Enforced mouth breathing decreases lung function in mild asthmatics

Background and objective: Nasal breathing provides a protective influence against exercise‐induced asthma. We hypothesized that enforced oral breathing in resting mild asthmatic subjects may lead to a reduction in lung function. Methods: Asymptomatic resting mild asthmatic volunteers (n = 8) were instructed to breathe either nasally only (N; tape over lips) or orally only (O; nose clip) for 1 h each, on separate days. Lung function (% predicted FEV₁) was measured using standard spirometry at baseline and every 10 min for 1 h. ‘Difficulty in breathing’ was rated using a Borg scale at the conclusion of the N and O periods. Results: Baseline FEV₁ on the N (101.2 ± 3.8% predicted) and O (102.7 ± 3.9% predicted) days was not significantly different (P > 0.3). At 60 min, FEV₁ on the O day (96.5 ± 4.1% predicted) was significantly less than on the N day (101.0 ± 3.5% predicted; P < 0.009). On the N day, FEV₁ did not change with time (P > 0.3), whereas on the O day, FEV₁ fell progressively (slope = ?0.06 ± 0.01% FEV₁/min, P < 0.0001; linear mixed effects modelling). Three subjects experienced coughing/wheezing at the end of the O day but none experienced symptoms at the end of the N day. Subjects perceived more ‘difficulty breathing in’ at the end of the O day (1.5 ± 0.4 arbitrary units) than on the N day (0.4 ± 0.3 arbitrary unit; P < 0.05). Conclusions: Enforced oral breathing causes a decrease in lung function in mild asthmatic subjects at rest, initiating asthma symptoms in some. Oral breathing may play a role in the pathogenesis of acute asthma exacerbations.     

Osteoporosis in Sweden

Sweden has one of the highest incidences of hip fractures in the world and we have started to consider osteoporosis as an important disease. We have created guidelines for BMD measurements and the recommendations for treatment are based on risk assessment. New guidelines for treatment with drugs will soon be developed by the Swedish FDA.     

Infant botulism was confirmed in Ehime Prefecture

The third case of infant botulism in Japan is reported. A four-month-old baby boy suddenly had weakness of suckling force, constipation and generalized hypotonicity. He was the product of normal gestation, labor and delivery. Growth and development were normal until he was nineteen weeks old. He received fruit-juice and honey daily. By bacteriological examination, Clostridium botulism type A was isolated from his feces and the honey which he had received. Type A toxin was detected from his feces but not from his serum.     

Cryptosporidiosis in southern Sweden

Two different groups of patients with diarrhoea, altogether 1,478 individuals, were examined for cryptosporidium oocysts. The technique used was feces concentration and staining according to a modified Ziehl-Neelsen method. 20 cases of cryptosporidiosis (3%) were found among 698 consecutive patients with acute gastroenteritis. In feces samples sent for parasitological examination from 780 patients, cryptosporidia were found on 9 occasions (1%). None of 519 healthy persons excreted cryptosporidia. 19/29 patients with cryptosporidiosis had recently been abroad and in 8 of these additional enteric pathogens were found. The median duration of diarrhoea was 14 days. All patients except 1 were cryptosporidia-negative in faeces within 2 months. An immunosuppressed patient excreted cryptosporidia for 14 months.     

Pathologically confirmed malignant syphilis in an HIV-infected patient

We report a case of pathologically confirmed malignant syphilis in an HIV-infected patient. Physical examinations revealed ulceronecrotic skin lesions. Skin biopsies demonstrated syphilis spirochetes on immunohistochemical stain, and syphilis serological titers were positive. Treatment with intravenous penicillin G was begun, and complete resolution of the skin lesions was observed. A rapid plasma reagin titer test performed 3 months after treatment revealed a 4-fold reduction in the titer, indicating successful treatment.