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TRAFFIC AND INDOOR POLLUTION
In this month’s Thorax we publish four papers on various aspects of air pollution. The first two papers deal with the issue of the relationship between air pollution and increased cardiovascular morbidity. Schwartz and colleagues report a study of elderly subjects in Boston and show that particles—especially black carbon which is an indicator of traffic particles—are associated with impaired autonomic control of the heart. However, in a study in Seattle Sullivan and colleagues found no relation between increased residence levels of particulate matter and heart rate variability in older people. In the accompanying editorial Townend explains why the two studies have come to different conclusions, including the point that the composition of the particles may be different in Boston and Seattle. Hwang and colleagues investigated the effect of air pollution on the risk of childhood asthma in a cross sectional study of Taiwanese school children. The results show that long term exposure to traffic related pollutants such as nitrogen oxides, ozone, and carbon monoxide increases the risk of asthma in children. In the final paper, Jarvis et al describe an association between indoor nitrous acid (produced directly from gas combustion and indirectly from nitrogen dioxide) and decrements in lung function and possibly with more symptoms. Indoor nitrogen dioxide was not related to lung function and the authors suggest that the inconsistent effects of nitrogen dioxide reported in studies may be due to failure to account for the health effects of nitrous acid.
See pages 441, 455, 462, 467 and 474
ASTHMA AND IRREGULAR MENSTRUATION
Asthmatic women are more likely to have abnormalities in sex hormone levels and, in this month’s Thorax, Svanes and colleagues describe an epidemiological study of the relation between asthma, allergy, and irregular menstruation. The results show that, in younger women, irregular menstruation was related to asthma, asthma symptoms and hay fever. This effect could not be attributed to the current use of asthma medications. The authors conclude by speculating that developmental or metabolic factors such as insulin resistance may be involved.
See page 445
IS CRP RELATED TO ASTHMA?
There has been increasing interest in the role of C-reactive protein (CRP) in respiratory conditions associated with lung inflammation such as COPD, and in this issue of Thorax Olafsdottir and colleagues describe a study of CRP in asthma using a highly sensitive assay. They show that increased CRP levels are associated with respiratory symptoms such as wheeze, breathlessness, cough, and non-allergic asthma but not with allergic asthma. Although the authors suggest that CRP may be used as a biomarker in asthma, they also show relationships between CRP and age, body mass index and smoking that will make individual results difficult to interpret.
See page 451
INHALED STEROID WITHDRAWAL IN COPD
In this issue of Thorax Wouters and colleagues report a randomised study in which inhaled fluticasone was withdrawn from COPD patients for 12 months after they had been prescribed 3 months of treatment with both inhaled fluticasone and salmeterol. Withdrawal of the inhaled steroid resulted in a fall in the FEV1 together with an early increase in the symptoms of dyspnoea and more disturbed nights. An increase in the number of mild exacerbations was seen after inhaled steroid withdrawal, although there was no change in the annual rate of moderate to severe exacerbations. A sustained decrease in the percentage of rescue medication-free days was also found in the group in whom inhaled steroids were withdrawn. These findings occurred despite continuation in both groups of the long acting β agonist, and emphasise the importance of inhaled steroid treatment in COPD.
See page 480
ANTIBIOTIC ALLERGY IN CYSTIC FIBROSIS
Treatment with high dose intravenous antibiotics is common in cystic fibrosis and allergic reactions to antibiotics are more common in people with cystic fibrosis than in the general population. In this month’s Thorax Parmar and Nasser discuss this important practical topic in an occasional review in which they consider the incidence, risk factors, mechanisms, and clinical manifestations. Management of antibiotic allergy is covered and desensitisation protocols are described in the online supplement at the Thorax website (www.thoraxjnl.com/supplemental).
See page 517