J ALLERGY CLIN IMMUNOL

FEBRUARY 2008

S222 Abstracts

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852-A Effectiveness of Adding Montelukast to Low DoseInhaled Corticosteroids in Patients with UncontrolledAsthma and Allergic Rhinitis

C. Koch1, R. McIvor2, S. Coyle3, N. Harvey1, S. Foucart1, F. Psaradellis4,

J. Sampalis4, J. Fitzgerald5; 1Merck Frosst Canada Ltd., Pointe-Claire,

QC, Canada, 2McMaster University, Hamilton, ON, Canada, 3Misericor-

dia Health Center, Winnipeg, MB, Canada, 4JSS Medical Research, West-

mount, QC, Canada, 5Vancouver Coastal Health Research Institute,

Vancouver, BC, Canada.

RATIONALE: The presence of Allergic Rhinitis (AR) which commonly

co-exists with asthma worsens the asthma symptoms. For asthmatic

patients not controlled with Inhaled Corticosteroids (ICS), the addition

of montelukast, a leukotriene receptor, may be beneficial.

METHODS: An 8-week Canadian multicenter, open-label, prospective

cohort study of uncontrolled adult asthma patients treated with ICS

received montelukast sodium 10 mg, once daily. A total of 319 uncon-

trolled asthma patients were enrolled, of which 192 patients had concurrent

AR. Uncontrolled asthma was defined according to the Canadian Asthma

Consensus Guidelines. Efficacy outcome measures included the change in

Asthma Control Questionnaire (ACQ) score between baseline and 8 weeks

of treatment and the proportion of patients with an ACQ score < 1.5.

Secondary outcome measures included patient and physician global

satisfaction with treatment.

RESULTS: At the time of this report, 181 (94.3%) patients with AR have

completed 8 weeks of treatment and 11 (6.1%) discontinued. The mean

(SD) age was 42.3 (15.6) years[M1]. After 8 weeks of treatment the mean

(SD) ACQ score changed from 1.94 (0.74) to 0.85 (0.74) (P50.001) which

is clinically significant as it exceeds the validated value of 0.5.

Furthermore, 145 (75.5%) of patients are considered controlled i.e. ACQ

score of < 1.5. The proportion of patients and physicians reporting being

satisfied with treatment at baseline and at 8 weeks increased from 40% to

89% (P<0.001) and 45% to 92% (P<0.001) respectively.

CONCLUSIONS: Montelukast is effective and well-tolerated add-on

therapy to the ICS treatment for the management of asthma in patients with

AR.

Funding: Merck Frosst Canada Ltd.

853 Childhood Asthma in Pediatric Practices: Still Out of ControlG. R. Bloomberg1, R. Sterkel2, C. Banister3, J. Epstein4,

J. Bruns5, L. Swerczek5, S. Wells5, J. Garbutt6; 1Washington University

School of Medicine, Dep’t of Pediatrics, Div. Allergy and Pulmonary

Medicine, St Louis, MO, 2Washington University School of Medicine,

Dep’t of Pediatrics, St Louis, MO, 3Washington University School of

Medicine, Dep’t of Medicine, St Louis, MO, 4Washington University

School of Medicine, Dep’t of Pediatrics, St Louis, MO, 5BJC Healthcare,

St Louis, MO, 6Washington University School of Medicine, Dep’t of

Pediatrics, Dep’t of Medicine, St Louis, MO.

RATIONALE: Assessment of asthma morbidity and management status

is essential to recommending specific interventions.

METHODS: Asthma morbidity was assessed using a brief questionnaire

administered to parents of children, 5-12 years of age, with persistent asthma.

Parents had been recruited from local, pediatric practices prior to an

intervention study. Short-term morbidity was assessed from symptoms,

short acting b2-agonist usage, and activity limitations over the prior 2 weeks.

Long-term morbidity was assessed from exacerbations requiring oral corti-

costeroid over 3 months and ED/hospitalization over 12 months. These

data were used to generate the child’s level of control (well, partially, and

poorly controlled) and matched with current use of controller medications.

RESULTS: 362 children were recruited from 95 general practice pedia-

tricians, mostly in suburban areas, with 61% Caucasian, 62% male, and 22%

Medicaid insurance; 73% reported using a controller medication daily. 82%

reported an acute exacerbation in past 12 months but only 48% had an asthma

maintenance visit in the past 6 months. Asthma was ‘‘well controlled’’ for

24% of children, ‘‘partially controlled’’ for 20%, and ‘‘poorly controlled’’ for

52%. Step level management per guideline recommendations indicated that

74% of children were being inadequately treated.

CONCLUSIONS: Data about asthma morbidity and medication use were

easy to collect using a brief questionnaire. More than half of children in this

community have poorly controlled asthma despite access to private care

and widespread prescribing of controller medications. More frequent

scheduled asthma management assessments, for morbidity and treatment

adjustment as necessary, are needed to improve asthma control.

Funding: AHRQ (#HS15378)

854 Asthma Control Test in a School Based Asthma ScreeningE. L. Goldstein, D. J. Dvorin; The Asthma Center Education

and Research Fund, Philadelphia, PA.

RATIONALE: Examine usefulness of the Asthma Control Test (ACT)

and Childhood Asthma Control Test (C-ACT) compared to pulmonary

function tests (PFTs) and SaO2 in school based asthma screenings.

METHODS: Part of a nationwide asthma screening, 600 packets were

sent home with children (K-8) attending 3 private schools. Packets

contained introductory letters, registration, demographic information,

release forms, age-specific child, and parent questionnaires including

ACT/C-ACT. Spirometry, peak flow, resting SaO2, and height were ob-

tained. Analysis compared functional parameters (PFTs and SaO2) versus

ACT/C-ACT in students with known asthma.

RESULTS: Of 114 screened (ages 4-13, mean 8.6 6 2.2, 1.1 M/F), 25

(22%) had asthma history, with 15 (60%) completing the ACT/C-ACT. The

mean ACT/C-ACT score was 21.3 6 4.7, range 11-25. Mean SaO2 was

98.8% 6 0.9 and mean PFTs (precent of predicted) were PEF 98.7% 6

20.8, FVC 100.1% 6 19.7, FEV1 97.8% 6 17.3, FEV1/FVC 87.1% 6

8.2, FEF25-75 92.2% 6 21.7, and FET100% 2.6 seconds 6 1.0. Of 3 students

with ACT/C-ACT scores� 19 (uncontrolled asthma), 0 had FEV1 � 80%

predicted and 2 (66.7%) had 1 or more other abnormal PFTs. Of 12 stu-

dents with ACT/C-ACT scores > 19 (controlled asthma), 3 (25%) had

FEV1� 80% predicted and a total of 8 (66.7%) had 1 or more other abnor-

mal PFTs. Analysis showed no significant correlations (all jrj < 0.45) be-

tween ACT/C-ACT scores and individual functional parameters.

CONCLUSIONS: Using ACT/C-ACT in school based asthma screenings

may be helpful tools in assessing asthma control and do not necessarily

correlate with functional parameters.

855 Underdiagnosis of Esophageal Candidiasis in AsthmaPatients

P. Giavina-Bianchi, M. Vivolo Aun, C. Leite Costa Garcia, M. Rosimeire

Ribeiro, J. Kalil; Clinical Immunology and Allergy Division, University

of Sao Paulo, Sao Paulo, BRAZIL.

RATIONALE: Inhaled glucocorticosteroids are currently the most effec-

tive anti-inflammatory medications for the treatment of persistent asthma.

Local adverse effects include oropharyngeal candidiasis, dysphonia and

coughing from upper airway irritation. Mouth washing, eat after drug

administration, new formulations and devices that reduce oropharyngeal

deposition may minimize such effects.

Esophageal candidiasis is a rare reported adverse effect of inhaled

corticosteroid use and its prevalence is not well known.

METHODS: We describe four cases of esophageal candidiasis in patients

with asthma taking inhaled budesonide.

RESULTS: Four asthma patients were being treated with inhaled com-

bination of budesonide and formoterol. Three were taking 800/24 micro-

grams/day, two with aerolyzer and one with turbuhaler. The other one were

taking 1600/24 micrograms/day with aerolyzer. Although none of them

were presenting signs or symptoms of oropharyngeal candidiasis, they had

dyspeptic pain and heartburn. They reported no oral steroid use in the past

three months. Patients did not present fever, neither diabetes mellitus, nor

immunodeficiency.

Esophagogastroduodenoscopy with biopsy confirmed the diagnosis of

candidal esophagitis. Treatment with fluconazole eliminated infection in

all patients.

CONCLUSIONS: Although a study has shown 37% of prevalence of

esophageal candidiasis among patients treated with inhaled fluticasone

propionate, it is an underdiagnosed disease. Asthma patients on inhaled