Cigarette smokers' profile in Lebanese adults

BACKGROUND

The objective of this study was to describe cigarette smoking prevalence among adults in Lebanon and to evaluate the profile of light cigarette smokers compared to never and heavy smokers.

METHODS

Data were taken from a cross-sectional study carried out from October 2009 to September 2010, using a multistage cluster sampling all over Lebanon. Lebanese residents aged 40 years and above were enrolled in the study with no exclusion criteria. After an oral informed consent, subjects answered a questionnaire, including detailed smoking history and cigarette dependence. SPSS version 17.0 was used for data analysis.

RESULTS

Out of 2201 individuals, 1320 (60.0%) had ever smoked cigarettes, out of whom 10.1% were light cigarette smokers. The adjusted odds ratio estimate of cigarette smoking was 3.08 for males compared to females (P<0.001), 1.13 for lower education (P=0.016), 1.87 and 3.12 for retired and jobless compared to working (P=0.001 and P<0.001) respectively, 1.17 for older age (P<0.001), 1.68 for presence versus absence of a family history of chronic respiratory disease (P<0.001), and 5.27 and 1.99 for presence compared to absence of at least one smoker at home (P<0.001) and at work (P<0.001) respectively.

CONCLUSION

This is the first epidemiological study in Lebanon that determined cigarette smoking prevalence at the national level. In Lebanon, males of the older generation seem to have higher smoking prevalence and dosing.

Waterpipe Smoking and Dependence are Associated with Chronic Obstructive Pulmonary Disease: A Case-Control Study

Introduction:

Waterpipe smoking gained popularity during recent years. Although waterpipe smoking exposes people to the same noxious substances found in cigarettes, popular belief considers it harmless. Our objective was to evaluate the association between waterpipe smoking and dependence, and COPD.

Methods:

We conducted a case-control study in two tertiary care hospitals. Cases were included if diagnosed as COPD by a pulmonologist and confirmed by post-bronchodilator FEV1/FVC<0.7; controls were included if free of any respiratory disease or symptom. After oral consent, a standardized questionnaire was administered and spirometry results were collected.

Results:

211 COPD cases and 527 controls were studied. In previous smokers, any smoking type was associated with COPD. The ORs were 29.0[14.3-58.8] (p<0.001) for previous cigarette smoking, 11.7[4.4-31.2] (p<0.001) for previous waterpipe smoking, and 44.1[16.3-4.4] (p<0.001) for previous mixed smoking. In current smokers, the ORs were 20.5[10.2-41.2] (p<0.001) for cigarette smoking, 1.8[0.5-5.9] (p=0.299) for waterpipe smoking, and 9.4[3.81-23.0] (p<0.001) for mixed smoking. Nevertheless, we found in waterpipe current smokers, an OR=8.9[3.9-20.7] (p<0.001) for the association between dependence evaluated by LWDS-11 scale, and COPD. These results were confirmed by stratified and multivariate analysis, after adjustment for cigarette smoking and confounding variables. A cumulative smoking of one waterpipe per week for 20years (or its equivalent) was predictive of higher risk of COPD.

Discussion:

Whereas evidence showing harmful effects of waterpipe smoking is sparse, this study showed a high OR between the risk of developing COPD and being an ex-smoker of waterpipe, or a current waterpipe dependent individual. Additional studies are necessary to confirm our results.

Exposure to outdoor air pollution and chronic bronchitis in adults: a case-control study

BACKGROUND

Although Lebanon is a highly polluted country, so far no study has specifically been designed to assess the association between outdoor air pollution and chronic bronchitis in this country.

OBJECTIVE

To assess the association between exposure to outdoor air pollution and chronic bronchitis in Lebanon.

METHODS

A pilot case-control study was conducted in two tertiary care hospitals. Cases consisted of patients diagnosed with chronic bronchitis by a pulmonologist and those epidemiologically confirmed. Controls included individuals free of any respiratory signs or symptoms. After obtaining informed consent, a standardized questionnaire was administered.

RESULTS

Bivariate, stratified (over smoking status and gender) and multivariate analyses revealed that passive smoking at home (ORa: 2.56, 95% CI: 1.73-3.80) and at work (ORa: 1.89, 95% CI: 1.13-3.17); older age (ORa: 1.75, 95% CI: 1.55-2.39); lower education (ORa: 1.44, 95% CI: 1.21-1.72); living close to a busy road (ORa: 1.95, 95% CI: 1.31-2.89) and to a local power plant (ORa: 1.62, 95% CI: 1.07-2.45); and heating home by hot air conditioning (ORa: 1.85, 95% CI: 1.00-3.43) were moderately associated with chronic bronchitis; an inverse association was found with heating home electrically (ORa: 0.58, 95% CI: 0.39-0.85). A positive dose-effect relationship was observed in those living close to a busy road and to a local diesel exhaust source.

CONCLUSION

Chronic bronchitis is associated with outdoor air pollution.

Could symptoms and risk factors diagnose COPD? Development of a Diagnosis Score for COPD

Background:

Diagnosing chronic obstructive pulmonary disease (COPD) without spirometry is still a challenge. Our objective in this study was to develop a scale for diagnosis of COPD.

Methods:

Data were taken from a cross-sectional epidemiological study. After reducing chronic respiratory symptoms, a logistic regression was used to select risk factors for and symptoms of COPD. The rounded coefficients generated a Diagnosis Score for COPD (DS-COPD), which was dichotomized and differentiated between COPD and other individuals with respiratory symptoms.

Results:

We constructed a tool for COPD diagnosis with good properties, comprising 12 items. The area under the curve was 0.849; the positive predictive value was 76% if the DS-COPD was >20 and the negative predictive value was 97% if the DS-COPD was <10. A DS-COPD of 10–19 represented a zone mostly suggestive of no COPD (77%). The score was also inversely correlated with forced expiratory volume in 1 second/forced vital capacity.

Conclusion:

In this study, a tool for diagnosis of COPD was constructed with good properties for use in the epidemiological setting, mainly in cases of low or high scoring. It would be of particular interest in the primary care setting, where spirometry may not be available. Prospective studies and application in clinical settings would be necessary to validate this scale further.

Correlates of COPD and chronic bronchitis in nonsmokers: data from a cross-sectional study

Purpose

Our objective was to assess the prevalence of chronic bronchitis and chronic obstructive pulmonary disease (COPD) and their correlates among a Lebanese nonsmoker group.

Material and methods

A cross-sectional study was conducted between October 2009 and September 2010, using a multistage cluster sample throughout Lebanon including Lebanese residents aged 40 years and above with no exclusion criteria. Pre- and postbronchodilator spirometry measurements were performed and carbon monoxide level was measured in exhaled air. COPD was defined and classified according to the Global Initiative for Chronic Obstructive Lung Disease guidelines or according to the lower limit of normal (forced expiratory volume in 1 second/forced vital capacity postbronchodilator < 5th percentile of the healthy population having the same age and sex). Chronic bronchitis was defined by the declaration of morning cough and expectorations for more than 3 months a year over more than 2 years in individuals with normal spirometry.

Results

Out of 2201 individuals, 732 were never-smokers: 25 (3.4%) of them had COPD, and 86 (11.75%) fulfilled the definition of chronic bronchitis. Correlates of COPD included a childhood respiratory disease, house heated by diesel, and older age. On the other hand, correlates of chronic bronchitis included childhood respiratory diseases, living in southern Lebanon versus other regions, heating home by gas, older age, number of smokers at work, and lower height.

Conclusion

A substantial percentage of the nonsmoking population may exhibit chronic bronchitis or COPD. The significant correlates mentioned above should be taken into consideration in order to reduce the risk of developing such chronic and debilitating respiratory diseases.

Lower extremity venous thrombosis in patients younger than 50 years of age

Aim

Lower extremity deep venous thrombosis in the young adult is uncommon and has not been well studied in the literature. The aim of this study is to define risk factors for deep venous thrombosis among patients younger than 50 years of age, to compare them with a control group, and to suggest recommendations for the management and treatment of venous thrombosis in this particular group of patients.

Methods

From January 2003 to January 2011, 66 consecutive Lebanese patients (29 males and 37 females) younger than 50 years, diagnosed in an academic tertiary-care center with lower extremity deep venous thrombosis by color flow duplex scan, were retrospectively reviewed. Their age varied between 21 and 50 years (mean 38.7 years). The control group included 217 patients (86 males and 131 females) older than 50 years (range: 50–96 years; mean 72.9 years).

Results

The most commonly reported risk factors in the younger age group were inherited thrombophilia (46.9% compared with 13.8% in the control group; P < 0.001), pregnancy (18.2% compared with 0.5%; P < 0.001), treatment with estrogen drugs (13.6% compared with 2.3%; P = 0.001), and family history of venous thromboembolism (9.1% compared with 3.8%; P = 0.084).

Conclusion

Inherited thrombophilia is the most commonly observed risk factor among patients younger than 50 years, with a prevalence of three times more than the control group. Young adults should be screened for thrombophilia even in the presence of transient acquired risk factors. Pregnancy and treatment with estrogen drugs essentially when associated with inherited thrombophilia represent a frequent cause of venous thrombosis among young female patients. Inferior vena cava abnormalities should be excluded in young patients with spontaneous proximal venous thrombosis especially when recurrent venous thrombosis or resistance to anticoagulation are observed.

Acquired and genetic risk factors for deep vein thrombosis of lower extremities among Lebanese patients

AIM

Venous thrombosis results from the interaction of environmental and genetic risk factors. These factors vary according to the ethnic and geographic distribution of the populations. The aim of this study is to define the role of acquired and genetic risk factors for venous thrombosis of lower extremities among Lebanese patients assessed in a university hospital and to discuss them according to the international literature.

MATERIAL AND METHODS

From January 2005 to January 2010, 166 patients (72 males and 94 females) were diagnosed with lower extremity deep vein thrombosis. Mean age was 67 years (range: 25 to 96 years).

RESULTS

The most frequently reported acquired risk factors for venous thrombosis in this study were advanced age, obesity, history of venous thromboembolism, immobilization, surgery, varicose veins and malignancy. Screening for prothrombotic genetic abnormalities was requested in patients with conditions highly suggestive of hypercoagulation state such as young patients, patients with spontaneous, recurrent or extensive venous thrombosis, patients with family history, oral contraceptives, air travel and pregnancy. All the 45 patients (27.1%) tested for thrombophilia were positive and were carriers for factors V-Leiden (17.4%), MTHFR C 677 T (16.8%), MTHFR A 1298 C (4.8%), II G 20210 A (1.8%) and V H 1299 R (1.2%) mutation. Twelve patients (7.2%) had increased homocysteine level.

CONCLUSION

Advanced age is the most common risk factor for venous thrombosis in these series. Thrombophilia is the second most frequently observed risk factor and is related to the high prevalence of factor V-Leiden and MTHFR C 677 T mutation among the Lebanese population.

Chronic obstructive pulmonary disease prevalence in Lebanon: a cross-sectional descriptive study

Background

Chronic obstructive pulmonary disease (COPD) continues to increase worldwide. The objective of this study was to determine the prevalence of COPD in Lebanese adults.

Methods

A cross-sectional study was carried out using a multistage cluster sample from all over Lebanon. Residents aged 40 years and over were enrolled. Subjects underwent baseline spirometry and answered a questionnaire. After an albuterol + ipratropium bromide bronchodilator, a posttest was performed.

Results

Of 2201 individuals, only 33.3% had never smoked. The prevalence of COPD by the Global Initiative for Chronic Obstructive Lung Disease definition, was 9.7% (95% confidence interval [CI]: 8.5%–10.9%). According to the 5% lower limit of normal definition of COPD, the prevalence was 12.5% (95% CI: 11.2%–13.9%). A total of 20.2% were already diagnosed by a physician. No differences in symptoms across stages of COPD were found, but there was a significant trend for a higher number of visits to the emergency room and to the doctor (P < 0.001), and a higher number of hospitalizations (P < 0.001). Older individuals had an increased risk of COPD (adjusted odds ratio [OR_a] = 1.05); so did “ever” cigarette smokers (OR_a = 4.88) and water-pipe smokers (OR_a = 2.53).

Conclusion

This is the first epidemiological study in Lebanon that determined COPD prevalence and the link with water-pipe smoking.

Value of venous color flow duplex scan as initial screening test for geriatric inpatients with clinically suspected pulmonary embolism

AIM

The contribution of lower extremity venous duplex scan to the diagnostic strategy for pulmonary embolism has been demonstrated by many authors. However, the positive diagnostic value of this noninvasive test in clinically suspected pulmonary embolism is not very high (10% - 18%). Since thromboembolic risks increase considerably in hospitalized patients with advanced age, this study aims to determine the importance of lower extremity venous color flow duplex scan in this particular subgroup of patients with clinically suspected pulmonary embolism. The effects of clinical presentation and risk factors on the results of duplex scan have been also studied.

METHODS

Between July 2007 and January 2010, 95 consecutive Lebanese geriatric (≥ 60 years of age) inpatients with clinically suspected pulmonary embolism assessed in an academic tertiary-care center for complete lower extremity venous color flow duplex scan were retrospectively reviewed. Age varied between 60 and 96 years (mean, 79.9 years). Forty patients were males and 55 females. Absence of compressibility was the most important criteria for detecting acute venous thrombosis.

RESULTS

Out of 95 patients, 33 patients (34.7%) were diagnosed with recent deep venous thrombosis of lower extremities (14 proximal and 19 distal) using complete venous ultrasound. Nine of these 33 patients (27.2%) had a history of venous thromboembolism and eleven (33.3%) presented with edema of lower extremities. A total of 28 patients (84.8%) with positive duplex scan had associated risk factors for venous thromboembolism.

CONCLUSION

Lower extremity venous color flow duplex scan appears to be a reasonable initial screening test in the diagnostic algorithm of pulmonary embolism in geriatric inpatients with clinically suspected pulmonary embolism. This is particularly true in patients with a history of venous thromboembolism, in patients with a clinical presentation suggesting venous thrombosis, in uremic patients and in patients with altered general and mental status who are not candidates for chest computed tomography.

The AVAIL ME Extension: a multinational Middle Eastern survey of venous thromboembolism risk and prophylaxis

BACKGROUND

Venous thromboembolism (VTE) is a major worldwide problem.

OBJECTIVES

The primary objectives of this survey were to identify patients at risk for VTE, to define the rate of patients receiving appropriate VTE prophylaxis and to examine the frequency of the presence of guidelines and their application.

PATIENTS AND METHODS

Ten countries, 101 hospitals and a total of 4983 patients were included in this multinational cross-sectional survey. Standardized case report forms were filled out by trained individuals on one predefined day. Risks were categorized according to the Caprini Risk Assessment Model. Logistic regressions were carried out to assess factors that determined VTE prophylaxis.

RESULTS

Of 4983 patients, 3368 (68%) and 1615 (32%) were surgical and medical, respectively. Seven hundred and seventy-two (15.5%) were considered to be at low risk, 1001 (20%) at moderate risk, 1289 (26%) at high risk and 1921 (38.5%) at very high risk for VTE. Of 3575 (72%) patients who were eligible to receive VTE prophylaxis, 2747 (77%) received any drug prophylaxis. Among these patients 720/1056 (68%) and 2027/2519 (80%) were medical and surgical patients, respectively. The overall compliance with ACCP guidelines was 38%, being 24% for medical patients and 44% for surgical patients.

CONCLUSIONS

The results of this large multinational survey, although indicating overall improvement in VTE prophylaxis, identify a considerable number of patients who either did not receive any VTE prophylaxis or received it inappropriately. Although more medical patients were at risk for VTE, they were given prophylaxis less frequently than surgical patients. Concordance with VTE prophylaxis guidelines was higher in surgical patients, but overall application of these tools was unacceptably low.

Water-pipe (narguile) smokers in Lebanon: a pilot study

We carried out a comparative study to assess the demographic and social characteristics of water pipe (WP) smokers, the association with cigarette smoking and chronic respiratory diseases and the dependence profile on 4 groups: exclusive WP smokers, exclusive cigarette smokers, mixed smokers and absolute non-smokers. Cigarette smoking was statistically significantly higher in WP smokers than non-WP smokers; 36.5% of exclusive WP smokers smoked > or =7 WPs/week. Chronic respiratory disease and chronic bronchitis were reported more frequently in exclusive WP smokers than absolute non-smokers. WP smoking seems to be as great a risk factor as cigarette smoking for chronic respiratory disease.

Risk factors for asthma and allergic diseases in school children across Lebanon

Introduction:

Childhood asthma is one of important diseases of childhood. There is no known prevalence of asthma and allergic diseases in Lebanon. This study was conducted with a secondary objective of finding the odds of exposure to asthma, allergic rhinitis and eczema potential risk factors in Lebanese children.

Material and methods:

It is a cross-sectional study on children in public and private schools. A sample of 22 schools participated, where standardized written core questionnaires were distributed. 5–12 year old students completed the questionnaires at home, while 13–14 year old students filled it in class.

Results:

5522 children were evaluated for asthma, allergic rhinitis and atopic eczema prevalence and their associated factors. These diseases seem to be similarly affected by parental respiratory problems, parental smoking, infancy gastroesophageal reflux, recurrent otitis, and previous pertussis. Humidity on the bedroom walls is associated with both asthma and allergic rhinitis, a spongy pillow with both allergic rhinitis and eczema, animal possession with asthma, and noncotton mattress with atopic eczema. The adjusted odds ratios for significant associations varied between 1.25 and 3 (0.0001 < p-value < 0.01).

Conclusion:

These factors are preventable, thus permitting a possible reduction of the prevalence of these diseases.

Waterpipe smoking: construction and validation of the Lebanon Waterpipe Dependence Scale (LWDS-11)

Waterpipe smoking is becoming fashionable in Lebanon, but no studies have studied nicotine dependence related to waterpipe smoking. A score was constructed from 21 items and subsequently submitted to two factor analyses, which led to the extraction of four factors. Reliability and test-retest reproducibility were measured. Convergent construct validity and discriminant validity also were assessed for different smokers' samples. The Lebanon Waterpipe Dependence Scale-11 (LWDS-11) was composed of four subscales, the first representing nicotine dependence, the second negative reinforcement, the third psychological craving, and the fourth positive reinforcement. Internal consistency and test-retest reproducibility were adequate, and the subscales correlated adequately with measurements of nicotine metabolites, exhaled carbon monoxide levels, and the frequency of waterpipe smoking. The LWDS-11 discriminated between mild, moderate, and heavy waterpipe smokers, based on a threshold score of 10. Results were biologically and psychologically sound. This is the first scale to characterize waterpipe dependence. With further improvement and confirmation, it could become a useful clinical and epidemiological tool.

Asthma, allergic rhinitis and eczema in 5-12-year-old school children across Lebanon

OBJECTIVES

To determine the prevalence of asthma, allergic rhinitis and eczema in Lebanese children.

STUDY DESIGN

Descriptive cross-sectional study on children in public and private schools in Lebanon.

METHODS

Standardized written questionnaires were distributed to 5-12-year-old students at 22 schools.

RESULTS

In total, 3909 individuals were analysed. The prevalence of diagnosed asthma (4.8%) was low, while the prevalence of allergic rhinitis was 21.2% and that of eczema was 11.8%. Marked variations and differences were found across the governates in Lebanon, with the lowest prevalence of diagnosed asthma (1.8%) in Bekaa and the highest prevalence in Beirut (11.6%).

CONCLUSION

Asthma symptoms, rhinitis and eczema have medium prevalence in Lebanon compared with worldwide data. Compared with other countries in the Eastern Mediterranean Region, the prevalence of 12 months of wheezing, night cough and wheezing on exercise were highest in Lebanon, but were much lower compared with English-speaking countries. Further studies are needed to understand the environmental, climatic and socio-economic causes of these discrepancies.

Saliva cotinine and exhaled carbon monoxide levels in natural environment waterpipe smokers

The purpose of this study is to evaluate the variations in exhaled CO and saliva cotinine in natural environment waterpipe smokers and compare them with cigarette smokers and absolute nonsmokers. Three groups were included in the study: nonsmokers (n = 20), waterpipe smokers (n = 15), and cigarette smokers (n = 20). A questionnaire was completed for each participant, exhaled CO was measured before and after waterpipe or cigarette smoking, and saliva cotinine was measured immediately after. We excluded from our study mixed smokers of both waterpipe and cigarettes. Mean values of saliva cotinine in waterpipe and cigarette smokers were very close: 77.8 ng/ml (SD = 110.4) and 87.1 (SD = 82.7) respectively. The weight and height of the persons as well as the size of the waterpipe bottle affected saliva cotinine. However, in waterpipe smokers, CO increased by 300% after 1 h of smoking, while in cigarette smokers, it only increased by 60%. In nonsmokers, exhaled CO was similar to environmental CO (10.2 ppm). The results of our study confirm that waterpipe device water does not filter nicotine and that the smoker him- or herself, by the frequency and the depth of inhalation, controls smoke inhalation. Like cigarette smokers, waterpipe smokers are exposed to harmful substances, such as CO, which was found to be quite high. The levels of expired CO and salivary cotinine could be good tools to detect exposure to waterpipe smoking.

Symptoms, severity and asthma control in 5-14 y-old Lebanon school children

BACKGROUND

This study addressed symptoms' profile, severity and determinants of asthma control in school-aged patients (5-14 y) across Lebanon.

METHODS

It is a cross-sectional study, applied on school children with physician-diagnosed asthma (PDA), divided into two groups: those who were on controllers (C+) and those who were not (NC).

RESULTS

Out of 5544 children, 275 (4.96%) had PDA. The C+ group (32.7%) had higher mother's education than the NC group (45.9%) (p = 0.037). NC children were more frequently found in public versus private schools (p = 0.0001). Higher frequencies of regular visits to the doctor were noted in the C+ compared to NC group. In C+ group, 90% were on reliever and controller, and 10% just on one controller. A trend for more severity in the C+ group was noted compared to the NC group. An impact of asthma on daily activities was reported by 40% in the C+ group versus 34% in the NC group.

CONCLUSION

Treatment of PDA in 5-14 y school children was quite adapted according to the recommendations. However, total control was reported in low percentages of patients reflecting universal discrepancy between evidence base medicine and real life.

Chronic bronchitis and pesticide exposure: a case–control study in Lebanon

OBJECTIVE

Pesticides are widely used toxics. The objective of the study is to evaluate the odds of exposure to pesticides in chronic bronchitis patients.

METHODS

Using the American Thoracic Society standardized questionnaire confirmed by medical diagnosis of chronic bronchitis, a case-control study was performed in Lebanon. Pesticide exposure was estimated and between groups comparison was made.

RESULTS

The study involved 262 controls and 110 chronic bronchitis outpatient subjects from 10 medical centers. Any exposure to pesticides was associated to chronic bronchitis (OR = 2.46 [1.53-3.94]; p < 10(-4)). Occupational use presented the highest association (15.92 [3.50-72.41]; p < 10(-4)), followed by regional exposure (3.70 [2.05-6.70]; p < 10(-4)). Results were confirmed by multivariate and subgroup analysis.

CONCLUSION

Pesticide exposure was associated with chronic bronchitis in Lebanese adults. Pesticides toxicological effects may explain chronic respiratory effects associations found with all exposure types.

Respiratory diseases and pesticide exposure: a case-control study in Lebanon

STUDY OBJECTIVE

To evaluate the odds of being exposed to pesticides in asthmatic adults.

DESIGN

A case-control study was performed in Lebanon.

SETTING

People were approached when consulting physicians as outpatients.

PATIENTS

Asthmatic patients and non-asthmatic controls in several Lebanese hospitals were interviewed.

MAIN RESULTS

The study included 407 subjects from 10 medical centres. Any exposure to pesticides was associated to asthma (OR = 2.11 (1.47 to 3.02); p<10(-4)). Occupational use presented the highest association (OR = 4.98 (1.07 to 23.28); p = 0.02), followed by regional exposure (OR 3.51 (2.11 to 5.85); p<10(-4)). Results were confirmed by multivariate analysis, particularly for regional exposure (OR(a) = 2.78; p = 0.02) and house exposure (OR(a) = 2.17; p = 0.001).

CONCLUSIONS

Results are comparable to those found in other studies; especially for occupational exposure. Pesticides toxicological effects may explain chronic respiratory symptoms and asthma associations found with all exposure types. Pesticide exposure was associated with asthma in Lebanese adults.

Asthma, allergic rhinitis and eczema in 13-14-year-old schoolchildren across Lebanon

INTRODUCTION

Childhood asthma is one of the most important diseases of childhood. There is no known prevalence of asthma and allergic diseases in Lebanon. This study was conducted with a primary objective of finding the prevalence of asthma, allergic rhinitis and eczema in Lebanese children.

MATERIAL AND METHODS

It is a descriptive cross-sectional study on children in Lebanese public and private schools. A sample of 22 schools participated in the study, where standardized ISAAC written core questionnaires were distributed. 13-14-year-old students filled in the questionnaires in class.

RESULTS

1613 individuals were analyzed. The prevalence of diagnosed asthma (5.6%) is the lowest in Lebanon compared to the eastern Mediterranean countries. Prevalence of ever wheezing (21.4%), last 12 months wheezing (19.9%), wheezing on effort (12.7%), night cough (22.8%), allergic rhinitis (32.7%) and eczema (11.5%) is on the medium prevalence trend noted all over the world, referring to ISAAC study. It also showed marked variations and differences across the governates in Lebanon, the lowest prevalence of diagnosed asthma (1.9%) but the highest prevalence of asthma symptoms like ever wheezing being in the Bekaa governate (26.8%).

CONCLUSION

Undiagnosed asthma, rhinitis and eczema have medium prevalence in Lebanon. Differences exist between Lebanese governates. Further studies are needed to understand the environmental, climate and socioeconomic causes of these discrepancies.

Spirometric changes following the use of pesticides

We compared the respiratory function of 19 pesticide factory workers and a control group of 43 other factory workers in Lebanon. The groups had no difference in smoking status. Baseline measurements of respiratory function showed significantly lower forced expiratory volume and flow rates (FEV1, FEF(25-75%), and FEV1/FVC ratio) among subjects working with pesticides, i.e. obstruction may be linked to chronic exposure to pesticides. After 4 hours of work, all respiratory variables were still significantly lower in pesticide-exposed subjects, but no acute changes in respiratory function were seen. Pesticide-exposed workers had 5.6 times higher risk of abnormal FEV1/FVC ratio and 16.5 higher risk for abnormal FEF(25-75%). Duration of occupation in the pesticide factory was significantly correlated with abnormal respiratory measures.

[Alveolar paraffinosis. (Apropos of an inhalation pneumopathy resistant to antibiotics in an aged woman)]

Case report of an exogenous lipoid pneumonitis fortuitously discovered during acute barbituric intoxication. Discussion about pathogenicity of paraffin oil.