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Showing papers by "Frank E. Speizer published in 1989"


Journal ArticleDOI
TL;DR: Examination of data from a second cross-sectional assessment of the association of air pollution with chronic respiratory health of children participating in the Six Cities Study of Air Pollution and Health suggests that children with hyperreactive airways may be particularly susceptible to other respiratory symptoms when exposed to these pollutants.
Abstract: Results are presented from a second cross-sectional assessment of the association of air pollution with chronic respiratory health of children participating in the Six Cities Study of Air Pollution and Health. Air pollution measurements collected at quality-controlled monitoring stations included total suspended particulates (TSP), particulate matter less than 15 microns (PM15) and 2.5 microns (PM2.5) aerodynamic diameter, fine fraction aerosol sulfate (FSO4), SO2, O3, and No2. Reported rates of chronic cough, bronchitis, and chest illness during the 1980-1981 school year were positively associated with all measures of particulate pollution (TSP, PM15, PM2.5, and FSO4) and positively but less strongly associated with concentrations of two of the gases (SO2 and NO2). Frequency of earache also tended to be associated with particulate concentrations, but no associations were found with asthma, persistent wheeze, hay fever, or nonrespiratory illness. No associations were found between pollutant concentrations and any of the pulmonary function measures considered (FVC, FEV1, FEV0.75, and MMEF). Children with a history of wheeze or asthma had a much higher prevalence of respiratory symptoms, and there was some evidence that the association between air pollutant concentrations and symptom rates was stronger among children with these markers for hyperreactive airways. These data provide further evidence that rates of respiratory illnesses and symptoms are elevated among children living in cities with high particulate pollution. They also suggest that children with hyperreactive airways may be particularly susceptible to other respiratory symptoms when exposed to these pollutants.(ABSTRACT TRUNCATED AT 250 WORDS)

681 citations


Journal ArticleDOI
TL;DR: Data support a strong association between obesity and symptomatic gallstones and suggest that even moderate overweight may increase the risk.
Abstract: To assess the risk factors for symptomatic gallstones, 88,837 women in the Nurses' Health Study cohort (age range, 34 to 59 years) were followed for four years after completing a detailed questionnaire about food and alcohol intake in 1980. A total of 433 cholecystectomies and 179 cases of newly symptomatic, unremoved gallstones, diagnosed by ultrasonographic examination or x-ray films, were reported during the four-year follow-up. The age-adjusted relative risk for very obese women, who had a Quetelet index of relative weight (weight in kilograms divided by the square of the height in meters) of more than 32 kg per square meter, was 6.0 (95 percent confidence interval, 4.0 to 9.0), as compared with women whose relative weight was less than 20 kg per square meter. For slightly overweight women (relative weight, 24 to 24.9 kg per square meter), the relative risk was 1.7 (95 percent confidence interval, 1.1 to 2.7). Overall, we observed a roughly linear relation between relative weight and the risk of gallstones. Among the 59,306 women whose relative weight was less than 25 kg per square meter, a high energy intake (greater than 8200 J per day), as compared with a low energy intake (less than 4730 J per day), was associated with an increased incidence of symptomatic gallstones (relative risk, 2.1; 95 percent confidence interval, 1.4 to 3.3), and an alcohol intake of at least 5 g per day was associated with a decreased incidence as compared with abstention (relative risk, 0.6; 95 percent confidence interval, 0.4 to 0.8). Parity did not appear to be an important risk factor after an adjustment was made for relative weight. These data support a strong association between obesity and symptomatic gallstones and suggest that even moderate overweight may increase the risk.

349 citations


Journal ArticleDOI
TL;DR: It is concluded that dampness in the home is common in many areas of the United States and that home dampness is a strong predictor of symptoms of respiratory and other illness symptoms among 8- to 12-yr-old children.
Abstract: This study examined the relationship between measures of home dampness and respiratory illness and symptoms in a cohort of 4,625 eight- to 12-yr-old children living in six U.S. cities. Home dampness was characterized from questionnaire reports of mold or mildew inside the home, water damage to the home, and the occurrence of water on the basement floor. Symptoms of respiratory and other illness were collected by questionnaire. Pulmonary function was measured by spirometry. Signs of home dampness were reported in a large proportion of the homes. In five of the six cities, one or more of the dampness indicators were reported in more than 50% of the homes. The association between measures of home dampness and both respiratory symptoms and other non-chest illness was both strong and consistent. Odds ratios for molds varied from 1.27 to 2.12, and for dampness from 1.23 to 2.16 after adjustment for maternal smoking, age, gender, city of residence, and parental education. The relationship between home dampness and pulmonary function was weak, with an estimated mean reduction of 1.0% in FEF25-75 associated with dampness and 1.6% with molds. We conclude that dampness in the home is common in many areas of the United States and that home dampness is a strong predictor of symptoms of respiratory and other illness symptoms among 8- to 12-yr-old children.

345 citations


Journal Article
TL;DR: A nested case-control analysis was conducted within the Nurses' Health Study cohort to examine the relation between timing of severe sun exposure and incidence of melanoma and no material association was found between blistering sunburns after 30 years of age and melanoma.
Abstract: Despite strong evidence that sun exposure causes malignant melanoma, the details of this relation remain unclear. A nested case-control analysis was conducted within the Nurses' Health Study cohort to examine the relation between timing of severe sun exposure and incidence of melanoma. The subjects were 130 white women aged 38 to 65 years with confirmed cutaneous melanoma (other than acral lentigenous) who reported no history of melanoma in first-degree relatives. The control subjects were 300 women matched by race, date of birth, and cycle of questionnaire who also reported no history of melanoma in first-degree relatives. We used conditional logistic regression to evaluate the relation of sun damage after 30 years of age and sun damage from 15 to 20 years of age to the incidence of melanoma. Blistering sunburns between 15 to 20 years of age were associated with risk of melanoma (relative risk = 2.2 for five or more burns vs none, 95% confidence interval 1.2 to 3.8). This association persisted when a history of burns after 30 years of age was controlled in the analysis. No material association was found between blistering sunburns after 30 years of age and melanoma. Similarly, a more equatorial latitude of residence between 15 and 20 years of age was positively associated with melanoma; latitude after 30 years of age was less strongly and not significantly related to melanoma risk. Sun exposure prior to 20 years of age is more closely associated with melanoma risk than sun exposure after 30 years of age.

306 citations


Journal ArticleDOI
24 Nov 1989-JAMA
TL;DR: It is suggested that obesity among premenopausal and early postmenopausal women does not increase breast cancer risk substantially and height is only weakly related among post menopausal women.
Abstract: We examined relative weight and height in relation to subsequent breast cancer risk among 115,534 women 30 to 55 years of age and free from cancer in 1976. By 1984, six hundred fifty-eight premenopausal and 420 postmenopausal breast cancers were documented during 734,716 person-years. Among premenopausal women, risk of breast cancer decreased significantly with increasing relative weight (relative risk for the highest category was 0.6). A similar inverse association was seen for recalled relative weight at 18 years of age. Postmenopausal breast cancer was not associated with relative weight, either recent or at age 18. Height was not associated with breast cancer risk among premenopausal women and only weakly related among postmenopausal women. These data suggest that obesity among premenopausal and early postmenopausal women does not increase breast cancer risk substantially.

237 citations


Journal ArticleDOI
TL;DR: Overall past use of oral contraceptives is not associated with a substantial increase in the risk of breast cancer, and women who used oral contraceptives for a long duration in early reproductive life was too small to permit firm conclusions regarding the risk.
Abstract: In 1976, 118,273 female nurses 30-55 years of age with no history of cancer completed a questionnaire regarding possible risk factors. By 1986, after 1,137,415 person-years of follow-up, we had documented 1,799 newly diagnosed cases of breast cancer. Compared with the risk of breast cancer for nonusers of oral contraceptives, the multivariate relative risks were 1.07 (95% confidence interval, 0.97-1.19) for all users, 1.06 (95% confidence interval, 0.96-1.18) for past users, and 1.53 (95% confidence interval, 1.06-2.19) for current users--women who used oral contraceptives up to 2 years before diagnosis of breast cancer. We conclude that overall past use of oral contraceptives is not associated with a substantial increase in the risk of breast cancer. Although we did not find women who used oral contraceptives before the first pregnancy to have an increased risk of breast cancer, the number of women who used oral contraceptives for a long duration in early reproductive life was too small to permit firm conclusions regarding the risk in this subgroup.

138 citations


Journal ArticleDOI
TL;DR: The results emphasize the importance of high blood pressure as an independent predictor of coronary heart disease and stroke in middle-aged women and suggest that the increased risk occurs in both lean and obese women.
Abstract: The relation of self-reported high blood pressure to the subsequent development of coronary heart disease and stroke was examined in a cohort of 119,963 women, aged 30-55 years, who were initially free from cardiovascular disease. Participants in the Nurses' Health Study reported high blood pressure and other cardiovascular risk factors on baseline questionnaires mailed in 1976. During six years of follow-up, there were 308 incident cases of coronary heart disease (66 fatal and 242 nonfatal myocardial infarctions) and 175 strokes (50 fatal and 125 nonfatal). Fatal as well as nonfatal coronary heart disease and stroke were all significantly more frequent among the women who had reported high blood pressure. After adjusting simultaneously for age and other risk factors, the relative risks were 3.5 (95% confidence interval (Cl) 2.8-4.5) for total coronary heart disease and 2.6 (95% Cl 1.8-3.5) for total stroke. This association was evident at all levels of relative weight. The results emphasize the importance of high blood pressure as an independent predictor of coronary heart disease and stroke in middle-aged women and suggest that the increased risk occurs in both lean and obese women.

123 citations


Journal ArticleDOI
TL;DR: Pneumonia and/or hospitalization for respiratory illness prior to the onset of study were associated with lower cross-sectional levels of forced expiratory volumes at entry to the study, even when asthmatics/persistent wheezers were eliminated from the analysis.
Abstract: This study investigated the relationship of acute lower respiratory illness (LRI) to level and change in level of forced expiratory volumes in a cohort of 801 children, followed longitudinally for a maximum of 13 yr. The co-occurrence of respiratory illness before 2 yr of age and two or more LRI during a single surveillance year was associated with a 20.3% lower mean cross-sectional level of FEF25-75, and with reduced longitudinal change in level of FEF25-75. The effect of LRI on lung function was uniformly stronger for boys than for girls. Of the children with illness before 2 yr of age and two or more LRI, six of 14 were male asthmatics with mean levels of FEF25-75 that were lower than those of other asthmatic children. Pneumonia and/or hospitalization for respiratory illness prior to the onset of study were associated with lower cross-sectional levels of forced expiratory volumes at entry to the study, even when asthmatics/persistent wheezers were eliminated from the analysis (6.1% lower level of FEV1 for a nonasthmatic boy with previous hospitalization versus a nonasthmatic boy without hospitalization). In the longitudinal analysis, pneumonia and/or hospitalization were associated with slower increase in level of forced expiratory volumes, even after adjusting for "ever diagnosis of asthma/current any wheeze" (starting at the same leve, after eight years a boy with hospitalization would develop a 5.0% lower FEV1 than a boy without hospitalization). Acute LRI also was evaluated as a predictor of chronic respiratory symptoms.(ABSTRACT TRUNCATED AT 250 WORDS)

116 citations


Journal ArticleDOI
TL;DR: Relative level of FEV1 compared with predicted was a strong predictor of sex-specific chronic obstructive pulmonary disease (COPD), cardiovascular (CV), and all-cause mortality, even after adjusting for age, respiratory symptoms, and smoking.
Abstract: Results are presented from a 9- to 12-yr mortality follow-up of 8,427 white adults in six U.S. cities between 25 and 74 yr of age at enrollment. Survival analyses were performed for all causes on 941 confirmed deaths, and for specific primary causes for the subset of 851 death with death certificates. Relative level of FEV1 compared with predicted was a strong predictor of sex-specific chronic obstructive pulmonary disease (COPD), cardiovascular (CV), and all-cause mortality, even after adjusting for age, respiratory symptoms, and smoking. Even in this relatively large cohort, the total number of respiratory deaths was small, and no trend in COPD mortality could be determined over the period of study.

110 citations


Journal ArticleDOI
TL;DR: Data suggest that phenotypic similarities in pulmonary function relate directly to genetic similarities, and are consistent with a multifactorial mode of inheritance.
Abstract: Population studies have demonstrated that obstructive airways disease aggregates within families. The authors used a twin family model of analysis to estimate the genetic and environmental influences on pulmonary function. A total of 1,635 members of 414 families of adult twins (252 monozygotic, 162 dizygotic) enrolled in the Greater Boston Twin Registry were studied between 1981 and 1982. Correlations in levels of forced expiratory volume in one second (FEV1) and forced vital capacity (FVC), adjusted for age, sex, height, and current smoking status, were compared among 16 groups of relatives sharing various degrees of genetic relatedness. A direct relation between shared genotype and the magnitude of the familial correlations for pulmonary function was observed. For FEV1, the correlations were 0.71 for monozygotic twins (100% shared genotype), 0.16 to 0.29 for relatives with 50% shared genotype, 0.09 to 0.27 for relatives with 25% shared genotype, 0.06 for cousins with 12.5% shared genotype, and -0.14 to 0.14 for unrelated family members. Correlations for FVC were similar. Stratification of the analysis by concordance or discordance for passive tobacco smoke exposure or for frequency with which families visited one another did not systematically alter these relations. These data suggest that phenotypic similarities in pulmonary function relate directly to genetic similarities, and are consistent with a multifactorial mode of inheritance.

110 citations


Journal ArticleDOI
TL;DR: It is concluded that ambient exposures to ozone at levels well below the National Ambient Air Quality Standard of 120 ppb are associated with transient decreases in lung function, the long-term significance of which is uncertain.
Abstract: As part of the ongoing Harvard Six Cities study of the respiratory effects of air pollution, repeated measurements of pulmonary function (FVC, FEV75, MMEF, and Vmax75) were taken at approximately weekly intervals in a population of 154 school children living in Kingston and Harriman, Tennessee. A series of as many as six measurements were obtained for each child over approximately a 2-month period beginning in February 1981. Concurrent measurements of ambient ozone, and fine particle and fine sulfate concentrations were obtained at a site near the study community. The maximal hourly ozone concentration observed during the study was 78 ppb. Child-specific linear regressions were fit that related short-term pulmonary function changes to air pollution or temperature. We found that decrements in FVC, FEV75, MMEF, and Vmax75 were associated with ozone, but not with particulate levels. Decrements in FVC, MMEF, and Vmax75 were also associated with temperature. Although slopes of pulmonary function on ozone varied across children, in general there was no evidence that this variation represented heterogeneity of response as opposed to random estimation errors. In addition, no evidence was found that individual response to ozone was related to sex, presence of asthma, respiratory illness before 2 yr of age, or the MMEF/FVC ratio, a rough surrogate for airway size. We conclude that ambient exposures to ozone at levels well below the National Ambient Air Quality Standard of 120 ppb are associated with transient decreases in lung function, the long-term significance of which is uncertain.

Journal ArticleDOI
TL;DR: It is suggested that smoking and breast cancer are not materially related and there is no dose-response relationship across categories of current smoking.
Abstract: In 1976, 117,557 women in the United States aged 30-55 years and without a history of cancer provided detailed information on current smoking habits By 1986, 1,788 cases of breast cancer had been documented during 1,133,682 person-years There was no association between current smoking and risk of breast cancer (multivariate-adjusted relative risk for smokers of greater than or equal to 25 cigarettes/day compared to nonsmokers: 102, 95% confidence interval, 096-122) Past smoking also was unrelated to breast cancer risk (relative risk, 108; 95% confidence interval, 096-120) The results did not differ by menopausal status Tumor size and the presence of nodal metastases were unrelated to smoking Smoking was weakly associated with estrogen receptor-positive tumors (relative risk for smokers of greater than or equal to 25 cigarettes/day compared with never smokers, 138; 95% confidence interval, 104-184), but there was no dose-response relationship across categories of current smoking These results suggest that smoking and breast cancer are not materially related

Journal ArticleDOI
TL;DR: The correlations of peak expiratory flow rate with pulmonary symptoms and other indices of chronic disease raise the possibility that peak expiral flow rate will predict mortality in an elderly population.
Abstract: A population survey was conducted in 1982-1983 among 3,812 persons aged 65 years and older residing in East Boston, Massachusetts, a geographically defined urban community. Three measurements of peak expiratory flow rate were obtained by using calibrated mini-Wright meters. Peak expiratory flow rate was strongly related to age, sex, smoking, and years smoked. After adjustment for these factors, low peak expiratory flow rate was associated with chronic respiratory symptoms (cough, wheeze, shortness of breath, exertional dyspnea, orthopnea, and paroxysmal nocturnal dyspnea; p less than 0.0001) and with certain cardiovascular variables (history of stroke, p = 0.0014; angina, p = 0.05; and high pulse rate, p = 0.004). No significant associations were found with history of myocardial infarction or systolic and diastolic blood pressures. Peak expiratory flow rate was positively related to education (p less than 0.0001) and income (p less than 0.0001). Peak expiratory flow rate also was strongly related (p less than 0.0001) to measures of functional ability and physical activity, self-assessment of health, and simple measures of cognitive function. The correlations of peak expiratory flow rate with pulmonary symptoms and other indices of chronic disease raise the possibility that peak expiratory flow rate will predict mortality in an elderly population.

Journal ArticleDOI
TL;DR: Estimating chronic exposure from the year-long measurement of acid aerosols and consideration of specific criteria for selecting communities to study hope to minimize potential confounding to allow us to assess the chronic impact of strong acid in the atmosphere on the respiratory health of these children.
Abstract: Techniques for measuring acid aerosols in the ambient environment have been developed only recently. As part of the on-going Harvard Study on the Health Effects of Sulfur Dioxide and Respirable Particulates, we have developed monitoring equipment for acidic particles that can be used in multiple field settings. Preliminary data suggest that these strong acid aerosol measurements may correlate with respiratory symptoms more closely than similar measurements of particulate matter less than 15 microns in size. These results have led to the beginning of a U.S.-Canadian cooperative study to assess the chronic effects of acid aerosols on the health of North American children. Communities are being selected on the basis of anticipated levels of H2SO4 in ambient air along with predicted levels of ozone and nitrates. Each community will undergo a 1-year period of every other day, 24-hr monitoring with newly developed monitoring equipment that will allow for quantification of H+ ion concentrations, as well as for specific measures of ozone and acid fractions. At the end of the 1-year period, while measurements are still being made, approximately 600 children aged 7 to 11 in each of up to 24 communities will be assessed with standardized questionnaires completed by parents, and pulmonary function will be measured in the children while in school. By estimating chronic exposure from the year-long measurement of acid aerosols and consideration of specific criteria for selecting communities to study, we hope to minimize potential confounding to allow us to assess the chronic impact of strong acid in the atmosphere on the respiratory health of these children.

Journal ArticleDOI
TL;DR: Ass associations between children's lung function and parental characteristics (smoking, lung function) remained significant and different growth patterns between boys and girls may be a critical factor in the study of lung function familial resemblance.
Abstract: Familial factors related to lung function between six and 10 years of age have been studied among 1,160 children whose both parents were examined in 1975 in the French PAARC (Pollution Atmospherique et Affections Respiratoires Chroniques) Cooperative Study. The three indices FVC (forced vital capacity), FEV1 (forced expiratory volume in one second), and FEF25-75 (forced expiratory flow between 25 and 75 per cent of the vital capacity) were studied after adjustment for sex, town, age, and height (and weight for children's FVC and FEV1). Maternal (but not paternal) smoking was associated with a significant decrease in FEV1 and FEF25-75, but not in FVC. Familial resemblance was observed for all indices between children and parents and between siblings. None of the environmental factors considered (i.e., parental smoking or education) or body habitus explained the familial resemblance observed. Conversely, after taking into account the aggregation between siblings, associations between children's lung function and parental characteristics (smoking, lung function) remained significant. Parental-children correlations exhibited an increasing temporal trend with increasing age of the children. All but one correlation for FVC, FEV1, and FEF25-75 residuals of children with mothers' residuals were higher in the oldest age group compared with the youngest age group at the 0.10 level. Furthermore, correlations between siblings of opposite sex were significantly lower than correlations between siblings of like sex, especially for FEV1/FVC and FEF25-75/FVC. Results suggest that different growth patterns between boys and girls may be a critical factor in the study of lung function familial resemblance.

Journal ArticleDOI
TL;DR: Self-reported mole counts and cutaneous melanoma with respect to anatomic site suggest that mole counts primarily indicate systemic melanoma risk, rather than direct risk from the moles themselves.
Abstract: We examined the relationship between self-reported mole counts and cutaneous melanoma with respect to anatomic site in 110 case and 231 control female nurses. Counts of moles on the lower leg were better predictors of melanoma risk than were counts of moles on the arm. The relative risk for the highest quintile of lower leg mole counts versus no lower leg moles was 4.2. Mole counts at each site (arm, thigh, and lower leg) were associated with risk of melanoma of the trunk and lower leg, but none were associated with the risk of melanoma of the upper extremity. The absence of direct site-specificity suggests that mole counts primarily indicate systemic melanoma risk, rather than direct risk from the moles themselves.

Journal ArticleDOI
TL;DR: Better housing conditions, higher divorce rates, more frequent exposure to passive smoking in childhood, and different selection factors for active smoking in the US compared to France might explain the lack of association of current spousal smoking habits with lower lung function in American women.
Abstract: Results are reported from a parallel analysis of the association of passive smoking with respiratory symptoms and lung function (FEV1, FVC and FEV1/FVC) in 2220 US and 3855 French women from the general population examined over the same time period using similar methods. Age, city, educational level, occupational exposure and height (for lung function) were taken into account. In the US survey, being a never smoker married to a current or former smoker was significantly associated only with wheezing compared to being a true never smoker. A borderline significant association between passive smoking and dyspnoea was observed among women older than 40 in the French survey. No association was observed with cough or phlegm production. Passive smoking was significantly related to lower FVC and FEV1 values among French women 40 years or more, even among those without a history of wheeze or asthma. However, even among US women older than 40 years of age, there was no significant association between passive smoking and level of lung function. Better housing conditions, higher divorce rates, more frequent exposure to passive smoking in childhood, and different selection factors for active smoking in the US compared to France might explain the lack of association of current spousal smoking habits with lower lung function in American women.

Journal ArticleDOI
TL;DR: The relationship between airway hyperresponsiveness and longitudinal change in lung function was assessed in a population-based sample of 184 children and young adults observed over a maximum span of 12 yr when asthmatics were excluded from the analyses.
Abstract: The relationship between airway hyperresponsiveness and longitudinal change in lung function was assessed in a population-based sample of 184 children and young adults observed over a maximum span of 12 yr. Pulmonary function was assessed annually with spirometry, and health and household information was obtained with standardized questionnaires. Nonspecific airway responsiveness to eucapneic hyperventilation with subfreezing air was measured on at least two occasions between the sixth and twelfth annual surveys. At any given survey, a significant bronchoconstrictor response was defined as ([prechallenge FEV1 -postchallenge FEV1/pre-FEV1) ⩾ 0.13, a value that identified 10% of the population. Subjects were classified as “never,” “always,” or “inconsistent” responders according to the consistency of responsiveness determined in different surveys. Subjects were classified further as “labile” if their maximal survey-to-survey difference in ΔFEV1/FEV1 was ⩾ 0.18, and as “nonlabile” otherwise. A Markov-type au...

Journal ArticleDOI
TL;DR: According to these prospective data, the use of oral contraceptive agents in the past does not materially raise a woman's risk of subsequent cardiovascular disease.
Abstract: We evaluated the effects of past use of oral contraceptive agents on the risk of various cardiovascular diseases among women in the Nurses' Health Study cohort. We studied 119,061 women who were 30 to 55 years of age in 1976, who provided information on their use of oral contraceptives, and who at entry had had no previous coronary disease or stroke. End points were documented by medical records. During eight years of follow-up (484,096 person-years among those who had never used oral contraceptives, 415,488 among past users, and 22,376 among current users), there were 485 new cases of major coronary disease (380 nonfatal myocardial infarctions and 105 deaths from coronary disease), 282 strokes (205 nonfatal and 77 fatal), and 48 other deaths from cardiovascular causes. We found no evidence to suggest an increase in the risk of cardiovascular diseases among past users of oral contraceptives, even with prolonged previous use. After adjustment for a variety of risk factors, the relative risk of maj...

01 Jan 1989
TL;DR: Airway hyperresponsiveness was demonstrated consistently over all surveys in only six of 49 (12%) subjects who had ever demonstrated a "positive" airway response, and significant predictors of airwayhyperresponsiveness were wheeze symptoms, hay fever, and a chest illness requiring bed rest.
Abstract: SUMMARY The degree and long-term variability of airway responsiveness to eucapneic hyperven­ tilation with cold air was assessed in 287children and young adults « 23 yr of age) (735 challenge tests) enrolled in a longitudinal study of pulmonary function, 179 of whom underwent two to five cold-air challenge tests between 1982 and 1986.Survey-to-survey variability in airway responsive­ ness was assessed with computation of adjusted within-subject correlation coefficients for con­ tinuous measures of response (percent decrease in FEV, after challenge) and with adjusted odds ratios for dichotomous outcomes ("positive" if percent decrease FEV, ~ 0.13). The relationships between variability in responsiveness and the following variables were examined: age, baseline lev­ el of pulmonary function, presence of respiratory symptoms and illnesses, smoking exposures, season, level of ventilation achieved during testing, and temperature of the expired air. Airway hyper­ responsiveness was demonstrated consistently over all surveys in only six of 49 (12%) subjects who had ever demonstrated a "positive" airway response. The odds relating positive responses be­ tween surveys was 12.1 for airway hyperresponsiveness, 21.5 for "persistent" wheeze, and 6.7 for ''any" wheeze. Significant predictors of airway hyperresponsiveness were wheeze symptoms (OR = 2.3), hay fever (OR = 1.6), and a chest illness requiring bed rest (OR = 2.5). Adjustment for survey-to-survey differences in respiratory symptoms, or for differences in testing conditions be­ tween surveys, did not alter the observed variability in airway responsiveness. Adjustment for "ran­ dom error" (assessed with replicate measures of airway responsiveness in a subsample of 21 sub­ jects) improved the observed survey-to-survey variability by 30%. These datasuggest that in a young, relatively healthy population, results of tests of airway responsiveness may vary between surveys. The sources of this variability may include unidentified differences in testing conditions or perfor­ mance, or differences in the physiologic properties of the airways between surveys.

Journal ArticleDOI
TL;DR: The degree and long-term variability of airway responsiveness to eucapneic hyperventilation with cold air was assessed in 287 children and young adults (< 23 yr of age) (735 challenge tests) enrolled in a longitudinal study of pulmonary function, 179 of whom underwent two to five cold-air challenge tests between 1982 and 1986 as discussed by the authors.
Abstract: The degree and long-term variability of airway responsiveness to eucapneic hyperventilation with cold air was assessed in 287 children and young adults (< 23 yr of age) (735 challenge tests) enrolled in a longitudinal study of pulmonary function, 179 of whom underwent two to five cold-air challenge tests between 1982 and 1986. Survey-to-survey variability in airway responsiveness was assessed with computation of adjusted within-subject correlation coefficients for continuous measures of response (percent decrease in FEV1 after challenge) and with adjusted odds ratios for dichotomous outcomes (“positive” if percent decrease FEV1 ⩾ 0.13). The relationships between variability in responsiveness and the following variables were examined: age, baseline level of pulmonary function, presence of respiratory symptoms and illnesses, smoking exposures, season, level of ventilation achieved during testing, and temperature of the expired air. Airway hyperresponsiveness was demonstrated consistently over all surveys in...

Journal ArticleDOI
TL;DR: Standardization of an acute respiratory illness questionnaire would provide greater opportunity than use of diaries for synthesis of prospective data from different epidemiologic studies.
Abstract: We compared two prospective survey methods, an interviewer-administered questionnaire and a daily diary, used concurrently to record acute respiratory illness experience over a 2-yr period in 422 children 5 to 11 yr of age from East Boston, Massachusetts. Respondents contributed more months of data with the questionnaire than with the diary method. Respiratory symptom and illness rates, as determined for the first year by each of the methods, were compared for 277 children who had less than 4 months of missing data. Respondents from families with more children tended to report a lower total respiratory illness rate by the diary than by the questionnaire method (p = 0.006). Although upper respiratory illness rates did not differ by method, lower respiratory illnesses were reported more frequently (p = 0.0001) by questionnaire than by diary. In the group of 49 children who were identified as having had greater than one lower respiratory illness, 25% of the illnesses reported as having been lower respiratory...

Journal ArticleDOI
TL;DR: The workshop participants concluded that as opportunities for the intervention in the series of COPD disorders develop, greater efforts will be required to train and encourage health care providers in the use of physiological and biochemical markers of disease.
Abstract: The workshop participants concluded the following. (1) COPD mortality is increasing. (2) The increase in COPD cannot be explained solely by changing diagnostic and coding practices. (3) Much of the increase in COPD mortality is associated with the temporal trends in cigarette smoking. (4) Factors other than smoking, such as occupational and other environmental exposure, contribute to the development of COPD. (5) COPD is a heterogeneous group of disorders with the common finding of obstructive airways disease. Those patients with an underlying increase in airways responsiveness may have a more favorable prognosis. (6) Ventilatory function testing, regardless of the presence and nature of the COPD, is a strong predictor of mortality. (7) As opportunities for the intervention in the series of COPD disorders develop, greater efforts will be required to train and encourage health care providers in the use of physiological and biochemical markers of disease.


Journal Article
TL;DR: The chapter discusses epidemiologic evidence for the role of acidic aerosols in the development and exacerbation of chronic obstructive pulmonary disease and the hypothesis that sulfuric acid was the most important component of the mix of pollutants responsible for classic air pollution episodes is proposed.
Abstract: The chapter discusses epidemiologic evidence for the role of acidic aerosols in the development and exacerbation of chronic obstructive pulmonary disease. The hypothesis that sulfuric acid was the most important component of the mix of pollutants responsible for classic air pollution episodes was first proposed more than 50 years ago. However, analyses of these episodes and more recent epidemiologic studies of lower level exposures are suggestive but not conclusive, primarily because of the limitations in technology available for measuring exposure.