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Respiratory disease research

Our combined real-world data and extensive therapeutic expertise supports our clients in evidence generation for their respiratory products.


Proven research expertise

The Optum® HEOR respiratory team has designed and conducted studies to support products for asthma, COPD and other respiratory diseases, leading to numerous conference presentations and publications in top clinical journals.

Researchers on the respiratory team have a broad range of backgrounds and expertise, including HEOR, epidemiology, geriatrics, pharmacy benefit management, biostatistics, public health and basic science research.  

Research topics and capabilities

Recent research projects include topics in asthma, COPD, idiopathic pulmonary fibrosis, allergic rhinitis, respiratory syncytial virus, pertussis, influenza and pneumonia.

Research topics and key capabilities include:

Medication treatment patterns and trends

  • Lines of controller therapy, medication switching patterns
  • Treatment persistence and compliance
  • Burden of rescue medication use

Disease severity classification

  • Severity classification by GINA step, NHLBI stage, GOLD stage
  • Eosinophil and IgE levels
  • Lung function test results (e.g. FEV1, FVC)
  • Symptoms

Burden of disease

  • COPD- and asthma-related exacerbations
  • Impact of patient management programs
  • Disease incidence
  • Health care utilization and costs

Bali V, Weaver J, Turzhitsky V, Schelfhout J, Paudel ML, Hulbert E, Peterson- Brandt J, Currie AG, Bakka D. Development of a natural language processing algorithm to detect chronic cough in electronic health records. BMC Pulm Med. 2022 Jun 28;22(1):256. doi: 10.1186/s12890-022-02035-6.

Oppenheimer J, Bogart M, Bengtson LGS, White J, Sundquist K, Lima R, Averell C. Treatment patterns and disease burden associated with multiple-inhaler triple-therapy use in asthma. J Allergy Clin Immunol Prac. 2022 Feb;10(2):485-494.e5. doi: 10.1016/j.jaip.2021.09.033. Epub 2021 Oct 6.

Palli S, Xie B, Chastek B, Elliott C, Bengtson LGS. Comparison of COPD healthcare utilization and associated costs across patients treated with LAMA+LABA fixed-dose therapies. J Manag Care Spec Pharm. 2021 Jul;27(7):810-24.

Bengtson LGS, Bancroft T, Schilling C, Buikema AR, Stanford RH. Development and validation of a Drug Adherence Index for COPD. J Managed Care Spec Pharm. 2021 Feb;27(2):198-209.

Singer D, Bengtson LGS, Elliott C, Buikema A, Franchino-Elder J. Healthcare Resource Utilizataion, Exacerbations, and Readmissions Among Medicare Patients With Chronic Obstructive Pulmonary Disease After Long-Acting Muscarinic Antagonist Therapy Initiation With Soft Mist Versus Dry Powder Inhalers. Int J Chron Obstruct Pulmon Dis. 2020 Dec 7;15:3239-50.

Palli SR, Frazer M, DuCharme M, Buikema AR, Anderson AJ, Franchino-Elder J. Differences in Real-World Health and Economic Outcomes Among Patients with COPD Treated with Combination Tiotropium/Olodaterol Versus Triple Therapy. J Manag Care Spec Pharm. 2020 Oct;26(10):1363-1374. doi: 10.18553/jmcp.2020.20159. Epub 2020 Jul 17.

Moretz C, Hahn B, White J, Goolsby Hunter A, Essoi B, Elliott C, Ray R. Symptom Burden and GOLD Classification in Medicare Advantage Patients With COPD Initiating Umeclidinium/Vilanterol or Fluticasone Propionate/Salmeterol Therapy. Int J Chron Obstruct Pulmon Dis. 2020 Oct 29;15:2715-25.

Standford RH, Engel-Nitz NM, Bancroft T, Essoi B. The Identification and Cost of Acute Chronic Obstructive Pulmonary Disease Exacerbations in a United States Population Healthcare Claims Database. COPD. 2020 Oct;17(5):499-508. doi: 10.1080/15412555.2020.1817357. Epub 2020 Sep 23.

Stanford RH, Korrer S, Brekke L, Reinsch T, Bengtson LGS. Validation and Assessment of the COPD Treatment Ratio as a Predictor of Severe Exacerbations. Chronic Obstr Pulm Dis. 2020;7(1):38–48.

Stanford RH, Tabberer M, Kosinski M, Johnson P, White J, Carlyle M, Tillery NA. Assessment of the COPD Assessment Test within US Primary Care. Chronic Obstr Pulm Dis. 2020;7(1):26-37.

Palli SR, Buikema AR, DuCharme M, Frazer M, Kaila S, Juday T. Costs, Exacerbations and Pneumonia after Initiating Combination Tiotropium Olodaterol versus Triple Therapy for Chronic Obstructive Pulmonary Disease. J Comp Eff Res. 2019 Nov;8(15):1299-1316.

Moretz C, Bengtson LGS, Sharpsten L, Koep E, Le L, Tong J, Stanford RH, Hahn B, Ray R. . Evaluation of rescue medication use and medication adherence receiving umeclidinium/vilanterol versus tiotropium bromide/olodaterol. Intl J COPD. 2019 Sep 4;14:2047-60.

Palli S, Buikema A, Ducharme M, Frazer M, Kaila S, Juday T. Economic and clinical burden among patients with COPD initiating combination tiotropium olodaterol versus triple therapy. J Comp Eff Res. 2019;8(15):1299-1316.

Moretz C, Sharpsten L, Bengtson LGS, Koep E, Le L, Tong J, Stanford RH, Hahn B, Ray R. Real-world effectiveness of umeclidinium/vilanterol versus fluticasone propionate/salmeterol as initial maintenance therapy for chronic obstructive pulmonary disease (COPD): a retrospective cohort study. Intl J COPD. 2019 Aug 1;14:1721-37.

Hahn B, Stanford RH, Goolsby Hunter A, Essoi B, White J, Ray R. Predictors of Symptom Burden in Patients with COPD on LAMA Monotherapy: Multivariable Analysis of a Claims-linked Survey Study. Pulm Ther. 2019;5(2):179-90.

Ray H, Hahn B, Stanford R, White J, Essoi B, Hunter A. Classification of Patients with COPD on LAMA Monotherapy using the GOLD Criteria: Analysis of a Claims-linked Patient Survey Study. Pulm Ther. 2019;5:191.

Strange C, Walker V, Depietro M, Tong J, Kurlander J, Carlyle M, Millette LA, Wittbrodt E. Patient-reported outcomes of dual bronchodilator fixed-dose combination versus bronchodilator monotherapy in individuals with COPD. Int J Chron Obstruct Pulmon Dis. 2019;14:1377-88.

Stanford RH, Averell C, Parker ED, Blauer-Peterson C, Reinsch TK, Buikema A. Assessment of adherence and asthma medication ratio (AMR) for once-daily and twice-daily inhaled corticosteroid/long acting beta agonist (ICS/LABA) for asthma. J Allergy Clin Immunol Pract. 2019 May-June;7(5):1488-96.

Strange C, Walker V, Tong J, Kurlander J, Carlyle M, Millette LA, Wittbrodt E. A retrospective claims analysis of dual bronchodilator fixed-dose combination versus bronchodilator monotherapy in patients with chronic obstructive pulmonary disease. Chronic Obstr Pulm Dis. 2019;6(3):221-32.

Hahn B, Stanford RH, Goolsby Hunter A, Essoi B, White J, Ray R. Patient-Reported Burden of Illness in a Prevalent COPD Population Treated with Long-Acting Muscarinic Antagonist Monotherapy: A Claims-Linked Patient Survey Study. Pulm Ther. 2019 Jun;5(1):69-80.

Stanford RH, Parker ED, Reinsch TK, Buikema AR, Blauer-Peterson C. Assessment of COPD-related outcomes in patients initiating a once daily or twice daily ICS/LABA. Respir Med. 2019 Apr;150:1-7.

Ortega H, Hahn B, Tran JN, Bell C, Shams SA, Llanos JP. Disease burden in patients with asthma before initiating biologics: A retrospective cohort database study. Allergy Asthma Proc. 2019 May 1;40(3):146-153. doi: 10.2500/aap.2019.40.4220. Epub 2019 Mar 29.

Averell C, Johnson P, Bell C, White J, Essoi B, Nelson L. Observational Vignette Study To Examine Patient, Healthcare Provider, and Caregiver Perceived Burden if Asthma-Related Exacerbations. Ann Allergy Asthma Immunol. 2018 Nov;121(5):S18-19.

Stanford RH, Bell C, Nag A, Johnson PT, Johnson MP, Watkins A. Cross-sectional survey study to examine underuse of twice daily inhaled maintenance therapy among patients with asthma. J Asthma. 2019 Nov;56(11):1172-1181. doi: 10.1080/02770903.2018.1531994. Epub 2018 Nov 5.

Buikema A, Brekke L, Anderson A, Koep E, Van Voorhis D, Sharpsten L, Hahn B, Ray R, Stanford R. The effect of delaying initiation with umeclidinium/vilanterol in patients with COPD: An observational administrative claims database analysis using marginal structural models. Multidiscip Respir Med. 2018;13:38

Mao J, Heithoff KA, Koep E, Murphy T, Hammerby E. Cost of subcutaneous immunotherapy in a large insured population in the United States. Curr Med Res Opin. 2018 Sep;12:1-8.

Bogart M, Stanford RH, Reinsch T, Hull M, Buikema A, Hulbert E. Clinical characteristics and medication patterns in patients with COPD prior to initiation of triple therapy with ICS/LAMA/LABA: a retrospective study.  Respir Med. 2018 Sep 1;142:73-80.

Hahn B, Hull M, Blauer-Peterson C, Buikema A, Ray R, Stanford RH. Rates of Escalation to Triple COPD Therapy among Incident Users of LAMA and LAMA/LABA. Respir Med. 2018;139:65-71

Hahn B, Hull M, Blauer-Peterson C, Buikema A, Ray R, Stanford RH. Use of triple COPD therapy among incident users of LAMA or LAMA/LABA. Respir Med. 2018 June;139:65-71.

Campos MA, Runken MC, Davis AM, Johnson MP, Stone GA, Buikema AR. Impact of a health management program on healthcare outcomes among patients on augmentation therapy for alpha 1-antitrypsin deficiency: An insurance claims analysis.  Adv Ther. 2018 Apr;35(4):467-81.

Bengtson L, DePietro M, McPheeters J, Fox KM. Real-world outcomes in patients with chronic obstructive pulmonary disease initiating long-acting mono bronchodilator therapy. Ther Adv Respir Dis. 2018 Jan-Dec;12:1753466618772750.

Allen-Ramey FC, Mao J, Blauer-Peterson C, Rock M, Nathan R, Halpern R. Healthcare costs for allergy rhinitis in patients on allergy immunotherapy: A retrospective observational study. Curr Med Res Opin. 2017 Nov;33(11):2039-47.

Bengtson LG, Yu Y, Wang W, Cao F, Hulbert EM, Wolbeck R, Elliott CA, Buikema AR. Inhaled corticosteroid-containing treatment escalation and outcomes for patients with asthma in a U.S. health care organization.  J Manag Care Spec Pharm. 2017 Nov;23(11):1149-59.

Rubin JL, Thayer S, Watkins A, Wagener JS, Hodgkins PS, Schechter MS. Frequency and costs of pulmonary exacerbations in patients with cystic fibrosis in the United States. Curr Med Res Opin. 2017 Apr;33(4):667-74.

Masseria C, Martin C, Krishnarajah G, Becker L, Buikema A, Tan T. Incidence and burden of pertussis among infants less than 1 year of age.  Pediatr Infect Dis J. 2017 Mar;36(3):e54-e61.

Chastek B, Korrer S, Nagar SP, Albers F, Yancey S, Ortega H, Forshag M, Dalal AA. Economic Burden of Illness Among Patients with Severe Asthma in a Managed Care Setting. J Manag Care Spec Pharm. 2016 Jul;22(7):848-61.

Shenolikar R, Mao J, Altan A. COPD medication adherence and persistence among Medicare enrollees. Am J Pharm Benefits. 2016;8(1):14-21.

Dang-Tan T, Ismaila A, Zhang S, Zarotsky V, Bernauer M. Clinical, humanistic, and economic burden of chronic obstructive pulmonary disease (COPD) in Canada: A systematic review. BMC Res Notes. 2015 Sep;8:464.

Mapel DW, Dalal AA, Johnson PT, Becker LK, Hunter AG. Application of the new GOLD COPD staging system to a US primary care cohort, with comparison to physician and patient impressions of severity. Int J Chron Obstruct Pulmon Dis. 2015 Jul 30;10:1477-86.

Mapel DW, Dalal AA, Johnson PT, Becker LK, Hunter AG. A clinical study of COPD severity assessment by primary care physicians and their patients compared with spirometry. Am J Med. 2015 Jun;128(6):629-37.

Nelson H, Cartier S, Allen-Ramey F, Lawton S, Calderon MA. Network meta-analysis shows commercialized subcutaneous and sublingual grass products have comparable efficacy. J Allergy Clin Immunol Pract. 2015 Mar-Apr;3(2):256-66.

Sharafkhaneh A, Altan AE, Colice GL, Hanania NA, Donohue JF, Kurlander JL, Rodriguez-Roisin R, Altman PR. A simple rule to identify patients with chronic obstructive pulmonary disease who may need treatment reevaluation. Respir Med. 2014 Sep;108(9):1310-20.

Marsico M, Mehta V, Chastek B, Liaw KL, Derkay C. Estimating the incidence and prevalence of juvenile-onset recurrent respiratory papillomatosis in publicly and privately insured claims databases in the United States. Sex Transm Dis. 2014 May;41(5):300-05.

Stewart DL, Ryan KJ, Seare JG, Pinsky B, Becker L, Frogel M. Association of RSV-related hospitalization and non-compliance with Palivizumab among commercially insured infants: a retrospective claims analysis.  BMC Infect Dis. 2013 Dec;13(1):334.

Sato R, Gomez Rey G, Nelson S, Pinsky B. Community-acquired pneumonia episode costs by age and risk in commercially insured US adults aged >/=50 years. Appl Health Econ Health Policy. 2013 Jun;11(3):251-58.

Stanford RH, Buikema AR, Riedel AA, Camargo Jr CA, Gomez Rey G, Chapman KR. Asthma controller delay and recurrence risk after an emergency department visit or hospitalization. Respir Med. 2012 Dec;106(12):1631-38.

Maleki-Yazdi MR, Kelly SM, Lam SS, Marin M, Barbeau M, Walker V. The burden of illness in patients with moderate to severe chronic obstructive pulmonary disease in Canada. Can Respir J. 2012 Sep-Oct;19(5):319-24.

Priest J, Buikema A, Engel-Nitz NM, Cook CL, Cantrell CR. Quality of care, health care costs and utilization among Medicare Part D enrollees with and without low-income subsidy. Popul Health Manag. 2012 Apr;15(2):101-12.

O'Sullivan AK, Sullivan J, Higuchi K, Montgomery B. Health care utilization & costs For cystic fibrosis patients with pulmonary infections.  Manag Care. 2011 Feb;20(2):37-44.

Romero JR, Stewart DL, Buysman EK, Fernandes AW, Jafri HS, Mahadevia PJ. Serious early childhood wheezing after respiratory syncytial virus lower respiratory tract illness in preterm infants. Clin Ther. 2010 Dec 1;32(14):2422-32.

Dalal AA, Christensen L, Liu F, Riedel AA. Direct costs of chronic obstructive pulmonary disease among managed care patients.  Int J Chron Obstruct Pulmon Dis. 2010 Oct;5:341-49.

Stanford RH, Riedel AA, Johnson JC, Astry CL. Comparative resource utilization in Medicaid-eligible patients with asthma treated with fixed-dose fluticasone propionate/salmeterol or fluticasone propionate monotherapy. Clin Ther. 2010 Sep;32(10):1782–93.

Marple B, Roberts C, Frytak J, Schabert V, Wegner J, Bhattacharyya H, Piccirillo J, Sanchez S. Azithromycin extended release vs. amoxicillin/clavulanate: Symptom resolution in acute sinusitis. Am J Otolaryngol. 2010 Jan-Feb;31(1):1-8.

Ye X, Gutierrez B, Zarotsky V, Nelson M, Blanchette C. Appropriate use of inhaled corticosteroid and long-acting B2-adrenergic agonist combination therapy among asthma patients in a US commercially insured population. Curr Med Res Opin. 2009 Sep;25(9):2251-58.

Akazawa M, Halpern R, Riedel AA, Stanford RH, Dalal A, Blanchette CM. Economic burden prior to COPD diagnosis: A matched case-control study in the United States. Respir Med. 2008 Dec;102(12):1744-52.

Stanford RH, Fulbrigge A, Riedel A, Rey GG, Stempel DA. An observational study of fixed dose combination fluticasone propionate/salmeterol or fluticasone alone on asthma-related outcomes.  Curr Med Res Opin. 2008 Nov;24(11):3141-48.

Darkow T, Chastek BJ, Shah H, Phillips AL. Health care costs among individuals with chronic obstructive pulmonary disease within several large, multi-state employers. J Occup Environ Med. 2008 Oct;50(10):1130-38.

Dalal AA, Stanford R, Henk H, Borah B. Economic burden of rhinitis in managed care: a retrospective claims data analysis. Ann Allergy Asthma Immunol. 2008 Jul;101(1):23-29.

Darkow T, Kadlubek PJ, Shah H, Phillips AL, Marton JP. A retrospective analysis of disability and its related costs among employees with chronic obstructive pulmonary disease. J Occup Environ Med. 2007 Jan;49(1):22-30.

Allen-Ramey FC, Markson LE, Riedel AA, Sajian S, Weiss KB. Patterns of asthma related health care resource utilization in children treated with montelukast or fluticasone. Curr Med Res Opin. 2006 Aug;22(8):1453-61.

Stempel DA, Riedel AA, Carranza-Rosenzweig JR. Resource utilization with fluticasone propionate and salmeterol in a single inhaler compared with other controller therapies in children with asthma. Curr Med Res Opin. 2006 Mar;22(3):463-70.

Allen-Ramey FC, Duong PT, Riedel AA, Markson LE, Weiss KB. Observational study of the effects of montelukast and fluticasone on patients matched at baseline. Ann Allergy Asthma Immunol. 2004 Oct;93(4):373-80.

Stempel DA, O'Donnell JC, Meyer JW. Inhaled corticosteroids plus salmeterol or montelukast: effects on resource utilization and costs. J Allergy Clin Immunol. 2002 Mar;109(3):433-39.

Stempel DA, Meyer JW, Stanford RH, Yancey SW. One-year claims analysis comparing inhaled fluticasone propionate with zafirlukast for the treatment of asthma. J Allergy Clin Immunol. 2001 Jan;107(1):94-98.

Dalal AA, Liu F, Riedel AA. Cost trends among commercially insured and Medicare Advantage-insured patients with chronic obstructive pulmonary disease: 2006 through 2009. Int J Chron Obstruct Pulmon Dis. 2011;6:533-42.

Halpern R, Baker CL, Jun S, Woodruff KB, Paulose-Ram R, Porter V, Shah H. Outcomes associated with initiation of tiotropium or fluticasone/salmeterol in patients with chronic obstructive pulmonary disease. Patient Prefer Adherence. 2011;5:375-88.

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