[Guideline for Long-Term Oxygen Therapy - S2k-Guideline Published by the German Respiratory Society]. / Leitlinie zur Langzeit-Sauerstofftherapie.

Long-term oxygen therapy is of great importance both for reducing mortality and for improving performance in patients with chronic lung diseases. The prerequisites for Long-term oxygen therapy are adequate diagnostics and clearly defined indication. A causal distinction into chronic hypoxaemic and hypercapnic respiratory failure is reasonable, from which the differential indication for non-invasive ventilation results.The revised guideline covers the diagnostics and indication of chronic lung and heart diseases, the role of oxygen in terminal illness and gives a detailed description of available oxygen devices. The guideline is intended to help avoid undersupply, oversupply and false prescriptions. Furthermore, the chapter "Postacute Oxygen Therapy" discusses the procedure, relevant in everyday life, but not yet clearly defined, for prescribing oxygen therapy for the home at the end of an inpatient stay. Another important point, the correct prescription of mobile oxygen systems, is also presented in the guideline. This document is a revised version of the guideline for longterm oxygen therapy and replaces the version of 2008.

[Guideline for the Diagnosis and Treatment of COPD Patients - Issued by the German Respiratory Society and the German Atemwegsliga in Cooperation with the Austrian Society of Pneumology]. / Leitlinie zur Diagnostik und Therapie von Patienten mit chronisch obstruktiver Bronchitis und Lungenemphysem (COPD).

This document is a revision of the guideline for diagnosis and treatment of COPD that replaces the version from 2007. A multitude of recent reports regarding risk factors, diagnosis, assessment, prevention and pharmacological as well as non-pharmacological treatment options made a major revision mandatory. The new guideline is based on the GOLD document taking into account specifics in Germany and Austria.

Association between lung function and dyspnoea and its variation in the multinational Burden of Obstructive Lung Disease (BOLD) study.

BACKGROUND: Dyspnoea is a common symptom of respiratory disease. However, data on its prevalence in general populations and its association with lung function are limited and are mainly from high-income countries. The aims of this study were to estimate the prevalence of dyspnoea across several world regions, and to investigate the association of dyspnoea with lung function. METHODS: Dyspnoea was assessed, and lung function measured in 25,806 adult participants of the multinational Burden of Obstructive Lung Disease study. Dyspnoea was defined as ≥2 on the modified Medical Research Council (mMRC) dyspnoea scale. The prevalence of dyspnoea was estimated for each of the study sites and compared across countries and world regions. Multivariable logistic regression was used to assess the association of dyspnoea with lung function in each site. Results were then pooled using random-effects meta-analysis. RESULTS: The prevalence of dyspnoea varied widely across sites without a clear geographical pattern. The mean prevalence of dyspnoea was 13.7 % (SD=8.2 %), ranging from 0 % in Mysore (India) to 28.8 % in Nampicuan-Talugtug (Philippines). Dyspnoea was strongly associated with both spirometry restriction (FVC

Development and validation of the Salzburg COPD-screening questionnaire (SCSQ): a questionnaire development and validation study.

Chronic obstructive pulmonary disease prevalence rates are still high. However, the majority of subjects are not diagnosed. Strategies have to be implemented to overcome the problem of under-diagnosis. Questionnaires could be used to pre-select subjects for spirometry and thereby help reducing under-diagnosis. We report a brief, simple, self-administrable and validated chronic obstructive pulmonary disease questionnaire to increase the pre-test probability for chronic obstructive pulmonary disease diagnosis in subjects undergoing confirmatory spirometry. In 2005, we completed the Austrian Burden of Obstructive Lung Disease-study in 1258 subjects aged >40 years. Post-bronchodilator spirometry was performed, and non-reversible airflow limitation defined by FEV1/FVC ratio below the lower limit of normal. Questions from the Salzburg chronic obstructive pulmonary disease screening-questionnaire were selected using a logistic regression model, and risk scores were based on regression-coefficients. A training sub-sample (n = 800) was used to create the score, and a test sub-sample (n = 458) was used to test it. In 2008, an external validation study was done, using the same protocol in 775 patients from primary care. The Salzburg chronic obstructive pulmonary disease screening questionnaire was composed of items related to "breathing problems", "wheeze", "cough", "limitation of physical activity", and "smoking". At the >=2 points cut-off of the Salzburg chronic obstructive pulmonary disease screening questionnaire, sensitivity was 69.1% [95%CI: 56.6%; 79.5%], specificity 60.0% [95%CI: 54.9%; 64.9%], the positive predictive value 23.2% [95%CI: 17.7%; 29.7%] and the negative predictive value 91.8% [95%CI: 87.5%; 95.7%] to detect post bronchodilator airflow limitation. The external validation study in primary care confirmed these findings. The Salzburg chronic obstructive pulmonary disease screening questionnaire was derived from the highly standardized Burden of Obstructive Lung Disease study. This validated and easy to use questionnaire can help to increase the efficiency of chronic obstructive pulmonary disease case-finding. CHRONIC OBSTRUCTIVE PULMONARY DISEASE: QUESTIONNAIRE FOR PRE-SCREENING POTENTIAL SUFFERERS: Scientists in Austria have developed a brief, simple questionnaire to identify patients likely to have early-stage chronic lung disease. Chronic obstructive pulmonary disease (COPD) is notoriously difficult to diagnose, and the condition often causes irreversible lung damage before it is identified. Finding a simple, cost-effective method of pre-screening patients with suspected early-stage COPD could potentially improve treatment responses and limit the burden of extensive lung function ('spirometry') tests on health services. Gertraud Weiss at Paracelsus Medical University, Austria, and co-workers have developed and validated an easy-to-use, self-administered questionnaire that could prove effective for pre-screening patients. The team trialed the five-point Salzburg COPD-screening questionnaire on 1258 patients. Patients scoring 2 points or above on the questionnaire underwent spirometry tests. The questionnaire seems to provide a sensitive and cost-effective way of pre-selecting patients for spirometry referral.

Aromatic hydroxylation in nasal lavage fluid following ambient ozone exposure.

Ozone at ambient concentrations affects lung function and initiates an inflammatory response of the airways. However, the underlying mechanisms are poorly understood. In vitro studies have shown that ozone reacts with water to give reactive hydroxyl radicals capable of oxidizing a wide range of biomolecules. We conducted a study to determine if in vivo hydroxyl radical attack on human airways occurs under natural exposure to ozone. The relation of orthotyrosine to para-tyrosine as a measure of hydroxyl radical attack was analyzed in nasal lavage samples of 44 primary school children in an epidemiologic study. Repeated nasal lavages were performed between May and October 1991 both following "low" (daily half-hour maximum < 140 micrograms/m3, approximately 70 ppb) and "high" (daily half-hour maximum > 180 micrograms/m3, approximately 90 ppb) ozone exposure. Concomitantly, lung function tests were performed. On average, 11.6 (6-16) nasal lavages were performed for each of 24 study days (10 days following "low" ozone exposure and 14 days following "high" ozone exposure). Average ortho-tyrosine (median; 5-95% percentile) for each child was 0.037 mumol/L (0.016-0.064 mumol/L) and average para-tyrosine was 15.7 mumol/L (9.8-24.1 mumol/L). Ortho-tyrosine (as percentage of tyrosine) was significantly higher following days with "high" ozone exposure (0.18%) vs. days following "low" ozone exposure (0.02%; p = .0001). Ortho-tyrosine showed an inverse relationship with forced vital capacity (p = .01) but was not related to inflammation of the upper airways as assessed by cell counts of polymorphonuclear neutrophils. Hydroxyl radical attack subsequent to ambient ozone occurs in the upper airways of healthy children and is related to lung function decrements.

The role of iodine-123-Tyr-3-octreotide scintigraphy in the staging of small-cell lung cancer.

The purpose of this study is to investigate the role of 123I-Tyr-3-octreotide scintigraphy in staging small-cell lung cancer (SCLC), its efficacy for the discrimination of limited and extensive disease stages and its regional sensitivity for different metastatic locations. Twenty patients with histologically confirmed SCLC and 50 radiologically staged tumors sites were investigated by an imaging protocol including dynamic (0-30 min p.i.), static (30 min, 90 min, 4 hr, 24 hr p.i.) and SPECT (90 min p.i.) studies. The primary tumor site was visualized in 84%, whereas the best delineation was noted in early planar (15-30 min p.i.) and SPECT studies, due to a rapidly decreasing tumor-to-background ratio. Lymph node metastases were seen in 73%, but SPECT was needed for anatomical localization. All three adrenal metastases could be identified in sequential planar images. One clinically unsuspected brain metastasis was seen, whereas a second clinically overt metastasis was not visualized. The global and regional sensitivity for liver and bone metastases was unsatisfactory. In summary, 78% (7/9) of the patients with extensive disease were correctly identified by scintigraphy alone. We conclude that 123I-Tyr-3-octreotide scintigraphy is a substantial tool in the staging work-up of SCLC if it is performed initially to allow fast identification of patients with extensive disease stages and save additional radiological or invasive examinations. Yet, 123I-Tyr-3-octreotide scintigraphy cannot substitute liver sonography or conventional bone scanning in patients who have no scintigraphic evidence of distant tumor spread.

Determinants of airway response to challenge with distilled water in a population sample of children aged 7 to 10 years old.

We challenged 446 schoolchildren and measured the percent decrease in FEV1 following 10 min of tidal inhalation of UNDW. Assessment tools for respiratory symptoms and atopy were questionnaire and skin testing, respectively. A previous diagnosis of asthma was most strongly associated with a positive airway response (defined as a fall in FEV1 greater than or equal to 10 percent. A positive response was also associated with atopy, presence of cough, cough during night, or any respiratory symptom. A child's age and the prechallenge FEF75% also explained response to distilled water indicating less responsiveness for older children and those with relative greater airway diameter. For the previous diagnosis of asthma, a positive distilled water challenge test had a sensitivity of 36 percent and a specificity of 92 percent. We conclude that a significant relationship between airway response to distilled water, asthma and symptoms suggestive for asthma exists for a childhood population sample.

Peripheral blood lymphocyte subsets and survival in small-cell lung cancer.

Measurement of lymphocyte subsets in peripheral blood is likely to reflect immune response of patients and therefore may be linked to survival in small-cell lung cancer (SCLC). Forty patients with SCLC (14 with limited and 26 with extensive disease at study entry) were included and followed for up to 23 months. Peripheral blood lymphocytes were determined by flow cytometry and levels for total-, T-, B-, helper-, suppressor-, activated T-cells and natural killer cells established and the T-helper-suppressor ratio (H-S ratio) calculated. Quartiles of lymphocyte subset cell counts at the start of follow-up and for the change over follow-up were investigated. Cox regression models indicated that H-S ratio was a significant predictor (p = 0.02) of survival. The risk ratio, after adjustment for competing risk factors, sex, age and stage of disease, was found to be 0.66 (95 percent confidence intervals, 0.46 to 0.95) and predicted that for each quartile of greater H-S ratio, the risk of death decreased by 34 percent. For change in cell counts over follow-up, total lymphocytes (p = 0.02) demonstrated a significant association with survival. Although our observation is limited by the fact that 13 patients were unavailable for follow-up, we conclude that H-S ratio can serve as an easily accessible marker of immune function and possible prognostic value in SCLC.

Determinants of reproducibility of lung function tests in children aged 7 to 10 years.

Lung function (LF) tests are part of many investigations in childhood lung disease. However, individual reproducibility of LF will confound between-subject differences. At the same time, increased LF variability has been linked to respiratory disease. In a sample of 598 children, two LF tests, separated by a 5-min interval, were recorded, and reliability (Rel) of forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), and maximal expiratory flow at 50% of FVC (MEF50) was determined. Rel was also assessed in children trained and untrained in the performance of LF. To investigate determinants of reproducibility for FEV1, the absolute difference between two repeated tests was calculated. Whenever this difference was > 120 ml, a child was considered to demonstrate excessive variability (poor reproducibility) in FEV1. For volume parameters coefficients of reliability (Crel) were found to be better than for MEF50 (FEV1: 0.96; FVC: 0.94, MEF50: 0.91). In untrained children Crel for FEV1 was only 0.91, but it was increased in subsequent visits (0.98, 0.97, and 0.97 at the second, third, and fourth tests, respectively). Excessive variability in FEV1 was observed in 10% of children and was related to the presence of wheeze [odds ratio (OR) 6.31; 95% confidence interval (CI) 1.78-22.4), shortness of breath (OR 3.14; 95% CI 1.00-9.93), a diagnosis of asthma (OR 6.25; 95% CI 1.76-22.1), and bronchial hyperresponsiveness (OR 4.30; 95% CI 2.07-8.94). We conclude that increased variability of LF is likely to be present in young children not accustomed to the testing procedure and in children with respiratory symptoms. Therefore, before guidelines for LF testing are applied, children should be trained to perform the tests and we should be cautious in the interpretation of test results in children who present with symptoms.

Immunostimulatory effects of dimerized lysozyme (KLP-602) on the nonspecific defense mechanisms and protection against furunculosis in salmonids.

Utilization of natural immunostimulants in fish culture offers a wide range of attractive methods for inducing and building protection against diseases. Lysozyme is an enzyme with bacteriolytic properties and is ubiquitous in its distribution among living organisms. This enzyme has antiviral, antibacterial and anti-inflammatory properties. In nature, lysozyme is found as a monomer. Lysozyme dimer is significantly less toxic than its monomer, and its high biological activity has been ascertained in cases of both viral and bacterial infections. In our study, we examined the influence of dimerized lysozyme (KLP-602) on the nonspecific cellular and humoral defense mechanisms and protection against furunculosis in rainbow trout (Oncorhynchus mykiss). We have analyzed the immunomodulatory effects of KLP-602 after experimental infection by Aeromonas salmonicida. Application of dimerized lysozyme (KLP-602) by injection stimulated the cellular and humoral defense mechanisms and provided protection against furunculosis. By contrast, mortality rate was reduced to 45% (one injection) and 25% (three injections) using 10 or 100 microg/kg KLP-602. Mortality in the untreated control group was 85%.

In vitro effects of beta-hydroxy-beta-methylbutyrate (HMB) on cell-mediated immunity in fish.

beta-Hydroxy-beta-methyl butyrate(HMB) has been shown to counteract many of the negative effects of intensive animal production methods and results in increased growth and protection against diseases. In the present study, the effect of HMB on the immunocompetence cell activity in rainbow trout (Oncorhynchus mykiss) and carp (Cyprinus carpio) was examined. Pronephric phagocytes and lymphocytes were isolated from the fish and grown in culture medium (RPMI-1640) containing either 0, 0.1, 1, 5, 10, 25, 50 or 100 microg HMB/ml of medium. The effects of HMB on the respiratory burst activity (RBA) stimulated by phorbol myristate acetate (PMA), the potential killing activity (PKA) and lymphocyte proliferation stimulated by either concanavalin A (Con-A) or lipopolysaccharide (LPS) were examined. The addition of HMB to the culture medium increased the RBA by up to 84% (p<0.01) over that of cells grown without HMB. Similarly, the PKA of the phagocytes was also increased with HMB addition to the medium by up to 140% (p<0.01) over that of cells grown without HMB. Lymphocyte proliferation stimulated by both ConA and LPS was also increased approximately two-fold (p<0.01) when HMB was added to the culture medium at concentrations between 10 and 100 microg HMB/ml in both rainbow trout and carp. The greatest effects of HMB on RBA and PKA activities were observed at a concentration >50 microg HMB/ml while lymphocyte proliferation was maximally stimulated at 25 microg HMB/ml. In conclusion, the current study shows that HMB could potentially improve immunocompetence cell activity in fish through increased cell proliferation and functionality.

[The effect of inhalable dust particles (PN10) on lung function and respiratory symptoms of school children in Lower Austria]. / Der Einfluss von inhalierbaren Staubpartikeln (PM10) auf Lungenfunktion und respiratorische Symptome bei niederösterreichischen Volksschulkindern.

The effect of PM10 (particulate matter less than 10 microns in diameter) on respiratory symptoms and lung function was evaluated in 881 children (aged 8 to 11 years) in 8 communities in Lower Austria. In each community, air pollution data (PM10, SO2, NO2, O3) were collected. The examination of each child included a questionnaire (spring 1996), and two lung function tests (autumn 1995, spring 1996). Statistically significant relationships were observed between PM10 levels (annual mean, 15.8-26.9 micrograms/m3) and parameters of lung function (adjusted for sex, height, atopy, passive smoking, altitude, temperature). A 10 micrograms/m3 increase in the last two weeks' mean PM10 in spring 1996 was associated with a 0.05% decrease in FVC, a 0.05% decrease in FEV1, a 0.15% decrease in MEF50, and a 0.13% decrease in MEF75-25. Furthermore, a 10 micrograms/m3 increase in last year's mean PM10 was associated with a 0.07% decrease in FVC. No association between the prevalence of respiratory symptoms and the last year's mean PM10-exposure was found. Our study demonstrates a small effect of low-level particulate air pollution on lung function of healthy school children.

Electromagnetic navigation bronchoscopy (ENB): Increasing diagnostic yield.

OBJECTIVES: To determine factors associated with diagnostic yield of ENB. METHODS: In 112 consecutive patients referred to our department between March 2010 and December 2010 the diagnostic work-up for solitary pulmonary lesions included a FDG-PET-CT scan, and ENB in combination with ROSE. The final diagnosis was confirmed by histopathological evaluation of specimen obtained either by ENB, or - if ENB was not diagnostic - by CT-guided fine needle aspiration or surgery. RESULTS: Thirty-seven (33%) subjects were female, mean age was 66.7 (±1.04) years. The mean diameter of lesions was 27mm (range: 6-46mm). In 83.9% the combination of PET-CT, ENB, and ROSE established a correct diagnosis, as defined by the definite histopathological result. 15.2% (17/112) of lesions were benign, and 84.8% (95/112) were malignant. For 112 procedures we observed a steep learning curve with a diagnostic yield of 80% and 87.5% for the first 30 and last 30 procedures, respectively. The diagnostic yield in lesions ≤20mm and >20mm in diameter was 75.6% and 89.6% (p=0.06), respectively. No significant difference in diagnostic yield was seen depending on lung function, and the localization of the lesions. Two cases (1.8%) of pneumothorax were seen during and up to 24h after bronchoscopy, none of them required a chest tube. CONCLUSION: Diagnostic yield increased with experience but was independent from the size of the lesion, the localisation in the lungs, and lung function. The diagnostic yield of ENB can be as high as for CT-guided transthoracic biopsies but carries a significantly lower complication rate.

The impact of PET and PET/CT on treatment planning and prognosis of patients with NSCLC treated with radiation therapy.

AIM: 18F fluoro-deoxy-glucose (FDG) positron emission tomography (PET)-imaging improves the diagnostic accuracy in staging non small cell lung cancer (NSCLC) with possible impact on survival. This prospective study aimed to investigate the impact of PET and PET/CT on treatment planning and prognosis in patients with NSCLC treated with radiation therapy. METHODS: From October 2003 to January 2008, 91 consecutive patients with proven NSCLC stage T1-4N0-3M0 (clinical stages: I-IIIb) underwent accelerated, twice daily radiation therapy in target splitting technique. 70 patients received chemotherapy before radiation therapy (76%). All patients underwent PET or PET/CT-imaging and were followed up for a median time of 30 months. Imaging findings were interpreted visually and a SUV cut-off of 2.5 was applied for delineation of tumor borders. Changes in staging and planning treatment volumes (PTV) due to PET or PET/CT-imaging and survival were defined as primary study endpoints. The impact of tumor-type, stage, age, gender, weight loss and FDG-uptake in PET imaging as measured by the standardized uptake value (SUV) on survival were analysed as secondary endpoints. RESULTS: PET imaging provided additional diagnostic information over CT alone in 20% (N.=18) of our study population, leading to upstaging in 17% of them, respectively. In 5 patients (5.5% of 91) atelectasis could be separated from tumor tissue, PTV was altered in 9% (N.=8). 39 patients (43%) died during the observation period, mean overall survival was 32.3 months (95% Confidence intervalI 27.6-37.1) and tumor specific survival was 36.9 months (95 % CI 32.0-42.0), respectively. One- and two year survival rates reached 90.1% and 67.7%, respectively. Multivariate analysis did not reveal any significant prognostic impact of tumor-type, stage, age, gender or FDG-uptake as given by SUVmax (mean 13.6±6.8) or SUVmean (mean 5.5±1.6). CONCLUSION: The use of FDG-PET- and PET/CT-imaging provided incremental information relevant for treatment-planning in about 10 % of patients with NSCLC undergoing accelerated radiation therapy with curative intent. This prospective trial did not provide evidence for the assumption that the SUV might be an independent predictor of outcome.

Successful bronchoscopic cryorecanalization in a case of endobronchial lipoma.

Endobronchial lipomas are rare benign tumors; less than 150 cases have been reported so far. Bronchial occlusion usually leads to a misdiagnosis of asthma/COPD or malignancy. We report the case of a 67-year-old man with a history of heavy smoking (100 pack years), dyspnea on exertion, cough, and malaise who was treated for pneumonia for three weeks. Due to nonresolving atelectasis of the superior segment of the right lower lobe, a malignant endobronchial tumor was suspected. Rigid bronchoscopy with cryorecanalization led to both the definite histopathological diagnosis of endobronchial lipoma and the reopening of an endoluminal airway obstruction during one procedure.

Quality of spirometry tests performed by 9893 adults in 14 countries: the BOLD Study.

OBJECTIVE: to determine the ability of participants in the Burden of Obstructive Lung Disease (BOLD) study to meet quality goals for spirometry test session quality and to assess factors contributing to good quality. METHODS: Following 2 days of centralized training, spirometry was performed pre- and post-bronchodilator (BD) at 14 international sites, in random population-based samples of persons aged ≥40 years, following a standardized protocol. The quality of each test session was evaluated by the spirometer software and an expert reading center. Descriptive statistics were calculated for key maneuver acceptability variables. A logistic regression model identified the predictors of acceptable quality test sessions. RESULTS: About 96% of test sessions met our quality goals for a low back-extrapolated volume (BEV), time to peak flow (PEFT), and end-of-test volume (EOTV). The mean forced expiratory time (FET) was 10.4 s. Ninety percent of the maneuvers with the highest FVC had a forced expiratory time (FET) > 6.8 s. About 90% of test sessions had FEV(1) and FVC which were repeatable within 150 mL. Test quality was slightly better for post-BD test sessions when compared to pre-BD. Independent predictors of adequate test quality included female sex, younger age, higher education, lack of dyspnea, higher pre-BD FEV(1), less BD responsiveness, and study site. CONCLUSIONS: Quality goals for spirometry tests were met about 90% of the time in these population-based samples of adults from several countries.

Non-reversible airway obstruction in never smokers: results from the Austrian BOLD study.

BACKGROUND: The presence of non-reversible airway obstruction (AO) in never smokers has only received limited attention until now. METHODS: We analyzed data from the Austrian Burden of Obstructive Lung Disease (BOLD) study. We defined non-reversible AO as post-bronchodilator FEV(1)/FVC <0.7 which corresponds to COPD I and higher (COPD I+) according to current GOLD guidelines. Significant AO was defined as FEV(1)/FVC <0.7 and FEV(1) <80% predicted (GOLD II and higher, GOLD II+). The prevalence and characteristics of non-reversible AO in never smokers were analyzed in relation to the severity of the disease. RESULTS: Never smokers comprised 47.3% of the study population. Non-reversible AO was seen in 18.2% of never smokers, and 5.5% of never smokers fulfilled criteria for significant non-reversible AO (GOLD stage II+). Therefore, the resulting population prevalence of significant non-reversible AO (GOLD stage II+) was 2.6%. Never smokers with non-reversible AO were predominantly female and slightly older. The airway obstruction was found to be less severe as compared with ever smokers. Despite this, 20% of never smokers with significant non-reversible AO (GOLD stage II+) reported respiratory symptoms and 50% reported impairment of quality of life. This burden of illness in never smokers was similar to that in smokers when severity of AO was taken into account. CONCLUSION: Approximately every third subject with non-reversible AO has never smoked, yet still demonstrates a substantial burden of symptoms and impairment of quality of life. Never smokers should receive far greater attention when efforts are undertaken to prevent and treat chronic airway obstruction.

Farming and the prevalence of non-reversible airways obstruction: results from a population-based study.

INTRODUCTION: Occupational exposure to noxious dusts, gases, and fumes most likely contributes to obstructive lung disease. We studied whether self-reported farming work is associated with non-reversible airways obstruction. METHODS: Following the burden of obstructive lung disease (BOLD) study protocol, we surveyed a gender-stratified population-based sample of 2,200 adults aged 40 years and over. Pre- and post-bronchodilator spirometry, as well as information on smoking, occupation, and reported respiratory disease was recorded. According to GOLD criteria, non-reversible airways obstruction was defined as a post-bronchodilator forced expiratory volume (FEV(1))/forced vital capacity (FVC) < 0.70. Occupational and smoking history was based on questionnaire. Farming was defined as ever working in this occupation for 3 months or longer. RESULTS: For 1,258 participants with complete data (post-bronchodilator spirometry and questionnaire data), 288 (=22.9%) reported farming. Among the 288 participants reporting farming, the prevalence of non-reversible airways obstruction was 30.2%. Farming was significantly associated with airways obstruction: chronic obstructive pulmonary disease (COPD) GOLD stage I or higher (OR 1.5; 95% CI 1.1-2.0) and COPD GOLD stage II or higher (OR 1.8; 95% CI 1.2-2.7). The latter estimate was unchanged when adjustment for competing risks gender, age, and smoking was done. In this population the risk for non-reversible airways obstruction attributable to farming was 7.7%. CONCLUSION: Farming should be considered a risk factor for non-reversible airways obstruction.

[Bronchial hyperreactivity to distilled water]. / Bronchiale Hyperreagibilität auf destilliertes Wasser.

For an epidemiological study 446 children were challenged with distilled water. The protocol consisted of 10 minutes tidal inhalation of an ultrasonically nebulized aerosol of distilled water. For children presenting with a clinical diagnosis of asthma the odds ratio for a positive challenge test was 9.1 compared to non-asthmatics [95% confidence intervals: 2.4-34.9; p = 0.001]. Symptoms cough (p = 0.03), cough at night (p = 0.03) and atopy defined by prick-test (p = 0.001) were also significantly associated with a positive challenge. The easy conduct of our protocol, the--from a pathophysiological point of view--"close to asthma" stimulus, and the small number of side-effects, indicate that the challenge with distilled water can be regarded as an alternative to metacholine provocation testing.