Asthma in a rural highland area of Papua New Guinea

Asthma is uncommon in the rural areas of Papua, New Guinea. Since 1976 an increasing number of people in the Fore linguistic group of the Eastern Highlands have been reported to have acute dyspnea responding to bronchodilator tablets. A preliminary investigation was undertaken to determine if these people had asthma. Forty-six patients who had been given bronchodilator therapy during the previous two years were examined by history, physical examination, lung function, methacholine provocation, skin prick tests, and IgE measurement. Nineteen patients had asthma with increased bronchial reactivity--defined as a 20% fall in FEV, after less than 0.75 mg of methacholine, or a greater than 20% rise in FEV1 after orciprenaline aerosol--together with a history of intermittent breathlessness. Eighteen had irreversible chronic airflow obstruction, and in nine patients it was not possible to distinguish between asthma and irreversible airflow obstruction. All but two of the asthmatics were over the age of 20, their symptoms began between 2 and 8 years previously, all were atopic, and all had elevated serum IgE levels. Non had a prior history of rhinitis or eczema. No obvious change in the environment or life style was found to explain the recent onset of severe asthma in these people.