Russell Dodge

Early childhood respiratory symptoms and the subsequent diagnosis of asthma

BACKGROUND Respiratory symptoms are frequent in very young children, and the relation of these symptoms to later asthma in some of these children is unknown. OBJECTIVE The aim of the study was to describe the natural history of respiratory symptoms in a community-based sample of young children who were prospectively observed for as long as 11 years. METHODS Subjects were participants in the Tucson Epidemiologic Study of Airways Obstructive Disease. They were under 5 years of age at enrollment and were studied by means of a parent-administered mail survey instrument every 1 to 2 years for 3 to 11 years. RESULTS Among subjects younger than 1 year of age, no single respiratory symptom, such as cough or wheeze only with colds, significantly increased the risk of a subsequent diagnosis of asthma. Among 1- and 2-year-olds, however, those with wheeze only with colds and those with attacks of shortness of breath with wheeze were more likely to be diagnosed with asthma later when compared with children without those symptoms (odds ration = 2.1; p < 0.05 for wheeze only with colds). At ages 3 to 4 years, symptoms were even more strongly associated with subsequent asthma (odds ratio = 7.2; p < 0.0001 for attacks of shortness of breath with wheeze). CONCLUSION Although respiratory symptoms reported by parents very early in life are not significantly associated with future asthma, those symptoms that begin at or persist through ages 3 to 4 years are.

Ketoconazole treatment of nonprimary coccidioidomycosis: Evaluation of 60 patients during three years of study☆

Sixty patients with coccidioidomycosis were treated with ketoconazole rather than with another antifungal agent, and their responses were evaluated in relation to the predominant site of involvement. For the three main groups, improvement occurred in 12 of 19 patients with chronic pulmonary infections, in 20 of 23 with soft tissue lesions and in six of 11 with skeletal involvement. Infections in soft tissues improved most rapidly (average of 34 days) and often with 200 mg per day, whereas pulmonary and skeletal infections improved more slowly (63 and 165 days, respectively), usually requiring 400 mg per day. Of 12 patients with response in whom therapy has been discontinued, seven have had relapses. Recurrence was apparent usually within the first month and after six months or less of treatment. Patients in remission had received ketoconazole for six to 17 months. Untoward drug effects included abdominal complaints (23 percent) and gynecomastia (8 percent). Therapy was discontinued in only three patients for side effects. Our findings support the use of ketoconazole in the treatment of certain forms of chronic coccidioidal infections.

Antecedent features of children in whom asthma develops during the second decade of life

In this report we compare 36 subjects in whom asthma was first diagnosed between the ages of 10 and 20 with 297 control subjects. All subjects were studied at age 5 to 9. Among the subjects who acquired a new diagnosis of asthma (NDA), the diagnosis was usually preceded by lower respiratory tract symptoms (31 of the 36 subjects had respiratory symptoms or a diagnosis of rhinitis or chronic bronchitis before asthma developed). Among those tested, more of those with NDA had positive allergy skin test results (56.5%) before diagnosis than control subjects (29.6%; p < 0.05), and the subjects with NDA had higher levels of serum IgE than control subjects (mean log serum IgE = 2.27 in subjects with NDA, 1.76 in control subjects; p < 0.05). Pulmonary function tests revealed no significant differences in the groups before diagnosis. Using logistic regression, we determined that wheezing, cough, a diagnosis of chronic bronchitis, and a positive allergy skin test result were independent risk factors for asthma. When combinations of variables were used, subjects with wheezing and a positive allergy skin test result, cough and a positive test result, and also those with a prior diagnosis of chronic bronchitis alone were at highest risk of a subsequent diagnosis of asthma.

The adverse health effects of biological aerosols, other aerosols, and indoor microclimate on asthmatics and nonasthmatics

Abstract Asthmatic and nonasthmatic families in a representative community population sample have been monitored over a 2-year period using daily diaries. Simultaneous micro-indoor and outdoor monitoring has been conducted in a representative sample of houses for air pollutants, pollen, fungi, algae, and climate. Macromonitoring of air pollutants and pollen was conducted simultaneously. The relationship of indoor to outdoor and micro to macro factors can be demonstrated. Acute symptoms were strongly related to age, weakly related to sex, and not related to smoking habits. The qualitative relationship of these micro and macro factors to symptoms in asthmatic and nonasthmatic families have been explored. Suspended particulate matter and pollen were related to symptoms in asthmatics and nonasthmatics. Fungi might be related to symptoms as well. The use of gas stoves is qualitatively related to symptoms. Algae and other contaminants of evaporative coolers do not appear to be important in producing symptoms. More complex statistical analyses are required to determine interactions of these factors. Distinction has to be drawn between infectious episodes, allergic episodes, nonallergic but similar episodes, and asthmatic attacks. This study demonstrates the need for further investigations in this area.

Prognosis of Pulmonary Heart Disease

Pulmonary heart disease complicates a variety of pulmonary disorders. While investigators of the natural history of diseases such as emphysema (1) and idiopathic pulmonary fibrosis (2) have carefully described the progressive worsening of symptoms and pulmonary function of their patients, progression of cardiovascular abnormalities has not been so closely studied. The authors have usually simply noted the mortality differences in patients with and without “cor pulmonale.” In these clinical studies “cor pulmonale” was usually not clearly defined, often depending on the clinical judgment of the investigator. Here we will equate the term cor pulmonale with overt pulmonary heart disease.

Pulmonary Thromboembolism: Evaluation By Intravenous Angiography

Using perfusion lung scans as a guide, digital video subtraction angiography of the pulmonary arteries was performed in human subjects suspected of having pulmonary embolism. Dogs were employed as a pulmonary embolism model and both routine pulmonary angiography and intravenous pulmonary angiograms were obtained for comparison purposes. We have shown by our preliminary results that the technique is extremely promising as a safe and accurate alternative to routine pulmonary angiography in selected patients.