Thorax: first published as 10.1136/thx.40.9.688 on 1 September 1985. Downloaded from Thorax 1985;40:688-728 Proceedings of the British Thoracic Society The 1985 summer meeting of the British Thoracic Society was held on 3-5 July at the University of York Asthma and indoor mould exposure 95%, W 88%, T 86%, C 48%, P 36%, A 16%, N 13% plus others (panic 11%o, sputum 7%). The symptoms used to ML BURR, J MULLINS, TG MERRET, NCH STOTT MRC judge asthma were B 75%, T 70%, W 52%, C 30%, P Epidemiology Unit, Cardiff; Sully Hospital, Penarth; 30%, A 16%, N 13% plus others (loss of inhaler response RAST Allergy Unit, Benenden; Ely Surgery, 5%, fast pulse rate 4%). Some volunteered that as asthma Cardiff Asthmatics aged 15-60 years, currently receiving worsened C disappeared, others that W disappeared. Apart treatment, were identified from a register maintained by a from B at least half of other symptoms were not group practice in Cardiff. Seventy-two patients were volunteered before specified questioning. Asthma identified and may be taken to represent the spectrum of symptoms and asthma judgment are not consistent but treated asthma in the community. Each patient was highly individual. This has implications for asthma matched with a control, of the same age and sex, registered symptom scoring. Pain should be regarded as a common with the same general practitioners. Patients and controls symptom of asthma. were investigated for evidence of allergy to moulds and copyright. other allergens. Nineteen of the asthmatics (26%o) and nine of the controls (12.501o) reported visible mould on the inside walls of their homes. The commonest moulds found in the Management of asthma in schools asthmatics' houses were Penicillium (13 asthmatics), Cladosporium (12), Stemphyllium (5), and RA HILL, JR BRITTON, AE TATTERSFIELD City Hospital, Cephalosporium (4); seven other moulds were also found. Nottingham A postal questionnaire was sent to 291 Eight asthmatics and one control had a positive skin test primary and comprehensive schools in Nottingham to http://thorax.bmj.com/ reaction (weal 3 mm or more) to one of five moulds. IgE evaluate the management of asthma in schools and antibodies to common moulds were found (with RAST teachers' attitudes to the disorder and its treatment. A 90% assay) much more frequently in the asthmatics than in the response was elicited. The percentage of children known to controls, often to the same moulds that were found in the have asthma by the schools ranged from nil to 12% (mean corresponding houses. Exposure to visible indoor mould 3.5%) for primary and from 1% to 6% (2.9%) for may be a contributory factor to the disease in a proportion comprehensive schools. The main source of information of asthmatics. for schools was informal notification from parents on a child's admission, although 26% of primary schools employed a parental questionnaire and 72% of on September 25, 2021 by guest. Protected What are the symptoms of asthma and their importance? comprehensive schools used previous school records. Information was less certain when children were diagnosed CMB HIGGS, P JONES, AR TANSER, G LASZLO Chest Unit, later. Supervision rested largely with teachers in primary Royal United Hospital, Bath In outpatient studies of schools, and more often with the school nurse in asthma it is usual to record a standard set of symptoms - comprehensive schools. Children were required to hand in cough (C), wheeze (W), tightness (T), breathlessness (B) + their inhalers and to have their administration supervised in nocturnal waking (N), limitation of daily activity (A). But 66% of primary and 10% of comprehensive schools. are these the symptoms of asthma, are they what patients Children kept their inhalers at all times in 10% of primary use to judge the severity of their asthma, and does each and 53% of comprehensive schools, while the remainder symptom increase as asthma worsens? Fifty-six patients permitted selected children to hold and adminster their own with asthma (31 male), aged 18-74 years, were asked, inhalers. Only 10% of schools employed teachers with any "What symptoms do you experience with your asthma?" training about asthma or other illnesses, and this usually and "Which do you use to judge the severity of your from voluntary courses. Concern was expressed by teachers asthma?" They were then asked specifically whether they over their ignorance about asthma and its treatment, experienced and used for assessment C, W, T, B, and and 89%o of schools considered further information chest/back pain (P). The occurence of symptoms was B desirable. 688 Thorax: first published as 10.1136/thx.40.9.688 on 1 September 1985. Downloaded from Proceedings of the British Thoracic Society 689 How differently from their European colleagues do British may be interrupted at any stage for an instantaneous video chest specialists manage asthma? disc sequence to explain the rationale of a question (EXPLAIN), to revise an answer (REVIEW), or to seek P VERMEIRE, E JANSSENS, W DE BACKER, W WITTESAELE, TJH assistance with operation (HELP). The system is designed CLARK University ofAntwerp (UIA), Belgium, and Guy's not to replace a doctor but to improve his diagnostic skills Hospital Medical School, London One hundred and and awareness that symptoms of bronchial hyperreactivity thirty-three British non-paediatric chest specialists are useful clues for the initial diagnosis and subsequent participated in a survey of the diagnosis and treatment of assessment of asthma in its various forms. asthma. Their answers were compared with those of 584 "adult" specialists from 15 other European countries and with a "mean European answer," weighted for the Paradoxical vocal cord motion in asthma respective populations served by these specialists. On several issues British specialists are at the extremes of the MT NOLAN, N GIBNEY, N BRENNAN, MX FITZGERALD Medical wide range of answers. For diagnostic work up they are Professorial Department, St Vincent's Hospital, among the most frequent users of reversibility testing, daily Dublin Paradoxical vocal cord motion (PVCM) has record cards for PEFR, and trial courses of steroids; they previously been described as a benign psychosomatic also measure most frequently lung function at each visit by condition, predominantly affecting females, characterised the patient. In contrast, they are the lowest users of by appreciable inspiratory stridor frequently misdiagnosed provocation tests and specific IgE. As first line for as asthma, and responding to voice training and maintenance treatment in adults they reported the highest psychotherapy. We describe four patients with asthma who use of inhaled steroids and the lowest of oral /B agonists developed appreciable stridor during attacks and who had and theophylline. For sodium cromoglycate they are only bronchoscopic evidence of PVCM with considerable slightly below, and for inhaled / agonists slightly above, paradoxical adduction of the vocal cords on inspiration. the "mean European answer." They are, however, among Flow-volume curves revealed reduced inspiratory flow rates those using the highest doses of inhaled ,B agonists and associated with sharp inspiratory cut off in two patients. steroids, only preceded by their Scandinavian colleagues. In All four patients were female health care workers (mean age allergic asthma they are the lowest users of desensitisation. 29 (range 24-33). Evidence for coincidental asthma included For treatment of asthmatic children they had similar history of episodic wheeze and dyspnoea, a fall in mean positions in the range of responses. Sixty British percentage predicted FEV, during attacks from 76% to paediatricians, also participating in the survey, used less 40%, considerable diurnal variation in PEFR, positive skin inhaled steroids and more oral /3 agonists and theophylline prick test responses, and arterial hypoxaemia during copyright. and their doses of inhaled /3 agonists and steroids were also attacks in three patients (Pao2 8.45, 5.18, and 6.1 kPa considerably lower. The wide differences in responses respectively). Three of our patients have been poorly between European specialists should prompt more controlled despite maximum oral and inhaled comparative studies relating asthma management to bronchodilator therapy, including high dose prednisolone objective performance indicators such as mortality or (40 mg/day), have required frequent hospital admissions, and have experienced serious steroid toxicity. Upper hospital admission rates. http://thorax.bmj.com/ airways obstruction caused by PVCM appeared to contribute substantially to the severity of the attacks in our patients, but did not respond to voice training or An expert system to improve the diagnosis and treatment of psychotherapy. A permanent tracheostomy was required in asthma one patient because of refractory stridor and asthma, resulting in dramatic reduction in the frequency and ST HOLGATE, JR BROOKS, JP KEARNEY, TW HIGENBOTTOM. JE severity of attacks and eventual cessation of steroid STARK, JP DEMPSEY, RM SMITH Southampton General therapy. Thus in our experience PVCM is not a benign Hospital, Allen and Hanburys Ltd, Addenbrookes condition, particularly in patients with asthma. Cambridge, Marconi Instruments, Hospital, and on September 25, 2021 by guest. Protected Dunfirmline Enhanced non-specific bronchial reactivity is a central feature of asthma that may be quantified from the Diagnosis of acute bronchitis and asthma in general clinical history. We have applied this clinical