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Pilot Study of Spirometry and Allergy Testing Among Guatemalan Children

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Pilot Study of Spirometry and Allergy TestingAmong Guatemalan ChildrenMaxwell Chair Student Projects (Max-04-2): Summer 2004Many thanks to the Brian and Jennifer Maxwell Endowed Chair Goals and Objectives of Pilot StudyMethodsRecruitmentSpirometryHealth QuestionnaireAllergy Skin TestingThirty children were recruited and baseline characteristics Table 1. Baseline characteristics of recruited childrenBoysn=15Mean ( SD)Girlsn=15Mean ( SD)ResultsSpirometryTable 2. Spirometry results for 28 participantsPredictedAbsolute FEV6 (L)Mean (SD)Mean (SD)Health QuestionnaireOf the 30 children initially recruited, 29 completed the queSkin TestingConclusionReferencesMax-04-2 School of Public Health, UC Berkeley 1 Pilot Study of Spirometry and Allergy Testing Among Guatemalan Children Lisa Thompson, MS, FNP Environmental Health Sciences School of Public Health University of California, Berkeley E-mail correspondence: [email protected] and Janet Diaz, MD Fellow, Division of Pulmonary and Critical Care Medicine University of California, San Francisco E-mail correspondence: [email protected] Maxwell Chair Student Projects (Max-04-2): Summer 2004 Citation Thompson L, Diaz J, 2004, “Pilot Study of Spirometry and Allergy Testing among Guatemalan Children,” Maxwell Student Projects, Max-04-2, EHS, School of Public Health, University of California, Berkeley.Max-04-2 School of Public Health, UC Berkeley 2 Acknowledgements Many thanks to the Brian and Jennifer Maxwell Endowed Chair in Public Health for funding this study, and to Dr. John Balmes and the FACES study staff for providing us with the protocols and the training in the use of the spirometers and the allergy skin testing kits. Without the fabulous help from Anaite Diaz Artiga, who coordinated participant recruitment, and the fieldworkers Esperanza Agustin Tomas and Micaela Isidro Marroquin, who did a great job of consenting the families and coaching the children to “ xupeche, xupeche” (blow out in Mam), we would never have been able to do this study.Max-04-2 School of Public Health, UC Berkeley 3 Goals and Objectives of Pilot Study In August 2004, a pilot study was conducted to 1) evaluate the applicability and acceptability of spirometry and allergy skin testing methods on the 5 to 9 year old siblings of the infants currently enrolled in the stove intervention trial and 2) gather health-related information about asthma and allergies among these siblings. The goal of the pilot study was to provide additional information for the NIH grant proposal to follow the cohort of infants enrolled in the stove intervention trial through the ages of 5-7 years. Methods Recruitment Mam-speaking field workers explained the pilot study at a recruitment meeting of families already participating in the intervention study. Families with children between the ages of 5-9 years were invited to participate. All participants were orally consented and children over the age of seven were assented. Research was approved by the Committee for the Protection of Human Subjects at the University of California at Berkeley, USA. Thirty children from Tuichilupe, San Francisco, and Vista Hermosa participated. Spirometry was conducted during the first week; children returned the second week for allergy skin testing. Two families were scheduled every 30 minutes at the Municipal Hall in Tuichilupe. Instruction was given in Spanish and in Mam and formal verbal consents were obtained. Two field workers who are experienced with spirometry methods were present to assist with translation and coaching. A pulmonologist from UCSF (J. Diaz) and a family nurse practitioner from UCB (L. Thompson) conducted all testing. Spirometry Prior to spirometry, the child practiced expiratory maneuvers with a whistle and candles. Spirometry was performed with a hand-held EasyOne spirometer, which allowed immediate interpretation of the quality of the maneuver, with results graded from A to F. The forced expiratory volume in 1 second (FEV1) and the forced expiratory volume in 6 seconds (FEV6) were measured. Acceptable tests were those that resulted in an A, B or C grade, defined as at least two acceptable maneuvers with reproducible measurements of FEV1 and the FEV6 (within at least 200 mL of each other). Unacceptable maneuvers resulted in a D or F grade, defined as no or only one acceptable maneuver OR lack of reproducibility in measurements of FEV1 and FEV6 (more than 200mL of each other). Bronchodilator (BD) response was used to test airway reactivity. Following the first round of spirometry (pre-BD), the child inhaled one puff of albuterol through a spacing device and spirometry was repeated after 15 minutes (post-BD). Reversibility was defined as improved post-BD spirometry ≥ 12 % in FEV1 or FEV6. Five of the children who were unable to provide Grade A-C spirometry results were retested the second week during the allergy skin testing sessions, when four succeeded.Max-04-2 School of Public Health, UC Berkeley 4Health Questionnaire Two Mam-speaking field workers administered questionnaires to the mothers. Questions asked about history of cough, phlegm, wheeze, allergic rhinitis and eczema in the past 6 months for both the child and/or the family. Current “cold” symptoms in the past 2 weeks were also ascertained. Allergy Skin Testing The child’s non-dominant forearm was cleaned with alcohol and the Multi Test II applicator was used to apply allergens. The Dipwell tray preparation included a (positive, +) histamine control at a concentration of 1 mg/mL, a (negative, -) saline control and six aeroallergens that were used in a Costa Rican study(1): cat pelt, dog-hair dander, cockroach mix, Dermatophagoides pteronyssinus, Dermatophagoides farinae, and Alternaria tenius. Skin test reactivity (STR) was determined at 15 minutes for histamine and at 20 minutes for negative control and allergens. The wheal was outlined with a pen along the long and perpendicular axis and measured with a ruler. The mean of these two measurements was calculated and interpreted as a (+) result if it was 3 mm greater than the mean of the negative control measurements. Thirty children were recruited and baseline characteristics are presented in Table 1. Table 1. Baseline characteristics of recruited children Boys n=15 Mean ( SD) Girls n=15 Mean ( SD) Age, years 6.6 (1.1) 6.3 (0.82)


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