J P Delwiche

Socioeconomic outcome of subjects experiencing asthma symptoms at work.

The aim of this study was to investigate the socioeconomic outcomes of subjects who experienced workrelated asthma symptoms in the absence of demonstrable occupational asthma (OA) and to compare these outcomes with those found in subjects with documented OA. Subjects (n=157) who were being investigated for workrelated asthma, were surveyed. Of these 86 had OA, ascertained by a positive specific inhalation challenge (SIC), and 71 subjects had a negative SIC response. After a median interval of 43 months (range 12–85 months), the subjects were interviewed to collect information on employment status, income changes, and asthmarelated work disability. Rates of work disruption and income loss at followup were similar in subjects with negative SIC (46% and 59%, respectively) and in those with OA (38% and 62%). The median loss as a percentage of initial income was 23% in subjects with negative SIC and 22% in subjects with OA. Asthmarelated work disability, defined as any job change or work loss due to asthma, was slightly more common in subjects with OA (72%) than in those with negative SIC (54%). This study shows that, even in the absence of demonstrable occupational asthma, workrelated asthma symptoms are associated with considerable socioeconomic consequences.

Increase in non-specific bronchial hyperresponsiveness as an early marker of bronchial response to occupational agents during specific inhalation challenges.

BACKGROUND: Specific bronchial reactivity to occupational agents may decline after exposure in the workplace ceases leading to falsely negative specific inhalation challenges. A study was carried out to assess prospectively whether increases in nonspecific bronchial hyperresponsiveness could be useful in detecting the bronchial response to occupational agents during specific inhalation challenges. METHODS: Specific inhalation challenges were performed in 66 subjects with possible occupational asthma due to various agents. After a control day the subjects were challenged with the suspected agent for up to two hours on the first test day. Those subjects who did not show an asthmatic reaction were rechallenged on the next day for 2-3 hours. The provocative concentration of histamine causing a 20% fall (PC20) in the forced expiratory volume in one second (FEV1) was assessed at the end of the control day as well as six hours after each challenge that did not cause a > or = 20% fall in FEV1. The subjects who had a significant (> or = 3.1-fold) reduction in PC20 value at the end of the second challenge day were requested to perform additional specific inhalation challenges. RESULTS: The first test day elicited an asthmatic reaction in 25 subjects. Of the other 41 subjects five (12%, 95% confidence interval (CI) 4% to 26%) exhibited a > or = 3.1-fold fall in the PC20 value after the inhalation challenge and developed an asthmatic reaction during the second (n = 3) or third (n = 2) challenge exposure. The offending agents included persulphate (n = 1), wood dust (n = 2), isocyanate (n = 1), or amoxycillin (n = 1). These five subjects had left their workplace for a longer period (mean (SD) 21 (14) months) than those who reacted after the first specific inhalation challenge (8 (11) months). CONCLUSIONS: The increase in non-specific bronchial hyperresponsiveness after a specific inhalation challenge can be an early and sensitive marker of bronchial response to occupational agents, especially in subjects removed from workplace exposure for a long time. Non-specific bronchial hyperresponsiveness should be systematically assessed after specific inhalation challenges in the absence of changes in airway calibre.

Occupational asthma caused by aluminium welding

Work-related asthma has been documented in workers employed in the primary aluminium industry and in the production of aluminium salts. The role of aluminium in the development of occupational asthma has, however, never been convincingly substantiated. We investigated a subject who experienced asthmatic reactions related to manual metal arc welding on aluminium. Challenge exposure to aluminium welding with flux-coated electrodes, as well as with electrodes without flux, elicited marked asthmatic reactions. Manual metal arc welding on mild steel did not cause significant bronchial response. The results of inhalation challenges combined with exposure assessments provided evidence that aluminium can cause asthmatic reactions in the absence of fluorides. Awareness of this possibility may be relevant to the investigation of asthma in workers exposed to aluminium.

Asthma to tetramethrin.

References 1. LAGUNOFF D, MARTIN TW. Agents that release histamine from mast cells. Annu Rev Pharmacol Toxicol 1983;23:331±351. 2. ARNDT KA, JICK H. Rates of cutaneous reactions to drugs. J Am Med Assoc 1976;235:918±923. 3. NABIL R, FAHMY MD. Hemodynamics, plasma histamine, and catecholamine concentrations during an anaphylactoid reaction to morphine. Anesthesiology 1981;55:329±331. 4. VOORHORST R, SPARREBOOM S. Four cases of recurrent pseudo-scarlet fever caused by phenathrene alkaloids with a 6-hydroxy group (codeine and morphine). Ann Allergy 1980;44:116±120. 5. HUNSKAAR S, DRAGSUND S. Scarlatiniform rash and urticaria due to codeine. Ann Allergy 1985;55:240±241. 6. DE GROOT AC, CONEMANS J. Allergic urticarial rash from oral codeine. Contact Dermatitis 1986;14:209±214. 7. RODRIGUEZ F, FERNAÂ NDEZ L, GARCIÂAABUJETA JL, MAQUEIRA E, LLACA HF, JEÂ REZ J. Generalized dermatitis due to codeine. Contact Dermatitis 1995;32:120.

Occupational asthma due to latex in a hospital administrative employee.

A case is described of occupational asthma caused by indirect exposure to airborne latex allergens in an administrative hospital employee who never used latex gloves.

Early Bronchodilating Effect of Oxitropium Bromide in Comparison with Ipratropium Bromide

The bronchodilating effects of a metered aerosol dose of 40 micrograms ipratropium bromide and of 200 micrograms oxitropium bromide are similar 15 min. after administration. The bronc hodilating activity of ipratropium bromide appears earlier (i.e., 75-90 s after administration) than that of oxitropium bromide but later than that of ibuterol, a beta2-agonist. Ipratropium bromide administered at the close of 80 micrograms provokes a bronchodilation about double of that obtained with 40 micrograms. An adaptation of the usual dosage should be considered.

Controlled trial of the effect of repeated administration of ipratropium bromide on ventilatory function of patients with severe chronic airways obstruction

A trial was designed to assess whether repeated administration of ipratropium bromide for two weeks produced greater improvement than was obtained after a single dose. The effect of ipratropium bromide was compared with that of a placebo during a double-blind cross-over randomized trial in patients with advanced chronic airways disease in a stable state. Ipratropium bromide and placebo were both administered by metered dose inhaler for 14 days. There was a slight statistically significant improvement of conductance, thoracic gas volume, FEV1 and VC after inhalation of ipratropium bromide, but repeated doses of the drug did not produce progressive improvement.

Bronchoalveolar lavage immunoglobulin A and G and antiproteases correlate with changes in diffusion indices during the natural course of pulmonary sarcoidosis

We wanted to determine whether cell populations and soluble components in bronchoalveolar lavage (BAL) could be useful in predicting the outcome of lung function and chest radiography in patients with untreated pulmonary sarcoidosis. Analysis of soluble proteins in BAL fluid, included the levels of immunoglobulins and the two major antiproteases, alpha 2-macroglobulin (alpha 2-M) and alpha 1-protease inhibitor (alpha 1-PI), expressed as a relative coefficient of excretion (RCE). Thirty one nonsmoking patients with biopsy proven sarcoidosis, who remained untreated, had reassessment of lung function tests after 6-54 months (median 21 months). No correlation was observed between initial BAL data and changes in lung volumes and radiographic opacities. By contrast, the initial BAL immunoglobulin A and G (IgA and IgG) RCE correlated inversely with the change in transfer factor for carbon monoxide (TLCO) in the whole group and in patients with sarcoidosis of recent origin (estimated disease duration < 6 months). In the whole group and in patients with longstanding disease (estimated disease duration > 24 months, or radiographic Stage 4), the change in carbon monoxide transfer coefficient (KCO) correlated negatively with the initial alpha 1-PI RCE and positively with the initial helper to suppressor T-cell (T4/T8) ratio. By contrast, no significant difference in BAL cellular and protein data was found between patients with recent and longstanding sarcoidosis.(ABSTRACT TRUNCATED AT 250 WORDS)

Does negative expiratory pressure influence performances of spirometry in older patients

The aim of this study is to assess the influence of the negative expiratory pressure (NEP) technique on the performance of maximal expiratory manoeuvre in elderly patients. Firstly, the authors studied how NEP (at 5 and 10 cmH2O, NEP5 and NEP10) influences forced vital capacity (FVC) and forced expiratory volume in one second (FEV1) in 60 young healthy volunteers, in order to assess the fluctuations of the method. In the second part of the study, 65 successive elderly inpatients (>70 yrs old) were examined. In this group, 15 elderly patients were unable to perform the manoeuvre, 27 had a normal function, 14 had a lung function with obstructive pattern and nine with restrictive pattern. In young subjects, FVC during NEP5 and NEP10 compared to baseline values was 101±5% and 103±5%, respectively, and FEV1 was 100±4% and 101±5%, respectively. In elderly patients with normal function, FVC during NEP5 and NEP10 compared to baseline values was 99±14% and 109±23%, respectively, and FEV1 was 97±9% and 104±13%, respectively. There were no relevant effects of the NEP application on FVC or FEV1 values in elderly patients with an obstructive or restrictive pattern. In elderly patients, the use of the negative expiratory pressure technique during maximal expiratory manoeuvres provides little complementary information compared to a classical manoeuvre. The negative expiratory pressure technique did not modify the initial diagnosis when compared with the classical manoeuvre.

Asthma to latex and amoxicillin.

positive patch tests. urticarial eruption 3 h after ingestion of tetrazepam 50 mg. Patient 2 developed lesions similar to those previously described ^—^-——^^^^———^^^ 10 h after ingestion of tetrazepam 12,5 mg. In patient 3, tests were not per^ ^ ^ ^ _ _ ^ ^ ^ ^ _ _ ^ ^ ^ ^ formed due to the severity of symptotns. All patients tolerated other benzodiazepines such as brot-nazepatii 1,5 vug (Lexatin®, Roche) and diazepatii 5 mg (Vahutn®, Roche) without ill effect,