Obstructive lung disease in the United Kingdom

BTTA

167

For Dermatophagoides there is a high correlation between skin test and presence of specific IgE in serum, provided that suitable concentrations of the allergen in question are used for the skin tests. Patients with high skin sensitivity present higher levels of specific IgE than patients with low skin sensitivity. There is no relation between levels of specific IgE and sensitivity of shock organ. Patients with intestinal parasites present extremely high IgE levels. In Kiviloog’s material from Uppsala, 51 of 116 patients with asthma (without or with chronic bronchitis) showed increased levels of IgE. In 16 of these 51, reaginic antibodies to mites (Dermatophagoides pteronyssinus) were demonstrated. They also had a positive intracutaneous testfor house dust. A suitable mite extract for inhalation provocation tests was not available. Treatment Betas-stimulating drugs have been extensively studied by Svedmyr and others. Others have suggested that resistance to beta-stimulators develops after use of, e.g. isoprenaline. Svedmyr’s group demonstrated that bronchial muscles do not develop resistance to betaZstimulation even after prolonged use. Other effects of beta-stimulation, namely skeletal muscle tremor (beta,-effect) and tachycardia (beta,-effect) diminish after prolonged use of beta,-stimulating drugs. With oral medication of these drugs the initial dose should be about l/2 the later maintenance dose. The beta,selectivity is much higher when the drugs are given by inhalation.

Obstructive lung disease in the United Kingdom D. D. REID (London) Mortality from obstructive lung disease in the United Kingdom is much higher than in Scandinavia. Research in this field in the U.K. has concentrated on explanatory environmental factors at successive stages of life. There is evidence of continuity between respiratory disease in childhood and adult life and such factors may operate in different ways at different ages to cause chronic respiratory disease. In childhood, social conditions and local air pollution appear to be important; but by early adult life, although childhood respiratory infections and social circumstances have a residual influence, smoking becomes the dominant factor in the prevalence of chronic cough. Follow-up studies in the U.K. have shown the prognostic importance in terms of subsequent death from obstructive lung disease of chronic phlegm production and dyspnoea, but a 15 year follow-up study emphasises the long-term implications of a history of wheezing and a low peak flow rate. Large-scale cross-sectional surveys have also suggested the effect of the amount smoked in relation to the forced expiratory volume with increasing age. Exposure to air pollution has apparently affected the frequency of respiratory symptoms in older subjects; and there is some evidence of a joint action of pollution and smoking. Such factors may partly explain the British urban excess in respiratory mortality. Reduction in air pollution following the Clean Air Act seems to have benefitted elderly patients suffering from obstructive lung disease in some parts of the United Kingdom. Effects on symptoms and lung function from a change in climate in patients with chronic airways obstruction: a pilot study. B. G. SIMONSSON (B. -E. SKOOGH,A. -G. BERGGREN,Z. BERGSTRGM and M. JOHANSSON) (Giitehorg, Sweden )

We studied the psychosomatic and lung physiologic status of 10 previously followed patients with weather-sensitive airways obstruction. They were all on equal medication and care during