der1; 1Allergy and Immunology, Long Island College Hospital, Brooklyn,NY, 2Pediatrics, Long Island College Hospital, Brooklyn, NY.RATIONALE: Implementation of NAEPP Asthma Guidelines is notfully embraced by primary-care practitioners. To improve compliance, ahospital based pediatric clinic(HBPC) and school based healthclinics(SBHC) located in inner city Brooklyn participated in an asthmaeducation program which trained the primary-care practitioners in theguidelines. During the program, compliance was excellent evidenced byclassification of asthma severity 83%(179/216) of visits. Documentationof asthma action plans and appropriate use of controller medication wasgreater than 90%(101/110). This study evaluates compliance one yearafter cessation of the intensive asthma education program.METHODS: Charts from the initial study were reviewed. Compliancewas measured by tracking the documentation of asthma severity, asthmaaction plans, and appropriate use of controller medication during visitsthat occurred after program cessation.RESULTS: 820 visits were reviewed. The SBHC classified asthma sever-ity in 66%(310/469), appropriately used controller medication in72%(39/54) and reviewed asthma action plans in 41%(194/469) of visits.The HBPC classified asthma severity in 55%(192/351), appropriatelyused controller medication in 74%(51/69) and reviewed asthma actionplans in 28%(97/351) of visits.CONCLUSIONS: The initial asthma education program improved pri-mary-care practitioners’ compliance with asthma guidelines. After cessa-tion of program, compliance decreased in both clinic settings, howevermore so in the HBPC. Continuity may be a factor as the HBPC is staffedby multiple residents and attending physicians whereas the SBHC isstaffed by fulltime nurse practitioners. However, even when continuityexisted with the HBPC attending physicians, compliance remained poor.Possibly more frequent guideline training will convince physicians to uti-

J ALLERGY CLIN IMMUNOL Abstracts S145VOLUME 115, NUMBER 2

577 Asthma Morbidity and Asthma-Related Risk Factors AmongInner-City School Children

K. Paris, M. Mvula, C. Moore; Department of Pediatrics, LSU HSC, NewOrleans, LA.RATIONALE: To determine the magnitude of asthma-related morbidity,treatment and risk factors in a select inner city population.METHODS: Routine health screenings, including tests for asthma, wereconducted at an urban high school. Participants (204) filled the Interna-tional Study of Asthma and Allergy in Childhood (ISAAC) questionnaire,identified their treatment, and asthma tools. Demographic informationwas collected.RESULTS: Participants were 13-19 years: 50.5% African American,45.1% white, 31.4% male. Cumulative asthma prevalence was 18.8%.Related morbidity was: Lifetime wheezing, 24%;12-month wheezing,12.7%, girls reporting it 3.36 times more often (95% CI: 1.54, 7.36);wheezing more than 4 times in 12 months, 4.7%; wheezing with exercise,10.9%; and night cough, 10.5%. There was significant associationbetween race and wheezing in the past 12 months (p < 0.024), whitesreporting 3.78 times more often (95% CI: 2.01, 7.10). Parents with lesseducation, <high school, were 8.33 times more likely (95% CI: 7.46, 9.30)to have children who developed wheezing. Body Mass Index (≥ 25) wasassociated with wheezing after exercise (p < 0.008), a 3.27-fold increase(95% CI: 2.46, 4.31). Among those with current asthma (15/204), fourwere not on medication, ten used a bronchodilator, and five used anti-inflammatories. Three reported using a spacer and six reported using apeak flow meter.CONCLUSIONS: This study confirms excessive asthma morbidityamong inner city children. Risk factors associated with excess morbidityincluded lesser parental education, female gender, and BMI ≥ 25.Funding: Pfizer Pharmaceuticals

578 Medication Use Prior to and Post Emergency Department (ED)Visit for Pediatric Asthma

T. P. McLaughlin1, D. A. Stempel2, R. H. Stanford3; 1NDCHealth,Phoenix, AZ, 2University of Washington, Seattle, WA, 3GlaxoSmithKline,Research Triangle Park, NC.RATIONALE: This study was designed to describe the treatment pat-terns in children in the year prior and two months after an ED event.METHODS: This retrospective, observational study utilized the Phar-Metrics Integrated Outcomes Database that contains administrativeclaims from over 20 managed care plans across the United States. Allpatients, aged 1-17 years, with at least one ED visit for asthma during2001 were included. Patients were required to have data available 12months prior to and 2 months following the ED visit.RESULTS: 5,501 asthma-related ED admissions were identified duringthe study period. In the year prior to the ED event 19.4% of the childrenreceived an inhaled corticosteroid (ICS), 31.4% oral corticosteroids(OCS) and 58.3% short-acting beta2-agonists (SABA). Overall, therewere more than three albuterol units for every ICS unit dispensed in the12-month period prior to the event. Ninety-four percent of patients had anoffice visit in the prior year but only 7.9% had spirometry performed. Pre-scriptions dispensed for ICS and OCS increased 2.9-fold and 8.2-foldrespectively in the month after the ED event; however, the dispensingrates for both of these medications reverted to near baseline rates by thesecond month after the index ED event.CONCLUSIONS: This study demonstrates the dependence of childrenwith asthma on the use of rescue medications including SABA and OCS.An ED event results in an incremental but transient, improvement in ICS-containing controller treatment.Funding: GlaxoSmithKline

579 Compliance With NAEPP Asthma Guidelines in a HospitalBased Pediatric Clinic and School Based Health Clinics Afteran Asthma Education Program

T. Tavarkiladze1, S. Kearney1, K. Garrett-Szymanski1, A. Khadavi1, Y.Persaud1, W. Mak1, R. Giusti2, S. Watson2, B. Silverman1, A. T. Schnei-

lize the NAEPP asthma guidelines.

580 School-Based Asthma Education Program and Impact onQuality of Life

A. A. Khuntia1, M. D. Cabana2, K. K. Slish2, T. M. Ghormley3, M. S.McMorris1; 1Internal Medicine/Allergy Division, University of Michigan,Ann Arbor, MI, 2Pediatrics, University of Michigan, Ann Arbor, MI, 3St.Joseph Mercy Hospital, Ann Arbor, MI.RATIONALE: Improving child and caregiver quality of life is a commongoal of asthma education programs, but few studies have evaluated thequality of life of both groups independently. We assessed the impact of aschool-based asthma education program on child and caregiver quality oflife.METHODS: 48 children between the ages of 7 and 15 with asthma wereenrolled in a six-week school-based asthma education program modeledafter the American Lung Association “Open-Airways for Schools” pro-gram. Quality of life of students and their caregivers were measured usinga previously validated Asthma Quality of Life Questionnaire (AQLQ).Six-week follow-up AQLQ outcomes were compared to baseline usingMcNemar’s test.RESULTS: Children had a mean age of 9.9 yrs; 54% were male. 94% ofthe children were non-Hispanic. 48% of the children were Caucasian,42% African American, 2% Asian and 8% were characterized as other.39% of children and 30% of caregivers showed an overall improvementin quality of life (minimal important difference-MID=0.5). Domain spe-cific questions were analyzed. 31% of students reached MID in the emo-tional domain, 50% in the activity domain, and 46% in the symptomdomain. 27% of caregivers attained MID in the emotional domain and30% in the activity domain. Student questions pertaining to exercising(p<0.0001), walking (p<0.045), tiredness (p<0.039), difficulty taking adeep breath (p<0.045) and chest tightness (p<0.020) were statisticallysignificant.CONCLUSIONS: A school-based asthma education program improvesoverall quality of life of participants and their caregivers. Additionally,students showed significant improvement in activities as well as symp-toms after program completion.

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