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Airway Obstruction in Primary Care Patients: Need for Implementing Spirometry Use. Diagnostics (Basel) 2022; 12:diagnostics12112680. [PMID: 36359521 PMCID: PMC9689256 DOI: 10.3390/diagnostics12112680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 10/23/2022] [Accepted: 11/02/2022] [Indexed: 11/06/2022] Open
Abstract
(1) Background: To detect early airway obstruction in an adult primary care setting. (2) Methods: Seventeen general practitioners (GP) were involved. A total of 912 patients consulting their GPs over 40 years were recruited: 583 of them (323M) agreed to perform/undergo all the procedures: respiratory questionnaire, mMRC questionnaire, and spirometry. We identified four subgroups: physician COPD patients; physician asthma patients; asthma-COPD overlap syndrome patients; and no respiratory diagnosis subjects, on the basis of physician diagnosis. For screening purposes, an FEV1/FVC < 70% was considered a marker of airway obstruction (AO). (3) Results: Prevalence rates of COPD, A, and ACOS were 12.5%, 7.8%, and 3.6%, respectively. In the overall sample 16.3% showed airway obstruction: 26% mild, 56% moderate, 17% severe, and 1% very severe. In obstructed subjects, those reporting neither respiratory symptoms nor a physician’s respiratory diagnosis were 60% level I; 43% level II; 44% level III; and none level IV. Wheezing (p < 0.001), sputum (p = 0.01), older age (p < 0.0001), and male gender (p = 0.002) were the best predictors of airway obstruction. (4) Conclusions: A high prevalence of AO was found. In AO we found a high prevalence of subjects without respiratory symptoms or respiratory chronic diagnosis. Airway obstruction was predicted by the presence of wheezing, sputum, older age, and male gender.
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Maio S, Baldacci S, Tagliaferro S, Angino A, Parmes E, Pärkkä J, Pesce G, Maesano CN, Annesi-Maesano I, Viegi G. Urban grey spaces are associated with increased allergy in the general population. ENVIRONMENTAL RESEARCH 2022; 206:112428. [PMID: 34838570 DOI: 10.1016/j.envres.2021.112428] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 10/27/2021] [Accepted: 11/21/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND the built environment in urban areas may have side effects on children's respiratory health, whilst less is known for adulthood. AIM to assess the association between increasing exposure to grey spaces and allergic status in an adult general population sample. METHODS 2070 subjects (age range 15-84 yrs), living in Pisa/Cascina, Italy, were investigated in 1991-93 through a questionnaire on health status and risk factors, skin prick test (SPT), serum Immunoglobulins E (IgE), and serum antibodies to benzo(a)pyrene diol epoxide (BPDE)-DNA adducts. Land-cover exposure within a 1000 m buffer from each subject's home address was assessed through the CORINE Land Cover program (CLC 1990) within the FP7/HEALS project (2013-2018). Participants' residential addresses were geocoded and the proportion of surrounding grey spaces was calculated. Through logistic regression models, adjusting for potential confounding factors, the effect of a 10% increase in grey spaces exposure on allergic biomarkers/conditions was assessed; the relationship with serum antibodies to BPDE-DNA adducts positivity was also analyzed. RESULTS A 10% increase in grey spaces coverage was associated with a higher probability of having SPT positivity (OR 1.07, 95% CI 1.02-1.13), seasonal SPT positivity (OR 1.12, 1.05-1.19), polysensitization (OR 1.11, 1.04-1.19), allergic rhinitis (OR 1.10, 1.04-1.17), co-presence of SPT positivity and asthma/allergic rhinitis (OR 1.16, 1.08-1.25), asthma/allergic rhinitis (OR 1.06, 1.00-1.12), presence of serum antibodies to BPDE-DNA adducts positivity (OR 1.07, 1.01-1.14). CONCLUSIONS grey spaces have adverse effects on allergic status and are related to a biomarker of polycyclic aromatic hydrocarbons exposure in adulthood. Thus, they may be used as a proxy of urban environmental exposure.
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Affiliation(s)
- S Maio
- Pulmonary Environmental Epidemiology Unit, CNR Institute of Clinical Physiology, Pisa, Italy.
| | - S Baldacci
- Pulmonary Environmental Epidemiology Unit, CNR Institute of Clinical Physiology, Pisa, Italy
| | - S Tagliaferro
- Pulmonary Environmental Epidemiology Unit, CNR Institute of Clinical Physiology, Pisa, Italy
| | - A Angino
- Pulmonary Environmental Epidemiology Unit, CNR Institute of Clinical Physiology, Pisa, Italy
| | - E Parmes
- VTT Technical Research Centre of Finland Ltd, Espoo, Finland
| | - J Pärkkä
- VTT Technical Research Centre of Finland Ltd, Espoo, Finland
| | - G Pesce
- INSERM, Paris-Saclay University, UVSQ, Center for Research in Epidemiology and Population Health (CESP), Villejuif, France
| | - C N Maesano
- INSERM, Montpellier University, Institut Desbrest d'Épidémiologie et de Santé Publique, Montpellier, France
| | - I Annesi-Maesano
- INSERM, Montpellier University, Institut Desbrest d'Épidémiologie et de Santé Publique, Montpellier, France
| | - G Viegi
- Pulmonary Environmental Epidemiology Unit, CNR Institute of Clinical Physiology, Pisa, Italy; CNR Institute for Research and Biomedical Innovation, Palermo, Italy
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Soriano JB, Dai X, Ancochea J. An Euler Proportional Venn Diagram of Obstructive Lung Disease. Arch Bronconeumol 2022; 58:627-628. [DOI: 10.1016/j.arbres.2022.01.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 01/19/2022] [Accepted: 01/20/2022] [Indexed: 11/02/2022]
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De Matteis S, Forastiere F, Baldacci S, Maio S, Tagliaferro S, Fasola S, Cilluffo G, La Grutta S, Viegi G. Issue 1 - “Update on adverse respiratory effects of outdoor air pollution”. Part 1): Outdoor air pollution and respiratory diseases: A general update and an Italian perspective. Pulmonology 2022; 28:284-296. [DOI: 10.1016/j.pulmoe.2021.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 12/12/2021] [Indexed: 10/19/2022] Open
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Alfano P, Cuttitta G, Audino P, Fazio G, La Grutta S, Marcantonio S, Bucchieri S. Relationship between Multimorbidity and Quality of Life in a Primary Care Setting: The Mediating Role of Dyspnea. J Clin Med 2022; 11:jcm11030656. [PMID: 35160105 PMCID: PMC8837036 DOI: 10.3390/jcm11030656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 01/17/2022] [Accepted: 01/24/2022] [Indexed: 11/25/2022] Open
Abstract
Multimorbidity is known to impair Quality of Life (QoL) in patients in a primary setting. Poor QoL is associated with higher dyspnea perception. How multimorbidity and dyspnea perception are related to QoL needs clarification. The aim of the present study is to evaluate the mediating role of dyspnea perception in the relationship between multimorbidity and QoL in adults with and without airflow obstruction in a primary care setting. Seventeen general practitioners participated in the study: a total of 912 adult patients attending the practitioner’s surgery for a generic consultation completed a preliminary respiratory screening; 566 of them answered a respiratory questionnaire between January and June 2014, and 259 of the latter (148 M, aged 40–88) agreed to go through all the of procedures including spirometry, the IMCA and QoL (SF-36 through Physical Health “PCS” and Mental Health components) questionnaires, evaluation of comorbidities and the mMRC Dyspnea Scale. For screening purpose, a cut-off of FEV1/FVC < 70% was considered a marker of airflow obstruction (AO). Of the sample, 25% showed airflow obstruction (AO). No significant difference in mMRC score regarding the number of comorbidities and the PCS was found between subjects with and without AO. Multimorbidity and PCS were inversely related in subjects with (p < 0.001) and without AO (p < 0.001); mMRC and PCS were inversely related in subjects with (p = 0.001) and without AO (p < 0.001). A mediation analysis showed that the relation between number of comorbidities and PCS was totally mediated by mMRC in subjects with AO and partially in subjects without AO. We conclude that the effect of multimorbidity on PCS is totally mediated by mMRC only in AO. Detecting and monitoring mMRC in a primary care setting may be a useful indicator for evaluating a patient’s global health.
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Affiliation(s)
- Pietro Alfano
- Institute for Biomedical Research and Innovation (IRIB), National Research Council of Italy, 90146 Palermo, Italy; (G.C.); (P.A.); (S.B.)
- Institute of Traslational Pharmacology (IFT), National Research Council of Italy, Via Fosso del Cavaliere 100, 00133 Roma, Italy
- Correspondence:
| | - Giuseppina Cuttitta
- Institute for Biomedical Research and Innovation (IRIB), National Research Council of Italy, 90146 Palermo, Italy; (G.C.); (P.A.); (S.B.)
- Institute of Traslational Pharmacology (IFT), National Research Council of Italy, Via Fosso del Cavaliere 100, 00133 Roma, Italy
| | - Palma Audino
- Institute for Biomedical Research and Innovation (IRIB), National Research Council of Italy, 90146 Palermo, Italy; (G.C.); (P.A.); (S.B.)
| | - Giovanni Fazio
- Triolo Zanca Clinic, Piazza Fonderia 23, 90133 Palermo, Italy;
| | - Sabina La Grutta
- Department of Psychology, Educational Science and Human Movement, University of Palermo, 90128 Palermo, Italy;
| | - Salvatore Marcantonio
- Quality, Planning and Strategic Support Area, University of Palermo, Piazza Marina 61, 90133 Palermo, Italy;
| | | | - Salvatore Bucchieri
- Institute for Biomedical Research and Innovation (IRIB), National Research Council of Italy, 90146 Palermo, Italy; (G.C.); (P.A.); (S.B.)
- Institute of Traslational Pharmacology (IFT), National Research Council of Italy, Via Fosso del Cavaliere 100, 00133 Roma, Italy
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Abstract
Objective To summarize the main updated evidence about the health effects of air pollution, with a special focus on Southern Europe. Data sources Literature was obtained through PubMed Central and the official websites of European Agencies and Scientific Societies. Study selection Recent shreds of evidence about the health effects of air pollution coming from international reports and original research were collected and described in this review. Results Air pollution is an avoidable risk factor that causes a huge burden for society, in terms of death, health disorders, and huge socio-economic costs. The southern European countries face a more threatening problem because they experience the effects of both anthropogenic pollutants and natural dusts (particulate matter [PM]). The European Environment Agency reported the number of premature deaths in the 28 countries of the European Union attributable to air pollutant exposure in the year 2016: 374,000 for PM2.5, 68,000 for nitrogen dioxide, and 14,000 for ozone. In Italy, time series and analytical epidemiological studies showed increased cardio-respiratory hospital admissions and mortality, as well as increased risk of respiratory diseases in people living in urban areas. Conclusions Based on abundant evidence, the World Health Organization, which hosts the Global Alliance against Chronic Respiratory Diseases (GARD), the scientific respiratory societies, and the patients’ associations, as well as others in the health sector, must increase their engagement in advocacy for clean air policies.
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Fasola S, Maio S, Baldacci S, La Grutta S, Ferrante G, Forastiere F, Stafoggia M, Gariazzo C, Viegi G. Effects of Particulate Matter on the Incidence of Respiratory Diseases in the Pisan Longitudinal Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E2540. [PMID: 32276330 PMCID: PMC7177905 DOI: 10.3390/ijerph17072540] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 03/27/2020] [Accepted: 04/06/2020] [Indexed: 12/17/2022]
Abstract
The current study aimed at assessing the effects of exposure to Particulate Matter (PM) on the incidence of respiratory diseases in a sub-sample of participants in the longitudinal analytical epidemiological study in Pisa, Italy. Three hundred and five subjects living at the same address from 1991 to 2011 were included. Individual risk factors recorded during the 1991 survey were considered, and new cases of respiratory diseases were ascertained until 2011. Average PM10 and PM2.5 exposures (µg/m3, year 2011) were estimated at the residential address (1-km2 resolution) through a random forest machine learning approach, using a combination of satellite data and land use variables. Multivariable logistic regression with Firth's correction was applied. The median (25th-75th percentile) exposure levels were 30.1 µg/m3 (29.9-30.7 µg/m3) for PM10 and 19.3 µg/m3 (18.9-19.4 µg/m3) for PM2.5. Incidences of rhinitis and chronic phlegm were associated with increasing PM2.5: OR = 2.25 (95% CI: 1.07, 4.98) per unit increase (p.u.i.) and OR = 4.17 (1.12, 18.71) p.u.i., respectively. Incidence of chronic obstructive pulmonary disease was associated with PM10: OR = 2.96 (1.50, 7.15) p.u.i. These results provide new insights into the long-term respiratory health effects of PM air pollution.
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Affiliation(s)
- Salvatore Fasola
- Institute for Biomedical Research and Innovation, National Research Council, 90146 Palermo, Italy; (S.L.G.); (F.F.); (G.V.)
| | - Sara Maio
- Institute of Clinical Physiology, National Research Council, 56126 Pisa, Italy; (S.M.); (S.B.)
| | - Sandra Baldacci
- Institute of Clinical Physiology, National Research Council, 56126 Pisa, Italy; (S.M.); (S.B.)
| | - Stefania La Grutta
- Institute for Biomedical Research and Innovation, National Research Council, 90146 Palermo, Italy; (S.L.G.); (F.F.); (G.V.)
| | - Giuliana Ferrante
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialities, University of Palermo, 90127 Palermo, Italy;
| | - Francesco Forastiere
- Institute for Biomedical Research and Innovation, National Research Council, 90146 Palermo, Italy; (S.L.G.); (F.F.); (G.V.)
| | - Massimo Stafoggia
- Department of Epidemiology, Lazio Region Health Service—ASL Roma 1, 00147 Rome, Italy;
| | - Claudio Gariazzo
- Occupational and Environmental Medicine, Epidemiology and Hygiene Department, Italian Workers’ Compensation Authority (INAIL), Monte Porzio Catone, 00144 Rome, Italy;
| | - Giovanni Viegi
- Institute for Biomedical Research and Innovation, National Research Council, 90146 Palermo, Italy; (S.L.G.); (F.F.); (G.V.)
- Institute of Clinical Physiology, National Research Council, 56126 Pisa, Italy; (S.M.); (S.B.)
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Maio S, Baldacci S, Carrozzi L, Pistelli F, Simoni M, Angino A, La Grutta S, Muggeo V, Viegi G. 18-yr cumulative incidence of respiratory/allergic symptoms/diseases and risk factors in the Pisa epidemiological study. Respir Med 2019; 158:33-41. [PMID: 31585374 DOI: 10.1016/j.rmed.2019.09.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 09/19/2019] [Accepted: 09/23/2019] [Indexed: 12/27/2022]
Abstract
BACKGROUND Few population-based studies on the effects of environmental exposure variation exist. AIM Assessing respiratory symptom/disease incidence related to risk factor exposure changes. METHODS A longitudinal general population sample from two surveys (PISA2:1991-1993; PISA3:2009-2011; no. = 970), aged ≥20 years at baseline, completed a questionnaire on respiratory symptoms/diseases, risk factor exposure and performed spirometry. 18-year follow-up cumulative incidence of respiratory symptoms/diseases and longitudinal changes (persistence, incidence, remittance) in risk factor exposure were computed. RESULTS Cumulative incidence values were: 3.2% (corresponding to a 1.8‰/year incidence rate), asthma; 6.6% (3.8‰/year), asthma attacks; 4.5% (2.6‰/year), wheeze; 31.7% (21.0‰/year), allergic rhinitis-AR; 7.6% (4.4‰/year), chronic obstructive pulmonary disease-COPD; 16.1% (9.7‰/year), usual cough; 18.5% (11.3‰/year), usual phlegm; 30.7% (20.1‰/year), dyspnoea 1+; 13.9% (8.3‰/year), airway obstruction. The following associations emerged among respiratory symptom/disease cumulative incidence and risk factor exposure changes: a two-to-five fold higher risk for COPD, phlegm, cough, dyspnoea, asthma attacks, airway obstruction in persistent smokers; a two-to-three fold higher risk for COPD in remittent smokers; a two-fold higher risk for AR, phlegm and a four-fold higher risk for asthma in subjects with persistent occupational exposure; a two-fold higher risk for cough, phlegm, dyspnoea, AR in subjects with incident occupational exposure; a two-fold higher risk for AR, asthma attacks, COPD in subjects with incident traffic exposure. CONCLUSIONS Our study showed noteworthy respiratory symptom/disease incidence values and indicated that life-style and environmental exposure changes can differently influence onset. This information could be useful for primary prevention strategies in order to reduce the chronic disease burden in the general population.
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Affiliation(s)
- Sara Maio
- Pulmonary Environmental Epidemiology Unit, CNR Institute of Clinical Physiology (IFC), Pisa, Italy; University of Palermo, Department of Economics, Business and Statistic, Palermo, Italy.
| | - Sandra Baldacci
- Pulmonary Environmental Epidemiology Unit, CNR Institute of Clinical Physiology (IFC), Pisa, Italy
| | - Laura Carrozzi
- Department of Surgical, Medical, Molecular Pathology and Critical Area, University of Pisa, Italy
| | - Francesco Pistelli
- Unit of Pulmonology, Cardio-Thoracic and Vascular Department, University Hospital of Pisa, Pisa, Italy
| | - Marzia Simoni
- Pulmonary Environmental Epidemiology Unit, CNR Institute of Clinical Physiology (IFC), Pisa, Italy
| | - Anna Angino
- Pulmonary Environmental Epidemiology Unit, CNR Institute of Clinical Physiology (IFC), Pisa, Italy
| | - Stefania La Grutta
- CNR Institute for Research and Biomedical Innovation (IRIB), Palermo, Italy
| | - Vito Muggeo
- University of Palermo, Department of Economics, Business and Statistic, Palermo, Italy
| | - Giovanni Viegi
- Pulmonary Environmental Epidemiology Unit, CNR Institute of Clinical Physiology (IFC), Pisa, Italy; CNR Institute for Research and Biomedical Innovation (IRIB), Palermo, Italy
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Lenoir A, Fitting JW, Marques-Vidal PM, Vollenweider P, Nicod LP. GLI 2012 equations define few spirometric anomalies in the general population: the PneumoLaus study. Respir Res 2018; 19:250. [PMID: 30545344 PMCID: PMC6293538 DOI: 10.1186/s12931-018-0955-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 11/26/2018] [Indexed: 11/10/2022] Open
Abstract
Background Reduced lung function predicts increased mortality, but its prevalence may vary depending on definition considered, use of bronchodilation and applied reference values. We aimed to assess lung function abnormalities in Lausanne, Switzerland, and their association with clinical history. Methods In a general population sample, spirometry was performed and bronchodilation applied if the ratio forced expiratory volume in 1 s (FEV1) / forced vital capacity (FVC) or the FVC was below the lower limit of normal (LLN) according to Global Lung Function Initiative 2012 references. Results for FEV1/FVC according to the LLN were compared to the 0.7 fixed ratio. Respiratory risk factors, symptoms and self-reported respiratory diagnoses were recorded through a questionnaire. Results Out of the 3342 included subjects, 3.8% had chronic obstruction and 2.5% reversible obstruction when using the LLN; possible lung restriction alone was present in 1.8%, and associated with chronic obstruction in 0.4%. Ever smokers had a higher prevalence of abnormal spirometry, chronic obstruction and reversible obstruction; there was no difference with regard to possible restriction. Overall, chronic airway obstruction was found in 8.9% of current smokers, 4.6% of former smokers and 1.5% of never smokers. Only one third of participants with chronic obstruction were aware of a respiratory disease. Conclusion Prevalence of abnormal lung function in the population of Lausanne is low. This may be due to a low rate of ever-smokers, the application of a full bronchodilation dose, but also to inherent characteristics of this population.
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Affiliation(s)
- Alexandra Lenoir
- Department of Medicine, Respiratory Medicine, Lausanne University Hospital (CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland.
| | - Jean-William Fitting
- Department of Medicine, Respiratory Medicine, Lausanne University Hospital (CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | | | - Peter Vollenweider
- Department of Medicine, Internal Medicine, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Laurent P Nicod
- Department of Medicine, Respiratory Medicine, Lausanne University Hospital (CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland
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Guerriero M, Caminati M, Viegi G, Senna G, Pomari C. Prevalence and features of asthma-chronic obstructive pulmonary disease overlap in Northern Italy general population. J Asthma 2018; 56:27-33. [PMID: 29420087 DOI: 10.1080/02770903.2018.1424190] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE There is controversy about the diagnostic criteria, prevalence, symptoms, and spirometry characteristics of asthma-chronic obstructive pulmonary disease (COPD) overlap (ACO). Recent data indicate that the fixed method for diagnosing airway obstruction (AO) may overestimate ACO prevalence in the elderly, and a variable method may be more accurate. We aimed at estimating ACO prevalence in a general population sample and comparing patient and clinical features in subjects with ACO, COPD, and asthma. METHODS We analyzed data from a cross-sectional study estimating COPD prevalence in randomly selected adults aged 20-79 years in Verona, Italy, and estimated prevalence and analyzed characteristics of asthma, COPD, and ACO. ACO was defined as AO (Forced Expiratory Volume in one second-FEV1/ Forced Vital Capacity-FVC < Lower Limit of Normal-LLN), highly positive bronchodilator test (≥15% increase in FEV1 and FVC ≥400 mL), and personal self-reported history of physician diagnosed asthma and atopy. RESULTS One thousand two hundred and thirty-six patients were included; 207 (16.7%) had asthma, COPD, or ACO (mean ages: 61.2, 59.7, and 57.2 years, respectively). The 3 groups had similar clinical and demographic variables; however, spirometry revealed differences between ACO and COPD patients, particularly post-bronchodilator FEV1 reversibility, which was detected in ACO and asthma patients but not in those with COPD. CONCLUSION ACO prevalence in Northern Italy was estimated at 2.1%, in the range of values reported by previous studies. Marked differences between ACO and COPD revealed by spirometry may have important clinical implications in terms of treatment for patients with ACO.
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Affiliation(s)
- Massimo Guerriero
- a Department of Computer Science , University of Verona , Verona , Italy
| | - Marco Caminati
- b Asthma Center and Allergy Unit , Verona University and General Hospital , Verona , Italy
| | - Giovanni Viegi
- c Institutes of Biomedicine and Molecular Immunology "Alberto Monroy" (IBIM) , Palermo , Italy , and Clinical Physiology (IFC) , CNR , Pisa , Italy
| | - Gianenrico Senna
- b Asthma Center and Allergy Unit , Verona University and General Hospital , Verona , Italy
| | - Carlo Pomari
- d Pulmonary Unit, Sacro Cuore-Don Calabria Hospital , Negrar , Verona , Italy
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Henriksen AH, Langhammer A, Steinshamn S, Mai XM, Brumpton BM. The Prevalence and Symptom Profile of Asthma-COPD Overlap: The HUNT Study. COPD 2017; 15:27-35. [PMID: 29257905 DOI: 10.1080/15412555.2017.1408580] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The concept of asthma and COPD as separate conditions has been questioned, and the term asthma-COPD overlap syndrome has been introduced. We assessed the prevalence, symptoms, and lifestyle factors of asthma-COPD overlap (ACO) in a large Norwegian population-based study. From 2006 to 2008, a total of 50,777 residents of Nord-Trøndelag participated in the Nord-Trøndelag Health Study, Norway. They completed questionnaires regarding respiratory symptoms, disease status, and medication use. We estimated the prevalence and 95% confidence intervals of ACO. Additionally, spirometry was used to estimate the prevalence of ACO in a subgroup. The prevalence of self-reported ACO was 1.9%, and in age groups <40, 40-60 and ≥60 years it was 0.7%, 1.4%, and 3.2%, respectively. Among those reporting COPD, the proportion of ACO was 0.56. In the spirometry subgroup when ACO was defined as doctor diagnosed asthma ever and FEV1/FVC < 0.70, the prevalence of ACO was 2.0%. All respiratory symptoms, separately or in combination, as well as medication use were reported most frequently in those with ACO compared to the other groups. Strikingly, we observed a two-fold higher proportion of allergic rhinitis in ACO compared to COPD only. In this Norwegian population, the prevalence of self-reported ACO was 1.9%, and the corresponding proportion of ACO among those with COPD was 0.56. Participants with ACO generally had the highest proportions of respiratory symptoms compared to asthma or COPD.
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Affiliation(s)
- Anne H Henriksen
- a Department of Thoracic and Occupational Medicine , Trondheim University Hospital , Trondheim , Norway.,b Department of Circulation and Medical Imaging , Norwegian University of Science and Technology , Trondheim , Norway
| | - Arnulf Langhammer
- c Department of Public Health and Nursing , Faculty of Medicine, Norwegian University of Science and Technology , Trondheim , Norway
| | - Sigurd Steinshamn
- a Department of Thoracic and Occupational Medicine , Trondheim University Hospital , Trondheim , Norway.,b Department of Circulation and Medical Imaging , Norwegian University of Science and Technology , Trondheim , Norway
| | - Xiao-Mei Mai
- c Department of Public Health and Nursing , Faculty of Medicine, Norwegian University of Science and Technology , Trondheim , Norway
| | - Ben M Brumpton
- a Department of Thoracic and Occupational Medicine , Trondheim University Hospital , Trondheim , Norway.,d K.G. Jebsen Center for Genetic Epidemiology, Department of Public Health and Nursing, Faculty of Medicine and Health Sciences , Norwegian University of Science and Technology , Trondheim , Norway
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Capozzolo A, Castellana G, Dragonieri S, Carratù P, Liotino V, Vulpi MR, Marra L, Resta E, Intiglietta P, Resta O. Voluntary lung function screening to reveal new COPD cases in southern Italy. Int J Chron Obstruct Pulmon Dis 2017; 12:2035-2042. [PMID: 28744118 PMCID: PMC5513831 DOI: 10.2147/copd.s136357] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background Underdiagnosis of COPD is a relevant issue, and most frequently involves patients at early stages of the disease. Physicians do not routinely recommend smokers to undergo spirometry, unless they are symptomatic. Aims To investigate the effectiveness of voluntary lung function screening in bringing to light patients with previously unknown COPD and to evaluate the relationships among symptoms, smoking status, and airway obstruction. Methods A voluntary screening study for COPD was conducted during two editions of the annual Fiera del Levante (2014 and 2015), an international trade fair in Bari. Subjects were eligible for the study if they fulfilled the following inclusion criteria: age ≥35 years, smoker/ex-smoker ≥5 pack-years (PYs), or at least one chronic respiratory symptom (cough, sputum production, shortness of breath, and wheezing). A free post-β2-agonist spirometry test was performed by trained physicians for each participant using portable spirometers. Post-β2-agonist forced expiratory volume in 1 second (FEV1):forced vital capacity ratio <0.7 was chosen to establish the diagnosis of COPD. Sensitivity, specificity, and negative and positive predictive values (NPVs and PPVs) of symptoms for the presence of obstruction were calculated. Results A total of 1,920 individuals were eligible for the study; 188 subjects (9.8%) met COPD criteria. There was a 10.4% prevalence of COPD in subjects with one or more symptoms who had never smoked or smoked ≤5 PYs. Among COPD patients, prevalence of symptoms increased in the presence of FEV1 <80%. COPD smokers were more symptomatic than smokers without COPD. Sensitivity and specificity in all subjects with one or more symptoms were 87% and 32%, respectively, whereas in smoker subgroups, sensitivity and specificity were 71% and 41% (≥5 PYs) and 74% and 35% (≥10 PYs), respectively. In all subjects, the presence of at least one symptom was associated with a low PPV for COPD of 11%, but a very high NPV (96%). These data did not change if the analysis was limited to smokers. Conclusion Voluntary public lung function screening programs in Italy are effective, and may detect a large number of undiagnosed subjects with COPD in early stages. In our population, COPD symptoms had low specificity and PPV, even considering smokers only.
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Affiliation(s)
- Alberto Capozzolo
- Department of Cardiac, Thoracic, and Vascular Science, Institute of Respiratory Disease, School of Medicine, University of Bari, Bari, Italy
| | - Giorgio Castellana
- Department of Cardiac, Thoracic, and Vascular Science, Institute of Respiratory Disease, School of Medicine, University of Bari, Bari, Italy
| | - Silvano Dragonieri
- Department of Cardiac, Thoracic, and Vascular Science, Institute of Respiratory Disease, School of Medicine, University of Bari, Bari, Italy
| | - Pierluigi Carratù
- Department of Cardiac, Thoracic, and Vascular Science, Institute of Respiratory Disease, School of Medicine, University of Bari, Bari, Italy
| | - Vito Liotino
- Department of Cardiac, Thoracic, and Vascular Science, Institute of Respiratory Disease, School of Medicine, University of Bari, Bari, Italy
| | - Maria Rosaria Vulpi
- Department of Cardiac, Thoracic, and Vascular Science, Institute of Respiratory Disease, School of Medicine, University of Bari, Bari, Italy
| | - Lorenzo Marra
- Department of Cardiac, Thoracic, and Vascular Science, Institute of Respiratory Disease, School of Medicine, University of Bari, Bari, Italy
| | - Emanuela Resta
- Department of Cardiac, Thoracic, and Vascular Science, Institute of Respiratory Disease, School of Medicine, University of Bari, Bari, Italy
| | - Pierluigi Intiglietta
- Department of Cardiac, Thoracic, and Vascular Science, Institute of Respiratory Disease, School of Medicine, University of Bari, Bari, Italy
| | - Onofrio Resta
- Department of Cardiac, Thoracic, and Vascular Science, Institute of Respiratory Disease, School of Medicine, University of Bari, Bari, Italy
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Gupta S, Arora V, Sharma OP, Satyanarayana L, Gupta AK. Prevalence & pattern of respiratory diseases including Tuberculosis in elderly in Ghaziabad - Delhi - NCR. Indian J Tuberc 2016; 63:236-241. [PMID: 27998495 DOI: 10.1016/j.ijtb.2016.09.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2016] [Accepted: 09/15/2016] [Indexed: 11/24/2022]
Abstract
Elderly population is continuously increasing all over the world including India. Old age is associated with significant prevalence of chronic illnesses. Population based study to find prevalence & pattern of respiratory diseases in elderly in India is difficult to find. Present study was done in an urban locality of Ghaziabad inhabited mainly by low socio - economic status population. Two part questionnaire was used as main tool. Through part one 1522 elderly were screened for respiratory disease. Respiratory disease was confirmed & diagnosed by part two of questionnaire, physical examination & necessary investigations. Prevalence of respiratory diseases was 18.8% in this study. Prevalence of respiratory diseases was almost double in elderly males as compared to females. COPD was most prevalent respiratory disease followed by Bronchial asthma.
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Affiliation(s)
- Sonisha Gupta
- Associate Professor, Department of Tuberculosis & Respiratory Diseases, Santosh Medical College & Hospital, Ghaziabad, India.
| | | | - O P Sharma
- Geriatric Society of India, K-49, 2nd Floor, Green Park Main, New Delhi, Delhi 110016, India
| | | | - Atul Kumar Gupta
- Department of Surgery, Santosh Medical College & Hospital, Ghaziabad, India
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14
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Sorino C, Pedone C, Scichilone N. Fifteen-year mortality of patients with asthma-COPD overlap syndrome. Eur J Intern Med 2016; 34:72-77. [PMID: 27357368 DOI: 10.1016/j.ejim.2016.06.020] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 05/23/2016] [Accepted: 06/15/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND The coexistence of asthma and chronic obstructive pulmonary disease (asthma-COPD overlap syndrome: ACOS) is increasingly recognized but data about its prevalence and long-term mortality are needed. METHODS Prevalence of ACOS and 15-year mortality rates were assessed in 1065 subjects aged >65years, enrolled in the SA.R.A. study, with complete clinical, lung functional and follow-up data. Physical performance, disease-related disability, and health-related quality of life (HRQL) were also evaluated. RESULTS ACOS was found in 11.1% of subjects (29.4% of those previously diagnosed with COPD and 19.7% of those with asthma). ACOS was positively associated with impaired physical performance, functional ability, and HRQL. Individuals with ACOS had higher mortality rates than controls (7.17 per 100 person-years; mortality rate ratio: 1.83). After adjustment for the main confounders, the risk of all-cause mortality remained significantly increased in subjects with ACOS (HR: 1.82), COPD (HR: 2.12), and restriction (HR: 2.41), but not asthma. CONCLUSIONS Long-term prognosis of ACOS was similar to COPD, and worse than asthma and healthy controls. ACOS had a significant impact on physical performance, functional ability, and HRQL.
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Affiliation(s)
- Claudio Sorino
- Biomedical Department of Internal and Specialist Medicine, Section of Pulmonology, University of Palermo, Italy; Division of Pulmonology, ASST Lariana S. Anna Hospital of Como, Italy.
| | - Claudio Pedone
- Unit of Geriatrics, University Campus Bio-Medico, Rome, Italy.
| | - Nicola Scichilone
- Biomedical Department of Internal and Specialist Medicine, Section of Pulmonology, University of Palermo, Italy.
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Rootmensen G, van Keimpema A, Zwinderman A, Sterk P. Clinical phenotypes of obstructive airway diseases in an outpatient population. J Asthma 2016; 53:1026-32. [PMID: 27366830 DOI: 10.3109/02770903.2016.1174258] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND AND OBJECTIVES Historically, obstructive airway diseases such as asthma and COPD are classified as different diseases. Although the definitions are clearly described, classification of patients into these traditional, clinical disease entity can be difficult. Recent evidence that there are complex, overlapping phenotypes of obstructive lung disease. Our aim was to capture clinical phenotypes of obstructive diseases through the use of cluster analysis in a representative patient population at a common Dutch pulmonary outpatient clinic. Clinical physiological and cellular/ molecular markers were used in the analysis. METHODS To carry out the cluster analysis, an imputed dataset was created from a random sample of 191 adult patients chosen from a pulmonary outpatient clinic. The selection criteria from the sample included patients with a doctor's diagnosis for asthma or COPD. Detailed assessment of patient pulmonary function, blood eosinophil counts, allergic sensitisation and smoking history was collected. RESULTS We observed four distinct clusters with different clinical characteristics of obstructive lung diseases. Cluster 1: patients with a history of extensive cigarette smoking, airway obstruction without signs of emphysema; cluster 2: patients with features of the emphysematous type of COPD; cluster 3: patients with characteristics of allergic asthma; cluster 4: patients with features suggesting an overlap syndrome of atopic asthma and COPD. CONCLUSION Four phenotypes of obstructive lung disease were identified amongst patients clinically labelled as asthma or COPD. These findings emphasize the concept that there are different phenotypes of obstructive lung diseases, including overlapping and complementary disease entities. These phenotypes of chronic airways disease can serve to tailor disease management.
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Affiliation(s)
- Geert Rootmensen
- a Department of Pulmonology , Academic Medical Centre , Amsterdam , the Netherlands.,b Department of Pulmonology , Waterland ziekenhuis , Purmerend , the Netherlands
| | - Anton van Keimpema
- c Department of Pulmonology , Astmacentrum Heideheuvel , the Netherlands
| | - Aeilko Zwinderman
- d Clinical Research Unit, Academic Medical Centre , Amsterdam , the Netherlands
| | - Peter Sterk
- a Department of Pulmonology , Academic Medical Centre , Amsterdam , the Netherlands
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16
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Maio S, Baldacci S, Carrozzi L, Pistelli F, Angino A, Simoni M, Sarno G, Cerrai S, Martini F, Fresta M, Silvi P, Di Pede F, Guerriero M, Viegi G. Respiratory symptoms/diseases prevalence is still increasing: a 25-yr population study. Respir Med 2015; 110:58-65. [PMID: 26614595 DOI: 10.1016/j.rmed.2015.11.006] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Revised: 11/06/2015] [Accepted: 11/09/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Few epidemiological surveys on general population samples estimated changes in prevalence of respiratory symptoms/diseases over a long time interval; our study aims to quantify the temporal changes in the prevalence rates of asthma, allergic rhinitis and Chronic Obstructive Pulmonary Disease (COPD) after 25 years from baseline. METHODS A general population sample participated in 3 cross-sectional surveys carried out in Central Italy (Pisa) in 1985-88 (n = 3865), 1991-93 (n = 2841), 2009-11 (n = 1620). 2276 (47%) subjects participated in at least 1 survey, 1723 (35.5%) in at least 2 surveys and 849 (17.5%) in all the 3 surveys. All subjects filled in a standardized questionnaire about health status and risk factors; a sub-sample performed spirometry. Chi-square test was used to compare adjusted prevalence rates of respiratory symptoms/diseases and descriptive characteristics among the surveys. Generalised estimating equations (GEE) were used to analyze the association between respiratory symptoms/diseases and risk factors. RESULTS There was an increasing trend in prevalence rates of all respiratory symptoms/diseases throughout the surveys: current asthma attacks (1st-3rd survey prevalence: 3.4-7.2%), allergic rhinitis (16.2-37.4%), usual phlegm (8.7-19.5%) and COPD (2.1-6.8%) more than doubled. The GEE model confirmed these increasing trends, indicating higher risk of having respiratory symptoms/diseases in the second and third surveys. CONCLUSIONS While asthma and allergic rhinitis increasing trends were confirmed, with respect to other international studies, also a COPD increasing prevalence rates was shown.
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Affiliation(s)
- Sara Maio
- Pulmonary Environmental Epidemiology Unit, CNR Institute of Clinical Physiology, Pisa, Italy.
| | - Sandra Baldacci
- Pulmonary Environmental Epidemiology Unit, CNR Institute of Clinical Physiology, Pisa, Italy
| | - Laura Carrozzi
- Unit of Pulmonology 1, CardioThoracic and Vascular Department, University Hospital of Pisa, Italy
| | - Francesco Pistelli
- Unit of Pulmonology 1, CardioThoracic and Vascular Department, University Hospital of Pisa, Italy
| | - Anna Angino
- Pulmonary Environmental Epidemiology Unit, CNR Institute of Clinical Physiology, Pisa, Italy
| | - Marzia Simoni
- Pulmonary Environmental Epidemiology Unit, CNR Institute of Clinical Physiology, Pisa, Italy
| | - Giuseppe Sarno
- Pulmonary Environmental Epidemiology Unit, CNR Institute of Clinical Physiology, Pisa, Italy
| | - Sonia Cerrai
- Pulmonary Environmental Epidemiology Unit, CNR Institute of Clinical Physiology, Pisa, Italy
| | - Franca Martini
- Pulmonary Environmental Epidemiology Unit, CNR Institute of Clinical Physiology, Pisa, Italy
| | - Martina Fresta
- Pulmonary Environmental Epidemiology Unit, CNR Institute of Clinical Physiology, Pisa, Italy
| | - Patrizia Silvi
- Pulmonary Environmental Epidemiology Unit, CNR Institute of Clinical Physiology, Pisa, Italy
| | - Francesco Di Pede
- Pulmonary Environmental Epidemiology Unit, CNR Institute of Clinical Physiology, Pisa, Italy
| | | | - Giovanni Viegi
- Pulmonary Environmental Epidemiology Unit, CNR Institute of Clinical Physiology, Pisa, Italy; CNR Institute of Biomedicine and Molecular Immunology, Palermo, Italy
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Distribution and etiology of chronic respiratory diseases in primary healthcare departments in Cape Verde. Rev Epidemiol Sante Publique 2015; 63:305-13. [PMID: 26386633 DOI: 10.1016/j.respe.2015.06.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Revised: 04/22/2015] [Accepted: 06/03/2015] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Data on chronic respiratory diseases (CRD) are scarce or unavailable in most African countries. We aimed to determine the prevalence of CRD and associated risk factors in Cape Verde, at the primary healthcare level. METHODS In the frame of the Global Alliance Against Chronic Respiratory Diseases, a cross-sectional study was carried out in October 2006 in 3256 outpatients (2142 women) (median age of 30 years) seeking care at primary healthcare departments, through a standardized interview questionnaire during two weeks. RESULTS The prevalence of emphysema, tuberculosis, chronic bronchitis, rhinoconjunctivitis and asthma were 0.7%, 2%, 4.5%, 12.3% and 6.2%, respectively. Current smoking was associated with emphysema (OR: 3.36; 95% CI: 0.97-11.40) and tuberculosis (OR: 2.14; 95% CI: 1.07-4.30), ever exposed to a dusty workplace with chronic bronchitis (OR: 2.20; CI 95%: 1.50-3.21) and rhinoconjunctivitis (OR: 1.56; CI 95%: 1.23-1.98) and cooking or heating using an open fire with asthma (OR: 1.59; CI 95%: 1.16-2.19). The estimates of attributable risks percent indicated that, in the sample, a noticeable part of CRD could be attributed to active smoking, exposure to dust and biomass. Results varied according to gender, particularly regarding current smoking which was more important for men. CONCLUSIONS Tobacco smoking, exposure to dust at work and using an open fire were important risk factors for CRD. Our results suggest that if actions were taken in order to reduce the aforementioned exposures, an important CRD decrease could be achieved.
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de Marco R, Marcon A, Rossi A, Antó JM, Cerveri I, Gislason T, Heinrich J, Janson C, Jarvis D, Kuenzli N, Leynaert B, Probst-Hensch N, Svanes C, Wjst M, Burney P. Asthma, COPD and overlap syndrome: a longitudinal study in young European adults. Eur Respir J 2015; 46:671-9. [PMID: 26113674 DOI: 10.1183/09031936.00008615] [Citation(s) in RCA: 102] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Accepted: 04/22/2015] [Indexed: 11/05/2022]
Abstract
We compared risk factors and clinical characteristics, 9-year lung function change and hospitalisation risk across subjects with the asthma-chronic obstructive pulmonary disease (COPD) overlap syndrome (ACOS), asthma or COPD alone, or none of these diseases.Participants in the European Community Respiratory Health Survey in 1991-1993 (aged 20-44 years) and 1999-2001 were included. Chronic airflow obstruction was defined as pre-bronchodilator forced expiratory volume in 1 s (FEV1)/forced vital capacity<lower limit of normal on both occasions. Based on their history of respiratory symptoms, spirometry and risk factors, subjects were classified as having asthma alone (n=941), COPD alone (n=166), ACOS (n=218) and none of these (n=5659).Subjects with ACOS shared risk factors and clinical characteristics with subjects with asthma alone, but they had an earlier age of asthma onset. FEV1 change in the ACOS group (-25.9 mL·year(-1)) was similar to that in the asthma group (-25.3 mL·year(-1)), and lower (p<0.001) than in the COPD group (-37.3 mL·year(-1)). ACOS was associated with the highest hospitalisation rate.Among young adults aged 20-44 years, ACOS seems to represent a form of severe asthma, characterised by more frequent hospitalisations, and to be the result of early-onset asthma that has progressed to fixed airflow obstruction.
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Affiliation(s)
- Roberto de Marco
- Unit of Epidemiology and Medical Statistics, Department of Public Health and Community Medicine, University of Verona, Verona, Italy
| | - Alessandro Marcon
- Unit of Epidemiology and Medical Statistics, Department of Public Health and Community Medicine, University of Verona, Verona, Italy
| | - Andrea Rossi
- Pulmonary Unit, Azienda Ospedaliera Universitaria Integrata and University of Verona, Verona, Italy
| | - Josep M Antó
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain Hospital del Mar Medical Research Institute, Barcelona, Spain Universitat Pompeu Fabra, Barcelona, Spain CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Isa Cerveri
- Istituto di Ricovero e Cura a Carattere Scientifico San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Thorarinn Gislason
- Department of Respiratory Medicine and Sleep, Landspitali University Hospital and Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Joachim Heinrich
- Institute of Epidemiology I, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Munich, Germany Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Inner City Clinic, University Hospital of Munich, Ludwig-Maximilians University (LMU), Munich, Germany
| | - Christer Janson
- Department of Medical Sciences: Respiratory Medicine and Allergology, Uppsala University Hospital, Uppsala, Sweden
| | - Deborah Jarvis
- Respiratory Epidemiology and Public Health Group, National Heart and Lung Institute, Imperial College, London, UK
| | - Nino Kuenzli
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland University of Basel, Basel, Switzerland
| | - Bénédicte Leynaert
- Inserm-U1152-Epidemiology, Institut National de la Santé et de la Recherche Médicale, Faculté Paris Diderot, Paris, France
| | - Nicole Probst-Hensch
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland University of Basel, Basel, Switzerland
| | - Cecilie Svanes
- Bergen Respiratory Research Group, Centre for International Health, University of Bergen, Bergen, Norway Department of Occupational Medicine, Haukeland University Hospital, Bergen, Norway
| | - Matthias Wjst
- Comprehensive Pneumology Center, Institute of Lung Biology and Disease, Helmholtz Zentrum Muenchen, German Research Center for Environmental Health, Munich, Germany Institute of Medical Statistics and Epidemiology, Technische Universitaet Muenchen, Munich, Germany
| | - Peter Burney
- Respiratory Epidemiology and Public Health Group, National Heart and Lung Institute, Imperial College, London, UK
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COPD prevalence in a north-eastern Italian general population. Respir Med 2015; 109:1040-7. [PMID: 26052037 DOI: 10.1016/j.rmed.2015.05.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2015] [Revised: 05/04/2015] [Accepted: 05/06/2015] [Indexed: 11/20/2022]
Abstract
BACKGROUND COPD prevalence estimates vary mostly depending on different study methodologies. We evaluated the prevalence and clinical features of COPD, as defined by GOLD and ERS/ATS recommendations in a representative sample of Northern Italy general population. METHODS A randomized cross-sectional study was performed. The study participants completed a questionnaire covering: key indicators for considering a diagnosis of COPD, self-reported physician diagnoses of respiratory disease, pharmacological treatment for respiratory disease, indirect costs, occupational and environmental exposures. They also underwent spirometry and physician assessment. RESULTS We evaluated 1236 subjects. Daily respiratory symptoms were experienced by 26.7%. Of this group, only 30.7% had previously performed a spirometry. The overall COPD prevalence was: 11.7% according to GOLD criterion; 9.1% according to LLN criterion; 6.8% according to self-reported physician diagnosis. Of note, 48,8% of subjects with a reported diagnosis of COPD had never undergone a spirometry before the study. CONCLUSIONS Our study provides an estimation of COPD prevalence in a representative sample of Northern Italy general population relying on both clinical symptoms and spirometry outcomes, and describes the different prevalence rates depending on the adopted diagnostic criterion. Spirometry underuse may account for under-diagnosis and misdiagnosis of COPD. It may result in a major impact on quality of life as well as in economic burden.
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20
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Huang S, Vasquez MM, Halonen M, Martinez FD, Guerra S. Asthma, airflow limitation and mortality risk in the general population. Eur Respir J 2014; 45:338-46. [PMID: 25323227 DOI: 10.1183/09031936.00108514] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Asthma and chronic obstructive pulmonary disease co-exist in a significant proportion of patients. Whether asthma increases mortality risk among subjects with airflow limitation remains controversial. We used data from 2121 adult participants in the population-based Tucson Epidemiological Study of Airway Obstructive Disease cohort. At enrolment (1972-1973), participants completed questionnaires and lung function tests. Participants were categorised into four groups based on the combination of airflow limitation (AL; forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC) <70%) and physician-confirmed asthma at baseline. Vital status as of January 2011 was assessed through the National Death Index. Cox proportional hazards models were used to test differences in mortality risk across the four airflow limitation/asthma groups. In multivariate Cox models, the AL+/asthma+ group had a 114% increased mortality risk during follow-up compared with the AL-/asthma- group (adjusted HR 2.14; 95% CI 1.64-2.79). The corresponding hazard ratios were 1.09 (95% CI 0.89-1.34) and 1.34 (95% CI 1.14-1.57) for the AL-/asthma+ and AL+/asthma- groups, respectively. Among subjects with airflow limitation, asthma was associated with increased mortality risk (HR 1.58, 95% CI 1.17-2.12). However, this increased risk was substantially reduced and no longer significant after further adjustment for baseline FEV1 levels. Similar results were obtained when airflow limitation was defined as FEV1/FVC less than the lower limit of normal. In a population-based cohort, subjects with concomitant airflow limitation and asthma had an increased risk of dying, which was mainly related to their baseline lung function deficits.
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Affiliation(s)
- Shuang Huang
- Arizona Respiratory Center, University of Arizona, Tucson, AZ, USA Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
| | - Monica M Vasquez
- Arizona Respiratory Center, University of Arizona, Tucson, AZ, USA Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
| | - Marilyn Halonen
- Arizona Respiratory Center, University of Arizona, Tucson, AZ, USA
| | | | - Stefano Guerra
- Arizona Respiratory Center, University of Arizona, Tucson, AZ, USA CREAL Centre, CIBERESP, Universitat Pompeu Fabra, Barcelona, Spain
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Micallef L, Rodgers P. eulerAPE: drawing area-proportional 3-Venn diagrams using ellipses. PLoS One 2014; 9:e101717. [PMID: 25032825 PMCID: PMC4102485 DOI: 10.1371/journal.pone.0101717] [Citation(s) in RCA: 342] [Impact Index Per Article: 34.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2014] [Accepted: 06/10/2014] [Indexed: 12/22/2022] Open
Abstract
Venn diagrams with three curves are used extensively in various medical and scientific disciplines to visualize relationships between data sets and facilitate data analysis. The area of the regions formed by the overlapping curves is often directly proportional to the cardinality of the depicted set relation or any other related quantitative data. Drawing these diagrams manually is difficult and current automatic drawing methods do not always produce appropriate diagrams. Most methods depict the data sets as circles, as they perceptually pop out as complete distinct objects due to their smoothness and regularity. However, circles cannot draw accurate diagrams for most 3-set data and so the generated diagrams often have misleading region areas. Other methods use polygons to draw accurate diagrams. However, polygons are non-smooth and non-symmetric, so the curves are not easily distinguishable and the diagrams are difficult to comprehend. Ellipses are more flexible than circles and are similarly smooth, but none of the current automatic drawing methods use ellipses. We present eulerAPE as the first method and software that uses ellipses for automatically drawing accurate area-proportional Venn diagrams for 3-set data. We describe the drawing method adopted by eulerAPE and we discuss our evaluation of the effectiveness of eulerAPE and ellipses for drawing random 3-set data. We compare eulerAPE and various other methods that are currently available and we discuss differences between their generated diagrams in terms of accuracy and ease of understanding for real world data.
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Affiliation(s)
- Luana Micallef
- School of Computing, University of Kent, Canterbury, Kent, United Kingdom
- * E-mail:
| | - Peter Rodgers
- School of Computing, University of Kent, Canterbury, Kent, United Kingdom
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Roggeri A, Micheletto C, Roggeri DP. Outcomes and costs of treating chronic obstructive pulmonary disease with inhaled fixed combinations: the Italian perspective of the PATHOS study. Int J Chron Obstruct Pulmon Dis 2014; 9:569-76. [PMID: 24940053 PMCID: PMC4051514 DOI: 10.2147/copd.s65693] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Fixed-dose combinations of inhaled corticosteroids and long-acting β2-agonists have proven to prevent and reduce chronic obstructive pulmonary disease (COPD) exacerbations. The aim of this analysis was to explore the clinical consequences and direct health care costs of applying the findings of the PATHOS (An Investigation of the Past 10 Years Health Care for Primary Care Patients with Chronic Obstructive Pulmonary Disease) study to the Italian context. PATIENTS AND METHODS Effectiveness data from the PATHOS study, a population-based, retrospective, observational registry study conducted in Sweden, in terms of reduction in COPD and pneumonia-related hospitalizations, were considered, in order to estimate the differences in resource consumption between patients treated with budesonide/formoterol and fluticasone/salmeterol. The base case considers the average dosages of the two drugs reported in the PATHOS study and the actual public price in charges to the Italian National Health Service, while the difference in hospitalization rates reported in the PATHOS study was costed based on Italian real-world data. RESULTS The PATHOS study demonstrated a significant reduction in COPD hospitalizations and pneumonia-related hospitalizations in patients treated with budesonide/formoterol versus fluticasone/salmeterol (-29.1% and -42%, respectively). In the base case, the treatment of a patient for 1 year with budesonide/formoterol led to a saving of €499.90 (€195.10 for drugs, €193.10 for COPD hospitalizations, and €111.70 for pneumonia hospitalizations) corresponding to a -27.6% difference compared with fluticasone/salmeterol treatment. CONCLUSION Treatment of COPD with budesonide/formoterol compared with fluticasone/salmeterol could lead to a reduction in direct health care costs, with relevant improvement in clinical outcomes.
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Maio S, Baldacci S, Martini F, Cerrai S, Sarno G, Borbotti M, Pala AP, Murgia N, Viegi G. COPD management according to old and new GOLD guidelines: an observational study with Italian general practitioners. Curr Med Res Opin 2014; 30:1033-42. [PMID: 24450467 DOI: 10.1185/03007995.2014.884492] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Guideline recommendations for COPD management are only partially applied within primary care clinical practice. OBJECTIVE To compare the COPD management by Italian general practitioners (GPs) according to either the old GOLD (oGOLD) or the new GOLD (nGOLD) guidelines. RESEARCH DESIGN AND METHODS Observational study in different Italian areas. A total of 176 GPs enrolled their patients with a COPD diagnosis. Questionnaires were used to collect data on: COPD symptoms, disease severity, exacerbations, prescribed pharmacological and non-pharmacological treatments. COPD severity was estimated according to oGOLD and nGOLD guidelines. RESULTS A total of 526 subjects had complete information to assess COPD severity level according to guidelines (symptoms level, spirometry, history of exacerbations). The investigated subjects were more frequently males (71.2%) with a mean age of 72.5 years, and ex-smokers (44.4%). GPs reported sufficient control of the disease in 47.2% of the subjects with over two exacerbations in the last 12 months. Most patients have moderate COPD (51.5%), according to oGOLD, and belong to D groups (high risk, more symptoms) (45.6%), according to nGOLD. Overall, a low use of post-bronchodilator spirometry (65.1%) and of pulmonary rehabilitation (13.4%) was shown. The results highlighted a low prescriptive appropriateness but with higher value according to nGOLD than oGOLD: 61.4% vs 35.6%. STUDY LIMITATIONS Prescription data only provide limited information to judge prescribing quality, thus the results have to be evaluated with caution; moreover, this study was not designed to assess the difference between oGOLD and nGOLD. CONCLUSIONS Guideline recommendations are applied only partially within clinical practice. A higher prescriptive appropriateness is shown by GPs using nGOLD classification. This might be due to the fact that nGOLD, with respect to oGOLD, takes into account anamnestic usual features considered by GPs in their clinical practice.
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Affiliation(s)
- S Maio
- Pulmonary Environmental Epidemiology Unit, CNR Institute of Clinical Physiology , Pisa , Italy
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de Marco R, Pesce G, Marcon A, Accordini S, Antonicelli L, Bugiani M, Casali L, Ferrari M, Nicolini G, Panico MG, Pirina P, Zanolin ME, Cerveri I, Verlato G. The coexistence of asthma and chronic obstructive pulmonary disease (COPD): prevalence and risk factors in young, middle-aged and elderly people from the general population. PLoS One 2013; 8:e62985. [PMID: 23675448 PMCID: PMC3651288 DOI: 10.1371/journal.pone.0062985] [Citation(s) in RCA: 232] [Impact Index Per Article: 21.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Accepted: 03/26/2013] [Indexed: 11/21/2022] Open
Abstract
Background The joint distribution of asthma and chronic obstructive pulmonary disease (COPD) has not been well described. This study aims at determining the prevalence of self-reported physician diagnoses of asthma, COPD and of the asthma-COPD overlap syndrome and to assess whether these conditions share a common set of risk factors. Methods A screening questionnaire on respiratory symptoms, diagnoses and risk factors was administered by mail or phone to random samples of the general Italian population aged 20–44 (n = 5163) 45–64 (n = 2167) and 65–84 (n = 1030) in the frame of the multicentre Gene Environment Interactions in Respiratory Diseases (GEIRD) study. Results A physician diagnosis of asthma or COPD (emphysema/chronic bronchitis/COPD) was reported by 13% and 21% of subjects aged <65 and 65–84 years respectively. Aging was associated with a marked decrease in the prevalence of diagnosed asthma (from 8.2% to 1.6%) and with a marked increase in the prevalence of diagnosed COPD (from 3.3% to 13.3%). The prevalence of the overlap of asthma and COPD was 1.6% (1.3%–2.0%), 2.1% (1.5%–2.8%) and 4.5% (3.2%–5.9%) in the 20–44, 45–64 and 65–84 age groups. Subjects with both asthma and COPD diagnoses were more likely to have respiratory symptoms, physical impairment, and to report hospital admissions compared to asthma or COPD alone (p<0.01). Age, sex, education and smoking showed different and sometimes opposite associations with the three conditions. Conclusion Asthma and COPD are common in the general population, and they coexist in a substantial proportion of subjects. The asthma-COPD overlap syndrome represents an important clinical phenotype that deserves more medical attention and further research.
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Affiliation(s)
- Roberto de Marco
- Unit of Epidemiology and Medical Statistics, University of Verona, Verona, Italy.
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Chronic obstructive pulmonary disease in Portugal: Pneumobil (1995) and 2002 prevalence studies revisited. REVISTA PORTUGUESA DE PNEUMOLOGIA 2013; 19:88-95. [PMID: 23639349 DOI: 10.1016/j.rppneu.2012.11.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2012] [Revised: 11/07/2012] [Accepted: 11/07/2012] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Chronic Obstructive Pulmonary Disease (COPD) has been a leading cause of morbidity and mortality worldwide, over the years. In 1995, the implementation of a respiratory function survey seemed to be an adequate way to draw attention to neglected respiratory symptoms and increase the awareness of spirometry surveys. By 2002 there were new consensual guidelines in place and the awareness that prevalence of COPD depended on the criteria used for airway obstruction definition. The purpose of this study is to revisit the two studies and to turn public some of the data and respective methodologies. METHODS From Pneumobil study database of 12,684 subjects, only the individuals with 40+ years old (n = 9.061) were selected. The 2002 study included a randomized representative sample of 1,384 individuals with 35-69 years old. RESULTS The prevalence of COPD was 8.96% in Pneumobil and 5.34% in the 2002 study. In both studies, presence of COPD was greater in males and there was a positive association between presence of COPD and older age groups. Smokers and ex-smokers showed a higher proportion of cases of COPD. CONCLUSIONS Prevalence in Portugal is lower than in other European countries. This may be related to lower smokers' prevalence. Globally, the most important risk factors associated with COPD were age over 60 years, male gender and smoking exposure. All aspects and limitations regarding different recruitment methodologies and different criteria for defining COPD cases highlight the need of a standardized method to evaluate COPD prevalence and associated risks factors, whose results can be compared across countries, as it is the case of BOLD project.
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Maio S, Baldacci S, Simoni M, Angino A, Martini F, Cerrai S, Sarno G, Pala A, Bresciani M, Paggiaro P, Viegi G. Impact of asthma and comorbid allergic rhinitis on quality of life and control in patients of Italian general practitioners. J Asthma 2012; 49:854-61. [PMID: 22957769 DOI: 10.3109/02770903.2012.716471] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Asthma is a disease with elevated prevalence within the general population. Although general practitioners (GPs) are among the first health-care professionals to whom patients refer for their symptoms, there are few evaluations of this disease based on data provided by the GPs. The aim of this observational study is to assess the impact of asthma and comorbid allergic rhinitis on individual/social burden, quality of life, and disease control in asthmatic patients of Italian GPs. METHODS Throughout Italy, 107 GPs enrolled 995 patients diagnosed with asthma and using anti-asthmatic drug prescriptions, or with asthma-like symptoms during the previous 12 months. Data were collected through questionnaires filled out by GPs and patients. RESULTS Of the 995 asthmatic patients, 60.6% had concomitant allergic rhinitis (R+A), 39.4% had asthma alone. The latter, compared to those with R+A, showed significantly lower prevalence of intermittent asthma (37.5% vs. 55.6%) and higher prevalence of mild, moderate, and severe persistent asthma (28.4% vs. 23.2%, 28.7% vs. 18.8%, and 5.4% vs 2.4%, respectively). Individual/social burden due to asthma was frequent and increased with disease severity: 87.5% of severe persistent asthma patients reported at least one medical consultation in the last 12 months, 37.5% emergency department visits, 26.7% hospitalization, and 62.5% limitations in daily activities. Control and quality of life were inversely associated with disease severity and were worse in patients with R+A than in those with asthma alone. CONCLUSIONS This study showed the negative impact of high severity levels and comorbid allergic rhinitis on quality of life of asthmatic patients and on individual/social burden due to asthma in an Italian GPs setting.
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Affiliation(s)
- Sara Maio
- Pulmonary Environmental Epidemiology Unit, CNR Institute of Clinical Physiology, Pisa, Italy.
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Rycroft CE, Heyes A, Lanza L, Becker K. Epidemiology of chronic obstructive pulmonary disease: a literature review. Int J Chron Obstruct Pulmon Dis 2012; 7:457-94. [PMID: 22927753 PMCID: PMC3422122 DOI: 10.2147/copd.s32330] [Citation(s) in RCA: 185] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2012] [Indexed: 11/23/2022] Open
Abstract
The aim of this study is to quantify the burden of chronic obstructive pulmonary disease (COPD) – incidence, prevalence, and mortality – and identify trends in Australia, Canada, France, Germany, Italy, Japan, The Netherlands, Spain, Sweden, the United Kingdom, and the United States of America. A structured literature search was performed (January 2000 to September 2010) of PubMed and EMBASE, identifying English-language articles reporting COPD prevalence, incidence, or mortality. Of 2838 articles identified, 299 full-text articles were reviewed, and data were extracted from 133 publications. Prevalence data were extracted from 80 articles, incidence data from 15 articles, and mortality data from 58 articles. Prevalence ranged from 0.2%–37%, but varied widely across countries and populations, and by COPD diagnosis and classification methods. Prevalence and incidence were greatest in men and those aged 75 years and older. Mortality ranged from 3–111 deaths per 100,000 population. Mortality increased in the last 30–40 years; more recently, mortality decreased in men in several countries, while increasing or stabilizing in women. Although COPD mortality increased over time, rates declined more recently, likely indicating improvements in COPD management. In many countries, COPD mortality has increased in women but decreased in men. This may be explained by differences in smoking patterns and a greater vulnerability in women to the adverse effects of smoking.
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Affiliation(s)
- Catherine E Rycroft
- Market Access and Outcomes Strategy, RTI Health Solutions, Didsbury, Manchester, United Kingdom.
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Diaz-Guzman E, Khosravi M, Mannino DM. Asthma, chronic obstructive pulmonary disease, and mortality in the U.S. population. COPD 2012; 8:400-7. [PMID: 22149399 DOI: 10.3109/15412555.2011.611200] [Citation(s) in RCA: 89] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND COPD and asthma are common diseases in the U.S. population and can coexist. Our goal was to determine the prevalence of self-reported, physician-diagnosed asthma and COPD in a sample of the U.S. population and their association with lung function impairment and mortality. METHODS We used baseline data from NHANES III and the follow-up mortality data. We used logistic regression and Cox Proportional Hazards models, adjusting for age, sex, race/ethnicity, education level, smoking status, and disease stage. RESULTS The sample consisted of 15,203 subjects, of whom 4,542 died during the follow-up period. Coexisting COPD and asthma was reported by 357 (2.7%), COPD by 815 (5.3%), and asthma by 709 (5.3%). Subjects with both conditions had a higher proportion of obstruction (30.9%) than those with COPD (24.3%), asthma (13.3%), or no lung disease (5.4%). In survival models adjusting for all factors except baseline lung function, coexisting COPD and asthma had the highest risk for mortality (Hazard Ratio [HR] 1.83, 95% confidence interval [CI] 1.34, 2.49), followed by COPD only (HR 1.44, 95% CI 1.28, 1.62), and asthma only (HR 1.16, 95% CI 0.94, 1.42). These affects were attenuated after controlling for baseline lung function: coexisting asthma and COPD (HR 1.45, 95% CI 1.06, 1.98), COPD only (1.28, 95% CI 1.13, 1.45), and asthma only (HR 1.04, 95% CI 0.85, 1.27). CONCLUSION In this analysis, subjects who report coexisting asthma and COPD have a higher risk of obstruction on spirometry and a higher risk of death during follow-up.
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Affiliation(s)
- Enrique Diaz-Guzman
- Division of Pulmonary, Sleep & Critical Care Medicine, University of Kentucky College of Medicine, 740 S. Limestone Street, Lexington, KY 40536, USA.
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Baldacci S, Maio S, Simoni M, Cerrai S, Sarno G, Silvi P, Di Pede F, Borbotti M, Pala AP, Bresciani M, Viegi G. The ARGA study with general practitioners: impact of medical education on asthma/rhinitis management. Respir Med 2012; 106:777-85. [PMID: 22436656 DOI: 10.1016/j.rmed.2012.02.013] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2011] [Revised: 01/26/2012] [Accepted: 02/21/2012] [Indexed: 11/20/2022]
Abstract
AIM To evaluate the impact of a medical education course (MEC) on the behaviour of general practitioners (GPs) to treat asthma and allergic rhinitis (AR). METHODS Data on 1820 patients (mean age 41 yrs ± 17 yrs) with asthma or AR were collected by 107 Italian GPs: 50% attended a MEC and 50% didn't (group B). The adherence for AR and asthma treatment was evaluated according to ARIA and GINA guidelines (GL). RESULTS AR and asthma were diagnosed in 78% and 56% of patients; 34% had concomitant AR and asthma. Regardless of the MEC, the adherence to GL was significantly higher for AR than for asthma treatment (52 versus 19%). Group B GPs were more compliant to ARIA guidelines in the treatment of mild AR, whereas group A were more compliant in the treatment of moderate-severe AR; the adherence didn't differ between the groups for AR patients with comorbid asthma. Adherence to GINA GL for asthma treatment did not differ between GPs of groups A and B, independently from concomitant AR. Though insignificantly, group A were more compliant to GINA GL in the treatment of patients with only severe persistent asthma (63 versus 46%) as group B were for patients with severe persistent asthma and concomitant AR. CONCLUSIONS GPs often tend to treat patients independently from GL. The impact of a single MEC did not improve adherence to GL in treating less severe AR and asthma patients, while there was a trend towards the opposite attitude in more severe AR patients without concomitant asthma.
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Affiliation(s)
- Sandra Baldacci
- Pulmonary Environmental Epidemiology Unit, CNR Institute of Clinical Physiology, Via Trieste, 41 - 56126 Pisa, Italy.
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Idrovo AJ, Albavera-Hernández C, Rodríguez-Hernández JM. Social epidemiology of a large outbreak of chickenpox in the Colombian sugar cane producer region: a set theory-based analysis. CAD SAUDE PUBLICA 2011; 27:1393-402. [DOI: 10.1590/s0102-311x2011000700014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2010] [Accepted: 03/29/2011] [Indexed: 11/22/2022] Open
Abstract
There are few social epidemiologic studies on chickenpox outbreaks, although previous findings suggested the important role of social determinants. This study describes the context of a large outbreak of chickenpox in the Cauca Valley region, Colombia (2003 to 2007), with an emphasis on macro-determinants. We explored the temporal trends in chickenpox incidence in 42 municipalities to identify the places with higher occurrences. We analyzed municipal characteristics (education quality, vaccination coverage, performance of health care services, violence-related immigration, and area size of planted sugar cane) through analyses based on set theory. Edwards-Venn diagrams were used to present the main findings. The results indicated that three municipalities had higher incidences and that poor quality education was the attribute most prone to a higher incidence. Potential use of set theory for exploratory outbreak analyses is discussed. It is a tool potentially useful to contrast units when only small sample sizes are available.
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The multiple dimensions of airways disease: targeting treatment to clinical phenotypes. Curr Opin Pulm Med 2011; 17:72-8. [PMID: 21150622 DOI: 10.1097/mcp.0b013e328341f181] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The recognition that asthma and chronic obstructive pulmonary disease (COPD) are not single diseases, but syndromes made up of multiple separate disorders that overlap, has led to attempts to develop a new taxonomy for the disorders of airflow obstruction. A better understanding of the distinct disorders of airways disease has the potential to inform on underlying mechanisms, risk factors, natural history, monitoring and treatment. RECENT FINDINGS Recent attempts to describe the different phenotypes have largely been based on cluster analysis. Preliminary evidence suggests that there may be five distinct phenotypes of airways disease. To date, however, no simple allocation criteria have been validated that enable clinicians to allocate individual patients to specific phenotypic groups. The concept of differential treatment responses in different phenotypes of airways disease has been established with the demonstration that eosinophilic asthma preferentially responds to inhaled corticosteroid therapy or monoclonal antibody against interleukin-5, and severe refractory noneosinophilic asthma to macrolide antibiotics. SUMMARY The priority is to further define the distinct phenotypes that make up the syndromes of asthma and COPD. This knowledge could lead to treatments specifically targeted for defined phenotypic groups, rather than for asthma and COPD in general, which represents the current management approach.
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Cibella F, Cuttitta G, La Grutta S, Melis MR, Lospalluti ML, Uasuf CG, Bucchieri S, Viegi G. Proportional Venn diagram and determinants of allergic respiratory diseases in Italian adolescents. Pediatr Allergy Immunol 2011; 22:60-8. [PMID: 20825572 DOI: 10.1111/j.1399-3038.2010.01097.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Large variations in prevalence of atopy and allergic diseases are reported worldwide in children, but in epidemiological studies the use of skin prick tests (SPT) and spirometry along with questionnaires is not common in the Mediterranean Area. The present work was aimed at evaluating the prevalence of current asthma (CA), rhinoconjunctivitis (RC), and eczema (E), with atopy and respiratory function, and the role of risk factors for allergic respiratory diseases. A total of 2150 Italian schoolchildren were cross-sectionally investigated through respiratory questionnaire, SPT, and spirometry. A proportional Venn diagram quantified the distribution of CA, RC, and E, stratifying for allergic sensitization to show differences in prevalence of allergic diseases among subjects with and without positive SPT. CA prevalence was 4.2%, RC 17.9%, and E 5.3%. CA and RC increased, while E decreased, with respect to previous local studies. Allergic sensitization prevalence (evaluated as positive response to at least one SPT) was 39.2%. A double Venn diagram identified 15 categories. Atopic CA was threefold more frequent than non-atopic CA. Atopic vs non-atopic RC and E were 9.6% vs 10.3% and 2.0% vs 3.3%, respectively. Atopic vs non-atopic RC associated with CA were 1.6% vs 0.5%; the same figures for RC associated with E were 0.8% vs 1.3%. Asymptomatic atopic subjects were 27.0%. Atopy, RC, parental asthma, and environmental risk factors were associated with CA. Atopy and environmental factors were risk factors also for RC. Asthma and traffic exposure were linked to reduced lung function. Respiratory allergic diseases are still increasing and largely concomitant in Italian adolescents. Atopy is more important for CA than RC. Avoiding exposures to measured environmental risk factors would prevent 41% of current asthma and 34% of rhinoconjunctivitis.
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Affiliation(s)
- Fabio Cibella
- Consiglio Nazionale delle Ricerche, Istituto di Biomedicina e Immunologia Molecolare, Palermo, Italy
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Shin KC. Clinical Year-in-Review of Chronic Obstructive Pulmonary Disease in Korea. Tuberc Respir Dis (Seoul) 2011. [DOI: 10.4046/trd.2011.71.1.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Kyeong-Cheol Shin
- Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea
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Cazzola M, Puxeddu E, Bettoncelli G, Novelli L, Segreti A, Cricelli C, Calzetta L. The prevalence of asthma and COPD in Italy: a practice-based study. Respir Med 2010; 105:386-91. [PMID: 20951017 DOI: 10.1016/j.rmed.2010.09.022] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2010] [Revised: 09/29/2010] [Accepted: 09/30/2010] [Indexed: 01/27/2023]
Abstract
We conducted a population-based cross-sectional epidemiologic survey of asthma and COPD in an adult representative national sample using information obtained from the Health Search Database owned by the Italian College of General Practitioners. General Practitioners who had a list of patient population of 909,638 individuals (429,962 men and 479,676 women; man/woman ratio [M/WR]: 0.89) ≥ 14 years old at the end of December 2009 were selected to be representatives of the whole Italian population. Cases of asthma and COPD were identified on the basis of the ICD-9 codes. The total sample included 55,500 (6.10% of the entire population; 5.49% of men and 6.64% of women; M/WR: 0.74) subjects suffering from asthma and 25,762 (2.83% of the entire population; 3.51% of men and 2.23% of women; M/WR: 1.41) subjects suffering from COPD. The asthma/COPD ratio in general population was 2.16. The odds ratio (OR) was chosen because asthma and COPD had a prevalence less than 10%. The OR of developing asthma decreased with age both in men and women, but in the first group of age (15-34 years) it was higher in men vs. women (1.69 vs. 1.00) although it became lower than 1 from 35 years old and up in men and from 75 years old and up in women. On the contrary, the OR of developing COPD became higher than 1 from 55 years old and up both in men and in women and progressively increased with age (in the group 75-84 years, it was 6.16 in men and 4.07 in women, respectively).
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Affiliation(s)
- Mario Cazzola
- Department of Internal Medicine, University of Rome Tor Vergata, Rome, Italy.
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Abstract
PURPOSE OF REVIEW In the clinical setting, patients who present with a combination of asthma and chronic obstructive pulmonary disease (COPD)-related traits are not uncommon. This review discusses recent advances in the characterization of the natural course, phenotypes, and molecular markers of cases with coexisting asthma and COPD and in the understanding of the nature of the link between these two conditions. RECENT FINDINGS Recent epidemiological evidence indicates that asthma accounts for a substantial proportion of cases of irreversible airflow limitation in the general population and that, in addition to the critical role of environmental exposures in adult age, alterations of developmental processes in childhood may also predispose patients with asthma to COPD later in life. Findings from clinical and experimental studies emphasize the existence of remarkable heterogeneity within the group of patients with coexisting asthma and COPD in terms of natural history of lung function, risk factors for disease progression, lung structural changes, and immunological profiles. SUMMARY The phenotypic complexity of cases with coexisting asthma and COPD challenges a rigid categorization of patients into existing diagnostic labels and suggests the importance of integrating clinical, functional, morphologic, immunological, and molecular assessments to tailor and optimize prevention and treatment.
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Affiliation(s)
- Stefano Guerra
- Centre for Research in Environmental Epidemiology, IMIM-Hospital del Mar, CIBERESP, Barcelona, Spain.
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Martins P, Rosado-Pinto J, do Céu Teixeira M, Neuparth N, Silva O, Tavares H, Spencer JL, Mascarenhas D, Papoila AL, Khaltaev N, Annesi-Maesano I. Under-report and underdiagnosis of chronic respiratory diseases in an African country. Allergy 2009; 64:1061-7. [PMID: 19210360 DOI: 10.1111/j.1398-9995.2009.01956.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Chronic respiratory diseases (CRD) are greatly underestimated. The aim of this study was to assess the burden associated with reported CRD and chronic obstructive pulmonary disease, as defined on the basis of various standardized criteria, by estimating their point prevalence in a sample of individuals attending the Primary Health Care (PHC) level and Emergency Room (ER) Departments in Cape Verde (CV) archipelago. The second aim of the study was to identify factors related to airways obstruction and reported CRD in this population. METHODS A cross-sectional study was carried out in CV during 2 weeks. Outpatients aged more than 20 years seeking care at PHC level and ER answered a standardized questionnaire and were subjected to spirometry, independently of their complaint. Two criteria for airways obstruction were taken into account: forced expiratory volume (FEV(1)) <80% of the predicted value and FEV(1)/forced vital capacity (FVC) ratio <0.70. RESULTS A total of 274 individuals with a satisfactory spirometry were included. 22% of the individuals had a FEV(1) < 80%. Individuals older than 46 years had a higher risk of having airways obstruction. Asthma diagnosis (11%) had a clear association with airways obstruction. Smoking was a risk factor for a lower FEV(1). Working in a dust place and cooking using an open fire were both related to chronic bronchitis and asthma diagnosis. CONCLUSION Under-report and underdiagnosis of chronic respiratory conditions seem to be a reality in CV just as in other parts of the world. To improve diagnosis, our results reinforce the need of performing a spirometry.
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Affiliation(s)
- P Martins
- Immunoallergy Department, Dona Estefânia Hospital, Rua Jacinta Marto, Lisbon, Portugal
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Radeos MS, Cydulka RK, Rowe BH, Barr RG, Clark S, Camargo CA. Validation of self-reported chronic obstructive pulmonary disease among patients in the ED. Am J Emerg Med 2009; 27:191-6. [PMID: 19371527 PMCID: PMC3422655 DOI: 10.1016/j.ajem.2008.01.011] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2007] [Revised: 01/29/2008] [Accepted: 01/29/2008] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND To determine whether the self-reported diagnosis of adults who present to the emergency department (ED) with an acute exacerbation of either asthma or chronic obstructive pulmonary disease (COPD) is validated by medical record review. METHODS This is cross-sectional study of 78 consecutive adults, 55 years and older, presenting to 3 EDs with symptoms suggestive of an exacerbation of asthma or COPD. We used current spirometric guidelines for a "spirometrically validated" diagnosis of COPD (eg, postbronchodilator forced expiratory volume in 1 second/forced ventilatory capacity <70%). Patients without office spirometry result were classified with COPD using clinical validation based on at least one of the following: primary care physician diagnosis of COPD, chronic bronchitis, or emphysema in the medical record or chest radiography, chest computed tomography, or arterial blood gas (ABG) diagnostic of COPD. RESULTS Among 60 patients who self-reported diagnosis of COPD, 98% (95% confidence interval, 89-100) had clinically validated or spirometrically validated COPD. In addition, 83% (95% confidence interval, 59-96) of patients who reported either asthma only or no respiratory disease had clinically validated or spirometrically validated COPD. In no case was the chest radiograph or the ABG useful as a stand-alone test in establishing the diagnosis of COPD. CONCLUSIONS Patients 55 years and older presenting to the ED with acute asthma or COPD, even those with clinical symptoms but no diagnosis of COPD, are likely to have COPD. Clinicians should maintain a high index of suspicion for COPD when older asthma patients deny COPD.
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Affiliation(s)
- Michael S. Radeos
- Department of Emergency Medicine, New York Hospital Queens, Flushing, NY, USA
- Weill Medical College of Cornell University, New York, NY, USA
- EMNet Coordinating Center, Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Rita K. Cydulka
- Department of Emergency Medicine, MetroHealth Medical Center, Cleveland, OH
| | - Brian H. Rowe
- Department of Emergency Medicine, University of Alberta, Edmonton, AB, Canada
| | - R. Graham Barr
- Division of General Medicine, Department of Medicine, Columbia University Medical Center, New York, NY, USA
| | - Sunday Clark
- EMNet Coordinating Center, Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Carlos A. Camargo
- EMNet Coordinating Center, Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
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Miniati M, Sostman HD, Gottschalk A, Monti S, Pistolesi M. Perfusion Lung Scintigraphy for the Diagnosis of Pulmonary Embolism: A Reappraisal and Review of the Prospective Investigative Study of Acute Pulmonary Embolism Diagnosis Methods. Semin Nucl Med 2008; 38:450-61. [DOI: 10.1053/j.semnuclmed.2008.06.001] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Marsh SE, Travers J, Weatherall M, Williams MV, Aldington S, Shirtcliffe PM, Hansell AL, Nowitz MR, McNaughton AA, Soriano JB, Beasley RW. Proportional classifications of COPD phenotypes. Thorax 2008; 63:761-7. [PMID: 18728201 DOI: 10.1136/thx.2007.089193] [Citation(s) in RCA: 160] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) encompasses a group of disorders characterised by the presence of incompletely reversible airflow obstruction with overlapping subsets of different phenotypes including chronic bronchitis, emphysema or asthma. The aim of this study was to determine the proportion of adult subjects aged >50 years within each phenotypic subgroup of COPD, defined as a post-bronchodilator ratio of forced expiratory volume in 1 s/forced vital capacity (FEV(1)/FVC) <0.7, in accordance with current international guidelines. METHODS Adults aged >50 years derived from a random population-based survey undertook detailed questionnaires, pulmonary function tests and chest CT scans. The proportion of subjects in each of 16 distinct phenotypes was determined based on combinations of chronic bronchitis, emphysema and asthma, with and without incompletely reversible airflow obstruction defined by a post-bronchodilator FEV(1)/FVC ratio of 0.7. RESULTS A total of 469 subjects completed the investigative modules, 96 of whom (20.5%) had COPD. Diagrams were constructed to demonstrate the relative proportions of the phenotypic subgroups in subjects with and without COPD. 18/96 subjects with COPD (19%) had the classical phenotypes of chronic bronchitis and/or emphysema but no asthma; asthma was the predominant COPD phenotype, being present in 53/96 (55%). When COPD was defined as a post-bronchodilator FEV(1)/FVC less than the lower limit of normal, there were one-third fewer subjects with COPD and a smaller proportion without a defined emphysema, chronic bronchitis or asthma phenotype. CONCLUSION This study provides proportional classifications of the phenotypic subgroups of COPD which can be used as the basis for further research into the pathogenesis and treatment of this heterogeneous disorder.
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Affiliation(s)
- S E Marsh
- Medical Research Institute of New Zealand, P O Box 10055, Wellington 6143, New Zealand.
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Scichilone N, Battaglia S, La Sala A, Bellia V. Clinical implications of airway hyperresponsiveness in COPD. Int J Chron Obstruct Pulmon Dis 2007; 1:49-60. [PMID: 18046902 PMCID: PMC2706603 DOI: 10.2147/copd.2006.1.1.49] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
COPD represents one of the leading causes of mortality in the general population. This study aimed at evaluating the relationship between airway hyperresponsiveness (AHR) and COPD and its relevance for clinical practice. We performed a MEDLINE search that yielded a total of 1919 articles. Eligible studies were defined as articles that addressed specific aspects of AHR in COPD, such as prevalence, pathogenesis, or prognosis. AHR appears to be present in at least one out of two individuals with COPD. The occurrence of AHR in COPD is influenced by multiple mechanisms, among which impairment of factors that oppose airway narrowing plays an important role. The main determinants of AHR are reduction in lung function and smoking status. We envision a dual role of AHR: in suspected COPD, specific determinants of AHR, such as reactivity and the plateau response, may help the physician to discriminate COPD from asthma; in definite COPD, AHR may be relevant for the prognosis. Indeed, AHR is an independent predictor of mortality in COPD patients. Smoking cessation has been shown to reduce AHR. Further studies are needed to elucidate whether this functional change is associated with improvement in lung function and respiratory symptoms.
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Affiliation(s)
- Nicola Scichilone
- Istituto di Medicina Generale e Pneumologia, Cattedra di Malattie dell'Apparato Respiratorio, Università di Palermo, Palermo, Italy.
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Simoni M, Carrozzi L, Baldacci S, Borbotti M, Pistelli F, Di Pede F, Maio S, Angino A, Viegi G. Respiratory symptoms/diseases, impaired lung function, and drug use in two Italian general population samples. Respir Med 2007; 102:82-91. [PMID: 17905576 DOI: 10.1016/j.rmed.2007.08.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2007] [Revised: 08/10/2007] [Accepted: 08/14/2007] [Indexed: 11/18/2022]
Abstract
BACKGROUND Research and practice indicate that a sizeable amount of prescribed drugs is never used. AIM To assess the habitual up-take of medicines in subjects with respiratory symptoms/diseases or impaired lung function in general population samples. METHODS Data regard 4010 subjects (8-88 years) from the rural area of Po River Delta (North Italy) and the urban area of Pisa (North-Central Italy). Analyses concern the habitual use of any or specific medicines (broncho-pulmonary, anti-allergic, cardio-vascular, diuretic) in subjects with asthma, chronic bronchitis/emphysema (COPD), COPD or chronic cough/phlegm (COPDsx), and airways obstruction (AO, FEV(1)/FVC<70%). RESULTS Asthma, COPD, COPDsx, and AO were present in 6%, 5%, 21%, and 13% of cases, respectively. Only 37% and 21% of subjects with respiratory symptoms/diseases used any or specific medicines, respectively. The subjects with COPD exhibited the highest prevalence of assumption (59% for any drug, 38% for specific medicines), followed by asthmatics (42% and 30%), and subjects with AO (40% and 25%). After accounting for sex, age, residence area, smoking habit, education, and presence of comorbidity, the conditions significantly related to any medicine up-take were COPD (OR 1.65, 95% CI 1.08-2.53) and asthma (OR 1.47, 95% CI 1.01-2.12). Only asthma resulted significantly associated with the use of specific drugs (OR 3.11, 95% CI 1.94-4.97). Drug use was higher in the urban than in the rural area. CONCLUSION The results indicate that most people in the general population do not use drugs, in spite of reported respiratory disorders. The underuse of medicines seems lower in the urban area.
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Affiliation(s)
- Marzia Simoni
- Pulmonary Environmental Epidemiology Unit, CNR Institute of Clinical Physiology, Via Trieste, 41, 56126 Pisa, Italy.
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Viegi G, Maio S, Pistelli F, Baldacci S, Carrozzi L. Epidemiology of chronic obstructive pulmonary disease: health effects of air pollution. Respirology 2007; 11:523-32. [PMID: 16916323 DOI: 10.1111/j.1440-1843.2006.00886.x] [Citation(s) in RCA: 84] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
COPD is one of the leading causes of morbidity and mortality in the industrialized and the developing countries. According to the prediction of the World Health Organization, COPD will become the third leading cause of mortality and the fifth cause of disability in 2020 worldwide. In epidemiology, distinct phenotypic entities converge on the term COPD, so that prevalence and mortality data may be inclusive of chronic bronchitis, emphysema and asthma; moreover, the assessment of prevalence rates may change considerably according to the diagnostic tools used. Thus, a considerable problem is to estimate the real prevalence of COPD in the general population. COPD is determined by the action of a number of various risk factors, among which, the most important is cigarette smoking. However, during the last few decades, evidence from epidemiological studies finding consistent associations between air pollution and various outcomes (respiratory symptoms, reduced lung function, chronic bronchitis and mortality), has suggested that outdoor air pollution is a contributing cause of morbidity and mortality. In conclusion, epidemiological studies suggest that air pollution plays a remarkable role in the exacerbation and in the pathogenesis of chronic respiratory diseases. Thus, respiratory physicians, as well as public health professionals, should advocate for a cleaner environment.
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Affiliation(s)
- Giovanni Viegi
- Pulmonary Environmental Epidemiology Unit, CNR Institute of Clinical Physiology, Via Trieste 41, 56126 Pisa, Italy.
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Simoni M, Baldacci S, Puntoni R, Pistelli F, Farchi S, Lo Presti E, Pistelli R, Corbo G, Agabiti N, Basso S, Matteelli G, Di Pede F, Carrozzi L, Forastiere F, Viegi G. Respiratory symptoms/diseases and environmental tobacco smoke (ETS) in never smoker Italian women. Respir Med 2006; 101:531-8. [PMID: 16893638 DOI: 10.1016/j.rmed.2006.06.021] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2006] [Revised: 06/19/2006] [Accepted: 06/23/2006] [Indexed: 11/26/2022]
Abstract
AIM To study the relationship between respiratory/allergic disorders and chronic environmental tobacco smoke (ETS) exposure to husband or at workplace among non-smoking women of a general population in Italy. METHODS Analyses regard 2195 married or employed women. Information was collected through a self-administered questionnaire. ETS exposure was validated by salivary cotinine. RESULTS Exposure both to husband and at work resulted a significant risk factor for current dyspnoea (odds ratio (OR) 1.61, 95% confidence interval (CI) 1.20-2.16), any shortness of breath at rest (OR 2.81, 95% CI 1.83-4.30), recent wheeze (OR 1.71, 95% CI 1.04-2.82), recent attacks of shortness of breath with wheeze (OR 1.85, 95% CI 1.05-3.26), asthma diagnosis/symptoms (OR 1.50, 95% CI 1.09-2.08), diagnosis of asthma or bronchitis/emphysema (obstructive lung diseases (OLD)) (OR 2.24, 95% CI 1.40-3.58), current cough/phlegm (OR 1.52, 95% CI 1.07-2.15), and rhino-conjunctivitis (OR 1.48, 95% CI 1.13-1.94). Exposure only at work yielded higher adjusted odds ratios for all health conditions, except for rhino-conjunctivitis. Overall, about 24% of shortness of breath at rest, 16% of dyspnoea, 17% of rhino-conjunctivitis, 12% of OLD, and 10% of asthma diagnosis/symptoms are attributable to the effect of exposures to both husband and at work. Twelve percent of shortness of breath at rest and 10% of rhino-conjunctivitis cases might be avoided by eliminating exposure only at work and only to husband, respectively. CONCLUSIONS Lifetime ETS exposure, especially at work, is associated with respiratory symptoms/diseases, and it accounts for a sizeable proportion of such disorders. The combined effect of both exposures is higher than the separate effects.
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Affiliation(s)
- Marzia Simoni
- Unità di Epidemiologia Ambientale Polmonare, Istituto di Fisiologia Clinica, CNR Institute of Clinical Physiology, Via Trieste, 41 56126 Pisa, Italy
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