Education And Debate

Recent Advances: Respiratory medicine

BMJ 1995; 310 doi: (Published 17 June 1995) Cite this as: BMJ 1995;310:1594
  1. R M du Bois, consultant physiciana
  1. a Royal Brompton Hospital, London SW3 6NP

    Clinical and molecular technological advances have transformed our understanding and knowledge of the complexities of respiratory disease over the past 20 years. Set against this background of rapid advances, this review will highlight some of the key recent developments during the past 12 months that are likely to influence clinical practice.


    Asthma is an important medical and social issue in the community, which will probably continue to have an impact on hospital resources throughout the 1990s. The number of admissions in England and Wales rose exponentially from just under 20000 a year in the 1960s to about 100000 in the 1980s.1 Although the rate now seems to have stabilised, no evidence exists for a decreasing trend in hospitalisation or mortality.

    Death rates continue to cause concern. Lang and Polansky reported patterns of mortality in Philadelphia and found an increase in the rate of death from asthma, from 1.68/100000 population in 1969 to 2.41/100000 in 1991.2 Contrary to common belief, this increase was not related to air pollution, measures of which showed a substantial improvement over the same period. The most important risk factors for death from asthma were being poor and being black. A second study, in contrast, found no increase in the expected number of deaths associated with asthma in residents of Rochester, Minnesota, a community in which 96% are predominantly middle class and white.3 The geographical variation in the prevalence of asthma has been too pronounced and the population increase too rapid for these to be attributable to genetic factors, suggesting that important environmental influences may be operating. Although multiple factors such as quality of health care, health education, and living conditions are likely to be important, the studies raise important questions about predisposition and causation.


    If pollution is not the cause of the increased …

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