685 Rhinovirus (RV) Plays an Etiologic Role in Acute Asthma Hos-pitalizations in Adults

D. L. Venarske1, W. W. Busse2, M. R. Griffin1, P. A. Minton1, E. Weis-shaar2, R. Virtis2, T. Gebretsadik1, S. B. Higgins1, A. K. Shintani1, T. V.Hartert1; 1Vanderbilt University School of Medicine, Nashville, TN, 2Uni-versity of Wisconsin, Madison, WI.RATIONALE: Although rhinovirus (RV) respiratory infections provokeasthma, the association of this virus with severe exacerbations requiringhospitalization and the clinical characteristics of asthmatics at risk havenot been established.METHODS: Adult asthmatic patients, age 18 and older, were prospec-tively enrolled following hospital admission for an acute asthma exacer-bation. Nasal lavages were obtained and analyzed for RV by nested(n)PCR at admission and 3 months after recovery at follow-up.RESULTS: RV was detected by nPCR in 19 of 95 (20%) hospitalizedsubjects and in 1 of 70 (1.4%) subjects who returned for a 3-monthvisit. Subjects with RV detected differed from those without RV: 95%were women vs. 76% (p=0.07), younger mean age 35.7 years vs. 43.4years (p=0.01), and 58% were smokers vs. 28% (p=0.013). Both RV+and RV- subjects had similar FEV1 at admission (52% vs. 55 % pre-dicted), but at the 3-month well-visit, the RV+ group had a greatermean improvement in FEV1 (84% vs. 66% predicted, p=0.04). RVdetection was strongly associated with asthma hospitalizations (adjust-ed Odds Ratio, 9.1 [95% CI, 1.1 to 76]; p < 0.04, adjusted for baselinedifferences in patients).CONCLUSIONS: These data indicate that RV respiratory infection is arisk factor for severe asthma exacerbations requiring hospitalization, andthose with RV infection appear to have unique features including femalegender, milder asthma, and current smoking.Funding: KO8 AI01582, ALA Clinical Research Grant, NIH AI50500

686 Rhinovirus and Soluble ICAM-1 in Nasal Washes From Chil-dren With Wheezing or Rhinitis in the Emergency Department(ED)

H. T. Carper1, J. W. Steinke2, M. S. Shaker1, L. Borish2, F. G. Hayden2,T. A. E. Platts-Mills2, P. W. Heymann1; 1Pediatrics, University of Virginia,Charlottesville, VA, 2Internal Medicine, University of Virginia, Char-lottesville, VA.RATIONALE: ICAM-1 is used by the majority of rhinovirus (HRV)strains to gain entry into epithelial cells for replication. In this study, weevaluated nasal washes from actively wheezing children, children withacute rhinitis, and controls for sICAM-1 and for HRV.METHODS: Children (4 to 18 years of age) with wheezing (n = 14), withacute rhinitis (n = 11), and controls (n = 8) were enrolled in our ED. Nasalwashes were assayed for sICAM-1 and tested for HRV by RT-PCR andculture (including viral titers). Total serum IgE was also measured.RESULTS: HRV was detected in washes from 43% of the asthmatics,54% of the rhinitics, and 0% of the controls. In culture, HRV wasdetected in 6 washes (3 from asthmatics, and 3 from rhinitics). Viraltiters were higher in those with rhinitis (1.2, 1.2, and 2.45log10TCID50/ml for rhinitics; 0.45, 0.95, 0.95 log10TCID50/ml for asth-matics). In the washes from children with positive RT-PCR tests forHRV, geometric mean (GM) levels of sICAM-1 were 7.2 and 12.6ng/ml in 6 asthmatics and 6 rhinitics, respectively. The levels in asth-matics, rhinitics, and controls who tested negative for HRV were 3.3,5.2, and 1.8 ng/ml, respectively. Total serum IgE levels (GM) from theasthmatics, rhinitics, and controls were 219, 56, and 37 IU/ml, respec-tively.CONCLUSIONS: : In this study, titers of HRV and sICAM-1 levelstended to be lower in nasal washes from the asthmatics compared torhinitics during acute symptoms.Funding: NIH, Merck & Co., Inc., Cove Point Foundation

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687 Efficacy of a School-Based Screening Program for Asthma inInner-City Children

K. W. Lien, J. Lee-Llacer, B. Peralejo, L. McConeghy, A. Wolff, L. Bielo-ry; Allergy and Immunology, UMDNJ-New Jersey Medical School,Newark, NJ.RATIONALE: Our goal is to evaluate the efficacy of a school-basedscreening program for asthma in an inner-city environment.METHODS: Questionnaires, adapted from the International Study ofAsthma and Allergy in Childhood (ISAAC) asthma core questionnaire,were distributed to the parents of 400 children of the East Orange Com-munity Charter School, East Orange, NJ. Children with completed ques-tionnaires were screened by physician with history, physical, and spirom-etry. Asthma classification is based on the 2002 National Asthma Educa-tion and Prevention Program Asthma Guidelines.RESULTS: A total of 35 children (ages 5-11) had completed surveys. Ofthese, 86%(N=30) had prior diagnosis of asthma, 9%(N=3) were newlydiagnosed with asthma, and 5.7%(N=2) did not have asthma. Of the asth-matics, 37.1%(N=13) were classified as mild-intermittent, 25.7%(N=9) asmild-persistent, 31.4%(N=11) as moderate-persistent, and none as severe-persistent. 44 %(N=15) of the previously diagnosed asthmatics had sub-optimal control. Of the asthmatics classified as mild-persistent or greater(N=20), 30%(N=6) were not currently receiving maintenance therapy.Compared to the physician-diagnosis of asthma, the 6-question parentalquestionnaire demonstrated a mean sensitivity of 57.7%[range, 21.9%-90.6%], mean specificity of 91.7%[50-100%], mean positive predictivevalue of 99.5%[96.7%-100%], and mean negative predictive value of14.7%[7.4%-25%] for each question.CONCLUSIONS: Parental screening by questionnaire alone may not be aneffective means of capturing undiagnosed asthma in inner-city children, asdemonstrated by a low survey return rate. School-based interventions can beeffective in identifying asthmatic children in need of maintenance therapy.Funding: State of New Jersey Department of Health and Senior Services

688 Asthma in Low-income Minority Children in Head Start Pro-grams and Middle Schools in Detroit

N. M. Clark, J. A. Dodge, B. W. Nelson, L. J. Thomas, R. W. Brown, D.F. Awad, R. H. Roberts; Health Behavior and Health Education, Universi-ty of Michigan, Ann Arbor, MI.RATIONALE: Prevalence of pediatric asthma is high in inner city com-munities. The comparative prevalence in different age groups of low-income, minority children has not been well studied. Further, variations inthe patterns of physician diagnosis and symptom experience in these pop-ulations are not well understood.METHODS: Asthma prevalence studied in 3,256 children enrolled in 66Head Start programs (ages 2.5 to 5) and 1,940 students in 19 middleschools (ages 10 to 13). Case identification criteria: physician’s diagnosisand symptoms; or physician’s diagnosis and prescribed medicines; or 3 ormore of 5 symptoms five or more times annually; or two exercise-inducedsymptoms five or more times annually; or nighttime symptoms three ormore times per month.RESULTS: Preschool prevalence 27% (n=890), preteen prevalence 29%(n=557), 68% in both groups were diagnosed, 3% in both groups no diag-nosis but active symptoms at night. More young children had asthma diag-noses and prescription medicine or active symptoms (18% vs. 13%, p=.02).More young children had nighttime symptoms and no diagnosis, medicines,or symptoms at other times (20% vs. 13%, p=.01). Asthma severity(NAEPP Guidelines for nighttime symptoms) showed a significantly largerfraction of younger children had persistent disease (59% vs. 51%, p=.002).CONCLUSION: Undiagnosed and under treated asthma appears to con-tinue as a problem in low-income minority children with younger childrenmost vulnerable. Efforts to confirm asthma through clinical assessment areneeded for these populations, as is appropriate use of prescribed medicines.Funding: NHLBI grant #R18/HL068654-01 and CDC grant#R06/CCR521533