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Exertional Dyspnea and Cardiopulmonary Function in Obese Asthmatics
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Association Between Asthma-related Emergency Department Visits And Mold Spore Or Pollen Concentrations In The Bronx S. P. Jariwala, J. Toh, P. Patel, J. Fodeman, S. Yee, G. Hudes, D. Rosenstreich; Albert Einstein/Montefiore Medical Center, Bronx, NY. RATIONALE: To examine the relationship between asthma-related emergency department (ED) visits, mold spore, and pollen concentrations for pediatric and adult patients in a high asthma prevalence area, the New York City borough of the Bronx. METHODS: The numbers of daily asthma-related adult and pediatric ED visits during one complete year (2007) were obtained from two Bronx hospitals. ED visit data was obtained through the CLG outcomes analysis software, which enabled a retrospective search of asthma-related ED patients. Daily mold spore and pollen counts from 3/2007 to 10/2007 were acquired from the Armonk counting station. ED visits were analyzed as weekly totals, whereas mold and pollen counts were converted into daily means. RESULTS: Total weekly asthma ED visits ranged from 53 in August to 308 in May. Most asthma ED visits were among children, with three peaks of increased visits: in January, May, and November. The spring peak was most striking and overlapped with high pollen levels observed in May. Mold spore counts peaked between May and July, during which asthma ED visits were extremely low. Although mold counts and asthma ED visits increased in October, there did not appear to be a strong correlation. The peaks in asthma ED visits and the association with spring pollen counts were consistent with our previous data from 1999. CONCLUSIONS: There is a large, spring increase in asthma ED visits in the Bronx that closely coincides with increased pollen counts. Mold spore counts do not appear to be strongly associated with any of the peaks in asthma ED visits in this locality.
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PHF11 is Not a Major Candidate Gene for Eczema or Asthma in Chinese Children T. F. Leung1, H. Y. Sy1, I. H. S. Chan2, G. W. K. Wong1, C. Y. Li1, M. M. Y. Waye3, C. W. K. Lam2, K. L. E. Hon1; 1Department of Pediatrics, The Chinese University of Hong Kong, Hong Kong, HONG KONG, 2Department of Chemical Pathology, The Chinese University of Hong Kong, Hong Kong, HONG KONG, 3School of Biomedical Sciences, The Chinese University of Hong Kong, Hong Kong, HONG KONG. RATIONALE: Positional cloning in Caucasians identified the gene encoding plant homeodomain zinc finger protein 11 (PHF11) to be associated with asthma and eczema. Microarray analysis confirmed increased PHF11 expression in Th1 cells. However, such associations are unclear in Asian subjects. This case-control study investigated the relationship between asthma and eczema and tagging single-nucleotide polymorphisms (SNPs) of PHF11 in Chinese children. METHODS: 319 asthmatic and 236 eczema children were recruited from our clinics and 445 non-allergic children were recruited as controls from local schools and hospitals. Atopy was defined by positive allergen-specific IgE in plasma or skin prick testing. Lung function of asthmatics was evaluated by pre-bronchodilator spirometry. Ten PHF11 SNPs were genotyped by multiplex SNaPshotä assay. RESULTS: Genotyping call rates were 100% for all SNPs, which also followed Hardy-Weinberg equilibrium. These SNPs were tightly linked in one haplotype block (DÕ 0.95 for nearly all SNP pairs). The minor allele frequencies (MAFs) of PHF11 SNPs differed significantly up to 0.34 for C allele of +22423 between our Chinese and published Caucasian data. MAF of +21425 also differed by 0.19 in these populations. Physician-diagnosed asthma was weakly associated with PHF11 +20860 and +22818 (P50.032 for both), whereas atopy was associated with +22398 (P50.029). However, none of the PHF11 SNPs was associated with eczema diagnosis, plasma total IgE or spirometric parameters in our patients. CONCLUSION: Our findings do not support PHF11 to be a major candidate gene for asthma, eczema and aeroallergen sensitization in Chinese children.
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Exertional Dyspnea and Cardiopulmonary Function in Obese Asthmatics R. C. Herring, A. L. Ford Burnette, S. R. Lucas, J. Y. Weltman, T. A. Platts-Mills, Y. M. Shim; University of Virginia, Charlottesville, VA. RATIONALE: Because obesity can cause deconditioning and subsequent dyspnea, it is unclear if dyspnea of obese asthmatics is caused by asthma or obesity alone or by a combination of both. We compared measures of cardiopulmonary function in obese adolescents with or without physician diagnosed asthma. METHODS: Ten non-obese subjects without asthma (CTL), eight obese subjects without asthma (OB-CTL), and ten obese subjects with asthma (OB-Asthma) underwent cardiopulmonary exercise testing, reaching 8090% maximal heart rate. Obesity was defined as greater than 95th percentile BMI for age, and asthma was defined as physiciansÕ previous diagnosis. Pre- and post-exercise spirometry was measured. RESULTS: Subjects were 12-19 years old (14.5 + 2.3) and included 17 males and 11 females. Baseline FEV1/FVC was lower in OB-Asthma versus OB-CTL and CTL (0.78, 0.83, and 0.85, respectively). Maximum oxygen consumption (VO2max) was significantly lower in OB-CTL and OB-Asthma versus CTL (21.4 ml/kg/min, 21.5 ml/kg/min, and 35.3 ml/kg/min, respectively, p<0.001). Pulmonary reserve (PR) was lower in OB-CTL and OB-Asthma versus CTL (40.3%, 38.3%, and 46.9%, respectively), but there was no significant difference in PR between OB-CTL and OBAsthma. Minute ventilation (VE) was greater in OB-asthma compared to OB-CTL (78 vs. 66) but maximal voluntary ventilation (MVV) and the dyspnea index (VE/MVV) were similar. CONCLUSIONS: Obesity was associated with deconditioning demonstrated by lower VO2max, but the presence of physician diagnosed asthma was not associated with lower PR among obese subjects. These results showed that subjective dyspnea among obese asthmatic adolescents may be primarily attributed to deconditioning.
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A Comparative Study of the Cut-Off Values of Fractional Exhaled Nitric Oxide Level and Serum High-Sensitivity C-Reactive Protein Level for the Differentiation Between Bronchial Asthma and Cough-Variant Asthma T. Shimoda1, M. Imaoka1, R. Kishikawa1, T. Iwanaga1, S. Nishima1, Y. Obase2, A. Miyatake3, S. Kasayama4; 1Fukuoka National Hospital, Fukuoka, JAPAN, 2Kawasaki Medical School, Kurashiki, JAPAN, 3Miyatake Asthma Clinic, Osaka, JAPAN, 4Nissei Hospital, Osaka, JAPAN. RATIONALE: Reports have shown that the level of both fractional exhaled nitric oxide (FENO) and high-sensitivity C-reactive protein (hs-CRP) can be used as the indicator of airway inflammation in bronchial asthma(BA) and cough-variant asthma(CVA). We determined the cut-off values of both FENO and hs-CRP in BA and CVA patients. METHODS: The subjects comprised 194 patients with CVA, 295 patients with BA who were untreated with inhaled steroids and during no asthma attack, and 110 healthy persons(HP). The hs-CRP values were measured by latex nephelometry. The FENO concentration was measured by online analysis using an NO analyzer (Model-280i NOA, Sievers). RESULTS: The hs-CRP levels were 245 6 118 ng/ml, 554 6 750 ng/ml, and 721 6 1,150 ng/ml and the FENO levels were 17.9 6 6.1 ppb, 35.6 6 47.2 ppb, and 90.9 6 79.2 ppb, in HP, CVA and BA, respectively. The FENO levels in BA were significantly higher than those in HP and in CVA(p < 0.01). On the other hand, hs-CRP levels in BA were significantly higher than those in HP (p < 0.01), but not those in CVA. At a sensitivity of 80%, the values of hs-CRP in BA were 300 ng/ml (vs. HP; specificity 60%) and 700 ng/ml (vs. CVA; specificity 30%). At the same sensitivity (80%), the values of FENO in BAwere 25 ppb (vs. HP; specificity 80%) and 35 ppb (vs. CVA; specificity 60%). CONCLUSIONS: FENO is superior to hs-CRP in terms of both sensitivity and specificity for differentiating between BA and CVA.
SATURDAY
Abstracts AB5
J ALLERGY CLIN IMMUNOL VOLUME 125, NUMBER 2
Association Between Asthma-related Emergency Department Visits And Mold Spore Or Pollen Concentrations In The Bronx S. P. Jariwala, J. Toh, P. Patel, J. Fodeman, S. Yee, G. Hudes, D. Rosenstreich; Albert Einstein/Montefiore Medical Center, Bronx, NY. RATIONALE: To examine the relationship between asthma-related emergency department (ED) visits, mold spore, and pollen concentrations for pediatric and adult patients in a high asthma prevalence area, the New York City borough of the Bronx. METHODS: The numbers of daily asthma-related adult and pediatric ED visits during one complete year (2007) were obtained from two Bronx hospitals. ED visit data was obtained through the CLG outcomes analysis software, which enabled a retrospective search of asthma-related ED patients. Daily mold spore and pollen counts from 3/2007 to 10/2007 were acquired from the Armonk counting station. ED visits were analyzed as weekly totals, whereas mold and pollen counts were converted into daily means. RESULTS: Total weekly asthma ED visits ranged from 53 in August to 308 in May. Most asthma ED visits were among children, with three peaks of increased visits: in January, May, and November. The spring peak was most striking and overlapped with high pollen levels observed in May. Mold spore counts peaked between May and July, during which asthma ED visits were extremely low. Although mold counts and asthma ED visits increased in October, there did not appear to be a strong correlation. The peaks in asthma ED visits and the association with spring pollen counts were consistent with our previous data from 1999. CONCLUSIONS: There is a large, spring increase in asthma ED visits in the Bronx that closely coincides with increased pollen counts. Mold spore counts do not appear to be strongly associated with any of the peaks in asthma ED visits in this locality.
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PHF11 is Not a Major Candidate Gene for Eczema or Asthma in Chinese Children T. F. Leung1, H. Y. Sy1, I. H. S. Chan2, G. W. K. Wong1, C. Y. Li1, M. M. Y. Waye3, C. W. K. Lam2, K. L. E. Hon1; 1Department of Pediatrics, The Chinese University of Hong Kong, Hong Kong, HONG KONG, 2Department of Chemical Pathology, The Chinese University of Hong Kong, Hong Kong, HONG KONG, 3School of Biomedical Sciences, The Chinese University of Hong Kong, Hong Kong, HONG KONG. RATIONALE: Positional cloning in Caucasians identified the gene encoding plant homeodomain zinc finger protein 11 (PHF11) to be associated with asthma and eczema. Microarray analysis confirmed increased PHF11 expression in Th1 cells. However, such associations are unclear in Asian subjects. This case-control study investigated the relationship between asthma and eczema and tagging single-nucleotide polymorphisms (SNPs) of PHF11 in Chinese children. METHODS: 319 asthmatic and 236 eczema children were recruited from our clinics and 445 non-allergic children were recruited as controls from local schools and hospitals. Atopy was defined by positive allergen-specific IgE in plasma or skin prick testing. Lung function of asthmatics was evaluated by pre-bronchodilator spirometry. Ten PHF11 SNPs were genotyped by multiplex SNaPshotä assay. RESULTS: Genotyping call rates were 100% for all SNPs, which also followed Hardy-Weinberg equilibrium. These SNPs were tightly linked in one haplotype block (DÕ 0.95 for nearly all SNP pairs). The minor allele frequencies (MAFs) of PHF11 SNPs differed significantly up to 0.34 for C allele of +22423 between our Chinese and published Caucasian data. MAF of +21425 also differed by 0.19 in these populations. Physician-diagnosed asthma was weakly associated with PHF11 +20860 and +22818 (P50.032 for both), whereas atopy was associated with +22398 (P50.029). However, none of the PHF11 SNPs was associated with eczema diagnosis, plasma total IgE or spirometric parameters in our patients. CONCLUSION: Our findings do not support PHF11 to be a major candidate gene for asthma, eczema and aeroallergen sensitization in Chinese children.
19
Exertional Dyspnea and Cardiopulmonary Function in Obese Asthmatics R. C. Herring, A. L. Ford Burnette, S. R. Lucas, J. Y. Weltman, T. A. Platts-Mills, Y. M. Shim; University of Virginia, Charlottesville, VA. RATIONALE: Because obesity can cause deconditioning and subsequent dyspnea, it is unclear if dyspnea of obese asthmatics is caused by asthma or obesity alone or by a combination of both. We compared measures of cardiopulmonary function in obese adolescents with or without physician diagnosed asthma. METHODS: Ten non-obese subjects without asthma (CTL), eight obese subjects without asthma (OB-CTL), and ten obese subjects with asthma (OB-Asthma) underwent cardiopulmonary exercise testing, reaching 8090% maximal heart rate. Obesity was defined as greater than 95th percentile BMI for age, and asthma was defined as physiciansÕ previous diagnosis. Pre- and post-exercise spirometry was measured. RESULTS: Subjects were 12-19 years old (14.5 + 2.3) and included 17 males and 11 females. Baseline FEV1/FVC was lower in OB-Asthma versus OB-CTL and CTL (0.78, 0.83, and 0.85, respectively). Maximum oxygen consumption (VO2max) was significantly lower in OB-CTL and OB-Asthma versus CTL (21.4 ml/kg/min, 21.5 ml/kg/min, and 35.3 ml/kg/min, respectively, p<0.001). Pulmonary reserve (PR) was lower in OB-CTL and OB-Asthma versus CTL (40.3%, 38.3%, and 46.9%, respectively), but there was no significant difference in PR between OB-CTL and OBAsthma. Minute ventilation (VE) was greater in OB-asthma compared to OB-CTL (78 vs. 66) but maximal voluntary ventilation (MVV) and the dyspnea index (VE/MVV) were similar. CONCLUSIONS: Obesity was associated with deconditioning demonstrated by lower VO2max, but the presence of physician diagnosed asthma was not associated with lower PR among obese subjects. These results showed that subjective dyspnea among obese asthmatic adolescents may be primarily attributed to deconditioning.
20
A Comparative Study of the Cut-Off Values of Fractional Exhaled Nitric Oxide Level and Serum High-Sensitivity C-Reactive Protein Level for the Differentiation Between Bronchial Asthma and Cough-Variant Asthma T. Shimoda1, M. Imaoka1, R. Kishikawa1, T. Iwanaga1, S. Nishima1, Y. Obase2, A. Miyatake3, S. Kasayama4; 1Fukuoka National Hospital, Fukuoka, JAPAN, 2Kawasaki Medical School, Kurashiki, JAPAN, 3Miyatake Asthma Clinic, Osaka, JAPAN, 4Nissei Hospital, Osaka, JAPAN. RATIONALE: Reports have shown that the level of both fractional exhaled nitric oxide (FENO) and high-sensitivity C-reactive protein (hs-CRP) can be used as the indicator of airway inflammation in bronchial asthma(BA) and cough-variant asthma(CVA). We determined the cut-off values of both FENO and hs-CRP in BA and CVA patients. METHODS: The subjects comprised 194 patients with CVA, 295 patients with BA who were untreated with inhaled steroids and during no asthma attack, and 110 healthy persons(HP). The hs-CRP values were measured by latex nephelometry. The FENO concentration was measured by online analysis using an NO analyzer (Model-280i NOA, Sievers). RESULTS: The hs-CRP levels were 245 6 118 ng/ml, 554 6 750 ng/ml, and 721 6 1,150 ng/ml and the FENO levels were 17.9 6 6.1 ppb, 35.6 6 47.2 ppb, and 90.9 6 79.2 ppb, in HP, CVA and BA, respectively. The FENO levels in BA were significantly higher than those in HP and in CVA(p < 0.01). On the other hand, hs-CRP levels in BA were significantly higher than those in HP (p < 0.01), but not those in CVA. At a sensitivity of 80%, the values of hs-CRP in BA were 300 ng/ml (vs. HP; specificity 60%) and 700 ng/ml (vs. CVA; specificity 30%). At the same sensitivity (80%), the values of FENO in BAwere 25 ppb (vs. HP; specificity 80%) and 35 ppb (vs. CVA; specificity 60%). CONCLUSIONS: FENO is superior to hs-CRP in terms of both sensitivity and specificity for differentiating between BA and CVA.
SATURDAY
Abstracts AB5
J ALLERGY CLIN IMMUNOL VOLUME 125, NUMBER 2