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Effects Of Rhinovirus (RV) 39 Infection On Airway Hyper-Reactivity (AHR) To Histamine and Carbachol In Human Airways
AB228 Abstracts
789
Effects Of Rhinovirus (RV) 39 Infection On Airway HyperReactivity (AHR) To Histamine and Carbachol In Human Airways Joshua L. Kennedy, MD1, Stacie M. Jones, MD1,2, Ms. Megan Kurten1,3, Ms. Suzanne House1,3, Richard Kurten, PhD1,3; 1Arkansas Children’s Hospital Research Institute, Little Rock, AR, 2University of Arkansas for Medical Sciences and Arkansas Children’s Hospital, Little Rock, AR, 3University of Arkansas for Medical Sciences, Little Rock, AR. RATIONALE: RV infection is associated with asthma exacerbations. We hypothesized that airway infection with RV39 would induce AHR, a diagnostic feature of asthma, in lung tissue derived from deceased organ donors with and without a history of asthma. METHODS: Precision cut lung slices (PCLS) were prepared from cadaver lungs and cultured ex-vivo. Airway viability was confirmed microscopically by ciliary motility, by bronchoconstriction with carbachol, and subsequent bronchodilation with isoproterenol. Cumulative dose response curves for carbachol- and histamine-induced contractility (as a biomarker for AHR) were measured using slices derived from asthmatic (n54) and non-asthmatic donors (n51) before and after infection with RV39. RESULTS: Overall, RV39 infection of PCLS from donors with a history of asthma failed to stimulate enhanced AHR within 48h. In one donor, RV39 induced histamine-specific AHR (EC50 was reduced from 109 nM to 30nM after 48h; p<0.01) with little change in responsiveness to carbachol (EC50 81nM to 109nM p5NS). By contrast, RV39-infected PCLS derived from a donor without a history of asthma were less responsive to histamine (EC50 40nM to 200nM) with no change in response to carbachol (EC50200nM to 180nM). CONCLUSIONS: RV39 induced AHR in human PCLS airways derived from 1 of 4 donors previously diagnosed with asthma. AHR to histamine, but not to carbachol in a subset of ’asthmatic’ airway provides insights into a potential mechanism by which viral infections and atopy could synergize to induce asthma exacerbations. Human PCLS provide an outstanding platform with which to dissect these interactions.
MONDAY
790
Poor Asthma Control In Older Adults Is Associated With Reduced Adherence To Controller Therapies and Inability To Afford Medications Dr. Jessica Tan, MD, MPH1, Dr. David I. Bernstein, MD, FAAAAI2, Ms. Cheryl Koff Bernstein, RN, BSN, CCRC3, Dr. Patrick Ryan, PhD4, Dr. Jonathan A. Bernstein, MD, FAAAAI5, Ms. Banu Kesavalu6, Dr. Manuel S. Villareal, MD, FAAAAI1,7, Dr. Andrew M. Smith, MD, FAAAAI8, Dr. Peter Lenz9, Dr. Tolly Epstein, MD, MS10; 1University of Cincinnati Medical Center, Cincinnati, OH, 2Bernstein Allergy Group, Cincinnati, OH, 3Bernstein Clinical Research Center, LLC, Cincinnati, OH, 4Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, 5Division of Immunology Allergy & Rheumatology, University of Cincinnati Medical Center, Cincinnati, OH, 6University of Cincinnati, 7 University of Cincinnati, Cincinnati, OH, 83255 Eden Ave., HPB 350, University of Cincinnati Medical Center, Cincinnati, OH, 9The University of Cincinnati Medical Center, 10Allergy Partners of Central Indiana, Indianapolis, IN. RATIONALE: Nonadherence to asthma medications may contribute significantly to higher morbidity and mortality from asthma in adults age 65 years and older. Standardized measures to evaluate nonadherence in this population are lacking. METHODS: Adults age 65 years and older with an objective diagnosis of asthma (n5175) were recruited from Allergy and Pulmonary clinics.
J ALLERGY CLIN IMMUNOL FEBRUARY 2014
They were administered a standardized survey with Likert scale responses, consisting of questions regarding asthma medication use and reasons for nonadherence in the previous month. Demographic data, medical history, including emergency department (ED) visits in the past year, and the validated asthma control questionnaire (ACQ) and asthma control test (ACT) were completed. Composite medication use scores (CMUS) were determined by summing responses. Logistic regression was used to compare asthma outcomes (ACT, ACQ, ED visits) to composite scores and individual questions, and to evaluate predictors of adherence. RESULTS: The mean CMUS was 7.162.9 (range 5-25; 55perfect _1.5 8.5, ACQ <1.5 6.7. Subjects with ACQ > _1.5 and/ adherence); ACQ> or ACT<20 (poor asthma control) and/or any ED visits were less likely to be adherent (OR 0.37, [95% CI 0.19-0.72], p < 0.05; 0.44 [0.24-0.79], p < _1.5 0.05; 0.19 [0.07-0.50], p < 0.001, respectively). Individuals with ACQ> were less likely to report continued asthma medication use despite symptom improvement (OR 0.29, [0.13-0.65], p < 0.005), and less able to afford medications (OR 0.23 [0.08-0.71], p < 0.05). Findings were similar for ED visits. CONCLUSIONS: Discontinuation of medications and the inability to afford medications were significant predictors of poor asthma control in older adults.
791
Texting Medication Reminders For Better Asthma Control In Children and Teens Dr. Humaa M. Bhatti, DO1, Ms. Wafa Alame, RN1, Mr. Joseph Adams2, Dr. Jenny M. Montejo, MD1, Dr. Milind V. Pansare, MD, FAAAAI1, Dr. Pavadee Poowuttikul, MD1, Dr. Elizabeth A. Secord, MD, FAAAAI2; 1 Children’s Hospital of Michigan, Detroit, MI, 2Wayne State University, Detroit, MI. RATIONALE: Non-adherence to medication regimens continues to be a persistent problem among patients with asthma. Technology makes communication with our patients between visits easier and more meaningful for all parties. We examine the effects on asthma control of sending medication reminders and allowing patients to communicate with staff via text messaging. METHODS: 22 participants (up to age 18 years) enrolled, with ongoing enrollment for future addition to the study population. Written assent obtained from teenage participants and informed consent obtained from all parents. Text reminders were sent twice daily by a research assistant to the parents and/or teenage patients with understanding that patients should receive medication at receipt of reminders. Retrospective chart review was completed to examine frequency of steroid bursts, ER visits, and hospitalizations for asthma occurring in the year prior to starting the study, and number of these occurring since starting. RESULTS: 18/22 participants completed 2-5 months of the study to date, four dropped out. In the 12 months prior to the study, 14/18 patients had two or more steroid bursts, all 18 patients had at least one urgent visit, and 14/18 had been admitted. Since starting the study, 14/18 patients had no steroid bursts, ER visits, or hospitalizations since starting the study. Extrapolating the results for each participant since starting the study to 12 months, this represents a significant reduction in the above unfavorable outcomes. CONCLUSIONS: Our results suggest that communicating with our patients via text reminders is effecting positive change on control of their asthma.
789
Effects Of Rhinovirus (RV) 39 Infection On Airway HyperReactivity (AHR) To Histamine and Carbachol In Human Airways Joshua L. Kennedy, MD1, Stacie M. Jones, MD1,2, Ms. Megan Kurten1,3, Ms. Suzanne House1,3, Richard Kurten, PhD1,3; 1Arkansas Children’s Hospital Research Institute, Little Rock, AR, 2University of Arkansas for Medical Sciences and Arkansas Children’s Hospital, Little Rock, AR, 3University of Arkansas for Medical Sciences, Little Rock, AR. RATIONALE: RV infection is associated with asthma exacerbations. We hypothesized that airway infection with RV39 would induce AHR, a diagnostic feature of asthma, in lung tissue derived from deceased organ donors with and without a history of asthma. METHODS: Precision cut lung slices (PCLS) were prepared from cadaver lungs and cultured ex-vivo. Airway viability was confirmed microscopically by ciliary motility, by bronchoconstriction with carbachol, and subsequent bronchodilation with isoproterenol. Cumulative dose response curves for carbachol- and histamine-induced contractility (as a biomarker for AHR) were measured using slices derived from asthmatic (n54) and non-asthmatic donors (n51) before and after infection with RV39. RESULTS: Overall, RV39 infection of PCLS from donors with a history of asthma failed to stimulate enhanced AHR within 48h. In one donor, RV39 induced histamine-specific AHR (EC50 was reduced from 109 nM to 30nM after 48h; p<0.01) with little change in responsiveness to carbachol (EC50 81nM to 109nM p5NS). By contrast, RV39-infected PCLS derived from a donor without a history of asthma were less responsive to histamine (EC50 40nM to 200nM) with no change in response to carbachol (EC50200nM to 180nM). CONCLUSIONS: RV39 induced AHR in human PCLS airways derived from 1 of 4 donors previously diagnosed with asthma. AHR to histamine, but not to carbachol in a subset of ’asthmatic’ airway provides insights into a potential mechanism by which viral infections and atopy could synergize to induce asthma exacerbations. Human PCLS provide an outstanding platform with which to dissect these interactions.
MONDAY
790
Poor Asthma Control In Older Adults Is Associated With Reduced Adherence To Controller Therapies and Inability To Afford Medications Dr. Jessica Tan, MD, MPH1, Dr. David I. Bernstein, MD, FAAAAI2, Ms. Cheryl Koff Bernstein, RN, BSN, CCRC3, Dr. Patrick Ryan, PhD4, Dr. Jonathan A. Bernstein, MD, FAAAAI5, Ms. Banu Kesavalu6, Dr. Manuel S. Villareal, MD, FAAAAI1,7, Dr. Andrew M. Smith, MD, FAAAAI8, Dr. Peter Lenz9, Dr. Tolly Epstein, MD, MS10; 1University of Cincinnati Medical Center, Cincinnati, OH, 2Bernstein Allergy Group, Cincinnati, OH, 3Bernstein Clinical Research Center, LLC, Cincinnati, OH, 4Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, 5Division of Immunology Allergy & Rheumatology, University of Cincinnati Medical Center, Cincinnati, OH, 6University of Cincinnati, 7 University of Cincinnati, Cincinnati, OH, 83255 Eden Ave., HPB 350, University of Cincinnati Medical Center, Cincinnati, OH, 9The University of Cincinnati Medical Center, 10Allergy Partners of Central Indiana, Indianapolis, IN. RATIONALE: Nonadherence to asthma medications may contribute significantly to higher morbidity and mortality from asthma in adults age 65 years and older. Standardized measures to evaluate nonadherence in this population are lacking. METHODS: Adults age 65 years and older with an objective diagnosis of asthma (n5175) were recruited from Allergy and Pulmonary clinics.
J ALLERGY CLIN IMMUNOL FEBRUARY 2014
They were administered a standardized survey with Likert scale responses, consisting of questions regarding asthma medication use and reasons for nonadherence in the previous month. Demographic data, medical history, including emergency department (ED) visits in the past year, and the validated asthma control questionnaire (ACQ) and asthma control test (ACT) were completed. Composite medication use scores (CMUS) were determined by summing responses. Logistic regression was used to compare asthma outcomes (ACT, ACQ, ED visits) to composite scores and individual questions, and to evaluate predictors of adherence. RESULTS: The mean CMUS was 7.162.9 (range 5-25; 55perfect _1.5 8.5, ACQ <1.5 6.7. Subjects with ACQ > _1.5 and/ adherence); ACQ> or ACT<20 (poor asthma control) and/or any ED visits were less likely to be adherent (OR 0.37, [95% CI 0.19-0.72], p < 0.05; 0.44 [0.24-0.79], p < _1.5 0.05; 0.19 [0.07-0.50], p < 0.001, respectively). Individuals with ACQ> were less likely to report continued asthma medication use despite symptom improvement (OR 0.29, [0.13-0.65], p < 0.005), and less able to afford medications (OR 0.23 [0.08-0.71], p < 0.05). Findings were similar for ED visits. CONCLUSIONS: Discontinuation of medications and the inability to afford medications were significant predictors of poor asthma control in older adults.
791
Texting Medication Reminders For Better Asthma Control In Children and Teens Dr. Humaa M. Bhatti, DO1, Ms. Wafa Alame, RN1, Mr. Joseph Adams2, Dr. Jenny M. Montejo, MD1, Dr. Milind V. Pansare, MD, FAAAAI1, Dr. Pavadee Poowuttikul, MD1, Dr. Elizabeth A. Secord, MD, FAAAAI2; 1 Children’s Hospital of Michigan, Detroit, MI, 2Wayne State University, Detroit, MI. RATIONALE: Non-adherence to medication regimens continues to be a persistent problem among patients with asthma. Technology makes communication with our patients between visits easier and more meaningful for all parties. We examine the effects on asthma control of sending medication reminders and allowing patients to communicate with staff via text messaging. METHODS: 22 participants (up to age 18 years) enrolled, with ongoing enrollment for future addition to the study population. Written assent obtained from teenage participants and informed consent obtained from all parents. Text reminders were sent twice daily by a research assistant to the parents and/or teenage patients with understanding that patients should receive medication at receipt of reminders. Retrospective chart review was completed to examine frequency of steroid bursts, ER visits, and hospitalizations for asthma occurring in the year prior to starting the study, and number of these occurring since starting. RESULTS: 18/22 participants completed 2-5 months of the study to date, four dropped out. In the 12 months prior to the study, 14/18 patients had two or more steroid bursts, all 18 patients had at least one urgent visit, and 14/18 had been admitted. Since starting the study, 14/18 patients had no steroid bursts, ER visits, or hospitalizations since starting the study. Extrapolating the results for each participant since starting the study to 12 months, this represents a significant reduction in the above unfavorable outcomes. CONCLUSIONS: Our results suggest that communicating with our patients via text reminders is effecting positive change on control of their asthma.