ACUTE AND CHRONIC PULMONARY AIRWAY DISEASE IN PACIFIC ISLAND MICRONESIANS

Abstract

The populations of Mogmog and Falalop Islands of Ulithi Atoll, and of Ifaluk Atoll, In the Western Caroline Islands (481 people of all ages) were questioned and examined for the presence of asthma, chronic bronchitis, and chronic obstructive airway disease (COAD). Adults were also given spirometry tests. Seventy-five per cent of children under 5 years of age were found to have asthma, declining to an adult level of 20–30% by late adolescence, with attacks predominantly linked to periodic epidemics of upper respiratory viral infections. Although elevated eosinophil and serum IgE levels in many Individuals suggest an underlying allergic state on which viral-triggered asthma is superimposed, there was no positive correlation between asthma and ascaris infestation. Over one-third of adults, and almost one-half of adults over the age of 40, were affected by chronic bronchitis, often with an asthmatic component, and typical COAD occurred In almost one-third of the population over 50, mostly in males. Although 90% of the adult population smoked an average of one pack of cigarettes daily, respiratory disease occurred in non-smokers as frequently as in smokers. Alpha-1 antitrypsin deficiency was excluded in the finding of 100% homozygosity for the PI M allele. Infection by Mycobacterium tuberculosis is common, but active pulmonary tuberculosis, while previously a serious problem, is at present only occasionally found on these islands, and atypical mycobacterial and fungal pulmonary Infections do not appear to occur. Pulmonary airway diseases constitute the most Important causes of morbidity and mortality in this population.