Research

Read about the study in the New England Journal of Medicine

Stephen Teach, MD, MPH, was one of eight investigators in an NIH-funded study conducted by the Inner City Asthma Consortium. The landmark study examined a novel role for omalizumab, a drug sold under the brand name Xolair. Findings of this study were published in the New England Journal of Medicine (NEJM) in March 2011.

The Consortium study, led by William Busse, MD, the principal investigator of ICAC and professor of medicine at the University of Wisconsin-Madison, evaluated the efficacy of the drug among inner city children and teens who are highly sensitized to asthma triggers and who have those triggers in their environments. The drug is already approved by the FDA for use in patients 12 years old and older. The researchers found that the drug significantly reduced asthma symptoms, exacerbations, and hospitalizations. A surprise finding was the near elimination of fall seasonal flare ups. These flare ups typically are triggered by exposure to respiratory viruses when children and teens return to school and are in close quarters with other children and teens who are ill.

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• Asthma Phenotypes in the Inner-City (APIC)
• Preventative Omalizumab or Step-up Therapy for Severe Fall Exacerbations (PROSE)
• Improving Pediatric Asthma Care in the District of Columbia through Electronic Care Coordination (ECCO)
• Parent Empowerment Program in Asthma Care (PEPAC)
• Asthma Severity Modifying Polymorphisms (AsthMaP®)
• Registry for Asthma Characterization and Recruitment (RACR)
• Epigenetics

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Asthma Phenotypes in the Inner-City (APIC)
[PI: Stephen Teach, MD, MPH]

Funded by the NIH/NIAID under the Inner City Asthma Consortium, this study seeks to determine the characteristics of children and adolescents ages 6-17 years of age who have asthma that is “difficult to control.”

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Preventative Omalizumab or Step-up Therapy for Severe Fall Exacerbations (PROSE)
[PI: Stephen Teach, MD, MPH]

Funded by the NIH/NIAID under the Inner City Asthma Consortium, this study examines the efficacy of increased inhaled steroids and omalizumab (an injected anti-IgE agent) in preventing fall exacerbations of asthma.

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Improving Pediatric Asthma Care in the District of Columbia through Electronic Care Coordination (ECCO)
[PI Stephen Teach, MD, MPH]

Funded by the NIH/NHLBI, this study assesses the effectiveness of an enhanced version of the existing IMPACT DC intervention consisting of short-term case management by trained asthma educators that leverages the new electronic medical record (EMR) that has recently been implemented within the Goldberg Center for Community Pediatrics. By encouraging and facilitating families’ efforts to make and keep follow-up appointments with their children’s primary care providers (PCPs) and by electronically communicating data collected in the IMPACT DC Asthma Clinic to primary care providers in the Goldberg Center, we seek to increase subsequent utilization of these providers for ongoing asthma care.

The study is a prospective cohort study of an enhanced version of the IMPACT DC intervention designed to facilitate the smooth transition of patients from episodic asthma care in the ED through the IMPACT DC Asthma Clinic to longitudinal care in partnership with a PCP. The intervention consists of: (1) short-term case management to facilitate PCP follow-up appointments, and (2) transfer of clinical data to the PCP using the electronic medical record. Specifically, we seek to increase the proportion of families identifying the child’s PCP as their primary source of asthma care at 6 months after a visit to the IMPACT DC Asthma Clinic.

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Parent Empowerment Program in Asthma Care (PEPAC)
[PI: Ivor Horn, MD, MPH]

Funded by the NIH/NCRR this study assesses the effectiveness of an enhanced version of the existing IMPACT DC intervention consisting of short-term case management by trained asthma educators. By empowering parents to communicate better with their children’s providers at appointments, we seek to increase subsequent utilization of these providers for ongoing asthma care while simultaneously increasing parental self-efficacy in communicating with their children’s PCPs.

The study is a prospective randomized clinical trial of an enhanced version of the IMPACT DC intervention involving education for parents about how to communicate more effectively with their children’s PCPs as a means (1) to improve the rate of utilization of primary care services for ongoing asthma care and (2) to enhance the self-efficacy of parents in their interactions with their children’s provider regarding the child’s asthma care.

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Asthma Severity Modifying Polymorphisms (AsthMaP®)
[PI: Robert Freishtat, MD, MPH]

Funded by the Asthma and Allergy Foundation of America and others, this study investigates why and how environmental factors, including the region in which they live and second-hand smoke, affect asthmatic children differently. For more information, visit: http://www.childrensnational.org/research/clinicaltrials/AsthMaP/

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Registry for Asthma Characterization and Recruitment (RACR)
[PI: Stephen Teach, MD, MPH]

Funded by the NIH/NIAID under the Inner City Asthma Consortium , the primary objective of this study is to create and maintain a database of potential participants who may be eligible for future ICAC trials. The database will be used to link researchers to these potential participants who have expressed interest in participating in future trials. This study characterizes the asthma severity, allergen skin test sensitivity and IgE levels of study participants.

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Epigenetics
[PI: Stephen Teach, MD, MPH]

Funded by the NIH/NIAID under the Inner City Asthma Consortium, this study looks at the cross-sectional association between epigenetic modifications of the DNA of children with asthma and their clinical phenotypes.

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Pillai DK, Iqbal SF, Benton AS, Lerner J, Wiles A, Foerster M, Ozerdirne T, Holbrook HP, Payne PW, Gordish-Dressman H, Teach SJ, Freishtat RJ. Associations between genetic variants in vitamin D metabolism and asthma characteristics in young African Americans: a pilot study. Journal of Investigative Medicine. [In Press].

Busse W, Morgan W, Gergen P, Mitchell H, Gern J, Liu A, Gruchalla R, Kattan M, Teach SJ, Pongracic J, Chmiel J, Steinbach S, Calatroni A, Togias A, Thompson K, Szefler S, Sorkness C. An Omalizumab (Anti-IgE) Randomized Trial for Asthma in Inner-City Children. New England Journal of Medicine: 2011;364:1005-1015.

Cohen JS, Benton AS, Teach SJ, Freishtat RJ. P-Glycoprotein Transporter Expression on A549 Respiratory Epithelial Cells is Positively Correlated with Intracellular Dexamethasone Levels. Journal of Investigative Medicine. 2010 ;58:991-994.

Matsui EC, Sampson HA, Bahnson HT, Gruchalla RS, Pongracic JA, Teach SJ, Gergen PJ, Bloomberg GR, Chmiel JF, Liu AH, Kattan M, Sorkness CA, Steinbach SF, Story RE, Visness CM. Allergen-specific IgE is a Biomarker of Exposure and Clinical Status in Inner-city Adolescents with Asthma. Allergy 2010;65:1414-22.

Benton AS, Kumar N, Lerner J, Wiles AA, Foerster M, Teach SJ, Freishtat RJ. Airway platelet activation is associated with airway eosinophilic inflammation in asthma. Journal of Investigative Medicine 2010;58:987-90.

Benton AS, Wang Z, Lerner J, Foerster M, Teach SJ, Freishtat RF. Overcoming heterogeneity in pediatric asthma: tobacco smoke and asthma characteristics within phenotypic clusters. Journal of Asthma. 2010;47:728-34.

Kattan M, Kumar R, Bloomberg G, Mitchell H, Calatroni A, Gergen P, Kercsmar CM, Matsui E, Steinbach SF, Szefler SJ, Sorkness CA, Morgan WJ, Teach SJ, Gan V. Asthma Control, Adiposity and Adipokines among Inner-City Adolescents. Journal of Asthma and Clinical Immunology 2010;125:584-92.

Freishtat RJ, Iqbal SF, Pillai DK, Klein CJ, Ryan LM, Benton AS, Teach SJ. High Prevalence of Vitamin D Deficiency among Inner-City African American Youth with Asthma in Washington, DC. Journal of Pediatrics 2010;156:948-52..

Quint DM, Teach SJ. IMPACT DC: Reconceptualizing the Role of the Emergency Department for Urban Children with Asthma. Clinical Pediatric Emergency Medicine 2009;10:115-121.

Teach SJ, Quint DM. Pulmonary Perspectives: The IMPACT DC Asthma Clinic. Chest Physician 2009;4:10-11.

Szefler SJ, Mitchell H, Sorkness CA, Gergen PJ, O'Connor GT, Morgan WJ, Kattan M, Pongracic JA, Teach SJ, Bloomberg GR, Eggleston PA, Gruchalla RS, Kercsmar CM, Liu AH, Wildfire JJ, Curry MD, Busse WW. Management of asthma based on exhaled nitric oxide in addition to guideline-based treatment for inner-city adolescents and young adults: a randomised controlled trial. Lancet. 2008;372:1065-72.

Guagliardo MF, Huber WA, Quint DM, Teach SJ. Does spatial accessibility of pharmacy services predict compliance with long-term asthma control medications? Journal of Asthma. 2007;44:881-3.

Stanley R, Teach SJ, Mann NC, Alpern ER, Gerardi MJ, Mahajan PV, Chamberlain JM. Variation in ancillary testing among pediatric asthmatics seen in emergency departments. Academic Emergency Medicine 2007;14:532-8.

Freishstat RJ, Teach SJ. Understanding genomics: Implications for the treatment of asthma. Pediatric Emergency Care 2006;22:71-76.

Teach SJ, Guagliardo M, Crain E, Quint D, Joseph JG. Spatial accessibility of primary care pediatric services in an urban environment: association with asthma management and outcomes. Pediatrics 2006;117:S78-S85.

Teach SJ, Crain E, Quint D, Hylan M, Joseph JG. Indoor environmental exposures among children with asthma seen in an urban emergency department. Pediatrics 2006;117:S152-S158.

Teach SJ, Crain E, Quint D, Hylan, M, Joseph JG. Improved asthma outcomes in a high morbidity pediatric population: Results of an emergency department-based randomized clinical trial. Archives of Pediatrics and Adolescent Medicine. 2006;160:535-541.

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