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Race, Asthma Exacerbations and Leaving against Medical Advice
There was a trend toward decreased emotional QOL scores associated with increased child asthma severity (p 5 0.007) and increased missed school days (p 5 0.001). There was a notable decrease in activity QOL scores associated with increased child asthma severity (p<0.001), increased missed school days (p<0.001), increased emergency room visits (p 5 0.001), and number of parents with asthma (p 5 0.007). CONCLUSIONS: Pediatric asthma negatively affects the QOL of caregivers of underserved children with asthma and lower QOL scores are associated with increased asthma related morbidity. Funding: USPHS Health Disparities Program MD00532-03, MD Cigarette Restitution Fund and Southern CA Asthma and Allergy Foundation
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Asthma Control Test: reliability, validity, and responsiveness in Korean patients K. Hyouk-Soo1,2, K. Deok-In1,2, P. Chang-Han1,2, S. Seong-Wook1,2, L. Sang-Min1,2, S. Woo-Jung1,2, K. Yong-Eun3, P. Heung-Woo1,2, K. SunSin1,2, C. Sang-Heon1,2, M. Kyoung-Up1,2, K. You-Young1,2, C. YoonSeok1,4; 1Department of Internal Medicine, Seoul National University College of Medicine, Seoul, REPUBLIC OF KOREA, 2Instutute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul, REPUBLIC OF KOREA, 3Department of Internal Medicine, Chosun University College of Medicine, Gwangju, REPUBLIC OF KOREA, 4Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, REPUBLIC OF KOREA. RATIONALE: Asthma Control Test (ACT) is a simple, patient-based tool for identifying patients with poorly controlled asthma which has been validated in USA. We evaluated a Korean translation of ACT and sought to evaluate the reliability and validity of the ACT in a longitudinal study of Korean asthmatic patients in the care of an asthma specialist. METHODS: Patients (n 5 117, baseline visit) completed the ACT and the Quality of Life Questionnaire for Korean Asthmatic Adults(QLQAKA) at multiple physician visits (2-5 visits; 298 total visits, 4-12 weeks apart). Pulmonary function was measured, and asthma specialists rated asthma control. RESULTS: Internal consistency reliability of the ACT was 0.79 (baseline, n 5 117) and 0.74 (total visits, n 5 298). Test-retest reliability was 0.77. Criterion validity was demonstrated by significant correlations between baseline ACT scores and baseline specialists’ ratings of asthma control (r 5 0.81, P<.001) and QLQAKA scores (r 5 0.69, P<.001). Discriminant validity was demonstrated, with significant (P<.001) differences in mean ACT scores across patients differing in asthma control, pulmonary function, and treatment recommendation. Responsiveness of the ACT to changes in asthma control and lung function was demonstrated with significant correlations between changes in ACT scores and changes in specialists’ ratings (r 5 0.72, P<.001), QLQAKA scores (r 5 0.60, P<.001), and percent predicted FEV1 values (r 5 0.39, P<.001). An ACT score of 20 or less provided optimum balance of sensitivity (85%) and specificity (93%) for detecting uncontrolled asthma. CONCLUSIONS: The Korean translation of ACT is reliable, valid, and responsive to changes in asthma control over time in patients under the care of an asthma specialist. Funding: Clinical Research Center for Chronic Obstructive Airway Disease Grant 0412-CR03-0704-0001 from Korean Ministry of Health and Welfare
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Self Reported Provider Adherence to NAEPP Guidelines for Control of Factors Contributing to Asthma Severity P. J. Warrier1, S. Dever1, M. Shah2, D. M. O’Sullivan3, J. E. Thomas1; 1 Hartford Hospital, University of Connecticut, Hartford, CT, 2Bridgeport Hospital, Bridgeport, CT, 3Hartford Hospital, Hartford, CT. RATIONALE: One of the major components of the NAEPP guidelines stresses the need to identify and reduce exposures to allergens and irritants that exacerbate asthma. Through a self-reported survey questionnaire we attempt to identify physicians’ usage of this component of the guidelines and hypothesize that it is under-utilized.
METHODS: A 28 item one-page survey questionnaire designed for self completion by participants was distributed to Internal Medicine Residents at a primary care clinic. RESULTS: 40 of 48 residents completed the survey. Only 40% of this study population reported awareness of the NAEEP guidelines. Interestingly however, of the questions recommended by the NAEPP, all residents reported asking about smoking (100%), and most residents about exposure to secondhand smoke (87.5%), seasonal changes (97.5%), the specific season of asthma exacerbation (95%), occurrence of year round symptoms (94.9%), exposure to pets (92.5%), and history of nasal congestion (85%). Residents were also more likely to ask questions regarding exposure to triggers like mold (67.5%), fumes (65%), dampness (62.5%), heartburn (52.5%) and occupational exposures (52.5%) than exposure to cockroaches (42.5%), use of aspirin (37.5%), use of beta blockers (35%), and sulfite sensitivity (20%). CONCLUSIONS: Awareness of the NAEPP guidelines was found to be sub-optimal. However, residents report asking many of the assessment questions recommended by the NAEPP for control of allergens and irritants in asthmatics. Our study suggests that there is opportunity for further improvement in physicians’ control of factors contributing to asthma severity. Self-reported studies often over-estimate adherence to guidelines and our study may be limited by this.
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Race, Asthma Exacerbations and Leaving against Medical Advice B. D. Tano; University of Texas Health Center at Tyler, Tyler, TX. RATIONALE: Leaving against medical advice (LAMA) is a frustrating event for physicians and medical staff and a costly behavior for patients. In asthma exacerbation, this decision by patients can lead to death. This study was to assess the determinants, characteristics and prevalence by race of LAMA in patients admitted for asthma exacerbations. METHODS: Healthcare Cost and Utilization Project (HCUP) data are used. The study focuses on years 1997-2004 and only 2004 results are reported. Both national and state data are used. RESULTS: It is found that LAMA is more prevalent in the uninsured (4.4%), low income ($0-35,999) (1.8%), and Medicaid recipients (1.9%). LAMA is highest in young asthmatics (ages 18-44, 4.3%), followed by middle age adults (ages 45-64, 1.7%). The very young (ages < 1 and 117) and the older adults (ages 651) have minimal LAMA rates. Males have higher rates than females (1.6%) vs. (1.3%) respectively. The LAMA rates by race were CA (2.8, 1.1, and 1.7), MA (2.4, 1.8, and 1.5), NY (3.26, 3.82, and 1.96), and FL (1.3, 1.7, and 1.5) for blacks, Hispanics, and whites respectively in California, Massachusetts, New York and Florida. CONCLUSION: LAMA, a marker of non-adherence/noncompliance in hospitalized patients coincides with male gender, young age, uninsurance and poverty (MYUP) and depends on the concentration of the minority population in the US. Educational measures used to combat non-adherence/noncompliance behaviors can be used to help these patients.
SATURDAY
Abstracts S7
J ALLERGY CLIN IMMUNOL VOLUME 119, NUMBER 1
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Asthma Control Test: reliability, validity, and responsiveness in Korean patients K. Hyouk-Soo1,2, K. Deok-In1,2, P. Chang-Han1,2, S. Seong-Wook1,2, L. Sang-Min1,2, S. Woo-Jung1,2, K. Yong-Eun3, P. Heung-Woo1,2, K. SunSin1,2, C. Sang-Heon1,2, M. Kyoung-Up1,2, K. You-Young1,2, C. YoonSeok1,4; 1Department of Internal Medicine, Seoul National University College of Medicine, Seoul, REPUBLIC OF KOREA, 2Instutute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul, REPUBLIC OF KOREA, 3Department of Internal Medicine, Chosun University College of Medicine, Gwangju, REPUBLIC OF KOREA, 4Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, REPUBLIC OF KOREA. RATIONALE: Asthma Control Test (ACT) is a simple, patient-based tool for identifying patients with poorly controlled asthma which has been validated in USA. We evaluated a Korean translation of ACT and sought to evaluate the reliability and validity of the ACT in a longitudinal study of Korean asthmatic patients in the care of an asthma specialist. METHODS: Patients (n 5 117, baseline visit) completed the ACT and the Quality of Life Questionnaire for Korean Asthmatic Adults(QLQAKA) at multiple physician visits (2-5 visits; 298 total visits, 4-12 weeks apart). Pulmonary function was measured, and asthma specialists rated asthma control. RESULTS: Internal consistency reliability of the ACT was 0.79 (baseline, n 5 117) and 0.74 (total visits, n 5 298). Test-retest reliability was 0.77. Criterion validity was demonstrated by significant correlations between baseline ACT scores and baseline specialists’ ratings of asthma control (r 5 0.81, P<.001) and QLQAKA scores (r 5 0.69, P<.001). Discriminant validity was demonstrated, with significant (P<.001) differences in mean ACT scores across patients differing in asthma control, pulmonary function, and treatment recommendation. Responsiveness of the ACT to changes in asthma control and lung function was demonstrated with significant correlations between changes in ACT scores and changes in specialists’ ratings (r 5 0.72, P<.001), QLQAKA scores (r 5 0.60, P<.001), and percent predicted FEV1 values (r 5 0.39, P<.001). An ACT score of 20 or less provided optimum balance of sensitivity (85%) and specificity (93%) for detecting uncontrolled asthma. CONCLUSIONS: The Korean translation of ACT is reliable, valid, and responsive to changes in asthma control over time in patients under the care of an asthma specialist. Funding: Clinical Research Center for Chronic Obstructive Airway Disease Grant 0412-CR03-0704-0001 from Korean Ministry of Health and Welfare
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Self Reported Provider Adherence to NAEPP Guidelines for Control of Factors Contributing to Asthma Severity P. J. Warrier1, S. Dever1, M. Shah2, D. M. O’Sullivan3, J. E. Thomas1; 1 Hartford Hospital, University of Connecticut, Hartford, CT, 2Bridgeport Hospital, Bridgeport, CT, 3Hartford Hospital, Hartford, CT. RATIONALE: One of the major components of the NAEPP guidelines stresses the need to identify and reduce exposures to allergens and irritants that exacerbate asthma. Through a self-reported survey questionnaire we attempt to identify physicians’ usage of this component of the guidelines and hypothesize that it is under-utilized.
METHODS: A 28 item one-page survey questionnaire designed for self completion by participants was distributed to Internal Medicine Residents at a primary care clinic. RESULTS: 40 of 48 residents completed the survey. Only 40% of this study population reported awareness of the NAEEP guidelines. Interestingly however, of the questions recommended by the NAEPP, all residents reported asking about smoking (100%), and most residents about exposure to secondhand smoke (87.5%), seasonal changes (97.5%), the specific season of asthma exacerbation (95%), occurrence of year round symptoms (94.9%), exposure to pets (92.5%), and history of nasal congestion (85%). Residents were also more likely to ask questions regarding exposure to triggers like mold (67.5%), fumes (65%), dampness (62.5%), heartburn (52.5%) and occupational exposures (52.5%) than exposure to cockroaches (42.5%), use of aspirin (37.5%), use of beta blockers (35%), and sulfite sensitivity (20%). CONCLUSIONS: Awareness of the NAEPP guidelines was found to be sub-optimal. However, residents report asking many of the assessment questions recommended by the NAEPP for control of allergens and irritants in asthmatics. Our study suggests that there is opportunity for further improvement in physicians’ control of factors contributing to asthma severity. Self-reported studies often over-estimate adherence to guidelines and our study may be limited by this.
26
Race, Asthma Exacerbations and Leaving against Medical Advice B. D. Tano; University of Texas Health Center at Tyler, Tyler, TX. RATIONALE: Leaving against medical advice (LAMA) is a frustrating event for physicians and medical staff and a costly behavior for patients. In asthma exacerbation, this decision by patients can lead to death. This study was to assess the determinants, characteristics and prevalence by race of LAMA in patients admitted for asthma exacerbations. METHODS: Healthcare Cost and Utilization Project (HCUP) data are used. The study focuses on years 1997-2004 and only 2004 results are reported. Both national and state data are used. RESULTS: It is found that LAMA is more prevalent in the uninsured (4.4%), low income ($0-35,999) (1.8%), and Medicaid recipients (1.9%). LAMA is highest in young asthmatics (ages 18-44, 4.3%), followed by middle age adults (ages 45-64, 1.7%). The very young (ages < 1 and 117) and the older adults (ages 651) have minimal LAMA rates. Males have higher rates than females (1.6%) vs. (1.3%) respectively. The LAMA rates by race were CA (2.8, 1.1, and 1.7), MA (2.4, 1.8, and 1.5), NY (3.26, 3.82, and 1.96), and FL (1.3, 1.7, and 1.5) for blacks, Hispanics, and whites respectively in California, Massachusetts, New York and Florida. CONCLUSION: LAMA, a marker of non-adherence/noncompliance in hospitalized patients coincides with male gender, young age, uninsurance and poverty (MYUP) and depends on the concentration of the minority population in the US. Educational measures used to combat non-adherence/noncompliance behaviors can be used to help these patients.
SATURDAY
Abstracts S7
J ALLERGY CLIN IMMUNOL VOLUME 119, NUMBER 1