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068-PA11 Paradoxical reactions to environmental ozone?
Abstracts
asthma, tuberculosis and chronic bronchitis/emphysema, were the most frequent underlying causes and comprised 86% of the total diagnoses made. Bronchial asthma occurred in 36% of the patients. Pulmonary vascular diseases including pulmonary schistosomiasis were difficult to diagnose in our set up and the relative contribution of these diseases to the prevalence of chronic cor-pulmonale is unknown but appears to be rare. Right sided heart failure and cyanosis were the most frequent clinical presentations and occurred in 86% and 93% of the patients respectively. There was no evidence of alpha-1 anti-trypsin deficiency.
Conclusion: Bronchial asthma as a cause of chronic cor-pulmonale has been underestimated both in developed and developing countries in the past and the likely reasons for this are discussed. The preventive strategy of chronic cor-pulmonale should include optimal treatment of bronchial asthma, avoidance of cigarette smoking and early diagnosis and treatment of pulmonary tuberculosis.
068-PAll ozone?
Paradoxical reactions to environmental
Praml, G., HO'ppe, P., Lindner, J., Rabe, G., Fruhmann, G. Institute and Outpatient Clinic for Occupational Medicine (Director: Prof Dr. G. Fruhmann), University of Munich, Ziemssenstr. 1, D-80336 Miinchen, Germany
In a comprehensive field study five groups of subjects were examined during the ozone seasons of 1992 to 1994 in order to assess their pulmonary reactions and subjective votes in respect to environmental ozone concentrations. These were "Senior Citizens", "Juvenile Asthmatics", "Athletes" and "Forestry Workers" - all commonly said to be at risk - and "Clerks" initially intended as a control group, in total 208 subjects with app. 40 subjects per group. Lung function measurements (FVC, FEV1, PEF, sRaw etc.) along with interviews on ozone related irritations were effected on site in a mobile lab equipped with a body plethysmograph on at least eight days per subject, four of which with elevated (> 50 ppb, "ozone days") and four with low ozone concentrations (> 40 ppb, "control days"), both in the morning and subsequent to exposure in the afternoon. 03 , PAN, NO, NO2, CxHy, acid aerosols and the standard meteorological parameters were monitored next to the lab. The highest outdoor ozone concentrations (half hour mean value between 1 and 4 p.m.) was 112 ppb, the lowest 1 ppb. The subjective votes did not reveal any relevant ozone related difference, nor did the lung volumes FVC and FEV1. Major differences were found for the specific airway resistance sRaw: "Senior Citizens" and "Athletes" even had an improved lung function (lower resistance) on days with elevated ozone concentrations, while "Juvenile Asthmatics", "Clerks" and "Forestry Workers" showed slight to marked deteriorations, the latter with a highly significant sRaw increase of 25% on ozone days compared to control
61
days. Since forestry workers' ozone exposure is relatively low, particularly when working with motor tools like chain saws (the clerks' indoor exposure is still lower), and on the other hand "Athletes" with their high ventilation rate do not reveal any deterioration, other reasons than elevated ozone concentrations or increased physical activities have to be taken into account. Possibly this could be the products resulting from chemical reactions of ozone with indoor surfaces resp. with exhaust gases or substances emitted by trees (e.g. terpenes). In conclusion, we don't see an ozone risk factor "old age" or "physical exercise". However, the effects observed in the forest and in the offices require clarification.
074-PAll l'enfant
L'environnement et l'asthme chez
Tayeb, B. Cabinet de Pneumologie et Allergologie, Oran, Alg~rie
Une augmentation de la morbidit6 et de la mortalit6 par asthme bronchique a 6t6 rapportte dans plusieurs pays, lors de ces dernitres anntes, malgr6 la raise au point et la meilleure utilisation de mddicaments plus efficaces. A Oran, on rapporte que le nombre d'hospitalisations pour asthme bronchique, dans la ptriode 1980-1990 a augment6 de 40% par rapport ~ la dtcade prdctdente, avec un tanx d'admission 5 fois 61ev6 pour tes sujets de moins de 15 ans. Parmi les raisons 6voqutes pour expliquer l'aggravation, rdcente de l'asthme chez l'enfant, l'environnement semble tenir une place importante. Le but de cet expos6 est de souligner l'importance des facteurs lids ~ l'environnement dans l'asthme chez 1' enfant.
088-PAll Preliminary results of multicenter study about bronchial asthmatics in Istanbul Gemicio~lu, B., Erkan, F., Ereglen, M., Akkaya, E., ~amsari, G., Tutluoglu, B., Alcman, M., Oztiirk, E. et al. Thoracic Society, istanbul Asthma Working Group, Istanbul, Turkey
This prospective study was performed to collect biometric and diagnostic data of bronchial asthmatic patients who are residents of istanbul. Mean age of 345 female (70%) and 149 male (30%) asthmatics was 31.8. The most frequent symptom was found to be dyspnea (89.9%). 70.6% of the subjects had nasal problems. 8.5% were active smokers, 28.5% had previously been smoking, 61.3% were passively exposed to tobacco smoke. 25.7% had gastroesophageal reflux. 55.7% had atopic parents. 5% had professional exposure. According to their lung functions 50% of patients were graded mild, 35.4% moderate, 16.2% severe asthmatics. For the reversibility test 50.2% had over 200 ml increase in FEV~, while 38.2% had 12% increase in FEV v 53% had at least one positive result in skin prick test,
asthma, tuberculosis and chronic bronchitis/emphysema, were the most frequent underlying causes and comprised 86% of the total diagnoses made. Bronchial asthma occurred in 36% of the patients. Pulmonary vascular diseases including pulmonary schistosomiasis were difficult to diagnose in our set up and the relative contribution of these diseases to the prevalence of chronic cor-pulmonale is unknown but appears to be rare. Right sided heart failure and cyanosis were the most frequent clinical presentations and occurred in 86% and 93% of the patients respectively. There was no evidence of alpha-1 anti-trypsin deficiency.
Conclusion: Bronchial asthma as a cause of chronic cor-pulmonale has been underestimated both in developed and developing countries in the past and the likely reasons for this are discussed. The preventive strategy of chronic cor-pulmonale should include optimal treatment of bronchial asthma, avoidance of cigarette smoking and early diagnosis and treatment of pulmonary tuberculosis.
068-PAll ozone?
Paradoxical reactions to environmental
Praml, G., HO'ppe, P., Lindner, J., Rabe, G., Fruhmann, G. Institute and Outpatient Clinic for Occupational Medicine (Director: Prof Dr. G. Fruhmann), University of Munich, Ziemssenstr. 1, D-80336 Miinchen, Germany
In a comprehensive field study five groups of subjects were examined during the ozone seasons of 1992 to 1994 in order to assess their pulmonary reactions and subjective votes in respect to environmental ozone concentrations. These were "Senior Citizens", "Juvenile Asthmatics", "Athletes" and "Forestry Workers" - all commonly said to be at risk - and "Clerks" initially intended as a control group, in total 208 subjects with app. 40 subjects per group. Lung function measurements (FVC, FEV1, PEF, sRaw etc.) along with interviews on ozone related irritations were effected on site in a mobile lab equipped with a body plethysmograph on at least eight days per subject, four of which with elevated (> 50 ppb, "ozone days") and four with low ozone concentrations (> 40 ppb, "control days"), both in the morning and subsequent to exposure in the afternoon. 03 , PAN, NO, NO2, CxHy, acid aerosols and the standard meteorological parameters were monitored next to the lab. The highest outdoor ozone concentrations (half hour mean value between 1 and 4 p.m.) was 112 ppb, the lowest 1 ppb. The subjective votes did not reveal any relevant ozone related difference, nor did the lung volumes FVC and FEV1. Major differences were found for the specific airway resistance sRaw: "Senior Citizens" and "Athletes" even had an improved lung function (lower resistance) on days with elevated ozone concentrations, while "Juvenile Asthmatics", "Clerks" and "Forestry Workers" showed slight to marked deteriorations, the latter with a highly significant sRaw increase of 25% on ozone days compared to control
61
days. Since forestry workers' ozone exposure is relatively low, particularly when working with motor tools like chain saws (the clerks' indoor exposure is still lower), and on the other hand "Athletes" with their high ventilation rate do not reveal any deterioration, other reasons than elevated ozone concentrations or increased physical activities have to be taken into account. Possibly this could be the products resulting from chemical reactions of ozone with indoor surfaces resp. with exhaust gases or substances emitted by trees (e.g. terpenes). In conclusion, we don't see an ozone risk factor "old age" or "physical exercise". However, the effects observed in the forest and in the offices require clarification.
074-PAll l'enfant
L'environnement et l'asthme chez
Tayeb, B. Cabinet de Pneumologie et Allergologie, Oran, Alg~rie
Une augmentation de la morbidit6 et de la mortalit6 par asthme bronchique a 6t6 rapportte dans plusieurs pays, lors de ces dernitres anntes, malgr6 la raise au point et la meilleure utilisation de mddicaments plus efficaces. A Oran, on rapporte que le nombre d'hospitalisations pour asthme bronchique, dans la ptriode 1980-1990 a augment6 de 40% par rapport ~ la dtcade prdctdente, avec un tanx d'admission 5 fois 61ev6 pour tes sujets de moins de 15 ans. Parmi les raisons 6voqutes pour expliquer l'aggravation, rdcente de l'asthme chez l'enfant, l'environnement semble tenir une place importante. Le but de cet expos6 est de souligner l'importance des facteurs lids ~ l'environnement dans l'asthme chez 1' enfant.
088-PAll Preliminary results of multicenter study about bronchial asthmatics in Istanbul Gemicio~lu, B., Erkan, F., Ereglen, M., Akkaya, E., ~amsari, G., Tutluoglu, B., Alcman, M., Oztiirk, E. et al. Thoracic Society, istanbul Asthma Working Group, Istanbul, Turkey
This prospective study was performed to collect biometric and diagnostic data of bronchial asthmatic patients who are residents of istanbul. Mean age of 345 female (70%) and 149 male (30%) asthmatics was 31.8. The most frequent symptom was found to be dyspnea (89.9%). 70.6% of the subjects had nasal problems. 8.5% were active smokers, 28.5% had previously been smoking, 61.3% were passively exposed to tobacco smoke. 25.7% had gastroesophageal reflux. 55.7% had atopic parents. 5% had professional exposure. According to their lung functions 50% of patients were graded mild, 35.4% moderate, 16.2% severe asthmatics. For the reversibility test 50.2% had over 200 ml increase in FEV~, while 38.2% had 12% increase in FEV v 53% had at least one positive result in skin prick test,