Study Highlights Need For Greater Treatment Practice Standardization Of Inpatient Asthma Care

Study Highlights Need For Greater Treatment Practice Standardization Of Inpatient Asthma Care

shutterstock_224584318The heterogeneity of asthma, comprising a group of related disorders that can be caused or contributed to by a diverse range of factors, makes the disease challenging to study and treat. In addressing that issue, the Cincinnati Children’s Hospital Medical Center has compiled a comprehensive statewide repository linking asthma-related questionnaire and medical record data with health outcomes in order to characterize the variability of clinical treatment practices at Ohio children’s hospitals. The Ohio Pediatric Asthma Repository provides a unique statewide resource in which scientists can conduct observational, comparative effectiveness, and intervention studies for pediatric asthma.

A study of the program’s effectiveness published this month in the journal Pediatrics analyzed the treatment of children aged 2 to 17 admitted at six participating Ohio children’s hospitals for asthma exacerbation or reactive airway disease. The patients’ medical, social, and environmental histories and past asthma admissions were collected from questionnaires and their medical records.

The paper, entitled Heterogeneity in Asthma Care in a Statewide Collaborative: the Ohio Pediatric Asthma Repository (Pediatrics 2015; Vol. 135 No. 2 February 1, 2015 pp. 271 -279  doi: 10.1542/peds.2014-2230) is coauthored by Jocelyn M. Biagini Myers, PhD; Jeffrey M. Simmons, MD, MS; Carolyn M. Kercsmar, MD; Lisa J. Martin, PhD; Valentina V. Pilipenko, PhD; Stephen R. Austin, BS; Mark A. Lindsey, BSa; Katharine M. Amalfitano, BS; Theresa W. Guilbert, MD, MS; Karen S. McCoy, MD; Shalini G. Forbis, MD, MPH; John T. McBride, MD; Kristie R. Ross, MD, MS; Pierre A. Vauthy, MD; and Gurjit K. Khurana Hershey, MD, PhD; — variously representing the Divisions of Asthma Research, Hospital Medicine, Pulmonary Medicine, and Human Genetics at Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio; the Division of Pediatric Pulmonology at Nationwide Children’s Hospital, Columbus, Ohio; the Department of Pediatrics at Dayton Children’s Hospital, Dayton, Ohio; the Department of Pulmonary Medicine at Akron Children’s Hospital, Akron, Ohio; the Department of Pediatrics-Pulmonary at Rainbow Babies and Children’s Hospital, Cleveland, Ohio; and the Department of Pediatric Pulmonary  Medicine, ProMedica at Toledo Children’s Hospital, Toledo, Ohio.

The coauthors note that 1012 children were enrolled in their study between December 2012 to September 2013, and that significant variance in population demographics served, emergency department and inpatient practices, intensive care unit usage, discharge criteria, and length of stay across the sites were observed and recorded. They found that public insurance was highest in Cleveland and Cincinnati (72 and 65 percent respectively). In emergency department care, Cincinnati and Akron were noted to have the highest rates of intravenous magnesium sulfate use (37% and 33%), while Columbus administered the most intramuscular epinephrine (15 percent). Cleveland and Columbus had the highest rates of intensive care unit admittance (44% and 41%) and greatest proportion of long-stay patients (95% and 85%). The researchers also found that moderate/severe asthma severity classification was associated with discharge prescription for inhaled corticosteroids but not stay length.

The coauthors conclude that the data they’ve compiled highlight a need for greater treatment practice standardization of inpatient asthma care. They observe that considerable opportunity exists for personalized care plans that incorporate a particular patient’s asthma impairment, risk, and treatment response history into hospital practices for asthma exacerbation treatment, and that the Ohio Pediatric Asthma Repository is a unique statewide resource that can be referenced in conducting studies of comparative effectiveness of pediatric asthma intervention and treatment.

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Study lead author Dr. Jocelyn M. Biagini Myers, PhD is an Assistant Professor in the University of Cincinnati Department of Pediatrics and a molecular epidemiologist. As a fellow in the Molecular Epidemiology in Children’s Environmental Health training program at UC from 2001-2004, Dr. Biagini Myers played an integral role in building a new birth cohort of children at high risk for developing allergic disease and established her research interests in secondhand smoke exposures and allergic disease pathogenesis. During a postdoctoral fellowship at Cincinnati Children’s Hospital from 2008-2011, she collaborated on a project focused on characterizing epithelial genes in allergic diseases and delineating the mechanisms by which they contribute to the allergic response, and also assisted collaborators in developing a custom SNP-chip for studying genes related to asthma and atopic dermatitis.

Dr. Biagini Myers hopes to develop her research career as a molecular epidemiologist focused on reducing and preventing secondhand smoke-related pediatric asthma and allergic disease, and is also interested in intervention-based research for early-life prevention and reduction of smoke exposures in children and providing further evidence to promote public policies for smoking bans around children.

Another study in which Dr. Biagini Myers participated was published in the journal Pediatric Allergy, Immunology, and Pulmonology in 2012, entitled The Greater Cincinnati Pediatric Clinic Repository: A Novel Framework for Childhood Asthma and Allergy Research (Pediatr Allergy Immunol Pulmonol. 2012 Jun; 25(2): 104113. doi: 10.1089/ped.2011.0116 PMCID: PMC3377950), coauthored by Dr. Biagini Myers; Melinda Butsch Kovacic, Ph.D; Mark Lindsey, B.S.; Tia Patterson, M.H.A.; Sharon Sauter, M.S.; Mark B. Ericksen, B.S.; Patrick Ryan, Ph.D.; Amal Assa’ad, M.D.; Michelle Lierl, M.D.; Thomas Fischer, M.D.; Carolyn Kercsmar, M.D.; Karen McDowell, M.D.; Anne W. Lucky, M.D.; Anita P. Sheth, M.D.; Andrew D. Hershey, M.D.; Richard M. Ruddy, M.D.; Marc E. Rothenberg, M.D.; and Gurjit K. Khurana Hershey, M.D., Ph.D; variously representing the Divisions of Allergy and Immunology, Neurology, Asthma Research, Environmental Health, Emergency Medicine, Pulmonary Medicine, and Dermatology at Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio.

The coauthors observe that allergic disorders, including asthma, allergic rhinitis, atopic dermatitis, eosinophilic esophagitis, and food allergy, comprise a major global health burden affecting up to 40 percent of the world’s population, study and management of which is complicated by these disease conditions’ heterogeneity in both presentation and natural history, noting that biorepositories serve as an excellent source of data and biospecimens for delineating sub phenotypes of allergic disorders.

The Greater Cincinnati Pediatric Clinic Repository (GCPCR) is cited as a model for establishing similar resource facilities elsewhere, through which children with allergic disorders as well as healthy controls can be followed longitudinally during hospital clinic, emergency department, and inpatient visits, with data compiled on subjects’ asthma, allergy, and skin symptoms; past medical, family, social, diet, and environmental histories; physical activity; medication adherence; perceived quality of life; and demographics. DNA is also collected from all participants along with other biospecimens such as blood, hair, and nasal epithelial cells being collected on a subset. At the time of publication, 93 percent of the GCPCR’s 6,317 predominantly Caucasian and African American participants had banked DNA, a large sampling size that supports adequately powered genetic, epidemiologic, environmental, and health disparities studies of childhood allergic diseases.

The researchers conclude that the GCPCR is a well-designed and growing biorepository that has been constantly evaluated and refined to achieve and maintain rigorous clinical phenotype and biological data, and that it constitutes a unique resource that is continuously evaluated and refined to achieve and maintain rigorous clinical phenotype and biological data, and project that development of similar disease-specific repositories using common data elements will be necessary to enable studies across populations of extensively phenotyped patients.

The Greater Cincinnati Pediatric Clinic Repository (GCPCR)
Pediatric Allergy, Immunology, and Pulmonology

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