Passive Smoking, Potential Atopy and Asthma in the First Five Years

Evidence of prolonged exposure to cigarette smoke was sought in a group of 86 children aged five years and under with moderately severe asthma, and in 1199 infants from a mixed background population of Armed Service and civilian families. Asthmatics with a normal serum IgE (less than +1 s.d. for age) made up almost half of the cases and, compared with those with an elevated serum IgE (+1 s.d. for age or more), a greater proportion were male, had experienced prolonged exposure to cigarette smoke, were from Service families and already had fixed chest deformity. It is suggested that, in addition to facilitating the expression of asthma in young potential atopics, passive smoking may be an important contributory cause of the more severe disease reported in the socalled ‘intrinsic’ group. Perhaps the burden of illness and the extent of exposure noted in this survey will prompt renewed efforts to be made to discourage smoking in families, particularly two years before and for at least five years after the birth of a child.

Initial medical reception, intervention and survey work in combined military and civilian humanitarian aid: operation 'Safe Haven', northern Iraq 1991

Service medical teams were involved in the medical screening and initial reception of displaced Kurds into the first United Nations Relocation Camp in Zakho, Northern Iraq in April 1991. Massive logistic support and adequate security were required for the delivery of the essential elements of relief. The prompt deployment of such teams enabled rapid surveys of the medical extent of the disaster to be undertaken during the screening process whilst individuals were prioritized for rehydration, supplement feeding and therapy. Over 12,000 displaced persons entered the camp in the first 10 days. Reported perinatal mortality during the two-month exodus crisis in an unselected group of 2,200 was 375 per 1,000 births. In the same group of families surviving to tell the tale, one in five of the infants who had been in the mountains had died and the fertility rate may have been as high as 380 per 1,000 women of child-bearing age in the previous year. In a larger survey of 3,825 unselected persons entering the camp, 745 (19.5 per cent) were estimated to be under five years of age and a quarter of these had a significant medical problem. There were 290 (7.6 per cent) estimated to be under two, and a quarter of these were judged to be severely malnourished. A high degree of international cooperation between military and civilian medical and relief teams was demonstrated in dealing with this crisis.

A short exercise and living course for asthmatics

A 5-day, non-residential exercise and living course for children with asthma is described as a feature of a programme of outpatient physiotherapy. Eleven children undertaking such a course were compared with 10 asthmatic children in a control group. The subject group showed, in the short term at least, an improvement in bronchial lability, peak flow rates, nocturnal and daytime wheeze, and activity compared with the controls. These findings were statistically significant. There was no difference between the groups in the number of days on which extra medication was taken. A short, sharp course is of benefit physically, socially and psychologically to children with asthma.

Bronchiectasis in acute leukaemia

Five children in remission from acute lymphoblastic leukaemia developed bronchiectasis when on chemotherapy. Persistent collapse or consolidation on chest radiographs was helpful in suggesting the diagnosis. Necropsy established the diagnosis in one child who died of massive haemoptysis when in complete remission, and bronchography confirmed the diagnosis in three. In a further child the diagnosis was based on clinical and chest X-ray findings alone. The surviving children were treated with prophylactic rotating antibiotics. Routine chest radiographs are recommended in children with acute lymphoblastic leukaemia, as bronchiectasis may otherwise be underdiagnosed.