Faculty Bibliography

BACKGROUND:The Asthma Impairment and Risk Questionnaire (AIRQ) predicts 12-month exacerbation occurrence for patients aged ≥12 years. OBJECTIVE:To assess the short- and long-term exacerbation prediction ability of the AIRQ in patients with mild-to-moderate and severe asthma. METHODS:This post hoc analysis from the AIRQ longitudinal study classified patients with asthma aged ≥12 years as having mild-to-moderate or severe disease based on prescribed pharmacotherapy. Participant-reported severe asthma exacerbations were assessed monthly over 12 months. For both severity groups and relative to baseline AIRQ control category, exacerbation occurrence was assessed via logistic regression and Kaplan-Meier time-to-first event analyses for the overall 12-month period, months 0-3 (short-term), and months 4-12 (long-term) post-enrollment. RESULTS:Of 1070 patients who completed ≥1 follow-up assessment, 374 (35.0%) had mild-to-moderate and 696 (65.0%) had severe asthma. Over the 12-month follow-up, 134 (35.8%) patients with mild-to-moderate disease versus 355 (51.0%) patients with severe disease experienced ≥1 exacerbation (P < .001). Over months 0-3 and months 4-12, the proportion of patients experiencing ≥1 exacerbation was lower in those with mild-to-moderate than severe asthma (76 [21.0%] vs 201 [29.8%], P = .002; 93 [26.1%] vs 283 [41.4%], P < .001, respectively). For both severity groups, over the 12-month follow-up, months 0-3, and months 4-12, baseline AIRQ control category predicted exacerbation occurrence and time to first exacerbation (P < .001 for all). CONCLUSION/CONCLUSIONS:The AIRQ predicts short- and long-term exacerbation occurrence in patients with mild-to-moderate and severe asthma. Understanding how current asthma control relates to exacerbation risk could facilitate point-of-care shared decision-making on management optimization.

OBJECTIVES/OBJECTIVE:To assess the effects of World Trade Center (WTC) exposures, obesity, and smoking on post-bronchodilator (post-BD) lung function in WTC Survivors. METHODS:Data included 5,243 participants enrolled in WTC Environmental Health Center (WTC EHC) program between 2005 and 2022. WTC-related exposures included dust-cloud exposure and occupational/residential roles. Lung function included post-BD spirometry (FEV1, FVC) and impulse oscillometry (R5, R20, AX). Multivariable linear and quantile regressions assessed associations with WTC exposures, BMI, and smoking, adjusting for demographics. RESULTS:Dust-cloud exposure and Worker status were associated with elevated AX, R5, and R20, indicating small airway dysfunction. Spirometry showed minimal impact from dust exposure, though Workers had lower FEV₁ and FVC than Residents. Obesity and smoking were consistently linked to poorer lung function, with effect sizes surpassing WTC exposure. No significant interactions were found between BMI and WTC exposures. CONCLUSIONS:WTC exposures are associated with small airway dysfunction, especially in Workers. Obesity and smoking independently worsen lung function, underscoring the importance of both environmental and physiological risk factors in disaster-exposed populations. Post-BD oscillometry adds critical sensitivity in detecting injury to small airways.

Studies suggest that environmental disasters have a big impact on population health conditions including metabolic risk factors, such as obesity and hypertension. The World Trade Center (WTC) destruction from the 9/11 terrorist attack resulted in environmental exposures to community members (Survivors) with potential for metabolic effects. We now examine the impact of WTC exposure on Body Mass Index (BMI) using the data from 7136 adult participants enrolled in the WTC Environmental Health Center (EHC) from August 1, 2005, to December 31, 2022. We characterized WTC-related exposures by multiple approaches including acute dust-cloud exposure, occupational or residential exposures, and latent exposure patterns identified by synthesizing multiplex exposure questions using latent class analysis. Employing multivariable linear and quantile regressions for continuous BMI and ordered logistic regression for BMI categories, we found significant associations of BMI with WTC exposure categories or latent exposure patterns. For example, using exposure categories, compared to the group of local residents, local workers exhibited an average BMI increase of 1.71 kg/m² with 95% confidence intervals (CI) of (1.33, 2.09), the rescue/recovery group had an increase of 3.13 kg/m² (95% CI: 2.18, 4.08), the clean-up worker group had an increase of 0.75 kg/m² (95% CI: 0.09, 1.40), and the other mixer group had an increase of 1.01 kg/m² (95% CI: 0.43, 1.58). Furthermore, quantile regression analysis demonstrated that WTC exposures adversely affected the entire distribution of BMI in the WTC EHC Survivors, not merely the average. Our analysis also extended to blood pressure and hypertension, demonstrating statistically significant associations with WTC exposures. These outcomes highlight the intricate connection between WTC exposures and metabolic risk factors including BMI and blood pressure in the WTC Survivor population.

SummaryWhat is this summary about?• The Asthma Impairment and Risk Questionnaire (AIRQ^®) has been designed and tested to measure patients' levels of asthma control in a healthcare setting.• Unlike other available questionnaires that only assess asthma symptoms that can be bothersome or limit a person's activities and quality of life (impairment-related symptoms), the AIRQ also includes questions related to risk of an asthma attack. This allows for a broader measurement of asthma control and a prediction of the chance of having future asthma attacks.• AIRQ scores are linked to a patient's own experience of their health and how it impacts their daily life (health-related quality of life).• The AIRQ may make it easier for patients and healthcare professionals to have shared decision-making discussions that can lead to better asthma care and asthma outcomes.• This document summarizes several published studies of the AIRQ in people with asthma.

The World Trade Center (WTC) Health Program is a limited federal health care program that provides medical monitoring and treatment for WTC-related health conditions to responders and survivors impacted by the terrorist attacks on September 11, 2001.This study described the characteristics of the Program survivor members (who lived, worked, went to school, daycare or adult daycare or present in the New York City Disaster Area of 9/11/2001) to stimulate innovative ideas for improving healthcare services, generate new research interest, and serve as a reference for future research on this population. Administrative and medical claims data collected from the Program start date (07/01/2011) through 2022 were used. As of 12/31/2022, there were 37,384 enrolled survivors: 5.0% were aged ≤21 years on 9/11/2001, 45.9% females, and 31.2% non-Hispanic Whites. A total of 24,148 (64.6%) were certified for at least one WTC-related condition, including neoplasms (36.0%), aerodigestive disorders (35.6%) and mental health conditions (18.6%); 22.9% were certified for more than one category. Certification rates of some WTC-related conditions differed by sex, age and race/ethnicity. WTC survivor population is diverse in sex, age and race/ethnicity, with a high proportion certified for certain WTC-related health conditions, providing great opportunities for research in various areas.

The collapse of the World Trade Center (WTC) buildings in New York City generated a large plume of dust and smoke. WTC dust contained human carcinogens including metals, asbestos, polycyclic aromatic hydrocarbons (PAHs), persistent organic pollutants (POPs, including polychlorinated biphenyls (PCBs) and dioxins), and benzene. Excess levels of many of these carcinogens have been detected in biological samples of WTC-exposed persons, for whom cancer risk is elevated. As confirmed in this structured literature review (n studies = 80), all carcinogens present in the settled WTC dust (metals, asbestos, benzene, PAHs, POPs) have previously been shown to be associated with DNA methylation dysregulation of key cancer-related genes and pathways. DNA methylation is, therefore, a likely molecular mechanism through which WTC exposures may influence the process of carcinogenesis.

BACKGROUND:Complex models combining impairment-based control assessments with clinical characteristics and biomarkers have been developed to predict asthma exacerbations. The composite Asthma Impairment and Risk Questionnaire (AIRQ) with adjustments for demographics (age, sex, race, and body mass index) predicts 12-month exacerbation occurrence similarly to these more complex models. OBJECTIVE:To examine whether AIRQ exacerbation prediction is enhanced when models are adjusted for a wider range of clinical characteristics and biomarkers. METHODS:Patients aged 12 years and older completed monthly online surveys regarding exacerbation-related oral corticosteroid use, emergency department or urgent care visits, and hospitalizations. Univariate logistic regressions to predict exacerbations were performed with sociodemographics, comorbidities, exacerbation history, lung function, blood eosinophils, IgE, and FeNO. Significant (P ≤ .05) variables were included in multivariable logistic regressions with and without AIRQ control categories to predict 12-month exacerbations (log odds ratio [95% Wald confidence interval]). Model performances were compared. RESULTS:Over 12 months, 1,070 patients (70% female; mean [SD] age, 43.9 [19.4] years; 22% non-White; body mass index [SD], 30.6 [8.7]) completed one or more survey (mean [SD], 10.5 [2.8] surveys). In the multivariable analysis, AIRQ control category adjusted for significant clinical characteristics and biomarkers was predictive of one or more exacerbations: odds ratio (95% CI) not well-controlled versus well-controlled: 1.93 (1.41-2.62), very poorly controlled versus well-controlled: 3.81 (2.65-5.47). Receiver operating characteristic area under the curve (AUC) for this more complex model of exacerbation prediction (AUC = 0.72) did not differ from AIRQ (AUC = 0.70). Models with AIRQ performed better than those without AIRQ (AUC = 0.67; P < .05). CONCLUSION/CONCLUSIONS:Costly and time-consuming complex modeling with clinical characteristics and biomarkers does not enhance the strong exacerbation prediction ability of AIRQ.

BACKGROUND:The Asthma Impairment and Risk Questionnaire (AIRQ) is a 10-item, yes/no, equally weighted control tool. Lower scores indicate better control. Seven impairment items reflect prior 2-week symptoms, and three risk items assess prior 12-month exacerbations. The Follow-up AIRQ for use between annual assessments has a 3-month recall period for exacerbation items. OBJECTIVE:To evaluate the responsiveness of the AIRQ over time and identify a minimal important difference (MID). METHODS:AIRQ longitudinal study data were analyzed from patients with asthma aged ≥12 years. Anchor-based methods assessed differences in AIRQ scores relative to Patient Global Impression of Change (PGIC), the accepted MIDs for St. George's Respiratory Questionnaire (SGRQ) and Asthma Control Test (ACT), and exacerbation occurrence over 12 months. Baseline and 12-month data reflected 12-month recall AIRQ scores; Follow-up AIRQ scores were utilized for 3-, 6-, and 9-month analyses. RESULTS:1070 patients were included. PGIC "much improved" was associated with AIRQ mean score changes from baseline to months 3, 6, 9, and 12 of -2.0, -1.9, -1.9, and -1.8, respectively. Mean AIRQ score change among patients who met the SGRQ MID (≥4-point decrease) was -1.8 at 6 and 12 months. AIRQ mean scores decreased from baseline by -2.2 to -2.5 points at months 3, 6, 9, and 12 for patients who met the ACT MID (≥3 point increase). A 2-point higher baseline AIRQ score was associated with a 1.7 odds ratio of 12-month exacerbation occurrence (95% CI 1.53-1.89). CONCLUSION/CONCLUSIONS:A change score of 2 is recommended as the AIRQ MID.

BACKGROUND:National and international asthma guidelines and reports do not include control tools that combine impairment assessment with exacerbation history in one instrument. OBJECTIVE:To analyze performance of the composite Asthma Impairment and Risk Questionnaire (AIRQ®) in assessing both domains of control and predicting exacerbation risk compared to Global Initiative for Asthma's 4-question symptom control tool (GINA SCT), Asthma Control Test (ACTTM), and physician expert opinion (EO) informed by GINA SCT responses and appraisal of GINA-identified risk factors for poor asthma outcomes. METHODS:Multivariable logistic regressions evaluated AIRQ and GINA SCT as predictors of ACT. McNemar's test compared the proportion of patients categorized at baseline as completely or well-controlled by each assessment but with current impairment or prior- and subsequent-year exacerbations. RESULTS:The analysis included 1064 patients aged ≥12 years; mean(SD) age 43.8(19.3) years; 70% female; 79% White; 6% Hispanic or Latino. AIRQ and GINA SCT were highly predictive of ACT well-controlled versus not well- and very poorly controlled (ROC AUC AIRQ=0.90, GINA SCT=0.86, P=0.03 AIRQ vs GINA SCT) and ACT very poorly controlled versus well- and not well-controlled asthma (ROC AUC AIRQ=0.91, GINA SCT=0.87, P=0.01 AIRQ vs GINA SCT). AIRQ rated fewer patients as completely or well-controlled who had current impairment (P<0.01) or with prior- and subsequent-year exacerbations (P<0.001) compared with GINA SCT, ACT, and EO. CONCLUSION/CONCLUSIONS:Relative to other control tools and EO informed by GINA SCT and risk factors for poor asthma outcomes, AIRQ performs better in assessing both domains of current control and predicting exacerbation risk.

BACKGROUND/UNASSIGNED:Increased incidence of cancer has been reported among World Trade Center (WTC)-exposed persons. Aberrant DNA methylation is a hallmark of cancer development. To date, only a few small studies have investigated the relationship between WTC exposure and DNA methylation. The main objective of this study was to assess the DNA methylation profiles of WTC-exposed community members who remained cancer free and those who developed breast cancer. METHODS/UNASSIGNED:WTC-exposed women were selected from the WTC Environmental Health Center clinic, with peripheral blood collected during routine clinical monitoring visits. The reference group was selected from the NYU Women's Health Study, a prospective cohort study with blood samples collected before 9 November 2001. The Infinium MethylationEPIC array was used for global DNA methylation profiling, with adjustments for cell type composition and other confounders. Annotated probes were used for biological pathway and network analysis. RESULTS/UNASSIGNED:, and dysregulation of these genes contributes to cancer immune evasion. CONCLUSION/UNASSIGNED:WTC exposure likely impacts DNA methylation and may predispose exposed individuals toward cancer development, possibly through an immune-mediated mechanism.