- Email: [email protected]
305 – IgE and IgG anti-house dust mite specificities in asthma patients
S278
METHODS 5,482 interviews were conducted globally online, by telephone & face-to-face: 1,733 physicians & 1,726 asthma patients in a 16-country adult arm; 1,006 physicians treating children with asthma & 1,017 parents of children with asthma in a 9-country pediatric arm. In North America, 304 pediatric physicians & 314 parents of pediatric patients were surveyed.
RESULTS Of patients who have taken asthma medication, parents report 29% experienced short-term side effects; 5% experienced long-term side effects. Side effects lead to patients switching or discontinuing treatment (39% considered switching medications, 36% switched medication & 32% skipped doses). 60% of parents say their child does not take medication according to physician’s instructions 100% of the time; physicians say their average patient takes medication according to instructions 56% of the time. Those who are not compliant all of the time experienced: increased symptoms (67%); limited physical activity (47%); more frequent attacks or exacerbations (39%); nighttime awakenings (32%); more physician visits (24%); absences from school (26%).
CONCLUSIONS Compliance is low & according to parents, experience with side effects appears to be an important factor; compliance appears directly linked to an increased symptomatology & resource utilization. In addition, the availability of new ICS treatment options with comparable efficacy & improved safety & tolerability might enhance patient outcomes. DOI: 10.1016/j.prrv.2006.04.037
A12/130 – Human metapneumovirus and asthma A. Goh, N. Tee, L.H. Loo, O.M. Chay, R. Lin, J. Tang, K.C. Ng, A.H. Teo and M.Y. Z Binte KK Women’s and Children’s Hospital, Singapore
AIM To determine the frequency of respiratory viruses and in particular metapneumovirus infection in children presenting with an asthma exacerbation.
METHOD Children presenting to the Children’s Emergency or admitted with an asthma exacerbation were enrolled after informed consent was taken. An asthma exacerbation was defined as the presence of wheeze in a child with physiciandiagnosed asthma OR a past history of at least 3 previous
POSTER PRESENTATIONS
episodes of wheeze. A nasopharyngeal swab was taken and sent for identification of metapneumovirus and rhinovirus by PCR and respiratory viruses by immunofluorescence.
RESULTS 298 children were enrolled of which 200 were inpatients and 98 outpatients. The mean age was 6.44 yrs (Range: 0.78–18.97 yrs). 62.4% were boys. 61.7% of the children had intermittent asthma while 38.3% had persistent asthma. Children with persistent asthma were more likely to be admitted during an asthma exacerbation (p < 0.001, OR = 126.0, 95% CI 17.2–129.5). Viruses were detected in 50.3% of children. Human metapneumovirus was present in 5% of children. The commonest virus isolated was rhinovirus (39.2%). Coinfection with 2 viruses was present in 4 children. Mean duration of hospital stay was 3 days (Range: 1–6days). Those with dual infections did not stay longer.
CONCLUSIONS Human Metapneumovirus infection was identified in children presenting with asthma exacerbations and may have a role as a viral trigger. Rhinoviruses remain the main viral agent identified in asthma exacerbations. DOI: 10.1016/j.prrv.2006.04.038
A13/305 – IgE and IgG anti-house dust mite specificities in asthma patients W.R. Thomas1, B.J. Hales1, A.C. Martin2 and P.N. LeSouef3 1 Telethon Institute for Child Health Research, Perth, Australia; 2Princess Margaret Hospital, Perth, Australia; 3 University of Western Australia, Perth, Australia Allergy to the house dust mite is found in about 80% of asthmatic children in Australia. Many of the strategies that could make immunotherapy a first choice treatment such as the administration of recombinant allergens and peptides will require the selection of an effective formulation of allergens. The large IgE responses induced by the Der p 1 and Der p 2 allergens have been known for some time but their relative importance has not been ascertained because of the lack of knowledge of the IgE binding of the other allergens and their representation in house dust mite extracts compared to inhaled air. Here, a 9-allergen panel known to be able to absorb out the IgE binding to the house dust mite specificities found in extracts, has been used compare the IgE binding in quantitative assays. The sum of the IgE binding to the different allergens correlated well with the IgE binding measured with extract by CAP assay. The combined IgE binding to Der p 1 and 2 accounted for 60% of all the IgE binding and except for very low IgE binders this percentage was found for patients
POSTER PRESENTATIONS
with high and low IgE titres. The mid-range allergens Der p 4, 5 and 7 accounted for most of the residual IgE binding while titres to Der p 3, 8, 10 and 20 were low. The level of IgE binding to the mid-range allergens was similar to that found for the major cat and cockroach allergens indicating that they could be a significant for disease. The IgE binding of sera taken from children treated in an emergency department had similar titres and pattern of binding to children without asthma exacerbations. The IgG binding, which was limited to children and to the major allergens, was however decreased in the sera from the emergency-department patients. The IgE binding to Der p 1 and 2 constitutes 60% of the IgE binding to allergens in mite extracts and IgG to these allergens is decreased in acute asthma. DOI: 10.1016/j.prrv.2006.04.039
A14/238 – Improving children’s knowledge of asthma triggers H.L. Haver1 and E. Stieb2 1 Newton North High School, Newton, USA; 2Massachusetts General Hospital, Boston, USA Exposure to triggers can lead to acute asthma exacerbations and chronic poorly controlled asthma. Recognizing and avoiding asthma triggers was the focus of one interactive session of an asthma education program we ran for children with asthma living in a large urban center. To determine if this session led to increased knowledge about asthma triggers, we administered an asthma trigger questionnaire developed by the American Lung Association before and after the session The questionnaire was administered to children aged 6– 11 years (n = 16) during one session of an asthma education program focused on asthma triggers. The questionnaire consists of twelve questions. Each correct answer was given one point with zero points for each incorrect answer. Twelve children (75%) completed identical questionnaires pre- and post-trigger education session. Scores increased for 50% percent of the children tested, decreased for 8%, and stayed the same for both questionnaires for 42% of the children. Of the children whose scores remained the same, 60% received scores of 100% on both questionnaires. The questionnaire was straightforward to administer and took less than 5 minutes to complete. Trigger identification is a critical component of asthma education. Unrecognized triggers may contribute to poorly controlled asthma. Children need to be able to recognize their triggers in order to avoid them. Gaps in trigger identification persist. This gap in knowledge can be addressed, as reflected by improved scores on an asthma trigger questionnaire, with a brief educational intervention. This questionnaire should be considered for use in other trials and may prove useful in clinical practice. DOI: 10.1016/j.prrv.2006.04.040
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A15/98 – In vitro performance of novel non electrostatic Valved Holding Chember (VHC) evaluated without pre-treatment is comparable with that of similar sized pre-washed, non conducting VHC M. Nagel, K. Wiersema, C. Doyle, J. Mitchell and J. Malpass Trudell Medical International London, Ontario, Canada Effective aerosol delivery via non-conducting VHCs is dependent on the removal of electrostatic charge by pre-washing in detergent. Although manufacturers indicate that pre-washing should be performed, in practice this is often not done in the hospital, where time pressure exists to deliver treatment, or poor patient compliance. We report an in vitro study in which the therapeutically relevant fine particle (<4.0 mm aerodynamic diameter) delivery of a beta-2 agonist (Ventolin1-HFA, GSK Canada Inc.) by pressurized metered dose inhaler (pMDI) and a non-conducting, pre-washed VHC (AeroChamber Plus1, Trudell Medical International, Canada) was compared with delivery via a new VHC (AeroChamber Plus1 with antistatic polymer (AeroChamber1 Hospital & Z-STAT PlusTM)) that was evaluated without pre-washing (n = 3 devices/group, 1 measurement/ device). Measurements were made at 30 L/min, deemed relevant for older children, using a Next Generation Pharmaceutical Impactor (NGI) following the procedure described in Canadian Standard (CAN/CSA/ Z264.1-02:2002), with a 2-s delay between pMDI actuation and the onset of sampling. Fine particle mass (FPM) of albuterol was subsequently quantified by HPLC-UV spectrophotometry. The performance of both VHCs was substantially equivalent, with more than 80% of the total emitted mass delivered as fine particles. In addition, FPM ex AeroChamber Plus1 (mean SD) at 25.6 3.2 mg, was comparable with 27.3 2.2 mg ex AeroChamber1 Hospital & Z-STAT PlusTM VHCs (un-paired t-test, p = 0.49). On this basis, the AeroChamber1 Hospital & Z-STAT PlusTM VHC can be expected to deliver medication as efficiently as the pre-washed, but non-conducting AeroChamber Plus1 VHC, with the added convenience of not requiring pre-treatment. Funded by Trudell Medical International DOI: 10.1016/j.prrv.2006.04.041
A16/309 – Intronic (CCTTT)n polymorphism in NOS2 is not associated with asthma, atopy or exhaled nitric oxide in Chinese children T.F. Leung1, E.K.H. Liu1, C.Y. Li1,2, I.H.S. Chan2, E. Yung1, N.L.S Tang2, C.W.K. Lam2 and G.W.K Wong1 1 The Chinese University of Hong Kong, Department of Pediatrics Hong Kong, Hong Kong, China; 2The Chinese University of Hong Kong, Department of Chemical Pathology Hong Kong, Hong Kong, China
METHODS 5,482 interviews were conducted globally online, by telephone & face-to-face: 1,733 physicians & 1,726 asthma patients in a 16-country adult arm; 1,006 physicians treating children with asthma & 1,017 parents of children with asthma in a 9-country pediatric arm. In North America, 304 pediatric physicians & 314 parents of pediatric patients were surveyed.
RESULTS Of patients who have taken asthma medication, parents report 29% experienced short-term side effects; 5% experienced long-term side effects. Side effects lead to patients switching or discontinuing treatment (39% considered switching medications, 36% switched medication & 32% skipped doses). 60% of parents say their child does not take medication according to physician’s instructions 100% of the time; physicians say their average patient takes medication according to instructions 56% of the time. Those who are not compliant all of the time experienced: increased symptoms (67%); limited physical activity (47%); more frequent attacks or exacerbations (39%); nighttime awakenings (32%); more physician visits (24%); absences from school (26%).
CONCLUSIONS Compliance is low & according to parents, experience with side effects appears to be an important factor; compliance appears directly linked to an increased symptomatology & resource utilization. In addition, the availability of new ICS treatment options with comparable efficacy & improved safety & tolerability might enhance patient outcomes. DOI: 10.1016/j.prrv.2006.04.037
A12/130 – Human metapneumovirus and asthma A. Goh, N. Tee, L.H. Loo, O.M. Chay, R. Lin, J. Tang, K.C. Ng, A.H. Teo and M.Y. Z Binte KK Women’s and Children’s Hospital, Singapore
AIM To determine the frequency of respiratory viruses and in particular metapneumovirus infection in children presenting with an asthma exacerbation.
METHOD Children presenting to the Children’s Emergency or admitted with an asthma exacerbation were enrolled after informed consent was taken. An asthma exacerbation was defined as the presence of wheeze in a child with physiciandiagnosed asthma OR a past history of at least 3 previous
POSTER PRESENTATIONS
episodes of wheeze. A nasopharyngeal swab was taken and sent for identification of metapneumovirus and rhinovirus by PCR and respiratory viruses by immunofluorescence.
RESULTS 298 children were enrolled of which 200 were inpatients and 98 outpatients. The mean age was 6.44 yrs (Range: 0.78–18.97 yrs). 62.4% were boys. 61.7% of the children had intermittent asthma while 38.3% had persistent asthma. Children with persistent asthma were more likely to be admitted during an asthma exacerbation (p < 0.001, OR = 126.0, 95% CI 17.2–129.5). Viruses were detected in 50.3% of children. Human metapneumovirus was present in 5% of children. The commonest virus isolated was rhinovirus (39.2%). Coinfection with 2 viruses was present in 4 children. Mean duration of hospital stay was 3 days (Range: 1–6days). Those with dual infections did not stay longer.
CONCLUSIONS Human Metapneumovirus infection was identified in children presenting with asthma exacerbations and may have a role as a viral trigger. Rhinoviruses remain the main viral agent identified in asthma exacerbations. DOI: 10.1016/j.prrv.2006.04.038
A13/305 – IgE and IgG anti-house dust mite specificities in asthma patients W.R. Thomas1, B.J. Hales1, A.C. Martin2 and P.N. LeSouef3 1 Telethon Institute for Child Health Research, Perth, Australia; 2Princess Margaret Hospital, Perth, Australia; 3 University of Western Australia, Perth, Australia Allergy to the house dust mite is found in about 80% of asthmatic children in Australia. Many of the strategies that could make immunotherapy a first choice treatment such as the administration of recombinant allergens and peptides will require the selection of an effective formulation of allergens. The large IgE responses induced by the Der p 1 and Der p 2 allergens have been known for some time but their relative importance has not been ascertained because of the lack of knowledge of the IgE binding of the other allergens and their representation in house dust mite extracts compared to inhaled air. Here, a 9-allergen panel known to be able to absorb out the IgE binding to the house dust mite specificities found in extracts, has been used compare the IgE binding in quantitative assays. The sum of the IgE binding to the different allergens correlated well with the IgE binding measured with extract by CAP assay. The combined IgE binding to Der p 1 and 2 accounted for 60% of all the IgE binding and except for very low IgE binders this percentage was found for patients
POSTER PRESENTATIONS
with high and low IgE titres. The mid-range allergens Der p 4, 5 and 7 accounted for most of the residual IgE binding while titres to Der p 3, 8, 10 and 20 were low. The level of IgE binding to the mid-range allergens was similar to that found for the major cat and cockroach allergens indicating that they could be a significant for disease. The IgE binding of sera taken from children treated in an emergency department had similar titres and pattern of binding to children without asthma exacerbations. The IgG binding, which was limited to children and to the major allergens, was however decreased in the sera from the emergency-department patients. The IgE binding to Der p 1 and 2 constitutes 60% of the IgE binding to allergens in mite extracts and IgG to these allergens is decreased in acute asthma. DOI: 10.1016/j.prrv.2006.04.039
A14/238 – Improving children’s knowledge of asthma triggers H.L. Haver1 and E. Stieb2 1 Newton North High School, Newton, USA; 2Massachusetts General Hospital, Boston, USA Exposure to triggers can lead to acute asthma exacerbations and chronic poorly controlled asthma. Recognizing and avoiding asthma triggers was the focus of one interactive session of an asthma education program we ran for children with asthma living in a large urban center. To determine if this session led to increased knowledge about asthma triggers, we administered an asthma trigger questionnaire developed by the American Lung Association before and after the session The questionnaire was administered to children aged 6– 11 years (n = 16) during one session of an asthma education program focused on asthma triggers. The questionnaire consists of twelve questions. Each correct answer was given one point with zero points for each incorrect answer. Twelve children (75%) completed identical questionnaires pre- and post-trigger education session. Scores increased for 50% percent of the children tested, decreased for 8%, and stayed the same for both questionnaires for 42% of the children. Of the children whose scores remained the same, 60% received scores of 100% on both questionnaires. The questionnaire was straightforward to administer and took less than 5 minutes to complete. Trigger identification is a critical component of asthma education. Unrecognized triggers may contribute to poorly controlled asthma. Children need to be able to recognize their triggers in order to avoid them. Gaps in trigger identification persist. This gap in knowledge can be addressed, as reflected by improved scores on an asthma trigger questionnaire, with a brief educational intervention. This questionnaire should be considered for use in other trials and may prove useful in clinical practice. DOI: 10.1016/j.prrv.2006.04.040
S279
A15/98 – In vitro performance of novel non electrostatic Valved Holding Chember (VHC) evaluated without pre-treatment is comparable with that of similar sized pre-washed, non conducting VHC M. Nagel, K. Wiersema, C. Doyle, J. Mitchell and J. Malpass Trudell Medical International London, Ontario, Canada Effective aerosol delivery via non-conducting VHCs is dependent on the removal of electrostatic charge by pre-washing in detergent. Although manufacturers indicate that pre-washing should be performed, in practice this is often not done in the hospital, where time pressure exists to deliver treatment, or poor patient compliance. We report an in vitro study in which the therapeutically relevant fine particle (<4.0 mm aerodynamic diameter) delivery of a beta-2 agonist (Ventolin1-HFA, GSK Canada Inc.) by pressurized metered dose inhaler (pMDI) and a non-conducting, pre-washed VHC (AeroChamber Plus1, Trudell Medical International, Canada) was compared with delivery via a new VHC (AeroChamber Plus1 with antistatic polymer (AeroChamber1 Hospital & Z-STAT PlusTM)) that was evaluated without pre-washing (n = 3 devices/group, 1 measurement/ device). Measurements were made at 30 L/min, deemed relevant for older children, using a Next Generation Pharmaceutical Impactor (NGI) following the procedure described in Canadian Standard (CAN/CSA/ Z264.1-02:2002), with a 2-s delay between pMDI actuation and the onset of sampling. Fine particle mass (FPM) of albuterol was subsequently quantified by HPLC-UV spectrophotometry. The performance of both VHCs was substantially equivalent, with more than 80% of the total emitted mass delivered as fine particles. In addition, FPM ex AeroChamber Plus1 (mean SD) at 25.6 3.2 mg, was comparable with 27.3 2.2 mg ex AeroChamber1 Hospital & Z-STAT PlusTM VHCs (un-paired t-test, p = 0.49). On this basis, the AeroChamber1 Hospital & Z-STAT PlusTM VHC can be expected to deliver medication as efficiently as the pre-washed, but non-conducting AeroChamber Plus1 VHC, with the added convenience of not requiring pre-treatment. Funded by Trudell Medical International DOI: 10.1016/j.prrv.2006.04.041
A16/309 – Intronic (CCTTT)n polymorphism in NOS2 is not associated with asthma, atopy or exhaled nitric oxide in Chinese children T.F. Leung1, E.K.H. Liu1, C.Y. Li1,2, I.H.S. Chan2, E. Yung1, N.L.S Tang2, C.W.K. Lam2 and G.W.K Wong1 1 The Chinese University of Hong Kong, Department of Pediatrics Hong Kong, Hong Kong, China; 2The Chinese University of Hong Kong, Department of Chemical Pathology Hong Kong, Hong Kong, China