Background-Small cell lung cancer (SCLC) represents about 20% of primary lung tumours and the costs associated with the management of SCLC can be significant. The main objective of this study was to obtain information on current patterns of care and associated resource use and costs for patients with SCLC from initial diagnosis and treatment phase, throughout disease progression and terminal care. Methods-A 4 year retrospective patient chart analysis (1994-7) was conducted on a consecutive series of 109 patients diagnosed with SCLC in two Newcastle hospitals. For this consecutive series of patients all details about care received including tests and procedures, treatment, and medication from diagnosis till death were recorded. Pathways of care and forms were designed to enable resource use to be captured for diVerent disease phases. Unit costs were determined from a variety of sources including the Newcastle Hospitals NHS Trust Finance Department and the British National Formulary. Results-The average total cost per patient calculated for the full cohort of 109 patients was £11 556. Initial treatment was the most resource use intensive constituting 48.2% of the total cost. The major cost element throughout all disease phases was hospitalisation. Twenty eight percent of the total costs of care occur after recurrence of the disease until death, of which 73% are generated by terminal care. Conclusion-The results of this retrospective medical chart analysis show that the costs of care of SCLC are considerable, although the variability between patients in terms of the type and quantity of resource use is very high. Analyses such as this provide a useful insight into resources used in actual clinical practice. (Thorax 2001;56:785-790)

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A patient receiving carbamazepine and imipramine presented with severe bronchiolitis obliterans organizing pneumonia (BOOP). He developed progressive respiratory failure in spite of high-dose steroid treatment. Cyclophosphamide was given as adjunctive therapy, and a rapid improvement was seen. The authors suggest that an early therapeutic trial of cyclophosphamide should be considered in patients with BOOP who fail to respond to steroids.

Background -To assess the possible magnitude of differences between normal populations an epidemiological investigation ofasthma was conducted in two strongly contrasting districts of northern England -rural West Cumbria on the west coast and urban Newcastle upon Tyne on the east coast. Methods -A cross sectional survey of randomly identified men aged 20-44 years was conducted in two phases: phase 1, a postal survey of respiratory symptoms and asthma medication in 3000 men from each district; and phase 2, a clinical assessment of 300 men from each district comprising investigator administered questionnaires, skin prick tests, spirometry, and methacholine challenge tests. Results -The phase 1 (but not phase 2) study showed a small excess of "ever wheezed" in Newcastle (44% versus 40%), but neither phase showed differences between the two districts for recent wheeze or for other symptoms characteristic of asthma. There were also no differences with regard to diagnosed asthma, current asthma medication, spirometric parameters, or airways responsiveness. The prevalence of quantifiable airways responsiveness (PD20 < 6400 dg) was 27 7% in West Cumbria and 28-2% in Newcastle. Regression analyses showed that PD20 was negatively associated with atopy and positively with forced expiratory volume in one second (FEV,); that an association between PD20 and current smoking could be explained by diminished FEV,; and that PD20 was not related to geographical site of residence. Conclusions -Neither airways responsiveness nor the other parameters of diagnostic relevance to asthma varied much between the two study populations, despite the apparent environmental differences. The most obvious of these were the levels of outdoor air pollution attributable to vehicle exhaust emissions, the ambient levels of which were 2-10 fold greater in Newcastle. Our findings consequently shed some doubt over the role of such pollution in perceived recent increases in asthma prevalence. It is possible, however, that an air pollution effect in Newcastle has been balanced by asthmagenic effects of other agents in West Cumbria. (Thorax 1996;51:169-174) Keywords: asthma, epidemiology, airways responsiveness, air pollution.There is concern at present over reported increases in asthma symptoms, diagnosis, medication, sickness absence, hospital admission, and death.'-7 These apparent increases in morbidity and mortality have occurred despite advances in the understanding and management of the disease,89 and despite diminishing morbidity and mortality from other diseases amenable to effective preventive and therapeutic intervention.'0 A plausible and popular explanation is that the incidence of asthma is increasing, though trends may have been exaggerated by changes in diagnostic fashion."Migration and twin studies have shown that asthma is largely an acquired disease determined by environmental factors. 1-14 A logical step towards their elucidation is standardised investigation of populations living under different environmental conditions. Al...

Conclusions -If airways responsiveness is related to dietary sodium the relationship is not likely to be strong. (Thorax 1995;50:941-947)