adel, Yun, Jeong H, Sciurba, Frank, Barwick, Lucas, Limper, Andrew H, Flaherty, Kevin, Criner, Gerard, Brown, Kevin K, Wise, Robert, Martinez, Fernando J, Lomas, David, Castaldi, Peter J, Carey, Vincent J, DeMeo, Dawn L, Cho, Michael H, Silverman, Edwin K, Hersh, Craig P, Crapo, James D, Make, Barry J, Regan, Elizabeth A, Beaty, Terri H, El-Boueiz, Adel, Foreman, Marilyn G, Hayden, Lystra P, Hetmanski, Jacqueline, Hokanson, John E, Kim, Wonji, Laird, Nan, Lange, Christoph, Lutz, Sharon M, McDonald, Merry-Lynn, Prokopenko, Dmitry, Morrow, Jarrett, Qiao, Dandi, Sakornsakolpat, Phuwanat, Wan, Emily S, Centeno, Juan Pablo, Charbonnier, Jean-Paul, Coxson, Harvey O, Galban, Craig J, Han, MeiLan K, Hoffman, Eric A, Humphries, Stephen, Jacobson, Francine L, Judy, Philip F, Kazerooni, Ella A, Kluiber, Alex, Lynch, David A, Nardelli, Pietro, Newell, John D, Notary, Aleena, Oh, Andrea, Ross, James C, Estepar, Raul San Jose, Schroeder, Joyce, Sieren, Jered, Stoel, Berend C, Tschirren, Juerg, Van Beek, Edwin, van Ginneken, Bram, van Rikxoort, Eva, Sanchez-Ferrero, Gonzalo Vegas, Veitel, Lucas, Washko, George R, Wilson, Carla G, Jensen, Robert, Everett, Douglas, Crooks, Jim, Pratte, Katherine, Strand, Matt, Austin, Erin, Kinney, Gregory, Young, Kendra A, Bhatt, Surya P, Bon, Jessica, Diaz, Alejandro A, Make, Barry, Murray, Susan, Regan, Elizabeth, Soler, Xavier, Bowler, Russell P, Kechris, Katerina, Banaei-Kashani, Farnoush, Curtis, Jeffrey L, Pernicano, Perry G, and Hanania, Nicola

Subjects
Biomedical and Clinical Sciences, Cardiovascular Medicine and Haematology, Clinical Sciences, Chronic Obstructive Pulmonary Disease, Lung, Emphysema, Clinical Research, Aetiology, 2.1 Biological and endogenous factors, Respiratory, Adult, Aged, Aged, 80 and over, Case-Control Studies, Female, Genetic Markers, Genotype, Heterozygote, Humans, Longitudinal Studies, Male, Middle Aged, Phenotype, Pulmonary Disease, Chronic Obstructive, Respiratory Function Tests, Survival Analysis, Whole Genome Sequencing, alpha 1-Antitrypsin, COPDGene Investigators, RNA sequencing, alpha-1 antitrypsin, chronic obstructive pulmonary disease, meta-analysis, Medical and Health Sciences, Respiratory System, Cardiovascular medicine and haematology, Clinical sciences
Abstract

Rationale: Multiple studies have demonstrated an increased risk of chronic obstructive pulmonary disease (COPD) in heterozygous carriers of the AAT (alpha-1 antitrypsin) Z allele. However, it is not known if MZ subjects with COPD are phenotypically different from noncarriers (MM genotype) with COPD. Objectives: To assess if MZ subjects with COPD have different clinical features compared with MM subjects with COPD. Methods: Genotypes of SERPINA1 were ascertained by using whole-genome sequencing data in three independent studies. We compared outcomes between MM subjects with COPD and MZ subjects with COPD in each study and combined the results in a meta-analysis. We performed longitudinal and survival analyses to compare outcomes in MM and MZ subjects with COPD over time. Measurements and Main Results: We included 290 MZ subjects with COPD and 6,184 MM subjects with COPD across the three studies. MZ subjects had a lower FEV1% predicted and greater quantitative emphysema on chest computed tomography scans compared with MM subjects. In a meta-analysis, the FEV1 was 3.9% lower (95% confidence interval [CI], -6.55% to -1.26%) and emphysema (the percentage of lung attenuation areas

Published
2022

13. Clinical Markers Associated With Risk of Suicide or Drug Overdose Among Individuals With Smoking Exposure: A Longitudinal Follow-up Study of the COPDGene Cohort

Author

Crapo, James D., Silverman, Edwin K., Make, Barry J., Regan, Elizabeth A., Beaty, Terri H., Castaldi, Peter J., Cho, Michael H., DeMeo, Dawn L., El Boueiz, Adel, Foreman, Marilyn G., Ghosh, Auyon, Hayden, Lystra P., Hersh, Craig P., Hetmanski, Jacqueline, Hobbs, Brian D., Hokanson, John E., Kim, Wonji, Laird, Nan, Lange, Christoph, Lutz, Sharon M., McDonald, Merry-Lynn, Prokopenko, Dmitry, Moll, Matthew, Morrow, Jarrett, Qiao, Dandi, Saferali, Aabida, Sakornsakolpat, Phuwanat, Wan, Emily S., Yun, Jeong, Centeno, Juan Pablo, Charbonnier, Jean-Paul, Coxson, Harvey O., Galban, Craig J., Han, MeiLan K., Hoffman, Eric A., Humphries, Stephen, Jacobson, Francine L., Judy, Philip F., Kazerooni, Ella A., Kluiber, Alex, Lynch, David A., Nardelli, Pietro, Newell, John D., Jr., Notary, Aleena, Oh, Andrea, Ross, James C., San Jose Estepar, Raul, Schroeder, Joyce, Sieren, Jered, Stoel, Berend C., Tschirren, Juerg, Van Beek, Edwin, van Ginneken, Bram, van Rikxoort, Eva, Sanchez-Ferrero, Gonzalo Vegas, Veitel, Lucas, Washko, George R., Wilson, Carla G., Jensen, Robert, Strand, Matthew, Crooks, Jim, Pratte, Katherine, Khatiwada, Aastha, Austin, Erin, Kinney, Gregory, Young, Kendra A., Bhatt, Surya P., Bon, Jessica, Diaz, Alejandro A., Make, Barry, Murray, Susan, Regan, Elizabeth, Soler, Xavier, Bowler, Russell P., Kechris, Katerina, Banaei-Kashani, Farnoush, Curtis, Jeffrey L., Pernicano, Perry G., Hanania, Nicola, Atik, Mustafa, Boriek, Aladin, Guntupalli, Kalpatha, Guy, Elizabeth, Parulekar, Amit, Hersh, Craig, Washko, George, Barr, R. Graham, Austin, John, D’Souza, Belinda, Thomashow, Byron, MacIntyre, Neil, Jr., McAdams, H. Page, Washington, Lacey, McEvoy, Charlene, Tashjian, Joseph, Wise, Robert, Brown, Robert, Hansel, Nadia N., Horton, Karen, Lambert, Allison, Putcha, Nirupama, Casaburi, Richard, Adami, Alessandra, Budoff, Matthew, Fischer, Hans, Porszasz, Janos, Rossiter, Harry, Stringer, William, Sharafkhaneh, Amir, Lan, Charlie, Wendt, Christine, Bell, Brian, Kunisaki, Ken M., Flenaugh, Eric L., Gebrekristos, Hirut, Ponce, Mario, Terpenning, Silanath, Westney, Gloria, Bowler, Russell, Rosiello, Richard, Pace, David, Criner, Gerard, Ciccolella, David, Cordova, Francis, Dass, Chandra, D’Alonzo, Gilbert, Desai, Parag, Jacobs, Michael, Kelsen, Steven, Kim, Victor, Mamary, A. James, Marchetti, Nathaniel, Satti, Aditi, Shenoy, Kartik, Steiner, Robert M., Swift, Alex, Swift, Irene, Vega-Sanchez, Maria Elena, Dransfield, Mark, Bailey, William, Iyer, Anand, Nath, Hrudaya, Wells, J. Michael, Conrad, Douglas, Yen, Andrew, Comellas, Alejandro P., Hoth, Karin F., Newell, John, Jr., Thompson, Brad, Kazerooni, Ella, Labaki, Wassim, Galban, Craig, Vummidi, Dharshan, Billings, Joanne, Begnaud, Abbie, Allen, Tadashi, Sciurba, Frank, Chandra, Divay, Weissfeld, Joel, Anzueto, Antonio, Adams, Sandra, Maselli-Caceres, Diego, Ruiz, Mario E., Singh, Harjinder, Adviento, Brigid A., Iyer, Anand S., Kinney, Gregory L., Hanania, Nicola A., Lowe, Katherine E., Holm, Kristen E., Yohannes, Abebaw M., Shinozaki, Gen, and Fiedorowicz, Jess G.

Published
2023
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14. Emphysema Progression and Lung Function Decline Among Angiotensin Converting Enzyme Inhibitors and Angiotensin-Receptor Blockade Users in the COPDGene Cohort

Author

Tejwani, Vickram, Fawzy, Ashraf, Putcha, Nirupama, Castaldi, Peter J, Cho, Michael H, Pratte, Katherine A, Bhatt, Surya P, Lynch, David A, Humphries, Stephen M, Kinney, Gregory L, D’Alessio, Franco R, Hansel, Nadia N, Crapo, James D, Silverman, Edwin K, Make, Barry J, Regan, Elizabeth A, Beaty, Terri, Begum, Ferdouse, Cho, Michael, DeMeo, Dawn L, Boueiz, Adel R, Foreman, Marilyn G, Halper-Stromberg, Eitan, Hayden, Lystra P, Hersh, Craig P, Hetmanski, Jacqueline, Hobbs, Brian D, Hokanson, John E, Laird, Nan, Lange, Christoph, Lutz, Sharon M, McDonald, Merry-Lynn, Parker, Margaret M, Prokopenko, Dmitry, Qiao, Dandi, Regan, Elizabeth, Sakornsakolpat, Phuwanat, Wan, Emily S, Won, Sungho, Centeno, Juan Pablo, Charbonnier, Jean-Paul, Coxson, Harvey O, Galban, Craig J, Han, MeiLan K, Hoffman, Eric A, Humphries, Stephen, Jacobson, Francine L, Judy, Philip F, Kazerooni, Ella A, Kluiber, Alex, Nardelli, Pietro, Newell, John D, Notary, Aleena, Oh, Andrea, Ross, James C, San Jose Estepar, Raul, Schroeder, Joyce, Sieren, Jered, Stoel, Berend C, Tschirren, Juerg, Van Beek, Edwin, Ginneken, Bramvan, van Rikxoort, Eva, Sanchez-Ferrero, Gonzalo Vegas, Veitel, Lucas, Washko, George R, Wilson, Carla G, Jensen, Robert, Everett, Douglas, Crooks, Jim, Pratte, Katherine, Strand, Matt, Kinney, Gregory, Young, Kendra A, Bon, Jessica, Diaz, Alejandro A, Make, Barry, Murray, Susan, Soler, Xavier, Bowler, Russell P, Kechris, Katerina, Banaei-Kashani, Farnoush, Curtis, Jeffrey L, Pernicano, Perry G, Hanania, Nicola, Atik, Mustafa, Boriek, Aladin, Guntupalli, Kalpatha, and Guy, Elizabeth

Subjects
Biomedical and Clinical Sciences, Cardiovascular Medicine and Haematology, Clinical Sciences, Clinical Research, Emphysema, Lung, Tobacco, Chronic Obstructive Pulmonary Disease, Tobacco Smoke and Health, Cancer, Respiratory, Aged, Angiotensin Receptor Antagonists, Angiotensin-Converting Enzyme Inhibitors, Cohort Studies, Disease Progression, Female, Forced Expiratory Volume, Humans, Lung Volume Measurements, Male, Middle Aged, Prospective Studies, Protective Factors, Pulmonary Disease, Chronic Obstructive, Pulmonary Emphysema, Spirometry, Tomography, X-Ray Computed, Vital Capacity, Walk Test, angiotensin II, COPD, emphysema progression, COPDGene Investigators, Respiratory System, Cardiovascular medicine and haematology, Clinical sciences
Abstract

BackgroundAttenuation of transforming growth factor β by blocking angiotensin II has been shown to reduce emphysema in a murine model. General population studies have demonstrated that the use of angiotensin converting enzyme inhibitors (ACEis) and angiotensin-receptor blockers (ARBs) is associated with reduction of emphysema progression in former smokers and that the use of ACEis is associated with reduction of FEV1 progression in current smokers.Research questionIs use of ACEi and ARB associated with less progression of emphysema and FEV1 decline among individuals with COPD or baseline emphysema?MethodsFormer and current smokers from the Genetic Epidemiology of COPD Study who attended baseline and 5-year follow-up visits, did not change smoking status, and underwent chest CT imaging were included. Adjusted linear mixed models were used to evaluate progression of adjusted lung density (ALD), percent emphysema (%total lung volume

Published
2021

15. The Association Between Lung Hyperinflation and Coronary Artery Disease in Smokers

Author

Chandra, Divay, Gupta, Aman, Kinney, Gregory L, Fuhrman, Carl R, Leader, Joseph K, Diaz, Alejandro A, Bon, Jessica, Barr, R Graham, Washko, George, Budoff, Matthew, Hokanson, John, Sciurba, Frank C, Crapo, James D, Silverman, Edwin K, Make, Barry J, Regan, Elizabeth A, Beaty, Terri, Begum, Ferdouse, Boueiz, Adel R, Castaldi, Peter J, Cho, Michael, DeMeo, Dawn L, Foreman, Marilyn G, Halper-Stromberg, Eitan, Hayden, Lystra P, Hersh, Craig P, Hetmanski, Jacqueline, Hobbs, Brian D, Hokanson, John E, Laird, Nan, Lange, Christoph, Lutz, Sharon M, McDonald, Merry-Lynn, Parker, Margaret M, Prokopenko, Dmitry, Qiao, Dandi, Sakornsakolpat, Phuwanat, Wan, Emily S, Won, Sungho, Al Qaisi, Mustafa, Coxson, Harvey O, Gray, Teresa, Han, MeiLan K, Hoffman, Eric A, Humphries, Stephen, Jacobson, Francine L, Judy, Philip F, Kazerooni, Ella A, Kluiber, Alex, Lynch, David A, Newell, John D, Ross, James C, San Jose Estepar, Raul, Schroeder, Joyce, Sieren, Jered, Stinson, Douglas, Stoel, Berend C, Tschirren, Juerg, Van Beek, Edwin, van Ginneken, Bram, van Rikxoort, Eva, Wilson, Carla G, Jensen, Robert, Crooks, Jim, Everett, Douglas, Moore, Camille, Strand, Hughes, John, Kinney, Gregory, Pratte, Katherine, Young, Kendra A, Bhatt, Surya, Martinez, Carlos, Murray, Susan, Soler, Xavier, Banaei-Kashani, Farnoush, Bowler, Russell P, Kechris, Katerina, Curtis, Jeffrey L, Pernicano, Perry G, Hanania, Nicola, Atik, Mustafa, Boriek, Aladin, Guntupalli, Kalpatha, Guy, Elizabeth, and Parulekar, Amit

Subjects
Biomedical and Clinical Sciences, Cardiovascular Medicine and Haematology, Clinical Sciences, Tobacco Smoke and Health, Emphysema, Chronic Obstructive Pulmonary Disease, Atherosclerosis, Biomedical Imaging, Clinical Research, Heart Disease - Coronary Heart Disease, Heart Disease, Lung, Tobacco, Cardiovascular, Prevention, Respiratory, Good Health and Well Being, Airway Obstruction, Airway Remodeling, Asymptomatic Diseases, Biological Variation, Population, Coronary Artery Disease, Coronary Vessels, Female, Humans, Male, Middle Aged, Organ Size, Plethysmography, Pulmonary Emphysema, Respiratory Function Tests, Risk Factors, Smoking, Tomography, X-Ray Computed, United States, COPD, coronary artery disease, lung hyperinflation, smoking, COPDGene Investigators, Respiratory System, Cardiovascular medicine and haematology, Clinical sciences
Abstract

BackgroundSmokers manifest varied phenotypes of pulmonary impairment.Research questionWhich pulmonary phenotypes are associated with coronary artery disease (CAD) in smokers?Study design and methodsWe analyzed data from the University of Pittsburgh COPD Specialized Center for Clinically Oriented Research (SCCOR) cohort (n = 481) and the Genetic Epidemiology of COPD (COPDGene) cohort (n = 2,580). Participants were current and former smokers with > 10 pack-years of tobacco exposure. Data from the two cohorts were analyzed separately because of methodologic differences. Lung hyperinflation was assessed by plethysmography in the SCCOR cohort and by inspiratory and expiratory CT scan lung volumes in the COPDGene cohort. Subclinical CAD was assessed as the coronary artery calcium score, whereas clinical CAD was defined as a self-reported history of CAD or myocardial infarction (MI). Analyses were performed in all smokers and then repeated in those with airflow obstruction (FEV1 to FVC ratio, < 0.70).ResultsPulmonary phenotypes, including airflow limitation, emphysema, lung hyperinflation, diffusion capacity, and radiographic measures of airway remodeling, showed weak to moderate correlations (r < 0.7) with each other. In multivariate models adjusted for pulmonary phenotypes and CAD risk factors, lung hyperinflation was the only phenotype associated with calcium score, history of clinical CAD, or history of MI (per 0.2 higher expiratory and inspiratory CT scan lung volume; coronary calcium: OR, 1.2; 95% CI, 1.1-1.5; P = .02; clinical CAD: OR, 1.6; 95% CI, 1.1-2.3; P = .01; and MI in COPDGene: OR, 1.7; 95% CI, 1.0-2.8; P = .05). FEV1 and emphysema were associated with increased risk of CAD (P < .05) in models adjusted for CAD risk factors; however, these associations were attenuated on adjusting for lung hyperinflation. Results were the same in those with airflow obstruction and were present in both cohorts.InterpretationLung hyperinflation is associated strongly with clinical and subclinical CAD in smokers, including those with airflow obstruction. After lung hyperinflation was accounted for, FEV1 and emphysema no longer were associated with CAD. Subsequent studies should consider measuring lung hyperinflation and examining its mechanistic role in CAD in current and former smokers.

Published
2021

18. EUFOREA pocket guide on the diagnosis and management of asthma: An educational and practical tool for general practitioners, non-respiratory physicians, paramedics and patients

Author

Diamant, Zuzana, Jesenak, Milos, Hanania, Nicola A., Heaney, Liam G., Djukanovic, Ratko, Ryan, Dermot, Quirce, Santiago, Backer, Vibeke, Gaga, Mina, Pavord, Ian, Antolín-Amérigo, Darío, Assaf, Sara, Bakakos, Petros, Bobcakova, Anna, Busse, William, Kappen, Jasper, Loukides, Stelios, van Maaren, Maurits, Panzner, Petr, Pite, Helena, Spanevello, Antonio, Stenberg, Henning, Striz, Ilja, Thio, Boony, Vasakova, Martina Koziar, Conti, Diego, Fokkens, Wytske, Lau, Susanne, Scadding, Glenis K., Van Staeyen, Elizabeth, Hellings, Peter W., and Bjermer, Leif

Published
2023
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20. Patterns of care in the management of high-risk COPD in the US (2011–2019): an observational study for the CONQUEST quality improvement program

Author

Kerr, Margee, Tarabichi, Yasir, Evans, Alexander, Mapel, Douglas, Pace, Wilson, Carter, Victoria, Couper, Amy, Drummond, M. Bradley, Feigler, Norbert, Federman, Alex, Gandhi, Hitesh, Hanania, Nicola A., Kaplan, Alan, Kostikas, Konstantinos, Kruszyk, Maja, van Melle, Marije, Müllerová, Hana, Murray, Ruth, Ohar, Jill, Pollack, Michael, Pullen, Rachel, Williams, Dennis, Wisnivesky, Juan, Han, MeiLan K., Meldrum, Catherine, and Price, David

Published
2023
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21. Bayesian Inference of Networks Across Multiple Sample Groups and Data Types

Author

Shaddox, Elin, Peterson, Christine B., Stingo, Francesco C., Hanania, Nicola A., Cruickshank-Quinn, Charmion, Kechris, Katerina, Bowler, Russell, and Vannucci, Marina

Subjects
Statistics - Methodology, Statistics - Applications
Abstract

In this paper, we develop a graphical modeling framework for the inference of networks across multiple sample groups and data types. In medical studies, this setting arises whenever a set of subjects, which may be heterogeneous due to differing disease stage or subtype, is profiled across multiple platforms, such as metabolomics, proteomics, or transcriptomics data. Our proposed Bayesian hierarchical model first links the network structures within each platform using a Markov random field prior to relate edge selection across sample groups, and then links the network similarity parameters across platforms. This enables joint estimation in a flexible manner, as we make no assumptions on the directionality of influence across the data types or the extent of network similarity across the sample groups and platforms. In addition, our model formulation allows the number of variables and number of subjects to differ across the data types, and only requires that we have data for the same set of groups. We illustrate the proposed approach through both simulation studies and an application to gene expression levels and metabolite abundances on subjects with varying severity levels of Chronic Obstructive Pulmonary Disease (COPD).

Published
2019
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22. A Risk Prediction Model for Mortality Among Smokers in the COPDGene® Study.

Author

Strand, Matthew, Austin, Erin, Moll, Matthew, Pratte, Katherine A, Regan, Elizabeth A, Hayden, Lystra P, Bhatt, Surya P, Boriek, Aladin M, Casaburi, Richard, Silverman, Edwin K, Fortis, Spyridon, Ruczinski, Ingo, Koegler, Harald, Rossiter, Harry B, Occhipinti, Mariaelena, Hanania, Nicola A, Gebrekristos, Hirut T, Lynch, David A, Kunisaki, Ken M, Young, Kendra A, Sieren, Jessica C, Ragland, Margaret, Hokanson, John E, Lutz, Sharon M, Make, Barry J, Kinney, Gregory L, Cho, Michael H, Pistolesi, Massimo, DeMeo, Dawn L, Sciurba, Frank C, Comellas, Alejandro P, Diaz, Alejandro A, Barjaktarevic, Igor, Bowler, Russell P, Kanner, Richard E, Peters, Stephen P, Ortega, Victor E, Dransfield, Mark T, and Crapo, James D

Subjects
Biomedical and Clinical Sciences, Epidemiology, Public Health, Health Sciences, Clinical Sciences, Prevention, Tobacco Smoke and Health, Lung, Tobacco, Chronic Obstructive Pulmonary Disease, Clinical Research, Respiratory, Good Health and Well Being, COPD, COPD Genetic Epidemiology study, COPDGene, spirometry, preserved ratio-impaired spiromety, PRISm, risk score, copd, preserved ratio-impaired spirometry
Abstract

BackgroundRisk factor identification is a proven strategy in advancing treatments and preventive therapy for many chronic conditions. Quantifying the impact of those risk factors on health outcomes can consolidate and focus efforts on individuals with specific high-risk profiles. Using multiple risk factors and longitudinal outcomes in 2 independent cohorts, we developed and validated a risk score model to predict mortality in current and former cigarette smokers.MethodsWe obtained extensive data on current and former smokers from the COPD Genetic Epidemiology (COPDGene®) study at enrollment. Based on physician input and model goodness-of-fit measures, a subset of variables was selected to fit final Weibull survival models separately for men and women. Coefficients and predictors were translated into a point system, allowing for easy computation of mortality risk scores and probabilities. We then used the SubPopulations and InteRmediate Outcome Measures In COPD Study (SPIROMICS) cohort for external validation of our model.ResultsOf 9867 COPDGene participants with standard baseline data, 17.6% died over 10 years of follow-up, and 9074 of these participants had the full set of baseline predictors (standard plus 6-minute walk distance and computed tomography variables) available for full model fits. The average age of participants in the cohort was 60 for both men and women, and the average predicted 10-year mortality risk was 18% for women and 25% for men. Model time-integrated area under the receiver operating characteristic curve statistics demonstrated good predictive model accuracy (0.797 average), validated in the external cohort (0.756 average). Risk of mortality was impacted most by 6-minute walk distance, forced expiratory volume in 1 second and age, for both men and women.ConclusionsCurrent and former smokers exhibited a wide range of mortality risk over a 10- year period. Our models can identify higher risk individuals who can be targeted for interventions to reduce risk of mortality, for participants with or without chronic obstructive pulmonary disease (COPD) using current Global initiative for obstructive Lung Disease (GOLD) criteria.

Published
2020

23. Disease Progression Modeling in Chronic Obstructive Pulmonary Disease

Author

Young, Alexandra L, Bragman, Felix JS, Rangelov, Bojidar, Han, MeiLan K, Galbán, Craig J, Lynch, David A, Hawkes, David J, Alexander, Daniel C, Hurst, John R, Crapo, James D, Silverman, Edwin K, Make, Barry J, Regan, Elizabeth A, Beaty, Terri, Begum, Ferdouse, Castaldi, Peter J, Cho, Michael, DeMeo, Dawn L, Boueiz, Adel R, Foreman, Marilyn G, Halper-Stromberg, Eitan, Hayden, Lystra P, Hersh, Craig P, Hetmanski, Jacqueline, Hobbs, Brian D, Hokanson, John E, Laird, Nan, Lange, Christoph, Lutz, Sharon M, McDonald, Merry-Lynn, Parker, Margaret M, Qiao, Dandi, Wan, Emily S, Won, Sungho, Sakornsakolpat, Phuwanat, Prokopenko, Dmitry, Al Qaisi, Mustafa, Coxson, Harvey O, Gray, Teresa, Hoffman, Eric A, Humphries, Stephen, Jacobson, Francine L, Judy, Philip F, Kazerooni, Ella A, Kluiber, Alex, Newell, John D, Ross, James C, Estepar, Raul San Jose, Schroeder, Joyce, Sieren, Jered, Stinson, Douglas, Stoel, Berend C, Tschirren, Juerg, Van Beek, Edwin, van Ginneken, Bram, van Rikxoort, Eva, Washko, George, Wilson, Carla G, Jensen, Robert, Everett, Douglas, Crooks, Jim, Moore, Camille, Strand, Matt, Hughes, John, Kinney, Gregory, Pratte, Katherine, Young, Kendra A, Bhatt, Surya, Bon, Jessica, Martinez, Carlos, Murray, Susan, Soler, Xavier, Bowler, Russell P, Kechris, Katerina, Banaei-Kashani, Farnoush, Curtis, Jeffrey L, Martinez, Carlos H, Pernicano, Perry G, Hanania, Nicola, Alapat, Philip, Atik, Mustafa, Bandi, Venkata, Boriek, Aladin, Guntupalli, Kalpatha, Guy, Elizabeth, Nachiappan, Arun, Parulekar, Amit, Barr, R Graham, Austin, John, D’Souza, Belinda, Pearson, Gregory DN, Rozenshtein, Anna, Thomashow, Byron, MacIntyre, Neil, McAdams, H Page, Washington, Lacey, McEvoy, Charlene, and Tashjian, Joseph

Subjects
Biomedical Imaging, Lung, Clinical Research, Chronic Obstructive Pulmonary Disease, Aetiology, 4.2 Evaluation of markers and technologies, Detection, screening and diagnosis, 4.1 Discovery and preclinical testing of markers and technologies, 2.1 Biological and endogenous factors, Respiratory, Aged, Disease Progression, Female, Humans, Male, Middle Aged, Models, Theoretical, Pulmonary Disease, Chronic Obstructive, Tomography, X-Ray Computed, clustering, CT imaging, emphysema, bronchitis, chronic obstructive pulmonary disease, COPDGene Investigators, Medical and Health Sciences, Respiratory System
Abstract

Rationale: The decades-long progression of chronic obstructive pulmonary disease (COPD) renders identifying different trajectories of disease progression challenging.Objectives: To identify subtypes of patients with COPD with distinct longitudinal progression patterns using a novel machine-learning tool called "Subtype and Stage Inference" (SuStaIn) and to evaluate the utility of SuStaIn for patient stratification in COPD.Methods: We applied SuStaIn to cross-sectional computed tomography imaging markers in 3,698 Global Initiative for Chronic Obstructive Lung Disease (GOLD) 1-4 patients and 3,479 controls from the COPDGene (COPD Genetic Epidemiology) study to identify subtypes of patients with COPD. We confirmed the identified subtypes and progression patterns using ECLIPSE (Evaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoints) data. We assessed the utility of SuStaIn for patient stratification by comparing SuStaIn subtypes and stages at baseline with longitudinal follow-up data.Measurements and Main Results: We identified two trajectories of disease progression in COPD: a "Tissue→Airway" subtype (n = 2,354, 70.4%), in which small airway dysfunction and emphysema precede large airway wall abnormalities, and an "Airway→Tissue" subtype (n = 988, 29.6%), in which large airway wall abnormalities precede emphysema and small airway dysfunction. Subtypes were reproducible in ECLIPSE. Baseline stage in both subtypes correlated with future FEV1/FVC decline (r = -0.16 [P

Published
2020

24. Prevalence of abnormal spirometry in individuals with a smoking history and no known obstructive lung disease

Author

Crapo, James D., Silverman, Edwin K., Make, Barry J., Regan, Elizabeth A., Beaty, Terri H., Castaldi, Peter J., Cho, Michael H., DeMeo, Dawn L., El Boueiz, Adel, Foreman, Marilyn G., Ghosh, Auyon, Hayden, Lystra P., Hersh, Craig P., Hetmanski, Jacqueline, Hobbs, Brian D., Hokanson, John E., Kim, Wonji, Laird, Nan, Lange, Christoph, Lutz, Sharon M., McDonald, Merry-Lynn, Prokopenko, Dmitry, Moll, Matthew, Morrow, Jarrett, Qiao, Dandi, Saferali, Aabida, Sakornsakolpat, Phuwanat, Wan, Emily S., Yun, Jeong, Centeno, Juan Pablo, Charbonnier, Jean-Paul, Coxson, Harvey O., Galban, Craig J., Han, MeiLan K., Hoffman, Eric A., Humphries, Stephen, Jacobson, Francine L., Judy, Philip F., Kazerooni, Ella A., Kluiber, Alex, Lynch, David A., Nardelli, Pietro, Newell, John D., Jr., Notary, Aleena, Oh, Andrea, Ross, James C., San Jose Estepar, Raul, Schroeder, Joyce, Sieren, Jered, Stoel, Berend C., Tschirren, Juerg, Van Beek, Edwin, van Ginneken, Bram, van Rikxoort, Eva, Sanchez Ferrero, Gonzalo Vegas, Veitel, Lucas, Washko, George R., Wilson, Carla G., Jensen, Robert, Everett, Douglas, Crooks, Jim, Pratte, Katherine, Strand, Matt, Austin, Erin, Kinney, Gregory, Young, Kendra A., Bhatt, Surya P., Bon, Jessica, Diaz, Alejandro A., Make, Barry, Murray, Susan, Regan, Elizabeth, Soler, Xavier, Bowler, Russell P., Kechris, Katerina, BanaeiKashani, Farnoush, Curtis, Jeffrey L., Pernicano, Perry G., Hanania, Nicola, Atik, Mustafa, Boriek, Aladin, Guntupalli, Kalpatha, Guy, Elizabeth, Parulekar, Amit, Hersh, Craig, Washko, George, Barr, R. Graham, Austin, John, D'Souza, Belinda, Thomashow, Byron, MacIntyre, Neil, Jr., McAdams, H. Page, Washington, Lacey, McEvoy, Charlene, Tashjian, Joseph, Wise, Robert, Brown, Robert, Hansel, Nadia N., Horton, Karen, Lambert, Allison, Putcha, Nirupama, Casaburi, Richard, Adami, Alessandra, Budoff, Matthew, Fischer, Hans, Porszasz, Janos, Rossiter, Harry, Stringer, William, Sharafkhaneh, Amir, Lan, Charlie, Wendt, Christine, Bell, Brian, Kunisaki, Ken M., Flenaugh, Eric L., Gebrekristos, Hirut, Ponce, Mario, Terpenning, Silanath, Westney, Gloria, Bowler, Russell, Rosiello, Richard, Pace, David, Criner, Gerard, Ciccolella, David, Cordova, Francis, Dass, Chandra, D'Alonzo, Gilbert, Desai, Parag, Jacobs, Michael, Kelsen, Steven, Kim, Victor, Mamary, A. James, Marchetti, Nathaniel, Satti, Aditi, Shenoy, Kartik, Steiner, Robert M., Swift, Alex, Swift, Irene, Vega-Sanchez, Maria Elena, Dransfield, Mark, Bailey, William, Iyer, Anand, Nath, Hrudaya, Wells, J. Michael, Conrad, Douglas, Yen, Andrew, Comellas, Alejandro P., Hoth, Karin F., Newell, John, Jr., Thompson, Brad, Kazerooni, Ella, Labaki, Wassim, Galban, Craig, Vummidi, Dharshan, Billings, Joanne, Begnaud, Abbie, Allen, Tadashi, Sciurba, Frank, Chandra, Divay, Weissfeld, Joel, Anzueto, Antonio, Adams, Sandra, Maselli-Caceres, Diego, Ruiz, Mario E., Singh, Harjinder, Tran, Thuonghien V., Kinney, Gregory L., Comellas, Alejandro, Baldomero, Arianne K., Hokanson, John, and Fortis, Spyridon

Published
2023
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27. Efficacy of dupilumab in patients with moderate-to-severe asthma and persistent airflow obstruction

Author

Hanania, Nicola A., Castro, Mario, Bateman, Eric, Pavord, Ian D., Papi, Alberto, FitzGerald, J. Mark, Maspero, Jorge F., Katelaris, Constance H., Singh, Dave, Daizadeh, Nadia, Altincatal, Arman, Pandit-Abid, Nami, Soler, Xavier, Siddiqui, Shahid, Laws, Elizabeth, Jacob-Nara, Juby A., Rowe, Paul J., Lederer, David J., Hardin, Megan, and Deniz, Yamo

Published
2023
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28. COPD: Providing the right treatment for the right patient at the right time

Author

Agusti, Alvar, Ambrosino, Nicolino, Blackstock, Felicity, Bourbeau, Jean, Casaburi, Richard, Celli, Bartolome, Criner, Gerard J., Crouch, Rebecca, Negro, Roberto W. Dal, Dreher, Michael, Garvey, Chris, Gerardi, Daniel A., Goldstein, Roger, Hanania, Nicola A., Holland, Anne E., Kaur, Antarpreet, Lareau, Suzanne, Lindenauer, Peter K., Mannino, David, Make, Barry, Maltais, François, Marciniuk, Jeffrey D., Meek, Paula, Morgan, Mike, Pepin, Jean-Louis, Reardon, Jane Z., Rochester, Carolyn L., Singh, Sally, Spruit, Martijn A., Steiner, Michael C., Troosters, Thierry, Vitacca, Michele, Clini, Enico, Jardim, Jose, Nici, Linda, Raskin, Jonathan, and ZuWallack, Richard

Published
2023
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30. Test Performance Characteristics of the AIR, GAD-7 and HADS-Anxiety Screening Questionnaires for Anxiety in Chronic Obstructive Pulmonary Disease

Author

Baker, Anna M, Holbrook, Janet T, Yohannes, Abebaw M, Eakin, Michelle N, Sugar, Elizabeth A, Henderson, Robert J, Casper, Anne S, Kaminsky, David A, Rea, Alexis L, Mathews, Anne M, Que, Loretta G, Ramsdell, Joe W, Gerald, Lynn B, Wise, Robert A, Hanania, Nicola A, Hanania, Nicola, Sockrider, Marianna, Bertrand, Laura, Atik, Mustafa, Lopez, Blanca A, Reibman, Joan, DiMango, Emily, Rogers, Linda, Carapetyan, Karen, Rivera, Kristina, Scheuerman, Melissa, Fiorino, Elizabeth, Bryce-Robinson, Newel, Green, Deanna, Noveck, Robert, Foss, Catherine, Ghidorzi, Jessica, Wang, Zongyao, Pangborn, Elise, Robertson, V Susan, Eberlein, Nicholas, Stiles, Jane, Land, Michael, Vickery, Brian, Wu, Eveline, Jaggers, Denise, Allen, Stephanie, Mervin-Blake, Sabrena, Smith, Lewis, Kalhan, Ravi, Moy, James, Naureckas, Edward, Hixon, Jenny, Gonsalves, Zenobia, Zagaja, Virginia, Kustwin, Jennifer, Xu, Ben, Matthews, Thomas, Robinson, Lucius, Singh, Noopur, Happel, Kyle, Sandi, Marie C, Graham, Jennifer M, Sullivan, Katelyn, Poretta, Elizabeth, Katial, Rohit, Hoyte, Flavia, Rojas, Maria, Castro, Mario, Bacharier, Leonard B, Sumino, Kaharu, Yusen, Roger D, Tarsi, Jaime J, Patterson, Brenda, Montgomery, Terri, Busk, Michael, Weiss, Debra, Sundblad, Kimberly, Irvin, Charles, Dixon, Anne E, Teneback, Charlotte, Kanagalingam, Jothi, Burns, Stephanie M, Dwinell, Kathleen, Goodwin, James L, Brown, Mark A, Carr, Tara F, Berry, Cristine E, Bime, Christian, Goforth, Mark A, Ryan, Elizabeth A, Wences, Jesus A, Lopez, Silvia L, Priefert, Janette C, Provencio-Dean, Natalie S, Ogas, Destinee R, Bloss, Valerie R, Wasserman, Stephen I, Soler, Xavier T, Kinninger, Katie H, and Martineau, Amber J

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Lung, Mental Health, Brain Disorders, Chronic Obstructive Pulmonary Disease, Clinical Research, Mental health, Respiratory, Good Health and Well Being, test anxiety scale, chronic obstructive pulmonary disease, anxiety, psychometric properties, American Lung Association Airways Clinical Research Centers, Cardiovascular medicine and haematology, Clinical sciences
Abstract

Rationale: Anxiety is a common comorbidity of chronic obstructive pulmonary disease (COPD) that is associated with higher morbidity and mortality. We evaluated three anxiety screening questionnaires: the Generalized Anxiety Disorder 7-Item Scale (GAD-7), the Hospital Anxiety and Depression Scale Anxiety subscale (HADS-A), and the Anxiety Inventory for Respiratory Disease (AIR).Objectives: To evaluate and compare the test performance characteristics of three anxiety screening questionnaires, using the Mini-International Neuropsychiatric Interview (MINI), version 7.0, as the "gold standard."Methods: Individuals with COPD were recruited at 16 centers. The MINI and questionnaires were administered by trained research coordinators at an in-person visit and readministered by telephone 2-4 weeks later. A composite score for the presence of any Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-V) anxiety disorder was computed, based on the MINI as the gold standard, compared with a participant screening positive on self-report measures for these analyses.Results: Two hundred and twenty eligible individuals with COPD were enrolled; 219 completed the study. Eleven percent were identified as having a DSM-V anxiety disorder, based on the MINI. Elevated anxiety symptoms based on questionnaires were 38% for the AIR, 30% for the GAD-7, and 20% for the HADS-A. Area under the receiver operating characteristic curve (AUC) was highest for the GAD-7 (0.78; 95% confidence interval [CI], 0.69-0.87), followed by the HADS-A (0.74; 95% CI, 0.64-0.84) and the AIR (0.66; 95% CI, 0.56-0.76). The AUC for the GAD-7 was significantly greater than for the AIR (P = 0.014). Sensitivity was not statistically different among the questionnaires: 77% for the GAD-7, 63% for the HADS-A, and 66% for the AIR. The HADS-A had the highest specificity, 85%, which was significantly higher than that of the GAD-7 (77%; P

Published
2018

32. COPDGene® 2019: Redefining the Diagnosis of Chronic Obstructive Pulmonary Disease.

Author

Lowe, Katherine E, Regan, Elizabeth A, Anzueto, Antonio, Austin, Erin, Austin, John HM, Beaty, Terri H, Benos, Panayiotis V, Benway, Christopher J, Bhatt, Surya P, Bleecker, Eugene R, Bodduluri, Sandeep, Bon, Jessica, Boriek, Aladin M, Boueiz, Adel Re, Bowler, Russell P, Budoff, Matthew, Casaburi, Richard, Castaldi, Peter J, Charbonnier, Jean-Paul, Cho, Michael H, Comellas, Alejandro, Conrad, Douglas, Costa Davis, Corinne, Criner, Gerard J, Curran-Everett, Douglas, Curtis, Jeffrey L, DeMeo, Dawn L, Diaz, Alejandro A, Dransfield, Mark T, Dy, Jennifer G, Fawzy, Ashraf, Fleming, Margaret, Flenaugh, Eric L, Foreman, Marilyn G, Fortis, Spyridon, Gebrekristos, Hirut, Grant, Sarah, Grenier, Philippe A, Gu, Tian, Gupta, Abhya, Han, MeiLan K, Hanania, Nicola A, Hansel, Nadia N, Hayden, Lystra P, Hersh, Craig P, Hobbs, Brian D, Hoffman, Eric A, Hogg, James C, Hokanson, John E, Hoth, Karin F, Hsiao, Albert, Humphries, Stephen, Jacobs, Kathleen, Jacobson, Francine L, Kazerooni, Ella A, Kim, Victor, Kim, Woo Jin, Kinney, Gregory L, Koegler, Harald, Lutz, Sharon M, Lynch, David A, MacIntye, Neil R, Make, Barry J, Marchetti, Nathaniel, Martinez, Fernando J, Maselli, Diego J, Mathews, Anne M, McCormack, Meredith C, McDonald, Merry-Lynn N, McEvoy, Charlene E, Moll, Matthew, Molye, Sarah S, Murray, Susan, Nath, Hrudaya, Newell, John D, Occhipinti, Mariaelena, Paoletti, Matteo, Parekh, Trisha, Pistolesi, Massimo, Pratte, Katherine A, Putcha, Nirupama, Ragland, Margaret, Reinhardt, Joseph M, Rennard, Stephen I, Rosiello, Richard A, Ross, James C, Rossiter, Harry B, Ruczinski, Ingo, San Jose Estepar, Raul, Sciurba, Frank C, Sieren, Jessica C, Singh, Harjinder, Soler, Xavier, Steiner, Robert M, Strand, Matthew J, Stringer, William W, Tal-Singer, Ruth, Thomashow, Byron, Vegas Sánchez-Ferrero, Gonzalo, and Walsh, John W

Subjects
COPD Genetic Epidemiology study, preserved ratio-impaired spirometry, COPD diagnosis, COPD diagnosis, COPDGene, GOLD, Global initiative for chronic Obstructive Lung Dis, PRISm, chronic obstructive pulmonary disease, copd, preserved ratio-impaired spirometry, spirometry, Prevention, Tobacco Smoke and Health, Tobacco, Lung, Chronic Obstructive Pulmonary Disease, Biomedical Imaging, Clinical Research, 4.2 Evaluation of markers and technologies, Detection, screening and diagnosis, 4.1 Discovery and preclinical testing of markers and technologies, Respiratory, Good Health and Well Being, COPD, COPD Genetic Epidemiology study, Global initiative for chronic Obstructive Lung Disease
Abstract

BackgroundChronic obstructive pulmonary disease (COPD) remains a major cause of morbidity and mortality. Present-day diagnostic criteria are largely based solely on spirometric criteria. Accumulating evidence has identified a substantial number of individuals without spirometric evidence of COPD who suffer from respiratory symptoms and/or increased morbidity and mortality. There is a clear need for an expanded definition of COPD that is linked to physiologic, structural (computed tomography [CT]) and clinical evidence of disease. Using data from the COPD Genetic Epidemiology study (COPDGene®), we hypothesized that an integrated approach that includes environmental exposure, clinical symptoms, chest CT imaging and spirometry better defines disease and captures the likelihood of progression of respiratory obstruction and mortality.MethodsFour key disease characteristics - environmental exposure (cigarette smoking), clinical symptoms (dyspnea and/or chronic bronchitis), chest CT imaging abnormalities (emphysema, gas trapping and/or airway wall thickening), and abnormal spirometry - were evaluated in a group of 8784 current and former smokers who were participants in COPDGene® Phase 1. Using these 4 disease characteristics, 8 categories of participants were identified and evaluated for odds of spirometric disease progression (FEV1 > 350 ml loss over 5 years), and the hazard ratio for all-cause mortality was examined.ResultsUsing smokers without symptoms, CT imaging abnormalities or airflow obstruction as the reference population, individuals were classified as Possible COPD, Probable COPD and Definite COPD. Current Global initiative for obstructive Lung Disease (GOLD) criteria would diagnose 4062 (46%) of the 8784 study participants with COPD. The proposed COPDGene® 2019 diagnostic criteria would add an additional 3144 participants. Under the new criteria, 82% of the 8784 study participants would be diagnosed with Possible, Probable or Definite COPD. These COPD groups showed increased risk of disease progression and mortality. Mortality increased in patients as the number of their COPD characteristics increased, with a maximum hazard ratio for all cause-mortality of 5.18 (95% confidence interval [CI]: 4.15-6.48) in those with all 4 disease characteristics.ConclusionsA substantial portion of smokers with respiratory symptoms and imaging abnormalities do not manifest spirometric obstruction as defined by population normals. These individuals are at significant risk of death and spirometric disease progression. We propose to redefine the diagnosis of COPD through an integrated approach using environmental exposure, clinical symptoms, CT imaging and spirometric criteria. These expanded criteria offer the potential to stimulate both current and future interventions that could slow or halt disease progression in patients before disability or irreversible lung structural changes develop.

Published
2019

37. The role of small airway dysfunction in asthma control and exacerbations: a longitudinal, observational analysis using data from the ATLANTIS study

Author

Pizzichini, Emilio, Cukier, Alberto, Stelmach, Rafael, Olivenstein, Ronald, Zhang, Qingling, Badorrek, Philipp, Gessner, Christian, Scichilone, Nicola, Chetta, Alfredo, Paggiaro, Pierluigi, Milleri, Stefano, D'Amato, Mariella, Spanevello, Antonio, Foschino, Maria Pia, Boersma, Willem Germen, Broeders, Marielle, Vroegop, J Sebastiaan, Plaza Moral, Vicente, Djukanovic, Ratko, Usmani, Omar, Schilz, Robert, Martin, Richard, Hanania, Nicola, Kraft, Monica, Richardson, Matthew, Hallmark, Brian, Billheimer, Dean, Van den Berge, Maarten, Fabbri, Leonardo M, Van der Molen, Thys, Nicolini, Gabriele, Papi, Alberto, Rabe, Klaus F, Singh, Dave, Brightling, Chris, and Siddiqui, Salman

Published
2022
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41. Longitudinal Association Between Muscle Loss and Mortality in Ever Smokers

Author

Crapo, James D., Silverman, Edwin K., Cummings, Sara, Madden, Kelley, Make, Barry J., Nabbosa, Juliet, Port, Emily, Rashdi, Serine, Regan, Elizabeth A., Stepp, Lori, Watts, Shandi, Weaver, Michael, Beaty, Terri, Bowler, Russell P., Curtis, Jeffrey L., Han, MeiLan K., Hokanson, John E., Lynch, David A., Strand, Matthew J., Anderson, Gary, Bleecker, Eugene R., Coxson, Harvey O., Crystal, Ronald G., Hogg, James C., Province, Michael A., Rennard, Stephen I., Croxton, Thomas, Gan, Weiniu, Postow, Lisa A., Viviano, Lisa M., Costa-Davis, Corinne, Malanga, Elisha, Prieto, Delia, Tal-Singer, Ruth, Farzadegan, Homayoon, Hadji, Akila, Sathe, Leena, Baraghoshi, David, Chen, Grace, Crooks, James, Knowles, Ruthie, Pratte, Katherine, Wilson, Carla, Zelarney, Pearlanne T., Kechris, Katerina J., Leach, Sonia, Austin, Erin E., Czizik, Annika, Kinney, Gregory, Li, Yisha, Lutz, Sharon M., Ragland, Margaret F., Richmond, Nicole, Young, Kendra A., Cho, Michael, Castaldi, Peter J., Glass, Kimberly, Hersh, Craig, Kim, Wonji, Liu, Yang-Yu, Hersh, Craig P., Bidinger, Jacqueline, Cho, Michael H., Conrad, Douglas, DeMeo, Dawn L., El-Boueiz, Adel R., Foreman, Marilyn G., Ghosh, Auyon, Hahn, Georg, Hansel, Nadia N., Hayden, Lystra P., Hobbs, Brian, Kim, Woori, Lange, Christoph, McDonald, Merry- Lynn, McGeachie, Michael, Moll, Matthew, Morris, Melody, Patsopoulos, Nikolaos A., Qiao, Dandi, Ruczinski, Ingo, Wan, Emily S., Dy, Jennifer G., Fain, Sean B., Ginsburg, Shoshana, Hoffman, Eric A., Humphries, Stephen, Judy, Philip F., Stefanie Mason, Alex Kluiber, Oh, Andrea, Poynton, Clare, Reinhardt, Joseph M., Ross, James, San Jose Estepar, Raul, Schroeder, Joyce D., Sitek, Arkadiusz, Steiner, Robert M., van Beek, Edwin, Ginneken, Bram van, van Rikxoort, Eva, Washko, George R., Jensen, Robert, John E. Hokanson, Co-Chair, Bhatt, Surya P., Casaburi, Richard, Kim, Victor, Putcha, Nirupama, Han, MeiLan, Bon, Jessica, Diaz, Alejandro A., Regan, Elizabeth, Anzueto, Antonio, Bailey, William C., Criner, Gerard J., Dransfield, Mark T., Kinney, Greg, Sprenger, Kim, Benos, Takis, Hanania, Nicola A., Hoth, Karin F., Lambert, Allison, Lowe, Katherine, Oates, Gabriela, Parekh, Trisha, Westney, Gloria, Young, Kendra, Balasubramanian, Aparna, Boriek, Aladin, Fawzy, Ashraf, Jacobson, Francine, LaFon, David C., MacIntyre, Neil, Maselli-Caceres, Diego, McCormack, Meredith C., McDonald, Merry-Lynn, Sciurba, Frank, Soler, Xavier, Tejwani, Vickram, van Beek, Edwin JR., Wade, Raymond C., Wells, Mike, Wendt, Chris H., Yun, Jeong H., Zhang, Jingzhou, Gillenwater, Lucas, Lowe, Katherine E., Pratte, Katherine A., Ragland, Margaret, Attaway, Amy, Mason, Stefanie, Rossiter, Harry B., Saha, Punam Kumar, Wilson, Ava, Amaza, Hannatu, Baldomero, Adrienne, Mamary, A. James, O’Brien, James, Wise, Robert A., Eakin, Michelle, Fiedorowicz, Jess G., Henkle, Ben, Holm, Kristen, Iyer, Anand, Kunisaki, Ken M., McEvoy, Charlene, Mkorombindo, Takudzwa, Shinozaki, Gen, Yohannes, Abebaw, Hobbs, Brian D., Miller, Bruce E., Retson, Tara, McCloskey, Lisa, Pernicano, Perry G., Atik, Mustafa, Bertrand, Laura, Monaco, Thomas, Narendra, Dharani, Lenge de Rosen, Veronica V., Badu-Danso, Kwame, Jacobson, Francine L., Kaufman, Laura, Maguire, Cherie, Struble, Sophie, Wilson, Seth, Barr, R. Graham, Almonte, Casandra, Austin, John H.M., Gomez Blum, Maria Lorena, D’Souza, Belinda M., Florez, Emilay, Martinez, Rodney, MacIntyre, Neil, Jr., Curry, Wendy, McAdams, H. Page, Reikofski, Charlotte V., Washington, Lacey, Brown, Robert, Clare, Cheryl, Daniel, Marie, Horton, Karen, Ting “Tony” Lin, Cheng, Mirza, Tahira, Scott, Meagan, Shade, Becky, Budoff, Matt, Calmelat, Robert, Cavanaugh, Deborah, Dailing, Chris, Diaz, Leticia, Fischer, Hans, Indelicato, Renee Love, Porszasz, Janos, Soriano, April, Stringer, William, Urrutia, Miriam, Baldomero, Arianne, Bell, Brian, Deconcini, Miranda, Loes, Linda, Phelan, Jonathan, Robichaux, Camille, Sasse, Cheryl, Tashjian, Joseph H., Flenaugh, Eric L., Abson, Kema, Gebrekristos, Hirut, Johnson, Priscilla, Jordan, Jessica, Ponce, Mario, Terpenning, Silanath, Wilson, Derrick, Broadhurst, Grace, Dyer, Debra, Engel, Elena, Finigan, Jay, Hill, Andrew, Jones, Alex, Jones, Ryan, Owen, Jordan, Rosiello, Richard, Andries, Nicole, Charpentier, Mary, Kirk, Diane, Pace, David, Ciccolella, David, Cordova, Francis, Dass, Chandra, D’Alonzo, Gilbert, Davis, Valena, Desai, Parag, Fehrle, Dee, Grabianowski, Carla, Jacobs, Michael, Jameson, Laurie, Jones, Gayle M., Kelsen, Steven, Marchetti, Nathaniel, McGonagle, Francine, Satti, Aditi, Shenoy, Kartik, Sheridan, Regina, Vega-Sanchez, Maria, Wallace, Samantha, Akinseye-kolapo, Samuel, Baker, Matthew, Goggins, Arnissa, McClain, Anny, Nath, Hrudaya, Singh, Satinder P., Sonavane, Sushil K., Westfall, Elizabeth, Gil, Marissa, El Hajjaoui, Tarek, Hsiao, Albert, Martineau, Amber, Mielke, Jenna, Perez, Karl, Querido, Gabriel, Reston, Tara, Yen, Andrew, Comellas, Alejandro, Fortis, Spyridon, Galizia, Mauricio, Garcia, Eric, Keating, Janet, Laroia, Archana, Lee, Changhyun, Meyer, Amber, Mullan, Brian, Nagpal, Prashant, Ofori, Oloigbe, Suiter, Sierra, Mason, Stefanie E., Moreta-Martinez, Rafael, Labaki, Wassim W., San Jose Estepar, Ruben, Make, Barry, and Stringer, Kathleen

Published
2022
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46. Blood eosinophil count thresholds and exacerbations in patients with chronic obstructive pulmonary disease

Author

Yun, Jeong H, Lamb, Andrew, Chase, Robert, Singh, Dave, Parker, Margaret M, Saferali, Aabida, Vestbo, Jørgen, Tal-Singer, Ruth, Castaldi, Peter J, Silverman, Edwin K, Hersh, Craig P, Crapo, James D, Make, Barry J, Regan, Elizabeth A, Beaty, Terri, Begum, Ferdouse, Busch, Robert, Cho, Michael, DeMeo, Dawn L, Boueiz, Adel R, Foreman, Marilyn G, Halper-Stromberg, Eitan, Hansel, Nadia N, Hardin, Megan E, Hayden, Lystra P, Hetmanski, Jacqueline, Hobbs, Brian D, Hokanson, John E, Laird, Nan, Lange, Christoph, Lutz, Sharon M, McDonald, Merry-Lynn, Qiao, Dandi, Santorico, Stephanie, Silverman, E, Wan, Emily S, Won, Sungho, Qaisi, Mustafa Al, Coxson, Harvey O, Gray, Teresa, Han, MeiLan K, Hoffman, Eric A, Humphries, Stephen, Jacobson, Francine L, Judy, Philip F, Kazerooni, Ella A, Kluiber, Alex, Lynch, David A, Newell, John D, Ross, James C, San Jose Estepar, Raul, Schroeder, Joyce, Sieren, Jered, Stinson, Douglas, Stoel, Berend C, Tschirren, Juerg, Van Beek, Edwin, van Ginneken, Bram, van Rikxoort, Eva, Washko, George, Wilson, Carla G, Jensen, Robert, Everett, Douglas, Crooks, Jim, Moore, Camille, Strand, Matt, Hughes, John, Kinney, Gregory, Pratte, Katherine, Young, Kendra A, Curtis, Jeffrey L, Martinez, Carlos H, Pernicano, Perry G, Hanania, Nicola, Alapat, Philip, Atik, Mustafa, Bandi, Venkata, Boriek, Aladin, Guntupalli, Kalpatha, Guy, Elizabeth, Nachiappan, Arun, Parulekar, Amit, Hersh, Craig, Barr, R Graham, Austin, John, D'Souza, Belinda, Pearson, Gregory DN, and Rozenshtein, Anna

Subjects
Lung, Chronic Obstructive Pulmonary Disease, Clinical Research, Respiratory, Aged, Disease Progression, Eosinophils, Female, Humans, Leukocyte Count, Longitudinal Studies, Male, Middle Aged, Observational Studies as Topic, Pulmonary Disease, Chronic Obstructive, Chronic obstructive pulmonary disease, asthma, eosinophil, exacerbation, COPDGene and ECLIPSE Investigators, Immunology, Allergy
Abstract

BACKGROUND:Eosinophilic airway inflammation in patients with chronic obstructive pulmonary disease (COPD) is associated with exacerbations and responsivity to steroids, suggesting potential shared mechanisms with eosinophilic asthma. However, there is no consistent blood eosinophil count that has been used to define the increased exacerbation risk. OBJECTIVE:We sought to investigate blood eosinophil counts associated with exacerbation risk in patients with COPD. METHODS:Blood eosinophil counts and exacerbation risk were analyzed in patients with moderate-to-severe COPD by using 2 independent studies of former and current smokers with longitudinal data. The Genetic Epidemiology of COPD (COPDGene) study was analyzed for discovery (n = 1,553), and the Evaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoints (ECLIPSE) study was analyzed for validation (n = 1,895). A subset of the ECLIPSE study subjects were used to assess the stability of blood eosinophil counts over time. RESULTS:COPD exacerbation risk increased with higher eosinophil counts. An eosinophil count threshold of 300 cells/μL or greater showed adjusted incidence rate ratios for exacerbations of 1.32 in the COPDGene study (95% CI, 1.10-1.63). The cutoff of 300 cells/μL or greater was validated for prospective risk of exacerbation in the ECLIPSE study, with adjusted incidence rate ratios of 1.22 (95% CI, 1.06-1.41) using 3-year follow-up data. Stratified analysis confirmed that the increased exacerbation risk associated with an eosinophil count of 300 cells/μL or greater was driven by subjects with a history of frequent exacerbations in both the COPDGene and ECLIPSE studies. CONCLUSIONS:Patients with moderate-to-severe COPD and blood eosinophil counts of 300 cells/μL or greater had an increased risk exacerbations in the COPDGene study, which was prospectively validated in the ECLIPSE study.

Published
2018

47. Lobar Emphysema Distribution Is Associated With 5-Year Radiological Disease Progression

Author

Boueiz, Adel, Chang, Yale, Cho, Michael H, Washko, George R, San José Estépar, Raul, Bowler, Russell P, Crapo, James D, DeMeo, Dawn L, Dy, Jennifer G, Silverman, Edwin K, Castaldi, Peter J, Crapo, James, Silverman, Edwin, Make, Barry, Regan, Elizabeth, Beaty, Terri, Laird, Nan, Lange, Christoph, Santorico, Stephanie, Hokanson, John, DeMeo, Dawn, Hansel, Nadia, Hersh, Craig, Castaldi, Peter, McDonald, Merry-Lynn, Wan, Emily, Hardin, Megan, Hetmanski, Jacqueline, Parker, Margaret, Foreman, Marilyn, Hobbs, Brian, Busch, Robert, Qiao, Dandi, Halper-Stromberg, Eitan, Begum, Ferdouse, Won, Sungho, Lutz, Sharon, Lynch, David A, Coxson, Harvey O, Han, MeiLan K, Hoffman, Eric A, Humphries, Stephen, Jacobson, Francine L, Judy, Philip F, Kazerooni, Ella A, Newell, John D, Ross, James C, Estépar, Raul José, Stoel, Berend C, Tschirren, Juerg, van Rikxoort, Eva, van Ginneken, Bram, Wilson, Carla G, Qaisi, Mustafa Al, Gray, Teresa, Kluiber, Alex, Mann, Tanya, Sieren, Jered, Stinson, Douglas, Schroeder, Joyce, Van Beek, Edwin, Jensen, Robert, Everett, Douglas, Faino, Anna, Strand, Matt, Wilson, Carla, Hokanson, John E, Kinney, Gregory, Young, Kendra, Pratte, Katherine, Duca, Lindsey, Curtis, Jeffrey L, Martinez, Carlos H, Pernicano, Perry G, Hanania, Nicola, Alapat, Philip, Bandi, Venkata, Atik, Mustafa, Boriek, Aladin, Guntupalli, Kalpatha, Guy, Elizabeth, Parulekar, Amit, Nachiappan, Arun, Jacobson, Francine, Barr, R Graham, Thomashow, Byron, Austin, John, D’Souza, Belinda, and Pearson, Gregory DN

Subjects
Clinical Research, Chronic Obstructive Pulmonary Disease, Lung, Emphysema, Prevention, 2.1 Biological and endogenous factors, Aetiology, Respiratory, Aged, Comorbidity, Disease Progression, Female, Forced Expiratory Volume, Humans, Male, Middle Aged, Pulmonary Emphysema, Severity of Illness Index, Tomography, X-Ray Computed, clustering, COPD, COPD disease progression, emphysema distribution, machine learning, COPDGene Investigators, Clinical Sciences, Respiratory System
Abstract

BackgroundEmphysema has considerable variability in its regional distribution. Craniocaudal emphysema distribution is an important predictor of the response to lung volume reduction. However, there is little consensus regarding how to define upper lobe-predominant and lower lobe-predominant emphysema subtypes. Consequently, the clinical and genetic associations with these subtypes are poorly characterized.MethodsWe sought to identify subgroups characterized by upper-lobe or lower-lobe emphysema predominance and comparable amounts of total emphysema by analyzing data from 9,210 smokers without alpha-1-antitrypsin deficiency in the Genetic Epidemiology of COPD (COPDGene) cohort. CT densitometric emphysema was measured in each lung lobe. Random forest clustering was applied to lobar emphysema variables after regressing out the effects of total emphysema. Clusters were tested for association with clinical and imaging outcomes at baseline and at 5-year follow-up. Their associations with genetic variants were also compared.ResultsThree clusters were identified: minimal emphysema (n = 1,312), upper lobe-predominant emphysema (n = 905), and lower lobe-predominant emphysema (n = 796). Despite a similar amount of total emphysema, the lower-lobe group had more severe airflow obstruction at baseline and higher rates of metabolic syndrome compared with subjects with upper-lobe predominance. The group with upper-lobe predominance had greater 5-year progression of emphysema, gas trapping, and dyspnea. Differential associations with known COPD genetic risk variants were noted.ConclusionsSubgroups of smokers defined by upper-lobe or lower-lobe emphysema predominance exhibit different functional and radiological disease progression rates, and the upper-lobe predominant subtype shows evidence of association with known COPD genetic risk variants. These subgroups may be useful in the development of personalized treatments for COPD.

Published
2018

49. Defining a Severe Asthma Super-Responder: Findings from a Delphi Process

Author

Mansur, Adel, Detoraki, Aikaterini, Altraja, Alan, James, Alan, Nanzer-Kelly, Alexandra, Côté, Andréanne, Menzies-Gow, Andrew, Papaioannou, Andriana, Cheffins, Anne-Maree, Bourdin, Arnaud, Mahboub, Bassam, Lipworth, Brian, Celis-Preciado, Carlos Andrés, Torres-Duque, Carlos, Bucca, Caterina, Porsbjerg, Celeste, Ulrik, Charlotte, Corrigan, Chris, Taube, Christian, Farah, Claude, Katelaris, Constance, Langton, David, Ryan, Dermot, Larenas-Linnemann, Désirée, Zervas, Eleftherios, Heffler, Enrico, Hoyte, Flavia, Puggioni, Francesca, Christoff, George, Canonica, Giorgio Walter, Carpagnano, Giovanna Elisiana, Guida, Giuseppe, Katsoulotos, Gregory, Brusselle, Guy, Rupani, Hitashi, Jersmann, Hubertus, Clifton, Ian, Dhariwal, Jaideep, Fingleton, James, Duke, Jane, Rimmer, Janet, Douglass, Jo, Fonseca, João, van Boven, Job, Corless, John, Harrington, John, Maspero, Jorge, Miguel, José Luis, Pipatvech, Kanok, Kenny, Karrinda, Chapman, Kenneth, Kostikas, Konstantinos, Lehtimäki, Lauri, Chung, Li Ping, Heaney, Liam, Hang, Liang-Wen, Boulet, Louis-Philippe, Perez-de-Llano, Luis, Ricciardi, Luisa, Idrees, Majdy, Milanese, Manlio, Conte, Maria Elisabetta, Costantino, Maria Teresa, Siyue, Mariko Koh, Fitzgerald, Mark, Hew, Mark, Peters, Matthew, Tsai, Ming-Ju, Patel, Mitesh, Khan, Mohammad Hashim, Sadatsafavi, Mohsen, Al-Ahmad, Mona, Yacoub, Mona-Rita, De Gennaro, Mónica, Radhakrishna, Naghmeh, Hanania, Nicola Alexander, Papadopoulos, Nikolaos, Lugogo, Njira, Linaker, Norma, Crimi, Nunzio, Dennison, Paddy, Nair, Parameswaran, Mitchell, Patrick David, O’Byrne, Paul, Pfeffer, Paul, Kauppi, Paula, Hughes, Pauline, Middleton, Peter, Wark, Peter, Bardin, Philip, Fu, Pin-Kuei, Akuthota, Praveen, Chaudhuri, Rekha, Campos, Ricardo, Al-Lehebi, Riyard, Parente, Roberta, Francisco, Rovira, Wenzel, Sally, Pierachille, Santus, Pawar, Shrikant, Loukides, Stelios, Fowler, Stephen, Mackenzie, Tara, Brown, Thomas, Lee Tan, Tze, Björnsdóttir, Unnur, McDonald, Vanessa, Lawriwskyj, Veronica, Backer, Vibeke, Vasileva, Violina, Chien, Ying-Chun, Harrington, Zinta, Upham, John W., Le Lievre, Chantal, Jackson, David J., Masoli, Matthew, Wechsler, Michael E., and Price, David B.

Published
2021
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50. Tocilizumab and remdesivir in hospitalized patients with severe COVID-19 pneumonia: a randomized clinical trial

Author

Rosas, Ivan O., Diaz, George, Gottlieb, Robert L., Lobo, Suzana M., Robinson, Philip, Hunter, Bradley D., Cavalcante, Adilson W., Overcash, J. Scott, Hanania, Nicola A., Skarbnik, Alan, Garcia-Diaz, Julia, Gordeev, Ivan, Carratalà, Jordi, Gordon, Oliver, Graham, Emily, Lewin-Koh, Nicholas, Tsai, Larry, Tuckwell, Katie, Cao, Huyen, Brainard, Diana, and Olsson, Julie K.

Published
2021
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