Esko Huhti

Prevalence of chronic obstructive pulmonary disease in elderly Finns

The prevalence of chronic obstructive pulmonary disease (COPD) in the elderly is poorly known. The aim of this study was to determine the prevalence of COPD and to analyse the factors associated with it in an elderly Finnish population. The population consisted of persons resident in Lieto, Finland, born in or before 1926. One thousand one hundred and ninety-six individuals (488 men and 708 women, 93% of those eligible) participated in the survey, which was carried out in 1990-91 at the Lieto Health Centre. The methods included a nurses interview and spirometry with a bronchodilator test. The participants were also clinically examined, and the number of subjects with COPD was determined using simple diagnostic criteria. Sixty-one men and 21 women with COPD were found. Thus the prevalence was 12.5% for the men and 3.0% for the women. In both sexes only about 2% of those who had never smoked suffered from COPD, but among the current smokers the prevalence was 35% for the men and 13% for the women. In a stratified analysis COPD was commonest among those with a low social status and histories of smoking and working in dusty occupations. In a majority the obstruction was only minimally reversible when tested with salbutamol inhalation. The study confirmed that the prevalence of COPD in the elderly with negative histories of smoking is low, and emphasizes the importance of reducing smoking as the only effective preventive measure.

Course and Outcome of Ocular Sarcoidosis

In a series of 281 patients with histologically confirmed sarcoidosis, 79 initially had ophthalmic sarcoid manifestations. Of 22 patients with uveitis, 21 were seen regularly as long as the inflammation was active, and 71 of the 79 patients (90%) underwent a follow-up study five to 16 years (mean, nine years) later and using the same protocol. In the 21 patients with uveitis, the disease exhibited either a monophasic course (eight patients) with favorable visual outcome or a relapsing course (13 patients) with severe visual loss in five eyes. Thirty-three patients showed chronic ophthalmic changes at the follow-up examination, including conjunctival granulomas (13 patients), lacrimal gland involvement (22 patients), uveitis (four patients), and involvement of lacrimal passages (three patients). In 15 of these 33 patients, the general physical examination and the chest x-ray showed no evidence of systemic sarcoidosis. However, the serum angiotensin converting enzyme level was increased in a significantly greater proportion of these 15 patients than in the patients assessed as totally recovered from sarcoidosis.

Prevalence of asthma in elderly finns

There is uncertainty about the prevalence of asthma even in countries in which extensive epidemiological surveys have been carried out and attention has been drawn to a probable increase in prevalence. A cross-sectional epidemiological survey of asthma in the population aged 64 years or over was carried out in the rural district of Lieto, Finland. All 1196 participants (488 men and 708 women, 93% of those eligible) were examined and individually assessed using a set of criteria for asthma. The prevalence of current asthma was 2.9% in the men and 3.8% in the women and it accounted for about 40% of the cumulative (life-time) prevalence of self-reported asthma. Current asthma was uncommon in men aged 75 years or over and no cases were found in men who smoked. Current asthma in women was associated with low social status, smoking and dusty working conditions in the past. The difference in prevalence between the men and women was greatest among the smokers, which may be due to a previous high mortality among elderly asthmatic men who had been smoking, or a lack of the typical characteristics of asthma in men with long histories of smoking. The prevalence of asthma was similar to that obtained earlier in Finland and elsewhere.

Chronic obstructive pulmonary disease and cognitive impairment in the elderly.

In a cross-sectional epidemiological study in Lieto, Finland, 61 men and 21 women with chronic obstructive pulmonary disease (COPD) were compared with age- and sex-matched controls from the same community to analyze the associations between COPD, cognitive performance, and occurrence of dementia. The cognitive assessment was based on the Mini-Mental State Examination (MMSE), previous clinical documents, and the assessment made by the research nurse after she had interviewed and tested each subject. These three measures revealed no differences between the COPD patients and the age-matched controls, and MMSE subtest scores did not differ significantly between the patients and controls. The findings suggest that the relative contribution of COPD to the occurrence of cognitive impairment and dementia in the elderly may be none or minimal at the community level.

Incidence and clinical picture of sarcoidosis in a circumscribed geographical area

The incidence and clinical picture of sarcoidosis were studied on the basis of an unselected series of 354 sarcoidosis patients (168 men, 186 women) in a defined geographical area during the years 1970-81. All the patients were examined in hospital. The mean annual incidence of sarcoidosis was 15 cases per 100 000 population 15 years or older. Sixty-four per cent of the cases began or were diagnosed in the first half of the year (P less than 0.001). The disease was diagnosed in 67% of the male cases and 38% of the females before the age of 35. Sarcoidosis was found by mass chest radiographic survey or by chance in 99 men (59%) and 103 women (55%), but 85 men (51%) and 129 women (69%) had symptoms of the disease. Two hundred and eighteen patients (62%) had bilateral hilar adenopathy upon diagnosis of the disease, 120 (34%) parenchymal changes and three fibrotic radiographic changes. Lung function test results tended to decrease with the radiographic stage and were indicative more of obstruction than restriction.

Serum Copper Levels in Patients with Lung Cancer

An increased mean serum copper level was found in 149 patients with lung cancer when compared with 19 healthy people and 23 patients with non-malignant lung diseases. The level seemed to reflect the stage of disease, with asymptomatic patients showing the lowest values, and patients with metastatic symptoms the highest. In spite of significant differences between the groups of subjects the scatter in the values was large. Hence serum copper determinations can be of only limited importance for differential diagnosis or in assessing the clinical stage of cancer. No differences in copper levels were found between the groups of patients with different histological types of lung cancer.

Chronic obstructive pulmonary disease and self-maintaining functions in the elderly--a population-based study.

OBJECTIVE To describe and analyse the problems in self-maintaining activities among chronic obstructive pulmonary disease (COPD) patients aged 64 years and over. DESIGN A case-control study. SETTING Health Centre in Lieto, Finland, 1990-91. SUBJECTS 61 men and 21 women with COPD and 183 male and 63 female sex- and age-matched controls. The COPD group included 8 men and 11 women who also had asthma. MAIN OUTCOME MEASURES Numbers of subjects with difficulties or dependence in self-maintaining activities. RESULTS The number of subjects with difficulty or dependence in the activities of daily living (ADL) was similar among the patients and the controls, but some differences between the two groups were seen on items of mobility and instrumental activities of daily living (IADL). The COPD patients had more difficulties or showed dependence in moving outdoors or walking at least 400 m. In addition, the male COPD patients reported more difficulty or dependence in doing heavy housework and the female patients in even doing light housework than the controls. CONCLUSION The study indicated that the female COPD patients in particular have a great need for assistance in self-maintaining functions. This information is valuable for local primary health care planning.

Emergency Room Visits for Acute Attacks of Asthma: Characterization of Patients and Visits

To characterize asthma emergencies, all patients attending the hospital because of an asthma attack in 1 year were studied. Of the 212 patients concerned, 148 attended the hospital once, 34 twice and 30 three times or more. The total number of visits was 351. The mean age of the patients was 50 (15-85) years, and 32% of those under 65 years were receiving a pension because of asthma. Eleven patients (5%) had drinking problems, and 62 (29%) had treatment for other diseases. Atopy was diagnosed in 83 patients (39%). Of the patients with one, two or more numerous visits 39, 74 and 90%, respectively, were taking oral steroids, whereas the corresponding figures for those using inhaled steroids were 34, 71 and 61%. Medical treatment seemed to be inadequate more often among the frequent visitors. Seasonal variation in visits was evident, the rates being lowest in July and highest in March. Time-of-day variation was also found, visits being most common from 10 to 11 a.m.

Serum Copper, Zinc and Ceruloplasmin Concentrations in Patients with Lung Cancer

Serum copper (SCu), zinc (SZn) and ceruloplasmin (SCP) concentrations were measured in 199 patients with lung cancer and 81 with nonmalignant lung disease. No significant differences were detected between these groups in the mean concentrations or in the SCu:SZn ratio, nor was any correlation found between the histological type or clinical extent of the tumor and the level of SCu, SZn or SCP. SCu and SCP increased significantly in accordance with the symptomatic stages of Feinstein, and in a parallel manner. These measures were also significantly higher in the patients who died within 4 months of diagnosis than in those who lived for 4 months or longer. SZn was similar throughout and was not predictive of the prognosis. It is concluded that SCu, SZn and SCP determinations are of no help in distinguishing malignant from nonmalignant lung disease and are only of limited importance for estimating the extent of the disease or the prognosis of a patient with lung cancer.

Comparison of Fenoterol, Ipratropium Bromide, and Their Combination in Patients with Asthma or Chronic Airflow Obstruction

Berotec (0.4 mg fenoterol hydrobromide, regimen B), Atrovent (0.08 mg ipratropium bromide, regimen A) and Duovent (0.2 mg fenoterol hydrobromide and 0.08 mg ipratropium bromide, regimen D) were administered by metered dose inhalers (MDI) to 12 patients with asthma (regimens D and B only) and 12 patients with chronic airflow obstruction (CAO). The increase in FEV1 was similar after all regimens, but greater in the patients with asthma than those with CAO. In the patients with asthma, the increase in FVC was greater after Berotec than Duovent but the difference may not be clinically important. In the patients with CAO, the increase in FVC was greater after Duovent than after the other regimens. Subjective side effects were commoner after Berotec than the other regimens, hence in the doses used Duovent may offer some clinical advantage as compared with Berotec and Atrovent used alone.