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Increased Exhaled Nitric Oxide Levels are Associated with Methacholine Responsiveness in Atopic but not in Non-Atopic African American subjects
S80 Abstracts
J ALLERGY CLIN IMMUNOL FEBRUARY 2008
SUNDAY
Validity and Reliability of the St. George's Respiratory Questionnaire in Asthmatic Patients T. Kim; Asan Medical Center, University of Ulsan College of Medicine, Seoul, REPUBLIC OF KOREA. RATIONALE: Asthma is a chronic respiratory disease which can affect health related quality of life and finally cause disability. Therefore, adequate and valid assessment of quality of life by questionnaire is one of very important tools in monitoring for level of control in asthmatics. St George’s Respiratory Questionnaire (SGRQ), a self-administered questionnaire has been used for evaluation of quality of life in chronic obstructive lung disease and asthma. However, the validity and reliability of SGRQ were not proved in large population of asthmatic patients yet. METHODS: We used Korean version of SGRQ permitted by the author previously. We analyzed 688 patients of asthma recruited from ÔCohort for Reality and Evolution of Adult Asthma in KoreaÕ (COREA) since the year of 2005. Statistically, we used Cronbach’s alpha coefficient for reliability and Pearson’s coefficient for the correlation between SGRQ scores and various clinical factors. RESULTS: Cronbach’s alpha reliability coefficient was 0.92 for total score, 0.49 for the domain of symptoms, 0.88 for activity, and 0.88 for impacts. The correlation coefficients between the total score and symptom duration, diagnosis duration, treatment duration, previous hospital visit due to exacerbation, FVC (predicted %), FEV1 (predicted %), and FVC/FEV1 were 0.179 (p < 0.001), 0.080 (0.140), -0.043 (0.467), -0.163 (<0.001), -0.197 (<0.001), -0.312 (<0.001), and -0.199 (<0.001) respectively. CONCLUSIONS: SGRQ was a reliable and valid test of quality of life for patients with asthma, and scores were well correlated with duration of symptom, lung function, and previous exacerbation history.
307
University Medical Center, Durham, NC, 2Ohio State University, Columbus, OH. RATIONALE: Exhaled Nitric Oxide (FeNO) is increasingly being used as a measure of lung inflammation in the diagnosis and treatment of asthma. We determined the relationship between FeNO and methacholine response. METHODS: Fifty-nine self-declared healthy 18-40 year old African American subjects, underwent skin testing, FeNO measurements, Serum IgE testing and methacholine challenge. Subjects were initially divided on the basis of skin test results, IgE was confirmatory. RESULTS: Subjects were divided on the basis on allergy skin test reactions. Non-atopic, methacholine negative subjects (n 5 32, controls) had a mean FeNO 16.8 ppb; mean serum IgE of 35.0 kU/L (median 11.5 kU/L). In non-atopic, methacholine positive subjects (n 5 5) mean FeNO was 16.2 ppb (p 5 0.951 vs. controls); mean serum IgE of 19.4 kU/L (p 5 0.852 vs. controls, median 517.0). Atopic, methacholine negative subjects (n 5 17) FeNO was 22.9 ppb (p 5 0.354 vs. controls) mean IgE of 221.5 kU/L (p 5 0.001 vs. contols, median 72.0),. Atopic, methacholine positive subjects (n 5 5) mean FeNO was 108.4 ppb (p < 0.001 vs. controls), mean serum IgE was 270.0 (p 5 0.0083 vs controls, median 5 132.0). CONCLUSIONS: These results indicate that FeNO is predictive of methacholine responsiveness in atopic, but not in non-atopic healthy African Americans. Skin testing for atopy was confirmed with IgE, furthermore, elevated IgE levels with an elevated FeNO also predict methacholine responsiveness in this cohort. These data suggest that clinical use of atopy skin tests and FeNO together can serve as a surrogate for methacholine challenge. Funding: Sandler Program in Asthma Research
308
310
Measuring Severity of Acute Asthma in Pediatric Patients L. M. Nelsen1, J. M. Norquist1, X. Zhu1, D. M. Gurner2, M. H. 3 1 Gorelick ; Merck & Co., Inc., North Wales, PA, 2Merck & Co., Inc., Rahway, NJ, 3Medical College of Wisconsin, Milwaukee, WI. RATIONALE: Valid, reliable clinical assessment of acute asthma severity and response to treatment is important to guide disposition decisions given limitations in the use of objective measures of lung function in children in emergency departments (ED). We validated a modified version of the widely used Pulmonary Index (PI) in children with asthma in the ED. The PI includes respiratory rate, wheezing, accessory muscle use and inspiratory:expiratory ratio (I:E). The modification includes a simplified measure of the I:E component. METHODS: Data from a multi-center, prospective, observational study in pediatric patients (6-14 years) were used to assess inter-rater reliability, validity and responsiveness of the mPI. Patients were randomized (2:1) to mPI or PI; assessments were done by 2 independent raters at initiation of ED treatment and 2 hours. Other clinical assessments included PEFR, O2sat (pulse oximetry) bronchodilator use, and clinical asthma severity. Disposition was determined at 4 hours. RESULTS: 194 patients were enrolled (mPI: 69%). Baseline mPI showed acceptable rater agreement (intra-class correlation coefficient >0.70). Rater agreement on the new I:E component was moderate (k > 0.40). The mPI correlated significantly with PEFR, O2sat and clinical asthma severity. Significant differences in baseline and changes in mPI were observed for children with treatment failure compared to children discharged by 4 hours, and responsiveness, measured by effect size, was strong (>0.8). Overall, the mPI was shown to have superior measurement characteristics compared to the PI. CONCLUSIONS: The mPI, is a valid, reliable, responsive clinical measure of asthma in children (6-14 years) in the ED. Funding: Merck & Co. Inc.
309
Increased Exhaled Nitric Oxide Levels are Associated with Methacholine Responsiveness in Atopic but not in NonAtopic African American subjects C. Foss1, D. W. Hauswirth2, J. S. Sundy1, Z. Y. Yang1, S. Mervin-Blake1, K. M. Alexander1, S. Allgood1, P. D. McNair1, M. C. Levesque1; 1Duke
Clinical Profile of Asthmatic Children Demonstrating a Positive Bronchodilator Response (BDR) D. P. Galant1, T. Morphew2, S. Amaro1, K. Hioe1; 1Children’s Hospital of Orange County, Orange, CA, 2AAFA, Los Angeles, CA. RATIONALE: Although national guidelines recommend spirometry for asthma diagnosis and severity classification, baseline values in children are generally normal. We have previously shown that the BDR can identify many asthmatic children, even those with mild disease. In this study, we further describe the clinical profile of children demonstrating a positive BDR. METHODS: The BDR calculated as the post bronchodilator (BD) forced expiratory volume in 1 sec. (FEV1) - pre BD FEV1/pre BD FEV1 was determined 10 minutes following 2 puffs of albuterol. We compared demographics, clinical severity, prior albuterol usage, exercise limitation and previous year morbidity in those with and without a BDR of 12%. RESULTS: Children with a BDR 12% were more likely to be younger (less than 10 years), odds ratio (OR) 1.5 (p < .05); have severe persistent asthma, OR 2.2 (p < .01); have usual exercise limitation, OR 1.6 (p < .05); use albuterol > 2 days/week, OR 2.0 (p < .01); and experience more morbidity with acute attacks (2/yr), OR 1.6 (p < .05) and school absenteeism (5 days/yr) OR 1.7 (p < .01). CONCLUSIONS: A BDR of 12% identifies a population of children with more poorly controlled asthma.
J ALLERGY CLIN IMMUNOL FEBRUARY 2008
SUNDAY
Validity and Reliability of the St. George's Respiratory Questionnaire in Asthmatic Patients T. Kim; Asan Medical Center, University of Ulsan College of Medicine, Seoul, REPUBLIC OF KOREA. RATIONALE: Asthma is a chronic respiratory disease which can affect health related quality of life and finally cause disability. Therefore, adequate and valid assessment of quality of life by questionnaire is one of very important tools in monitoring for level of control in asthmatics. St George’s Respiratory Questionnaire (SGRQ), a self-administered questionnaire has been used for evaluation of quality of life in chronic obstructive lung disease and asthma. However, the validity and reliability of SGRQ were not proved in large population of asthmatic patients yet. METHODS: We used Korean version of SGRQ permitted by the author previously. We analyzed 688 patients of asthma recruited from ÔCohort for Reality and Evolution of Adult Asthma in KoreaÕ (COREA) since the year of 2005. Statistically, we used Cronbach’s alpha coefficient for reliability and Pearson’s coefficient for the correlation between SGRQ scores and various clinical factors. RESULTS: Cronbach’s alpha reliability coefficient was 0.92 for total score, 0.49 for the domain of symptoms, 0.88 for activity, and 0.88 for impacts. The correlation coefficients between the total score and symptom duration, diagnosis duration, treatment duration, previous hospital visit due to exacerbation, FVC (predicted %), FEV1 (predicted %), and FVC/FEV1 were 0.179 (p < 0.001), 0.080 (0.140), -0.043 (0.467), -0.163 (<0.001), -0.197 (<0.001), -0.312 (<0.001), and -0.199 (<0.001) respectively. CONCLUSIONS: SGRQ was a reliable and valid test of quality of life for patients with asthma, and scores were well correlated with duration of symptom, lung function, and previous exacerbation history.
307
University Medical Center, Durham, NC, 2Ohio State University, Columbus, OH. RATIONALE: Exhaled Nitric Oxide (FeNO) is increasingly being used as a measure of lung inflammation in the diagnosis and treatment of asthma. We determined the relationship between FeNO and methacholine response. METHODS: Fifty-nine self-declared healthy 18-40 year old African American subjects, underwent skin testing, FeNO measurements, Serum IgE testing and methacholine challenge. Subjects were initially divided on the basis of skin test results, IgE was confirmatory. RESULTS: Subjects were divided on the basis on allergy skin test reactions. Non-atopic, methacholine negative subjects (n 5 32, controls) had a mean FeNO 16.8 ppb; mean serum IgE of 35.0 kU/L (median 11.5 kU/L). In non-atopic, methacholine positive subjects (n 5 5) mean FeNO was 16.2 ppb (p 5 0.951 vs. controls); mean serum IgE of 19.4 kU/L (p 5 0.852 vs. controls, median 517.0). Atopic, methacholine negative subjects (n 5 17) FeNO was 22.9 ppb (p 5 0.354 vs. controls) mean IgE of 221.5 kU/L (p 5 0.001 vs. contols, median 72.0),. Atopic, methacholine positive subjects (n 5 5) mean FeNO was 108.4 ppb (p < 0.001 vs. controls), mean serum IgE was 270.0 (p 5 0.0083 vs controls, median 5 132.0). CONCLUSIONS: These results indicate that FeNO is predictive of methacholine responsiveness in atopic, but not in non-atopic healthy African Americans. Skin testing for atopy was confirmed with IgE, furthermore, elevated IgE levels with an elevated FeNO also predict methacholine responsiveness in this cohort. These data suggest that clinical use of atopy skin tests and FeNO together can serve as a surrogate for methacholine challenge. Funding: Sandler Program in Asthma Research
308
310
Measuring Severity of Acute Asthma in Pediatric Patients L. M. Nelsen1, J. M. Norquist1, X. Zhu1, D. M. Gurner2, M. H. 3 1 Gorelick ; Merck & Co., Inc., North Wales, PA, 2Merck & Co., Inc., Rahway, NJ, 3Medical College of Wisconsin, Milwaukee, WI. RATIONALE: Valid, reliable clinical assessment of acute asthma severity and response to treatment is important to guide disposition decisions given limitations in the use of objective measures of lung function in children in emergency departments (ED). We validated a modified version of the widely used Pulmonary Index (PI) in children with asthma in the ED. The PI includes respiratory rate, wheezing, accessory muscle use and inspiratory:expiratory ratio (I:E). The modification includes a simplified measure of the I:E component. METHODS: Data from a multi-center, prospective, observational study in pediatric patients (6-14 years) were used to assess inter-rater reliability, validity and responsiveness of the mPI. Patients were randomized (2:1) to mPI or PI; assessments were done by 2 independent raters at initiation of ED treatment and 2 hours. Other clinical assessments included PEFR, O2sat (pulse oximetry) bronchodilator use, and clinical asthma severity. Disposition was determined at 4 hours. RESULTS: 194 patients were enrolled (mPI: 69%). Baseline mPI showed acceptable rater agreement (intra-class correlation coefficient >0.70). Rater agreement on the new I:E component was moderate (k > 0.40). The mPI correlated significantly with PEFR, O2sat and clinical asthma severity. Significant differences in baseline and changes in mPI were observed for children with treatment failure compared to children discharged by 4 hours, and responsiveness, measured by effect size, was strong (>0.8). Overall, the mPI was shown to have superior measurement characteristics compared to the PI. CONCLUSIONS: The mPI, is a valid, reliable, responsive clinical measure of asthma in children (6-14 years) in the ED. Funding: Merck & Co. Inc.
309
Increased Exhaled Nitric Oxide Levels are Associated with Methacholine Responsiveness in Atopic but not in NonAtopic African American subjects C. Foss1, D. W. Hauswirth2, J. S. Sundy1, Z. Y. Yang1, S. Mervin-Blake1, K. M. Alexander1, S. Allgood1, P. D. McNair1, M. C. Levesque1; 1Duke
Clinical Profile of Asthmatic Children Demonstrating a Positive Bronchodilator Response (BDR) D. P. Galant1, T. Morphew2, S. Amaro1, K. Hioe1; 1Children’s Hospital of Orange County, Orange, CA, 2AAFA, Los Angeles, CA. RATIONALE: Although national guidelines recommend spirometry for asthma diagnosis and severity classification, baseline values in children are generally normal. We have previously shown that the BDR can identify many asthmatic children, even those with mild disease. In this study, we further describe the clinical profile of children demonstrating a positive BDR. METHODS: The BDR calculated as the post bronchodilator (BD) forced expiratory volume in 1 sec. (FEV1) - pre BD FEV1/pre BD FEV1 was determined 10 minutes following 2 puffs of albuterol. We compared demographics, clinical severity, prior albuterol usage, exercise limitation and previous year morbidity in those with and without a BDR of 12%. RESULTS: Children with a BDR 12% were more likely to be younger (less than 10 years), odds ratio (OR) 1.5 (p < .05); have severe persistent asthma, OR 2.2 (p < .01); have usual exercise limitation, OR 1.6 (p < .05); use albuterol > 2 days/week, OR 2.0 (p < .01); and experience more morbidity with acute attacks (2/yr), OR 1.6 (p < .05) and school absenteeism (5 days/yr) OR 1.7 (p < .01). CONCLUSIONS: A BDR of 12% identifies a population of children with more poorly controlled asthma.