F Pistelli

Epidemiology of Chronic Obstructive Pulmonary Disease (COPD)

Chronic Obstructive Pulmonary Disease (COPD) is one of the leading causes of morbidity and mortality in the industrialized and the developing countries. During 1997, COPD has been estimated to be the number four cause of death after cardiovascular diseases, tumors and cerebrovascular diseases in the United States. In 2020 COPD will probably become the third leading cause of death all over the world, following the trend of increasing prevalence of lung cancer. The impact of this respiratory disease worldwide is expected to increase with a heavy economic burden on individuals and society. In the United States direct and indirect costs of COPD were estimated at about USD24 billion in 1993. Unfortunately, there are few data on health-care utilization despite the great interest in COPD among researchers. As all chronic diseases, the prevalence of COPD is strongly associated with age. Data collected in a general population sample (living in Italy) showed a progressive increase of the prevalence of chronic bronchitis and emphysema with age, both in males and in females. COPD is determined by the action of a number of various risk factors either singly or interacting among themselves in a synergistic way. Among these, the most important is cigarette smoking, ranking at the first level for developing chronic bronchitis and emphysema. Also air pollution and some occupational exposures represent risks for developing COPD. Many epidemiological studies have indicated an association between the prevalence of chronic bronchitis and a low socioeconomic status. Furthermore, in the etiology of COPD we must consider endogenous risk factors such as gender, genetic features, presence of respiratory troubles in childhood, and family history. To date, epidemiologic studies have been of great importance for the characterization of the disease at a population level, indicating possible causes and assessing its impact on the individual and on society as a whole. Unfortunately, international standards for the diagnosis of COPD are lacking, which complicates the organization of appropriate epidemiological surveys.

Geographical information system and environmental epidemiology: a cross-sectional spatial analysis of the effects of traffic-related air pollution on population respiratory health

BackgroundTraffic-related air pollution is a potential risk factor for human respiratory health. A Geographical Information System (GIS) approach was used to examine whether distance from a main road (the Tosco-Romagnola road) affected respiratory health status.MethodsWe used data collected during an epidemiological survey performed in the Pisa-Cascina area (central Italy) in the period 1991-93. A total of 2841 subjects participated in the survey and filled out a standardized questionnaire on health status, socio-demographic information, and personal habits. A variable proportion of subjects performed lung function and allergy tests. Highly exposed subjects were defined as those living within 100 m of the main road, moderately exposed as those living between 100 and 250 m from the road, and unexposed as those living between 250 and 800 m from the road. Statistical analyses were conducted to compare the risks for respiratory symptoms and diseases between exposed and unexposed. All analyses were stratified by gender.ResultsThe study comprised 2062 subjects: mean age was 45.9 years for men and 48.9 years for women. Compared to subjects living between 250 m and 800 m from the main road, subjects living within 100 m of the main road had increased adjusted risks for persistent wheeze (OR = 1.76, 95% CI = 1.08-2.87), COPD diagnosis (OR = 1.80, 95% CI = 1.03-3.08), and reduced FEV1/FVC ratio (OR = 2.07, 95% CI = 1.11-3.87) among males, and for dyspnea (OR = 1.61, 95% CI = 1.13-2.27), positivity to skin prick test (OR = 1.83, 95% CI = 1.11-3.00), asthma diagnosis (OR = 1.68, 95% CI = 0.97-2.88) and attacks of shortness of breath with wheeze (OR = 1.67, 95% CI = 0.98-2.84) among females.ConclusionThis study points out the potential effects of traffic-related air pollution on respiratory health status, including lung function impairment. It also highlights the added value of GIS in environmental health research.

Rhinitis is an independent risk factor for developing cough apart from colds among adults

Background:  In cross‐sectional clinical studies, rhinitis has been shown to be strongly associated with co‐existing chronic cough. However, to date, this association has been poorly delineated from a prospective and epidemiological standpoint.

Reduction of risk of dying from tobacco-related diseases after quitting smoking in Italy

Aims and Background The aims of this paper are to compute the risks of dying of ischemic heart disease (IHD), lung cancer (LC), stroke, and chronic obstructive pulmonary disease (COPD) for Italian smokers by gender, age and daily number of cigarettes smoked, and to estimate the benefit of stopping smoking in terms of risk reduction. Methods Life tables by sex and smoking status were computed for each smoking-related disease based on Italian smoking data, and risk charts with 10-year probabilities of death were computed for never, current and former smokers. Results Men aged 45-49 years, current smokers, have a 8, 10, 3 and 1 in 1,000 chance of dying of IHD, LC, stroke and COPD, respectively, whereas women with the same characteristics have a 2, 6, 3 and 1 in 1,000 chance, respectively, for all smokers combined, i.e., independent of the smoking intensity. The risk reduction rates from quitting smoking are remarkable: a man who quits smoking at 45-49 years can reduce the risk of dying of IHD, LC, stroke and COPD in the next 10 years by 43%, 53%, 57% and 55%, respectively; a woman by 49%, 49%, 59% and 57%, respectively. Conclusions Estimates of risk reduction by quitting smoking are useful to provide a sounder scientific basis for public health messages and clinical advice.

The global burden of chronic respiratory diseases

Key points Currently, the serious consequences of chronic diseases and their risk factors are not fully recognised by the international health community. In the period of 1990–2020, COPD deaths are expected to increase from 2.2 to 4.7 million worldwide. Reducing chronic disease death rates by an additional 2% annually would avert 36 million deaths by 2015. The abatement of the main risk factors for respiratory diseases, in particular tobacco smoking, environmental tobacco smoke, indoor biomass fuels, outdoor air pollution and unhealthy diet, can achieve huge health benefits. Educational aims To define the burden of chronic respiratory diseases all over the world. To underline the importance of chronic diseases recognition by the international health community. To provide details about the burden of chronic obstructive pulmonary disease (COPD): the predicted third cause of death by 2020. Summary Currently, the serious consequences of chronic diseases and their risk factors are not fully recognised by the international health community. Moreover, chronic diseases are not only a problem of the ageing population in developed countries. In fact, it has been estimated that 80% of mortality for chronic diseases occurred in low-income and middleincome countries in 2005. Thus, the World Health Organization (WHO) Dept of Chronic Diseases and Health Promotion has suggested a new Millennium Development Goal for the next few years: to reduce chronic disease death rates by an additional 2% annually, in order to avert 36 million deaths by 2015.

How to Predict Exacerbations and Hospital Admissions in Stable COPD Outpatients

Accessible online at: www.karger.com/journals/res The incidence, morbidity and mortality from chronic obstructive pulmonary disease (COPD) are rising. While the diagnosis of COPD by general practitioners (GPs) is underestimated [1, 2], COPD will be the fourth among the diseases that will contribute to the global burden of disease by 2020, preceded by ischemic heart disease, unipolar major depression and cerebrovascular disease, respectively [3]. Moreover, prevalence rates of respiratory symptoms associated with COPD are relatively high [1, 2, 4] and COPD is at present a major cause of frequent use of both general practice and hospital services in Europe [5, 6]. In order to standardize the assessment and management of COPD, in the last few years a number of national and international respiratory societies have published guidelines on diagnosis and care of COPD patients [1, 4– 6]. As COPD is a chronic, slowly progressive and largely irreversible disorder, medical interventions of primary, secondary and tertiary prevention have been particularly recommended. Further, due to the natural course of the COPD, characterized by recurrent acute exacerbations and hospital admissions, shared care between GPs and hospital doctors seems to be the recommended way to follow up such patients. Epidemiological studies play a central role in identifying risk factors for COPD that can be usefully utilized in preventive clinical interventions in the general practice setting. In the current issue of Respiration, Miravitlles et al. [7] report the results of a multiple logistic regression analysis, aimed at estimating the probability of having either frequent exacerbations or hospital admissions in outpatients with stable COPD. Reduced forced expiratory volume in 1 s (FEV1) values were found to increase the risk for the two outcomes of the study, as expected. However, while those patients with chronic mucus hypersecretion and older age had an increased likelihood of two or more exacerbations per year, those with comorbidity – including cardiac insufficiency, ischemic heart disease and diabetes – were more likely to have hospital admissions. These results confirm the importance of the respiratory function level in affecting the course of COPD, and, thus, the usefulness of a frequent spirometric follow-up of these patients. However, the finding of chronic mucus hypersecretion as predictor of acute exacerbations is particularly interesting. Results from longitudinal epidemiological surveys have previously shown an association of chronic mucus hypersecretion with FEV1 decline, and subsequent hospitalization because of COPD [8]. Although international clinical guidelines do not strictly recommend mucokinetic agents in the treatment of COPD, they are used in clinical practice in some European countries. Possibly, in the light of such new epidemiological evidence, the role of