Annals of the American Thoracic Society最新文献

{"title":"Impact of Clinical Practice Guidelines on Palliative Care and Health Outcomes in Idiopathic Pulmonary Fibrosis in a Canadian Province.","authors":"Jenny Lu-Song, Xueyi Chen, Jeffrey A Bakal, Giovanni Ferrara, Meena Kalluri","doi":"10.1513/AnnalsATS.202501-090RL","DOIUrl":"https://doi.org/10.1513/AnnalsATS.202501-090RL","url":null,"abstract":"","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144287450","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence and Impact of Traumatic Life Events among Black and White Family Members of ICU Patients.","authors":"Deepshikha Charan Ashana, Joanna Hart, Kimberly S Johnson, Ernestine C Briggs, Alice Parish, Maren K Olsen, Jennie Jaggers, Greer Tiver, Amy Summer, Deepa Ramadurai, Nicholas Madamidola, Bassam Syed, Carrie Purbeck Trunzo, Katherine Ramos, Muhammed S Bah, Christopher E Cox","doi":"10.1513/AnnalsATS.202411-1157OC","DOIUrl":"https://doi.org/10.1513/AnnalsATS.202411-1157OC","url":null,"abstract":"<p><strong>Rationale: </strong>Lifetime trauma is common and may affect interactions with the healthcare system.</p><p><strong>Objective: </strong>To measure the prevalence of lifetime trauma and its association with family-clinician interpersonal outcomes in the intensive care unit (ICU).</p><p><strong>Methods: </strong>Cross-sectional study conducted in nine ICUs in one urban and one suburban-rural health system. Participants were Black or White surrogate decision-makers for mechanically ventilated patients. Independent variables were the number of lifetime traumatic events measured using the Life Stressor Checklist-Revised (LSC-R), and secondarily and separately, discrimination-related traumatic stress symptoms. The primary outcome was family-reported conflict with ICU clinicians about treatment decisions. Secondary outcomes were family-reported quality of clinician communication and therapeutic alliance.</p><p><strong>Results: </strong>Among 141 family members (median age 52.7 years [IQR 41.9, 62.0]; female n=100, 70.9%; White n=85, 60.3%; Black n=56, 39.7%), the median number of lifetime traumatic events was 6.0 (IQR 4.0, 9.0). Lifetime trauma was significantly but non-linearly associated with family-clinician conflict (OR=1.44, 95% CI: 1.09,1.90 for LSC-R values 0-7.5; OR=0.75, 95% CI: 0.55, 1.02 for LSC-R values 7.5-16; p=0.03). Discrimination-related stress symptoms were also associated with conflict (OR=1.04, 95% CI: 1.003, 1.07; p=0.03). Interactions between the independent variables and family member race were not significant, suggesting the effects of lifetime trauma and discrimination-related traumatic stress on family-clinician conflict were similar for Black and White caregivers.</p><p><strong>Conclusions: </strong>Lifetime trauma is common among families of critically ill patients and is associated with negative experiences of critical care. Trauma-informed care may reduce family-clinician conflict and improve other measures of family experience.</p>","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144251272","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"National Economic Burden of Pediatric Asthma Hospitalizations.","authors":"Jonathan M Gabbay, Benjamin Vm Bajaj, Samantha R Levano, Jennifer M Perez, Florinda Islamovic, Robert J Graham, James G Kahn, Patricia A Hametz, Kevin P Fiori, Deepa Rastogi","doi":"10.1513/AnnalsATS.202501-128RL","DOIUrl":"https://doi.org/10.1513/AnnalsATS.202501-128RL","url":null,"abstract":"","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144251271","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Working Together in Sarcoidosis: Experience and Impact of a Formalized Multidisciplinary Discussion.","authors":"Michelle Sharp, Ali M Mustafa, Kristen Mathias, Jasmine Malhi, Edward S Chen, Stephen C Mathai, Barney J Stern, Susana C Dominguez-Penuela, Paula Barreras, Nisha A Gilotra","doi":"10.1513/AnnalsATS.202412-1294RL","DOIUrl":"https://doi.org/10.1513/AnnalsATS.202412-1294RL","url":null,"abstract":"","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144251273","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Weak Age Restriction Enforcement and Retailer Proliferation Reveal Limits in Tobacco Control Policy.","authors":"Anthony J Fischer, Justin D Krogh, Miah Boyle, Yosra Saad, Allison Frahm, Mary Teresi, Margaret Carrel","doi":"10.1513/AnnalsATS.202501-095OC","DOIUrl":"https://doi.org/10.1513/AnnalsATS.202501-095OC","url":null,"abstract":"<p><p><b>Rationale.</b> Tobacco use disorder begins in adolescence. In December 2019, the Tobacco 21 law restricted sales of tobacco products to persons ≥ 21 years old in the US. It is unclear how underaged tobacco sales changed following Tobacco 21. <b>Objectives.</b> To compare underaged sales violations in Iowa before and after Tobacco 21, identify retailers with frequent violations, and measure assessed federal penalties. <b>Methods.</b> We analyzed 2017-2023 retail inspections in Iowa from FDA Tobacco Compliance Checks. We classified retailers by store type and used binary logistic regression to model underaged sales by retailer type, location, and time. We tabulated monetary penalties from FDA letters to retailers. <b>Measurements and Main Results.</b> The FDA recorded 16,530 inspections at 3,789 locations. 1148 inspections (6.9%) resulted in sales violations. 24% of locations had ≥1 violation. Tobacco/vape shops proliferated 3.8-fold in seven years. Retailers with highest violation rates included tobacco/vape shops, liquor stores, and some gas station chains. Violations trended higher in urban counties. Inspections and violations varied owing to the COVID-19 pandemic. After inspections paused in 2020, violations grew to 10.6% in 2021. Federal penalties to retailers totaled $152,903 in 7 years. By contrast, tobacco marketing in Iowa exceeds $100 million annually. <b>Discussion.</b> Underaged sales remained prevalent following Tobacco 21. Tobacco specialty retailers proliferated in Iowa and frequently violated underaged sales restrictions. Violations rose after decreased inspections from the COVID-19 pandemic, emphasizing the importance of continued surveillance. Penalties for underaged sales were small relative to tobacco revenues. Higher penalties are needed to deter illegal sales. This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License 4.0 (http://creativecommons.org/licenses/by-nc-nd/4.0/).</p>","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144227893","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gestational Age and Birthweight Predict Obstructive Lung Disease - A Study from the Swedish National Airway Register.","authors":"Maria Ödling, Mikael Andersson Franko, Helena Backman, Lowie E G W Vanfleteren, Caroline Stridsman, Jon R Konradsen","doi":"10.1513/AnnalsATS.202411-1236OC","DOIUrl":"https://doi.org/10.1513/AnnalsATS.202411-1236OC","url":null,"abstract":"<p><strong>Rationale: </strong>Few studies have identified risk sets for perinatal factors and airflow obstruction into middle adulthood.</p><p><strong>Objectives: </strong>To investigate associations between gestational age (GA), GA-adjusted birthweight, and mode of delivery and persistent airflow obstruction among patients 7-49 years with obstructive lung diseases.</p><p><strong>Methods: </strong>The study population encompassed 44,778 individuals with asthma or chronic obstructive pulmonary disease (COPD) and ≥1 registration of post-bronchodilator values of forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC) recorded in the Swedish National Airway Register in 2014-2022, and with both GA and birthweight data in the Medical Birth Register between 1973-2015. Persistent airflow obstruction was defined as a FEV1/FVC z-score below the lower limit of normal. Analyses were done separately for children, young adults, and middle-aged adults.</p><p><strong>Measurements and main results: </strong>Those extremely, very, moderate, and late preterm-born all had increased odds ratios (ORs) of persistent airflow obstruction up to age 49 years compared with those term-born. Middle-aged adults born small for GA had increased OR of persistent airflow obstruction compared with those appropriate for GA (OR 1.49; 95% confidence interval 1.23-1.81). In the risk sets, GA was the most significant covariate for persistent airflow obstruction. GA-adjusted birthweight was an additional covariate for those born late preterm, term, or post-term. Mode of delivery did not contribute.</p><p><strong>Conclusions: </strong>GA was an independent covariate of persistent airflow obstruction and, in the risk sets, proved to be the most important covariate in patients of all ages with either asthma or COPD. GA-adjusted birthweight further improved the prediction.</p>","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144227892","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of Early Epinephrine with Hemodynamics and Outcome in Pediatric In-Hospital Cardiac Arrest: A Secondary Analysis of a Multi-center, Cluster-randomized Clinical Trial (ICU-RESUS).","authors":"Ashley Siems, Maryam Y Naim, Robert A Berg, Ron W Reeder, Tageldin Ahmed, Michael J Bell, Robert Bishop, Matthew Bochkoris, Candice Burns, Joseph A Carcillo, Todd C Carpenter, J Michael Dean, J Wesley Diddle, Myke Federman, Richard Fernandez, Ericka L Fink, Deborah Franzon, Aisha H Frazier, Stuart H Friess, Kathryn Graham, Mark Hall, Monica L Harding, David A Hehir, Christopher M Horvat, Leanna L Huard, Todd J Kilbaugh, Tensing Maa, Arushi Manga, Patrick S McQuillen, Kathleen L Meert, Peter M Mourani, Vinay M Nadkarni, Daniel Notterman, Murray M Pollack, Danna W Qunibi, Anil Sapru, Carleen Schneiter, Matthew P Sharron, Neeraj Srivastava, Sarah Tabbutt, Bradley Tilford, Shirley Viteri, David Wessel, Heather A Wolfe, Andrew R Yates, Athena F Zuppa, Ryan W Morgan, Robert M Sutton","doi":"10.1513/AnnalsATS.202408-825OC","DOIUrl":"https://doi.org/10.1513/AnnalsATS.202408-825OC","url":null,"abstract":"<p><strong>Rationale: </strong>Delayed (> 5 minutes) epinephrine during pediatric in-hospital cardiac arrest (IHCA) is associated with worse outcomes. Epinephrine is nearly always given earlier, limiting 5 minutes as a quality target.</p><p><strong>Objectives: </strong>To assess early epinephrine (≤2 minutes) on outcomes and hemodynamics during CPR in pediatric IHCA from pulseless non-shockable rhythms.</p><p><strong>Methods: </strong>This study leveraged the database of ICU-RESUScitation project (NCT02837497). Primary exposure was time to epinephrine bolus: early versus >2 minutes. Primary outcome was survival to discharge. Secondary outcomes included return of spontaneous circulation (ROSC), survival with favorable neurologic outcome, change from baseline to discharge functional status scale (FSS), total FSS at discharge, new morbidity among survivors, and invasively measured blood pressure (BP) over the first 10 minutes of CPR.</p><p><strong>Measurements and main results: </strong>Among 352 CPR events, median age was 1.0 (0.3, 8.0) year, 186 (53%) were male, an 185 (52.6%) had cardiac disease. Early epinephrine was administered in 273 (78%), and median time to administration was 1.0 (0.0, 2.0) minute. Survival to discharge was similar between patients who received early epinephrine versus those who did not. Early epinephrine was associated with higher ROSC, a change from baseline to discharge in FSS, lower total FSS scores at discharge, and lower rates of new morbidity compared to epinephrine >2 minutes. The probability of ROSC and survival to discharge with favorable neurologic outcome decreased for each minute of delay in epinephrine. There was no difference in the invasive BP targets during the first 10 minutes of CPR.</p><p><strong>Conclusions: </strong>Early epinephrine was common, associated with higher ROSC and improved functional outcomes compared to epinephrine > 2 minutes in pediatric IHCA.</p>","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144227939","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"SGLT-2 Inhibitors and the Risk of Chronic Obstructive Pulmonary Disease Exacerbations and Mortality in Chronic Obstructive Pulmonary Disease Patients.","authors":"Fu-Shun Yen, James Cheng-Chung Wei, Yu-Han Huang, Tzu-Ju Hsu, Sing-Ting Wang, Chii-Min Hwu, Chih-Cheng Hsu","doi":"10.1513/AnnalsATS.202407-703OC","DOIUrl":"10.1513/AnnalsATS.202407-703OC","url":null,"abstract":"<p><p><b>Rationale:</b> Patients with chronic obstructive pulmonary disease (COPD) are susceptible to acute exacerbations, cardiovascular disease, and premature death. <b>Objectives:</b> To compare the risk of COPD exacerbation, cardiovascular diseases, and mortality between SGLT-2 (sodium-glucose cotransporter-2) inhibitor use and nonuse in patients with type 2 diabetes mellitus (T2DM) and COPD. <b>Methods:</b> The study included 299,168 patients with diagnoses of T2DM and COPD in the National Health Insurance Research Database from January 1, 2009, to December 31, 2020. Cox proportional hazards models were used to examine the relative hazard of the primary outcome (a composite of hospitalization for COPD, noninvasive positive-pressure ventilation [NIPPV], invasive mechanical ventilation, and all-cause mortality) and secondary outcomes: major adverse cardiovascular events, hospitalization for COPD, NIPPV, invasive mechanical ventilation, lung cancer, and mortality between SGLT-2 inhibitor users and nonusers. We used propensity score matching to select 1,288 pairs of SGLT-2 inhibitor users and nonusers. <b>Results:</b> In the matched cohorts, SGLT-2 inhibitor use was associated with a significantly lower risk of the primary outcome (multivariable-adjusted hazard ratio [aHR], 0.79 [95% confidence interval (CI), 0.67-0.93]), NIPPV (aHR, 0.48 [95% CI, 0.27-0.87]), hospitalization for COPD (aHR, 0.82 [95% CI, 0.69-0.98]), and mortality (aHR, 0.64 [95% CI, 0.43-0.95]), than SGLT-2 inhibitor nonuse. Subgroup and dose-response analyses showed that SGLT-2 inhibitor use was associated with a significantly lower risk of mortality, NIPPV, and hospitalization for COPD (<i>P</i> < 0.05) than nonuse of SGLT-2 inhibitors. <b>Conclusions:</b> This population-based cohort study showed that SGLT-2 inhibitor use was associated with a lower risk of the primary outcome, COPD exacerbations, ventilator support, and mortality than SGLT-2 inhibitor nonuse in patients with T2DM and COPD. SGLT-2 inhibitors may have a role in treating patients with COPD and diabetes.</p>","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":"846-854"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143412111","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidence and Predictors of Long-Term Hypnotic Receipt among Patients with Chronic Obstructive Pulmonary Disease.","authors":"Jason M Castaneda, Aristotle Leonhard, Laura J Spece, Kevin I Duan, Brian N Palen, Jessica A Chen, Y Irina Li, Steve Zeliadt, Kevin Josey, Laura C Feemster, David H Au, Lucas M Donovan","doi":"10.1513/AnnalsATS.202407-798OC","DOIUrl":"10.1513/AnnalsATS.202407-798OC","url":null,"abstract":"<p><p><b>Rationale:</b> Many patients with chronic obstructive pulmonary disease (COPD) receive hypnotic prescriptions to mitigate insomnia symptoms. Although clinical practice guidelines advise short-term use, patients often receive these medications on a long-term basis. Because patients with COPD may be more susceptible to adverse effects of hypnotic medication, it is critical that we better understand the incidence and potential influences of this practice. <b>Objectives:</b> To characterize the incidence and predictors of guideline-discordant long-term receipt of hypnotic medications among patients with COPD. <b>Methods:</b> Using nationwide Veterans Health Administration data, we identified patients with clinically diagnosed COPD from 2010 to 2019 without prior hypnotic medication receipt in the previous 1 year. To identify individuals with new hypnotic agent use, we restricted this sample to those who received at least 30 total days of zolpidem, melatonin, trazodone, and/or doxepin within a 90-day period. We defined long-term hypnotic medication receipt as continued availability of one of these hypnotic medications for ≥30 days within the subsequent 90-day period. We then used a mixed-effects logistic regression model to assess patient and site-level associations with long-term receipt. <b>Results:</b> Among 4,262 patients with COPD and new hypnotic medication receipt, 55.6% (<i>n</i> = 2,371) continued to receive hypnotic medications on a long-term basis. Long-term receipt was positively associated with short-acting β-agonist receipt (for every 10% increase in days with short-acting β-agonist availability, odds ratio [OR], 1.03; 95% confidence interval [CI], 1.02-1.05), maintenance inhaler prescriptions (monotherapy, OR, 1.35; 95% CI, 1.10-1.68; dual therapy, OR, 1.43; 95% CI, 1.20-1.70; triple therapy, OR, 1.54; 95% CI, 1.24-1.91), posttraumatic stress disorder (OR, 1.21; 95% CI, 1.02-1.44), major depressive disorder (OR, 1.24; 95% CI, 1.07-1.44), anxiety disorder (OR, 1.21; 95% CI, 1.03-1.44), and more frequent primary care visits (more than five visits in the past 12 mo, OR, 1.86; 95% CI, 1.19-2.90). Long-term receipt was negatively associated with initial receipt of melatonin (OR, 0.70; 95% CI, 0.55-0.91) and more than one pulmonary visit in the previous 12 months (OR, 0.74; 95% CI, 0.56-0.97). <b>Conclusions:</b> Despite guideline recommendations, long-term hypnotic medication receipt is common among patients with COPD. Future work to prevent long-term hypnotic prescriptions should consider the role that respiratory symptoms and mental health comorbidities may have in driving this practice.</p>","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":"863-871"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143412098","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-Term PM_2.5 Exposure and Upregulation of <i>CLCA1</i> Expression in Nasal Epithelium from Youth with Asthma.","authors":"Franziska J Rosser, Molin Yue, Yueh-Ying Han, Erick Forno, Chris Qoyawayma, Michelle L Manni, Edna Acosta-Pérez, Glorisa Canino, Wei Chen, Juan C Celedón","doi":"10.1513/AnnalsATS.202403-309OC","DOIUrl":"10.1513/AnnalsATS.202403-309OC","url":null,"abstract":"<p><p><b>Rationale:</b> Little is known about long-term particulate matter 92.5 μm in aerodynamic diameter (PM_2.5) exposure and airway epithelial gene expression. <b>Objectives:</b> To test for association between long-term PM_2.5 exposure and nasal epithelial gene expression in youth with asthma. <b>Methods:</b> Transcriptome-wide association study (TWAS) of long-term PM_2.5 in nasal epithelium from youth aged 6-20 years in the <i>1</i>) Epigenetic Variation and Childhood Asthma in Puerto Ricans study (<i>n</i> = 182), <i>2</i>) Vitamin D Kids Asthma Study (<i>n</i> = 58), and <i>3</i>) Stress and Treatment Response in Puerto Rican and African American Children with Asthma study (<i>n</i> = 81). Satellite hybrid models were used to estimate PM_2.5 exposure in the prior year at each participant's residence. Multivariable negative binomial regression was used for each TWAS, adjusting for age, sex, and other covariates. A meta-analysis of all TWAS results was then conducted using an inverse variance-weighted average approach. <b>Results:</b> Most participants (∼95%) in the meta-analysis of TWAS for PM_2.5 exposure identified as Puerto Rican or Black. Long-term PM_2.5 was associated with <i>1</i>) upregulated expression of <i>CLCA1</i> (calcium-activated chloride channel regulator 1; false discovery rate-adjusted <i>P</i> [FDR-P] = 0.008), <i>SYCP2</i> (synaptonemal complex protein 2; FDR-P = 0.01), and <i>CYP2A6</i> (cytochrome p450 family 2 subfamily A member 6; FDR-P = 0.02); and <i>2</i>) downregulated expression of <i>EDAR</i> (ectodysplasin A receptor; FDR-P = 0.01). In a meta-analysis, <i>CLCA1</i> upregulation was associated with one or more positive allergen-specific IgE (FDR-P < 0.001) and increased blood eosinophils (FDR-P < 0.001) and total IgE (FDR-P < 0.001). <b>Conclusions:</b> In a meta-analysis of TWASs in predominantly Puerto Rican and Black youth with asthma, long-term PM_2.5 exposure was associated with upregulated airway epithelial <i>CLCA1</i> expression, in turn linked to biomarkers of T2-high immunity.</p>","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":"872-880"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12143435/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141581810","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}