Christopher H Goss

Seattle Children’s Research Institute, Seattle, Washington, United States

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Publications (104)687.36 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Treatment of pulmonary exacerbations (PEx) in cystic fibrosis (CF) varies widely with no consensus on management practices or best indicators of therapeutic success. To design trials evaluating PEx treatment factors, we characterise the heterogeneity of PEx care in adults and paediatrics, and correlate it with measures of clinical response including short-term and long-term lung function changes, change in symptom severity score and time to next intravenous antibiotic therapy. Data were used from a prospective observational study of patients with CF ≥10 years of age enrolled at six sites between 2007 and 2010. All were started on intravenous antibiotics for a clinically diagnosed PEx. Analysis of variance, logistic and Cox regression were used to examine the association of treatment factors with short-term and long-term clinical response. Of 123 patients with CF (60% women, aged 23.1±10.2 years), 33% experienced <10% relative improvement in FEV1 during treatment, which was associated with failing to recover baseline lung function 3 months after treatment (OR=7.8, 95% CI 1.9 to 31.6, p=0.004) and a longer time to next intravenous antibiotic (HR=0.48, 95% CI 0.27 to 0.85, p=0.011). Symptom improvement was observed but was not associated with subsequent lung function or time to next antibiotic therapy, which had a median recurrence time of 143 days. Immediate symptomatic or respiratory response to PEx treatment did not have a clear relationship with subsequent outcomes such as lung function or intravenous antibiotic-free interval. These results can inform future research of treatment regimens for PEx in terms of interventions and outcome measures. NCT00788359 ( Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to
    Thorax 04/2015; DOI:10.1136/thoraxjnl-2014-206750 · 8.56 Impact Factor
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    ABSTRACT: The extent to which sweat chloride concentration predicts survival and clinical phenotype independently of CFTR genotype in cystic fibrosis is not well understood. We analyzed the US Cystic Fibrosis Foundation Patient Registry data using Cox regression to examine the relationship between sweat chloride concentration (<60, 60-<80, ≥80mmol/L), CFTR genotype (high and lower risk for lung function decline), and survival and mixed linear regression to examine the relationship between sweat chloride, CFTR genotype, and measures of lung function and growth. When included in the same model, CFTR genotype, but not sweat chloride, was independently associated with survival and with lung function, height, and BMI. Among patients with unclassified CFTR genotype, sweat chloride was an independent predictor of survival (<60 HR 0.53 [0.37, 0.77], 60-<80 0.51 [0.42, 0.63]). Sweat chloride concentration may be a useful predictor of mortality and clinical phenotype when CFTR genotype functional class is unclassified. Copyright © 2015 European Cystic Fibrosis Society. Published by Elsevier B.V. All rights reserved.
    Journal of cystic fibrosis: official journal of the European Cystic Fibrosis Society 02/2015; DOI:10.1016/j.jcf.2015.01.005 · 3.82 Impact Factor
  • Bradley S Quon, Christopher H Goss
    American Journal of Respiratory and Critical Care Medicine 01/2015; 191(1):4-5. DOI:10.1164/rccm.201411-2089ED · 11.99 Impact Factor
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    ABSTRACT: Studies seeking to estimate the burden of influenza among hospitalized adults often use case definitions that require presence of pneumonia. The goal of this study was to assess the extent to which restricting influenza testing to adults hospitalized with pneumonia could underestimate the total burden of hospitalized influenza disease. We conducted a modelling study using the complete State Inpatient Databases from Arizona, California, and Washington and regional influenza surveillance data acquired from CDC from January 2003 through March 2009. The exposures of interest were positive laboratory tests for influenza A (H1N1), influenza A (H3N2), and influenza B from two contiguous US Federal Regions encompassing the study area. We identified the two outcomes of interest by ICD-9-CM code: respiratory and circulatory hospitalizations, as well as critical illness hospitalizations (acute respiratory failure, severe sepsis, and in-hospital death). We linked the hospitalization datasets with the virus surveillance datasets by geographic region and month of hospitalization. We used negative binomial regression models to estimate the number of influenza-associated events for the outcomes of interest. We sub-categorized these events to include all outcomes with or without pneumonia diagnosis codes. We estimated that there were 80,834 (95% CI 29,214-174,033) influenza-associated respiratory and circulatory hospitalizations and 26,760 (95% CI 14,541-47,464) influenza-associated critical illness hospitalizations. When a pneumonia diagnosis was excluded, the estimated number of influenza-associated respiratory and circulatory hospitalizations was 24,816 (95% CI 6,342-92,624). The estimated number of influenza-associated critical illness hospitalizations was 8,213 (95% CI 3,764-20,799). Around 30% of both influenza-associated respiratory and circulatory hospitalizations, as well as influenza-associated critical illness hospitalizations did not have pneumonia diagnosis codes. Surveillance studies which only consider hospitalizations that include a diagnosis of pneumonia may underestimate the total burden of influenza hospitalizations.
    PLoS ONE 11/2014; 9(11):e113903. DOI:10.1371/journal.pone.0113903 · 3.53 Impact Factor
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    ABSTRACT: Obese patients with Idiopathic Pulmonary Fibrosis (IPF) have a higher 90-day mortality after lung transplantation. We sought to investigate whether body mass index (BMI) differentially modified the effect of transplant procedure type on 90-day mortality in IPF patients. We analyzed data from the Organ Procurement and Transplantation Network (OPTN) for all patients with IPF who were transplanted between 2000-2010. Post-transplant survival was examined using Kaplan Meier estimates. Multivariable logistic regression modeling was used to determine the difference in 90-day survival. The primary variable of interest was the interaction term between BMI and transplant type. A total of 3,389 (58% single lung transplant [SLT]; 42% bilateral lung transplant) [BLT]) subjects were included. Multivariable logistic regression modeling demonstrated a statistically significant interaction between BMI and transplant type (p=0.047). Patients with a BMI>30 kg/m2 who received a BLT are 1.71 times (95% CI [1.03, 2.85], p=0.038) more likely to die within 90-days than BLT recipients with a BMI of 18.5-30 kg/m2. Our results suggest that obese patients who receive a BLT may be at higher risk of 90-day mortality compared to patients of normal weight. Future studies that evaluate more detailed information about co-morbidities and other risk factors for early death not included in the OPTN database are warranted.
    The Journal of Heart and Lung Transplantation 09/2014; 34(2). DOI:10.1016/j.healun.2014.09.031 · 5.61 Impact Factor
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    ABSTRACT: People with cystic fibrosis (CF) are managed differently in the USA and UK providing an opportunity to learn from differences in practice patterns.
    Thorax 09/2014; 70(3). DOI:10.1136/thoraxjnl-2014-205718 · 8.56 Impact Factor
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    ABSTRACT: Influenza is the most common vaccine-preventable disease in the United States; however, little is known about the burden of critical illness due to influenza virus infection. Our primary objective was to estimate the proportion of all critical illness hospitalizations that are attributable to seasonal influenza.
    Critical Care Medicine 08/2014; 42(11). DOI:10.1097/CCM.0000000000000545 · 6.15 Impact Factor
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    ABSTRACT: Background: Advances in treatments for cystic fibrosis (CF) continue to extend survival. An updated estimate of survival is needed for better prognostication and to anticipate evolving adult care needs. Objective: To characterize trends in CF survival between 2000 and 2010 and to project survival for children born and diagnosed with the disease in 2010. Design: Registry-based study. Setting: 110 Cystic Fibrosis Foundation-accredited care centers in the United States. Patients: All patients represented in the Cystic Fibrosis Foundation Patient Registry (CFFPR) between 2000 and 2010. Measurements: Survival was modeled with respect to age, age at diagnosis, gender, race or ethnicity, F508del mutation status, and symptoms at diagnosis. Results: Between 2000 and 2010, the number of patients in the CFFPR increased from 21 000 to 26 000, median age increased from 14.3 to 16.7 years, and adjusted mortality decreased by 1.8% per year (95% CI, 0.5% to 2.7%). Males had a 19% (CI, 13% to 24%) lower adjusted risk for death than females. Median survival of children born and diagnosed with CF in 2010 is projected to be 37 years (CI, 35 to 39 years) for females and 40 years (CI, 39 to 42 years) for males if mortality remains at 2010 levels and more than 50 years if mortality continues to decrease at the rate observed between 2000 and 2010. Limitations: The CFFPR does not include all patients with CF in the United States, and loss to follow-up and missing data were observed. Additional analyses to address these limitations suggest that the survival projections are conservative. Conclusion: Children born and diagnosed with CF in the United States in 2010 are expected to live longer than those born earlier. This has important implications for prognostic discussions and suggests that the health care system should anticipate greater numbers of adults with CF.
    Annals of internal medicine 08/2014; 161(4):233-241. DOI:10.7326/M13-0636 · 16.10 Impact Factor
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    ABSTRACT: Bringing new therapies to patients with rare diseases depends in part on optimizing clinical trial conduct through efficient study start-up processes and rapid enrollment. Suboptimal execution of clinical trials in academic medical centers not only results in high cost to institutions and sponsors, but also delays the availability of new therapies. Addressing the factors that contribute to poor outcomes requires novel, systematic approaches tailored to the institution and disease under study.
    Journal of General Internal Medicine 07/2014; DOI:10.1007/s11606-014-2896-8 · 3.42 Impact Factor
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    ABSTRACT: Objective To examine the prevalence of symptoms of depression and anxiety among patients with cystic fibrosis (CF) followed at the University of Washington Adult CF Clinic and to identify sociodemographic and clinical factors associated with symptoms. Methods 178 CF adults were asked to complete the Patient Health Questionnaire-9 (PHQ-9) for depression and General Anxiety Disorder-7 (GAD-7) for anxiety when clinically stable. Clinically significant symptoms of depression and anxiety were defined in two ways: 1) symptom definition: presence of moderate-to-severe symptoms based on the questionnaires; 2) composite definition: symptom definition or the use of psychiatric medications to manage symptoms. Associations between PHQ-9 and GAD-7 scores with sociodemographic (gender, age, age of CF diagnosis, vocation, spousal status) and clinical factors (forced expiratory volume in 1 second (FEV1), body mass index, CF-related diabetes on insulin) were examined. Results 153 of 178 (85%) patients completed the screening questionnaires. Based on the symptom definition, 7% of patients had symptoms of depression and 5% had symptoms of anxiety. Using the composite definition, 22% of patients had symptoms of depression and 10% had symptoms of anxiety. Based on the PHQ-9, 5% of patients reported suicidal thoughts. In multiple linear regression analysis, only FEV1% predicted was independently associated with PHQ-9 depression scores and no sociodemographic or clinical factors were associated with GAD-7 anxiety scores. Conclusions We conclude that all CF adults should be screened for symptoms of depression and anxiety given the difficulty in identifying strong clinical risk factors and the unexpected high rates of suicidal ideation.
    Psychosomatics 06/2014; DOI:10.1016/j.psym.2014.05.017 · 1.67 Impact Factor
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    ABSTRACT: Since the earliest days of cystic fibrosis (CF) treatment, patient data have been recorded and reviewed in order to identify the factors that lead to more favourable outcomes. Large data repositories, such as the US Cystic Fibrosis Registry, which was established in the 1960s, enabled successful treatments and patient outcomes to be recognized and improvement programmes to be implemented in specialist CF centres. Over the past decades, the greater volumes of data becoming available through Centre databases and patient registries led to the possibility of making comparisons between different therapies, approaches to care and indeed data recording. The quality of care for individuals with CF has become a focus at several levels: patient, centre, regional, national and international. This paper reviews the quality management and improvement issues at each of these levels with particular reference to indicators of health, the role of CF Centres, regional networks, national health policy, and international data registration and comparisons.
    Journal of Cystic Fibrosis 05/2014; 13:S43–S59. DOI:10.1016/j.jcf.2014.03.011 · 3.82 Impact Factor
  • Bradley S Quon, Christopher H Goss, Bonnie W Ramsey
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    ABSTRACT: Inhaled antibiotics have been used to treat chronic airway infections since the 1940s. The earliest experience with inhaled antibiotics involved aerosolizing antibiotics designed for parenteral administration. These formulations caused significant bronchial irritation due to added preservatives and nonphysiologic chemical composition. A major therapeutic advance took place in 1997, when tobramycin designed for inhalation was approved by the U.S. Food and Drug Administration (FDA) for use in patients with cystic fibrosis (CF) with chronic Pseudomonas aeruginosa infection. Attracted by the clinical benefits observed in CF and the availability of dry powder antibiotic formulations, there has been a growing interest in the use of inhaled antibiotics in other lower respiratory tract infections, such as non-CF bronchiectasis, ventilator-associated pneumonia, chronic obstructive pulmonary disease, mycobacterial disease, and in the post-lung transplant setting over the past decade. Antibiotics currently marketed for inhalation include nebulized and dry powder forms of tobramycin and colistin and nebulized aztreonam. Although both the U.S. Food and Drug Administration and European Medicines Agency have approved their use in CF, they have not been approved in other disease areas due to lack of supportive clinical trial evidence. Injectable formulations of gentamicin, tobramycin, amikacin, ceftazidime, and amphotericin are currently nebulized "off-label" to manage non-CF bronchiectasis, drug-resistant nontuberculous mycobacterial infections, ventilator-associated pneumonia, and post-transplant airway infections. Future inhaled antibiotic trials must focus on disease areas outside of CF with sample sizes large enough to evaluate clinically important endpoints such as exacerbations. Extrapolating from CF, the impact of eradicating organisms such as P. aeruginosa in non-CF bronchiectasis should also be evaluated.
    03/2014; 11(3):425-34. DOI:10.1513/AnnalsATS.201311-395FR
  • Richard Kim, Christopher H Goss
    JAMA Internal Medicine 02/2014; 174(4). DOI:10.1001/jamainternmed.2013.13509 · 13.25 Impact Factor
  • BMJ quality & safety 01/2014; 23. DOI:10.1136/bmjqs-2013-002378 · 3.28 Impact Factor
  • Christopher H Goss, Nicole Mayer-Hamblett
    American Journal of Respiratory and Critical Care Medicine 11/2013; 188(10):1181-3. DOI:10.1164/rccm.201309-1703ED · 11.99 Impact Factor
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    American Journal of Respiratory and Critical Care Medicine 11/2013; 188(10):1253-1261. DOI:10.1164/rccm.201310-1790ST · 11.99 Impact Factor
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    ABSTRACT: Current definitions of pulmonary exacerbation (PE) in cystic fibrosis are based on studies in participants with significant lung disease and may not reflect the spectrum of findings observed in younger patients with early lung disease. We used data from a recent trial assessing the efficacy of azithromycin in children to study signs and symptoms associated with PEs and related changes in lung function and weight. While increased cough was present in all PEs, acute weight loss and reduction in oxygen saturation were not observed. Changes in lung function did not differ between subjects who did experience a PE and those who were exacerbation-free. Cough was the predominant symptom in CF patients with early lung disease experiencing a PE. There was no significant difference in mean 6-month change in lung function or weight among subjects with one or more exacerbations and those without an exacerbation.
    Journal of cystic fibrosis: official journal of the European Cystic Fibrosis Society 09/2013; 13(1). DOI:10.1016/j.jcf.2013.07.006 · 3.82 Impact Factor
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    Irl B Hirsch, Mary M Janci, Christopher H Goss, Moira L Aitken
    Diabetes care 08/2013; 36(8):e121-2. DOI:10.2337/dc12-1859 · 8.57 Impact Factor
  • Christopher H Goss, Nathan Tefft
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    ABSTRACT: Recent initiatives have increased focus on medical research that explores robust comparisons of clinical approaches broadly defined as comparative effectiveness research (CER). Federal mandates have generated definitions, established priorities, and offered organizational approaches for coordinating and conducting CER. This review will summarize the various definitions of CER, the role of cost assessment, and key study components of CER including study populations, study design, the use of secondary data, comparators employed in studies, outcome measures, and how results of CER should be disseminated.
    Paediatric Respiratory Reviews 07/2013; 14(3). DOI:10.1016/j.prrv.2013.06.006 · 2.22 Impact Factor
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    ABSTRACT: Rationale: The incidence of influenza-associated acute respiratory failure is unknown. Objectives: We conducted this study to estimate the population-based incidence of influenza-associated acute respiratory failure hospitalizations. Methods: This is a cohort study from January 2003 through March 2009 using hospitalization databases for Arizona, California, and Washington from the Healthcare Cost and Utilization Project and influenza surveillance data for regions encompassing these states. Acute respiratory failure requiring mechanical ventilation was defined by ICD-9-CM code. We used negative-binomial regression modeling to estimate the incidence of influenza-associated events. Measurements and Main Results: The incidence of influenza-associated acute respiratory failure was 2.7 per 100,000 person-years (95% CI 0.2, 23.5), and during the influenza season, 3.8% of all respiratory failure hospitalizations were attributable to influenza. Compared with adults aged 18-49 years, the incidence rate ratio (IRR) for influenza-associated acute respiratory failure was lower among children aged 1-4 years (0.9) and 5-17 years (0.3). However, the IRR was higher among adults aged 50-64 years (4.8), 65-74 years (10.4), 75-84 years (19.9), and 85 years and older (33.7). Results were similar with more sensitive and specific outcome definitions and in a sensitivity analysis using only Arizona-specific outcome and surveillance data. Conclusion: Our data indicate that influenza was an important contributor to respiratory failure hospitalizations during 2003-2009. Physicians should consider influenza testing and empiric antiviral therapy for hospitalized patients with severe acute respiratory disease during periods of influenza activity. Influenza has a greater effect on respiratory failure in the elderly, for whom better prevention measures are needed.
    American Journal of Respiratory and Critical Care Medicine 07/2013; 188(6). DOI:10.1164/rccm.201212-2341OC · 11.99 Impact Factor

Publication Stats

3k Citations
687.36 Total Impact Points


  • 2015
    • Seattle Children’s Research Institute
      Seattle, Washington, United States
  • 2002–2015
    • University of Washington Seattle
      • • Department of Pediatrics
      • • Department of Medicine
      • • Division of Pulmonary and Critical Care Medicine
      Seattle, Washington, United States
  • 2011–2012
    • Seattle Children's Hospital
      • Department of Pediatrics
      Seattle, Washington, United States