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P228 Change in pulmonary function over time in obese compared to healthy weight asthmatics
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Abstracts: Poster Sessions / Ann Allergy Asthma Immunol 119 (2017) S17eS96
Results: Spirometry performed in clinic showed no evidence of obstruction and no change with bronchodilator therapy but did show evidence of flattening of the inspiratory and expiratory loop. Echocardiogram showed normal wall motion and left ventricle function. Dynamic CT scan showed evidence of greater than 50% airway collapse of the central airways suggesting tracheobronchomalacia. After an evaluation by pulmonology, she was given a flutter valve for positive expiratory pressure which resolved her persistent cough and dyspnea. Conclusion: Tracheobronchomalacia can be present in patients with asthma. Patients should therefore be evaluated for tracheobronchomalacia refractory to standard asthma therapy.
are consistent with the diagnosis of hypersensitivity pneumonitis related to antigen exposure to parakeet, cockatiel and parrot. It can be difficult to identify the relevant environmental exposure especially in the case of uncommon environmental triggers. Previous studies have shown significant cross-reactivity between pigeon-specific IgG and antigens from other avian species. This case reveals that cross-reactivity may not be complete and highlights the clinical utility of testing serum precipitins to specific bird species. We recommend that extensive testing beyond the standard panel of antigens should be pursued as identification of the causative antigen is crucial for successful antigen avoidance.
P228
P230
CHANGE IN PULMONARY FUNCTION OVER TIME IN OBESE COMPARED TO HEALTHY WEIGHT ASTHMATICS M. Henao*1, F. Ishmael2, 1. Harrisburg, PA; 2. Hershey, PA.
LONG-TERM ASSESSMENT OF THE BURDEN OF ATOPIC SENSITIZATION IN PATIENTS WITH SEVERE/DIFFICULTTO-TREAT ASTHMA R. Zeiger*1, B. Chipps2, B. Ortiz3, F. Kianifard3, B. Paknis3, T. Haselkorn4, A. Foreman5, S. Szefler6, 1. San Diego, CA; 2. Sacramento, CA; 3. East Hanover, NJ; 4. South San Francisco, CA; 5. San Francisco, CA; 6. Aurora, CO.
Background: Recently, multiple studies have confirmed a positive association between obesity and the development of asthma. Obese asthmatics tend to suffer from a more severe form of asthma that is considered to be a unique phenotype and appears to be more difficult to treat. It is unclear, however, if lung function decreases more rapidly in obese versus non-obese asthmatics. Methods: We gathered data from 1,009 adults that had received a diagnosis of asthma based on ICD-9 and ICD-10 codes between March 2010 and January 2016. We used two tailed t-tests to compare pulmonary function. To compare the change in pulmonary function over time we created a value for the delta FEV1 and FVC over the change in days and used a two-tailed t-test for analysis. Results: Data was obtained from 1,009 adults, 657 females and 452 males. 546 patients were obese (BMI>30), 463 were considered healthy/overweight (BMI 18-30). Obese asthmatics were noted to have worse pulmonary function based on FEV1 (p <0.05) and on FVC (p <0.05). However, when evaluating the change in pulmonary function over time, obese asthmatics did not have a statistically significant decrease in the rate of change of their pulmonary function scores compared to their healthier weight counterparts, FEV1 p¼0.3 and FVC p¼0.31. Conclusions: Our data supports that obese asthmatics have worse pulmonary function tests scores; however, this preliminary data does not suggest that their lung function decreases more rapidly than for asthmatics of healthy weight.
P229 BIRDS OF A FEATHER: A CASE OF HYPERSENSITIVITY PNEUMONITIS L. Robinson*, C. Sokol, Boston, MA. Introduction: Hypersensitivity pneumonitis is a rare immunologically mediated disease caused by exposure of inhaled environmental antigens. Here we describe the case of a 56 yo female who presented with rapid onset of shortness of breath, severe dyspnea on exertion and non-productive cough. Results: Evaluation was notable for hypoxemia and ground glass opacities with mosaic attenuation on CT scan. Bronchoalveolar lavage showed markedly elevated lymphocytes of 62.2% and CD4:CD8 ratio of 0.92. The patient’s hobbies included working at a bird rescue and she had at least 19 pet birds in her home including parrots, parakeets, finches and cockatoos. Studies of serum precipitants were sent to standard panel of common antigens including pigeon, which were all negative. An extended panel of antibodies to avian antigens was performed showing evidence of precipitins to parakeet, cockatiel and parrot antigen. Conclusion: The presence of antigen exposure, radiographic findings, elevated lymphocyte count on BAL and serum precipitins
Introduction: Analyses of data from TENOR II demonstrated that approximately 50% of patients had uncontrolled asthma based on NHLBI impairment category. Here we report the long-term burden of disease in patients relative to aeroallergen sensitization from the TENOR II cohort. Methods: TENOR II was a multicenter, observational study with a cross-sectional single visit follow-up assessment of patients with severe or difficult-to-treat asthma in the United States more than 10 years after enrolment in the TENOR I study. Patients were divided into 5 subgroups according to the number of positive aeroallergens determined by serum specific IgE testing. A high aeroallergen sensitization was defined being positive for 4 allergens. Results: Of the 317 patients included in the analysis, the majority (n¼123, 38.8%) had high aeroallergen sensitization burden. These patients were younger at age of asthma diagnosis. Black and Hispanic patients were more sensitive to aeroallergen. Patients with
Abstracts: Poster Sessions / Ann Allergy Asthma Immunol 119 (2017) S17eS96
Results: Spirometry performed in clinic showed no evidence of obstruction and no change with bronchodilator therapy but did show evidence of flattening of the inspiratory and expiratory loop. Echocardiogram showed normal wall motion and left ventricle function. Dynamic CT scan showed evidence of greater than 50% airway collapse of the central airways suggesting tracheobronchomalacia. After an evaluation by pulmonology, she was given a flutter valve for positive expiratory pressure which resolved her persistent cough and dyspnea. Conclusion: Tracheobronchomalacia can be present in patients with asthma. Patients should therefore be evaluated for tracheobronchomalacia refractory to standard asthma therapy.
are consistent with the diagnosis of hypersensitivity pneumonitis related to antigen exposure to parakeet, cockatiel and parrot. It can be difficult to identify the relevant environmental exposure especially in the case of uncommon environmental triggers. Previous studies have shown significant cross-reactivity between pigeon-specific IgG and antigens from other avian species. This case reveals that cross-reactivity may not be complete and highlights the clinical utility of testing serum precipitins to specific bird species. We recommend that extensive testing beyond the standard panel of antigens should be pursued as identification of the causative antigen is crucial for successful antigen avoidance.
P228
P230
CHANGE IN PULMONARY FUNCTION OVER TIME IN OBESE COMPARED TO HEALTHY WEIGHT ASTHMATICS M. Henao*1, F. Ishmael2, 1. Harrisburg, PA; 2. Hershey, PA.
LONG-TERM ASSESSMENT OF THE BURDEN OF ATOPIC SENSITIZATION IN PATIENTS WITH SEVERE/DIFFICULTTO-TREAT ASTHMA R. Zeiger*1, B. Chipps2, B. Ortiz3, F. Kianifard3, B. Paknis3, T. Haselkorn4, A. Foreman5, S. Szefler6, 1. San Diego, CA; 2. Sacramento, CA; 3. East Hanover, NJ; 4. South San Francisco, CA; 5. San Francisco, CA; 6. Aurora, CO.
Background: Recently, multiple studies have confirmed a positive association between obesity and the development of asthma. Obese asthmatics tend to suffer from a more severe form of asthma that is considered to be a unique phenotype and appears to be more difficult to treat. It is unclear, however, if lung function decreases more rapidly in obese versus non-obese asthmatics. Methods: We gathered data from 1,009 adults that had received a diagnosis of asthma based on ICD-9 and ICD-10 codes between March 2010 and January 2016. We used two tailed t-tests to compare pulmonary function. To compare the change in pulmonary function over time we created a value for the delta FEV1 and FVC over the change in days and used a two-tailed t-test for analysis. Results: Data was obtained from 1,009 adults, 657 females and 452 males. 546 patients were obese (BMI>30), 463 were considered healthy/overweight (BMI 18-30). Obese asthmatics were noted to have worse pulmonary function based on FEV1 (p <0.05) and on FVC (p <0.05). However, when evaluating the change in pulmonary function over time, obese asthmatics did not have a statistically significant decrease in the rate of change of their pulmonary function scores compared to their healthier weight counterparts, FEV1 p¼0.3 and FVC p¼0.31. Conclusions: Our data supports that obese asthmatics have worse pulmonary function tests scores; however, this preliminary data does not suggest that their lung function decreases more rapidly than for asthmatics of healthy weight.
P229 BIRDS OF A FEATHER: A CASE OF HYPERSENSITIVITY PNEUMONITIS L. Robinson*, C. Sokol, Boston, MA. Introduction: Hypersensitivity pneumonitis is a rare immunologically mediated disease caused by exposure of inhaled environmental antigens. Here we describe the case of a 56 yo female who presented with rapid onset of shortness of breath, severe dyspnea on exertion and non-productive cough. Results: Evaluation was notable for hypoxemia and ground glass opacities with mosaic attenuation on CT scan. Bronchoalveolar lavage showed markedly elevated lymphocytes of 62.2% and CD4:CD8 ratio of 0.92. The patient’s hobbies included working at a bird rescue and she had at least 19 pet birds in her home including parrots, parakeets, finches and cockatoos. Studies of serum precipitants were sent to standard panel of common antigens including pigeon, which were all negative. An extended panel of antibodies to avian antigens was performed showing evidence of precipitins to parakeet, cockatiel and parrot antigen. Conclusion: The presence of antigen exposure, radiographic findings, elevated lymphocyte count on BAL and serum precipitins
Introduction: Analyses of data from TENOR II demonstrated that approximately 50% of patients had uncontrolled asthma based on NHLBI impairment category. Here we report the long-term burden of disease in patients relative to aeroallergen sensitization from the TENOR II cohort. Methods: TENOR II was a multicenter, observational study with a cross-sectional single visit follow-up assessment of patients with severe or difficult-to-treat asthma in the United States more than 10 years after enrolment in the TENOR I study. Patients were divided into 5 subgroups according to the number of positive aeroallergens determined by serum specific IgE testing. A high aeroallergen sensitization was defined being positive for 4 allergens. Results: Of the 317 patients included in the analysis, the majority (n¼123, 38.8%) had high aeroallergen sensitization burden. These patients were younger at age of asthma diagnosis. Black and Hispanic patients were more sensitive to aeroallergen. Patients with