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Surveying a cohort of ambulatory urban asthmatic patients to assess the reliability of information obtained from next-of-kin
S120
Abstracts
41 The Influence of Long-Term Treatment With Histamine H1 Receptor Antagonists and Theophylline on the Incidence of Febrile Convulsion in Children With Atopic Dermatitis and/or Asthma Y Morisawa*, Y Ohya*, T Katsunuma*, T lshii*, H Watanabe*, T Suda*, H Kawahara*, H Matsumota*, Hiroshi Wakiguchi§, A Akasawa*, Hirohisa Saito* *National Children's Hospital, Tokyo, Japan §Kochi Medical School, Kochi, Japan BACKGROUND: Histamine H1 receptor antagonist (HI antagonist) and theophylline have widely been used for the treatment of asthma and the former has been used also for that of atopic dermatitis. Some reports pointed out that taking these therapeutic agents might cause to evoke convulsion. Most of them are case reports or laboratory experiments and no systematic study to explore their risk to convulsion has been published so far. The prevalence of febrile convulsion (FC) in preschool children is not rare in Japan. Therefore we are keen to know the association between H1 antagonists or theophylline and FC. PATIENTS AND METHODS: All patients who visited the outpatient units in the department of allergy National Children's Hospital in March 2001 are asked whether they had history of FC which occurred under 7 years old. One thousand and twenty-three patients who had no episode of neurological disorder except FC are recruited to join this study and examined their detail history of taking HI antagonists and theophylline. Multiple logistic regression analysis was used to explore the risk of these medicines against FC. RESULT: Six hundreds and two are male and four hundreds and twenty-one are female. Ketotifen and theophylline did not increase the prevalence of FC in users (adjusted odds ratio (OR) of FC prevalence in ketotifen users versus that in nonusers = 2.53, 95% confidence interval (CI) for differences = 0.55 - 11.6, adjusted OR of FC prevalence in theophylline users versus that in nonusers = 1.11, 95% CI = 0.49 - 2.51). The patients taking H 1 antagonists except ketotifen had tendency to lower the incidence of FC (adjusted OR = 0.36, 95% CI = 0.14 - 0.97). CONCLUSION: Ketotifen and theophylline are not the risk factors to increase the incidence of FC. H1 antagonists except ketotifen may lower the risk of FC.
A n ) Assessing the Burden of Seasonal Allergic Rhinitis on Sleep "It ~ - Patterns MB Scharf Tri-State Sleep Disorders Center, Cincinnati, OH Recently, studies of microarousals observed in the sleep EEG have resulted in the identification of a Cyclic Pattern of Alternating States of Arousal Sequences (CAPS) that correlate with subjective estimates of sleep quality. The current study was designed to evaluate the effects of seasonal allergic rhinitis on sleep architecture (sleep staging), the number of awakenings, arousals and microarousals (CAPS) with respiratory patterns, during symptomatic and asymptomatic periods in patients with a history of seasonal allergic rhinitis. Fourteen subjects between the ages of 18 and 60 with a minimum of a 2-year history of seasonal allergic rhinitis who were positive for skin test to a seasonal allergen and found to be in stable health were monitored for 3 consecutive nights in the sleep laboratory during a period in which they were asymptomatic and again for 3 consecutive nights during which they were symptomatic of allergic rhinitis. All subjects showing a severity of greater than 6 for the combined nasal symptom scores (including nasal stuffiness/congestion score of equal or greater than 2) and equal or greater than 11 for the total nasal and non-nasal symptom score at baseline were included. Data were analyzed for normality and parameters normally distributed were tested using the Kolmogorov-Smirnov one sample t-test. Parameters that were non-normally distributed were evaluated using the Kruskal-Wallis one way analysis of variance and the Mann Whitney U Test. Subjects reported mean score values of 14.5 while symptomatic compared to 2.9 while asymptomatic. No significant differences were seen
J ALLERGY CLIN IMMUNOL JANUARY 2002
in sleep latency, wake time during or after sleep, number of awakenings, sleep efficiency or sleep stage percentages in subjects between their symptomatic or asymptomatic periods. Both number of CAP epochs and CAP percentages were significantly higher during the symptomatic period than when subjects were asymptomatic. Part of the burden of SAR on quality of life is reflected in the finding that sleep is disrupted by a higher frequency of microarousals in subjects symptomatic for SAR than when they are asymptomatic. This may account for the increased reports of non-restorative sleep increased sleep fragmentation by patients with SAR during symptomatic periods. Table 1
Symptomatic Cap epochs
Cap%
201.9 +- 65.6
32.1 +- 10.5
Asymptomatic
P
117.0 +_43.0
P < .01
19.327.6
P< .01
Je~ Surveying a Cohortof Ambulatory Urban Asthmatic Patients To • '1'~]1 Assessthe Reliability of InformationObtained From Next-of-Kin Pare Capocci-Tolomeo*, Marcia Polansky§, Michael S Sherman,, David M Lang* *Thomas Jefferson University, Philadelphia, PA §MCP/Hahne-
3A
mann University, Philadelphia, PA ¥MCP/Hahnemann University, Philadelhia, PA We described a surge in rates of asthma mortality in Philadelphia (NEJM 1994; 331:1572), that continued through the late 1990's (JACI 1998; 101 :$224); however, the circumstances surrounding these fatalities were not fully analyzed. Prior to carrying out a case-control study to entail analyses of information provided by next-of-kin (NK) of asthma decedents, we carried out a pilot study to determine the reliability of information provided by proxy respondents. Asthmatics receiving care at TJU were invited to partake in a brief telephone interview regarding their asthma. Each asthmatic identified NK respondents, who were surveyed using the same questionnaire concerning asthma progression, severity, management, and medication exposures. Asthmatics were categorized as mild/moderate/severe based on EPR2 criteria. Agreement levels between information reported by asthmatics and NK was compared using % correct, Chi-Square, and McNemar Test statistics. Of 28 asthmatics, 22 were women, 15 Caucasian. High agreement levels were observed for hospital admittance (82%, p=.001), ER visits (82%, p=.001), missed school/work days (79%, p=.043), and inhaled steroid use (75%, p=NS). Poor agreement was observed for recent asthma improvement (50%, p=NS), last asthma flare (50%, p=.012), suddenness of flare onset (21%, p=NS), pre-flare health status (32%, p=NS), and missing inhaled steroid doses (39%, p=NS), with NK more likely to underestimate degree of non-adherence (p=.013, McNemar). For rating asthma as mild/moderate/severe, there was only 33% agreement (p=.031, McNemar) between EPR2 criteria/patient, compared to 52% agreement between EPR2 criteria/NK and 54% for patient/NK. For rating asthma as severe versus mild/moderate, better agreement was observed for EPR2 criteria/patient (74%), physician/NK (70%), and patient/NK (82%). A high agreement trend was observed for NK who were cohabitants: missing inhaled steroid doses (73% versus 27%), rating as mild/moderate/severe (67% vs 33%), determining asthma improvement (71% vs 29%), hospital admission (61% vs 39%), recognition of sudden/quick flares (67% vs 33%), pre-flare health status (78% vs 22%), seasonal asthma (62% vs 38%), nocturnal awakening (65% vs 35%), and oral steroid use (65% vs 35%). Our findings show that asthmatics are more likely to underestimate asthma severity, compared with both EPR2 criteria and NK. NK provided more accurate information for health service utilization, missed school/work days, and for inhaled steroid exposure, and less accurate for asthma flare details; NK tend to underestimate the degree of therapeutic non-adherence. Obtaining information from NK who are cohabitants may increase reliability of information provided in studies of circumstances surrounding asthma fatalities.
Abstracts
41 The Influence of Long-Term Treatment With Histamine H1 Receptor Antagonists and Theophylline on the Incidence of Febrile Convulsion in Children With Atopic Dermatitis and/or Asthma Y Morisawa*, Y Ohya*, T Katsunuma*, T lshii*, H Watanabe*, T Suda*, H Kawahara*, H Matsumota*, Hiroshi Wakiguchi§, A Akasawa*, Hirohisa Saito* *National Children's Hospital, Tokyo, Japan §Kochi Medical School, Kochi, Japan BACKGROUND: Histamine H1 receptor antagonist (HI antagonist) and theophylline have widely been used for the treatment of asthma and the former has been used also for that of atopic dermatitis. Some reports pointed out that taking these therapeutic agents might cause to evoke convulsion. Most of them are case reports or laboratory experiments and no systematic study to explore their risk to convulsion has been published so far. The prevalence of febrile convulsion (FC) in preschool children is not rare in Japan. Therefore we are keen to know the association between H1 antagonists or theophylline and FC. PATIENTS AND METHODS: All patients who visited the outpatient units in the department of allergy National Children's Hospital in March 2001 are asked whether they had history of FC which occurred under 7 years old. One thousand and twenty-three patients who had no episode of neurological disorder except FC are recruited to join this study and examined their detail history of taking HI antagonists and theophylline. Multiple logistic regression analysis was used to explore the risk of these medicines against FC. RESULT: Six hundreds and two are male and four hundreds and twenty-one are female. Ketotifen and theophylline did not increase the prevalence of FC in users (adjusted odds ratio (OR) of FC prevalence in ketotifen users versus that in nonusers = 2.53, 95% confidence interval (CI) for differences = 0.55 - 11.6, adjusted OR of FC prevalence in theophylline users versus that in nonusers = 1.11, 95% CI = 0.49 - 2.51). The patients taking H 1 antagonists except ketotifen had tendency to lower the incidence of FC (adjusted OR = 0.36, 95% CI = 0.14 - 0.97). CONCLUSION: Ketotifen and theophylline are not the risk factors to increase the incidence of FC. H1 antagonists except ketotifen may lower the risk of FC.
A n ) Assessing the Burden of Seasonal Allergic Rhinitis on Sleep "It ~ - Patterns MB Scharf Tri-State Sleep Disorders Center, Cincinnati, OH Recently, studies of microarousals observed in the sleep EEG have resulted in the identification of a Cyclic Pattern of Alternating States of Arousal Sequences (CAPS) that correlate with subjective estimates of sleep quality. The current study was designed to evaluate the effects of seasonal allergic rhinitis on sleep architecture (sleep staging), the number of awakenings, arousals and microarousals (CAPS) with respiratory patterns, during symptomatic and asymptomatic periods in patients with a history of seasonal allergic rhinitis. Fourteen subjects between the ages of 18 and 60 with a minimum of a 2-year history of seasonal allergic rhinitis who were positive for skin test to a seasonal allergen and found to be in stable health were monitored for 3 consecutive nights in the sleep laboratory during a period in which they were asymptomatic and again for 3 consecutive nights during which they were symptomatic of allergic rhinitis. All subjects showing a severity of greater than 6 for the combined nasal symptom scores (including nasal stuffiness/congestion score of equal or greater than 2) and equal or greater than 11 for the total nasal and non-nasal symptom score at baseline were included. Data were analyzed for normality and parameters normally distributed were tested using the Kolmogorov-Smirnov one sample t-test. Parameters that were non-normally distributed were evaluated using the Kruskal-Wallis one way analysis of variance and the Mann Whitney U Test. Subjects reported mean score values of 14.5 while symptomatic compared to 2.9 while asymptomatic. No significant differences were seen
J ALLERGY CLIN IMMUNOL JANUARY 2002
in sleep latency, wake time during or after sleep, number of awakenings, sleep efficiency or sleep stage percentages in subjects between their symptomatic or asymptomatic periods. Both number of CAP epochs and CAP percentages were significantly higher during the symptomatic period than when subjects were asymptomatic. Part of the burden of SAR on quality of life is reflected in the finding that sleep is disrupted by a higher frequency of microarousals in subjects symptomatic for SAR than when they are asymptomatic. This may account for the increased reports of non-restorative sleep increased sleep fragmentation by patients with SAR during symptomatic periods. Table 1
Symptomatic Cap epochs
Cap%
201.9 +- 65.6
32.1 +- 10.5
Asymptomatic
P
117.0 +_43.0
P < .01
19.327.6
P< .01
Je~ Surveying a Cohortof Ambulatory Urban Asthmatic Patients To • '1'~]1 Assessthe Reliability of InformationObtained From Next-of-Kin Pare Capocci-Tolomeo*, Marcia Polansky§, Michael S Sherman,, David M Lang* *Thomas Jefferson University, Philadelphia, PA §MCP/Hahne-
3A
mann University, Philadelphia, PA ¥MCP/Hahnemann University, Philadelhia, PA We described a surge in rates of asthma mortality in Philadelphia (NEJM 1994; 331:1572), that continued through the late 1990's (JACI 1998; 101 :$224); however, the circumstances surrounding these fatalities were not fully analyzed. Prior to carrying out a case-control study to entail analyses of information provided by next-of-kin (NK) of asthma decedents, we carried out a pilot study to determine the reliability of information provided by proxy respondents. Asthmatics receiving care at TJU were invited to partake in a brief telephone interview regarding their asthma. Each asthmatic identified NK respondents, who were surveyed using the same questionnaire concerning asthma progression, severity, management, and medication exposures. Asthmatics were categorized as mild/moderate/severe based on EPR2 criteria. Agreement levels between information reported by asthmatics and NK was compared using % correct, Chi-Square, and McNemar Test statistics. Of 28 asthmatics, 22 were women, 15 Caucasian. High agreement levels were observed for hospital admittance (82%, p=.001), ER visits (82%, p=.001), missed school/work days (79%, p=.043), and inhaled steroid use (75%, p=NS). Poor agreement was observed for recent asthma improvement (50%, p=NS), last asthma flare (50%, p=.012), suddenness of flare onset (21%, p=NS), pre-flare health status (32%, p=NS), and missing inhaled steroid doses (39%, p=NS), with NK more likely to underestimate degree of non-adherence (p=.013, McNemar). For rating asthma as mild/moderate/severe, there was only 33% agreement (p=.031, McNemar) between EPR2 criteria/patient, compared to 52% agreement between EPR2 criteria/NK and 54% for patient/NK. For rating asthma as severe versus mild/moderate, better agreement was observed for EPR2 criteria/patient (74%), physician/NK (70%), and patient/NK (82%). A high agreement trend was observed for NK who were cohabitants: missing inhaled steroid doses (73% versus 27%), rating as mild/moderate/severe (67% vs 33%), determining asthma improvement (71% vs 29%), hospital admission (61% vs 39%), recognition of sudden/quick flares (67% vs 33%), pre-flare health status (78% vs 22%), seasonal asthma (62% vs 38%), nocturnal awakening (65% vs 35%), and oral steroid use (65% vs 35%). Our findings show that asthmatics are more likely to underestimate asthma severity, compared with both EPR2 criteria and NK. NK provided more accurate information for health service utilization, missed school/work days, and for inhaled steroid exposure, and less accurate for asthma flare details; NK tend to underestimate the degree of therapeutic non-adherence. Obtaining information from NK who are cohabitants may increase reliability of information provided in studies of circumstances surrounding asthma fatalities.