68 Tubercle and Lung Disease: Supplement 2

years) and 51 healthy people (mean age: 36.4 + 10.7 years). Of patients, investigated with fifteen skin prick tests (SPT), 76 (71.7%) were atopic and among healthy persons 10 (19.6%) were atopic. Of the total 86 atopic persons, 77 (89.5%) had high total serum IgE (> 100 kU/ L) and 48 (55.8%) had Phadiatop positivity. Among the total 71 nonatopic persons, 27 (38%) had high total serum IgE but none had Phadiatop positivity. We found significant relationship between atopy and some symp- toms in patients (presence of seasonal symptoms, attacks of sneezing, symptoms from strong smells and symp- toms when house-cleaning). We conclude that total serum IgE assay (sensitivity = 0.9, specificity = 0.56) and Phadiatop test (sensitivity = 0.56, specificity = i) can be added to the skin prick tests to detect respiratory allergy.

Material and methods: We studied 40 smokers (25 affected by COPD, 15 affected by non-obstructive chronic bronchitis, mean age 45 yrs). In all patients (pts) we performed skin prick tests with common aeroaller- gens, measurement of total and antigen-specific serum IgE, methacholine inhalation test and BAL with total and differential cell counts.

Results and conclusions: BH was related to FEV1 and COPD (FEV1/FVC % < 75), but there was no correla- tion with atopy. The pts affected by COPD had more cells per ml in BAL (100 + 78 × 104 versus 68 + 55 × 104). There was no difference as regards various cellular components. Obstructive pts have more BH and more cells in BAL than non-obstructive pts, but there is no influence due to atopy.

428-PAll ISAAC, Klang Valley, Malaysia

de Bruyne, J.A. University Hospital, Kuala Lumpur, Malaysia

Malaysia is a multiracial country with a population of 17 million people. The major races are the Malays and the Chinese with a minority of Indians and others. The International Study of Asthma and Allergy in Childhood (ISAAC) is being conducted in 6 centres in Malaysia. Preliminary findings from one centre are reported. The standard ISAAC questionnaire was used including the video questionnaire. The language used was the Malaysian language which is understood by the majority of the people but a few questionnaires were in Chinese. More than 3000 children in each age group were sampled randomly in the Klang Valley - an urban population.

The reported incidence of wheeze at any time in the past was much higher in the older, 13-14 year old age group than in the younger, 6-7 year old age group (29% vs 13.5%) whereas the actual diagnosis of asthma was more similar in the two age groups (17.6% vs 12.7%). Exercise-induced wheeze was also much more common in the older age group (16.3% vs 5.4%). The reported incidence of exercise-induced symptoms was nearly the same for the written and video questionnaires for the 13-14 year olds (16.3% and 17.7% respectively).

It will be interesting to note the racial and regional differences in the country when more data is collected.

There was more difficulty with the allergic rhinifis and eczema questionnaires. These diagnoses are rarely made in this country and there are no direct translations of these words.

437-PAll Correlation between bronchial hyperreactivity (BH), atopy, bronchoalveolar lavage (BAL), and their influence on the development of chronic obstructive pulmonary disease (COPD)

Bilancia, R., Margiotta, D., Cantacessi, G., Spampani, E., Roselli, P., Posca, A., Quaranta, A. Dept. of Respiratory Diseases, University of Bari, Italy

Aim of study: Aim of our study was to determine the relationship between BH to methacholine, atopy and cellular components of BAL in smokers and their influ- ence on the development of COPD.

445-PAll Persistent wheezing as an indication for bronchoscopy

Zivkovi~ Z. Children's Hospital for Pulmonary Diseases and Tuberculosis, Belgrade, Yugoslavia

Persistent or recurrent wheezing bronchitis is very fre- quent condition in children with allergic disposition. If an allergic base is not found, there is poor response to bronchodilators, the bronchoscopy is an indication. Bronchoscopy in 10 infants less than 2 years has been performed. The results were: tracheomalacia 3 cases, laryngomalacia 1 case, tracheal stenosis 1 case, bron- chial stenosis 2 cases, supernumerary bronchus 1 case and nonspecific chronic bronchitis 2 cases. It can be concluded that bronchoscopy is of great help in managing and treating persistent wheezing in infancy, especially for long term prognosis of these patients.

475-PAll Risk factors for asthma in Kenya school children

Odhiambo, J., Ng ' ang'a, L., Mungai, M., Gicheha, C., Nyamwaya, J., Mwawasi, G., Becklake, M.R., Menzies, R., Macklem, P.T., Respiratory Disease Research Unit, Kenya Medical Research Institute, Nairobi; McGill University, Montreal, Canada

Rural urban gradients for childhood asthma have been recorded in many countries including Kenya, where a 1993 survey of school children aged 9-11 recorded higher rates in urban vs rural children for shortness of breath with wheeze (SOB/WHZ: 9.5 vs 3.0%) and exer- cise induced bronchospasm (EIB: 22.9 vs 14.7%). In this report, we examine the extent to which these differences are explained by some of the recognized determinants of asthma. Compared to rural children, urban children were on average younger (10.2 vs 11.4 yrs), taller (136.7 vs 136.1 cm), and weighted more (29.4 vs 27.8kg). Fewer were breastfed beyond 6 months (5.4 vs 14.1%); more reported past chest illness (12.2 vs 2.2%) and a history of allergy (3.5 vs 13.5%); fewer were exposed to smoking (ETS: 35.5 vs 55.6%) or animals at home (35.5 vs 74%); fewer were atopic (44.4 vs 56.2%).

The risk factors examined do not appear to account

Abstracts 69

for the rural-urban differences in the markers of asthma examined. These essentially negative findings direct attention to search for other risk factors associated with urban residence, for instance, home construction, urban pollution and diet. (Supported by the KEMRI (Kenya), IDRC (Canada) and the IRDRU/IUAT-LD.)

Acute Resp ira tory Infect ions (ARI)

025-PAll Passive smoking as a determinant of bronchial hyperreactivity in children with respiratory diseases

Dorokhova, N.F., Tatochenko, V.K., Reutova, V.S., Shmakova, S.G. Institute of Pediatrics, RAMS, Moscow, Russia

Passive smoking is known to be one of the gravest risk factors for respiratory health in children. The influence of passive smoking on BHR and bronchial resistance has been the subject of many medical surveys. Most of the papers, however, give no data on healthy children; an increase in BHR and BR indices is more frequently observed in children with respiratory diseases.

During our survey we studied a group of 3500 chil- dren using cross-sectional and longitudinal examination, lung function tests, tests for bronchial reactivity to hista- mine. We investigated interaction between passive smoking and environmental pollution in an industrial town not far from Moscow (in polluted area, clean area, and rural area). The results of our investigation indicate that the prevalence of passive smoking in polluted and rural zones are lower in the "clean" one.

Criteria of various respiratory conditions were simple:

- Frequent ARI-more than 6 episodes per year with- out or only with an occasional bronchitis;

- Recurrent bronchitis-frequent ARI with 2-3 cases of bronchitis per year;

- Wheezing bronchitis.

Conclusion: - Prevalence of all recurrent respiratory conditions

is higher in passive smokers in both polluted and non-polluted areas.

- Passive smoking and air pollution has the most dramatic additive affect on pre-school children with non-wheezy recurrent bronchitis, the addition of each factor increases the prevalence by 5%.

- Both passive smoking and environmental pollution cause similar effect with respect to BR and BHR changes in healthy children, their effects also being additive.

2-4 years old exposed to frequent acute respiratory viral infection.

As a result of the study there have been established that reduction of children's health index is accompanied by increasing connection of vegetative nervous system functional state indices, and also by appearance of low- frequency oscillations (periods of 21 _+ 3 and 30 + 5 days) in the biorhythms' spectrum. There have been indicated correlation dependences between changes in state of base levels of summary CPR, fight-side asym- metry, reduction of cellular immunity tension and phagocytic functions. There have been revealed that beginning of respiratory infection is taking place 4 times more often with acrophases of indicated biologic cycles. These results permit to use chronomedical examination for prognosis of ARVI current in children and for con- ducting opportunity prevention.

141-PAll ARI in Tanzanian children

Egwaga, S.M. Ministry of Health, Dares Salaam, Tanzania

ARI is a public health problem in Tanzania. It is 2nd commonest cause of morbidity and 3rd commonest cause of mortality for under-fives. Data from Ministry of Health from 1984--1993 show that ARI contributes about 17% of all attendances and up to 16% of all deaths. Pneumonia caused by S. pneumoniae (51%) and H. influenzae (24%) is the main cause of death. Usually both are sensitive to penicillin and co-trimoxazole.

A pilot project commissioned in Bagamoyo district between 1983-88 aimed at reducing ARI mortality by increasing accessibility to standard case management at community level. Village health workers were trained using WHO guidelines and were integrated into PHC services. The health workers treated pneumonia with co-trimoxazole and provided health education. Emphasis was on continued breast feeding, increased fluid intake, clearing of blocked airways and watching for danger signs for timely referral.

Evaluation showed that ARI-related mortality for under-fives was reduced from 13/1000 per year to 5.1/ 1000. Misuse of antibiotics was also drastically reduced. Efforts are underway to copy the project in other parts of the country.

321-PAll Community acquired pneumonia in adults: clinical features and outcome in Africa and Europe

Sow, 0., Diallo, A., Soamah, S., Conde, M.K., Frechet, 34., Diot, P., Boissinot, E., Lemarie, E. Services de Pneumologie, CHU de Conakry, R@ublique de Guinge; CHU de Tours, France

045-PAll Infradian oscillations of vegetative nervous system functional state and immune status in children with frequent acute respiratory viral infection

Kochkin, A. V., Hasanova, A. V. The State Institute for Advanced Medical Studies, lrkoutsk, Russia

There has been carried out the 4 months monitoring of cutaneogalvanic palm reaction (CPR) in 46 children

A study was carried out in Conakry, Republic of Guinea, and Tours, France, in order to compare signs, symptoms, severity of illness, risk factors and clinical outcome of community-acquired pneumonia (CAP) in hospitalized adult patients. A severity score was evaluated according to ATS criteria. Follow-up was evaluated at days 2, 7, 15. A total of 333 patients (Conakry: 218; Tours: 115) were included. Mean age was higher and pre-existing