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Respiratory Health and Lung Function in Children Exposed to the World Trade Center Disaster

Trye, Alice; Berger, Kenneth I; Naidu, Mrudula; Attina, Teresa M; Gilbert, Joseph; Koshy, Tony T; Han, Xiaoxia; Marmor, Michael; Shao, Yongzhao; Giusti, Robert; Goldring, Roberta M; Trasande, Leonardo
OBJECTIVES/OBJECTIVE:To compare lung function in a representative sample of World Trade Center (WTC)-exposed children with matched comparisons, and examine relationships with reported exposures. STUDY DESIGN/METHODS:Study population consisted of 402 participants. Oscillometry, spirometry, and plethysmography were performed on WTC Health Registry (WTCHR) respondents who were ≤8 years of age on September 11, 2001 (n = 180) and a sociodemographically matched group of New York City residents (n = 222). We compared lung function by study arm (WTCHR and comparison group) as well as dust cloud (acute); home dust (subchronic); and other traumatic, nondust exposures. RESULTS:In multivariable models, post-9/11 risk of incident asthma was higher in the WTCHR participants than in the comparison group (OR 1.109, 95% CI 1.021, 1.206; P = .015). Comparing by exposure rather than by group, dust cloud (OR 1.223, 95% CI 1.095, 1.365; P < .001) and home dust (OR 1.123, 95% CI 1.029, 1.226; P = .009) exposures were also associated with a greater risk of incidence of post-9/11 asthma. No differences were identified for lung function measures. CONCLUSIONS:Although we cannot exclude an alternative explanation to the null findings, these results may provide some measure of reassurance to exposed children and their families regarding long-term consequences. Further study with bronchodilation and/or methacholine challenge may be needed to identify and further evaluate effects of WTC exposure. Biomarker studies may also be more informative in delineating exposure-outcome relationships. TRIAL REGISTRATION/BACKGROUND:ClinicalTrials.gov: NCT02068183.
PMID: 30029866
ISSN: 1097-6833
CID: 3202332

Association of airway esophageal eosinophils in children with refractory asthma and chronic cough [Meeting Abstract]

Erkman, J; Segal, L; Levine, J; Moy, L; Greifer, M; Giusti, R; Shah, R; Kazachkov, M
PURPOSE: Reflux esophagitis (ReE) and eosinophilic esophagitis (EoE) are associated with the presence of eosinophils in esophageal mucosa and are considered to be important co-morbid factors for chronic cough and asthma in adults. We hypothesize that esophageal eosinophils related to ReE and EoE are present in children with refractory asthma and chronic cough and correlate with airway eosinophilia. METHODS: We performed a retrospective analysis of medical records of children who underwent "triple endoscopy" (sleep laryngoscopy, bronchoscopy with bronchoalveolar lavage (BAL) and endobronchial biopsy (EBB), and esophagogastroduodenoscopy with esophageal biopsy (EsB)) at our Aerodigestive Center for evaluation of refractory asthma and cough. Inclusion criteriawere cough for 8 weeks or more with no response to trial of antibiotics and systemic/inhaled corticosteroids (ICS), poor control of asthma symptoms, and/or airflowlimitations and air trapping despite use ICS or ICS/long-acting beta-agonist combination. Children with known cystic fibrosis, primary ciliary dyskinesia and aspiration into airway were excluded. RESULTS: Thirty-two children (22 males) met inclusion criteria. Nineteen had refractory asthma and 13 had chronic cough. There were no significant complications recorded after procedures including EBB. Eosinophils (>1%) were present in BAL of 8 (25%) children. EBB showed eosinophils in 17 (53%) children. There were a total of 19 children with eosinophils isolated from the airway (either BAL or EBB), 4 (21%) had them in BAL alone, 8 (42%) in EBB only, and 7 (37%) in both BAL and EBB. EoE was diagnosed in 6 children (19%) and ReE in 13 (41%). EsB revealed esophageal eosinophils in 47% of children. Presence of eosinophils in EsB was related to presence of eosinophils in EBB chi2 (1, N = 32), p = 0.026, but not BAL (p=0.89). CONCLUSIONS: ReE and EoE with esophageal eosinophils was present in 47% of children with refractory asthma and chronic cough. There is a significant relationship between airway and esophageal eosinophils, which becomes evident only when EBB is performed for detection of airway eosinophils. Further research is required for understanding the association of airway and esophageal eosinophilia in the development and management of refractory asthma and cough
EMBASE:619297567
ISSN: 1931-3543
CID: 2860212

NYU LANGONE PEDIATRIC CYSTIC FIBROSIS DEPRESSION &amp; ANXIETY SCREENING INITIATIVE: ONGOING ASSESSMENT AND RISK IDENTIFICATION [Meeting Abstract]

Harris, M; Lois, B; Giusti, R; Mavaro, C; Delgado, D; Sklenar, D; Liaw, R
ISI:000411113700784
ISSN: 1099-0496
CID: 2726852

Airway Microbiota Shifts During Stable Cystic Fibrosis Treated With Inhaled Antibiotics Are Associated With Exacerbations And Disease Progression [Meeting Abstract]

Sulaiman, I; Beatty, J; Scaglione, B; Wu, BG; Wang, J; Scott, AS; Giusti, R; Amoroso, N; DiMango, E; Fiel, SB; Berdella, M; Walker, P; Condos, R; Segal, LN
ISI:000400372507409
ISSN: 1535-4970
CID: 2591342

EVALUATION OF MICROBIOME RESILIENCE IN CYSTIC FIBROSIS [Meeting Abstract]

Scaglione, B; Wang, J; Wu, B; Lesko, M; Li, Y; Scott, A; Giusti, R; Amoroso, N; DiMango, E; Fiel, S; Berdella, M; Walker, P; Condos, R; Segal, LN
ISI:000384815300451
ISSN: 1099-0496
CID: 2321832

IMPROVING PARENTAL EXPERIENCE WITH CYSTIC FIBROSIS NEWBORN SCREENING IN NEW YORK STATE [Meeting Abstract]

Fisher, L; Goetz, DM; Giusti, R; Grob, R
ISI:000360791500614
ISSN: 1099-0496
CID: 1788712

IMPROVING SCREENING AND TREATMENT OF VITAMIN D DEFICIENCY IN NEW YORK CF INFANTS [Meeting Abstract]

Ren, CL; Berry, M; Wang, H; Giusti, R; Quittell, L; NY CF NBS Consortium
ISI:000342926000584
ISSN: 1099-0496
CID: 1344022

PREVALENCE OF SMALL COLONY VARIANT AND ANTIBIOTIC RESISTANCE PATTERN OF STAPHYLOCOCCUS AUREUS STRAINS FROM AN URBAN ACADEMIC CYSTIC FIBROSIS CENTER SETTING IN NEW YORK CITY [Meeting Abstract]

Chandwani, S; Inglima, K; Giusti, R
ISI:000342926000428
ISSN: 1099-0496
CID: 1344012

13 Year-old female with cystic fibrosis, trichosporon airway infection, and bronchial diverticula [Meeting Abstract]

Goodman, I; Fiorino, E K; Giusti, R
Introduction: Multiple organisms have been recovered from the airways of patients with cystic fibrosis (CF). Aside from Pseudomonas aeruginosa (PA) and methicillin resistant Staphylococcus aureus (MRSA), influence on disease progression is not defined. Bronchiectasis is an established sequelea of CF airway disease; however, other airway anomalies have not been reported. Case Report: This is a 13 year-old female with CF (pancreatic insufficient) diagnosed at six months of age. She had a cough for four months, without the ability to expectorate sputum, as well as severe decline in pulmonary function, unresponsive to oral antibiotics and antifungals. Spirometry demonstrated a severe obstructive defect. The patient was hospitalized for further evaluation. Bronchoscopy was performed, and multiple small bronchial diverticula were present in the right and left lower lobar segmental airways (Figure 1). Otherwise, bronchoscopy demonstrated edematous and friable mucosa, thick secretions, and dynamic collapse of the large airways. Samples from bronchiolar lavage (BAL) fluid yielded Alcaligenes xylosoxidans and Trichosporon mucoides for which the patient was treated with piperacillin/tazobactam, sulfamethoxazole/trimethoprim, and voriconazole. The patient first grew Trichosporon mucoides from her BAL fluid one year prior to this presentation, when she also was hospitalized for pulmonary exacerbation; she subsequently was treated with a four month course of voriconazole and steroids, with a temporary improvement in pulmonary function and symptoms. Bronchoscopy performed by the same pulmonologist at that time did not show these bronchial diverticula; chest CT at that time showed diffuse tree-in-bud opacities in lower lobes and acinar nodules consistent with a fungal infection. Discussion: This case is significant because Trichosporon is a rare organism in patients with CF whom have not been transplanted, with only one documented case report in the literature. To our knowledge there have been no reported cases of bronchial diverticula in CF. Airway diverticula have been described in immunodeficiency and Mounier-Kuhn syndrome; however, in these reports, diverticula were restricted to the central airways. It is unclear whether the development of these bronchial diverticula is directly related to Trichosporon infection or to another etiology. It is also unclear how these diverticula may contribute to the patient's disease, potentially serving as a reservoir for pathogenic bacteria and fungi. (Figure presented)
EMBASE:71987954
ISSN: 1073-449x
CID: 1768852

Serial impulse oscillometry in patients with cystic fibrosis hospitalized for pulmonary exacerbation [Meeting Abstract]

Berger, K I; Fiorino, E K; Goldring, R M; Giusti, R
Introduction: Pulmonary function evaluation in patients with cystic fibrosis (CF) has demonstrated disparity between spirometric and oscillometric assessments. Most studies have indicated that oscillometry may appear normal despite significant abnormalities on spirometry. However, normal values for impulse oscillometry (IOS) in pediatric populations are limited and vary by study. The present study assessed the role for IOS by assessment of both the acute response to bronchodilator and the chronic response to treatment. Methods: Patients hospitalized with exacerbations of CF were evaluated with both spirometry and oscillometry. Data were obtained pre and post bronchodilator administration and related to published normative data. When feasible, lung volumes were assessed by plethysmography. Serial testing was performed during and following standard therapy which included vigorous chest physical therapy and intravenous antibiotics targeted to the predominate organism isolated from sputum or bronchoscopy specimens. Results: Data were available in 5 patients with CF with age ranging from 5 to 44 years. Abnormal spirometry was evident in 4 subjects. Although FEV1/FVC was mildly reduced in these subjects (68+5%), the predominant abnormality was reduction in vital capacity (50+12%). HRCT demonstrated severe mucous plugging in multiple airways and bronchoscopy in one patient confirmed total occlusion of the bronchial lumen form respiratory secretions. Despite these spirometric and radiographic abnormalities, oscillometric assessment of resistance assessed was within published normal limits in these subjects. However, a positive response to bronchodilator was observed in 3 patients and serial testing in one subject demonstrated further improvement in airway resistance by IOS. These changes in oscillometric data occurred with minimal change in FVC and FEV1. Conclusions: Although IOS parameters in an individual patient may be within published normal limits, reduction in resistance may be apparent either acutely post bronchodilator or chronically following treatment. These improvements in IOS parameters may not be apparent on spirometry, providing a potential role for IOS in the evaluation of patients with CF. These data suggest that improvement in post bronchodilator measurements of airway resistance may be a useful adjunct to guide the appropriate length of treatment for CF exacerbations
EMBASE:70845514
ISSN: 1073-449x
CID: 177217