Tag Archive for: Stephen Teach

doctor talking to young girl with asthma

Caregiver language preference is associated with asthma outcomes

doctor talking to young girl with asthma

A team of researchers found that language barriers can contribute to increased asthma-related healthcare utilization including emergency department (ED) visits, hospitalizations and intensive care unit (ICU) visits.

Asthma is one of the most common chronic pediatric diseases, affecting more than 4 million children and accounting for approximately 24% of pediatric hospitalizations nationwide. Asthma disproportionally impacts historically marginalized racial and ethnic minorities in the United States, with these populations experiencing increased unscheduled asthma-related healthcare utilization and worse asthma outcomes. Families that speak languages other than English can experience increased patient safety events and worse outcomes in other disease processes, but limited data exists on the role of caregiver language preference on asthma morbidity.

The big picture

In a study published in Pediatrics, a team of researchers found that language barriers can contribute to increased asthma-related healthcare utilization including emergency department (ED) visits, hospitalizations and intensive care unit (ICU) visits.

“Families who speak languages other than English can experience significant barriers to quality healthcare from how they navigate a complex healthcare system to how they are able to communicate with their healthcare providers and receive timely care,” said Mickey Emmanuel, M.D., a pediatric emergency medicine fellow at Children’s National Hospital and lead author of the study. “Understanding how caregiver language preference contributes to pediatric asthma outcomes is crucial.”

What’s been the hold up in the field?

Prior research has characterized that caregivers with non-English language preference or NELP were less likely to receive education on asthma disease management and to be given asthma action plans in their preferred language or use asthma action plans. To date, limited data exists on the role of caregiver language preference on asthma utilization.

“Future studies utilizing qualitative and quality improvement methodology that puts the family’s needs at the center are key,” says Dr. Emmanuel. “Efforts to reduce asthma-related ED visits and hospitalizations for families who speak languages other than English must focus on understanding the unique barriers that caregivers face in caring for their children with asthma, and on delivering linguistically competent asthma care in the ambulatory and hospital settings.”

What’s next?

“This work has allowed us to identify that caregiver language preference is an important determinant for asthma outcomes and will hopefully fuel additional research focused on improving care for this population,” says Dr. Emmanuel.

From here, Children’s National will continue to work with notable mentors and leaders in the Language Equity space, with a clear commitment toward improving care for this population of patients.

Additional Children’s National researchers include: Rachel Margolis, Ph.D., Ranjodh Badh, B.A., Nikita Kachroo, A.E.-C., Stephen J. Teach, M.D., MPH,  and Kavita Parikh, M.D., MSHS.

Child using inhaler for asthma

Monoclonal antibody reduces asthma exacerbations in urban youth: Q&A with Stephen Teach, M.D.

Child using inhaler for asthmaNew research found that mepolizumab, a monoclonal antibody, decreased asthma flare-ups by 27% in Black and Hispanic children and adolescents who have a severe form of asthma, are prone to asthma attacks, and live in low-income urban neighborhoods.

Stephen Teach, M.D., principal investigator of the IMPACT DC asthma program and co-author of the NIAID-funded Inner City Asthma Consortium-conducted study, offers insight on the importance of this work and what it means for the future of pediatric asthma care at Children’s National Hospital.

What has been the hold-up in this field and how does this work move the field forward?

Urban, Black, and Hispanic children with asthma continue to suffer a disproportionate share of asthma-related morbidity. These findings show that innovative, phenotype-specific therapies are necessary to address their needs.

The study’s investigators were able to document a significant treatment effect in a particularly at-risk population and demonstrated specific gene pathways that were downregulated by treatment with mepolizumab.

What did you find that excites you about this work?

The exciting part of the Inner-City Asthma Consortium’s work has always been that it not only studies whether or not phenotype-driven interventions improve outcomes in high-risk kids, but how those interventions work from a fundamental mechanistic perspective. Those insights drive the science, and the potential clinical applications, forward in an iterative fashion.

How is Children’s National leading in this space?

Investigators from Children’s National continue to be national leaders in developing and testing innovative interventions to address the national disparities in pediatric asthma care and outcomes.

The study, published in the journal The Lancet was co-authored by William Sheehan, M.D., allergist.

The Division of Pulmonary Medicine at Children’s National has been ranked as one of the top ten programs in the nation by U.S. News & World Report.

boy using asthma inhaler

Social determinants of health and asthma morbidity in youth

boy using asthma inhaler

Researchers believe these findings can help develop localized interventions that can improve pediatric asthma in affected communities.

In a study published in the journal Pediatrics, researchers from Children’s National Hospital found that census-tract measures of decreased educational attainment and increased violent crime were associated with increased census-tract rates of pediatric asthma morbidity.

“Knowing these adverse measures of social determinants are associated with increased asthma-related emergency department and hospitalization at-risk rates, may be an opportunity to inform community-based interventions to reduce pediatric asthma morbidity,” says Jordan Tyris, a hospitalist and lead author of the study.

Researchers evaluated data from 15,492 children with asthma, ages 2-17, living in Washington, D.C., from January 2018 to December 2019. The team discovered that living in areas with greater violent crime and less educational achievement were associated with higher rates of hospitalizations and emergency department visits for asthma, in comparison to other social determinants.

The study authors suggest that there may be complex reasons behind this data, noting that violent crime can reflect toxic stress, less education can be associated with less knowledge about health and medicine and that children in these communities may be less likely to have primary care doctors. Researchers believe these findings can help develop localized interventions that can improve pediatric asthma in affected communities and that more research is needed on the drivers of asthma related sickness, including toxic stress, structural racism and access to medical care.

Other study authors include Anand Gourishankar, M.D., Nikita Kachroo AE-C, Stephen Teach, M.D., Kavita Parikh, M.D., all of Children’s National Hospital and Maranda C. Ward, Ed.D., MPH, of George Washington School of Medicine and Health Sciences.

girl with asthma inhaler

Children’s National becomes part of CAUSE Network

girl with asthma inhaler

Seven clinical sites in six different cities will join forces to perform mechanistic and translational studies examining the basic immunology of pediatric asthma among urban, under-resourced and largely minority children and adolescents.

The National Institute of Allergy and Infectious Diseases (NIAID) allocated $10 million in funding to establish the Childhood Asthma in the Urban Setting (CAUSE) network. The NIAID plans to increase this number by $70 million over seven years to support the network. Children’s National Hospital will be part of the new research network, which is a 7-year consortium comprising of seven clinical sites in six different cities that will join forces to perform mechanistic and translational studies examining the basic immunology of pediatric asthma among urban, under-resourced and largely minority children and adolescents.

Children’s National is the home of Improving Pediatric Asthma Care in the District of Columbia (IMPACT DC). The program focuses on research, care and advocacy to decrease asthma morbidity experienced by at-risk youth in the region while serving as a model program for the nation. NIAID gave an initial $3 million to IMPACT DC to conduct its own pilot study of anti-IgE therapy to prevent asthma exacerbations. Additional support for this and other studies will come from subcontracts from the CAUSE Coordinating Center at the University of Wisconsin in Madison.

“This new award allows IMPACT DC to remain part of one of the nation’s most prestigious pediatric asthma research consortia,” said Stephen Teach, M.D, M.P.H., chair for the Department of Pediatrics at George Washington University School of Medicine and Health Sciences. “It will allow us to both pursue an independent research agenda while collaborating with similar academic centers nationwide.”

Pediatric asthma is the most common chronic disease in children, and it is estimated that about 6.1 million children under 18 years suffer from this condition. It disproportionately affects urban, minority and under-resourced children and adolescents.

“It is essential to develop an understanding of the basic immunology of the disease and therapeutic options to ameliorating these disparities,” said Dr. Teach.

CAUSE researchers will explore the mechanisms of immune tolerance to allergens, the role of early environmental exposures in the pathogenesis of asthma, the pathogenesis and mechanisms of non-atopic asthma, the role of the respiratory epithelium in asthma and more.

The CAUSE network comprises of seven clinical research centers, including Children’s National led by principal investigator, Dr. Teach, and the following research centers:

  • Boston Children’s Hospital. Principal investigators: Wanda Phipatanakul, M.D., and Talal Chatila, M.D.
  • Cincinnati Children’s Hospital Medical Center. Principal investigator: Gurjit Khurana Hershey, M.D., Ph.D.
  • Columbia University Health Sciences, New York. Principal investigator: Meyer Kattan, M.D.
  • Icahn School of Medicine at Mount Sinai, New York. Principal investigators: Paula Busse, M.D., Supinda Bunyavanich, M.D., and Juan Wisnivesky, M.D.
  • Lurie Children’s Hospital of Chicago. Principal investigators: Rajesh Kumar, M.D., and Jacqueline Pongracic, M.D.
  • University of Colorado Denver. Principal investigator: Andrew Liu, M.D.
doctor helping child with asthma

New guidelines advance treatment approach for children with asthma

doctor helping child with asthma

Patients with asthma will benefit from new recommendations from a team of national asthma experts.

Patients with asthma will benefit from new recommendations from a team of national asthma experts that includes Stephen Teach, M.D., M.P.H., director and principal investigator of the IMPACT DC Asthma Clinic at Children’s National Hospital. The new guidance, published in the Journal of Allergy and Clinical Immunology, represents the first update to federal comprehensive asthma management and treatment guidelines in more than a decade.

The new recommendations are based on systematic reviews conducted by the Agency for Healthcare Research and Quality, input from National Asthma Education Prevention Program participant organizations and a 19-member expert panel consisting of medical experts and the public.

“The updated guidelines touch on several management issues of critical importance to children, families, and clinicians struggling with the most common chronic disease of childhood,” says Dr. Teach. “Being a part of this expert panel allowed me to advocate for the unique needs of pediatric patients, especially those from under-resourced environments.”

The focused updates provide new guidance for six areas:

  • Using inhaled corticosteroids when needed for recurrent wheezing or persistent asthma.
  • Using long-acting antimuscarinic antagonists (LAMAs) with inhaled corticosteroids for long-term asthma management. A LAMA is a bronchodilator, a medicine that helps to keep airway muscles relaxed.
  • Using allergy shots that contain very small amounts of allergen to treat some people with allergic asthma.
  • Using one or more methods to reduce exposure to indoor asthma triggers.
  • Using a fractional exhaled nitric oxide test to help manage asthma or help confirm a diagnosis in some patients when the diagnosis is unclear. This test involves breathing into a tube connected to a machine that measures the amount of nitric oxide, which can increase when there is airway inflammation.
  • Using bronchial thermoplasty to treat selected adults with persistent asthma. During this procedure heat is used to reduce the muscle around the airways.

“The new and updated recommendations help to better control asthma in children and adolescents through the use of existing medicines, allergy shots and control of environmental triggers,” says Dr. Teach. “Taken together, application of these guidelines will significantly improve care and outcomes for kids of all ages.”

Drs. Dewesh Agrawal, Andrew Dauber, Robert Freishtat, Vittorio Gallo

Four Children’s National Hospital leaders named to APS

Drs. Dewesh Agrawal, Andrew Dauber, Robert Freishtat, Vittorio Gallo

Drs. Dewesh Agrawal, Andrew Dauber, Robert Freishtat and Vittorio Gallo were named as 2021 American Pediatric Society members.

The American Pediatric Society (APS) has announced 55 new members, four of which are experts from Children’s National Hospital. Founded in 1888, the APS is the first and most prestigious academic pediatric organization in North America.

APS members are recognized child health leaders of extraordinary achievement who work together to shape the future of academic pediatrics. New members are nominated by current members through a process that recognizes individuals who have distinguished themselves as child health leaders, teachers, scholars, policymakers and/or clinicians.

“Our members represent the most distinguished and accomplished academic leaders in pediatrics whose outstanding work has advanced child health,” said APS President Steven Abman, M.D. “I am honored to welcome this exceptional group of individuals to the APS. The APS is especially looking forward to the active engagement of our membership with many exciting programs within the organization that are directed towards improvements in academic pediatric medicine, including more vigorous approaches to express our values of anti-racism, equity, diversity and inclusion.”

APS 2021 active new members from Children’s National are:

  • Dewesh Agrawal, M.D., vice-chair for Medical Education at Children’s National. Agrawal’s career has been marked by academic honors and teaching awards at every stage of his training and faculty employment. He has relentlessly devoted his energy to improving the educational experience for students, residents and fellows at Children’s National.
  • Andrew Dauber, M.D., M.M.Sc., chief of Endocrinology at Children’s National. Dr. Dauber’s leadership is reflected, nationally and internationally, in his ability to create research consortia, bringing together investigators to tackle complex questions. For example, he leads an NIH-funded consortium on the genetics of short statures, with multiple top children’s hospitals as partners. He also leads a large clinical trial testing a novel therapeutic agent for genetic short stature.
  • Robert Freishtat, M.D., M.P.H., senior investigator in the Center for Genetic Medicine of the Children’s National Research Institute (CNRI). Dr. Freishtat has authored or co-authored more than 100 articles and book chapters in the fields of pediatric lung injury, asthma, obesity, exosomes and emergency medicine. His research has been continuously funded by the NIH since 2003.
  • Vittorio Gallo, Ph.D., chief research officer at Children’s National and scientific director of CNRI. Dr. Gallo’s scientific success is attested to by over 130 peer-reviewed publications, many in very high-profile journals, as well as over 30 review articles and book chapters. He has received many national and international awards, including the NINDS Javits award in Neuroscience in 2018. Dr. Gallo has served on the editorial boards of many neuroscience journals, including Glia and the Annual Review in Neuroscience, and has been reviewing editor for the Journal of Neuroscience, all of which is a testament to the tremendous impact that his studies have had on the advancement of neurosciences.

“These new members represent multiple areas of Children’s National and have all leveraged the intersection of science, medicine and clinical education to make advances in their field of study,” said Stephen J. Teach, M.D., M.P.H., chair of the Department of Pediatrics at Children’s National. “Their work has, and will continue to, advance pediatric health care, and I congratulate them on their APS membership.”