Wayne J Morgan

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• Bender, B. G., Crooks, J., Gerald, J. K., Hudson, B., King, D. K., Kobernick, A., Liu, A. H., Lowe, A. A., Morgan, W., Nez, P., Phan, H., Wightman, P., & Gerald, L. B. (2024). Childhood asthma exacerbations on the Navajo Nation. The journal of allergy and clinical immunology. In practice, 12(8), 2173-2175.e1.
• Covar, R., Lazarus, S. C., Krishnan, J. A., Blake, K. V., Sorkness, C. A., Dyer, A. M., Lang, J. E., Lugogo, N. L., Mauger, D. T., Wechsler, M. E., Wenzel, S. E., Cardet, J. C., Castro, M., Israel, E., Phipatanakul, W., & King, T. S. (2024). Association of Sputum Eosinophilia With Easily Measured Type-2 Inflammatory Biomarkers in Untreated Mild Persistent Asthma. The journal of allergy and clinical immunology. In practice, 12(4), 960-969.e6.
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  A multicenter clinical trial in patients with mild persistent asthma indicated that response to inhaled corticosteroids (ICS) is limited to those with sputum eosinophilia. However, testing for sputum eosinophilia is impractical in most clinical settings. [Dr. Morgan was a member of the Asthmanet NHBLI network, Chaired the Physiology Committee,  and participated in the research studies that underlay this paper]
• Cromwell, E. A., Ostrenga, J. S., Sanders, D. B., Morgan, W., Castellani, C., Szczesniak, R., & Burgel, P. R. (2024). Impact of the expanded label for elexacaftor/tezacaftor/ivacaftor in people with cystic fibrosis with no F508del variant in the USA. The European respiratory journal, 64(5).
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  Elexacaftor/tezacaftor/ivacaftor (ETI), which is approved for people with cystic fibrosis (pwCF) with a F508del variant, was further approved based on data in the USA for those carrying at least one of 177 rare (cystic fibrosis transmembrane conductance regulator) variants.
• Deshmukh, H., Whitsett, J., Zacharias, W., Way, S. S., Martinez, F. D., Mizgerd, J., Pryhuber, G., Ambalavanan, N., Bacharier, L., Natarajan, A., Tamburro, R., Lin, S., Randolph, A., Nino, G., Mejias, A., & Ramilo, O. (2024). Impact of Viral Lower Respiratory Tract Infection (LRTI) in Early Childhood (0-2 Years) on Lung Growth and Development and Lifelong Trajectories of Pulmonary Health: A National Institutes of Health (NIH) Workshop Summary. Pediatric pulmonology, e27357.
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  Viral lower respiratory tract infections (LRTI) are ubiquitous in early life. They are disproportionately severe in infants and toddlers (0-2 years), leading to more than 100,000 hospitalizations in the United States per year. The recent relative resilience to severe Coronavirus disease (COVID-19) observed in young children is surprising. These observations, taken together, underscore current knowledge gaps in the pathogenesis of viral lower respiratory tract diseases in young children and respiratory developmental immunology. Further, early-life respiratory viral infections could have a lasting impact on lung development with potential life-long pulmonary sequelae. Modern molecular methods, including high-resolution spatial and single-cell technologies, in concert with longitudinal observational studies beginning in the prenatal period and continuing into early childhood, promise to elucidate developmental pulmonary and immunophenotypes following early-life viral infections and their impact on trajectories of future respiratory health. In November 2019, under the auspices of a multi-disciplinary Workshop convened by the National Heart Lung Blood Institute and the Eunice Kennedy Shriver National Institute of Child Health and Human Development, experts came together to highlight the challenges of respiratory viral infections, particularly in early childhood, and emphasize the knowledge gaps in immune, virological, developmental, and clinical factors that contribute to disease severity and long-term pulmonary morbidity from viral LRTI in children. We hope that the scientific community will view these challenges in clinical care on pulmonary health trajectories and disease burden not as a window of susceptibility but as a window of opportunity. [Dr. Morgan participate in the Committee designing the workshop, the workshop itself, and reviewed/edited the final report]
• Rosenfeld, M., Cromwell, E. A., Schechter, M. S., Ren, C., Flume, P. A., Szczesniak, R. D., Morgan, W. J., & Jain, R. (2024). The impact of switching to race-neutral reference equations on FEV percent predicted among people with cystic fibrosis. Journal of cystic fibrosis : official journal of the European Cystic Fibrosis Society, 23(3), 443-449.
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  The American Thoracic Society recommended switching to race-neutral spirometry reference equations, as race is a social construct and to avoid normalizing disparities in lung function due to structural racism. Understanding the impact of the race-neutral equations on percent predicted forced expiratory volume in one second (ppFEV) in people with cystic fibrosis (PwCF) will help prepare patients and providers to interpret pulmonary function test results.
• Schechter, M. S., Ostrenga, J. S., Cromwell, E. A., Ren, C. L., Fink, A. K., Sanders, D. B., & Morgan, W. J. (2024). Treatment of small as well as large declines in lung function enhances recovery to baseline in people with CF. Pediatric pulmonology, 59(12), 3212-3220.
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  The benefit of antibiotic treatment of acute drops in FEV percent predicted (FEVpp) has been clearly established, but data from the early 2000s showed inconsistent treatment. Further, there is no empirical evidence for what magnitude of drop is clinically significant.
• Simon, R. H., Quittell, L. M., & Morgan, W. J. (2024). Omitting placebos from early-stage clinical trials of cystic fibrosis therapies.. Journal of Cystic Fibrosis, 23(1), 65-67. doi:10.1016/j.jcf.2023.12.010
• Simon, R. H., Quittell, L. M., & Morgan, W. J. (2024). The 25-year experience of the cystic fibrosis foundation data safety monitoring board. . Journal of Cystic Fibrosis, 23(4), 734-738.
• Tepper, R. S., Morgan, W. J., & Taussig, L. M. (2024). Additional Thoughts on Intrinsic Dysanapsis. American journal of respiratory and critical care medicine, 209(8), 1040-1041.
• Todd, J. V., Morgan, W. J., Szczesniak, R. D., Ostrenga, J. S., O'Connell, O. J., Cromwell, E. A., Faro, A., & Jain, R. (2024). Forced Expiratory Volume in 1 Second Variability Predicts Lung Transplant or Mortality in People with Cystic Fibrosis in the United States. Annals of the American Thoracic Society, 21(10), 1416-1420.
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  Declines in percent predicted forced expiratory volume in 1 second (ppFEV) are an important marker of clinical progression of cystic fibrosis (CF). We examined ppFEV variability in relation to a combined outcome of lung transplant or death. We estimated the association between ppFEV variability and the combined outcome of lung transplant or death. We included children aged 8 years and older with CF and two prior years of ppFEV data before baseline between 2005 and 2021. We defined ppFEV increased variability as any relative increase or decrease of at least 10% in ppFEV from a 2-year averaged baseline. A marginal structural Cox proportional hazards model was used. We examined a cumulative measure of ppFEV variability, defined as the cumulative proportion of visits with ppFEV variability at each visit. Kaplan-Meier survival curves were generated on the basis of quartiles of the cumulative distribution of ppFEV variability. We included 9,706 patients with CF in our cohort. The median age at cohort entry was 8.3 (interquartile range, 8.2-8.4) years; 50% of patients were female; 94% were White; and the median baseline ppFEV was 94.4 (interquartile range, 81.6-106.1). The unadjusted hazard ratio for increased ppFEV variability on lung transplant/mortality was 4.13 (95% confidence interval, 3.48-4.90), and the weighted hazard ratio was 1.49 (95% confidence interval, 1.19-1.86). Survival curves stratified by quartile of cumulative variability demonstrated an increased hazard of lung transplant/mortality as the proportion of cumulative ppFEV variability increased. We found a strong association between ppFEV variability and lung transplant or mortality in a cohort of people with CF in the United States.
• Zhai, J., Voraphani, N., Imboden, M., Keidel, D., Liu, C., Stern, D. A., Venker, C., Petersen, H., Bosco, A., Sherrill, D. L., Morgan, W. J., Tesfaigzi, Y., Probst-Hensch, N. M., Martinez, F. D., Halonen, M., & Guerra, S. (2024). Circulating biomarkers of airflow limitation across the life span. The Journal of allergy and clinical immunology.
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  Airflow limitation is a hallmark of COPD, which can develop through different lung function trajectories across the life span. There is a need for longitudinal studies aimed at identifying circulating biomarkers of airflow limitation across different stages of life.
• DeBoer, E. M., Morgan, W. J., Quiros-Alcala, L., Rosenfeld, M., Stout, J. W., Davis, S. D., & Gaffin, J. M. (2023). Defining and Promoting Pediatric Pulmonary Health: Assessing Lung Function and Structure. Pediatrics, 152(Suppl 2).
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  Lifelong respiratory health is rooted in the structural and functional development of the respiratory system in early life. Exposures and interventions antenatally through childhood can influence lung development into young adulthood, the life stage with the highest achievable lung function. Because early respiratory health sets the stage for adult lung function trajectories and risk of developing chronic obstructive pulmonary disease, understanding how to promote lung health in children will have far reaching personal and population benefits. To achieve this, it is critical to have accurate and precise measures of structural and functional lung development that track throughout life stages. From this foundation, evaluation of environmental, genetic, metabolic, and immune mechanisms involved in healthy lung development can be investigated. These goals require the involvement of general pediatricians, pediatric subspecialists, patients, and researchers to design and implement studies that are broadly generalizable and applicable to otherwise healthy and chronic disease populations. This National Institutes of Health workshop report details the key gaps and opportunities regarding lung function and structure.
• Morgan, W. J., VanDevanter, D. R., Pasta, D. J., Foreman, A. J., Wagener, J. S., Konstan, M. W., & , S. A. (2023). Corrigendum to FEV1 Variability Helps Identify Patients with Cystic Fibrosis at Risk of Greater Loss of Lung Function [The Journal of Pediatrics (2016) 116-121]. The Journal of pediatrics, 255, 265.
• Polverino, F., Stern, D. A., Snyder, E. M., Wheatley-Guy, C., Bhatt, S. P., Martinez, F. D., Guerra, S., & Morgan, W. J. (2023). Lower respiratory illnesses in childhood are associated with the presence of air trapping in early adulthood. Respiratory medicine, 206, 107062.
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  Several factors occurring in early life, including lower respiratory tract illnesses (LRIs), are involved in determining lung structure and function in adulthood, but the effects of these factors on lung development remain largely unknown. Hereby, we evaluated the parameters from computed tomography (CT) scans performed at the age of 26 years in 39 subjects from the birth cohort of the Tucson Children's Respiratory Study (TCRS) in order to determine the relationship between early childhood factors and lung structural changes in young adult life. We found that participants with LRIs in childhood had increased air trapping at the age of 26 suggesting an association between childhood infections and lung development.
• Quittell, L. M., Morgan, W. J., & Richard, S. H. (2023). Cystic fibrosis research: The only constant is change. Journal of Cystic Fibrosis, 22(4), 596-597.
• Sanders, D. B., Bartz, T. M., Zemanick, E. T., Hoppe, J. E., Hinckley Stukovsky, K. D., Cogen, J. D., Bendy, L., McNamara, S., Enright, E., Kime, N. A., Kronmal, R. A., Edwards, T. C., Morgan, W. J., & Rosenfeld, M. (2023). A Pilot Randomized Clinical Trial of Pediatric Cystic Fibrosis Pulmonary Exacerbations Treatment Strategies. Annals of the American Thoracic Society, 20(12), 1769-1776.
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  Despite the high prevalence and clear morbidity of cystic fibrosis (CF) pulmonary exacerbations (PEx), there have been no published clinical trials of outpatient exacerbation management. To assess the feasibility of a pediatric clinical trial in which treatment of mild PEx is assigned randomly to immediate oral antibiotics or tailored therapy (increased airway clearance alone with oral antibiotics added only for prespecified criteria). The outcome on which sample size was based was the proportion of tailored therapy participants who avoided oral antibiotics during the 28 days after randomization. In this randomized, open-label, pilot feasibility study at 10 U.S. sites, children 6-18 years of age with CF were enrolled at their well baseline visits and followed through their first randomized PEx. One hundred twenty-one participants were enrolled, of whom 94 (78%) reported symptoms of PEx at least once; of these, 81 (86%) had at least one exacerbation that met randomization criteria, of whom 63 (78%) were randomized. Feasibility goals were met, including enrollment, early detection of symptoms of PEx, and ability to randomize. Among the 33 participants assigned to tailored therapy, 10 (30%) received oral antibiotics, while 29 of 30 (97%) assigned to immediate antibiotics received oral antibiotics. The avoidance of oral antibiotics in 70% (95% confidence interval, 54-85%) was statistically significantly different from our null hypothesis that
• Simon, R. H., Quittell, L. M., & Morgan, W. J. (2023). Omitting placebos from early-stage clinical trials of cystic fibrosis therapies. Journal of cystic fibrosis : official journal of the European Cystic Fibrosis Society.
• Szczesniak, R., Andrinopoulou, E. R., Su, W., Afonso, P. M., Burgel, P. R., Cromwell, E., Gecili, E., Ghulam, E., Goss, C. H., Mayer-Hamblett, N., Keogh, R. H., Liou, T. G., Marshall, B., Morgan, W. J., Ostrenga, J. S., Pasta, D. J., Stanojevic, S., Wainwright, C., Zhou, G. C., , Fernandez, G., et al. (2023). Lung Function Decline in Cystic Fibrosis: Impact of Data Availability and Modeling Strategies on Clinical Interpretations. Annals of the American Thoracic Society, 20(7), 958-968.
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  Studies estimating the rate of lung function decline in cystic fibrosis have been inconsistent regarding the methods used. How the methodology used impacts the validity of the results and comparability between studies is unknown. The Cystic Fibrosis Foundation established a work group whose tasks were to examine the impact of differing approaches to estimating the rate of decline in lung function and to provide analysis guidelines. We used a natural history cohort of 35,252 individuals with cystic fibrosis aged ⩾6 years in the Cystic Fibrosis Foundation Patient Registry (CFFPR), 2003-2016. Modeling strategies using linear and nonlinear forms of marginal and mixed-effects models, which have previously quantified the rate of forced expiratory volume in 1 second (FEV) decline (percent predicted per year), were evaluated under clinically relevant scenarios of available lung function data. Scenarios varied by sample size (overall CFFPR, medium-sized cohort of 3,000 subjects, and small-sized cohort of 150), data collection/reporting frequency (encounter, quarterly, and annual), inclusion of FEV during pulmonary exacerbation, and follow-up length (
• Voraphani, N., Stern, D. A., Ledford, J. G., Spangenberg, A. L., Zhai, J., Wright, A. L., Morgan, W. J., Kraft, M., Sherrill, D. L., Curtin, J. A., Murray, C. S., Custovic, A., Kull, I., Hallberg, J., Bergström, A., Herrera-Luis, E., Halonen, M., Martinez, F. D., Simpson, A., , Melén, E., et al. (2023). Circulating CC16 and Asthma: A Population-based, Multicohort Study from Early Childhood through Adult Life. American journal of respiratory and critical care medicine, 208(7), 758-769.
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  Club cell secretory protein (CC16) is an antiinflammatory protein highly expressed in the airways. CC16 deficiency has been associated with lung function deficits, but its role in asthma has not been established conclusively. To determine ) the longitudinal association of circulating CC16 with the presence of active asthma from early childhood through adult life and ) whether CC16 in early childhood predicts the clinical course of childhood asthma into adult life. We assessed the association of circulating CC16 and asthma in three population-based birth cohorts: the Tucson Children's Respiratory Study (years 6-36; total participants, 814; total observations, 3,042), the Swedish Barn/Children, Allergy, Milieu, Stockholm, Epidemiological survey (years 8-24; total participants, 2,547; total observations, 3,438), and the UK Manchester Asthma and Allergy Study (years 5-18; total participants, 745; total observations, 1,626). Among 233 children who had asthma at the first survey in any of the cohorts, baseline CC16 was also tested for association with persistence of symptoms. After adjusting for covariates, CC16 deficits were associated with increased risk for the presence of asthma in all cohorts (meta-analyzed adjusted odds ratio per 1-SD CC16 decrease, 1.20; 95% confidence interval [CI], 1.12-1.28;  
• Carr, T. F., Stern, D. A., Morgan, W., Guerra, S., & Martinez, F. D. (2022). Elevated Childhood Insulin-related Asthma Is Risk Factor for Reduced Lung Function. American journal of respiratory and critical care medicine.
• Chang, E. H., Pouladi, N., Guerra, S., Jandova, J., Kim, A., Li, H., Li, J., Morgan, W., Stern, D. A., Willis, A. L., Lussier, Y. A., & Martinez, F. D. (2022). Epithelial cell responses to rhinovirus identify an early-life-onset asthma phenotype in adults. The Journal of allergy and clinical immunology, 150(3), 604-611.
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  The study of pathogenic mechanisms in adult asthma is often marred by a lack of precise information about the natural history of the disease. Children who have persistent wheezing (PW) during the first 6 years of life and whose symptoms start before age 3 years (PW) are much more likely to have wheezing illnesses due to rhinovirus (RV) in infancy and to have asthma into adult life than are those who do not have PW (PW).
• Ezmigna, D., Brown, M., Daines, C., & Morgan, W. (2022). Bronchoalveolar lavage profiles in uncontrolled wheezy children compared by asthma predictive index. Pediatric pulmonology, 57(1), 293-299.
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  The asthma predictive index (API) predicts later asthma in preschoolers with frequent wheeze. We hypothesized that airway cytology differs between API positive (API+)/negative (API-) children with uncontrolled/recurrent wheezing with dominance of eosinophils in API+ and neutrophils in API- groups respectively. The main objective of this study is to compare bronchoalveolar lavage (BAL) cell profiles in API+/API- children with recurrent wheezing unresponsive to inhaled corticosteroids (ICS).
• Harber, P., Furlong, M., Stern, D. A., Morgan, W. J., Wright, A. L., Guerra, S., & Martinez, F. D. (2022). Association of Childhood Respiratory Status with Adult Occupational Exposures in a Birth Cohort. Annals of the American Thoracic Society.
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  People with better early life respiratory health may be more likely to work in occupations with high workplace exposures in adult life, compared to people with poor respiratory health. This may manifest as a healthy worker effect bias potentially confounding the analysis of environmental exposure studies.
• Lowe, A. A., Simmons, B., Nez, P., Begay, E., Liu, A., King, D., Gerald, J. K., Aaron, K., Wightman, P., Solomon, T., Crooks, J., Phan, H., Morgan, W., Bender, B., & Gerald, L. B. (2022). An asthma collaboration to reduce childhood asthma disparities on the Navajo Nation: Trial protocol for the Community Asthma Program. Public health in practice (Oxford, England), 4, 100289.
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  Navajo children disproportionately experience poor asthma outcomes. Following a one-year community engagement period with key stakeholders from the Navajo Nation, the Community Asthma Program (CAP) was created using evidenced based programs with the goal of reducing asthma disparities among Navajo children. CAP is being evaluated with a six-year, multi-site step-wedge design in three Navajo communities: Tuba City, Chinle and Fort Defiance, Arizona. The primary outcome is asthma exacerbations defined as use of systemic oral corticosteroids, asthma hospitalizations, asthma related ED visits, and ICU admissions. Asthma exacerbations will be measured using data from the electronic medical records of the three community health care centers. Secondary outcomes include will changes in asthma-related events and asthma control. The RE-AIM ( , 2 , 3) , 4) , and 5) ) framework is being used to guide the implementation evaluation which includes iterative collection and analysis of process data to identify facilitators and barriers, describe relevant organizational contexts, and inform strategies for dissemination. The CAP intervention requires community engagement and participation, building community capacity, incorporating evidenced-based guidelines and practices while ensuring program strategies actively involve Navajo community members during all steps of the intervention. The outcome of this trial will allow us to determine the effectiveness of a multi-component, community-focused intervention to improve asthma in a tribal community.
• Rosenfeld, M., Ostrenga, J., Cromwell, E. A., Magaret, A., Szczesniak, R., Fink, A., Schechter, M. S., Faro, A., Ren, C. L., Morgan, W., & Sanders, D. B. (2022). Real-world Associations of US Cystic Fibrosis Newborn Screening Programs With Nutritional and Pulmonary Outcomes. JAMA pediatrics, 176(10), 990-999.
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  Newborn screening (NBS) for cystic fibrosis (CF) has been universal in the US since 2010, but its association with clinical outcomes is unclear.
• Sawicki, G. S., Konstan, M. W., McKone, E. F., Moss, R. B., Lubarsky, B., Suthoff, E., Millar, S. J., Pasta, D. J., Mayer-Hamblett, N., Goss, C. H., Morgan, W. J., Duncan, M. E., & Yang, Y. (2022). Rate of Lung Function Decline in People with Cystic Fibrosis Having a Residual Function Gene Mutation. Pulmonary therapy, 8(4), 385-395.
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  Cystic fibrosis (CF) is an autosomal recessive disease caused by mutations in the CF transmembrane conductance regulator (CFTR) gene. Approximately 5% of people with CF have residual function (RF) CFTR mutations that result in partially retained CFTR activity. Published literature on disease trajectory among those with RF mutations is limited. In this retrospective study, we characterized lung function decline across different age groups in CFTR modulator-untreated people with CF heterozygous for F508del and an RF mutation (F/RF).
• Voraphani, N., Stern, D. A., Zhai, J., Wright, A. L., Halonen, M., Sherrill, D. L., Hallberg, J., Kull, I., Bergström, A., Murray, C. S., Lowe, L., Custovic, A., Morgan, W. J., Martinez, F. D., Melén, E., Simpson, A., & Guerra, S. (2022). The role of growth and nutrition in the early origins of spirometric restriction in adult life: a longitudinal, multicohort, population-based study. The Lancet. Respiratory medicine, 10(1), 59-71.
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  Spirometric restriction, defined as a reduced forced vital capacity (FVC) with a preserved FEV/FVC ratio, is associated with increased respiratory and non-respiratory comorbidities and all-cause mortality in adulthood. Little is known about the early origins of this condition. We sought to identify early-life risk factors for spirometric restriction in adult life.
• Zhai, J., Emond, M. J., Spangenberg, A., Stern, D. A., Vasquez, M. M., Blue, E. E., Buckingham, K. J., Sherrill, D. L., Halonen, M., Gibson, R. L., Rosenfeld, M., Sagel, S. D., Bamshad, M. J., Morgan, W. J., & Guerra, S. (2022). Club cell secretory protein and lung function in children with cystic fibrosis. Journal of cystic fibrosis : official journal of the European Cystic Fibrosis Society, 21(5), 811-820.
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  Club cell secretory protein (CC16) exerts anti-inflammatory functions in lung disease. We sought to determine the relation of serum CC16 deficits and genetic variants that control serum CC16 to lung function among children with cystic fibrosis (CF).
• Asseri, A. A., Khattab, N., Ezmigna, D., Awadalla, N. J., Daines, C., & Morgan, W. (2021). Diagnostic Accuracy of Nasopharyngeal Swab Cultures in Children Less Than Five Years with Chronic Wet Cough. Children (Basel, Switzerland), 8(12).
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  It is necessary to find a non-invasive and accurate procedure to predict persistent bacterial bronchitis (PBB) causative organisms and guide antibiotic therapy. The study objective was to compare the diagnostic accuracy of nasopharyngeal swab cultures with bronchoalveolar lavage (BAL) cultures in children with PBB.
• Cogen, J. D., Onchiri, F. M., Hamblett, N. M., Gibson, R. L., Morgan, W. J., & Rosenfeld, M. (2021). Association of Intensity of Antipseudomonal Antibiotic Therapy With Risk of Treatment-Emergent Organisms in Children With Cystic Fibrosis and Newly Acquired Pseudomonas Aeruginosa. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 73(6), 987-993.
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  While Pseudomonas aeruginosa (Pa) eradication regimens have contributed to a decline in Pa prevalence in people with cystic fibrosis (CF), this antibiotic exposure might increase the risk of acquisition of drug-resistant organisms. This study evaluated the association between antipseudomonal antibiotic exposure intensity and acquisition risk of drug-resistant organisms among children with CF and new Pa infection.
• Daines, C. L., & Morgan, W. J. (2021). The Future of Highly Effective Modulator Therapy in Cystic Fibrosis. American journal of respiratory and critical care medicine, 203(12), 1453-1455.
• Knobbe, K., Partha, M., Seckeler, M. D., Klewer, S., Hsu, C. H., Edgin, J., Morgan, W. J., Provencio-Dean, N., Lopez, S., Parthasarathy, S., & Combs, D. (2021). Association Between Sleep Disturbances With Neurodevelopmental Problems and Decreased Health-Related Quality of Life in Children With Fontan Circulation. Journal of the American Heart Association, 10(21), e021749.
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  Background Children with Fontan circulation are known to be at increased risk for neurodevelopmental problems and decreased health-related quality of life (HRQOL), but many factors that may contribute to this risk are unknown. Sleep disturbances may be one previously unidentified factor that contributes to this risk. Methods and Results We analyzed data from the Pediatric Heart Network Fontan cross-sectional study to evaluate associations between a parent or child report of sleep disturbance with reported neurodevelopmental concerns and HRQOL in 558 children with Fontan circulation. Parent-reported sleep disturbance was present in 11% of participants and child-reported sleep disturbance was present in 15%. Parent-reported sleep disturbance was associated with a significantly higher risk of attention problems, anxiety, depression, behavioral problems, and developmental delay (
• Konstan, M. W., Pasta, D. J., VanDevanter, D. R., Wagener, J. S., Morgan, W. J., & , S. A. (2021). Epidemiologic Study of Cystic Fibrosis: 25 years of observational research. Pediatric pulmonology.
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  The Epidemiologic Study of Cystic Fibrosis (ESCF) was a prospective observational study of over 32,000 people with cystic fibrosis (CF) from 250 clinical care sites in North America from 1994 to 2005. Begun as a pharmacovigilance study in connection with the approval of dornase alfa in 1993, ESCF was open to all people with CF treated at any participating site in the United States or Canada. In addition to obtaining safety and effectiveness data on dornase alfa, ESCF collected encounter-based data to characterize the natural history and management of CF with a special focus on lung disease. During the study, 32,178 patients reported at least one encounter, contributing 869,136 encounters, 622,592 pulmonary function tests, 432,896 cultures, and 118,563 pulmonary exacerbations treated with intravenous antibiotics. Although ESCF data collection concluded in 2005, through a collaboration with the U.S. Cystic Fibrosis Foundation Patient Registry, additional follow-up data through 2017 was available for two-thirds of patients. This allowed for updating of CF genotype and survival information. Fifty-six peer-reviewed publications (cited over 3600 times) resulted from this study. In this manuscript we summarize the published ESCF manuscripts in thematic groups with key study findings and brief comments, and speculate on how ESCF findings will inform future data registries and patient care practices.
• Morgan, W. J. (2021). Diagnostic Accuracy of Nasopharyngeal Swab Cultures in Children Less Than Five Years with Chronic Wet Cough.. Children (Basel), 8(12), 1161. doi:10.3390/children8121161.
• Morgan, W. J. (2021). Further evidence that sex matters in lung development: maternal asthma and infant lung function.. Thorax, 76(10), 959-960. doi:10.1136/thoraxjnl-2021-217095
• Morgan, W. J. (2021). Geography, generalisability, and susceptibility in clinical trials.. Lancet Respir Med., 9(4), 330-332. doi:10.1016/S2213-2600(21)00046-1.
• Morgan, W. J. (2021). Preventing asthma in high risk kids (PARK) with omalizumab: Design, rationale, methods, lessons learned and adaptation.. Contemp Clin Trials, 100, 106228. doi:doi: 10.1016/j.cct.2020.106228
• Combs, D., Edgin, J. O., Klewer, S., Barber, B. J., Morgan, W. J., Hsu, C. H., Abraham, I., & Parthasarathy, S. (2020). OSA and Neurocognitive Impairment in Children With Congenital Heart Disease. Chest, 158(3), 1208-1217.
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  Children with congenital heart disease (CHD) have an increased risk of neurocognitive impairment. No prior studies have evaluated the role of OSA, which is associated with neurocognitive impairment in children without CHD.
• Guerra, S., Lombardi, E., Stern, D. A., Sherrill, D. L., Gilbertson-Dahdal, D., Wheatley-Guy, C. M., Snyder, E. M., Wright, A. L., Martinez, F. D., & Morgan, W. J. (2020). Fetal Origins of Asthma: A Longitudinal Study from Birth to Age 36 Years. American journal of respiratory and critical care medicine, 202(12), 1646-1655.
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  Deficits in infant lung function-including the ratio of the time to reach peak tidal expiratory flow to the total expiratory time (tptef/te) and maximal expiratory flow at FRC (V̇maxFRC)-have been linked to increased risk for childhood asthma. To examine the individual and combined effects of tptef/te and V̇maxFRC in infancy on risk for asthma and abnormalities of airway structure into mid-adult life. One hundred eighty participants in the Tucson Children's Respiratory Study birth cohort had lung function measured by the chest-compression technique in infancy (mean age ± SD: 2.0 ± 1.2 mo). Active asthma was assessed in up to 12 questionnaires between ages 6 and 36 years. Spirometry and chest high-resolution computed tomographic (HRCT) imaging were completed in a subset of participants at age 26. The relations of infant tptef/te and V̇maxFRC to active asthma and airway structural abnormalities into adult life were tested in multivariable mixed models. After adjustment for covariates, a 1-SD decrease in infant tptef/te and V̇maxFRC was associated with a 70% ( = 0.001) and 55% ( = 0.005) increased risk of active asthma, respectively. These effects were partly independent, and two out of three infants who were in the lowest tertile for both tptef/te and V̇maxFRC developed active asthma by mid-adult life. Infant V̇maxFRC predicted reduced airflow and infant tptef/te reduced HRCT airway caliber at age 26. These findings underscore the long-lasting effects of the fetal origins of asthma, support independent contributions by infant tptef/te and V̇maxFRC to development of asthma, and link deficits at birth in tptef/te with HRCT-assessed structural airway abnormalities in adult life.
• Hoppe, J. E., Hinds, D. M., Colborg, A., Wagner, B. D., Morgan, W. J., Rosenfeld, M., Zemanick, E. T., & Sanders, D. B. (2020). Oral antibiotic prescribing patterns for treatment of pulmonary exacerbations in two large pediatric CF centers. Pediatric pulmonology, 55(12), 3400-3406.
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  Oral antibiotics are frequently prescribed for outpatient pulmonary exacerbations (PEx) in children with cystic fibrosis (CF). This study aimed to characterize oral antibiotic use for PEx and treatment outcomes at two large US CF centers.
• Phipatanakul, W., Mauger, D. T., Guilbert, T. W., Bacharier, L. B., Durrani, S., Jackson, D. J., Martinez, F. D., Fitzpatrick, A. M., Cunningham, A., Kunselman, S., Wheatley, L. M., Bauer, C., Davis, C. M., Geng, B., Kloepfer, K. M., Lapin, C., Liu, A. H., Pongracic, J. A., Teach, S. J., , Chmiel, J., et al. (2020). Preventing asthma in high risk kids (PARK) with omalizumab: Design, rationale, methods, lessons learned and adaptation. Contemporary clinical trials, 100, 106228.
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  Asthma remains one of the most important challenges to pediatric public health in the US. A large majority of children with persistent and chronic asthma demonstrate aeroallergen sensitization, which remains a pivotal risk factor associated with the development of persistent, progressive asthma throughout life. In individuals with a tendency toward Type 2 inflammation, sensitization and exposure to high concentrations of offending allergens is associated with increased risk for development of, and impairment from, asthma. The cascade of biological responses to allergens is primarily mediated through IgE antibodies and their production is further stimulated by IgE responses to antigen exposure. In addition, circulating IgE impairs innate anti-viral immune responses. The latter effect could magnify the effects of another early life exposure associated with increased risk of the development of asthma - viral infections. Omalizumab binds to circulating IgE and thus ablates antigen signaling through IgE-related mechanisms. Further, it has been shown restore IFN-α response to rhinovirus and to reduce asthma exacerbations during the viral season. We therefore hypothesized that early blockade of IgE and IgE mediated responses with omalizumab would prevent the development and reduce the severity of asthma in those at high risk for developing asthma. Herein, we describe a double-blind, placebo-controlled trial of omalizumab in 2-3 year old children at high risk for development of asthma to prevent the development and reduce the severity of asthma. We describe the rationale, methods, and lessons learned in implementing this potentially transformative trial aimed at prevention of asthma.
• Sanders, D. B., Ostrenga, J. S., Rosenfeld, M., Fink, A. K., Schechter, M. S., Sawicki, G. S., Flume, P. A., & Morgan, W. J. (2020). Predictors of pulmonary exacerbation treatment in cystic fibrosis. Journal of cystic fibrosis : official journal of the European Cystic Fibrosis Society, 19(3), 407-414.
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  Most studies of pulmonary exacerbations (PEx) in cystic fibrosis (CF) focus on intravenous (IV)-treated PEx, though most PEx are treated with oral antibiotics. Our objectives were to describe predictors of antibiotic choice and outcomes for PEx initially identified in clinic.
• Wagener, J. S., VanDevanter, D. R., Konstan, M. W., Pasta, D. J., Millar, S. J., & Morgan, W. J. (2020). Lung function changes before and after pulmonary exacerbation antimicrobial treatment in cystic fibrosis. Pediatric pulmonology, 55(3), 828-834.
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  In cystic fibrosis, observation of a lung function drop (as percent predicted forced expiratory volume in 1 s [FEV ]; ppFEV ) frequently precedes pulmonary exacerbation (PEx) diagnosis. Recovery of ppFEV to a previous "baseline" is commonly used to assess antimicrobial treatment response. However, not all diagnosed PEx are associated with a ppFEV drop, and it is unclear whether these are a different type of PEx from those associated with a ppFEV drop.
• Bisch, A. L., Wheatley, C. M., Baker, S. E., Peitzman, E. R., Van Iterson, E. H., Laguna, T. A., Morgan, W. J., & Snyder, E. M. (2019). Cystic Fibrosis Transmembrane Conductance Regulator Genotype, Not Circulating Catecholamines, Influences Cardiovascular Function in Patients with Cystic Fibrosis. Clinical medicine insights. Circulatory, respiratory and pulmonary medicine, 13, 1179548419835788.
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  Cystic fibrosis (CF) is a genetic disease affecting multiple organ systems of the body and is characterized by mutation in the gene coding for the cystic fibrosis transmembrane conductance regulator (CFTR). Previous work has shown that a single dose of aβ-agonist increases cardiac output (Q) and stroke volume (SV) and decreases systemic vascular resistance (SVR) in healthy subjects. This effect is attenuated in patients with CF; however, the mechanism is unknown. Potential explanations for this decreased cardiovascular response to a β-agonist in CF include inherent cardiovascular deficits secondary to the CFTR mutation, receptor desensitization from prolonged β-agonist use as part of clinical care, or inhibited drug delivery to the bloodstream due to mucus buildup in the lungs. This study sought to determine the effects of endogenous epinephrine (EPI) and norepinephrine (NE) on cardiovascular function in CF and to evaluate the relationship between cardiovascular function and CFTR F508del mutation.
• Combs, D., Goodwin, J. L., Quan, S. F., Morgan, W. J., Hsu, C. H., Edgin, J. O., & Parthasarathy, S. (2019). Mother Knows Best? Comparing Child Report and Parent Report of Sleep Parameters With Polysomnography. Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine, 15(1), 111-117.
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  Parent report or child report is commonly used to obtain information on sleep in children. Data are lacking comparing the validity of parent-reported versus child-reported sleep parameters.
• Lazarus, S. C., Krishnan, J. A., King, T. S., Lang, J. E., Blake, K. V., Covar, R., Lugogo, N., Wenzel, S., Chinchilli, V. M., Mauger, D. T., Dyer, A. M., Boushey, H. A., Fahy, J. V., Woodruff, P. G., Bacharier, L. B., Cabana, M. D., Cardet, J. C., Castro, M., Chmiel, J., , Denlinger, L., et al. (2019). Mometasone or Tiotropium in Mild Asthma with a Low Sputum Eosinophil Level. The New England journal of medicine, 380(21), 2009-2019.
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  In many patients with mild, persistent asthma, the percentage of eosinophils in sputum is less than 2% (low eosinophil level). The appropriate treatment for these patients is unknown.
• Morgan, W. J. (2019). Challenges in assessing the efficacy of systemic corticosteroids for severe wheezing episodes in preschool children.. Journal of Allergy and Clinical Immunology.
• Morgan, W. J. (2019). Club Cell Secretory Protein Deficiency Leads to Altered Lung Function.. American Journal of Respiratory and Critical Care Medicine.
• Morgan, W. J. (2019). Cystic Fibrosis Transmembrane Conductance Regulator Genotype, Not Circulating Catecholamines, Influences Cardiovascular Function in Patients with Cystic Fibrosis.. Clin Med Insights Circ Respir Pulm Med.
• Morgan, W. J. (2019). Lung function changes before and after pulmonary exacerbation antimicrobial treatment in cystic fibrosis. Pediatr Pulmonol.
• Morgan, W. J. (2019). Mometasone or Tiotropium in Mild Asthma with a Low Sputum Eosinophil Level.. New England Journal of Medicine.
• Morgan, W. J. (2019). Mother Knows Best? Comparing Child Report and Parent Report of Sleep Parameters With Polysomnography. Journal of Clinical Sleep Medicine.
• Morgan, W. J. (2019). Peak flow variability in childhood and body mass index in adult life.. Journal of Allergy and Clinical Immunology.
• Morgan, W. J. (2019). Phenotypes of Recurrent Wheezing in Preschool Children: Identification by Latent Class Analysis and Utility in Prediction of Future Exacerbation.. Journal of Allergy and Clinical Immunology - In Practice.
• Morgan, W. J. (2019). Predictors of pulmonary exacerbation treatment in cystic fibrosis.. Journal of Cystic Fibrosis.
• Parthasarathy, S., Edgin, J. O., Hsu, C., Morgan, W. J., Quan, S. F., Goodwin III, J. L., & Combs, D. (2019). Mother knows best? Comparing child and parent report of sleep parameters with polysomnography. Journal of Clinical Sleep Medicine.
• Bose, S., Rosa, M. J., Mathilda Chiu, Y. H., Leon Hsu, H. H., Di, Q., Lee, A., Kloog, I., Wilson, A., Schwartz, J., Wright, R. O., Morgan, W. J., Coull, B. A., & Wright, R. J. (2018). Prenatal nitrate air pollution exposure and reduced child lung function: Timing and fetal sex effects. Environmental research, 167, 591-597.
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  Prenatal particulate air pollution exposure may alter lung growth and development in utero in a time-sensitive and sex-specific manner, resulting in reduced lung function in childhood. Such relationships have not been examined for nitrate (NO).
• Combs, D., Skrepnek, G., Seckeler, M. D., Barber, B. J., Morgan, W. J., & Parthasarathy, S. (2018). Sleep-Disordered Breathing is Associated With Increased Mortality in Hospitalized Infants With Congenital Heart Disease. Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine, 14(9), 1551-1558.
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  Sleep-disordered breathing (SDB) has adverse cardiovascular effects in children and adults. In adults with cardiac disease, SDB is highly prevalent and confers increased mortality risk. It is unknown if SDB confers a similar risk in infants with congenital heart disease (CHD). We evaluated clinical and economic outcomes associated with SDB among inpatient infants with CHD in the United States from 1997-2012.
• Gerhart, K. D., Stern, D. A., Guerra, S., Morgan, W. J., Martinez, F. D., & Wright, A. L. (2018). Protective effect of breastfeeding on recurrent cough in adulthood. Thorax, 73(9), 833-839.
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  Breastfeeding protects from respiratory infections in early life but its relationship to recurrent cough and other respiratory outcomes in adult life is not well established.
• Hiranrattana, A., Stern, D. A., Guerra, S., Halonen, M., Wright, A. L., Daines, M., Martinez, F. D., & Morgan, W. J. (2018). sensitisation at age 6 years is associated with subsequent airway hyper-responsiveness in non-asthmatics. Thorax, 73(12), 1170-1173.
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  In the non-selected birth cohort Tucson Children's Respiratory Study, early sensitisation to was associated with increased airway hyper-responsiveness (AHR) into adult life among non-asthmatics. The increase in AHR was of a similar magnitude to that seen for sensitised asthmatics and was primarily evident among those who were overweight or obese. In contrast, there was no significant association between early sensitisation to aeroallergens other than and AHR among non-asthmatics. Why this group of sensitised individuals without asthma demonstrated increased AHR of a magnitude similar to asthmatics is unknown and requires further investigation.
• Jackson, D. J., Bacharier, L. B., Mauger, D. T., Boehmer, S., Beigelman, A., Chmiel, J. F., Fitzpatrick, A. M., Gaffin, J. M., Morgan, W. J., Peters, S. P., Phipatanakul, W., Sheehan, W. J., Cabana, M. D., Holguin, F., Martinez, F. D., Pongracic, J. A., Baxi, S. N., Benson, M., Blake, K., , Covar, R., et al. (2018). Quintupling Inhaled Glucocorticoids to Prevent Childhood Asthma Exacerbations. The New England journal of medicine, 378(10), 891-901.
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  Asthma exacerbations occur frequently despite the regular use of asthma-controller therapies, such as inhaled glucocorticoids. Clinicians commonly increase the doses of inhaled glucocorticoids at early signs of loss of asthma control. However, data on the safety and efficacy of this strategy in children are limited.
• Kobernick, A., Liu, A. H., Bender, B., Lowe, A. A., Morgan, W. J., Gerald, L. B., & Solomon, T. G. (2018). Environmental concerns for children with asthma on the Navajo Nation. Annals of American Thoracic Society, 15(6), 745-753.
• Konstan, M. W., VanDevanter, D. R., Sawicki, G. S., Pasta, D. J., Foreman, A. J., Neiman, E. A., & Morgan, W. J. (2018). Association of High-Dose Ibuprofen Use, Lung Function Decline, and Long-Term Survival in Children with Cystic Fibrosis. Annals of the American Thoracic Society.
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  Cystic fibrosis (CF) deaths result primarily from lung function loss, so chronic respiratory therapies intended to preserve lung function are cornerstones of CF care. Although treatment-associated reduction in rate of lung function loss should ultimately improve CF survival, no such relationship has been described for any chronic CF therapy. In part, this is because the ages of most rapid lung function decline -- early adolescence -- precede the median age of CF deaths by more than a decade.
• Li, S. S., Hayes, D., Tobias, J. D., Morgan, W. J., & Tumin, D. (2018). Health Insurance and Use of Recommended Routine Care in Adults with Cystic Fibrosis. The clinical respiratory journal.
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  Low socioeconomic status is correlated with worse outcomes in patients with cystic fibrosis. Whether insurance status impacts adherence to care in this population is unknown.
• Lombardi, E., Stern, D. A., Sherrill, D., Morgan, W. J., Wright, A. L., Garcia-Aymerich, J., Serra Pons, I., Guerra, S., & Martinez, F. D. (2018). Peak flow variability in childhood and body mass index in adult life. The Journal of allergy and clinical immunology.
• Morgan, W. (2018). Spirometry and Impulse Oscillometry in Preschool Children: Acceptability and Relationship to Maternal Smoking in Pregnancy. Journal of Allergy and Clinical Immunology. In Practice, 6(5), 1596-1603.
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  Spirometry and Impulse Oscillometry in Preschool Children: Acceptability and Relationship to Maternal Smoking in Pregnancy.Kattan M, Bacharier LB, O'Connor GT, Cohen R, Sorkness RL, Morgan W, Gergen PJ, Jaffee KF, Visness CM, Wood RA, Bloomberg GR, Doyle S, Burton R, Gern JE.The journal of allergy and clinical immunology. In practice. 2018; 6(5):1596-1603.e6. NIHMSID: NIHMS943280PubMed [journal]PMID: 29449165 PMCID: PMC6089669
• Morgan, W. J. (2018). Environmental Concerns for Children with Asthma on the Navajo Nation.. Annals of the American Thoracic Society, 15(6), 745-753.
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  Environmental Concerns for Children with Asthma on the Navajo Nation.Lowe AA, Bender B, Liu AH, Solomon T, Kobernick A, Morgan W, Gerald LB.Annals of the American Thoracic Society. 2018; 15(6):745-753.PubMed [journal]PMID: 29485894 PMCID: PMC6207133
• Morgan, W. J. (2018). Longitudinal development of initial, chronic and mucoid Pseudomonas aeruginosa infection in young children with cystic fibrosis.. Journal of Cystic Fibrosis, 17(3), 341-347.
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  Longitudinal development of initial, chronic and mucoid Pseudomonas aeruginosa infection in young children with cystic fibrosis.Heltshe SL, Khan U, Beckett V, Baines A, Emerson J, Sanders DB, Gibson RL, Morgan W, Rosenfeld M.Journal of cystic fibrosis : official journal of the European Cystic Fibrosis Society. 2018; 17(3):341-347. NIHMSID: NIHMS913872PubMed [journal]PMID: 29110966 PMCID: PMC5924440
• Snyder, E. M., Snyder, E. M., Morgan, W. J., Morgan, W. J., Martinez, M. G., Martinez, M. G., Phan, H., Phan, H., Daines, C. L., Daines, C. L., Baker, S. E., Baker, S. E., Wheatley, C. M., & Wheatley, C. M. (2018). Influence of the Vibralung Acoustical Percussor on pulmonary function and sputum expectoration in individuals with cystic fibrosis.. Ther Adv Respir Dis., 12, 1-15. doi:10.1177/1753466618770997
• Van Iterson, E. H., Baker, S. E., Wheatley, C. M., Morgan, W. J., Olson, T. P., & Snyder, E. M. (2018). Exercise Stroke Volume in Adult Cystic Fibrosis: A Comparison of Acetylene Pulmonary Uptake and Oxygen Pulse. Clinical medicine insights. Circulatory, respiratory and pulmonary medicine, 12, 1179548418790564.
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  Cardiac hemodynamic assessment during cardiopulmonary exercise testing (CPET) is proposed to play an important role in the clinical evaluation of individuals with cystic fibrosis (CF). Cardiac catheterization is not practical for routine clinical CPET. Use of oxygen pulse (Opulse) as a noninvasive estimate of stroke volume (SV) has not been validated in CF. This study tested the hypothesis that peak exercise Opulse is a valid estimate of SV in CF. Measurements of SV via the acetylene rebreathe technique were acquired at baseline and peak exercise in 17 mild-to-moderate severity adult CF and 25 age-matched healthy adults. We calculated . Baseline relationships between SV and Opulse were significant in CF ( = .80) and controls ( = .40), persisting to peak exercise in CF ( = .63) and controls ( = .73). The standard error of estimate for Opulse-predicted SV with respect to measured SV was similar at baseline (14.1 vs 20.1 mL) and peak exercise (18.2 vs 13.9 mL) for CF and controls, respectively. These data suggest that peak exercise Opulse is a valid estimate of SV in CF. The ability to noninvasively estimate SV via Opulse during routine clinical CPET can be used to improve test interpretation and advance our understanding of the impact cardiac dysfunction has on exercise intolerance in CF.
• VanDevanter, D. R., Craib, M. L., Pasta, D. J., Millar, S. J., Morgan, W. J., Konstan, M. W., & , S. A. (2018). Cystic fibrosis clinical characteristics associated with dornase alfa treatment regimen change. Pediatric pulmonology, 53(1), 43-49.
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  When the chronic respiratory therapy dornase alfa was made commercially available for cystic fibrosis (CF) more than 20 years ago, two regimens were approved: 2.5 mg inhaled once daily (QD) or twice daily (BID). In the intervening years, there has been little guidance as to when to use each regimen. We have studied clinical practice patterns captured in the Epidemiologic Study of CF (ESCF) during the decade following dornase alfa approval (1994-2005) to better understand clinical characteristics associated with QD versus BID dornase alfa use. Methods We studied the characteristics of ESCF patients who received either dornase alfa regimen for at least 12 months and who were then switched to the alternate regimen for at least 6 months and who had adequate data available around the time of the switch. Average lung function and weight-for-age (WFA) z-scores, numbers of intravenous (IV) antibiotic-treated pulmonary exacerbations, and prevalence of signs and symptoms were determined for 6-month periods capturing the beginning (FIRST) and the end (LAST) of the initial regimen, the 6 months preceding the final 6 months of the initial regimen (PRIOR), and the beginning of the second regimen (POST). Changes in values from FIRST to LAST, PRIOR to LAST, and LAST to POST were studied to better understand clinical scenarios associated with decisions to change regimens.
• Vasquez, M. M., Sherrill, D. L., LeVan, T. D., Morgan, W. J., Sisson, J. H., & Guerra, S. (2018). Persistent light to moderate alcohol intake and lung function: A longitudinal study. Alcohol (Fayetteville, N.Y.), 67, 65-71.
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  Alcohol intake has been inconsistently associated with lung function levels in cross-sectional studies. The goal of our study was to determine whether longitudinally assessed light-to-moderate alcohol intake is associated with levels and decline of lung function. We examined data from 1333 adult participants in the population-based Tucson Epidemiological Study of Airway Obstructive Disease. Alcohol intake was assessed with four surveys between 1972 and 1992. Subjects who completed at least two surveys were classified into longitudinal drinking categories ("never", "inconsistent", or "persistent drinker"). Spirometric lung function was measured in up to 11 surveys between 1972 and 1992. Random coefficient models were used to test for differences in lung function by drinking categories. After adjustment for sex, age, height, education, BMI categories, smoking status, and pack-years, as compared to never-drinkers, persistent drinkers had higher FVC (coefficient: 157 mL, p 
• Wagener, J. S., Williams, M. J., Millar, S. J., Morgan, W. J., Pasta, D. J., & Konstan, M. W. (2018). Pulmonary exacerbations and acute declines in lung function in patients with cystic fibrosis. Journal of cystic fibrosis : official journal of the European Cystic Fibrosis Society, 17(4), 496-502.
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  Patients with cystic fibrosis (CF) who experience acute declines in percent predicted FEV (ppFEV decreased ≥10% relative to baseline) are often not treated with antibiotics for pulmonary exacerbations (PEx), whereas other patients are treated even when they have not experienced a decline in lung function.
• Wheatley, C. M., Baker, S. E., Daines, C. M., Phan, H., Martinez, M. G., Morgan, W. J., & Snyder, E. M. (2018). Influence of the Vibralung Acoustical Percussor on pulmonary function and sputum expectoration in individuals with cystic fibrosis. Therapeutic advances in respiratory disease, 12, 1753466618770997.
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  The Vibralung Acoustical Percussor is a new airway clearance therapy (ACT) utilizing intrapulmonary sound waves in addition to positive expiratory pressure (PEP). We evaluated the safety of the Vibralung and collected preliminary data on its ability to mediate sputum expectoration in individuals with cystic fibrosis (CF).
• Zhai, J., Stern, D. A., Sherrill, D. L., Spangenberg, A. L., Wright, A. L., Morgan, W. J., Halonen, M., Martinez, F. D., & Guerra, S. (2018). Trajectories and Early Determinants of Circulating CC16 from Birth to Age 32 Years. American journal of respiratory and critical care medicine, 198(2), 267-270.
• Fink, A. K., Loeffler, D. R., Marshall, B. C., Goss, C. H., & Morgan, W. J. (2017). Data that empower: The success and promise of CF patient registries. Pediatric pulmonology, 52(S48), S44-S51.
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  In this article, we describe existing CF registries with a focus on US registry data collected through the CF Foundation Patient Registry (CFFPR) and the Epidemiologic Study of CF (ESCF); highlight what registries have taught us regarding epidemiology of CF; showcase the impact of registries on research and clinical care; and discuss future directions. This manuscript complements the plenary address given by Dr Wayne Morgan at the 2016 North American CF Conference by summarizing the key points from the presentation and providing additional detail and information.
• Konstan, M. W., Pasta, D. J., Wagener, J. S., VanDevanter, D. R., & Morgan, W. J. (2017). BMI fails to identify poor nutritional status in stunted children with CF. Journal of cystic fibrosis : official journal of the European Cystic Fibrosis Society, 16(1), 158-160.
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  Body mass index (BMI) is currently emphasized for evaluating nutritional status in children with cystic fibrosis (CF). Weight for age (WFA) and height for age (HFA) may get less attention.
• Konstan, M. W., Wagener, J. S., VanDevanter, D. R., Pasta, D. J., Millar, S. J., Morgan, W. J., & , S. A. (2017). Comparison of FEV1 reference equations for evaluating a cystic fibrosis therapeutic intervention. Pediatric pulmonology, 52(8), 1013-1019.
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  The Global Lung Function Initiative (GLI, 2012) developed reference equations for forced expiratory volume in 1 s (FEV1 ). Previous equations were developed by groups led by Knudson (1983), Wang (1993), Hankinson (1999), and Stanojevic (2008).1,2,4,6 We assessed how different prediction equations affect the conclusions from a therapeutic intervention study that evaluated the rate of percent predicted FEV1 (ppFEV1 ) decline.
• Lee, A. G., Chiu, Y. M., Rosa, M. J., Cohen, S., Coull, B. A., Wright, R. O., Morgan, W. J., & Wright, R. J. (2017). Association of prenatal and early childhood stress with reduced lung function in 7-year-olds. Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology, 119(2), 153-159.
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  No prior study has examined associations between prenatal and early-life stress on childhood lung function or identified critical windows of exposure.
• McColley, S. A., Schechter, M. S., Morgan, W. J., Pasta, D. J., Craib, M. L., & Konstan, M. W. (2017). Risk factors for mortality before age 18 years in cystic fibrosis. Pediatric pulmonology, 52(7), 909-915.
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  Understanding early-life risk factors for childhood death in cystic fibrosis (CF) is important for clinical care, including the identification of effective interventions.
• Morgan, W. J., Wagener, J. S., Pasta, D. J., Millar, S. J., VanDevanter, D. R., Konstan, M. W., & , S. A. (2017). Relationship of Antibiotic Treatment to Recovery after Acute FEV1 Decline in Children with Cystic Fibrosis. Annals of the American Thoracic Society, 14(6), 937-942.
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  Children with cystic fibrosis often experience acute declines in lung function. We previously showed that such declines are not always treated with antibiotics, but we did not assess whether treatment improves the likelihood of recovery.
• Schechter, M. S., VanDevanter, D. R., Pasta, D. J., Short, S. A., Morgan, W. J., Konstan, M. W., & , S. A. (2017). Treatment Setting and Outcomes of Cystic Fibrosis Pulmonary Exacerbations. Annals of the American Thoracic Society.
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  There are important gaps in our knowledge of the optimal treatment of cystic fibrosis (CF) pulmonary exacerbations. Previous observational studies comparing inpatient to outpatient treatment have suffered from methodological weaknesses, especially indication bias.
• Subbarao, P., Milla, C. E., Morgan, W. J., Ratjen, F., & , W. A. (2017). Corrections to an ATS Workshop Report on Multiple-Breath Washout Testing for Patients with Cystic Fibrosis. Annals of the American Thoracic Society, 14(1), 145.
• Tumin, D., Li, S. S., Kopp, B. T., Kirkby, S. E., Tobias, J. D., Morgan, W. J., & Hayes, D. (2017). The effect of the affordable care act dependent coverage provision on patients with cystic fibrosis. Pediatric pulmonology, 52(4), 458-466.
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  The Patient Protection and Affordable Care Act (ACA), enacted in 2010, expanded private insurance coverage of young adults through the dependent coverage provision. This policy's implications for patients with cystic fibrosis (CF) are unknown.
• Berry, C. E., Billheimer, D., Jenkins, I. C., Lu, Z. J., Stern, D. A., Gerald, L. B., Carr, T. F., Guerra, S., Morgan, W. J., Wright, A. L., & Martinez, F. D. (2016). A Distinct Low Lung Function Trajectory from Childhood to the Fourth Decade of Life. American journal of respiratory and critical care medicine, 194(5), 607-12.
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  Low maximally attained lung function increases the risk of chronic obstructive pulmonary disease irrespective of the subsequent rate of lung function decline.
• Combs, D. A., Goodwin, J. L., Quan, S. F., Morgan, W. J., Shetty, S., & Parthasarathy, S. (2016). Insomnia, Health-Related Quality of Life and Health Outcomes in Children: A Seven Year Longitudinal Cohort. Scientific Reports, 6, 27921.
• Combs, D., Goodwin, J. L., Quan, S. F., Morgan, W. J., Shetty, S., & Parthasarathy, S. (2016). Insomnia, Health-Related Quality of Life and Health Outcomes in Children: A Seven Year Longitudinal Cohort. Scientific reports, 6, 27921.
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  Insomnia is common in children, and is associated with decreased school performance and increased psychopathology. Although adult insomnia is linked to worsened health-related quality of life (HRQOL), there is insufficient data evaluating insomnia and HRQOL in children. We examined the HRQOL and health associations of insomnia in a longitudinal cohort of 194 children (96 girls, age at study start 8.7 ± 1.6 years, age at data analysis 15.0 ± 1.8 years) over 7 years. International Classification of Sleep Disorders, second edition (ICSD2) derived insomnia was seen intermittently in 27% of children, and was persistent in 4%. Children reporting ICSD2-derived insomnia had lower HRQOL. Additionally, the presence of insomnia was associated with an increased risk of reporting a new medical condition (intermittent insomnia odds ratio 5.9 [95% CI 1.3-26.7, p = 0.04], persistent insomnia odds ratio 8 [95% CI 2.3-27.7, p = 0.001]). Persistent ICSD2-derived insomnia was associated with an increased risk of reporting a new medication (odds ratio 4.9 (95% CI 1.0-23.6), p = 0.049), and reporting a new psychiatric medication (odds ratio 13.7, 95% CI: 2.6-73.5, p = 0.002). These associations were present even after adjusting for socioeconomic factors and the presence of obstructive sleep apnea. Insomnia in children is associated with worsened HRQOL and health outcomes.
• Daines, C. L., & Morgan, W. J. (2016). Planning the future of newborn screening for cystic fibrosis. Pediatric pulmonology, 51(9), 883-5.
• Morgan, W. J., Pasta, D. J., & Konstan, M. W. (2016). Reply. The Journal of pediatrics, 172, 228-9.
• Sheehan, W. J., Mauger, D. T., Paul, I. M., Moy, J. N., Boehmer, S. J., Szefler, S. J., Fitzpatrick, A. M., Jackson, D. J., Bacharier, L. B., Cabana, M. D., Covar, R., Holguin, F., Lemanske, R. F., Martinez, F. D., Pongracic, J. A., Beigelman, A., Baxi, S. N., Benson, M., Blake, K., , Chmiel, J. F., et al. (2016). Acetaminophen versus Ibuprofen in Young Children with Mild Persistent Asthma. The New England journal of medicine, 375(7), 619-30.
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  Studies have suggested an association between frequent acetaminophen use and asthma-related complications among children, leading some physicians to recommend that acetaminophen be avoided in children with asthma; however, appropriately designed trials evaluating this association in children are lacking.
• Van Iterson, E. H., Wheatley, C. M., Baker, S. E., Olson, T. P., Morgan, W. J., & Snyder, E. M. (2016). The Coupling of Peripheral Blood Pressure and Ventilatory Responses during Exercise in Young Adults with Cystic Fibrosis. PloS one, 11(12), e0168490.
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  Cystic fibrosis (CF) is commonly recognized as a pulmonary disease associated with reduced airway function. Another primary symptom of CF is low exercise capacity where ventilation and gas-exchange are exacerbated. However, an independent link between pathophysiology of the pulmonary system and abnormal ventilatory and gas-exchange responses during cardiopulmonary exercise testing (CPET) has not been established in CF. Complicating this understanding, accumulating evidence suggests CF demonstrate abnormal peripheral vascular function; although, the clinical implications are unclear. We hypothesized that compared to controls, relative to total work performed (WorkTOT), CF would demonstrate increased ventilation accompanied by augmented systolic blood pressure (SBP) during CPET.
• Van Iterson, E. H., Wheatley, C. M., Baker, S. E., Morgan, W. J., & Snyder, E. M. (2015). The relationship between cardiac hemodynamics and exercise tolerance in cystic fibrosis. Heart & lung : the journal of critical care, 45(3), 283-90.
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  Individuals with cystic fibrosis (CF) have reduced pulmonary function and exercise tolerance. Additionally, these individuals may develop abnormal cardiac function. The implications of abnormal cardiac function on exercise tolerance are unclear in CF.

Proceedings Publications

• Parthasarathy, S., Patel, S. I., Morgan, W. J., Hsu, C., Abraham, I. L., & Combs, D. (2019, December). Comparison of parent and child treatment preferences for obstructive sleep apnea. In Chest.
• Parthasarathy, S., Abraham, I. L., Hsu, C., Morgan, W. J., Barber, B. J., Edgin, J. O., & Combs, D. (2018, Fall). Sleep-disordered breathing is associated with neurocognitive impairment in children with congenital heart disease. In Sleep, 41, A277.
• Parthasarathy, S., Abraham, I. L., Hsu, C., Morgan, W. J., Klewer, S. E., Barber, B. J., Edgin, J. O., & Combs, D. (2018, Fall). Obstructive sleep apnea is a novel risk factor for neurocognitive impairment in children with congenital heart disease. In Circulation, 138(Suppl 1), 14956.
• Parthasarathy, S., Bailey, O., Morgan, W. J., Hsu, C., Abraham, I. L., & Combs, D. (2018, Spring). Parent treatment preferences for mild obstructive sleep apnea in children. In American Journal of Respiratory and Critical Care Medicine, 197, A2005.

Presentations

• Combs, D., Parthasarathy, S., Bailey, O., Abraham, I. L., Hsu, C., Morgan, W. J., Morgan, W. J., Hsu, C., Bailey, O., Abraham, I. L., Parthasarathy, S., & Combs, D. (2018, May). Parent treatment preferences for mild obstructive sleep apnea in children. 2018 International Meeting of the American Thoracic Society. San Diego, CA.
• Parthasarathy, S., Parthasarathy, S., Abraham, I. L., Abraham, I. L., Hsu, C., Hsu, C., Morgan, W. J., Morgan, W. J., Barber, B. J., Barber, B. J., Edgin, J. O., Edgin, J. O., Combs, D., & Combs, D. (2018, June). Sleep-disordered breathing is associated with neurocognitive impairment in children with congenital heart disease. 2018 meeting of the Associated Professional Sleep Societies. Baltimore, MD.
• Gerald, L. B., Nez, P., Morgan, W. J., Kobernick, A., Solomon, T. G., Liu, A., Bender, B., & Lowe, A. (2017, October). Asthma severity determinants and needs assessment in children living on the Navajo Nation: A pilot study. Navajo Nation Human Research Review Board Conference. Window Rock, AZ: Navajo Nation Human Research Review Board.

Poster Presentations

• Seckeler, M., Combs, D. A., Seckeler, M., Seckeler, M., Fernandez, V., Klewer, S. E., Klewer, S. E., Klewer, S. E., Parthasarathy, S., Barber, B. J., Parthasarathy, S., Parthasarathy, S., Andrews, J. G., Morgan, W. J., Andrews, J. G., Andrews, J. G., Hsu, C., Hsu, C., Hsu, C., , Hsu, C., et al. (2020, November). Obstructive Sleep Apnea Is Associated with Cardiac Dysfunction In Children With Congenital Heart Disease. 2020 American Heart Association Scientific SessionsAmerican Heart Association.
• Parthasarathy, S., Patel, S. I., Morgan, W. J., Hsu, C., Abraham, I. L., & Combs, D. (2019, December). Comparison of parent and child treatment preferences for obstructive sleep apnea. 2019 meeting of the Associated Professional Sleep Societies. San Antonio, TX.
• Parthasarathy, S., Abraham, I. L., Hsu, C., Morgan, W. J., Barber, B. J., Edgin, J. O., & Combs, D. (2018, Fall). Sleep-disordered breathing is associated with neurocognitive impairment in children with congenital heart disease. Sleep Research SocietySleep Research Society.
• Parthasarathy, S., Bailey, O., Morgan, W. J., Hsu, C., Abraham, I. L., & Combs, D. (2018, Spring). Parent treatment preferences for mild obstructive sleep apnea in children. American Thoracic SocietyAmerican Thoracic Society.
• Parthasarathy, S., Hsu, C., Morgan, W. J., Klewer, S. E., Barber, B. J., Edgin, J. O., & Coombs, D. (2018, Nov). Obstructive sleep apnea is a novel risk factor for neurocognitive impairment in children with congenital heart disease. American Heart Association. Chicago.
• Parthasarathy, S., Morgan, W. J., Edgin, J. O., Abraham, I. L., Combs, D., Hsu, C., Barber, B. J., & Klewer, S. E. (2018, November). Obstructive sleep apnea is a novel risk factor for neurocognitive impairment in children with congenital heart disease. AHA Scientific Sessions. Chicago, Il: American Heart Association.
• Parthasarathy, S., Parthasarathy, S., Abraham, I. L., Abraham, I. L., Hsu, C., Hsu, C., Morgan, W. J., Morgan, W. J., Klewer, S. E., Klewer, S. E., Barber, B. J., Barber, B. J., Edgin, J. O., Edgin, J. O., Combs, D., & Combs, D. (2018, November). Obstructive Sleep Apnea is a Novel Risk Factor for Neurocognitive Impairment in Children with Congenital Heart Disease. 2018 American Heart Association Scientific Sessions. Chicago, IL.
• Combs, D., Parthasarathy, S., Edgin, J. O., Abraham, I. L., Barber, B. J., Hsu, C., Morgan, W. J., Morgan, W. J., Hsu, C., Barber, B. J., Abraham, I. L., Edgin, J. O., Parthasarathy, S., & Combs, D. (2017, July). Sleep-disordered breathing is associated with memory impairment in children with congenital heart disease. 15th International Symposium on Sleep and Breathing. Madison, WI.
• Oren, E., Wright, A. L., Martinez, F., Morgan, W. J., Gerald, L. B., Stern, D., & Mpody, C. (2017, April). Early caregiver stress and child's subsequent lung function through early adulthood: a longitudinal study from birth to 32 years of age. MEZCOPH Public Health Research Forum. Tucson, AZ: MEZCOPH.
• Parthasarathy, S., Edgin, J. O., Morgan, W. J., Quan, S. F., Goodwin, J., & Combs, D. (2017, June). Mother knows best? Comparing child and parent report of sleep parameters with polysomnography. 2017 meeting of the Associated Professional Sleep Societies.
• Parthasarathy, S., Edgin, J. O., Morgan, W. J., Quan, S. F., Goodwin, J., & Combs, D. (2017, June). Mother knows best? Comparing child and parent report of sleep parameters with polysomnography. 2017 meeting of the Associated Professional Sleep Societies. Boston, MA.
• Berry, C. E., Jenkins, I., Billheimer, D. D., Stern, D., Guerra, S., Wright, A. L., Morgan, W. J., & Martinez, F. (2015, May). Lung Function Trajectories in the Tucson Children’s Respiratory Study. American Thoracic Society. Denver, CO.
• Berry, C. E., Lu, Z. J., Jenkins, I., Billheimer, D., Stern, D., Gerald, L. B., Carr, T. F., Guerra, S., Wright, A. L., Morgan, W. J., Martinez, F., Berry, C. E., Lu, Z. J., Jenkins, I. C., Billheimer, D., Stern, D. A., Gerald, L. B., Carr, T. F., Guerra, S., , Wright, A. L., et al. (2015, May). Lung Function Trajectories in the Tucson Children's Respiratory Study. American Thoracic Society. Denver, CO: American Thoracic Society.
• Combs, D. A., Goodwin, J. L., Quan, S. F., Morgan, W. J., & Parthasarathy, S. (2015, June). Development of a Modified STOP-Bang Tool for Adolescent Children. Associated Professional Sleep Societies 2015 annual meeting. Seattle, WA.
• Combs, D. A., Parthasarathy, S., Edgin, J. O., Morgan, W. J., Archbold, K., Rice, S. A., Barber, B. J., Barber, B. J., Archbold, K., Rice, S. A., Morgan, W. J., Edgin, J. O., Parthasarathy, S., & Combs, D. A. (2015, May). Prevalence of Sleep-Disordered Breathing in Children with Congenital Heart Disease. 2015 International meeting of the American Thoracic Society. Denver, CO.
• Hiranrattana, A., Stern, D., Guerra, S., Halonen, M., Wright, A. L., Martinez, F., & Morgan, W. J. (2015, May). Alternaria Sensitization is Associated with Increased Airway Reactivity in Overweight/Obese Non-Asthmatics. American Thoracic Society International Conference.
• Khattab, N., Desoky, S. M., & Morgan, W. J. (2017, May). An Unusual Cause of Persistent Pneumonia with Fistulous Airway Connection: Mediastinal Teratoma in a Child. American Thoracic Society International Conference. San Diego, CA.
• Voraphani, N., Guerra, S., Stern, D., Halonen, M., Wright, A. L., Morgan, W. J., & Martinez, F. (2015, May). Circulating CC16 In Childhood Differentiates Between Persistent And Remitting Severe Asthma In Adult Life. American Thoracic Society International Conference.
• Voraphani, N., Guerra, S., Stern, D., Halonen, M., Wright, A. L., Morgan, W. J., & Martinez, F. (2015, May). Circulating CC16 in Childhood Differentiates Between Persistent and Remitting Severe Asthma in Adult Life. American Thoracic Society. Denver, CO.