Twitter Updates from the Severe Asthma Workshop at the 2008 Annual Meeting of American College of Allergy, Asthma & Immunology (ACAAI)

Twitter is a microblogging service where people answer the question "What are you doing?" via 140-character messages from their cellphone, laptop or desktop. The service can also be used to collect notes and ideas or to report from a medical conference. I have already explored the same communication channel while attending the NEJM Horizons Conference in October and the reports were generally met with approval by both the meeting participants and bloggers from around the world. This experience encouraged me to make the first attempt at using Twitter to post updates from the 2008 Annual Meeting of American College of Allergy, Asthma & Immunology (ACAAI). I attended the meeting to present our project AllergyCases.org to the program directors and fellows and to discuss 2 posters.

In order to make the Twitter postings (or "tweets") easily searchable, I included the hash tag "#ACAAI" with each tweet from the meeting. You can search Twitter for "#ACAAI" to find tagged updates from any participants who used Twitter to report from the ACAAI meeting.

The short updates from the workshop about treating severe asthma were posted in real time on Twitter at an interval of every 3-5 minutes. After the workshop, I used my cell phone and the mobile Twitter interface to discuss the asthma updates with several fellows during and after the ACAAI meeting.

The oldest post is at the bottom, the newest at the top:

#ACAAI Severe Asthma: AAF pts have more ER visits and hospitalizations for multiple reasons: poverty, obesity, no PCP, cockroach exposure... 7:04 PM Nov 8th from web

#ACAAI Severe Asthma: Theophylline pendulum may be swinging back -- useful again? 6:57 PM Nov 8th from web

#ACAAI Severe Asthma: No response to oral steroids? Consider GERD. 6:51 PM Nov 8th from web

#ACAAI Severe Asthma: Maximal dose of oral steroids beyond which there is no effect? 60 mg po qd. 6:51 PM Nov 8th from web

#ACAAI Severe Asthma: Older papers - methylprednisolone may "get into the lungs" better than prednisone - consider different steroid... 6:48 PM Nov 8th from web

#ACAAI Severe Asthma: Macrolides may be considered if nothing else helps. May have steroid-sparing effect. 6:47 PM Nov 8th from web

#ACAAI Severe Asthma: Clarithromycine tx for months is used in "infectious asthma" - studies ongoing. 6:45 PM Nov 8th from web

#ACAAI Severe Asthma: Monitor LFTs in Zileuton therapy. 6:44 PM Nov 8th from web

#ACAAI Severe Asthma: Zileuton is not the same as Singulair or Accolate. Works in a different way. 6:43 PM Nov 8th from web

#ACAAI Severe Asthma: Strategies for "SABA abuser" (Albuterol 18 x day), no response to ICS+LABA+LTRA? Consider zileuton and Xolair. 6:42 PM Nov 8th from web

#ACAAI Severe Asthma: FEV1 cutoff below which you don't use Xolair for fear they won't tolerate anaphylaxis? Some use 50-70% similar to SCIT 6:38 PM Nov 8th from web

#ACAAI Severe Asthma: Pts on Xolair tx - nasal polyps can get better. Nasal polyps are a heterogeneous disease like asthma. 6:32 PM Nov 8th from web

#ACAAI Severe Asthma: When do you give up on using Xolair? How long do you try? 4-6 months. 6:30 PM Nov 8th from web

#ACAAI Severe Asthma: There is no way to predict which patient will benefit from Xolair. 6:29 PM Nov 8th from web

#ACAAI Severe Asthma: Several attendees share experience with using Xolair in pts with IgE higher than 700. 6:28 PM Nov 8th from web

#ACAAI Severe Asthma: How do you monitor Xolair tx in pts with very high IgE? Monitor PFTs. Checking IgE levels is useless in these patients 6:26 PM Nov 8th from web

#ACAAI Severe Asthma: Xolair and IgE of 4k? Classic wisdom: Xolair will not bind enough IgE to be effective. Some pts still respond however 6:25 PM Nov 8th from web

#ACAAI Severe Asthma: Xolair use in pts with very high IgE (4-5 k)? Anecdotal evidence: it may help. Use the highest dose calculated for 700 6:23 PM Nov 8th from web

#ACAAI Severe Asthma: Treat GERD, if no response for a month, try doubling the dose. Don't give up if no response at the lower dose. 6:19 PM Nov 8th from web

#ACAAI Severe Asthma: GERD - Beta agonists and theophylline relax GE sphincter which may exacerbate GERD and make asthma worse. 6:18 PM Nov 8th from web

#ACAAI Severe Asthma: Obesity - Losing weight (diet or surgery) changes metacholine sensitivity. Losing wt improves asthma in obese pts. 6:15 PM Nov 8th from web

#ACAAI Severe Asthma: What is behind the connection between obesity and asthma? Can diet play a role? 6:12 PM Nov 8th from web

#ACAAI Severe Asthma: Workshop shifts to Q&A brought by the participants. 6:11 PM Nov 8th from web

#ACAAI Severe Asthma: With genetics, we may be able to tailor-make the therapy to individual patients rather than blindly follow guidelines. 6:10 PM Nov 8th from web

#ACAAI Severe Asthma: Vit D deficiency could be a risk factor of asthma but there is not enough data to make a final conclusion. 6:07 PM Nov 8th from web

#ACAAI Severe Asthma: Ciclesonide is the new ICS. Activated by esterase in target tissues. Less suppression of HPA than other ICS - FP/BUD 6:05 PM Nov 8th from web

#ACAAI Severe Asthma: Xolair decreases hospitalizations in pts on moderate dose ICS. 6:04 PM Nov 8th from web

#ACAAI Severe Asthma: Omega-3 FA, fish oil may be beneficial in children. 6:02 PM Nov 8th from web

#ACAAI Severe Asthma: Lactose is added or removed from DPIs, check contents of each inhaler. 6:00 PM Nov 8th from web

#ACAAI Severe Asthma: Consider lactose sensitivity in pts who don't respond to Advair or Symbicort. Check contents of each inhaler. 5:59 PM Nov 8th from web

#ACAAI Severe Asthma: Consider GERD if asthmatic pts don't respond to medications. 5:58 PM Nov 8th from web

#ACAAI Severe Asthma: Asthma in 30% pts of pts with chronic asthma. 5:57 PM Nov 8th from web

#ACAAI Severe Asthma: Sinusitis in 75% of pts with moderate asthma. 5:57 PM Nov 8th from web

#ACAAI Severe Asthma: Link between sinusitis and asthma. 5:56 PM Nov 8th from web

#ACAAI Severe Asthma: Treat co-morbid conditions - rhinitis, sinusitis, GERD - "One airway disease" 5:55 PM Nov 8th from web

#ACAAI Severe Asthma: Some pts may have airway irritation from the delivery system, e.g. dry powder inhalants. Listen to pts... 5:53 PM Nov 8th from web

#ACAAI Severe Asthma: A subpopulation of patients may benefit from erythromycin or other ABx. 5:52 PM Nov 8th from web

#ACAAI Severe Asthma: Is asthma an infectious disease? 5:50 PM Nov 8th from web

#ACAAI "Some asthmatics don't respond to ICS, so why try them at all?" but this is not what the guidelines say with their stepwise approach. 5:49 PM Nov 8th from web

#ACAAI Since 1976: Asthma is a heterogeneous disease, but this is not reflected in the guidelines. 5:47 PM Nov 8th from web

#ACAAI Attending the workshop Treating the severe asthmatic patient. 5:45 PM Nov 8th from web

#ACAAI As far as I know, this will be the first ACAAI meeting reflected on Twitter.

#ACAAI The #ACAAI tag means you will be able to find the tagged posts on Twitter Search http://search.twitter.com/

#ACAAI Going to the annual ACAAI meeting. I have 2 posters and 1 website presentation. Will be updating Twitter with the tag #ACAAI


Video: Twitter in Plain English by CommonCraft.

References:
Twitter Dispatches from the New England Journal of Medicine's Horizons Conference. The Efficient MD.
I will be attending NEJM Horizons Conference to push the boundaries of traditional medical publishing, suggestions welcomed
Allergists Can Use Twitter Microblogging Service to Send Patient Reminders
Using Twitter to Microblog a CME Meeting
A Doctor's Opinion: Why I Started Microblogging on Twitter