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Cryosurgery has proven effective in managing malignant tracheobronchial tumors, yet its role in benign lesions is not well established. A case of isolated tracheal papillomas recurring 15 years following laser surgery is reported. Cryosurgery allowed improvement in symptoms and adequate control of the papillomas.

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Rationale: The written asthma action plan (WAAP) is an essential component of asthma care. Adequacy of WAAP based on asthma guidelines in different clinical settings is unknown. Objective: To critically analyze the adequacy of inhaled (ICS), oral (OCS) corticosteroids use, and long acting β agonists (LABA), by emergency department (ED) and outpatient pulmonary clinic (OPC) in a large public teaching hospital with an Asthma Disease Management Program. Methods: A retrospective review of NHLBI WAAP completed by physicians at Medical Center of Louisiana New Orleans (MCLNO) ED and OPC from January 2007 to December 2008 was performed. The data was then analyzed using SPSS 16. Results: There were 637 WAAP completed in the ED and 163 in OPC for review. The majority of ED patients were classified as severe persistent asthma (42%), whereas the majority of OPC patients were classified as moderate persistent asthma (40%). Sixty three percent of the patients classified as mild persistent, were prescribed ICS in the ED, compared to 91% in OPC (p<0.001). Seventy five percent of moderate persistent asthmatics were prescribed ICS in the ED compared to 100% in OPC p<0.001). Fourteen percent of moderate persistent asthmatics were prescribed ICS+LABA in the ED compared to 72% in OPC (p=0.17). Ninety seven percent of severe persistent asthmatics were prescribed ICS compared to 100% in OPC (p<0.001). Nineteen of severe persistent asthmatics presenting to ED were prescribed ICS+LABA compared to 92% in OPC (p=0.44). Fifty one percent (n=326) of ED-WAAP had documented OCS compared to 92% (n=151) of OPC-WAAP (p<0.001): 5% in the green zone, 43% in the yellow zone and 3% for the red zone in the ED-WAAP compared to 0% in the green zone, 74% in the yellow zone and 58% in the red zone in the OPC-WAAP (p<0.001 for each category). The red zone was complete in 39% of ED-WAAP compared to 92% of OPC-WAAP (p<0.001). Conclusion: There is a significant difference in documentation of ICS and OCS use in the ED-WAAP compared to OPC-WAAP. Multidisciplinary educational efforts system-wide have been implemented to improve WAAP adherence to the asthma guidelines specifically in the yellow and red zones. This abstract is funded by: None Am J Respir Crit Care Med