Impact of climate variability on exercise-induced bronchospasm in adolescents living in a semi-arid region

OBJECTIVE

To examine the impact of climate variability on the occurrence of exercise-induced bronchospasm in the rainy and dry seasons of a Brazilian semi-arid region.

METHODS

This sample comprised 82 adolescents aged 15 to 18 years, who were submitted to exercise-induced bronchospasm assessment on a treadmill and outdoors, during the rainy and the dry season. Anthropometric variables, sexual maturity and forced expiratory volume in the first second were analyzed. Air temperature and humidity, decline in forced expiratory volume in the first second (%) and frequency of bronchospasm were compared between seasons using the independent Student's t test, the Wilcoxon and McNemar tests, respectively. The level of significance was set at p<0.05.

RESULTS

The mean age was 15.65±0.82 years. Air temperature, air humidity and decline in forced expiratory volume in the first second (%) differed between seasons, with higher air temperature and humidity in the rainy season (29.6ºC±0.1 and 70.8%±0.6 versus 28.5ºC±0.2 and 48.5%±0.6; p<0.05). The decline in forced expiratory volume in the first second (%) was greater in the dry season (9.43%±9.97 versus 12.94%±15.65; p<0.05). The frequency of bronchospasm did not differ between seasons.

CONCLUSION

The dry season had a negative impact on forced expiratory volume in the first second in adolescents, with greater decrease detected during this period. Findings of this study suggested bronchospasm tends to be more severe under low humidity conditions.

Paradoxical bronchospasm in U.S. military veterans with COPD or asthma at a tertiary VA medical center in Chicago, Illinois

Inhaled short-acting β₂-adrenergic agonists can rarely elicit paradoxical bronchospasm (PB), which may be fatal. The purpose to this study was to determine whether post-bronchodilator PB is reported in spirometry test results of veterans with Chronic Obstructive Pulmonary Disease (COPD) or asthma followed at the Jesse Brown Veterans Affairs (VA) Medical Center in Chicago between 2017-2020. Eighteen of 1,150 test reports reviewed were identified with post-bronchodilator PB (1.5%).12 out of the 18 identified patients with PB had COPD, 4 hadasthma and 2 had asthma/COPD. No report alluded to post-bronchodilator PB. Among the identified PB patients, there were 17 males and one female, 14 African Americans, 3 Caucasian and one Latinx, aged 67±8 years (mean±SD) with BMI 28±5 kg/m². Thirteen were ex-tobacco smokers, 4 current smokers and one never smoked. Most recent chest CT revealed emphysema in 8 veterans with COPD and bronchial wall thickening in 3. Chest radiographs of 4 veterans with asthma were unremarkable. All veterans were treated with inhaled β₂-adrenergic agonists. Five were treated with cardio selective beta₁ blockers and 10 for gastroesophageal reflux disease. Eleven veterans were diagnosed with obstructive sleep apnea. In 12 veterans, inhaled albuterol (4 actuations)-induced decrease in FEV₁ was 22±8% and 367±167 mL from baseline. In 6 veterans, only FVC decreased significantly from baseline (14±3% and 448±179 mL). No veteran reported respiratory symptoms during or after spirometry testing. Two veterans died during follow-up. Based on spirometry test reports, inhaled β₂-adrenergic agonists were discontinued in 2 veterans with COPD and asthma. We propose that post-bronchodilator PB observed during spirometry testing of veterans should be recognized and reported, and its possible clinical implications addressed accordingly.

[Diving and asthma: Literature review]

INTRODUCTION

Scuba diving has long been contraindicated for asthmatics. Recommendations are evolving towards authorisation under certain conditions. Our objective was to review the literature on the risks associated with scuba diving among asthmatics and about recommendations on this subject.

MATERIALS AND METHODS

We used the MEDLINE and LiSSa databases, until June 2018, in French, English or Spanish language, with the keywords "asthma AND diving" and "asthme plongée" respectively. References to the first degree were analyzed.

RESULTS

We have included 65 articles. Risk of bronchospasm is well documented, particularly in cold and/or deep water, or in the event of exposure to allergens (compressor without filter). Nonasthmatic atopic divers may be at greater risk of developing bronchial hyper-reactivity. Although the theoretical risk exists, epidemiological studies do not seem to show an over-risk of barotrauma, decompression sickness or arterial gas embolism in asthmatics. French, British, American, Spanish and Australian societies agreed on the exclusion of patients with moderate to severe persistent asthma, FEV1<80%, active asthma in the last 48hours, exercise/cold asthma and poor physical fitness.

CONCLUSION

A diver's examination should include a triple assessment: asthma control, number of exacerbations and treatment compliance. Homogenizing the recommendations would improve the framework for the practice of diving among asthmatics and allow larger studies in this population. Communicating the current recommendations remains important to divers, dive instructors and doctors in the context of the development of scuba diving.

Rainfall-Associated Bronchospasm Epidemics: The Epidemiological Effects of Air Pollutants and Weather Variables

BACKGROUND

This study compares different risk factors in patients visiting a hospital during five rainfall-associated bronchospasm epidemics in Ahvaz and those visiting on other occasions.

METHODS

This case-control study was conducted on 5307 patients with bronchospasm admitted to the Emergency Department of Imam Khomeini Hospital in Ahvaz (Iran) from late October to December (as the epidemic) and 916 patients admitted from late January to March (as the nonepidemic) in 2011 to 2015.

RESULTS

A total of the 41.7% of the cases and 48.8% of the controls had episodes of bronchospasm, suggesting a significant difference between the two groups (P < 0.001). The mean concentrations of PM10, NO, NO2, and NO x pollutants (except O3) were significantly higher in the nonepidemic periods (P < 0.05). The adjusted analysis showed a direct significant relationship between emergency respiratory admissions and each unit of increase in NO and SO2 concentration during the epidemic periods and NO2 concentration during the nonepidemic periods. During the epidemic periods, a direct and significant relationship was also observed between respiratory admissions and each unit of increase in relative humidity and evaporation.

CONCLUSION

The results suggest that certain pollutants and weather variables are associated with the risk of emergency respiratory admissions during epidemic periods.

Adverse Events in Children Receiving General Anaesthesia with Laryngeal Mask Airway Insertion

INTRODUCTION

Perioperative adverse events are more common in children compared to adult population. Reporting an adverse event proves effective in identifying problems and helps in prevention and early management. Our objective was to identify the types, incidence, and the time of occurrence of perioperative adverse event. We also aimed to find out whether the occurrence of the types of adverse events differ in children below and above five years.

METHODS

This was a prospective study in 242, ASA Physical Status I and II children aged day one to 14 years, receiving general anesthesia with laryngeal mask airway for various elective surgeries. Adverse events observed in the perioperative period were recorded.

RESULTS

Adverse events related to respiratory system (n=26, 55%) were the most common followed by cardiovascular system (n= 14, 30%). Adverse events were observed in 24(10%) children in the operating room and in 20 (8%) children in the post anaesthesia care unit. In the operating room, majority (14 of 27, 52%) of the events occurred immediately after removal of laryngeal mask airway. Respiratory events were more common in children below five years (p=0.007), whereas cardiac events were more common in children above five years (p=0.02).

CONCLUSIONS

The commonest adverse event in children is related to respiratory system. Adverse events occur more frequently in the operating room, mostly immediately after removal of laryngeal mask airway. Respiratory events are more frequent in children below five years whereas cardiac events are more frequent in children above five years.

Coincidence of asthma and bronchospasm during anesthesia in tympanomastoidectomy

High prevalence of asthma and bronchospasm was observed during induction of anesthesia in patients with chronic suppurative otitis mMedia (CSOM) who underwent tympanomastoidectomy. Although several studies have proposed association of allergic diseases with CSOM but no consensus about it has been established. Current study was designed to determine the coincidence of asthma in CSOM patients. In a cross-sectional study, authors investigated medical records of 106 CSOM patients underwent tympanomastoidectomy, aged 15 to 65 years, and 95 controls, which were matched by age and sex. Participants were admitted to Valiasr Hospital, Tehran, Iran, from April of 2011 to March of 2013. Required information, such as demographic characteristics and history of allergic rhinitis (AR) and asthma were obtained from patients' medical records. The prevalence of AR in the CSOM group was higher than controls' group (19.8% and 15.8%, respectively) (P>0.05). Asthma prevalence was significantly higher in patients with CSOM (P=0.03) (OR=7.67, 95% CI:  0.9-62.5). No significant association was found between history of AR and chronic ear infections. However, asthma was significantly more common in CSOM patients. Current study indicates that asthma and risk of bronchospasm need particular attention in patients with CSOM underwent tympanomastoidectomy before and during anesthesia.

[Adverse events of anesthesia in pediatric surgery scheduled at Gabriel Toure hospital]

The occurrence of an event planned or unplanned during anesthesia is a concern for staff. This event may jeopardize the success of surgery gesture. Pediatric Surgery therefore has its own specific complications that it requires anesthesia.

PURPOSE

To evaluate the incidence of adverse events during anesthesia in pediatric surgery scheduled.

STUDY TYPE

Descriptive non-randomized study.

PATIENTS AND METHODS

Descriptive non-randomized study on adverse events related to anesthesia in children over a period of seven months. It took place in the anesthesia and intensive care unit and the pediatric surgery unit of Gabriel Toure hospital in Bamako. It focused on patients aged 0 to 12 years scheduled for surgery under general anesthesia during the study period.

RESULTS

Sixty six percent of patients selected was male gender with a sex ratio of 3 in favor of males. The average age was 2 years with extremes of 16 days and 12 years and a standard deviation of 2.93. The old history of premature was found in 36% of patients and 2% of asthmatic. The number of patients experiencing an adverse event is 42 on a total of 107 patients collected either 39.25%. When the children were younger than one year adverse events occurred with 30, 76%. The occurrence of adverse events was more frequent when the child was not intubated with P < 0.05. All adverse events have received support except tachycardia, late revival but all developed positively.

CONCLUSION

This study estimates the incidence of adverse events in anesthesia during pediatric surgery. The overall rate of patients experiencing an adverse event is relatively high. Children age less than or equal to one year are most vulnerable.

Control of asthma for reducing the risk of bronchospasm in asthmatics undergoing general anesthesia and/or intravascular administration of radiographic contrast media

BACKGROUND

It is well known that patients suffering from bronchial asthma undergoing surgical procedures requiring general anesthesia (GA) or the administration of water soluble radiographic contrast media (RCM) have an increased risk of potentially severe bronchospasm. Nevertheless, little attention has been devoted to the possible preventive measures to reduce the occurrence of this potentially life-threatening event. It has been shown that the most important risk factor for bronchospasm during GA induction and/or the use of RCM is represented by a high degree of bronchial hyperreactivity with airway instability not adequately controlled by long-term anti-inflammatory treatment.

AIMS

The aim of this commentary is to underline the need for an accurate clinical and functional evaluation of asthmatics undergoing surgical procedures requiring GA or radiological procedures requiring the administration of RCM, as well as to suggest a stepwise preventive pharmacological approach for reducing the risk of bronchospasm.

METHODS

The authors' suggestions represent clinical experience of the respiratory section of an internal hospital-based working group whose aim is the prevention of asthmatic/anaphylactic/anaphylactoid reactions during the administration of anesthetics and/or RCM. The MEDLINE database was searched with a combination of keywords: general anesthesia, radio contrast media [and] bronchial asthma. The main limitation of this commentary is the scarcity of available literature on this topic.

FINDINGS

The authors suggest a therapeutic approach before surgical procedures requiring GA and/or RCM administration based on the degree of asthma control as assessed by clinical/functional criteria. In this setting, in addition to the necessity of obtaining the best control of airway reactivity, the authors suggest that an optimal control of asthma symptoms in 'real life' conditions might likely constitute a safety issue in asthmatic patients in the case of emergency procedures.

The prevalence of exercise-induced bronchospasm in soccer player children, ages 7 to 16 years

This study represents an attempt to determine the prevalence of exercise-induced bronchospasm among soccer player children. A total of 234 soccer player boys of all soccer schools from Shahr-Rey enrolled in this study. They did not have any history of a recent or chronic respiratory tract disease, a history of allergic diseases, and history of bronchodilator drugs consumption during the 24 hours prior to the study. Pulmonary function test (PFT) was performed for each participant before exercise and 6 and 15 minutes after playing soccer. The diagnosis of EIB was by a decrease in forced expiratory volume in 1 second (FEV1) by at least 10% and in peak expiratory flow rate (PEFR) by at least 15% with exercise challenge. If there was reduction in one parameter alone, the participants were considered as prone to EIB. Considering both FEV1 and PEFR the prevalence of EIB was 2.1% and 18.4% were prone to EIB. If FEV1 or PEFR tests were used as criteria for diagnosis of airway obstruction, the prevalence of EIB would be 6% and 15.8%, respectively. There was no significant difference between the post of players, family history of allergic disease and EIB in soccer players. This study suggests that at least 2.1% of soccer players will develop bronchospasm even if they do not have any history of asthma and allergy.

Exercise-induced bronchospasm among students of Tehran University of Medical Sciences in 2004

Exercise-induced bronchospasm (EIB) is a clinical syndrome that affects 8-20% of the general population and 11-50% of athletes. Although a variety of testing protocols for the diagnosis of EIB have been pursued, the optimal algorithm still is lacking. The aim of this study was to determine the prevalence of EIB among students of Tehran University of Medical Sciences and to find out whether self-reported symptoms are sufficient to establish the diagnosis of EIB. A total of 463 students completed an EIB symptoms-specific questionnaire, followed by a 9-minute exercise test. Spirometric measurements were performed before, and 6 and 15 minutes after exercise. In our study, decrements of >15% in forced expiratory volume in 1 second or 25% in peak expiratory flow or forced expiratory flow at 25-75% from baseline values were defined as positive indications of EIB. The overall prevalence of EIB was 10.8% (15.94% in men versus 8.62% in women; p = 0.02). There was no significant difference between the students with and without EIB regarding body mass index, family income, and allergy frequency. The frequency of at least two out of the four symptoms of coughing, wheezing, shortness of breathing, and chest pain/discomfort among students with EIB was significantly higher than those without EIB (26.5% versus 15.1%, respectively; p = 0.04). The sensitivity and specificity of self-reported symptoms for EIB diagnosis were 26.5 and 84.9%, respectively. Although among all determinants proposed for EIB, respiratory symptoms are closely related to the disease, diagnosis based on only these symptoms is not recommended because of high false positive and false negative results.

Preoperative Serum Fibrinogen Level Predicts Postoperative Pulmonary Complications After Lung Cancer Resection

BACKGROUND

Patients undergoing pulmonary resection are thought to be at high risk for the development of postoperative pulmonary complications (PPCs), and these complications may lead to serious morbidity. The purpose of this study was to identify the factors associated with postoperative pulmonary complications in patients undergoing lung cancer resection and to determine the effect of PPCs on survival.

METHODS

The study involved a retrospective review of 635 patients who had undergone curative resection for lung cancer. The patient group included 504 males (79.4%), and the overall mean age was 61.3 years. Patients were classified as those who had experienced PPCs (PPCs group, n = 105, 16.5%) or those who had not (no-PPCs group, n = 530, 83.5%).

RESULTS

The surgical procedures performed were 101 pneumonectomies (15.9%), 505 lobectomies (79.5%), and 29 lesser resections (4.6%). Cancer types comprised 330 squamous cell carcinomas (52.0%), 255 adenocarcinomas (40.2%) and 50 others (7.8%). Univariate analysis showed that the following factors were predictors for PPCs: male sex, erythrocyte sedimentation rate, preoperative serum fibrinogen level, pulmonary function, chronic obstructive pulmonary disease, smoking, double primary cancer, and surgical duration. Multivariate logistic regression showed that preoperative serum fibrinogen level (p < 0.001), surgical duration (p < 0.0001) and being male (p = 0.02) were significant predictors of PPCs. Overall survival 3 years after surgery was 68.2% in no-PPCs group and 38.8% in PPCs group (p < 0.0001). Regardless of tumor staging, overall survival differed significantly between PPCs and no-PPCs groups, whereas disease-free survival did not.

CONCLUSIONS

Higher preoperative serum fibrinogen levels, longer surgical duration, and being male were the predictive factors for PPCs in surgical candidates. The development of PPCs was linked to a shortened overall survival.

Corticosteroids and Inhaled Salbutamol in Patients with Reversible Airway Obstruction Markedly Decrease the Incidence of Bronchospasm after Tracheal Intubation

Background

In patients with bronchial hyperreactivity, airway instrumentation can evoke life-threatening bronchospasm. However, the best strategy for the prevention of bronchospasm has not been defined. Therefore, in a randomized, prospective, placebo-controlled study, the authors tested whether prophylaxis with either combined salbutamol-methylprednisolone or salbutamol alone (1) improves lung function and (2) prevents wheezing after intubation.

Methods

Thirty-one patients with partially reversible airway obstruction (airway resistance &gt; 180%, forced expiratory volume in 1 s [FEV1] &lt; 70% of predicted value, and FEV1 increase &gt; 10% after two puffs of salbutamol), who were naive to anti-obstructive treatment, were randomized to receive daily for 5 days either 3 x 2 puffs (0.2 mg) of salbutamol alone (n = 16) or salbutamol combined with methylprednisolone (40 mg/day orally) (n = 15). Lung function was evaluated daily. Another 10 patients received two puffs of salbutamol 10 min before anesthesia. In all patients, wheezing was assessed before and 5 min after tracheal intubation.

Results

Within 1 day, both salbutamol and salbutamol-methylprednisolone treatment significantly improved airway resistance (salbutamol, 4.3+/- 2.0 [SD] to 2.9+/-1.3 mmHg x s x l(-1); salbutamol-methylprednisolone, 5.5+/-2.9 to 3.4+/-1.7 mmHg x s x l(-1)) and FEV1 (salbutamol, 1.79+/-0.49 to 2.12+/-0.61 l; salbutamol-methylprednisolone, 1.58+/-0.66 to 2.04+/-1.05 l) to a steady state, with no difference between groups. However, regardless of whether single-dose salbutamol preinduction or prolonged salbutamol treatment was used, most patients (8 of 10 and 7 of 9) experienced wheezing after intubation. In contrast, only one patient receiving additional methylprednisolone experienced wheezing (P = 0.0058).

Conclusions

: Pretreatment with either salbutamol alone or salbutamol combined with methylprednisolone significantly and similarly improves lung function within 1 day. However, only combined salbutamol-methylprednisolone pretreatment decreases the incidence of wheezing after tracheal intubation. Therefore, in patients with bronchial hyperreactivity, preoperative treatment with combined corticosteroids and salbutamol minimizes intubation-evoked bronchoconstriction much more effectively than the inhaled beta2-sympathomimetic salbutamol alone.

[Diurnal variations of the respiratory system in patients with pulmonary tuberculosis]

Circadian variations of external respiratory parameters were determined in 44 patients with different forms of pulmonary tuberculosis. Salbutamol inhalation tests were performed at 6 a.m. and p.m. Worse patency of the bronchial tree was diagnosed in the evening than in the afternoon, which should be taken into account in distributing a daily dose of beta2-receptor agonists.

[Antiasthmatic drug consumption as an indicator of the prevalence of respiratory pathology in a pediatric population]

The study of disease prevalence requires specific and sensitive indicators, which are hardly gathered at population level. The use of anti-asthma drugs, which are relatively specific for diseases characterised by bronchospasms, has been already experimented in the USA with algorithms describing patients affected by asthmatic disease by their use of drugs. We retrospectively analyse spatial variations of drug use as dispensed by the SSN (National Health Service) to Lombardy children less than 15 years old, between 1st January 1995 and 31st December 1997, estimating prevalence of use as a proxy of disease prevalence. Two algorithms already experimented and a new one have been employed to select children treated with antiasthmatic therapy (R03 of ATC classification) dispensed. Local communities' data were used for basic demography. Number of daily defined doses (DDD) dispensed has been used as indicator of drug quantity. Euro/year per person has been used as indicator of costs. Small area distribution analysis has been performed with a Geographic Information System at local Communities level. Frequency of patients (of a total of 1,252,958 children): with at least one dispensed drug in the three years was 26.6% (SD 10.5), DDD per person per month were 1.21 (SD 0.78), Euro/Year per person 6.84 (SD 3.61); with the association of a anti-inflammatory and a b2-agonist was 8.2% (SD 5.6), DDD per person per month were 3.01 (SD 3.07), Euro/Year per person 15.87 (SD 15.07); with at least 90 days of DDD in the three years was 2.6% (SD 1.3) DDD per person per month were 7.79 (SD 4.48), Euro/Year per person 37.66 (SD 21.83). It must be taken into account that, in the best of cases, these approximation refers to the prevalence of all diseases, characterised by bronchospasm, treated with the selected drugs. Estimated data of prevalence are comparable with those of other authors. Prevalence of drug use appears to have relevant geographical differences. Taking into consideration these comments, prevalence of drug use and consequently the estimated disease prevalence appears to be worryingly high, having as well wide geographical differences.

[Analysis of 83 bronchospasm episodes seen at urgent care during one spring night]

BACKGROUND

The new treatments for the bronchial inflammation in asthma, have contributed to decrease the mortality rate. However, there is still a group of population with no diagnosis fo asthma, who requires urgent medical attention in situations such as air pollution or risen pollen levels. On 2nd June 2000, 83 subjects with an acute crisis of asthma, came to the Emergency Room in our Hospital in just 6 hours, coinciding with the highest annual pollen measurement and a strong storm.

METHODS AND RESULTS

Personal data from those 83 patients, medical behaviour at the Casualty and post-attention recommendations were considered for analysis. 21 % never had previous diagnosis of asthma and 93 % followed no regular medical control. 61.45 % did no treatment. A chest radiography was taken in 53.76 % of the patients. Salbutamol was administrated in most of them (92.18 %) and parentally administration of steroids in 23.47 %. 21 % were referred to an specialist.

CONCLUSIONS

A significant rate of asthmatics is under-diagnosed, under-controlled and under-treated. Public Health authorities should consider the creation of new Allergy Units, a fluid communication between general practitioners and specialists, and the monitorization of pollen recounts with special plans of emergency situations to contribute to solve this problem.

[Smoking in adolescents, saliva cotinine concentrations and respiratory disease]

OBJECTIVE

To assess cotinine levels in the saliva of adolescents and the relationship between these levels, smoking habits and respiratory disease.

PATIENTS AND METHODS

We studied 420 adolescents (54.7% boys and 45.3% girls) aged between 14 and 21 years (mean age, 16.4 +/- 1.32), from state and private schools in Tenerife. An individualized survey, based on the American Thoracic Society's model, was carried out and saliva cotinine concentrations were determined by radioimmunoassay.

RESULTS

Distribution according to smoking habits was as follows: 26.5% were regular smokers, 11% were sporadic smokers, 3.6% were former smokers, 45.6% were passive smokers, and 13.4% were not exposed to smoking. Mean cotinine levels were 225.4 ng/ml in regular smokers, 19.5 ng/ml in sporadic smokers, 17.4 ng/ml in former smokers, 4.2 ng/ml in passive smokers and 2.2 ng/ml in individuals not exposed to tobacco smoke, which demonstrated the correlation between saliva cotinine concentrations and smoking habits (p=0.0001). The cotinine level in smokers of <10 cigarettes/day was 142,7 ng/ml and in smokers of >10 cigarettes/day it was 341,1 ng/ml (p=0.0001). A significant correlation was also found between cotinine concentrations and the number of cigarettes smoked regularly and in the last 24 hours before sample collection (p=0.0001). Lower respiratory tract infection (p=0.0001), chronic cough (p=0.0001) and bronchospasm on physical exercise (p=0.0001) were more frequent in adolescents with higher cotinine concentrations.

CONCLUSIONS

Higher saliva cotinine concentrations were correlated with greater tobacco consumption and exposure to tobacco smoke. Adolescents with lower respiratory tract infections, chronic cough and bronchospasm on physical exercise had higher saliva cotinine concentrations.

[Comparison of epidural anesthesia and general anesthesia for patients with bronchial asthma]

We prospectively investigated the incidence of asthmatic attacks in 94 patients (1.5%) who were diagnosed as definite asthma. We separated the patients into three groups: epidural anesthesia (n = 10) including combined spinal/epidural anesthesia (n = 7), combined epidural and general anesthesia (n = 23), and general anesthesia (n = 54). General anesthesia was induced with propofol or midazolam and maintained with N2O and O2 with sevoflurane in adults. Patients who underwent epidural anesthesia and combined spinal and epidural anesthesia showed no asthmatic attacks. The incidence of bronchospasm with combined epidural and general anesthesia was 2/23. The incidence of bronchospasm with general anesthesia was 4/54. Bronchoconstriction occurred after tracheal intubation in 5 patients except in one patient, in whom it occurred after induction of anesthesia with midazolam. All episodes of bronchospasm in the operative period were treated successfully. The frequency of bronchospasm did not depend on the severity of asthmatic symptoms or the chronic use of bronchodilators before operation. These findings suggest that tracheal intubation, not the choice of anesthetic, plays an important role in the pathogenesis of bronchospasm.

Mortality and morbidity with outpatient anesthesia: the Massachusetts experience

PURPOSE

This study documented the incidence of mortality and morbidity for outpatient anesthesia delivered by oral and maxillofacial surgeons in Massachusetts.

MATERIALS AND METHODS

A questionnaire was mailed to the 151 active members of the Massachusetts Society of Oral and Maxillofacial Surgeons, and all members responded. Information regarding the incidence of specific anesthetic morbidity was reported for 1 year (1994), and the incidence of mortality for 5 years (1990 to 1994) was requested.

RESULTS

Approximately 1,500,000 patients underwent office treatment in the 5-year period without an office anesthetic death. The most common complication was syncope occurring in 1 of every 142 patients receiving local anesthesia. In patients undergoing general anesthesia, laryngospasm occurred 10 times more frequently than bronchospasm. The incidence of other specific anesthetic complications are documented.

CONCLUSION

The results of this study suggest that the incidence of death associated with office anesthesia, although small initially, has decreased.

Spirometry and airway reactivity in elite track and field athletes

OBJECTIVES

To characterize spirometry and to document the incidence of exercise-induced bronchospasm (EIB) during competition in elite track and field athletes.

DESIGN

Spirometry was performed in 120 men and 69 women athletes before competition and peak expiratory flows in 50 men and 23 women athletes before and after competition.

SETTING

The 1991 (Randalls Island, NY, U.S.A.) and the 1993 (Eugene, OR, U.S.A.) National Track and Field Championships (World Championship team-qualifying meet).

PARTICIPANTS

American track and field athletes who met World Championship qualifying standards.

MEASUREMENTS

Spirometry (Cybermedic, Inc., Boulder, CO, U.S.A.) and peak expiratory flows (Personal Best, Healthscan Products, Cedar Grove, NJ, U.S.A.)--the best of three reproducible efforts.

RESULTS

Male sprinters had lower vital capacities than other track athletes, whereas both male and female field (throwing) athletes had larger vital capacities than both runners and other field athletes. Decreases of 10% peak expiratory flows were found in 10% of men and 26% of women track athletes within 15 min after competition. The incidence was higher in longer-distance events. Most participants did not have a history of asthma.

CONCLUSIONS

A higher-than-expected prevalence of EIB was found in high-level track athletes. The results suggest that spirometry and/or peak flows should be measured in track athletes because small decreases in airflow may impair training or performance, a condition that is easily treated.

New-onset bronchospasm or recrudescence of asthma associated with cocaine abuse

OBJECTIVE

To determine whether the occurrence of new-onset bronchospasm or the recrudescence of asthma is associated with the use of cocaine.

METHODS

A consecutive sample of patients presenting to an inner-city adult ED with new-onset bronchospasm or recrudescence of bronchospasm after > 5 years were prospectively enrolled in a case-control prevalence study. The bronchospasm patients were queried as to their exposure to illicit drugs, and urine was obtained to screen for cocaine and its metabolite, benzoylecgonine. An age- and sex-matched control group was composed of randomly chosen subjects without respiratory complaints or a history of asthma. The control group was also screened by urine toxicology for cocaine and its metabolite, benzoylecgonine.

RESULTS

In the asthma group, 21/59 (36%) had a urine toxicologic screen positive for cocaine metabolite (benzoylecgonine). Of the 21 with a positive screen for cocaine, 8 denied illicit drug abuse. Among the 13 patients reporting drug use, 10 said that they smoked crack and 3 snorted cocaine. In the control group, 8/53 (15%) were positive. Multivariate logistic regression analysis, with adjustment for age and sex, indicated that the use of cocaine was associated with a 3-fold higher prevalence of new-onset bronchospasm or recrudescence of asthma (OR = 3.28, 95% CI: 1.26 to 8.50).

CONCLUSIONS

There appears to be an association between cocaine use and new-onset bronchospasm or recrudescence of asthma in this inner-city ED population. Further study is necessary to determine the basis for this association.

Exercise induced bronchospasm in Ghana: differences in prevalence between urban and rural schoolchildren

BACKGROUND

As more developing countries adopt a westernised style of living, an increase in the prevalence of asthma can be expected to occur in these areas. A study was undertaken to establish the normal response to exercise in Ghanaian children and to use these normal values to determine the prevalence of exercise induced bronchospasm (EIB) in urban rich (UR), urban poor (UP), and rural (R) school children. Skin test reactivity to common inhalant allergens in UR, UP, and R children with and without EIB was also investigated.

METHODS

Two hundred children aged 9-16 years without a previous history of respiratory symptoms were randomly selected and underwent free running exercise testing. A normal response to exercise was defined as the group mean change in peak expiratory flow rate (PEFR) +/- 2 standard deviations. This value was used to identify the prevalence of EIB in UR, UP, and R schoolchildren. A total of 1095 children from three different schools underwent exercise testing (220 UP, 599 UR, 276 R), after which 916 children underwent skin prick testing to six common inhalant allergens (D farinae, D pteronyssinus, cat, dog, Aspergillus flavus and Candida albicans).

RESULTS

From the results of exercise testing in asymptomatic children the normal range was defined as a fall in PEFR of < 12.5% after exercise. Thirty four children were classified as having EIB on the basis of the above definition, giving an overall prevalence of 3.1%. The prevalence of EIB was significantly higher in UR children (4.7%) than in both UP (2.2%; p < 0.05) and R children (1.4%; p < 0.01). However, the prevalence rates in the UP and R children were similar. The prevalence of atopy in the whole population was 4.4%. Of the children with EIB, 10% were skin test positive to at least one of the allergens tested. The prevalence of atopy was significantly higher in UR children (6.55%, 95% confidence interval (CI) 4.5% to 9.2%) than in UP (2.9%, 95% CI 0.9% to 6.7%) and R children (1.5%, 95% CI 0.4% to 3.7%), respectively (p < 0.005).

CONCLUSIONS

The prevalence of EIB and atopy is higher in urban rich than in urban poor or rural children suggesting that, in addition to genetic predisposition, social and environmental factors such as wealth, life style, and housing are important determinants of these phenotypes.

Socioeconomic status and indicators of asthma in children

Differential access and utilization of medical care by the poor and rich may contribute to differences in asthma prevalence. We therefore studied the relationship of socioeconomic status (SES) to various indicators of asthma in the Canadian context of universal access to medical care. Information on respiratory symptoms, demographics, and home exposures of 1,111 primary school children was collected by questionnaire. Parental occupation was used to establish SES. Exercise-induced bronchospasm (EIB) after a 6-min free-running test was our measure of airways responsiveness and was available for 989 children. As compared with children from the most advantaged homes, children from the least advantaged homes were more likely to present EIB (OR: 2.26, 95% CI: 1.12 to 4.58) and to report night cough (OR: 2.30, 95% CI: 1.04 to 5.06) and cough with mucus (OR: 3.15, 95% CI: 1.06 to 9.33), while there was no significant excess of the report of wheeze or diagnosed asthma. Among factors potentially linked to SES, the presence of a cat at home (OR: 1.63, 95% CI: 1.02 to 2.61) and lower respiratory infection before 2 yr of age were associated with an excess of EIB (OR: 1.71, 95% CI: 1.16 to 2.52). Our results suggest that unidentified environmental factors contribute to the excess asthma morbidity in poor children.

[A survey of perioperative bronchospasm in 105 patients with reactive airway disease]

We investigated the relationship between the intra- and postoperative incidence of bronchospasm and the predisposing preoperative factors in 105 patients with reactive airway disease. (1) The incidence of bronchospasm in intra- and postoperative period was not associated with age, sex, duration of bronchial asthma, severity of disease, duration of the anesthesia and operation, or with FEV1.0%. (2) The incidence of intraoperative bronchospasm was high with general anesthesia using endotracheal intubation (8.9%), but low with general anesthesia using mask and regional anesthesia (0% and 2.2%, respectively). (3) The incidence of postoperative bronchospasm was about 20% with both general and regional anesthesia. However, the incidence of postoperative bronchospasm was higher in thoracic and abdominal surgeries than in other surgeries (39.5%:10.4%). (4) The incidences of intra- and postoperative bronchospasm increased in proportion to the proximity of the latest asthmatic attack to the operative date. (5) Prophylactic preoperative inhalation of bronchodilators was effective in the prevention of intraoperative bronchospasm, but some patients developed postoperative wheezing within a few days after the cessation of postoperative inhalation.

Bronchospasm and cough as adverse reactions to the ACE inhibitors captopril, enalapril and lisinopril. A controlled retrospective cohort study

1. We report a controlled retrospective cohort study of respiratory adverse reactions to ACE inhibitors. Bronchospasm and cough occurred at a higher rate in patients treated with ACE inhibitors, no links with sex, past history of bronchospasm, drug type or dose were found. 2. Cohorts of 1013 patients on angiotensin converting enzyme (ACE) inhibitors and 1017 patients on lipid lowering drugs (LLDs) were compared for the occurrence of new bronchospasm, relapse of previous bronchospasm, increase of current bronchospasm, and cough. 3. The prevalence of bronchospasm was 5.5% for patients on ACE inhibitors and 2.3% for patients on LLDs, P < 0.001. The relative risk of a bronchospasm adverse reaction for a patient on an ACE inhibitor compared with a patient on a LLD was 2.39, 95% confidence interval 1.47 to 3.90. 4. No ACE inhibitor specificity, or significant sex differences were found in the prevalence of bronchospasm or cough after correcting for bias implicit in the original cohorts. The bronchospastic reactions were not dose dependent. 5. The prevalence of a past history of bronchospasm in patients reporting ACE inhibitor-induced bronchospasm (16%) was not significantly different from the prevalence in patients on ACE inhibitors without an adverse reaction (13%), P = 0.447. 6. The prevalence of ACE inhibitor cohort cough was 12.3% and 2.7% in the patients on LLDs, P < 0.0001. Cough did not occur more commonly in patients on ACE inhibitors who had experienced any bronchospasm (28%) than in patients on LLDs with bronchospasm (27%).

Complications of endoscopic sinus surgery: analysis of 2108 patients--incidence and prevention

The incidence of complications of endoscopic sinus surgery (ESS) in a combined experience with 2108 total patients is compared to complications in 11 other series of patients (2583 total) who underwent ESS and 6 series of patients (2110 total) who underwent traditional endonasal sinus surgery. The incidence of major perioperative complications was 0.85%, with cerebrospinal fluid (CSF) leak being the most common. The most common minor complications of ESS were those related to orbital penetration and middle turbinate adhesions; minor complications occurred in 6.9% of the 2108 patients. There were no statistically significant differences in the overall incidences of major complications between this series and the other two groups. Recommendations are made for the prevention of complications during ESS.

[Incidence of adverse reactions to additives. Our experience over 10 years]

No published information exists about the incidence of food additives reactions in the general population. Most studies have been made in patients with urticaria and bronchial asthma. The majority of them lack an adequate design and, therefore, the reported results should be interpreted with extreme caution. In this article, we expose our ten years experience in this field. We have added up 1941 oral provocation tests, with an ample battery of additives, administering the tested substances directly or in aqueous or acid solution (1110 in patients with urticaria, mainly chronic urticaria, and 831 in asthmatic subjects, with or without aspirin intolerance). From these exhaustive data, we get the following conclusions: 1) in contrast with other-investigators, and using similar or even higher provocation doses, we get a very low incidence of adverse reactions. 2) We are sceptical that food additives play any role in chronic urticaria or in other cutaneous processes (only 0.63% provocation tests resulted in an urticarial exacerbation, and none of them was repeated after re-provocation). 3) In asthmatic patients, similar results were obtained, except with sulfites in acid solution challenge test (10% asthmatic exacerbations), possibly as a sign of nonspecific bronchial hyperreactivity. 4) The prescription of food additives free restrictive diets does not seem to be justified. The should be followed only by those patients with clear evidence of additives reactions. 5) In most cases, with punctual exceptions, the study of food additives reactions, in clinical allergy, implies a waste of time.

Bronchodilator reversal of bronchospasm and symptoms incurred during methacholine bronchoprovocation challenge. Documentation of safety and time course

We undertook a prospective study of bronchoprovocation challenge (BPC) to look at issues of safety and reversibility of bronchospasm and symptoms induced by BPC. Over a 14-month interval, we documented 62 consecutive cases of bronchial hyperresponsiveness. During BPC, there was a statistically significant but clinically modest increase in both cough and dyspnea. Both bronchospasm and symptoms were readily reversed with a simple protocol of inhaled albuterol using a metered-dose inhaler with a spacer. Routine protocol was effective in every case; there was never a need for individualized physician intervention. Our prospective data document the safety of BPC; we could find no reason why BPC would need to be confined to the hospital. We conclude that BPC is a valuable clinical test which merits wider dissemination and use.

Complications and fiberoptic assessment of size 1 laryngeal mask airway

In pediatric practice, complications due to the laryngeal mask airway (LMA) have been studied with size 2 LMA, but not with size 1 LMA. We, therefore, compared prospectively the complications induced by LMA size 1 and 2 in 141 children aged 21 days to 11 yr. Intraoperative and lowest SpO2 values after removal of LMA were recorded. The following complications were recorded: cough, laryngospasm, bronchospasm, apnea, and airway obstruction. In 14 patients in the size 1 LMA group and 26 patients in the size 2 LMA group, pharyngolaryngeal structures were checked with fiberoptic examination. The number of attempts, complications, intraoperative SpO2, and lowest SpO2 values were similar when using size 1 and size 2 LMA. Fiberoptic examination of size 1 LMA showed a high incidence of impinging of the epiglottis in the LMA bars without airway obstruction. In conclusion, there was no difference in the complication rate between the two pediatric sizes of LMA when used in pediatric patients.

Immediate health effects of an urban wildfire

To document the immediate health effects of the urban wildfire that swept through parts of Alameda County, California, on October 20 and 21, 1991, we conducted a retrospective review of emergency department and coroner's records. Nine hospitals (6 local and 3 outlying) were surveyed for the week beginning October 20, 1991. Coroner's reports were reviewed for 25 identified fire-related deaths. A total of 241 fire-related emergency encounters, including 44 inpatient admissions, were recorded for 227 persons. Nearly a fourth of emergency department patients were seen for work-related injuries, more than half of which occurred among professional firefighters. Smoke-related disorders constituted more than half of all emergency department cases; of these, 61% had documented bronchospasm. Major trauma and burns contributed 1% and 4% of principal diagnoses, respectively; these were exceeded in number by corneal abrasions (13%), other medical problems (8%), and minor trauma (7%), among other diagnoses. All coroner's cases involved extensive burns, many with documented smoke inhalation injury. While the Oakland-Berkeley fire storm resulted in a high case-fatality ratio among major burn cases (25/31), those who survived the initial fire storm did well clinically. Among emergency department patients, medical (particularly smoke-related) disorders outnumbered traumatic presentations by a ratio of more than 2 to 1.

[Potroom asthma: irritative bronchospasm or due to sensitization?]

The incidence of occupational bronchial asthma (potroom asthma) among workers employed on electrolytic reduction of aluminium is between 0.4 and 4%. No precise etiological agent has been identified; irritating agents are usually blamed, especially fluoridric acid, dusts, and SO2. Nevertheless, some features of potroom asthma, such as the moderate prevalence, the latency period, the progressive increase in sensitivity with continuing exposure, the appearance of symptoms several hours after the beginning of the work shift, the persistence of symptoms and of aspecific bronchial hyperreactivity even after withdrawal from the working environment, suggest the possibility of occupational asthma due to sensitization. Knowledge of the pathogenetic mechanism has direct influence on prevention: in the case of asthma due to irritants it may be sufficient to comply with the TLV, while in the case of sensitization, even low levels of exposure can be sufficient to trigger off the symptoms of bronchial asthma.

[Epidemiological study of asthmatic crises in a maternal-child emergency service]

In our region, allergic respiratory diseases affects over 55% of the child up to 5 years. This could be attributed to some peculiarities of our region, such as consanguinity, climate and predominant sensitisation to dermatophagoides mite. We made an epidemiologic study on the bronchospasm urgent cases attended in the Urgency Unit of our Maternal-Child Hospital in Las Palmas. We took 935 patients with a mean age of 32.36 months with acute attacks of bronchospasm, and found no significant difference between patients from the Northern and Southern zones of the island. Bronchospasm cases were more frequently observed in Autumn and Winter. We discuss here about the possible causing agents involved and want to draw attention to the need of education for our patients' parents for them to learn antiasthmatic medication and how to use it, before going to the Urgency Unit of any Hospital.

Safety of bronchoalveolar lavage in the critically ill, mechanically ventilated patient

OBJECTIVE

To assess complications of bronchoalveolar lavage in the intubated, mechanically ventilated patient.

DESIGN

A retrospective, consecutive case series.

SETTING

Medical, surgical, and bone marrow transplant critical care units at a university teaching hospital.

PATIENTS

Ninety-nine consecutive critically ill, mechanically ventilated patients undergoing bronchoalveolar lavage were included in the study.

INTERVENTIONS

All patients underwent bronchoalveolar lavage using a standard method designed to maximize the safety of the procedure.

MEASUREMENTS

Each patient's hospital chart was reviewed for immediate and delayed medical complications of the procedure, including cardiac arrhythmias, bleeding, and hemodynamic disturbances. Specific indices of lung mechanics (peak inspiratory airway pressure and static compliance) and oxygenation (alveolar to arterial oxygen tension gradient [P(A-a)O2] and the ratio of FIO2/PaO2) were measured before and 4 hrs after bronchoalveolar lavage to assess durable physiologic consequences of the procedure.

RESULTS

No complications occurred that required premature termination of bronchoalveolar lavage. Three patients exhibited adverse effects (hypotension in two and wheezing in one) immediately after the procedure, all of which resolved promptly with treatment. No statistically significant changes were observed in the variables of arterial oxygenation or pulmonary mechanics. Although the sample mean did not change significantly for any of the oxygen variables, 19% of the patients experienced widening of the P(A-a)O2 by greater than 100 torr (greater than 13.3 kPa). A systematic analysis indicated that there was no statistically significant relationship between readily available clinical variables (including duration of mechanical ventilation before bronchoalveolar lavage and prebronchoalveolar lavage P[A-a]O2), and deterioration in oxygenation after the procedure.

CONCLUSIONS

We conclude that bronchoalveolar lavage is a well-tolerated procedure in critically ill, mechanically ventilated patients, provided that risk factors for complications are corrected before the procedure and one adheres to procedural guidelines focused on patient safety. Clinically important complications are uncommon. Some patients exhibit deterioration in oxygen after bronchoalveolar lavage; this occurrence cannot be predicted before the procedure.

Complications after cardiac operations in patients with severe pulmonary impairment

The postoperative courses of 39 patients with severe lung disease (31 with obstructive disease and 8 restrictive) who underwent a cardiac operation were retrospectively reviewed. The stay in the intensive care unit of the study group was 7.9 +/- 10.3 days (mean +/- standard deviation) compared with 2.4 +/- 3.9 days for the control group (100 patients with less impaired pulmonary function) (p less than 0.001). The study group also had a greater number of valve replacements than did the control group (p less than 0.01). Patients with obstructive disease had more respiratory complications than did patients with restrictive disease (p less than 0.05). There were 21 cases of atelectasis. Effusions were noted in 11 patients. Ten patients had bronchospasm. Bronchial secretions were a major problem in 6 patients. Pneumonia developed in 4 patients, and pneumothorax occurred in 3 others. The two in-hospital deaths were not directly related to pulmonary complications. Our findings indicate that (1) patients with severe lung impairment generally do well after a cardiac operation but have more postoperative pulmonary complications than patients with less impairment; (2) patients with restrictive pulmonary disease appear to fare better than those with obstructive disease; (3) pulmonary function tests can alert the clinician to the possible risk of postoperative complications, but they cannot, by themselves, be used to exclude patients from operation; and (4) patients with severe pulmonary impairment facing valve replacement are at greater risk of pulmonary complications than patients having other types of cardiac surgical intervention.

[Climatic factors and bronchospasm crises in children in the Maresme district (Barcelona)]

In the area of El Maresme (Barcelona), it was studied the correlation between climatic agents and episodes of bronchospasm in children from 0 to 14 years old, in the emergency hospital unit during 1985. In the 735 visits that were studied, there were remarked seasonal variation, with predominance of cases during autumn, and descent during summer. The episodes presented a simple correlation, statistically significant with temperatures and the wind's direction; the climatic agents represented a very low percentage in the variation observed.

Asthma, asthmalike symptoms, chronic bronchitis, and the degree of bronchial hyperresponsiveness in epidemiologic surveys

Measurement of bronchial hyperresponsiveness has been suggested to be a useful test in identifying subjects with asthma in epidemiologic groups. We explored the association between the degree of bronchial hyperresponsiveness, respiratory symptoms suggestive of asthma, chronic bronchitis, and various definitions of asthma based upon information obtained from a questionnaire. We determined bronchial hyperresponsiveness by methacholine inhalation test, administered a standardized respiratory questionnaire, and performed spirometry on 1,392 male workers in various industries: 229 (16.5%) had PC20 less than 8 mg/ml, 66 (4.7%) had PC20 less than 2 mg/ml, and 8 (0.6%) had PC20 less than 0.5 mg/ml. Only 760 workers had no respiratory symptoms; no workers with PC20 less than or equal to 0.5 mg/ml, 31.0% of workers with PC20 greater than 0.5 but less than or equal to 2 mg/ml, and 38.0% of workers with PC20 greater than 2 but less than or equal to 8 mg/ml had no chest symptoms. Those reporting wheeze or breathlessness, and especially those with both symptoms, were significantly more likely to have bronchial hyperresponsiveness with a low PC20. The reporting of chest tightness did not influence this relationship, and there was no difference between the occurrence of "wheeze without a cold" and "persistent wheeze." Although there was a stronger association of PC20 less than or equal to 2 mg/ml with asthma than with chronic bronchitis, the association of PC20 greater than 2 and less than or equal to 8 mg/ml was not different with asthma than with chronic bronchitis. Bronchial hyperresponsiveness was more closely associated with asthma than with any asthmalike symptoms ascertained by a questionnaire developed for the study of chronic bronchitis.(ABSTRACT TRUNCATED AT 250 WORDS)

Intraoperative respiratory complications in patients with upper respiratory tract infections

A retrospective survey of 3,585 patients aged newborn to 20 years was performed to investigate the prevalence of intraoperative respiratory complications in patients with symptoms of upper respiratory tract infections (URIs). There were no significant differences in complication rates between asymptomatic patients (1.61 per 100) and those with symptoms (1.64 per 100); however, patients who were asymptomatic but had a recent history of an URI had a significantly higher complication rate (5.31 per 100; p less than 0.05) than the asymptomatic patients. There were no significant differences in intraoperative complications between patients managed with and without tracheal intubation, nor was there any association between the type of anaesthetic agent used and the development of intraoperative respiratory complications. Results from the study suggest no increased risk of respiratory complications for patients presenting with uncomplicated URIs. However, patients who were asymptomatic but had a recent history of an URI showed a significantly increased risk for the development of intraoperative complications.

Bronchospasm during anaesthesia. A computer-aided incidence study of 136,929 patients

With the aid of a computer-based anaesthetic record-keeping system, anaesthetics complicated by bronchospasm during anaesthesia at the Karolinska Hospital were retrieved. The incidence of bronchospasm was calculated in groups characterized by various variables. In total, 246 cases of bronchospasm in 156,064 anaesthetics were retrieved. This corresponds to one case in 634 anaesthetics or 1.7 per 1000 patients. High incidence figures were seen in the age group 0-9 years (4.0/1000) when the patients showed a respiratory infection (41.1/1000), a pathological preoperative ECG (24.3/1000), an obstructive lung disease (21.9/1000), were classified as belonging to ASA class III (23.8/1000), if a tracheal intubation was performed (9.1/1000) or a rectal anaesthesia (35.7/1000) was given. In the age group 50-69 years (1.8/1000), high incidence figures were seen when there was an airway obstruction (8.8/1000), an obstructive lung disease (7.7/1000), a previous myocardial infarction (5.4/1000), a bronchoscopy (7.6/1000) or a mediastinoscopy (7.8/1000) was performed. Most of the cases had no history of allergy or asthma recorded in the anaesthetic form. In this series the triggering factor more often seemed to be of mechanical origin. There were no intraoperative deaths.

[Time and incidence of peroperative cardiovascular complications in geriatric patients]

The incidence of intraoperative and postoperative complications was determined in a retrospective study via data evaluation by computer. Two groups of patients were examined, one group comprising patients below 60 years of age, whereas the other group consisted of persons above 60 years of age. The results show that complications of the cardiovascular system are three to four times more frequent in patients older than 60 years; severe hypotension or hypertensive reactions were seen in 2.9 and 9.3% of the patients, respectively, while arrhythmias occurred in 3.9%. No differences could be found in respect of the time at which these complications became manifest (intraoperatively or in the recovery room). Enumeration of the secondary diseases covered by this study, reveals significant differences; this can explain the limited range of compensation in persons of advanced age. Hence, an optimal preanaesthetic treatment and diagnosis, as well as monitoring are mandatory in geriatric patients to ensure safe anaesthesia.

Serum IgE levels and the clinical expression of respiratory illnesses

The incidence, clinical manifestations, and infectious etiology of respiratory illnesses observed in a prospective longitudinal study were correlated with serum IgE values, which were used as objective markers of atopy. The incidence of wheezing illnesses was greater in children with elevated IgE levels, confirming an association previously reported. In contrast, the incidence of upper respiratory illness or middle ear disease showed no correlation with IgE values. The number and types of viral infections distributed evenly throughout the population. The results suggest that children with recurrent URI or MED deserve evaluation for allergy only if there are other clinical findings suggestive of atopy.

Age-sex incidence in symptomatic allergies: an excess of females in the child-bearing years

Eight-hundred and one patients amongst 1912 referred for skin testing because of suspected allergies were found suffering from asthma due to the house-dust mite or from grass pollenosis. They were analysed in terms of sex, age of referral and age of onset of symptoms. Amongst children referred below the age of 10 with house-dust mite asthma the ratio of males to females was 3:1; with grass pollenosis 2-1:1, as expected. The sex ratio gradually became reversed with increasing age of referral, females overtaking males in the third decade. Female-male ratios increased to a mean of 1-8:1 in the fourth and fifth decades. Reliable ages of onset of symptoms were obtained in 388 males and 323 females. Of these, 280 males and 162 females experienced their first symptoms before the age of 10 whereas 96 males and 148 females first developed symptoms between 10 and 29 years of age. The remaining 12 males and 13 females showed their first symptoms after the age of 29.