P121 The relationship between metered-dose inhaler (MDI) technique and asthma symptoms among rural georgia adolescents

P121 The relationship between metered-dose inhaler (MDI) technique and asthma symptoms among rural georgia adolescents

S56 Abstracts: Poster Sessions / Ann Allergy Asthma Immunol 117 (2016) S22eS124 medications used. For those patients who have asthma and EoE a compa...

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Abstracts: Poster Sessions / Ann Allergy Asthma Immunol 117 (2016) S22eS124

medications used. For those patients who have asthma and EoE a comparison analysis will estimate the association between severe EoE and severe asthma, using the Prevalence Ratio and its corresponding 95% Confidence Interval. Results: 30 patients with EoE participated in our study, male predominance 63% (19). Age distribution was more prevalent in de 6-10 years group (l 4). Half of the patients evaluated were asthmatic, 43% were mild intermittent asthmatic and 7% were persistent asthmatics. Almost all patients were diagnosed with asthma (4years old) previous to EoE diagnosis (9 years old); average time frame between asthma and EoE diagnosis was near 5 years. Conclusion: There was no relation between the total eosinophil count in the tissue biopsy and the presence of asthma. And there was no correlation between the severity of both conditions that can be attributable to the eosinophil count in the esophageal biopsy.

P119 SERUM VITAMIN D LEVELS AND ITS ASSOCIATION WITH ALLERGIC RESPIRATORY DISEASES IN CHILDREN G. Shieh*, Makati City, Philippines. Background: Vitamin D may protect against the development of allergic respiratory diseases through immunomodulation by suppressing the pro-inflammatory cytokine IL-17. In the presence of vitamin D, T-regulatory cells secrete high levels of anti-inflammatory cytokine IL-10. Decreased vitamin D levels were inconsistently linked with allergic respiratory diseases. Methods: A cross-sectional study was performed from 30 subjects diagnosed with allergic respiratory diseases. Asthma Control test (ACT), Composite Asthma Severity Index (CASI) for asthma and Japanese System for Grading Symptom Severity for allergic rhinitis were used. Spirometry and skin prick tests were done. Serum 25hydroxyvitamin D was obtained and categorized into: a) deficient (< 20 ng/mL), b) insufficient (21 - 29 ng/mL) and c) sufficient (¼ 30 ng/mL). Results: Thirty children were evaluated (17 male, 56.67%; age 10.13  3.06 years; BMI 18.92+ 4.14). The mean (SD) serum 25(OH)D concentrations were low (20.63 + 7.29 ng/mL). Fifteen subjects (50%) were deficient in vitamin D (15.21  4.02 ng/mL), 12 (40%) were insufficient (24.02  2.69 ng/mL), and 3 (10%) were sufficient (34.16  5.23 ng/mL). There was no statistically significant correlation between serum vitamin D levels and atopy index (r ¼ -0.0780, p ¼ 0.359), CASI (r ¼ 0.2357, p ¼ 0.237), ACT (r ¼ -0.2502, p ¼ 0.208), Japanese scoring for allergic rhinitis (r ¼ 0.1569, p ¼ 0.416) and pulmonary function test. Conclusion: The overall serum vitamin D levels in subjects with allergic respiratory diseases were low and were not consistently associated with asthma control, asthma severity and allergic rhinitis severity.

using large datasets of privately insured (PI) and governmentfunded (Medicaid; MD) patients. Methods: In PI or MD plans, we identified children (6-11 years old) with severe or poorly-controlled asthma (thereafter¼asthma; ¼2 medical claims with asthma [ICD-9-CM 493.x; 1st diagnosis ¼ ID], >¼2 prescription claims for asthma medications 12 months after ID, and >¼1 claim for high-dose ICS or chronic OCS or >¼5 claims for SABA in 3 consecutive months within 12 months after ID). We matched (1:1) children with asthma to their non-asthma counterparts by demographic characteristics. The outcomes included general healthcare use rates per 100 person-years and proportion of patients with allergic comorbidities. Results: The cohorts included 33,108 PI (5.6% prevalence of severe or poorly-controlled asthma) and 29,493 MD (9.8% prevalence) insured children with asthma matched to children without asthma (followed for 3.2 and 3.6 years (mean), respectively). For both PI and MD plans, children with asthma demonstrated higher rate of overall healthcare use and greater allergic co-morbidities than children without asthma (Table 1A-B). Conclusions: Insured children with severe or poorly-controlled asthma, regardless of payer status, use more (3-4 fold) healthcare services and have greater number of allergic co-morbidities than their counterparts without asthma.

Table 1A-B Notes: 1. Children with private insurance were matched on age, sex, plan type, index year, and region*. 2. Children from the Medicaid Database were matched on age, sex, plan type, index year, race** and state**. 3. Rates were compared using t-tests and proportions were compared using chi-squared tests. All p-values were <0.0001. 4 95% CIs: 95% confidence intervals are presented as (lower limit - upper limit)* Available in the private insurance data only.** Available in the Medicaid data only.

P121 P120 BURDEN OF SEVERE OR POORLY-CONTROLLED ASTHMA IN SCHOOL-AGE CHILDREN: HEALTHCARE USE AND ALLERGIC CO-MORBIDITIES W. Teague1, E. Antonova*2, A. Farr3, Y. Ding4, A. Iqbal2, B. Chipps5, 1. Charlottesville, VA; 2. South San Francisco, CA; 3. Cambridge, MA; 4. Bethesda, MD; 5. Sacramento, CA. Introduction: Children with severe or poorly-controlled asthma are thought to consume a disproportionate amount of healthcare resources, but the exact amount has not been well evaluated. This study aimed to compare real-world healthcare use and the prevalence of allergic co-morbidities in school-age children with severe or poorly-controlled asthma vs children without asthma

THE RELATIONSHIP BETWEEN METERED-DOSE INHALER (MDI) TECHNIQUE AND ASTHMA SYMPTOMS AMONG RURAL GEORGIA ADOLESCENTS L. Still*, S. Looney, D. Ownby, M. Tingen, Augusta, GA. Introduction: In children, metered-dose inhaler (MDI) technique can be highly variable. Methods: Students attending 4 rural public Georgia high schools were enrolled in an asthma education randomized-controlled trial (RCT). The RCT intervention, known as Puff City, is a computerbased program aimed at encouraging adolescents to more effectively self-manage asthma. Participants with an MDI were evaluated on inhaler technique using a 7-point scale. Students with scores <6 were instructed in proper technique. Because the data were highly skewed, Spearman correlation was used to measure

Abstracts: Poster Sessions / Ann Allergy Asthma Immunol 117 (2016) S22eS124

associations of inhaler technique with asthma symptoms as assessed at three time points: end of treatment (EOT) and 6 and 12 months post intervention (6 mo and 12 mo). Results: Of 371 participants, 180 (57% female, 72% African American) had MDI technique scores. Inhaler technique improved from EOT to 6 mo (p<0.01) but not to 12 mo. Overall, MDI technique was not associated with: activity limitation, beta-agonist inhaler use (IU), school absence because of asthma symptoms, school absence for any reason, night-time awakenings due to symptoms, and daytime asthma symptoms. However, improvement in inhaler technique between EOT and 6 mo was significantly associated with IU at 6 mo (rs ¼ 0.27, p ¼ 0.04) among males, and improvement in technique between EOT and 12 mo was significantly associated with IU at 12 mo (rs ¼ -0.38, p ¼ 0.02) among whites. Conclusion: Repeated MDI instruction did not improve technique at 12 month follow-up testing. Improvement in MDI technique was associated with beta-agonist inhaler use, but only after stratifying by gender and race.

P122 STATE-WIDE LEGISLATION POSITIVELY IMPACTS ATTENDANCE FOR STUDENTS WITH ASTHMA J. Krieger*1, R. Nelson1, E. Vandas1, H. Subramanian2, H. Pan1, M. Warrier1, 1. St. Louis, MO; 2. Creve Coeur, MO.

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Methods: Through a cross-sectional investigation, 3383 adolescents (13-19 years of age) were studied. Information was collected using a previously validated questionnaire. Two study groups of adolescent smokers were formed: one composed of asthmatic adolescents and the other of healthy youths. Results: Asthmatic adolescents were found to be more likely to smoke (21.6 vs 11.8%) and to have some degree of nicotine dependence compared to healthy adolescents (21.6 vs 11.8%). The most important characteristic of smoking in asthmatic adolescents was found to be an onset before 11 years of age due to the curiosity about cigarettes. These youths continue smoking because this habit decreases their anxiety and stress. Adolescents know that smoking is addictive and often smoke upon waking up in the morning or when they are sick. Yet, these adolescents do not consider smoking to be a problem. Conclusion: In this study, the curiosity about cigarettes is the primary reason why asthmatic adolescents smoke for the first time and developed a greater dependence to nicotine compared to healthy adolescents. Moreover, the findings show that many of the factors that favor the development of smoking are preventable given that they are present in the family and social environment.

P124 IMPACT OF MULTIPLE CARETAKERS ON PEDIATRIC ASTHMA OUTCOMES H. Chung, A. Fadahunsi*, D. Lew, W. Terry, Memphis, TN.

Introduction: Asthma disproportionately affects students from lower-income areas. This study evaluates the outcomes for students in the two years following the passage of Missouri House Bill 1188 (allows trained school employees to administer bronchodilator to students) and the implementation of the St. Louis Chapter of the Asthma & Allergy Foundation of America’s (AAFA-STL) school nurse RESCUE (Resources for Every School Confronting Unexpected Emergencies) program, which provides schools with equipment and access to medications to treat asthma. Methods: The RESCUE program mainly supports schools with lower-income populations. Participating schools were provided with, nebulizer, chambers and supplies along with access to free albuterol. When RESCUE supplies were used, school nurses logged outcomese return to classroom, sent home, sent to emergency department (ED) or other. Results: In the 2013-2014 school year, 90 of the 105 schools receiving equipment from RESCUE returned logs. Equipment was used 1357 individual times, with students going back to class 86.07%, sent home 10.83%, and sent to ED 1.33% of the time. In the 2014-2015 school year, 124 of the 207 schools returned logs. Equipment was used 1720 individual times, with students going back to class 84.48%, sent home 10.81%, and sent to ED 3.14% of the time. Conclusion: The RESCUE program ensures schools have access to the necessary equipment to treat acute asthma symptoms, thereby decreasing the need for ED visits and sending students home. This decreases the economic costs to parents and society and improves student health as well as academic performance, especially in schools serving lower-income populations.

Introduction: This study sought to investigate the relationship between multiple caretakers and pediatric asthma outcomes. Methods: 100 asthma patients aged 1-12 years old were enrolled in 2014. A questionnaire (10 questions, scale of 1-5) was designed to obtain subjective and objective information. The subjective portion was completed by the caretaker including number of caretakers, frequency of shared clinic visits, medications, and asthma action plan with other caretakers, self-confidence in using asthma action plan, and number of missed school days. The objective data was based on chart review to determine missed clinic visits, ED and hospital visits, documented poor compliance, and frequency of systemic steroids therapy. Logistic regressions applied to dichotomized question responses were used to assess the association of numbers of family and school caretakers with objective and subjective score categories (score 1 vs score >1), whereas linear regressions used for associations with total score. Results: A significant correlation between the number of family caregivers and clinical outcomes was only found with subjective (P¼0.003) and total scores (P¼0.01) in the study population. A strong correlation between the number of school caregivers and clinical outcomes was identified with all objective (P¼0.006), subjective (P¼0.03) and total scores (P¼0.0006). Conclusion: The results of the study indicate that both family and school caretakers play an important role in clinical outcomes in pediatric asthma. However, subjective survey may exaggerate the importance of family caretakers while objective chart review and total score reflect the actual situation more accurately.

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EPIDEMIOLOGICAL PROFILE OF SMOKING AND NICOTINE ADDICTION AMONG ASTHMATIC ADOLESCENTS F. Vazquez-Nava*1, C. Vazquez-Rodriguez2, E. Vazquez-Rodiguez3, O. Castillo-Ruiz4, J. Peinado-Herreros5, 1. Madero, TM, Mexico; 2. Orizaba, VE, Mexico; 3. Minatitlan, VE, Mexico; 4. Reynosa, TM, Mexico; 5. Granada, Spain.

PREVALENCE OF ASTHMA AND ALLERGIC RHINITIS IN SCHOOL GOING CHILDREN OF BANGALORE A. Parthasarathi*1, M. Padukudru1, R. Narasimhan2, K. Lokesh1, J. Biligere1, A. Holla1, P. Vedanthan3, A. Accamma1, 1. Mysore, Karnataka, India; 2. Mysore, India; 3. Denver, CO.

Introduction: Despite the known negative effects that smoke cigarettes cause, smoking in asthmatic adolescents continues to be a health problem worldwide. Objective: To determine the epidemiological profile of smoking and the degree of nicotine dependence among asthmatic adolescents.

Introduction: Asthma and allergic rhinitis are important causes of morbidity in children. There is paucity of data on the recent prevalence of allergic rhinitis and asthma in Bangalore, a rapidly urbanising city. Methodology: It is a descriptive cross sectional study using the ISAAC questionnaire that was administrated to parents of children randomly selected 10 schools in the 5 wards of Bangalore city