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Due to a combination of host and microbial factors, NTHi persists in the lower airways of these individuals which is associated with an increased frequency of exacerbations, worsening symptoms, inflammation causing tissue damage, compositional changes to the lung microbiome and overall worse clinical prognosis (Sethi and Murphy, 2001

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The report was uncontrolled, unblinded, not randomized, had no comparator arm, used patient-reported outcomes rather than validated pain instruments, and did not publish dose, effect size, confidence intervals, p-values, or systematically collected adverse events limitations that severely constrain any clinical inference

See Appendix C for additional policy options related to improving federal and state collaboration