Atopy and pulmonary function abnormalities in children with a history of acute bronchiolitis.

To assess the relationship between acute viral bronchiolitis and subsequent development of asthma, we studied retrospectively 97 index children, aged between 9 and 14 years, and 52 controls. The bronchiolitis group showed significantly lower values for mean expiratory flow at 50% of vital capacity (MEF50) higher incidence of atopy, and were more sensitive to methacholine than were controls, even if they had not shown recurrent wheezing episodes. It is suggested that an increased incidence of atopy, bronchial hyperresponsiveness, and reduced expiratory flows may be detectable in children with a history of acute bronchiolitis, regardless of the fact that they did not develop subsequent clinical symptoms suggestive of bronchial asthma.

[The internal consistency and content validity of the Spanish version of the Asthma Autonomy Questionnaire]. / Consistencia interna y validez de contenido de la versión española del Asthma Autonomy Questionnaire.

The Asthma Autonomy Questionnaire (AAQ) was designed to evaluate asthmatics' desire to learn about their disease and to make decisions. The AAQ consists of 26 items distributed in two scales: Preferences in the Search for Information (PSI, 8 items) and Preferences in Decision Making (PDM, 6 general items and 12 related to 3 scenarios depicting asthma in stable phase, during mild exacerbation and during severe exacerbation). The aim of this study was to analyze the internal consistency (Cronbach's-coefficient) and content validity (factorial analysis of principal components) of the AAQ. After translation and back translation, the Spanish version of the AAQ was administered to 115 adult asthmatics of both sexes and differing levels of severity. The alpha coefficients for the two scales and 3 scenarios ranged from 0.42 (PSI) to 0.73 (stable phase scenario); only for the stable-phase scenario were values high or statistically acceptable. Factorial analysis reproduced the content of the scales only approximately, with some items proving to relate to factors that were different from the scale they originally belonged to. These results indicate that, in its current formulation, the AAQ presents important measurement problems and revision is advisable.

Consistencia interna y validez de contenido de la versión española del Asthma Autonomy Questionnaire / Internal consistency and content validity of the Spanish version of the Asthma Autonomy Questionnaire

El Asthma Autonomy Questionnaire (AAQ) es un instrumento diseñado para evaluar en asmáticos el deseo de recibir información acerca de su enfermedad y el deseo de tomar decisiones en el manejo de la misma. Está constituido por 26 ítems distribuidos en dos escalas: Preferencias en la Búsqueda de Información (PBI, 8 ítems) y Preferencias en la Toma de Decisiones (PTD, 6 ítems generales y 12 relacionados con 3 escenarios; asma en fase estable, exacerbación leve y exacerbación grave). El objetivo del presente trabajo ha sido analizar su consistencia interna (coeficientes * de Cronbach) y validez de contenido (análisis factorial de componentes principales). Para ello, y tras un doble proceso de traducción, la versión española del AAQ se aplicó a 115 asmáticos adultos, de ambos sexos y diferentes niveles de gravedad. Los valores * de las dos escalas y los 3 escenarios oscilaron entre 0,42 (PBI) y 0,73 (escenario asma en fase estable); únicamente en este último caso los valores encontrados fueron superiores a los estadísticamente aceptables. Los análisis factoriales reprodujeron sólo aproximadamente el contenido de las escalas del cuestionario, detectándose la inclusión de algunos ítems en factores que no se correspondían con su escala inicial de pertenencia. Estos resultados indican que, en su formulación actual, el AAQ presenta problemas métricos importantes que aconsejan su depuración. (AU)

[Information seeking and decision making in asthmatic patients]. / Búsqueda de información y toma de decisiones en pacientes asmáticos.

Patient cooperation in controlling asthma is a key element for achieving the most efficient therapy possible according to current guidelines. Cooperation requires that the patient be adequately informed about his disease and able to make certain decisions. The aim of this study was to analyze whether patients really desire information about asthma and to what point they are disposed to cooperate actively in managing their disease. Ninety-five adult asthmatics with different levels of severity of disease were studied in stable condition. All responded to the Spanish version of the questionnaire on autonomy in asthma, an instrument with a scoring range of 0 to 100 and 26 items grouped in two subscales: preferences in the search for information (PSI) and preferences in decision making (PDM). The second subscale was based on three scenarios describing stable asthma, slight exacerbation and severe exacerbation. The results obtained indicate that although patients are greatly interested in receiving information (PSI scores of 86.4 +/- 8.7) they express substantially less desire to make decisions (PDM 45 +/- 10.2) (p < 0.01). Attitudes did not change in relation to education, number of exacerbations during the last year, duration of disease or severity as assessed by the patient. Only patient age (with older patients scoring higher on PSI) and presence of severe asthma (according to consensus guidelines) increased the desire for information (but not the preference for decision making). These data indicate the need to implement educational programs about asthma, components of which promote effective desire for self-management.

Lack of effects of moderate-high altitude upon lung function in healthy middle-aged volunteers.

This study investigates the effects of moderate-high altitude on lung function and exercise performance in 46 volunteers (19 females, 27 males), with a mean age of 42.4 +/- 1.4 years (+/- SEM) and varying smoking and exercise habits, who were not previously acclimatized. Measures obtained in the base camp (1140 m) and at altitude (2630 m), in random order, included forced spirometry, maximal voluntary ventilation, maximal inspiratory and expiratory pressures, arterial oxygen saturation and capillary lactate concentration after a standardized exercise test. The smoking history, Fagerström test and degree of habitual physical activity were also recorded for each participant. The percentage of smokers was similar in males (19%) and females (21%) (P = n.s.). Mean habitual physical activity index was 8.2 +/- 0.2 (range, 5.88-11.63). At the base camp, all lung function variables were within the normal range. Lactate concentration after exercise averaged 3.7 +/- 0.3 mm l-1. No significant change was observed at altitude, except for a higher heart rate and a lower arterial oxygen saturation (SaO2) (both at rest and after inspiratory manoeuvres). The smoking history and the degree of physical activity did not influence lung function or exercise performance at altitude. The results of this study show that in middle-aged, healthy, not particularly well-trained individuals, lung function is not significantly altered by moderate-high altitude, despite the absence of any acclimatization period and independent of their smoking history and previous exercise habits.

[The specific bronchial provocation test in the diagnosis of occupational asthma]. / La prueba de provocación bronquial específica en el diagnóstico del asma ocupacional.

Specific bronchial challenge (SBC) testing is a key technique for diagnosing the origin of occupational asthma (OA). SBC is indicated in specific circumstances, including whenever several agents present in the work environment may be the cause of OA, when new or unusual occupational agents need to be identified, when evidence for legal action is required, or when research is conducted. SBC procedures are not standardized, because of the great diversity of occupational agents and the variety of physical and chemical properties involved. Thus, SBC testing with agents found in fumes, gases or vapors can be administered in special cabins or in closed circuits with continuous monitoring of sub-irritant concentrations. Agents found in dust, most but not all of which have high molecular weights, may be appropriate for routine SBC testing in an allergy laboratory. This paper will treat only these cases. SBC must be formed in specialized centers by experienced personnel, as it is a sophisticated and potentially dangerous technique. We describe a series of 20 patients diagnosed of OA in our unit over the past two years in whom SBC provided an etiologic diagnosis. All were exposed to dust or aerosols at work. The cause was a substance of high molecular weight in 17 cases, and low molecular weight in 3. The procedure used is described and models of bronchial response are discussed.

Occupational asthma induced by aniseed.

This report deals with clinical and immunologic studies in a butcher with work-related asthma. Both the positive methacholine inhalation test and the significant changes observed in PEFR measurements supported the diagnosis of asthma. The significant fall observed in PEFR measurements when the patient handled aniseed supported the diagnosis of occupational asthma. Skin prick tests carried out with 13 spices showed positive reactions only to aniseed extract. The patient had high levels of specific antianiseed IgE antibodies. The bronchial challenge test with an aniseed extract showed an immediate response without a late response. These findings suggest that the respiratory symptoms in our patient were induced by the inhalation of aniseed dust through an IgE-mediated immunologic mechanism of immediate hypersensitivity. This study established the diagnosis of occupational asthma from aniseed dust sensitization.

Cytogenetic study in peripheral blood lymphocytes from asthmatic patients receiving continued therapy with theophylline.

Possible cytogenetic effects of theophylline have been investigated in asthmatic patients undergoing continuous therapy with this drug. Sister-chromatid exchanges (SCE), chromosome aberrations (CA) and proliferating rate indices (PRI) were evaluated in cultured peripheral blood lymphocytes from patients receiving theophylline alone, theophylline plus inhaled beta 2 adrenergic drugs or theophylline in combination with beta 2 adrenergic agents and corticoids. Two samples from each individual were obtained in order to perform a prospective study: before the theophylline medication (sample A) and at a time after the beginning of treatment (sample B). After treatment (66.3 +/- 37.8 days), an increase in SCE was observed without modifications either in PRI or in CA. Patients receiving beta 2 adrenergics or beta 2 adrenergics plus glucocorticoids before and during theophylline treatment, did not respond differently than those on theophylline alone.

A prospective and immunologic study of factory workers exposed to TDI (toluene diisocyanate).

Thirty factory workers whose annual exposure to TDI amounted to 280 hours were examined. Seven of them had been removed from their jobs for presenting respiratory symptomatology and a further five were removed for presenting bronchial asthma. Their medical histories were consulted and further measures were taken such as a radiological thorax study, total IgE, TDI, MDI and HDI RAST, a basal spirometric study and finally a provocation test. The Rast proved negative in every case. In the spirometric study carried out on the provocation test, four cases showed a significant decrease in the FEV1 over 20% and over 40% in the FMEF and PEFR. There was no connection between the four patients who presented an elevated total IgE and the four who presented a positive provocation test. The provocation test proved negative in five of the seven patients removed from their places of work. Two of the four workers who responded positively to the provocation test remained in their places of work during the TDI foam test without showing any symptoms. The patients who presented symptoms did not appear to present bronchial obstruction during the provocation test. Nonetheless, patients who seemingly had not shown any symptoms presented what appeared to be bronchial obstruction.

Cockroach hypersensitivity in asthmatic patients.

Hypersensitivity to cockroach antigen has been recognized as an important cause of perennial allergic rhinitis and asthma. To assess the frequency of cockroach hypersensitivity in our country, 150 asthmatic atopic subjects were studied using skin testing and in vitro assays for cockroach-specific IgE antibodies (Oriental and German cockroaches). Twenty-two of 61 patients who had a positive history of cockroach exposure had positive skin tests, and only 3 of 89 patients who had no history of exposure had positive skin reactions. Of 25 patients with positive skin tests, 23 showed specific IgE antibodies against oriental and German cockroaches using RAST and EIA techniques. In summary, approximately 15% of asthmatic atopics in Madrid area are sensitive to cockroaches (positive skin test + specific IgE antibodies). These results indicate that cockroach hypersensitivity should be considered in every patient with perennial asthma.

A study of IgG blocking antibodies in patients affected with respiratory allergy.

The levels of blocking antibodies were studied in 200 patients affected with bronchial asthma and/or allergic extrinsic rhinitis with sensitization to grass pollen and dust mites shown by cutaneous and RAST tests. IgG blocking antibodies were studied using ELISA, in relation to: Immunotherapy treatment duration. The degree of clinical improvement obtained. The conditions, before and after immunotherapy treatment. The conditions, 12-24 months after having completed 3 years of immunotherapy. The results indicate that: A high level of blocking antibodies is reached in the group of patients between 4-7 months of immunotherapy treatment. These patients also reached the stage of the maintenance dosage. There exists a significant and specific response of blocking antibodies in patients treated with specific immunotherapy. There exists a close correlation between symptomatology and the level of blocking antibodies, although this correlation is not perfect. The hyposensitization preparations used did not succeed in maintaining permanently high levels of blocking antibodies once the treatment was completed. ELISA is a good alternative to other more frequently used techniques in measuring blocking antibodies, and it can be used in following patients during the course of immunotherapy.

[Specific receptors for sex hormones in tumors of the central nervous system]. / Receptores especificos de hormonas sexuales en tumores del sistema nervioso central.

The hormone sensitivity of some tumors seems to be mediated by the presence of specific receptor proteins, and a correlation seems to exist between the amount of receptor molecules and the behavior of the tumor evolution. Epidemiological data suggest a relation between the steroid sexual hormones and the development of some tumors of the central nervous system (CNS). The authors determine the amount of receptors specific to 17-beta-estradiol and progesterone in several cases of meningioma, glioma, neurinoma and intracerebral metastases. 17-beta-estradiol receptors were always detected, although in very variable amount (3 to 74 fm/mg protein). Progesterone receptors were found in all the studied CNS in women, and only in a few male gliomas, in amounts varying between 3 and 17 fm/mg protein. The significance of hormone receptors in the CNS tumors need further studies to know if they can be applied to prognosis and suggest the assay of a complementary endocrine therapy of CNS tumors.

Versatile spectrophotometric method for the determination of silicon.

A versatile spectrophotometric method is described for the determination of microgram levels of silicon, as molybdenum blue. It combines the desirable features of existing spectrophotometric methods with three pretreatment procedures, namely (a) the removal of cations with a cation-exchange resin in the H(+)-form, (b) the conversion of all silicon species into the reactive monomer with an alkaline treatment, and (c) the decomposition of silicon fluoride with boric acid in the presence of cation-exchange resin. These pretreatments coupled with the colour development provide five procedures which are applicable to a wide variety of samples including natural and industrial waters and solutions of various nuclear reactor fuels and components. Provisions are included for the selective determination of total silicon.