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Алябьева Ю.М., Клинг В.И. English listening com...doc
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1) Listen to the 4th section of the talk and say what it is about.

2) Listen to it again and choose the correct statements:

1) The most important step to take in treating asthmatic pati­ents is:

a) avoidance

b) desensitization

2) The 1st line of defense for asthmatic patients is:

a) bronchodilator

b) adequate water

3) Cortisone-like products are used to:

a) keep the water balance

b) stop the inflammatory response...

4) Smoking is dangerous mainly because it causes: a) cancer

b) allergies

3) Answer the questions:

1) What is the treatment scheme of asthma (план лечения астмы)?

2) What effect does intal produce?

3) What is the role of water in treating asthmatic people?

4) What specific treatment can be offered to people suffering with extrinsic asthma?

5) What is the good news and what is the bad news about, clinical trials of large groups of asthmatic children?

4) Listen to the passage on the danger of smoking for asthmatic individuals and then read aloud. Try to imitate the speaker:

The last thing I want to talk about is the danger of cigarette smoking for asthmatic, or in the homes of asthmatic children. In the United States, over 60% of homes with small children have at least one person who is a smoker. In our country, the highest percentage of smokers is women of the age of child-bearing. This means that there are 9 to 12 mil1ion American children who live in a home where they are exposed to cigarette smoke. When this happens, there is four times as many admissions to the hospital as in the homes where no-one smokers; bronchitis is almost three ti­mes as frequent. We want to be sure to stress at every opportu­nity that smoking is dangerous to everyone's health, not just because it causes cancer, but because it causes many forms of allergies and respiratory problems.

After listening

1. Переведите письменно со словарем отрывок из текста об астме, состоящий из двух вопросов и двух ответов (50 мин).

Apart from taking the appropriate drugs, what other precautions can be taken to prevent an asthma attack?

Several simple measures can reduce the risk of attack. Most attacks occur at night, and so anxiety arising from the possibi­lity can be lessened by taking a mild sedative at bedtime, a person with allergic, asthma should sleep in a room without carpets or rugs. Blankets and pillows of synthetic fiber reduce the risk of house dust and mites. In dry climates, a humidifier can be used to increase the moisture content of the air in the room.

For patients in whom asthma is caused by respiratory infection, breathing exercises may be of value. A physiotherapist can teach the most appropriate ones. These exercises are not only a physi­ological help in preventing an attack, but when minor respirato­ry infection occurs, the lungs should function more effici­ently.

Because so much air held in the lungs during an asthma attack, the air cells (alveoli) can become go stretched that the cell walls may tear. This damage causes a gradual loss of elasticity in the lungs and can lead to the condition known as EMPHYSEMA.

If the patient coughs too much, the surface of a lung may burst causing the air to escape into the cavity that encloses the lung (pleural cavity). This condition in known as a pneumothorax.

Other complications can arise from the mucus sections that do not drain properly during an asthma attack. This can lead to bronchitis and sometime bronchial pneumonia. Frequent attacks may result in chronic bronchitis.

What other disorders might be confused with asthma?

A disorder mistakenly known as cardiac asthma has symptoms si­milar to asthma (gasping for breath, "tight" chest), but is ac­tually a type of heart disease immediate medical attention is required.

2. Разговорная ситуация: «Прием у врача». Один из вас – врач, другой – пациент-астматик.

У пациента затрудненное дыхание, бывают приступы сухого кашля. Приступы начинаются неожиданно по вечерам и продолжаются несколько минут. У пациента есть собака, которую ему недавно подарили. Пациент недавно купил мягкую мебель и красивый палас. Он не курит, но курит один из членов семьи. Пациент работает в лаборатории НИИ, где ему приходится соприкасаться с реактивами. Доктор заполняет карту пациента, затем после небольшого обследования назначает пациенту процедуры, выписывает лекарство и выдает больничный лист.

Text 2

In this second part of the lecture we are going to talk about a special form of allergy that is called BRONCHIAL ASTHMA. This is Dr. Harold Habenicht, a board-certified specialist in al­lergies from America who was visiting in your lovely city, and I hope that you will enjoy listening to this second part of the tape.

Bronchial asthma is a very common medical problem. In the Uni­ted Stated of America it is the most common reason that child­ren are admitted to pediatric hospitals. It is the most important reason that children are absent from school. We figured out about 9 mln. children are absent from the school every day in the United States because of bronchial asthma. In our country there are over 10 mln. people who suffer from asthma.

Asthma can be a very serious problem. For the patient who suffers from asthma it is a very frightening problem and it can be a fatal disease. About 10 people every day die of bronchial asthma in the United States, that's between 3 and 4 hundred people every year. As we talk together about this today, I would like to work through several questions: “What is Asthma? What can we do for the asthmatic patient?” and a question that patients very often ask me, particularly about their children, “Will my child outgrow his asthma with time?”. So as you are listening I hope you just sit back and relax, and we shall talk about this very interesting subject together for a few more minutes. I'm sorry that I'm not been able to learn about the frequency of asthma here in Russia, but I'm sure that asthma in this country it is a very prevalent disease. As I visited in your country hospital earlier today, we visited in the pulmonary section, and there is a number of patients right there at this time in the hospital, with bronchial asthma.

So «What is asthma?"- our first question. Asthma is a lung dis­order frequently allergic, that causes coughing, which is very important and it causes wheezing. So asthma is a coughing and a wheezing disease the coughing because of irritation of the bronchial tubes. We must add one other word to our defini­tion, asthma is always intermittent. If the person coughs or wheezes all the time it is not asthma, it is some other diagnosis, and you have to look for another cause. The asthmatic has times when he has more symptoms come once more.

These symptoms are caused by irritation or hyperirritability of the lung alveoli. This irritation causes mucus production, and the mucus in turn, has to be coughed up. The irritation also causes spasms of the smooth muscles that surround alveoli, dec­reasing their diameter. This is what causes the wheezing part. The wheezing in the asthmatic is always in the expiratory phase of the lung cycle. When we breathe in, the inspiration over­comes the muscle spasm, and allows the air to flow freely. But as we exhale, the alveoli become too tight, and we actually have to push the air out instead of natural elastic recoil, so we have a whhh..., a wheezing noise as the air goes out.

Sometimes in very small children, because their alveoli are so very small to start with, a little extra spasm closes them completely, so there is no wheezing on expiration, and the ... a young doctor who is not experienced to his working in the emer­gency room may put a stethoscope on the infant's or small child's chest and not hearing any wheezing, say, " My, it's not a serious problem. You can go back home", when actually more experience would've shown him that child is very sick and should stay in the hospital and be treated more vigorously. Now we know that asthma is intermittent hyperirritability of these alveoli causing spasm and mucus. Why do so many people get asthma?

You must remember that asthma is inherited disease. Earlier in the first part of this tape we talked about the atopic dermatitis and hives, and food allergies, and migraine headac­hes and medication reactions. Remember this is a recessive gene that means it comes from both parents to be expressed, although there may be carrier state that is passed on from one generation to another.

Once we have a possibility, and about one in four people ha­ve this gene in our country, then we must further say that ast­hma can be intrinsic or extrinsic or a mixture of these two. What do these words mean in simpler terms?

"EXTRINSIC" means that external, or outside things cause, asthma. “INTRINSIC” means that internal or inside things cause, or trigger the asthma.

Let me explain and give you some examples. Extrinsic asthma wo­uld be like a person who has a dog or a cat in their external en­vironment. In these cases, within, 5 minutes of being around a dog or a cat they will start, in the case they are asthmatic, wheezing or coughing, or in the case of the person who suffers with allergic rhinitis, sneezing or blowing their nose. In the case of pollens, the person who was out to cut the grass or work in the garden will start having symptoms. Here it will be the weeds that are blooming in your vegetable garden that would cause the dif­ficulty. In spring of the year, it will be birch trees and other trees that are causing the difficulty.

Molds are much longer in their duration of symptoms. As soon as snow begins to melt in the spring, molds become a problem. They last all through the summer and until snow covers the ground in the fall, molds will be a difficulty. Indoors, there can be molds in damp areas, or if you bring in apples or potatoes produce and put them in your cellar where you keep them when you store them, they may mold and spoil and cause difficulty when you're going to get things out to it in the winter time. Then there's always dust and dust mites, these are attributes of asthma just like we've talked about earlier in the allergy section.

Now what is intrinsic or internal asthma? Some examples will be those people who get asthma when they run, or play, or exercise.

People who breathe cold air and start wheezing will be having intrinsic asthma. People who have a viral infection, a common cold, a respiratory infection, will always have their asthma get worse. In fact, almost every asthmatic who goes to the hospital for treatment has some viral infection. This is intrinsic or in­ternal asthma. Then there are those people who may even get ast­hma because of stress emotional problems. These once again represent still another kind of intrinsic or internal asthma.

People who get asthma when they use aspirin or aspirin-like medications demonstrate another type of intrinsic asthma.

We should say a little more about exercise. Exercise is a real problem for asthmatic people because it is the trigger that ma­kes their asthma worse. And nevertheless, asthmatic individuals can participate in sport, in fact they can even get to the Olym­pic level of competition and still be asthmatic. In recent Olym­pic Games in Los Angeles in the United States there were 41 participants who got gold, silver or bronze Olympic medals, who were ta­king asthma medication during and before their Olympic competition.

So as you young doctors have patients who may be concerned about not being able to play foot ball or to do the skiing or to be swimming because they have asthma, reassure them that with proper care and with good medications they can do any type of activity that they want to.

I should say a little bit more about aspirin-containing medications. So many people are asthmatic or allergic to aspirin that it probably is a good thing to warn and to counsel all of your ast­hma sufferers who use some other types of medication for head ac­hes or pain control. Today when I visited in the hospital the doc­tor who was in charge of internal medicine told me about a patient who was exposed to plastic. They had rolls of plastic that they stored in the house in the winter that they use to cover their cucumbers in the garden in the summer time. And as the films of the plastic were given to the air, this engineer became a very sick person and had to go to hospital and be admitted for asthma and when he was discharged from hospital his asthma started immediately. And they analyzed the situation they realized indeed that it was re­ally the plastic from his garden that was causing the difficulty. When the plastic was removed permanently from his environment, he had no further difficulty

In the United States there are some 10 thousand people who work in the plastic industry. The reason for the difficulty is a chemical that its the base material for TDI which means tolylenedisocyanate. This is a very serious form of asthma, and it has no cure unless the person is willing to stop their work completely and move to another industrial area where there is no TDI exposure whatever.

There are some more problems with farmers who work with silage, hey and materials that are fed to animals. If they develop asthma or alveolitis from these organic substances from these or... fi­bers in the hay they may have to change their work as well. There are some carpenters who work with cedar trees who develop problems with red cedar, and once again, the only answer to their problem is to change occupations and get away from the sawdust.

Yea, indeed, it’s difficult at times to figure out what is cau­sing the difficulty. I remember a patient who only had asthma on Wednesdays and I asked him, what kind of work do you do? He told me he was a bread-baker. And than I said, “Well, what's the dif­ference between baking bread on Wednesdays and other days of the week”, and he said at once “On Wednesday’s the day when we make rye bread instead of wheat bread”, and sure enough I got some material and tested him for rye, and he had a large allergic reac­tion, and when we arranged with his boss for him to have Wednes­days an his day off, he had no more asthma difficulty.

Sometimes, the diagnosis of asthma is very difficult, but we can use a test that is called spirometry, or a breathing test. Only today I was visiting in the hospital in the pulmonary laboratory, and I see that you have good equipment here and very good technicians here to do the work, and you will find it a very helpful way to make the diagnosis or to establish the diagnosis to confirm your suspicion of bronchial asthma.

There is one problem, and that is in small children under the age of 6. They cannot cooperate with the instructions and do accu­rate spirometry before that age. And so how do we make the diagnosis of asthma in a small child? Here it is very important that we take a detailed patient history, and. do a careful physical examination. And then we will do a clinical trial. We will give the young child an asthma medication, and when their asthma gets better, this tells us that our diagnosis is correct. At times we will do skin test on people to know if there is some allergic factor that is causing their asthma. Once we had established the diagnosis, then how do we treat the problem?

Just as we talked in the first part of the tape, with allergies in general avoidance is the most important step to take. In the case of a dog or a cat, or bird we can eliminate these animal pro­ducts from our environment. If it is a chemical allergy, we can ask the person to change the job.

At home, we can be more careful as we clean and we dust. Sometimes small children have toys, stuffed animals, or teddy-bears that they sleep with, and these are important sources of dust mites, and we can clean them or remove them. We can take up the carpeting and use linoleum or hardwood for floors to have better dust control.

Then we must think of some medications. I'm going to leave the details of medications to your teachers here, because many of the medications that I use every day are not available. But I will mention Albuterol, or sometimes in English-speaking countries it’s called Salbuterol which is a ... which is a bronchodilator, a better enhancer, a better antagonist. This is the 1st of defense when we are using medications for allergic indivi­duals. This is the medication that was used by those participants of Olympic Games in Los Angeles I told you about and this comes in tablet form, but it is best used in inhale form, because it is much quicker in its action, and has much fewer side effects.

Another medication that is very useful for the treatment of asthma is called sodium chromalin, or Intal. That is a trade-name that is commonly used. Thin is also a medication that prevents asthma by being a mast cell stabilizer.

And then we have medicines that are called Phyaphthons. Phyaphthons that are used around the world for many years and are still a good medication to use. Last I would like to mention inhaled steroids, cortisone-like products that are in inhaler form that can be used after bronchodilator to stop the coughing and the in­flammatory response which is the most important part of the ... in the asthma response.

Then you must remember that the water that is not usually thoug­ht of as a medication... Drinking adequate water is very impor­tant in the asthmatic because it causes better hydration. Extra water loosens the mucus, makes it less sticky, and reduces the swelling. It keeps the blood chemistry under control, and keeps the fluid balance. And then we should say something about allergy shots.

Once again, when these are available, we can desensitize the per­son.

The extrinsic part of them, if they are allergic to cats and dogs, or to pollens or to moulds, they can use these materials in their allergy injections, and can be cured of the allergic part of their asthma.

The last question I promised to talk to you about is the natu­ral history of bronchial asthma. Often parents will ask me, "Is my child going to outgrow this condition? What can I expect in the years ahead?"

There are some very interesting studies done with large groups of asthmatic children that give us encouraging response. One stu­dy I remember reading was almost 500 13 year-old asthmatics.

71 % of these that's almost 3 out of 4 by the age of 20 were free of their bronchial asthma. Another study of over 200 preschool children, that means the children below the age of 6.

80% of these had no asthma by the age of ten. But there are some bad news that we must share as well, some of these that are free of ast­hma in their teens or by 20-ies later on in adult life may once again have some form of asthma as they grow older.

The last thing that I want to talk about is the danger of ciga­rette smoking for asthmatics, or in the homes of asthmatic chil­dren. In the United States, over 60% of homes with small chil­dren have at least one person who is a smoker. In our country the highest percentage of smokers are women of the child-bearing. This means that there are 9 to 12 million American children who live in a home where they are exposed to cigarette smoke. When this happens, there’s four times as many admission to the hospital as in the homes where no one smoke, bronchitis is almost 3 times as frequent. We want to be sure to stress, at every opportunity that smoking is dangerous to everyone's health not just because it causes cancer, but because it causes many forms of allergies and respiratory problems.

I hope you've enjoyed this lecture and that you've learned something about bronchial asthma that you can apply as you become physicians here in your great country , and I do hope that you will become more interested in allergy problems and that may be even one person who has listened will become an allergy specialist. Thank you very much.

A victim to one hundred and seven fatal maladies

from “Three Men in a Boat” by Jerome K. Jerome.

1. Vocabulary:

slight ailment – легкое недомогание,

idly – лениво, праздно,

to glance – мельком взглянуть,

premonitory symptoms – продромальные симптомы,

housemaid’s knee – воспаление сумки надколенника,

wreck – развалина,

chum – разг. приятель, товарищ.

2. Translate from Russian into English:

In an unthinking moment, idly turn the leaves, a fatal malady, to walk the hospitals, to time the pulse, all for nothing, the prescription ran, to follow the directions, his life was preserved.

3. Listen to the text.

4. Choose the right variants:

1) Which illnesses does the man think he has:

cholera

malaria

hepatitis

scarlet fever

diphtheria

housemaid’s knee

2) The man first thought

a. his pulse was too fast.

b. his pulse was too slow.

c. his heart has stopped.

3) The man thought

a. his tongue looked normal.

b. something was wrong with his tongue.

c. his tongue wasn’t there at all.

4) He doesn’t tell the doctor what illnesses he’s got because

a. he’s not sure.

b. it would take too long.

c. he’s frightened.

5) The doctor thinks

a. the man is very ill.

b. the man is slightly ill.

c. the man isn’t ill.

6) How is the doctor’s prescription unusual? Reproduce it.

Am I All Right?

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