Department of Pediatrics

Respiratory Research


Respiratory diseases pose a significant burden in pediatric emergency departments, highlighting the urgent need to address existing gaps in care. One concerning aspect is the high mortality rate associated with pneumonia in children under the age of 5. Pneumonia remains a leading cause of death worldwide among young children, particularly in low-income countries. Despite advances in medical knowledge and treatment options, access to appropriate healthcare, including timely diagnosis, effective antibiotics, and supportive care, remains limited in many regions. Closing this gap requires comprehensive strategies, such as improved access to healthcare facilities, increased vaccination coverage, and enhanced community-based interventions to prevent, diagnose, and manage pneumonia in young children.

Another respiratory condition that significantly impacts pediatric emergency departments is bronchiolitis. This viral infection primarily affects infants and young children, causing inflammation and obstruction in the small airways of the lungs. Bronchiolitis places a considerable burden on healthcare systems, with a substantial number of hospitalizations each year. However, there are inconsistencies in the management of bronchiolitis across different healthcare settings, leading to variations in care and potentially unnecessary interventions. Addressing these gaps necessitates the development and implementation of evidence-based guidelines, standardizing diagnostic criteria, and promoting appropriate supportive care measures to reduce hospitalizations and improve outcomes for children with bronchiolitis.

Asthma, a chronic respiratory condition, also contributes to the workload in pediatric emergency departments. It is one of the most common chronic diseases among children, and its prevalence has been increasing over the years. However, disparities in asthma management and outcomes persist, particularly among marginalized populations. Factors such as limited access to healthcare, inadequate asthma education, environmental triggers, and socioeconomic challenges contribute to these disparities. Efforts to bridge the gaps in asthma care should focus on promoting equitable access to healthcare services, ensuring proper asthma education for patients and caregivers, and implementing comprehensive strategies to address environmental triggers and social determinants of health.

In conclusion, respiratory diseases pose significant challenges in pediatric emergency departments. Gaps in care, including high under 5 pneumonia mortality rates, the burden of bronchiolitis, and disparities in asthma management, demand immediate attention. By implementing evidence-based guidelines, improving access to healthcare services, strengthening preventive measures, and addressing social determinants of health, we can strive towards reducing the burden of respiratory diseases among children and improving their overall outcomes.

Esther Sampayo is the site PI a multi-center international retrospective cohort study of eligible children with acute moderate and severe asthma exacerbations in the tertiary-care pediatric EDs associated with the Pediatric Emergency Medicine Networks (PERN).

Shubhada Hooli has worked extensively on the prevention of morbidity and mortality for young children with pneumonia in low- and middle-income countries (LMICs). She has served as a WHO consultant for childhood pneumonia and is a member of the WHO's Research Partnership to Assess WHO Recommendations (WHO PREPARE) and the Pediatric Acute Lung Injury and Sepsis Investigators Global Health (PALISI-GH) network.

Faculty with a research focus on respiratory disease:

Hooli S, King C, McCollum ED, Colubourn T, Lufesi N, Mwansambo C, Gregory CJ, Thamthitiwat S, Cutland C, Madhi SA, Nunes MC, Gessner BD, Hazir T, Mathew JL, Addo-Yobo E, Chisaka N, Hassan M, Hibberd PL, Jeena P, Lozano JM, MacLeod WB, Patel A, Thea DM, Nguyen NTV, Zaman SM, Ruvinsky RO, Lucero M, Kartasasmita CB, Turner C, Asghar R, Banajej S, Iqbal I, Maluen-Radovan I, Mino-Leon G, Saha SK, Santosham M, Singhi S, Awasthi S, Bavdekar A, Chou M, Nymadawa P, Pape JW, Paranhos-Baccala G, Picot VS, Rakoto-Andrianarivelo M, Rouzier V, Russomando G, Sylla M, Vanhems P, Wang J, Basnet S, Strand TA, Neuman MI, Arroyo LM, Echavarria M, Bhatnagar S, Wadhwa N, Lodha R, Aneja S, Gentile A, Chadha M, Hirve S, O'Grady KF, Clara AW, Rees CA, Campbell H, Nair H, Falconer J, Williams LJ, Horne M, Qazi SA, Nisar YB; Pneumonia REsearch Partnership to Assess WHO REcommendations (PREPARE) study group. In-hospital mortality risk stratification in children aged under 5 years with pneumonia with or without pulse oximetry: A secondary analysis of the Pneumonia REsearch Partnership to Assess WHO REcommendations (PREPARE) datasetInt J Infect Dis. 2023. PMID 36805325.

Hooli S, Makwenda C, Lufesi N, Colbourn T, Mvalo T, McCollum E, King C. Implication of the 2014 World Health Organization Integrated Management of Childhood Illness Pneumonia Guidelines with and without pulse oximetry use in Malawi: A retrospective cohort study. Gates Open Research. 2023. DOI: 10.12688/gatesopenres.13963.1

Hooli S, Schuh HB, Ahmed S, King C, Roy AD, Lufesi N, Ashraful Islam ASM.D., Mvalo T, Chowdhury NH, Ginsburg AS, Colbourn T, Checkley W, Baqui AH, McCollum ED. Clinical hypoxemia score for outpatient child pneumonia care lacking pulse oximetry in Africa and South Asia. medRxiv .2023. 

Martin H, Falconer J, Addo-Yobo E, Aneja S, Arroyo LM, Asghar R, Awasthi S, Banajeh S, Bari A, Basnet S, Bavdekar A, Bhandari N, Bhatnagar S, Bhutta ZA, Brooks A, Chadha M, Chisaka N, Chou M, Clara AW, Colbourn T, Cutland C, D'Acremont V, Echavarria M, Gentile A, Gessner B, Gregory CJ, Hazir T, Hibberd PL, Hirve S, Hooli S, Iqbal I, Jeena P, Kartasasmita CB, King C, Libster R, Lodha R, Lozano JM, Lucero M, Lufesi N, MacLeod WB, Madhi SA, Mathew JL, Maulen-Radovan I, McCollum ED, Mino G, Mwansambo C, Neuman MI, Nguyen NTV, Nunes MC, Nymadawa P, O'Grady KF, Pape JW, Paranhos-Baccala G, Patel A, Picot VS, Rakoto-Andrianarivelo M, Rasmussen Z, Rouzier V, Russomando G, Ruvinsky RO, Sadruddin S, Saha SK, Santosham M, Singhi S, Soofi S, Strand TA, Sylla M, Thamthitiwat S, Thea DM, Turner C, Vanhems P, Wadhwa N, Wang J, Zaman SM, Campbell H, Nair H, Qazi SA, Nisar YB; World Health Organization Pneumonia Research Partnership to Assess WHO Recommendation (PREPARE) study group. Assembling a global database of child pneumonia studies to inform WHO pneumonia management algorithm: methodology and applicationsJ Glob Health. 2022. PMID 36579417.

Rajan A, Piedra FA, Aideyan L, McBride T, Robertson M, Johnson HL, Aloisio GM, et al. Multiple respiratory syncytial virus (RSV) strains infecting Hep-2 and A549 cells reveal cell line-dependent differences in resistance to RSV infectionJ Virol. 2022;96(7):e0190421. PMID 35285685. 4/13/22.

Rajan A, Weaver AM, Aloisio GM, et al. The human nose organoid respiratory virus model: an ex vivo human challenge model to study respiratory syncytial virus (RSV) and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pathogenesis and evaluate therapeuticsmBio. 2022;13(1):e0351121. PMID 35164569. 

McLaughlin P, Banuelos RC, Camp EA, Kancharla V, Sampayo EM. The clinical respiratory score: investigating the reliability of an asthma scoring tool across a multidisciplinary teamJ Asthma. 2022;59(10):1915-1922. PMID 34530678.

Moschovis PP, Sampayo EM, et al. The diagnosis of respiratory disease in children using a phone-based cough and symptom analysis algorithm: the smartphone recordings of coughs 2 (SMARTCOUGH-C 2) trial designContemp Clin Trials. 2021. PMID 33444779.

Rees CA, Hooli S, King C, McCollum ED, Colbourn T, Lufesi N, Mwansambo C, Lazzerini M, Madhi SA, Cutland C, Nunes M, Gessner BD, Basnet S, Kartasasmita CB, Mathew JL, Zaman SMAU, Paranhos-Baccala G, Bhatnagar S, Wadhwa N, Lodha R, Aneja S, Santosham M, Picot VS, Sylla M, Awasthi S, Bavdekar A, Pape JW, Rouzier V, Chou M, Rakoto-Andrianarivelo M, Wang J, Nymadawa P, Vanhems P, Russomando G, Asghar R, Banajeh S, Iqbal I, MacLeod W, Maulen-Radovan I, Mino G, Saha S, Singhi S, Thea DM, Clara AW, Campbell H, Nair H, Falconer J, Williams LJ, Horne M, Strand T, Qazi SA, Nisar YB, Neuman MI; World Health Organization PREPARE study group48. External validation of the RISC, RISC-Malawi, and PERCH clinical prediction rules to identify risk of death in children hospitalized with pneumoniaJ Glob Health. 2021. 34737862.

Lam SHF, Homme J, Avarello J, Heins A, Pauze D, Mace S, Dietrich A, Stoner M, Chumpitazi CE, Saidinejad M. Use of antitussive medications in acute cough in young childrenJ Am Coll Emerg Physicians Open. 2021. PMID 34179887.

McCollum ED, King C, Ahmed S, Hanif AAM, Roy AD, Islam AA, Colbourn T, Schuh HB, Ginsburg AS, Hooli S, Chowdhury NH, Rizvi SJR, Begum N, Baqui AH, Checkley W. Defining hypoxaemia from pulse oximeter measurements of oxygen saturation in well children at low altitude in Bangladesh: an observational study. BMJ Open Respir Res. 2021. PMID 34728475.

Colbourn T, King C, Beard J, Phiri T, Mdala M, Zadutsa B, Makwenda C, Costello A, Lufesi N, Mwansambo C, Nambiar B, Hooli S, French N, Bar Zeev N, Qazi SA, Bin Nisar Y, McCollum ED. Predictive value of pulse oximetry for mortality in infants and children presenting to primary care with clinical pneumonia in rural Malawi: a data linkage studyPLoS Med. 2020. PMID 33095763.

Kaiser SV, Johnson M.D., Walls TA, Teach SJ, Sampayo EM, Dudley NC, Zorc JJ. Pathways to Improve Pediatric Asthma Care: A Multisite, National Study of Emergency Department Asthma Pathway Implementation. J Pediatr. 2020. PMID: 32409021

McDaniel CE, Jeske M, Sampayo EM, Liu P, Walls TA, Kaiser SV. Implementing Pediatric Asthma Pathways in Community Hospitals: A National Qualitative Study. J Hosp Med. 2020. PMID: 31532746

Foradori DM, Sampayo EMFanny SA, Namireddy MK, Kumar AM, Lo HY. Improving Influenza Vaccination in Hospitalized Children With Asthma.  Pediatrics. 2020. PMID: 32107285

Colbourn T, King C, Beard J, Phiri T, Mdala M, Zadutsa B, Makwenda C, Costello A, Lufesi N, Mwansambo C, Nambiar B, Hooli S, French N, Bar Zeev N, Qazi SA, Bin Nisar Y, McCollum ED. Predictive value of pulse oximetry for mortality in infants and children presenting to primary care with clinical pneumonia in rural Malawi: A data linkage study.  PLoS Med. 2020. PMID: 33095763.

Ahmed S, Mvalo T, Akech S, Agweyu A, Baker K, Bar-Zeev N, Campbell H, Checkley W, Chisti MJ, Colbourn T, Cunningham S, Duke T, English M, Falade AG, Fancourt NS, Ginsburg AS, Graham HR, Gray DM, Gupta M, Hammitt L, Hesseling AC, Hooli S, Johnson AB, King C, Kirby MA, Lanata CF, Lufesi N, Mackenzie GA, McCracken JP, Moschovis PP, Nair H, Oviawe O, Pomat WS, Santosham M, Seddon JA, Thahane LK, Wahl B, Van der Zalm M, Verwey C, Yoshida LM, Zar HJ, Howie SR, McCollum ED. Protecting children in low-income and middle-income countries from COVID-19. BMJ Glob Health. 2020. PMID: 32461228. 

Hooli S, King C, Zadutsa B, Nambiar B, Makwenda C, Masache G, Lufesi N, Mwansambo C, Malla L, Costello A, Colbourn T, McCollum ED. The Epidemiology of Hypoxemic Pneumonia among Young Infants in Malawi. Am J Trop Med Hyg. 2020. PMID: 31971153.