[In towns there is a higher prevalence of asthmatic symptoms in children than in rural areas]. / Ve mestech je vetsí prevalence príznaku astmatu detí nez ve venkovských oblastech.

The authors assessed the prevalence of symptoms of bronchial asthma by means of a standardized questionnaire used in the international survey PEACE (Pollution Effect on Asthmatic Children in Europe). The questions about complaints were addressed to children aged 6-13 years (the questionnaires were completed with the parents assistance). In urban areas 5669 children participated from Prague 5, i.e. 35% of all elementary school children, in Teplice 2489 (21% children), in rural areas: in the Benesov district 5619, i.e. 61% children, in the Prachatice district 1983, i.e. 37% children. The response rate of questionnaires in the urban areas was 86-88%, in rural areas 93%. In urban areas the annual prevalence of wheezing in the chest or dyspnoea or possibly both symptoms was within the range of 3.8-13.8% and differed significantly from the prevalence in rural areas where it was 2.4-3.6%. The most frequent symptom was nocturnal dry cough without a cold (in urban areas 14.1-36.7%, in rural areas 6.0-10.6%). Rural areas differed from urban ones by a lower contamination of the atmosphere, a lower density of the population as well as some parameters caused by a different lifestyle.

[Quality of life in patients with chronic obstructive pulmonary disease and bronchial asthma]. / Kvalita zivota nemocných s chronickou obstrukcní plicní nemocí a s bronchiálním astmatem.

Review of data in the literature on the quality of life and its assessment in chronic obstructive lung disease and in bronchial asthma. The authors mention the most frequently used types of questionnaires and results achieved when using them. General questionnaires include the Sickness Impact Profile or the short version of a very detailed questionnaire which has 36 questions with sub-questions (SF-36 = Short Form-36). Specific questionnaires are focused on certain questions concerning different diseases. These questionnaires include SGRQ (St. George's Respiratory Questionnaire) which is used mainly in chronic obstructive lung disease. For this disease also the CRQ was developed (Chronic Respiratory Questionnaire) but its section on dyspnoea is not standardized. For evaluation of the quality of life of asthmatic patients several questionnaires exist, in particular for children. Several questions call for further standardization. The value of questionnaires is, however, beyond dount. They elucidate the situation which does not ensue even from detailed functional examination of the lungs or immunological examination. It appraises bodily and mental functions of man, restriction of his activity, the sensation of comfort and general evaluation of his health. Thus "classical" evaluation methods are extended by now non-traditional ways of appraisal of diseases which have a high prevalence and thus also great impact in the population.

[What dosage is sufficient in combined inhalation therapy (fenoterol + ipratropium bromide) in patients with exacerbation of chronic obstructive lung disease?]. / Jaká dávka je dostatecná pri kombinované inhalacní lécbe (fenoterol + ipratropium bromid) u nemocných s exacerbací chronické obstrukcní plicní nemoci (CHOPN)?

The authors compared in a prospective study the bronchodilatating and undesirable effects of combined inhalation treatment (phenoterol + ipratropium bromide) in the treatment of patients with exacerbation of chronic obstructive pulmonary disease, using different dosages. The patients were divided at random into two groups--group one inhaled berodual sol 3.5 ml/day (i.e. 1.75 mg phenoteroli + 0.875 mg ipratropii bromidium), the second group had a dose of double size. During the trial the authors monitored the peak expiration rate, the heart and respiration rate, blood gases and the subjective state of dyspnoea, using a 10 cm line. By comparison of bronchodilatating and undesirable effects they reached the conclusion that a daily dose of 3.5 ml berodual sol. is sufficiently effective. Increasing the daily dose to 7 ml did not produce a greater therapeutic effect nor increase the risk of undesirable effects.

[The prevalence of bronchial asthma is increasing and mortality varies]. / Prevalence bronchiálního astmatu stoupá, mortalita kolísá.

The authors are presenting a review on the prevalence of bronchial asthma (AB) worldwide and in this country in the child and adult population. The cumulative prevalence of AB in children in Europe is 2.8-19.5%, most frequently 5-10%. The highest prevalence is in Australia (as high as 30%). The cumulative and present prevalence of AB in children doubled in the last ten years. A rise is described in most countries (Scandinavia, Spain, Wales, USA, New Zealand, Australia and Czech Republic). In adults the prevalence of AB is lower, but the rise is similar. The mortality from AB is no longer increasing during the last five years, or is even declining. In the Czech Republic the mortality declined from 2.61/100 000 population to 2.05/100 000 population in 1990-93, in 1994 to 1.58/100 000 population. In 1994 in our country 163 people died from AB.

[Mortality in non-specific respiratory tract inflammation and bronchial obstructive diseases in relation to the environment in the Czech Republic]. / Umrtnost na nespecifické zánety dýchacích cest, na nemoci s bronchiální obstrukcí a vztahy k zivotnímu prostredí v Ceské republice.

BACKGROUND: Despite antibiotic treatment the mortality from inflammations of the airways is still high in our country and worldwide. The objective of the present work is a review of the mortality from respiratory diseases with regard to their prevalence, in relation to gender in the whole Czech Republic and in different regions, in Prague and in southern and northern Bohemia. METHODS AND RESULTS: During the last years the order of mortality from respiratory diseases is as follows: lung cancer, chronic bronchitis and pneumonia, whereby in men the first place is held by lung cancer, in women by pneumonia. In 1992-1994 in the Czech Republic the relative mortality rate from acute bronchitis (bronchiolitis). pneumonia and influenza combined was 24.8, 20.7 and 20.6/100,000 population. In Prague the increment of this mortality was as follows: in 1993-13.5/100,000, in 1994-14.8/100,000. A marked increase was recorded in southern Bohemia (from 16.9 to 26.0) but a drop in northern Bohemia (from 14.5 to 12.2/100,000 population). In 1992 and 1993 in the Czech Republic the number of deaths from diseases associated with respiratory infections -influenza, pneumonia, acute bronchitis (bronchiolitis) and diseases associated with bronchial obstruction (chronic bronchitis, bronchial asthma and pulmonary emphysema) was balanced. In 1994 there was a marked drop in the mortality from diseases with bronchial obstruction as compared with 1993-N 2104/679. In 1994, as compared with 1992 and 1993, the mortality relation in these two groups was reversed and in 1994 mortality from respiratory infections predominates markedly over mortality from obstructions. In Prague infections predominate 1.6 times, in northern Bohemia 1.5 times and in southern Bohemia as much as 3.8 times. CONCLUSIONS: In the Czech Republic the mortality from acute bronchitis (bronchiolitis), pneumonia and influenza combined was in 1993 and 1994 20.7 and 20.6 per 100 000 population. In 1994 the mortality from diseases associated with bronchial obstruction declined markedly, while the mortality from respiratory infections increased in southern Bohemia.

[Occurrence of smoking in a southern Moravian District in comparison with the Prague 8 District]. / Výskyt kourení v jihomoravském okrese a srovnání s tímto zlozvykem v Praze 8.

From the literature ensues that in 1995 we cannot expect that in the Czech Republic the ratio of smoking in the mortality from lung cancer, chronic obstructive pulmonary diseases and cardiovascular diseases will decline, as compared with 1990. The prevalence of smoking assessed in an epidemiological study in 1992 in the district of Uherské Hradiste was in adults 31% and in ex-smokers 16%. In Prague 8 the prevalence was similar-32% and 17%. Adults aged 21-60 years smoked most frequently (in Uherské Hradiste from 21 to 40, in Prague from 41-60 years). Statistically more significant prevalence of smoking was recorded in patients with chronic bronchitis than in those with bronchial asthma in Prague 8 (55% and 32%) and in Uherské Hradiste (37% and 15%). Patients with bronchial asthma smoked roughly twice less frequently in Uherské Hradiste than in Prague 8 (15% and 32%) and the same applies to chronic bronchitis (37% and 55%). In the district of Uherské Hradiste 81% of adults consider smoking a health hazard and 77% consider even passive smoking a health hazard. From this it may be concluded that as regards smoking the population of Uherské Hradiste is smarter than in Prague 8 and it may be expected that health education can gain another 12% of adults to quit smoking. In particular health professionals should change their attitude to smoking.

[Prevalence of bronchial asthma, chronic bronchitis and allergic rhinitis in a South Moravian District]. / Prevalence bronchiálního astmatu, chronické bronchitidy a alergických rým v jihomoravském okrese.

In a random sample of 648 adults (18-70 years), representing 95,836 people by age and sex, the prevalence of the above mentioned diseases was assessed. The chi 2-test revealed that the sample of examined subjects did not differ significantly from the distribution of the population as regards age and sex. The prevalence of bronchial asthma was 2.0%, of chronic bronchitis 16.3%, pollen rhinitis 4.5% and non-seasonal rhinitis 4.9%. In asthma the immunological type of the disease predominated markedly. Bronchial hyperreactivity after inhaled histamine was almost five time higher in asthma than in bronchitis (100% and 22.5%).

[The bronchodilator agent, Ventodisk, in the powdered inhalation form without freon is better]. / Bezfreonová prásková inhalacní forma bronchodilatancia Ventodisku je výhodnejsí.

The authors compared the effectiveness and advantages of the powdered inhalation variety of the preparation Ventodisc (Glaxo) with the "classical" dosed inhalation form of Salbutamol (Polfa) in 21 patients with bronchial asthma. During administration of 0.2 mg of the two drugs various conditions (mastering of the inhalation technique, elimination of the action of other drugs and the same time of day when the drug was administered) was respected. Values of ventilation parameters of the central and peripheral respiratory pathways before administration of the drugs did not differ significantly. The powdered form of salbutamol--Ventodisc (Glaxo) had a greater dilatating action than the classical dosed aerosol form--Salbutamol (Polfa) because: 1. in FEV1 values between rest and Ventodisc (1.47 l and 1.73 l) differed significantly, however, after subsequent inhalation of Salbutamol no further significant improvement occurred (1.79 l); 2. when the sequence of stimuli was reversed a significant increase of the FEV1; value occurred after Salbutamol (from 1.50 l to 1.67 l, p < 0.004) but Ventodisc caused a further significant increase (p < 0.0006). The tolerance of both drugs was equal. The powdered inhalation form of Salbutamol (Ventodisc--Glaxo) was better than the "classical" dosed aerosol form of salbutamol (Salbutamol--Polfa) as it had a greater dilatating effect in the central airways and moreover did not contaminate the environment.

[Prevalence of bronchial asthma, chronic bronchitis and bronchial hyperreactivity in the adult population in the Prague 8 district]. / Výskyt bronchiálního astmatu, chronické bronchitidy a bronchiální hyperreaktivity u dospelých obyvatel Prahy 8.

The prevalence was assessed in a randomized group of 18-year-old and older inhabitants of Prague 8. A total of 8458 internationally tested questionnaires were sent out to a population of 90,458; information was obtained on 7605 (89.9%), 1274 were given a detailed examination by standardized methods. Cumulative prevalence of bronchial asthma (B): 2.3% +/- 0.3% (same in M and F). The highest values at the age of 18-20 years were 3.5%; 3.6% in the age group 21-30 years, the absolutely highest values--4.6%--were recorded in 18-year-old men. Contemporary prevalence of BA: 1.99%. In BA bronchial obstructions were found in 51%, bronchial hyperreactivity in 75%, positive skin tests in 71%, an increase of IgE in 36%. Prevalence of chronic bronchitis (CHB): 14.1%; men 17.6% women--11.3%, highest value--18.9%--in the age group 70-80 years; absolutely highest values were recorded in men aged 70-80 years--20.9%. In CHB there was a bronchial obstruction in 55% and this obstruction was reversible in 40%. In the group CHB bronchial asthma was recorded in 20%. Prevalence of bronchial hyperreactivity (BHR) was estimated from results of broncho-provocative tests and from the calculation according to prevalence of BHR in respiratory diseases. The thus calculated figure was 13.7%. The incidence of bronchial asthma in chronic bronchitis in 1/6 and of bronchial hyperreactivity in more than 1/10 of the adult population are striking facts. It is essential to find the causes of these findings and make effective provisions to counteract them.

[The prevalence of bronchial asthma in a selected sample of the adult Prague population]. / Prevalence bronchiálního astmatu ve vybraném vzorku dospelé Prazské populace.

The authors assessed the prevalence of bronchial asthma in 8458 18-year-old and older inhabitants of an economic area in Prague 8. The population of the area up to December 31, 1987 was 90,458 adults. The health communities were selected in a random way to comprise the central as well as peripheral parts of Prague 8. By means of questionnaires information was assembled from 70.9% of the respondents and after supplementation of data by various doctors the scope of information was 89.9% (7605/8458). For detailed examination 902 subjects were selected with "confirmed" and suspect symptoms of asthma. The anamnestic data were analyzed and pulmonary ventilation was examined (flow-volume), and depending on indication, also the provocation or bronchodilatation inhalation test, skin tests, and total IgE. The cumulative prevalence of bronchial asthma was 2.3% +/- 0.3% (174/7605). The highest prevalence values were in subjects under 20 years--3.5% and under 30 years--3.6%. The contemporary prevalence was 2.0% +/- 0.3% (152/7605). Nonatopic asthma was recorded in 54%, atopic asthma in 46% of the subjects.

[Epidemiology of bronchial asthma and bronchial hyperreactivity]. / Epidemiologie bronchiálního astmatu a bronchiální hyperreaktivity.

Prevalence of bronchial asthma and bronchial hyperreactivity (BH) was studied in a randomized sample of Prague 8 inhabitants aged 19 and over. The number of adults living in Prague 8 had been 90 458 by December 31, 1987. 8458 questionnaires had been sent to 5 randomly selected districts. Information mainly concerned with respiratory diseases was received from 89.9% persons. Cumulative prevalence (i.e. both contemporary and past) of bronchial asthma was 2.3% +/- 0.3% in both sexes. The cumulative prevalence calculated by way of direct standardization was slightly higher - 2.33% +/- 0.33% (men 2.33% +/- 0.5%, women 2.32% +/- 0.45%). The highest value of 3.6% was found at the age of 21-30 years. Evidence of BH was found in 75% cases of bronchial asthma by means of the inhalation histamine test. In adult population, the BH value was calculated on the basis of distribution of incidence in the healthy population and in persons with respiratory disease and the BH prevalence was found in each group. The BH in total adult population of Prague 8 was 13.7%. This is an alarming figure.

[Pharmacokinetics and chronotherapy of delayed action theophylline (Euphyllin CR)]. / Farmakokinetika a chronoterapie protrahovane pusobícím teofylinem (Euphyllin CR).

Monitoring of theophyllinaemia in the course of 24 h during treatment with theophylline anhydrate capsules (Euphyllin CR) was used in 20 children (9-15 years) and in 20 adults (18-61 years) with bronchial asthma. The doses used in children were 5.96 mg/kg at 7 a.m. and 10.2 mg/kg at 7 p.m., while in adults the morning and evening doses were similar (4.35 and 4.89 mg/kg). After the first dose in the morning the serum theophylline concentration (STC) did not differ in children and adults (10.4 and 10.5 mg/l). In adults the half-time of absorption was twice as high as in children (0.63 and 0.3 h), as well as the time when the peak theophylline concentration was reached (2.7 and 1.39 h). In children a double dose of the drug at night ensured a STC of 11.2 mg/l and a maximum theophyllinaemia (C max = 13.5 mg/l between 8 p.m. and 6 a.m. (measured by the EMIT method). In adults the values during the night were significantly lower than in day-time (STC: ANOVA test P less than 0.05, C max: T-test P less than 0.01). The percentage fluctuation in individual subjects was small (36-49) interindividual, fluctuations in children and adults were considerable (105 to 207). From the chronoprofile of the pharmacokinetics of Euphyllin CR ensues that at the age of 9-15 years the most important indicators are similar to those in adults and that both groups should be given at night a double dose, as compared with that administered in the morning.