zXovember, 1933] ASTH~a AND PULMONARY" DISEASE 83

T U B E R C L E .

NO VEM BEl t , 1933.

Asthma and Pulmonary Disease.

There is an aphorism attributed to a wise physician of an older generation that " all asthmatics tend to become bronchitic and all bronchitics to become asthmatic." On the broad view that the asthmatic individual labours under the disadvantages of an unstable vegeta- tive nervous system, tile association of asthma ancl other pulmonary diseases is not surprising. Of recent years it has been the habit to attribute nmch in the causation to a protein hypersensi- tivity, but statistics show that at best such a view counts for less than half the eases, and even then it does not really carry us much further in the study of mtiology. There is, indeed, a very definite danger of using the term allergy to cover the unknown immunological factors of a disease without really attempting to explain them.

:Figures published some time ago by t ta rkavy and 51aisel [1] showed that of 409 cases of bronchial as thma 200 were found to be non-sensitive to protein tests, and of this number the underlying cases revealed were sinus disease (the ethmoids and antra being chiefly impli- cated), bronchitis, unresolved pneumonia and bronchiectasis, whilst a comparative study of the pathological changes in fatal cases of bronchial asthma showed that in non-sensitive patients the lesions bore definite resemblances to those shown by the sensitive cases.

Incited by a publication which seemed to show a great tendency of asthmatics to develop pulmonary tuber- culosis, Lorenzen [2] put the question to the test by examining radiologically 170 asthmatic patients. Sixteen per cent. of them were found probably to have lung tuberculosis, while 8 per cent. had apparently non-specific infiltrations: But a similar examination of 170 cases of primary emphysema and brpnchifis gave 14 per cent. tuberculous infiltra- tions and 11 per cent. non-specific ones. These figures do not indicate the patti-

cularly frequent occurrence of pulmon- ary tuberculosis in cases of asthma, nor do they point to an antagonism between the two diseases as has been suggested in some quarters. Only in a few cases was there reason to suppose that the tubercle might possibly h a v e given rise to the asthma. The series gives no support to the possibility that the hereditary influence is less potent in asthmatics who also suffer from tuber- culosis of the lungs.

In a thesis recently published Dr. R. Alduy [3] has approached the subject from a slightly different angle. He re- cords the histories of 93 cases in patients aged from 21 to 61, ill which asthma was associated with more or less old-stand- ing tuberculosis. Tile characteristic features of this tuberculous asthma appeared to be that it was continuous, tenacious, recurrent, refractory to ordinary treatment, and often had a bad effect on the general condition. Radiological examination ill most cases showed the appearances of fibrous sclerosis, definite apical sclerosis, opaque nodules and pleural adhesions. Nothing special was found on examina- tion of the blood beyond the eosino- philia being lower than in other forms of a s t h m a . Cholesterin content of the blood was generally normal. In most cases the asthma is not due to specific intoxication, but is merely asthma oc- curring in a tuberculous subject. The prognosis is grave, as the presence o1~ tuberculosis centre-indicates the use of certain anti .asthmatic drugs and the asthma is refractory to ordinary treat- meat.

Lastly it may be noted that patients seldom die of uncomplicated spasmodic asthma. As Dr. g. B. Christopherson (4) indicated in his Hunteria~l Oration a year ago, the hypothesis of a vago- sympathetic complex in the relationship of asthm~ to other forms of pulmonary disease calls for a comprehensive team research.

REFERENCES. [1]:ttAnKAVV, J., and ~IAIsEL, F. JollrT~.

Amcr. Med. Assoc., 1931, 96, 18t3. [.2] Lonrz.';z~:s,J. N. Acla Tub. Scand., 193~,

6, 64. [3] ALDUX', R. Thdse de 1)arts, 1933, No. 503. [4] CHrCZSTOI'HEaSO.'r J .B . Med. Dress and

Circular~ 193"2, ~Iay 11 and 18.