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Multiple Hospitalizations for Childhood Asthma: Predictors and Risk Factors
AB242 Abstracts
780
Positive Intradermal Mold Skin Testing Correlates with Past and Future Asthma Emergency Room Visits and Hospitalizations Efren L. Rael, MD, FAAAAI; Allergy/Immunology, Penn State University College of Medicine, Hershey, PA. RATIONALE: Little is known about the effects of allergen testing modalities and outcomes in asthmatics. Controversy exists regarding the utility of intradermal testing (IDT) in allergy practice. METHODS: After informed consent and IRB approval, subjects recruited to the study between 2011 and 2014 underwent clinical evaluation, asthma assessment and allergen skin testing using Greer reagents. Skin testing was interpreted by a board certified allergy physician. IDT was performed if initial mold skin prick testing was negative and was interpreted as positive if 8 millimeters larger than the negative saline control. Past and future asthma emergency room visits, hospitalizations, intubations, and prednisone use was tracked. RESULTS: IDT positivity to Alternaria alternata was associated with future 12 month emergency room visits and intubations. IDT positivity to Cladosporium/Hormodendrum, Epicoccum nigrum, and Aspergillus fumigatus were associated with asthma hospitalization in the past 12 months. IDT positivity to Stemphylium solani was associated with emergency room visits and hospitalization in the past 12 months. CONCLUSIONS: In this observational study, IDT positivity to molds, correlated with significant clinical outcomes. Further studies are necessary to confirm the utility of on asthma outcomes.
781
TUESDAY
Multiple Hospitalizations for Childhood Asthma: Predictors and Risk Factors Bella Lerman, DO1, Ejaz Yousef, MD, FAAAI1,2; 1Marshfield Clinic, Marshfield, WI, 2Marshfield Clinic, MARSHFIELD, WI. RATIONALE: Assess the risk factors for multiple hospitalizations for childhood asthma to prevent future admissions with more appropriate interventions. METHODS: Data for 91 children with asthma, aged 1-18, was collected. We compared characteristics of children with <2 hospital admissions for asthma (Group A, N554) with children who were hospitalized twice or more for asthma (Group B, N537). RESULTS: Group A: Male: Female ratio 70/30. Caucasian 95%, other race 5%. 59% had commercial insurance and 41% had public insurance. 32% had 4 or more ER visits. 24% had 4 or more courses of systemic corticosteroids. 45% had atopic dermatitis. 57% had allergic rhinitis. 24% had food allergies. 84% had family history of asthma. 31% were exposed to secondhand smoke. 45% had gastroesophageal reflux and 9% had enlarged adenoids. Group B: Male: Female ratio 54/46. Caucasian 77%, other race 23%. 25% had commercial insurance and 75% had public insurance. 60% had 4 or more ER visits. 52% had 4 or more courses of systemic corticosteroids. 57% had atopic dermatitis. 49% had allergic rhinitis. 27% had food allergies. 94% had family history. 66% subjects with history of passive household cigarette smoke exposure. 50% had gastroesophageal reflux and 50% had enlarged adenoids. CONCLUSIONS: These data suggest that secondhand smoke exposure, minority race, public insurance, systemic corticosteroid use and presence of atopic dermatitis may act as risk factors for multiple hospital admissions for childhood asthma. Early identification and interventions need to address or take these factors into account to reduce asthma morbidity.
782
Asthma and Asthma Exacerbation Exists in Infants (<1 year) and Can be Treated Effectively with Inhaled Corticosteroids Benjamin Volovitz; Head of Asthma Clinic (ret.), Schneider Children’s Hospital, Tel-Aviv, Israel. RATIONALE: The study provides prospective evidence that asthma exists in infants (<1 year of age) and can be effectively treated using inhaled corticosteroids. METHODS: We evaluated 1500 children aged 0-5 years (31% <1 year) with asthma exacerbation who failed to be controlled by conventional drug
J ALLERGY CLIN IMMUNOL FEBRUARY 2015
therapy. The children were treated with inhaled corticosteroids using three protocols according to the severity of their exacerbation: inhalers, inhalation, or inhalation + azithromycin. RESULTS: The sex ratio, asthma in the family, emergency department visits, hospitalization, duration of asthma symptoms, and usage of beta2agonists or oral corticosteroids were similar in infants and older children. All treated children had a history of prolonged cough and were coughing during their first visit, but only 45% had also wheezing. During the follow-up period there was, for the entire cohort, a 99% reduction in the number of emergency department visits, 93% fewer hospitalizations, and 100% reduction in oral corticosteroid usage. The vast majority of treated children (88%) showed good response to treatment, with similar responses in infants and in older children. No significant differences were found between children with prolonged cough, with or without wheezing. CONCLUSIONS: The data presented indicates that asthma exists also in infants. Asthmatic infants with or without wheezing, have a similar history, signs and symptoms as older children do, and respond well, similarly to treatment with inhaled corticosteroids.
783
Comparisons of Etiology and Clinical Feature of Wheezing Bronchitis Among Lower Respiratory Tract Infections in Hospitalized Young Children in Southern Taiwan Yung-Feng Huang1, Chih-An Chou1, Ying-Yao Chen1, Yao-Shen Chen2; 1 Department of Pediatrics, Kaohsiung Veterans General Hospital, Taiwan, 2 Section of Infectious Diseases, Kaohsiung Veterans, Taiwan. RATIONALE: Lower respiratory tract infections (LRTIs) play an important role in pediatric diseases and cause acute wheezing episodes in young children. This study aimed to investigate the clinical and etiology data of wheezing bronchitis in southern Taiwan. METHODS: Children aged under five years who were hospitalized at a medical center in southern Taiwan with acute LRTIs without recurrent wheezing episodes or asthma from July 2010 to May 2011 were prospectively enrolled. Nasopharyngeal aspirates were obtained and sent for viral cultures, multiplex polymerase chain reactions (PCR) and traditional quick tests. The clinical features, laboratory data and imaging findings were recorded and analyzed. RESULTS: A total of 90 children were enrolled, 70 of whom had detectable pathogens. Adenovirus and enterovirus were the most common viral etiologies identified (26.5%, respectively) and Streptococcus pneumoniawas the leading bacterial etiology(46.4%). Of 22 patients of wheezing, 19 (86.4%) were associated with identifiable viral infections. Respiratory syncytial virus (RSV) (45%) infections and Influenza A virus (43%) infeections show high rate for wheezing. Human metapneumovirus and adenovirus show 25% vs 17% respectively. There were no differences in otitis media, peripheral eosinophile count, and severity of disease or hospital stay among wheezing bronchitis. A similar result was found between non-pneumococcal and pneumococcal infections. CONCLUSIONS: Viral infections were the main etiologies of LRTIs associated wheezing episodes in young children. Mixed infections do not seem to affect the severity of disease or wheezing episodes. RSV and Influenza A virus show leading etiology for wheezing bronchitis.
780
Positive Intradermal Mold Skin Testing Correlates with Past and Future Asthma Emergency Room Visits and Hospitalizations Efren L. Rael, MD, FAAAAI; Allergy/Immunology, Penn State University College of Medicine, Hershey, PA. RATIONALE: Little is known about the effects of allergen testing modalities and outcomes in asthmatics. Controversy exists regarding the utility of intradermal testing (IDT) in allergy practice. METHODS: After informed consent and IRB approval, subjects recruited to the study between 2011 and 2014 underwent clinical evaluation, asthma assessment and allergen skin testing using Greer reagents. Skin testing was interpreted by a board certified allergy physician. IDT was performed if initial mold skin prick testing was negative and was interpreted as positive if 8 millimeters larger than the negative saline control. Past and future asthma emergency room visits, hospitalizations, intubations, and prednisone use was tracked. RESULTS: IDT positivity to Alternaria alternata was associated with future 12 month emergency room visits and intubations. IDT positivity to Cladosporium/Hormodendrum, Epicoccum nigrum, and Aspergillus fumigatus were associated with asthma hospitalization in the past 12 months. IDT positivity to Stemphylium solani was associated with emergency room visits and hospitalization in the past 12 months. CONCLUSIONS: In this observational study, IDT positivity to molds, correlated with significant clinical outcomes. Further studies are necessary to confirm the utility of on asthma outcomes.
781
TUESDAY
Multiple Hospitalizations for Childhood Asthma: Predictors and Risk Factors Bella Lerman, DO1, Ejaz Yousef, MD, FAAAI1,2; 1Marshfield Clinic, Marshfield, WI, 2Marshfield Clinic, MARSHFIELD, WI. RATIONALE: Assess the risk factors for multiple hospitalizations for childhood asthma to prevent future admissions with more appropriate interventions. METHODS: Data for 91 children with asthma, aged 1-18, was collected. We compared characteristics of children with <2 hospital admissions for asthma (Group A, N554) with children who were hospitalized twice or more for asthma (Group B, N537). RESULTS: Group A: Male: Female ratio 70/30. Caucasian 95%, other race 5%. 59% had commercial insurance and 41% had public insurance. 32% had 4 or more ER visits. 24% had 4 or more courses of systemic corticosteroids. 45% had atopic dermatitis. 57% had allergic rhinitis. 24% had food allergies. 84% had family history of asthma. 31% were exposed to secondhand smoke. 45% had gastroesophageal reflux and 9% had enlarged adenoids. Group B: Male: Female ratio 54/46. Caucasian 77%, other race 23%. 25% had commercial insurance and 75% had public insurance. 60% had 4 or more ER visits. 52% had 4 or more courses of systemic corticosteroids. 57% had atopic dermatitis. 49% had allergic rhinitis. 27% had food allergies. 94% had family history. 66% subjects with history of passive household cigarette smoke exposure. 50% had gastroesophageal reflux and 50% had enlarged adenoids. CONCLUSIONS: These data suggest that secondhand smoke exposure, minority race, public insurance, systemic corticosteroid use and presence of atopic dermatitis may act as risk factors for multiple hospital admissions for childhood asthma. Early identification and interventions need to address or take these factors into account to reduce asthma morbidity.
782
Asthma and Asthma Exacerbation Exists in Infants (<1 year) and Can be Treated Effectively with Inhaled Corticosteroids Benjamin Volovitz; Head of Asthma Clinic (ret.), Schneider Children’s Hospital, Tel-Aviv, Israel. RATIONALE: The study provides prospective evidence that asthma exists in infants (<1 year of age) and can be effectively treated using inhaled corticosteroids. METHODS: We evaluated 1500 children aged 0-5 years (31% <1 year) with asthma exacerbation who failed to be controlled by conventional drug
J ALLERGY CLIN IMMUNOL FEBRUARY 2015
therapy. The children were treated with inhaled corticosteroids using three protocols according to the severity of their exacerbation: inhalers, inhalation, or inhalation + azithromycin. RESULTS: The sex ratio, asthma in the family, emergency department visits, hospitalization, duration of asthma symptoms, and usage of beta2agonists or oral corticosteroids were similar in infants and older children. All treated children had a history of prolonged cough and were coughing during their first visit, but only 45% had also wheezing. During the follow-up period there was, for the entire cohort, a 99% reduction in the number of emergency department visits, 93% fewer hospitalizations, and 100% reduction in oral corticosteroid usage. The vast majority of treated children (88%) showed good response to treatment, with similar responses in infants and in older children. No significant differences were found between children with prolonged cough, with or without wheezing. CONCLUSIONS: The data presented indicates that asthma exists also in infants. Asthmatic infants with or without wheezing, have a similar history, signs and symptoms as older children do, and respond well, similarly to treatment with inhaled corticosteroids.
783
Comparisons of Etiology and Clinical Feature of Wheezing Bronchitis Among Lower Respiratory Tract Infections in Hospitalized Young Children in Southern Taiwan Yung-Feng Huang1, Chih-An Chou1, Ying-Yao Chen1, Yao-Shen Chen2; 1 Department of Pediatrics, Kaohsiung Veterans General Hospital, Taiwan, 2 Section of Infectious Diseases, Kaohsiung Veterans, Taiwan. RATIONALE: Lower respiratory tract infections (LRTIs) play an important role in pediatric diseases and cause acute wheezing episodes in young children. This study aimed to investigate the clinical and etiology data of wheezing bronchitis in southern Taiwan. METHODS: Children aged under five years who were hospitalized at a medical center in southern Taiwan with acute LRTIs without recurrent wheezing episodes or asthma from July 2010 to May 2011 were prospectively enrolled. Nasopharyngeal aspirates were obtained and sent for viral cultures, multiplex polymerase chain reactions (PCR) and traditional quick tests. The clinical features, laboratory data and imaging findings were recorded and analyzed. RESULTS: A total of 90 children were enrolled, 70 of whom had detectable pathogens. Adenovirus and enterovirus were the most common viral etiologies identified (26.5%, respectively) and Streptococcus pneumoniawas the leading bacterial etiology(46.4%). Of 22 patients of wheezing, 19 (86.4%) were associated with identifiable viral infections. Respiratory syncytial virus (RSV) (45%) infections and Influenza A virus (43%) infeections show high rate for wheezing. Human metapneumovirus and adenovirus show 25% vs 17% respectively. There were no differences in otitis media, peripheral eosinophile count, and severity of disease or hospital stay among wheezing bronchitis. A similar result was found between non-pneumococcal and pneumococcal infections. CONCLUSIONS: Viral infections were the main etiologies of LRTIs associated wheezing episodes in young children. Mixed infections do not seem to affect the severity of disease or wheezing episodes. RSV and Influenza A virus show leading etiology for wheezing bronchitis.