Prevalence of asthma in adolescents in various parts of France and its relationship to respiratory allergic manifestations.

Six studies have been carried out in France and French Polynesia to investigate the prevalence of asthma in adolescents attending secondary school and in Paris university students (68,179 subjects overall). All the studies used the same questionnaire, self-administered in the classroom, and interviews administered to students during the university's preventive medicine examination. An epidemiologic definition of asthma was considered an affirmative answer to the question, "Have you ever had attacks of asthma?" The prevalence of asthma ranged from 4 to 12 percent, most often higher in boys with a tendency to increase with age. The relationship between asthma and other allergic respiratory conditions was studied. Some recommendations are made here to improve the validity of data and to increase knowledge about the etiology of asthma.

Mortality from chronic obstructive pulmonary diseases and asthma in France, 1969-1983. Comparisons with the United States and Canada.

This article focuses on international similarities and differences in levels and trends of mortality for chronic obstructive pulmonary disease (COPD) and asthma in the US, Canada and France from 1969 to 1983. Comparisons have been made of national vital statistics data for age groups 55-64 years, 65-74 years and 75-84 years. From 1969 to 1978, under the 8th revision of the International Classification of Diseases (ICD), the COPD and asthma category included the codes 490-493 and, for the US and Canada, a special code 519.3. From 1979, under the 9th revision, COPD and asthma codes 490-493, 496 were in use in all three countries. The analyses of US, Canadian and French data show lower death rates for COPD and asthma in France. The ratio of male to female deaths from COPD increased with age in the US and Canada, but not in France. The proportion of COPD and asthma deaths attributed to bronchitis was higher in France. An increased use of code 496 (under 9th revision) was observed in the US and above all in Canada. In the three countries, death rates increased faster between 1979 and 1983 in women than in men and increases in women were steeper in the US and Canada than in France. Intercountry comparability is better for COPD mortality in the 9th revision than the 8th revision. Some differences observed between the three countries can be partly explained by coding practices and ICD revisions, but, allowing for differences in coding and classifying respiratory causes of death as well as ICD revisions, death rates are obviously higher in the US and Canada than in France. This suggests that the difference is real.

Respiratory history during infancy and childhood, and respiratory conditions in adulthood.

The aim of this paper was to study respiratory disorders in infancy and childhood as a risk factor for respiratory conditions in adulthood. During the first part of the survey 15,247 adolescents in the Bordeaux area (average age: 16.5 years, boys = 46.6%) filled in a self-administered questionnaire concerning their respiratory history during infancy and childhood, their present symptoms and their smoking habits. Each subject with chronic cough (n = 538) was then matched with two controls (n = 1094) and the parents of these subjects and of their controls were sent a complementary questionnaire. During the second part, 1807 adults (average age: 39.3 years; men = 49.7%) working at Bordeaux University filled in a self-administered questionnaire about their present respiratory symptoms, smoking habits and respiratory symptoms during adolescence. Spirometry was performed in 172 adolescents and 1665 adults. The results of the first part showed a very significant relationship in adolescents between respiratory history during infancy and childhood and current chronic cough even in non-smokers, non-wheezers and non-asthmatics. The second part showed a very significant relationship in adults between respiratory symptoms during adolescence and present respiratory symptoms on the one hand, and a lower pulmonary function on the other, taking wheezing, smoking and asthma into account. In common with many similar studies, we conclude that respiratory disorders in young children may predispose to later disease, and that consequently it might be important to determine appropriate measures to prevent respiratory illness in childhood.

Asbestos risk among full-time workers in an electricity-generating power station.

A matched survey of 55 full-time workers probably exposed to asbestos in an electricity-generating power station (exposed group) and of 53 unexposed workers in an automobile plant has been conducted. The asbestos risk in the power station was confirmed by the presence of airborne fibers in the range 0.1--6000 X 10(-9) g/m3 in the air sampled during the survey period and by the presence of FB in the sputa of 32.7% of the workers. The following parameters were significantly related to asbestos exposure in the study group: FB in the sputa, localized rectitude of the diaphragm, pleural thickening, pleural calcification, and the chest pain. Moreover, for all persons studied, gastrointestinal symptoms and recent hoarsening of the voice were significantly related to the number of FB in the sputa.

Prevalence of respiratory symptoms in Parisian teenagers according to smoking habits.

The relationship between respiratory symptoms and smoking habits, according to sex, was studied in 2266 teenagers attending secondary school in Paris. Among smokers, the prevalence of usual cough or phlegm, or both, was higher in girls than in boys, whereas such was not the case among non-smokers. That prevalence, as well as the proportion of people with wheezing, were more closely associated with the total number of cigarettes ever smoked by girls than by boys. Moreover, there was a weak but significant association between the total number of cigarettes smoked and respiratory function--FEV1/Ht3 in girls only.

[Effect of parents on the tobacco use of their children]. / Influence des parents sur le tabagisme de leurs enfants.

A survey carried out in autumn 1978 in a Paris state secondary school (2266 pupils) enabled us to study the precocity and prevalence of smoking habits in boys and girls aged 14.9 years on average, according to their parents' smoking habits and attitudes. The proportions of smokers were 21.8% in boys and 31.2% in girls. These proportions were lower if parents forbade smoking and higher if they allowed it, or simply advised their children against it. The proportion of smokers and precocity of smoking increased with parents' smoking habits. This result was confirmed by a stepping-up discriminant analysis. We also found that the influence of peers entailed a greater precocity in smoking and that those who smoked to assume a countenance smoked a greater number of cigarettes.

[Can the results of pulmonary function tests and evidence of tobacco-related respiratory symptoms be used to dissuade adolescents from smoking?]. / Les résultats des tests de la fonction pulmonaire et la mise en évidence des symptômes respiratoires liés au tabac peuvent-ils être utilisés pour dissuader les adolescents de fumer?

The purpose of this paper is to review arguments recently used to dissuade youth from smoking, nd to propose new ones based on the results obtained in an epidemiological study carried out between 1978 and 1980 among young people attending school. A questionnaire focused on respiratory symptoms and smoking habits was filled out by 2,269 students between 10 and 19 years of age. Among them, a representative sample of 971 underwent a respiratory function test. Two years later, the students who had shown an impaired respiratory function were again examined--along with a representative control group--using the same protocol. During the first examination, we had found a very meaningful relationship between smoking and respiratory symptoms. MOreover, girl smokers evidenced significantly diminished expiratory flows. The students were informed of the results at the time. When the second examination was carried out, some smokers had increased their cigarette consumption, while others had cut back- and it was the latter group that, during the first examination, had had a significantly higher proportion of symptoms and lower respiratory function values. This suggests that showing proof of the real problems caused by smoking could be used as an element in antismoking campaigns among school-attending youth.

Comparison of respiratory symptoms and pulmonary function between two communities; Tecumseh (US) and Bordeaux (France).

Respiratory symptoms, pulmonary function and smoking habits in two adult populations, aged 20-59 years, are compared in Tecumseh (Michigan) and Bordeaux (France). Personal, demographic, and medical characteristics were ascertained by self-administered questionnaires; Forced vital capacity and Forced expiratory volume in one second (FEV1) were measured. In Tecumseh, the proportion of smokers was higher, people started to smoke earlier and the number of cigarettes per day was higher, the differences were significant. The prevalences of respiratory symptoms tended to be higher in Tecumseh than in Bordeaux although the differences did not reach statistical significance. The age-adjusted odds ratios according to smoking and socio-economic status for respiratory conditions, or relating FEV1 less than 80% predicted did not differ significantly but tended to be greater in Tecumseh. These trends might suggest a greater morbidity and/or a greater impact of risk factors in Tecumseh.

[A self-administered questionnaire applied to 30,000 teen-agers. Assessment of this method of data collection (author's transl)]. / Un auto-questionnaire appliqué à 30,000 adolescents. Evaluation de ce mode de recueil des données.

In the French "département" of "Bas-Rhin", about 30,000 teen-agers filled in a self-administered questionnaire about respiratory symptoms, in spring 1976. The assessment of this method of data collection shows a very high response rate (99,7 p. cent). If we consider as incomplete all the questionnaires having at least one unanswered question concerning respiratory symptoms or smoking, 55,8 p. cent of them were incomplete, but for most questions non-response rate was lower than 4 p. cent. The consistency of answers was very satisfactory (mean inconsistency rate: 0,39 p. cent) and the likelihood of answers was proved.

[Factors related to a population's behaviour towards x-ray screening of tuberculosis (author's transl)]. / Recherche des facteurs liés au comportement d'une population à l'égard du radiodépistage systématique de la tuberculose.

A study on the behaviour of a population towards a preventive measure (X-ray screening of tuberculosis) was carried out in 6,176 adults (average age 55), offered screening by the Mobile X-ray Screening Department of "D.D.A.S.S.", from February to June 1979, 68.6 per cent of them completed and returned the self-administered postal questionnaire. The following factors were related to people's behaviour: age, occupation, educational level, the fact of being invited for the second or third time and of not being vaccinated by B.C.G. According to the results of this survey no personal motivation related to the knowledge and the fear of the disease seems to guide people in their response to the measure offered.

Silica exposure and chronic airflow limitation in pottery workers.

We assessed the relationship between exposure to silica dust and chronic airflow limitation in an epidemiological survey conducted among pottery workers and controls who were of the same socioeconomic status (average age: 35 y; 78% males). Data were collected by questionnaire for respiratory symptoms, allergy, respiratory history, smoking habits, and occupation. Lung function was measured with a computer-equipped Gauthier spirometer. We excluded subjects with silicosis or doubtful chest x-ray, and two exposure levels were defined. No differences were observed between exposed subjects and controls with respect to respiratory conditions. Mean pulmonary function values for men and women were significantly lower, after adjustment for age, height, and smoking habits, in even indirectly exposed pottery workers, compared with controls. These results suggest that exposure to silica dust is a risk factor for chronic airflow limitation and is independent of radiographic changes.

Smoking in teenagers: some psychological aspects.

A large survey was carried out by means of a self-administered questionnaire to the 30,000 teenagers attending school in a French "département" (Bas-Rhin) during spring 1976. This survey revealed some psychological factors about smoking in teenagers as they relate to school and family environment; 30.3% of the subjects were smokers. This proportion was higher in boys than in girls, and increased with age. Statistical analysis showed a greater number of smokers in non-mixed schools, in schools where adults were admitted or where regulations did not forbid smoking, as well as among boarders. We also found a greater number of smokers when the family smoked, when the parents lived outside the "départment" or belonged to the lower social classes.

[Mortality by respiratory disease in ten European and North American countries (1979-1990)]. / Mortalité par maladies de l'appareil respiratoire dans dix pays d'Europe et d'Amerique du Nord (1979-1990).

The aim of this paper is to compare respiratory mortality, cancer and tuberculosis excluded, in 10 countries during 12 years. Mortality data came from World Health Statistics Annual of the WHO and age adjusted rates were calculated. For all causes respiratory mortality, acute pathologies and chronic obstructions not elsewhere classified, United Kingdom and above all Eire have the highest rates; Italy, France and Germany have the lowest rates; the other countries (Belgium, Denmark, Netherlands, Canada, United States) have rates similar, sometimes equal). For chronic conditions, Denmark has the highest rates, Canada and United States the lowest; Eire and United Kingdom begin a great decrease from 1983. On the whole, differences between countries do not vary very much with the years or the pathologies and the evolution over the time is not very marked apart from some countries.

[Chronic cough in adolescents and respiratory symptoms in adults]. / Toux chronique de l'adolescent et symptômes respiratoires de l'adulte.

The object of this work was to study the relationship between chronic cough in adolescence, and chronic symptoms and airflow obstruction in adults. The data were collected between 1982 and 1984 from 1807 men and women living in Bordeaux (France) and its surrounds. A self administered questionnaire was used which focused on current respiratory symptoms and respiratory symptoms during adolescence. Spirometric curves (FVC, FEV1 and FEF 25-75) were measured. The population was evenly split between men (mean age 40.1) and women (mean age 38.6). Most subjects were French; more than half were non smokers; all socioprofessional categories were represented except farmers, craftsmen and merchants. The proportion of subjects with current respiratory symptoms was 2 to 10 times higher amongst subjects with respiratory symptoms during their adolescence than in those who had none. The relationships were highly significant and remained so after adjustments for the confounding factors following: sex, age, nationality, socio-economic status, smoking habits, occupational exposure and previous occupational disease. Mean spirometric values were higher amongst subjects without chronic cough during their adolescence than those who had cough. Differences were significant for FVC, FEV1, FEF 25-75 in women and were on the borderline for FEF 25-75 in men. This study showed that respiratory conditions in adolescence represent an important risk factor for chronic symptoms and airflow obstruction in adult life.

[Mortality related to asthma. Trends in France from 1970 to 1987]. / Mortalité rapportée à l'asthme. Tendances pour la France de 1970 à 1987.

An increase in mortality related to asthma has been observed in a great number of countries during the last decade. The purpose of this work is to study this evolution in France from 1970 to 1987. Numbers of deaths were obtained from INSERM, by sex and age groups and the corresponding populations from INSEE. Data were interpreted from crude rates and with the computation of age adjusted and age specific rates. In men, we observed a decrease in mortality from 1972 to 1979, then an increase from 1980 to 1987. In women, the decrease stopped as early as 1974 and we observed an increase from 1975 to 1987. On the other hand their crude and age-adjusted rates become higher than men's rates as early as 1977.

[Respiratory history in children and asthma]. / Antécédents respiratoires de l'enfant et maladie asthmatique.

The purpose of this study was to examine the relationship between asthma, the respiratory history and possible disturbances of pulmonary function in teenage asthmatics. This aetiological study was carried out in 103 asthmatics and 1094 controls who were teenagers attending schools in Bordeaux. In addition to the data collected by the teenagers using a self administered questionnaire, parents also filled out a complementary questionnaire. Spirometry was performed in a sample of 112 subjects. The result showed a significant relationship between asthma and respiratory history in childhood and infancy. Moreover there was a significant decrease of FEV1, (in girls only) and FEF 25-75 (boys and girls) amongst the asthmatic pupils.

[Smoking among nursing students]. / Le tabagisme chez les élèves infirmières.

The aim of this work is to study smoking habits in young adults in a particularly sensitive environment. The data were collected in 28 nursing schools of the Public Hospital System in Paris by means of anonymous self-administered questionnaire. The questions focused on smoking habits, knowledge of risks and student attitudes. The 5,598 respondents (mean age of 22.6 years) were 89 per cent female. The results showed a high prevalence of current smoking (44%) especially amongst the younger students. Students preferred brands with a medium range tar level. Most of the students knew the smoking risk, agreed with the policy of prohibiting smoking in the hospital and thought that it is the role of nurses to counsel patients to stop smoking, but only one third hold a positive view of this role.