perception of asthma control is not consistent with reported symptom frequency in urban adolescents

J ALLERGY CLIN IMMUNOL

FEBRUARY 2014

AB14 AbstractsSATURDAY

51 Perception Of Asthma Control Is Not Consistent With ReportedSymptom Frequency In Urban Adolescents

Emily C. Ledford1, Ms. Jean Curtin-Brosnan, MA2, Dr. Meredith C.

McCormack, MD3, Dr. Elizabeth Matsui, MD4; 1Johns Hopkins School

of Medicine, 2Johns Hopkins University, Baltimore, MD, 3The Johns

Hopkins Pulmonary, Baltimore, MD, 4The Johns Hopkins University

School of Medicine, Baltimore, MD.

RATIONALE: The relationship between perception of asthma control

and reported symptom frequency among adolescents remains unclear.

METHODS: 48 Baltimore adolescents (14-17y) with persistent asthma

were enrolled in an observational prospective study. A questionnaire

captured symptoms, rescue medication use, and perceived asthma control.

The reported frequency of symptoms, activity limitation, nocturnal

awakenings, and albuterol use within the past two weeks were used to

determine actual asthma control. Misperception of control was defined as

report of well-controlled asthma when the child’s asthma met NAEPP

criteria for not well-controlled or poorly controlled asthma.

RESULTS: 54.2%were female, 91.7%African American, and 85.4% had

public insurance. At baseline, 75% perceived that their asthma was well

controlled, but 54% actually had well-controlled asthma. Adolescents who

reported well-controlled asthma had fewer symptoms than those who

reported uncontrolled asthma (mean: 3.1 vs. 5.8 days/2 weeks, p50.008).

At the baseline visit, among thosewho reported that their asthmawas well-

controlled, 39% had symptom frequencies indicative of uncontrolled

asthma (means: 7.0 days symptoms, 4.9 days of albuterol). The proportion

of adolescents who exhibitedmisperception of control decreased over time

(22, 17, 3, and 1%at the 3, 6, 9, and 12month visits, respectively; p50.004).

CONCLUSIONS: A substantial proportion of adolescents who perceived

that their asthma was well-controlled reported symptom frequencies

indicative of uncontrolled asthma; however, their perception of asthma

control improved over time. These findings suggest that education about

goals of asthma management and repeated follow-up may improve

adolescents’ ability to accurately assess and manage their asthma.

52 Urban Residence Modifies The Association Between Atopy andWheeze

Dr. Pablo F. Endara1, Dr. Phil J. Cooper2,3, Thomas A. E. Platts-

Mills, MD, PhD, FAAAAI4, Lisa J. Workman, BA4, Maritza Vaca5,

Dr. Martha Chico6, Mauricio L. Barreto, PhD7, Prof. Laura Rodrigues8;1Universidad San Francisco de Quito, 2St. George’s University, London,

United Kingdom, 3Pontificia Universidad Catolica del Ecuador, 4Division

of Asthma, Allergy & Immunology, University of Virginia Health System,

Charlottesville,VA, 5Laboratorio deFEPIS,Quinind�e, EsmeraldasProvince,

Ecuador, 6Laboratorio de Investigacion FEPIS, 7Instituto de Sa�ude Coletiva,

UFBa, Salvador, BA, Brazil, 8London School of Hygiene and Tropical

Medicine.

RATIONALE: The association between atopy and allergic disease

appears to be stronger in affluent compared to non-affluent populations,

an effect that may be explained by attenuation of atopy by environmental

exposures. We hypothesized that urban residence could modify the

association between atopy indicators and wheeze and identified environ-

mental exposures contributing to this effect.

METHODS: Two nested case-control studies were done among school-

children living in rural communities and urban neighbourhoods in the

Province of Esmeraldas-Ecuador. Cases were defined as children with

parentally-reported wheeze in the last year and controls as children with no

history of wheeze. We measured geohelminths in stool samples and atopy

by the specific IgE and skin prick test (SPT) reactivity to aeroallergens.

RESULTS: Atopy, particularly measured as specific IgE against house

dust mite (HDM), was more strongly associated with recent wheeze in

urban than rural schoolchildren: (urban, adj. OR 5.19, 95% CI 3.37-8.00,

P<0.0001; rural, adj. OR 1.81, 95%CI 1.09-2.99, P50.02; interaction,

P<0.001). Twice as many wheeze cases were explained by atopy in urban

compared to rural children: SPT toHDM (urban 18.5% vs. rural 9.6%), and

anti-HDM IgE (urban 26.5% vs. rural 10.5%). The association between

atopy and recent wheeze was attenuated by markers of geohelminth

infections.

CONCLUSIONS: Our data suggest that urban residence modifies the

association between HDM atopy and recent wheeze, and this effect is

explained partly by the presence of geohelminth infection markers.

53 Allergic Inflammation and Health Outcomes Of Comorbid Asthmaand Obesity In Inner-City Black and Hispanic Schoolchildren

Dr. Perdita Permaul, MD1,2, Dr. William J. Sheehan, MD2,3, Mr. Carter

Petty, MA3, Dr. Sachin N. Baxi, MD2,3, Dr. Jonathan M. Gaffin, MD,

MMSc2,3, Dr. Lianne S. Kopel, MD2,3, Dr. Watcharoot

Kanchongkittiphon, MD, PhD3, Mrs. Chunxia Fu, MS4, Dr. Diane R.

Gold, MD, MPH2,4, Dr. Wanda Phipatanakul, MD, MS, FAAAAI2,3; 1Di-

vision of Pediatric Allergy/Immunology, Massachusetts General Hospital,

Boston, MA, 2Harvard Medical School, Boston, MA, 3Boston Children’s

Hospital, Boston, MA, 4Channing Laboratory, Brigham and Women’s

Hospital, Boston, MA.

RATIONALE: The impact of obesity on asthma outcomes and its

relationship with allergic inflammation in inner-city black and Hispanic

children is poorly understood.

METHODS: The School Inner City Asthma Study (SICAS) examines

urban classroom allergen exposures and asthma morbidity in students with

asthma. Allergen sensitization data is collected at baseline. Classroom

mouse allergen (Mus m 1) levels, linked to enrolled students, are collected

during the academic year. Asthma morbidity outcome measures are

obtained every 3 months. Students are stratified by body mass index

percentile for age and sex.

RESULTS: Of 303 enrolled students, 49% were normal weight, 50%

overweight, and 34% obese. Participants were predominantly black (35%)

and Hispanic (37%). Mouse allergen levels and skin testing data were

available in 257 students from 29 schools; 27% (N570 students) were

mouse sensitized. Among sensitized, no significant interaction between

obesity and mouse allergen exposure (p50.82) when stratified by race (all

races p>0.60) or as a main effect of obesity (p50.32) on asthma symptom

days exists. However, obese black students had more symptom days

compared to normal/overweight black students (3.59 vs. 2.25 vs. 2.09,

p50.002) regardless of allergen sensitization and exposure, not seen in

Hispanic students. No significant interactions of obesity and race were

seen when predicting positive skin tests, FeNO level, healthcare and

controller medication use.

CONCLUSIONS: Obesity is not a risk factor for allergic inflammation

and subsequent asthma symptoms suggesting a non-Th2 obesity-asthma

phenotype. Obesity effects on asthma symptoms may vary by race,

however, with obese black students having more symptom days than

Hispanics.