Asthma Cases in the Emergency Department (ED) in Relation to Environmental and Meteorological Factors in Brooklyn, New York W. Y. Mak, B. Silverman, A. T. Schneider; Long Island College Hospital, Brooklyn, NY. RATIONALE: The number of asthma cases in the ED tends to fluctuate during the year. The environment and weather are known to be major contributors to exacerbations. We analyze the trend of asthma exacerbation cases in the ED in relation to environmental and meteorological data. METHODS: The 79-week period from January 2003 to June 2004 was selected. ED asthma cases were obtained by record review. Pollen data was obtained using the Rotorod Sampler. Barometric pressure and temperature data were obtained from the National Climatic Data Center (NCDC). Influenza data was obtained from the CDC. All parameters were tabulated and analyzed utilizing Microsoft Excel. Weekly averages of each parameter versus ED asthma cases were graphed with calculated trend lines. RESULTS: ED asthma cases (Week-19 [N=77] and Week-73 [N=68]) peaked after the peak of pollen count (Week-18 [N=273/m3] and Week-70 [N=323/m3]). During the influenza season of 2003-2004, nationwide influenza morbidity peaked during early to mid December (Weeks 49-51). This coincided with a surge of our ED asthma cases during Week50[N=91] to Week-52[N=76]. Barometric pressure and temperature changes appeared to correlate with the number of ED asthma cases. CONCLUSION: The cause of asthma exacerbations is multi-factorial. Perennially, the change in barometric pressure and temperature can be contributory. Seasonally, respiratory infections such as influenza during the winter and high pollen count during the springtime may also trigger asthma exacerbations in Brooklyn.
Changes in Asthma Medication Use During Pregnancy
A. K. Degala, G. Wegienka, S. L. Havstad, E. M. Zoratti; Henry Ford Health System, Detroit, MI. RATIONALE: Management guidelines emphasize that asthma should be tightly controlled during pregnancy. However, pregnant asthmatics and doctors often seek to minimize medication use during this period. We analyzed asthma medication use during pregnancy in a large HMO. METHODS: A retrospective cohort of 14-46 year old women in a large southeast Michigan HMO was observed for a 12 month asthma surveillance period and during 9 months of pregnancy. Asthma was identified by having 1 ED visit with asthma as the primary diagnosis, or 1 inpatient asthma stay, or at least 2 prescription fills for asthma medications during the surveillance period. Asthma medication use was compared during the 6 months prior to delivery among pregnant women (n=136) and non-pregnant asthmatic controls (n=245) who were assigned matched “delivery” dates. RESULTS: Among women not receiving controller asthma medications during the first 6 months of the surveillance period, pregnant asthmatics (n=80) were less likely to fill prescriptions for controller medications in the 6 months before delivery compared to non-pregnant controls (n=160), (9% vs 22%, p<0.008). This pattern was similar for beta-agonist medications (25% vs 58%, p<0.012). Among women filling controller medications in the surveillance period, a trend was observed for pregnant women (n=56) to fill less controller medications in the 6 month period before delivery than non-pregnant controls (n=85), (43% vs 59%; p<0.07). The trend was similar for beta-agonists (52% vs 62%, p<0.21). CONCLUSION: During pregnancy, asthmatics may take less asthma medication. Whether the decrease in medication use is clinically justifiable requires further investigation.
J ALLERGY CLIN IMMUNOL FEBRUARY 2005
Predictors of Emergency Room Utilization Among Inner-City School Children A. Arrey-Mensah, M. Mvula, C. Moore; Department of Pediatrics, LSU HSC, New Orleans, LA. RATIONALE: Determine predictors of excessive Emergency Department use among inner-city school children in New Orleans. METHODS: From November 2001 to February 2002, 106 mild to moderate persistent inner-city asthmatic children were enrolled in a school-based asthma case management program. Base line information included: initial assessment, demographics, history, asthma risk factors, current treatment, quality of life, functional severity scale and pulmonary functions. Usage of peak flow meters, asthma action plans, and previous asthma education were assessed. Outcomes included number ER visits / hospitalization, days missed from school / from work by parents, urgent care to the PCP and awakenings due to asthma symptoms. Our main concern was the number of ER visits, in the last twelve months. Data analysis was performed using SPSS 10.0. Bivariate association was performed using X2 for categorical data and t test for continuous data. RESULTS: 48% were male, the majority was African American. The mean age was 10 years. Half visited the emergency room at least once in the previous year, 75% had health insurance. Of those, 9 (17%) were on anti-inflammatories compared to 18 (34%) in the non-users group (p<.043). Users of ER were more likely to have an asthma action plan. Knowledge of how to use the asthma action plan did not significantly differ between the groups. Users of ER departments were more likely to have allergies compared to non-users. Significant differences were found among users and non-users of ER departments in terms of hospitalization (p<.015). CONCLUSIONS: Anti-inflammatory drugs were associated with strong reduction in ER visits. Funding: Pfizer Pharmaceuticals
Relationship Between Elevated Body Mass Index and Asthma
M. Michelis1, P. Sorace2, G. Walco2; 1Center for Allergy Asthma and Immune Disorders, Hackensack University Medical Center, Hackensack, NJ, 2Hackensack University Medical Center, Hackensack, NJ. PURPOSE: To determine a possible increased prevalence of asthma among individuals with an elevated Body Mass Index (BMI) versus a normal BMI. BMI = 18.5-24.9 is normal weight. BMI= 25-29.9 is overweight. BMI= >30 is obese. An elevated BMI is >25. METHODS: 513 newly presented male and female patients, between the ages 12-85 years of age, that visited the Center for Allergy, Asthma, & Immune Disorders at Hackensack University Medical Center during 2003 were sampled. The following variables were recorded from their initial visit: age, gender, height, weight, BMI, temperature, pulse rate, blood pressure, respiration rate, peak flow, and predicted peak flow. Asthma, rhinitis, bronchitis, urticaria, and sinusitis were looked at and recorded if they had any of these during their initial visit or any follow-up visit during 2003. The data was then analyzed by SSPS to determine any if there was any statistical significance between normal, overweight, and obese BMI and asthma prevalence. RESULTS: There was no statistically significant relationship between individuals with an elevated BMI and asthma prevalence. CONCLUSION: Overweight or obesity does not seem to increase the prevalence of asthma.