EpiPen4Schools pilot survey: Occurrence of anaphylaxis, triggers, and epinephrine administration in a U.S. school setting.

BACKGROUND: Although epinephrine is the treatment of choice for anaphylaxis, it remains underused. OBJECTIVE: This study was designed to describe anaphylactic events and epinephrine autoinjector (EAI) use in U.S. schools enrolled in the EpiPen4Schools program. METHODS: This exploratory, cross-sectional, Web-based survey of 6019 schools that participated in the EpiPen4Schools program assessed anaphylactic events and EAI use at responding schools during the 2013-2014 school year. RESULTS: A total of 919 anaphylactic events were reported in 607 schools. Of the 852 anaphylactic events with data on those who experienced an event, most 88.8% (n = 757) occurred in students, and 21.9% of events (n = 187) occurred in individuals with no known allergies. Of the 851 events with data on EAI use, 74.7% (n = 636) were treated with EAIs and 8.5% (n = 54) received a second epinephrine injection. Of the 204 individuals not treated with an EAI, 77.0% (n = 157) received antihistamines, 12.7% (n = 26) received another treatment, and 8.3% (n = 17) received no treatment. Of the 850 events with data on hospital transport, 79.6% of individuals (n = 677) were transported to the hospital. Common triggers varied seasonally, with food listed most frequently overall (62.5%). CONCLUSION: More than one in ten schools that participated in the EpiPen4Schools survey reported an anaphylactic event. Approximately 25% of individuals with anaphylactic events were not treated with EAIs, and 20.4% of patients were not taken to the hospital after an anaphylactic event. Analysis of these data supports the value of stocking EAIs and of providing continuing education regarding the recognition and proper treatment of anaphylaxis for school personnel.

Perceptions and attitudes toward the use of nebulized therapy for COPD: patient and caregiver perspectives.

Although delivery of medications through nebulization is effective for patients with COPD, nebulization is often perceived negatively. This survey evaluated patient and caregiver attitudes and perceptions related to the use of nebulization for the management of COPD. A total of 400 patients and a separate population of 400 caregivers were randomly selected and interviewed via telephone. Responses were assessed on the basis of 4 domains: health of patients with COPD, satisfaction with nebulization therapy, benefits and challenges, and the caregiver role. Most patients (58%) self-classified their COPD as "mild to moderate," with shortness of breath upon minimal to moderate exertion; caregivers reported similar findings. The majority of patients and caregivers (89% and 92%, respectively) were "generally satisfied with their (or their friend's or family member's) current nebulized treatment." Based on their personal experiences, 80% of patients and caregivers reported that using a nebulizer was better than using only an inhaler. Patients and caregivers agreed (79% and 85%, respectively) that the benefits of nebulization therapy outweighed the difficulties or inconveniences. Patients believed that their overall quality of life had improved since beginning nebulization (75%) and that nebulization better enabled their caregiver to provide care (77%); caregivers echoed this sentiment. Overall, this survey demonstrated that an overwhelming majority of patients and caregivers were satisfied with nebulization therapy, reporting benefits in symptom relief, ease of use, and improved quality of life.