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547 The prevalence of allergic and non-allergic respiratrory symptoms in the U.S. population: Data from the second National Health and Nutrition Examination Survey,1976–1980 (NHANES II)
547
548
TICI3B OF ALLEEGIC AND IWN-ALLERGIC RESPIPATRoRy SYMPIQE IN THE U.S. FORTLATION: DATAFK@lITiESECND~TIONALSEWUiAND NUIRCTION EXAMINATION SURVI3y,1976-80 (IWANES II). Turkeltaub P.C.,M.D. Gergen P.J.,M.D., M.P.H., Bethesda ahd Hyattsville, MD. Information on the diagnosis(D) of hayfever (AR), asthma(Rs) , chr bronchitis(CJ3) , wheezing, chr cough(CC) , chr rhinitis(CP) , catarrhal synptans, relation to season and/or pollen exposufe, and smoking status was collected on a sample of the U.S. civilian noninstitutional non-black population 12-74 years of age (N=12,727). Regardless of D, seasonal and pollen related symptoms were labeled AR an;l wheezing was labeled AS . The overall orevalences were: AR:9.8; CR:20.4; AS:6.9; h only(without AS) :7.8; AS cnly(without AR):4.9; AR and AS:2.0; AR or AS:14.8; Ck1.3; CE1.1; with peak prevalences in the age group 55-74 yrs for all diseases except AR and AR only where the peak was in the 35-54 yrs group. The prevalence for males(M) > females(F) for AS only, whereas F)M for AR, AR only, AR and AS, AR or AS, CB. The prevalence of AR, AR only was higher for urban vs rural residence. Persons belaw poverty(P1) had higher prevalence of AS, AS only, AS or AR, CR than those, PI. Smokers had 2-3X higher prevalences of all diseases except AR, AR and AS, AR only. MIANES II provides an important reference for assessing the prevalence of allergic and non-allergic synptans in the U.S. pcpulation. NHANES III (1988-1994) will determine whether changes in allergic and nonallergic synptum have occurred in the U.S. over the past decade.
549
ASTHMA MORTALITY RATE (AMR)--MASSACHUSETTS 1971-1986. Paul J. Hannaway, M.D., Salem, Mass. EDidemioloqic studies reoort an increase in AMR in Great Britain, Western Europe and the United States from 1978 to 1984. Certificates of asthma deaths (ADS) from Massachusetts were reviewed from 1971 to 1986. Mass. "death tapes" record name, age, sex and race of decedent, date and place of death (hospital, enroute, home) and if an autopsy was performed. There were 950 ADS from 1971 to- 1986.. Females outnumbered males by 3:2. The AMR was stable from 1970 to 1979. After 1979, AMR increases more than E-fold from .66 to 1.80/100,000 pop. There were only 4 deaths under age 4. .AMR in the 5-34 yr old age aroup remained unchanaed from 1971 to 1986. Childhood ADS (O-14 yr) are more common in females. There is a slight increase in ADS in the 30-65 yr old age group. The greatest increase after 1979 is seen in elderly females 265 (2-3-fold). There was no increase in ADS in black males or females. Blacks make u a higher percentage of ADS in 5-34 yr olds (28% P , as opposed to 35 (2%). 53% of ADS occur in hospital (DOA or enroute-31%, at home-16%). Young blacks were more likely to die outside hospital. There was an alarming increase in ADS outside hospital in 84 and 85-11 of 13 deaths. Autopsy material is readily available as 12 of 13 deaths in 84-85 Were'autoDsied. This observable increase in AMR in Mass. may be due to diagnostic,arti:fact or physician bias where elderly females c>65) with wheezing (or chest congestion) are coded as an asthma death as opposed to elderly males and smokers who are coded as a COPD death.
550
THE EPIDEMIOLOGY ?XKDF~UODX?T~~MA
~RTF%,Thica~o,
OF EMERGENCY
ROOM VISITS
FOR
K Kim,ml;-R. ---____bans InsI I1-iii=
-YniZl~to gain a better understanding of the reason(s) for the increasing hospitalization rate for asthma in our 265-bed tertiary children's hospital, we reviewed a random sample of 400 records from a total of 2400 Emergency Room visits for asthma (ERA) between 1 January 1985 and 10 October 1987. 52% of the ERA were under 6 years of age, 66% were male, 39% black, 37% hispanic and 64% were on Public Aid. 15% were under the care of an allergist. 52% of the records indicated 3 or more ERA in the last 3 years. 63% of the ERA were associated with an upper respiratory infection (URI) and a large proportion (107/400) presented in Sept. and Oct. During the 34 months there was a marked increase in the use of steroids and beta agonists. 30 of the 400 ERA were admitted. Only 2 were not receiving regular bronchodilator agents. 9 were on corticosteroids. Factors associated with hospitalization were a history of 3 or more previous ERA (O.R. = 4.1) and a history of prior hospitalization (O.R. = 3.5). Age, gender, race, socioeconomic status and the Presence of a URI were not associated with. hospitalization for asthma. These data suggest that although frequent prior ER-A and hospitalization for asthma are identifiers of the patient who may require hospitalization, the reasons for the increasing frequency of hospitalizations for childhood asthma are not explained by the epidemiologic measurements used in this study.
ASTHMA IN THE EMERGENCY Leora A. Traynor, M.D.
ROOM Akron,
Ohio
Admissions for status at our hospital have escalated from 79 in 1971 to 576 in 1986. PURPOSE: To identify characteristics of asthma patients presenting to the ER of a community pediatric hospital. METHOD: A 30 item questionnaire was given to parents of patients presenting to the ER of Childrens Hospital Medical Center of Akron, Ohio with the complaints of wheezing or asthma during the period March 1,1987 through August 15, 1987. Questionnaires and ER records were matched daily to provide demographic information and treatment outcome. 504 patients received treatment in 704 ER encounters. Parents completed questionnaires for 502(71%) of the 704 ER visits. Only 70 parents(l4%) reported the visit to be the child's first episode of wheezing. A second ER visit for the same episode of asthma was necessary in 43 instances( 112 ER visits (22%) resulted in hospital admission. 271 (54%) had required hospital admission during the previous year. 361 (72%) were known asthmatics who had prescribed asthma medication available. Only 54%(194 of the 361) received REGULAR medication. The predominant management program was "ONLY AS NEEDED" oral beta adrener ic drugs for 247 of the 361 known asthmatics 4 68%). CONCLUSION: The majority of pediatric ER patients presenting with wheezing have chronic rather than acute asthma, for which PRN beta adrenergic drugs are an unsuccessful and an unacceptable form of management.
305
548
TICI3B OF ALLEEGIC AND IWN-ALLERGIC RESPIPATRoRy SYMPIQE IN THE U.S. FORTLATION: DATAFK@lITiESECND~TIONALSEWUiAND NUIRCTION EXAMINATION SURVI3y,1976-80 (IWANES II). Turkeltaub P.C.,M.D. Gergen P.J.,M.D., M.P.H., Bethesda ahd Hyattsville, MD. Information on the diagnosis(D) of hayfever (AR), asthma(Rs) , chr bronchitis(CJ3) , wheezing, chr cough(CC) , chr rhinitis(CP) , catarrhal synptans, relation to season and/or pollen exposufe, and smoking status was collected on a sample of the U.S. civilian noninstitutional non-black population 12-74 years of age (N=12,727). Regardless of D, seasonal and pollen related symptoms were labeled AR an;l wheezing was labeled AS . The overall orevalences were: AR:9.8; CR:20.4; AS:6.9; h only(without AS) :7.8; AS cnly(without AR):4.9; AR and AS:2.0; AR or AS:14.8; Ck1.3; CE1.1; with peak prevalences in the age group 55-74 yrs for all diseases except AR and AR only where the peak was in the 35-54 yrs group. The prevalence for males(M) > females(F) for AS only, whereas F)M for AR, AR only, AR and AS, AR or AS, CB. The prevalence of AR, AR only was higher for urban vs rural residence. Persons belaw poverty(P1) had higher prevalence of AS, AS only, AS or AR, CR than those, PI. Smokers had 2-3X higher prevalences of all diseases except AR, AR and AS, AR only. MIANES II provides an important reference for assessing the prevalence of allergic and non-allergic synptans in the U.S. pcpulation. NHANES III (1988-1994) will determine whether changes in allergic and nonallergic synptum have occurred in the U.S. over the past decade.
549
ASTHMA MORTALITY RATE (AMR)--MASSACHUSETTS 1971-1986. Paul J. Hannaway, M.D., Salem, Mass. EDidemioloqic studies reoort an increase in AMR in Great Britain, Western Europe and the United States from 1978 to 1984. Certificates of asthma deaths (ADS) from Massachusetts were reviewed from 1971 to 1986. Mass. "death tapes" record name, age, sex and race of decedent, date and place of death (hospital, enroute, home) and if an autopsy was performed. There were 950 ADS from 1971 to- 1986.. Females outnumbered males by 3:2. The AMR was stable from 1970 to 1979. After 1979, AMR increases more than E-fold from .66 to 1.80/100,000 pop. There were only 4 deaths under age 4. .AMR in the 5-34 yr old age aroup remained unchanaed from 1971 to 1986. Childhood ADS (O-14 yr) are more common in females. There is a slight increase in ADS in the 30-65 yr old age group. The greatest increase after 1979 is seen in elderly females 265 (2-3-fold). There was no increase in ADS in black males or females. Blacks make u a higher percentage of ADS in 5-34 yr olds (28% P , as opposed to 35 (2%). 53% of ADS occur in hospital (DOA or enroute-31%, at home-16%). Young blacks were more likely to die outside hospital. There was an alarming increase in ADS outside hospital in 84 and 85-11 of 13 deaths. Autopsy material is readily available as 12 of 13 deaths in 84-85 Were'autoDsied. This observable increase in AMR in Mass. may be due to diagnostic,arti:fact or physician bias where elderly females c>65) with wheezing (or chest congestion) are coded as an asthma death as opposed to elderly males and smokers who are coded as a COPD death.
550
THE EPIDEMIOLOGY ?XKDF~UODX?T~~MA
~RTF%,Thica~o,
OF EMERGENCY
ROOM VISITS
FOR
K Kim,ml;-R. ---____bans InsI I1-iii=
-YniZl~to gain a better understanding of the reason(s) for the increasing hospitalization rate for asthma in our 265-bed tertiary children's hospital, we reviewed a random sample of 400 records from a total of 2400 Emergency Room visits for asthma (ERA) between 1 January 1985 and 10 October 1987. 52% of the ERA were under 6 years of age, 66% were male, 39% black, 37% hispanic and 64% were on Public Aid. 15% were under the care of an allergist. 52% of the records indicated 3 or more ERA in the last 3 years. 63% of the ERA were associated with an upper respiratory infection (URI) and a large proportion (107/400) presented in Sept. and Oct. During the 34 months there was a marked increase in the use of steroids and beta agonists. 30 of the 400 ERA were admitted. Only 2 were not receiving regular bronchodilator agents. 9 were on corticosteroids. Factors associated with hospitalization were a history of 3 or more previous ERA (O.R. = 4.1) and a history of prior hospitalization (O.R. = 3.5). Age, gender, race, socioeconomic status and the Presence of a URI were not associated with. hospitalization for asthma. These data suggest that although frequent prior ER-A and hospitalization for asthma are identifiers of the patient who may require hospitalization, the reasons for the increasing frequency of hospitalizations for childhood asthma are not explained by the epidemiologic measurements used in this study.
ASTHMA IN THE EMERGENCY Leora A. Traynor, M.D.
ROOM Akron,
Ohio
Admissions for status at our hospital have escalated from 79 in 1971 to 576 in 1986. PURPOSE: To identify characteristics of asthma patients presenting to the ER of a community pediatric hospital. METHOD: A 30 item questionnaire was given to parents of patients presenting to the ER of Childrens Hospital Medical Center of Akron, Ohio with the complaints of wheezing or asthma during the period March 1,1987 through August 15, 1987. Questionnaires and ER records were matched daily to provide demographic information and treatment outcome. 504 patients received treatment in 704 ER encounters. Parents completed questionnaires for 502(71%) of the 704 ER visits. Only 70 parents(l4%) reported the visit to be the child's first episode of wheezing. A second ER visit for the same episode of asthma was necessary in 43 instances( 112 ER visits (22%) resulted in hospital admission. 271 (54%) had required hospital admission during the previous year. 361 (72%) were known asthmatics who had prescribed asthma medication available. Only 54%(194 of the 361) received REGULAR medication. The predominant management program was "ONLY AS NEEDED" oral beta adrener ic drugs for 247 of the 361 known asthmatics 4 68%). CONCLUSION: The majority of pediatric ER patients presenting with wheezing have chronic rather than acute asthma, for which PRN beta adrenergic drugs are an unsuccessful and an unacceptable form of management.
305