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.

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.

[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.

[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.

[Evolution of knowledge on the treatment of tuberculosis and therapy prescribed in all new cases of pulmonary tuberculosis in a French community since 1970]. / Evolution des connaissances sur le traitement de la tuberculose et prescriptions thérapeutiques appliquées à l'ensemble des nouveaux cas de tuberculose pulmonaire d'un département français depuis 1970.

The many papers about the treatment of tuberculosis published during the last fifteen years show the different stages of the evolution of knowledge in this field. The Register of tubercular patients, steadily brought up to date in the French "département" Bas-Rhin, gives interesting information concerning the evolution of treatment in routine. The nature of chemotherapy shows that the newly acquired knowledge is rapidly applied, whereas the average duration of treatment is regularly shortened but is still longer than the duration recommended by researchers. A greater discrepancy appears in hospitalisation: although the efficacy of domiciliary treatment has been known and proved since the early sixties, the proportion of patients having an entirely domiciliary treatment is still low, and in 1978 over 3 patients out of 4 were hospitalized for 4.4 months on average.

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.

[Chronic bronchitis. Development, prevention]. / La bronchite chronique. Evolution, prévention.

The adoption of an arbitrary epidemiological definition for chronic bronchitis has enabled some progress to be made in the understanding of the frequency and natural course of this disease. It is important to distinguish between chronic airflow obstruction and chronic hypersecretion of bronchial mucus. The prevalence of the disease can only be assessed in selective groups of the population and varies according to the characteristics of these groups, but is approximately 15% of men and 8% of women. There is relatively low mortality in France: 6/100,000 in 1985 and varies according to the departments, up to 38/100,000 inhabitants. These data ought to be interpreted with care and it is also important to take account of factors linked to their evolution. Longitudinal studies undertaken 20 years ago have allowed two hypotheses to be formulated to aid in a more precise understanding of the natural history of the disease: the first of these was the Dutch hypothesis which is currently undergoing a renewal of interest linked to epidemiological studies on HRB, and the English hypothesis which has the merit of emphasizing the principal risk factor in chronic bronchitis. Certain smokers are sensitive to tobacco, even though some others are not. Does the explanation of this lie in the relationship between obstructive ventilatory problems and bronchial hyper-reactivity? This association is discussed in the light of recent work as well as the relationship between bronchial hyperactivity, smoking and chronic bronchitis. Other risk factors have been studied: occupational hazards, air pollution and acute respiratory infections in childhood. But, in spite of all the work carried out to better define the risk factors and prognosis of the disease, this makes up a complex overall picture which is poorly understood and which should stimulate us to further research. The prevention of the disorder should be aimed at three levels; at the primary level (to prevent the appearance of the disorder) the only objective which may lead to a satisfactory solution in public health terms, a secondary level would be to identify those people or groups at special risk, but it is not recommended to undertake systematic examination of large populations in view of the fact that the early diagnosis of non-specific chronic pulmonary disease as well as special studies have not been shown to demonstrate the value of these procedures. The objective of prevention is to eliminate or neutralise factors linked to the disease.(ABSTRACT TRUNCATED AT 400 WORDS)

[Validity of mortality data in respiratory diseases in France and 7 other countries of the E.E.C]. / Validité des données de mortalité par maladies respiratoires en France et dans sept autres pays de la C.E.E.

A recent study of mortality due to respiratory disease, carried out in the eight member countries of the European Economic Community (E.E.C.) has shown different levels of mortality between the countries. To establish whether these variations in mortality were real or due to methods of filing and coding, a study of death certification was carried out in each country based on 10 common clinical diagnostic categories to assess overall accuracy. In France, 75 doctors picked a random, were asked to fill in a form for each observation as though it were a real death. The cause of death was coded by the usual national centre and re-coded by a reference centre in London. The protocol was similar for each country taking part. Important differences were found between and within each country. Some arise from the way in which doctors write out the death certificates (an excess of deaths from "other disease of the respiratory tract" in France and from cardio-vascular diseases in Italy), in others the way of coding was due to (an "excess of deaths by other disease of the respiratory tract" in Belgium). The degree of concordance depends on the complexity of the case (possible interaction of several pathologies), particular national characteristics, and whether account of these is made by the medical profession. These divergences can in part explain the different mortality statistics from respiratory disease between countries of the E.E.C. Later on it will be necessary to make the wording and the coding of the death certificate more standardised within the E.E.C.

[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 in adolescents in Guadeloupe]. / Tabagisme chez les adolescents en Guadeloupe.

A study was made of the smoking habits of 10,349 teenagers attending secondary school in Grande-Terre, Lamentin and Marie-Galante in Guadeloupe (41.4% were male; mean age 16.4 +/- 1.8). The study was made using a self administered questionnaire which also included questions on respiratory symptoms in teenagers and the smoking habits of their parents. The proportion of regular smokers (greater than one cigarette per day) was 9.2% in boys and 5.6% in girls: the boys were smoking on average 7.3 cigarettes a day, the girls 5.9. The proportion of smokers increased with age, being the highest in the children of managerial and commercial classes or skilled artisans, and was strongly linked to the smoking habits of the parents. Respiratory symptoms were more common in teenagers who smoked.

[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.

[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.

[Long-term radiology and respiratory function study following exposure to asbestos]. / Etude radiologique et fonctionnelle respiratoire au long cours après exposition à l'amiante.

During the supervision of 93 workers in an asbestos factory pulmonary function tests and radiographs were performed using the same equipment and by the same team, at 5 yearly intervals. The assessment of radiographic changes was judged by following both the reader of the films and the technique used (either un-named films or simultaneous films at 5 yearly intervals). On reading un-named films the appraisal of parenchymal abnormalities was variable from one reader to another; on the other hand they were less marked for simultaneous readings made by the same observer. Progressive pulmonary function tests showed that the fall in vital capacity and of VEMS in 5 year intervals was more rapid when there was a parenchymal abnormality, when the duration of exposure was long or the subject was older when first exposed. The results showed that in spite of ceasing to be exposed the parenchymal abnormalities progressed.

[Antitubercular therapeutic regimens routinely prescribed in Bas-Rhin and results of treatment]. / Régimes thérapeutiques antituberculeux prescrits en routine dans le Bas-Rhin et résultats du traitement.

The overall plans and therapeutic regimens prescribed for new cases of pulmonary tuberculosis notified in the Bas-Rhin in 1979 to 1980 (372 Subjects) were studied, as were relapses occurring over a three year period from the date of notification. As in the preceding analysis of cases between 1970/78, the proportion of patients treated exclusively at home was low (22.8%) and the duration of stay in a Sanatorium was lengthy (mean 86.6 days for cases without bacteriological confirmation and 142.3 days for bacteriologically positive cases). The mean duration of chemotherapy was 12.5 months (+/- 3.7). The therapeutic regimens prescribed showed a significant variability: if 80.6% of patients received, at one time or another, the combination of Isoniazid (H), Rifampicin (R) and Ethambutol (E), only 33.9% of the adults treated received the HRE/HR regimen, for periods of variable duration. Four relapses were seen during the fixed follow-up period.

[Respiratory pathology in occupational medicine: evaluation of 3 methods of data collection and research on risk factors]. / Pathologie respiratoire en médecine du travail: évaluation de trois modes de recueil des données et recherche des facteurs de risque.

Three methods of gathering data of respiratory symptoms (using a self questionnaire, a detailed interview and a shortened interview) were compared in 4.206 construction workers in different branches of their profession. There was non significant difference between the replies given, in either sex, to the self questionnaire and those given in the detailed interview by employees of the research bureau. The comparison between the long and the short interview, carried out on the painters, plumbers, carpenters and brick-layers did not show any difference for those questions asked in the same manner in the two documents. On the other hand the question relating to intrathoracic wheezing, which was more condensed in the shortened interview, did not have the same degree of affirmative replies. The replies concerning cough and expectoration obtained by the two methods enabled a comparison to be made between prevalance of chronic bronchitis in the different occupations. This pathology was most frequently seen amongst bricklayers and painters. Other factors (nationality, age, smoking habits) were also linked to chronic bronchitis. Taking all these factors into account has not weakened the link between chronic bronchitis and occupation.

[Lessons from a long-term survey on the effects of massive occupational exposure to asbestos. The AMISOL affair 10 years later]. / Enseignements d'une enquête au long cours sur les effets d'une exposition professionnelle massive à l'amiante. L'affaire AMISOL 10 ans plus tard.

For the past 10 years the authors have followed up a cohort of workers who had been massively exposed to dust in an asbestos textile factory which closed down in 1974. They report on the difficulties of all kinds they encountered during this epidemiological survey. The most original result is that they were able to establish that the radiological and functional manifestations of asbestosis pursue their course after the subjects have ceased to be exposed. Another important point is the early development of lesions in peripheral bronchioles, detected by volume-flow loops. The authors insist on the psycho-social problems at the site of work or in daily life which arise from the use of asbestos or of fibres with similar properties. Social protection, at present well organized, should suppress the risk of asbestosis in Western countries. However, a number of problems remain to be solved, notably those concerning the long-term risk of pleural mesothelioma, the mode of action of the fibers and the immune reactions they induce, and the economic and social consequences of a hypothetical ban on asbestos--a material very difficult to replace. This study embodies, in miniature, all the problems of society associated with asbestos during this second half of the XX th century.