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Follow-up of Wheezing in Preschool Children From Cuiabá, MT, Brazil
AB208 Abstracts
Follow-up of Wheezing in Preschool Children From Cuiaba, MT, Brazil Lillian Sanchez Lacerda Moraes, MD, MSc1, Dirceu Sole, MD, PhD2, Olga Takano, MD, PhD3; 1Federal University of Mato Grosso, 2Federal University of Sao Paulo, Sao Paulo, Brazil, 3Federal University of Mato Grosso, cuiaba, Brazil. RATIONALE: The prevalence of wheezing in infants in Cuiaba, Brazil is high, as previously identified by the International Study of Wheezing in Infants (EISL)-Phase3 (P3).The aim of this study was to verify the persistence and onset of wheezing and related factors in preschool children involved in EISL-P3. METHODS: Parents of infants who participated in EISL-P3. in Cuiaba, answered a telephone interview after 12 6 6 months of the first questionnaire. Factors associated to wheezing were studied by bivariate and multivariate analysis (SPSS v.18.0) and expressed as odds ratio (OR) and 95% confidence interval (95%CI). RESULTS: Parents of 130 wheezy children (W) and of 366 children whose not wheezy (NW) in the first year of life were interviewed. The average age was 29.863.2 months and 262 were girls (52.9%). Among the W children, 70 (14.1%) still had current wheezing (persistent wheezers), nine (12.9%) of these children were diagnosed as asthmatic. Among the NW children, 48 (9.7%) had current wheezing (intermediate-onset wheezer). Factors associated with persistent and intermediate-onset wheezing were: allergic rhinits (OR54.85; 95%CI 52.98-7.88); exposure to maternal smoking (OR53.38; 95%CI51.31-8.73); antibiotics for pneumonia (OR53.55; 95%CI51.73-7.34); paracetamol more than four times (OR52.00; 95%CI51,27-3.16). CONCLUSIONS: Wheezing that started in the first year of life remains frequent among preschool children from Cuiaba, but the diagnosis of asthma are still rare. Exposure to antibiotics and paracetamol was associated with persistent wheezing but more researches are required to clarify this potential association.
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742
TUESDAY
How Does Asthma Related Internet Search Correlate with Extrinsic Triggers in Urban Centers? Rohit Divekar, MBBS, PhD, Suresh Bhavnani, PhD; Univ. of Texas Medical Branch at Galveston, Galveston, TX. RATIONALE: To assess the relation between real-time location-specific asthma related Internet search information and extrinsic triggers of asthma exacerbations. METHODS: In order to extend our previous work to include air quality information, we collected pollen, mold [City of Houston] and air quality data [Texas Commission on Environmental Quality] during the period 2010-2011. Further more, we extracted all searches related to asthma from Google Insights for Houston. Cumulative data on a monthly scale was normalized using min-max algorithm, and heat maps generated for comparative analyses. RESULTS: Consistent with our prior observations for other cities, search volume for asthma related terms demonstrated phases of increased activity in some months e.g. Jan and Oct (2011), Asthma related Internet searches demonstrated a consistent correlation with the level of SO2 (sulfur dioxide) and NO2 (nitrogen dioxide) [mean r 5 0.56 and 0.54 respectively, p<0.05]. There was also a weaker positive correlation with weed pollen and CO (carbon monoxide) [r 5 0.41 and 0.38, p < 0.05]. Surprisingly, there was no correlation with mold, tree, grass, ozone, and suspended particulate matter (PM2.5) for the duration studied. CONCLUSIONS: Results suggest that asthma related Internet searches vary temporally with extrinsic triggers. Because recent studies have shown strong correlation between pollen and asthma related ED visits, the results suggest that asthma searches contain important information and combined with data from physician/ER visits, could provide clinicians with an important tool for the health planning, resource utilization and management of asthma exacerbation in specific geographic locations.
J ALLERGY CLIN IMMUNOL FEBRUARY 2013
743
Analysis of Relationship Between Asthma and Rhinitis Symptoms in Patients Treated in University Hospital by Using Sacra Questionnaire Hiroyuki Nagase, MD, PhD1, Naoya Sugimoto1, Yuko Nakase1, Yusuke Tanaka1, Asae Kamiyama1, Yasuhiro Kojima1, Hisanao Yoshihara1, Michio Kuramochi1, Hiroyuki Tashimo1, Hidenori Arai1, Masao Yamaguchi1, Ken Ohta1,2; 1Teikyo University School of Medicine, Tokyo, Japan, 2 National Hospital Organization Tokyo National Hospital, Tokyo, Japan. RATIONALE: Recently, a nation-wide study investigating the relationship between rhinitis and asthma symptoms (SACRA study) was performed in Japan and 67.4% of asthma patients were diagnosed to have rhinitis and the relationship between asthma and rhinitis were shown. But in SACRA study, 86% of participants were primary care physicians and the effect of treatment was not evaluated. We investigated if the same relationship is also observed in patients treated by specialists and the effect of treatment was also evaluated. METHODS: Asthma patients diagnosed by specialists were enrolled and consecutive 111 patients filled the SACRA questionnaire. RESULTS: One hundred questionnaire (90.1%) was available and 65% of those cases were diagnosed as rhinitis. SACRA questionnaire contains visual analogue scale (VAS) and VAS of asthma symptom was significantly longer in rhinitis (+) as compared to rhinitis (-) (28.2 vs 11.2 mm), but the absolute length was shorter than nation-wide study (47.5 vs 29 mm). The ratio of uncontrolled asthma was significantly higher in rhinitis (+) (16.9 vs 5.7%). VAS of asthma and rhinitis were significantly and positively correlated. Although leukotriene receptor antagonist (50 vs 24.2%) and anti-histamine (48.3 vs 18.2%) was significantly more frequently prescribed, asthma control was still significantly worse in rhinitis (+), as described above. Twenty (33.3%) out of 60 rhinitis (+) patients were newly diagnosed as rhinitis by SACRA questionnaire, suggesting its potential usefulness in diagnosing rhinitis. CONCLUSIONS: The significant difference in asthma control depending on rhinitis was still observed in patients treated by specialists and closer attention should be paid for rhinitis in asthma.
744
Associations Between Asthma and Puberty in Swedish Children Jennifer Protudjer, PhD, Cecilia Lundholm, MSc, Anna Bergstrom, PhD, Inger Kull, PhD, Catarina Almqvist, MD, PhD; Karolinska Institute, Stockholm, Sweden. RATIONALE: The evidence relating to asthma, puberty and growth is conflicting. METHODS: Using data from a longitudinal, population-based, asthmacentric cohort of Swedish singletons (born 1994-1996), we sought to 1 consider the association between pubertal staging and asthma (presence, timing, severity, treatment), and 2 examine if the use of asthma medications influences pubertal staging and height. At Yr8 and Yr12, anthropometric data were collected, as were data on asthma (presence, symptoms, management) in the previous 12 months. At Yr12, children answered pubertyrelated questions. RESULTS: Retention through Yr12 was high (3339/4089 [82%]). We excluded 593 for whom pubertal data were not available, yielding a study population of 2746 (50.2% boys). Nearly all (97.8%) boys were pre, early or mid-pubertal, and almost half (47.6%) of girls were late/post pubertal. At Yr8, 7.3% boys and 5.2% girls had asthma. At Yr12, 84% boys and 4.9% girls had asthma. Amongst girls, late/post puberty was associated with a reduced odds of asthma at Yr12 (OR 0.23; 95%CI 0.09-0.60) and incident asthma (OR 0.17; 95%CI 0.05-0.52). Amongst boys, inhaled corticosteroids use with or without long-acting ß-agonists, was crosssectionally associated with shorter height vs. asthma medications/bronchodilators only at Yr12 (ß-4.32, 95%CI -8.20 - -0.43, p<0.01). CONCLUSIONS: Girls who enter puberty earlier have a lower risk of asthma by the time they reach late/post puberty. Boys who use ICS or ICSLABA tend to be shorter at ages 11.4-14.3 years than boys with asthma who do not use asthma medications or use bronchodilators only.
Follow-up of Wheezing in Preschool Children From Cuiaba, MT, Brazil Lillian Sanchez Lacerda Moraes, MD, MSc1, Dirceu Sole, MD, PhD2, Olga Takano, MD, PhD3; 1Federal University of Mato Grosso, 2Federal University of Sao Paulo, Sao Paulo, Brazil, 3Federal University of Mato Grosso, cuiaba, Brazil. RATIONALE: The prevalence of wheezing in infants in Cuiaba, Brazil is high, as previously identified by the International Study of Wheezing in Infants (EISL)-Phase3 (P3).The aim of this study was to verify the persistence and onset of wheezing and related factors in preschool children involved in EISL-P3. METHODS: Parents of infants who participated in EISL-P3. in Cuiaba, answered a telephone interview after 12 6 6 months of the first questionnaire. Factors associated to wheezing were studied by bivariate and multivariate analysis (SPSS v.18.0) and expressed as odds ratio (OR) and 95% confidence interval (95%CI). RESULTS: Parents of 130 wheezy children (W) and of 366 children whose not wheezy (NW) in the first year of life were interviewed. The average age was 29.863.2 months and 262 were girls (52.9%). Among the W children, 70 (14.1%) still had current wheezing (persistent wheezers), nine (12.9%) of these children were diagnosed as asthmatic. Among the NW children, 48 (9.7%) had current wheezing (intermediate-onset wheezer). Factors associated with persistent and intermediate-onset wheezing were: allergic rhinits (OR54.85; 95%CI 52.98-7.88); exposure to maternal smoking (OR53.38; 95%CI51.31-8.73); antibiotics for pneumonia (OR53.55; 95%CI51.73-7.34); paracetamol more than four times (OR52.00; 95%CI51,27-3.16). CONCLUSIONS: Wheezing that started in the first year of life remains frequent among preschool children from Cuiaba, but the diagnosis of asthma are still rare. Exposure to antibiotics and paracetamol was associated with persistent wheezing but more researches are required to clarify this potential association.
741
742
TUESDAY
How Does Asthma Related Internet Search Correlate with Extrinsic Triggers in Urban Centers? Rohit Divekar, MBBS, PhD, Suresh Bhavnani, PhD; Univ. of Texas Medical Branch at Galveston, Galveston, TX. RATIONALE: To assess the relation between real-time location-specific asthma related Internet search information and extrinsic triggers of asthma exacerbations. METHODS: In order to extend our previous work to include air quality information, we collected pollen, mold [City of Houston] and air quality data [Texas Commission on Environmental Quality] during the period 2010-2011. Further more, we extracted all searches related to asthma from Google Insights for Houston. Cumulative data on a monthly scale was normalized using min-max algorithm, and heat maps generated for comparative analyses. RESULTS: Consistent with our prior observations for other cities, search volume for asthma related terms demonstrated phases of increased activity in some months e.g. Jan and Oct (2011), Asthma related Internet searches demonstrated a consistent correlation with the level of SO2 (sulfur dioxide) and NO2 (nitrogen dioxide) [mean r 5 0.56 and 0.54 respectively, p<0.05]. There was also a weaker positive correlation with weed pollen and CO (carbon monoxide) [r 5 0.41 and 0.38, p < 0.05]. Surprisingly, there was no correlation with mold, tree, grass, ozone, and suspended particulate matter (PM2.5) for the duration studied. CONCLUSIONS: Results suggest that asthma related Internet searches vary temporally with extrinsic triggers. Because recent studies have shown strong correlation between pollen and asthma related ED visits, the results suggest that asthma searches contain important information and combined with data from physician/ER visits, could provide clinicians with an important tool for the health planning, resource utilization and management of asthma exacerbation in specific geographic locations.
J ALLERGY CLIN IMMUNOL FEBRUARY 2013
743
Analysis of Relationship Between Asthma and Rhinitis Symptoms in Patients Treated in University Hospital by Using Sacra Questionnaire Hiroyuki Nagase, MD, PhD1, Naoya Sugimoto1, Yuko Nakase1, Yusuke Tanaka1, Asae Kamiyama1, Yasuhiro Kojima1, Hisanao Yoshihara1, Michio Kuramochi1, Hiroyuki Tashimo1, Hidenori Arai1, Masao Yamaguchi1, Ken Ohta1,2; 1Teikyo University School of Medicine, Tokyo, Japan, 2 National Hospital Organization Tokyo National Hospital, Tokyo, Japan. RATIONALE: Recently, a nation-wide study investigating the relationship between rhinitis and asthma symptoms (SACRA study) was performed in Japan and 67.4% of asthma patients were diagnosed to have rhinitis and the relationship between asthma and rhinitis were shown. But in SACRA study, 86% of participants were primary care physicians and the effect of treatment was not evaluated. We investigated if the same relationship is also observed in patients treated by specialists and the effect of treatment was also evaluated. METHODS: Asthma patients diagnosed by specialists were enrolled and consecutive 111 patients filled the SACRA questionnaire. RESULTS: One hundred questionnaire (90.1%) was available and 65% of those cases were diagnosed as rhinitis. SACRA questionnaire contains visual analogue scale (VAS) and VAS of asthma symptom was significantly longer in rhinitis (+) as compared to rhinitis (-) (28.2 vs 11.2 mm), but the absolute length was shorter than nation-wide study (47.5 vs 29 mm). The ratio of uncontrolled asthma was significantly higher in rhinitis (+) (16.9 vs 5.7%). VAS of asthma and rhinitis were significantly and positively correlated. Although leukotriene receptor antagonist (50 vs 24.2%) and anti-histamine (48.3 vs 18.2%) was significantly more frequently prescribed, asthma control was still significantly worse in rhinitis (+), as described above. Twenty (33.3%) out of 60 rhinitis (+) patients were newly diagnosed as rhinitis by SACRA questionnaire, suggesting its potential usefulness in diagnosing rhinitis. CONCLUSIONS: The significant difference in asthma control depending on rhinitis was still observed in patients treated by specialists and closer attention should be paid for rhinitis in asthma.
744
Associations Between Asthma and Puberty in Swedish Children Jennifer Protudjer, PhD, Cecilia Lundholm, MSc, Anna Bergstrom, PhD, Inger Kull, PhD, Catarina Almqvist, MD, PhD; Karolinska Institute, Stockholm, Sweden. RATIONALE: The evidence relating to asthma, puberty and growth is conflicting. METHODS: Using data from a longitudinal, population-based, asthmacentric cohort of Swedish singletons (born 1994-1996), we sought to 1 consider the association between pubertal staging and asthma (presence, timing, severity, treatment), and 2 examine if the use of asthma medications influences pubertal staging and height. At Yr8 and Yr12, anthropometric data were collected, as were data on asthma (presence, symptoms, management) in the previous 12 months. At Yr12, children answered pubertyrelated questions. RESULTS: Retention through Yr12 was high (3339/4089 [82%]). We excluded 593 for whom pubertal data were not available, yielding a study population of 2746 (50.2% boys). Nearly all (97.8%) boys were pre, early or mid-pubertal, and almost half (47.6%) of girls were late/post pubertal. At Yr8, 7.3% boys and 5.2% girls had asthma. At Yr12, 84% boys and 4.9% girls had asthma. Amongst girls, late/post puberty was associated with a reduced odds of asthma at Yr12 (OR 0.23; 95%CI 0.09-0.60) and incident asthma (OR 0.17; 95%CI 0.05-0.52). Amongst boys, inhaled corticosteroids use with or without long-acting ß-agonists, was crosssectionally associated with shorter height vs. asthma medications/bronchodilators only at Yr12 (ß-4.32, 95%CI -8.20 - -0.43, p<0.01). CONCLUSIONS: Girls who enter puberty earlier have a lower risk of asthma by the time they reach late/post puberty. Boys who use ICS or ICSLABA tend to be shorter at ages 11.4-14.3 years than boys with asthma who do not use asthma medications or use bronchodilators only.