The FLOW Study of COPD (Function, Living, Outcomes, and Work)

The FLOW study is a prospective cohort study of 1,202 Kaiser Permanente Northern California members with COPD and an age-,sex-, and race-matched reference group of 302 subjects. Even though COPD is a common and morbid medical condition, our current understanding of how disability develops in COPD is very limited, which impedes development of early intervention and prevention strategies. Pulmonary function impairment alone does not explain most of the disability risk in COPD. In the FLOW cohort study of COPD, we are studying how disability, which is the restriction of daily activities and work disability, develops in COPD. We are also studying how the disablement process affects future health status and outcomes.

The Severe Asthma Cohort

Despite the increasing burden of severe asthma, our understanding of it remains limited. The Severe Asthma Cohort is a study of 865 Kaiser Permanente Northern California members who where hospitalized for asthma, may of whom were admitted to an intensive care unit for their exacerbation. The overall goal is to elucidate the risk factors for adverse health outcomes in severe asthma; to study the effects of cigarette smoking and secondhand smoke exposure on adult asthma outcomes; to examine the effects of other indoor and outdoor environmental exposures on asthma health status; to study the impact of health care process factors, such as pulmonary or allergy specialist care, and patient level factors, such as race, depression, perceived control of asthma, disease severity, and health-related quality of life on longitudinal health outcomes; to examine the impact of severe asthma on disability in daily activities and work; and to study the risk factors for mortality in severe asthma. Recently, we have added a home visit component to evaluate the impact of the social and physical environment on asthma health outcomes.

Asthma and Anaphylaxis

Anaphylaxis is a rare but potentially fatal allergic reaction, often to food, insect stings, or medications. We have assembled a study of more than 1 million Kaiser members to study the incidence of anaphylaxis and whether it is more common among people with asthma than in the general population. We will also study whether greater asthma severity is associated with a higher risk of anaphylaxis. This study will provide important new insights into the inter-connections between asthma and this potentially fatal allergic disorder.

Passive Smoking and COPD Outcomes

We are using a variety of direct secondhand smoke (SHS) measurements to study the impact of SHS exposure on COPD outcomes, including pulmonary function decline, COPD severity, functional limitations, and disability. We are also studying the impact of SHS exposure on the risk of cardiovascular outcomes, including myocardial infarction and stroke. Another goal is to elucidate whether these effects of SHS exposure are mediated by systemic inflammation.

Acute Lung Injury Studies

We have an active clinical research program in Acute Lung Injury (ALI) and Acute Respiratory Distress Syndrome (ARDS) which are directly related to our involvement in the NHLBI-funded ARDS Network. In addition to conducting multicenter randomized controlled trials in ALI/ARDS, we conduct other studies to elucidate the natural history and pathogenesis of the condition. Recent studies have included temporal trends in ALI/ARDs mortality during the past decade, racial disparities in mortality, trauma-related ALI/ARDS, acute renal failure in ALI/ARDS, and biomarkers that provide indirect evidence pertinent to pathogenesis of ALI/ARDS (markers of endothelial dysfunction, pulmonary epithelium, systemic inflammation, surfactant proteins, disordered coagulation, and the like). 

Sleep Apnea Cohort

We have partnered with the UCSF Sleep Disorders Center to create a prospective cohort of patients with obstructive sleep apnea. There is very little known about the impact of this condition on peoples' daily lives. The overall goal of this study is to elucidate the risk factors for adverse health outcomes and disability in the condition.