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School-based asthma education program and impact on quality of life
Abstracts S145
J ALLERGY CLIN IMMUNOL VOLUME 115, NUMBER 2
Medication Use Prior to and Post Emergency Department (ED) Visit for Pediatric Asthma T. P. McLaughlin1, D. A. Stempel2, R. H. Stanford3; 1NDCHealth, Phoenix, AZ, 2University of Washington, Seattle, WA, 3GlaxoSmithKline, Research Triangle Park, NC. RATIONALE: This study was designed to describe the treatment patterns in children in the year prior and two months after an ED event. METHODS: This retrospective, observational study utilized the PharMetrics Integrated Outcomes Database that contains administrative claims from over 20 managed care plans across the United States. All patients, aged 1-17 years, with at least one ED visit for asthma during 2001 were included. Patients were required to have data available 12 months prior to and 2 months following the ED visit. RESULTS: 5,501 asthma-related ED admissions were identified during the study period. In the year prior to the ED event 19.4% of the children received an inhaled corticosteroid (ICS), 31.4% oral corticosteroids (OCS) and 58.3% short-acting beta2-agonists (SABA). Overall, there were more than three albuterol units for every ICS unit dispensed in the 12-month period prior to the event. Ninety-four percent of patients had an office visit in the prior year but only 7.9% had spirometry performed. Prescriptions dispensed for ICS and OCS increased 2.9-fold and 8.2-fold respectively in the month after the ED event; however, the dispensing rates for both of these medications reverted to near baseline rates by the second month after the index ED event. CONCLUSIONS: This study demonstrates the dependence of children with asthma on the use of rescue medications including SABA and OCS. An ED event results in an incremental but transient, improvement in ICScontaining controller treatment. Funding: GlaxoSmithKline
578
Compliance With NAEPP Asthma Guidelines in a Hospital Based Pediatric Clinic and School Based Health Clinics After an Asthma Education Program T. Tavarkiladze1, S. Kearney1, K. Garrett-Szymanski1, A. Khadavi1, Y. Persaud1, W. Mak1, R. Giusti2, S. Watson2, B. Silverman1, A. T. Schnei-
579
der1; 1Allergy and Immunology, Long Island College Hospital, Brooklyn, NY, 2Pediatrics, Long Island College Hospital, Brooklyn, NY. RATIONALE: Implementation of NAEPP Asthma Guidelines is not fully embraced by primary-care practitioners. To improve compliance, a hospital based pediatric clinic(HBPC) and school based health clinics(SBHC) located in inner city Brooklyn participated in an asthma education program which trained the primary-care practitioners in the guidelines. During the program, compliance was excellent evidenced by classification of asthma severity 83%(179/216) of visits. Documentation of asthma action plans and appropriate use of controller medication was greater than 90%(101/110). This study evaluates compliance one year after cessation of the intensive asthma education program. METHODS: Charts from the initial study were reviewed. Compliance was measured by tracking the documentation of asthma severity, asthma action plans, and appropriate use of controller medication during visits that occurred after program cessation. RESULTS: 820 visits were reviewed. The SBHC classified asthma severity in 66%(310/469), appropriately used controller medication in 72%(39/54) and reviewed asthma action plans in 41%(194/469) of visits. The HBPC classified asthma severity in 55%(192/351), appropriately used controller medication in 74%(51/69) and reviewed asthma action plans in 28%(97/351) of visits. CONCLUSIONS: The initial asthma education program improved primary-care practitioners’ compliance with asthma guidelines. After cessation of program, compliance decreased in both clinic settings, however more so in the HBPC. Continuity may be a factor as the HBPC is staffed by multiple residents and attending physicians whereas the SBHC is staffed by fulltime nurse practitioners. However, even when continuity existed with the HBPC attending physicians, compliance remained poor. Possibly more frequent guideline training will convince physicians to utilize the NAEPP asthma guidelines. School-Based Asthma Education Program and Impact on Quality of Life A. A. Khuntia1, M. D. Cabana2, K. K. Slish2, T. M. Ghormley3, M. S. McMorris1; 1Internal Medicine/Allergy Division, University of Michigan, Ann Arbor, MI, 2Pediatrics, University of Michigan, Ann Arbor, MI, 3St. Joseph Mercy Hospital, Ann Arbor, MI. RATIONALE: Improving child and caregiver quality of life is a common goal of asthma education programs, but few studies have evaluated the quality of life of both groups independently. We assessed the impact of a school-based asthma education program on child and caregiver quality of life. METHODS: 48 children between the ages of 7 and 15 with asthma were enrolled in a six-week school-based asthma education program modeled after the American Lung Association “Open-Airways for Schools” program. Quality of life of students and their caregivers were measured using a previously validated Asthma Quality of Life Questionnaire (AQLQ). Six-week follow-up AQLQ outcomes were compared to baseline using McNemar’s test. RESULTS: Children had a mean age of 9.9 yrs; 54% were male. 94% of the children were non-Hispanic. 48% of the children were Caucasian, 42% African American, 2% Asian and 8% were characterized as other. 39% of children and 30% of caregivers showed an overall improvement in quality of life (minimal important difference-MID=0.5). Domain specific questions were analyzed. 31% of students reached MID in the emotional domain, 50% in the activity domain, and 46% in the symptom domain. 27% of caregivers attained MID in the emotional domain and 30% in the activity domain. Student questions pertaining to exercising (p<0.0001), walking (p<0.045), tiredness (p<0.039), difficulty taking a deep breath (p<0.045) and chest tightness (p<0.020) were statistically significant. CONCLUSIONS: A school-based asthma education program improves overall quality of life of participants and their caregivers. Additionally, students showed significant improvement in activities as well as symptoms after program completion.
580
MONDAY
Asthma Morbidity and Asthma-Related Risk Factors Among Inner-City School Children K. Paris, M. Mvula, C. Moore; Department of Pediatrics, LSU HSC, New Orleans, LA. RATIONALE: To determine the magnitude of asthma-related morbidity, treatment and risk factors in a select inner city population. METHODS: Routine health screenings, including tests for asthma, were conducted at an urban high school. Participants (204) filled the International Study of Asthma and Allergy in Childhood (ISAAC) questionnaire, identified their treatment, and asthma tools. Demographic information was collected. RESULTS: Participants were 13-19 years: 50.5% African American, 45.1% white, 31.4% male. Cumulative asthma prevalence was 18.8%. Related morbidity was: Lifetime wheezing, 24%;12-month wheezing, 12.7%, girls reporting it 3.36 times more often (95% CI: 1.54, 7.36); wheezing more than 4 times in 12 months, 4.7%; wheezing with exercise, 10.9%; and night cough, 10.5%. There was significant association between race and wheezing in the past 12 months (p < 0.024), whites reporting 3.78 times more often (95% CI: 2.01, 7.10). Parents with less education,
577
J ALLERGY CLIN IMMUNOL VOLUME 115, NUMBER 2
Medication Use Prior to and Post Emergency Department (ED) Visit for Pediatric Asthma T. P. McLaughlin1, D. A. Stempel2, R. H. Stanford3; 1NDCHealth, Phoenix, AZ, 2University of Washington, Seattle, WA, 3GlaxoSmithKline, Research Triangle Park, NC. RATIONALE: This study was designed to describe the treatment patterns in children in the year prior and two months after an ED event. METHODS: This retrospective, observational study utilized the PharMetrics Integrated Outcomes Database that contains administrative claims from over 20 managed care plans across the United States. All patients, aged 1-17 years, with at least one ED visit for asthma during 2001 were included. Patients were required to have data available 12 months prior to and 2 months following the ED visit. RESULTS: 5,501 asthma-related ED admissions were identified during the study period. In the year prior to the ED event 19.4% of the children received an inhaled corticosteroid (ICS), 31.4% oral corticosteroids (OCS) and 58.3% short-acting beta2-agonists (SABA). Overall, there were more than three albuterol units for every ICS unit dispensed in the 12-month period prior to the event. Ninety-four percent of patients had an office visit in the prior year but only 7.9% had spirometry performed. Prescriptions dispensed for ICS and OCS increased 2.9-fold and 8.2-fold respectively in the month after the ED event; however, the dispensing rates for both of these medications reverted to near baseline rates by the second month after the index ED event. CONCLUSIONS: This study demonstrates the dependence of children with asthma on the use of rescue medications including SABA and OCS. An ED event results in an incremental but transient, improvement in ICScontaining controller treatment. Funding: GlaxoSmithKline
578
Compliance With NAEPP Asthma Guidelines in a Hospital Based Pediatric Clinic and School Based Health Clinics After an Asthma Education Program T. Tavarkiladze1, S. Kearney1, K. Garrett-Szymanski1, A. Khadavi1, Y. Persaud1, W. Mak1, R. Giusti2, S. Watson2, B. Silverman1, A. T. Schnei-
579
der1; 1Allergy and Immunology, Long Island College Hospital, Brooklyn, NY, 2Pediatrics, Long Island College Hospital, Brooklyn, NY. RATIONALE: Implementation of NAEPP Asthma Guidelines is not fully embraced by primary-care practitioners. To improve compliance, a hospital based pediatric clinic(HBPC) and school based health clinics(SBHC) located in inner city Brooklyn participated in an asthma education program which trained the primary-care practitioners in the guidelines. During the program, compliance was excellent evidenced by classification of asthma severity 83%(179/216) of visits. Documentation of asthma action plans and appropriate use of controller medication was greater than 90%(101/110). This study evaluates compliance one year after cessation of the intensive asthma education program. METHODS: Charts from the initial study were reviewed. Compliance was measured by tracking the documentation of asthma severity, asthma action plans, and appropriate use of controller medication during visits that occurred after program cessation. RESULTS: 820 visits were reviewed. The SBHC classified asthma severity in 66%(310/469), appropriately used controller medication in 72%(39/54) and reviewed asthma action plans in 41%(194/469) of visits. The HBPC classified asthma severity in 55%(192/351), appropriately used controller medication in 74%(51/69) and reviewed asthma action plans in 28%(97/351) of visits. CONCLUSIONS: The initial asthma education program improved primary-care practitioners’ compliance with asthma guidelines. After cessation of program, compliance decreased in both clinic settings, however more so in the HBPC. Continuity may be a factor as the HBPC is staffed by multiple residents and attending physicians whereas the SBHC is staffed by fulltime nurse practitioners. However, even when continuity existed with the HBPC attending physicians, compliance remained poor. Possibly more frequent guideline training will convince physicians to utilize the NAEPP asthma guidelines. School-Based Asthma Education Program and Impact on Quality of Life A. A. Khuntia1, M. D. Cabana2, K. K. Slish2, T. M. Ghormley3, M. S. McMorris1; 1Internal Medicine/Allergy Division, University of Michigan, Ann Arbor, MI, 2Pediatrics, University of Michigan, Ann Arbor, MI, 3St. Joseph Mercy Hospital, Ann Arbor, MI. RATIONALE: Improving child and caregiver quality of life is a common goal of asthma education programs, but few studies have evaluated the quality of life of both groups independently. We assessed the impact of a school-based asthma education program on child and caregiver quality of life. METHODS: 48 children between the ages of 7 and 15 with asthma were enrolled in a six-week school-based asthma education program modeled after the American Lung Association “Open-Airways for Schools” program. Quality of life of students and their caregivers were measured using a previously validated Asthma Quality of Life Questionnaire (AQLQ). Six-week follow-up AQLQ outcomes were compared to baseline using McNemar’s test. RESULTS: Children had a mean age of 9.9 yrs; 54% were male. 94% of the children were non-Hispanic. 48% of the children were Caucasian, 42% African American, 2% Asian and 8% were characterized as other. 39% of children and 30% of caregivers showed an overall improvement in quality of life (minimal important difference-MID=0.5). Domain specific questions were analyzed. 31% of students reached MID in the emotional domain, 50% in the activity domain, and 46% in the symptom domain. 27% of caregivers attained MID in the emotional domain and 30% in the activity domain. Student questions pertaining to exercising (p<0.0001), walking (p<0.045), tiredness (p<0.039), difficulty taking a deep breath (p<0.045) and chest tightness (p<0.020) were statistically significant. CONCLUSIONS: A school-based asthma education program improves overall quality of life of participants and their caregivers. Additionally, students showed significant improvement in activities as well as symptoms after program completion.
580
MONDAY
Asthma Morbidity and Asthma-Related Risk Factors Among Inner-City School Children K. Paris, M. Mvula, C. Moore; Department of Pediatrics, LSU HSC, New Orleans, LA. RATIONALE: To determine the magnitude of asthma-related morbidity, treatment and risk factors in a select inner city population. METHODS: Routine health screenings, including tests for asthma, were conducted at an urban high school. Participants (204) filled the International Study of Asthma and Allergy in Childhood (ISAAC) questionnaire, identified their treatment, and asthma tools. Demographic information was collected. RESULTS: Participants were 13-19 years: 50.5% African American, 45.1% white, 31.4% male. Cumulative asthma prevalence was 18.8%. Related morbidity was: Lifetime wheezing, 24%;12-month wheezing, 12.7%, girls reporting it 3.36 times more often (95% CI: 1.54, 7.36); wheezing more than 4 times in 12 months, 4.7%; wheezing with exercise, 10.9%; and night cough, 10.5%. There was significant association between race and wheezing in the past 12 months (p < 0.024), whites reporting 3.78 times more often (95% CI: 2.01, 7.10). Parents with less education,
577