Respiratory symptoms and long-term risk of death from cardiovascular disease, cancer and other causes in Swedish men.
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BACKGROUND: Depressed respiratory function and respiratory symptoms are associated with impaired survival. The present study was undertaken to assess the relation between respiratory symptoms and mortality from cardiovascular causes, cancer and all causes in a large population of middle-aged men. METHODS: Prospective population study of 6442 men aged 51-59 at baseline, free of clinical angina pectoris and prior myocardial infarction. RESULTS: During 16 years there were 1804 deaths (786 from cardiovascular disease, 608 from cancer, 103 from pulmonary disease and 307 from any other cause). Men with effort-related breathlessness had increased risk of dying from all of the examined diseases. After adjustment for age, smoking habit and other risk factors, the relative risk (RR) associated with breathlessness of dying from coronary disease was 1.43 (95% CI : 1.16-1.77), from stroke 1.77 (95% CI: 1.07-2.93), from any cardiovascular disease 1.48 (95% CI : 1.24-1.76), cancer 1.36 (95% CI : 1.11-1.67) and from any cause 1.62 (95% CI: 1.44-1.81). An independent effect of breathlessness on cardiovascular death, cancer death and mortality from all causes was found in life-time non-smokers, and also if men with chest pain not considered to be angina were excluded. An independent effect was also found if all deaths during the first half of the follow-up were excluded. Men with cough and phlegm, without breathlessness, also had an elevated risk of dying from cardiovascular disease and cancer, but after adjustment for smoking and other risk factors this was no longer significant. However, a slightly elevated independent risk of dying from any cause was found (RR = 1.18 [95% CI: 1.02-1.36]). CONCLUSION: A positive response to a simple question about effort related breathlessness predicted subsequent mortality from several causes during a follow-up period of 16 years, independently of smoking and other risk factors. (+info)
SWORD '97: surveillance of work-related and occupational respiratory disease in the UK.
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SWORD is one of seven clinically based reporting schemes which together now provide almost comprehensive coverage of occupational diseases across the UK. Although SWORD is now in its tenth year, participation rates remain high. Of an estimated 3,903 new cases seen this year, 1,031 (26%) were of occupational asthma, 978 (25%) of mesothelioma, 794 (20%) of non-malignant pleural disease, 336 (9%) of pneumoconiosis and 233 (6%) of inhalation accidents. Incidence rates of occupational asthma were generally highest among workers in the manufacture of wood products, textiles and food (particularly grain products and crustaceans) and additionally, in the production of precious and non-ferrous metals, rubber goods, detergents and perfumes, and in mining. Health care workers were noted to have a surprisingly high incidence of inhalation accidents. Occupational asthma attributed to latex has increased dramatically; the highest rates are among laboratory technicians, shoe workers and health care workers. (+info)
Renal failure predisposes patients to adverse outcome after coronary artery bypass surgery. VA Cooperative Study #5.
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BACKGROUND: More than 600,000 coronary artery bypass graft (CABG) procedures are done annually in the United States. Some data indicate that 10 to 20% of patients who are undergoing a CABG procedure have a serum creatinine of more than 1.5 mg/dl. There are few data on the impact of a mild increase in serum creatinine concentration on CABG outcome. METHODS: We analyzed a Veterans Affairs database obtained prospectively from 1992 through 1996 at 14 of 43 centers performing heart surgery. We compared the outcome after CABG in patients with a baseline serum creatinine of less than 1.5 mg/dl (median 1.1 mg/dl, N = 3271) to patients with a baseline serum creatinine of 1.5 to 3.0 mg/dl (median 1.7, N = 631). RESULTS: Univariate analysis revealed that patients with a serum creatinine of 1.5 to 3.0 mg/dl had a higher 30-day mortality (7% vs. 3%, P < 0.001) requirement for prolonged mechanical ventilation (15% vs. 8%, P = 0.001), stroke (7% vs. 2%, P < 0.001), renal failure requiring dialysis at discharge (3% vs. 1%, P < 0.001), and bleeding complications (8% vs. 3%, P < 0.001) than patients with a baseline serum creatinine of less than 1.5 mg/dl. Multiple logistic regression analyses found that patients with a baseline serum creatinine of less than 1.5 mg/dl had significantly lower (P < 0.02) 30-day mortality and postoperative bleeding and ventilatory complications than patients with a serum creatinine of 1.5 to 3.0 mg/dl when controlling for all other variables. CONCLUSION: These results demonstrate that mild renal failure is an independent risk factor for adverse outcome after CABG. (+info)
Short-term associations between outdoor air pollution and visits to accident and emergency departments in London for respiratory complaints.
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Many epidemiological studies have shown positive short-term associations between health and current levels of outdoor air pollution. The aim of this study was to investigate the association between air pollution and the number of visits to accident and emergency (A&E) departments in London for respiratory complaints. A&E visits include the less severe cases of acute respiratory disease and are unrestricted by bed availability. Daily counts of visits to 12 London A&E departments for asthma, other respiratory complaints, and both combined for a number of age groups were constructed from manual registers of visits for the period 1992-1994. A Poisson regression allowing for seasonal patterns, meteorological conditions and influenza epidemics was used to assess the associations between the number of visits and six pollutants: nitrogen dioxide, ozone, sulphur dioxide, carbon monoxide, and particles measured as black smoke (BS) and particles with a median aerodynamic diameter of <10 microm (PM10). After making an allowance for the multiplicity of tests, there remained strong associations between visits for all respiratory complaints and increases in SO2: a 2.8% (95% confidence interval (CI) 0.7-4.9) increase in the number of visits for a 18 microg x (-3) increase (10th-90th percentile range) and a 3.0% (95% CI 0.8-5.2) increase for a 31 microg x m(-3) increase in PM10. There were also significant associations between visits for asthma and SO2, NO2 and PM10. No significant associations between O3 and any of the respiratory complaints investigated were found. Because of the strong correlation between pollutants, it was difficult to identify a single pollutant responsible for the associations found in the analyses. This study suggests that the levels of air pollution currently experienced in London are linked to short-term increases in the number of people visiting accident and emergency departments with respiratory complaints. (+info)
Fine particulate air pollution, resuspended road dust and respiratory health among symptomatic children.
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The short-term association of particulate air pollution with peak expiratory flow rate (PEF) and respiratory symptoms was examined. Forty-nine children with chronic respiratory symptoms aged 8-13 yrs were followed daily for six weeks in spring, 1995, in Kuopio, Finland. Daily concentrations of particulate material with a 50% cut-off aerodynamic diameter < or = 10 microm and < or = 2.5 microm (PM10 and PM2.5, respectively), black carbon, and the number concentrations of particles from 0.01-10 microm diameter were measured. During the study period, PM10 were mainly resuspended soil and street dust, and the concentration was estimated using aluminum content of PM10 samples. No consistent effect of particles was found as the associations varied by lag. Of the lags examined, only 1-day lagged PM2.5 was statistically significantly associated with morning PEF (beta=-1.06, SE=0.52 (per interquartile increase in pollutant)). Evening PEF was significantly associated with the 1-day lagged number of particles in the size range 0.1-1.0 microm (beta=-1.56, SE=0.72). One-day lagged PM10, PM2.5-10, PM2.5 and resuspended PM10, and 4-day average of PM2.5 were significantly associated with increased risk of cough. Given the short duration of the study, separating the effects of different types of particles was difficult. The present study demonstrates the highly variable size and number distribution and chemical composition of particles in Finland, and underlines the importance of measuring the size and chemical composition of particles to determine which types of particles are associated with health effects. (+info)
Health effects of passive smoking-10: Summary of effects of parental smoking on the respiratory health of children and implications for research.
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BACKGROUND: Two recent reviews have assessed the effect of parental smoking on respiratory disease in children. METHODS: The results of the systematic quantitative review published as a series in Thorax are summarised and brought up to date by considering papers appearing on Embase or Medline up to June 1998. The findings are compared with those of the review published recently by the Californian Environmental Protection Agency (EPA). Areas requiring further research are identified. RESULTS: Overall there is a very consistent picture with odds ratios for respiratory illnesses and symptoms and middle ear disease of between 1.2 and 1.6 for either parent smoking, the odds usually being higher in pre-school than in school aged children. For sudden infant death syndrome the odds ratio for maternal smoking is about 2. Significant effects from paternal smoking suggest a role for postnatal exposure to environmental tobacco smoke. Recent publications do not lead us to alter the conclusions of our earlier reviews. While essentially narrative rather than systematic and quantitative, the findings of the Californian EPA review are broadly similar. In addition they have reviewed studies of the effects of environmental tobacco smoke on children with cystic fibrosis and conclude from the limited evidence that there is a strong case for a relationship between parental smoking and admissions to hospital. They also review data from adults of the effects of acute exposure to environmental tobacco smoke under laboratory conditions which suggest acute effects on spirometric parameters rather than on bronchial hyperresponsiveness. It seems likely that such effects are also present in children. CONCLUSIONS: Substantial benefits to children would arise if parents stopped smoking after birth, even if the mother smoked during pregnancy. Policies need to be developed which reduce smoking amongst parents and protect infants and young children from exposure to environmental tobacco smoke. The weight of evidence is such that new prevalence studies are no longer justified. What are needed are studies which allow comparison of the effects of critical periods of exposure to cigarette smoke, particularly in utero, early infancy, and later childhood. Where longitudinal studies are carried out they should be analysed to look at the way in which changes in exposure are related to changes in outcome. Better still would be studies demonstrating reversibility of adverse effects, especially in asthmatic subjects or children with cystic fibrosis. (+info)
Aspirated foreign bodies in the tracheobronchial tree: report of 250 cases.
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During the last 14 years, 250 patients with aspirated foreign bodies in the tracheobronchial tree were admitted to Kuwait Chest Diseases Hospital. Ninety-six per cent of the cases were under 10 years of age and 38% gave a clear history of foreign body inhalation. The rest were diagnosed either clinically, from the chest radiograph findings or because of unexplained pulmonary symptoms. In 247 cases, bronchoscopy under general anaesthesia was successful in removing the foreign bodies. In only three cases was bronchotomy needed. Seventy per cent of the foreign bodies were melon seeds. Asphyxia and cardiac arrest occurred in four cases during bronchoscopy but the patients were successfully resuscitated. In 10 cases a tracheostomy was done before bronchoscopy and the removal of the foreign body, while in five it was needed after bronchoscopy. Fifteen patients developed late complications such as recurrent pneumonia or atelectasis of the lung. Early diagnosis and adequate treatment are essential to prevent pulmonary and cardiac complications and to avoid radical lung surgery. (+info)
Sarcoidosis of the upper respiratory tract and its association with lupus pernio.
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In a series of 34 patients with sarcoidosis affecting the upper respiratory tract and nose, 26 had lupus pernio (LP) and 17 had sarcoidosis of the upper respiratory tract (SURT). In nine patients these features coexisted. A patient presenting with SURT carried a 50% risk of developing LP although one feature could be present without the other. Both were disorders of women of the child-bearing years of life. SURT, like LP, was an indicator of chronic fibrotic sarcoidosis, developing insidiously and progressing indolently over the years. It was complicated by ulceration, septal perforation, and LP. Three patients had nasal septal perforations, in two instances following submucous resection. This operation is contraindicated in patients with active sarcoidosis, particularly when granulomas are found on nasal biopsy. The Kveim-Siltzbach skin test was positive in all patients with SURT, making it invaluable in the differential diagnosis of granuloma of the nasal cavity. (+info)