... due to non-perceived fac- tors. Further work is needed to identify these factors. J ALLERGY CLIN IMMUNOL. FEBRUARY 2009. S220 Abstracts. TUESDAY.
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Age- and Gender-specific Risk Factors Associated with Difficult-to-treat Asthma Phenotype among Japanese Asthmatic Patients Y. Fukutomi, M. Taniguchi, T. Tsuburai, N. Higashi, S. Tatsuno, H. Tanimoto, C. Oshikata, E. Ono, K. Sekiya, N. Turikisawa, M. Otomo, Y. Maeda, A. Mori, M. Hasegawa, K. Akiyama; Sagamihara National Hospital, Sagamihara Kanagawa, Japan. RATIONALE: Although the widespread use of anti-inflammatory drugs has resulted in good control of asthma for many patients, an important subgroup of patients remain symptomatic despite the high-dose treatment. The risk factors associated with difficult-to-treat asthma phenotype among Japanese adult asthmatic patients are yet unknown. METHODS: We retrospectively studied adult outpatients with asthma, who visited Sagamihara National Hospital from 2000 to 2007 . Difficultto-treat asthma phenotype was defined as patients who do not reach an acceptable level of control despite treatment at step 4 of the GINA 2006 guideline. The age- and gender-specific risk factors for difficult-to-treat asthma phenotype were examined using multivariate logistic regression analysis. RESULTS: There were 2,012 patients included in the analysis, and the prevalence of difficult-to-treat asthma phenotype was 13.9%. Multivariate logistic regression analysis showed that asthma duration was a significant risk factor for difficult-to-treat asthma phenotype among all age groups. NSAIDs intolerance increased the risk for difficult-to-treat asthma phenotype among middle-aged or elderly patients by about 3.5 to 6 times. Being overweight (BMI equal to or greater than 25 kg/m2) appeared to be associated with difficult-to-treat asthma phenotype only among elderly females (OR, 3.64; 95%CI, 1.50-8.84). Current smoking was a significant risk factor only among middle-aged males (OR, 4.20; 95%CI, 1.01-17.5). CONCLUSIONS: Asthma duration, NSAIDs intolerance, being overweight, and smoking status were found to be associated with difficultto-treat asthma phenotype. Some of these risk factors were age- and gender-specific. Being overweight was associated with difficult-to-treat asthma phenotype only among elderly females.
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Prevalence and Risk Factors of Wheezing in Infants from Sa˜o Paulo-Brazil A. C. C. Dela Bianca, G. F. Wandalsen, D. Sole´; Universidade Federal de Sa˜o Paulo-UNIFESP, Sa˜o Paulo-SP, Brazil. RATIONALE: To study the prevalence, severity and risk factors related to recurrent wheezing in infants (12 to 15 month-old) in the city of Sa˜o Paulo, Brazil. METHODS: Parents of infants (N 5 1,014) who were being attended for routine evaluation in Public Health Centers were interviewed in southern Sa˜o Paulo. All had answered the standardized written questionnaire from ‘‘Estudio Internacional de sibilancia en lactentes’’ (EISL). RESULTS: Forty six percent of the infants had at least one wheezing episode in their first year of life, with onset at 5.0 6 3.0 months (mean 6 standard deviation), and 270 (26.6%) had had three or more episodes. The use of inhaled b2-agonists, inhaled corticosteroids or leukotriene receptor antagonist, nocturnal symptoms, visits to emergency room, respiratory distress, and hospitalization due to severe wheezing were significantly more frequent in this last group. Logistic regression analysis suggested that, history of previous pneumonia, consumption of processed food, presence of a cat at home, to have had more than five upper respiratory infections (URI) episodes and a first URI before the age of sixth month are risk factors significantly associated with recurrent wheezing. CONCLUSIONS: The prevalence of wheezing episodes among one yearold infants living in Sa˜o Paulo is high and starts early in life. Twenty five percent of them will have recurrent wheezing, requiring specialized attention.
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Clinical Characteristics of Early- and Late-onset Elderly Asthma S. Lee1,2, H. Lee2, S. Lee1,2, S. Kim1,2, H. Park1,2, S. Kim1,2, S. Cho1,2, K. Min1,2, Y. Kim1,2; 1Seoul National University College of Medicine, Seoul, Republic of Korea, 2Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul, Republic of Korea. RATIONALE: Elderly asthmatics are defined as asthmatics aged over 65 years and late onset asthmatics are elderly asthma patients with symptoms after the age of 65 yrs. In our knowledge, the difference of sputum eosinophilia and the difference of clinical manifestations according to the onset of disease in elderly asthmatics have not been studied in Korea. METHODS: We evaluated 270 elderly asthma patients confirmed by positive results in methacholine bronchial provocation test. They underwent basal pulmonary function test, induced sputum exam, peripheral blood eosinophilia and total IgE level, and skin prick test for 55 common aeroallergens. RESULTS: Late onset asthmatics were 50.9% of total elderly asthmatics. Elderly asthma patients with earlier onset had more severe airway obstruction than those with later onset (g 5 20.146; P 5 0.032 for FEV1 and g 5 20.238; P 5 0.041 for FEF25-75, respectively). They also showed more increased airway hyperresponsiveness (g 5 20.165; P 5 0.016). However, we can not find significant difference between late onset and early onset asthma in sputum eosinophilia atopy and blood eosinophilia. CONCLUSIONS: Early onset elderly asthma patients had more severe airway obstruction and airway hyperresponsiveness.
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No Difference in Asthma Control Among Obese Children Despite Increased Airflow Obstruction Compared to Nonobese Children T. H. Ly, G. D. Marshall, Jr, J. H. Olivier, S. R. Roy; University of Mississippi Medical Center, Jackson, MS. RATIONALE: Complex interactions regarding pathophysiologic relations between pediatric asthma and obesity have been reported. We evaluated effects of obesity on pediatric asthma control using the asthma control test (ACT), pulmonary function, and physician asthma control assessment (controlled, uncontrolled, or poorly controlled) based on the 2007 NAEPP guidelines. METHODS: Retrospective chart reviews were performed on 157 randomly selected patients ages 6-21 years selected from our clinic population. Data collection from the most recent visit included age, sex, race, body mass index (BMI) percentile for age, ACT score, FEV1, FEV1/ FVC ratio, FEF25-75 and physician assessment of asthma control. RESULTS: There were 134 complete data sets that compared obese (defined as BMI percentile 95, n 5 54) versus non-obese patients. There were no significant group differences in sex, race or mean ACT scores. In the obese group, mean FEV1 was 92% and mean FEF25-75 was 85% predicted compared to 93% and 88% (respectively) in the non-obese groups. FEV1/FVC was 83% in the obese vs. 91% in the non-obese groups (p < 0.05). There were no significant group differences in physician assessment. CONCLUSIONS: Obese children with asthma appear to have increased airflow obstruction compared to their non-obese counterparts not reflected in either ACT scores or physician asthma control assessment, emphasizing the limitations of current asthma assessment methods, and questioning the clinical value of isolated subjective perceptions of asthma control. Obese patients may be at risk for more severe disease due to non-perceived factors. Further work is needed to identify these factors.
