Bruce G. Bender

National Jewish Health · Department of Pediatrics

Investigators conducting translational research in real-world settings may experience changes that create challenges to the successful completion of the trial as well as post-trial adoption and implementation. Adaptive designs support translational research by systematically adapting content and methods to meet the needs of target populations, sett...

BACKGROUND Few studies have looked at the effect of an asthma exacerbation on asthma medication adherence. OBJECTIVE To measure asthma medication adherence in the 12 months after an asthma exacerbation and the influence of care type (specialist vs primary care provider) as well as social economic status on adherence. METHODS Portion of days cover...

Objective: The first case of COVID-19 on the Navajo Nation (NN) was found on March 17, 2020. Even with strong public health efforts, NN saw the highest per capita infection rate in the US during May of 2020 with 2450/100,000. To determine the impact of COVID-19 on families of children with asthma on the NN, families participating in the NHLBI fund...

Background The COVID-19 pandemic increased reliance on virtual care for patients with persistent asthma. Objective This retrospective cohort study assessed changes from in-person to virtual care during the pandemic in patients with persistent asthma compared the same time period prior to the pandemic. Methods Kaiser Permanente Colorado members ag...

Adherence to prescribed medications for chronic respiratory disease is considered a keystone for successful management. There is little consensus though, on how to measure adherence, what is optimal adherence or the goals of appropriate medication utilization. These criteria may differ when studying medication utilization at the patient or populati...

Use of digital communication technologies (DCT) shows promise for enhancing outcomes and efficiencies in asthma care management. However, little is known about the impact of DCT interventions on healthcare personnel requirements and costs, thus making it difficult for providers and health systems to understand the value of these interventions. This...

Rationale: Decisions in medicine are made on the basis of knowledge and reasoning, often in shared conversations with patients and families in consideration of clinical practice guideline recommendations, individual preferences, and individual goals. Observational studies can provide valuable knowledge to inform guidelines, decisions, and policy. O...

Background Few interventions have targeted low-income adults with moderate-severe asthma despite their high mortality. Objective To assess whether a Patient Advocate intervention improves asthma outcomes over usual care. Methods This 2-armed randomized clinical trial recruited adults with moderate-severe asthma from primary care and asthma specia...

Background: RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) and CFIR (Consolidated Framework for Implementation Research) dissemination and implementation frameworks define theory-based domains associated with the adoption, implementation and maintenance of evidence-based interventions. Used together, the two frameworks identif...

Background: Challenges to health care efficiency are increasingly addressed with the help of digital communication technology tools (DCTs). Objective: The objective of this study was to test whether DCT, compared with Usual Care, can reduce health care clinician burden without increasing asthma-related exacerbations among patients with asthma in...

Introduction: The COPD Assessment Test (CAT) is a self-administered questionnaire that measures symptomatic burden. CAT is used as part of the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines refined ABCD tool and is usually performed during office visit assessment. Electronic medication monitors (EMMs) capture utilization...

Chronic respiratory diseases such as asthma and COPD are typically managed by daily inhaled medication. However, the efficacy of an inhaled medication depends upon a patient's adherence to therapy, which refers to whether the medication is actually taken as prescribed. In patients with these diseases, higher adherence has been associated with bette...

Treatment nonadherence in young children with asthma involves multiple factors and should be viewed within an ecological framework. Few interventions have targeted multiple bidirectional factors, however, and little research has examined which interventions may be most appropriate for young children. Additional research is needed to identify essent...

Background: The Colorado Asthma Toolkit Program (CATP) has been shown to improve processes of care with less evidence demonstrating improved outcomes. Objective: To model the association between pre-and-post-CATP status and asthma-related process and outcome measures among patients ages 5 to 64 years receiving care in safety-net primary care pra...

Abstract Digital health interventions have been associated with reduced rescue inhaler use and improved controller medication adherence. This quality improvement project assessed the benefit of these interventions on asthma-related healthcare utilizations, including hospitalizations, emergency department (ED) utilization and outpatient visits. The...

Outcomes for patients with chronic respiratory diseases remain poor despite the development of novel therapies. In part, this reflects the fact that adherence to therapy is low, and clinicians lack accurate methods to assess this issue. Digital technologies hold promise to overcome these barriers to care. For example, algorithmic analysis of large...

Background: Use of health technology has shown potential to improve asthma adherence and outcomes. Few studies have looked at the implementation of such research within larger asthma populations. Objective: This report examines the process of translating results from a pragmatic trial using speech recognition (SR) in children with persistent ast...

Objective: Shared decision making (SDM) is becoming more commonly appreciated and used in medical practice as a way to empower patients who are facing treatment preference-sensitive conditions, such as allergic rhinitis, atopic dermatitis, food allergy, and persistent asthma. The purpose of this review is to educate the allergy health care provide...

A novel mutation affects how depression influences the severity of asthma symptoms, with opposite effects in children and the elderly. Depression is known to affect the severity of symptoms experienced by patients with chronic disorders, such as asthma. Heung-Woo Park at Seoul National University College of Medicine in South Korea and coworkers inv...

Objective: The present article will review current findings regarding the management of stress in allergic disease. Data sources: The present review article uses articles and books published between 1995 and 2017. Approximately 85% of sources used were published in the last 10 years and 60% were published in the last 5 years. The majority of sou...

Rationale: Navajo children living on the reservation have high rates of asthma prevalence and severity. Environmental influences may contribute to asthma on the Navajo Nation and are inadequately understood. Objectives: We performed a comprehensive, integrative literature review to determine the environmental factors that may contribute to incre...

Background: Depression is common in asthma and is associated with poor outcomes. However, antidepressant therapy in depressed asthma patients has been the topic of little research. Objective: This study examined the impact of antidepressant treatment with escitalopram vs. placebo on the Hamilton Rating Scale for Depression (HRSD), Inventory of D...

Objective: To describe the behavioral components and complications in treating pediatric patients with atopic dermatitis (AD) and the critical role of behavioral health professionals in addressing disease impact and behavioral aspects of disease management for these patients and families. Data sources: Studies and review articles were selected f...

Asthma is the most common childhood illness and disproportionately affects low-income, minority children who live in urban areas. A range of risk factors are associated with asthma morbidity and mortality, such as treatment non-adherence, exposure to environmental triggers, low-income households, exposure to chronic stress, child psychological prob...

Nonadherence to asthma medications is well recognized. Interventions to improve adherence, however, have been only moderately successful and are not often adopted because of limited provider time, training, or institutional support. The potential for mobile communication technology to improve adherence has gathered sharply growing interest. Technol...

Drug-delivery technology has come a long way since the handmade tinctures, lozenges, and pills of the eighteenth and nineteenth centuries. Today, a new generation of smart pharmaceuticals offers the potential to monitor and improve self-management of chronic conditions, enhance adherence, and tailor treatment more precisely to the patient. Smart ph...

Background: Accurate assessment of preference-based health-related quality of life is important in determining the value of asthma interventions. Objective: To examine the sensitivity and responsiveness of the EQ-5D and the AQL-5D to differences in asthma control measured by the Asthma Control Questionnaire (ACQ-5). Methods: The Observational...

Background: Exercise-induced laryngeal obstruction (EILO) may affect as many as 6% of the adolescent population, with some patients experiencing symptoms refractory to conservative interventions. Objectives: This report describes therapeutic laryngoscopy during exercise, a novel, non-surgical intervention that harnesses real-time laryngoscopy vi...

Background: Many advances in health care fail to reach patients. Implementation science is the study of novel approaches to mitigate this evidence-to-practice gap. Methods: The American Thoracic Society (ATS) created a multidisciplinary ad hoc committee to develop a research statement on implementation science in pulmonary, critical care, and sl...

Background: Pulmonary rehabilitation programs improve dyspnea and health status associated with chronic obstructive pulmonary disease (COPD), but benefits wane when patients return to a sedentary lifestyle. This study tested a simple, low-resource, low-cost home walking program. Methods: In this single center, 3-month study, 115 COPD patients were...

Background: Low adherence and persistence to inhaled therapy result in poor outcomes in patients with asthma and chronic obstructive pulmonary disease (COPD). Although adherence has been widely studied, growing awareness of the large number of patients who abandon their asthma treatment suggests that persistence to treatment may be more relevant f...

Background: Understanding the effect of worsening asthma control on expenditures and health resource utilization (HRU) is important. Objective: To explore the association of economic outcomes with asthma control cutoffs and longitudinal changes on the Asthma Control Questionnaire 5 (ACQ-5). Methods: The Observational Study of Asthma Control an...

Asthma is the most common chronic illness among children in the United States and can impact nearly all aspects of functioning. Most research suggests that children with severe asthma display more emotional and behavioral problems than their healthy peers. These psychological difficulties are associated with increased risk for functional impairment...

Background: Previous studies have shown an association between cost and poor asthma control. However, longitudinal studies of general populations are lacking. Objective: To examine the cost of poor asthma control and exacerbations across a broad spectrum of asthma patients. Methods: The Observational Study of Asthma Control and Outcomes (OSACO...

Current estimates indicate that 4% to 8% of children in the United States are diagnosed with food allergy, and more than 40% of US children with food allergy experience severe allergic reactions. Families trying to avoid foods that may trigger an allergic reaction and ensure adequate treatment of allergic reactions that do occur face numerous chall...

Allergen immunotherapy (All) can improve allergic response by modifying the underlying disease. Many patients are nonadherent, and do not achieve full benefit. Numerous studies reveal that fewer than 10% of patients complete a full course and that most abandon treatment in the first year. The development and testing of interventions to improve AIT...

To advance implementation research (IR) in respiratory, sleep, and critical care medicine, the American Thoracic Society and the Division of Lung Diseases from the NHLBI cosponsored an Implementation Research Workshop on May 17, 2014. The goals of IR are to understand the barriers and facilitators of integrating new evidence into healthcare practic...

Asthma is a common chronic disease without cure. Our understanding of asthma onset, pathobiology, classification and management has evolved substantially over the past decade; however, significant asthma-related morbidity and excess healthcare utilization and cost persist. To address this important clinical condition, the National Heart, Lung, and...

Background and objectives: Programs designed to enhance the diagnosis and management of asthma and chronic obstructive pulmonary disease (COPD) in primary care settings have had variable success and have not been broadly implemented. The Respiratory Toolkit was created to bridge this gap. Methods: The 2-year program providing primary care traini...

Patient nonadherence significantly burdens the treatment of allergic rhinitis (AR). Fewer than half of prescribed doses of intranasal corticosteroid medication are taken. The challenges for immunotherapies are even greater. While sustained treatment for 3 to 5 years is required for full benefit, most patients receiving immunotherapy, either subcuta...

Most patients with asthma take fewer than half of prescribed doses of controller medication. Interventions to improve adherence have typically been costly, impractical, and at best only minimally successful. To test a speech recognition (SR) intervention to improve adherence to pediatric asthma controller medication. The Breathe Well study was a 24...

Glucocorticoids are the most commonly prescribed anti-inflammatory/immunosuppressant medications worldwide. This article highlights the risk of clinically significant and sometimes severe psychological, cognitive, and behavioral disturbances that may be associated with glucocorticoid use, as well as ways to prevent and treat these disturbances. An...

Patient nonadherence is a problem that impacts all chronic illness treatments. To determine the degree of nonadherence and its impact on treatment effect in sublingual immunotherapy (SLIT), we conducted a systematic review of published research that assessed adherence or tested interventions to improve SLIT adherence. Adherence to SLIT is similar t...

Nonadherence to inhaled corticosteroids (ICS) is a significant risk factor for poor asthma outcomes in minority adolescents with persistent asthma. To identify factors associated with nonadherence to daily ICS in this target population. Adolescents 11 to 16 years old, self-identified as African American or Hispanic, diagnosed with persistent asthma...

Although nonadherence research in patients with chronic obstructive pulmonary disease (COPD) lags well behind other diseases, new evidence helps inform understanding about the degree and underlying causes of patient nonadherence, interventions that can improve adherence, and areas of research needed to further progress in improving this problem in...

Abstract Many Americans are failing to engage in both the behaviors that prevent and those that effectively manage chronic health conditions, including pulmonary disorders, cardiovascular conditions, diabetes, and cancer. Expectations that health care providers are responsible for changing patients' health behaviors often do not stand up against th...

Poor adherence to inhaled corticosteroids (ICS) is a critical risk factor contributing to asthma morbidity among low-income minority adolescents. This trial tested whether peer support group meetings and peer asthma messages delivered via mp3 players improved adherence to ICS. Low-income African American and/or Hispanic adolescents, ages 11-16 year...

Background: Asthmatic adults from low-income urban neighborhoods have inferior health outcomes which in part may be due to barriers accessing care and with patient-provider communication. We adapted a patient advocate (PA) intervention to overcome these barriers. Objective: To conduct a pilot study to assess feasibility, acceptability and prelim...

Background: Low health literacy is associated with poor outcomes in asthma and other diseases, but the mechanisms governing this relationship are not well defined. Objective: We sought to assess whether literacy is related to subsequent asthma self-management, measured as adherence to inhaled steroids, and asthma outcomes. Methods: In a prospe...

Combination inhaled asthma medications containing corticosteroids and long-acting beta-adrenergic (LABA) agents are generally well tolerated, although a small minority of children receiving them may develop side-effects. Herein is reported a case of a 9-year-old boy who developed insomnia, pressured speech, agitation, and suicidal ideation within t...

The study of children with Turner syndrome (TS), a type of sex chromosome abnormality, has received little emphasis within the domain of pediatric psychology. One of the reason for this may be the fact that in some cases the condition does not become evident until late adolescence or early adulthood. Second, although it has been known for some time...

Information comparing subjective and objective measurements of adherence to study medications and the effects of adherence on treatment-related differences in asthma clinical trials are limited. We sought to compare subjective and objective measurements of children's adherence to inhaled corticosteroids or placebo and to determine whether adherence...

Much has been written about how the medical home model can enhance patient-centeredness, care continuity, and follow-up, but few comprehensive aids or resources exist to help practices accomplish these aims. The complexity of primary care can overwhelm those concerned with quality improvement. The RE-AIM planning and evaluation model was used to de...

Appendix 1. Measures: Scales chosen, rationale for selection, actionable results.

Adherence with inhaled controller medications for asthma is known to be highly variable with many patients taking fewer doses than recommended for consistent control of lung inflammation. Adherence also worsens as children become teenagers, although the exact causes are not well established. To use focus group methodology to examine beliefs, feelin...

Human behavior can prevent or invite disease and is a major determinant of treatment success. Consequently, many efforts have been directed toward developing interventions to promote behaviors essential to managing or preventing respiratory disease. The process of developing, testing, and disseminating health behavior interventions should closely f...

Asthma is often under-diagnosed and under-treated in primary care. The Colorado Asthma Toolkit Program was initiated to establish a method for improving asthma care by providing to primary care practices coaching, training, and support for (1) evidence-based asthma diagnosis and treatment, and (2) education and activation of patients toward effecti...

To determine factors associated with 24-month change in quality of life in children with asthma and their parents during the Childhood Asthma Management Program (CAMP). Participants from 4 CAMP clinical centers were administered the Pediatric Asthma Quality of Life questionnaire and protocol measures of asthma symptoms, lung function, and psycholog...

Moderate to severe atopic dermatitis (AD) negatively affects patients and their families. Pruritus, scratching, and sleep problems are common complaints linked to disturbed quality of life. Treatment is complex, and nonadherence rates are high. This article reviews the effect of AD on patients and their families and intervention strategies that hav...

Art therapy has been used to help children cope with chronic illness but has not been specifically tested with children who have asthma. To test an art therapy intervention in a randomized controlled trial in children with asthma. Twenty-two children with asthma were randomized to an active art therapy or wait-list control group. Those in the activ...

This study was conducted to test the effectiveness of a theory-based interactive voice response (IVR) intervention to improve adherence to controller medications among adults with asthma. Fifty participants aged 18 to 65 years who had a physician diagnosis of asthma and a prescription for a daily inhaled corticosteroid, attended a baseline visit an...

In this chapter, we provide a systematic review of randomized controlled trials, meta-analysis, case-control, or cohort studies that compared patient adherence with, or preference for, oral or inhaled controller medication for asthma. Among 17 studies meeting inclusion criteria for our review, patients were more adherent to oral than inhaled medica...

IntroductionEpidemiology of AsthmaDefinition and Characteristics of AsthmaRole of the Psychologist in the Interdisciplinary TeamDelivery of Psychological Services in the Treatment of AsthmaThe Future of Psychology in Tertiary Care SettingsFuture Research on Interdisciplinary InterventionsReferences