High prevalence of asthma and atopy in the Canary Islands, Spain.

OBJECTIVE: To evaluate the prevalence of and risk factors for asthma and related conditions in the Canaries, Spain. METHODS: From a randomised sample of 9506 adults aged 20-44 years who answered a short questionnaire, a random sample corresponding to 20% of the original was taken. Subjects classified as symptomatic in the previous survey and who were not included in the random sample were also invited to participate. The subjects completed a respiratory questionnaire, and underwent spirometry, bronchial hyperresponsiveness (BHR) test, skin tests and immunoglobulin E (IgE) measurements. RESULTS: The random sample included 593 subjects. The prevalence of skin sensitisation to mites was 30.3% (95%CI 26.7-34.2) and the prevalence of IgE to mites 30.5% (95%CI 26.2-35.2). A prevalence of 40.6% (95%CI 35.9-45.5) was found for atopy, 14.1% (95%CI 11.1-17.1) for BHR and 4.2% (95%CI, 2.5-5.9) for asthma. The risk factors most strongly associated with asthma were atopy (OR 4.89, 95%CI 3.07-7.78) and respiratory infection before the age of 5 years (OR 2.78, 95%CI 1.66-4.67). CONCLUSION: This study shows a high prevalence of sensitisation to mites, atopy, BHR and asthma in the Canaries, similar to that observed in English-speaking countries. We suggest that these findings could partially result from climatic conditions.

High prevalence of asthma symptoms in the Canary Islands: climatic influence?

The worldwide variation in asthma prevalence prompted us to carry out a study to assess the variability of asthma-related symptoms in young adults on the islands of Gran Canaria and Tenerife. We used the questionnaire used in the European Community Respiratory Health Survey with the addition of two questions on smoking and ancestors from the Canary Islands. In each island, this questionnaire was distributed to a random sample of 5000 subjects aged 20-44 years. Of the 10,000 subjects, 9,506 (95.06%) were considered eligible. We obtained 7,132 (75.03%) responses. The prevalence of the different symptoms was wheezing 25.3%, nocturnal thoracic tightness 18.0%, awakened by an attack of shortness of breath 13.1%, attack of nocturnal coughing 33.3%, attack of asthma 4.3%, current asthma treatment 6.2%, and nasal allergies 18.0%. Women and smokers showed a significantly higher prevalence of asthma symptoms. No significant difference in symptoms was found between subjects whose ancestors were of Canarian origin and those with ancestors born outside the Canaries. As has been observed on other islands (Great Britain and New Zealand), asthma is common in individuals from 20 to 44 years of age in the Canaries. We hypothesize that climatic conditions play an important role in the prevalence of asthma symptoms.

[Identification of emergencies for asthma and chronic obstructive pulmonary disease in the emergency rooms of a hospital. A reliability study]. / Identificación de urgencias por asma y enfermedad pulmonar obstructiva crónica en el servicio de urgencias de un hospital. Estudio de concordancia.

OBJECTIVE: To analyse the reliability of the obtained results in the identification of cases of asthma and chronic obstructive pulmonary disease (COPD) diagnosed in the medical records of the emergency rooms of the <> of Valencia, Spain. METHODS: In the context of a study on the relationship between emergency rooms for asthma and COPD and specific environmental risks, we revised all the emergency rooms medical records of people aged over 14 attended at the <> of Valencia, Spain, during 1993 and 1994. The observers were two nurses who received previous training in the identification of cases. One observer revised the year 1993 and the other one 1994. To evaluate the reliability of the results we obtained a 24 days sample for each year and we estimated the inter-observer agreement using the Proportion of Observed Agreement (POA) and the Kappa Index (KI) and the 95 % confidence intervals (95% CI). We also carried out a specific analysis for each study category estimating the specific Kappa Index and the Proportions of Specific Agreement (PSA). To assess the inter-observer agreement we used the first 59 days of 1994, to estimate the same indexes mentioned above. RESULTS: In the total of emergency rooms, the POA for both observers was 0.99 and the KI was 0.91 (95% CI: 0.88-0.94) for the first observer and 0.79 (0.76-0.82) for the second one. In the specific analysis the PSA for <> versus <> were 0.92 (0.75-1) and 0.48 (0.31-0. 66) respectively. For the analysis of <> versus <> the PSA were 0.78 (0.69-0.87) and 0.75 (0.64-0.86). In the inter-observer agreement study we obtained, for the overall analysis, a POA equal to 0.99 and a KI to 0.87 (0.86-0.88). In the specific study the PSA for <> versus <> were 0.64 (0.53-0. 74) and 0.82 (0.77-0.87) for <> versus <>. CONCLUSIONS: The consistency of the results is good for both observers, but better for the first observer, particularly for asthma. For the COPD category the results are more homogeneous, showing a good concordance for both observers. The results for the inter-observer study also show a good reliability.

[Impact of air pollution on the mortality and emergencies of chronic obstructive pulmonary disease and asthma in Barcelona]. / Impacto de la contaminación atmosférica sobre la mortalidad y las urgencias por enfermedad pulmonar obstructiva crónica y asma en Barcelona.

OBJECTIVES: Air pollution has been associated with increased mortality according to studies carried out in the US. The APHEA project (Air Pollution on Health: a European Approach) analyzes the short-term effects in 15 european cities. We evaluated the acute relation between air pollution, mortality, and hospital emergency-room visits in Barcelona, one of the cities participating in the APHEA project. METHODS: Daily variations in total mortality, cardiovascular mortality, respiratory mortality, and emergency-room visits for chronic obstructive pulmonary disease (COPD), and asthma were studied in relation to daily variations in air pollution levels in 1985-1991. Poisson regression was done and temperature, relative humidity, and epidemics of asthma and flu were controlled. Temporal trends and auto-regressive terms were examined. RESULTS: A reduction of about 50 micrograms/m3 in particles and sulfur dioxide was accompanied by a reduction of about 4% and 6% (p < 0.05), respectively, in daily deaths from respiratory and cardiovascular causes and emergency-room visits for COPD. Oxidant pollutants (nitrogen dioxide and ozone) were related positively with cardiovascular mortality and emergency visits for COPD and asthma. The role of ozone was notable, with a reduction in ozone levels of 50 micrograms/m3 originating a 4% reduction in emergency-room visits for COPD and asthma (p < 0.05). CONCLUSIONS: Current levels of air pollutants had an epidemiologically measurable impact on mortality and emergency-room visits in Barcelona. These results were consistent with the findings of similar studies in other european and american cities and with previous studies of emergency-room admissions in Barcelona. These studies suggest the possible toxicity of air pollution.

[Comparison of two sources on mortality information in a retrospective cohort study on occupational cancer]. / Concordancia entre dos fuentes de información sobre causas de mortalidad en un estudio de seguimiento retrospectivo de cáncer ocupacional.

In the context of a historical cohort study among workers in the pulp and paper industry, we examined the agreement between the underlying cause of death obtained from municipal mortality files and from the mortality register of Catalonia (n = 50 pairs). The percentage of simple agreement (P0) for major causes of death was 76%. The agreement and the Kappa index was higher for external causes (P0 = 98%; K = 0.87) and for cancer (P0 = 90%; K = 0.79). The agreement was moderate for mortality from circulatory diseases (K = 0.57). Agreement between 3 digit ICD codes was 48% but was higher for deaths from cancer (P0 = 67%). These results indicate that information on major causes of death and on specific causes of cancer retrieved from municipal mortality files may be used for the follow-up of historical cohort studies.

[A comparison of the information obtained in a health survey by interview with primary care registries]. / Comparación de la información obtenida en una encuesta de salud por entrevista con los registros de atención primaria.

To estimate the levels of underreporting of medical visits and to compare the reporting of chronic restrictive diseases, 203 individuals who had been visited in a Primary Health Center were interviewed in the period of two weeks following the medical visit. Underreporting of a medical visit was identified in 31 (15.3%) of the users. The level of underreporting was not related with age, sex, education or socioeconomic status. Reporting of chronic restrictive illness was compared with the information recorded in the user's medical record. The highest global agreement (91.6%) was observed for hypertensive disease (kappa index = 0.71), while the lowest agreement was found for chronic back pain (global agreement = 77.8% and kappa index = 0.14). Since underreporting of medical visits was moderate, the results suggest that this question can be used for the analysis of social differences in the access to health services. Nevertheless, estimation of the prevalence of chronic limiting conditions in a health interview survey should be done with great caution.

[Chronic eosinophilic pneumonia: report of eight cases (author's transl)]. / Neumonía eosinófila crónica. Estudio de ocho casos.

Eight cases of chronic eosinophilic pneumonia (CEP) diagnosed between January 1977 and December 1979 are described. Clinical manifestations included toxic syndrome, cough and fever, lasting from 1 to 15 months. Chest x-ray revealed peripheric bilateral infiltrates, with the exception of one case. In two patients there was no peripheral eosinophilia and five received antituberculous drugs at some point during the illness. In all cases tests for fungi and parasites were negative. In only two patients was an increase in IgE found. Hystological study confirmed CEP in 7 patients through either trans-bronchial biopsy or minimal thoracotomy. Treatment with corticosteroids was dramatically effective in all patients; both clinically and radiologically. In two cases which were asymptomatic, decreased carbon monoxide diffusing capacity persisted six months later. One hundred fifteen cases of CEP published since Carrington et al. first described CEP as a separate entity of the pulmonary infiltrates with eosinophilia syndrome are reviewed.