Novel and Engaging Teaching Method for Pulmonary Physiology.

BACKGROUND: Pulmonary physiology is a challenging, necessary component of pediatric pulmonary fellowship education. Our pediatric pulmonology fellowship program provided this education utilizing a flipped classroom approach but satisfaction with the method was declining. Evidence suggests that adult learners benefit from an engaging lecture method, but no evidence exists to compare the flipped classroom approach to the engaging lecture approach for pulmonary physiology education. OBJECTIVE: To develop the most effective physiology curriculum for pediatric pulmonary fellows by comparing the flipped classroom approach to an engaging lecture method. METHODS: Five physiology teaching sessions were assigned to the flipped classroom method and 5 to the engaging lecture style. Anonymous surveys assessing satisfaction, utilizing a five-point Likert scale, were completed by fellows at the end of each session. An unpaired t-test was used to compare responses. RESULTS: Seven pediatric pulmonary fellows enrolled in the study. The average attendance per session was 5 fellows. There was no significant difference in fellows' perceived understanding of the assigned physiology topic prior to the flipped classroom versus engaging lecture sessions. Fellows' perceived understanding of the topics improved after both session types, with significantly more improvement after the engaging lecture sessions. Fellows also reported that engaging lecture sessions were more useful and improved their test-taking confidence. They were more likely to recommend engaging lecture sessions to future pulmonary fellows. CONCLUSIONS: Pediatric pulmonary fellows benefited from the use of the engaging lecture style for physiology education.

Long-term pulmonary sequelae in adolescents post-SARS-CoV-2 infection.

RATIONALE: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes long-term pulmonary sequelae in adults, but little is known about pulmonary outcomes in pediatrics. OBJECTIVE(S): The aim of this study was to describe long-term subjective and objective pulmonary abnormalities after SARS-CoV-2 infection in pediatric populations. METHODS: Single-center, retrospective cohort of patients seen in post-coronavirus disease 2019 (COVID-19) pulmonary clinic in 2021. Subjects evaluated had persistent pulmonary symptoms 4 weeks or more after initial infection. Clinical testing included a 6-min walk test (6MWT), chest X-ray, pre- and postbronchodilator spirometry, plethysmography, and diffusion capacity. Patients were followed 2-to-3-months after the initial visit with repeat testing. The primary outcome was the presence of abnormal pulmonary function testing. Secondary measures included variables associated with pulmonary outcomes. RESULTS: Eighty-two adolescents were seen at a median of 3.5 months postinfection, with approximately 80% reporting two or more symptoms at clinic presentation (cough, chest pain, dyspnea at rest, and exertional dyspnea). At follow-up (~6.5 months) exertional dyspnea persisted for most (67%). Spirometry was normal in 77% of patients, but 31% had a positive bronchodilator response. No abnormalities were noted on plethysmography or diffusion capacity. Clinical phenotypes identified included inhaled corticosteroid responsiveness, paradoxical vocal fold motion disorder, deconditioning, and dysautonomia. Multivariable modeling demonstrated that obesity, anxiety, and resting dyspnea were associated with reduced 6MWT, while female sex and resting dyspnea were associated with higher Borg Dyspnea and Fatigues scores. CONCLUSIONS: This is the largest study to date of pediatric patients with long-term pulmonary sequelae post-COVID-19. Identified clinical phenotypes and risk factors warrant further study and treatment.

Impact of asthma severity on long-term asthma control.

Background: Asthma is a common childhood disease with significant morbidity. Severe asthma accounts for just 4-6% of patients, but this group is more difficult to treat and is responsible for up to 40% of asthma expenses.Objective: The relationship between asthma severity and control is not well characterized. The main objective of this study was to determine impact of asthma severity on asthma control over time.Methods: This was a three year, prospective observational cohort study at a tertiary care children's hospital. Results were compared over time and between patients with severe and non-severe persistent asthma. Intervention included therapy based on severity and control, accompanied by a NAEPP (EPR-3) guidelines based structured asthma education program.Results: The sample included 471 children referred from primary care offices with the diagnosis of persistent asthma, mean age 6.4 ± 2.4 years. Forty-one children (8.7%) had severe persistent asthma and 430 (91.3%) children had non-severe persistent asthma (mild-moderate persistent). Our sample size decreased over the three-year period and the number of patients completing the third year were 176 (38%) and among them 20 (11.4%) had severe asthma. At the initial visit, children with severe persistent asthma had significantly more acute care needs, more daily symptoms, and lower mean Asthma Control Test™ scores compared to children with non-severe persistent asthma. Differences between groups decreased within six months with significant improvements in most indicators persisting throughout three-year follow up in both groups (p < 0.05).Conclusion: Asthma control improves independent of severity if asthma guidelines are followed.

Whole-blood transcriptomic responses to lumacaftor/ivacaftor therapy in cystic fibrosis.

BACKGROUND: Cystic fibrosis (CF) remains without a definitive cure. Novel therapeutics targeting the causative defect in the cystic fibrosis transmembrane conductance regulator (CFTR) gene are in clinical use. Lumacaftor/ivacaftor is a CFTR modulator approved for patients homozygous for the CFTR variant p.Phe508del, but there are wide variations in treatment responses preventing prediction of patient responses. We aimed to determine changes in gene expression related to treatment initiation and response. METHODS: Whole-blood transcriptomics was performed using RNA-Seq in 20 patients with CF pre- and 6 months post-lumacaftor/ivacaftor (drug) initiation and 20 non-CF healthy controls. Correlation of gene expression with clinical variables was performed by stratification via clinical responses. RESULTS: We identified 491 genes that were differentially expressed in CF patients (pre-drug) compared with non-CF controls and 36 genes when comparing pre-drug to post-drug profiles. Both pre- and post-drug CF profiles were associated with marked overexpression of inflammation-related genes and apoptosis genes, and significant under-expression of T cell and NK cell-related genes compared to non-CF. CF patients post-drug demonstrated normalized protein synthesis expression, and decreased expression of cell-death genes compared to pre-drug profiles, irrespective of clinical response. However, CF clinical responders demonstrated changes in eIF2 signaling, oxidative phosphorylation, IL-17 signaling, and mitochondrial function compared to non-responders. Top overexpressed genes (MMP9 and SOCS3) that decreased post-drug were validated by qRT-PCR. Functional assays demonstrated that CF monocytes normalized calcium (increases MMP9 expression) concentrations post-drug. CONCLUSIONS: Transcriptomics revealed differentially regulated pathways in CF patients at baseline compared to non-CF, and in clinical responders to lumacaftor/ivacaftor.

Asthma Self-management: It's Not One Size Fits All.

Asthma exacerbations are a significant cause of health care use and mortality. Home management strategies may be effective in managing many exacerbations before presentation to a health care institution. This article focuses on the variety of options available to patients and providers to choose from as they customize an asthma self-management plan. Literature regarding short-acting bronchodilators is reviewed along with studies on more controversial therapies, such as use of home oral steroids, inhaled corticosteroid and beta agonist combination therapy, and macrolides in acute asthma exacerbations.