Diagnosis of chronic obstructive pulmonary disease in the primary care setting.

Chronic obstructive pulmonary disease (COPD) remains a major cause of morbidity and mortality with increasing rates during the last decades. Due to the progressive nature of the disease, underestimation of symptoms by the patients, lack of knowledge and underuse of spirometry by the Primary Care providers the disease remains under-diagnosed in about half of the cases. Patients with a smoking history of ≥20 pack-years and relevant symptoms (e.g. dyspnea, chronic cough and sputum production) are considered a high risk group. Measurement of spirometric parameters after administration of a short acting bronchodilator confirms the presence of irreversible airflow obstruction and establishes the diagnosis. However in the primary care spirometry is usually not available and differential diagnosis with other obstructive pulmonary diseases (e.g. asthma, bronchiectasis) is not always easy. General Practitioners (GPs) need simple screening tools to decide if a patient belong to a high risk group and pulmonary consultation is necessary. Early and accurate diagnosis of COPD in the primary care setting allowing for a timely and effective management which reduces the rate of decline in lung function improves survival of patients, their quality of life and reduces health-care utilization. The aim of the present review is to provide the existing information about COPD diagnosis and the related problems in the Primary Care. Also we reviewed numerous simple COPD diagnosis questionnaires as well as the use of hand-held flow meters which could be used as effective screening tools.

Interferon α-induced sarcoidosis to a patient with polycythemia vera.

Treatment with interferon (IFN) can precipitate a variety of inflammatory conditions, including sarcoidosis. Although many other systems can be affected, the clinical picture in this case mostly includes cutaneous and pulmonary symptoms. The prognosis is better than the idiopathic form of the disease, and the most effective treatment is considered the discontinuation of antivirus therapy alone or in combination with corticosteroid administration. The authors present the case of a 36-year-old man who developed sarcoidosis stage I after 2 years of IFNα therapy for polycythemia vera.

Therapeutic pneumoperitoneum in a patient with pulmonary tuberculosis and persistent fever.

Artificial pneumoperitoneum represents a therapeutic technique first applied in the treatment of pulmonary tuberculosis (TB) in prechemotherapy antimycobacterial era. A 25-year-old patient presented with pulmonary TB diagnosed during the 8th month of her pregnancy. She was febrile and in severe clinical condition. An antituberculous regimen of four primary drugs was initiated immediately after the caesarean section. There was no clinical improvement after 3 months despite full drug sensitivity of Mycobacterium tuberculosis isolates. An artificial pneumoperitoneum was applied along with the drug treatment for 6 months. Soon the patient became afebrile, her body weight increased and sputum smears gave negative results. The combination of the old technique of therapeutic pneumoperitoneum along with the current antituberculosis treatment proved to be effective in this advanced case of pulmonary TB initially unresponsive to drug therapy alone.

Pleural plaques in dentists from occupational asbestos exposure: a report of three cases.

BACKGROUND: White asbestos (chrysotile) has been used in dentistry since 1930 when it was introduced as a lining material for casting rings. METHODS: All three patients presented with pleural plaques on chest X-rays as well as on CT-scans. They were working as dentists for 35-45 years. Under the instructions of the first dentist we represented precisely the whole process of manipulating a kind of paper that contained asbestos. In order to measure asbestos fibers concentration we used the membrane filter method and phase contrast optical microscopy. Dry asbestos sheets were scanned with x-ray diffraction and electron microscope. RESULTS: Analysis of the filter demonstrated 0.008 fibers/cm(3) during the sampling period. X-ray diffraction analysis revealed that the material consisted of chrysotile exclusively. Electron microscope pictures confirmed the presence of chrysotile. CONCLUSION: Everyday occupational exposure for many years even to low asbestos levels, under poor ventilation conditions in a closed space, could cause pleural lesions.

Mortality from occupational exposure to relatively pure chrysotile: a 39-year study.

BACKGROUND: Asbestos exposure is related to serious adverse health effects. However, there is disagreement about the relationship between chrysotile exposure and mesothelioma or lung cancer. OBJECTIVES: Our aim was to investigate the mortality rate among workers exposed to relatively pure chrysotile in an asbestos cement factory. PATIENTS AND METHODS: In an asbestos cement plant opened in 1968, we prospectively studied all 317 workers. A quantity of 2,000 tons of chrysotile, with minimal amphibole contamination, was used annually until 1 January 2005. Asbestos fiber concentration was measured regularly. Date and cause of death were recorded among active and retired workers. RESULTS: Asbestos fiber concentration was always below permissible levels. Fifty-two workers died during the study. The cause was cancer in 28 subjects; lung cancer was diagnosed in 16 of them. No case of mesothelioma was reported. Death was attributed to cardiovascular diseases in 23 subjects and to liver cirrhosis in 1. Overall mortality rate was significantly lower than that of the Greek general population, standardized mortality ratio (SMR) was 0.71 (95% CI 0.53-0.93). Mortality due to cancer was increased (SMR 1.15, 95% CI 0.77-1.67), mainly due to lung cancer mortality (SMR 1.71, 95% CI 0.98-2.78), but not significantly. CONCLUSIONS: Occupational exposure to relatively pure chrysotile within permissible levels was not associated with a significant increase in lung cancer or with mesothelioma. Decreased overall mortality of workers indicates a healthy worker effect, which--together with the relatively small cohort size--could have prevented small risks to be detected.

Smoking and pollution cause an increase in expired carbon monoxide in kiosk workers.

BACKGROUND: The measurement of expired carbon monoxide (CO) is a direct and non-invasive method for the detection of exposure to CO. OBJECTIVE: Our aim was to investigate the impact ofatmospheric pollution and smoking on expired CO in kiosk workers in Thessaloniki, Greece. METHODS: Twenty kiosks were selected in the commercial centre of city. The workers were all men aged 30.5 +/- 5.5 years. Measurements of expired CO and environmental CO were carried out twice per day, during two different seasons of the year, summer and winter. Expired CO was measured via a MicroCOMeter equipped with a fuel cell type electrochemical sensor. The CO levels in ambient air were determined using the method of Non-Dispersive Infra-Red analysis. RESULTS: Ambient CO levels were 2.11 +/- 0.64 ppm at h. 17:00 and 3.64 +/- 1.45 at h. 21:00 in winter and 1.26 +/- 0.17 ppm at h. 17:00 and 1.73 +/- 0.22 at h. 21:00 in summer. Expired CO in non-smokers was 3.2 +/- 2.7 ppm at h. 17:00 and 4.2 +/- 3.2 at h. 21:00 in winter and 1.3 +/- 1 ppm at h. 17:00 and 2.2 +/- 1.4 at h. 21:00 in summer. In smokers it was +/- 5.2 ppm at h. 17:00 and 13.9 +/- 7.5 at h. 21:00 in winter and 10 +/- 4.8 ppm at h. 17:00 and 18 +/- 7 at h. 21:00 in summer. All these differences were statistically significant. The concentrations of expired CO were significantly correlated with the number of the cigarettes smoked. CONCLUSIONS: The levels of expired CO in kiosk workers increase mainly due to smoking and to a lesser degree due to environmental pollution.

Expiratory flow limitation in patients with pleural effusion.

BACKGROUND: Expiratory flow limitation (EFL) is one of the main mechanisms contributing to dyspnea in patients with chronic obstructive pulmonary disease but has not been explored in patients with pleural effusion. OBJECTIVES: It was the aim of this study to determine whether patients with pleural effusion exhibit EFL and to investigate the effect of therapeutic thoracentesis on EFL. PATIENTS AND METHODS: The study was performed on 21 patients with pleural effusion who were subjected to thoracentesis and measurement of pleural pressure (PP). Spirometry and estimation of flow limitation by the negative expiratory pressure technique were performed before and after thoracentesis. RESULTS: Statistically significant differences were observed in all spirometric parameters. No correlation between the increase in lung volumes and flows and any of the aspirated fluid parameters was observed. Before thoracentesis, 14 out of 21 patients were flow limited, compared with 7 patients after thoracentesis (chi(2) = 6.151, p = 0.013). Mean values of flow limitation before and after thoracentesis differed significantly. The decrease in flow limitation did not correlate with the increase in the spirometric parameters, the aspirated fluid volume or PP decrease. CONCLUSIONS: In the majority of patients with pleural effusion, flow limitation improves after thoracentesis. Flow limitation may be a contributing factor to the sensation of dyspnea in these patients.

Tuberculosis in patients receiving anti-TNF agents despite chemoprophylaxis.

SETTING: A major concern surrounding the use of tumor necrosis factor-alpha (TNF-alpha) inhibitors is their potential to increase the risk of opportunistic infections, particularly tuberculosis (TB). OBJECTIVE: To estimate the incidence of active TB in patients with rheumatic diseases receiving anti-TNF drug therapy and to evaluate the effectiveness of an antituberculosis chemoprophylaxis regimen. DESIGN: Retrospective study of the files of 613 patients with rheumatic diseases who had received anti-TNF agent (etanercept, infliximab and adalimumab) therapy from July 2000 to June 2004 at the Aristotle University of Thessaloniki, Greece. All patients had a tuberculin skin test (TST) and a postero-anterior chest radiograph (CXR) prior to anti-TNF therapy. When indicated (TST > or =10 mm and/or fibrotic lesions on CXR), treatment for latent TB was established (6 months isoniazid [INH] or 3 months INH and rifampicin [RMP]). Anti-TNF agent therapy was started again 2 months later. RESULTS: Of 45 patients who fulfilled the criteria for chemoprophylaxis, only 36 were treated correctly. Eleven patients developed active TB 2-35 months after the beginning of anti-TNF therapy. Six patients developed pulmonary and five extra-pulmonary TB. Eight of these had received infliximab and three adalimumab. CONCLUSION: The incidence of active TB in this study population was estimated at 449 cases per 100,00 population annually. Anti-tuberculosis chemoprophylaxis was only of partial preventive success in these patients.

Diachronic study of pleural plaques in rural population with environmental exposure to asbestos.

BACKGROUND: The progress of pleural plaques in persons exposed to environmental asbestos in Almopia, Greece were studied prospectively. METHODS: During a 15-year period, 198 individuals, in whom pleural plaques had been observed during the period 1988-1990 were followed. Respiratory function was initially evaluated in 23. All were inhabitants of seven villages of Northern Greece, where rocks with high concentration in asbestos fibers were used for whitewashing until 1935. RESULTS: Out of this population, 126 survived and underwent chest X-ray in 2003 while respiratory function was retested in 18. New radiological findings were compared to previous ones using digital technology. Furthermore, the cause of death of the remaining 72 was recorded. Deterioration of X-ray findings was observed in all survivors. Not only did the surface area of previous plaques increase (8.66 +/- 12.6 cm2, mean value +/- SD) but new ones also appeared. Total lung capacity decreased from 95.6 +/- 14.8 in 1998 to 76.5 +/- 9.3% predicted in 2003. It was found that out of 72 deaths, 11 people died of malignant lung neoplasm, and 4 of mesothelioma. CONCLUSIONS: Radiological appearance of pleural plaques and respiratory function of people previously exposed to asbestos environmental pollution worsens over the years. Prevalence of mesothelioma was found to be higher than expected.

Hypoxemia: an early indication of pigeon breeders' disease. Clinical and laboratory findings among pigeon breeders in the Salonica area.

The purpose of this study is to identify pathological findings among pigeon breeders in the Salonica area. Fifty-four volunteer breeders with varying intensity of contact with pigeons participated in the study. All the breeders, after filling in a questionnaire that included questions about the existence of conjunctivitis, rhinitis, chronic cough and sputum, were subjected to clinical examination and spirometric, hematological (arterial and venous), radiographic and immunologic tests. Twenty-five point nine percent of the breeders suffered from conjunctivitis, 31.5% from rhinitis and 33.3% from chronic cough and sputum. Fourteen point eight percent of them had class I precipitins, 7.4% had class II, 5.6% had class III and 16.7% had class IV and a positive correlation of precipitin class with the number of pigeons bred was found. Seven breeders (13%) had hypoxemia at rest and other 8 (14.8%) presented with hypoxemia after the exercise testing. Two breeders presented with a combination of findings of allergic alveolitis that satisfied the criteria of the Pigeon Breeders' Disease (PBD). A substantial number of the examined pigeon breeders were sensitized to pigeon serum antigens. Arterial hypoxemia, either at rest and/or after exercise was observed in 27.8% of breeders. Three point seven percent of breeders presented with clinical and laboratory findings consistent with PBD. Chronic cough and sputum in pigeon breeders should be considered as a possible manifestation of PBD.

The effects of environmental pollution on the respiratory system of children in western Macedonia, Greece.

The indoor and outdoor environmental pollution effects on the respiratory system of 3,559 children aged 9-12 were studied. It was a cross-sectional and interlocal (geographical differentiation) study. The research was conducted during the period between 2000-2001 in five cities of Western Macedonia and more particularly: 1046 children from Ptolemaida, 1249 children from Kozani, 466 from Florina, 419 from Kastoria and 379 from Grevena. The study was performed by means of a questionnaire for the detection of respiratory diseases during childhood, plus spirometry and rhinomanometry measurements. The diachronic quantitative analysis of environmental pollutants was conducted by The Laboratory of Physics of the Atmosphere of the Aristotle University of Thessaloniki. The environmental pollution was found to have a detrimental effect on the respiratory system of children, mainly attributable to the occurrence of rhinitis and infectious bronchitis. The highest prevalence of rhinitis (40.3%) and infectious bronchitis (12.1%) was observed in Ptolemaida, which is a highly polluted region, whereas the lowest (21.2% and 6.7%, respectively) was seen in Grevena, a non-polluted area. As for the indoor pollution, maternal smoking was found to increase the prevalence of respiratory problems in children. Finally, the father's educational level and a past history of nursery school attendance increase the prevalence of respiratory diseases during childhood.

Prevalence of chronic obstructive pulmonary disease and rhinitis in northern Greece.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) constitutes one of the main factors responsible for morbidity and mortality worldwide. Rhinitis has a high prevalence, but its relationship to COPD has not been determined. OBJECTIVES: To estimate the prevalence of COPD and rhinitis in northern Greece and to examine their correlation. PATIENTS AND METHODS: Of a total of 8,151 subjects (aged 21-80 years, from three regions of northern Greece) invited to participate in the study, 6,112 (75%) were included. The regions studied were: (a) Thessaloniki (1,733 study participants, 52.7 +/- 18.6 years old), an urban area with particulate air pollution frequently exceeding the acceptable limit, (b) Eordea (3,537 study participants, 51.4 +/- 15.5 years old), a typical industrial area with particulate air pollution with daily values exceeding the acceptable limit and (c) Grevena (842 study participants, 55.6 +/- 15.4 years old), a mountainous area without pollution. The study participants filled in the questionnaire on respiratory symptoms of the Committee on Environmental and Occupational Health of the Medical Research Council and underwent spirometry and rhinomanometry tests. RESULTS: The prevalence of COPD was 5.6% (8.2% in men and 2.5% in women) and that of rhinitis 24.7% (27.4% in men and 21.4% in women). COPD and rhinitis are related to common predisposing factors (smoking, age and sex). Moreover, rhinitis is related to particulate air pollution levels. CONCLUSIONS: The prevalence of COPD and rhinitis in northern Greece does not differentiate from that found in other industrial countries. A functional relationship between upper and lower airways is speculated.

Respiratory effects in workers processing dried tobacco leaves.

OBJECTIVES: The aim of this study was to examine the pollution level of the occupational environment and to investigate the effects of occupational exposure to tobacco dust on the respiratory system of tobacco workers. No such study has previously been conducted in Greece, which is one of the main tobacco-producing countries. METHODS: A total of 1,020 seasonal and permanent tobacco workers (188 men and 832 women) were studied in a factory in Thessaloniki. The study included: 1) completion of a questionnaire (British Medical Research Council 1986), 2) spirometry and 3) rhinomanometry. At the same time, tobacco dust levels in the working environment were measured. As controls, 469 workers (87 men and 382 women) at a Thessaloniki hospital were used. Seventy six workers with nasal symptoms underwent: 1) special nasal provocation test with tobacco dust antigen, 2) skin prick tests, and 3) measurement of total IgE, specific IgE and specific IgG against tobacco protein. RESULTS: Very high levels of total suspended dust were found in work site air (45.3-54.4 mg/m3). The prevalence of chronic bronchitis was 8.7 % versus 20.6 % in controls. Chronic obstructive pulmonary disease was found in 13 workers (1.3 %) and in 16 controls (3.4 %). FEV1 %pred, FVC %pred and the FEV1/FVC ratio were lower in controls, whereas FEF25-75 % %pred was lower in workers. There were no workers with bronchial asthma or extrinsic allergic alveolitis. Rhinitis was reported by 27.3 % of the workers versus 17.9 % of controls, whereas nasal flows were 563+/-211 versus 645 +/- 321 ml/sec, respectively. According to the results of skin prick tests, six workers were sensitized to dried tobacco leaf dust. CONCLUSIONS: The results of our study do not support an association between the development of chronic diseases of the lower respiratory system and pollutants associated with the processing of dried tobacco leaves. In contrast, an association between disorders of the upper airways and tobacco dust in work sites is postulated.

Respiratory effects in workers processing dried tobacco leaves

Objectives: The aim of this study was to examine the pollution level of the occupational environment and to investigate the effects of occupational exposure to tobacco dust on the respiratory system of tobacco workers. No such study has previously been conducted in Greece, which is one of the main tobacco-producing countries. Methods: A total of 1,020 seasonal and permanent tobacco workers (188 men and 832 women) were studied in a factory in Thessaloniki. The study included: 1) completion of a questionnaire (British Medical Research Council 1986), 2) spirometry and 3) rhinomanometry. At the same time, tobacco dust levels in the working environment were measured. As controls, 469 workers (87 men and 382 women) at a Thessaloniki hospital were used. Seventy six workers with nasal symptoms underwent: 1) special nasal provocation test with tobacco dust antigen, 2) skin prick tests, and 3) measurement of total IgE, specific IgE and specific IgG against tobacco protein. Results: Very high levels of total suspended dust were found in work site air (45.3-54.4 mg/m3). The prevalence of chronic bronchitis was 8.7 % versus 20.6 % in controls. Chronic obstructive pulmonary disease was found in 13 workers (1.3 %) and in 16 controls (3.4 %). FEV1 %pred, FVC %pred and the FEV1/FVC ratio were lower in controls, whereas FEF25-75 % %pred was lower in workers. There were no workers with bronchial asthma or extrinsic allergic alveolitis. Rhinitis was reported by 27.3 % of the workers versus 17.9 % of controls, whereas nasal flows were 563±211 versus 645 ± 321 ml/sec, respectively. According to the results of skin prick tests, six workers were sensitized to dried tobacco leaf dust. Conclusions: The results of our study do not support an association between the development of chronic diseases of the lower respiratory system and pollutants associated with the processing of dried tobacco leaves. In contrast, an association between disorders of the upper airways and tobacco dust in work sites is postulated (AU)

Objetivos: El propósito del estudio era examinar el nivel de contaminación del entorno de trabajo e investigar los efectos de la exposición laboral al polvo de tabaco sobre el aparato respiratorio de los trabajadores de la industria tabacalera. Fue el primer estudio de estas características realizado en Grecia, uno de los principales países productores de tabaco. Métodos: Se estudiaron los casos de 1.020 trabajadores temporales y permanentes de la industria tabacalera (188 hombres y 832 mujeres) en una fábrica de Tesalónica. El estudio consistió en los siguientes pasos: 1) cumplimentar un cuestionario (Consejo Bri- tánico de Investigaciones Médicas, 1986); 2) espirometría, y 3) rinomanometría. Al mismo tiempo, se midieron los niveles de polvo de tabaco en el entorno de trabajo. Se emplearon como controles 469 trabajadores (87 hombres y 382 mujeres) del hospital de Tesalónica. Se sometieron 76 trabajadores con síntomas nasales a los siguientes procedimientos: 1) prueba de provocación nasal especial con polvo de tabaco como antígeno; 2) pruebas cutáneas, y 3) medición de la IgE total, la IgE específica y la IgG específica contra proteína de tabaco. Resultados: En el aire del entorno de trabajo se observaron niveles muy elevados de polvo suspendido total (45,3-54,4 mg/m3). La prevalencia de la bronquitis crónica era del 8,7 por ciento, frente al 20,6 por ciento de los controles. Se observó enfermedad pulmonar obstructiva crónica (EPOC) en 13 trabajadores (1,3 por ciento) y en 16 controles (3,4 por ciento). Los valores del porcentaje predicho de FEV1y FVC, así como el cociente FEV1/FVC resultaron inferiores en los controles, mientras que el porcentaje predicho de FEF25-75 por ciento era inferior en los trabajadores. Ningún trabajador presentaba asma bronquial ni alveolitis alérgica extrínseca. Se observó rinitis en un 27,3 por ciento de los trabajadores frente al 17,9 por ciento de los controles, mientras que los flujos nasales resultaron ser de 563ñ211 frente a 645ñ321 ml/seg, respectivamente. Según las pruebas cutáneas, 6 trabajadores presentaban sensibilidad al polvo de las hojas secas de tabaco. Conclusiones: Los resultados de nuestro estudio no respaldan una relación entre el desarrollo de enfermedades crónicas del tracto respiratorio inferior y los contaminantes asociados a la manipulación de hojas secas de tabaco. En cambio, se postula una asociación entre los trastornos del tracto respiratorio superior y el polvo de tabaco de los entornos de trabajo (AU)

The prevalence of allergic asthma and rhinitis in children of Polichni, Thessaloniki.

AIM: To define the prevalence of asthma and rhinitis in primary school children in the Polichni Municipality of the city of Thessaloniki. METHODS AND RESULTS: The parents of 2005 students living in the area of Polichni completed a questionnaire for the detection of pulmonary disease in childhood. Of 493 children who gave positive answers to the questions about allergies, asthma and rhinitis, 203 were excluded after an interview with the parents, because they suffered from either atopic dermatitis or drug allergy or had normal lgE levels. Of the remaining children, 290 were further examined: methacholine test was positive in 109, exercise test was positive in 67, nasal provocation test with histamine was positive in 244, and rhinodilation test with tramazoline was positive in 206. Skin prick tests were positive in 142 children (90 to grass-cereal pollen, 66 to acarea and 59 to Parietaria officinalis). CONCLUSIONS: We found that 168 children suffered from rhinitis, 84 from both asthma and rhinitis concurrently and 38 from asthma alone. Only 37 % of the parents knew that their children suffered from asthma, while even fewer (32 %) knew that their children had rhinitis. The prevalence of asthma was 6.1 % and that of rhinitis was 12.6 % among children aged 9-12 years in the area of Polichni, Thessaloniki. Childhood rhinitis and asthma seem to be frequently underdiagnosed and undertreated.

The prevalence of allergic asthma and rhinitis in children of Polichni, Thessaloniki

Aim: To define the prevalence of asthma and rhinitis in primary school children in the Polichni Municipality of the city of Thessaloniki. Methods and results: The parents of 2005 students living in the area of Polichni completed a questionnaire for the detection of pulmonary disease in childhood. Of 493 children who gave positive answers to the questions about allergies, asthma and rhinitis, 203 were excluded after an interview with the parents, because they suffered from either atopic dermatitis or drug allergy or had normal lgE levels. Of the remaining children, 290 were further examined: methacholine test was positive in 109, exercise test was positive in 67, nasal provocation test with histamine was positive in 244, and rhinodilation test with tramazoline was positive in 206. Skin prick tests were positive in 142 children (90 to grass-cereal pollen, 66 to acarea and 59 to Parietaria officinalis). Conclusions: We found that 168 children suffered from rhinitis, 84 from both asthma and rhinitis concurrently and 38 from asthma alone. Only 37 % of the parents knew that their children suffered from asthma, while even fewer (32 %) knew that their children had rhinitis. The prevalence of asthma was 6.1 % and that of rhinitis was 12.6 % among children aged 9-12 years in the area of Polichni, Thessaloniki. Childhood rhinitis and asthma seem to be frequently underdiagnosed and undertreated (AU)

Información básica: El objetivo del estudio era definir la prevalencia de asma y rinitis en estudiantes de educación primaria en colegios del municipio de Polichni en la ciudad de Tesalónica. Métodos y resultados: Los padres de 2.005 estudiantes, que vivían en el área de Polichni, rellenaron un cuestionario para la detección de enfermedades pulmonares durante la infancia. De los 493 niños que respondieron de manera positiva a las preguntas referentes a alergias, asma y rinitis, se excluyó a 203 después de una entrevista con los padres porque padecían dermatitis atópica o alergia a fármacos, o presentaban valores normales de IgE. Por lo que respecta a los otros niños, se examinó con más detenimiento a 290; 109 respondieron positivamente a la prueba de la metacolina, 67 realizaron una prueba de esfuerzo positiva, 244 una prueba de provocación nasal positiva con histamina y 206 una prueba positiva de rinodilatación con tramazolina, mientras que las pruebas de punción cutánea fueron positivas en 142 niños (90 a polen de gramíneas-cereales, 66 a ácaros y 59 a Parietaria officinalis). Conclusiones: Se comprobó que 168 niños presentaban rinitis, 84 asma y rinitis al mismo tiempo y 38 sólo asma. Únicamente el 37 por ciento de los padres sabían que sus hijos padecían asma, mientras que un porcentaje aún menor (32 por ciento) sabía que sus hijos tenían rinitis. Se observó que la prevalencia de asma es del 6,1 por ciento, mientras que la de la rinitis es del 12,6 por ciento en los niños de 9-12 años del área de Polichni en Tesalónica. Parece que la rinitis y el asma durante la infancia suelen ser enfermedades diagnosticadas y tratadas insuficientemente (AU)

The effect of environmental pollution on the respiratory system of lignite miners: a diachronic study.

BACKGROUND: It is not known whether working in surface lignite mines can cause x-ray lesions or disorders of respiratory function. OBJECTIVES: The aim of the study was to investigate the diachronic impact of environmental pollution on the respiratory system of lignite miners at mines in Eordea, Greece. METHODS: Cases of 199 workers (Group A) residing permanently in the Eordea valley and 151 (Group B) living outside the Eordea valley were studied during Phase I and then re-examined after three years (Phase II). These cases were compared to those of 71 office workers living in Eordea valley (Group C) and to 96 living in Grevena, a region without pollution (Group D). The study included the completion of the MRC questionnaire for the detection of respiratory diseases, pulmonary function tests, measurement of diffusion capacity, otorhinolaryngologic examination, rhinomanonetry as well as chest and paranasal cavity X-rays. RESULTS: Chronic bronchitis was reported by 26.8%, 24.8%, 17.9% and 10.6% respectively of the subjects of groups A, B, C and D according to the answers of the questionnaire (p<0.001). The spirometry and diffusion capacity findings presented no considerable differences either in the 4 groups or between phases I and II of the study. The main problems were detected in the upper airways. A very high prevalence of severe nasal obstruction (73%, 71.2%, 55.7% and 19.3% in Groups A, B, C and D respectively) was detected. Furthermore, a high percentage of atrophic rhinitis (14%) was detected both among workers (Groups A and B) and subjects living in the Eordea valley who participated as controls (Group C). From the X-rays, hypertrophy of nasal turbinates-cartilage and polyposis was observed as follows: Group A: 53.9%, Group B: 48.1%, Group C: 46.5% and Group D: 20.3% (p<0.001). The findings related to the upper respiratory system may be due to excessive pollution by airborne particles (fly ash) pollution in the region and particularly to chromium, nickel, cobalt and lead found at high concentration levels in airborne dust. A marked association between the total air-flow in the nose and the mid-expiratory flow (p<0.01) was detected. CONCLUSIONS: We conclude that subjects working in lignite mines under conditions of excessive pollution by airborne contaminants have a high prevalence of atrophic rhinitis and, in addition to other standard examinations, should undergo rhinomanometry testing and X-ray imaging of the paranasal cavities.

Comparative efficacy of salbutamol and salmeterol in exercise-induced asthma.

This study compared the protection provided by salbutamol and salmeterol against exercise-induced asthma. Asthmatic patients (n = 12) with exercise-induced asthma were exercised submaximally for 6 min on a treadmill 1, 6 and 12 h after inhalation of 200 micrograms salbutamol or 50 micrograms salmeterol. Each patient also took baseline exercise 1 h after two puffs of placebo. Two days later the drugs were administered in a double-blind trial of crossover design with an interval of 48 h between the two treatments. The main parameters measured were: air flow with a Wright flowmeter and mediator concentrations (histamine, leucotriene and prostaglandin D2 measured by radioimmunoassay) in venous blood, which was withdrawn before and 4 min after each exercise period. The maximum percentage bronchoconstriction recorded following placebo was 29 +/- 4% and following salbutamol inhalation it was 4 +/- 4%, 20 +/- 13%, 27 +/- 10%, respectively, for the exercise periods performed 1, 6 and 12 h after inhalation of the drug. Following salmeterol, the corresponding figures were 3 +/- 4%, 3 +/- 3% and 11 +/- 9%. The concentrations of mediator in plasma were significantly increased after exercise. Salbutamol and salmeterol intake reduced these concentrations both when the patients were at rest and following the exercise period. This effect of both drugs on the mediators corresponded with the protection they provided against exercise-induced asthma and was maintained for 12 h after salmeterol inhalation and for 6 h after salbutamol inhalation.

Five cases of pleural mesothelioma with endemic pleural calcifications in a rural area in Greece.

The authors describe 5 cases of pleural mesothelioma in a rural population of Macedonia, Greece. This population had been covered by an X-ray study over a 3-year period to detect pleural calcifications compatible with asbestos exposure. The study revealed a 24.2% prevalence of pleural plaques among the inhabitants aged over 40 years of 7 rural villages. High contents of asbestos (chrysotile and tremolite)--up to 90% by volume--were found in the material that was used for whitewashing the houses up to 1935. Even now, environmental concentrations of 0.01 fibres/ml were recorded in the houses. The prevalence of pleural mesothelioma in this rural population is high compared to the general population. A possible explanation of the phenomenon may be a cumulative environmental exposure to asbestos which, even though presumably within the acceptable limits for occupational exposure, lasted over a much longer time period, in terms of both daily exposure and total duration.