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OBJECTIVES: This study estimated the burden of disease due to 48 major causes in the Netherlands in 1994 in disability-adjusted life-years (DALYs), using national epidemiologic data and disability weights, and explored associated problems and uncertainties. METHODS: We combined data from Dutch vital statistics, registrations, and surveys with Dutch disability weights to calculate disease-specific health loss in DALYs, which are the sum of years of life lost (YLLs) and years lived with disability (YLDs) weighted for severity. RESULTS: YLLs were primarily lost by cardiovascular diseases and cancers, while YLDs were mostly lost by mental disorders and a range of chronic somatic disorders (such as chronic nonspecific lung disease and diabetes). These 4 diagnostic groups caused approximately equal numbers of DALYs. Sensitivity analysis calls for improving the accuracy of the epidemiologic data in connection with disability weights, especially for mild and frequent diseases. CONCLUSIONS: The DALY approach appeared to be feasible at a national Western European level and produced interpretable results, comparable to results from the Global Burden of Disease Study for the Established Market Economies. Suggestions for improving the methodology and its applicability are presented.

Mortality from chronic nonspecific lung disease reported in the United States and in England and Wales during the period 1968 to 1976 was studied to determine if excessive deaths from this condition were associated with epidemics of influenza. In both countries, peaks of excess mortality of this type did indeed occur during such epidemics; however, these excesses were considerably more marked in the British data where the estimated number of such deaths over the 8-yr period was 15,800 compared with 6,000 for the United States. There was a decreasing secular trend in age-specific death rates for chronic nonspecific lung disease among British males of all ages, whereas only middle-aged males showed such a trend in the United States; older American males were subject to a substantially increasing trend. The respective trends in such mortality observed among males in the 2 countries were also seen among females but were smaller in magnitude.

Summary In patients with chronic nonspecific lung disease (CNSLD), who had precipitins against Haemophilus influenzae (HI), a biphasic bronchial obstructive reaction is described after inhalation of killed HI bacteria. There was an early obstructive reaction, occurring immediately after the inhalation and lasting for 1 hr, followed by a late reaction, which started 5–6 hr after the inhalation and lasted for about 8 hr. The late reaction was accompanied by fever, malaise and leucocytosis. The difference in reaction after HI inhalation in five patients and two controls, and the effect of protection with sodium cromoglycate and prednisolone are discussed.

The prevalence of chronic nonspecific lung disease was studied in four samples of cement workers and in adequate controls. British Medical Research Council’s examination technique was used. Smoking, age, and to some extent socioeconomic factors were taken into account In all samples the prevalence rates of characteristic respiratory symptoms and syndromes were significantly higher in cement workers. The higher prevalence rates were found in workers with longer rather than shorter work experience in cement production. The results suggest that exposure to occupational factors in cement plants may play a role in the occurrence and development of chronic nonspecific lung disease. However, further studies are needed to clarify more precisely the nature of the association observed.

Die Autoren beschreiben eine Methode zur Aufgliederung einer Gruppe von Individuen in zwei Teilgruppen derart, daß je eine Person der einen Teilgruppe mit je einer Person der anderen ein in ihren charakteristischen Kennzeichen möglichst gut übereinstimmendes Paar bildet. Diese Methode wurde bei einer Patientengruppe mit chronischen unspezifischen Lungenerkrankungen angewandt. Die günstigen Ergebnisse dieser Aufteilung zeigten, daß die beschriebene Methode als zufriedenstellend bezeichnet werden kann.

The relationship of the symptoms and signs of chronic nonspecific lung disease and alcohol consumption was studied in a group of 763 male workers aged 20–59, mean age 37 years. The effects of concurrent smoking habit and age were also considered. The results obtained indicate that in addition to being associated with the use of tobacco and age, respiratory symptoms and ventilatory impairment are also related to alcohol consumption. This is particularly true for the syndrome of chronic bronchitis.

Exposure to nitrogen dioxide (NO 2 ) and tobacco smoke in the home was assessed in a population of adult women living in a rural area. The population was a subpopulation participating in a large longitudinal study on the natural history and causes of chronic nonspecific lung disease. Statistically significant negative associations between pulmonary function and exposure to NO 2 in the home were found in nonsmoking but not in smoking women. A negative but generally insignificant association was found between pulmonary function and exposure to tobacco smoke and pulmonary function in nonsmoking women.

The data of long-term follow-up of 130 patients who suffered in childhood with protracted (32) and chronic (98) pneumonia are presented. When examined at the age of 14-30, 23 people were recognized as healthy, in 107 chronic nonspecific lung diseases were revealed, in the formation and course of which viral and bacterial pneumonia transferred in childhood, pathology of pregnancy and childbirth in the mother, tuberculous bronchoadenitis were important; smoking and unfavorable living conditions contributed to the development of severe forms of bronchitis.

To the Editor:— Will we ever agree on a single term to describe the diffuse lung damage associated with cigarette smoking? Here are some terms in current use: Emphysema Chronic emphysema Pulmonary emphysema Destructive emphysema Chronic emphysema and bronchitis Chronic nonspecific lung disease Chronic obstructive lung disease Chronic obstructive airway disease Chronic obstructive pulmonary disease Chronic obstructive ventilatory disease Chronic obstructive bronchopulmonary disease Irreversible general obstructive lung disease Obstructive ventilatory disease of the lung Some authors will use one of these terms for one disease and a second term for another disease. If so, it is difficult to find uniformity among the workers in this field as to where the line is drawn. This disease, whatever we choose to call it, is most certainly important. Let us hope that authors and editors will come to some sort of agreement on naming it. "Emphysema," alone, will certainly not do. There are

Useful epidemiological comparisons may under certain conditions be obtained by using populations attending hospitals. Two examples of such comparisons will be discussed. One of these has been completed; the other is proposed for future consideration. The first comparison arose from the widespread opinion that among patients with chronic nonspecific lung disease, emphysema predominates in the United States while obstructive bronchitis predominates in Great Britain. To study this question 50 men aged 45-64 at a "bronchitis" clinic in London were compared with 50 similar patients at an "emphysema" clinic in Chicago. The men had a one-second forced expiratory volume (FEV1) below 1.5 liters and below 60 per cent of the vital capacity. They had no other complicating diseases and were able to walk 100 yards on the level without stopping. An extension of the Medical Research Council's standardized questionnaire on respiratory symptoms was used for the clinical histories and a brief physical examination was carried out, using a simple standardized recording system. Dr. Benjamin Burrows of Chicago and the author used both forms in consultation on a number of patients in order to assist standardization. Twentyfour-hour sputum specimens were examined for volume and purulence, x-rays were read for evidence of emphysema and chronic inflammatory changes, and a set of standarized pulmonary function tests was carried out, including a simple step test for dyspnea.