Asthma

Question 1

The benefits of specific IgE testing in the primary care setting

Author
Journal

Answer 1

Kwong

American Journal of Managed Care (AJMC)

Question 2

% of patients with allergy-like symptoms treated in primary care setting

Answer 2

80%

Question 3

Percent of asthmatics treated in primary care

Answer 3

76%

Question 4

Kwong: $ spent on AR and Asthmatics

Answer 4

AR= $7.3 Billion
Asthma= $37.2 Billion

Question 5

% of adults and children who have allergic triggers

Answer 5

60% adults

90% children

Question 6

Kwong: % of patients with eczema who have underlying allergic disease

Answer 6

30-40%

Question 7

Advantages of SPT

Answer 7

• Results available within 1 hour
• Equally as sensitive as in vitro tests
• Can be less expensive than in vitro tests
• Results are visible to patients, which may encourage compliance with environmental control measures

Question 8

Advantages of In Vitro Tests

Answer 8

• No need for testing technique
• No need for allergen extracts
• Patients can continue medications
• No risk for systematic rx (anaphylaxis)
• Can do for pts with eczema
• Quantitative results with established 95% cutoff values

Question 9

REACT Study
What does it stand for?
Which Journal?

Answer 9

Real World Evaluation of Asthma Control and Tx

Journal of Allergy and Clinical Immunology

Question 10

Who was the author of the REACT study

Answer 10

Peters et all

Question 11

Primary objective of the REACT study

Answer 11

Web based survey to asthmatics who were on multiple controller meds to assess the prevalence of uncontrolled asthma in the US

Question 12

Key Numbers from the REACT study
# of patients
% controlled vs uncontrolled
% of patients with healthcare coverage

Answer 12

1812 patients
45% controlled
55% uncontrolled
88% had healthcare coverage

Question 13

REACT study bottom line

Answer 13

Need for improved asthma care, better asthma control, need for implementation of asthma treat plans, need for better management of co-morbid conditions such as rhinosinusitis

Question 14

Rules of Two

Answer 14

• Using rescue inhaler > 2x/week
• Waking up due to asthma > 2x/month
• Refilling rescue meds > 2x/year

Question 15

NIH Guidelines two pronged approach

Answer 15

1) Meds alone NOT enough and Targeted exposure works
2) Category A Evidence that persistent asthmatics should be evaluated about the potential role of allergens- particularly indoor allergens

Question 16

NIH Guidelines: Most important step in tx of asthma

Answer 16

Identify allergic triggers

Question 17

NIH guidelines: 4 Components of comprehensive asthma management

Answer 17

1) Assessment & Monitoring
2) Controlling allergic/non allergic triggers
3) Pharmacotherapy
4) Education (patient and family)

Question 18

Effect of mattered and pillow encasing on children with asthma and house dust mite allergy
Who authored?
Which Journal?

Answer 18

Halken et all

Journal of Allergy and Clinical Immunology

Question 19

Halken:
N=__?
Age range
Monitored for how long?

Answer 19

N=60
6-15 years old
Monitored for 1 year

Question 20

Halken key results

Answer 20

73% of patients in control group with HDM covers reduced their dosage of inhaled steroids by at least 50%

Bottom line: Targeted Exposure Reductions works and leads to reductions in medications

Question 21

Results of a home-based environmental intervention among urban children with asthma (Inner city Study)
Author?
Journal?

Answer 21

Morgan et all

New England Journal of Medicine (NEJM)

Question 22

Morgan study objective

Answer 22

To establish that environmental control measures improves outcomes in children with asthma

Question 23

Morgan
N=__?
Age range
Demographics

Answer 23

N= 937 patients
5-11 years old
Children from 7 major cities for 1 year (+1 year follow up)

Question 24

Morgan study objective

Answer 24

Establish that environmental control measures improve outcomes in children with asthma

Question 25

``` Morgan study intervention group results: lost school days Children's lost sleep Fewer unscheduled visits Fewer days with symptoms ```

Answer 25

4.4 fewer days of missed school 5.5 fewer less sleep days 2.1 fewer unscheduled visits per year 21.3 fewer days with symptoms 17 fewer days of wheezing (this is not Morgan but from veeva)

Question 26

How many people have asthma?

Answer 26

25.9 million or also 24.6 million? | 1 in 14 people

Question 27

Asthma death stats and rates to know

Answer 27

``` 9 ppl / day die 3600 per year Equally distributed between mild, moderate and severe 65% are women Rates 47% higher in blacks than whites ```

Question 28

Cost of asthma breakdown

Answer 28

$56 Billion total: - -> $50 B direct - -> $6 B indirect

Question 29

Percentage of allergic triggers in adults and children

Answer 29

60% adults | 90% children

Question 30

Allergic rhinitis ranks __th most common disease overall

Answer 30

5th

Question 31

AR affects 1 in how many Americans?

Answer 31

1 in 6

Question 32

Percentage of patients polysensitized: Clinical Practice Guidelines for AR

Answer 32

90%

Question 33

AR Ranks __ th in most common diagnosis in primary care

Answer 33

16th

Question 34

SABA

Answer 34

Bronchodilators/Rescue Meds NOT for long term use I.e.) Albuterol

Question 35

Long Term: Persistent Asthma/Controller Meds

Answer 35

If Corticosteroids don't work (preferred first line of tx) Leukotriene modifiers Combo: Advair & Symbicort- most commonly prescribed Others: Cromolyn, Theophylline

Question 36

Histological changes that occur in asthmatic airways during inflammation

Answer 36

Contraction of airway smooth muscle Airway wall hypertrophic and airway narrowing Over-secretion of mucus

Question 37

__% children and __% adults with asthma are atopic

Answer 37

90%, 60%

Question 38

Only asthma medication indicated for use in allergic rhinitis

Answer 38

Singular