Patrizia Silvi

Respiratory symptoms/diseases prevalence is still increasing: a 25-yr population study

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.

COPD symptoms/diagnoses and work exposure: A 20 years population-based survey

Background: work exposure to fumes/gases/chemicals is associated with COPD symptoms/diagnosis but few epidemiological surveys on general population samples estimated such relationship over a long time interval. Objectives: to assess the association between long term work exposure to fume/gas/chemicals and COPD symptoms/diagnosis over a 20 yrs period. Methods: a general population sample participated in 2 surveys carried out in Pisa in 1991-93 and 2009-11. A standardised questionnaire on health status and risk factors was used. Chi-square test was used to compare long term work exposure [ever exposed (EE), at least once exposed (ATOE), never exposed (NE)] and the change in COPD symptoms/diagnosis from the 1st to the 2nd survey (COPD symptoms: persistent/incident vs never/remittent; COPD diagnosis: persistent/incident vs never/remittent). Logistic regression models (LRM) were run to analyse the association between persistent/incident COPD symptoms/diagnosis and work exposure adjusted for gender, age, smoking habits, asthma symptoms/diagnosis at the 1st survey, smoking habits and lifetime passive smoke exposure. Results: there were 1107 longitudinal subjects: 27.5% EE, 30.4% ATOE and 42.1% NE. LRM showed a significantly higher risk of having persistence/onset of: COPD diagnosis (OR=2.4, 95%CI=1.4-3.9), dyspnoea (OR=2.0, 95%CI=1.4-2.9), usual phlegm (OR=2.2, 95%CI=1.5-3.3), usual cough (OR= 1.6, 95%CI=1.0-2.3), in EE; dyspnoea (OR=1.7, 95%CI=1.2-2.3), usual phlegm (OR=1.5, 95%CI=1.1-2.2) in ATOE. Conclusions: our findings indicate a longitudinal association between work exposure and COPD. There is a need for the EU to implement effective strategies for COPD prevention in work settings.

Odor annoyance perception and health effects in an Italian general population sample

Background: Recently, there has been a growing interest about the emission of unpleasant odors due to their potential health impacts. Aim: to evaluate the associations between odor annoyance perception and health in neighbors of Pisa waste incinerator. Methods: the circular study area, centered on the incinerator, was divided in 5 rings, with radius 0.4, 0.8, 1.4, 2.7, 4.0, for sampling subjects according to household residence. Controls were randomly chosen outside the study area. 1407 subjects filled out a self-administered standardized questionnaire on respiratory symptoms/diseases, cancer, cardiovascular diseases, risk factors and odor annoyance levels (no, slightly annoying, very annoying). Results: prevalence rates of odor annoyance perception in 1407 subjects participating in the survey (50% males, mean age 44 ± 22 yrs) were: 39.8% no odor perceived;19.1% slightly annoying odors; 41.2% very annoying odors. By multivariate analysis, adjusted for independent effects ofgender, age, residence-incinerator distance, education, working position, active and passive smoking, residence duration, occupational exposure, odor annoyance perception was significantly associated with the following respiratory symptoms/diseases: phlegm (OR 2.13, 95%CI 1.40-3.23), cough (OR 2.54, 95%CI 1.74-3.71), Chronic Obstructive Pulmonary Disease (OR 1.88, 95%CI 1.01-3.48), dyspnea (OR 1.89, 95%CI 1.33-2.67), asthma (OR 1.95, 95%CI 1.14-3.35), asthma symptoms (OR 1.85, 95%CI 1.23-2.78) and allergic rhinitis (OR 1.53, 95%CI 1.05-2.24). Conclusion: Our study shows an association among respiratory effects and odor annoyance perception, which thus might be used as a proxy of environmental air pollution exposure.