J ALLERGY CLIN IMMUNOL FEBRUARY 2015
The Burden of Asthma in the United States: Updated Nationally Representative Estimates of the Cost of Asthma Patrick W. Sullivan, PhD1, Vahram Ghushchyan, PhD2; 1Regis University, 2American University of Armenia. RATIONALE: To comprehend the burden of asthma in the U.S., it is important to have accurate estimates of the costs associated with the condition. The current study aims to provide updated nationally representative estimates of the healthcare expenditures and health resource utilization associated with asthma in the U.S. METHODS: The 2008-2010 Medical Expenditure Panel Survey (MEPS) was used to estimate the impact of asthma on healthcare expenditures and health resource utilization. Multivariable regression analyses of outcomes were conducted controlling for age, sex, race, ethnicity, income, smoking status, insurance status and comorbidity. Medical expenditure analysis used the Heckman selection method with logarithmic transformation of expenditures. Expenditure data was inflated to $US 2011 using the Medical Care component of the Consumer Price Index (CPI). Utilization data was modeled using negative binomial regression. RESULTS: Of the 102,767 adults in MEPS (2008-2010), 9,782 individuals (10%) had a diagnosis of asthma. Individuals with a diagnosis of asthma incurred an additional $1,095 (p<0.01) in annual healthcare expenditures attributable to asthma compared to those without asthma. Likewise, individuals with asthma experienced 1.28 (p<0.01) times the number of annual office-based visits, 1.43 (p<0.01) times the number of annual ER visits, 1.20 (p<0.01) times the number of annual inpatient visits and 2.0 (p<0.01) times the number of annual prescription drugs compared to those without asthma. CONCLUSIONS: In recent national data, asthma is associated with significantly greater expenditures and utilization. Asthma continues to represent a significant direct cost burden in the United States.
Evaluation of MDI Inhaler Technique Using a New Training Device Michael J. Welch, MD, FAAAAI1, Nancy K. Ostrom, MD, FAAAAI1, Alexander N. Greiner, MD, FAAAAI1, Susan Stefanac Laubach, MD, FAAAAI1, Mark Sanders2; 1Allergy and Asthma Medical Group & Research Center, San Diego, CA, 2Clement-Clarke International, Harlow, Essex, United Kingdom. RATIONALE: Poor inhaler technique can lead to decreased lung deposition resulting in reduced asthma control. There is a need for an easy and effective tool to teach proper pMDI use. We hypothesized a new device to train patients on inhaler technique will result in better pMDI mastery compared to usual pMDI education. METHODS: This study evaluated 2 methods of pMDI teaching in normal (i.e. no history of asthma) subjects (> 12 years of age). 45 subjects were randomly assigned to one of 3 groups: 1. training using the Trainhaler with Flo-Tone (T+F) (Clement Clarke International) 2. training by reading the ProAir package insert (PI) 3. control group who received no training (C). Technique was scored by direct observation by a blinded observer, with backup videotape. The scoring method utilized a pre-determined list of 13 steps considered necessary for proper inhaler technique, with extra weighting for ‘‘critical’’ steps. RESULTS: The average technique score for T+F (17.3 + 2.4) was significantly greater (p < .05) than the score for PI (15.1 + 2.8) and C (12.9 + 3.8).groups. The specific step which demonstrates proper slow inhalation, a step greatly influenced by the T+F, was done correctly by almost 50% of subjects in the T+F group, but none of the subjects in the other 2 groups. CONCLUSIONS: Proper inhaler technique can be taught using the T+F device resulting in significantly fewer inhaler step errors compared to training by simply reading the package insert, or to no education at all.
Digitalized Tracking of Developmental Information on Maternal and Baby Care (eBABY) – Taiwan Experience Su Boon Yong; Show Chwan Memorial Hospital. RATIONALE: We collaborated with interdisciplinary staff and constructed the health cloud based on the digitalized tracking of developmental information from maternal and baby care, called eBABY, in the Show-Chwan Healthcare System in Taiwan. Now we will present the pioneering experience of the first eBABY in Taiwan. We conducted concise and kinetic questionnaire for net-page of prenatal and postnatal health conditions. METHODS: The parents are able to maintain their prenatal conditions at home monthly and/or weekly. The eBabay system could provide prenatal conditions like ultrasonography, estimated fetal weight, and maternal conditions, and allow the parents to upload the photo in this website. The pregnant woman can input her information of diets, drugs, and physiological data during pregnancy. In neonatal period, the time, types and amount of feeding as well as the stool color were also recorded. RESULTS: The parents satisfied the real time access of maternal and baby information recorded by health providers and uploaded by their own transmission of photos and conditions in the website. In the call center, personalized clinical manager can help collect the medical history of maternal and baby information, and arrange medical consulting for making the most suitable treatment decision for the mother and baby through the electronic alarm (threshold) processes. The system can remind the prenatal care schedule, and brief maintenance of weekly maternal conditions. CONCLUSIONS: Health cloud of developmental information in Taiwan is constructed from technology of cloud computing. The results from this study conclude that the members of eBABY satisfied with the characteristics.
Applied Multiple ''Umbrella'' Shaped Visual Analogue Scale for Respiratory Allergy – Preliminary Study Norbert Lukan1, Anna Chmelarova2, Jozefina Petrovicova2; 1Safarik University Kosice, Kosice, Slovakia, 2Safarik University Kosice. RATIONALE: The aim of the presented work was to design short useful evaluation instrument for subjective quantification of complaints in united airway disease. Proposed instrument is not one-parametric as visual analogue scale, but not as complicated as many allergy specific questionnaires either. METHODS: Multiple ‘‘umbrella’’ shaped visual analogue scale is a questionnaire using 9 most common questions concerning respiratory allergy symptoms and graphically interpreting intensity of surviving by multiple visual analogue scale and Sheehan disability scale in concentric circles. Three symptoms describe most common upper airway complaints, three symptoms lower airway complaints and three symptoms are general (social) disability feelings. Instrument allows to quickly evaluate changes before/after treatment, before/after exacerbation and to monitor long lasting treatment (allergen immunotherapy) in everyday praxis as well as in clinical research work. RESULTS: Preliminary study based on 73 adult patients showed significant statistical correlation (Pearson: 0,54-0,67 at p<0,01) and reliability (Cronbach: a 5 0,830, p<0,01) of evaluating instrument. Practical utilization of one-parametric visual analogue scale in clinical praxis supports the use of our expanded form of similar questionnaire. CONCLUSIONS: Proposed new questionnaire is quick and simple instrument for evaluation of QoL in everyday praxis as well as in clinical research work based on graphic-numerical data. It allows individual (9parametric), sub-group (3-parametric) or summary (one-parametric) quantification as well as quick one-look analysis of subjective complaints in respiratory allergy patients.