The aim of this study was to assess the influence of some risk factors for onset and remission of allergic rhinitis and asthma in Swedish adults. A random sample of 1,370 subjects, age 20 to 44 yr was investigated by means of postal questionnaires in 1990 and 1993. Skin prick tests were conducted in 1991-1992. The association between risk factors and onset or remission of allergic rhinitis and asthma was estimated using multivariate logistic regression analysis. Onset of allergic rhinitis was associated with sensitization to birch (odds ratio [OR] = 6.5), Parietaria (OR = 7.4); and pets (OR = 3.0) and with female sex (OR = 1.9). Onset of asthma was associated with allergic rhinitis (OR = 4.9), sensitization to pets (OR = 2.4); and with smoking (OR = 3.0). Onset of asthma was strongly associated with allergic rhinitis among atopics (OR = 5.7), but onset of asthma and rhinitis also tended to be related among nonatopics (OR = 3.5). A strong association between smoking and onset of asthma was found among nonatopics (OR = 5.7). In conclusion, sensitization to pollens and pets were risk factors for onset of allergic rhinitis, whereas allergic rhinitis, sensitization to pets, and smoking were risk factors for onset of asthma.

I In nc cr re ea as se ed d p pr re ev va al le en nc ce e o of f s sl le ee ep p d di is st tu ur rb ba an nc ce es s a an nd d d da ay yt ti im me e s sl le ee ep pi i--n ne es ss s i in n s su ub bj je ec ct ts s w wi it th h b br ro on nc ch hi ia al l a as st th hm ma a: : a a p po op pu ul la at ti io on n s st tu ud dy y o of f y yo ou un ng g a ad du ul lt ts s i in n t th hr re ee e E Eu ur ro op pe ea an n c co ou un nt tr ri ie es s ABSTRACT: The aim of this study was to investigate whether asthma is associated with decreased quality of sleep and increased daytime sleepiness. The study involved a random population of 2,202 subjects supplemented by 459 subjects with suspected asthma, aged 20-45 yrs. The subjects were from Reykjavik (Iceland), Uppsala and Göteborg (Sweden) and Antwerp (Belgium), and participated in the European Community Respiratory Health Survey. The investigation included a structured interview, methacholine challenge, skinprick tests and a questionnaire on sleep disturbances. Participants in Iceland and Sweden also estimated their sleep times and made peak expiratory flow (PEF) recordings during a period of 1 week. Asthma was defined as self-reported physician-diagnosed asthma with current asthma-related symptoms (n=267).Difficulties inducing sleep (DIS) and early morning awakenings (EMA) were about twice as common, and daytime sleepiness 50% more common, in asthmatics compared with subjects without asthma. After adjusting for possible confounders, a positive association was found between asthma and: DIS (odds ratio (OR)=1.8); EMA (OR=2.0); daytime sleepiness (OR=1.6); snoring (OR=1.7); and self reported apnoeas (OR=3.7). Allergic rhinitis, which was reported by 71% of subjects with asthma, was independently related to DIS (OR=2.0) and daytime sleepiness (OR=1.3). A significant correlation was found between the number of asthma-related symptoms and sleep disturbances (p<0.001).Asthma is associated with decreased subjective quality of sleep and increased daytime sleepiness. Concurrent allergic rhinitis may be an important underlying cause of sleep impairment in asthmatic patients.

Both accidental and intentional non-adherence with controller therapy is common among adult asthmatics. The reasons for suboptimal adherence seem to be accessible through education of both patients and caregivers.

Local anaesthetics (LA) are widely used drugs. Adverse reactions are rare but may be caused by delayed-type hypersensitivity reactions and probably also immediate-type reactions. As it is not always easy to clinically differ between these subtypes, allergy skin testing should be considered. Although numerous test protocols have been published, how patients with hypersensitivity reactions to LA are ideally evaluated remains a topic of discussion. This review attempts to generate a comprehensive update on allergic reactions to LA and to present an algorithm that can be used for the evaluation of patients suspected with immediate-and delayed-type immune reactions. Literature was examined using PubMed-Medline, EMBASE, Biosis and Science Citation Index. Based on the literature, the proposed algorithm may safely and rapidly distinguish between immediate-type and delayed-type allergic immune reactions.

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.

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.

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The prevalence of snoring was about the same in all four areas, whilst there was a geographical variation in daytime sleepiness and tiredness. As complaints of DS and DT and disrupted breathing were more common in subjects who reported symptoms of gastro-oesophageal reflux, we suggest that polysomnographic studies comparing sleep patterns in adult patients with and without reflux should be conducted.