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Nurses, printers, woodworkers have higher asthma risk
Nurses, printers and woodworkers have an increased risk of developing asthma, possibly due to exposure to substances at work, according to a study in The Lancet. A team of European scientists analyzed health information and details about workplace exposure for more than 6,800 subjects who participated in the European Community Respiratory Health Survey between 1990 and 1995. None of the subjects had asthma when the study began. The team analyzed exposure to potentially asthma-causing substances using information from asthma experts. Exposure to substances known to cause occupational asthma on average increased the risk of asthma by 60 percent. Highest-risk jobs were printing (137 percent), nursing (122 percent) and woodworking (122 percent). Fires, chemical spills and other such incidents tripled subjects’ asthma risk.

Teens with poorly controlled asthma
like electronic disease management
Adolescents with poorly controlled asthma may benefit from using the Web and instant messaging to manage their disease, according to a study in Chest. Scientists at Leiden University Medical Center in the Netherlands enrolled 97 adolescents to electronically monitor their asthma daily for one month, including entering lung function data at a Web site or via instant message. Subjects received feedback about their lung function so they could react to changes and optimize their asthma control. Researchers then held focus groups with 35 study subjects. Among subjects with poor asthma control, 65 percent were able and ready to incorporate Internet-based asthma self-management, compared with only 11 percent of subjects with good asthma control.

High-intensity warm ups may help exercisers with asthma
A small study by researchers at Indiana University in Bloomington says recreational athletes with asthma may be able to reduce airway tightening during physical activity by starting with short, high-intensity warm ups. To investigate whether such repeat warm-ups could improve exercise-induced bronchoconstriction (EIB) without drugs, researchers enrolled eight moderately trained athletes with documented EIB to exercise on a treadmill under four different conditions. With no warm up, the subjects’ lung capacity was reduced by about 18 percent. After running at peak speed eight times for 30 seconds with 45-second rests between intervals, lung capacity was reduced by 9 percent, slightly less than the 10-percent drop defining EIB. After taking 200 micrograms of salbutamol, lung capacity rose by 9 percent with no warm up and 15 percent with the high-intensity warm ups.

A message from Dr. Jay M. Portnoy, ACAAI president-elect and program chair

Continuing education and professional development is a core mission of ACAAI. At a meeting of the CME Committee in Chicago last spring, questions were raised about the effectiveness of the educational experiences being provided at the Annual Meeting. One of the primary goals of the College is “to be the world leader in providing clinically relevant continuing education reflecting state-of-the-art science in all areas pertinent to the allergic diseases and selected related conditions.”

To be the world leader in education requires more than simply putting on an annual meeting with world-class speakers and interesting, cutting-edge topics. It also requires that information be provided in a way that maximizes the value of the meeting to College members and helps them improve patient care. Though the College leadership always seeks to accomplish this, we have yet to prove that attendance at the College meeting actually enhances clinical practice.

Furthermore, the Accreditation Council for Continuing Medical Education (ACCME) that accredits ACAAI for conducting CME released new accreditation criteria in September of 2006. The new ACCME requirements focus on rewarding CME providers for changing and improving the practice of CME, emphasizing patient care quality and safety, and physician competence, performance, and patient outcomes. CME providers must now demonstrate Educational Outcomes Measures (EOM).

This year we have decided to embark on a new journey of discovery to determine exactly how valuable the ACAAI Annual Meeting actually is to attendees. To do this, it is necessary to measure the current state of knowledge and practice of College members in specific areas prior to their attendance at the annual meeting and then to reassess this after the meeting.

The CME committee therefore recommended that the organizers of the various plenary sessions pose a series of questions to the College membership in the areas to be discussed during the Annual Meeting. Since the number of questions is large, they will be posted periodically in the form of surveys throughout the summer and early fall with links from this newsletter. The answers to these questions will be presented at their respective plenary sessions this November at the Annual Meeting.

This fall a series of similar questions will be posed to attendees both before and after each of the plenary sessions. Though the feedback will not be as immediate as it would be with an audience response system, the results of these surveys will be made available to the College membership after the Annual Meeting. Similarly, during the months following the meeting, a series of parallel questions will be posed to the College membership to determine whether attendance at the educational session has a significant impact on clinical practice.

Though in this first year of evaluation, we will measure the educational effectiveness of the major plenary sessions, it should also be possible to measure the benefit of workshops and breakfast symposia, as well. The information obtained by these surveys will inform future program chairs as they develop educational experiences for the College’s annual meetings. We are hopeful that this information will lead to the development of novel educational approaches that will maximize the value of the Annual Meeting for each College member.

As one of our previous presidents, Dr. William Dolen, repeatedly stated, the College is an organization of people congenially working together toward a common, well-defined mission. We hope that by working together, this new educational initiative will lead to enhancements in the practice of allergy and provide meeting attendees with the services and resources that they expect and deserve from the American College of Allergy, Asthma and Immunology. After all, to be the world’s leader in education is no small feat.

Please take a few minutes to respond to CME questions at the links provided as they become available.

Online registration for the ACAAI Annual Meeting is now open
Online registration for the ACAAI Annual Meeting in Dallas, Nov. 8-14, is now up and running. You may access online registration, online housing, printable housing forms and the Preliminary Program from the College member Web site.

Attendees can register for housing by using the housing form located on the Web site and in the preliminary program.

Don’t forget to order your tickets early for the Annual Fundraising Dinner and Wynonna Judd concert Sunday evening, Nov. 11.

Preliminary Programs have been mailed to all members.

The College, AMA and others take action in support of SCHIP
The College joined 30 other organizations including the AMA, the American Academy of Family Physicians and the American Academy of Pediatrics in issuing statements supporting the reauthorization of the State Children’s Health Insurance Program (SCHIP), which will expire in September.

“As asthma and other allergic diseases are growing among children every year, the College is concerned that, without SCHIP reauthorization, many children may not be able to get the care they need to keep them healthy and in school,” ACAAI President Dr. Daniel Ein said.

President Bush has threatened to veto bipartisan Senate legislation that would increase SCHIP funding by $35 billion over five years. According to the U.S. Census Bureau, more than 8 million children are still uninsured in the United States, many of them eligible for the SCHIP, but still not enrolled.

Almost two-thirds of voters surveyed late last week on behalf of the Catholic Health Association of the United States show overwhelming public support for a strong, ongoing SCHIP program. Eight in 10 voters surveyed said they believe that such a high number of uninsured children represents a crisis or very serious problem. More than six in 10 voters said the current health care system is not meeting the needs of children.

See the new AMA Corner for more on SCHIP.

Exceptions to FDA’s CFC removal requested by ACAAI
In a letter to the FDA, the College requested that each asthma medication containing CFCs on the list for removal should be evaluated separately by the FDA “because some of the medications are unique and removal from the market will put a hardship on our patients.”

Two products mentioned for which there is no available substitute in an HFA device include: cromolyn sodium, the only non-steroid inhaler for control of asthma in the United States; and Pirbuterol, a short-acting beta agonist and the only breath-actuated device available.

The College recommends these agents be continued to be produced and available by a prescription until their HFA formulations are developed and approved for use by the FDA.

ACAAI and ACEP anaphylaxis review published in Annals
featured on XM’s ReachMD radio, “Hot Topics in Allergy”
The ACAAI and ACEP anaphylaxis campaign review article published in the June issue of Annals of Allergy, Asthma & Immunology, is discussed by lead author Dr. Phillip Lieberman, on ACAAI’s “Hot Topics in Allergy” currently being broadcast on XM’s ReachMD radio for health care professionals. The 15-minute interview conducted by Dr. Todd Mahr is available as a podcast.

The cornerstone of the article, titled “SAFE: A Multidisciplinary Approach to Anaphylaxis Education in the Emergency Department,” is a tool to raise awareness about anaphylaxis and its treatments among individuals at risk and the ED personnel charged with their care.

Reprints of the Annals article have been mailed to some 7,000 emergency physicians and ED directors. The College also is conducting a national trade media campaign promoting the SAFE system. The campaign is supported by an educational grant from Dey, L.P.

Emergency physicians raise concerns over spike in ED visits
A recent report by the Centers for Disease Control and Prevention (CDC) found that visits to U.S. emergency departments grew to an all-time high of 115 million in 2005, an increase of 5 million from 2004. The full report on the latest data on hospital ED visits, “Injuries Accounted for 42 Million ER Visits in 2005,” is available on the CDC Web site.

According to the American College of Emergency Physicians (ACEP), the rise in visits, combined with ED closures, threatens the safety of patients and will further endanger an already fragile system.

View the new Literature Review Course vodcasts
Presentations from the popular Literature Review Course, Everything You Should Have Read Last Year, But Didn’t, at the 2006 ACAAI Annual Meeting, are vodcast weekly.

Previous vodcasts from the Literature Review Course, the International Food Allergy Symposium and the “Asthma Control: How Are We Doing?” symposium are archived for continued viewing.

Each vodcast contains the original audio and presentation slides and can be viewed from a computer or downloaded to a portable media player (like an iPod). The ACAAI vodcast program is sponsored by an unrestricted educational grant from GlaxoSmithKline.

Apply for Young Faculty and Scholars Return grant by August 17
If you are an ACAAI member interested in undertaking a research or teaching project, updating your skills or learning new clinical or basic science techniques, the Foundation of ACAAI invites you to apply for a Young Faculty Support or Scholars Return grant.
The deadline for applications is Aug. 17.

Young Faculty Support: Young faculty who are less than 40 years of age, or those within the first five years of medical practice in an academic environment, may apply for three $50,000 Young Faculty Support grants. The grant will fund a one-year project with a possible one-year renewal for clinically relevant research projects involving basic research, innovative teaching or delivery of care in an academic setting.

Scholars Return: Practicing allergists-immunologists who are out of training for five years may apply for a Scholars Return grant. The grant will help fund week-long rotations to study evaluation of “sick buildings,” methacholine and antigen challenges, home assessments, evaluation for autoimmunity, immunodeficiency, or other areas in clinical laboratory immunology. Awards include $500 to the physicians and $1,000 to the academic centers to help defray their respective expenses. Recipients are responsible for arranging the rotation at the academic centers.

Dr. Gower discusses “Traveling the Globe with Asthma” on HealthTalk
ACAAI Vice President Dr. Richard G. Gower discusses “Traveling the Globe with Asthma” on HealthTalk to better prepare travelers with allergic diseases to cope with new climates and new triggers. He also answered public questions submitted online prior to the program.

From the deserts of Arizona to the damp coast of Ireland, vacation travelers are exposed to everything from grasses to mold and pollution to musty hotel rooms. During this informative hour, he covers preparing for a trip and preventative measures; traveling with medications; exposure to mold; avoiding and preparing for allergic food and insect sting reactions; preparing for extreme adventures, such as scuba diving or mountain climbing; the need to find a doctor quickly and much more.

Board Review Corner
Welcome to the Board Review Corner prepared by Soo Kim-Delio, M.D., Senior Representative of ACAAI’s fellows-in-training (FITs) to the Board of Regents. The Board Review Corner is your chance to test your Board preparedness.

To refer to a previous Board Review Corner, click the “FIT Archive” link in the left column.

Review Questions: Chapter 6 of Pediatric Allergy: Principles & Practices, edited by Donald Y.M. Leung, et al. Review questions were written by Dr. Soo Kim-Delio at Walter Reed Army Medical Center.