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Biomedical subjects

N S Zhong

Publications and source records attributed to N S Zhong.

At least 19 recordsLinked to original sources
PubMed2006

Increasing COPD awareness.

Early diagnosis and smoking cessation are the only available methods to stop the progression of chronic obstructive pulmonary disease (COPD). The aim of this study was to evaluate the effects of early detection of airflow limitation (AL) in a population with high risk for COPD, using spirometric screening. Smokers aged 40 yrs with a smoking history of 10 pack-yrs were invited to visit a local outpatient chest clinic for simple spirometry (forced expiratory volume in one second (FEV1) and forced vital capacity (FVC)). Smoking history was recorded, followed by smoking cessation advice relating the results of spirometry to the smoking behaviour. Subjects who did not fulfil the above criteria (younger and/or nonsmokers) were also screened. A total 110,355 subjects were investigated; they were aged 53.5+/-11.5 yrs and 58.2% were males. Of the total amount of subjects, 64% were current smokers, 25.1% were former smokers and 10.9% were lifelong nonsmokers. Spirometry tests were within normal values for 70.3%, and 20.3% showed signs of AL: this was mild in 7.6%, moderate in 6.7% and severe in 5.9%. The remaining 8.3% of subjects presented with a restrictive pattern of ventilatory impairment. Airflow limitation was found in 23% of smokers aged 40 yrs with a history of 10 pack-yrs. This study concluded that large-scale voluntary spirometry screening of the population with high risk for COPD detects a large number of subjects with AL.

Adult↗
PubMed2005

Wheezing in Chinese schoolchildren: disease severity distribution and management practices, a community-based study in Hong Kong and Guangzhou.

BACKGROUND: Asthma is a common chronic disease and information on its management practices at the community level is helpful in identifying problems and improving asthma care. OBJECTIVE: To assess the severity status and management of the asthma symptom of wheeze of children at the community level in Hong Kong (HK) and Guangzhou (GZ). METHODS: Cross-sectional study of children aged 10 years using the International Study of Asthma and Allergic disease in Childhood (ISAAC Phase II protocol). Asthma management and lung function were assessed in 178 (98 from HK and 80 from GZ) randomly selected children with wheeze over the past 12 months. RESULTS: Eighty-three percent, 11%, 6% and 0% of children suffered from intermittent, mild persistent, moderate persistent and severe persistent asthma, respectively, according to the frequency of their symptoms. Addition of spirometric parameter only changed the asthma severity classification in 2.8% of children. Medications were used by 30.6% and 71.3% of children for wheeze in HK and GZ, respectively. In HK, inhaled beta(2)-agonist (73.3% among the drug users) was the commonest medication used followed by inhaled corticosteroid (ICS) (23.3%). In GZ, inhaled beta(2)-agonist was used by 75.4% of children, but use of ICS (26.3%), oral beta(2)-agonist (26.3%), oral theophylline (45.6%), oral ketotifen (36.8%) and oral steroid (35.1%) were also common. ICS was only used by 11.4% of children with persistent asthma. Ten percent and 18.7% of children in HK and GZ, respectively, had emergency department visits, while 16.3% and 11.6% of children in HK and GZ, respectively, had missed school secondary to asthma over the past 1 year. CONCLUSIONS: Most children in the community had intermittent asthma and addition of lung function to symptoms did not significantly affect classification of asthma severity. Significant morbidity was seen even in this group of children with mostly intermittent and mild persistent asthma.

Administration, Inhalation↗
PubMed2004

Pentaglobin in steroid-resistant severe acute respiratory syndrome.

SETTING: The treatment of severe acute respiratory syndrome (SARS) is at best controversial, although there is considerable anecdotal experience to show the benefits of corticosteroid therapy for selected patients. Some patients deteriorate relentlessly despite treatment with antibiotic, corticosteroid and mechanical ventilation. OBJECTIVE: To attempt to determine the clinical efficacy of pentaglobin, an IgM-enriched immunoglobulin preparation, on 12 severe SARS patients who continued to deteriorate despite corticosteroid and ribavirin therapy. DESIGN: Retrospective analysis of daily quantitative and radiographic data on the cohort in a regional teaching hospital. RESULTS AND CONCLUSION: There was significant improvement in radiographic scores, when compared with day 1, on days 5, 6 and 7 (P < 0.05) after commencement of pentaglobin treatment. Similarly, there was significant improvement in oxygen requirement, when compared with day 1, on days 6 and 7 (P < 0.05) after commencement of pentaglobin treatment. There were no reported adverse events attributable to pentaglobin administration. Ten patients made an uneventful recovery after treatment. One elderly man died from cardiorespiratory arrest despite clinical and radiological improvement, and another patient is making good progress. Pentaglobin is safe and probably effective in the treatment of steroid-resistant SARS. A double-blind placebo-controlled study should therefore be considered.

Adrenal Cortex Hormones↗
PubMed2003

Epidemiology and cause of severe acute respiratory syndrome (SARS) in Guangdong, People's Republic of China, in February, 2003.

BACKGROUND: An epidemic of severe acute respiratory syndrome (SARS) has been associated with an outbreak of atypical pneumonia originating in Guangdong Province, People's Republic of China. We aimed to identify the causative agent in the Guangdong outbreak and describe the emergence and spread of the disease within the province. METHODS: We analysed epidemiological information and collected serum and nasopharyngeal aspirates from patients with SARS in Guangdong in mid-February, 2003. We did virus isolation, serological tests, and molecular assays to identify the causative agent. FINDINGS: SARS had been circulating in other cities of Guangdong Province for about 2 months before causing a major outbreak in Guangzhou, the province's capital. A novel coronavirus, SARS coronavirus (CoV), was isolated from specimens from three patients with SARS. Viral antigens were also directly detected in nasopharyngeal aspirates from these patients. 48 of 55 (87%) patients had antibodies to SARS CoV in their convalescent sera. Genetic analysis showed that the SARS CoV isolates from Guangzhou shared the same origin with those in other countries, and had a phylogenetic pathway that matched the spread of SARS to the other parts of the world. INTERPRETATION: SARS CoV is the infectious agent responsible for the epidemic outbreak of SARS in Guangdong. The virus isolated from patients in Guangdong is the prototype of the SARS CoV in other regions and countries.

China↗
PubMed2003

Overview on SARS in Asia and the world.

Severe Acute Respiratory Syndrome (SARS) is the first major novel infectious disease to hit the international community in the 21st century. It originated in southern China in November 2002, reached Hong Kong in February 2003 and spread rapidly thereafter to 29 countries/regions on five continents. At the end of the epidemic, the global cumulative total was 8098 with 774 deaths. Seven Asian countries/regions were among the top ten on the list. Mainland China and Hong Kong, SAR, accounted for 87% of all cases and 84% of all deaths. Severe acute respiratory syndrome is caused by a novel coronavirus. It has alarmed the world with its infectivity and significant morbidity and mortality, its lack of a rapid, reliable diagnostic test and lack of effective specific treatment and vaccination. The adverse impact on travel and business around the world, particularly in Asia, has been enormous. Some lessons learnt from this epidemic included: (1) any outbreak of infectious disease can rapidly spread around the world by air travel; (2) early reporting of the outbreak to neighbouring countries/regions and the World Health Organization is essential to prevent international spread; and (3) infection control, tracing and quarantine of contacts are essential to control the epidemic. Many questions remain unanswered, including the origin and pathogenesis of the novel coronavirus, the natural history and the best specific treatment of the disease. The SARS-CoV has probably jumped from an animal host to humans. There is an urgent need to evaluate the human-animal habitat in southern China and to remove animal reservoirs if found.

China↗
PubMed2002

Individual allergens as risk factors for asthma and bronchial hyperresponsiveness in Chinese children.

The role of allergen sensitization in the development of asthma in the Chinese is not clear. This study aims to determine the relationship of sensitization to individual allergens, and the development of asthma and bronchial hyperresponsiveness (BHR) in schoolchildren from three Chinese cities: Hong Kong, Beijing and Guangzhou. Community-based random samples of 10-yr-old schoolchildren from three Chinese cities were recruited for study using the International Study of Asthma and Allergies in Childhood (ISAAC) Phase II protocol. Subjects were studied by parental questionnaires (n=10,902), skin-prick tests (n=3,479), and methacholine challenge tests (n=608). The prevalence rates of wheeze in the past 12 months (Hong Kong, 5.8%; Beijing, 3.8%; Guangzhou, 3.4%) and atopy (Hong Kong, 41.2%; Beijing, 23.9%; Guangzhou, 30.8%) were highest in schoolchildren from Hong Kong. Multivariate logistic regression analyses revealed that sensitization to Dermatophagoides pteronyssinus (odds ratio (OR)=4.48; 95% confidence interval (CI): 3.02-6.66), cat (2.59; 1.67-4.03), Dermatophagoides farinae (2.41; 1.65-3.51) and mixed grass pollen (2.85; 1.24-6.50) were significantly associated with current wheeze. Atopy, defined as having > or = 1 positive skin-prick tests, was not an independent risk factor for current wheeze in children from any of the three cities. Furthermore, atopy (OR=2.53; 95% CI: 1.07-5.97), sensitization to cat (3.01; 1.39-6.52) and D. farinae (3.67; 1.93-6.97) were significantly associated with BHR. The authors confirmed that sensitization to house dust mite and cat was significantly associated with current wheeze and bronchial hyperresponsiveness in Chinese schoolchildren. However, the difference in the prevalence rate of atopic sensitization cannot explain the higher prevalence of childhood asthma in Hong Kong, when compared with those children from Beijing and Guangzhou.

Allergens↗
PubMed2001

Prevalence of respiratory and atopic disorders in Chinese schoolchildren.

BACKGROUND: Epidemiological surveys have shown that the prevalence of asthma in the Asian population is relatively low. Within the Chinese population, schoolchildren from Hong Kong were found to have the highest rate of asthma. OBJECTIVE: To compare the prevalence of respiratory and atopic disorders, and to assess the role of atopy in the development of asthma, in Chinese schoolchildren from Hong Kong, Beijing and Guangzhou. METHODS: Community-based random samples of schoolchildren aged 9-11 years from three Chinese cities (Hong Kong, Beijing and Guangzhou) were recruited for study using the International Study of Asthma and Allergies in Childhood (ISAAC) Phase II protocol. Subjects were studied by parental questionnaires (n = 10902), skin-prick tests (n = 3479) and skin examination (n = 3479). RESULTS: The prevalence rates of current wheeze, speech limiting wheeze, rhinoconjunctivitis and flexural dermatitis were significantly more common in Hong Kong than in Beijing or Guangzhou. The atopy rate was also higher in Hong Kong (41.2%) than in Beijing (23.9%) or Guangzhou (30.8%). Atopy was strongly correlated with current wheeze (OR 7.74; 95% CI = 5.70-10.51). Subgroup analyses of children from Hong Kong revealed that children born in mainland China who had subsequently migrated to Hong Kong had a significantly lower rate of allergic symptoms and atopy than those children born in Hong Kong. CONCLUSION: Using a standardized written questionnaire along with a skin prick test and skin examination, we confirmed that the prevalence of asthma, allergic diseases and atopy was highest in schoolchildren from Hong Kong. Atopic sensitization is an important factor associated with asthma in Chinese children.

Asian People↗
PubMed1999

Mechanisms of bronchial hyperresponsiveness: the interaction of endothelin-1 and other cytokines.

Bronchial hyperresponsiveness (BHR) is a fundamental characteristic of asthma and has become part of a more recent definition of asthma. Data show a close link between bronchial hyperresponsiveness (both transient and persistent) and airway inflammation. Airway inflammation is orchestrated by a complex network of cytokines. It has been considered that endothelin-1 is involved in bronchoconstriction and airway structural remodelling and has several pro-inflammatory properties of potential relevance to asthma. We focus on endothelin-1, its activities and interaction with other cytokines in the pathogenesis of asthma.

Airway Resistance↗
PubMed1997

The interaction of tumour necrosis factor alpha and endothelin-1 in pathogenetic models of asthma.

BACKGROUND: There is evidence that tumour necrosis factor alpha (TNF alpha) may be an important mediator in initiating asthmatic airway inflammation. It has been proposed that endothelin-1 (ET-1) is involved in bronchoconstriction and airway remodelling in asthma. It is not known, however, if there is any interaction between TNF alpha and ET in perpetuating airway inflammation in asthma. OBJECTIVE: The present study aimed to determine the activities of ET-1 and TNF alpha in ovalbumin-sensitized guinea pigs and their roles in the development of airway inflammation. METHOD: Twelve guinea pigs were sensitized by ovalbumin injection and aerosol inhalation. ET-1 levels were measured in both bronchoalveolar lavage fluid (BALF) and plasma by 125-labelled endothelin-1 (ET-1) radioimmunoassay. The TNF alpha activity released from alveolar macrophage (AM) in BALF was estimated by ELISA. Cultured bovine airway smooth muscle cells (BASMCs) were treated with TNF alpha (1000 units/5 x 10(4) cells) for different times. ET-1 levels in harvested medium from these cells were measured by radioimmunoassay. Cultured human fetal lung fibroblasts (HFLFs) were incubated with ET-1 (10(-8) approximately 10(-6)M), then 3HTdR incorporation to these cells and cell counting were performed. The effects of ET-1 stimulation on the granulocyte macrophage colony stimulating factor (GM-CSF) gene expression in HFLFs were estimated by using RT-PCR method. RESULTS: ET-1 levels in both plasma and BALF were significantly higher in ovalbumin-sensitized guinea-pigs compared with those in controls (422.27 +/- 175.0 pg/mL vs 277.311 +/- 88.0 pg/mL, P < 0.05, 81.22 +/- 16.15 vs 49.81 +/- 12.64 pg/mL, P < 0.05) while TNF alpha activity was also significantly increased in the OVA-sensitized group compared with that in the control group (6010 +/- 1900 pg/mL vs 2810 +/- 450 pg/mL, P < 0.05). The ET-1 level in harvested medium of BASMCs rose significantly in 12 h in the TNF-alpha treated group (from < 5 pg/mL to 53.72 +/- 14.3 pg/mL, P < 0.001), and remained at a similar level for 24 h in the TNF alpha treated group. It was shown that ET-1 not only stimulated cell proliferation but also induced GM-CSF mRNA expression in HFLFs. CONCLUSION: ET-1 levels in both plasma and BALF and TNF alpha release from macrophage are increased significantly in ovalbumin-sensitized guinea-pigs. TNF alpha stimulates ET-1 secretion from cultured BASMCsw; ET-1 accelerates cell proliferation and induces GM-CSF mRNA expression in the human fetal lung fibroblast.

Administration, Inhalation↗
PubMed1996

New insights into risk factors of asthma.

The prevalences of bronchial asthma in the Asia-Pacific region range from 0 to 24% and appear to be increasing in some countries. The increased prevalence of asthma may be related to the urbanization of these countries or areas. Risk factors relating to the development of asthma are multiple and complex. These include: Predisposing or genetic factors: (atopy and bronchial hyperresponsiveness; BHR) that increase an individuals susceptibility. Longitudinal studies in children have shown that BHR precedes asthma in some individuals. A gene governing BHR is located near a major locus that regulates serum IgE levels on chromosome 5 q. An additional gene that determines the specificity of the immune response located in the human leukocyte antigen complex (HLA) may govern the specificity of the immune response to common aeroallengens in some individuals. Causal Factors: inhaled allergens are the most important causal factors of asthma, which include indoor allergens (domestic mites, animal, cockroach and fungus allergens), domestic mites being the most common potential allergen, and outdoor allergens (pollens from trees, grasses and weeds). Owing to the geographic location and different sensitivity to allergen between races, allergens vary from area to area. Certain drugs, food and food additives are also the cause of asthma attack. Contributing factors: smoking is an important trigger and a serious problem in most Asian-Pacific countries. Air pollution in particular sulfur dioxide (SO2), nitrogen dioxide (NO2) and respirating particles are common contributing factors. Very low concentration of SO2 (0.5 ppm) can cause bronhospasm in asthmatics. A combination of low concentration of SO2 and NO2 often encountered in heavy traffic further enhances the airway responsiveness to inhaled allergen. In addition, respiratory virus infection is closely associated to the development of asthma in childhood.

Air Pollution↗
PubMed1994

[Effects of hypoxia-induced endothelin release on the proliferation of pulmonary artery smooth muscle cells].

On the Co-culture model of pulmonary arterial endothelial cells (PECs) and smooth muscle cells (PSMCs), we studied the effects of hypoxia on the release of endothelin in cultured PECs and whether or not these effects could trigger the proliferation in PSMCs. Increase of the transcription of ET gene in cultured pulmonary arterial endothelial cells was shown when endothelial cells were exposed to hypoxia for 24h (95% N2 + 5% CO2, PO2 40-45mmHg in media), was showed to increase the transcription of ET gene in cultured pulmonary arterial endothelial cells by using situ hybridization method. The secretion of ET-1 from those cells into media by ET-1 radioimmunologic detection while 3HTdr incorporation in cultured PMCs was higher compared with normoxia, and administration of ETAb significantly reduced the increase of the incorporation in those compared with hypoxia alone. These results showed that exposure to hypoxia can promote ET-1 gene expression in PECs as well as release of ET from those cells, which of ET can stimulate DNA synthesis in cultured PMCs. It is suggested that enhanced ET release from PECs under hypoxia could stimulate PSMCs' proliferation which may induce pulmonary vessel remodeling--which may involve in the development of hypoxic pulmonary hypertension.

Animals↗
PubMed1994

[Short-term energy and protein support in mechanically ventilated patients with acute exacerbation of cor pulmonale].

Twenty-one mechanically ventilated patients with acute exacerbation of cor pulmonale had received home made "Nutritient" via nasal gastric tube as energy and protein support for four weeks (energy supplement 37-45 kcal.kg-1.d-1, protein 1.40-1.67 g.kg-1.d-1). Anthropometry, serum albumin, serum prealbumin were measured on the 1st day and at the end of the 1st, 2nd, 4th week of ventilation. The results were compared with those in 15 age-matched ventilated patients who received routine hospital nasal gastric feeding (energy 24-29 kcal.kg-1.d-1, protein: 0.92-1.09 g.kg-1.d-1). All patients were in protein deficient type malnutrition. At the end of the 1st week of ventilation, serum albumin dropped significantly in both groups, resulting in a status of mixed type malnutrition. At the end of the 2nd week, however, serum prealbumin in the experimental group (24.31 +/- 4.80 mg/dl) returned nearly to normal level, being significantly higher than that in the control group (15.10 +/- 3.10 mg/dl, P < 0.01). At the end of the 4th week, both serum albumin (3.90 +/- 0.31 g/dl) and prealbumin (27.33 +/- 3.30 mg/dl) in experimental group returned to normal, being also significantly higher than those in the control group (3.00 +/- 0.23 g/dl, P < 0.05; 17.11 +/- 3.22 mg/dl, P < 0.01). Anthropometry showed no significant change between the two groups during ventilation. It is shown that nasal tube administration of "Nutritient" provides much higher energy and protein as compared with routine nasal feeding, and enables the patient to overcome protein deficiency and to reach positive nitrogen balance earlier.

Aged↗
PubMed1993

[Histamine release from mast cell induced by main pathogenic bacteria of respiratory infections in Guangzhou area].

The methodology for isolating rat peritoneal mast cell was established. The main pathogenic bacterial ultrasonicates of respiratory infection in GuangZhou area have been examined for their ability to release histamine from purified rat peritoneal mast cells. The results were as following: (1) 7 pathogenic bacteria can cause direct release of histamine from rat mast cells. The most effective histamine releasers were P. mira (histamine release percent is 26.89% +/- 6.70%), Strep. Pneu (24.16% +/- 3.71%), E. Coli (20.40% +/- 4.83%) and K. Pneu (17.91% +/- 4.60%). (2) Histamine release initiated by bacterial ultrasonicates was completed within 30 minutes E. Coli differed from K. Pneu induced histamine release was independent of its dose. (3) The products of K. Pneu did not induce histamine release directly and bacterial hemolysin may play a potent role in bacteria-induced release of histamine. Our findings provide some evidence for mechanism by which respiratory bacterial infection can precipitate or exacerbate attacks of bronchial asthma.

Animals↗
PubMed1992

Is asymptomatic bronchial hyperresponsiveness an indication of potential asthma? A two-year follow-up of young students with bronchial hyperresponsiveness.

To determine the possibility that asymptomatic bronchial hyperresponsiveness (BHR) develops into symptomatic asthma, a two-year follow-up study was conducted in 81 students (48 male, 33 female; 11 to 17 years) who were found to have BHR in a 3,067 population survey (BHR group). Eighty-eight age-matched students (48 male, 40 female) with normal bronchial responsiveness served as control subjects. Daily symptom cards were recorded. Peak expiratory flow rate was measured for 24 h when symptoms occurred. Histamine inhalation tests were performed at the beginning of the study and at the end of the first and the second year. In the BHR group, 58 students remained bronchial hyperresponsive at the end of follow-up. Nine of 31 students with initially diagnosed bronchial asthma had their symptoms relieved entirely, but ten asymptomatic students developed asthma. The incidence of newly diagnosed asthma (12.5 percent in the BHR group or 20 percent in the asymptomatic BHR group) and the total percentage of diagnosed asthma (39.5 percent) in the BHR group were significantly higher than those (2.27 percent, 2.27 percent) in the control group. FVC and FEV1 showed no significant difference between two groups. PD20 FEV1 values in newly diagnosed asthmatics were significantly lower than those in asymptomatic students both at the beginning (3.05 +/- 1.56 mumol vs 6.14 +/- 1.60 mumol, p < 0.05) or the end (3.47 +/- 1.73 mumol vs 6.55 +/- 1.51 mumol, p < 0.05). The percentage of early respiratory illness was significantly higher in those with newly diagnosed asthma (80 percent) than in asymptomatic students (22.3 percent), but atopic index and the percentage of parental asthma showed no difference between two groups. In nine asthmatics whose symptoms were relieved entirely in the two-year follow-up, PD20 FEV1 was undetectable within the cumulative dose of 7.8 mumol of histamine in three students and rose from 4.58 +/- 1.85 mumol to 7.62 +/- 1.02 mumol in the remaining six. The higher the BHR, the more likely the students developed asthma. About 45 percent of asymptomatic students with PD20 < or = 3.2 mumol developed asthma in the following two years and 80 percent of them had a history of early respiratory illness, suggesting that they may have subclinical or potential asthma.

Adolescent↗
PubMed1991

[Suppression of pituitary-adrenal axis by triamcinolone acetonide in asthmatics].

To assess the inhibitory effect of triamcinolone acetonide on pituitary-adrenal axis, we measured plasma cortisol, plasma ACTH and performed short ACTH stimulation test before and after injection of 40 mg of triamcinolone acetonide intramuscularly in 34 asthmatic patients. At the same time salivary cortisol levels had been followed up for four weeks in ten of the 34 patients. Maximum adrenal suppression was found in two to three days after the administration. The suppression rates of salivary cortisol, plasma cortisol, plasma ACTH and ACTH stimulation test were 81.5%, 53.2%, 70% and 45.6% respectively. Such suppression lasted for two weeks. Afterwards the secretion of pituitary and adrenal glands recovered gradually. The secretion of plasma ACTH and salivary cortisol returned to normal in four weeks and that of plasma cortisol in five weeks. Triamcinolone acetonide, 40 mg monthly, is comparable with prednisone 10 mg daily, or oral dexamethasone 0.75 mg daily. The inhibitory effect of the steroids on pituitary-adrenal axis was in the order of dexamethasone, triamcinolone acetonide and prednisone.

Adolescent↗
PubMed1990

Bronchial hyperresponsiveness in young students of southern China: relation to respiratory symptoms, diagnosed asthma, and risk factors.

A cross sectional study was carried out to determine the prevalence of bronchial hyperresponsiveness and asthma in 3067 students aged 11-17 years in an urban and a rural area of Guangzhou (Canton), China. The methods used included a self administered questionnaire, a histamine bronchial provocation test, and allergen skinprick tests. Bronchial hyperresponsiveness was defined as a 20% fall in FEV1 and peak expiratory flow at a provoking dose of histamine (PD20) less than 7.8 mumol on two occasions four weeks apart. The response rate was 98.0% and 99.2% in the two areas. The prevalence of bronchial hyperresponsiveness was 4.1% and of diagnosed asthma 2.4% in the total population. There were no significant differences in prevalence between the urban and the rural area or between boys and girls. The 11-12 year group had a higher prevalence of bronchial hyperresponsiveness (7.6%) than the older groups. Of the 125 with bronchial hyperresponsiveness, 12.0% were defined as having severe or moderate (PD20 less than 0.8 mumol), 26% mild (0.9-3.2 mumol), and 62% slight bronchial hyperresponsiveness (3.3-7.8 mumol). The severity of bronchial hyperresponsiveness was closely related to diagnosed asthma, wheezing, and cough, though half the students with bronchial hyperresponsiveness were symptom free. The most common allergens were house dust and house dust mite in the city, and hay dust, pollen, and feathers in the rural area. The odds ratios for having respectively slight, mild or moderate, and severe bronchial hyperresponsiveness were 5.9, 21.0, and 30.4 for atopy; 1.9, 1.9, and 7.3 for early respiratory infection; and 3.1, 2.5, and 5.6 for a history of parental asthma.

Adolescent↗