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Utility of FEV1% as a screening tool for asthma
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Abstracts
1' l
Evaluation of Atopy in the Asthmatic Population of St. Vincent and the Grenadines
H. Bacchus i, C. D. Schwindt2; ZMinistry of Health and the Environment, St. Vincent, SAINT VINCENT AND THE GRENADINES, 2pediatrics, University of Maryland, Baltimore, MD. RATIONALE: St. Vincent and the Grenadines is a developing country in the West Indies reporting a four-fold increase in asthma cases over the last 10 years. Potential allergic triggers to asthma have never been evaluated. METHODS: 87 subjects were recruited from the asthma clinic for skin testing and assessment of asthma severity levels according to NHLBI guidelines. The aeroallergen panel was selected based on review of a questionnaire administered to 292 subjects seen in the asthma clinic from 1999 to 2001. Commonly reported triggers included dust (49%), cat (21%), and dog (41%). Cockroach and goat were added given potential environmental exposure. Subjects were skin tested using Multi-Test II to Dermatophagoides pteronyssinus, Dermatophagoides farinae, Periplaneta americana, cat, dog, and goat. Exclusion criteria included dermatographism (2). RESULTS: Of 85 subjects, 69% were skin test positive to at [east one aeroallergen, with 56% positive to Dermatophagoides pteronyssinus, 62% to Dermatophagoides farinae, 33% to Periplaneta americana, 6% to cat, 4% to dog and 2% to goat. Asthma severity levels were determined in 86% of subjects. Atopy was found in 56% of subjects with mild intermittent asthma, 79% with mild persistent asthma, 100% with moderate persistent asthma, and 63% of severe persistent asthmatics. CONCLUSIONS: This preliminary investigation demonstrates atopy in the asthmatic population of St. Vincent and the Grenadines. It further suggests Dermatophagoides pteronyssinus, Dermatophagoides farinae and Periplaneta americana are potential allergic triggers to asthma. Further studies are required to correlate aeroallergens levels with clinical findings in this population.
Funding: University of Maryland
512 Utility of FEV1%as a Screening Tool for Asthma M. L. Dyer I, M. Li l, T. Kimia l, L. Clement 1, K. Kwong 1, N. Maalouf I, J. Hanley-Lopez 1, K. Feliciano ], T. Morphew I , E Lison 2, C. Jones]; ILos Angeles County + University of Southern California Medical Center, Los Angeles, CA, 2Southern California Chapter of the Asthma and Allergy Foundation of America, Los Angeles, CA. RATIONALE: Validated screening methods can help direct inner city asthma interventions for children. This study compares the utility of FEVI and a 7 question parental survey to identify children with asthma. M E T H O D S : As part of a school based treatment program, parental surveys, blinded physician evaluations, and spirometry were completed on a sequential, self referred, population of 675 children. RESULTS: Clinical assessment and parental survey responses were compared (n=636) to develop a tiered algorithm that estimates the probability of asthma based on survey answers (sensitivity = 86.7%, specificity = 83.0%, PVP = 93.3%, NPV = 69.6%, ->80% probability of asthma). The sensitivity was 77.3% and 91.3% for detecting intermittent and persistent asthma. In the same population, abnormal FEVI% (<80% predicted) detected asthma with a sensitivity of 29. 1%, specificity of 80.7%, PPV of 86.7%, and NPV of 21).9%. Abnormal FEVI discriminated between intermittent and persistent asthma with a sensitivity and specificity of 35.0% and 82.5%, and between mild asthma and moderate to severe with a sensitivity of 42.3% and a specificity of 81. 1%. CONCLUSIONS: Parental responses to a seven question survey provide a sensitive and specific way to identify children with asthma. In comparison FEV 1% has a poor sensitivity and lower specificity as a screening tool.
Funding: Southern Cal~lbrnia Chapter c)f the Asthma and Allergy Foundation c~['America t fJ) Children with Asthma at Risk in America (CARA): A Survey of ;J I Parents' Concerns about Asthma J. Golding I, S. Wade2; ]AstraZeneca, LP, Wilmington, DE, 2Harris Interactive, Claremont, CA.
J ALLERGY CLIN IMMUNOL FEBRUARY 2003
RATIONALE: Families of asthmatic children may have considerable concerns about the long-term health risks of asthma and its impact on family life. METHODS: The CARA survey assessed parents' perceptions regarding the risks of poorly controlled asthma and its impact on family functioning. Telephone interviews were conducted with 501 respondents from a nationwide panel of parents identified as having a child _<12years with physiciandiagnosed asthma; respondents answered questions about only 1 child. RESULTS: The majority of parents expressed concerns about irreversible airway damage and the risk of death from asthma complications (81% and 68%, respectively). Notably, 69% of children with a specific diagnosis (n = 459) had only mild intermittent or persistent asthma, yet 41% to 49% of their parents were still very concerned about these long-term risks. Parents also were concerned about unscheduled visits to a physician's office (57%), emergency department treatment (59%), or hospitalization (56%). Indeed, many children with even mild persistent asthma required emergency department treatment more than twice a year and unscheduled doctor visits more than 3 times per year, whereas many children <3 years averaged 7 unscheduled doctor visits per year. Family lifestyle was affected across all asthma severities, with 72% of parents agreeing that being prepared for asthma symptoms is always a consideration when planning activities, and 33% indicating that family events had been "stopped short" because of asthma. CONCLUSIONS: Asthma places a substantial emotional and physical burden on families of afflicted children, even if the child has only mild disease.
Funding: AstraZeneca, LP
1A Prevalence and Causes of Medication Non-compliance in Dis"If advantaged Elderly Patients with Reversible Obstructive Airways Disease C. A. Saltouu, P. Yarnold, L. C. Grammer; Northwestern University Medical School, Chicago, IL. RATIONALE: Reversible obstructive airways disease (ROAD) is underdiagnosed and consequently sub-optimally managed in disadvantaged elderly patients. This leads to poor symptom control, decreased quality of life, and increased healthcare utilization. Medication non-compliance may also contribute to disease disparity in this population. METHODS: We undertook to determine the prevalence of non-compliance and what factors contributed to non-compliance in a small group of disadvantaged elderly adults with ROAD. Study participants were selected on the basis of a diagnosis of ROAD from a group of elderly adults attending centers subsidized by the Chicago Department on Aging who had agreed to complete a 5 page questionnaire about their general health. RESULTS: From a total of 86 patients with diagnosed disease, only 24 (28%) took their prescribed medications regularly. Both patients taking their medication regularly and those not taking them regularly were asked to respond yes or no as to whether the following factors contributed to their compliance: (1) too expensive, (2) inconvenient to use, (3) do not trust medications, (4) difficult to remember to take, (5) do not think they work, and (6) do not like side effects. Although each factor contributed for a subset of patients, the only statistically significant factor using Fisher's exact test was "too expensive" (p<0.0007). C O N C L U S I O N S : Medication non-compliance in the disadvantaged elderly population with ROAD in Chicago is likely due to the high cost of medications. Although better medication compliance would lead to decrease health care utilization, this long-term savings is not always apparent to this study population.
Funding: AAAAL ACAAL ASP, GDI, JHE Sprague Foundation
515 Among Primary Care Provider (PCP) Adherence to NAEPP Guidelines High-Risk Inner-City Children With Asthma K. A. Riekert I, K. Huss 2, A. M. Butz 3, P. Eggleston 3, M. Winkelstein 2, C. S. Randl; tMedicine, Johns Hopkins University, Baltimore, MD, 2Nursing, Johns Hopkins University, Baltimore, MD, 3pediatrics, Johns Hopkins University, Baltimore, MD. RATIONALE: Under-treatment of asthma has been well documented in
Abstracts
1' l
Evaluation of Atopy in the Asthmatic Population of St. Vincent and the Grenadines
H. Bacchus i, C. D. Schwindt2; ZMinistry of Health and the Environment, St. Vincent, SAINT VINCENT AND THE GRENADINES, 2pediatrics, University of Maryland, Baltimore, MD. RATIONALE: St. Vincent and the Grenadines is a developing country in the West Indies reporting a four-fold increase in asthma cases over the last 10 years. Potential allergic triggers to asthma have never been evaluated. METHODS: 87 subjects were recruited from the asthma clinic for skin testing and assessment of asthma severity levels according to NHLBI guidelines. The aeroallergen panel was selected based on review of a questionnaire administered to 292 subjects seen in the asthma clinic from 1999 to 2001. Commonly reported triggers included dust (49%), cat (21%), and dog (41%). Cockroach and goat were added given potential environmental exposure. Subjects were skin tested using Multi-Test II to Dermatophagoides pteronyssinus, Dermatophagoides farinae, Periplaneta americana, cat, dog, and goat. Exclusion criteria included dermatographism (2). RESULTS: Of 85 subjects, 69% were skin test positive to at [east one aeroallergen, with 56% positive to Dermatophagoides pteronyssinus, 62% to Dermatophagoides farinae, 33% to Periplaneta americana, 6% to cat, 4% to dog and 2% to goat. Asthma severity levels were determined in 86% of subjects. Atopy was found in 56% of subjects with mild intermittent asthma, 79% with mild persistent asthma, 100% with moderate persistent asthma, and 63% of severe persistent asthmatics. CONCLUSIONS: This preliminary investigation demonstrates atopy in the asthmatic population of St. Vincent and the Grenadines. It further suggests Dermatophagoides pteronyssinus, Dermatophagoides farinae and Periplaneta americana are potential allergic triggers to asthma. Further studies are required to correlate aeroallergens levels with clinical findings in this population.
Funding: University of Maryland
512 Utility of FEV1%as a Screening Tool for Asthma M. L. Dyer I, M. Li l, T. Kimia l, L. Clement 1, K. Kwong 1, N. Maalouf I, J. Hanley-Lopez 1, K. Feliciano ], T. Morphew I , E Lison 2, C. Jones]; ILos Angeles County + University of Southern California Medical Center, Los Angeles, CA, 2Southern California Chapter of the Asthma and Allergy Foundation of America, Los Angeles, CA. RATIONALE: Validated screening methods can help direct inner city asthma interventions for children. This study compares the utility of FEVI and a 7 question parental survey to identify children with asthma. M E T H O D S : As part of a school based treatment program, parental surveys, blinded physician evaluations, and spirometry were completed on a sequential, self referred, population of 675 children. RESULTS: Clinical assessment and parental survey responses were compared (n=636) to develop a tiered algorithm that estimates the probability of asthma based on survey answers (sensitivity = 86.7%, specificity = 83.0%, PVP = 93.3%, NPV = 69.6%, ->80% probability of asthma). The sensitivity was 77.3% and 91.3% for detecting intermittent and persistent asthma. In the same population, abnormal FEVI% (<80% predicted) detected asthma with a sensitivity of 29. 1%, specificity of 80.7%, PPV of 86.7%, and NPV of 21).9%. Abnormal FEVI discriminated between intermittent and persistent asthma with a sensitivity and specificity of 35.0% and 82.5%, and between mild asthma and moderate to severe with a sensitivity of 42.3% and a specificity of 81. 1%. CONCLUSIONS: Parental responses to a seven question survey provide a sensitive and specific way to identify children with asthma. In comparison FEV 1% has a poor sensitivity and lower specificity as a screening tool.
Funding: Southern Cal~lbrnia Chapter c)f the Asthma and Allergy Foundation c~['America t fJ) Children with Asthma at Risk in America (CARA): A Survey of ;J I Parents' Concerns about Asthma J. Golding I, S. Wade2; ]AstraZeneca, LP, Wilmington, DE, 2Harris Interactive, Claremont, CA.
J ALLERGY CLIN IMMUNOL FEBRUARY 2003
RATIONALE: Families of asthmatic children may have considerable concerns about the long-term health risks of asthma and its impact on family life. METHODS: The CARA survey assessed parents' perceptions regarding the risks of poorly controlled asthma and its impact on family functioning. Telephone interviews were conducted with 501 respondents from a nationwide panel of parents identified as having a child _<12years with physiciandiagnosed asthma; respondents answered questions about only 1 child. RESULTS: The majority of parents expressed concerns about irreversible airway damage and the risk of death from asthma complications (81% and 68%, respectively). Notably, 69% of children with a specific diagnosis (n = 459) had only mild intermittent or persistent asthma, yet 41% to 49% of their parents were still very concerned about these long-term risks. Parents also were concerned about unscheduled visits to a physician's office (57%), emergency department treatment (59%), or hospitalization (56%). Indeed, many children with even mild persistent asthma required emergency department treatment more than twice a year and unscheduled doctor visits more than 3 times per year, whereas many children <3 years averaged 7 unscheduled doctor visits per year. Family lifestyle was affected across all asthma severities, with 72% of parents agreeing that being prepared for asthma symptoms is always a consideration when planning activities, and 33% indicating that family events had been "stopped short" because of asthma. CONCLUSIONS: Asthma places a substantial emotional and physical burden on families of afflicted children, even if the child has only mild disease.
Funding: AstraZeneca, LP
1A Prevalence and Causes of Medication Non-compliance in Dis"If advantaged Elderly Patients with Reversible Obstructive Airways Disease C. A. Saltouu, P. Yarnold, L. C. Grammer; Northwestern University Medical School, Chicago, IL. RATIONALE: Reversible obstructive airways disease (ROAD) is underdiagnosed and consequently sub-optimally managed in disadvantaged elderly patients. This leads to poor symptom control, decreased quality of life, and increased healthcare utilization. Medication non-compliance may also contribute to disease disparity in this population. METHODS: We undertook to determine the prevalence of non-compliance and what factors contributed to non-compliance in a small group of disadvantaged elderly adults with ROAD. Study participants were selected on the basis of a diagnosis of ROAD from a group of elderly adults attending centers subsidized by the Chicago Department on Aging who had agreed to complete a 5 page questionnaire about their general health. RESULTS: From a total of 86 patients with diagnosed disease, only 24 (28%) took their prescribed medications regularly. Both patients taking their medication regularly and those not taking them regularly were asked to respond yes or no as to whether the following factors contributed to their compliance: (1) too expensive, (2) inconvenient to use, (3) do not trust medications, (4) difficult to remember to take, (5) do not think they work, and (6) do not like side effects. Although each factor contributed for a subset of patients, the only statistically significant factor using Fisher's exact test was "too expensive" (p<0.0007). C O N C L U S I O N S : Medication non-compliance in the disadvantaged elderly population with ROAD in Chicago is likely due to the high cost of medications. Although better medication compliance would lead to decrease health care utilization, this long-term savings is not always apparent to this study population.
Funding: AAAAL ACAAL ASP, GDI, JHE Sprague Foundation
515 Among Primary Care Provider (PCP) Adherence to NAEPP Guidelines High-Risk Inner-City Children With Asthma K. A. Riekert I, K. Huss 2, A. M. Butz 3, P. Eggleston 3, M. Winkelstein 2, C. S. Randl; tMedicine, Johns Hopkins University, Baltimore, MD, 2Nursing, Johns Hopkins University, Baltimore, MD, 3pediatrics, Johns Hopkins University, Baltimore, MD. RATIONALE: Under-treatment of asthma has been well documented in