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The purpose of this study was to assess the longitudinal course of pigeon breeders' disease by evaluating 24 patients with the acute form of the disease 10 years after their original diagnosis. Twenty one patients attended for clinical assessment, pulmonary function studies, chest radiography, and antibody measurement. Eighteen had continued to keep pigeons, emphasising their commitment to the hobby. Despite continued antigen exposure pigeon related symptoms had improved in most patients and only five still had troublesome symptoms. Four patients had residual abnormalities of pulmonary function or chest radiographs and three had chronic bronchitis. Fanciers had attempted to regulate their exposure to the birds by use of masks and by spending less time in their lofts but this is an unlikely explanation for the benign course of their disease, as levels of antibody to pigeon gammaglobulin remained high, suggesting that appreciable antigen exposure was still occurring. In most cases a state of equilibrium between host and antigen appeared to have developed. This observation has implications for the clinical management and understanding of the nature of the disease.

Data collected by National Cancer Institute grantees on the use of smokeless tobacco by youth are reported. Self-reports were collected from over 43,000 students from grades 4 through 11 in 16 locations in the United States and 1 location in Canada. Lifetime and recent use of smokeless tobacco are reported by location, sex, grade level, and ethnic group. Use of smokeless tobacco increased with grade level. Typically, 40 to 60% of males had tried smokeless tobacco, and in most locations, 10 to 20% of older male youths reported recent use. With the exception of Native Americans, rates of use among females were lower than those among males. Use was highest among Native Americans and lowest among blacks and Asians. Smokeless tobacco use by Hispanics was comparable to that by whites. Collectively, the data indicate that large numbers of male youths in many areas of the United States are using smokeless tobacco. In light of recent research on the health consequences of using smokeless tobacco, the health of these youth may be endangered.

In a double-blind crossover trial on forty chronic bronchitics Phyllocontin Continus tablets were shown to produce a greater improvement in objective lung function tests than Ventolin tablets. A combination of Ventolin tablets and Phyllocontin tablets were found to produce a greater effect than either drug alone. Changes in objective measurements were not paralleled by the patients' subjective opinions.

Using a radial immunodiffusion technique, the concentrations of eight serum proteins have been measured in sera from 60 chest clinic patients previously shown to have abnormally low alpha1-antitrypsin levels, and in 60 age and sex matched control sera. Of the proteins, only alpha2-macroglobulin showed a highly significant increase in the alpha1-antitrypsin deficient group. The findings confirm a previously reported association between alpha1-antitrypsin deficiency and increased alpha2-macroglobulin, and lend support to the suggestion that the rise in alpha2-macroglobulin is a specific compensatory response.

Prevalence data that are currently available indicate that smokeless tobacco use among youths in various parts of the United States is a significant and growing problem. Although relatively little is known about the factors that contribute to the initiation and maintenance of this behavior, previous research focusing on other substance use provides a valuable framework for both a study of smokeless tobacco use and the design of effective interventions for its prevention. The papers presented in this monograph address many of the gaps in our current knowledge and provide an accurate overview of research efforts in this area to date.

In a large scale clinical survey of Scottish pigeon fanciers, 277 people completed a detailed questionnaire and provided a venous blood sample. There were 29 (10.4%) who fulfilled the clinical criteria for pigeon breeders' disease used in the study and 84 (30.3%) who showed a significant serum IgG antibody response to pigeon gammaglobulin (4 micrograms/ml) and were considered to have been sensitised. Increasing exposure was associated with a progressive tendency towards sensitisation, but the intensity of the antibody response was related to the presence of symptoms and not the degree of exposure. Thirteen out of 15 subjects in the survey with a serum concentration of antipigeon IgG greater than 60 micrograms/ml fulfilled the clinical criteria for pigeon breeders' disease, and those affected within 10 years of starting the hobby had the highest mean antibody response. Accurate quantitation of antibody response is therefore helpful in the investigation of pigeon breeders' disease. The radioimmunoassay provides a quantitative method for determining antibody response that can be used in the routine screening of pigeon fanciers and in serial monitoring of their response.

Thirty extrinsic asthmatics were challenged by inhalation with Dermatophagoides pteronyssinus extract. In twenty-four an immediate reaction was observed and in sixteen this was followed by a late reaction. Those with late reactions tended to have more severe asthma but did not report greater sensitivity to housedust mite. The occurrence of a late reaction was not related to the degree of airways obstruction before challenge or to the intensity of the immediate reaction. Patients in whom the early reaction was induced by a low dose of inhaled antigen were those most likely to develop a late response. Results of histamine challenge testing suggested that this greater sensitivity of the airway might in part be due to greater non-specific bronchial reactivity.

Effects of smoking on spontaneous bilateral skin conductance were studied as a consequence of interactions with set and setting. Bilateral skin conductance was recorded in six men and six women who smoked and an equal number of nonsmokers on two different days. On the first day, spontaneous electrodermal activity was recorded before and after a 10-minute rest period during which half the smokers smoked a cigarette. On the second day, one week later, spontaneous activity was again recorded before and after a 10-minute rest period during which the remaining smokers smoked a cigarette. Nonsmokers did not smoke at any time. Following smoking there was a significant negative correlation between a preference for visual over nonvisual imagery and spontaneous skin conductance responsivity in the left as compared to the right hand. Correlations were significantly different in smokers and nonsmokers. Smokers showed significantly greater preferences for either visual or nonvisual imagery than nonsmokers. Nonresponding nonsmokers were higher on the psychoticism (P) scale of the Eysenck Personality Questionnaire (EPQ) than responding nonsmokers. Smokers scored higher on P than nonsmokers. Interactions between personality, cognitive style, and the experimental situation, set, and setting were discussed in relation to the arousing effects of nicotine.

In-flight exposure to nicotine, urinary cotinine levels, and symptom self-reports were assessed in a study of nine subjects (five passengers and four attendants) on four routine commercial flights each of approximately four hours' duration. Urine samples were collected for 72 hours following each flight. Exposures to nicotine measured during the flights using personal exposure monitors were found to be variable, with some nonsmoking areas attaining levels comparable to those in smoking sections. Attendants assigned to work in nonsmoking areas were not protected from smoke exposure. The type of aircraft ventilation was important in determining the levels of in-flight nicotine exposure. The environmental tobacco smoke levels that occurred produced measurable levels of cotinine (a major metabolite of nicotine) in the urine of passengers and attendants. Passengers who experienced the greatest smoke exposure had the highest levels of urinary cotinine. Changes in eye and nose symptoms between the beginning and end of the flights were significantly related both to nicotine exposure during the flight and to the subsequent urinary excretion of cotinine. In addition, subjects' perceptions of annoyance and smokiness in the airplane cabin were also related to in-flight nicotine exposure and urinary excretion measures.

On March 25, 1986, the Surgeon General of the Public Health Service released a report that detailed the results of the first comprehensive, indepth review of the relationship between smokeless tobacco use and health. This review, prepared under the auspices of the Surgeon General's Advisory Committee on the Health Consequences of Using Smokeless Tobacco, is summarized in this article. In the United States, smokeless tobacco is used predominantly in the forms of chewing tobacco and snuff. During the past 20 years, the production and consumption of these products have risen significantly in marked contrast to the decline in smokeless tobacco use during the first half of the century. National estimates indicate that more than 12 million persons age 12 and older in the United States used some form of smokeless tobacco in 1985, and half of these were regular users. The highest rates of smokeless tobacco use occurred among adolescent and young adult males. Examination of the relevant epidemiologic, experimental, and clinical data revealed that oral use of smokeless tobacco is a significant health risk. This behavior can cause cancer in humans, and the evidence is strongest for cancer of the oral cavity, particularly at the site of tobacco placement. Smokeless tobacco use can also lead to the development of noncancerous oral conditions, particularly, oral leukoplakias and gingival recession. Further, the levels of nicotine in the body resulting from smokeless tobacco can lead to nicotine addiction and dependence.

Titres of circulating IgG antibodies to pigeon gammaglobulin and end expired carbon monoxide concentrations were measured in 86 pigeon fanciers attending the "Show of the Year." Antibody levels were significantly higher in non-smokers and in those with end expired carbon monoxide concentrations below 10 parts per million.

Three serological tests for antibody to Micropolyspora faeni, the precipitin test (Ouchterlony double diffusion test in two dimensions) the fluorescent antibody test (double-layer technique using patient's serum in middle layer) and a quantitative radioimmunoassay for IgG antibody were applied to cases of farmer's lung syndrome and compared as to their value in diagnosis and management of these cases. Of twenty-one cases with clinical symptoms only ten (48%) had positive precipitin tests, while all (100%) showed a positive fluorescent antibody test. Sixteen (76-4%) were found by the radioimmunoassay to have antibody in excess of the normal controls. The remaining five cases with symptoms had a range of antibody levels which overlapped with those of symptom-free individuals (with sera negative to fluorescent antibody tests). The precipitin test was positive above a level of 75 mug/ml of IgG antibody as determined by the radioimmunoassay, whilst the cases judged by the fluorescent antibody test to be positive were all above a level of 35 mug/ml of IgG antibody. Application of the radioimmunoassay to a group of farmers in the West of Scotland successfully detected high antibody levels in all with clinical evidence of farmer's lung syndrome; farmers who were symptom-free also had measurable antibody. The advantages of a quantitative test for antibody levels in the management of cases of this disease are discussed.

Pigeon bloom, a waxy powder which coats the feathers of racing pigeons, has been investigated as a potential antigen in pigeon fanciers' lung. Precipitins to a soluble bloom-extract were demonstrated in fifty-nine of ninety-seven people studied at two Scottish-pigeon shows, whilst precipitins to pigeon serum were found in thirty-seven. A radioimmunoassay was developed to allow an estimation of the intensity of antibody response to this antigen in nineteen pigeon fanciers being investigated for pigeon fanciers' lung. The mean antibody level to bloom extract was significantly higher (P less than 0.05) in those with acute symptoms compared to those with less severe symptoms. Pigeon bloom is a highly antigenic material and provides an alternative to pigeon droppings as a source for the inhalant antigens regularly encountered by those keeping pigeons.

The incidence and characteristics of P1-antibodies in Scottish pigeon fanciers has been assessed. Of 223 individuals participating in the study, 23.3% were P1-negative and of these, 53.9% had detectable P1-antibodies. These antibodies were shown to belong to the IgM class and the highest serum levels were found in those pigeon fanciers with symptoms of respiratory disease who were sensitized to pigeon antigens. Of pigeon fanciers' sera, 10.3% gave false positive reactions for the Hepatitis B surface antigen in a reversed passive haemagglutination test. The reactions were most prevalent in sensitized fanciers and were shown to be directed not against the absorbed HBsAg antibody, but against the turkey red cells used as carriers in the test. No relationship was observed between the existence of P1-antibodies and false-positive hepatitis reactions. It was concluded that the inhalation of avian antigens by pigeon fanciers can induce the production of at least three distinct populations of antibodies. No evidence was obtained to imply any special role for P1-antibodies in the aetiology of pigeon fanciers' disease.

The development of elastic fibres in the upper urinary tract was studied in 31 fetuses ranging in ovulatory age from 10 to 24 weeks using special staining techniques for elastic fibres. The number, orientation and distribution of elastic fibres are described and correlated with age, ureteric level, and fetal weight. Significantly, before 10 weeks, elastic fibres were few in number, poorly developed, and randomly arranged. After 12 weeks, these fibres became more numerous at each level of the urinary tract, and were seen to develop specific orientation. The findings are described and potential clinical implications are discussed.

Chronic bronchitis is probably associated with two distinct processes, 'hypersecretory chronic bronchitis' and 'obstructive chronic bronchitis'. These, however, have common causes and typically chronic bronchitis develops as a result of several factors in conjunction. Smoking, air pollution and infection all predispose to chronic bronchitis and elimination of these hazards can slow the progress of the disease.

Skin testing with six common allergens, tuberculin and a sterile avian antigen preparation from pigeon serum was performed on 102 pigeon fanciers. The incidence of positive prick tests to common allergens was no different for subjects with extrinsic allergic alveolitis. EAA, caused by avian exposure than the whole group. Positive immediate weal and flare reactions following skin prick testing with avian antigen occurred in 22 subjects and was closely correlated with atopy. However, when the same antigen was administered intradermally, 69 subjects developed an immediate (15 min) weal and flare reaction which did not correlate with atopy, instead, the weal diameter correlated significantly with the serum IgG antibody titre against pigeon serum gamma-globulin antigen, and furthermore, the higher grades of reaction were highly selective for subjects with EAA. Ten subjects, all with strong early intradermal skin reactions, developed a late (4-6 h) skin reaction; this was again highly selective for EAA. The subjects with cutaneous anergy to tuberculin had markedly higher IgG antibody titres to avian antigens, and these included the majority of the subjects with alveolitis.

A review of surveys on smoking was undertaken by the Smoking, Tobacco, and Cancer Program of the National Cancer Institute as part of its planning for smoking control interventions. Eighteen surveys collecting smoking data were identified. The key persons associated with the surveys were interviewed according to a uniform protocol developed to obtain comparable data on the content, timeframe, population sample, methodology, availability of data, and mode of information dissemination of the surveys. Analysis indicated that the main variations among surveys occurred in the age range of the population sampled, the definition of smoking behavior, and the quantification of cigarettes smoked. Other issues of special interest compared in the surveys included type of cigarette smoked, attempts at smoking cessation, smokeless tobacco use, passive smoking, use of low tar and low nicotine cigarettes, and smoking among special populations (women, youth, Hispanics, and blacks). Two main areas of concern in planning, targeting, and evaluating timely and appropriate smoking behavior interventions are the lag between data collection and publication of survey results and the variability in the content and methodology of the surveys.

Two summer outbreaks of humidifier fever (HF) are described in a microprocessor factory (factory A) and a printing factory (factory B). The air in each factory was humidified intermittently and controlled by present humidistats operating to maintain a relative humidity of 45% by an air handler incorporating a spray humidifier in factory A and two ceiling mounted spray humidifiers in factory B. Questionnaire data from each workforce suggested that although symptoms apparently occurred most commonly in both factories on return from holiday (41/57, 71.9%), many subjects (24/40, 60%) in factory A also had intermittent symptoms of ill defined periodicity for some time before the disorder was recognised. Similar intermittent symptoms with no discernible pattern occurred in factory B in a smaller number of subjects (4/17, 23.5%), all of whom were night or rotating shift workers. Both episodes of humidifier fever after return from summer holiday developed when nocturnal air temperatures were unseasonably low; not on the day of return to work but two days later (factory A) and one day later (factory B). Symptoms were most common in most workers who had circulating serum IgG antibody measured by ELISA to humidifier sludge in factory B (14/17, 82.9%) but were most common in IgG antibody negative subjects in factory A (27/40, 67.5%). A more classic form of humidifier fever redeveloped in factory B during winter when meteorological recordings suggested that humidification of intake air was more continuous. Humidifier fever in winter may have been the major influence on the formulation of the symptom pattern thought to be relevant for recognition of the disorder. A form of the illness, however, can occur during the summer which is camouflaged by intermittent humidification when the symptoms appear to be more closely associated with cool nocturnal air intake and unrelated to the pattern of attendance at work.

Serum IgG antibody against purified avian antigens was quantified by radioimmunoassay in 507 active pigeon fanciers, of whom 110 had documented Pigeon Breeders Disease (PBD). The incidence of PBD increased from 3.7% in the antibody-negative group to 78% of those with IgG antibody greater than 30 micrograms/ml. The highest levels of antibody tended to occur in subjects with relatively short avian exposure, and a significant correlation between decreasing antibody levels and increasing years of avian contact was demonstrated, which was unrelated to age or smoking history. The antibody -positive subjects had lower daily hours of avian contact and this group which contained most of the PBD subjects demonstrated some self-regulation of antigen exposure.

Arterial hypoxia has been accepted as a potent stimulus to increased fibrinolytic activity in vivo. This study has shown that significant levels of arterial hypoxaemia induced in healthy volunteers by breathing a hypoxic gas mixture have failed to induce changes in the fibrinolytic enzyme system.

When a patient presents with wheezing, pulmonary embolism is not usually considered as a possible cause. However, undoubtedly bronchoconstriction can be caused by pulmonary emboli and occasionally wheezing may be so obvious as to suggest a diagnosis of bronchial asthma. Eleven cases are reported in which wheezing was attributable to recurrent pulmonary emboli and one in which it was a clamant feature after a single embolic incident.