J ALLERGY CLIN IMMUNOL

VOLUME 125, NUMBER 2

Abstracts AB99

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389 Assessment of Pulmonary Function in Asthma Patients ofSelf-Reported Puerto Rican or Mexican Descent

J. Zangrilli1, L. E. Mansfield2, T. Uryniak1, C. D. O’Brien1; 1AstraZeneca

LP, Wilmington, DE, 2Texas Tech University, El Paso, TX.

RATIONALE: Asthma severity heterogeneity across Hispanic subgroups

could involve differing responses to inhaled corticosteroids (ICSs). To test

this, a post hoc analysis of pulmonary function was performed before and

after 2 wk of budesonide (BUD) in asthma patients of Puerto Rican (PR) or

Mexican (MX) descent.

METHODS: Hispanic (self-reported) asthma patients �12 y (screening

FEV1 45%-85% predicted; FEV1 reversibility�12% and�0.20 L) report-

ing prior treatment with medium- to high-dose ICS were placed on BUD

160mg bid during a 2-wk run-in period as part of a 12-wk, randomized,

double-blind, active-controlled US study (NCT00419757). Patients self-

identified as PR, South/Central American/MX, Cuban/Caribbean, or

mixed descent had spirometry testing at screening and after 2 wk.

Inclusion criteria: asthma symptom score >0 (scale: 0-3) on �3 of 7

run-in days, predose FEV1 45%-85% at run-in completion.

RESULTS: At screening, patients of PR origin (n547) had lower pulmo-

nary function than those of MX origin (n5105): predose FEV1, 1.94 vs

2.16 L; FEV1% predicted, 62.9% vs 70.6%. After 2-wk BUD, differences

between PR and MX were smaller (FEV1: 2.14 and 2.22L; FEV1% pre-

dicted: 69.4% and 72.5%), representing increases from screening FEV1

of 10.3% and 2.8%, respectively.

CONCLUSIONS: PR asthma patients had lower pulmonary function than

MX at screening despite the same entry criteria. Increases in FEV1 after 2-

wk BUD 160mg bid were larger for PR than MX. The observed lower FEV1

values at entry may involve undertreatment, despite the historical ICS dose.

These findings suggest that decreased adherence may contribute to the re-

ported asthma heterogeneity in Hispanic subpopulations.

390 Background Variability During a Well Period of Parent-Identified Respiratory and Non-Respiratory Signs andSymptoms in Children with Asthma

L. P. Newton, R. C. Strunk, L. B. Bacharier, J. M. Garbutt, K. Rivera-

Spoljaric; Washington University School of Medicine, Saint Louis, MO.

RATIONALE: Little is known about how respiratory and non-respiratory

signs and symptoms vary in children with asthma on a day-to-day basis

during wellness or if parents are able to monitor this variability.

METHODS: Parents of children aged 2-11 years with persistent asthma

scored 41 signs and symptoms using a 5-point likert scale daily for 2 weeks.

The signs and symptoms were based upon a previous study of parent-iden-

tified respiratory and non-respiratory signs and symptoms. Parents an-

swered the Asthma Control Questionnaire (ACQ) by telephone weekly.

RESULTS: We enrolled 21 parents (86% mothers). The majority were

well-educated (62% college or above), employed full time (57%), privately

insured (81%), and Caucasian (86%). The average child age was 7 years

and 62% were boys. 71% were classified as moderate persistent asthma

and 86% had well-controlled asthma (ACQ<1.5). None required systemic

corticosteroids, medical provider visits, or hospitalizations during the 2-

week study. Diaries were well understood and compliance with entry

was 100%. Of the well-controlled group, there was little deviation of symp-

toms from baseline, with a score of 3 (representing usual state) for 93.3% of

non-respiratory symptoms (behavioral 91.8%, appearance 95.7%), and

93.8% of respiratory symptoms (90.8% upper, 95.4% lower).

CONCLUSIONS: Adherence and understanding of this symptom moni-

toring approach was high. During well periods, children with asthma had

minimal variability of respiratory and non-respiratory signs and symptoms.

Extension of this monitoring strategy to children during periods with an

asthma exacerbation would be useful to further evaluate sensitivity and

specificity of these early warning signs and symptoms to detect asthma

exacerbations.

391 Relationship Between Caregiver Characteristics andMorbidity Among High-Risk Rural Children with Asthma

A. C. Strong, R. H. Brown, A. McCracken, T. G. Nick, D. R. Watkins,

T. T. Perry; University of Arkansas for Medical Sciences/Arkansas Child-

ren’s Hospital, Little Rock, AR.

RATIONALE: To examine the relationship between caregiver character-

istics and morbidity among rural children with asthma in the Mississippi

Delta region of Arkansas.

METHODS: Caregivers of 116 rural children with persistent asthma were

screened for depressive symptoms, life stressors, and asthma self-efficacy.

The relationship between caregiver characteristics and asthma morbidity

was examined.

RESULTS: Of the 116 children enrolled, all reside in an agricultural rural

environment, 82%were African-American, 55% male, and 70% from house-

holds with annual income�$20,000. Caregivers reported depressive symp-

toms (36%), feelings of helplessness during their child’s asthma attacks

(72%), and interference with their job (43%). The majority of caregivers re-

ported that their child had symptoms consistent with poorly controlled

asthma including daytime symptoms �2 days per week (54%), nocturnal

symptoms�2 nights per month (61%), and rescue medication use�2 times

per week (73%). No significant difference was detected in asthma symptoms

among children whose caregivers reported depressive symptoms compared

to those without depressive symptoms. Children of caregivers who reported

that their child’s asthma interfered with their job were more likely to report

daytime symptoms �2 days per week [OR 3.31 (95% CI 1.46-7.53)] and

nocturnal symptoms �2 nights per month [OR 2.41 (95% CI 1.05-5.53)].

Caregiver feelings of helplessness was more common [OR 2.9 (95%CI

1.21-7.33)] among children with day symptoms �2 days per week.

CONCLUSIONS: Asthma morbidity is high among predominately low-

income, minority rural children living in the Arkansas Delta region and in-

creased asthma symptoms were associated with increased caregiver report

of job interference and feelings of helplessness.

392 Correlation of Parent and Student Asthma and AllergyQuestionnaires in a Diverse Inner City Elementary SchoolPopulation

J. Yodying1, S. N. Baxi2, J. Gaffin2, D. R. Gold3,4, W. J. Sheehan2, W. Phi-

patanakul2,3; 1Children’s Hospital Boston, Boston, MA, 2Children’s Hos-

pital Boston/Harvard Medical School, Boston, MA, 3Channing

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

RATIONALE: Many school aged children have unrecognized asthma and

allergy symptoms. A questionnaire given to children and/or parents may

improve identification. Our study evaluates the correlation between parent

and child responses to a questionnaire overall and among the different race/

ethnicities.

METHODS: A 20 item allergy and asthma questionnaire was distributed

for parents and children to fill out separately. Spearman correlation coeffi-

cients (r) and Kappa statistic were calculated to determine the correlation

and agreement between their answers.

RESULTS: 716 pairs (parents and children) returned surveys. The race/eth-

nicities consisted of Hispanic (53.07%), African American (25.98%), Asian

(4.75%) and White (4.05%). All questions had at least a moderate correlation

(r50.456 to 0.930, p <0.01) and 10 questions had strong correlations (r > 0.7,

p<0.01). The strongest correlations were to questions regarding diagnosis of

asthma, symptoms of wheeze, medication use, hospitalization, missed

school, and home environment (pets or rodents). Kappa statistic demon-

strated strong agreement for 18 questions (>0.6), one had moderate agree-

ment (0.57), and one had fair agreement (0.31). Further evaluation of

correlations and agreement by race/ethnicity demonstrated similar results.

The number of questions with moderate to strong correlations was: African

American 19 of 20, Hispanic 20 of 20, Asian 17 of 20, and White 17 of 20.

Kappa statistic showed moderate to strong agreement by race: African

American 19 of 20, Hispanic 19 of 20, Asian18 of 20 and White16 of 20.

CONCLUSION: Our study found that correlations and agreement be-

tween parent and student questionnaires were strong to moderate across

all races.