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Characteristics of children hospitalized for acute asthma at Charity Hospital of New Orleans
S212
Abstracts
35 ginia Asthma Screening in Head Start Children in Southeastern VirCynthia Szelc-Kelly*, Jude C Taylor-Fishwick*, Aaron Donne/l§, Cynthia CoUins-Odoms* *Center for Pediatric Research, Norfolk, VA §Children's Hospital of The King's Daughters, Norfolk, VA PURPOSE: The Head Start Program (HS) in the Hampton Roads area of Virginia has been successfully utilized as a source to assess the asthma prevalence, health care utilization and medication use of high risk preschool aged children during the school year 2000-2001. Children in HS are an underserved, low income, and predominantly minority population in need of comprehensive, preventive care for all their medical needs, including the chronic illness of asthma. METHODS: The HS Centers in Hampton Roads currently provide early childhood education for 1,400 children between the ages of 3 and 6 at 31 centers in our region. Asthma screening questionnaires were administered to 675 caregivers of children attending 10 HS centers in Hampton Roads. RESULTS: Of the 508 (75%) surveys returned 50% of the children were male, 87% were African American and 95% were between 3 -4 years of age. Over 90% of families had a working phone in their home. Most families had health insurance (92%) and predominantly Medicaid (76%). The prevalence of parent-reported, physician-diagnosed asthma was 19%. Of these, 60% had been in the emergency department (ED) for asthma in the past year and 40% had 2 or more visits to the ED in that time period. Eighteen children (19%) had been hospitalized for asthma in the last year. Only 20% had taken any controller medication in the last 12 months (fluticasone 8%, beclomethasone 6%, cromolyn sodium 6%, and montelukust 4%). Of the children diagnosed with asthma 29% reported exercise and play limitations. One third of the children lived in a home that had at least one smoker present. Over 90% of families reported that they usually received their child's asthma medication from their child's primary care doctor, as opposed to the ED or urgent care centers. When asked where a child would be taken with wheezing, coughing or worsening asthma, 65% of parents reported their child's doctor, and 35% the ED. The majority of children were taking albuterol - 65% by metered dose inhaler, 82% by nebulizer, and 58% by liquid or syrup, suggesting that these children had multiple mechanisms for the delivery of their medications. Strikingly, while 92% of caregivers had informed the HS center of their child's asthma diagnosis, only 18% had provided albuterol for use at school. CONCLUSIONS: Our information indicates that HS is an important venue to identify a high-risk pediatric asthma population. The high frequency of ED visits and hospitalizations combined with low use of controller medications suggests that many children in this population have uncontrolled asthma symptoms. HS provides a unique setting to promote culturally appropriate asthma education and prevention in a population that has the potential for significant benefit from an intervention.
636 Charity Characteristics of Children Hospitalized for Acute Asthma at Hospital of New Orleans Gungor Eroglu, Faruk Sulun, Jane M E/-Dahr Tulane University, New Orleans, LA This study was undertaken to evaluate the characteristics of pediatric patients with at least one admission to an inner city hospital in New Orleans for acute asthma as well as to determine the number of ER visits for asthma. A centralized hospital computer database was used to identify all children hospitalized for a primary diagnosis of asthma with or without status asthmaticus between June 1, 1997 and July 30, 2000 at Charity Hospital in New Orleans. A one-page form was used to record demographic data, past medical and family history, insurance status, source of usual medical care, ER visits/other hospitalizations for asthma, and medication history. A total of
J ALLERGY CLIN IMMUNOL JANUARY 2002
143 charts were reviewed. The mean age was 7.4 (0.9-18 yrs) with 63% males and 37% females. Forty-four percent were below age 6, 42% were of school age, and 14% were adolescents. Almost all of the patients (97%) were African-American. Half came from single parent homes. Medicaid covered 55% while 45% were uninsured. Forty children (28%) had only a single admission while 60 (42%) were admitted to the hospital 1 to 3 additional times, 33 (23%) 4 to 10 more times, and 10 (7%) more than 10 subsequent times within 3 years. Of these 143 patients, a pediatrician followed 50 (35%) and an asthma specialist followed 23 (16%)~ Almost half of the patients used the ER for their routine care. Only 10 (7%) had no ER visits for asthma during the subsequent two years while 11 (8%) had 10 or more. At the time of admission, 121 (85%) were using beta-agonists while 22 were on no medication. Despite their moderate or severe asthma, only 43 (30%) of the 143 patients reported taking some form of anti-inflammatory medication. Thirty-four patients (24%) used inhaled corticosteroids, 22 as the only anti-inflammatory and 12 in combination with other types. Eight (6%) were on cromolyn alone while 6 used this in combination with inhaled corticosteroids. Five (3.5%) were on a leukotriene antagonist; a single patient used this as monotherapy. Two reported taking an oral steroid at the time of admission with one using this as the only anti-inflammatory. The remaining patients using preventative medication were on other combinations of these medications. Children with Medicaid were much more likely to be taking anti-inflammatory medications, but the presence of insurance did not decrease more frequent admissions. Inadequate education in the proper use of outpatient medications appeared to be the norm. We conclude that sub-optimal treatment of patients, particularly under use of inhaled anti-inflammatory medication, lack of primary care (much less specialty care), economic barriers, and lack of education and knowledge about the disease and treatment by the patients and their parents are among the many factors that contribute to frequent ER visits and hospitalization in the population studied.
6
a'~"7 Review of the Increasing Asthma Cases in St Vincent and the ~ll/Grenadines
Christina Dane//Schwindt. Hyacinth Bacchus Kingstown General Hospital, Kingstown, St Vincent St. Vincent and the Grenadines (SVG) is a third world country in the West Indies reporting a 4-fold increase in asthma cases presenting to their district clinics and Accident and Emergency Department (A&E) over the last 10 years. The country has no access to spirometry or skin testing materials. The aim of this study is to assess asthma severity and possible allergic triggers of 292 of these subjects. The charts of 292 subjects (age range 4 months to 96 years, 51% male), seen from 1999 to 2001, were reviewed to assess asthma severity and possible exacerbating factors. Asthma severity was determined by self-report of recurrent symptoms of wheezing, chest tightness, shortness of breath, or cough based on NHLBI guidelines. An environmental questionnaire was used to assess potential triggers to dust, cats, dogs, strong odors and one of the two seasons, rainy or dry. A diagnosis of asthma was confirmed in 98% of cases. The subjects" asthma severity level and potential asthma triggers are reported in Table I. Most subjects reported multiple environmental triggers to their asthma. The rainy season in SVG is the predominant seasonal trigger, suggesting mold may be a significant potential allergen, although barometric pressure or other atmospheric factors may play a role. Dust was the predominant environmental trigger reported. Strong odors appeared more important in the severe and moderate persistent groups. Based on subject symptom analysis, the report of an increasing prevalence of asthma in SVG is supported by the identification of asthma in 98% of the cases reviewed. This evaluation suggests the majority of cases fall into the mild intermittent category, although this
Abstracts
35 ginia Asthma Screening in Head Start Children in Southeastern VirCynthia Szelc-Kelly*, Jude C Taylor-Fishwick*, Aaron Donne/l§, Cynthia CoUins-Odoms* *Center for Pediatric Research, Norfolk, VA §Children's Hospital of The King's Daughters, Norfolk, VA PURPOSE: The Head Start Program (HS) in the Hampton Roads area of Virginia has been successfully utilized as a source to assess the asthma prevalence, health care utilization and medication use of high risk preschool aged children during the school year 2000-2001. Children in HS are an underserved, low income, and predominantly minority population in need of comprehensive, preventive care for all their medical needs, including the chronic illness of asthma. METHODS: The HS Centers in Hampton Roads currently provide early childhood education for 1,400 children between the ages of 3 and 6 at 31 centers in our region. Asthma screening questionnaires were administered to 675 caregivers of children attending 10 HS centers in Hampton Roads. RESULTS: Of the 508 (75%) surveys returned 50% of the children were male, 87% were African American and 95% were between 3 -4 years of age. Over 90% of families had a working phone in their home. Most families had health insurance (92%) and predominantly Medicaid (76%). The prevalence of parent-reported, physician-diagnosed asthma was 19%. Of these, 60% had been in the emergency department (ED) for asthma in the past year and 40% had 2 or more visits to the ED in that time period. Eighteen children (19%) had been hospitalized for asthma in the last year. Only 20% had taken any controller medication in the last 12 months (fluticasone 8%, beclomethasone 6%, cromolyn sodium 6%, and montelukust 4%). Of the children diagnosed with asthma 29% reported exercise and play limitations. One third of the children lived in a home that had at least one smoker present. Over 90% of families reported that they usually received their child's asthma medication from their child's primary care doctor, as opposed to the ED or urgent care centers. When asked where a child would be taken with wheezing, coughing or worsening asthma, 65% of parents reported their child's doctor, and 35% the ED. The majority of children were taking albuterol - 65% by metered dose inhaler, 82% by nebulizer, and 58% by liquid or syrup, suggesting that these children had multiple mechanisms for the delivery of their medications. Strikingly, while 92% of caregivers had informed the HS center of their child's asthma diagnosis, only 18% had provided albuterol for use at school. CONCLUSIONS: Our information indicates that HS is an important venue to identify a high-risk pediatric asthma population. The high frequency of ED visits and hospitalizations combined with low use of controller medications suggests that many children in this population have uncontrolled asthma symptoms. HS provides a unique setting to promote culturally appropriate asthma education and prevention in a population that has the potential for significant benefit from an intervention.
636 Charity Characteristics of Children Hospitalized for Acute Asthma at Hospital of New Orleans Gungor Eroglu, Faruk Sulun, Jane M E/-Dahr Tulane University, New Orleans, LA This study was undertaken to evaluate the characteristics of pediatric patients with at least one admission to an inner city hospital in New Orleans for acute asthma as well as to determine the number of ER visits for asthma. A centralized hospital computer database was used to identify all children hospitalized for a primary diagnosis of asthma with or without status asthmaticus between June 1, 1997 and July 30, 2000 at Charity Hospital in New Orleans. A one-page form was used to record demographic data, past medical and family history, insurance status, source of usual medical care, ER visits/other hospitalizations for asthma, and medication history. A total of
J ALLERGY CLIN IMMUNOL JANUARY 2002
143 charts were reviewed. The mean age was 7.4 (0.9-18 yrs) with 63% males and 37% females. Forty-four percent were below age 6, 42% were of school age, and 14% were adolescents. Almost all of the patients (97%) were African-American. Half came from single parent homes. Medicaid covered 55% while 45% were uninsured. Forty children (28%) had only a single admission while 60 (42%) were admitted to the hospital 1 to 3 additional times, 33 (23%) 4 to 10 more times, and 10 (7%) more than 10 subsequent times within 3 years. Of these 143 patients, a pediatrician followed 50 (35%) and an asthma specialist followed 23 (16%)~ Almost half of the patients used the ER for their routine care. Only 10 (7%) had no ER visits for asthma during the subsequent two years while 11 (8%) had 10 or more. At the time of admission, 121 (85%) were using beta-agonists while 22 were on no medication. Despite their moderate or severe asthma, only 43 (30%) of the 143 patients reported taking some form of anti-inflammatory medication. Thirty-four patients (24%) used inhaled corticosteroids, 22 as the only anti-inflammatory and 12 in combination with other types. Eight (6%) were on cromolyn alone while 6 used this in combination with inhaled corticosteroids. Five (3.5%) were on a leukotriene antagonist; a single patient used this as monotherapy. Two reported taking an oral steroid at the time of admission with one using this as the only anti-inflammatory. The remaining patients using preventative medication were on other combinations of these medications. Children with Medicaid were much more likely to be taking anti-inflammatory medications, but the presence of insurance did not decrease more frequent admissions. Inadequate education in the proper use of outpatient medications appeared to be the norm. We conclude that sub-optimal treatment of patients, particularly under use of inhaled anti-inflammatory medication, lack of primary care (much less specialty care), economic barriers, and lack of education and knowledge about the disease and treatment by the patients and their parents are among the many factors that contribute to frequent ER visits and hospitalization in the population studied.
6
a'~"7 Review of the Increasing Asthma Cases in St Vincent and the ~ll/Grenadines
Christina Dane//Schwindt. Hyacinth Bacchus Kingstown General Hospital, Kingstown, St Vincent St. Vincent and the Grenadines (SVG) is a third world country in the West Indies reporting a 4-fold increase in asthma cases presenting to their district clinics and Accident and Emergency Department (A&E) over the last 10 years. The country has no access to spirometry or skin testing materials. The aim of this study is to assess asthma severity and possible allergic triggers of 292 of these subjects. The charts of 292 subjects (age range 4 months to 96 years, 51% male), seen from 1999 to 2001, were reviewed to assess asthma severity and possible exacerbating factors. Asthma severity was determined by self-report of recurrent symptoms of wheezing, chest tightness, shortness of breath, or cough based on NHLBI guidelines. An environmental questionnaire was used to assess potential triggers to dust, cats, dogs, strong odors and one of the two seasons, rainy or dry. A diagnosis of asthma was confirmed in 98% of cases. The subjects" asthma severity level and potential asthma triggers are reported in Table I. Most subjects reported multiple environmental triggers to their asthma. The rainy season in SVG is the predominant seasonal trigger, suggesting mold may be a significant potential allergen, although barometric pressure or other atmospheric factors may play a role. Dust was the predominant environmental trigger reported. Strong odors appeared more important in the severe and moderate persistent groups. Based on subject symptom analysis, the report of an increasing prevalence of asthma in SVG is supported by the identification of asthma in 98% of the cases reviewed. This evaluation suggests the majority of cases fall into the mild intermittent category, although this