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Evidence for Harm Reversal in Asthmatic Smokers Who Switched to Regular Electronic Cigarettes Use
Abstracts AB157
J ALLERGY CLIN IMMUNOL VOLUME 135, NUMBER 2
Empowering Students with Asthma in Chicago Schools through Photovoice and Videovoice Jesse Blumenstock1, Ruchi Gupta, MD, MPH1,2, Christopher Warren, BA3; 1Northwestern Feinberg School of Medicine, Chicago, IL, 2Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, 3University of Southern California, Los Angeles, CA. RATIONALE: Asthma is a problem of epidemic proportions in Chicago with childhood prevalence and mortality rates above the national average. The objective of this study was to partner with adolescents to improve asthma management and increase community asthma knowledge and support. METHODS: Middle School students with asthma (N512) were recruited to engage in a 13-week program grounded in Community-Based Participatory Research (CBPR) principles. Students were given minitablets to investigate socio-environmental factors influencing their asthma by taking photographs, recording video Public Service Announcements to educate their communities, and implementing a targeted community intervention. Wilcoxon–Mann–Whitney and paired t-tests were used to analyze changes in student and caregiver asthma knowledge, self-efficacy, empowerment, quality of life, symptom frequency, severity, and adherence to management practices pre-/post-program implementation. RESULTS: Students identified asthma triggers in their communities, including pollution, smoking and automobile idling. Participants showed significant improvement in self-efficacy and empowerment scores on the Asthma Belief Survey (p50.03) and the Sociopolitical Control Scale (p50.033). Caregivers demonstrated significant improvement in quality of life (p50.006) and asthma knowledge scores (p50.006) and increased use of peak flow meters (p50.001), spacers (p50.046), and asthma action plans (p50.003). Students developed and presented videos to peers and caregivers and posted them to a website to disseminate results to the community. CONCLUSIONS: Utilizing CBPR principles involves students in many aspects of the research process and allows students to actively take control of their asthma. Photovoice allows students to investigate how their asthma is impacted by their unique communities and to communicate information to the larger community.
512
Taking Advantage of Smartphones and Cloud Computing to Decrease the Cost of Asthma Richard W. Lucas, PhD1,2, Josh Dees3, Bryn Rhodes4, Rob Reynolds3, Nathan Allan4, Richard W. Hendershot, MD, FAAAAI5; 1OSIA Medical, Phoenix, AZ, 2Swedish University of Agricultural Sciences, Ume a, Sweden, 3OSIA Medical, Sandy, UT, 4Database Consulting Group, Orem, UT, 5 Intermountain Healthcare, Salt Lake City, UT. RATIONALE: Asthma is a growing disease burden and a substantial cost to society. Smartphone technologies interfacing with cloud computing platforms have the potential to improve asthma control by illuminating many environmental exposures eliciting asthma exacerbations, and thus enabling the design of effective personalized preventative strategies. METHODS: We conducted a case study comparing asthma control before and after the regular use of AsthmaAlly, a cloud computing platform tracking asthma symptoms and automatically compiling temporally and spatially appropriate environmental data (e.g. air quality, climate, pollen, etc.). Efficacy was quantified by compiling emergency department and urgent care facility visits from insurance billing records over a four year time frame, up to two years prior and two years following the regular use of AsthmaAlly. RESULTS: In the years prior to AsthmaAlly use, the mean number of urgent care visits per year was 3.0. Following AsthmaAlly use, the mean number of urgent care visits dropped to 0.5. The drop in urgent care visits represents an average annual savings of $345 per patient given the average cost of $138 per urgent care visit. CONCLUSIONS: Preliminary results suggest that use of smartphone technology and improved understanding of the environmental factors triggering asthma events enabled better decision making and the design of effective personalized preventative strategies, thus decreasing the need for
urgent care. Smartphone and cloud computing technology could be useful tools to improve disease control for individuals and decrease the costs of asthma in terms of human suffering and monetary expenditures.
513
Gestational Asthma and Eczema: A New Reality? Subashini Rajagopalan1, Wilfried Karmaus1, Syed H. Arshad, DM, FRCP2,3; 1Division of Epidemiology, Biostatistics, and Environmental Health, School of Public Health, University of Memphis, Memphis, TN, 2The David Hide Asthma and Allergy Research Centre, United Kingdom, 3University of Southampton, United Kingdom. RATIONALE: Pregnant state influences the course of existing asthma and eczema. However, little is known of the influence of pregnancy on natural history of allergy in terms of new onset, or relapse of previously remitted, asthma and eczema. We analyzed asthma and eczema status in women who became pregnant in a longitudinal birth cohort assessed at 1, 2, 4, 10, and 18 years. METHODS: Within the Isle of Wight (UK) birth cohort, girls were followed from birth until a pregnancy occurred (n5128). Questionnaires were administered in early and late pregnancy to assess new occurrences of asthma, eczema and changes (remission, persistence) of existing disease. RESULTS: Of 85 women without asthma at 18 years, 13 women developed new-onset asthma during the 1stpregnancy (15.3%) which persisted in three (of five) women with a second pregnancy. Of these 13 women, 11 had prior wheezing history. Asthma persisted in 28 of 33 (84.9%) women from 18 years to first pregnancy and in all who had a second pregnancy. Regarding eczema, 96 were eczema-free at age 18. Of these, 15 developed eczema (15.6%), which persisted in two (of five) with a second pregnancy. Two developed new-onset eczema during second pregnancy. Of the 15 who developed eczema during pregnancy, 4 had a prior history of rash. Of 21 girls who had eczema at 18 years, 11 continued to have eczema, 7 had a remission, but 1 woman had eczema recurring in the second pregnancy. CONCLUSIONS: New-onset of asthma and eczema occurs in pregnancy in about 15% of disease-free women.
514
Evidence for Harm Reversal in Asthmatic Smokers Who Switched to Regular Electronic Cigarettes Use Pasquale Caponnetto1, Riccardo Polosa, MD, PhD, FAAAAI2, Jaymin Morjaria3, Massimo Caruso, PhD, FIT, AAAAI2, Simona Strano4, Cristina Russo, MD5; 1University of Catania, Italy, 2University of Catania, Catania, Italy, 3Dept of Academic Respiratory Medicine, University of Hull, Castle Hill Hospital, Cottingham, East Yorkshire, United Kingdom, HU16 5JQ, 4University of Catania, 5university of catania, Catania, Italy. RATIONALE: Asthmatic smokers have more severe disease, inadequate disease control, and poor response to therapies. Here we retrospectively evaluate asthma outcomes in smoking asthmatics who switched to ecigarettes (EC) use. METHODS: Changes in lung function, methacholine airway hyperresponsiveness, exacerbations and subjective asthma outcomes were assessed after 6 (61){V1} and 12 (61.5){V2} months of regular EC use compared to baseline {BL} as well 6-12 {pre-BL} months earlier. RESULTS: Eighteen (11M, 7F; 38.8 6 12.3 years) subjects were reviewed, of whom ten were single (EC only) and eight dual (EC and cigarettes) users. No differences were noted in any outcomes between BL and pre-BL. Compared to BL there were significant improvements in all objective and subjective asthma parameters at V2, and some at V1. FEV1 improved from 3,30 6 0.78 L (BL) to 3,40 6 0.73 L (V2); FVC improved from 4,28 6 0.90 L (BL) to 4,43 6 0.78 L (V2); FEF25-75% improved from 2,75 6 0.72 L/sec (BL) to 3,11 6 0.57 L/sec (V2); PC20 Mch improved from 1,24 mg/ml (BL) to 2,56 mg/ml (V2); ACQ improved from 2,03 (BL) to 1,47 (V2). At both V1 and V2 compared to BL there were marked reductions in daily conventional cigarette consumption. No adverse events were reported with EC use. CONCLUSIONS: In asthmatics who smoke, EC use is well tolerated and may have a positive impact on asthma outcomes. We hypothesize that EC use in smoking asthmatics may be a safer alternative to conventional cigarette consumption and has potential for smoking cessation/reduction and respiratory harm reversal.
SUNDAY
511
J ALLERGY CLIN IMMUNOL VOLUME 135, NUMBER 2
Empowering Students with Asthma in Chicago Schools through Photovoice and Videovoice Jesse Blumenstock1, Ruchi Gupta, MD, MPH1,2, Christopher Warren, BA3; 1Northwestern Feinberg School of Medicine, Chicago, IL, 2Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, 3University of Southern California, Los Angeles, CA. RATIONALE: Asthma is a problem of epidemic proportions in Chicago with childhood prevalence and mortality rates above the national average. The objective of this study was to partner with adolescents to improve asthma management and increase community asthma knowledge and support. METHODS: Middle School students with asthma (N512) were recruited to engage in a 13-week program grounded in Community-Based Participatory Research (CBPR) principles. Students were given minitablets to investigate socio-environmental factors influencing their asthma by taking photographs, recording video Public Service Announcements to educate their communities, and implementing a targeted community intervention. Wilcoxon–Mann–Whitney and paired t-tests were used to analyze changes in student and caregiver asthma knowledge, self-efficacy, empowerment, quality of life, symptom frequency, severity, and adherence to management practices pre-/post-program implementation. RESULTS: Students identified asthma triggers in their communities, including pollution, smoking and automobile idling. Participants showed significant improvement in self-efficacy and empowerment scores on the Asthma Belief Survey (p50.03) and the Sociopolitical Control Scale (p50.033). Caregivers demonstrated significant improvement in quality of life (p50.006) and asthma knowledge scores (p50.006) and increased use of peak flow meters (p50.001), spacers (p50.046), and asthma action plans (p50.003). Students developed and presented videos to peers and caregivers and posted them to a website to disseminate results to the community. CONCLUSIONS: Utilizing CBPR principles involves students in many aspects of the research process and allows students to actively take control of their asthma. Photovoice allows students to investigate how their asthma is impacted by their unique communities and to communicate information to the larger community.
512
Taking Advantage of Smartphones and Cloud Computing to Decrease the Cost of Asthma Richard W. Lucas, PhD1,2, Josh Dees3, Bryn Rhodes4, Rob Reynolds3, Nathan Allan4, Richard W. Hendershot, MD, FAAAAI5; 1OSIA Medical, Phoenix, AZ, 2Swedish University of Agricultural Sciences, Ume a, Sweden, 3OSIA Medical, Sandy, UT, 4Database Consulting Group, Orem, UT, 5 Intermountain Healthcare, Salt Lake City, UT. RATIONALE: Asthma is a growing disease burden and a substantial cost to society. Smartphone technologies interfacing with cloud computing platforms have the potential to improve asthma control by illuminating many environmental exposures eliciting asthma exacerbations, and thus enabling the design of effective personalized preventative strategies. METHODS: We conducted a case study comparing asthma control before and after the regular use of AsthmaAlly, a cloud computing platform tracking asthma symptoms and automatically compiling temporally and spatially appropriate environmental data (e.g. air quality, climate, pollen, etc.). Efficacy was quantified by compiling emergency department and urgent care facility visits from insurance billing records over a four year time frame, up to two years prior and two years following the regular use of AsthmaAlly. RESULTS: In the years prior to AsthmaAlly use, the mean number of urgent care visits per year was 3.0. Following AsthmaAlly use, the mean number of urgent care visits dropped to 0.5. The drop in urgent care visits represents an average annual savings of $345 per patient given the average cost of $138 per urgent care visit. CONCLUSIONS: Preliminary results suggest that use of smartphone technology and improved understanding of the environmental factors triggering asthma events enabled better decision making and the design of effective personalized preventative strategies, thus decreasing the need for
urgent care. Smartphone and cloud computing technology could be useful tools to improve disease control for individuals and decrease the costs of asthma in terms of human suffering and monetary expenditures.
513
Gestational Asthma and Eczema: A New Reality? Subashini Rajagopalan1, Wilfried Karmaus1, Syed H. Arshad, DM, FRCP2,3; 1Division of Epidemiology, Biostatistics, and Environmental Health, School of Public Health, University of Memphis, Memphis, TN, 2The David Hide Asthma and Allergy Research Centre, United Kingdom, 3University of Southampton, United Kingdom. RATIONALE: Pregnant state influences the course of existing asthma and eczema. However, little is known of the influence of pregnancy on natural history of allergy in terms of new onset, or relapse of previously remitted, asthma and eczema. We analyzed asthma and eczema status in women who became pregnant in a longitudinal birth cohort assessed at 1, 2, 4, 10, and 18 years. METHODS: Within the Isle of Wight (UK) birth cohort, girls were followed from birth until a pregnancy occurred (n5128). Questionnaires were administered in early and late pregnancy to assess new occurrences of asthma, eczema and changes (remission, persistence) of existing disease. RESULTS: Of 85 women without asthma at 18 years, 13 women developed new-onset asthma during the 1stpregnancy (15.3%) which persisted in three (of five) women with a second pregnancy. Of these 13 women, 11 had prior wheezing history. Asthma persisted in 28 of 33 (84.9%) women from 18 years to first pregnancy and in all who had a second pregnancy. Regarding eczema, 96 were eczema-free at age 18. Of these, 15 developed eczema (15.6%), which persisted in two (of five) with a second pregnancy. Two developed new-onset eczema during second pregnancy. Of the 15 who developed eczema during pregnancy, 4 had a prior history of rash. Of 21 girls who had eczema at 18 years, 11 continued to have eczema, 7 had a remission, but 1 woman had eczema recurring in the second pregnancy. CONCLUSIONS: New-onset of asthma and eczema occurs in pregnancy in about 15% of disease-free women.
514
Evidence for Harm Reversal in Asthmatic Smokers Who Switched to Regular Electronic Cigarettes Use Pasquale Caponnetto1, Riccardo Polosa, MD, PhD, FAAAAI2, Jaymin Morjaria3, Massimo Caruso, PhD, FIT, AAAAI2, Simona Strano4, Cristina Russo, MD5; 1University of Catania, Italy, 2University of Catania, Catania, Italy, 3Dept of Academic Respiratory Medicine, University of Hull, Castle Hill Hospital, Cottingham, East Yorkshire, United Kingdom, HU16 5JQ, 4University of Catania, 5university of catania, Catania, Italy. RATIONALE: Asthmatic smokers have more severe disease, inadequate disease control, and poor response to therapies. Here we retrospectively evaluate asthma outcomes in smoking asthmatics who switched to ecigarettes (EC) use. METHODS: Changes in lung function, methacholine airway hyperresponsiveness, exacerbations and subjective asthma outcomes were assessed after 6 (61){V1} and 12 (61.5){V2} months of regular EC use compared to baseline {BL} as well 6-12 {pre-BL} months earlier. RESULTS: Eighteen (11M, 7F; 38.8 6 12.3 years) subjects were reviewed, of whom ten were single (EC only) and eight dual (EC and cigarettes) users. No differences were noted in any outcomes between BL and pre-BL. Compared to BL there were significant improvements in all objective and subjective asthma parameters at V2, and some at V1. FEV1 improved from 3,30 6 0.78 L (BL) to 3,40 6 0.73 L (V2); FVC improved from 4,28 6 0.90 L (BL) to 4,43 6 0.78 L (V2); FEF25-75% improved from 2,75 6 0.72 L/sec (BL) to 3,11 6 0.57 L/sec (V2); PC20 Mch improved from 1,24 mg/ml (BL) to 2,56 mg/ml (V2); ACQ improved from 2,03 (BL) to 1,47 (V2). At both V1 and V2 compared to BL there were marked reductions in daily conventional cigarette consumption. No adverse events were reported with EC use. CONCLUSIONS: In asthmatics who smoke, EC use is well tolerated and may have a positive impact on asthma outcomes. We hypothesize that EC use in smoking asthmatics may be a safer alternative to conventional cigarette consumption and has potential for smoking cessation/reduction and respiratory harm reversal.
SUNDAY
511