Smoking-related interstitial lung disease.

Exposure to smoke is associated with the development of diseases of the airways and lung parenchyma. Apart from chronic obstructive pulmonary disease (COPD), in some individuals, tobacco smoke can also trigger mechanisms of interstitial damage that result in various pathological changes and pulmonary fibrosis. A causal relation has been established between tobacco smoke and a group of entities that includes respiratory bronchiolitis-associated interstitial lung disease (RB-ILD), desquamative interstitial pneumonia (DIP), Langerhans cell histiocytosis (LCH), and acute eosinophilic pneumonia (AEP). Smoking is considered a risk factor for idiopathic pulmonary fibrosis (IPF); however, the role and impact of smoking in the development of this differentiated clinical entity, which has also been called combined pulmonary fibrosis and emphysema (CPFE) as well as nonspecific interstitial pneumonia (NIP), remains to be determined. The definition of smoking-related interstitial fibrosis (SRIF) is relatively recent, with differentiated histological characteristics. The likely interconnection between the mechanisms involved in inflammation and pulmonary fibrosis in all these processes often results in an overlapping of clinical, radiological, and histological features in the same patient that can sometimes lead to radiological patterns of interstitial lung disease that are impossible to classify. For this reason, a combined approach to diagnosis is recommendable. This combined approach should be based on the joint interpretation of the histological and radiological findings while taking the clinical context into consideration. This paper aims to describe the high-resolution computed tomography (HRCT) findings in this group of disease entities in correlation with the clinical manifestations and histological changes underlying the radiological pattern.

Clinical profile of idiopathic pulmonary fibrosis patients treated with nintedanib in routine clinical practice in Spain: the BROAD Study / Perfil clínico de pacientes con fibrosis pulmonar idiopática tratados con nintedanib en la práctica clínica habitual en españa: estudio broad

Background. Few data are available on the clinical profile of patients diagnosed with idiopathic pulmonary fibrosis (IPF) treated with nintedanib. The primary objective of the study was to describe, based on pulmonary function variables, disease severity in IPF patients who initiated treatment with nintedanib in routine clinical practice. The secondary objectives were to analyze their clinical characteristics and comorbidities. Methods. A multicenter, retrospective study including 173 patients from 32 Spanish hospitals. Patients were stratified by their forced vital capacity (FVC) % predicted and diffusing capacity for carbon monoxide (DLCO) % predicted. These measures were taken as a marker of IPF severity. Results. Mean age ± SD at treatment initiation was 70.1 ± 8.1, and 76.6% of patients were male. Based on FVC, 57% of patients had mild IPF (FVC ≥ 70%), 38.4% moderate IPF (FVC 50%-69%), and 4.7% severe IPF (FVC < 50%). Based on DLCO, 42.5% of patients had mild IPF (DLCO ≥ 50%), 35.5% moderate IPF (DLCO 35%-49%), and 22.2% severe IPF (DLCO < 35%). Eighty-nine percent of patients had at least one comorbid condition. The most prevalent comorbidities were high blood pressure (45.9%), dyslipidemia (42.4%), gastroesophageal reflux (25.6%), diabetes (19.8%), emphysema (15.7%), and cardiovascular diseases (15.7%). Most patients received concomitant treatment (79.7%). Conclusions. The study provides relevant information on the clinical characteristics of IPF patients who initiate nintedanib treatment. Classification of severity depends on the lung function parameter used. The proportion of patients classified as having severe IPF was up to 4 times greater when DLCO, instead of FVC, was used (AU)

Introducción. Se dispone de pocos datos sobre el perfil clínico de los pacientes diagnosticados de fibrosis pulmonar idiopática (FPI) tratados con nintedanib. El objetivo principal del estudio fue describir, basándose en variables de función pulmonar, la gravedad de la enfermedad en pacientes con FPI que iniciaron tratamiento con nintedanib en la práctica clínica habitual. Los objetivos secundarios fueron analizar sus características clínicas y comorbilidades. Métodos. Estudio retrospectivo y multicéntrico que incluyeron a 173 pacientes de 32 hospitales españoles. Los pacientes fueron estratificados por su capacidad vital forzada (CVF) % predicho y por la capacidad de difusión de monóxido de carbono (DLCO) % predicho. Estas variables se consideraron como marcadores de la gravedad de la FPI. Resultados. La edad media ± DE al inicio del tratamiento fue de 70,1 ± 8,1 y el 76,6% de los pacientes eran varones. Según la CVF, el 57% de los pacientes tenían FPI leve (CVF ≥ 70%), el 38,4% FPI moderada (CVF 50%-69%) y el 4,7% FPI grave (CVF < 50%). Según la DLCO, el 42,5% de los pacientes tenían FPI leve (DLCO ≥ 50%), el 35,5% FPI moderada (DLCO 35%-49%) y el 22,2% FPI grave (DLCO < 35%). El 89% de los pacientes tenían al menos una comorbilidad, siendo las más prevalentes la hipertensión arterial (45,9%), dislipidemia (42,4%), reflujo gastroesofágico (25,6%), diabetes (19,8%), enfisema (15,7%) y enfermedades cardiovasculares (15,7%). La mayoría de los pacientes recibieron tratamientos concomitantes (79,7%) (AU)

Estudio en fibroblastos humanos del sistema angiotensina en la fisiopatología de la fibrosis pulmonar idiopática / The study of angiotensin system human fibroblasts in the physiopathology of idiopathic pulmonary fibrosis

En el tejido pulmonar de modelos murinos, la angiotensina II induce la proliferación de fibroblastos, su diferenciación a miofibroblastos y la producción de procolágeno tras su unión al receptor I de la angiotensina. Hemos estudiado el comportamiento de fibroblastos pulmonares humanos procedentes de una línea celular comercial tras la estimulación con TGF-β1. Hemos observado que estos fibroblastos, cuando son estimulados, aumentan la expresión de bFGF, colágeno y α-SMA. Tras el bloqueo del receptor de Angiotensina II con Losartan a una concentración de 10 µM y la estimulación con TGF- β1, se produce una disminución, tanto de los niveles de bFGF como de la concentración de colágeno, sin que llegue a alcanzar la significación estadística con respecto a las células no tratadas. En cuanto a la expresión de α-SMA como marcador de transformación a miofibroblastos, no había diferencias entre las células tratadas con TGF-β1 y TGF-β1 más losartán

In murine model lung tissue, angiotensin II induces the proliferation of fibroblasts, their distinction from myofibroblasts and procollagen production after its binding with the type 1 receptor. We have studied the behavior of human lung fibroblasts from a commercial cell line after stimulation with TGF-β1. We observed that those fibroblasts, when stimulated, increased bFGF, collagen and α-SMA expression. After blocking the angiotensin II receptor with losartan at a concentration of 10 µM and stimulation with TGF- β1, there was a decrease in both bFGF levels and collagen concentration, without reaching statistical significance with regard to untreated cells. With regard to α-SMA expression as an indicator of transformation to myofibroblasts, there were no differences between cells treated with TGF-β1 and TGF-β1 with losartan

Recomendaciones sobre el diagnóstico y manejo de la enfermedad pleural y pulmonar por asbesto / Recommendations for the diagnosis and management of asbestos-related pleural and pulmonary disease

Asbesto, también conocido en España como amianto, es el término utilizado para nombrar a un conjunto de silicatos minerales que suelen romperse en fibras. Su uso ha comportado la aparición de numerosas enfermedades, especialmente pleuropulmonares, todas ellas caracterizadas por su prolongada latencia. El asbesto es, además, un carcinógeno del grupo IA reconocido por la OMS desde 1987. En España está prohibido desde 2002. La publicación en 2013 de la 3.ª edición del protocolo de vigilancia sanitaria específica del amianto junto con la aparición de nuevas técnicas diagnósticas han motivado al grupo EROM de SEPAR a promover la elaboración de esta normativa que revisa aspectos clínicos, radiológicos y funcionales de las diferentes enfermedades relacionadas. También establece recomendaciones para el diagnóstico y seguimiento de los pacientes expuestos. Dichas recomendaciones han sido establecidas mediante sistema GRADE.(AU)

Asbestos is the term used for a set of mineral silicates that tend to break up into fibers. Its use has been associated with numerous diseases affecting the lung and pleura in particular, all of which are characterized by their long period of latency. Asbestos, moreover, has been recognized by the WHO as a Group IA carcinogen since 1987 and its use was banned in Spain in 2002. The publication in 2013 of the 3rd edition of the specific asbestos health monitoring protocol, together with the development of new diagnostic techniques, prompted the SEPAR EROM group to sponsor publication of guidelines, which review the clinical, radiological and functional aspects of the different asbestos-related diseases. Recommendations have also been made for the diagnosis and follow-up of exposed patients. These recommendations were drawn up in accordance with the GRADE classification system.(AU)

Producción de factor básico de crecimiento de fibroblastos (Beta-fgf) trasla estimulación de fibroblastos pulmonares humanos in vitro confactor transformador del crecimiento Beta1 (tGf-Beta1). Estudio dosis respuesta / The production of basic fibroblast growth factor following in vitro stimulation of human lung fibroblasts with transforming growth factor Beta1: Dose response Study

Objetivo: Establecer cuál es la dosis de TGF-β1 más adecuada para la estimulación de cultivos de fibroblastos pulmonares humanos y el tiempo necesario de incubación de los mismos para obtener la máxima respuesta. Material y métodos: Diseñamos un estudio de dosis respuesta con TGF-β1 sobre una línea celular de fibroblastos pulmonares humanos. Analizamos la producción de factor básico de crecimiento de fibroblastos (b-FGF) como marcador de estímulo fibrogénico. Para ello se cultivaron fibroblastos humanos procedentes de una línea celular (MRC5) obtenida de la ECCC (European Collection of Cell Culture, UK). Las células se cultivaron en placas de 33cm2, cuando estuvieron confluentes se les estimuló con diferentes dosis de TGF-β1 (Peprotech, USA): 5, 10 ng/ml. Las células se incubaron durante 12, 24, 48 y 72 horas. Se usaron como control células no estimuladas con TGF-β1. Los niveles de factor básico de crecimiento de fibroblastos (b-FGF) se midieron por ELISA (R&D System, Minneapolis, MN). Se analizó la viabilidad celular mediante Azul Trypan a las 24, 48 y 72 horas de la estimulación con TGF-β1. Resultados: La mayor producción de b-FGF se produjo a las 24 horas tras la estimulación con la dosis de 10 ng/ml de TGF-β1, siendo la producción de b-FGF igual a 501 pg/ml. La viabilidad celular tiene su mayor valor a las 48 horas, disminuyendo en horas sucesivas, alcanzando los niveles más bajos a las 72 horas. Conclusiones: Existe un efecto estimulador del TGF-β1 sobre los fibroblastos pulmonares humanos in vitro. Esta acción del TGF-β1 es dosis dependiente y alcanza el nivel máximo de proliferación con la dosis de 10 ng/ml a las 24 horas de su tratamiento (AU)

Objective: To establish the most appropriate dose of TGF-β1 to stimulate human lung fibroblasts cultures and their necessary incubation time to obtain the maximum response. Material and methods: A dose response study was designed with TGF - β1 based on human lung fibroblast cells. The production of basic fibroblast growth factor (b-FGF) was analyzed as a marker for fibrogenic stimulus. Human fibroblasts from a cell line (MRC5) were obtained from the ECCC (European Collection of Cell Culture, UK) and cultivated. Cells were cultured on 33 cm2 plates; once confluent, they were stimulated with various doses of TGF - β1 (Peprotech, USA): 5, 10 ng/ml. The cells were incubated for 12, 24, 48 and 72 hours. Cells not stimulated with TGF - β1 were used as a control. The levels of basic fibroblast growth factor (b-FGF) were measured using ELISA (R&D System, Minneapolis, MN). Cell viability was analyzed using Trypan Blue at 24, 48 and 72 hours following the stimulation with TGF - β1. Results: The greatest production of b-FGF took place 24 hours after the stimulation with the dose of 10ng/ml of TGF - β1, with the production of b-FGF being equal to 501 pg/ml. The cell viability reached its greatest value at the 48 hours, decreasing in the hours thereafter, to reach the lowest levels at 72 hours. Conclusions: TGF-β1 has a stimulating effect on human lugn fibroblasts in vitro. This action of the TGF - β1 is dose dependent and reaches maximum proliferation levels with a dose of 10ng/ml 24 hours following treatment (AU)

Niveles séricos de mesotelina. Valor pronóstico en mesotelioma pleural maligno / Serum levels of mesothelin. Prognosis value in malignant pleural mesothelioma

El mesotelioma pleural maligno (MPM) es un tumor agresivo que surge del epitelio pleural. Se han detectado concentraciones aumentadas de proteínas solubles relacionadas con la mesotelina (SMRP) en suero de pacientes con MPM (..) (AU)

Malignant pleural mesothelioma (MPM) is an aggressive tumour that arises from pleural epithelium. Increased concentrations of soluble mesothelin related proteins (SMRP)

Interleukin-8 activates coagulation and correlates with survival after talc pleurodesis.

The aim of our study was to investigate whether interleukin (IL)-8 activates systemic coagulation after talc pleurodesis in malignant pleural effusion (MPE), and whether levels of IL-8 in plasma are related to early death after talc pleurodesis. IL-8 and tumour necrosis factor (TNF)-alpha were measured in samples from 231 MPE patients before and after talc pleurodesis. Whole blood from 31 healthy volunteers was incubated with IL-8, TNF-alpha and thromboplastin for 3 h in vitro, and thrombin-antithrombin (TAT) levels were measured. The same stimulation of blood samples was repeated using doses of calibrated talc. Nine, 12 and 17 patients died within 7, 10 and 15 days respectively. IL-8 was elevated in 102 patients within 48 h, and thrombotic events were observed in six of those patients. Survival correlated inversely with IL-8 at 24 and 48 h, and a significant correlation was also found between IL-8 and TAT. A positive dose-dependent correlation with TAT production was observed when blood was stimulated with IL-8 in vitro. However, there was no significant response to stimulation with talc, as compared with control blood samples. IL-8 is involved in the activation of coagulation that may occur after talc pleurodesis, and might also be implicated in early death of patients with MPE.

Utilidad e indicaciones de Omaluzumab en el asma bronquia / No disponible

No disponible

Obstrucción severa al flujo aéreo como forma de presentación de carcinoma epidermoide traqueal / No disponible

No disponible

Análisis clínico-epidemiológico de pacientes consecutivos con tromboembolismo pulmonar / Clinical-epidemiological analysis of consecutive patients with pulmonary thromboembolism

INTRODUCCIÓN: El tromboembolismo pulmonar (TEP) constituye un problema sanitario de gran trascendencia debido a su elevada morbimortalidad. La enfermedad tromboembólica venosa (ETV) ocasiona unas 300.000 hospitalizaciones al año, con una incidencia del 0,5 al 2,5% entre los pacientes ingresados por patología médica y del 0,1 al 0,6% de los ingresados por causa quirúrgica. La prevalencia entre los ingresados es aproximadamente del 1%.OBJETIVO: Estudiar las características de los pacientes ingresados por TEP en nuestro medio hospitalario a fin de poder valorar la epidemiología, los factores de riesgo y la evolución durante el periodo agudo. PACIENTES Y MÉTODO: Se estudiaron a todos los pacientes ingresados y diagnosticados de TEP en los Hospitales Universitarios Virgen del Rocío de Sevilla en el periodo comprendido desde febrero de 2003 hasta septiembre del 2004. Se realizó una sistemática recogida de datos clínicos, diagnósticos, y evolutivos hasta el alta hospitalaria. RESULTADOS: Durante 19 meses consecutivos un total de456 pacientes ingresaron en nuestra área hospitalaria por sospecha de TEP. De estos sólo en 165 casos (36%) se confirmó dicho diagnóstico. Ochenta y dos (49.7%) eran mujeres y ochenta y tres hombres (50.3%). La edad media de fue de 64.47±16.77. El factor de riesgo para la ETV presente con más frecuencia fue la inmovilización secundaria. Los síntomas de presentación más frecuente fueron la disnea y el dolor torácico. El electrocardiograma fue normal en la mayoría de los pacientes [N=61(37%)] El derrame pleural fue el hallazgo radiológico más frecuente (37.6%). El signo más prevalente en la ecocardiografía fue la presencia de insuficiencia tricuspíde a (50.3%). La mortalidad en nuestra serie fue del 10.3%. CONCLUSIONES: El incremento en la edad de nuestros pacientes, los factores de riesgo asociados a la enfermedad tromboembólica, y las nuevas herramientas pronosticas, pueden facilitarnos el manejo de esta enfermedad que escasamente ha variado su morbimortalidad a pesar de los avances médicos

INTRODUCTION: Pulmonary thromboembolism (PTE) constitutes a health problem of great importance due to its high morbimortality. Venous thromboembolic disease (VTE) causes 300,000 hospitalizations a year, with an incidence from 0.5 to 2.5%among the patients admitted for medical pathology and from 0.1 to0.6% of those admitted for surgical causes. The prevalence among admissions is approximately 1%.OBJECTIVE: To study the characteristics of the patients admitted for PTE in our hospital area in order to be able to evaluate the epidemiology, the risk factors and the evolution during the acute period. PATIENTS AND METHOD: We studied all patients who were admitted to the University Hospitals Virgen del Rocio of Seville in the period included from February 2003 to September 2004 and diagnosed with PTE. Clinical data, diagnoses, and evolutions were systematically collected until the hospital discharge. Troponin and BNP (brain natriuretic peptide) levels in blood were determined, and echocardiography was performed, in the first 48 h after admission. RESULTS: During 19 consecutive months a total of 456patients entered our hospital area with suspicion of PTE. Of these, this diagnosis was confirmed in only 165 cases (36%). Eighty two(49.7%) were women and eighty three (50.3%) were men. The average age was 64.47±16.77. The risk factor for VTE presented with more frequency was immobilisation secondary to admission. The symptoms presented more frequently were dyspnoea and thoracic pain. The electrocardiogram was normal in most of the patients [N=61 (37%). Pleural effusion was the more frequent radiological finding (37.6%). The more prevalent sign in the echocardiography was the presence of tricuspid insufficiency (50.3%). Mortality in our series was 10.3%.CONCLUSIONS: The increase in the age of our patients, the risk factors associated to thromboembolic disease mainly in hospitalized patients, and the new prognostic tools, can facilitate our handling of this disease that has barely varied its morbimortality in spite of the technological advances

Neumonía lipoidea exógena aguda por aspiración accidental de gasolina / Exogenous lipoid pneumonia following accidental gasoline aspiration

Las enfermedades por aspiración representan una causaimportante de morbimortalidad. Dentro de éstas, la neumoníalipoidea exógena aguda por aspiración de gasolina se presentacomo una causa rara, más aún en los pacientes adultos, en los quese han descrito casos en los comedores de fuego (Fire eaters). Presentamosel caso de un paciente varón de 28 años que aspiró accidentalmentegasolina al intentar extraerla de un depósito a otro,ingresando quince días después por expectoración hemoptoica yatelectasia parcial del lóbulo medio. El cuadro se resolvió adecuadamenteen veinte días con tratamiento antibiótico y de soporte

Aspiration diseases represent an important cause of morbimortality.Among these, acute exogenous lipoid pneumonia resultingfrom gasoline aspiration is considered rare, especially in thecase of adult patients. However, it is usual among fire eaters.We report the case of a 28-year-old male patient who accidentallyinhaled gasoline when trying to transfer it from one tank toanother. Fifteen days later, the patient was admitted to hospitaldue to haemoptysis and partial atelectasis of the middle lobe. Thepatient was administered antibiotics and adjunctive therapy andhe recovered after 20 days

[Blood levels of eosinophil cationic protein in patients with allergic rhinitis. Evolution after treatment with corticoids]. / Niveles séricos de proteína catiónica del eosinófilo en pacientes con rinitis alérgica. Evolución tras tratamiento con corticoides.

We analyze changes in eosinophilic cationic protein (ECP) serum levels after treatment with intranasal corticoids. Fifty-three healthy individuals (control group) and 21 patients diagnosed of allergic rhinitis, with or without bronchial asthma, were enrolled at a time when they had only nasal symptoms. Data were collected from skin Prick tests, forced spirometry, methacholine challenge, and complete blood workups, including IgE measurement, eosinophil counts and ECP serum levels determined by immunofluorescence. The patients received intranasal budesonide at a dose of 200 micrograms/24 h. ECP levels and eosinophil counts were determined before (baseline levels) and during treatment (on days 21 and 60). We found significant differences (p < 0.01) in baseline ECP levels of the controls (9.34 +/- 5.76) and patients (16.47 +/- 15.28). These values were significantly lower than baseline 21 and 60 days after treatment, although the changes between days 21 and 60 were not significant. Eosinophil counts did not fall significantly. We also found that eosinophil counts and ECP levels were correlated (r = 0.53) at baseline but not after treatment (r = 0.25). No patient experienced bronchial symptoms during the study. We conclude that ECP serum levels in patients with symptoms of rhinitis are significantly higher than levels in non symptomatic individuals. These levels fall significantly, possibly due to intranasal corticoid treatment, although eosinophil counts remain constant. ECP levels can therefore be used to monitor inflammatory activity in patients with allergic rhinitis.

[Prediction of maximal ventilation during exercise in patients with chronic obstructive pulmonary disease]. / Predicción de la ventilación máxima alcanzada en el esfuerzo en pacientes con enfermedad pulmonar obstructiva crónica.

To analyze the validity of baseline lung function parameters as predictors of maximal exercise ventilation (VEmax) in patients with chronic obstructive pulmonary disease (COPD), we studied 33 stable patients (FEV1 43.6 +/- 16.8%, FEV1/FVC% 48.4 +/- 9.2, FRC 156.8 +/- 32.7% and RV 212 +/- 53.9%). The sample was later divided into 3 groups based on severity of disease (severe, moderate or mild) in order to determine whether ability to predict VEmax increased with airways obstruction (FEV1 26.9 +/- 4.9%, 40.2 +/- 3.5% and 63.9 +/- 10%, respectively). The patients underwent lung function testing at rest and after a progressive stress test, with the maximal reading taken with the subject on a tread mill. We found greater correlation between VEmax and RV, FEV1 and FRC (r = -0.77, 0.75 and -0.74, respectively); the correlation was stronger in patients with severe COPD, in whom FEV1 was under 35% of the predicted value (r = -0.88, 0.753 and -0.83, respectively). Correlation decreased or disappeared with less functional impairment. Prediction of VEmax was more reliable with equations that employed FEV1 accompanied by data reflecting degree of insufflation, RV or FRC (VEmax = 45.2 +/- 8.98 x FEV1 - 5.07 x RV; r2 = 0.72) than with equations based on FEV1 alone (VEmax = 14.79 + 15.03 x FEV1; r2 = 0.56). We therefore conclude that ventilatory limitation during exercise in patients with COPD is better defined by considering parameters related to lung insufflation along with those reflecting degree of expiratory obstruction, given that the former affect the greater or lesser efficacy of muscles under stress.(ABSTRACT TRUNCATED AT 250 WORDS)

[Inflammation mediators (eosinophilic cationic protein, ECP) in a normal population and in patients with bronchial asthma or allergic rhinitis]. / Mediadores de la inflamación (proteína catiónica del eosinófilo, ECP) en población normal y pacientes con asma bronquial o rinitis alérgica.

We analyzed serum levels of eosinophilic cationic protein (ECP), one of the 4 main eosinophilic proteins; ECP is released from an activated cell and acts as a mediator of inflammation. Serum samples from 139 persons were studied prospectively. Fifty-three individuals from the general population provided the control group. Eighty-six consecutive patients were also studied: 69 with bronchial asthma and 17 with allergic rhinitis and no signs of asthma. The level of severity of disease was established in the asthmatics by the method proposed by Aas (Aas score), based on symptoms and medications received within the last year. We also classified these patients as having mild, moderate or severe asthma according to the latest criteria issued by the International Consensus for Diagnosis and Treatment of Asthma. Atopic status was estimated by skin Prick tests. ECP levels in the control group (9.34 +/- 5.76 micrograms/l) were significantly lower (p < 0.001) than those of the total population of patients (17.59 +/- 16.85 micrograms/l). The mean for patients with rhinitis was 14.76 +/- 10.94 micrograms/l, whereas it was 18.29 +/- 18 micrograms/l in the asthmatics; the levels for both groups were statistically different from that of the control group (p < 0.03 and p < 0.001, respectively). Levels by degrees of severity established at the time of revision and by sensitivity to allergens were also significantly different from the level of the control group, although the mean levels were low in the group of severely affected patients who had received treatment with inhaled corticoids.(ABSTRACT TRUNCATED AT 250 WORDS)

[An analysis of the prevalence of respiratory symptomatology in the general population]. / Análisis de la prevalencia de sintomatología respiratoria en la población general.

This paper is a report of a cross-sectional epidemiological study that formed part of multicenter European project; the aim was to estimate the prevalence of respiratory symptoms and signs related to asthma over a period of 12 months in the city of Seville. A sample of 4,000 persons of both sexes, aged between 20 and 44 years old, was surveyed first by mail questionnaire and later by telephone interview. We analyzed the response index obtained with the mail survey for the epidemiological study of asthma in the area and for the frequency of respiratory symptoms and their distribution by age and sex. The response index was 53.36% and was similar for men and for women. Forty-nine percent reported at least one respiratory symptom, with nocturnal coughing attacks (27.7%) and wheezing (22.2%) being the most frequent. The frequency of these symptoms was different by sex, however, with the former more often reported by women (p < 0.02) and the latter by men (p < 0.001). We found that 14.9% of the population had rhinitis and that women reported this symptom more often (p < 0.02). Symptoms related to asthma were nocturnal attacks of breathlessness, the use of asthma medication and an asthma attack diagnosed by a physician within the last 12 months. With these criteria the estimated prevalence of asthma was 11.72%, a proportion that held steady for all age groups except the middle-aged and for both sexes.(ABSTRACT TRUNCATED AT 250 WORDS)