Air Pollution Asthmatic-Bronchitis among United States Personnel in Japan

Asthmatic-bronchitis, presumably due to air pollution, has been a major cause of sickness among U.S. Forces personnel in the Tokyo-Yokohama area. The most prominent symptoms are nocturnal cough, wheezing, and shortness of breath. The disease seems to differ from typical bronchial asthma in the following ways: (1) Onset in early adult life. (2) Absence of allergy history. (3) Persistent shortness of breath between attacks. (4) Persistent abnormal pulmonary function tests between attacks. (5) Resistance to treatment early in the course of the disease. (6) No improvement of pulmonary function studies after Intermittent Positive Pressure Breathing (IPPB) using Isuprel or epinephrine. Perhaps most characteristic of this disease is the marked subsidence of symptoms when the patient leaves the Kanto Plain. Treatment has been outlined with special emphasis on bronchodilators, hydration, and liquefaction of bronchial secretions. Steroids are used in the seriously ill patient, but they do not completely relieve him of exertional dyspnea. Patients with marked shortness of breath with air flow obstruction by pulmonary function studies and with frequent occurrence of coughing and wheezing, should not be maintained on long-term steroids but should move out of the Kanto Plain. A simple test would be to have the patient go for a few days out of the Kanto Plain and see if he gets relief of his symptoms. If he does get relief, then he should consider moving. It is reasonable to assume that, with increasing industrialization in the Kanto Plain and accompanying increased air pollution, the incidence rate of this disease will increase. With increased smog in other areas of the world, it may be that this disease will be found elsewhere.