INTERNATIONAL UNION AGAINST TUBERCULOSIS AND LUNG-DISEASE (IUATLD) - INITIATIVES IN NONTUBERCULOUS LUNG-DISEASE

IUATLD initiatives in non-tuberculous lung disease developed in the la te 1970s, coincident with improving tuberculosis control, and have tar geted acute respiratory infections in children and chronic airways dis ease in adults and in children. The focus has been on methodology and the tools required to document the distribution and determinants of di sease, and is illustrated in data gathered in African populations. Ins truments developed include a simplified method of measuring bronchial hyper-reactivity and an asthma questionnaire Non-standard methods of q uestionnaire administration have also been validated, methods which ar e appropriate for use in the burgeoning urban communities and workforc es of sub-Saharan Africa made up of rural migrants from different trib es and language groups. In addition, a review of reference values avai lable for interpreting lung function in sub-Saharan African population s indicates a need to take into account a secular trend over the last two decades towards higher spirometric values. In the published data f rom Africa, not inconsiderable between-country differences are evident in the prevalence of chronic bronchitis in adults and of asthma in ch ildren. In addition, rates for childhood asthma were consistently high er in urban vs rural communities, with environmental factors playing a n important role as well as being locally specific. Not only does the burden of morbidity attributable to both the chronic airway diseases r eviewed justify past IUATLD initiatives in non-tuberculous lung diseas e, but it also argues that future initiatives should focus on investig ating between- and within-country differences using a standardized met hodology, with a view to identifying local environmental determinants susceptible to intervention and control. Curbing tobacco use is clearl y important, not only to benefit the health of adult smokers for whom the ill-health consequences have long been recognized, but, and more i mportant, to protect the health of children, born and unborn, with who m they share the environment.