with 10 mg IM olanzapine (n=99), 2 mg IM lorazepam (n=51), or IM placebo(n=51). The frequency of patients who experienced a reduction from baseline to 30minutes post IM injection in ratings on individual behavioral items was determinedin subsets of patients with moderate/extreme ratings on the Corrigan AgitatedBehavior Scale (ABS), the Positive and Negative Syndrome Scale-Excited Component(PANSS-EC) scale, and those with a score of 1 on the Agitation and CalmnessEvaluation Scale (ACES), which is marked agitation consistent with potentialphysical violence and need for constant care and supervision. Treatment differenceswere compared by Fisher’s exact test.

Results: ABS items rated as moderate or extreme for violence were significantlyreduced in 90.9% (11/12) vs. 25.0 % (4/16) (p=.033) of olanzapine- vs. placebo-treated manic bipolar patients with agitation and not significantly reduced inlorazepam- vs. placebo-treated patients. Explosive anger was significantly reduced in77.4% (31/40) vs. 40.0% (15/38) (p=.021) of olanzapine- vs. placebo-treated and in90.9% (20/22) vs. 40.0% (6/15) (p=.002) of haloperidol- vs. placebo-treated agitatedpatients with schizophrenia without significant difference between active treatments.

Conclusion: While control of agitation overall is important, achieving rapidcontrol of symptoms in severely agitated patients may reduce the risk of harm to boththe patient and caregivers, as well as the intensity of care required in emergencytreatment settings. In light of the fact that the primary endpoint in registration studiesof IM agents in treating acute agitation has generally been the reduction in totalscores of the PANSS-EC within a two-hour period, this analysis demonstrated that inregistration trials for treatment of agitation in schizophrenia and bipolar mania at 30minutes post-IM injection, olanzapine-treated patients with moderate to severesymptoms of agitation had statistically and clinically significant reductions in severalitems measuring specific clinically-relevant agitated behaviors vs. placebo.

361 The Effect of Beta-2-Adrenoreceptor Polymorphisms

on the Response to Therapy in Asthmatics in the

Emergency Department

Henderson SO, Simma-Chiang V, Keck School of Medicine of the University of

Southern California, Los Angeles, CA; LACCUSC Medical Center, Los Angeles,

CA

Objective: In the emergency department, we examined the effect of the Beta-2-adrenoreceptor (B-2-AR) polymorphisms (A46G and C79G) in asthmatics withregards to their response to standard therapy measured by change in FEV1. Ourhypothesis was that these polymorphisms would predict clinical response to therapy.

Methods: This study is an IRB-approved project. After consenting patients,baseline data was obtained (FEV1). Patients received standard care (albuterol andsteroids). FEV1 was measured after each treatment. A blood specimen was obtainedand DNA was extracted. Genotyping of the B-2-AR was done using the Taqmanassay. Demographic characteristics and genotype were considered as independentpredictors of outcome. Demographic variables included age (19-57 years), gender,and ethnicity. Analyses considered the concomitant effects of smoking, height(142.2-193.0 cm), weight (52-163.6 kg), body mass index (18.5-56.6 kg/m2), andmedications.

Results: A total of 54 patients were enrolled. Analyses revealed that the 46-A alleleis in linkage disequilibrium with 79-G. We noted that genotype frequency varied byethnicity. At the A49G locus, there was no significant difference in FEV1improvement between the groups (F-value 1.42; p=0.2481). While no significantdifferences were noted among genotypes at the C79G locus (F-value 0.46; p=0.6360),it appears as if there might be a trend in improving FEV value with each additional‘G’ allele at the C79G locus. However, this trend was not statistically significant(p=0.3400). In a multivariate risk model, no individual risk factor attained statisticalsignificance in predicting an improvement in FEV1.

Conclusion: In this pilot study of emergency department patients with acuteasthma exacerbation, there was no significant effect of B-2-AR genotype on responseto therapy.

362 Chronic Asthma Severity Among Children Presenting

to the Emergency Department with Asthma

Exacerbations

Camargo CA Jr, Clark S, Massachusetts General Hospital, Boston, MA

Study Objectives: ED-initiated preventive interventions for asthma depend, inlarge part, on chronic asthma severity, as defined by the national asthma guidelines.For example, inhaled corticosteroids are preferred controller therapy for patients withpersistent asthma but are not recommended for those with intermittent asthma. Ourobjective was to describe chronic asthma severity among children presenting to theED with an asthma exacerbation.

Methods: This prospective cohort study was performed as part of the MulticenterAirway Research Collaboration. Investigators at 14 US sites enrolled consecutivechildren ages 2-17 years presenting to the ED with acute asthma. Children weredetermined to be in one of four chronic asthma severity categories: mild intermittent,mild persistent, moderate persistent, or severe persistent. Chronic asthma severity wasdetermined based on daytime symptoms, nighttime symptoms, and medicationusage.

Results: This cohort of 311 children had a mean age of 7.7 years (standarddeviation, 4.5), was 61% male, and 50% African American. Overall 89% reportedhaving a primary care provider (PCP) and 29% reported having an asthma specialist.Among these children, 57 (18%) were mild intermittent, 116 (37%) mild persistent,76 (24%) moderate persistent, and 62 (20%) severe persistent. Thus, 82% of childrenhad persistent asthma. Severity groups (e.g., % persistent) did not differ by age, race,or PCP status. Children with persistent asthma were more likely to have an asthmaspecialist and to report an ED visit or hospitalization for asthma during the past year.Although patients with persistent asthma were more likely to report moderate orsevere asthma symptoms during the past 12 months (58%), 19% of children withintermittent asthma reported moderate or severe asthma symptoms. Children withpersistent asthma had more ED visits during the past year (median, 2 vs. 1;p\0.001). They also reported worse control of their asthma. The groups presented to

Research Forum Abstracts

360 The Treatment of Acute Hyperventilation Syndrome

in In- or Out-of-Hospital Patients: Drug Sedation,

Reservoir Bag with O2 and Combination

Kim HJ, Bucheon Sooncheonhyang University Hospital, Bucheon, Republic of

Korea

Study Objectives: Hyperventilation is considered an important factor in theproduction of a variety of somatic symptoms. This complex of symptoms is called thehyperventilation syndrome (HVS). The etiology of HVS often remains unknown buthas been suggested to have a disproportionate ventilatory pattern caused by emotionalstress, psychosis, and somatic disease. The treatment of HVS includes reassurance,retraining to change breathing patterns; applying the reservoir bag, psychotherapyand sedative drug therapy. Currently, applying the reservoir bag to thehyperventilating patient is not recommended because of complications such ashypoxia. But in in-or out-of-hospital emergency situations, it must be applied to theHVS patient by an emergency medical technician (EMT) or emergency physician(EP) because of the uncontrolled stressful nature of the patient and lack of prepareddrug.

Methods: We prospectively enrolled 52 patients (48 female, 4 male) withhyperventilation from March and April 2005 in the emergency department (ED) ofBucheon Sooncheonhyang University Hospital. Patients with past psychotic history,surgical problems, acute infection, malignancy and trauma were excluded from thisstudy. The diagnosis of HVS is based on the symptom of tachypnea with relatedcomplaint such as peripheral sensory or motor abnormality and the blood gas patternsof hypercapnia and metabolic alkalosis. Clinical assessment of hyperventilationincluded patient present illness, stress, record (main cause, emotional status, stressscale; 1-10 mm) past history (personal, familial, suicidal, psychologic), out-of-hospital record (transport vehicle, use of reservoir bag with O2 or drug), physicalexamination, inhospital treatment (reassurance, retraining to change breathingpattern, applying the reservoir bag with O2, psychotherapy and sedative drugtherapy), arterial blood gas analysis, (initial, 30 minutes and 60 minutes; pH, pO2,pCO2, HCO3, Base deficit), ECG studies, chest X-ray and basic serum lab (blood cellcount and electrolytes). We compared and analyzed with known treatment (reservoirbag with O2, sedative drug, both and oral reassurance) at in-or out-of-hospital.

Results: Of 52 enrolled patients, 18 were treated with reservoir bag with O2

(Group I, 12 of 18 from out-of-hospital), 12 sedative drug (Group II), 14 both(Group III) and 8 oral reassurance (Group IV). Mean age was 37 years, 16 below 20years old were in two groups: Group I (12/18, 67%), Group II (4/12, 33%), and 36above 21 years old were in 4 Groups: Group I (6/18, 33%), Group II (8/12, 67%),Group III (14/14, 100%) and Group IV (8/8, 100%). The main cause ofhyperventilation was the stress during work or normal life. Stress scale was higher inGroup I (mean 9.1 mm) and Group II (mean 9.7 mm) than others. There was nosignificant difference in physical examination between two groups. Twelve with out-of-hospital treatment (reservoir bag with O2) were all stabilized and discharged within

Volume 46, no. 3 : September 2005

1 hour from the ED but 4 of 6 without out-of-hospital treatment were dischargedover 2 hours; 2 of 6 were admitted because of reattack.

Conclusion: The use of reservoir bag with O2 by EMT or EP at in- or out-of-hospital to patients with hyperventilation due to emotional stress is recommended atall ages because of the ease of application and rapid stabilization or treatment.

Annals of Emergency Medicine S101