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Asthma Education Camp: Immediate and Long term Impacts on Thai Asthmatic Children and Their Families
S274 Abstracts
Factors Predictive of Future Clinically Significant Exacerbations in Severe Asthma R. Slavin1, H. Fox2, K. Surrey2, C. Reisner3; 1Saint Louis University School of Medicine, Saint Louis, MO, 2Novartis Horsham Research Centre, Horsham, UNITED KINGDOM, 3Novartis Pharmaceuticals Corporation, East Hanover, NJ. RATIONALE: Identifying asthma patients most at risk of clinically significant exacerbations (requiring systemic corticosteroids) enhances focussed management. We evaluated the association of baseline asthmarelated variables and their influence on rate of future significant exacerbations during a randomized, placebo-controlled study of omalizumab efficacy and safety in patients with severe persistent allergic asthma that was inadequately controlled despite GINA step 4 therapy. METHODS: Baseline demographic measures (56 variables) from 419 patients were included one at a time in a simple model without treatment or other study design terms. The association of each variable with significant exacerbations during the treatment phase of the study was assessed separately using Poisson regression, disregarding any correlations between variables. RESULTS: Fifteen baseline demographic characteristics demonstrated a strong association with future exacerbations (p<0.01). Three characteristics (number of clinically significant exacerbations, number of severe exacerbations and time since last exacerbation) were associated with exacerbation history (all p<0.0001). Five characteristics were indirectly associated with exacerbations: missed work/school days (p<0.0001), unscheduled visits due to asthma (p=0.0004), hospitalizations during runin phase (p=0.0018), doctor visits due to asthma (p=0.0021) and hospital admissions (p=0.0034). The remaining seven characteristics included measures of lung function and symptoms, expected to be associated with exacerbation, as well as mold allergy (a known predictive factor of severe exacerbation). Notably, baseline total IgE in this allergic population was found not to be a predictive factor of future significant exacerbations. CONCLUSIONS: Baseline measures related to previous exacerbations are the most important predictive factors of future clinically significant exacerbations in patients with severe persistent allergic asthma. Funding: Novartis
1056
Improving Influenza Vaccination Rates in a Pediatric Asthma Management Program by Utilization of an Electronic Medical Record E. Martin; Health Point Family Care, Covington, KY. RATIONALE: An electronic medical record (EMR) was implemented between 2000 and 2001 at Cincinnati Group Health Associates (CGHA), and a function of the EMR was utilized as a tool to discover if improvement of influenza vaccination rates could be achieved among moderate to severe asthmatics in the CGHA pediatric population in 2002 and 2003. METHODS: The pediatric population was estimated in the same manner each year from 1993 through 2003, and ranged from 27,000 to 34,000 patients. A roster function of the EMR was used to create patient lists of moderate to severe asthmatics. These patients were chosen by their primary care doctors by using national guidelines . The year 2001 was selected as the baseline for the list, and it was updated yearly in 2002 and 2003. Efforts were made to increase influenza vaccination rates in the 2002 and 2003 roster lists by contacting the patients during the pre-influenza season. RESULTS: Influenza vaccination levels in the moderate to severe asthmatic population were increased 80% by 2003 over baseline 2001 levels. Correspondingly, CGHA pediatric asthma admissions declined 50% by 2003 from a plateau level between 1999 and 2001. All of these results were statistically significant to 95% confidence levels. CONCLUSIONS: An EMR can be used successfully as a tool to improve influenza vaccination compliance in a pediatric moderate to severe asthmatic population.
1057
J ALLERGY CLIN IMMUNOL FEBRUARY 2006
Which Patients are More Likely to Receive an Asthma Action Plan? D. C. Chaffin, Jr., K. K. Slish, M. D. Cabana, N. M. Clark; Division of Allergy/Immunology, University of Michigan, Ann Arbor, MI. RATIONALE: We investigated which physician and caregiver factors were assosiated with receipt of an asthma action plan for pediatric patients. METHODS: We conducted secondary data analyses from the patients of 101 primary care providers from 10 US regions enrolled in a randomized controlled trial. Patients were a random sample of asthma patients aged 212 years with no other pulmonary diseases. From interviews, we collected information regarding demographics, asthma symptoms, smoke exposure and clinical care information. We used a multivariate logistic regression model controlling for age, gender, education, smoke exposure and severity of illness to determine associations of physician and caregiver variables with receipt of an action plan. RESULTS: Response rate was 896 of 1077 (83%). Patients had a mean age of 7 yrs; 64% were male; 14% had Medicaid; 38% had persistent asthma. Bivariate analysis demonstrated an association (p=0.004) between receipt of an asthma action plan and a lower level of parental educational achievement (i.e., less than a high school education). Approaching significance (p=0.065) was the association of receipt of an asthma action plan and physicians who were less familiar with patient education guidelines. Multivariate analysis revealed that children whose parents had a lower level of educational achievement were more likely to receive an asthma action plan (odds ratio 1.69, 95% CI 1.17-2.44). CONCLUSIONS: Patients with less educated parents are more likely to receive an asthma action plan. With decreasing resources, physicians may be targeting caregivers of patients whom they suspect may benefit most from asthma action plans.
1058
TUESDAY
Asthma Education Camp: Immediate and Long term Impacts on Thai Asthmatic Children and Their Families S. Numkiatwongsa1, T. Tongkaew1, S. Tongkum2, P. Chatchatee1, J. Ngamphaiboon1; 1Pediatric, Chulalongkorn University School Medicine, Bangkok, THAILAND, 2Rehabilitation and physiotherapy, Chulalongkorn University School Medicine, Bangkok, THAILAND. RATIONALE: Patient education is a critical requirement for successful asthma control. Different culture perception can affect patients’ acceptance of educational message. In Thailand, asthmatic children and their families have rare opportunity to participate in the education camp, and therefore they are not familiar with this form of education. We assessed the impacts of asthma camp on asthma knowledge and long term quality of life(QOL) of Thai asthmatic children and their families in their first asthma camp participation. METHODS: 65 children with asthma and their families participates for the first time in the Asthmatic Education camp. (Camp1 n=32, aged 3-7 years; Camp2 n=33, aged 8-18 years). Activities include education session, interactive activities related to the use of asthma medications, self monitoring and exercise. Asthma knowledge and QOL were measured using asthma knowledge assessment questionnaire and a previously validated Asthma QOL Questionnaire(QOL-modified QOL score for Thai children). The questionnaires were administered at three times points: pre-camp, immediate post camp and six months post camp. The data were compared to assess the immediate and long term impact of camp participation. RESULTS: There was a statistically significant improvement in asthma knowledge scores (mean pre-and post-test score = 24.40 vs 27.46 p<0.0001).The modified QOL scores also showed significantly improvement in the emotional, activity and symptom domain in the 6-month follow up ((mean pre-and post-test score = 4.0±1.6 vs 6.1±1.0, 4.4±1.7 vs 6.1±1.0, 3.4±1.6 vs 5.7±1.1 respectively, p<0.0001). CONCLUSIONS: Asthma education camp has both immediate and long term positive impact on asthma knowledge and QOL. It is well accepted in Thai culture and can be used to improved asthma care.
1059
Factors Predictive of Future Clinically Significant Exacerbations in Severe Asthma R. Slavin1, H. Fox2, K. Surrey2, C. Reisner3; 1Saint Louis University School of Medicine, Saint Louis, MO, 2Novartis Horsham Research Centre, Horsham, UNITED KINGDOM, 3Novartis Pharmaceuticals Corporation, East Hanover, NJ. RATIONALE: Identifying asthma patients most at risk of clinically significant exacerbations (requiring systemic corticosteroids) enhances focussed management. We evaluated the association of baseline asthmarelated variables and their influence on rate of future significant exacerbations during a randomized, placebo-controlled study of omalizumab efficacy and safety in patients with severe persistent allergic asthma that was inadequately controlled despite GINA step 4 therapy. METHODS: Baseline demographic measures (56 variables) from 419 patients were included one at a time in a simple model without treatment or other study design terms. The association of each variable with significant exacerbations during the treatment phase of the study was assessed separately using Poisson regression, disregarding any correlations between variables. RESULTS: Fifteen baseline demographic characteristics demonstrated a strong association with future exacerbations (p<0.01). Three characteristics (number of clinically significant exacerbations, number of severe exacerbations and time since last exacerbation) were associated with exacerbation history (all p<0.0001). Five characteristics were indirectly associated with exacerbations: missed work/school days (p<0.0001), unscheduled visits due to asthma (p=0.0004), hospitalizations during runin phase (p=0.0018), doctor visits due to asthma (p=0.0021) and hospital admissions (p=0.0034). The remaining seven characteristics included measures of lung function and symptoms, expected to be associated with exacerbation, as well as mold allergy (a known predictive factor of severe exacerbation). Notably, baseline total IgE in this allergic population was found not to be a predictive factor of future significant exacerbations. CONCLUSIONS: Baseline measures related to previous exacerbations are the most important predictive factors of future clinically significant exacerbations in patients with severe persistent allergic asthma. Funding: Novartis
1056
Improving Influenza Vaccination Rates in a Pediatric Asthma Management Program by Utilization of an Electronic Medical Record E. Martin; Health Point Family Care, Covington, KY. RATIONALE: An electronic medical record (EMR) was implemented between 2000 and 2001 at Cincinnati Group Health Associates (CGHA), and a function of the EMR was utilized as a tool to discover if improvement of influenza vaccination rates could be achieved among moderate to severe asthmatics in the CGHA pediatric population in 2002 and 2003. METHODS: The pediatric population was estimated in the same manner each year from 1993 through 2003, and ranged from 27,000 to 34,000 patients. A roster function of the EMR was used to create patient lists of moderate to severe asthmatics. These patients were chosen by their primary care doctors by using national guidelines . The year 2001 was selected as the baseline for the list, and it was updated yearly in 2002 and 2003. Efforts were made to increase influenza vaccination rates in the 2002 and 2003 roster lists by contacting the patients during the pre-influenza season. RESULTS: Influenza vaccination levels in the moderate to severe asthmatic population were increased 80% by 2003 over baseline 2001 levels. Correspondingly, CGHA pediatric asthma admissions declined 50% by 2003 from a plateau level between 1999 and 2001. All of these results were statistically significant to 95% confidence levels. CONCLUSIONS: An EMR can be used successfully as a tool to improve influenza vaccination compliance in a pediatric moderate to severe asthmatic population.
1057
J ALLERGY CLIN IMMUNOL FEBRUARY 2006
Which Patients are More Likely to Receive an Asthma Action Plan? D. C. Chaffin, Jr., K. K. Slish, M. D. Cabana, N. M. Clark; Division of Allergy/Immunology, University of Michigan, Ann Arbor, MI. RATIONALE: We investigated which physician and caregiver factors were assosiated with receipt of an asthma action plan for pediatric patients. METHODS: We conducted secondary data analyses from the patients of 101 primary care providers from 10 US regions enrolled in a randomized controlled trial. Patients were a random sample of asthma patients aged 212 years with no other pulmonary diseases. From interviews, we collected information regarding demographics, asthma symptoms, smoke exposure and clinical care information. We used a multivariate logistic regression model controlling for age, gender, education, smoke exposure and severity of illness to determine associations of physician and caregiver variables with receipt of an action plan. RESULTS: Response rate was 896 of 1077 (83%). Patients had a mean age of 7 yrs; 64% were male; 14% had Medicaid; 38% had persistent asthma. Bivariate analysis demonstrated an association (p=0.004) between receipt of an asthma action plan and a lower level of parental educational achievement (i.e., less than a high school education). Approaching significance (p=0.065) was the association of receipt of an asthma action plan and physicians who were less familiar with patient education guidelines. Multivariate analysis revealed that children whose parents had a lower level of educational achievement were more likely to receive an asthma action plan (odds ratio 1.69, 95% CI 1.17-2.44). CONCLUSIONS: Patients with less educated parents are more likely to receive an asthma action plan. With decreasing resources, physicians may be targeting caregivers of patients whom they suspect may benefit most from asthma action plans.
1058
TUESDAY
Asthma Education Camp: Immediate and Long term Impacts on Thai Asthmatic Children and Their Families S. Numkiatwongsa1, T. Tongkaew1, S. Tongkum2, P. Chatchatee1, J. Ngamphaiboon1; 1Pediatric, Chulalongkorn University School Medicine, Bangkok, THAILAND, 2Rehabilitation and physiotherapy, Chulalongkorn University School Medicine, Bangkok, THAILAND. RATIONALE: Patient education is a critical requirement for successful asthma control. Different culture perception can affect patients’ acceptance of educational message. In Thailand, asthmatic children and their families have rare opportunity to participate in the education camp, and therefore they are not familiar with this form of education. We assessed the impacts of asthma camp on asthma knowledge and long term quality of life(QOL) of Thai asthmatic children and their families in their first asthma camp participation. METHODS: 65 children with asthma and their families participates for the first time in the Asthmatic Education camp. (Camp1 n=32, aged 3-7 years; Camp2 n=33, aged 8-18 years). Activities include education session, interactive activities related to the use of asthma medications, self monitoring and exercise. Asthma knowledge and QOL were measured using asthma knowledge assessment questionnaire and a previously validated Asthma QOL Questionnaire(QOL-modified QOL score for Thai children). The questionnaires were administered at three times points: pre-camp, immediate post camp and six months post camp. The data were compared to assess the immediate and long term impact of camp participation. RESULTS: There was a statistically significant improvement in asthma knowledge scores (mean pre-and post-test score = 24.40 vs 27.46 p<0.0001).The modified QOL scores also showed significantly improvement in the emotional, activity and symptom domain in the 6-month follow up ((mean pre-and post-test score = 4.0±1.6 vs 6.1±1.0, 4.4±1.7 vs 6.1±1.0, 3.4±1.6 vs 5.7±1.1 respectively, p<0.0001). CONCLUSIONS: Asthma education camp has both immediate and long term positive impact on asthma knowledge and QOL. It is well accepted in Thai culture and can be used to improved asthma care.
1059