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Patient and Physician Differences in Understanding Asthma Symptom Deterioration Terminology From the Asthma Insight and Management (AIM) Survey
AB80 Abstracts
297
SUNDAY
The Influence of Cesarean section on the Incidence of Childhood Asthma: A Propensity Score Approach B. Kim1,2, R. Qin3, S. Katusic3, Y. J. Juhn1; 1Department of Pediatric and Adolescent Medicine Mayo Clinic, Rochester, MN, 2Department of Pediatrics, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung-Si, KOREA, REPUBLIC OF, 3Department of Health Sciences Research Mayo Clinic, Rochester, MN. RATIONALE: In an observational study assessing the role of mode of delivery (vaginal delivery vs. cesarean section) at birth in subsequent risk of asthma, which cannot be assigned randomly, covariate imbalance between comparison groups is a significant obstacle. METHODS: The study was designed as a retrospective cohort study. Study subjects were all children born in Rochester, Minnesota, between 1976 and 1979. Asthma status during the first 6 years of life was determined by applying predetermined criteria. The propensity scores were formulated using 16 covariates using a logistic regression model for mode of delivery. The cumulative incidence of asthma between comparison groups was calculated using Kaplan-Meier curve and log-rank test was used to test statistical significance. RESULTS: There were significant covariate imbalance between groups of children born by cesarean section vs. vaginal delivery that include the number of prenatal visits, birth weight, ethnicity, complication during pregnancy, complication during labor, induction, maternal age, a family history of atopy, and maternal smoking history. After matching with propensity scores, imbalance of these covariates reduced and became statistically not significant. We found that children born by cesarean section had a similar risk to the matched children born by vaginal delivery (2.1% vs. 2.5%, p50.79). CONCLUSIONS: Mode of delivery is not associated with risk of asthma during the first six years of life. The propensity score method is a useful tool for addressing covariate imbalance in an observational study concerning risk factors in asthma epidemiology.
298
Patient and Physician Differences in Understanding Asthma Symptom Deterioration Terminology From the Asthma Insight and Management (AIM) Survey D. E. Doherty1, E. O. Meltzer2, S. W. Stoloff3, K. R. Murphy4, R. A. Nathan5, M. Blaiss6; 1Division of Pulmonary, Critical Care, and Sleep Medicine, University of Kentucky, Lexington, KY, 2Allergy and Asthma Medical Group and Research Center, San Diego, CA, 3University of Nevada School of Medicine, Reno, NV, 4Boys Town National Research Hospital, Boys Town, NE, 5Asthma and Allergy Associates, P.C. and Research Center, Colorado Springs, CO, 6University of Tennessee Health Science Center, Memphis, TN. RATIONALE: The 2009 Asthma Insight and Management (AIM) survey was a large and comprehensive national survey of asthma patients, physicians, and the general population that assessed the status of asthma burden and management in the US. Because patient-physician communication is a critical component of successful asthma management, we compared AIM data showing patient- and physician-reported familiarity and use of terminology used to describe asthma symptom deterioration. METHODS: Phone interviews were conducted in a national random _12y (60,682 households screened) sample of 2500 asthma patients aged > and 309 physicians (allergists5104; family practitioners5101; pulmonologists554; internists550). RESULTS: ‘‘Exacerbation’’ is the term used most commonly by physicians (77% vs ‘‘flare-up’’570% and ‘‘attack’’565%) but is least familiar to patients (24%). ‘‘Attack’’ is familiar to 97% of patients but used by only 65% of physicians (57%-74% across specialties). Concordance in use and familiarity was highest for ‘‘flare-up’’ (physicians570% [57%78% across specialties]; patients571%). ‘‘Exacerbation’’ and ‘‘flare-up’’ were considered similar by 94% of physicians (90%-98% across specialties) but only 38% of patients. ‘‘Attack’’ was considered the same as ‘‘asthma exacerbation’’ or ‘‘flare-up’’ by 65% of physicians, but only 36% of patients. For patients (n51555) and physicians (n5107) who did not believe these terms were the same, 18% vs 50%, respectively, described
J ALLERGY CLIN IMMUNOL FEBRUARY 2011
an asthma attack as ‘‘more sudden,’’ and 17% vs 55% described an asthma attack as ‘‘more severe’’ than ‘‘exacerbation/flare-up.’’ CONCLUSIONS: Results from the AIM survey suggest a substantial communication gap exists between physicians and patients in familiarity and use of asthma symptom deterioration terminology, which may undermine optimal asthma management.
299
Association of Obesity with Asthma in Japanese Preschool Children Y. Adachi1, T. Itazawa1, Y. S. Adachi1, Y. Ito1, Y. Okabe1, K. Yoshida2, Y. Ohya2, H. Odajima3, A. Akasawa4, T. Miyawaki1; 1Department of Pediatrics, University of Toyama, Toyama, JAPAN, 2National Center for Child Health and Development, Tokyo, JAPAN, 3Fukuoka National Hospital, Fukuoka, JAPAN, 4Tokyo Metropolitan Children’s Medical Center, Tokyo, JAPAN. RATIONALE: Obesity may increase the risk of subsequent asthma. We have previously reported a clear association between obesity and asthma in Japanese school-aged children. METHODS: To evaluate whether the similar association exists in younger children, a cross-sectional and ISAAC questionnaire-based survey was performed among children aged 4-5 years. A child who had experienced wheezing during the past 12 months and had ever diagnosed as asthma by a physician was defined as having current asthma. Overweight and un_10th, respectively, according to _90th and < derweight was defined as BMI > the reference values for Japanese children during 1978 to 1981. RESULTS: After omitting 547 incomplete data, 34,699 children were analyzed. Current asthma was found in 10.5% of underweight, in 11.1% of normoweight, and in 13.2% of overweight children. There was a significant association between overweight and asthma (p<0.001). This association still remained even after adjusted for other variables, such as gender, coexisting other allergic diseases, and parental history of asthma (adjusted OR: 1.22, 95% CI: 1.10-1.37, p<0.001). CONCLUSIONS: Even in preschool children, obesity may already associate with asthma. Physicians should consider the impact of obesity when managing asthma in younger children.
300
Risk of Asthma in Former Late Preterm Infants: A Propensity Score Approach G. A. Matthews, R. Qin, S. K. Katusic, Y. J. Juhn; Mayo Clinic, Rochester, MN. RATIONALE: The risk of asthma in former late preterm infants has not been well defined. The propensity score approach allows us to evaluate the impact of being a former late preterm infant while controlling for covariate imbalance. METHODS: The study was designed as a retrospective cohort study. Study subjects were all children born in Rochester, Minnesota between 1976 and 1982. Asthma status during the first six years of life was assessed by applying predetermined criteria. The propensity score was formulated using 16 covariates by fitting a logistic regression model for late preterm birth versus term birth. We applied the propensity score method to match late preterm infants (34 0/7 to 36 6/7 weeks gestation) to term infants (37 0/7 to 40 6/7 weeks gestation) within a caliper of 0.2 standard deviation of logit function of propensity score. RESULTS: Of the 7,040 infants, 52% were male and 94% were Caucasians. Before matching, late preterm infants had a higher risk of asthma (27 of 333, 8.1%) compared to full term infants that developed asthma (314 of 6,707, 4.7%) (p50.004). There was significant covariate imbalance between comparison groups. After matching with propensity scores, we found that former late preterm infants had a similar risk of asthma to the matched full term infants (7.1% vs. 8.7%, respectively, p50.64). Covariate imbalance was greatly reduced. CONCLUSIONS: Being a former late preterm infant is not associated with a risk of asthma. The propensity score method is a useful tool in addressing covariate imbalance.
297
SUNDAY
The Influence of Cesarean section on the Incidence of Childhood Asthma: A Propensity Score Approach B. Kim1,2, R. Qin3, S. Katusic3, Y. J. Juhn1; 1Department of Pediatric and Adolescent Medicine Mayo Clinic, Rochester, MN, 2Department of Pediatrics, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung-Si, KOREA, REPUBLIC OF, 3Department of Health Sciences Research Mayo Clinic, Rochester, MN. RATIONALE: In an observational study assessing the role of mode of delivery (vaginal delivery vs. cesarean section) at birth in subsequent risk of asthma, which cannot be assigned randomly, covariate imbalance between comparison groups is a significant obstacle. METHODS: The study was designed as a retrospective cohort study. Study subjects were all children born in Rochester, Minnesota, between 1976 and 1979. Asthma status during the first 6 years of life was determined by applying predetermined criteria. The propensity scores were formulated using 16 covariates using a logistic regression model for mode of delivery. The cumulative incidence of asthma between comparison groups was calculated using Kaplan-Meier curve and log-rank test was used to test statistical significance. RESULTS: There were significant covariate imbalance between groups of children born by cesarean section vs. vaginal delivery that include the number of prenatal visits, birth weight, ethnicity, complication during pregnancy, complication during labor, induction, maternal age, a family history of atopy, and maternal smoking history. After matching with propensity scores, imbalance of these covariates reduced and became statistically not significant. We found that children born by cesarean section had a similar risk to the matched children born by vaginal delivery (2.1% vs. 2.5%, p50.79). CONCLUSIONS: Mode of delivery is not associated with risk of asthma during the first six years of life. The propensity score method is a useful tool for addressing covariate imbalance in an observational study concerning risk factors in asthma epidemiology.
298
Patient and Physician Differences in Understanding Asthma Symptom Deterioration Terminology From the Asthma Insight and Management (AIM) Survey D. E. Doherty1, E. O. Meltzer2, S. W. Stoloff3, K. R. Murphy4, R. A. Nathan5, M. Blaiss6; 1Division of Pulmonary, Critical Care, and Sleep Medicine, University of Kentucky, Lexington, KY, 2Allergy and Asthma Medical Group and Research Center, San Diego, CA, 3University of Nevada School of Medicine, Reno, NV, 4Boys Town National Research Hospital, Boys Town, NE, 5Asthma and Allergy Associates, P.C. and Research Center, Colorado Springs, CO, 6University of Tennessee Health Science Center, Memphis, TN. RATIONALE: The 2009 Asthma Insight and Management (AIM) survey was a large and comprehensive national survey of asthma patients, physicians, and the general population that assessed the status of asthma burden and management in the US. Because patient-physician communication is a critical component of successful asthma management, we compared AIM data showing patient- and physician-reported familiarity and use of terminology used to describe asthma symptom deterioration. METHODS: Phone interviews were conducted in a national random _12y (60,682 households screened) sample of 2500 asthma patients aged > and 309 physicians (allergists5104; family practitioners5101; pulmonologists554; internists550). RESULTS: ‘‘Exacerbation’’ is the term used most commonly by physicians (77% vs ‘‘flare-up’’570% and ‘‘attack’’565%) but is least familiar to patients (24%). ‘‘Attack’’ is familiar to 97% of patients but used by only 65% of physicians (57%-74% across specialties). Concordance in use and familiarity was highest for ‘‘flare-up’’ (physicians570% [57%78% across specialties]; patients571%). ‘‘Exacerbation’’ and ‘‘flare-up’’ were considered similar by 94% of physicians (90%-98% across specialties) but only 38% of patients. ‘‘Attack’’ was considered the same as ‘‘asthma exacerbation’’ or ‘‘flare-up’’ by 65% of physicians, but only 36% of patients. For patients (n51555) and physicians (n5107) who did not believe these terms were the same, 18% vs 50%, respectively, described
J ALLERGY CLIN IMMUNOL FEBRUARY 2011
an asthma attack as ‘‘more sudden,’’ and 17% vs 55% described an asthma attack as ‘‘more severe’’ than ‘‘exacerbation/flare-up.’’ CONCLUSIONS: Results from the AIM survey suggest a substantial communication gap exists between physicians and patients in familiarity and use of asthma symptom deterioration terminology, which may undermine optimal asthma management.
299
Association of Obesity with Asthma in Japanese Preschool Children Y. Adachi1, T. Itazawa1, Y. S. Adachi1, Y. Ito1, Y. Okabe1, K. Yoshida2, Y. Ohya2, H. Odajima3, A. Akasawa4, T. Miyawaki1; 1Department of Pediatrics, University of Toyama, Toyama, JAPAN, 2National Center for Child Health and Development, Tokyo, JAPAN, 3Fukuoka National Hospital, Fukuoka, JAPAN, 4Tokyo Metropolitan Children’s Medical Center, Tokyo, JAPAN. RATIONALE: Obesity may increase the risk of subsequent asthma. We have previously reported a clear association between obesity and asthma in Japanese school-aged children. METHODS: To evaluate whether the similar association exists in younger children, a cross-sectional and ISAAC questionnaire-based survey was performed among children aged 4-5 years. A child who had experienced wheezing during the past 12 months and had ever diagnosed as asthma by a physician was defined as having current asthma. Overweight and un_10th, respectively, according to _90th and < derweight was defined as BMI > the reference values for Japanese children during 1978 to 1981. RESULTS: After omitting 547 incomplete data, 34,699 children were analyzed. Current asthma was found in 10.5% of underweight, in 11.1% of normoweight, and in 13.2% of overweight children. There was a significant association between overweight and asthma (p<0.001). This association still remained even after adjusted for other variables, such as gender, coexisting other allergic diseases, and parental history of asthma (adjusted OR: 1.22, 95% CI: 1.10-1.37, p<0.001). CONCLUSIONS: Even in preschool children, obesity may already associate with asthma. Physicians should consider the impact of obesity when managing asthma in younger children.
300
Risk of Asthma in Former Late Preterm Infants: A Propensity Score Approach G. A. Matthews, R. Qin, S. K. Katusic, Y. J. Juhn; Mayo Clinic, Rochester, MN. RATIONALE: The risk of asthma in former late preterm infants has not been well defined. The propensity score approach allows us to evaluate the impact of being a former late preterm infant while controlling for covariate imbalance. METHODS: The study was designed as a retrospective cohort study. Study subjects were all children born in Rochester, Minnesota between 1976 and 1982. Asthma status during the first six years of life was assessed by applying predetermined criteria. The propensity score was formulated using 16 covariates by fitting a logistic regression model for late preterm birth versus term birth. We applied the propensity score method to match late preterm infants (34 0/7 to 36 6/7 weeks gestation) to term infants (37 0/7 to 40 6/7 weeks gestation) within a caliper of 0.2 standard deviation of logit function of propensity score. RESULTS: Of the 7,040 infants, 52% were male and 94% were Caucasians. Before matching, late preterm infants had a higher risk of asthma (27 of 333, 8.1%) compared to full term infants that developed asthma (314 of 6,707, 4.7%) (p50.004). There was significant covariate imbalance between comparison groups. After matching with propensity scores, we found that former late preterm infants had a similar risk of asthma to the matched full term infants (7.1% vs. 8.7%, respectively, p50.64). Covariate imbalance was greatly reduced. CONCLUSIONS: Being a former late preterm infant is not associated with a risk of asthma. The propensity score method is a useful tool in addressing covariate imbalance.