Revue de l'Institut d'hygiene des mines最新文献

Treatments combining acetylcysteine by mouth and beta 2-agonists aerosols were given to 293 coal-miners or ex-coal miners suffering from chronic bronchitis presenting an acute phase of their illness and complaining of an increased sputum production. None of them related complaints nor showed objective signs of atopy. From the whole group, 41 cases carefully followed during periods of time varying from 17-26 days having taken in this period a regular treatment combining both types of drugs. This group could be compared to another group comprising 37 cases receiving only acetylcysteine. In both groups the author observed a general tendency to a better pourability after treatment than before. This resulted in an increase of the sputum production without concomitant increased cough. These facts were associated with an improvement in the auscultatory findings. It is not possible to ascertain whether these results were due to acetylcysteine alone. Indeed all patients received during different periods of time other drugs in combination, in particular antimicrobial substances. When comparing answers concerning the opinion on general respiratory improvement, there was no significant difference between both groups.

The authors compared the results of measurements of blood gases on arterialized blood taken at the earlobe and on arterial blood collected at the brachial artery. The measurements were made at rest and during exercise with the main pre-occupation of the respective feasibility and relevance of both techniques in epidemiology. Ninety-four in-patients suffering from respiratory diseases at various stages of their evolution were concerned by this investigation. The techniques of blood collection were standardized. In particular the authors took care that the blood samples were collected simultaneously at the brachial artery and at the earlobe. All blood samples were taken by the same trained experimenter. All the measurements were performed by the same experienced medical analyst. Both types of samples were compared by means of an apparatus Corning 165. As the authors also had a Corning 175 at their disposal, it was possible to investigate the importance of the factor "apparatus" in the differences which were stated. An approach of the role played by the measurement cells in these differences was possible by studying simultaneously by means of the Corning 165 a same sample of arterial blood before and after transfer in a heparinized capillary. The results suggest that the measurements on arterial and arterialized blood are concordant in in-patients at rest with the applied normalisation. During exercise, the differences are greater; nevertheless they are not large enough to reject the technics on arterialized blood in epidemiology. On the other hand the authors confirmed the observation of numerous other investigators showing that the method on arterialized blood gives on the average rise to underestimation. This might result from the technical characteristics of the measurement cells.

We have examined 272 steelworkers, aged 45 to 55 years, by means of the ECSC-questionnaire and the following lung function tests: vital capacity (VC) and forced expiratory volume in one second (FEV1), residual volume (RV) and total lung capacity (TLC); maximal expiratory flow rates (Vmax, Vmax 50, Vmax 75); specific airways conductance (SGaw); slope of the N2 alveolar plateau after oxygen inhalation (delta N2) and the bolus closing volume (CV). The influence of smoking on respiratory symptoms and lung function was confirmed. In order to assess the influence of occupational pollution a sample of 163 workers was classified according to smoking habits and workplace (either LD-steelplant and continuous casting department, or sheet rolling mill). In the nonsmokers group we found that the workers from the steelplant and continuous casting department (n = 12) had a significantly lower SGaw value (delta = 0.065 cm H2O-1 . s-1, p less than 0.01) and a significantly higher CV value (delta = 4.5% VC, p less than 0.05) than the workers from the sheet rolling mill (n = 11). Differences in FEV1/VC, Vmax 50 and Vmax 75 were not significant, but were also consistent with a slight airflow obstruction in the steelplant workers. In the smokers (n = 99) and exsmokers (n = 41) groups no differences existed between both working categories. Our results suggest that nonsmoking workers from the steelplant and the continuous casting department have undergone moderate, but detectable effects from industrial pollution. These effects are probably masked by those of tobacco in smokers and exsmokers.

We have studied the effects of respiratory physiotherapy and physical training on the cardiopulmonary function of patients with early chronic bronchitis and broncho-obstruction presumably at the beginning stages. The trained group was compared with a control group who was treated with infra-red rays on the thorax. Both groups were treated during four weeks. All patients were less than 50 years old and all were smokers. They complained of dyspnea on exertion (stage 2 ECCS), cough and expectoration for at least one year. Their spirometry and airway resistance values were normal or near normal but at least two of the following functional indices were altered in all: the He residual volume, the slope of N2 phase III and/or the He bolus phase IV. In the trained group, functional indices of central or peripheral airway obstruction did not change after the four weeks of treatment. On the contrary, the slow vital capacity (SVC) and the peak expiratory flow (PEF), which are presumably more influenced by the force of respiratory muscles, were significantly increased after respiratory rehabilitation. During steady-state exercise of moderate intensity 1.) a slight increase of pH (P less than 0.1 at a VO2 of 1.5 l/min and 1.75 l/min), perhaps due to a lessened lactacidemia, 2.) a decrease in ventilation (VE) (P less than 0.1 at a VO2 of 1.25 l/min) and 3.) a reduction in the alveolo-arterial gradient (AaDO2) (P less than 0.1 at a VO2 of 1.25 l/min) were observed. In the control group there was no change of respiratory functional indices at rest or during exercise after treatment. The reduction of AaDO2 observed in the trained group could be due to an improvement of pulmonary gas exchange. This was small, however, and probably without clinical significance. We believe that the improvement of dyspnea noted in the trained group could be due to the increase in ventilatory performance (SVC, PEF and VE) and to a better O2 extraction in the peripheral muscles.