Objective: To examine predictors of spirometry use at a tertiary academic health system and association between receipt of spirometry and outcomes. Patients and Methods: We conducted a retrospective cohort study of adult patients with an ICD-9 CM diagnostic code for asthma and a 2014 outpatient visit in either a community health center or private practice associated with a tertiary academic medical center. The main outcome was receipt of spirometry during a 2007-2015 "exposure period." We secondarily examined future hospitalizations and emergency department (ED) visits during a follow-up period (2016)(2017)(2018)(2019).Results: In a sample of 394 patients, the majority were white (48%; n=188) and female (72%; n=284). Mean (SD) age was 52 years. Approximately half (185, 47%) of the patients received spirometry and 25% (n=97) saw a specialist during the exposure period. Nearly, 88% (n=85) of patients who saw a specialist received spirometry. More than half of the cohort (220/394, 56%) had an ED visit or admission during the follow-up period. Of these, 168 (76.4%) had not seen a specialist and 111 (50.5%) had not received spirometry within the exposure period. We saw no association between spirometry in the exposure window and future ED visit or hospitalization. Conclusion: In a cohort of patients at a tertiary medical center, spirometry was underused. We observed a strong association between seeing a specialist and use of spirometry, suggesting a need to better incorporate spirometry into routine primary care for patients with asthma. Among 220 patients who had an asthma-related hospitalization or ED visit in 2016-2019, the majority had no record of receiving spirometry and no documentation indicating a prior specialist visit.

BackgroundFood protein–induced enterocolitis syndrome (FPIES) is a non-IgE mediated food allergy characterized by delayed, repetitive vomiting. FPIES is improving in recognition; however, there remains a lag in diagnosis. This study aimed to further explore this lag, as well as referral patterns and healthcare utilization, to help determine areas for earlier recognition.MethodsA retrospective chart review of pediatric FPIES patients at two hospital systems in New York was completed. Charts were reviewed for FPIES episodes and healthcare visits prior to diagnosis, and reason/source of referral to an allergist. A cohort of patients with IgE-mediated food allergy was reviewed for comparison of demographics and the time to the diagnosis.ResultsIn total, 110 patients with FPIES were identified. The median time to diagnosis was 3 months, vs. 2 months in IgE-mediated food allergy (p < 0.05). Most referrals were from the pediatrician (68%) or gastroenterology (28%), none were from the ED. The most common reason for referral was concern of IgE-mediated allergy (51%), followed by FPIES (35%). There was a statistically significant difference in race/ethnicity between the FPIES cohort and IgE-mediated food allergy group (p < 0.0001), with a greater proportion of Caucasian patients in FPIES vs. IgE-mediated food allergy cohort.ConclusionThis study demonstrates a lag in the diagnosis of FPIES and a lack of recognition outside of the allergy community, as only one-third of patients were considered to have FPIES prior to an allergy evaluation.

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RATIONALE: Cytomegalovirus seropositivity (CMV+) has been associated with poorer clinical outcomes in older patients with several chronic conditions. While the underlying mechanism for this relationship is not fully defined, it likely involves heightened systemic inflammation in combination with a decreased CD4:CD8 ratio usually referred to as the "immune risk profile (IRP).'' However, the effect of CMV+ and aging on asthma control has not been studied. METHODS: The objective of this study was to evaluate the effect of CMV on immune function in young vs. aged asthmatics. Plasma was collected from younger (20-40 years; n512) and older (>60 years; n511) inner-city patients with asthma. CMV was detected by ELISA and blood T-helper and T-suppressor (CD4:CD8) ratio measured using flow cytometry. Levels as asthma control were assessed with the Asthma Control Test (ACT). RESULTS: The aged CMV+ vs. CMV-subjects had a significantly decreased CD4:CD8 ratio (1.15 vs 3.16, p50.01) and ACT score (13 vs 17, p50.02). In contrast, the younger CMV+ vs CMV-subjects had a higher CD4:CD8 ratio (3.0 vs 2.2, p50.02) and no significant differences in ACT scores (16 vs 21, p50.08). A positive CMV was associated with a 7.7 point reduction in ACT in the aged and a 4.1point reduction in the younger. CONCLUSIONS: Patients with asthma who are CMV+, older and have decreased CD4:CD8 ratio tend to have worse asthma control. Additional larger studies are needed to validate these preliminary findings, investigate the underlying mechanism and determine if there are clinical benefits to screening older subjects with asthma for CMV.