From 1954 to 1961, pulmonary function was assessed in 2,718 British men by forced expiratory maneuvers, and mucus hypersecretion and smoking habits were assessed by questionnaires. In 20 to 25 yr of follow-up, 104 men (all of whom had smoked) died of chronic obstructive pulmonary disease (COPD). The risk of death from COPD was strongly correlated with the initial degree of air-flow obstruction. Among men with similar initial air-flow obstruction, however, age-specific COPD death rates were not significantly related to initial mucus hypersecretion, supporting the concept that air-flow obstruction and mucus hypersecretion are largely independent disease processes. A moderate relationship existed between initial mucus hypersecretion and subsequent lung cancer mortality, but it is not known whether this was due solely to a common correlation of both conditions with the effective degree of exposure of the large bronchi to causative factors such as tobacco smoke.

A report by Lee and Fraumeni in 1969 linked exposure to arsenic and other contaminants to a threefold excess of respiratory cancer among 8,047 employees at the Anaconda copper smelter. We established vital status through December 1977 for a sample of 1,800 men from the original cohort. Average arsenic concentrations were estimated for each smelter department based on industrial hygiene measurements made from 1943 to 1965. Departments with similar concentrations were combined into four categories of exposure: 1) low (less than 100 micrograms/m3), 2) medium (100-499 micrograms/m3), 3) high (500-4,999 micrograms/m3) and 4) very high (greater than or equal to 5,000 micrograms/m3). Three indices of individual arsenic exposure were developed: time-weighted average, 30-day ceiling, and cumulative. Exposures to sulfur dioxide and asbestos were also examined. Smoking habits were obtained by questionnaire. Mortality was compared to that of men in the State of Montana using the modified lifetable method. A clear dose-response relationship between arsenic exposure and respiratory cancer was demonstrated. Men in the highest exposure category had a sevenfold excess. Those in the low and medium categories had a risk close to that expected. Ceiling arsenic exposure appeared to be more important than did time-weighted average exposure. Sulfur dioxide and asbestos did not appear to be important in the excess of respiratory cancer, although sulfur dioxide and arsenic exposures could not be separated completely. Smoking did not appear to be as important as arsenic exposure. Our findings suggest that had men worked only in departments with low or medium arsenic exposures (i.e., less than 500 micrograms/m3) there would have been little excess respiratory cancer. Since the estimates of arsenic exposure were based on department averages rather than on concentrations for individual jobs, these results must be interpreted with caution.

The relationship between daily deaths and daily concentrations of Smoke and SO2 in London, England for 14 winters during the years 1958-1959 through 1971-1972 has been explored. Three types of analyses were used: (1) year-by-year multiple regression; (2) stratification using nested quartiles of one pollutant within quartiles of the other; and (3) multiple regression of a special subset of high pollution days. An association was found with Smoke, but not with SO2. Whether a linear model with zero threshold or a threshold model best fits could not be determined unambiguously because of a statistical artifact. Reasons for preferring a threshold-type quadratic model are given.

This study was undertaken to determine if the ventilatory capacity of children is affected by hourly concentrations of ozone inhaled during their daily activity. Over a 3-wk period (June-July 1987) children who were attending a summer camp in the San Bernardino mountains of California performed spirometry up to three times per day during their stay at the camp. A total of 43 children were tested a total of 461 times. Ozone, oxides of nitrogen, sulfur dioxide, temperature, and relative humidity were measured continuously. Daily average measurements of total suspended particulate and the PM10 particulate fraction (less than or equal to 10 microns) were also made. Hourly ozone concentrations at the time of testing varied between 20 and 245 ppb. Regressions of each individual's FEV1 and FVC supported the view that high ozone levels reduced these lung function parameters. The average regression coefficient for FEV1 on ozone was -0.39 ml/ppb (SEM = 0.12) and for FVC -0.44 ml/ppb (SEM = 0.15), both of which were significantly different from zero. Statistical allowance for temperature and humidity increased the magnitude of these slopes. Nitrogen dioxide never exceeded 40 ppb during the time of testing and averaged 13 ppb. Sulfur dioxide's highest measurement was 8 ppb and often was at the limit of detection. Neither NO2 nor SO2 was considered in the statistical modeling. Data were divided based on whether each subject had been exposed to levels of ozone in excess of the National Ambient Air Quality Standard (NAAQS) during the several hours previous to being tested. Exposures exceeding the NAAQS indicated a significant negative relationship between ozone and FEV1, FVC, and PEFR. Data for nonexceedance periods did not indicate this negative relationship for any of the three lung function parameters, but it could not be determined if this was due to an absence of an ozone effect or to a combination of the increased variability and decreased size of this data subset. These data indicate that lung function changes on a daily basis relate in a negative fashion to ambient ozone levels. The magnitude of the changes are small and are reversed as ambient ozone decreases.

The diagnosis in life of coalworkers' pneumoconiosis is based on the industrial history and the chest radiograph. The most striking complaint is excessive breathlessness on exertion. The relationship of this symptom to radiological abnormality is of practical importance in assessing compensation; in most schemes the assumption is made that if a readily diagnosable degree of pneumoconiosis is present and the man is breathless, then the breathlessness is caused by the pneumoconiosis if no other cause is apparent. This assumes a reasonably close relationship between radiological abnormality and breathlessness after allowing for the effects of age.In full reviews of the literature, Worth and Schiller (1954), and Gilson, Hugh-Jones, Oldham, and Meade (1955), conclude that complicated pneumoconiosis is a cause of moderate or severe breathlessness and the extent of the radiological abnormality relates reasonably well to the degree of breathlessness when age is taken into account.The position in the case of simple pneumoconiosis is far less certain. A number of investigators (Jequier-Doge

Bronchodilator Therapy-Hoffbrand et al.be the preferable instrument for following changes in airway resistance in consulting-room and bedside practice. SummaryA comparison has been made using lung-function tests of three proprietary bronchodilator preparations given by dry metered aerosol to 24 patients with asthma and chronic bronchitis.Isoprenaline sulphate (1.20 mg.) was found to be the most effective preparation for the first 30 to 45 minutes after inhalation. Though orciprenaline (2.25 mg.) was less effective in the short term, it proved superior to isoprenaline in having a substantial bronchodilator effect three hours after inhalation. There was, however, considerable individual variation in the response.Bronchilator, a combination of three separate drugs (total dose 1.35 mg.), was less effective than either orciprenaline or isoprenaline in the above doses.The peak-flow meter was found to give a more sensitive index of changes in airway resistance after bronchodilator drugs than a portable bellows spirometer. We conclude that the peak-flow meter provides the method of choice when a convenient portable instrument for following changes in airway resistance is required.

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Reduction of the risk of lung cancer as a result of giving up smoking is examined according to the number of years of cessation from smoking and the number of cigarettes that were smoked per day before quitting smoking. Patients with histologically diagnosed lung cancer from 26 hospitals in six cities in the US were compared with controls matched for age, sex, race, time of diagnosis, and hospital. Smoking habits were recorded by trained interviewers using a questionnaire. In men, a fairly consistent reduction in risk with years of cessation for each category of cigarettes per day before giving up smoking was found. In women, however, a much less consistent pattern was observed. Analysis of the data by histologic type of lung cancer showed that among women, as among men, risk was less and declined more consistently in those with Kreyberg I cancers than in those with Kreyberg II tumors. The inconsistency was seen mainly in patients with Kreyberg II cancers, which were more common among women.