Whatever the reason for this excess of chronic bronchitis among the "droopers"-more prolonged and concentrated tobacco smoke exposure or differing proportions of "sidestream" and "mainstream" smoke-there seems little doubt that it is a dangerous method of smoking cigarettes involving greater risk of developing chronic bronchitis and, on the evidence of Brett and Benjamin (1968), of increased mortality from lung cancer than is the normal method.I wish to thank Professor M. R. Alderson, formerly Director of the Regional Cancer Registration Bureau, who helped plan the investigation, and the Manchester Regional Hospital Board who allowed the staff of the Ma.f Radiography Service to obtain the histories and the computer section to process the information. I am particularly grateful for the care and attention to detail given by the staffs of these departments.

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We have studied the serial changes in arterial blood gases in fourteen patients with acute severe asthma, all of whom received a standard therapeutic regime and had similar measurements made at identical time intervals under standard conditions. Hypoxaemia on admission was a constant finding, and the arterial oxygen tension often took a week or longer to return to a normal level. Treatment with 60% inspired oxygen provided a safe means of relieving hypoxaemia, provided that blood gases were measured before and during oxygen therapy. Most patients had a normal arterial carbon dioxide tension, which indicated the severity of their illness. Acid-base disturbances, when present, were mild and needed no specific treatment. Age, duration of the acute attack, and severity of airways obstruction were all unrelated to the changes in blood gas tension, and pulse rate was found to be a poor predictor of hypoxaemia in elderly asthmatics. Serial measurements of the arterial blood gases should be made in all patients with acute severe asthma.

A cohort of I 9 consecutive asthma patients, stable prior to admission, were investigated in the 'clean' atmosphere of the Airedale Allergy Centre, starting with a therapeutic fast. The peak expiratory flow rate (PEF)fell initially, whether medication had been reduced or not (withdrawal), but by about the sixth day most patients were symptom-fiee on less medication; by the last week of admission the reduction in medication was very highly significant (p < 0.0005). All patients gave positive wheals on intradermal injection of inhalant allergens (4 prick-test negative). Bronchoconstriction was provoked by open food challenge in 18 patients, and by sublingual challenge with chemicals in ten patients.The implications of the findings were discussed with the patients at each stage of the investigation. They were discharged on 'vaccines' containing their Miller endpoints f I]for prophylaxis, and an individually designed rotation diet (including most trigger foods), and advised how to reduce exposure to relevant inhalants and chemicals. At follow-up >6 months after discharge, patients had more control over their asthma: 13/19 (68%) claimed to be at least 'definitely better': 5 'well' or 'almost well'. Symptoms were significantly reduced, and medication was lower at follow-up than on admission (p

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