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Comparison of Patient Responses to Self Administered and Interviewer Administered Asthma Control Test
S76 Abstracts
SATURDAY
279
Natural History of Viral Upper Respiratory Infections (vURIs) in Children H. Barth, D. Gentile, J. Koehrsen, A. Patel, D. Skoner; Allegheny General Hospital, Pittsburgh, PA. RATIONALE: vURIs are common in children and often predispose to the development of complications including asthma, otitis media and sinusitis. Previous studies have demonstrated a role for leukotrienes in mediating signs/symptoms of vURIs in adults. The purpose of this study was to characterize the natural history of vURIs in children with an emphasis on examining leukotriene levels and signs/symptoms of vURIs. METHODS: Thirty pediatric subjects aged 6 to <14 years with vURI signs/symptoms of less than 24 hours duration were enrolled (study day 0). Nasal leukotriene levels (pg/ml), secretion weights (grams), and symptom scores (0 5 none, 1 5 mild, 2 5 moderate, 3 5 severe) for congestion, rhinorrea and sneezing were monitored on a daily basis for the next 5 days (study days 1-6). RESULTS: The mean age of subjects was 9.5 6 2.2 years and 57% were female. Nasal leukotrienes were detected in all subjects. Median leukotriene levels were 450.5, 253.1 and 398.0 on days 1, 3 and 5, respectively. Mean nasal secretion weights and symptom scores were 1.4 and 3.7; 1.1 and 3.0; and 1.0 and 1.3 on days 1, 3 and 5, respectively. CONCLUSIONS: The results demonstrate elevations in nasal leukotriene levels as well as nasal symptom scores and secretion weights during naturally acquired vURIs in pediatric subjects. Moreover, they provide additional evidence that suggests that leukotrienes play a role in the pathogenesis of vURIs. Future studies should determine whether treatment with leukotriene modifiers attenuates signs/symptoms and complications of vURIs including otitis media, sinusitis and asthma.
280
Survey of U.S. School Personnel on Food Allergy Management and Prevention Practices L. Verduin1, A. CorbettRD, LD/N2; 1International Food Information Council, Washington, DC, 2School Nutrition Association, Alexandria, VA. RATIONALE: The rate of food allergy in the U.S. appears to be increasing, especially in young children. Food allergic children can be exposed to potential allergens through ingesting foods at school. Therefore, it is important for school personnel, parents, and allergists to work together in preventing and managing food allergies in schools. METHODS: The IFIC-SNA Food Allergy Management Survey was designed to assess food allergy trends in schools, and track knowledge and awareness by school personnel. The survey was administered as a Webbased, quantitative survey to members of the School Nutrition Association (SNA). There were a total of 844 survey respondents. The survey participants included a representative sample of schools across the U.S., and also had a majority of enrolled students aged 4-12 years. RESULTS: A majority of schools report having children with food allergies (84%), and take actions to prevent allergic reactions in schools (69%). However, fewer schools are involving physicians in their food allergy management programs than in previous years. School directors, managers, supervisors and cooks would all like more training and education, as well as materials, on the best practices for food allergy management. CONCLUSIONS: 1. Food allergies appear to be an increasing problem in schools. 2. Although more schools are addressing food allergies, management is not consistent. 3. All levels of school personnel should be involved in food allergy management. 4. It is important for allergists, parents, and school personnel to communicate with each other to improve food allergy management and prevention in the school foodservice setting.
J ALLERGY CLIN IMMUNOL FEBRUARY 2009
281
Asthma Symptom History Reported by Inner-city Parents/ Guardians is More Strongly Associated with Exhaled Nitric Oxide and Lung Function than Adolescent-reported Symptoms J. N. Saams1, J. Cutrin-Brosnan1, G. B. Diette1, P. N. Breyesse2, E. C. Matsui1; 1Johns Hopkins University, Baltimore, MD, 2Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD. RATIONALE: Previous studies found that parent- and adolescent-reported asthma symptoms are highly concordant, but it is unclear whether these findings are applicable to inner-city populations. METHODS: Thirty-two Baltimore City adolescents with asthma and their parents/guardians were independently administered a questionnaire that captured the adolescents’ asthma symptoms and rescue medication use. Exhaled nitric oxide (eNO) and pre- and post-bronchodilator spirometry were performed. Concordance between adolescent and parent/guardian responses was examined using the kappa statistic. Adolescent- and parent-reported wheezing and rescue medication use were compared to eNO and lung function. RESULTS: Participants were 14-17y and predominantly African American (97%). Adolescent- and parent/guardian-reported days of wheeze over the previous 2 weeks (wheeze/2wks) and days of short-acting beta-agonist use (SABA/2wks) were weakly concordant (kappa 5 0.28, p 5 .06; kappa 5 0.22, p < .01, respectively). Overall, adolescents reported fewer days SABA/ 2wks than parents/guardians (4.1 vs. 5.1 days, respectively; p5.0.30), but similar days wheeze/2wks as parents/guardians (3.8 vs. 3.4 days, respectively; p 5 0.86). Parent/guardian report of days SABA/2wks was positively correlated with eNO (rs 5 0.45, p 5 0.02) and %change in FEV1 (rs 5 0.32 p 5 0.08), while adolescent-reported days SABA/2wks was not correlated with eNO or %change in FEV1 (rs 5 0.12, p 5 0.54 and rs 5 0.20, p 5 0.28 respectively). Neither parent/guardian- nor adolescent-reported days wheeze/2wks was correlated with eNO or %change in FEV1. CONCLUSIONS: Parent/guardian-reported asthma symptoms and SABA use were not concordant with adolescent-reported symptoms and SABA use, and parent/guardian-reported SABA use was more strongly associated with objective measures of asthma status, including pulmonary inflammation and lung function. Clinical information obtained from parents/guardians may be important in determining asthma control status in adolescent patients.
282
Comparison of Patient Responses to Self Administered and Interviewer Administered Asthma Control Test M. Bossard, X. Liu, D. Lang; Cleveland Clinic, Cleveland, OH. RATIONALE: The Asthma Control Test (ACT) is a validated, patient response, written questionnaire for assessing asthma control. However, in settings with paperless records, patient responses are commonly obtained verbally then entered into an electronic medical record (EMR). For this reason, it is important to validate ACT as an interviewer-driven questionnaire. We studied agreement of responses between patient completed self administered, written ACT (SA), and ACT completed by patient interviewer asking the 5 ACT questions, and then entering responses into EMR (INTVA). METHOD: Patients completed ACT by SA and INTVA. Weighted kappa coefficients (Fleiss-Cohen) were estimated to assess the agreement of SA and INTVA. Patients with COPD or lung disorders other than asthma were excluded. RESULTS: We analyzed 98 who completed SA and INTVA concurrently. Mean age was 47 years (range:16-85); 78.6% were female; 70.4% were Caucasian, 24.5% African American, 2% Hispanic, 3.1% Asian. Most had moderate-severe persistent asthma: severe 5 40.8%, moderate 5 26.5%, mild 5 25.5%, intermittent 5 7.1%. Total ACT scores between SA (mean 5 18.2) and INTVA (mean 5 18.6) demonstrated 93% agreement, kappa 5 0.96 (95% CI: 0.93-0.99). Individual ACT scores demonstrated 79% agreement for activity limitation, kappa 5 0.87 (95% CI: 0.80-0.94), 80% agreement for frequency of shortness of breath, kappa 5 0.94 (95% CI: 0.91-0.97), 86% agreement for sleep interruption, kappa 5 0.92 (95% CI: 0.86-0.98), 82% agreement for use of rescue medication, kappa 5 0.92 (95% CI: 0.88-0.97), and 84% agreement for asthma control, kappa 5 0.90 (95% CI: 0.85-0.96). CONCLUSIONS: Responses from INTVA agree well with SA in our patient population at an asthma referral center. Additional studies in other populations of asthmatics are required to substantiate our findings.
SATURDAY
279
Natural History of Viral Upper Respiratory Infections (vURIs) in Children H. Barth, D. Gentile, J. Koehrsen, A. Patel, D. Skoner; Allegheny General Hospital, Pittsburgh, PA. RATIONALE: vURIs are common in children and often predispose to the development of complications including asthma, otitis media and sinusitis. Previous studies have demonstrated a role for leukotrienes in mediating signs/symptoms of vURIs in adults. The purpose of this study was to characterize the natural history of vURIs in children with an emphasis on examining leukotriene levels and signs/symptoms of vURIs. METHODS: Thirty pediatric subjects aged 6 to <14 years with vURI signs/symptoms of less than 24 hours duration were enrolled (study day 0). Nasal leukotriene levels (pg/ml), secretion weights (grams), and symptom scores (0 5 none, 1 5 mild, 2 5 moderate, 3 5 severe) for congestion, rhinorrea and sneezing were monitored on a daily basis for the next 5 days (study days 1-6). RESULTS: The mean age of subjects was 9.5 6 2.2 years and 57% were female. Nasal leukotrienes were detected in all subjects. Median leukotriene levels were 450.5, 253.1 and 398.0 on days 1, 3 and 5, respectively. Mean nasal secretion weights and symptom scores were 1.4 and 3.7; 1.1 and 3.0; and 1.0 and 1.3 on days 1, 3 and 5, respectively. CONCLUSIONS: The results demonstrate elevations in nasal leukotriene levels as well as nasal symptom scores and secretion weights during naturally acquired vURIs in pediatric subjects. Moreover, they provide additional evidence that suggests that leukotrienes play a role in the pathogenesis of vURIs. Future studies should determine whether treatment with leukotriene modifiers attenuates signs/symptoms and complications of vURIs including otitis media, sinusitis and asthma.
280
Survey of U.S. School Personnel on Food Allergy Management and Prevention Practices L. Verduin1, A. CorbettRD, LD/N2; 1International Food Information Council, Washington, DC, 2School Nutrition Association, Alexandria, VA. RATIONALE: The rate of food allergy in the U.S. appears to be increasing, especially in young children. Food allergic children can be exposed to potential allergens through ingesting foods at school. Therefore, it is important for school personnel, parents, and allergists to work together in preventing and managing food allergies in schools. METHODS: The IFIC-SNA Food Allergy Management Survey was designed to assess food allergy trends in schools, and track knowledge and awareness by school personnel. The survey was administered as a Webbased, quantitative survey to members of the School Nutrition Association (SNA). There were a total of 844 survey respondents. The survey participants included a representative sample of schools across the U.S., and also had a majority of enrolled students aged 4-12 years. RESULTS: A majority of schools report having children with food allergies (84%), and take actions to prevent allergic reactions in schools (69%). However, fewer schools are involving physicians in their food allergy management programs than in previous years. School directors, managers, supervisors and cooks would all like more training and education, as well as materials, on the best practices for food allergy management. CONCLUSIONS: 1. Food allergies appear to be an increasing problem in schools. 2. Although more schools are addressing food allergies, management is not consistent. 3. All levels of school personnel should be involved in food allergy management. 4. It is important for allergists, parents, and school personnel to communicate with each other to improve food allergy management and prevention in the school foodservice setting.
J ALLERGY CLIN IMMUNOL FEBRUARY 2009
281
Asthma Symptom History Reported by Inner-city Parents/ Guardians is More Strongly Associated with Exhaled Nitric Oxide and Lung Function than Adolescent-reported Symptoms J. N. Saams1, J. Cutrin-Brosnan1, G. B. Diette1, P. N. Breyesse2, E. C. Matsui1; 1Johns Hopkins University, Baltimore, MD, 2Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD. RATIONALE: Previous studies found that parent- and adolescent-reported asthma symptoms are highly concordant, but it is unclear whether these findings are applicable to inner-city populations. METHODS: Thirty-two Baltimore City adolescents with asthma and their parents/guardians were independently administered a questionnaire that captured the adolescents’ asthma symptoms and rescue medication use. Exhaled nitric oxide (eNO) and pre- and post-bronchodilator spirometry were performed. Concordance between adolescent and parent/guardian responses was examined using the kappa statistic. Adolescent- and parent-reported wheezing and rescue medication use were compared to eNO and lung function. RESULTS: Participants were 14-17y and predominantly African American (97%). Adolescent- and parent/guardian-reported days of wheeze over the previous 2 weeks (wheeze/2wks) and days of short-acting beta-agonist use (SABA/2wks) were weakly concordant (kappa 5 0.28, p 5 .06; kappa 5 0.22, p < .01, respectively). Overall, adolescents reported fewer days SABA/ 2wks than parents/guardians (4.1 vs. 5.1 days, respectively; p5.0.30), but similar days wheeze/2wks as parents/guardians (3.8 vs. 3.4 days, respectively; p 5 0.86). Parent/guardian report of days SABA/2wks was positively correlated with eNO (rs 5 0.45, p 5 0.02) and %change in FEV1 (rs 5 0.32 p 5 0.08), while adolescent-reported days SABA/2wks was not correlated with eNO or %change in FEV1 (rs 5 0.12, p 5 0.54 and rs 5 0.20, p 5 0.28 respectively). Neither parent/guardian- nor adolescent-reported days wheeze/2wks was correlated with eNO or %change in FEV1. CONCLUSIONS: Parent/guardian-reported asthma symptoms and SABA use were not concordant with adolescent-reported symptoms and SABA use, and parent/guardian-reported SABA use was more strongly associated with objective measures of asthma status, including pulmonary inflammation and lung function. Clinical information obtained from parents/guardians may be important in determining asthma control status in adolescent patients.
282
Comparison of Patient Responses to Self Administered and Interviewer Administered Asthma Control Test M. Bossard, X. Liu, D. Lang; Cleveland Clinic, Cleveland, OH. RATIONALE: The Asthma Control Test (ACT) is a validated, patient response, written questionnaire for assessing asthma control. However, in settings with paperless records, patient responses are commonly obtained verbally then entered into an electronic medical record (EMR). For this reason, it is important to validate ACT as an interviewer-driven questionnaire. We studied agreement of responses between patient completed self administered, written ACT (SA), and ACT completed by patient interviewer asking the 5 ACT questions, and then entering responses into EMR (INTVA). METHOD: Patients completed ACT by SA and INTVA. Weighted kappa coefficients (Fleiss-Cohen) were estimated to assess the agreement of SA and INTVA. Patients with COPD or lung disorders other than asthma were excluded. RESULTS: We analyzed 98 who completed SA and INTVA concurrently. Mean age was 47 years (range:16-85); 78.6% were female; 70.4% were Caucasian, 24.5% African American, 2% Hispanic, 3.1% Asian. Most had moderate-severe persistent asthma: severe 5 40.8%, moderate 5 26.5%, mild 5 25.5%, intermittent 5 7.1%. Total ACT scores between SA (mean 5 18.2) and INTVA (mean 5 18.6) demonstrated 93% agreement, kappa 5 0.96 (95% CI: 0.93-0.99). Individual ACT scores demonstrated 79% agreement for activity limitation, kappa 5 0.87 (95% CI: 0.80-0.94), 80% agreement for frequency of shortness of breath, kappa 5 0.94 (95% CI: 0.91-0.97), 86% agreement for sleep interruption, kappa 5 0.92 (95% CI: 0.86-0.98), 82% agreement for use of rescue medication, kappa 5 0.92 (95% CI: 0.88-0.97), and 84% agreement for asthma control, kappa 5 0.90 (95% CI: 0.85-0.96). CONCLUSIONS: Responses from INTVA agree well with SA in our patient population at an asthma referral center. Additional studies in other populations of asthmatics are required to substantiate our findings.