American Thoracic Society Journal news tips for September (second issue)

September 17, 2002

ANTIBIOTIC USE IN MOTHER DURING PREGNANCY ASSOCIATED WITH ASTHMA IN THE CHILD

In a study of 24,690 British children, researchers found that exposure to antibiotics in the mother's womb was associated, in a dose-related manner, with an increased risk of asthma in the child. British investigators found that exposure to antibiotics and to infection in utero are potentially important risk factors in the development of allergic disease. They examined antibiotic use and the development of various infections in the mother during pregnancy. The problems included viral and bacterial infections such as those seen in the gastrointestinal and respiratory tracts. The researchers also looked at conjunctivitis, otitis media, and candida. Approximately one-third of the women were prescribed one or more courses of antibiotics during pregnancy. The authors said that the women's exposure was associated with an increased incidence of asthma, eczema, and hay fever in their children. In the group, slightly over 20 percent (5,091 children) were diagnosed with asthma or wheeze; just over 31 percent (7,758 children) were diagnosed with eczema. The study appears in the second issue for September 2002 of the American Thoracic Society's peer-reviewed American Journal of Respiratory and Critical Care Medicine.

ALASKAN RACING SLED DOGS MODEL "SKI ASTHMA"

Alaskan sled dogs who compete in the Iditarod 1,100 mile endurance race are a model for a human condition called "ski asthma," a lung disease resulting from exercise-induced airway injury and inflammation provoked by strenuous exercise in cold air, according to a study published in the second issue for September 2002 of the American Thoracic Society's peer- reviewed American Journal of Respiratory and Critical Care Medicine. The researchers studied 59 racing sled dogs 24 to 48 hours after they completed the 2000 Iditarod race. Eighty-one percent of the dogs (48 out of 59) had an abnormal accumulation of mucus or cellular debris present in their lower airways. Twenty-seven of the dogs (46 percent) were classified as moderately or severely affected. The authors said that sled dogs can sustain speeds of up to 15 miles per hour and endurance dogs can cover 120 miles per day. Racing sled dogs can expend nearly four times more weight-specific energy than do cyclists competing in the Tour de France. This process places a substantial thermal load on an animal incapable of sweating. Consequently, the dogs must rely on respiratory heat exchange to release approximately 60 percent of their heat excess, while at the same time maintaining adequate ventilation in the tiny air sacs of the lungs in order to support strenuous aerobic exercise. The authors believe that their observations provide additional support for the contention that repeated, deep, rapid breathing with cold air can injure peripheral airways. Consequently, the airway disease identified in this population of racing sled dogs makes them potentially a very useful model for "ski asthma."

NEW YORK CITY FIREMAN DIAGNOSED WITH RARE PNEUMONIA FROM "GROUND ZERO"

A 38-year-old New York City fireman, working 16-hour days looking for survivors or bodies at "ground zero" of the World Trade Center disaster, suffered a rare case of acute eosinophilic pneumonia caused by what his doctors believe was exceptionally high dust exposure. The fire- fighter's doctors reversed the course of this rare disease, which is characterized by noninfectious respiratory failure, through the use of oxygen and corticosteroid drugs. His computed tomography scan showed that he suffered from patchy ground glass density, thickened bronchial walls, and abnormal accumulation of fluid in the pleura-the delicate membrane covering the lung and the interior wall of the chest. Analysis of lung fluid identified fly ash, degraded glass, and asbestos fibers. In an editorial in the same issue, an expert points out that acute eosinophilic pneumonia is a condition recognized only in the last 15 years, and is of uncertain etiology. The expert notes that five other firefighters at the disaster site were offered the same treatment for similar complaints and recovered. However, this firefighter is the only one to have broncho-alveolar lavage that could distinguish true eosinophilic pneumonia. He points out that the analysis of dust from the World Trade Center found predominately coarse particles of cement and gypsum that were extremely alkaline, making the dust potentially very irritating to the respiratory system. On the subject of protective devices or "masks" for respiration, the expert notes that most users find the discomfort of the mask difficult to tolerate for more than brief periods. He hopes that out of this disaster will come new ways of protecting the respiratory systems of those who risk their lives to save others. The research and editorial appear in the second issue for September 2002 of the American Thoracic Society's peer-reviewed American Journal of Respiratory and Critical Care Medicine.
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For the complete text of these articles, please see the American Thoracic Society Online Web Site at http://www.atsjournals.org. For contact information or to request a complimentary journalist subscription to ATS journals online, or if you would like to add your name to the Society's twice monthly journal news mailing list (please select either postal or electronic delivery), contact Cathy Carlomagno at (212) 315-6442, or by e-mail at: ccarlomagno@thoracic.org

American Thoracic Society

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