- Journal of Allergy and Clinical Immunology

Abstracts AB107
J ALLERGY CLIN IMMUNOL
VOLUME 131, NUMBER 2
Characteristics of Asthma Patients Seeking Specialist Care
Thomas B. Casale, MD, FAAAAI1, Kurt Elward2, Wilson
Pace3, Paul Turner4, Ryan Walters4, Michael Schatz, MD, MS, FAAAAI5;
1
Creighton University School of Medicine, Omaha, NE, 2U Virginia, 3U
Colorado, Denver, 4Creighton University, 5Kaiser Permanente, San Diego,
CA.
RATIONALE: Little is known about the characteristics of asthma patients
seeking care from specialists. We hypothesized that the majority of these
patients would have uncontrolled and more severe disease.
METHODS: We obtained data from 2,614 unique patient entries into the
Asthma IQ program from specialists, the majority of whom were allergist/
immunologists.
RESULTS: Baseline demographic data were: age, 28.9 (SD, 22); BMI,
24.7 (SD, 8.3); ethnicity: 74.1% white, 12.6% black, 5.8% Hispanic, 2.8%
Asian Americans, 1.9% multi-racial; and smoking history: 83% never
smoked, 7.7% former smokers, 3.5% current smokers, and 5.8% exposed
to passive smoke. Family history of asthma or hay fever was identified in
10 to 20% of parents and siblings. The most important asthma triggers
noted by history were: animals 33%, dust 28%, exercise 19%, cold air 14%,
smoke 11%, air pollution 9%, upper respiratory infections 8%, and aspirin
2%. Of the queried co-morbidities, the most common were: rhinosinusitis
47%, GERD 12%, obesity 11% and depression 2%. Guideline severity
levels were obtained for 500 initial patient visits and were: 47% intermittent; 15% mild, 21% moderate, and 17% severe. Guideline-driven control
levels were ascertained for 1565 patients and were 63% well controlled;
25% not well controlled, and12% poorly controlled. The mean Asthma
Control Test score was 21 (SD, 4) and FEV1 % predicted 88% (SD, 18).
CONCLUSIONS: Data from the Asthma IQ program do not support the
postulate that asthma patients cared for by specialists have a high rate of
uncontrolled and more severe disease, but this could be due to more
appropriate management.
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Associations Between Patient Perceived Health Status,
Disease Severity, and Specific Demographic or Individual
Factors in Primary Immunodeficiency
Filiz Seeborg, MD, MPH1, Marcia Boyle2, Christopher
Scalchunes, MPA2, Linzhi Xu, MS3, Jordan Orange, MD PhD FAAAAI1;
1
Baylor College of Medicine and Texas Children’s Hospital, Section of
Immunology, Allergy and Rheumatology, 2Immune Deficiency Foundation, 3Baylor College of Medicine/Texas Children’s Hospital, Department
of Pediatrics, TX.
RATIONALE: Patients perceived health status (PPHS) is an important,
subjective measure of overall wellbeing and quality of care. While many
studies have evaluated outcomes in patients with primary immunodeficiency (PID), PPHS has not been objectively and scientifically assessed.
We evaluated the largest self-reported database of patients with PID to
determine the range of factors that may contribute to differences in PPHS.
METHODS: Data from the Second National Survey of Patients with
Immune Deficiency Diseases conducted in 2002 was studied. Multivariate
logistic regression was employed for data analysis.
RESULTS: Patients without permanent functional impairment, and
limited physical activity were more likely to report good health perception
(GHP). Not surprisingly, the probability of reporting GHP decreased by
aging. Interestingly, the association between PPHS and severity of PID was
not significant. In addition, the history of serious chronic disease affected
the PPHS differently according to the respondent (adult vs. parent of child
with PID). Patients without a history of serious chronic disease were more
likely to report GHP if they were from the adult respondent group
compared to parent respondents.
CONCLUSIONS: Our results emphasize the importance of PPHS in
clinical practice. We suggest that in a comprehensive evaluation and
follow-up of patients with PID, a thorough assessment of PPHS be
performed in order to document the outcomes of clinical management and
therapeutic intervention. Specifically, we propose attention to the variables
that drive PPHS will help guide future innovation and improvement in
clinical practice applied to PID.
391
Asthma Knowledge Level of Teachers in Child Daycare Center
Ahmet Akcay, MD1, Zeynep Tamay, MD2, Saime Ulker
Ones, MD, FAAAAI3, Nermin Guler, MD4; 1Associate Professor of
Pediatrics, Istanbul University, Istanbul School of Medicine, Department
of Pediatrics, Division of Pediatric Allergy, Istanbul, Turkey, 2Associate
Professor of Pediatrics, Istanbul University, Istanbul School of Medicine,
Department of Pediatrics, Division of Pediatric Allergy, Istanbul, Turkey,
3
Istanbul Medical Faculty, Istanbul, Turkey, 4Professor of Pediatrics,
Istanbul University, Istanbul School of Medicine, Department of Pediatrics, Division of Pediatric Allergy, Turkey.
RATIONALE: Teachers are primarily responsible for supervising schoolchildren with asthma during school hours. The purpose of this study was to
elucidate the level of knowledge of child daycare center teachers about
asthma and factors affecting their knowledge.
METHODS: This study was performed on 297 teachers from 20 randomly
selected child daycare centers in Istanbul. The teachers’ level of knowledge
about asthma was assessed by a questionnaire with 32 questions about
asthma. The teachers were asked thirteen additional questions about
demographic and other characteristics of the child daycare centers and
about themselves. One-way ANOVA and the independent samples t-test
were used to determine differences in the level of asthma knowledge.
RESULTS: A total of 297 teachers (287 F/10 M) filled in the questionnaire. The mean age of the teachers was 26,46 8,1 years (range, 20–53 y).
The mean of teachers responses score rate for the 32 questions was
113,64 6 20,26 (71%) from a maximum of 160 marks. The teachers
response score rate for each question ranged from 38% to 94%. The
teachers completely true response rate for each question was lower and
ranged between 1.6% and 83.9%. Asthma knowledge score for all
questions was related to teachers gender, age, location and property of
child daycare center and number of children in child daycare center.
CONCLUSIONS: Although asthma knowledge of child daycare centre
teachers was within normal levels, their completely true response rate for
each question was insufficient. Much more efficient educational programs
are needed for these teachers.
392
Status of the Allergy and Immunology Clinical Trials Portfolio:
Data From Clinicaltrials.Gov
Ankoor Shah, MD1, Samuel Broderick, PhD1, Karen Chiswell, PhD2,
Asba Tasneem, PhD2, John S. Sundy, MD, PhD, FAAAAI1; 1Duke University Medical Center, Durham, NC, 2Duke University Medical Center.
RATIONALE: In an effort to provide a comprehensive listing of clinical
trials Congress mandated the creation of the ClinicalTrials.gov (CT.gov)
registry in 1997. As part of the Clinical Trials Transformation Initiative
we analyzed the CT.gov dataset to describe the current state of trials in
allergy/immunology (A/I).
METHODS: A dataset of 96,346 studies was restricted to 40,970 interventional studies registered between 10/2007 and 9/2010. Clinical specialists
annotated medical subject heading and submitted condition terms for relevance
_ 1 condition terms,
to A/I (excluding asthma). After identifying studies with >
manual review of individual studies yielded the final A/I study dataset. Studies
were further divided into disease and sponsorship subcategories and comparisons were made between these subcategories, and with non-A/I studies.
RESULTS: A/I trials (n5696) represented 1.7% of the CT.gov dataset
with 52.6% dedicated to allergic rhinitis/conjunctivitis studies. 8.8% had
sites outside North America and Europe. Median (quartiles) enrollment
ranged from 21 (10,50) in immunodeficiency to 100 (40,313) in allergic
rhinitis, which was similar to non-A/I studies. Primary purpose was treatment in 79.0% of studies. 62.8% were industry-sponsored. Only 21.0% reported using a data monitoring committee (DMC). 17.0% were limited to
pediatrics compared to 2.3% non-A/I studies.
CONCLUSIONS: The A/I clinical trial enterprise represents a small
number of trials. Common A/I diseases are under represented relative to
disease prevalence. DMC was employed in a minority of studies. Our
results indicate that there is an opportunity to improve the quality of A/I
trials globally and initiate a policy discussion on whether resources are
optimally focused on highest priorities.
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