No abstract

We investigated the constituents of bronchoalveolar lavage (BAL) regarding cell profiles and released eosinophilic cationic protein (ECP) in 11 patients treated occasionally with inhaled bronchodilators (Group A) and 11 patients treated regularly with inhaled corticosteroids (Group B). A normal, healthy control group of 12 subjects was also recruited. Compared with Group A, Group B had a reduced recovery percentage of infused volume (p less than 0.05) and total cell number (p less than 0.01). Compared with the control group, there was a significant increase in the percentage of eosinophils (p less than 0.05) in both groups of asthmatics. In Group A there was also a significant increase in mast cells (p less than 0.05), serum-ECP (p less than 0.05), and BAL-ECP (p less than 0.001). No correlations between any of the cell variables and the level of airway responsiveness measured as PC20 histamine were found in any group. Group A patients were investigated twice--before and after 4 wk of randomly allocated treatment with either a regular beta-2-receptor agonist (terbutaline 250 micrograms, two puffs four times a day) or a regularly inhaled corticosteroid (budesonide 200 micrograms twice a day). The BAL differential cell counts were similar and not significantly affected by either treatment. However, BAL-ECP levels were decreased by budesonide treatment (p less than 0.05). ECP levels in serum and BAL were significantly correlated (p less than 0.05 to 0.001). The eosinophilic cell involvement in asthma is further emphasized by this study but the increase in numbers of eosinophils seems less important than their activity, here measured as release of one degranulation product, ECP. To suppress disease activity, repeated long-term treatment is important, but clear preference for either treatment cannot be given on the basis of our present results.

S Sy ym mp pt to om ms s r re el la at te ed d t to o a as st th hm ma a a an nd d c ch hr ro on ni ic c b br ro on nc ch hi it ti is s i in n tWheezing was reported by 20.5%, and the combination of wheezing without a cold and wheezing with breathlessness by 7.4%. The use of asthma medication was reported by 5.3%. Long-term cough and/or morning cough together with problems with phlegm was reported by 12.8%; the prevalence being highest in the most polluted area (Göteborg). When using multivariate analysis, no significant difference in asthma-related symptoms was found between the centres. Women reported cough more frequently, but otherwise gender did not influence symptom prevalence.Our results indicate that bronchitis symptoms occur more frequently in Göteborg, the most polluted of the Swedish centres, but that the prevalence rates of asthmarelated symptoms do not differ between these three regions.

The type of care depended on who the patient met: either a task-oriented nurse or an individual-oriented nurse. Therefore, nursing programmes should pay special attention to the support and guidance of new and inexperienced and task-oriented nurses. Healthcare planners should take into consideration the need for individualized care when organizing care and allocating resources for chronically ill people.

Asthma is a common chronic disorder which may be increasing in prevalence. However, little is known of its distribution and determinants. The European Community Respiratory Health Survey (ECRHS) is a multicentre survey of the prevalence, determinants and management of asthma. This paper presents a descriptive account of the variation in self-reported attacks of asthma and asthma symptoms across Europe, and in part fulfils the first aim of the study. A screening questionnaire, including seven questions relating to the 12 month prevalence of symptoms of asthma, was distributed to representative samples of 20-44 year old men and women in 48 centers, predominantly in Western Europe. The median response rate to the questionnaire was 75% but, after removing from the denominator those who were the wrong age, were known to have moved out of the area, or had died, it was 78% (range 54-100). The prevalence of all symptoms varied widely. Although these were generally lower in northern, central and southern Europe and higher in the British Isles, New Zealand, Australia and the United States, there were wide variations even within some countries. Centres with a high prevalence of self-reported attacks of asthma also reported high prevalences of nasal allergies and of waking at night with breathlessness. The use of asthma medication was more common where wheeze and asthma attacks were more frequent. In most centres in The Netherlands, Sweden, New Zealand and the United Kingdom over 80% of those with a diagnosis of asthma were currently using asthma medication. In Italy, France and Spain the rate was generally less than 70%. These data are the best evidence to date that geographical differences in asthma prevalence exist, are substantial and are not an artefact of the use of noncomparable methods.

Ten patients were studied during an acute episode of farmer's lung. Prominent findings were an impaired diffusion capacity (on average only 51% of predicted) and substantially increased amounts of hyaluronate and type III procollagen peptide recovered during bronchoalveolar ravage; mean concentrations ofthese constituents in ravage fluid were 547 (range 137-1125) and 9-7 (2-8-19-4) Wgfl, respectively. In bronchoalveolar ravage fluid from healthy controls (n=21) hyaluronate concentrations were less than 15 gl and procollagen peptide concentrations less than 0.2 i/l. Lavage fluid concentrations of these potential markers of fibroblast activation declined during the recovery phase of farmer's lung; four to 10 weeks after admission (n=7) mean concentrations of hyaluronate and procollagen peptide were 154 (range 384650) and 4-4 (0-6-15-8) M/gfl, respectively. At clinical remission six to 14 months after admission concentrations of these markers had returned almost to normal, though slightly increased concentrations were still evident in about half the patients (n=7). At that time lung volumes were normal but diffusion capacity remained slightly subnormal.It was concluded that in farmer's lung release of hyaluronate and type mI procollagen peptide reflects activity of the disease.Increased synthesis of these connective tissue components

Budesonide/formoterol in a single inhaler is as safe and effective in the long-term treatment of asthma as budesonide plus formoterol via separate inhalers. The lower number of withdrawals with budesonide/formoterol may reflect better adherence to treatment compared with budesonide plus formoterol.

Bronchoalveolar lavage (BAL) has been performed in 22 healthy nonsmoking male volunteers after exposure to 8 ppm SO2 (20 mg/m3). The exposure level exceeds the US Short-Term Exposure Limit (STEL) of 5 ppm, but occurs as peak exposures in industrial indoor environments. Exposures were made during light work on a bicycle ergometer in an environmental exposure chamber for 20 min. BAL was performed 2 wk or more before exposure and 4, 8, 24, and 72 h after exposure in eight subjects at each time interval. Four hours after exposure significant increases were found in the numbers of lysozyme-positive macrophages, lymphocytes, and mast cells (p less than 0.02 to 0.05). Lymphocytes, lysozyme-positive macrophages, total count of alveolar macrophages, and total cell number increased to peak values 24 h after exposure (p less than 0.02 to 0.05). Seventy-two hours after exposure the cell numbers and distribution had returned to normal. The time course of the cell reactions found in BAL fluid after controlled SO2 exposure represents a new and previously not reported response to a noxious gas.