Epidemiological and sociological aspects of occupational bronchial asthma

Opisani su glavni problemi s kojima se susrećemo u epidemiološkim ispitivanjima profesionalne bronhalne astme, kao sto su nedostatak definicije bolesti, potreba za standardnim upitnikom za simptome bolesti i neujednačenost funkcionalnog ispitivanja pluća, Razmatrani su najčešći upitnici za respiratorne simptome, najpogodniji testovi za ispitivanje ventilacijske funkcije pluća i njihova interpretacija te problem utvrđivanja osoba u kojih je povećana opasnost od pojave profesionalne bronhalne astme.The main problems confronted in epidemiological investigations of occupational bronchial asthma are described, such as the absence of a definition of the disease, the need for a standardized questionnaire for the symptoms of the disease and the heterogeneity of the functional lung tests. The questionnaires most frequently used for respiratory symptoms and the most suitable tests for mea-suring and evaluating ventilatory lung function are discussed. The problem of identifying the persons who are at risk of developing occupational bronchial asthma is also dealt with

Cutaneous reactivity to grass pollen and house dust mite in prick test with two types of allergen extracts

Upotrebljivost domaćih nestandardiziranih pripravaka za prick-test htjela se provjeriti usporedbom s internacionalno priznatim standardiziranim pripravcima aktivnosti 100 000 BU. Komparativna su upotrijebljeni alergeni grinje Dermatophagoides pteronyssinus kod 107 ispitanika te pojedinačni poleni trava, i to: Dactylis glomerata, Poa pratensis, Phleum pratense i Secale cereale kod 39 ispitanika. Klinička značajnost kožne reakcije određena je usporedbom veličine urtike izazvane alergenom s onom izazvanom negativnom kontrolom (puferom) te pozitivnom kontrolom (otopinom histamina koncentracije 1 mg/ml). Utvrđeno je da domaći preparat grinje od 3000 PNU/ml ne daje podjednake kožne reakcije kao standardizirani pripravak te ne daje klinički vjerodostojne rezultate, dok su pripravci polena trave, s izuzetkom trave Poa pratensis, vrlo dobri i usporedivi sa standardnim pripravcima, te se mogu pouzdano upotrebljavati u praksi. Na temelju rezultata ovog istraživanja zaključuje se da treba postrožiti kriterije za ocjenu klinički značajno pozitivne kožne reakcije na alergenske pripravke.The reliability of prick testing with allergen preparations produced in Yugoslavia was assessed by comparison to the internationally accepted ones (Pharmacia Diagnostica) of 100 000 BU activity. The following allergens were used: the mite Dermatophagoides pteronyssinus in 107 subjects, and grass pollens: Dactylis glomerata, Poa pratensis, Pbleum pratense and Secale cereale in 39 subjects. The clinical significance of the response was assessed in relation to the skin reaction to the negative control solution and positive histamine control (in concentration of 1 mg/ml). The results indicate that the allergen extract of Dermatophagoides pteronyssinus (3000 PNU/ml) produced in Yugoslavia does not provoke skin reactions comparable to those provoked by the standardized extract of 100 000 BU in contrast to the grass pollen allergens, with the exception of Poa pratensis, which evokes equivalent skin reactions. Thus grass pollen allergens are reliable extracts and can be applied with good confidence in routine work. The need to set more rigorous criteria for assessing skin prick reactions, when domestic, unstandardized products are used, emerged as a result of this study

Respiratory response to physical exercise in patients with chronic bronchitis and bronchial asthma

Respiratorna funkcija prije i poslije testa fizičkim opterećenjem analizirana je u 15 bolesnika (7 s kroničnim bronhitisom i 8 s bronhalnom astmom), koji su nakon fizičkog opterećenja pokazali porast bronhalne rezistencije 50% i više u odnosu na kontrolnu vrijednost prije opterećenja. Test fizičkim opterećenjem izveden je na pokretnom sagu s opterećenjem od 50 do 120 Watta. Bronhalna rezistencija (Raw), specifična bronhalna provodljivost (SGaw), maksimalni ekspiratorni volumen u prvoj sekundi (FEV1) i maksimalni ekspiratorni protok kod izdahnutih 50% vitalnog kapaciteta (FEF50) izmjereni su prije te 5 i 20 minuta nakon opterećenja. Parcijalni tlak kisika u arterijskoj krvi (PaO2) izmjeren je prije i odmah nakon testa fizičkim opterećenjem. Bolesnici oboljeli od kroničnog bronhitisa pokazali su nakon opterećenja prosječni porast Raw (5 min: + 127%, 20 min: + 96%) i prosječni pad FEF50 (5 min:-12%; 20 min: -10%). Bolesnici oboljeli od bronhalne astme pokazali su nakon opterećenja prosječni porast Raw (5 min: + 147%; 20 min: + 105%) i prosječni pad FEF50 (5 min: -24%; 20 min: -21%). Rezultati pokazuju da je kod oboljelih od bronhalne astme došlo do statistički značajnog pada FEF50 5 i 20 minuta nakon testa fizičkim opterećenjem, dok kod oboljelih od kroničnog bronhitisa to nije utvrđeno. Kod oboljelih od kroničnog bronhitisa statistički je značajan porast Raw i 20 minuta nakon opterećenja, dok kod oboljelih od bronhalne astme porast Raw 20 minuta nakon opterećenja više nije statistički značajan, upućujući na bolju spontanu reverzibilnost Raw kod astmatičara. PaO2 se nije statistički značajno promijenio nakon fizičkog opterećenja u oboljelih od bronhalne astme, dok je kod oboljelih od kroničnog bronhitisa došlo do značajnog prosječnog porasta PaO2 (P < 0,01).Respiratory function before and after exercise was analysed in 15 patients (seven with chronic bronchitis and eight with bronchial asthma). The patients were selected on the basis of increase in airway resistance (Raw) of 50% or more after exercise. The patients were tested on a treadmill under a load ranging from 50 to 120 W. Airway resistance, specific airway conductance (SGaw), one-second forced expiratory volume (FEV1) and maximum expiratory flow rate at 50% vital capacity (FEF50) were measured before and again at 5 and 20 minutes after exercise. Arterial partial oxygen pressure (Pa02) was measured before exercise and immediately after it. The patients with chronic bronchitis demonstrated an average increase in Raw after exercise (5 min: + 127%: 20 min: + 96%) and an average decrease in FEF50 (5 min: -12%, 20 min.: -10%). Patients with bronchial asthma demonstrated after exercise an average increase in Raw (5 min: + 147%, 20 min: + 105%) and an average decrease in FEF50 (5 min: - 24%, 20 min: - 21%). The data analysed show a significant decrease in FEF50 5 and 20 minutes after exercise in patients with bronchial asthma, while in patients with chronic bronchitis decrease in FEF50 was not significant. There was a significant increase in Raw as long as 20 minutes after exercise in patients with chronic bronchitis. In patients with bronchial asthma increase in Raw 20 minutes after exercise was not significant indicating better spontaneous reversibility of increased Raw in asthmatics. Pa02 did not show significant changes after exercise in respect to the values before exercise in asthmatic patients. In bronchitic patients there was a significant average increase in Pa02 after exercise (P < 0,01

Disability reassessment in chronic bronchitis and pulmonary functional criteria

U sklopu reevaluacije gubitka radne sposobnosti 579 osoba s glavnom internističkom dijagnozom specifično je obrađeno 88 muškaraca (dob 52,82 g) s dominantnom bolešću - kronični bronhitis te posljedičnim gubitkom radne sposobnosti. Rearbitraža gubitka radne sposobnosti koju je proveo neformalni arbitrarni tim upućuje na nesklad s obzirom na neispravno donijetu odluku o statusu invalidnosti, posebno s aspekta preostale radne sposobnosti. Kronični opstruktivni bronhitis imalo je 68 muškaraca (dob 52,29 g). U uzorku 68 ispitanika izvršena je kompletna funkcijska obrada uključivši plinsku analizu arterijske krvi, neke izvedene pokazatelje i nespecifičnu reaktivnost dišnih putova. Uzorak ispitanika reevaluiran je prema pokazateljima: pravilna ocjena, neispravna ocjena, preostala radna sposobnost, nezavršeno liječenje. Neparametrijska statistička obrada podataka jednosmjernom Kruskal-Walli-sovom analizom rangova atribuira kao specifične prediktore: dob ispitanika, PC20 FEV1, stanje hiperreaktivnosti i stupanj opstrukcije dišnih putova. U radu se obrazlaže važnost funkcijske obrade u mirovanju, a napose značenje varijable FEV1 u ocjeni gubitka radne sposobnosti osoba s kroničnim opstruktivnim bronhitisom.As part of an investigation to reassess disability which was performed in .579 subjects with an internist\u27s diagnosis, disability was reassessed in 68 males with chronic bronchitis as the main diagnosis. Disability reassessment was carried out by an informal team of physicians consisting of pulmologists and members of a second degree disability board. The aim of the study was to define the differences between disability reevaluation and residual working capacity. In chronic bronchitis, a complete functional pulmonary test was carried out including measurement of the degree of obstruction, several specific parameters, non-specific bronchial reactivity and an analysis of arterial blood gases. Disability was reassessed in accordance with the following parameters: accurate evaluation, inaccurate evaluation, residual working capacity, uncompleted treatment. The one-way Kruskal-Wallis rank analysis of non-parametric data attributed the following predictors as specific: age, PC20, FEV1, the condition of hyperreactive airways and the degree of airway obstruction. The relevance of functional criteria arrest, particularly of FEY1, for assessing the loss of working capacity in persons with chronic obstructive bronchitis is emphasized

Allergotoxicology: Research of Pollutant Influence on the Development of Allergic Reactions

Alergotoksikologija je znanstvenoistraživačko područje koje se bavi ispitivanjem utjecaja polutanata (onečišćivača zraka) na nastanak alergijskih reakcija i bolesti. Ispitivanja su prvobitno bila usmjerena na polutante vanjskih prostora, a u novije vrijeme sve više na polutante unutarnjih prostora u kojima ljudi provode većinu vremena. Polutanti po svojoj prirodi mogu biti krute, tekuće ili plinovite čestice, koje se razlikuju s obzirom na veličinu, sastav i izvor iz kojeg nastaju. S obzirom na izvor mogu biti biološkog i nebiološkog podrijetla. Polutanti koji su predmet suvremenih istraživanja s gledišta nastanka alergijskih bolesti su respirabilne krute čestice, ozon, dušični oksidi i bioaerosoli. Mehanizam djelovanja polutanata ovisi o veličini čestica, njihovoj topljivosti i mjestu ulaska u organizam. Dosadašnja ispitivanja su pokazala da različite čestice uvjetuju različite imunosne i neimunosne odgovore u organizmu. Interakcija polutanata i alergena može se zbivati izvan eksponirane osobe, tj. sa samim alergenom ili u eksponiranoj osobi na sluznicama i koži. Polutanti mogu biti nosioci alergena i mogu interferirati na različitim nivoima u nastanku alergijske reakcije. U ovom prikazu razma raju se dosadašnja saznanja o mehanizmima djelovanja polutanata na alergene, na imunosni sustav izloženih osoba na osnovi epidemioloških populacijskih istraživanja, kliničkih studija ekspozcije u kontroliranim uvjetima i eksperimentalnih testnih sistema in vivo i in vitro.Allergotoxicology studies the infl uence of pollutants on the development of allergic reactions and diseases. At the beginning, the research was focused on outdoor air pollutants, while recently it turns to the indoor environment, mainly because people this is where people spend most of their time. Air pollutants may be solid, soluble, or gaseous particles in nature, and they can differ in size, structure, and sources. Pollutants can be of biological or nonbiological origin. Currently interesting air pollutants include particulate matter, ozone, nitrogen oxides, and bioaerosols. The mechanisms of pollutant activity depend on the particle size, solubility, site of deposition, and specifi c chemical properties. Recent studies have shown that different pollutants provoke different immunological and nonimmunological responses in exposed persons. Interaction between air pollutants and allergens can take place outside the exposed person i.e. with allergen itself, or inside the organism on mucous membranes and skin. Pollutants may be the carriers of allergens and may exacerbate allergic reactions and diseases. This review presents recent views about the mechanisms of pollutant activity on allergens and immune system response in exposed persons, based on epidemiological population studies, clinical studies of exposure under controlled conditions, and experimental tests in vitro and in vivo

Hypersensitivity to Pollen of Olea Europea in Patients with Pollen Allergy in Zadar Country, Croatia

Preosjetljivost na pelud masline važan je uzrok peludnih alergija u mediteranskim zemljama. Cilj ovoga rada bio je utvrditi učestalost preosjetljivosti na pelud masline među bolesnicima s peludnom alergijom u Zadru i Zadarskoj županiji. Dobivene rezultate usporedili smo s ranijim ispitivanjem preosjetljivosti na pelud masline u Dalmaciji. Ukupno je obrađen 671 ispitanik s preosjetljivosti na peludne alergene. Od toga broja 61 % ispitanika bilo je muškog spola, a 39 % je bilo ženskog spola. Od ukupno ispitanih 53.5 % činila su djeca u dobi od 4 do 14 godina, a preostalih 46.5 % bili su odrasli u dobi od 15 do 59 godina života. Svim ispitanicima uzeta je detaljna obiteljska i osobna anamneza, napravljen klinički pregled te učinjeno kožno prick-testiranje i enzimatsko-imunološki UniCAP-test za određivanje specifi čnih IgE-protutijela. Statistička obrada podataka učinjena je χ2-testom. Preosjetljivost na pelud masline dokazana je u 8.8 % bolesnika s peludnom alergijom. Najveći broj bolesnika s preosjetljivosti na pelud masline boluje od alergijskog rinitisa, 58 % bolesnika. Postoji statistički značajna razlika u broju bolesnika između dvije ispitivane sredine, gradske i seoske. Samo 3 % bolesnika stanovnici su otoka. Preosjetljivost na pelud masline u našem ispitivanju najniža je u odnosu na ispitivanja provedena u drugim mediteranskim zemljama. Najčešće se očituje kliničkom slikom alergijskog rinitisa, a statistički je značajno češća u gradskoj sredini. Usporedba preosjetljivosti na pelud masline tijekom dvaju ispitivanih razdoblja u našoj zemlji nije pokazala porast broja bolesnika s preosjetljivosti na pelud masline.Olive pollen is one of the most common respiratory allergens in the Mediterranean countries. The aim of this study was to establish the frequency of hypersensitivity to the pollen of Olea europea in pollen allergic patients in the County of Zadar. The study included 671 patients with pollen allergy; 61 % were male and 39 % female. 53.5 % were children aged from 4 to 14 years and 46.5 % adolescents and adults from 15 to 59 years. We took their case history, clinically examined them, and tested using the skin prick test and enzymo-immunologic UniCAP test for specifi c IgE antibodies. For statistical analysis we used the chi-square test. Hypersensitivity to Olea europea pollen was confi rmed in 8.8 % patients with pollen allergy. Among them, the most prevalent symptom was rhinitis (58 %). Most hypersensitive patients were urban residents. Only 3 % patients lived on an island. Judging by available data, our fi ndings show the lowest hypersensitivity to olive pollen in the Mediterranean. A comparison with our two earlier studies did not show any fl uctuation in this kind of hypersensitivity