United States in respect to demographics, medical care utilization, partic- ipation in ... Asthma Services Argentina, Victoria, ARGENTINA, 2Unidad de Alergia.
Abstracts S131
J ALLERGY CLIN IMMUNOL VOLUME 115, NUMBER 2
Need for Interdisciplinary Intervention in an Indigent Suburban Asthma Population E. M. Ambizas1,2, M. Frieri3; 1Clinical Pharmacy Practice, St. John’s University, Jamaica, NY, 2Nassau Univeristy Medical Center, East Meadow, NY, 3Department of Allergy and Immunology, Nassau Univeristy Medical Center, East Meadow, NY. INTRODUCTION: Our ambulatory Allergy and Immunology clinic has routinely performed asthma management -assessment/monitoring, controlling factors contributing to asthma severity, pharmacotherapy, and education. With the growing diversity of our asthmatic population and increasing healthcare demands, physicians have limited time to adequately manage these patients. In this preliminary analysis of ten patients, we determined the need for an interdisciplinary approach to the management of adult asthma. METHODS: Our goal was to ascertain how well our patients are currently controlled. A validated Juniper Quality of Life survey was distributed to all asthmatics within a two-month period. The surveys, medications prescribed and peak flow measures were evaluated. RESULTS: Answers were based on activities and symptoms experienced over a 2 week period. 80% felt limited in their five most important activities. 60% experienced discomfort or distress due to chest tightness. 48% felt they had to avoid cigarette smoke, dust, weather/pollution, or perfume. 70% felt throat discomfort. 61% felt concerned about the need to use or lack of medication. Overall, 50% of patients felt limited in all activities. Patients’ appreciation of symptom severity was more apparent after this objective assessment. CONCLUSION: This failure of control could be due to non-compliance, misuse of medication, and lack of knowledge about their disease and can be addressed through an interdisciplinary team of a physician assessing and monitoring and a pharmacist providing education and assisting in the
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monitoring of the patient. A larger scale study is required to determine if this team approach will increase patient quality of life. Poor and Minority Asthma in Argentina: A Descriptive and Intervention Study E. Malbrán1, G. L. Rey2, C. E. Malbrán1, A. Malbrán3; 1International Asthma Services Argentina, Victoria, ARGENTINA, 2Unidad de Alergia Asma e Inmunología Clinica, Buenos Aires, ARGENTINA, 3Allergy and Immunology, Hospital Británico Buenos Aires, Buenos Aires, ARGENTINA. RATIONALE: Asthma morbidity and mortality is over represented in poor and minority population. Difficulty in accessing medical care and medication contribute to this outcome. We delivered specialty medical care to an extremely poor cohort in a primary care environment. Social characteristics and preliminary results are presented. METHODS: Patients were offered specialty asthma care and free medication through posters and primary care center physicians. An asthma camp was set to a specific date. A group of 3 volunteers, three medical students and two allergy specialist conducted a consult that included a questionnaire, spirometry and a medical interview. Free medication was offered according to asthma status. RESULTS: 128 first visits were evaluated. Mean age was 20.7 yo (1-83), 69% hyspanics, 31% caucasians, mean income U$S 31 per month (0 to 133), mean years of education 5.8 (0-12). Parent asthma was present in 37.3% and patient/family smoking in 62.1%. Medication at arrival included inhaled steroids in 31.7% of patients and medication after care included inhaled steroids in 60.5% of patients. Fifty three per cent of patients missed days to school or work before intervention and 33% after care. Only 28 out of 78 (35.9%) of patients expected to come to follow up did come to control. CONCLUSIONS: Delivering specialty care and free medication to poor and minority asthma populations in primary care centers improves diagnosis, treatment and asthma related quality of life. However, adherence to treatment remains low and requires a better strategy.
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Control of the House Dust Mite, Dermatophagoides farinae, by Neem Seed Extracts H. Rembold; Max-Planck-Institute for Biochemistry, Munich, Germany, GERMANY. RATIONALE: For house dust mite control, most of the presently used acaricides are based on benzyl benzoate. This and other synthetics are under critical observation due to side effects. As an alternative, formulations based on neem (margosa) oil are available as OTC products in Europe. Seven of these products have been tested for their effect on house dust mites. METHODS: Following the ISO guide line, ANFOR NFG39-011, the neem oil derived products were tested for their effect against a mixed culture of D. farinae mites/eggs for 14 weeks. RESULTS: Starting with 200 mites and 50 eggs each, control reached an average level of 3.550 mites after 14 weeks. All the neem oil containing preparations showed no acaricidal effect. There was a clear difference in their inhibitory activity, however. Only two of them, TN-MP100® and Milbiol®, were able to inhibit growth and reproduction down to an insignificant level of about 100 mites after 14 weeks. All the other five products also significantly reduced growth and reproduction of the house dust mite, but only in the range of two thousand to 500 mites. CONCLUSIONS: TN-MP100® and Milbiol® are highly effective and safe neem formulations for the control of the house dust mite and consequently of house dust allergy. The results clearly demonstrate the high effect of the two neem based products against the allergens producing house dust mite. Funding: GTZ Germany
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A Comparison of U.S. vs. Louisiana Asthmatics Using the BRFSS Survey A. L. Sabel-Soteres1, D. F. Soteres2, B. Bates3; 1Preventive Medicine, Tulane University, New Orleans, LA, 2Allergy and Immunology, Tulane University, New Orleans, LA, 3Chronic Diseases Epidemiology Unit, Office of Public Health, New Orleans, LA. RATIONALE: This study compared asthmatics in Louisiana and the United States in respect to demographics, medical care utilization, participation in daily living activities, and asthma severity. METHODS: BRFSS is a state-based, telephone survey of U.S. adults which collects self-reported information about modifiable risk factors for chronic diseases. This study analyzed data from the 2002 BRFSS using SAS software. RESULTS: In Louisiana (LA), 10.4% of the population is diagnosed with asthma by a physician and 59% currently suffer from this disease, compared to 11.8% and 67% nationally. The gender distribution of asthmatics in LA and the U.S. is equal, 37% female and 63% male. The racial distribution of asthmatics is 67% Caucasian compared to 87% nationally. The mean age of asthmatics is 42.8 years in LA vs. 44.5 in the U.S. Annually, the mean number of asthma attacks was 1.5 in both locations, ER visits for asthma was 0.5 in both places, and non-ER urgent treatments was 0.8 in LA and 0.9 nationally. Within LA, 34% utilized no asthmatic medication, 31% used prn meds, and 35% required daily meds. Nationally asthmatics report medication use as 31%, 30%, and 39%, respectively. Daily living activities were limited 3.6 days in LA and 11.6 nationally. In LA, the majority of asthmatics were mild intermittent while nationally the majority were moderate persistent. CONCLUSIONS: Asthmatics in LA vs. the U.S. have similar medical care utilization, even though disease categorization is less severe in LA. Fewer asthmatics are Caucasian in LA. Louisianans use less medication and have less activity limitations
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