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775 Asthma deaths in Chicago
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Abstracts
F a c t o r s associated with a s t h m a in a birth c o h o r t o f children followed to six y e a r s o f age. CC Johnson. PkD. EL Peterson, PhD. Ownbv. DR. ME) Detroit, MIAJSA A population based cohort of 841 children have been followed from birth through six years of age and evaluated by a pediatric allergist for asthma, including the taking of a medical history, physical examination, pulmonary function testing, skin testing and total serum leE. Included in this analysis are 202 children who have reached six years of age and completed the clinic visit. All parts of the evaluation were completed in >90% of the children. Nine percent were reported to have a previous physician diagnosis of asthma. Only 44.4% of the children with asthma had a positive methaeholine response (>20% fall in FEV, at a methacholine dose of<65 breath units (10 mg/ml)), (with an odds ratio (OR) of 4.63; p<0.005). Positive skin tests (wheal diameter >2 mm with a negative control) for ragweed and grass were not associated with history of asthma. Higher percentages of positive skin reactions to Derf(OR~3.03;p< 0.046 ), Derp (OR=l.61;p<0.364), eat (OR=2.70;p=0.143) and Alternaria (OR=1.2;p=0.730) were associated with asthma. Children with asthma had significantly higher total IgE concentrations (116.0 IU vs 25.5 IU;p<0.001). We conclude that multiple factors influence clinical asthma, as evidenced by associations with total IgE concentration, methacholine challenge and skin test reactions to selected allergens, but our data suggest that other unehicidated factors play a major role.
T h e I m p a c t o f E c z e m a in Seattle S c h o o l Children. C K C o o k M S . GJ Reddin,, M D . B H M o r r a v . H M A r r i e h i P h D . R T P , N C a n d Seattle, W A The prevalence and impact of respiratory and allergic disease was assessed in a community based survey of children aged 13-14 years. A validated questionnaire was given to all children enrolled in four schools selected from the Seattle Public School District in 1993-4. Impact was defined by limitations in activities, sleep loss, physician and other health care visits, health concerns, and self-satisfaction. Among the 2084 respondents, a physician confirmed diagnosis of eczema was reported by 124 (6%), eczema-like symptoms by 140 (7%), and those who reported neither comprised the remainder 1820 (87%). Patients with eczema or eczema-like symptoms were more likely to report limitations in activities requiring a lot of energy, sleep loss, physician visits, and ER visits. Eczema F_,ezema-like Asymptomatic ~2, symptoms df=2 Sleep Loss 10% 10% 3% p=0.001 Activity Limits 9% 11% 4% p=0.001 MD Office 10% 6% 3% p=0.001 Visit ER Visits 2% 2% <1% p---O.001 In concludion, young adults with eczema or eczema-like symptoms are more likely to have impacts than asymptomatic groups. The possibility of asthma as a comorbid condition may explain the impact observed.
J ALLERGY CLIN IMMUNOL JANUARY 1996
775
A s t h m a D e a t h s in C h i c a g o . T Levenson MD, PA Greenberger MD, B Lifschultz MD, Chicago, IL This study investigated the circumstances surrounding asthma deaths in 102 patients age 28.0 a: ll yrs in Cook County (Chicago), Illinois during the period from January, 1992 until July, 1994. A retrospective review of the reports, autopsy findings, and toxicology screenings done by one medical examiner was conducted, in addition surviving kin, friends or informants were contacted to obtain additional historical data. Eighty-six (84.3%) of the deaths were in African-Americans, 12 (11.8%) in Caucasians, and 4 (3.9%) in Hispanics. Deaths occurred at the victim's home 60.8% and 24.5% of the deaths occurred in an ER. Medications were being used by 59 (57.8%) of the deceased. Prednisone was used by 11 at some time, 1 used inhaled corticosteroids, and 1 used cromolyn. Beta-adrenergic agonist inhalers were used by 23 people and 11 used nebulizers. Of the 12 people taking theophylline, the concentrations ranged from 2.8-9.8 mcg/ml. Six of 20 victims whose survivors could be reached had potentially fatal asthma. Toxicology screening tests were positive for illicit drugs and/or ethanol in 29/92 (31.5%) of the cases tested. Based on prodromal symptoms and toxicologic test results, 46 (45.5%) died from asthma, 17 (16.7%) probably died from asthma, 23 (22.5%) had an indeterminate cause of death, and 14 (13.7%) died with, not from asthma. Mucus plugging and/or hyperinflation occurred in 65/93 (69.9%) of cases. Two additional people had reportedly used illicit drugs but were not tested. The use of illicit drugs was about as high as that found in an age-matched group of homicide victims (46.3%). These data suggest that the Chicago epidemic of asthma deaths reflects a high incidence of substance abuse.
776
Asthma mortality in Israel 1971-1990 Y. Katz. M. Livne. Zerifin, lsrael The worldwide trend of increased asthma mortality rate was not observed in Israel in a survey that examined the changes in asthma mortality rate in Israel during 1960-1986. A small but statistically insignificant increase in asthma mortality rate during the last years of that survey solicited for reexamination and extension of the survey. We evaluated the changes in asthma mortality rate in Israel in the years 1971-1990. Because of the small numbers of death each year and the variations in asthma mortality rate between years, the data was analyzed after grouping the a s i a mortality rate into five year periods. The rates, expressed as cases per 100,000 population per year were 0.43, 0.18, 0.39 and 0.40 in the 5-34 year old group for the periods 1971-1975, 1976-1980, 1981-1985 and 1986-1990, respectively. We found a statistically significant increase in asthma mortality rate during 1981-1985 and 1986-1990 periods, when compared with 1975-1980, in the young (<34 year old) population. The increase in asthma mortality rate was greater among males. The mortality rate in the older population (34-65 year old), ceded under the same coding, decreased during 1976-80 when compared with 1971-1975, but did not changed during thereafter. The rates were 10.4, 4.8, 4.5 and 4.4 cases per 100,000 for 1971-1975, 1976-80, 1981-85 and 1986-90, respectively. We conclude that the decrease in asthma mortality rate in the period 1976-80 reflects the general improvement in medical care in Israel. Asthma mortality rate increased in Israel in the young age group (5-34) during 1980-1990, probably reflecting similar trends that were reported from many other countries with advanced medical care system.
773
774
Abstracts
F a c t o r s associated with a s t h m a in a birth c o h o r t o f children followed to six y e a r s o f age. CC Johnson. PkD. EL Peterson, PhD. Ownbv. DR. ME) Detroit, MIAJSA A population based cohort of 841 children have been followed from birth through six years of age and evaluated by a pediatric allergist for asthma, including the taking of a medical history, physical examination, pulmonary function testing, skin testing and total serum leE. Included in this analysis are 202 children who have reached six years of age and completed the clinic visit. All parts of the evaluation were completed in >90% of the children. Nine percent were reported to have a previous physician diagnosis of asthma. Only 44.4% of the children with asthma had a positive methaeholine response (>20% fall in FEV, at a methacholine dose of<65 breath units (10 mg/ml)), (with an odds ratio (OR) of 4.63; p<0.005). Positive skin tests (wheal diameter >2 mm with a negative control) for ragweed and grass were not associated with history of asthma. Higher percentages of positive skin reactions to Derf(OR~3.03;p< 0.046 ), Derp (OR=l.61;p<0.364), eat (OR=2.70;p=0.143) and Alternaria (OR=1.2;p=0.730) were associated with asthma. Children with asthma had significantly higher total IgE concentrations (116.0 IU vs 25.5 IU;p<0.001). We conclude that multiple factors influence clinical asthma, as evidenced by associations with total IgE concentration, methacholine challenge and skin test reactions to selected allergens, but our data suggest that other unehicidated factors play a major role.
T h e I m p a c t o f E c z e m a in Seattle S c h o o l Children. C K C o o k M S . GJ Reddin,, M D . B H M o r r a v . H M A r r i e h i P h D . R T P , N C a n d Seattle, W A The prevalence and impact of respiratory and allergic disease was assessed in a community based survey of children aged 13-14 years. A validated questionnaire was given to all children enrolled in four schools selected from the Seattle Public School District in 1993-4. Impact was defined by limitations in activities, sleep loss, physician and other health care visits, health concerns, and self-satisfaction. Among the 2084 respondents, a physician confirmed diagnosis of eczema was reported by 124 (6%), eczema-like symptoms by 140 (7%), and those who reported neither comprised the remainder 1820 (87%). Patients with eczema or eczema-like symptoms were more likely to report limitations in activities requiring a lot of energy, sleep loss, physician visits, and ER visits. Eczema F_,ezema-like Asymptomatic ~2, symptoms df=2 Sleep Loss 10% 10% 3% p=0.001 Activity Limits 9% 11% 4% p=0.001 MD Office 10% 6% 3% p=0.001 Visit ER Visits 2% 2% <1% p---O.001 In concludion, young adults with eczema or eczema-like symptoms are more likely to have impacts than asymptomatic groups. The possibility of asthma as a comorbid condition may explain the impact observed.
J ALLERGY CLIN IMMUNOL JANUARY 1996
775
A s t h m a D e a t h s in C h i c a g o . T Levenson MD, PA Greenberger MD, B Lifschultz MD, Chicago, IL This study investigated the circumstances surrounding asthma deaths in 102 patients age 28.0 a: ll yrs in Cook County (Chicago), Illinois during the period from January, 1992 until July, 1994. A retrospective review of the reports, autopsy findings, and toxicology screenings done by one medical examiner was conducted, in addition surviving kin, friends or informants were contacted to obtain additional historical data. Eighty-six (84.3%) of the deaths were in African-Americans, 12 (11.8%) in Caucasians, and 4 (3.9%) in Hispanics. Deaths occurred at the victim's home 60.8% and 24.5% of the deaths occurred in an ER. Medications were being used by 59 (57.8%) of the deceased. Prednisone was used by 11 at some time, 1 used inhaled corticosteroids, and 1 used cromolyn. Beta-adrenergic agonist inhalers were used by 23 people and 11 used nebulizers. Of the 12 people taking theophylline, the concentrations ranged from 2.8-9.8 mcg/ml. Six of 20 victims whose survivors could be reached had potentially fatal asthma. Toxicology screening tests were positive for illicit drugs and/or ethanol in 29/92 (31.5%) of the cases tested. Based on prodromal symptoms and toxicologic test results, 46 (45.5%) died from asthma, 17 (16.7%) probably died from asthma, 23 (22.5%) had an indeterminate cause of death, and 14 (13.7%) died with, not from asthma. Mucus plugging and/or hyperinflation occurred in 65/93 (69.9%) of cases. Two additional people had reportedly used illicit drugs but were not tested. The use of illicit drugs was about as high as that found in an age-matched group of homicide victims (46.3%). These data suggest that the Chicago epidemic of asthma deaths reflects a high incidence of substance abuse.
776
Asthma mortality in Israel 1971-1990 Y. Katz. M. Livne. Zerifin, lsrael The worldwide trend of increased asthma mortality rate was not observed in Israel in a survey that examined the changes in asthma mortality rate in Israel during 1960-1986. A small but statistically insignificant increase in asthma mortality rate during the last years of that survey solicited for reexamination and extension of the survey. We evaluated the changes in asthma mortality rate in Israel in the years 1971-1990. Because of the small numbers of death each year and the variations in asthma mortality rate between years, the data was analyzed after grouping the a s i a mortality rate into five year periods. The rates, expressed as cases per 100,000 population per year were 0.43, 0.18, 0.39 and 0.40 in the 5-34 year old group for the periods 1971-1975, 1976-1980, 1981-1985 and 1986-1990, respectively. We found a statistically significant increase in asthma mortality rate during 1981-1985 and 1986-1990 periods, when compared with 1975-1980, in the young (<34 year old) population. The increase in asthma mortality rate was greater among males. The mortality rate in the older population (34-65 year old), ceded under the same coding, decreased during 1976-80 when compared with 1971-1975, but did not changed during thereafter. The rates were 10.4, 4.8, 4.5 and 4.4 cases per 100,000 for 1971-1975, 1976-80, 1981-85 and 1986-90, respectively. We conclude that the decrease in asthma mortality rate in the period 1976-80 reflects the general improvement in medical care in Israel. Asthma mortality rate increased in Israel in the young age group (5-34) during 1980-1990, probably reflecting similar trends that were reported from many other countries with advanced medical care system.