Air pollution, weather, and associated risk factors related to asthma prevalence and attack rate

Asthma is an important public health challenge. The objective of this research was to investigate the relationship of air pollution and weather to adolescent asthma prevalence and attack rate. A 6-month mass screening asthma study was conducted from October 1995 to March 1996 in Taiwan. The study population included junior high school students from throughout the country (1,139,452 students). Eighty-nine percent of students completed questionnaires (International Study of Asthma and Allergies in Childhood-ISAAC and New England Core Questionnaires) and passed a logical screening error program. Lung function data was collected to assist in the diagnosis of asthma status. From the students screened during this mass survey, a stratified random sample of 64,660 students was analyzed for asthma prevalence and attack rate. Using a regression model to compare the USEPA National Ambient Air Quality Standards 2000 (NAAQS, 2000) to asthma prevalence, this investigation found that the standards may not provide enough protection for adolescents after controlling for age, rhinitis, eczema, urban birth location, parental education level, exercise, cigarette smoking, environmental tobacco smoking, alcohol beverage consumption and weather factors. The general estimating equations (GEE) model, a repeated measurement regression model, was used to examine the relationship between the monthly asthma attack rate among asthma patients and air pollution (nitrogen oxides; nitrogen dioxide; nitric oxide; Ozone; PM10) while controlling for household smoking. The GEE model demonstrated that air pollution is related to asthma attack rate. Air pollution factors also interacted with weather parameters when related to asthma attack rate.

[Status asthmaticus with rhabdomyolysis of the respiratory muscles]

A 40-year-old roofer called the medical emergency team because of sudden dyspnea and chest constriction. He was suffering from bronchial asthma that exacerbated probably due to the inhalation of a solvent while at work. Because of status asthmaticus he was intubated immediately after arrival in the hospital and breathing had to be assisted artificially for ten hours. After extubation he complained of chest pain. In view of an elevated creatinkinase of 4368 U/1 this was interpreted as rhabdomyolysis of the respiratory muscles due to the status asthmaticus. As a cause of chest pain and elevation of creatinkinase after severe respiratory work under hypoxic conditions rhabdomyolysis of the involved musculature has to be considered.

Inhaled heroin-induced status asthmaticus: five cases and a review of the literature

We report five cases of status asthmaticus (four requiring mechanical ventilation) that were triggered by inhaled heroin and review the pertinent literature. These cases share common features of sudden and severe asthma exacerbations temporally related to heroin use, stress the importance of considering illicit drug use in like cases, and call attention to a public health issue.

[Clinical characteristics of near-fatal asthma attack induced by NSAIDs]

Despite advance in the treatment of asthma, asthma-related deaths have not declined. One of the reasons in those cases may be that there is a surprising lack of information on death from asthma since most of asthma deaths take place outside the hospital. Learning about near-fatal asthma attack (NFA) patients is useful to understand the mechanisms of asthma deaths because NFA patients and fatal asthma possess common clinical characteristics. It is well-known that there are two types of severe asthma exacerbation, that is, "sudden onset" and "slow onset attaches", in terms of clinical, functional and blood gas parameters. On the other hand, NSAIDs is one of the factors leading to exacerbation of asthma or asthma-related death. We examined the characteristics of NSAIDs-induced asthma and the pattern of respiratory arrest in the NSAIDs-induced NFA group compared to non-NSAIDs group at a Kyoto National Hospital from 1986 to 1997. A Total of 30 patients (34 cases) with NSAIDs-induced asthma among 265 admissions with asthma attack were reviewed involving 15 women and 15 men, mean age 46 +/- 14 years old. Six patients (8 cases) of NSAIDs group and 13 patients of non-NSAIDs group had intubation for their NFA. NSAIDs group showed more severe respiratory insufficiency with higher arterial CO2 level compared to non-NSAIDs group (91.5 +/- 16.3 vs 76.3 +/- 17.0 Torr) and significant lower pH level (7.02 +/- 0.14 vs 7.18 +/- 0.07, p < 0.05). But, NSAIDs group showed significantly more short weaning time than that of non-NSAIDs group (p < 0.01). We suggest that many sporadic cases of rapid onset severe asthma attacks may result from the ingestion of NSAIDs.

Prolonged severe hypercapnia complicating near fatal asthma in a 35-year-old woman

OBJECTIVE

We describe a patient with a prolonged and severe hypercapnia occurring during an episode of status asthmaticus induced by ophthalmic instillation of carteolol.

SETTING

Prehospital Emergency Medical Service and Pulmonary Intensive Care Unit in a university hospital.

PATIENT

A 35-year-old female developed an acute asthma attack while at home, which required advanced life support.

INTERVENTION

On hospital admission, arterial blood gases revealed a PaCO2 of 208 mmHg. Hypercapnia persisted with a PaCO2 of more than 190 mmHg for 10 h, with pH always less than 7.00. The patient was finally discharged after 26 days without sequelae.

CONCLUSION

This case illustrates the cerebral and cardiovascular tolerance of severe and prolonged hypercapnia associated with major acidosis.

[Theophylline-associated epilepsy with lacuna infarction]

We reported a 9-year-old boy who had complex partial seizure for the first time, 4 years and 7 months after an episode of theophylline--associated convulsive status. An ictal EEG showed abnormal theta wave burst which showed no superficial focus, implying existence of deep focus in the brain. MRI revealed left thalamic infarction and hippocampal sclerosis. We regarded these abnormalities as the sequelae of theophylline-associated convulsive status.

Hot dog vapor-induced status asthmaticus

BACKGROUND

Asthma induced by the inhalation of food vapors is unusual and indicative of extreme allergy. Identification of the specific cause and subsequent avoidance is essential.

METHODS

We report a patient with asthma who had status asthmaticus following inhalation of boiling hot dog vapors. Prick skin tests were performed to various ingredients of the offending hot dog including chicken, pork, potato, and the aeroallergens.

RESULTS

Prick skin tests reacted strongly to chicken and mildly to pork and potato. There was no reaction to aeroallergens. Our patient has not had any acute asthma after avoiding eating and exposure to chicken and hot dog vapors.

CONCLUSIONS

Exquisite allergy to chicken was responsible for acute asthma.

Near-death asthmatic reaction induced by disodium cromoglycate

A near-death asthmatic reaction was induced by disodium cromoglycate (DSCG) as evidenced by positive skin and inhalation provocation tests. The patient's history revealed an episode of exacerbation by inhalation of DSCG. In spite of such an experience, he inhaled DSCG for relief of asthmatic attack, resulting in near-death exacerbation. This patient emphasizes the need to re-recognize that DSCG is not a reliever and the DSCG could cause fatal asthma.

Near-fatal status asthmaticus induced by nasal insufflation of cocaine

Asthma and cocaine abuse are both common. While cocaine has been associated with numerous pulmonary complications, only smoking cocaine has been clearly linked to the precipitation of life-threatening exacerbations of asthma. We report a case in which nasal insufflation of cocaine ("snorting") triggered a near-fatal asthmatic attack.

[A case of fatal asthma induced by timolol eye-drop]

A 74 year-old man, a known asthmatic since 1972, was treated by timolol eye-drop for acute glaucoma. Several hours later the patient developed a severe attack of asthma, and died subsequently. The autopsy findings were consistent with those of typical status asthmaticus. Our patient is, to our knowledge, the first case of fatal asthma induced by timolol eye-drop in Japan.

Aspirin-intolerance as a precipitating factor of life-threatening attacks of asthma requiring mechanical ventilation

The records of 92 asthmatics who underwent mechanical ventilation were reviewed. In seven patients (8%) the severe attack was precipitated by a non-steroidal anti-inflammatory drug (NSAID); one of these patients died. Five of the cases had a history of asthmatic attacks provoked by NSAIDs; whilst in two the severe attack requiring mechanical ventilation was the first manifestation of NSAID-intolerance. In two patients the NSAID had been prescribed by their physicians. Another aspirin-intolerant patient, a general practitioner, self-administered a NSAID. The sudden attack in another patient was precipitated by a preparation which contains aspirin and is usually recommended for indigestion. In the fatal case the attack was provoked by a capsule containing aspirin, which had been given by a herbalist. Unlike other reports, we found that NSAID-intolerance is a frequent provoking factor in severe acute asthma requiring mechanical ventilation. Inadequate investigation of precipitating factors in asthmatics with severe sudden attacks is a possible reason why this phenomenon is underreported.

[Acetylsalicylic acid pseudoallergy: an anomaly of thrombocyte function?]

After a short historical review, the clinical symptomatology of the pseudoallergic reactions (PAR) after intake of acetylsalicylic acid (ASS) is examined. An intolerance to ASS mostly becomes manifest as bronchial asthma--sometimes up to a status asthmaticus: it is frequently combined with vasomotoric rhinopathia and nasal polyps (so-called "aspirin triad") or as urticaria and angio-edema, seldom as a shock reaction. These symptoms can - in contrast to an allergy--appear at the first intake of the drug. Changes in the arachidonic acid metabolism are of pathogenetic importance, as all substances that inhibit the cyclooxygenase pathway [e.g., most of the nonsteroidal anti-inflammatory drugs (NSAIDs)] are not tolerated by ASS-sensitive patients. Generally, a typical clinical history is sufficient for the diagnosis. Due to the fact that the ASS and NSAID pseudoallergy so far cannot be proved by in vitro methods, oral or inhalative provocation tests are needed when the tolerance situation to the drugs is unknown. However, these tests present high risks. A research group working with Capron (Lille) has recently been able to prove that washed platelets from patients with an analgetic asthma syndrome show an abnormal in vitro response to ASS or NSAID - like indomethacin and fluriprufen - which is characterized by liberation of cytocydal supernatants against parasites, as well as of free O2 radicals, which can be detected by chemiluminescence. Therefore, a platelet anomaly of arachidonic acid metabolism seems to be pathognomonic for ASS asthma. It is not yet known whether or not this is also related to ASS urticaria.(ABSTRACT TRUNCATED AT 250 WORDS)