- Email: [email protected]
Occupational Asthma in a Developing Country
FICURE
1
methotrexate, actinomycin-D and cyclophosphamide, with subsequently oormaI ~human cboriooic gonadutropin level. Common clinical manifestations of pulmonary involvement with metastatic choriocarcinoma Include hemoptysis, cough, and tumor emboli. However, a less commonly appreciated presentation is with oontraumatic hemothorax. I Our patient demonstrates two important clioical points concerning choriocarcinoma. First, massive bilateral hemothoraces may complicate carcloomatous pleural effusion.' Second, in any pregnant or postpartum woman, metastatic choriocarcinoma should be considered as a cause fur spontaneous bemothorax despite an apparently normal pregnancy, delivery, and otherwise negative evaluation fur metastases....
C.lJGoid Sudduth, M.D.; Charlie StrlJngB. M.D., F.C.C.P.; Berry A. CampbeU. M.D.; and Steven A Sahn, M.D.• F.C.C.P., Medicol UnWer3fty of South ClJf'OlIlItJ, Charluton Reprint requem: Dr Sudduth, Department of l'lIlmonary/CritictJl Care Medicine, Medical Urdvemty of South Caf'OlllltJ, 171 Aahley Avenue, Charluton, SC 29425
alI were diagnosed with broncbial asthma according to American Thoracic Society criteria.' The group consisted of320 men and 240 women. Their age range was 20 to 75 years, with a median age of 49 years. Occupational asthma was diagnosed on the basis of the following criteria: 1) no history of asthma before commencing employment; 2) e~ure to a recognized inducing agent at work; 3) symptoms of wheezing and dyspnea a few hours after exposure to the inducing agent; 4) improvement of symptoms when off work; and 5) change of employment due to persistence of symptoms. Wl bad only 34 patients (5.9 percent)-30 men and four womenwho fuIJUIed the clinical criteria fur the diagnosis of OA. Occupational asthma was due to employment handling chemicals in 15 patients (44.1 percent); agricultural products in 11 patients (32.4 percent); metallic products in 6ve patients (14.7 percent); and timber by-products in three patients (8.8 percent). The central conclusion of this study is that the prevalence rate of OA In technically less developed Third-World countries is low compared to that reported in industrialized developed countries,'" especially in female patients. Although OA in this study was not con6rmed by pulmonary function tests at work and at home, or by bronchopulmonary pl'OYOCation tests and immunologic tests, this study does attempt to identify occupations most likely to be associated with OA, as well as the prevalence rate of OA. in a technically less industrialized country. which is scarcely described in the literature. Nightingale Syabbalo, M.B .• Ch.B.• Ph.D., F.C.C.P., Umt4ttJ Chut H08plttJl, UmttJta, 'lrafl8kei, South Africa REFERENCES
1 American Thoracic Society. De6nition and classification of chronic bronchitis, asthma and pulmonary emphysema. Am Rev Respir Dis 1986; 136:225-44 2 Brooks SM. Occupational asthma. In: Weiss EB, et ai, eds. Bronchial asthma. Boston: Little, Brown and Co. 1985; 461-93 3 Kobayashi S. Occupational asthma in Japan. In: Proceedings of the VIIIth International Congress on Allergology. Amsterdam: Excerpta. 1974; 124-32 4 Pauli C. Bessot Je. Dietmaon-Molard A. L'asthma professional: investigation et prlncipale ~tiologies. Bull Eur Physiopathol Respir 1986; 22:399-425
REFERENCES
1 DeFrance JH, Blewett JH Jr, Ricci A, Patterson LT. Massive hemothorax: two unusual cases. Chest 1974; 66:82-84 2 Evans lIT, Cocbhott WP, Hendrickse P de V. Pulmonary changes in malignant trophoblastic disease. Br J RadioII965; 38:412-16 3 DrlsooU SC. Choriocarclnoma: an "incidental 6nding" within a term placenta. Obstet CyneooI21:96-101 4 KuIbmi R, Uster UC. Metastatic choriocarcinoma coexisting with full term viable pregnancy. ~tgrad Med J 1985; 61:101314
OCCupational Asthma in a Developing
Country 1b the Editor:
In tecbnically less developed Third-World countries, there is very little infOrmation on the prevalence rate of occupational asthma (OA) and occupations most likely to be associated with this type of
asthma. Wl reguIar1y attended to 580 adult asthmatic patients at our
Enata The editon of Chut wish to apologize to Steven L. Shepherd. M.P.H., fOr a typographical error that appeared in his article, "A Comparative Study of the Psychosocial Assets of Adults with Cystic On Fibrosis and Their Healthy Peen" (Chut 1990; 97:131o-16~ page 1315, right-band column, the fOllowing sentence appeared: "They had married and gained dependents at the same rates as had members of the comparison group an~ the occupational status attained by those who had never entered the work force was at least as good as that attained by members of the comparison group." It should have read: "attained by those who had ever entered the work furce ... " In the article "Prophylactic Antibiotic Usage in Cardiothoraclc Surgery" (Chut 1990; 98:719-23), the first sentence of the last paragraph on page 722 should read: "In this survey, the surgical membership of the American College of Cheat PhyMcitJf18 clearly agrees that prophylactic antibiotics are a requirement in today's major cardiothoraclc surgical procedures."
university teaching hospital respiratory clinic in Lusalca, Zambia;
528
CommunIcalions to the EdlIor
1
methotrexate, actinomycin-D and cyclophosphamide, with subsequently oormaI ~human cboriooic gonadutropin level. Common clinical manifestations of pulmonary involvement with metastatic choriocarcinoma Include hemoptysis, cough, and tumor emboli. However, a less commonly appreciated presentation is with oontraumatic hemothorax. I Our patient demonstrates two important clioical points concerning choriocarcinoma. First, massive bilateral hemothoraces may complicate carcloomatous pleural effusion.' Second, in any pregnant or postpartum woman, metastatic choriocarcinoma should be considered as a cause fur spontaneous bemothorax despite an apparently normal pregnancy, delivery, and otherwise negative evaluation fur metastases....
C.lJGoid Sudduth, M.D.; Charlie StrlJngB. M.D., F.C.C.P.; Berry A. CampbeU. M.D.; and Steven A Sahn, M.D.• F.C.C.P., Medicol UnWer3fty of South ClJf'OlIlItJ, Charluton Reprint requem: Dr Sudduth, Department of l'lIlmonary/CritictJl Care Medicine, Medical Urdvemty of South Caf'OlllltJ, 171 Aahley Avenue, Charluton, SC 29425
alI were diagnosed with broncbial asthma according to American Thoracic Society criteria.' The group consisted of320 men and 240 women. Their age range was 20 to 75 years, with a median age of 49 years. Occupational asthma was diagnosed on the basis of the following criteria: 1) no history of asthma before commencing employment; 2) e~ure to a recognized inducing agent at work; 3) symptoms of wheezing and dyspnea a few hours after exposure to the inducing agent; 4) improvement of symptoms when off work; and 5) change of employment due to persistence of symptoms. Wl bad only 34 patients (5.9 percent)-30 men and four womenwho fuIJUIed the clinical criteria fur the diagnosis of OA. Occupational asthma was due to employment handling chemicals in 15 patients (44.1 percent); agricultural products in 11 patients (32.4 percent); metallic products in 6ve patients (14.7 percent); and timber by-products in three patients (8.8 percent). The central conclusion of this study is that the prevalence rate of OA In technically less developed Third-World countries is low compared to that reported in industrialized developed countries,'" especially in female patients. Although OA in this study was not con6rmed by pulmonary function tests at work and at home, or by bronchopulmonary pl'OYOCation tests and immunologic tests, this study does attempt to identify occupations most likely to be associated with OA, as well as the prevalence rate of OA. in a technically less industrialized country. which is scarcely described in the literature. Nightingale Syabbalo, M.B .• Ch.B.• Ph.D., F.C.C.P., Umt4ttJ Chut H08plttJl, UmttJta, 'lrafl8kei, South Africa REFERENCES
1 American Thoracic Society. De6nition and classification of chronic bronchitis, asthma and pulmonary emphysema. Am Rev Respir Dis 1986; 136:225-44 2 Brooks SM. Occupational asthma. In: Weiss EB, et ai, eds. Bronchial asthma. Boston: Little, Brown and Co. 1985; 461-93 3 Kobayashi S. Occupational asthma in Japan. In: Proceedings of the VIIIth International Congress on Allergology. Amsterdam: Excerpta. 1974; 124-32 4 Pauli C. Bessot Je. Dietmaon-Molard A. L'asthma professional: investigation et prlncipale ~tiologies. Bull Eur Physiopathol Respir 1986; 22:399-425
REFERENCES
1 DeFrance JH, Blewett JH Jr, Ricci A, Patterson LT. Massive hemothorax: two unusual cases. Chest 1974; 66:82-84 2 Evans lIT, Cocbhott WP, Hendrickse P de V. Pulmonary changes in malignant trophoblastic disease. Br J RadioII965; 38:412-16 3 DrlsooU SC. Choriocarclnoma: an "incidental 6nding" within a term placenta. Obstet CyneooI21:96-101 4 KuIbmi R, Uster UC. Metastatic choriocarcinoma coexisting with full term viable pregnancy. ~tgrad Med J 1985; 61:101314
OCCupational Asthma in a Developing
Country 1b the Editor:
In tecbnically less developed Third-World countries, there is very little infOrmation on the prevalence rate of occupational asthma (OA) and occupations most likely to be associated with this type of
asthma. Wl reguIar1y attended to 580 adult asthmatic patients at our
Enata The editon of Chut wish to apologize to Steven L. Shepherd. M.P.H., fOr a typographical error that appeared in his article, "A Comparative Study of the Psychosocial Assets of Adults with Cystic On Fibrosis and Their Healthy Peen" (Chut 1990; 97:131o-16~ page 1315, right-band column, the fOllowing sentence appeared: "They had married and gained dependents at the same rates as had members of the comparison group an~ the occupational status attained by those who had never entered the work force was at least as good as that attained by members of the comparison group." It should have read: "attained by those who had ever entered the work furce ... " In the article "Prophylactic Antibiotic Usage in Cardiothoraclc Surgery" (Chut 1990; 98:719-23), the first sentence of the last paragraph on page 722 should read: "In this survey, the surgical membership of the American College of Cheat PhyMcitJf18 clearly agrees that prophylactic antibiotics are a requirement in today's major cardiothoraclc surgical procedures."
university teaching hospital respiratory clinic in Lusalca, Zambia;
528
CommunIcalions to the EdlIor