S. Baldacci

Sister chromatid exchange and micronucleus frequency in human lymphocytes of 1,650 subjects in an Italian population: II. Contribution of sex, age, and lifestyle.

Sister chromatid exchange (SCE) and micronuclei (MN) analysis was carried out on 1,650 healthy individuals living in Pisa and in two nearby small cities, Cascina and Navacchio (Ca‐Na). The effect of smoking on SCEs was linearly correlated with the number of cigarettes per day, and an increase of 7.3% SCEs was detectable for as few cigarettes as 1–10/day. Ex‐smokers showed intermediate mean values of SCEs (8.09 ± 1.88) in comparison with never smokers (7.54 ± 1.61) and current smokers (8.45 ± 1.94). Mean values of SCEs of ex‐smokers decreased linearly with time of smoking cessation, reaching the mean values of never smokers within 8 years. The extent of SCE decrease was inversely proportional to the number of cigarettes previously smoked. No interaction between smoking habits and coffee or alcohol drinking on SCEs was observed. A borderline (P = 0.053) increase in mean SCE values in coffee drinkers (more than 3 cups/day) was found. The age effect on SCEs was remarkable in Ca‐Na, but not in Pisa donors. Job type was not associated with significant modification of mean values of SCEs. Multiple logistic regression analysis revealed a statistically significant association between the proportion of high frequency cells (HCF) outliers and coffee consumption. Age and sex appeared to be by far the most important variables associated with modifications in MN frequency, which increased by 0.04 and 0.02 per year in males and females, respectively. Children and young donors (age ≤ 40 years) showed lower MN frequency regardless of sex, whereas sex appeared to determine a significantly higher increase of MN only in females older than 40 years. In contrast, in males the MN rate by age tended to level off after the age of 30–50. MN frequencies of Pisa blue‐ and white‐collar workers were statistically significantly higher than in students (+0.71 and +0.55, respectively). Smoking did not determine any increase of MN frequency. A total lack of correlation (P = 0.913) between MN and SCEs was observed. Environ. Mol. Mutagen. 31:228–242, 1998

Longitudinal changes of body mass index, spirometry and diffusion in a general population

The aim of this study was to evaluate the effects of body mass index (BMI) changes over an 8-yr follow-up, on longitudinal changes of vital capacity (VC), forced vital capacity (FVC), forced expiratory volume in one second (FEV1), and carbon monoxide diffusing capacity of the lung (DL,CO) indices in a general population sample of North Italy. To avoid including weight changes possibly related to physical growth, only the 1,426 adults (>24 yrs, 46% males) with complete follow-up were selected. Median linear regression models were applied to estimate the medians of change (computed as follow-up minus baseline values) of VC, FVC, FEV1 and DL,CO indices, as functions of changes of BMI over the follow-up period, separately by sex, after considering several potential confounders and effect modifiers. The extent of lung function loss tended to be higher among those who, at baseline, reported greater BMI values. Males experienced larger losses than females (20 and 16 mL FEV1 median reduction for a BMI unit increase in males and females, respectively). Conversely, longitudinal changes of BMI caused a slight and nonsignificant increase in DL,CO values in both sexes. Over an 8-yr follow-up, the detrimental effect of gaining weight might be reversible for many adults as most of those who reduced their body mass index values also increased their lung function. Overweight patients with ventilatory impairment should be routinely encouraged to lose weight for improving their lung function.

Skin prick test reactivity to common aeroallergens in relation to total IgE, respiratory symptoms, and smoking in a general population sample of northern Italy.

Skin prick test (SPT) reactivity to common airborne allergens and its relationships to sex, age, smoking habits, and respiratory symptoms/ diseases were evaluated in a general population sample (n= 2841, 8–75 years of age) living in the Po delta area (northern Italy). Subjects completed a standardized questionnaire and underwent prick tests (12 local allergens, a negative and a positive control) and determination of total serum IgE. Atopy was evaluated by measuring the maximal diameter for each allergen, after subtracting that of the negative control. Thirty‐one percent of subjects showed a positive skin response at a 3‐mm threshold. Pollens, Dermatophagoides pteronyssinus, and D. farinae caused the highest frequencies of reactions. Young people and those who had never smoked had higher prevalence rates of SPT reactivity. Asthma, asthma symptoms, and rhinitis were significantly associated with SPT reactivity in both sexes (cough only in females) and with the number of positive reactions. IgE values were also significantly associated with SPT reactivity. In conclusion, our findings indicate that almost one‐third of the general population of an Italian rural area is skin test positive, emphasizing the importance of assessing atopy in respiratory epidemiologic surveys.

Indoor air pollution and respiratory health in the elderly

People spend about ≥80–90% of their daily time indoors, elderly people especially at home. Thus, it is important to investigate possible health effects of indoor air pollutants and to consider their contributions to the total human exposure. This report summarises current knowledge on health effects of three common indoor air pollutants, respirable suspended particles, nitrogen dioxide and environmental tobacco smoke, with focus on the adults and the elderly. Preliminary findings on exposure distributions and health effects of these pollutants in older subjects of two panel studies carried out in Italian general populations will also be reported. The two indoor pollution studies were performed in the Po Delta area in North Italy (428 subjects and 140 houses investigated) and in Pisa in Central Italy (761 subjects and 282 houses investigated). Individuals aged ≥65 yrs spent a significantly larger number of hours at home than the other age groups both in winter and in summer. A trend of higher occurrence of acute respiratory symptoms in the presence of environmental tobacco smoke was shown in comparison to the unexposed elderly both in winter (31 versus 29%) and summer (33 versus 16%). The occurrence of acute respiratory symptoms was consistently higher in relation to the high respirable suspended particles-index exposure compared to low exposure (33 versus 27% in winter, 27 versus 21% in summer). Both the presence of environmental tobacco smoke at home and exposure to the high respirable suspended particles-index were associated with a decrease in the mean daily peak expiratory flow.

The Po River Delta Respiratory Epidemiological Survey: an analysis of factors related to level of total serum IgE

The purpose of the present study was to analyse whether sex, age, skin test reactivity, cigarette smoking and occupational exposure were related to the total serum immunoglobulin (Ig)E concentrations (kU x L[-1]), in a general population sample. We studied 1,905 subjects (915 males, 990 females) of a general population sample (n=2,841, 8-73 yrs) participating in the second cross-sectional respiratory epidemiological survey in the rural Po Delta area (near Venice, North Italy). Distribution of total serum IgE concentrations was skewed, thus a log-transformation was performed to obtain a Gaussian shape. Significantly higher values of IgE were found in males compared to females. In general, a peak of IgE concentration was found at 8-14 yrs. IgE values tended to be lower in older than younger adults. Significantly higher serum IgE levels were shown in subjects with a positive skin-prick test index (ST+) than in those with a negative skin-prick test index (ST-). There was a significant relationship of total IgE levels with skin reactivity to pollens and house-dust mites. In both sexes higher values of IgE were found in current smokers than in ex-nonsmokers, regardless of skin-test reactivity. There was no significant difference in IgE values between ex- and nonsmokers. Passive smoking and occupational exposure were significantly related to increased IgE values. Our results confirm that in a general population sample immunoglobulin E concentrations are related not only to skin-prick test reactivity to common aeroallergens, but also to other risk factors for chronic obstructive lung diseases, such as sex, active/ passive smoking and occupational exposure.

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.

The Po River Delta epidemiological survey: Reference values of total serum IgE levels in a normal population sample of North Italy (8-78 yrs)

The aim of this paper was to define, for the first time in Italy, normal levels of total serum IgE in a general population sample of North Italy. Total serum IgE in 1905 subjects, living in Po Delta area (near Venice), were measured by PRIST method. Normal values were derived from 558 subjects without asthma and/or asthmatic/rhinitic symptoms, noncurrent smokers, skin prick-test negatives (‘normals’). Cut-off values to differentiate ‘normals’ from the remaining part of the sample (‘others’), from asthmatic, and from rhinitic subjects, were established with the IgE value midway between the upper limit of the 95% confidence intervals (CI) of the geometric mean for ‘normals’ and the lower limit for ‘others’, asthmatics, and rhinitics, respectively. Geometric mean of normal children–adolescents was 45 kU/L (SD: 2.6; 95% CI: 38–63). In normal adults geometric mean was 29 kU/L (SD: 3.3; 95% CI: 25–40) in males and 19 kU/L (SD: 3.8; 95% CI: 16–22) in females. The diagnostic sensitivity of IgE test was low, while the specificity was very high. A good positive predictive value in discriminating ‘normals’ from ‘others’ was found, on the contrary, we found a good negative predictive value in discriminating ‘normals’ from asthmatics or from rhinitics. In conclusion, our results confirm that it is necessary to provide separate total serum IgE reference values for what concerns age in children–adolescents and in adults, and gender, in adults. Low level of total serum IgE are helpful to exclude allergic asthma or rhinitis.

Risk factors for chronic obstructive pulmonary disease in a North Italian rural area

To assess the role of risk factors for chronic obstructive lung disease (COPD) by multiple logistic models, the data of the first cross-sectional epidemiological survey in the unpolluted rural area of the Po River Delta were analyzed (n=2382; 20–64 years). Each subject filled out a standardized questionnaire; 94% of the subjects were also able to perform forced expirograms. Dependent variables were chronic respiratory symptoms, asthma, abnormal parameters of flow-volume curve (ABNFVC), and a complex characterized by chronic phlegm and/or any wheeze and/or dyspnea grade 2+ and/or diagnosis of asthma and/or an FEV1/FVC ratio less than 60% (ANYABN). Independent variables were: age, ever cigarette smoking (SMK) and lifetime cigarette consumption expressed as pack-years, childhood respiratory infections (CRI), adolescence-adulthood respiratory infections (ARI), familial history for COPD (FCOPD) or for asthma/allergies (FASTHMA), work exposure to dusts/chemicals (EXPO), low socio-economic conditions (SES). A significant relationship with almost all dependent variables was shown by pack-years, ARI and age in both sexes. In males, FCOPD was related to chronic mucus hypersecretion and to ABNFVC, FASTHMA was associated with wheeze and ANYABN. EXPO was related to dyspnea and asthmatic symptoms in both sexes and also to bronchitic symptoms in males. CRI was a significant contributor for asthma symptoms in males, for ANYABN in females. SES had no significant association. In conclusion, our findings show that, beside lifetime cigarette smoking, other host — or environment — related conditions are important risk factors for COPD, suggesting the need for a more thorough strategy for prevention.

COPD management according to old and new GOLD guidelines: an observational study with Italian general practitioners

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.

The ARGA study with Italian general practitioners: prescriptions for allergic rhinitis and adherence to ARIA guidelines

Abstract Background: General practitioners (GPs) are the healthcare professionals to whom patients with rhinitis firstly refer for their symptoms. Objective: In the present study, we assessed drug prescriptions for allergic rhinitis (AR) and evaluated prescriptive adherence to ARIA treatment guidelines. Methods: Data on 1379 AR patients were collected by 107 Italian GPs. Adherence to ARIA guidelines was evaluated according to AR severity classification. Results: AR was diagnosed by GPs as mild intermittent for 46.2% of patients, mild persistent for 26.6%, moderate–severe intermittent for 20.2%, and moderate–severe persistent for 7%; 43.7% of AR patients had concomitant asthma. The most frequently prescribed therapeutic groups were antihistamines (anti-H, 76%) and nasal corticosteroids (NCS, 46%). Anti-H were significantly used more often to treat AR alone than AR + asthma (85 vs. 68%, p < 0.001), whereas NCS were used more often to treat AR + asthma than AR alone (50 vs. 42%, p = 0.01). Among patients with only mild intermittent AR, 39% were prescribed combined therapy. Among patients with moderate–severe persistent AR, 30% of those with AR alone and 18% of those with AR + asthma were prescribed monotherapy based on anti-H. GPs were more compliant with ARIA guidelines while treating AR alone (57%) than AR + asthma (46%) patients. The adherence increased according to the severity grade and was satisfactory for moderate–severe persistent AR (89% for AR alone and 95% for AR + asthma). Conclusions: Adherence to ARIA guidelines is satisfactory only for treatment of more severe patients, thus GPs often tend to treat patients independently from ARIA guidelines. Since prescription data only provide limited information to judge prescribing quality, some deviation from the gold standard are to be expected.