Etiology of Non-specific Chronic Respiratory Illness and Cor Pulmonale in Bosnia and Hercegovina

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Abstract
Žarkovic, G. (Professor of Preventive Medicine, Medical School, University of Sarajevo, Mose Pijade 6, Sarajevo, Yugoslavia). Etiology of non-specific chronic respiratory illness and cor pulmonale in Bosnia and Hercegovina. Int J. Epid. 1972, 1: 167–176. A survey of 12,000 adults and 10,000 schoolchildren was undertaken in ten counties of Bosnia and Hercegovina to try to establish the prevalence rates of chronic respiratory illnesses and cor pulmonale. Probability samples of settlements and families were selected at random from within the counties concerned to provide age and sex matched groups. Table I lists the examinations which were carried out on all the adults in the study. Differences in the prevalence rates of chronic bronchitis and cor pulmonale were found to be statistically significant for age, sex and geographical region. Prevalence was highest in rural areas of Central Bosnia and lowest in rural regions of Hercegovina as shown in Table ll. It was higher for males with an age gradient for both sexes; and a very high association of cor pulmonale, lung emphysema and chronic bronchitis with obstruction of the upper respiratory airways was noted (Tables IV and VI). There was no difference by sex in prevalence rates of coughing among schoolchildren (Table V) but the geographic differences between Bosnia and Hercegovina were present in this as in the adult group. Smokers had higher prevalence rates than non-smokers, but the differences in prevalence rates of respiratory illnesses and cor pulmonale between smokers and non-smokers in the Bosnian and Hercegovinian areas remained significant. It was found that the rural population in Bosnia had more respiratory illness than even the urban population of Sarajevo and Zenica, towns notorious for having the highest degree of air pollution in Yugoslavia. There was slight association of the prevalence of respiratory illness with occupational dust exposure, average annual temperature and altitude above sea level, but these differences were compatible with the geographic differences between the two regions. In rural areas of Bosnia, higher rates of incidence of sudden acute illness with fever and breathlessness, similar to ‘farmer's lung’, were found. The author concludes that smoking habits and other environmental variables cannot entirely explain the geographic differences in the prevalence of chronic bronchitis and cor pulmonale and feels it likely that the respiratory illnesses found in rural Bosnia are not clinically or etiologically identical with those in Hercegovina.

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