We measured breathlessness and exercise tolerance in 12 patients with chronic airways obstruction, moderate or severe breathlessness, and low or normal arterial carbon dioxide tension, after the patients received dihydrocodeine, alcohol, caffeine, or placebo (through double-blind administration). Forty-five minutes after ingestion, dihydrocodeine had reduced breathlessness by 20 per cent and increased exercise tolerance by 18 per cent, with a reduction in ventilation and oxygen consumption at submaximal work loads but with no change in spirometric volumes. Oxygen also reduced breathlessness and provided additional benefit to that achieved with dihydrocodeine (at three hours after ingestion) when the two were given together: the reduction of breathlessness was 18 per cent with dihydrocodeine; 22 per cent with oxygen; and 32 per cent with dihydrocodeine plus oxygen. Alcohol increased forced vital capacity by 9 per cent, and exercise tolerance by 7 per cent. Caffeine had no deleterious effect on breathlessness or exercise tolerance, despite increasing ventilation during rest and exercise. We conclude that opiates may be valuable for the treatment of breathlessness in selected patients; further evaluation is needed, particularly of the long-term benefits and safety.

For the diagnosis of bronchial carcinoma the fibreoptic bronchoscope has a wider visual range' than the rigid bronchoscope, and gives a higher rate of positive biopsy specimens when tumour is visible2 and a greater accuracy of cell type prediction.3 But histological interpretation of individual bronchial biopsy specimens obtained through the fibreoptic bronchoscope may be difficult because they are smaller than those obtained through the rigid bronchoscope, and because they may be crushed during withdrawal through the biopsy channel of the instrument. Rudd et al3 suggested that the greater accuracy of prediction of carcinoma cell type by fibreoptic bronchial biopsies might be attributable to the fact that a larger number of biopsy samples is usually taken during fibreoptic bronchoscopy than during rigid bronchoscopy.It is generally recommended that multiple biopsy specimens should be taken during fibreoptic bronchoscopy but the optimal number for the diagnosis of carcinoma has not been defined. This study examines the relation between the number of biopsy samples taken during fibreoptic bronchoscopy and the frequency of obtaining histological evidence of carcinoma when an endobronchial lesion is seen and when the only visible abnormality is extrinsic bronchial compression.Reprints will not be available from the authors. Methods CASE SELECTIONRecords of fibreoptic bronchoscopies performed at the London Chest Hospital during 1978-81 were examined. Two hundred and fifteen cases were identified in which an endobronchial lesion thought to represent tumour was seen, and in which biopsy specimens were taken from the tumour. In all 215 cases the bronchoscopic appearances were of fleshy tumour or raised mucosal nodules. A further 56 cases were identified in which the only visible abnormality was extrinsic bronchial compression and in which bronchial biopsy specimens were taken from the site of compression.

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Thirty two patients with asbestosis were assessed by means of bronchoalveolar lavage (27 patients) and the half time clearance from lungs to blood (T1/2LB) of an inhaled aerosol of diethylenetriamine pentacetate (DTPA) labelled with technetium 99m (32 patients). T1/2LB was also measured in 20 non-smoking normal individuals and 17 smokers without a history of exposure to asbestos. Thirteen patients (46%) showed an increase in the percentage of neutrophils with or without an increase in the percentage of eosinophils and eight (29%) showed an increased percentage of lymphocytes. The number of neutrophils plus eosinophils expressed as a percentage of the total count was positively correlated with the length of the history of disease (r = 0.53, p < 0.025) and greater percentages were associated with more severe impairment of lung function. Smokers had lower percentages of lymphocytes than non-smokers (p < 0.002) and showed increased proportions of neutrophils and eosinophils more often than non-smokers (p < 0.05). In 18 non-smokers with asbestosis the mean T1/2LB was 33.8 (range 10.0-62.0) minutes, significantly less than 57.2 (30.5-109) minutes in 20 non-smoking normal subjects (p < 0.002). In nonsmokers shorter T1/2 LB correlated with a longer time since first exposure to asbestos (r = -0.65, p < 0.005), longer duration of exposure (r = -0.70, p < 0.001), and a shorter time since last exposure (r = 0.59, p < 0.01). Shorter T1/2LB was also associated with increased inflammatory activity as shown by higher bronchoalveolar lavage cell counts (r = -0.53, p < 0.025) and higher combined percentages of neutrophils, eosinophils, and lymphocytes (r = -0.47, p < 0.05). The