BREATHING

ASTHMA AND RESPIRATORY INFECTIONS IN SCHOOL CHILDREN WITH SPECIAL REFERENCE TO MOISTURE AND MOULD PROBLEMS IN THE SCHOOL
Moisture problems in buildings readily lead to fungal growth within its structures, thereby exposing the inhabitants to spores and other mould products.  The association between indoor air problems and respiratory symptoms has been documented in many epidemiological studies.  Therefore, a study was carried out to evaluate whether exposure to moisture and sensitisation to moulds are associated with respiratory manifestations in school children.  Two schools were included in the study, one with moisture problems (index school), the other being the control school. 

It was found that the prevalence of asthma was 4.8, which was similar in the children from both schools.  However, the children from the index school more often had wheezing (16% vs 6%) and cough (21% vs 9%) symptoms than control children.  Positive skin reactions to moulds were rare (2.4%), being present in 7% of asthmatic and in 1-2% of non-asthmatic children.  Lower respiratory tract infections were more common in the spring than in the fall in children from the index school, but not in control children, and the difference between the schools was significant in emergency visits and antibiotic courses.  Thus, evidence was found of an association between moisture or mould problems in school buildings and the occurrence of respiratory infections, repeated wheezing and prolonged cough in school children.
Taskinen,T. et al
ACTA. PAEDIATR. 1999, 88 (12) 1373-9

IRRITABLE BOWEL SYNDROME, GASTRO-OESOPHAGEAL REFLUX, AND BRONCHIAL HYPER-RESPONSIVENESS IN THE GENERAL POPULATION
Symptoms of irritable bowel syndrome (IBS) and gastro-oesophageal reflux are common in the general population but only a minority of people with these symptoms consult a doctor about them.  As the two conditions often coexist it has been proposed that  they may share a common aetiology.  Therefore, a  study was carried out to explore the inter-relations between these conditions and also bronchial hyper-responsiveness (BHR) using a validated postal symptom questionnaire. 

One year prevalences, in men and women respectively, of IBS were 10.5% and 22.9%, of dyspepsia 26.3% and 25.25%, of gastro-oesophageal reflux symptoms 29.4% and 28.2%, of BHR 13.2% and 14.6%, and of chronic bronchitis 8.3% and 4.9%.  Logistic regression showed independent associations between IBS and BHR, gastro-oesophageal reflux symptoms and dyspepsia.  However, there was no significant independent association between IBS and chronic bronchitis.  In men and women the odds ratio for IBS and gastro-oesophageal reflux symptoms was 2.6 and for IBS and BHR 2.1.  Also, IBS, gastro-oesophageal reflux symptoms, and bronchial hyper-responsiveness occurred more frequently together than expected, 2.5% of the sample having all three conditions compared with an expected prevalence of 0.7%.  

These observations may indicate the presence of an underlying disorder producing symptoms in both the gastrointestinal and respiratory systems.
Kennedy, K.M.  et al
GUT  1998, 43 (6)  770-4

NEW WAY TO GET RID OF DUST MITES
House dust mites cannot survive without a fungus, Aspergillus repens, which predigests the flakes of human skin into a form which they can eat.   A new bedding material impregnated with a fungicide has been produced that kills the fungus and thus makes the skin indigestible, starving the mites.  It is also impregnated with triclosan, which kills the bacteria which makes socks smell. Courtaulds say the substances are unlikely to trigger allergic reactions.
NEW SCIENTIST, 19th Sept. 1998

EFFECTS OF THE MENSTRUAL CYCLE ON MEDICAL DISORDERS
It is well recognised that certain medical conditions are exacerbated at specific phases of the menstrual cycle.  Abrupt changes in the concentrations of circulating ovarian steroids at ovulation and premenstrually may account for menstrual-cycle related changes in these chronic conditions.  Accurate documentation of symptoms on a menstrual calendar allows identification of women with cyclic alterations in disease activity. 

The evidence supporting a relationship between oestrogen withdrawal and migraine headache is compelling.   The frequency of migraine headaches in women increases considerably after menarche and 60% of women with migraine link attacks to menstruation.  Seventy to ninety percent of women with menstrual migraine experience improvement during pregnancy but may experience migraine attacks in the postpartum period. 

Menstrual exacerbations occur with all types of seizures.  Catamenial epilepsy is believed to result from cyclic alterations in both ovarian hormone levels and drug metabolism. 

In many women with asthma there is an increased frequency and severity of attacks premenstrually or at menstruation and may be related to changing levels of progesterone or prostaglandins. 

Symptoms of rheumatoid arthritis often improve in the luteal phase when gonadal steroid production is maximal. A subjective increase in morning stiffness and arthritic pain during menstruation and the early follicular phase has been shown. 

In women with irritable bowel syndrome symptoms tend to recur and become cyclic, with exacerbation during the postovulatory and premenstrual phases of the menstrual cycle, suggesting a hormonal influence. 

Menstrual cycle-related alterations in glycemic control during the luteal and premenstrual phases have been reported in some women with diabetes. 

Other disorders exacerbated by the postovulatory and premenstrual phases of the menstrual cycle include acne, endocrine allergy and anaphylaxis, erythema multiforme, urticaria, apthous ulcers, glaucoma and multiple sclerosis.
Case, A.M.  and Reid, R.L.
ARCH.INT.MED.  1998, 158 (13) 1405-12

IMPAIRMENT OF HEALTH AND QUALITY OF LIFE IN PEOPLE WITH LARGE WAIST CIRCUMFERENCE
A study was carried out to define the symptoms associated with excess central fat distribution and to assess the risks of chronic disorders.  A cross-sectional study of 5,887 men and 7,018 women aged 20-59 years assessed respiratory insufficiency, low back pain, degree of physical function, presence of non-insulin-dependent diabetes, and cardiovascular risk factors.  Bodyweight, body-mass index, and waist circumference were measured by action levels (men; less than action level 1 <94.0 cm, action levels 1-2 94.0-101.9 cm, more than action level 2 >102.0 cm; women: less than action level 1 <80.0 cm, action levels 1-2 80.0-87.9 cm, more than action level 2 >88.0 cm). The reference group were people with waist circumferences lower than action level 1.  It was found that all symptoms and risks increased among participants higher than action level 2, after adjustment for age and lifestyle, by 3.1 in men and 2.7 in women for shortness of breath when walking upstairs; 4.5 and 3.8 for non-insulin dependent diabetes; and 4.2 and 2.8 for at least one major cardiovascular risk factor.  Above action level 2, compared with the reference group, men and women were at twice the risk of difficulties in everyday life, and women were 1.5 times more likely to have low back pain or symptoms of intervertebral disc herniation. The researchers conclude that waist action levels could be useful for health promotion to raise awareness of the need for weight management.
Lean,M.E.  et al
LANCET 1998, 351 (9106) 853-56

SUMMARY OF ANALYSIS OF ASTHMA AND ECZEMA PILOT STUDY
The Natural Medicines Society initiated a pilot study to ascertain whether naural medicines were helpful to people suffering with either asthma or eczema, or both.   Eighty people completed the section relating to asthma and 98 people completed the section on eczema.   Some completed both.   The Nuffield Institute for Health was asked to analyse the responses and their summary is as follows.

Between two-thirds and three-quarters of the questionnaires were completed by women.   In both the asthma and eczema surveys:

  • the under twentys were the largest group
  • around 50% have used natural medicines for over 2 years
  • between 56-60% of all products used had been prescribed by practitioners
  • between 88-95% of respondents experienced no side-effects
  • only 9% of patients felt that they had not benefited from using natural medicines
  • in both conditions 42% of respondents were still taking natural medicines to control their symptoms
  • almost 70% of the asthma respondents and only 37% of the eczema respondents were taking orthodox medicine as well as natural medicine
  • if respondents had experienced any problem with their natural medicine, they reported back to the practitioner
  • the majority of respondents had turned to natural medicine due to worries about side effects and a lack of confidence in the efficacy of the orthodox treatment

    Homoeopathy was used by 17.8% of respondents and the rest were split between a variety of therapies, mainly nutrition, yoga, diet, acupuncture, etc.   It was concluded that natural medicines may be useful in the treatment of asthma and especially of eczema.   The small sample may not be representative.   Further research should be carried out, but funding is so far unobtainable.
    NMS NEWS No. 42

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