2011 AAAAI Annual Meeting

SAN FRANCISCO – During 2009’s peak influenza season, children with asthma were nearly twice as likely to be infected with the novel H1N1 influenza virus compared with other viruses, results from a prospective single-center study demonstrated.

In addition, H1N1 influenza infection caused increased severity of both cold and asthma symptoms compared with other infections.

Although reasons for the association remain unclear, "this really proves that asthmatics need to be vaccinated for the flu, because we can see that they’re more susceptible to be infected when they’re exposed, and they’re more susceptible to have loss of asthma control when they get it," lead investigator Dr. Kirsten M. Kloepfer said in an interview during a poster session at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.

Dr. Kloepfer, a fellow in allergy and clinical immunology at the University of Wisconsin, Madison, and her associates evaluated 161 children aged 4-12 years who provided at least six of eight consecutive weekly nasal samples between Sept. 5 and Oct. 24, 2009. The children also submitted daily cold symptom diaries, and when applicable, asthma symptom diaries including frequency of albuterol use and daily peak flow. The researchers used reverse transcriptase polymerase chain reaction testing to evaluate the nasal specimens.

Of these 161 children, 94 had asthma and 67 did not. Their mean age was 9 years, and 60% were male.

Dr. Kloepfer reported that the incidence of H1N1 influenza infection was 39% in asthmatics and 25% in nonasthmatics, a difference that was not statistically significant, with an odds ratio of 1.9 (P = .06). However, after adjustment for race, sex, and allergic sensitization, the difference became statistically significant, increasing to an OR of 3.5 (P less than .002).

The incidence of human rhinovirus was statistically similar between the two groups (89% in asthmatics vs. 93% in nonasthmatics), as was the incidence of other viral infections (37% vs. 42%).

Both asthmatics and nonasthmatics reported significant increases in moderate and severe cold symptoms with H1N1, compared with human rhinovirus (63% vs. 28%). Also, a significantly higher proportion of moderate to severe asthma severity was observed in patients infected with H1N1 influenza, compared with those infected with human rhinovirus (48% vs. 23%). This association held true for severe asthma symptoms as well (19% vs. 4%).

Dr. Kloepfer acknowledged certain limitations of the study, including its single-center design, the fact that it included only children aged 4-12 years, and the fact that it lasted only 8 weeks.

The study was supported by grants from the National Institutes of Health. Dr. Kloepfer said that she had no other relevant financial disclosures.

SAN FRANCISCO – During 2009’s peak influenza season, children with asthma were nearly twice as likely to be infected with the novel H1N1 influenza virus compared with other viruses, results from a prospective single-center study demonstrated.

In addition, H1N1 influenza infection caused increased severity of both cold and asthma symptoms compared with other infections.

Although reasons for the association remain unclear, "this really proves that asthmatics need to be vaccinated for the flu, because we can see that they’re more susceptible to be infected when they’re exposed, and they’re more susceptible to have loss of asthma control when they get it," lead investigator Dr. Kirsten M. Kloepfer said in an interview during a poster session at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.

Dr. Kloepfer, a fellow in allergy and clinical immunology at the University of Wisconsin, Madison, and her associates evaluated 161 children aged 4-12 years who provided at least six of eight consecutive weekly nasal samples between Sept. 5 and Oct. 24, 2009. The children also submitted daily cold symptom diaries, and when applicable, asthma symptom diaries including frequency of albuterol use and daily peak flow. The researchers used reverse transcriptase polymerase chain reaction testing to evaluate the nasal specimens.

Of these 161 children, 94 had asthma and 67 did not. Their mean age was 9 years, and 60% were male.

Dr. Kloepfer reported that the incidence of H1N1 influenza infection was 39% in asthmatics and 25% in nonasthmatics, a difference that was not statistically significant, with an odds ratio of 1.9 (P = .06). However, after adjustment for race, sex, and allergic sensitization, the difference became statistically significant, increasing to an OR of 3.5 (P less than .002).

The incidence of human rhinovirus was statistically similar between the two groups (89% in asthmatics vs. 93% in nonasthmatics), as was the incidence of other viral infections (37% vs. 42%).

Both asthmatics and nonasthmatics reported significant increases in moderate and severe cold symptoms with H1N1, compared with human rhinovirus (63% vs. 28%). Also, a significantly higher proportion of moderate to severe asthma severity was observed in patients infected with H1N1 influenza, compared with those infected with human rhinovirus (48% vs. 23%). This association held true for severe asthma symptoms as well (19% vs. 4%).

Dr. Kloepfer acknowledged certain limitations of the study, including its single-center design, the fact that it included only children aged 4-12 years, and the fact that it lasted only 8 weeks.

The study was supported by grants from the National Institutes of Health. Dr. Kloepfer said that she had no other relevant financial disclosures.

SAN FRANCISCO – During 2009’s peak influenza season, children with asthma were nearly twice as likely to be infected with the novel H1N1 influenza virus compared with other viruses, results from a prospective single-center study demonstrated.

In addition, H1N1 influenza infection caused increased severity of both cold and asthma symptoms compared with other infections.

Although reasons for the association remain unclear, "this really proves that asthmatics need to be vaccinated for the flu, because we can see that they’re more susceptible to be infected when they’re exposed, and they’re more susceptible to have loss of asthma control when they get it," lead investigator Dr. Kirsten M. Kloepfer said in an interview during a poster session at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.

Dr. Kloepfer, a fellow in allergy and clinical immunology at the University of Wisconsin, Madison, and her associates evaluated 161 children aged 4-12 years who provided at least six of eight consecutive weekly nasal samples between Sept. 5 and Oct. 24, 2009. The children also submitted daily cold symptom diaries, and when applicable, asthma symptom diaries including frequency of albuterol use and daily peak flow. The researchers used reverse transcriptase polymerase chain reaction testing to evaluate the nasal specimens.

Of these 161 children, 94 had asthma and 67 did not. Their mean age was 9 years, and 60% were male.

Dr. Kloepfer reported that the incidence of H1N1 influenza infection was 39% in asthmatics and 25% in nonasthmatics, a difference that was not statistically significant, with an odds ratio of 1.9 (P = .06). However, after adjustment for race, sex, and allergic sensitization, the difference became statistically significant, increasing to an OR of 3.5 (P less than .002).

The incidence of human rhinovirus was statistically similar between the two groups (89% in asthmatics vs. 93% in nonasthmatics), as was the incidence of other viral infections (37% vs. 42%).

Both asthmatics and nonasthmatics reported significant increases in moderate and severe cold symptoms with H1N1, compared with human rhinovirus (63% vs. 28%). Also, a significantly higher proportion of moderate to severe asthma severity was observed in patients infected with H1N1 influenza, compared with those infected with human rhinovirus (48% vs. 23%). This association held true for severe asthma symptoms as well (19% vs. 4%).

Dr. Kloepfer acknowledged certain limitations of the study, including its single-center design, the fact that it included only children aged 4-12 years, and the fact that it lasted only 8 weeks.

The study was supported by grants from the National Institutes of Health. Dr. Kloepfer said that she had no other relevant financial disclosures.

SAN FRANCISCO – During 2009’s peak influenza season, children with asthma were nearly twice as likely to be infected with the novel H1N1 influenza virus compared with other viruses, results from a prospective single-center study demonstrated.

In addition, H1N1 influenza infection caused increased severity of both cold and asthma symptoms compared with other infections.

Although reasons for the association remain unclear, "this really proves that asthmatics need to be vaccinated for the flu, because we can see that they’re more susceptible to be infected when they’re exposed, and they’re more susceptible to have loss of asthma control when they get it," lead investigator Dr. Kirsten M. Kloepfer said in an interview during a poster session at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.

Dr. Kloepfer, a fellow in allergy and clinical immunology at the University of Wisconsin, Madison, and her associates evaluated 161 children aged 4-12 years who provided at least six of eight consecutive weekly nasal samples between Sept. 5 and Oct. 24, 2009. The children also submitted daily cold symptom diaries, and when applicable, asthma symptom diaries including frequency of albuterol use and daily peak flow. The researchers used reverse transcriptase polymerase chain reaction testing to evaluate the nasal specimens.

Of these 161 children, 94 had asthma and 67 did not. Their mean age was 9 years, and 60% were male.

Dr. Kloepfer reported that the incidence of H1N1 influenza infection was 39% in asthmatics and 25% in nonasthmatics, a difference that was not statistically significant, with an odds ratio of 1.9 (P = .06). However, after adjustment for race, sex, and allergic sensitization, the difference became statistically significant, increasing to an OR of 3.5 (P less than .002).

The incidence of human rhinovirus was statistically similar between the two groups (89% in asthmatics vs. 93% in nonasthmatics), as was the incidence of other viral infections (37% vs. 42%).

Both asthmatics and nonasthmatics reported significant increases in moderate and severe cold symptoms with H1N1, compared with human rhinovirus (63% vs. 28%). Also, a significantly higher proportion of moderate to severe asthma severity was observed in patients infected with H1N1 influenza, compared with those infected with human rhinovirus (48% vs. 23%). This association held true for severe asthma symptoms as well (19% vs. 4%).

Dr. Kloepfer acknowledged certain limitations of the study, including its single-center design, the fact that it included only children aged 4-12 years, and the fact that it lasted only 8 weeks.

The study was supported by grants from the National Institutes of Health. Dr. Kloepfer said that she had no other relevant financial disclosures.

SAN FRANCISCO – During 2009’s peak influenza season, children with asthma were nearly twice as likely to be infected with the novel H1N1 influenza virus compared with other viruses, results from a prospective single-center study demonstrated.

In addition, H1N1 influenza infection caused increased severity of both cold and asthma symptoms compared with other infections.

Although reasons for the association remain unclear, "this really proves that asthmatics need to be vaccinated for the flu, because we can see that they’re more susceptible to be infected when they’re exposed, and they’re more susceptible to have loss of asthma control when they get it," lead investigator Dr. Kirsten M. Kloepfer said in an interview during a poster session at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.

Dr. Kloepfer, a fellow in allergy and clinical immunology at the University of Wisconsin, Madison, and her associates evaluated 161 children aged 4-12 years who provided at least six of eight consecutive weekly nasal samples between Sept. 5 and Oct. 24, 2009. The children also submitted daily cold symptom diaries, and when applicable, asthma symptom diaries including frequency of albuterol use and daily peak flow. The researchers used reverse transcriptase polymerase chain reaction testing to evaluate the nasal specimens.

Of these 161 children, 94 had asthma and 67 did not. Their mean age was 9 years, and 60% were male.

Dr. Kloepfer reported that the incidence of H1N1 influenza infection was 39% in asthmatics and 25% in nonasthmatics, a difference that was not statistically significant, with an odds ratio of 1.9 (P = .06). However, after adjustment for race, sex, and allergic sensitization, the difference became statistically significant, increasing to an OR of 3.5 (P less than .002).

The incidence of human rhinovirus was statistically similar between the two groups (89% in asthmatics vs. 93% in nonasthmatics), as was the incidence of other viral infections (37% vs. 42%).

Both asthmatics and nonasthmatics reported significant increases in moderate and severe cold symptoms with H1N1, compared with human rhinovirus (63% vs. 28%). Also, a significantly higher proportion of moderate to severe asthma severity was observed in patients infected with H1N1 influenza, compared with those infected with human rhinovirus (48% vs. 23%). This association held true for severe asthma symptoms as well (19% vs. 4%).

Dr. Kloepfer acknowledged certain limitations of the study, including its single-center design, the fact that it included only children aged 4-12 years, and the fact that it lasted only 8 weeks.

The study was supported by grants from the National Institutes of Health. Dr. Kloepfer said that she had no other relevant financial disclosures.

SAN FRANCISCO – During 2009’s peak influenza season, children with asthma were nearly twice as likely to be infected with the novel H1N1 influenza virus compared with other viruses, results from a prospective single-center study demonstrated.

In addition, H1N1 influenza infection caused increased severity of both cold and asthma symptoms compared with other infections.

Although reasons for the association remain unclear, "this really proves that asthmatics need to be vaccinated for the flu, because we can see that they’re more susceptible to be infected when they’re exposed, and they’re more susceptible to have loss of asthma control when they get it," lead investigator Dr. Kirsten M. Kloepfer said in an interview during a poster session at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.

Dr. Kloepfer, a fellow in allergy and clinical immunology at the University of Wisconsin, Madison, and her associates evaluated 161 children aged 4-12 years who provided at least six of eight consecutive weekly nasal samples between Sept. 5 and Oct. 24, 2009. The children also submitted daily cold symptom diaries, and when applicable, asthma symptom diaries including frequency of albuterol use and daily peak flow. The researchers used reverse transcriptase polymerase chain reaction testing to evaluate the nasal specimens.

Of these 161 children, 94 had asthma and 67 did not. Their mean age was 9 years, and 60% were male.

Dr. Kloepfer reported that the incidence of H1N1 influenza infection was 39% in asthmatics and 25% in nonasthmatics, a difference that was not statistically significant, with an odds ratio of 1.9 (P = .06). However, after adjustment for race, sex, and allergic sensitization, the difference became statistically significant, increasing to an OR of 3.5 (P less than .002).

The incidence of human rhinovirus was statistically similar between the two groups (89% in asthmatics vs. 93% in nonasthmatics), as was the incidence of other viral infections (37% vs. 42%).

Both asthmatics and nonasthmatics reported significant increases in moderate and severe cold symptoms with H1N1, compared with human rhinovirus (63% vs. 28%). Also, a significantly higher proportion of moderate to severe asthma severity was observed in patients infected with H1N1 influenza, compared with those infected with human rhinovirus (48% vs. 23%). This association held true for severe asthma symptoms as well (19% vs. 4%).

Dr. Kloepfer acknowledged certain limitations of the study, including its single-center design, the fact that it included only children aged 4-12 years, and the fact that it lasted only 8 weeks.

The study was supported by grants from the National Institutes of Health. Dr. Kloepfer said that she had no other relevant financial disclosures.

SAN FRANCISCO – A new skin prick test detects type-1 hypersensitivity to nitrile, the synthetic rubber in the gloves increasingly used by hospitals.

With latex allergies not uncommon among health care workers, "most hospitals have been switching over to nitrile gloves," said allergist and immunologist Dr. Santhosh Kumar of Virginia Commonwealth University, Richmond.

Photo credit: Anton Gvozdikov/Fotolia.com

But nitrile gloves can cause reactions, too, a problem not often recognized in the medical community and one that may emerge as a significant issue with expanded use, he said.

Since hospitals have been making the switch, "We’ve seen more and more people present with contact sensitivity [to nitrile], with hives and rashes on their hands. Some have it all over their body. It starts off initially on the hands, and then it gradually progresses," Dr. Kumar said.

To detect nitrile hypersensitivity, "we came up with a new skin prick test," he said.

Dr. Kumar and his colleagues tried it out on three people who had reacted to nitrile gloves in the past.

They cut 5-cm-square pieces from blue and purple nitrile gloves, and soaked them in normal saline for 2 hours.

They then applied the pieces to the underside of the patients’ forearms, and pricked the skin through the patches with Greer DermaPIKs. The pieces were removed and rubbed over the pricked areas a few times.

Skin tests were read 15 minutes later and considered positive if the wheal was 3 mm larger than saline control pricks.

All three patients had positive tests with mean wheal diameters of 5.5 mm. The mean saline prick wheal diameter was 2.17 mm, the mean diameter of histamine pricks—also used as controls—was 5.17 mm.

Latex IgE was positive in the one patient who had previously reacted to latex gloves.

The test "is a simple and effective method to detect type-1 hypersensitivity reactions to nitrile products," Dr. Kumar and his colleagues concluded.

"If a patient is positive, we tell them to avoid nitrile gloves," he said. Vinyl gloves are option, though less elastic than latex and nitrile.

Dr. Kumar said he has no disclosures.

SAN FRANCISCO – A new skin prick test detects type-1 hypersensitivity to nitrile, the synthetic rubber in the gloves increasingly used by hospitals.

With latex allergies not uncommon among health care workers, "most hospitals have been switching over to nitrile gloves," said allergist and immunologist Dr. Santhosh Kumar of Virginia Commonwealth University, Richmond.

Photo credit: Anton Gvozdikov/Fotolia.com

But nitrile gloves can cause reactions, too, a problem not often recognized in the medical community and one that may emerge as a significant issue with expanded use, he said.

Since hospitals have been making the switch, "We’ve seen more and more people present with contact sensitivity [to nitrile], with hives and rashes on their hands. Some have it all over their body. It starts off initially on the hands, and then it gradually progresses," Dr. Kumar said.

To detect nitrile hypersensitivity, "we came up with a new skin prick test," he said.

Dr. Kumar and his colleagues tried it out on three people who had reacted to nitrile gloves in the past.

They cut 5-cm-square pieces from blue and purple nitrile gloves, and soaked them in normal saline for 2 hours.

They then applied the pieces to the underside of the patients’ forearms, and pricked the skin through the patches with Greer DermaPIKs. The pieces were removed and rubbed over the pricked areas a few times.

Skin tests were read 15 minutes later and considered positive if the wheal was 3 mm larger than saline control pricks.

All three patients had positive tests with mean wheal diameters of 5.5 mm. The mean saline prick wheal diameter was 2.17 mm, the mean diameter of histamine pricks—also used as controls—was 5.17 mm.

Latex IgE was positive in the one patient who had previously reacted to latex gloves.

The test "is a simple and effective method to detect type-1 hypersensitivity reactions to nitrile products," Dr. Kumar and his colleagues concluded.

"If a patient is positive, we tell them to avoid nitrile gloves," he said. Vinyl gloves are option, though less elastic than latex and nitrile.

Dr. Kumar said he has no disclosures.

SAN FRANCISCO – A new skin prick test detects type-1 hypersensitivity to nitrile, the synthetic rubber in the gloves increasingly used by hospitals.

With latex allergies not uncommon among health care workers, "most hospitals have been switching over to nitrile gloves," said allergist and immunologist Dr. Santhosh Kumar of Virginia Commonwealth University, Richmond.

Photo credit: Anton Gvozdikov/Fotolia.com

But nitrile gloves can cause reactions, too, a problem not often recognized in the medical community and one that may emerge as a significant issue with expanded use, he said.

Since hospitals have been making the switch, "We’ve seen more and more people present with contact sensitivity [to nitrile], with hives and rashes on their hands. Some have it all over their body. It starts off initially on the hands, and then it gradually progresses," Dr. Kumar said.

To detect nitrile hypersensitivity, "we came up with a new skin prick test," he said.

Dr. Kumar and his colleagues tried it out on three people who had reacted to nitrile gloves in the past.

They cut 5-cm-square pieces from blue and purple nitrile gloves, and soaked them in normal saline for 2 hours.

They then applied the pieces to the underside of the patients’ forearms, and pricked the skin through the patches with Greer DermaPIKs. The pieces were removed and rubbed over the pricked areas a few times.

Skin tests were read 15 minutes later and considered positive if the wheal was 3 mm larger than saline control pricks.

All three patients had positive tests with mean wheal diameters of 5.5 mm. The mean saline prick wheal diameter was 2.17 mm, the mean diameter of histamine pricks—also used as controls—was 5.17 mm.

Latex IgE was positive in the one patient who had previously reacted to latex gloves.

The test "is a simple and effective method to detect type-1 hypersensitivity reactions to nitrile products," Dr. Kumar and his colleagues concluded.

"If a patient is positive, we tell them to avoid nitrile gloves," he said. Vinyl gloves are option, though less elastic than latex and nitrile.

Dr. Kumar said he has no disclosures.

SAN FRANCISCO – A new skin prick test detects type-1 hypersensitivity to nitrile, the synthetic rubber in the gloves increasingly used by hospitals.

With latex allergies not uncommon among health care workers, "most hospitals have been switching over to nitrile gloves," said allergist and immunologist Dr. Santhosh Kumar of Virginia Commonwealth University, Richmond.

Photo credit: Anton Gvozdikov/Fotolia.com

But nitrile gloves can cause reactions, too, a problem not often recognized in the medical community and one that may emerge as a significant issue with expanded use, he said.

Since hospitals have been making the switch, "We’ve seen more and more people present with contact sensitivity [to nitrile], with hives and rashes on their hands. Some have it all over their body. It starts off initially on the hands, and then it gradually progresses," Dr. Kumar said.

To detect nitrile hypersensitivity, "we came up with a new skin prick test," he said.

Dr. Kumar and his colleagues tried it out on three people who had reacted to nitrile gloves in the past.

They cut 5-cm-square pieces from blue and purple nitrile gloves, and soaked them in normal saline for 2 hours.

They then applied the pieces to the underside of the patients’ forearms, and pricked the skin through the patches with Greer DermaPIKs. The pieces were removed and rubbed over the pricked areas a few times.

Skin tests were read 15 minutes later and considered positive if the wheal was 3 mm larger than saline control pricks.

All three patients had positive tests with mean wheal diameters of 5.5 mm. The mean saline prick wheal diameter was 2.17 mm, the mean diameter of histamine pricks—also used as controls—was 5.17 mm.

Latex IgE was positive in the one patient who had previously reacted to latex gloves.

The test "is a simple and effective method to detect type-1 hypersensitivity reactions to nitrile products," Dr. Kumar and his colleagues concluded.

"If a patient is positive, we tell them to avoid nitrile gloves," he said. Vinyl gloves are option, though less elastic than latex and nitrile.

Dr. Kumar said he has no disclosures.

SAN FRANCISCO – A new skin prick test detects type-1 hypersensitivity to nitrile, the synthetic rubber in the gloves increasingly used by hospitals.

With latex allergies not uncommon among health care workers, "most hospitals have been switching over to nitrile gloves," said allergist and immunologist Dr. Santhosh Kumar of Virginia Commonwealth University, Richmond.

Photo credit: Anton Gvozdikov/Fotolia.com

But nitrile gloves can cause reactions, too, a problem not often recognized in the medical community and one that may emerge as a significant issue with expanded use, he said.

Since hospitals have been making the switch, "We’ve seen more and more people present with contact sensitivity [to nitrile], with hives and rashes on their hands. Some have it all over their body. It starts off initially on the hands, and then it gradually progresses," Dr. Kumar said.

To detect nitrile hypersensitivity, "we came up with a new skin prick test," he said.

Dr. Kumar and his colleagues tried it out on three people who had reacted to nitrile gloves in the past.

They cut 5-cm-square pieces from blue and purple nitrile gloves, and soaked them in normal saline for 2 hours.

They then applied the pieces to the underside of the patients’ forearms, and pricked the skin through the patches with Greer DermaPIKs. The pieces were removed and rubbed over the pricked areas a few times.

Skin tests were read 15 minutes later and considered positive if the wheal was 3 mm larger than saline control pricks.

All three patients had positive tests with mean wheal diameters of 5.5 mm. The mean saline prick wheal diameter was 2.17 mm, the mean diameter of histamine pricks—also used as controls—was 5.17 mm.

Latex IgE was positive in the one patient who had previously reacted to latex gloves.

The test "is a simple and effective method to detect type-1 hypersensitivity reactions to nitrile products," Dr. Kumar and his colleagues concluded.

"If a patient is positive, we tell them to avoid nitrile gloves," he said. Vinyl gloves are option, though less elastic than latex and nitrile.

Dr. Kumar said he has no disclosures.

SAN FRANCISCO – A new skin prick test detects type-1 hypersensitivity to nitrile, the synthetic rubber in the gloves increasingly used by hospitals.

With latex allergies not uncommon among health care workers, "most hospitals have been switching over to nitrile gloves," said allergist and immunologist Dr. Santhosh Kumar of Virginia Commonwealth University, Richmond.

Photo credit: Anton Gvozdikov/Fotolia.com

But nitrile gloves can cause reactions, too, a problem not often recognized in the medical community and one that may emerge as a significant issue with expanded use, he said.

Since hospitals have been making the switch, "We’ve seen more and more people present with contact sensitivity [to nitrile], with hives and rashes on their hands. Some have it all over their body. It starts off initially on the hands, and then it gradually progresses," Dr. Kumar said.

To detect nitrile hypersensitivity, "we came up with a new skin prick test," he said.

Dr. Kumar and his colleagues tried it out on three people who had reacted to nitrile gloves in the past.

They cut 5-cm-square pieces from blue and purple nitrile gloves, and soaked them in normal saline for 2 hours.

They then applied the pieces to the underside of the patients’ forearms, and pricked the skin through the patches with Greer DermaPIKs. The pieces were removed and rubbed over the pricked areas a few times.

Skin tests were read 15 minutes later and considered positive if the wheal was 3 mm larger than saline control pricks.

All three patients had positive tests with mean wheal diameters of 5.5 mm. The mean saline prick wheal diameter was 2.17 mm, the mean diameter of histamine pricks—also used as controls—was 5.17 mm.

Latex IgE was positive in the one patient who had previously reacted to latex gloves.

The test "is a simple and effective method to detect type-1 hypersensitivity reactions to nitrile products," Dr. Kumar and his colleagues concluded.

"If a patient is positive, we tell them to avoid nitrile gloves," he said. Vinyl gloves are option, though less elastic than latex and nitrile.

Dr. Kumar said he has no disclosures.

SAN FRANCISCO – A new skin prick test detects type-1 hypersensitivity to nitrile, the synthetic rubber in the gloves increasingly used by hospitals.

With latex allergies not uncommon among health care workers, "most hospitals have been switching over to nitrile gloves," said allergist and immunologist Dr. Santhosh Kumar of Virginia Commonwealth University, Richmond.

Photo credit: Anton Gvozdikov/Fotolia.com

But nitrile gloves can cause reactions, too, a problem not often recognized in the medical community and one that may emerge as a significant issue with expanded use, he said.

Since hospitals have been making the switch, "We’ve seen more and more people present with contact sensitivity [to nitrile], with hives and rashes on their hands. Some have it all over their body. It starts off initially on the hands, and then it gradually progresses," Dr. Kumar said.

To detect nitrile hypersensitivity, "we came up with a new skin prick test," he said.

Dr. Kumar and his colleagues tried it out on three people who had reacted to nitrile gloves in the past.

They cut 5-cm-square pieces from blue and purple nitrile gloves, and soaked them in normal saline for 2 hours.

They then applied the pieces to the underside of the patients’ forearms, and pricked the skin through the patches with Greer DermaPIKs. The pieces were removed and rubbed over the pricked areas a few times.

Skin tests were read 15 minutes later and considered positive if the wheal was 3 mm larger than saline control pricks.

All three patients had positive tests with mean wheal diameters of 5.5 mm. The mean saline prick wheal diameter was 2.17 mm, the mean diameter of histamine pricks—also used as controls—was 5.17 mm.

Latex IgE was positive in the one patient who had previously reacted to latex gloves.

The test "is a simple and effective method to detect type-1 hypersensitivity reactions to nitrile products," Dr. Kumar and his colleagues concluded.

"If a patient is positive, we tell them to avoid nitrile gloves," he said. Vinyl gloves are option, though less elastic than latex and nitrile.

Dr. Kumar said he has no disclosures.

SAN FRANCISCO – A new skin prick test detects type-1 hypersensitivity to nitrile, the synthetic rubber in the gloves increasingly used by hospitals.

With latex allergies not uncommon among health care workers, "most hospitals have been switching over to nitrile gloves," said allergist and immunologist Dr. Santhosh Kumar of Virginia Commonwealth University, Richmond.

Photo credit: Anton Gvozdikov/Fotolia.com

But nitrile gloves can cause reactions, too, a problem not often recognized in the medical community and one that may emerge as a significant issue with expanded use, he said.

Since hospitals have been making the switch, "We’ve seen more and more people present with contact sensitivity [to nitrile], with hives and rashes on their hands. Some have it all over their body. It starts off initially on the hands, and then it gradually progresses," Dr. Kumar said.

To detect nitrile hypersensitivity, "we came up with a new skin prick test," he said.

Dr. Kumar and his colleagues tried it out on three people who had reacted to nitrile gloves in the past.

They cut 5-cm-square pieces from blue and purple nitrile gloves, and soaked them in normal saline for 2 hours.

They then applied the pieces to the underside of the patients’ forearms, and pricked the skin through the patches with Greer DermaPIKs. The pieces were removed and rubbed over the pricked areas a few times.

Skin tests were read 15 minutes later and considered positive if the wheal was 3 mm larger than saline control pricks.

All three patients had positive tests with mean wheal diameters of 5.5 mm. The mean saline prick wheal diameter was 2.17 mm, the mean diameter of histamine pricks—also used as controls—was 5.17 mm.

Latex IgE was positive in the one patient who had previously reacted to latex gloves.

The test "is a simple and effective method to detect type-1 hypersensitivity reactions to nitrile products," Dr. Kumar and his colleagues concluded.

"If a patient is positive, we tell them to avoid nitrile gloves," he said. Vinyl gloves are option, though less elastic than latex and nitrile.

Dr. Kumar said he has no disclosures.

SAN FRANCISCO – A new skin prick test detects type-1 hypersensitivity to nitrile, the synthetic rubber in the gloves increasingly used by hospitals.

With latex allergies not uncommon among health care workers, "most hospitals have been switching over to nitrile gloves," said allergist and immunologist Dr. Santhosh Kumar of Virginia Commonwealth University, Richmond.

Photo credit: Anton Gvozdikov/Fotolia.com

But nitrile gloves can cause reactions, too, a problem not often recognized in the medical community and one that may emerge as a significant issue with expanded use, he said.

Since hospitals have been making the switch, "We’ve seen more and more people present with contact sensitivity [to nitrile], with hives and rashes on their hands. Some have it all over their body. It starts off initially on the hands, and then it gradually progresses," Dr. Kumar said.

To detect nitrile hypersensitivity, "we came up with a new skin prick test," he said.

Dr. Kumar and his colleagues tried it out on three people who had reacted to nitrile gloves in the past.

They cut 5-cm-square pieces from blue and purple nitrile gloves, and soaked them in normal saline for 2 hours.

They then applied the pieces to the underside of the patients’ forearms, and pricked the skin through the patches with Greer DermaPIKs. The pieces were removed and rubbed over the pricked areas a few times.

Skin tests were read 15 minutes later and considered positive if the wheal was 3 mm larger than saline control pricks.

All three patients had positive tests with mean wheal diameters of 5.5 mm. The mean saline prick wheal diameter was 2.17 mm, the mean diameter of histamine pricks—also used as controls—was 5.17 mm.

Latex IgE was positive in the one patient who had previously reacted to latex gloves.

The test "is a simple and effective method to detect type-1 hypersensitivity reactions to nitrile products," Dr. Kumar and his colleagues concluded.

"If a patient is positive, we tell them to avoid nitrile gloves," he said. Vinyl gloves are option, though less elastic than latex and nitrile.

Dr. Kumar said he has no disclosures.

SAN FRANCISCO – Physicians don’t always follow federal asthma guidelines, and quality of life has improved only slightly for asthma patients since 1998, according to two studies.

"We have not moved the pendulum very far despite of all the information and studies that have occurred over the last 12 to 13 years. [Doctors] know about the guidelines, but they don’t incorporate them into practice. Three and half years of writing guidelines didn’t change a thing," said asthma specialist Dr. Stuart Stoloff, a clinical professor at the University of Nevada, Reno, and one of the experts who worked on the National Heart, Lung, and Blood Institute guidelines.

The problem is "patients have not received information about how good they should be able to feel. The other part of it is that clinicians who provide care for those patients are not aware of how well someone should feel with the disease," said Dr. Stoloff, an author on both studies, which were presented at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.

The first study compared 1998 Asthma in America survey results from 2,509 pediatric and adult asthma patients with 2009 Asthma Insight and Management survey results from 2,500 pediatric and adult asthma patients, assessing disease burden and other issues.

The findings: Asthma exacerbations sent about the same percentage of patients to the emergency department or hospital in 2009 as in 1998, while the 2009 patients missed only slightly less work or school due to asthma.

In 1998, 64% of adults said asthma limited their daily activities. In 2009, it was 55%.

About 28% of patients owned peak-flow meters in 1998 and 35% had lung function testing in the previous year. In 2008, 35% owned a meter and 33% had their lungs tested within a year.

In the second study, 309 asthma specialists and general practitioners were surveyed. The findings reveal that what many consider to be adequate asthma control falls short of treatment goals in the NHLBI 2007 Guidelines for the Diagnosis and Management of Asthma.

About 96% of physicians surveyed knew about the NHLBI guidelines, but only 28% said that they "always" complied with them. The numbers were slightly higher for allergists and pulmonologists.

Half of physicians considered asthma well managed if patients had two urgent doctor visits per year. About a third considered both one ED visit and three to four exacerbations per year compatible with good management. One in five physicians thought patients who needed quick relief medication three times per week were well managed.

For adults with mild persistent asthma, only 67% of physicians overall preferred inhaled corticosteroid monotherapy as the first-line treatment, though the number was a bit higher for specialists. Only about half reported drawing up asthma action plans as recommended by the guidelines for most or all of their patients.

Dr. Stoloff said pay-for-performance is solution. Physicians should be rewarded for good outcomes and compensated for patient education and other efforts to achieve good outcomes.

Accountable care organizations and patient-centered medical homes are moving in that direction, but "we need to accelerate the process," he said.

Asthma mortality has decreased in recent years because of better diagnosis and treatment, but Dr. Stoloff said the findings indicate that change is "not occurring fast enough."

Outcome benchmarks in pay-for-performance models should include "patients going to school, going to work, going to play" and "normal or near-normal lung function; not ending up in an emergency room or hospital; [and] not taking oral steroids," he said.

Dr. Stoloff is a consultant for AstraZeneca, Alcon, Merck & Co., Novartis, Dey Pharma, GlaxoSmithKline, Boehringer-Ingelheim, Sepracor, and Teva Pharmaceuticals. The studies were funded by Merck.

SAN FRANCISCO – Physicians don’t always follow federal asthma guidelines, and quality of life has improved only slightly for asthma patients since 1998, according to two studies.

"We have not moved the pendulum very far despite of all the information and studies that have occurred over the last 12 to 13 years. [Doctors] know about the guidelines, but they don’t incorporate them into practice. Three and half years of writing guidelines didn’t change a thing," said asthma specialist Dr. Stuart Stoloff, a clinical professor at the University of Nevada, Reno, and one of the experts who worked on the National Heart, Lung, and Blood Institute guidelines.

The problem is "patients have not received information about how good they should be able to feel. The other part of it is that clinicians who provide care for those patients are not aware of how well someone should feel with the disease," said Dr. Stoloff, an author on both studies, which were presented at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.

The first study compared 1998 Asthma in America survey results from 2,509 pediatric and adult asthma patients with 2009 Asthma Insight and Management survey results from 2,500 pediatric and adult asthma patients, assessing disease burden and other issues.

The findings: Asthma exacerbations sent about the same percentage of patients to the emergency department or hospital in 2009 as in 1998, while the 2009 patients missed only slightly less work or school due to asthma.

In 1998, 64% of adults said asthma limited their daily activities. In 2009, it was 55%.

About 28% of patients owned peak-flow meters in 1998 and 35% had lung function testing in the previous year. In 2008, 35% owned a meter and 33% had their lungs tested within a year.

In the second study, 309 asthma specialists and general practitioners were surveyed. The findings reveal that what many consider to be adequate asthma control falls short of treatment goals in the NHLBI 2007 Guidelines for the Diagnosis and Management of Asthma.

About 96% of physicians surveyed knew about the NHLBI guidelines, but only 28% said that they "always" complied with them. The numbers were slightly higher for allergists and pulmonologists.

Half of physicians considered asthma well managed if patients had two urgent doctor visits per year. About a third considered both one ED visit and three to four exacerbations per year compatible with good management. One in five physicians thought patients who needed quick relief medication three times per week were well managed.

For adults with mild persistent asthma, only 67% of physicians overall preferred inhaled corticosteroid monotherapy as the first-line treatment, though the number was a bit higher for specialists. Only about half reported drawing up asthma action plans as recommended by the guidelines for most or all of their patients.

Dr. Stoloff said pay-for-performance is solution. Physicians should be rewarded for good outcomes and compensated for patient education and other efforts to achieve good outcomes.

Accountable care organizations and patient-centered medical homes are moving in that direction, but "we need to accelerate the process," he said.

Asthma mortality has decreased in recent years because of better diagnosis and treatment, but Dr. Stoloff said the findings indicate that change is "not occurring fast enough."

Outcome benchmarks in pay-for-performance models should include "patients going to school, going to work, going to play" and "normal or near-normal lung function; not ending up in an emergency room or hospital; [and] not taking oral steroids," he said.

Dr. Stoloff is a consultant for AstraZeneca, Alcon, Merck & Co., Novartis, Dey Pharma, GlaxoSmithKline, Boehringer-Ingelheim, Sepracor, and Teva Pharmaceuticals. The studies were funded by Merck.

SAN FRANCISCO – Physicians don’t always follow federal asthma guidelines, and quality of life has improved only slightly for asthma patients since 1998, according to two studies.

"We have not moved the pendulum very far despite of all the information and studies that have occurred over the last 12 to 13 years. [Doctors] know about the guidelines, but they don’t incorporate them into practice. Three and half years of writing guidelines didn’t change a thing," said asthma specialist Dr. Stuart Stoloff, a clinical professor at the University of Nevada, Reno, and one of the experts who worked on the National Heart, Lung, and Blood Institute guidelines.

The problem is "patients have not received information about how good they should be able to feel. The other part of it is that clinicians who provide care for those patients are not aware of how well someone should feel with the disease," said Dr. Stoloff, an author on both studies, which were presented at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.

The first study compared 1998 Asthma in America survey results from 2,509 pediatric and adult asthma patients with 2009 Asthma Insight and Management survey results from 2,500 pediatric and adult asthma patients, assessing disease burden and other issues.

The findings: Asthma exacerbations sent about the same percentage of patients to the emergency department or hospital in 2009 as in 1998, while the 2009 patients missed only slightly less work or school due to asthma.

In 1998, 64% of adults said asthma limited their daily activities. In 2009, it was 55%.

About 28% of patients owned peak-flow meters in 1998 and 35% had lung function testing in the previous year. In 2008, 35% owned a meter and 33% had their lungs tested within a year.

In the second study, 309 asthma specialists and general practitioners were surveyed. The findings reveal that what many consider to be adequate asthma control falls short of treatment goals in the NHLBI 2007 Guidelines for the Diagnosis and Management of Asthma.

About 96% of physicians surveyed knew about the NHLBI guidelines, but only 28% said that they "always" complied with them. The numbers were slightly higher for allergists and pulmonologists.

Half of physicians considered asthma well managed if patients had two urgent doctor visits per year. About a third considered both one ED visit and three to four exacerbations per year compatible with good management. One in five physicians thought patients who needed quick relief medication three times per week were well managed.

For adults with mild persistent asthma, only 67% of physicians overall preferred inhaled corticosteroid monotherapy as the first-line treatment, though the number was a bit higher for specialists. Only about half reported drawing up asthma action plans as recommended by the guidelines for most or all of their patients.

Dr. Stoloff said pay-for-performance is solution. Physicians should be rewarded for good outcomes and compensated for patient education and other efforts to achieve good outcomes.

Accountable care organizations and patient-centered medical homes are moving in that direction, but "we need to accelerate the process," he said.

Asthma mortality has decreased in recent years because of better diagnosis and treatment, but Dr. Stoloff said the findings indicate that change is "not occurring fast enough."

Outcome benchmarks in pay-for-performance models should include "patients going to school, going to work, going to play" and "normal or near-normal lung function; not ending up in an emergency room or hospital; [and] not taking oral steroids," he said.

Dr. Stoloff is a consultant for AstraZeneca, Alcon, Merck & Co., Novartis, Dey Pharma, GlaxoSmithKline, Boehringer-Ingelheim, Sepracor, and Teva Pharmaceuticals. The studies were funded by Merck.

SAN FRANCISCO – Physicians don’t always follow federal asthma guidelines, and quality of life has improved only slightly for asthma patients since 1998, according to two studies.

"We have not moved the pendulum very far despite of all the information and studies that have occurred over the last 12 to 13 years. [Doctors] know about the guidelines, but they don’t incorporate them into practice. Three and half years of writing guidelines didn’t change a thing," said asthma specialist Dr. Stuart Stoloff, a clinical professor at the University of Nevada, Reno, and one of the experts who worked on the National Heart, Lung, and Blood Institute guidelines.

The problem is "patients have not received information about how good they should be able to feel. The other part of it is that clinicians who provide care for those patients are not aware of how well someone should feel with the disease," said Dr. Stoloff, an author on both studies, which were presented at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.

The first study compared 1998 Asthma in America survey results from 2,509 pediatric and adult asthma patients with 2009 Asthma Insight and Management survey results from 2,500 pediatric and adult asthma patients, assessing disease burden and other issues.

The findings: Asthma exacerbations sent about the same percentage of patients to the emergency department or hospital in 2009 as in 1998, while the 2009 patients missed only slightly less work or school due to asthma.

In 1998, 64% of adults said asthma limited their daily activities. In 2009, it was 55%.

About 28% of patients owned peak-flow meters in 1998 and 35% had lung function testing in the previous year. In 2008, 35% owned a meter and 33% had their lungs tested within a year.

In the second study, 309 asthma specialists and general practitioners were surveyed. The findings reveal that what many consider to be adequate asthma control falls short of treatment goals in the NHLBI 2007 Guidelines for the Diagnosis and Management of Asthma.

About 96% of physicians surveyed knew about the NHLBI guidelines, but only 28% said that they "always" complied with them. The numbers were slightly higher for allergists and pulmonologists.

Half of physicians considered asthma well managed if patients had two urgent doctor visits per year. About a third considered both one ED visit and three to four exacerbations per year compatible with good management. One in five physicians thought patients who needed quick relief medication three times per week were well managed.

For adults with mild persistent asthma, only 67% of physicians overall preferred inhaled corticosteroid monotherapy as the first-line treatment, though the number was a bit higher for specialists. Only about half reported drawing up asthma action plans as recommended by the guidelines for most or all of their patients.

Dr. Stoloff said pay-for-performance is solution. Physicians should be rewarded for good outcomes and compensated for patient education and other efforts to achieve good outcomes.

Accountable care organizations and patient-centered medical homes are moving in that direction, but "we need to accelerate the process," he said.

Asthma mortality has decreased in recent years because of better diagnosis and treatment, but Dr. Stoloff said the findings indicate that change is "not occurring fast enough."

Outcome benchmarks in pay-for-performance models should include "patients going to school, going to work, going to play" and "normal or near-normal lung function; not ending up in an emergency room or hospital; [and] not taking oral steroids," he said.

Dr. Stoloff is a consultant for AstraZeneca, Alcon, Merck & Co., Novartis, Dey Pharma, GlaxoSmithKline, Boehringer-Ingelheim, Sepracor, and Teva Pharmaceuticals. The studies were funded by Merck.

SAN FRANCISCO – Physicians don’t always follow federal asthma guidelines, and quality of life has improved only slightly for asthma patients since 1998, according to two studies.

"We have not moved the pendulum very far despite of all the information and studies that have occurred over the last 12 to 13 years. [Doctors] know about the guidelines, but they don’t incorporate them into practice. Three and half years of writing guidelines didn’t change a thing," said asthma specialist Dr. Stuart Stoloff, a clinical professor at the University of Nevada, Reno, and one of the experts who worked on the National Heart, Lung, and Blood Institute guidelines.

The problem is "patients have not received information about how good they should be able to feel. The other part of it is that clinicians who provide care for those patients are not aware of how well someone should feel with the disease," said Dr. Stoloff, an author on both studies, which were presented at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.

The first study compared 1998 Asthma in America survey results from 2,509 pediatric and adult asthma patients with 2009 Asthma Insight and Management survey results from 2,500 pediatric and adult asthma patients, assessing disease burden and other issues.

The findings: Asthma exacerbations sent about the same percentage of patients to the emergency department or hospital in 2009 as in 1998, while the 2009 patients missed only slightly less work or school due to asthma.

In 1998, 64% of adults said asthma limited their daily activities. In 2009, it was 55%.

About 28% of patients owned peak-flow meters in 1998 and 35% had lung function testing in the previous year. In 2008, 35% owned a meter and 33% had their lungs tested within a year.

In the second study, 309 asthma specialists and general practitioners were surveyed. The findings reveal that what many consider to be adequate asthma control falls short of treatment goals in the NHLBI 2007 Guidelines for the Diagnosis and Management of Asthma.

About 96% of physicians surveyed knew about the NHLBI guidelines, but only 28% said that they "always" complied with them. The numbers were slightly higher for allergists and pulmonologists.

Half of physicians considered asthma well managed if patients had two urgent doctor visits per year. About a third considered both one ED visit and three to four exacerbations per year compatible with good management. One in five physicians thought patients who needed quick relief medication three times per week were well managed.

For adults with mild persistent asthma, only 67% of physicians overall preferred inhaled corticosteroid monotherapy as the first-line treatment, though the number was a bit higher for specialists. Only about half reported drawing up asthma action plans as recommended by the guidelines for most or all of their patients.

Dr. Stoloff said pay-for-performance is solution. Physicians should be rewarded for good outcomes and compensated for patient education and other efforts to achieve good outcomes.

Accountable care organizations and patient-centered medical homes are moving in that direction, but "we need to accelerate the process," he said.

Asthma mortality has decreased in recent years because of better diagnosis and treatment, but Dr. Stoloff said the findings indicate that change is "not occurring fast enough."

Outcome benchmarks in pay-for-performance models should include "patients going to school, going to work, going to play" and "normal or near-normal lung function; not ending up in an emergency room or hospital; [and] not taking oral steroids," he said.

Dr. Stoloff is a consultant for AstraZeneca, Alcon, Merck & Co., Novartis, Dey Pharma, GlaxoSmithKline, Boehringer-Ingelheim, Sepracor, and Teva Pharmaceuticals. The studies were funded by Merck.

SAN FRANCISCO – Physicians don’t always follow federal asthma guidelines, and quality of life has improved only slightly for asthma patients since 1998, according to two studies.

"We have not moved the pendulum very far despite of all the information and studies that have occurred over the last 12 to 13 years. [Doctors] know about the guidelines, but they don’t incorporate them into practice. Three and half years of writing guidelines didn’t change a thing," said asthma specialist Dr. Stuart Stoloff, a clinical professor at the University of Nevada, Reno, and one of the experts who worked on the National Heart, Lung, and Blood Institute guidelines.

The problem is "patients have not received information about how good they should be able to feel. The other part of it is that clinicians who provide care for those patients are not aware of how well someone should feel with the disease," said Dr. Stoloff, an author on both studies, which were presented at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.

The first study compared 1998 Asthma in America survey results from 2,509 pediatric and adult asthma patients with 2009 Asthma Insight and Management survey results from 2,500 pediatric and adult asthma patients, assessing disease burden and other issues.

The findings: Asthma exacerbations sent about the same percentage of patients to the emergency department or hospital in 2009 as in 1998, while the 2009 patients missed only slightly less work or school due to asthma.

In 1998, 64% of adults said asthma limited their daily activities. In 2009, it was 55%.

About 28% of patients owned peak-flow meters in 1998 and 35% had lung function testing in the previous year. In 2008, 35% owned a meter and 33% had their lungs tested within a year.

In the second study, 309 asthma specialists and general practitioners were surveyed. The findings reveal that what many consider to be adequate asthma control falls short of treatment goals in the NHLBI 2007 Guidelines for the Diagnosis and Management of Asthma.

About 96% of physicians surveyed knew about the NHLBI guidelines, but only 28% said that they "always" complied with them. The numbers were slightly higher for allergists and pulmonologists.

Half of physicians considered asthma well managed if patients had two urgent doctor visits per year. About a third considered both one ED visit and three to four exacerbations per year compatible with good management. One in five physicians thought patients who needed quick relief medication three times per week were well managed.

For adults with mild persistent asthma, only 67% of physicians overall preferred inhaled corticosteroid monotherapy as the first-line treatment, though the number was a bit higher for specialists. Only about half reported drawing up asthma action plans as recommended by the guidelines for most or all of their patients.

Dr. Stoloff said pay-for-performance is solution. Physicians should be rewarded for good outcomes and compensated for patient education and other efforts to achieve good outcomes.

Accountable care organizations and patient-centered medical homes are moving in that direction, but "we need to accelerate the process," he said.

Asthma mortality has decreased in recent years because of better diagnosis and treatment, but Dr. Stoloff said the findings indicate that change is "not occurring fast enough."

Outcome benchmarks in pay-for-performance models should include "patients going to school, going to work, going to play" and "normal or near-normal lung function; not ending up in an emergency room or hospital; [and] not taking oral steroids," he said.

Dr. Stoloff is a consultant for AstraZeneca, Alcon, Merck & Co., Novartis, Dey Pharma, GlaxoSmithKline, Boehringer-Ingelheim, Sepracor, and Teva Pharmaceuticals. The studies were funded by Merck.

SAN FRANCISCO – Physicians don’t always follow federal asthma guidelines, and quality of life has improved only slightly for asthma patients since 1998, according to two studies.

"We have not moved the pendulum very far despite of all the information and studies that have occurred over the last 12 to 13 years. [Doctors] know about the guidelines, but they don’t incorporate them into practice. Three and half years of writing guidelines didn’t change a thing," said asthma specialist Dr. Stuart Stoloff, a clinical professor at the University of Nevada, Reno, and one of the experts who worked on the National Heart, Lung, and Blood Institute guidelines.

The problem is "patients have not received information about how good they should be able to feel. The other part of it is that clinicians who provide care for those patients are not aware of how well someone should feel with the disease," said Dr. Stoloff, an author on both studies, which were presented at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.

The first study compared 1998 Asthma in America survey results from 2,509 pediatric and adult asthma patients with 2009 Asthma Insight and Management survey results from 2,500 pediatric and adult asthma patients, assessing disease burden and other issues.

The findings: Asthma exacerbations sent about the same percentage of patients to the emergency department or hospital in 2009 as in 1998, while the 2009 patients missed only slightly less work or school due to asthma.

In 1998, 64% of adults said asthma limited their daily activities. In 2009, it was 55%.

About 28% of patients owned peak-flow meters in 1998 and 35% had lung function testing in the previous year. In 2008, 35% owned a meter and 33% had their lungs tested within a year.

In the second study, 309 asthma specialists and general practitioners were surveyed. The findings reveal that what many consider to be adequate asthma control falls short of treatment goals in the NHLBI 2007 Guidelines for the Diagnosis and Management of Asthma.

About 96% of physicians surveyed knew about the NHLBI guidelines, but only 28% said that they "always" complied with them. The numbers were slightly higher for allergists and pulmonologists.

Half of physicians considered asthma well managed if patients had two urgent doctor visits per year. About a third considered both one ED visit and three to four exacerbations per year compatible with good management. One in five physicians thought patients who needed quick relief medication three times per week were well managed.

For adults with mild persistent asthma, only 67% of physicians overall preferred inhaled corticosteroid monotherapy as the first-line treatment, though the number was a bit higher for specialists. Only about half reported drawing up asthma action plans as recommended by the guidelines for most or all of their patients.

Dr. Stoloff said pay-for-performance is solution. Physicians should be rewarded for good outcomes and compensated for patient education and other efforts to achieve good outcomes.

Accountable care organizations and patient-centered medical homes are moving in that direction, but "we need to accelerate the process," he said.

Asthma mortality has decreased in recent years because of better diagnosis and treatment, but Dr. Stoloff said the findings indicate that change is "not occurring fast enough."

Outcome benchmarks in pay-for-performance models should include "patients going to school, going to work, going to play" and "normal or near-normal lung function; not ending up in an emergency room or hospital; [and] not taking oral steroids," he said.

Dr. Stoloff is a consultant for AstraZeneca, Alcon, Merck & Co., Novartis, Dey Pharma, GlaxoSmithKline, Boehringer-Ingelheim, Sepracor, and Teva Pharmaceuticals. The studies were funded by Merck.

SAN FRANCISCO – Physicians don’t always follow federal asthma guidelines, and quality of life has improved only slightly for asthma patients since 1998, according to two studies.

"We have not moved the pendulum very far despite of all the information and studies that have occurred over the last 12 to 13 years. [Doctors] know about the guidelines, but they don’t incorporate them into practice. Three and half years of writing guidelines didn’t change a thing," said asthma specialist Dr. Stuart Stoloff, a clinical professor at the University of Nevada, Reno, and one of the experts who worked on the National Heart, Lung, and Blood Institute guidelines.

The problem is "patients have not received information about how good they should be able to feel. The other part of it is that clinicians who provide care for those patients are not aware of how well someone should feel with the disease," said Dr. Stoloff, an author on both studies, which were presented at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.

The first study compared 1998 Asthma in America survey results from 2,509 pediatric and adult asthma patients with 2009 Asthma Insight and Management survey results from 2,500 pediatric and adult asthma patients, assessing disease burden and other issues.

The findings: Asthma exacerbations sent about the same percentage of patients to the emergency department or hospital in 2009 as in 1998, while the 2009 patients missed only slightly less work or school due to asthma.

In 1998, 64% of adults said asthma limited their daily activities. In 2009, it was 55%.

About 28% of patients owned peak-flow meters in 1998 and 35% had lung function testing in the previous year. In 2008, 35% owned a meter and 33% had their lungs tested within a year.

In the second study, 309 asthma specialists and general practitioners were surveyed. The findings reveal that what many consider to be adequate asthma control falls short of treatment goals in the NHLBI 2007 Guidelines for the Diagnosis and Management of Asthma.

About 96% of physicians surveyed knew about the NHLBI guidelines, but only 28% said that they "always" complied with them. The numbers were slightly higher for allergists and pulmonologists.

Half of physicians considered asthma well managed if patients had two urgent doctor visits per year. About a third considered both one ED visit and three to four exacerbations per year compatible with good management. One in five physicians thought patients who needed quick relief medication three times per week were well managed.

For adults with mild persistent asthma, only 67% of physicians overall preferred inhaled corticosteroid monotherapy as the first-line treatment, though the number was a bit higher for specialists. Only about half reported drawing up asthma action plans as recommended by the guidelines for most or all of their patients.

Dr. Stoloff said pay-for-performance is solution. Physicians should be rewarded for good outcomes and compensated for patient education and other efforts to achieve good outcomes.

Accountable care organizations and patient-centered medical homes are moving in that direction, but "we need to accelerate the process," he said.

Asthma mortality has decreased in recent years because of better diagnosis and treatment, but Dr. Stoloff said the findings indicate that change is "not occurring fast enough."

Outcome benchmarks in pay-for-performance models should include "patients going to school, going to work, going to play" and "normal or near-normal lung function; not ending up in an emergency room or hospital; [and] not taking oral steroids," he said.

Dr. Stoloff is a consultant for AstraZeneca, Alcon, Merck & Co., Novartis, Dey Pharma, GlaxoSmithKline, Boehringer-Ingelheim, Sepracor, and Teva Pharmaceuticals. The studies were funded by Merck.

SAN FRANCISCO – Physicians don’t always follow federal asthma guidelines, and quality of life has improved only slightly for asthma patients since 1998, according to two studies.

"We have not moved the pendulum very far despite of all the information and studies that have occurred over the last 12 to 13 years. [Doctors] know about the guidelines, but they don’t incorporate them into practice. Three and half years of writing guidelines didn’t change a thing," said asthma specialist Dr. Stuart Stoloff, a clinical professor at the University of Nevada, Reno, and one of the experts who worked on the National Heart, Lung, and Blood Institute guidelines.

The problem is "patients have not received information about how good they should be able to feel. The other part of it is that clinicians who provide care for those patients are not aware of how well someone should feel with the disease," said Dr. Stoloff, an author on both studies, which were presented at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.

The first study compared 1998 Asthma in America survey results from 2,509 pediatric and adult asthma patients with 2009 Asthma Insight and Management survey results from 2,500 pediatric and adult asthma patients, assessing disease burden and other issues.

The findings: Asthma exacerbations sent about the same percentage of patients to the emergency department or hospital in 2009 as in 1998, while the 2009 patients missed only slightly less work or school due to asthma.

In 1998, 64% of adults said asthma limited their daily activities. In 2009, it was 55%.

About 28% of patients owned peak-flow meters in 1998 and 35% had lung function testing in the previous year. In 2008, 35% owned a meter and 33% had their lungs tested within a year.

In the second study, 309 asthma specialists and general practitioners were surveyed. The findings reveal that what many consider to be adequate asthma control falls short of treatment goals in the NHLBI 2007 Guidelines for the Diagnosis and Management of Asthma.

About 96% of physicians surveyed knew about the NHLBI guidelines, but only 28% said that they "always" complied with them. The numbers were slightly higher for allergists and pulmonologists.

Half of physicians considered asthma well managed if patients had two urgent doctor visits per year. About a third considered both one ED visit and three to four exacerbations per year compatible with good management. One in five physicians thought patients who needed quick relief medication three times per week were well managed.

For adults with mild persistent asthma, only 67% of physicians overall preferred inhaled corticosteroid monotherapy as the first-line treatment, though the number was a bit higher for specialists. Only about half reported drawing up asthma action plans as recommended by the guidelines for most or all of their patients.

Dr. Stoloff said pay-for-performance is solution. Physicians should be rewarded for good outcomes and compensated for patient education and other efforts to achieve good outcomes.

Accountable care organizations and patient-centered medical homes are moving in that direction, but "we need to accelerate the process," he said.

Asthma mortality has decreased in recent years because of better diagnosis and treatment, but Dr. Stoloff said the findings indicate that change is "not occurring fast enough."

Outcome benchmarks in pay-for-performance models should include "patients going to school, going to work, going to play" and "normal or near-normal lung function; not ending up in an emergency room or hospital; [and] not taking oral steroids," he said.

Dr. Stoloff is a consultant for AstraZeneca, Alcon, Merck & Co., Novartis, Dey Pharma, GlaxoSmithKline, Boehringer-Ingelheim, Sepracor, and Teva Pharmaceuticals. The studies were funded by Merck.