J ALLERGY CLIN IMMUNOL

FEBRUARY 2012

AB152 Abstracts

MONDAY

571 Follow-up of Wheezing in Preschool Children from S~ao Pauloand Macei�o, Brazil: International Study of Wheezing inInfants - phase 2

A. C. C. Dela Bianca1, M. L. Medeiros2, G. F. Wandalsen1, F. J. Soares2,

J. Mallol3, D. Sole1; 1Universidade Federal de Sao Paulo - UNIFESP, Sao

Paulo - SP, BRAZIL, 2State University of Health Sciences (UNCISAL),

Maceio - AL, BRAZIL, 3Universidad do Chile, Santiago, CHILE.

RATIONALE: The prevalence of wheezing in infants in S~ao Paulo and

Macei�o, two Brazilian cities, is high, as identified by the International

Study ofWheezing in Infants (EISL) - Phase 1. The aim of this studywas to

verify the persistence and onset of wheezing and its related factors in

preschool children involved in the EISL - Phase 1.

METHOD: Parents of infants who participated in the EISL-Phase 1 in S~ao

Paulo and Macei�o, answered a telephone questionnaire after 30.066.0

months of the first interview.

RESULTS: Parents from124 childrenwithwheezing and from162 children

without wheezing in the first year of life were interviewed. The average age

was 42.56 7.1 months and 145 were boys (50.6%). Among the 96 children

with current wheezing, 63 (65.6%) had wheezed at the first year of life, eight

(12.7%) of these children were diagnosed as asthmatic and nine (14.3%) had

used inhaled corticosteroids. Infants with probable asthma had a higher

number of airway infections and a greater need for antibiotics in the first year

of life compared to those who have transient wheezing. Children with

persistent wheezing usedmore antibiotics in the first year of life compared to

those with transient wheezing and children with late-onset wheezing.

CONCLUSIONS: Wheezing that started in the first year of life tend to

persist among preschool children from S~ao Paulo and Macei�o. The use ofantibiotics and the association with respiratory infections are frequent

during exacerbations, but the diagnosis of asthma and its specific treatment

are still rare.

572 Burden of Acute Pediatric Asthma Exacerbations inGaborone, Botswana

K. M. Best1, A. P. Steenhoff2,3, S. Barenbaum2, L. Mazhani4, S. Kung2,4;1School of Nursing, University of Pennsylvania, Philadelphia, PA, 2Child-

ren’s Hospital of Philadelphia, Philadelphia, PA, 3Botswana-UPenn Part-

nership, Gaborone, BOTSWANA, 4School of Medicine, University of

Botswana, Gaborone, BOTSWANA.

RATIONALE: Asthma contributes significantly to pediatric morbidity

andmortality. In Botswana, the contribution of acute asthma exacerbations

to overall pediatric Emergency Department (ED) visits is unknown. We

reviewed these in Botswana’s largest referral hospital.

METHODS: Hospital records from April 2009 to September 2010 of

children (<19 years) with respiratory conditions presenting to the ED of

Princess Marina Hospital in Gaborone, were retrospectively reviewed.

Contribution of asthma to overall and respiratory diagnoses was analysed

using summary statistics.

RESULTS: Of 9005 pediatric ED encounters, 1922 (21%) were respira-

tory. Of these, 55% were pneumonia, 16% asthma, 16% upper respiratory

tract infection and 4% bronchiolitis. The remaining 9% included tubercu-

losis, chemical pneumonitis, croup and upper airway obstruction. Of 300

asthmatics, 47% were male. However, in preadolescents (<13 years), 53%

were male compared to adolescents where 72%were female (OR 2.9; 95%

CI: 1.6-5.4; p<0.001). Overall, median age was 6.0 years (interquartile

range 3.0-12.0). The median number of monthly asthma exacerbations in

2010 (median523 visits/month; IQR 17-23) was higher than in 2009

(median510 visits/month; IQR: 7-18; p50.02 Wilcoxon rank-sum). Of

asthma exacerbations, 40% (n5118) were hospitalized, accounting for

10% of pediatric respiratory admissions. Admitted asthmatics were

younger (median age 4.8 years; IQR: 2.0-7.0) than those discharged (7.0

years; IQR: 4.0-15.0; p<0.001 Wilcoxon rank-sum). Asthma-related

admissions did not differ between 2009 and 2010. There were no ED

asthma deaths during the study period.

CONCLUSION: In Botswana, asthma exacerbations contribute signifi-

cantly to ED encounters and hospitalizations. Greater asthma visits in 2010

did not correlate with an increase in asthma-related admissions.

573 Evolving Prescription Trends in the Management of ChildhoodWheeze in Singapore

J. Soh1, S. Xu2, Z. Tan2, Z. Ng2, W. Hing3, T. Wu3, Y. Chan2, B. Lee1;1National University Health Systems, Singapore, SINGAPORE, 2Yong

Loo Lin School of Medicine, National University of Singapore, Singa-

pore, SINGAPORE, 3Pharmacy, National University Health Systems, Sin-

gapore, Singapore, SINGAPORE.

RATIONALE: The management of childhood wheeze is highly variable

even with global treatment guidelines. We sought to characterize the

prescription trends of asthma medications for children aged 0-18 years in a

Singapore tertiary hospital over 2001-2010.

METHODS: A search of prescription data used to treat childhood wheeze

was conducted using the hospital pharmacy database. These included

short-acting beta-agonists (SABAs’), inhaled corticosteroids (ICS), com-

bination therapy (long-acting beta-agonists, LABA-ICS), and montelu-

kast, and ipratropium bromide. The number of patients prescribed SABA

was used as the surrogate for current wheeze. Ratios of ICS, LABA-ICS

and montelukast prescriptions versus SABAwere calculated to determine

the trends in presciptions of controller medications.

RESULTS: The number of children prescribed SABA and ICS increased

through 2001-2010 (+69%, p<0.001, +32%, p50.004; respectively). The

ratio of ICS:SABA also increased (p5 0.001), especially in those <_5 years

old (p<0.001). Therewas an increase in LABA-ICS initially (2001 to 2004,p>0.05), but then reversed subsequently (2007-2010) (p50.044). A

similarly decreasing trend for LABA-ICS:SABA ratio was also seen for

this later period(p50.026). There was an increase in trends of montelukast

prescriptions in children <_ 5 years (p<0.001 in infants, p50.026 in

toddlers), but this remained constant for those >5 years. The ratio of

Montelukast to SABA prescription increased significantly (p50.007) in

infants, but decreased over time in those aged >5 years (p50.020).

CONCLUSIONS: The asthma prescription practice for children in a large

University Hospital in Singapore showed an overall rising trend in ICS use,

montelukast use in younger children, and reducing trend in LABA-ICS use.

574 Factors Related to Repeated Admission in Children withAsthma

S. Choi1, Y. Rha2; 1Kyung Hee University Gangdong Hospital, Seoul, RE-

PUBLIC OF KOREA, 2Kyung Hee University Hospital, Seoul, REPUB-

LIC OF KOREA.

RATIONALE: A group at high risk for hospital admission will have high

cost of care unless effective preventive methods are implemented. The aim

of the present study was to assess the risk factors for the repeated

hospitalization for asthma attacks in chlidren.

METHODS: The study was done by as a retrospective medical record

review. Inclusion criteriawere age<18 years, 2<_admissions to five different

tertially care hospitals and discharge diagnosis of acute asthma. To explore

the independent associations of the risk factors, a logistic regression

analysis for variables was done. The outcome variable was repeated

hospitalization for asthma.

RESULTS: 1,260 children were admitted to the hospital for asthma.

Repeated admission was common (27%). After controlling for a wide

range of variables, factors that were significantly associated with repeated

hospitalization were irregular check-up by doctor (relative risk (RR) 1.9,

95% confidence interval (CI) 1.01-3.69), history of atopic dermati-

tis(1.8,1.01-3.3), exposure to environmental tobacco smoke (2.97; 1.4 -

5.9), and a history of bronchiolitis (2.8, 1.48 - 5.40). Factors that did not

predict repeated hospitalization included family history of atopy, gender,

and prophylactic treatment.

CONCLUSIONS: Clinical characteristics, including history of atopic

dermatitis, exposure to cigarette smoke at home, and a history of

bronchiolitis identify those at high risk for repeated hospitalization for

asthma. The development of preventive strategies could lead to both

improved health outcomes and decreased cost of care.