Division Of Pulmonology Research Articles

Pulmonary hypertension within individuals suffering from chronic obstructive pulmonary disease.

Objective: To establish the frequency in regards to pulmonary hypertension within individuals suffering from chronic obstructive pulmonary disease. Study Design: Cross-sectional study. Setting: Pulmonology Division of Jinnah Hospital Lahore. Period: January, 2023 to April, 2023. Material & Methods: A total of 200 patients of both male and female patients with age from 40 to 70 years having chronic obstructive pulmonary disease were included by nonprobability consecutive sampling. Patients with history of other respiratory disease like interstitial lung disease, bronchiectasis, allergic broncho-pulmonary aspergillosis (ABPA), sarcoidosis, occupational lung diseases, asthma, ischemic heart disease, pulmonary hypertension, collagen vascular disease were factored out of the study. Cardiac echocardiography was performed in all the patients and pulmonary hypertension as assessed. Results: In this study, 87 (43.5%) were between 40-55 years of age while 113 (56.5%) were within the ages of 56-70, and thus the mean age was 57.28±8.44 years. 131 (65.5%) patients were male and 69 (34.5%) were females. 49 (24.5%), 103 (51.5%) and 48 (24%) patients had mild, moderate and severe COPD respectively. Pulmonary hypertension was found in 105 (52.5%) patients. Pulmonary hypertension is more prevalent in severe cases of COPD than mild and moderate patients with p-value = 0.0001. Conclusion: Patients with chronic obstructive lung disease have a high prevalence of pulmonary hypertension. This is shown to be more common within patients suffering from severe cases of COPD.

Short comparison of talc poudrage and tetracycline pleurodesis within patients suffering from malignant pleural effusion.

Objective: To compare talc poudrage and tetracycline pleurodesis within patients suffering from malignant pleural effusion. Study Design: Controlled Clinical Trial. Setting: Division of Pulmonology, Jinnah Hospital Lahore. Period: September, 2022 up until May, 2023. Material & Methods: 100 individuals, both male and female, ranging in age from 20 to 80 years, diagnosed with malignant pleural effusion confirmed on biopsy were included by nonprobability consecutive sampling. Patients with active pleural infection, hemodynamic instability, systemic infection, serum hematocrit < 25%, hemothorax, chylothorax, multiple etiologies of pleural effusion, prior chemical pleurodesis, sensitivity to study drugs, life expectancy < 1 month, pregnancy and chest X-ray displaying trapped lung post chest tube drainage on the affected side were excluded. The patients were allocated into two groups at random using a lottery system. In group 1, patients received pleurodesis with talc poudrage and in group 2, patients received pleurodesis alongside tetracycline. Success was assessed after 4 weeks of pleurodesis. Results: In this study, mean age in talc group was 58.94±13.6 years and in tetracycline group it was 59.26±13.7 years.65% patients were male and 35% were females.Success was 94% in talc group and 76% in tetracycline group with p-value = 0.012. In terms of adverse effects, there is no statistically significant difference between the two groups. Conclusion: Talc pleurodesis has a higher success rate than the tetracycline pleurodesis. Talc pleurodesis also has less adverse effects than tetracycline pleurodesis.

The utility of chest ultrasound-guided fine-needle biopsy in the diagnosis of plasmacytoma.

Plasmacytoma is a plasma cell dyscrasia originating from a single clone of plasma cells of B-lymphocyte lineage and produces a monoclonal immunoglobulin. Transthoracic fine-needle aspiration (TTNA) under ultrasound (US) guidance is a well-validated technique for the diagnosis of many neoplasms and has been shown to be safe and cost effective, with diagnostic yields comparable to more invasive techniques. However, the role of TTNA in the diagnosis of thoracic plasmacytoma is not well established. The aim of this study was to assess the utility of TTNA and cytology in confirming a diagnosis of plasmacytoma. All cases of plasmacytoma diagnosed from January 2006 to December 2017 by the Division of Pulmonology, Tygerberg Hospital, were retrospectively identified. All patients who underwent an US-guided TTNA and of whose clinical records could be retrieved were included in this cohort. The International Myeloma Working Group's definition of a plasmacytoma was used as the gold standard. A total of 12 cases of plasmacytoma were identified and 11 patients included (one patient was excluded owing to missing medical records). Six of the 11 patients (mean age 59.5 ± 8.5 years) were male. Radiologically, most had multiple lesions (n=7), most commonly bony (n=6) with vertebral body involvement (n=5) and pleural-based lesions (n=2). Rapid onsite evaluation (ROSE) was performed and documented in 6 of the 11 cases, and a provisional diagnosis of plasmacytoma was suggested in 5 of the 6 patients (83.3%). The final laboratory cytological diagnoses of all 11 cases were compatible with plasmacytoma which was further confirmed via a bone marrow biopsy (n=4) and by serum electrophoresis (n=7). US-guided fine-needle aspiration is feasible and is useful to confirm a diagnosis of plasmacytoma. Its minimally invasive nature may be the ideal investigation of choice in suspected cases.

Pediatric Research Challenge, Alignment with the National Research Agenda

Pediatric Research Challenge, Alignment with the National Research Agenda

The future of pediatric pulmonology: A survey of division directors, assessment of current research funding, and discussion of workforce trends.

In 2018-2020, The American Thoracic Society's Pediatric Pulmonology Division Directors Association (PPDDA) and Pediatric Pulmonology Training Directors Association (PEPTDA) convened a series of workshops to analyze workforce issues from the perspectives of current leaders within the discipline. In this, the report from the 3rd workgroup, we examine future workforce issues from several perspectives. We describe a PPDDA survey regarding current state and future needs of the discipline; an assessment of the current NIH research funding portfolio for major children's respiratory disorders; and an estimate of workforce trends in training, based mainly on ABP data. We conclude that current fellowship graduation rates appear to be sufficient to maintain and even grow the total number of pulmonologists, but demand for pediatric pulmonologists may still be greater than supply, and there are geographical disparities in access to care. New treatments for CF, growth of hospitalist services, care of technology dependent children, and multidisciplinary care for complex chronic disease, will likely change our practice over the next 10 years. Research funding appears to be robust for asthma, CF, BPD, microbiome, and pulmonary hypertension, compared to other chronic respiratory disorders. Few of these grants are led by pediatric pulmonologists. Thus, our discipline needs to adjust our training of fellows and junior faculty to take advantage of existing funding opportunities as well as advocate for greater funding for the other disorders we manage. Finally, we highlight opportunities for the discipline to enhance its roles in addressing emerging respiratory pathogens and expanding the diversity of its workforce. This article is protected by copyright. All rights reserved.

Pediatric Resident Education in Pulmonary (PREP): A Subspecialty Preparatory Boot Camp Curriculum for Pediatric Residents.

IntroductionMedical errors can occur any time resident physicians transition between rotations, especially to unfamiliar areas such as subspecialty pediatrics. To combat this, we created and implemented the pediatric resident education in pulmonary (PREP) boot camp using Kern's six-step approach to curriculum development.MethodsPREP was a 5-hour session with multiple high-yield components held on the first day of each new rotation, aimed to prepare residents to care for complex pulmonary inpatients, including those with tracheostomy and ventilator dependence, asthma, and cystic fibrosis. The curriculum was evaluated at multiple time points through surveys of residents and faculty and two formal resident focus group sessions.ResultsPREP was successfully implemented in July 2018 with continued monthly sessions held. Thirty-five residents participated in the first year. Resident perceived preparedness and confidence in taking call duties increased significantly following PREP. All residents rated PREP as extremely helpful or very helpful, the highest ratings possible. Overall, residents preferred active learning strategies. All qualitative data revealed positive effects of PREP. Clinical faculty in the pulmonology division found PREP similarly helpful and felt that PREP better prepared residents to provide care to pulmonary inpatients than our previous model.DiscussionOur monthly preparatory boot camp on the first day of residents’ inpatient pulmonary rotation has improved resident experience, preparedness, and ability to care for complex pulmonary patients. The curriculum was adjusted in response to feedback to increase hands-on time and interactive sessions. Protected time for residents and active learning strategies were key to success of PREP.

A statement on the current status and future needs of the pediatric pulmonology workforce: Pipeline Workgroup.

There is growing concern that current trends in pediatric pulmonology will lead to a workforce shortage resulting in patients having difficulty accessing subspecialty care. As part of the Pediatric Pulmonology Division Directors Association and Pediatric Pulmonary Training Directors Association Workforce Summit, we examined factors affecting the recruitment of learners into pediatric pulmonary fellowship training (PPFT) programs. The goal of our workgroup was to describe these issues and develop a plan to increase the pipeline of learners who ultimately pursue PPFT. Specifically, we summarize factors that impact decisions to undertake PPFT, describe existing initiatives to enhance recruitment, and propose future strategies to increase early career learner interest.

Collateral effects of the coronavirus disease 2019 pandemic on lung cancer diagnosis in Korea

BackgroundThe COVID-19 pandemic is predicted to significantly affect patients with lung cancer, owing to its rapid progression and high mortality. Studies on lung cancer diagnosis and treatment during an epidemic are lacking. We analyzed the impact of COVID-19 on lung cancer diagnosis in Korea, where lung cancer incidence continues to rise.MethodsThe number of newly diagnosed lung cancer cases in three university-affiliated hospitals during the pandemic and their clinical features were compared with lung cancer cases diagnosed during the same period in the past 3 years. The effectiveness of measures taken by the study hospitals to prevent nosocomial transmission was reviewed.ResultsA total of 612 patients were diagnosed with lung cancer from February through June, 2017–2020. During the pandemic, the number of patients who sought consultation at the division of pulmonology of study hospitals dropped by 16% from the previous year. Responding to the pandemic, the involved hospitals created physically isolated triage areas for patients with acute respiratory infection symptoms. Wide-range screening and preventive measures were implemented, thus minimizing the delay in lung cancer diagnosis. No patient acquired COVID-19 due to hospital exposure. The proportion of patients with stage III–IV non-small-cell lung cancer (NSCLC) significantly increased (2020: 74.7% vs. 2017: 57.9%, 2018: 66.7%, 2019: 62.7%, p = 0.011). The number of lung cancers diagnosed during this period and the previous year remained the same.ConclusionsThe proportion of patients with advanced NSCLC increased during the COVID-19 pandemic.

Clinical T category for lung cancer staging: A pragmatic approach for real-world practice.

BackgroundTo determine which components should be measured and which window settings are appropriate for computerized tomography (CT) size measurements of lung adenocarcinoma (ADC) and to explore interobserver agreement and accuracy according to the eighth edition of TNM staging.MethodsA total of 165 patients with surgically resected lung ADC earlier than stage 3A were included in this study. One radiologist and two pulmonologists independently measured the total and solid sizes of components of tumors on different window settings and assessed solidity. CT measurements were compared with pathologic size measurements.ResultsIn categorizing solidity, 25% of the cases showed discordant results among observers. Measuring the total size of a lung adenocarcinoma predicted pathologic invasive components to a degree similar to measuring the solid component. Lung windows were more accurate (intraclass correlation [ICC] = 0.65–0.81) than mediastinal windows (ICC = 0.20–0.72) at predicting pathologic invasive components, especially in a part‐solid nodule. Interobserver agreements for measurement of solid components were good with little significant difference (lung windows, ICC = 0.89; mediastinal windows, ICC = 0.91). A high level of interobserver agreement was seen between the radiologist and pulmonologists and between residents (from the division of pulmonology and critical care) versus a fellow (from the division of pulmonology and critical care) on different windows.ConclusionsA considerable percentage (25%) of discrepancies was encountered in categorizing the solidity of lesions, which may decrease the accuracy of measurements. Lung window settings may be superior to mediastinal windows for measuring lung ADCs, with comparable interobserver agreement and moderate accuracy for predicting pathologic invasive components.Key pointsSignificant findings of the study Lung window settings are better for evaluating part‐solid lung adenocarcinoma (ADC), with comparable interobserver agreement and moderate accuracy for predicting pathologic invasive components. The considerable percentage (25%) of discrepancies in categorizing solidity of the lesions may also have decreased the accuracy of measurements. What this study adds For accurate measurement and categorization of lung ADC, robust quantitative analysis is needed rather than a simple visual assessment.

The history of workforce concerns in pediatric pulmonary Medicine.

Children are affected by a broad spectrum of acute and chronic respiratory disorders. The number of children with respiratory disease is increasing, as are the complexity of disease pathophysiology and the management demands on pediatric pulmonologists. Despite slowly increasing numbers of board-certified pediatric pulmonologists, large areas of the country are underserved and there is a perception of an impending workforce crisis. There are multiple reasons for these concerns. A joint effort between the Pediatric Pulmonology Division Directors Association and Pediatric Pulmonary Training Directors Association was undertaken to address these issues.

Calcineurin Inhibitors in COVID-19: Lessons Learnt from Transplantation Medicine

René Hage1,2*, Carolin Steinack1,2 and Macé M Schuurmans1,2 Author Affiliations 1University Hospital Zurich, Division of Pulmonology, Switzerland 2University of Zurich, Faculty of Medicine, Switzerland Received: July 25, 2020 | Published: August 10, 2020 Corresponding author: René Hage, University Hospital Zurich, Division of Pulmonology, Faculty of Medicine, Switzerland DOI: 10.26717/BJSTR.2020.29.004802

The impact of age at presentation on lung cancer staging.

Background Primary lung cancer is one of the most common causes of cancer and of death due to cancer worldwide. The tumour node metastases staging for non-small-cell lung cancer (NSCLC) helps to prognosticate and plan for treatment. Most patients have advanced disease at the time of diagnosis. Primary lung malignancy was previously diagnosed mostly in older individuals. Objectives The primary aim of this study was to determine whether younger age at presentation is a risk factor for more advanced disease. We defined younger age as <45 years. Methods This was a retrospective analytical study covering 5.5 years. The information was obtained from the lung cancer registry of all patients presented at our Division of Pulmonology weekly combined oncology meeting. Results A total of 52 of 1 083 patients with lung malignancy were <45 years, and 48 of these had NSCLC. Adenocarcinoma was the predominant type (48%), followed by squamous cell carcinoma (27%), NSCLC not otherwise specified (NOS; 21%) and large-cell carcinoma (4%). Overall, the majority of patients (98%) had advanced disease at presentation. However, there was no statistical difference compared with presenting stage in older patients (odds ratio 0.25, 95% confidence interval (CI) 0.034 - 1.874 and risk ratio 0.27 (95% CI (0.038 - 1.900)). Conclusion Primary lung malignancy remains a disease of the elderly. This study demonstrated that NSCLC tends to present in advanced stages in younger patients, although the difference was not statistically significant.

Propofol versus Fentanyl for Sedation in Pediatric Bronchoscopy: A Randomized Controlled Trial

To compare propofol and fentanyl to induce conscious sedation in children undergoing flexible bronchoscopy. Randomized controlled trial. Pediatric Pulmonology division at a tertiary care center in Delhi, India. Children aged 3-15 years who underwent flexible bronchoscopy. Children received either intravenous propofol 1 mg/kg administered as a slow bolus over 1 minute followed by 2 mg/kg/hour infusion, or intravenous Fentanyl 2 µg/kg administered as a slow bolus over one minute. Primary outcome was time to achieve conscious sedation (Ramsay score 3). Secondary outcomes were need for adjuvant midazolam, physician satisfaction, level of cough, recovery features, and side-effects in the groups. 53 children (propofol 27, fentanyl 26) were enrolled in the study. The mean (SD) time taken to achieve Ramsay score 03 was lower in propofol than fentanyl [15.7 (4.4) s vs 206 (55) s, P<0.001]. Propofol arm had significantly higher physician satisfaction, less requirement of adjuvant midazolam, less coughing and faster regain of full consciousness. There was no difference in drug side-effects between the groups. Propofol has a shorter sedation induction time, less coughing during procedure, less recovery time, and better physician satisfaction compared to fentanyl for flexible bronchoscopy in children.

Evaluation of the knowledge and correct use of metered-dose inhalers by healthcare professionals and medical students in Gauteng Province

Background. The Global Initiative for Asthma (GINA) estimates that South Africa (SA) has over 3.9 million asthma sufferers, of whom 1.5% die of the condition annually. SA has the world’s fourth highest asthma death rate among 5 - 35-year-olds. Chronic obstructive pulmonary disease (COPD) will be the third leading cause of death globally by 2030, and will surpass HIV/AIDS in Africa. Uncontrolled asthma and COPD are frequent causes of emergency department visits and hospital admissions. Poor metered-dose inhaler (MDI) technique is probably a major contributory cause. It is the responsibility of all treating doctors and healthcare professionals to educate patients on inhaled therapy with the correct MDI technique, as well as to routinely check and repeatedly demonstrate the technique to them. Objectives. This study evaluated study participants’ knowledge of MDI technique, and their compliance in checking and demonstrating MDI use to patients prescribed inhaled therapy. The study participants included doctors, nurses and final-year medical students at Helen Joseph Hospital and Chris Hani Baragwanath Academic Hospital, in the Departments of Internal Medicine and Emergency Medicine, and the Division of Pulmonology. Methods. A total of 195 study participants volunteered to take part in the study. A questionnaire was administered to participants to gauge their perceptions, level of knowledge and understanding of MDI technique. They were then requested to demonstrate correct inhaler technique via a placebo MDI. Participants’ use of a placebo MDI was evaluated by a scoring system. Results. The total sample of 195 comprised 130 (67%) female and 65 (33%) male participants. Of these, 133 (68%) were qualified medical staff, and 62 were final-year medical students. Only 32 (16%) could demonstrate correct MDI technique. Over 50% of participants did not demonstrate MDI technique to patients, or check their patients’ technique at every hospital-related visit. Conclusion. Healthcare professionals and final-year medical students have poor knowledge of inhaler technique and are ill-prepared to teach patients. Also of concern is that the majority do not routinely demonstrate or observe patients’ inhaler technique.

THE NINTH FORUM OF THE EUROPEAN &amp; DEVELOPING COUNTRIES CLINICAL TRIALS PARTNERSHIP

THE NINTH FORUM OF THE EUROPEAN &amp; DEVELOPING COUNTRIES CLINICAL TRIALS PARTNERSHIP

The economic impact of a nurse practitioner–directed lung cancer screening, incidental pulmonary nodule, and tobacco-cessation clinic

ObjectiveLung cancer screening programs have become increasingly prevalent within the United States after the National Lung Screening Trial results. We aimed to review the financial impact after programmatic implementation of Advanced Registered Nurse Practitioner–led programs of Lung Cancer Screening and Tobacco Related Diseases, Incidental Pulmonary Nodule Clinic, and Tobacco Cessation Services. MethodsWe reviewed revenue from 2013 to 2016 by our nurse practitioner–led program. Encounters were queried for charges related to outpatient evaluation and management, professional procedures, and facility charges related to both outpatient and inpatient procedures. Revenue was normalized using 2016 data tables and the national Medicare conversion factor (35.8043). ResultsOur program evaluated 694 individuals, of whom 75% (518/694) are enrolled within the lung cancer–screening program. Overall revenue associated with the programs was $733,336. Outpatient evaluation and management generated revenue of $168,372. In addition, professional procedure revenue accounted for an additional $60,015 with facility revenue adding an additional $504,949. ConclusionsA nurse practitioner–led program of lung cancer screening, incidental pulmonary nodules, and tobacco-cessation services can provide additional revenue opportunities for a Thoracic Surgery and Interventional Pulmonology Division, as well as a health care system. The current national, median annual wage of a nurse practitioner is $98,190, and the cost associated directly to their salary (and benefits) may remain neutral or negative within certain programs. However, the larger economic benefit may be realized within the division and institution. This potential additional revenue appears related to evaluation of newly identified diseases and subsequent evaluations, procedures, and operations.

Serum C - Reactive Protein Level and Peripheral Blood Picture in Children with Pneumonia

This cross sectional study aimed to determine the relation between serum C-reactive protein (CRP) levels and peripheral blood picture in children with bronchopneumonia, conducted at the Division of Pulmonology, Sanglah Hospital, Denpasar during 3 months (December 1996 to February 1997). Serum CRP levels, hemoglobin, leukocyte count, neutrophil count and ESR values in 30 cases between 1 month and 4.5 years (20 male and 10 female) were measured. Bronchopneumonia was mostly found in &lt; 1 year old (67%) and with male to female ratio of 2:1. High CRP serum level (&gt;12 microgram/ml) was found in 33% of 30 cases. Anemia was found in 37%, leukocytosis in 50%, increase segment neutrophil ratio in 30%, increase of ESR in 40% and increase of body temperature more than 38°C in 4 7% of the cases. Neutrophilia, increase of ESR and increase of body temperature were found statistically significant difference between the positive CRP and negative CRP group. Most bronchopneumonia patients in this study were probably caused by non bacteria. Neutrophilia, higher ESR and higher body temperature could be used as an indicator of bacterial infection besides the increase of serum CRP levels.

Fhit, a tumor suppressor protein, induces autophagy via 14-3-3τ in non-small cell lung cancer cells.

Inactivation of the fragile histidine triad (Fhit) gene has been reported in the majority of human cancers, particularly in lung cancer. The role of Fhit as a tumor suppressor gene has been well documented, and restoration of Fhit expression suppresses tumorigenicity in tumor cell lines and in mouse models by inducing apoptosis and inhibiting proliferation of tumor cells. Autophagy is a catabolic pathway, whereby cytoplasmic proteins and organelles are sequestered in vacuoles and delivered to lysosomes for degradation and recycling. Although autophagy is necessary for cell survival under stress conditions, recent studies have shown that autophagy can also promote cell death. Due to the fact that both autophagy induction and Fhit expression are commonly associated with nutrient starvation, we hypothesized that Fhit expression may be related to autophagy induction. In the present study, we assessed whether Fhit overexpression by gene transfer induces autophagy in Fhit-deficient non-small cell lung cancer (NSCLC) cells. The results of our study indicate that Fhit protein induces autophagy in NSCLC cells, and that this autophagy prevents apoptotic cell death in vivo and in vitro in a 14-3-3τ protein-dependent manner. To the best of our knowledge, this is the first report to describe Fhit-induced autophagy. Suppressing autophagy might be a promising therapeutic option to enhance the efficacy of Fhit gene therapy in NSCLC.

A Clinical System Integration Methodology for Bio-Sensory Technology with Cloud Architecture

Here, we outline the design, implementation, testing and evaluation phases of our bi-directional semantic and syntactic interoperability framework interconnecting traditional healthcare, industrial telemedicine and IoT wearable eHealth-domains. Specifically, our study demonstrates system interoperability among a hospital information system, an industrial telemedicine instrument and an eHealth smart wearable consumer electronic product through the Open Telemedicine Interoperability Hub (OTI-Hub) embedded in a hybrid Cloud architecture. The novelty of this study is the handling of Internet-ofThingssmart healthcare devices and traditional healthcare devices through the same Cloud-based solution. This healthcare interoperability solution, service architecture and corresponding software engineering technique bridges technology barriers among the above-mentioned healthcare segments. Standard interoperability solutions exist and have already been described in related literature, but they are not applicable to the IoT healthcare devices and vice versa. Our study goes beyond isolated, individual interoperability solutions and seeks to bridge all major healthcare architecture frameworks including classical, telemedicine and eHealth IoT applications and appliances. This study presents the results of a two-year OTI-Hub Research Program. These experiments are manifestations of a trilateral cooperation among the University of Debrecen, Faculty of Informatics, the Semmelweis University 2nd Department of Paediatrics Pulmonology Division and an international hospital information system service provider.

An Analysis of Obesity and Asthma Morbidity in Patients Managed at the Children's Hospital at Montefiore's Asthma Center

S A T U R D A Y Gary K. Soffer, MD, Jennifer Toh, MD, Sunit P. Jariwala, MD, Deepa Rastogi, MD; Children’s Hospital at Montefiore, Bronx, NY, Albert Einstein/Montefiore Medical Center, Bronx, NY, Division of Allergy and Immunology, Department of Medicine, Montefiore Medical Center, Bronx, NY, Division of Pulmonology, Children’s Hospital at Montefiore. RATIONALE: Previous studies suggest a relationship between obesity and childhood asthma. We investigated the impact of body weight and clinic visit compliance on asthma morbidity. METHODS: We reviewed 45 charts of children with moderate to severe persistent asthma seen at the Montefiore Asthma Center (MAC), a multidisciplinary center comprised of Allergy, Pulmonary, and Asthma Education services. Patients had 1 or more asthma-related emergency department (ED) visit or hospitalization or 3 ormore steroid courses within 12months of their first visit. Patients were categorized as obese/overweight (n524) and normal-weight (n521), based on CDC guidelines. Betweengroup comparisons were done for compliance with MAC appointments, asthma-related hospitalizations, and ED visits one year following the patient’s last visit. Compliance was defined as 3 MAC visits. RESULTS: Most patients lived in the Bronx (82%), were of minority ethnicities (37% Latino, 35% African-American) and were obese/overweight (53%). Visit compliance was similar between both groups (50% obese/overweight vs 48% normal-weight.). However, more obese/overweight patients (45%)were hospitalized the year following their last visit than normal-weight children (28%) with more hospitalizations than normal-weight children (12 vs 2, p50.05). Similarly, 50% of obese/ overweight patients had asthma-related ED visits the year following their last visit compared to 23% of normal-weight children with more ED visits than normal-weight children (30 vs 10, p 5 0.045). CONCLUSIONS: In spite of being compliant with asthma center evaluations, obese and overweight patients had more asthma-related ED visits and hospitalizations, suggesting continued higher asthma morbidity. This relationship requires further investigation as it may imply that obesity interventions might play a substantive role in asthma management.