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BACKGROUND Higher all-cause mortality in asthmatics has been shown previously. Polysensitization is associated with higher morbidity among asthmatic children, and allergic rhinitis and/or allergic conjunctivitis (AR/AC) are associated with higher morbidity in adult asthmatics. Little is known about the effect of AR/AC and other factors on mortality among adult asthmatics. The aim was to study mortality and its risk factors in adults with and without asthma. METHODS We randomly selected 1648 asthmatics with age over 30 years from national registers and matched the asthma sample with one or two controls. Baseline information was obtained by a questionnaire in 1997, and the study population was linked with the death certificate information of Statistics Finland from 1997 to 2013. Overall and cause-specific survival between the groups was compared in several adjusted models. RESULTS During a mean follow-up period of 15.6 years, 221 deaths among 1052 asthma patients and 335 deaths among 1889 nonasthmatics were observed. Cardiovascular diseases were the main cause of death in both groups. Asthma was associated with increased all-cause mortality (adjusted HR 1.25; 95% CI 1.05-1.49, P = .011) as well as mortality from chronic obstructive pulmonary disease (HR 12.0, 4.18-34.2, P < .001) and malignant neoplasms of respiratory organs (HR 2.33, 1.25-4.42, P = .008). Among asthmatics, smoking was associated with increased all-cause mortality, and self-reported AR/AC was associated with decreased mortality. Among nonasthmatics, smoking, and obesity were associated with increased all-cause mortality, whereas female gender showed an association with a decreased risk. CONCLUSIONS Increased mortality among adult asthmatics was largely explained by the development of COPD, malignant respiratory tract neoplasms, and cardiovascular diseases. Smoking cessation is important for reduction in total mortality in both asthmatic and nonasthmatic adults. AR/AC was associated with decreased mortality only in asthmatics. Thus, studies in other populations of larger size are needed to explore further the nature of this association.

Objectives To investigate whether there is an increased risk of cancer associated with lithium treatment in patients with bipolar disorder compared to the general population. Methods A nationwide Swedish register study of incidence rate ratios (IRRs) of total cancer and site-specific cancer in the 50–84-year age range was carried out in patients with bipolar disorder (n = 5,442) with and without lithium treatment from July 2005 to December 2009 compared to the general population using linked information from The Swedish Cancer Register, The National Patient Register, and The Drug Prescription Register. Results The overall cancer risk was not increased in patients with bipolar disorder. There was no difference in risk of unspecified cancer, neither in patients with lithium treatment compared to the general population [IRR = 1.04, 95% confidence interval (CI): 0.89–1.23] nor in patients with bipolar disorder without lithium treatment compared to the general population (IRR = 1.03, 95% CI: 0.89–1.19). The cancer risk was significantly increased in patients with bipolar disorder without lithium treatment in the digestive organs (IRR = 1.47, 95% CI: 1.12–1.93), in the respiratory system and intrathoracic organs (IRR = 1.72, 95% CI: 1.11–2.66), and in the endocrine glands and related structures (IRR = 2.60, 95% CI: 1.24–5.47), but in patients with bipolar disorder with lithium treatment, there was no significantly increased cancer risk compared to the general population. Conclusions Bipolar disorder was not associated with increased cancer incidence and neither was lithium treatment in these patients. Specifically, there was an increased risk of respiratory, gastrointestinal, and endocrine cancer in patients with bipolar disorder without lithium treatment.

The spectrum of pulmonary pathology in the Middle East is as versatile as its civilizations and cultures. In this review, we outline the key challenges confronting pulmonologists in the Middle East. We shed light on the diverse conditions commonly encountered in the region, from the centuries-old illnesses of tuberculosis, to contemporary problems such as lung complications from chemical warfare. We specifically highlighted unique aspects related to respiratory illnesses in the Middle East, for example, climate factors in the desert region, cultural habits, for example, water-pipe smoking and disorders unique to the region, such as Behcet's disease. Pulmonologists are also faced with the consequences of modernization, including large immigrant population and associated social and health issues, rising incidence of obesity and sleep apnoea, and drug-resistant tuberculosis. Tackling these health issues will require an integrated approach involving public health, primary care as well as specialist pulmonology input, taking into consideration the unique cultural and environmental factors to ensure effective management and compliance to medical care.

BACKGROUND. Incense use is an integral part of daily life in large parts of Asia. The burning of incense is a powerful producer of particulate matter and the smoke contains a multitude of well-characterized carcinogens. However, to the authors' knowledge, no convincing association has been reported between exposure to incense smoke and the development of cancer. Therefore, the relation between incense use and the risk of respiratory tract carcinomas was analyzed in a prospective cohort study. METHODS. Between 1993 and 1998, a population-based cohort of 61,320 Singapore Chinese who were free of cancer and ages 45 to 74 years completed a comprehensive interview regarding living conditions and dietary and lifestyle factors. Through linkage to population-based registries, the cohort was followed through 2005 and cancer occurrence determined. The relative risk for these cancers associated with incense use was estimated using a Cox proportional hazards model. RESULTS. A total of 325 upper respiratory tract (UPT) carcinomas and 821 lung carcinomas were observed during follow-up. Incense use was associated with a significantly increased risk of UPT carcinomas other than nasopharyngeal, whereas no overall effect was observed on lung cancer. The duration and intensity of incense use were associated with an increased risk of squamous cell carcinomas in the entire respiratory tract (P for trend = .004), whereas there was no significant association noted between incense use and nonsquamous cell carcinomas. The relative risk of squamous cell carcinomas among long-term incense users was 1.8 (95% confidence interval [95% CI], 1.2-2.6; P = .004) in the entire respiratory tract. CONCLUSIONS. The results of the current study indicate that long-term use of incense is associated with an increased risk of squamous cell carcinoma of the respiratory tract. Cancer 2008. © 2008 American Cancer Society.

The authors considered the incidence of second neoplasms among 1,672 oesophageal cancers diagnosed between 1974 and 2004 in the Cancer Registries of the Swiss Cantons of Vaud and Neuchâtel, and followed-up to 2004. A total of 141 second neoplasms were observed versus 38.5 expected, corresponding to a standardized incidence ratio (SIR) of 3.7 (95% confidence interval: 3.1–4.3). The SIRs were statistically significant for cancers of the oral cavity and pharynx (57.3), larynx (24.3), lung (6.6) and intestines (2.6). The SIRs were higher in subjects diagnosed below age 50 and in the first year after diagnosis. The SIR of upper digestive and respiratory tract neoplasms was higher for oesophageal cancers diagnosed in the upper (87.5) and middle (68.1), as compared with the lower third (19.4). There was no rise of second oral, pharyngeal and laryngeal cancer with advancing age, and their incidence tended indeed to decline from 100/1,000 at age 40–49 to 25/1,000 at age 70–79. There was no tendency to rise with age in the incidence of first oesophageal cancer in subjects who subsequently developed another upper digestive or respiratory tract neoplasm. The excess risks of upper digestive and respiratory tract neoplasms are attributable to increased diagnosis and registration of second neoplasms following a diagnosis of oesophageal cancer, as well as to heavy tobacco and alcohol consumption in oesophageal cancer cases. The absence of rise in incidence with age is also compatible with the existence of a subset of the population of susceptible individuals. © 2007 Wiley-Liss, Inc.

Recurrent respiratory papillomatosis (RRP) primarily is a disease of children and adolescents. Most patients experience spontaneous regression at a later age, while others continue to be affected throughout their lives. Here, we present the case of a 26-yr-old man who presented with persistent cough, worsening dyspnea, and development of pneumothorax. Eight years prior, he had presented with similar complaints and an evaluation at that time had showed RRP. Follow-up since that time showed recurrent disease managed by multiple surgical procedures. At the most current admission, an ultrasound-guided fine-needle aspiration (FNA) of the lung showed numerous papillary tissue fragments and single atypical squamous cells consistent with recurrent RPR. To our knowledge, morphological findings of RRP have been reported rarely.

Wood dust has been classified as a human carcinogen by the International Agency for Research on Cancer with a footnote that the evaluation was based on a marked excess of sino-nasal cancer among workers exposed primarily to hardwood dusts. Because the epidemiologic data on the carcinogenic effects of softwoods are weaker than for hardwoods, standard setting for softwood dust presents a greater dilemma. Unfortunately, the studies of wood dust and cancer do not have the quantitative exposure data necessary for standard setting for either hardwoods or softwoods. Asthma, non-asthmatic airflow obstruction, and both upper and lower respiratory symptoms have been associated with exposure to both 'allergenic' and 'non-allergenic' softwood dusts, and an association with increasing intensity of exposure has been observed in multiple studies. The available evidence seems to indicate that to prevent these nonmalignant effects, the level of exposure to all softwood dust should be at least as low 2 mg/m3. A standard of 1 mg/m3 may be more appropriate to provide a safety margin to protect more sensitive workers. It may be that some of the health effects observed are due to the natural components of wood, such as resin acids or monoterpenes, or to molds.

Smoking is the major cause of upper aerodigestive tract cancers. Among the many constituents of tobacco smoke, polynuclear aromatic hydrocarbons and tobacco-specific nitrosamines are strongly implicated as causative factors for these cancers. The probability that these compounds will induce cancer in a given individual will depend on that person's ability to metabolically activate or detoxify them. Chronic production of DNA damage by these metabolically activated carcinogens is consistent with current concepts of carcinogenesis in which multiple genetic changes, such as activation of oncogenes or inactivation of tumor suppressor genes, appear to be critical. Chemopreventive agents which decrease the level of DNA damage should therefore decrease the risk for cancer. Biomarkers such as carcinogen-DNA adducts, carcinogen-hemoglobin adducts, and urinary metabolites of carcinogens will indicate the amount of metabolically activated carcinogen which may damage DNA in an individual and can therefore be used as an index of risk. Selected biomarkers are discussed in this paper. These biomarkers of internal dose have great potential for application in chemoprevention trials.

A cohort of 1075 men who completed their working lifetimes with an asbestos company, worked at a facility in the United States, and retired with a company pension during the period 1941--67 was updated for deaths through 1973. The average length of employment was 25 years, and all had been exposed to asbestos dust. Respiratory cancer and pneumoconiosis-pulmonary fibrosis mortalities were examined in relation to cumulative dust exposure and to other factors after taking into account cumulative dust exposure. Men who worked in the production of asbestos cement pipe exhibited a higher risk of respiratory cancer, as did men with some crocidolite asbestos exposure. Because these two groups overlap, we could not be certain that crocidolite asbestos was responsible for the increased risk. Men working in general plant maintenance displayed a striking lack of deaths due to pneumoconiosis-pulmonary fibrosis, as compared with production workers and with maintenance personnel assigned to specific departments. Five mesothelioma deaths were observed at age 65 and over. Three of these deaths occurred during the period 1970--3.

Alcohol and tobacco appear to act synergistically in the pathogenesis of epithelial cancers of the oropharynx (excluding lip), larynx, and esophagus. For the subsites within the upper aerodigestive tract, over 10,000 deaths in United States men during 1978 may be attributed to tobacco and alcohol consumption. The cancer sites for which tobacco and alcohol are major determinants occur with greater frequency in men, blacks, lower socioeconomic groups, and with increasing urbanization and increasing age (35--70 years). Because primary hepatocellular carcinoma occurs more commonly in patients with cirrhosis, chronic alcohol abuse is an important risk mechanism for carcinoma of the liver parenchyma. Although experimental animal studies have failed to demonstrate whether ethanol can independently initiate tumorigenesis, various alternative or associated biochemical and immunological mechanisms of action have been proposed.

Two women are described in whom adenoid cystic carcinoma of upper respiratory tract origin presented as a large intracranial tumour with involvement of cranial nerves. Smears of the neurosurgical biopsies were distinguished by abundant metachromatic mucin.

In view of the historic importance of smelter workers in the field of occupational medicine, it is surprising that until very recently little data was available on the mortality experience of these workers. The problem in most studies lies in identifying the smelter workers, because smelting, strictly speaking, refers to the melting of ores for the purposes of recovering metals, whereas smelters sometimes perform the operations of roasting, calcining, sintering, converting, and refining. These distinctions are not made in most mortality studies. Most mortality studies of smelter workers conducted to date have shown some excess in lung cancer. For lead, copper, cadmium, and nickel smelters a different etiologic agent has been proposed for each. These different explanations arise partly from different initial perspectives in conducting the studies. In this paper, data are presented on a current historical-prospective study of males who worked a year or more during the period January 1, 1940 to December 31, 1964 at a copper smelter in Tacoma, Washington. This smelter (and refinery) handled a copper ore with a relatively high arsenic content and produced arsenic trioxide as a by-product. Overall 97.2% of the original study population was traced through 1976. Of the 1,061 who were found to have died, death certificates were obtained for 1,018, or 96%. For all causes of death, the mortality rates in this cohort, expressed as a Standardized Mortality Ratio (SMR), were 3.5% higher than that expected based on the United States white male mortality experience. A total of 104 respiratory system cancers were observed compared to 54.6 expected (SMR = 190.5, p less than .05). Respiratory cancer rates were found to be elevated in both smokers and nonsmokers. Overall, a gradual rise in SMR's for respiratory cancer was observed with increasing duration of exposure but not with an increasing interval from onset of exposure. This observation is consistent with the notion that the effects of arsenic on cancer incidence disappear with time. This phenomenon has also been observed for cigarette smokers and chromate workers. Additional analyses are planned for the Tacoma cohort, which will examine mortality according to process as well as by exposure to arsenic and other contaminants. The importance of studies of workers at other kinds of smelters and refineries is stressed.

Patients with carcinoma of the respiratory tract have been demonstrated to have elevated levels of immunoglobulins in the secretions bathing these areas. The clinical significance of this finding has remained unclear. In the present study, IgA and IgG levels were correlated with 5 year survival statistics in 53 patients with oral squamous cell carcinoma. Our findings indicate that there is no correlation between local IgA or IgG level and length of patient survival.