David Hahn

IntraCell Research Group

Asthma and chronic obstructive pulmonary disease (COPD) have traditionally been approached as separate entities that must be researched and treated separately. There is growing recognition, however, that a substantial proportion of patients with obstructive lung disease have characteristics of both asthma and COPD (termed the asthma–COPD overlap sy...

David L Hahn, Nikki M Schultek Intracell Research Group, Winston-Salem, NC, USACorrespondence: David L Hahn, Intracell Research Group, Wake Forest, Winston-Salem, NC, USA, Tel +1 608 234-3212, Email dlhahn@wisc.edu

Purpose: Macrolides are a recommended treatment option for severe asthma, but data for "difficult-to-treat" asthma, the asthma-COPD "overlap" syndrome, and treatment duration beyond one year are lacking. We present long-term data from community practice experience providing insights for practice and research. Methods: We report data from (1) bas...

Background Chlamydia pneumoniae (Cp) is an obligate intracellular human respiratory pathogen producing persisting lung infection with a plausible link to asthma pathogenesis. The population attributable risk of potentially treatable Cp infection in asthma has not been reported.Methods The author searched from 2000 to 2020 inclusive for previously u...

Maintaining the health of survivors requires communication, collaboration and care coordination between oncology and primary care. Primary care clinicians have been acknowledged as important recipients of survivorship care plans (SCPs); however, current SCP templates have not been evaluated for usefulness in the primary care context. We surveyed an...

Abstract Background Clinician utilization of practice guidelines can reduce inappropriate opioid prescribing and harm in chronic non-cancer pain; yet, implementation of “opioid guidelines” is subpar. We hypothesized that a multi-component quality improvement (QI) augmentation of “routine” system-level implementation efforts would increase clinician...

Survivorship care plans (SCPs) may facilitate cancer survivorship care shared between oncologists and primary care, particularly for patients more likely to receive care across healthcare systems such as rural patients. However, limited research has addressed primary care clinicians’ information or workflow needs with regard to SCPs. This study’s o...

Background: Atopic dermatitis (AD) is a common, chronic skin disorder often beginning in infancy. Skin barrier dysfunction early in life serves as a central event in the pathogenesis of AD. In infants at high risk of developing AD, preventative application of lipid-rich emollients may reduce the risk of developing AD. This study aims to measure th...

Background: Clinician utilization of practice guidelines can reduce inappropriate opioid prescribing and harm in chronic non-cancer pain; yet, implementation of “opioid guidelines” is subpar. We hypothesized that a multi-component quality improvement (QI) augmentation of “routine” system-level implementation efforts would increase clinician adheren...

Background: Clinician utilization of practice guidelines can reduce inappropriate opioid prescribing and harm in chronic non-cancer pain; yet, implementation of “opioid guidelines” is subpar. We hypothesized that a multi-component quality improvement (QI) augmentation of “routine” system-level implementation efforts would increase clinician adheren...

Background: Clinician utilization of practice guidelines can reduce inappropriate opioid prescribing and harm in chronic non-cancer pain; yet, implementation of “opioid guidelines” is subpar. We hypothesized that a multi-component quality improvement (QI) augmentation of “routine” system-level implementation efforts would increase clinician adheren...

Background: Clinician utilization of practice guidelines can reduce inappropriate opioid prescribing and harm in chronic non-cancer pain; yet, implementation of “opioid guidelines” is subpar. We hypothesized that a multi-component quality improvement (QI) augmentation of “routine” system-level implementation efforts would increase clinician adheren...

This class of drugs has the potential to benefit patients with persistent, poorly controlled asthma and those with new-onset disease as an adjunct to first-line therapy.

Background: Little is known about the burden of atopic dermatitis (AD) encountered in US primary care practices and the frequency and type of skin care practices routinely used in children. Objective: To estimate the prevalence of AD in children 0 to 5 years attending primary care practices in the United States and to describe routine skin care...

Purpose: Boot camp translation is a proven process to engage community members and health professionals in translating and disseminating evidence-based "best practices" models for health prevention and chronic illness care. Primary care practice improvement studies, particularly involving patient-driven change, as seen with self-management support...

Purpose: Self-management support (SMS) is a pillar of the well-established chronic care model and a key component of improving outcomes for patients with chronic illnesses. The Implementing Networks’ Self-management Tools Through Engaging Patients and Practices (INSTTEPP) trial sought to determine whether a boot camp translation process could assis...

Purpose: With one-half of Americans projected to be living with at least one chronic condition before 2020, enhancing patient self-management support (SMS) may improve health-related behaviors and clinical outcomes. Routine SMS implementation in primary care settings is difficult. Little is known about the practice conditions required for successf...

Purpose: Patient self-management is an inevitable part of the work of being a patient, and self-management support (SMS) has become increasingly important in chronic disease management. However, the majority of SMS resources available in the Agency for Healthcare Research and Quality SMS Resource Library were developed without explicit collaborati...

Historically, a single research project involving numerous practice-based research networks (PBRNs) required multiple institutional review boards (IRBs) to be involved in approval of the project. However, to avoid redundancies, federal IRB regulations now allow cooperative research projects that involve more than one institution to use reasonable m...

Background: Systematic implementation of guidelines for opioid therapy management in chronic non-cancer pain can reduce opioid-related harms. However, implementation of guideline-recommended practices in routine care is subpar. The goal of this quality improvement (QI) project is to assess whether a clinic-tailored QI intervention improves the imp...

Objectives: Interest is increasing in collaborations between public health and primary care to address the health of a community. Although the understanding of how these collaborations work is growing, little is known about the barriers facing these partners at the local level. The objective of this study was to identify barriers to collaboration...

Background: Over-the-counter (OTC) cough remedies are lightly regulated and their potential side effects may go unrecognized. During 2015, over 282 million cough drops were sold in the United States. A Wisconsin community clinician (RM) made clinical observations suggesting that excessive use of OTC cough drops may exacerbate rather than benefit c...

Objective: The Institute of Medicine argues that the integration of primary care (PC) and public health (PH) is of paramount importance. We undertook this qualitative study to better understand how these collaborations function. Data sources: Investigators from PC and PH practice-based research networks in Colorado, Minnesota, Washington, and Wi...

Introduction: The goal of public health infectious disease surveillance systems is to provide accurate laboratory results in near-real time. When it comes to influenza surveillance, most current systems are encumbered with inherent delays encountered in the real-life chaos of medical practice. To combat this, we implemented and tested near-real-ti...

Asthma is a chronic respiratory disease characterized by reversible airway obstruction and airway hyperresponsiveness to non-specific bronchoconstriction agonists as the primary underlying pathophysiology. The worldwide incidence of asthma has increased dramatically in the last 40 years. According to World Health Organization (WHO) estimates, over...

Background: Patient engagement throughout research is a way to generate more relevant patient-important research questions, methods and results with the ultimate aim of facilitating translation of research into practice. Tokenism is defined as the practice of making perfunctory or symbolic efforts to engage communities or patients. Objective: We...

This poster described our ongoing efforts to apply GDTA to understand the cognitive work of primary care teams.

Background: The success of practice-based research (PBR) depends on the willingness of clinicians and staff to incorporate meaningful and useful research protocols into already demanding clinic schedules. The impact of participation on those who implement multiple projects and how to address the issues that arise during this complex process remain...

Survivorship care plans for cancer survivors may facilitate provider-to-provider communication. Primary care provider (PCP) perspectives on care plan provision and use are limited, especially when care plans are generated by an electronic health record (EHR) system. We sought to examine PCPs' perspectives regarding EHR-generated care plans. PCPs (N...

An inescapable fact of all cancer screening is that (of those undergoing screening) vastly more people will be harmed than helped. The key question then becomes: What are the qualities of the harms? For colon cancer screening, the United States Preventive Services Task Force (USPSTF) has determined that on a population basis, the quantity and quali...

Background: Several Chlamydia pneumoniae (Cp) biomarkers have been associated with asthma but Cp-specific IgE (Cp IgE) has not been investigated extensively. Our objective was to investigate Cp IgE in community adult asthma patients. Methods: (1) Prevalence of Cp IgE (measured by immunoblotting) and Cp DNA (by polymerase chain reaction) in peripher...

168 Background: SCPs may address inadequate provider-to-provider communication but PCP views regarding EHR-generated SCPs have not been assessed. A multiple choice survey was used to evaluate an EHR-generated SCP for appropriate content, length, perceived accuracy, need for updates and preferred method of delivery (the Clinican survEy of Care Plan...

Limited health literacy (HL) results in medication mismanagement, inadequate utilization of healthcare services, and worse health outcomes. Rural cancer patients tend to have lower levels of HL than their counterparts in more urban areas. The ROLES developed and evaluated a pilot intervention to reduce HL barriers among rural cancer patients. The i...

Macrolides have antimicrobial and anti-inflammatory properties that may be useful in the treatment of chronic asthma. We performed a randomized, placebo-controlled, double-blinded effectiveness trial of 12 weekly doses of adjunctive azithromycin, with follow-up to 1 year after randomization, in adults with persistent asthma. Measurements included o...

Several Chlamydia pneumoniae (Cp) biomarkers have been associated with asthma but Cp-specific IgE (Cp IgE) has not been investigated extensively. Our objective was to investigate Cp IgE in community adult asthma patients. (1) Prevalence of Cp IgE (measured by immunoblotting) and Cp DNA (by polymerase chain reaction) in peripheral blood, and biomark...

To the Editor: Albert et al. (Aug. 25 issue)(1) report that the use of daily azithromycin reduced the frequency of exacerbations in patients with chronic obstructive pulmonary disease (COPD). However, they did not mention the possible role of the immunomodulatory effects of macrolides in the discussion of their results.(2),(3) Macrolides decrease t...

Alpha1-antitrypsin Deficiency (AATD) is a rare hereditary disorder with a prevalence of about 1/5000 individuals in Italy. Deficient patients are at a higher risk to develop lung emphysema at an early age and liver cirrhosis. The low prevalence of AATD suggested the establishment of a registry with the aim to learn more details about the natural hi...

The US Preventive Services Task Force (USPSTF) recommends that clinicians screen all adult patients for obesity and offer intensive counseling and behavioral interventions to promote sustained weight loss for obese adults. This recommendation acknowledges the absence of evidence for patient-oriented benefits (lower morbidity or mortality). We sough...

To the Editors: As a clinician involved in the diagnosis, treatment and aetiological research of obstructive airways disease in primary care practice-based networks, I read with interest the description by Weatherall et al. 1 of four or five distinct clinical types of airways disease. Their results appear to confirm and extend observations from a...

The goal of evidence-based clinical guidelines is to improve the value of health care by recommending treatments with favorable benefit/harm ratios. Achieving this goal requires use of evidence-grading systems that explicitly address strength of evidence in terms of external validity (generalizability), internal validity, and patient-oriented outco...

Chlamydia pneumoniae has been associated with asthma. It has also been suggested that C pneumoniae infection may lead to lung remodeling in a subset of asthmatic patients. Seroreactivity against Chlamydia trachomatis heat shock protein 60 (hsp60), a highly conserved, immunoreactive chaperone protein, is associated with immunopathologic abnormalitie...

Chlamydia pneumoniae has been associated with asthma. It has also been suggested that C pneumoniae infection may lead to lung remodeling in a subset of asthmatic patients. Seroreactivity against Chlamydia trachomatis heat shock protein 60 (hsp60), a highly conserved, immunoreactive chaperone protein, is associated with immunopathologic abnormalitie...

The respiratory pathogen Chlamydia pneumoniae (C. pneumoniae) produces acute and chronic lung infections and is associated with asthma. Evidence for effectiveness of antichlamydial antibiotics in asthma is limited. The primary objective of this pilot study was to investigate the feasibility of performing an asthma clinical trial in practice setting...

As outlined in Table II this review has delineated similarities and differences in the epidemiology, pathogenesis, clinical symptoms, and immune responses to chlamydial pneumonias. Each organism may induce unique immune responses, as different pneumonia syndromes result from infection with different chlamydiae. Understanding such species difference...

To the Editors: I would like to comment on the interesting article by van Schayck and Smit 1, which documents time trends in the prevalence of childhood asthma in a Dutch general practice registry and corresponding data from repeated cross-sectional surveys in another venue within the same country. While they and others have described an apparent...

Practical clinical trials (PCTs) are essential to generate relevant evidence-based information to improve patient health. Primary care physicians' experience performing randomized controlled trials (RCTs) on representative patient populations is limited. We implemented a pilot practice-based asthma PCT to answer the following feasibility questions:...

Chlamydia pneumoniae is a recently recognized human respiratory pathogen with a unique biphasic life cycle characterized by an obligate intracellular (replicative) and an extracellular (infectious) form of the organism. C. pneumoniae is widely distributed and, via the respiratory route, infects the majority of the world's population. The majority (...

Chlamydia pneumoniae infection has been associated with asthma. It has also been suggested that heat shock protein 60 (Hsp60) belonging to a class of highly conserved proteins may play a role in the pathogenesis of chlamydial infections. The purpose was to study whether the host immune response to C. pneumoniae Hsp60 is associated with asthma and d...

A significant portion of research project costs is incurred before the receipt of grant funds. This poses a problem for the initiation of primary care research, especially in community practice settings. Potential investigators need financial support for staff time, training, pilot work, and grant proposal writing if primary care researchers are to...

Emerging evidence suggests an association between some asthma and pulmonary infection by the atypical organisms Chlamydia pneumoniae and Mycoplasma pneumoniae, but a causal role for infection remains unproven and controversial. Most acute exacerbations of asthma are triggered by acute infections that are due to viral respiratory pathogens, not to b...

Emerging evidence suggests an association between some asthma and pulmonary infection by the atypical organisms Chlamydia pneumoniae and Mycoplasma pneumoniae, but a causal role for infection remains unproven and controversial. Most acute exacerbations of asthma are triggered by acute infections that are due to viral respiratory pathogens, not to b...

Chlamydia pneumoniae infection has been reported as a possible etiologic agent in asthma, which in primary care settings often appears to be initiated by acute respiratory infections. To determine if serologic markers for C. pneumoniae are associated with adult asthma that first became symptomatic after an acute respiratory illness (asthma associat...

. Evidence-based clinical preventive services are underutilized. We explored the major factors associated with delivery of these services in a large physician-owned community-based group practice that provided care for both fee-for-service (FFS) and health maintenance organization (HMO) patient populations. We performed a cross-sectional audit of t...

Reading this article will familiarize the reader with (1) the unique chlamydial intracellular life cycle and the propensity for human chlamydial infections to become persistent and to result in immunopathologic (inflammatory) damage in target organs and (2) current evidence linking Chlamydia pneumoniae (Cpn) infection to obstructive lung diseases (...

Asthma is a chronic respiratory condition of uncertain etiology and often multifactorial that is characterized by chronic bronchial inflammation and airway hyperreactivity that result in episodes of reversible airway obstruction usually manifested as symptoms of cough, shortness of breath and wheeze triggered by a variety of stimuli [1]. Earlier in...

Chlamydia pneumoniae infection can cause acute respiratory illnesses (including sinusitis, bronchitis, and pneumonia) that are sometimes associated with wheezing. Little is known about whether acute infection in a previously unexposed, nonasthmatic individual can produce persistent wheezing leading to a diagnosis of chronic asthma. We sought to det...

Chlamydia pneumoniae is an obligate intracellular respiratory pathogen capable of persistent infection. Seroepidemiologic studies and the results of open-label antimicrobial treatment of patients with non-steroid-dependent asthma have suggested a potential role for C. pneumoniae in asthma. To evaluate the results of antimicrobial treatment in patie...

To determine whether recently diagnosed adult-onset asthma is associated with serologic evidence of chronic Chlamydia pneumoniae infection, we performed a case-control study in a primary care clinic of cases with asthma (25 adults reporting first symptoms of asthma within 2 years of enrollment) and 45 concurrently enrolled sex and age (+/- 10 years...

The majority of asthma experts believe that asthma is a noninfectious inflammatory condition. Nevertheless, an accumulating body of evidence suggests that a group of obligate intracellular viral (respiratory syncytial virus (RSV), parainfluenza and adenoviruses) and nonviral (Chlamydia trachomatis and Chlamydia pneumoniae) organisms may be involved...

Some diseases previously believed to be noninfectious, eg, peptic ulcer disease, are now known to be caused by chronic infection. Recently, chronic Chlamydia pneumoniae infection has been suggested as a cause for adult-onset asthma. The purpose of this study was to determine whether antichlamydial treatment would affect the natural history of this...

In the primary care setting, patients often report that their asthma began after an acute respiratory infection such as bronchitis, pneumonia, or an influenza-like illness ("infectious asthma"). Preceding respiratory illnesses such as bronchitis and pneumonia are also epidemiologic correlates of asthma in both children and adults. These association...

I would like to comment on the interesting report by Emre et al1 associating Chlamydia pneumoniae infection and reactive airway disease in children. They found evidence for C pneumoniae infection in 25 (21.2%) of 118 children with acute episodes of wheezing; nine had positive cultures for C pneumoniae but did not have diagnostic antibody, 13 had di...

According to the British Thoracic Society, “asthma is a common and chronic inflammatory condition of the airways whose cause is not completely understood” [1]. Two important clinical characteristics of asthma are: 1) reversible airway obstruction, usually manifested by complaints of episodic cough, wheeze, shortness of breath and/or chest tightness...