Emotional Bother, Rather than Disease Severity, Determines Environmental Control Practices in Inner-City Preschool Children

Emotional Bother, Rather than Disease Severity, Determines Environmental Control Practices in Inner-City Preschool Children J. Curtin-Brosnan, P. A. Eggleston, E. C. Matsui, N. N. Hansel, C. S. Rand, K. A. Callahan, G. B. Diette; Johns Hopkins University, Baltimore, MD. RATIONALE: Although environmental control practices (ECPs) are an integral part of NAEPP guidelines, many inner-city families of asthmatics do not implement them. We hypothesized that caregiver frustration and worry about child’s asthma (emotional bother) would be a predictor of ECP use. METHODS: Caregivers of children, age 2-6 years, with asthma (n=150) completed a questionnaire about ECPs to manage asthma-related health of the child. Mean scores of emotional bother were calculated from the Children’s Health Survey for Asthma (CHSA), a validated, self-reported measure for parents of asthmatic children. RESULTS: 50% of children were female, 90% black and the mean age was 4.4. Caregivers who reported being more bothered by their child’s asthma were significantly more likely to install devices to improve air quality (e.g., dehumidifiers and air conditioners) (OR, 1.04, 95% CI 1.011.07 and OR, 1.03, 95% CI 1.01-1.06, respectively, per 1 point increase in the 100-point emotional bother scale). Caregivers who were more bothered were also more likely to make changes to the family room (OR, 1.04, CI 1.01-1.07) and child’s bedroom (OR, 1.02, 95% CI 1.00-1.04, p=0.06) for the child’s health. Cockroach and mouse control were not related to emotional bother of the caregiver. The child’s NAEPP severity category did not predict ECPs and adjustment for severity did not alter the association between emotional bother and ECPs. CONCLUSIONS: In inner-city families, emotional bother is associated with some ECPs, but not others. Awareness of the importance of emotional bother of the caregiver can help increase the use of ECPs in asthmatic families. Funding: NIEHS, EPA

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Pharmoeconomics of Penicillin Skin Testing (PST) on Inpatient Antibiotic Use in Patients with Penicillin Allergy (PA) S. Nootheti, E. Kavosh, L. Bielory; Dept. of Allergy and Immunology, UMDNJ, Newark, NJ. RATIONALE: Penicillin is frequently cited on inpatients self-reported drug allergies. PST is a reliable and useful diagnostic tool to determine the risk of an immediate systemic allergic reaction. Pharmoeconomic analysis of PST on inpatients with PA requiring antimicrobial therapy is limited. METHODS: A retrospective chart review of 30/120 inpatients (ages 1992) consulted for PST between January 2001 to June 2005 was done. Prick and intradermal testing to minor and major (Pre-Pen) determinants was performed. Therapeutic changes implemented as a result of PST, reduction in cost of antibiotics, and adverse reactions were assessed. Cost analysis was based on the hospital cost of antibiotics. RESULTS: 87% (26/30) of subjects had PST (-) 10% (3/30) refused PST, and 3% (1/30) had a PST (-). 85% (22/26) subjects with PST (-), had antimicrobials switched to beta-lactam, 4 (15%) didn’t receive betalactams. The average cost of antibiotics prior to PST was $4,767 that decreased to $3,864 (19%). Pre-PST prescribed regimens included vancomycin/gentamycin ($10/day,n=4), and quinolones ($18/day,n=5). With piperacillin/tazobactam ($52/day,n=3), there was an increase in cost, but when naficillin ($11/dayn=4), or cephalosporins ($10-15,n=3) were used, switching to beta-lactams proved to be cost effective and decreased broad spectrum antibiotics use. There were no adverse reactions in the PST (-) group of patients who received beta-lactams. 92% of PST (-) patients were still listed as PA on their discharge sheets. CONCLUSIONS: Inpatient PST contributed to changes in antimicrobial therapy from broad spectrum agents to beta-lactams, with a decrease in therapy cost.

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Use of Respiratory Protection in a Mouse Research and Production Facility and Risk of Allergic Sensitization E. A. O’Neil1, K. A. Hagberg1, B. J. Paigen2, P. A. Eggleston3, K. A. Callahan3, E. C. Matsui3; 1Employee Health Center, The Jackson Laboratory, Bar Harbor, ME, 2Research, The Jackson Laboratory, Bar Harbor, ME, 3School of Medicine, Johns Hopkins University, Baltimore, MD. RATIONALE: To examine predictors of respiratory protection (RP) use, and to determine if RP use protects against the development of allergic sensitization. METHODS: New employees at a mouse facility (n=29) were followed for six months. A questionnaire captured allergic history and RP use at baseline and 6 months. Skin prick testing (SPT) was performed at baseline and 6 months. RESULTS: The participants were predominantly mouse handlers (72%). The mean age was 25y. and 55% were female. Twenty-one percent reported having physician-diagnosed asthma and 59% had at least one positive SPT at baseline. At baseline, 66% of all participants and 72% of mouse handlers reported being offered RP. At six months, 20/21 (95%) of mouse handlers reported being offered RP but only 9/20 (45%) opted to use RP. Atopic workers, defined as greater than or equal to 1 positive SPT were somewhat more likely to opt for RP than non-atopic workers (58% vs. 25%, p=0.14). Employees with asthma were not more likely than nonasthmatics to use RP (60% vs. 40%, p=0.44). 30% of mouse handlers reported always using RP, 15% sometimes used RP and 55% never used RP. Employees who reported always using RP were less likely to develop skin test sensitivity to mouse than those who intermittently used RP (0% vs. 67%, p=0.09). CONCLUSIONS: Less than 50% of mouse handlers opted to use RP even though 95% reported being offered RP. Consistent use of RP may protect workers against allergic sensitization, but only 30% of workers who were offered RP used it consistently.

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Smoke Free Laws and Asthma Outcomes

E. J. Hahn, P. Burkhart, M. Rayens, D. Moser, S. Lee; College of Nursing, University of Kentucky, Lexington, KY. RATIONALE: The purpose of the study is to evaluate the effects of a local 100% comprehensive smoke-free law on asthma outcomes including the rate of hospital and emergency department (ED) discharges, length of stay, and total hospital costs. METHODS: A time series design using five 6-month time periods prior to and after the enforcement of the smoke-free ordinance was used. The administrative data base used to summarize and track all Kentucky inpatient hospital billing records was accessed for all Lexington, Kentucky hospitals. Data included hospital discharge diagnosis (ICD-9 codes), length of stay, total hospital charges, dates of service, gender, age, and zip code of residence. Each Lexington hospital provided all data fields of interest for the ED discharges. RESULTS: Preliminary pre-law data will be presented. Multiple linear regression was used to determine predictors for length of stay and total costs; predictors include year, month, gender, age, and an indicator variable for whether the observation occurred before or after the ordinance took effect. For the number of events (hospital and ED discharges) per atrisk population, an incidence rate, Poisson regression was used with the same predictors. CONCLUSIONS: The epidemiological evidence is clear that exposure to secondhand smoke causes physiological changes to the respiratory system and triggers asthma. However, the evidence that community-level reduction in secondhand smoke exposure leads to improved asthma outcomes is inconclusive. This study is the first to examine the effect of a comprehensive smoke-free ordinance on population-level asthma outcomes over time. Funding: Flight Attendant Medical Research Institute

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Abstracts S81

J ALLERGY CLIN IMMUNOL VOLUME 117, NUMBER 2