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Fatal asthma in an urban population—Preliminary findings of a retrospective study
J ALLERGY CLIN IMMUNOL VOLUME 111, NUMBER 2
359 Asthma in Puerto Rico
Abstracts
61
$159
High Medication Usage in a Large Cohort of Patients with Severe or Difficult-to-Treat Asthma
E. R. Bleecker j , R. Perez-Perdomo 2, J. Arvizu 3, S. Howard 1, D. A. Meyerst; JCenter for Human Genomics, Wake Forest University School of Medicine, Winston-Salem, NC, 2University of Puerto Rico, San Juan, PR, 3GlaxoSmithKline, San Juan, PR. RATIONALE: Since the prevalence and severity of asthma varies based on the ethnic population studied, with prior studies in Puerto Rico having shown asthma estimates as high as 15.9%, we conducted a more comprehensive study of the disease in this territory. METHODS: We performed a random digit dialed phone survey of patients diagnosed with asthma based on a modified Asthma in America survey, translated into Spanish. A total of 6,934 households were contacted and 1,069 interviews were conducted. Participants were asked questions concerning the frequency of their asthma symptoms, healthcare utilization and the effect asthma had on their quality of life. RESULTS: The asthma prevalence in Puerto Rico was 15.4%, with 34% of the respondents being classified as severe persistent (NAEP Guidelines). The findings revealed that asthma management in Puerto Rico falls short of the goals established by NAEP Guidelines: 35% reported experiencing nocturnal symptoms once a week and 45% of the "at risk group" had an asthma related absence in the past year. The effect extends to the health care system with 20% being hospitalized for asthma in the past year and 55% requiring some form of urgent care. CONCLUSIONS: There is a high prevalence of asthma in Puerto Rico, with a large percentage of asthmatics classified as severe persistent. In addition, there is evidence of very high healthcare utilization and asthma related morbidity. Further study is necessary to assess how healthcare delivery, genetic susceptibility and social factors affect the prevalence and severity of asthma in Puerto Rico.
C. Johnson 1, B. E. Chipps 2, C. M. Dolan l, E. H. Warrenl; IGenentech, Inc, South San Francisco, CA, 2Capitol Allergy and Respiratory Disease Center, Sacramento, CA. RATIONALE: Severe asthma patients account for much of the morbidity, mortality and healthcare costs of the disease, yet little is known about medication use and treatment practices for these patients. METHODS: 4,756 patients with severe or difficult-to-treat asthma were enrolled in The Epidemiology and Natural History of Asthma: Outcomes and Treatment regimens (TENOR) study between Jan-Oct, 2001. Subjects reported current asthma control medications, including long-term controller (LTC) and quick-relief medications. RESULTS: The majority of patients reported currently taking LTC for their asthma, with 98% on ->1 controller medication. The use of multiple controllers was common (91%): 35% of the cohort reported using two controllers and 56% were using three. The most common LTC were inhaled corticosteroids (94%), long acting beta2-agonists (77%), and leukotriene modifiers (61%). The use of LTC was similar by age, although leukotriene modifiers were more common in children than adults (71% v 57%). Current systemic corticosteroid use was reported by 19% of the cohort. Short acting beta-agonists were used by 93% of the cohort. Patients reported high rates of asthma-related healthcare utilization (HCU) in the previous three months despite the high use of multiple LTC. Among those on >3 LTC (n=2,679) rates of HCU remained high including unscheduled office visits (47%), steroid bursts (52%), emergency room visits (17%), and hospitalizations (7%). CONCLUSIONS: The TENOR study characterizes a group of patients with severe or difficult-to-treat asthma reporting very high rates of HCU despite the use of multiple standard-of-care asthma medications.
Funding: GlaxoSmithKline
Funding: Industry
3 6 0 ""' Asthma in an Urban Population--Preliminary Findings of
362 ,s c in Hanoi, Vietnam: 1999-2002
a Retrospective Study P. C. Tolomeo l, M. Polansky 2, M. Sherman 3, D. Lang4; IThomas Jefferson University, Philadelphia, PA, 2School of Public Health, Drexel University, Philadelphia, PA, 3School of Public Health, Drexel University, Philadelphia, PA, 4Cleveland Clinic Foundation, Cleveland, OH. Annual rates of urban asthma mortality (AM) have surged (NEJM 1994;331:1572). Data suggest a subgroup without severe asthma are at risk forAM (Med J Aust 1990;152:511); this has not been examined in an urban US population. We surveyed decedents' next-of-kin (NK) to explore circumstances surrounding AM. Death certificates of AM (J45/J46) in Philadelphia residents from 1999-2001 were obtained from Pennsylvania Health Department. We contacted NK for phone interviews regarding demographics, asthma duration/severity/management, and terminal episode. TJU IRB approved the study. Of 103 cases, 71 could be contacted. Of the 71, 26 (37%) agreed to be surveyed. Median age was 57 years: 69% were female, 77% were African-American; 19 were hospitalized for asthma, 23 required emergency department (ED) management; 24 were managed by generalists, 13 saw an asthma specialist. Inhaled steroid was taken by 22, oral steroid by 12. Those with "severe" asthma were more likely to awak n at night (p=0.01, Z2 likelihood ratio), require ED visits (p=0.04)/hospitalization for asthma (p=0.02), and experience daily activity disruption (p<0.001). "Mild" (6) or "moderate" (5) asthmatics were more likely to experience sudden fatal episodes without prior asthma worsening (p=0.07). "Severe" asthmatics were not more likely to be managed by AS, and were significantly more likely to use television as primary entertainment (p=0.001). Our preliminary findings support the contention that an AM subgroup did not have "severe" asthma. Fatal asthma may be more likely in association with sedentary lifestyle. If confirmed in additional studies, these data have implications for AM prevention and pharmacotherapeutic management of persistent asthma.
Funding: GlaxoSmithKline
S. K. Chai j, N. N. Nga 2, H. Checkoway 1, T. T. Binh 2, T. K. Takaro I, G. J. Redding 3, D. K. Van 2, P. H. Son 2, M. C. Keifer I, L. V. Trung 2, S. Barnhart4; 1Department of Environmental Health, University of Washington, Seattle, WA, 2National Institute of Occupational and Environmental Health, Ministry of Health, Hanoi, VIETNAM, 3Department of Pediatrics, Division of Pulmonary Medicine, University of Washington, Seattle, WA, 4Harborview Medical Center, University of Washington, Seattle, WA. RATIONALE: Two critical issues regarding international asthma and allergy epidemiology at the local level are translational concerns and time trends. The modern Vietnamese language has terms for "wheezing," "asthma," and "hay fever" which are evolving into the colloquial. In addition, Hanoi is a growing urban center whose population's lifestyle is rapidly modernizing. METHODS: The parent-administered ISAAC was implemented in Dong Anh, a suburb of Hanoi in 2001 and in Hanoi in 1999 and 2002. We describe here results of the 2002 study and relevance to the 2 previous studies. The response rate was 97.0% (N=3251 ). RESULTS: The overall prevalence of ever wheeze was 21.4%, for wheeze in last 12 months 13.0%, for wheeze disturbs sleep 15.0%, for ever asthma 10.5%. The overall prevalence of ever allergic rhinitis symptoms (AR) was 31.9%, for AR symptoms in last 12 months 24.4%, for AR-conjunctivitis symptoms in last 12 months 9.7%, for ever hay fever 13.8%. All prevalence estimates in Dong Anh in 2001 were significantly higher than in Hanoi in 2002. Hanoi in 1999 had significantly higher estimates than in 2002 for all symptoms except wheeze in last 12 months, ever asthma, ever AR-conjunctivitis symptoms in last 12 months, and AR symptoms in last 12 months. C O N C L U S I O N S : ISAAC symptom estimates continue to be near or above global averages in Hanoi. Response rate, translational, linguistic and other issues may explain the decreasing trend. It is unlikely that the results of this study reflect a true decrement in childhood asthma and allergy prevalence in Vietnam.
Funding: Fogarty International Center, National Institutes of Health
359 Asthma in Puerto Rico
Abstracts
61
$159
High Medication Usage in a Large Cohort of Patients with Severe or Difficult-to-Treat Asthma
E. R. Bleecker j , R. Perez-Perdomo 2, J. Arvizu 3, S. Howard 1, D. A. Meyerst; JCenter for Human Genomics, Wake Forest University School of Medicine, Winston-Salem, NC, 2University of Puerto Rico, San Juan, PR, 3GlaxoSmithKline, San Juan, PR. RATIONALE: Since the prevalence and severity of asthma varies based on the ethnic population studied, with prior studies in Puerto Rico having shown asthma estimates as high as 15.9%, we conducted a more comprehensive study of the disease in this territory. METHODS: We performed a random digit dialed phone survey of patients diagnosed with asthma based on a modified Asthma in America survey, translated into Spanish. A total of 6,934 households were contacted and 1,069 interviews were conducted. Participants were asked questions concerning the frequency of their asthma symptoms, healthcare utilization and the effect asthma had on their quality of life. RESULTS: The asthma prevalence in Puerto Rico was 15.4%, with 34% of the respondents being classified as severe persistent (NAEP Guidelines). The findings revealed that asthma management in Puerto Rico falls short of the goals established by NAEP Guidelines: 35% reported experiencing nocturnal symptoms once a week and 45% of the "at risk group" had an asthma related absence in the past year. The effect extends to the health care system with 20% being hospitalized for asthma in the past year and 55% requiring some form of urgent care. CONCLUSIONS: There is a high prevalence of asthma in Puerto Rico, with a large percentage of asthmatics classified as severe persistent. In addition, there is evidence of very high healthcare utilization and asthma related morbidity. Further study is necessary to assess how healthcare delivery, genetic susceptibility and social factors affect the prevalence and severity of asthma in Puerto Rico.
C. Johnson 1, B. E. Chipps 2, C. M. Dolan l, E. H. Warrenl; IGenentech, Inc, South San Francisco, CA, 2Capitol Allergy and Respiratory Disease Center, Sacramento, CA. RATIONALE: Severe asthma patients account for much of the morbidity, mortality and healthcare costs of the disease, yet little is known about medication use and treatment practices for these patients. METHODS: 4,756 patients with severe or difficult-to-treat asthma were enrolled in The Epidemiology and Natural History of Asthma: Outcomes and Treatment regimens (TENOR) study between Jan-Oct, 2001. Subjects reported current asthma control medications, including long-term controller (LTC) and quick-relief medications. RESULTS: The majority of patients reported currently taking LTC for their asthma, with 98% on ->1 controller medication. The use of multiple controllers was common (91%): 35% of the cohort reported using two controllers and 56% were using three. The most common LTC were inhaled corticosteroids (94%), long acting beta2-agonists (77%), and leukotriene modifiers (61%). The use of LTC was similar by age, although leukotriene modifiers were more common in children than adults (71% v 57%). Current systemic corticosteroid use was reported by 19% of the cohort. Short acting beta-agonists were used by 93% of the cohort. Patients reported high rates of asthma-related healthcare utilization (HCU) in the previous three months despite the high use of multiple LTC. Among those on >3 LTC (n=2,679) rates of HCU remained high including unscheduled office visits (47%), steroid bursts (52%), emergency room visits (17%), and hospitalizations (7%). CONCLUSIONS: The TENOR study characterizes a group of patients with severe or difficult-to-treat asthma reporting very high rates of HCU despite the use of multiple standard-of-care asthma medications.
Funding: GlaxoSmithKline
Funding: Industry
3 6 0 ""' Asthma in an Urban Population--Preliminary Findings of
362 ,s c in Hanoi, Vietnam: 1999-2002
a Retrospective Study P. C. Tolomeo l, M. Polansky 2, M. Sherman 3, D. Lang4; IThomas Jefferson University, Philadelphia, PA, 2School of Public Health, Drexel University, Philadelphia, PA, 3School of Public Health, Drexel University, Philadelphia, PA, 4Cleveland Clinic Foundation, Cleveland, OH. Annual rates of urban asthma mortality (AM) have surged (NEJM 1994;331:1572). Data suggest a subgroup without severe asthma are at risk forAM (Med J Aust 1990;152:511); this has not been examined in an urban US population. We surveyed decedents' next-of-kin (NK) to explore circumstances surrounding AM. Death certificates of AM (J45/J46) in Philadelphia residents from 1999-2001 were obtained from Pennsylvania Health Department. We contacted NK for phone interviews regarding demographics, asthma duration/severity/management, and terminal episode. TJU IRB approved the study. Of 103 cases, 71 could be contacted. Of the 71, 26 (37%) agreed to be surveyed. Median age was 57 years: 69% were female, 77% were African-American; 19 were hospitalized for asthma, 23 required emergency department (ED) management; 24 were managed by generalists, 13 saw an asthma specialist. Inhaled steroid was taken by 22, oral steroid by 12. Those with "severe" asthma were more likely to awak n at night (p=0.01, Z2 likelihood ratio), require ED visits (p=0.04)/hospitalization for asthma (p=0.02), and experience daily activity disruption (p<0.001). "Mild" (6) or "moderate" (5) asthmatics were more likely to experience sudden fatal episodes without prior asthma worsening (p=0.07). "Severe" asthmatics were not more likely to be managed by AS, and were significantly more likely to use television as primary entertainment (p=0.001). Our preliminary findings support the contention that an AM subgroup did not have "severe" asthma. Fatal asthma may be more likely in association with sedentary lifestyle. If confirmed in additional studies, these data have implications for AM prevention and pharmacotherapeutic management of persistent asthma.
Funding: GlaxoSmithKline
S. K. Chai j, N. N. Nga 2, H. Checkoway 1, T. T. Binh 2, T. K. Takaro I, G. J. Redding 3, D. K. Van 2, P. H. Son 2, M. C. Keifer I, L. V. Trung 2, S. Barnhart4; 1Department of Environmental Health, University of Washington, Seattle, WA, 2National Institute of Occupational and Environmental Health, Ministry of Health, Hanoi, VIETNAM, 3Department of Pediatrics, Division of Pulmonary Medicine, University of Washington, Seattle, WA, 4Harborview Medical Center, University of Washington, Seattle, WA. RATIONALE: Two critical issues regarding international asthma and allergy epidemiology at the local level are translational concerns and time trends. The modern Vietnamese language has terms for "wheezing," "asthma," and "hay fever" which are evolving into the colloquial. In addition, Hanoi is a growing urban center whose population's lifestyle is rapidly modernizing. METHODS: The parent-administered ISAAC was implemented in Dong Anh, a suburb of Hanoi in 2001 and in Hanoi in 1999 and 2002. We describe here results of the 2002 study and relevance to the 2 previous studies. The response rate was 97.0% (N=3251 ). RESULTS: The overall prevalence of ever wheeze was 21.4%, for wheeze in last 12 months 13.0%, for wheeze disturbs sleep 15.0%, for ever asthma 10.5%. The overall prevalence of ever allergic rhinitis symptoms (AR) was 31.9%, for AR symptoms in last 12 months 24.4%, for AR-conjunctivitis symptoms in last 12 months 9.7%, for ever hay fever 13.8%. All prevalence estimates in Dong Anh in 2001 were significantly higher than in Hanoi in 2002. Hanoi in 1999 had significantly higher estimates than in 2002 for all symptoms except wheeze in last 12 months, ever asthma, ever AR-conjunctivitis symptoms in last 12 months, and AR symptoms in last 12 months. C O N C L U S I O N S : ISAAC symptom estimates continue to be near or above global averages in Hanoi. Response rate, translational, linguistic and other issues may explain the decreasing trend. It is unlikely that the results of this study reflect a true decrement in childhood asthma and allergy prevalence in Vietnam.
Funding: Fogarty International Center, National Institutes of Health