Relationship between dyspnea, peak expiratory flow rate and wheeze in obstructive lung disease.

The relationship between dyspnea and airway obstruction is complex, and it is unclear to what extent measures of each correlate in patients with obstructive lung disease (OLD). Thus, the correlation between subjective assessment of dyspnea (dyspnea score using modified Borg scale) and objective assessment of dyspnea (peak expiratory flow rate using Mini Wright Peak Flow Meter and wheeze score using stethoscope) before and after bronchodilator (1 mg of turbutaline sulphate) were studied in 115 patients (62 males, 53 females) with OLD attending the chest clinic of Royal Irrigation Hospital, Nonthaburi, Thailand. The mean age of these patients was 47.4 +/- 16.4 years. Good correlations were found (r = 0.37 to 0.52; p < 0.001) but dyspnea scores were better correlated with wheeze scores than peak expiratory flow rates. The change in dyspnea scores after bronchodilator also correlated with the change in peak expiratory flow rates and the change in wheeze scores (r = 0.22; p < 0.02 and r = 0.28; p < 0.005 respectively). Analyzing a subgroup of 48 dyspneic patients (prebronchodilator dyspnea score of 2 or more) revealed the following response groups: those with either a bronchodilator or dyspnea response alone, both together, or neither. Twenty-three patients (47.92 per cent) responded both subjectively and objectively. One (2.08 per cent) had a bronchodilator response only. Twenty (41.66 per cent) had a dyspnea response only, while four (8.33 per cent) had neither measurable response. The present study suggests that the assessment of dyspnea by using dyspnea score is vital and may be specially helpful in a situation where the objective assessment cannot be performed. In some individuals the subjective assessment of response to bronchodilator may be at least as valuable as objective data.

Environmental surveillance of Legionella species in Thailand.

Legionellae was found in 57 per cent of 94 cooling towers and 21.8 per cent of 78 other environmental sources. These figures reveal that the existence of legionellae in cooling towers is more prevalent than that found in other environmental sources. Legionella pneumophila serogroup 1 was the most prevalent organism among the legionellae found in cooling towers and other environmental sources. The recovery of legionellae in each province was seasonally independent and was found throughout the year. This is the first report of an environmental survey representing the existence of legionellae in every region of Thailand.