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Obstructive airway diseases, i. e., bronchial asthma and COPD, have a prevalence of about 5 % each in our population. 5 to 25 % of the cases are caused by the impact of hazardous substances in workplace atmospheres. Pathophysiologically and according to legal definitions on occupational diseases, allergic disorders (occupational disease no 4301) have to be differentiated from those of chemically irritative genesis (occupational disease no 4302 and predominantly also no 1315) and from afflictions in coal miners induced by inorganic dust (occupational disease no 4111). At present, hard coal mine dust is still the prevailing noxious agent followed by flour/baking additives, fumes occurring during welding, casting and cutting procedures, and isocyanates. In the majority of cases, the prognosis is not good and depends on the duration of exposure to the causative impact. This emphasises the urgency of early diagnosis and targetted individual prevention. The new international labelling of working materials hazardous to health (GHS; EU: CLP) also refers to inhalative noxae. It replaces the hitherto valid R und S notes by hazard statements (H) and precautionary statements (P) as well as by new hazard pictograms., (© Georg Thieme Verlag KG Stuttgart · New York.)

Aim of the Study: In Westelijke Mijnstreek (WM), Midden-Limburg (ML), both The Netherlands, and Kreis Heinsberg (HS), Germany, the relationship between quality of the indoor environment and respiratory symptoms in children was studied, finally resulting in proposals for prevention of respiratory symptoms in the three regions. This paper presents the results of the first part of the study, investigating prevalences of respiratory complaints., Methods and Results: A brief questionnaire was used to document prevalences of respiratory complaints, physicians diagnoses and treatment in about 7,000 children 5-6 resp. 7-8 years of age from HS, ML and WM, in 1995 and 1997. Prevalences of respiratory symptoms differed slightly between the regions, but there were differences in physician-diagnosed asthma and bronchitis and treatment of the children., Perspectives: The brief questionnaire is a useful instrument to get an overview on respiratory symptoms. Since 1995, it is used by several German Municipal Health Services for Public Health Reports.

Different ways to define interaction between exposition factors in epidemiological studies as well as the choice between additive and multiplicative no interaction leads frequently to confusion during data analysis. In their standard form methods of event data analysis such as Poisson or logistic regression assume a multiplicative parameterization of no interaction. However, evidence from empirical investigations as well as causal models of disease etiology, e.g. the simple independent action model of Finney or the sufficient-component-causes model of Rothman, suggest additive or other kinds of non-multiplicative concepts of no interaction. For additive structured data we illustrate the asymptotic bias ("interaction-bias") of main effect estimates which are based on inappropriate data analysis using multiplicative models and omitting significant or non-significant interaction terms. We show that both the epidemiological study design as well as the underlying causal model are determinants of the interaction structure of the data and should be considered in the model selection process. The definition of interaction should distinguish between risk, rate and odds if risks are not very small. Using generalized linear models with parametrical link functions we are able to analyze non-multiplicative interaction structures.

Unlabelled: GOAL OF THE INVESTIGATION: It was investigated (1) whether guidelines for the treatment of bronchial asthma and chronic obstructive pulmonary diseases (chronic obstructive bronchitis and lung emphysema) are distributed in Germany, (2) whether they are accepted by general practitioners and physicians for internal medicine without subspecialty, and (3) how much they are used., Methods: (1) The mostly read medical journals have been screened. (2) 1200 physicians have been questioned with regard to the main criteria of these guidelines. (3) 600 physicians were asked to write a documentation for two patients each with bronchial asthma and chronic obstructive pulmonary disease. 344 of the questionnaires (28.7%) and 544 of the documentations could be analyzed (22.7%)., Results: Guidelines for the treatment of bronchial asthma are published in all leading journals. Substantially less references were found for the therapy of chronic obstructive bronchitis. The main concepts of training, diagnosis of the disease's severity, and physical therapy are all known by the practitioners. The training plays a sufficient role in only half of the questioned physicians. The self-measurement of the patient is not every where accepted. The treatment according to a stage by stage pharmacological therapy cannot be seen in one third of the questioned physicians., Conclusions: Differential diagnosis and therapy are not sufficiently emphasized in the current guidelines. Practitioners should participate in the development of guidelines, to include the aspects of realization.

Public health costs ascribable to air pollution are socialized in our society. To quantify the damage to public health, epidemiologic studies are needed. We present the methods and epidemiologic background data which form the basis for estimating the public health effect ascribable to air pollution. The figures are presented per 1 million "average" Swiss population and per 10 micrograms/m3 increase in long-term annual mean particulate pollution (PM10). Quantification was restricted to the health effects given below (due to lack of complete data for other effects or to avoid duplicating health effects which may be described by overlapping measurements). In parenthesis we present (1) the mean effect estimates (+/-1 SE) (% increase per 10 micrograms/m3 increment in PM10) derived from national and international epidemiologic studies, and (2) the expected absolute additional health effects (+/-1 SE) per 1 million Swiss population and per 10 micrograms/m3 increment in PM10, based on Swiss population statistics: total mortality (long-term estimates from the 2 US cohort studies) (+4.4% [+/-1.1]/349 [+/-91] premature deaths per year); prevalence of chronic bronchitis in adults (+25% [+8.4]/increase in long-term prevalence by 3,513 [+/-1.475]); bronchitis among children (35% [+/-13]/5,180 [+/-2,590] additional children sufferers in a year); repeated cough among children (+54% [+/-8.8]/23,490 [+/-5,873] additional children per year); cough/phlegm in adults (+12.8% [+/-7.8]/1.56 [+/-1.08] million person-days per year); hospital admissions for respiratory diseases (+1.47% [+/-0.5]/71 [+/-24] additional admissions or 1,104 (+/-390) hospital days); admissions for cardiovascular diseases (+0.9% [+/-0.25]/70 [+19] admissions; 970 (+/-270) hospital days); restricted activity days (+10.5% [+/-0.77]/0.42 [+/-0.03] million person-days); days with asthma attacks among the 6.7% asthmatics (Swiss prevalence) (+5.3% [+/-2.1]/ 240,000 [+/-102,000] additional person-days). Conservative assumptions were used throughout the study and thus the true effects are likely to be larger. Estimates of Swiss population exposure distribution would be needed to apply these results to the entire population. This step, and monetary quantification of these total effects, were the second and third elements (not shown in this report) of this Swiss government funded project. Although individual relative risks of air pollution are rather slight, the public health burden of even moderate pollution may be substantial.

Data concerning the occurrence of chronic-obstructive pulmonary disease (COPD) in patients with obstructive sleep apnea syndrome (OSAS) vary between 11 and 20% due to the underlying definition of COPD. We investigated the frequency of COPD in 202 patients with OSAS. The obstructive pattern was defined by bodyplethysmography (Rt > 0.35 kPa x 1(-1) x s(-1)), flow-volume-curve (MEF50 < 50% pred.), Tiffeneau-index (FEV1/IVC < 70% pred.) and anamnesis (cough and/or sputum). Prevalence of COPD in our 202 patients with OSAS was 16.3%. Patients with OSAS and COPD had a higher body-mass-index (BMI), lower PaO2 and spent more time in an oxygen saturation < or = 90% in relation to total recording time (t90). Polysomnographically there was no difference between the two groups with regard to the ventilatory parameters apnea-index (AI) and apnea-hypopnea-index (AHI). As there is a high risk of developing hypercapnia, pulmonary arterial hypertension and cor pulmonale in patients with OSAS and COPD there is need for early diagnosis of the combination of both diseases.

The harmful effects of passive smoking (PSE) start early in intrauterine life and comprise direct toxic effects of components of tobaccos smoke on the fetus as well as indirect effects by impeding the normal nutrition of the growing child over effects on the placenta. Consequences are diminished birthweight, and increased perinatal mortality. The sudden infant death syndrome is associated with PSE as are increased incidence of respiratory illnesses in early childhood. Increased bronchial responsiveness, increased asthma prevalence, delayed lung growth and increased incidence of chronic respiratory symptoms later in childhood may well put these children at increased risk for developing chronic obstructive pulmonary disease in their later life.

In the present study the incidence of bronchial asthma, airway complaints, and allergic rhinitis was investigated in a randomized population section including 3000 male and female inhabitants of Vienna (sex ratio 1:1), aged 20-44. Data on complaints in the respiratory tract were obtained from a total of 71% of the study population. Our results suggest that 14.7% of the entire population was suffering from allergic rhinitis (16.4% male versus 13.0% female; p < 0.05). Airway complaints such as wheezing, whistling, and feeling of tightness in the chest, awakening because of shortness of breath or cough were frequently reported, with no major differences between male and female subjects. The overall percentage of study subjects stating that they had suffered from airway complaints in the year before, i.e., the percentage of those giving affirmative answers to one of the questions, was 29%. Bronchial asthma was calculated to be present in 5.1% of the entire population (5.9 male versus 4.4 female). Attacks of asthma were reported by only 2.2% of the subjects, which gives an indication of the discrepancy between identified and unidentified bronchial asthma. Allergic rhinitis is correlated to, and constitutes a risk factor for the occurrence of complaints in the respiratory tract; public health policy should therefore be aimed at the prevention or early treatment of allergic rhinitis, and at reducing the proportion of cases suffering from unidentified bronchial asthma.

A test was carried out in order to determine representative information on CNSRD prevalence in children at the age of 3 to 15 and to check possibilities of registration. A clinical examination was performed at a totality of 122,400 children of a district, a sample test of 2,927 children was carried out. 10% of the children suffer from chronic diseases of the respiratory tract. In 3 to 4% of these children it is required to apply an acute or frequent therapy. The incidence of asthma bronchiale totals 1 to 2%.

On the basis of the statistics provided by health insurance organisations and pension insurance carriers, the incidence, socio-medical significance and cost to the general economy of chronic obstructive airways diseases in the Federal Republic of Germany can be calculated. In 1986, in the Federal Republic of Germany, these disorders (ICD No. 490-496 in the Key to the International Classification of Diseases) resulted in early pensioning in 9,611 cases, 36,752 inpatient curative measures that were carried by the pension insurance scheme, and also 7.8 million lost working days and 1.4 million days of hospitalisation within the area of activity of the general local health insurances. Of the costs thus incurred, 5.3 billion DM can be itemized (outpatient drugs, inpatient curative measures, early pensioning, lost working days, hospital treatment), but the overall costs to the country's economy in 1986 must be estimated at approximately 7-9 billion DM.

During one year investigations were made in the city of Kassel to collect data on respiratory diseases, immission rates and climate. The frequency of disease was registered by doctors and parents. All of them prepared daily lists. Parallel immission and climatic conditions were measured. From this a typical annual variation was found that governed the influence of weather and air pollution in disease. Moreover, through daily interpretation more detailed results the connection between disease rates and air pollution could be found, even throughout the city.

The problems of lung function testing methods in epidemiological studies were assessed in a study population of 853 men aged 40-70. The Helium-rebreathing-method, the X-ray densitometry, the oxygen-method were evaluated for the estimation of the residual volume in epidemiological conditions. The Pneumotest was proved for measurement of unequal ventilation. The necessity of reference values for these methods is discussed.

In 3 districts of the county of Halle and in the cities of Halle and Halle-Neustadt about 18,000 children of different groups of age were examined wether they were suffering from recurrent or chronic nonspecific lung diseases (CNSLD). Among the 18,000 children we found 4.3% with lung diseases. The morbidity rate was the lowest in the city of Halle and in the district of Quedlinburg, while in Bitterfeld, the district with the highest air pollution, about two times more children had fallen ill. In all districts the prevalence of CNSLD in young children was much higher than in elder ones. In the district with the highest air pollution with increasing age of the children the rate of prevalence lowered more slowly than in the other districts.

In 2,091 agricultural workers (animal production, plant production, agrochemistry) the parameters of ventilatory screening FVC and FEV 1.0 were investigated, completed by determination of PaO2 in 1,324 persons with the intention of making evident differences of pulmonary function for diagnosis between these fields of activity. The persons employed in animal production showed more obstructive disturbances of ventilation and highly significantly lower values of PaO2 than the persons in plant production. The regression-coefficient b1 for the decrease of PaO2 in dependence on the duration of activity was more than double as high in animal production than in plant production. The exposure to organic dust (of irritative, allergenic, infectious, toxic action) must be regarded as the essential etiologic factor in animal production.

Applying a broad scale of lung function tests in epidemiological surveys (929 metal workers of a big industrial shop, 211 of them with signs of chronic obstructive lung disease, COLD, and 1,266 pupils of 2 towns with different dust exposition) we found similar multivariate discriminant functions in all age groups between 7 and 79 years of age to differentiate between COLD-population and normal population. Residual volume in % of total capacity (RV/TC) seems to be the most relevant central parameter in all age groups, which should be combined with one of the inhomogeneity parameters of single breath or multi breath distribution tests ( delta F/ delta V or breath of inhomogeneity IHB) in juveniles between 7 to 16 years of age and with closing volume (CV/VC) in adults between 20 to 79 years of age. Conventional ventilation parameters and the arterial oxygen tension don't contribute additional information to multivariate analysis, which isn't already summarized by the parameters RV/TC.

Smoking and professional influence of harmful substances prevail epidemiologically in the etiology of chronic obstructive lung diseases. Often, both factors act additively. Chronic obstructive lung disease of irritative and allergic pathogenesis are steadily increasing in the statistics of GDR. Dust of mineral, animal and vegetable origin are prevailing, however, chemical inhalative damages are gaining increasing significance. The problem of demarcating occupational from nonoccupational influence factors is discussed.

In connection with the chronic bronchitis key program of the German Research Society 1501 workers in a Munich engineering plant with foundry were examined from 1965 to 1970. With increasing exposure to dust at the work place, bronchitic symptoms such as coughing and sputum become significantly more frequent. Obstructive ventilation disturbances do not increase. Heavy smokers show an overwhelmingly greater frequency of bronchitic symptoms than those exposed to excessive dust. The increase in bronchial obstruction in relation to the consumption of tobacco is remarkable. The effect of age seems to be rather less than that of smoking and greater than that of dust.

Lung function measurements in 472 dust-exposed workers have shown, that bronchial obstructions prevail, irrespective of the occurrence and severity of silicosis. Severe obstructions were growing more frequent with increasing duration of exposure. The incidence rate of arterial hypoxia at rest also increased with increasing duration of exposure. Regardless of the duration of exposure to dust there was pulmonary hypertension at rest in about 15 per cent of the patients examined. It is not unlikely that a correlation exists between the duration of exposure and the incidence rate of exercise-induced pulmonary hypertension (in about 40 per cent), in which arterial hypoxia concerning the functional aspect of increasing precapillary resistance (Euler-Liljestrand mechanism) seems to be of paramount significance.

Diseases affecting the respiratory organs are widespread among the population, and are of considerable importance both in the socio-medical area and for the economy. On the basis of the statistics issued by the umbrella organisation of the AOK (general health insurers), it can be seen that, within the inhomogeneous group of diseases of the respiratory organs classified in accordance with the International Classification of Diseases (ICD Code 460-519), within the course of the years 1975 to 1985, a shift can be seen to have occurred with respect to the amount and duration of time off work and hospitalisation. Acute and chronic infections of the upper airways are on the decrease, while chronic obstructive bronchial diseases are becoming more and more important. In the statistics recorded by the Verband Deutscher Rentenversicherungsträger (VDR = Association of German Compensation Carriers), since 1984, there has been a decrease in cases of early retirement due to chronic obstructive bronchial diseases - in 1986, the overall number of new cases of early retirement for health reasons dropped to below 10000 for the first time. In any attempt at calculating the cost to the general economy, reliable figures (VDR sector) must be distinguished from projected figures (AOK sector), since only just on 50 per cent of all persons pursuing an occupation are insured in the General Local Health Insurances (AOK). The greater part of the overall costs incurred by chronic obstructive bronchial diseases, however, is accounted for by the cost of premature retirement (compensation).

A method is presented for extrapolating the hospitalization rates for all Switzerland, using both VESKA diagnostic statistics and hospital administration data. The method is applied to chronic and obstructive lung diseases for the year 1982. A total of 33,430 hospitalizations is estimated with this diagnosis.