- Email: [email protected]
Moscow study on ISAAC project
118
Tubercle and Lung Disease: Supplement
437 MOSCOW STUDY ON ISAAC PROJECT Rakhim M. Khaitov, Olga E. Zaikina, Institute of Immunology, 24-2 Kashirskoye Shosse, 115478 Moscow, Russia
We have already in our possession statistics on the problem of specific and nonspecific bronchial reactivity in ex-USSR children and teenagers suffering from different forms of bronchial asthma (intrinsic and extrinsic ones). We also have information on the role of etiological factors, immunological indices and peculiarities of clinical manifestation of bronchial asthma in children living in different geographic regions of ex-USSR. But it is difficult to compare our data to the data obtained in other countries because of nonstandardized conditions and methods of collecting data. The International Study of Asthma and Allergies in Childhood (ISAAC) was founded to carry out an international epidemiological research on asthma, rhinitis and eczema according to the standardized methodology. Approximately about 4000 Moscow schoolchildren of X3-14 years old are now being investigated according to ISAAC standardized methods and criteria. Schoolchildren are given Russian version of ISAAC questionnaires (including video questionnaire) to be filled. The investigation includes collecting materials during 5 months (October-March: out of pollen season) and the following data development.
439 THERAPEUTIC EFFECT OF DRY POWDER SALBUTAMOL INHALATION (DISKHALERm) IN COMPARISON WITH METERED DOSE INHALER IN ADULT ASTHMA Charoenratanakul, S. and Dejsomritrutai, W.; Department of Medicine, Siriraj Hospital, Mahidol University Bangkok, Thailand
438 CLINICAL STUDY OF THE CAUSE OF MEDIASTINAL EMPHYSEMA
The aim of our study was to compare bronchodilator response and adverse effects of salbutamol when administered via a metered dose inhaler (MDI) or via a DiskhalerTM (dry powder inhaler, DPI). Twenty adult patients with bronchial asthma entered the study which was of an open, crossover design. Their baseline FEVl were below 70% of the predicted value. The patients inhaled with 30minute interval increasing doses of salbutamol(0.2 mg to a cumulative dose of 2.0 mg) from either the MD1 or the DiskhalerTM. After each inhalation, FEVl, FVC, heart results showed equipotency between DiskhalerTM and MDI, both with respect to bronchodilatation and side effects. The mean FEVl, and FVC dose-response curves for both DiskhalerTM and MD1 treatment showed a statistically significant increase over basal value for all doses (p < 0.001). There was no statistically significant different between the two treatments. No increase in pulse rate was seen with either treatments, but there was an increase in tremor with increasing dose of salbutamol (after a cumulative dose of 1 mg) with both treatment. Inhalation of salbutamol via a DiskhalerTM seems safe and effective in the treatment of asthma.
Yoneyama, H., Tanabe, .I., and Matsushima, T.; Medical School Kawasaki Hospital, 2-I-80 Nakasange, 700, Japan
440 PERCEPTION
Kawasaki Okayama
Twenty-nine patients with a total of 31 episodes of mediastinal emphysema were admitted to our hospital during 9 years from 1985 to 1993. Of these, 9 patients were treated in 1993. Therefore, the prevalence of the disease seems to have increased, although it is thought to be rare. Seven of these patients, five men and two women, ranging in age from 54 to 79 years old (mean, 69.7) had underlying lung disease (four with pulmonary fibrosis, two with pulmonary emphysema, and one with pneumonia). Twelve patients with bronchial asthma, seven men and five women, ranging in age from 16 to 24 years old (mean, 20.3) experienced 14 episodes. There were ten patients, nine men and one woman, ranging in age from 1.5 to 23 years old (mean, 17.9) with no underlying lung disease. In the seven patients with underlying lung disease, the mediastinal emphysema was secondary to cough in four patients, due to use of a respirator in two patients, and due to progression of subcutaneous emphysema in one patient. In 22 patients with spontaneous medistinal emphysema, the emphysema was caused by attacks of asthma in twelve patients. The longest duration of these attacks was 14 days. Among the remaining ten patients, spontaneous mediastinal emphysema occurred after forced utterance in three patients, with a cough associated repiratory infection in three patients, and during exercise in three patients. In all of them, the mechanism of the emphysema was suspected to be related to an increase in intrathoracic pressure. The remaining patient experienced the emphysema at rest during the class lecture. These findings causing mediastinal suggest that the mechanism emphysema may be closely related to an increase in intrathoracic pressure.
OF OBSTRUCTIONRELATED COMPLAINTS IN SMOKERS AND NONSMOKERS
Harnoncourt, K., Wurzinger, G.; Joanneum institute for Preventive Medicine, Marburgerkai 51, A-8010 GrazlAustria
The high prevalence of COPD in industrialized countries makes the number of patients with unrecognized and untreated disease a public health problem particularly as early treatment can slow or halt the progression of COPD to irreversible changes and car pulmonale. Screening studies with the Pneumobile in Austria (1) showed 20% of 66,339 probands to have objective bronchopulmonary abnormalities. Of 1979 probands with COPD, 39% had not noticed a problem and only 24% had treatment. The perception of obstruction-related compaints was strongly associated with smoking habits (Table 1). Only 12% of smokers had or adhered to adequate treatment, as compared to 26% of nonsmokers and 37% of ex-smokers. Table 1: Smoking habits and perception related complaints.
of obstruction-
The reasons for this apparent complacency on the part of smokers should be analyzed and addressed by antismoking campaigns. (1) Harnoncourt, K.: A program (1990) Suppl.:514-9.
for the prevention
of lung diseases.
Lung
Tubercle and Lung Disease: Supplement
437 MOSCOW STUDY ON ISAAC PROJECT Rakhim M. Khaitov, Olga E. Zaikina, Institute of Immunology, 24-2 Kashirskoye Shosse, 115478 Moscow, Russia
We have already in our possession statistics on the problem of specific and nonspecific bronchial reactivity in ex-USSR children and teenagers suffering from different forms of bronchial asthma (intrinsic and extrinsic ones). We also have information on the role of etiological factors, immunological indices and peculiarities of clinical manifestation of bronchial asthma in children living in different geographic regions of ex-USSR. But it is difficult to compare our data to the data obtained in other countries because of nonstandardized conditions and methods of collecting data. The International Study of Asthma and Allergies in Childhood (ISAAC) was founded to carry out an international epidemiological research on asthma, rhinitis and eczema according to the standardized methodology. Approximately about 4000 Moscow schoolchildren of X3-14 years old are now being investigated according to ISAAC standardized methods and criteria. Schoolchildren are given Russian version of ISAAC questionnaires (including video questionnaire) to be filled. The investigation includes collecting materials during 5 months (October-March: out of pollen season) and the following data development.
439 THERAPEUTIC EFFECT OF DRY POWDER SALBUTAMOL INHALATION (DISKHALERm) IN COMPARISON WITH METERED DOSE INHALER IN ADULT ASTHMA Charoenratanakul, S. and Dejsomritrutai, W.; Department of Medicine, Siriraj Hospital, Mahidol University Bangkok, Thailand
438 CLINICAL STUDY OF THE CAUSE OF MEDIASTINAL EMPHYSEMA
The aim of our study was to compare bronchodilator response and adverse effects of salbutamol when administered via a metered dose inhaler (MDI) or via a DiskhalerTM (dry powder inhaler, DPI). Twenty adult patients with bronchial asthma entered the study which was of an open, crossover design. Their baseline FEVl were below 70% of the predicted value. The patients inhaled with 30minute interval increasing doses of salbutamol(0.2 mg to a cumulative dose of 2.0 mg) from either the MD1 or the DiskhalerTM. After each inhalation, FEVl, FVC, heart results showed equipotency between DiskhalerTM and MDI, both with respect to bronchodilatation and side effects. The mean FEVl, and FVC dose-response curves for both DiskhalerTM and MD1 treatment showed a statistically significant increase over basal value for all doses (p < 0.001). There was no statistically significant different between the two treatments. No increase in pulse rate was seen with either treatments, but there was an increase in tremor with increasing dose of salbutamol (after a cumulative dose of 1 mg) with both treatment. Inhalation of salbutamol via a DiskhalerTM seems safe and effective in the treatment of asthma.
Yoneyama, H., Tanabe, .I., and Matsushima, T.; Medical School Kawasaki Hospital, 2-I-80 Nakasange, 700, Japan
440 PERCEPTION
Kawasaki Okayama
Twenty-nine patients with a total of 31 episodes of mediastinal emphysema were admitted to our hospital during 9 years from 1985 to 1993. Of these, 9 patients were treated in 1993. Therefore, the prevalence of the disease seems to have increased, although it is thought to be rare. Seven of these patients, five men and two women, ranging in age from 54 to 79 years old (mean, 69.7) had underlying lung disease (four with pulmonary fibrosis, two with pulmonary emphysema, and one with pneumonia). Twelve patients with bronchial asthma, seven men and five women, ranging in age from 16 to 24 years old (mean, 20.3) experienced 14 episodes. There were ten patients, nine men and one woman, ranging in age from 1.5 to 23 years old (mean, 17.9) with no underlying lung disease. In the seven patients with underlying lung disease, the mediastinal emphysema was secondary to cough in four patients, due to use of a respirator in two patients, and due to progression of subcutaneous emphysema in one patient. In 22 patients with spontaneous medistinal emphysema, the emphysema was caused by attacks of asthma in twelve patients. The longest duration of these attacks was 14 days. Among the remaining ten patients, spontaneous mediastinal emphysema occurred after forced utterance in three patients, with a cough associated repiratory infection in three patients, and during exercise in three patients. In all of them, the mechanism of the emphysema was suspected to be related to an increase in intrathoracic pressure. The remaining patient experienced the emphysema at rest during the class lecture. These findings causing mediastinal suggest that the mechanism emphysema may be closely related to an increase in intrathoracic pressure.
OF OBSTRUCTIONRELATED COMPLAINTS IN SMOKERS AND NONSMOKERS
Harnoncourt, K., Wurzinger, G.; Joanneum institute for Preventive Medicine, Marburgerkai 51, A-8010 GrazlAustria
The high prevalence of COPD in industrialized countries makes the number of patients with unrecognized and untreated disease a public health problem particularly as early treatment can slow or halt the progression of COPD to irreversible changes and car pulmonale. Screening studies with the Pneumobile in Austria (1) showed 20% of 66,339 probands to have objective bronchopulmonary abnormalities. Of 1979 probands with COPD, 39% had not noticed a problem and only 24% had treatment. The perception of obstruction-related compaints was strongly associated with smoking habits (Table 1). Only 12% of smokers had or adhered to adequate treatment, as compared to 26% of nonsmokers and 37% of ex-smokers. Table 1: Smoking habits and perception related complaints.
of obstruction-
The reasons for this apparent complacency on the part of smokers should be analyzed and addressed by antismoking campaigns. (1) Harnoncourt, K.: A program (1990) Suppl.:514-9.
for the prevention
of lung diseases.
Lung