Smoking cessation and changes in respiratory symptoms in two populations followed for 13 years

To investigate the relationship between persistence and incidence rates of respiratory symptoms, and the cessation of cigarette smoking, the data from longitudinal studies conducted in Cracow, Poland and Tucson, USA were analysed jointly. Among 1722 subjects smoking at the beginning of the study, 468 had given up smoking at the 13-year follow-up. The persistence and incidence rates of chronic cough, chronic phlegm, wheeze and attacks of breathlessness were reduced by 50% in ex-smokers compared to the subjects continuing to smoke. The beneficial effects of smoking cessation were decreased in subjects smoking more cigarettes per day in the past and starting to smoke at a younger age. The symptoms were less likely if smoking ceased before the onset of any respiratory disease. These results were similar in the Cracow and Tucson populations, confirming the universal nature of the observations.

Relation of peak expiratory flow rates and symptoms to ambient ozone

The temporal association between peak expiratory flow rates (PEFRs) and ambient ozone (O3) was studied in a group of 287 children and 523 nonsmoking adults in Tucson. In children, noon PEFRs were decreased on days when there was a higher O3 concentration; children with physician-confirmed asthma experienced the greatest decrease in noon PEFR. Evening PEFR levels were also significantly related to O3 in children, especially asthmatics. Among adults, evening PEFRs were decreased in asthmatics who spent more time outdoors on days when O3 levels were higher. After we adjusted for covariates, significant effects of interactions of 8-h O3 levels with particulate matter (PM10) and temperature on daily PEFR were found. There was some overnight effect of 8-h O3 on morning PEFRs. In general, the respiratory response to low-level ambient O3 is acute, occurs more in asthmatics, and increases as temperature and PM10 increase.

Changes in chronic respiratory symptoms in two populations of adults studied longitudinally over 13 years

Data from two longitudinal studies conducted in Cracow, Poland, and Tucson, Arizona, USA, were used to evaluate the differences in period prevalence, incidence and remission rates of respiratory symptoms between two populations, as well as to assess the between-cities similarities in the relationships of the symptoms to age and smoking habit. The analysis was based on data from 3,082 adult Cracow residents, interviewed twice 13 yrs apart, and from 1,452 Tucson adults, with mean period between initial and final survey of 12.2 yrs. Log-linear models were used to consider possible interactions of the symptoms, age, smoking, gender and city. The relationship of the symptoms to smoking was similar in both cities, after adjustment for age and gender, with at least doubled incidence rates of most symptoms in continuous smokers compared to lifetime nonsmokers. The between-population differences in the symptoms were related to age, indicating onset of bronchitic symptoms occurring earlier in life in Cracow, and of asthmatic symptoms in Tucson. These differences were due to factors other than tobacco smoking e.g. various types of ambient air pollution.

Changes in chronic respiratory symptoms in two populations of adults studied longitudinally over 13 years

Data from two longitudinal studies conducted in Cracow, Poland, and Tucson, Arizona, USA, were used to evaluate the differences in period prevalence, incidence and remission rates of respiratory symptoms between two populations, as well as to assess the between-cities similarities in the relationships of the symptoms to age and smoking habit. The analysis was based on data from 3,082 adult Cracow residents, interviewed twice 13 yrs apart, and from 1,452 Tucson adults, with mean period between initial and final survey of 12.2 yrs. Log-linear models were used to consider possible interactions of the symptoms, age, smoking, gender and city. The relationship of the symptoms to smoking was similar in both cities, after adjustment for age and gender, with at least doubled incidence rates of most symptoms in continuous smokers compared to lifetime nonsmokers. The between-population differences in the symptoms were related to age, indicating onset of bronchitic symptoms occurring earlier in life in Cracow, and of asthmatic symptoms in Tucson. These differences were due to factors other than tobacco smoking e.g. various types of ambient air pollution.

Multipollutant exposures and health responses to particulate matter

Epidemiological methods provide opportunities to study interactions of pollutants in complex environments. During the study of health and the environment and the evaluation of particulate matter in Tucson, we found that type, location, and temporality of particulate matter exposures were critical with respect to the various interactions that related to health effects. Indoor particulate matter interacted with other components of particulate matter found in tobacco smoke, as evidenced by lung function. The interaction of environmental tobacco smoke with indoor formaldehyde caused various symptoms. Other interactions occurred between indoor and outdoor forms of particulate matter, which caused symptoms in some of the subjects.

[Monitoring of the treatment of endogenous depression with imipramine and amitriptyline (preliminary report)]

Monitored treatment of a depressed phase of unipolar affective disorder was conducted in 11 female patients receiving imipramine and in 12 females taking amitriptyline. Patients were randomly assigned to one of the drug and in 6 patients the drugs were switched because of the lack of response to the first used compound. In the imipramine treated group a satisfactory response after 4 weeks of management (less than 6 points on Hamilton's depression scale) was observed in 6 patients and in amitriptyline treated group in 5 patients. Patients displaying a satisfactory response to amitryptyline had significantly higher--as compared to remaining patients in the group--plasma levels of the drug after two and four weeks of treatment. Such an association was not observed in patients treated wtih imipramine. Severity of depression and motor retardation before the treatment was similar both in patients with satisfactory and with poor response to imipramine as well as to amitriptyline. However the intensity of anxiety symptoms was higher in patients exhibiting poor response to treatment with amitriptyline and imipramine as well.

Respiratory effects of non-tobacco cigarettes: a longitudinal study in general population

Data from four consecutive surveys of Tucson longitudinal study of airways obstructive disease were used to examine the relation of respiratory symptoms and pulmonary function to non-tobacco cigarette smoking. The surveys were conducted over a six-year period and provided data on 1802 subjects 15-60 years of age, with a total of 5659 individual questionnaires. Estimated odds ratio (OR) of current non-tobacco smoking for chronic cough was 1.73, for chronic phlegm: 1.53, and for wheeze: 2.01 (p less than 0.05). These estimates were adjusted for age, tobacco smoking and occurrence of the symptom in preceding survey. The increased risk of the symptoms was related to the habit continued for several years, and there was no immediate remission of the symptoms after quitting smoking. A significant (p less than 0.05) reduction in pulmonary function (FEV1, Vmax50 and their ratios with FVC) was found a year or more after current non-tobacco smoking was reported. Although the average consumption of non-tobacco cigarettes, believed to be marijuana smoking, was less than one per day, significant effects were still detectable in both pulmonary function and respiratory symptoms.

Relationship of respiratory symptoms and pulmonary function to tar, nicotine, and carbon monoxide yield of cigarettes

The data from consecutive surveys of the Tucson Epidemiologic Study (1981-1988) were used to evaluate the relationship in cigarette smokers of respiratory symptoms and pulmonary function to tar, nicotine, and carbon monoxide (CO) yields of the cigarette. There were 690 subjects who reported smoking regularly in at least one survey, over age 15. After adjustment for intensity and duration of smoking and for depth of inhalation, the risk of chronic phlegm, cough, and dyspnea were not related to the tar and nicotine yields. In 414 subjects with pulmonary function tested in at least one of the three surveys the spirometric indices used were significantly related to the daily dose of tar, nicotine, and CO (product of the cigarette yield and daily number of cigarettes smoked). The effects were more pronounced for past than for current doses. However, the differentiation of pulmonary function due to various yields of cigarettes was small in comparison to the difference in pulmonary function between smokers and nonsmokers.

The normal range of diurnal changes in peak expiratory flow rates. Relationship to symptoms and respiratory disease

Measuring peak expiratory flow rates (PEFR) several times a day can provide an objective assessment of functional changes relative to environmental or occupational exposures. This report describes the pattern of diurnal changes in PEFR in a reference population, and defines ranges of "normal" between- and within-day variability. An index of diurnal changes was defined as the ratio between maximal and minimal values, where the maximal value was restricted to PEFR measured at noon or in the evening (N, E) and the minimal value was restricted to the morning or at bedtime (M, B). A ratio greater than normal represented an exaggeration of the normal diurnal pattern in PEFR. Normal limits, based on the ninety-fifth percentile in the reference population, were larger for children (130%) than for adults 15 to 35 yr of age (117%) and those older than 35 yr of age (118%). The meaningfulness of excessive diurnal changes in PEFR was examined by relating this ratio (Max/Min), and a similar measure (the amplitude percent mean) to chronic respiratory symptoms and diseases in 938 adults and children who recorded PEFR values 2 to 4 times per day for as long as 14 days. There was a strong relationship of diurnal changes in PEFR that exceed normal limits with physician-confirmed asthma (relative risk of 2.99 with Max/Min), with exertional dyspnea (Grade 2+), and with more frequent reporting of acute symptoms of wheeze, attacks of wheezing dyspnea, cough, and chest colds. In addition, those exceeding the normal limits had about 2.9 times greater risk of having a FEV1 below 80% of predicted, and nearly 7 times greater risk of being below 70%.(ABSTRACT TRUNCATED AT 250 WORDS)

Exposure assessment approaches to evaluate respiratory health effects of particulate matter and nitrogen dioxide

Several approaches can be taken to estimate or classify total personal exposures to air pollutants. While personal exposure monitoring (PEM) provides the most direct measurements, it is usually not practical for extended time periods or large populations. This paper describes the use of indirect approaches to estimate total personal exposure for NO2 and particulate matter (PM), summarizes the distributions of these estimates, and compares the effectiveness of these estimates with microenvironmental concentrations for evaluating effects on respiratory function and symptoms. Pollutant concentrations were measured at several indoor and outdoor locations for over 400 households participating in an epidemiological study in Tucson, Arizona. Central site monitoring data were significantly correlated with samples collected directly outside homes, but the former usually had higher pollutant concentrations. Integrated indices of daily total personal exposure were calculated using micro-environmental (ME) measurements or estimates and time-budget diary information. Peak expiratory flow rates (PEFR) were measured for up to four times a day during two-week study periods. In thirty children (ages 6-15 years) with current diagnosed asthma, a significant reduction in PEFR was associated with NO2 levels measured outside of their homes. Additional decrements of morning PEFR were found in those children sleeping in bedrooms with higher measured NO2 levels. Morning and noon PEFR decrements were also linked to higher morning NO2 levels that were measured at central monitoring stations. Effects of PM were also found, but were limited to morning PEFR. No effects were found in non-asthmatic children. The relationship of PEFR to the calculated indices of daily average total exposure were weaker than to the microenvironment concentrations. This suggests that diary and ME monitoring data need to yield better time resolution in order to incorporate short-term average exposures to higher concentrations into the exposure indices and into the analysis of within day health responses.

Risk factors of cardiovascular death in diabetic patients

In 1974 a cross-sectional study was conducted on 4591 out-patients (2095 males and 2496 females) aged 18-67 years, with diabetes of 1-10 years duration, and cardiovascular fatalities followed for 10 years. A multiple logistic regression was then performed on total cardiovascular deaths, deaths from ischaemic heart disease, and from stroke on selected baseline variables related to the course and control of diabetes, selected symptoms of macroangiopathy, and other risk factors, separately for insulin-treated and non-insulin-treated patients. Hyperglycaemia, proteinuria, arterial hypertension, various symptoms of ischaemic heart disease, age, and current cigarette smoking were found to be important predictors of cardiovascular mortality, more so in non-insulin-treated than in insulin-treated patients. Proteinuria and arterial hypertension carried a greater risk in females than males, but the opposite was true for the signs and symptoms of ischaemic heart disease. Relative body mass was found to correlate inversely with probability of cardiovascular death among insulin-treated males but not in non-insulin-treated males, whereas duration of diabetes was a significant factor only among non-insulin-treated females.

Relationships between pulmonary function and changes in chronic respiratory symptoms. Comparison of Tucson and Cracow longitudinal studies

Parallel analyses of data from two longitudinal studies, one in Poland and one in the United States, were performed to assess the relationships between pulmonary function and respiratory symptoms. Similar relationships were seen in the both cities using the same methods of analysis. The rate of FEV1 decline and its final level were related to the prior presence of attacks of breathlessness or to a syndrome that also included wheezing and diagnosed asthma. Initial FEV1 level was lower in subjects with dyspnea appearing during the follow-up than in the never-symptom group. These relationships were independent of smoking habits. The consistencies in the parallel analyses strengthen the relationships observed. In Tucson, Ariz, the FEV1 decline in smokers with persistent chronic cough was greater than that due to separate effects of the symptom and smoking. This suggests that chronic cough may be an indicator of an increased effect of tobacco smoke on pulmonary function.

Longitudinal analysis of the effects of acute lower respiratory illnesses on pulmonary function in an adult population

The data from a longitudinal population study in Tucson, Arizona, were used to evaluate the effects of acute lower respiratory illnesses on pulmonary function in subjects over 25 years of age. In five of nine surveys performed during the first 13 years of follow-up (1972-1985), similar questions were asked concerning chest colds occurring in the past few years. There were 1,151 men and 1,473 women who had questionnaire and spirometric data collected in at least one of these surveys. The random effects longitudinal model with first-order autoregressive error structure was used in the analysis of changes in pulmonary function after the acute illness episode, adjusted for the effects of age, height, cigarette smoking, and chronic respiratory diseases. The analyses indicated that pulmonary function is reduced for several years after a single chest cold in men and after multiple chest colds in women. After an episode of pneumonia, pulmonary flow indices were reduced, with lower values sometimes persisting for several years.

The effect of acute broncho-pulmonary infections on the FEV1 change in 13-year follow-up. The Cracow Study

The aim of this study was to assess the effect of acute bronchitis and pneumonia on the FEV1 decline rate in a random sample of Cracow inhabitants followed over a 13-year period. A total of 718 males and 1029 females completed the spirometric testing and interview in 13-year follow-up period. Acute chest diseases diagnosed and treated by doctors and reported by respondents in surveys were the source of data on broncho-pulmonary infections. The rate of FEV1 change, expressed in ml per year was estimated for each person in 13-year follow-up period. Persons who reported recurrent bronchitis and pneumonia had significantly lower initial FEV1 levels than those without infections. The effect was controlled for confounders like age, height, smoking and chronic chest symptoms. The initial low ventilatory function by itself was not a predisposing factor for chest infections, unless they were associated with chronic respiratory symptoms. Lung function in men decreased steeply after pneumonia infection, but the effect appeared to be reversible. This effect was not limited to people with pre-existing chronic respiratory disease. The data indicated that in some subjects who reported new symptoms of dyspnea on effort, the acceleration of FEV1 decline due to pneumonia was greater than in people without the symptoms. This may result from the fact that in lower respiratory infection, bacterial or viral agents can produce serious dysfunction of small airways.

Occupational exposure and incidence of chronic respiratory symptoms among residents of Cracow followed for 13 years

We analyzed the relationship between incidence rates of chronic respiratory symptoms over 13 years and occupational exposure during the first five years of follow-up. The study group contained 1132 males and 1598 females, 19 to 60 years of age, randomly selected from residents of Cracow, Poland. The data was collected in three surveys conducted in 1968, five and 13 years later. Prolonged occupational exposure (i.e. reported in the initial survey and 5 years later) to dusts doubled the odds for the appearance of chronic phlegm and attacks of breathlessness in all men, and of chronic bronchitis in men aged 41 to 50, initially free of the symptom. In women, this exposure doubled the odds for new chronic cough and for chronic bronchitis. Prolonged exposure to chemicals doubled the incidence rates of attacks of breathlessness and dyspnea in all women and of chronic bronchitis in women with the lowest level of education. Prolonged work in variable temperatures doubled the risk of wheeze in women. The effects of discontinuation or start of exposure during the initial 5 years of the study were also seen on the incidence rates of the symptoms but were less pronounced. The detected effects of occupational exposure were not modified by cigarette smoking or living in areas of the city with various levels of air pollution. This longitudinal analysis confirms the results of cross-sectional studies which have indicated deleterious effects of even moderate occupational exposures on respiratory symptoms.

[Mortality risk factors in cardiovascular diseases in patients with diabetes mellitus in Warsaw--a 10-year prospective study]

A prospective study was made in the years 1973 through 1983 on mortality among 4591 patients (2095 men and 2469 women) with usually noninsulin dependent diabetes, of 1-10 years duration. The anamnestic data and examination parameters obtained during a cross-sectional investigation served as the prognostic changeables (risk factors) to assess the mortality due the most frequent circulatory diseases. The applied model of the logistic regression allowed an attempt of the assessment of their independent effect. Analysis regarding the sex and the methods of diabetes treatment was done in four groups of mortality causes classified according to the VIII Revision of the International Classification of Disease. Injuries and Causes of Death: 1. Cardiovascular system diseases. 2. Ischaemic heart diseases. 3. Other diseases of the cardiovascular system. 4. Vascular diseases of the brain. The quantitative and qualitative effect of the arbitrarily chosen factor of death risk was of varying importance and was related to the sex and the methods of the hypoglycemising treatments. The effect of ageing was an independent factor of death risk among all analysed causes of mortality in both sexes independent from the methods of the hypoglycemising treatment with the one exception of women treated with insulin who died of stroke. Generally however, the ageing factor showed a greater prognostic value in patients treated with insulin. Hypertension, especially if marked, showed to have the most prognostic value among the all analysed factors of death-risk especially in patients on oral antidiabetics. The risk in this group was due mainly to the cerebral stroke, to a lesser degree to the "other" diseases of the circulatory system, and to the all diseases of the circulatory system but to the least degree it was related to the ischaemic heart disease, in both sexes. Among insulin treated diabetics the hypertension was a death-risk of most importance in men usually due to the vascular brain disease and other diseases of the cardiovascular system but to a lesser degree to the circulatory diseases, as a whole. In women however the marked hypertension increased the death-risk in patients with coexisting circulatory disease, not a particular one, but as a whole. Albuminuria had a pronounced prognostic value, especially if massive, in both types of diabetes, mainly, however, among women who died of any cardiovascular causes.(ABSTRACT TRUNCATED AT 400 WORDS)

Ventilatory lung function and chronic chest symptoms among the inhabitants of urban areas with various levels of acid aerosols: prospective study in Cracow

The analysis carried out earlier in Cracow showed that the high level of SO2 and particulate matter (PM) alone cannot be responsible for an excess of chronic chest symptoms and faster lung function deterioration in the population at large. To check the hypothesis that acid aerosols present in the urban air may cause substantial damage of the lungs, data from a 13-year follow-up survey of chronic chest diseases in Cracow (1968-1981) have been reanalyzed. In the plan of the analysis, three areas of the city with various levels of sulfate and sulfur transformation ratio (STR) in the urban air have been defined. In each of the defined areas, the prevalence of chronic chest symptoms, as well as lung function decline, have been studied. In total, the lung function study group consisted of 1414 persons (584 males and 830 females). Those men who lived in the area with the higher sulfate and STR had lower FEV1 levels by about 151 mL than did the residents of the other areas, and this was equivalent to the effect of smoking. In females, the pattern was generally the same. In men, the FEV1 decline rate (mL/year) over the 13-year period was significantly faster by about 11 mL/year in the areas with higher and intermediate STR, which was again equivalent to the effect of smoking. It was found that the level of SO2 and PM in the urban air correlated with the symptom prevalence in women; however, it had no clear impact on lung function deterioration.

A study of the self-perception of being overweight in adult inhabitants of Cracow

The self-assessment of body weight (normal vs overweight) reported in an interview in a group of 783 men and 1085 women aged 32-83, was compared with weight and height measurements taken a few days after the interview. Among subjects with body mass indices revealing excess weight (over 27 kg/m2 in men and 45 kg/m in women), 24% of men and 15% of women reported having normal body weight. The proportion of overweight persons unaware of their condition was related to age, smoking habit, education and physical activity. In men with hypertension, the proportion of subjects unaware of being overweight was smaller by 25% compared with others. This was not the case in women. A history of cardiovascular disease, diabetes, dyspnea or poor health status had no effect on the awareness of being overweight.

Are chronic wheezing and asthma-like attacks related to FEV1 decline? The Cracow Study

Analysis is presented of the relationship between decline in ventilatory function and possible symptoms of bronchial hyperreactivity. Data comes from three consecutive surveys within a 13-year follow-up study of a population sample of 1747 persons (718 males and 1029 females) who completed spirometric testing and interviews. Chest symptoms recorded in the two initial surveys were used as baselines for the prognostic study on FEV1 change. To evaluate changes in lung function the FEV1 decline index, expressed as percentage of FEV1 loss during the study period, was calculated. Chronic wheezing and asthma-like attacks were very strongly related to FEV1 baseline level. Multiple linear regression analysis for each separate symptom including age and smoking habits as confounders and showed that the FEV1 decline index was higher and more significant when wheezing and asthma-like attacks or chronic cough were present. When the combination of symptoms were introduced into the regression model, the effect of wheezing became insignificant. Only attacks of shortness of breath in both sexes and chronic cough in women were significantly associated with more rapid FEV1 decline. However, the effect of persistent wheezing in men had a rather substantial impact on FEV1 change. Comparing the effect of the number of cigarettes smoked with the effect of symptoms, one can see that FEV1 decline due to attacks of shortness of breath is comparable to that seen with heavy smoking. There was no strong evidence that the symptoms under study precede the more rapid FEV1 decline.

The relation of respiratory symptoms and ventilatory function to moderate occupational exposure in a general population. Results from the French PAARC study of 16,000 adults

Data from the French PAARC (Pollution Atmosphérique et Affections Respiratoires Chroniques) study were used to assess the effect of a priori moderate occupational exposure to dust, gases or chemical fumes on the prevalence of respiratory symptoms and ventilatory function. In this community-based population, without households 'headed' by manual workers, 34% of the 8692 men and 23% of the 7772 women, 25-59 years of age, ever occupationally active, reported some exposure. The studied relationships were adjusted for age, height, smoking habits, socio-occupational class, education and air pollution by logistic or linear regression methods. For men and women, some 50% increase (p less than 0.01) in chronic cough, chronic bronchitis, dyspnoea grade 2 and wheezing prevalence was observed in the exposed group compared to the never exposed, with the strongest association for wheezing. FEV1 and FEF25-75% were not associated with occupational exposure. Among men, FEV1/FVC and FEF25-75%/FVC were significantly lower (p less than 0.001 and p less than 0.05) among the exposed compared to never exposed, but FVC was significantly greater (p less than 0.05). Among women, occupational exposure was significantly related to a lower FEV1/FVC in the subgroup with a history of asthma or wheezing. Results suggest that occupational exposures of relatively low intensity, encountered in the non-industrial work places may constitute a non-negligible risk for respiratory health.

Hospital use in Poland and the United States

This report presents national statistics on hospital use from the U.S. National Hospital Discharge Survey and the Polish General Hospital Morbidity Study. Comparisons are made of discharge rates, average lengths of stay, rates of patient care days, and fatality rates by sex, age, and diagnostic category. The similarities and differences between the two countries in population characteristics, health status, health services systems, and health care resources are also described.

Factors associated with the change in ventilatory function and the development of chronic obstructive pulmonary disease in a 13-year follow-up of the Cracow Study. Risk of chronic obstructive pulmonary disease

In a longitudinal, epidemiologic study, we investigated the relation of a number of factors to the loss of ventilatory lung function over time and to the incidence of chronic obstructive pulmonary disease (COPD). Data on 759 men and 1,065 women 19 to 70 yr of age examined twice during a 13-yr period were analyzed. The decline rate in FEV1 was related to age and was greater in persons with lower FEV1 values and in taller persons. The clear relation to smoking was confirmed. Occupational exposure to dusts in men and to variable temperatures in women significantly increased the FEV1 decline rate. In men in blood group A, the loss of FEV1 was smaller than in men in the other blood groups. In women who had had 4 or more children, we observed a faster decline in FEV1. In the analysis of COPD incidence, we confirmed that age, baseline FEV1 value, and, in men, smoking habit are the most important predictors of disease. Among women, also, attacks of breathlessness were demonstrated to increase disease risk twofold (p less than 0.10), even after adjustment for other factors in the logistic regression model. We estimated the index of risk for COPD and predicted 63% of male and 67% of female cases in the top 20% of risk distribution.