AAAAI 2014 Abstracts Monday

All abstracts are strictly embargoed until the date of presentation at the 2014 Annual Meeting. AB172 Abstracts J ALLERGY CLIN IMMUNOL FEBRUARY 2014 Asthma In The Elderly: The Role Of Vitamin D Assessment Of Asthma Education and Teaching Practices 592 Dr. Michele Columbo, MD, FAAAAI1, Dr. Reynold A. Panet- 594 Among Allergists tieri, Jr, MD2, Dr. Albert S. Rohr, MD, FAAAAI3; 1Asthma, Allergy and Natalia Vernon, MD1, Dr. Timothy Craig, DO2; 1Penn State Hershey Immunology Specialists, Bryn Mawr, PA, 2University of Pennsylvania, Medical Center, Hershey, PA, 2Penn State University, Hershey, PA. Philadelphia, PA, 3Rohr and Columbo Asthma, Allergy and Immunology RATIONALE: Asthma management driven by level of asthma control Specialists, Bryn Mawr, PA. involves a partnership between the physician and patient. Asthma control RATIONALE: Asthma in the elderly is poorly understood and vitamin D may be influenced by inhaler technique, aerochamber use and peak flow deficiency/insufficiency are very common in older individuals. We studied meter availability. The purpose of this study was to assess asthma the role of vitamin D in stable elderly asthmatics. education and teaching practices by allergists and to identify any potential METHODS: Thirty asthmatics, age 72.665.6 (mean6SD) were followed areas for improvement in providing quality care to asthma patients. every 4 weeks for 12 weeks in the period November 1, 2012-March 31, METHODS: We conducted an online survey of all Pennsylvania Allergy 2013. During the study period they took 2,000 I.U. vitamin D daily. Serum and Asthma Association members who provide medical care to asthma 25-Hydroxyvitamin D and calcium were measured at baseline and study patients. The 10-question survey addressed asthma education and teaching end. 18 were female, 26 atopic, Body Mass Index was 25.163.2, disease practices. duration 36.4621.1 years. At baseline 27 subjects were on inhaled steroids RESULTS: Fifty six allergists and five fellows-in-training responded to (4146306 mcg/day), 21 on long-acting bronchodilators. 13 on leukotriene the survey. Of the 61 respondents, 88% provide teaching at the initial visit antagonists. Data were analyzed by the unpaired, two-tailed Student’s t test for all asthmatic patients being prescribed metered dose inhalers (MDIs) and Pearson correlation coefficient. and dry powder inhalers (DPIs). A physician is mainly responsible for the RESULTS: 27% of subjects were deficient and 47% insufficient in vitamin education and teaching (62.5%) in the office compared to nurses or D at baseline. Vitamin D increased from 24.869.1 I.U. at baseline to respiratory therapists. Teaching sessions typically take 10 minutes or less 34.467.1 I.U. at study end (p<0.001). Calcium did not change significantly (90%) and involve mostly verbal directions (78%) and a live demonstration during the same period (9.5960.3 and 9.5560.4 mg/dl, respectively). The with a demo inhaler (87%). The majority of allergists (64%) recommend Asthma Control Test (ACT) score at baseline was 22.563.1, FEV1% was use of an aerochamber to all patients using MDIs. If a patient is prescribed a 69.9616.3%, and neither changed at the end of the study (p>0.92), similar peak flow meter, 17% will assess technique at every office visit. Many to the other spirometric values (p>0.53). No correlation was found between allergists (49%) never bill for asthma education and teaching performed in vitamin D and demographics (p>0.08), comorbidities (p>0.49), inhaled the office. steroid dose (p>0.22), spirometric values (p>0.11), or ACT (p>0.24). CONCLUSIONS: This survey suggests that the majority of allergists CONCLUSIONS: Stable elderly asthmatics very commonly have vitamin provide interactive patient-oriented education and teaching of aerocham- D deficiency/insufficiency. Vitamin D supplementation did not induce ber use and inhaler technique to asthma patients. changes in spirometric values or ACT scores. Serum vitamin D levels were not associated with subjects’ demographics, comorbidities, treatment, Comparison Of Asthma-Related ED Visits In Public Versus symptoms, or spirometric values. 595 Private Hospitals In The Bronx Dr. Mili Shum, MD1, Dr. David L. Rosenstreich, MD, FAAAAI2, A Preliminary Randomized Controlled Trial:Educational Dr. Sunit Jariwala, MD3; 1Weill Cornell Medical College, New York, 593 Intervention For Treatment Of Hispanic and African NY; Montefiore Medical Center, Bronx, NY, 2Albert Einstein/Montefiore American Adults With Asthma: Allergen Triggers, Peak Medical Center, Bronx, NY, 3Albert Einstein/Montefiore Medical Center, MONDAY Flow, and Spirometry New York, NY. Reenal Patel, MD1, Josha Fogel, PhD2, Marianne Frieri, MD, PhD, RATIONALE: To examine asthma-related emergency department visits FAAAAI3; 1UMDNJ, Newark, NJ, 2Nassau University Medical Center, (AREDV) in public versus private hospitals in a high asthma prevalence East Meadow, NY, 3State University of NY @ Stony brook, Stony Brook, area. Public hospitals often care for uninsured/underinsured patients that NY. are associated with increased asthma morbidity. We hypothesize that RATIONALE: Asthma can be better managed with an understanding of public hospitals manage more AREDV than private hospitals. allergen triggers, peak flow, and spirometry. We compare allergen triggers, METHODS: Daily AREDV numbers from 2008 were obtained from two baseline and follow-up peak flow, and spirometry FEV1 and FEV 25-75. public hospitals [Jacobi and North Central Bronx (NCB)] and two private METHODS: Data were obtained from a preliminary randomized non-profit hospitals [Montefiore-Moses (MM) and Montefiore-Weiler controlled trial of adult patients with asthma who received either targeted (MW)] in the Bronx. Data were acquired through Clinical Looking education (evidence-based educational pamphlets and tailored learning Glass, which enabled a retrospective search of asthma visits by ICD-9 style; n57) or standard education (medication review; n58) over 8 weeks. code. Hospital bed numbers served as a proxy for hospital size. AREDV Allergen triggers and spirometry were recorded at baseline. Peak flow was numbers between the public and private hospitals were compared in measured both at baseline and at follow-up. Allergen triggers were relation to their bed capacities. measured with either skin prick or allergen-specific immunoglobulin E. RESULTS: In 2008, three distinct peaks of increased AREDVin February, Spirometry and FEV were compared with paired t-tests and allergens with May, and October were observed in public and private hospitals. Jacobi, the Fisher’s exact test. NCB, MM, and MW had 4971, 2211, 3150, 1117 AREDVand 207, 85, 665, RESULTS: FEV 1 (M575.1, SD519.43) had significantly greater mean and 264 beds, respectively. The public hospitals had 68% higher AREDV scores (p5<0.001) than FEV 25-75 (M561.7, SD522.25). Mean peak although the private hospitals have a 3-fold greater bed capacity. The ratio flow did not significantly differ between baseline and follow-up. Allergens of AREDV to bed capacity was 24.6 in public versus 4.6 in private did not significantly differ between the treatment and control groups. For hospitals. the 6 perennial allergies, 4 had more than 25% (cockroach, D-farinae, D- CONCLUSIONS: Although the public and private hospitals are adjacent pteronyssinus, and dog-dander). For the 11 seasonal allergies, 10 had to one another, the public hospitals had a relatively higher number of allergy presence with allergy percentages ranging as high as 42.9% for AREDV despite a smaller bed capacity. AREDV may be higher in public mugwort and as high as 37.5% for june grass, maple, oak, and timothy hospitals because they care for more uninsured patients with limited access grass. to primary care. Public hospitals may serve as a site of enhanced CONCLUSIONS: Clinicians should consider use of educational in- intervention for asthma prevention and education. terventions, identification of allergen triggers, and explanation of spirometry for their Hispanic and African American asthma patients to encourage greater adherence to treatment. ABS 5.2.0 DTD YMAI10634_proof 11 January 2014 8:37 pm All abstracts are strictly embargoed until the date of presentation at the 2014 Annual Meeting. J ALLERGY CLIN IMMUNOL Abstracts AB173 VOLUME 133, NUMBER 2 Comparison Of Pre- and Post-Pubertal Gender Differences In accounted for 84% (95%CI, 80%-88%) of all ED visits for acute asthma 596 Markers Of Angiogenesis and Asthma Outcomes in the past year. Dr. Amy Thomas, MD1, Mark DeVries2, Mr. Christopher J. Tisler, MT2, CONCLUSIONS: In this multicenter study, patients with 2+ ED visits Ms. Victoria Rajamanickam3, Dr. James E. Gern, MD, FAAAAI2, accounted for 25% of ED patients with acute asthma, but 84% of all ED Dr. Robert F. Lemanske, Jr, MD, FAAAAI2, Dr. Daniel J. Jackson, visits in the past year. Frequent utilizers of the ED for acute asthma had MD4; 1University of Wisconsin Hospitals and Clinics, Madison, WI, several markers of worse chronic asthma severity. Integrated strategies 2University of Wisconsin School of Medicine and Public Health, Madison, aimed at reducing potentially-preventable asthma ED visits are WI, 3University of Wisconsin Hospitals and Clinics, 4Pediatrics, warranted. University of Wisconsin School of Medicine and Public Health, Madison, WI. The Relationship Of The Serum Vitamin D Levels With 598 Asthmatic Severity Responses In Asthmatic Children RATIONALE: Previous studies have demonstrated increased numbers of 1 2 1 circulating endothelial progenitor cells (EPCs), defined as peripheral blood

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