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