The Platino project: methodology of a multicenter prevalence survey of chronic obstructive pulmonary disease in major Latin American cities

BACKGROUND: The prevalence of Chronic Obstructive Pulmonary Disease (COPD) in many developed countries appears to be increasing. There is some evidence from Latin America that COPD is a growing cause of death, but information on prevalence is scant. It is possible that, due to the high frequency of smoking in these countries, this disease may represent a major public health problem that has not yet been recognized as such. The PLATINO study is aimed at measuring COPD prevalence in major cities in Latin America. METHODS/DESIGN: A multi-country survey is being carried out in major cities in Latin America. In each metropolitan area, a population-based sample of approximately 1,000 individuals aged 40 years or older is being interviewed using standardized questionnaires. Eligible subjects are submitted to pre- and post-bronchodilator spirometry, and classified according to several criteria for COPD. Anthropometric examinations are also performed. Several risk factors are being studied, including smoking, socioeconomic factors, exposure to domestic biomass pollution, occupational exposure to dust and hospital admissions due to respiratory conditions during childhood. Whether or not subjects affected by COPD are aware of their disease, and if so how it is being managed by health services, is also being investigated, as are the consequences of this condition on quality of life and work performance. RESULTS: At the present time, the study is completed in São Paulo, Mexico City and Montevideo; Chile has started the study in March 2004 and it will be followed by Venezuela; two other metropolitan areas could still join the PLATINO project. Similar sampling procedures, with stratification for socio-economic status, are being used in all sites. Strict coordination, training and standardization procedures have been used to ensure comparability of results across sites. Overall 92% of the pre-bronchodilator spirometry tests fulfilled ATS criteria of quality in the three first sites (97% in Montevideo, 91% in Mexico and 89% in Sao Paulo). CONCLUSIONS: The PLATINO project will provide a detailed picture of the global distribution of COPD in Latin America. This project shows that studies from Latin America can be carried out with adequate quality and be of scientific value

Exposure to bioaerosols at open dumpsites: A case study of bioaerosols exposure from activities at Olusosun open dumpsite, Lagos Nigeria

Activities associated with the open dumping of municipal solid waste has the potential for greater impact on the environment and public health compared to other forms of waste-to-land treatment of such wastes. However, there is a lack of quantitative data on the exposure to bioaerosols from open dumpsites, hence impeding the development of effective interventions that would reduce the risk of respiratory symptoms among scavengers and waste workers at such dumpsites. This study investigated exposure to bioaerosols at Olusosun open dumpsite, Lagos Nigeria using three methodologies; (1) Conducting a cross-sectional survey on the respiratory health of the population on the dumpsite, (2) Measuring bioaerosol concentrations in the ambient air by measuring four bioaerosols indicator groups (total bacteria, gram-negative bacteria, Aspergillus fumigatus and total fungi) using a Anderson six stage impactor sampler, (3) Measuring activity related exposures to bioaerosols using an SKC button personal sampler. After a cross sectional health survey of 149 participants (waste workers, scavengers, middlemen, food vendors and business owners), smokers reported higher symptoms of chronic cough (21%) and chronic phlegm (15%) compared to non-smokers (chronic cough 15%, chronic phlegm 13%). Years of work > 5 years showed no statistically significant association with chronic phlegm (OR 1.2, 95% CI 0.4–3.4; p > 0.05) or asthma (OR 1.8, 95% CI 0.6–5.2; p > 0.05). At the 95th percentile, the concentration of total bacteria was the highest (2189 CFU/m3), then gram negative bacteria (2188 CFU/m3), total fungi (843 CFU/m3) and Aspergillus fumigatus (441 CFU/m3) after ambient air sampling. A comparison of the data showed that the activity-based sampling (undertaken using body worn personal sampler) had higher bioaerosols concentrations (104 –106 CFU/m3), i.e. 2–3 logs higher than those recorded from static ambient air sampling. Bioaerosol exposure was highest during scavenging activities compared to waste sorting and site supervision. Particle size distributions showed that 41%, 46%, 76% and 63% of total bacteria, gram-negative bacteria, Aspergillus fumigatus and total fungi respectively were of respirable sizes and would therefore be capable of penetrating deep into the respiratory system, posing a greater human health risk. This study has shown that exposure to bioaerosols can be associated with activities undertaken at open dumpsites and may contribute to the high prevalence of the chronic respiratory symptoms among the workers in such environments

Allergic rhinitis and asthma comorbidity in a survey of young adults in Italy.

BACKGROUND: Several studies have provided evidence of a strong association between asthma and allergic or nonallergic rhinitis, leading to the hypothesis that allergic rhinitis (AR) and asthma represent a continuum of the same disease. AIM: The aims of our study were: (i) to measure the comorbidity of AR and asthma and asthma-like symptoms and (ii) to assess whether asthma, AR, and their coexistence share a common pattern of individual risk factors. METHODS: The subjects are participants from the Italian multicentre, cross-sectional survey on respiratory symptoms in the young adult general population (Italian Study of Asthma in Young Adults, ISAYA). The relationship between individual risk factors and asthma, AR and their coexistence, was studied by means of a multinomial logistic regression. RESULTS: About 60% of asthmatics reported AR. On the other hand, subjects with AR presented an eightfold risk of having asthma compared to subjects without AR. Age was negatively associated with asthma [OR = 0.89, 95% confidence interval (CI): 0.82-0.96], AR (OR = 0.92, 95% CI: 0.86-0.98), and asthma associated with AR (OR = 0.83, 95% CI: 0.79-0.88). The risk of AR without asthma was significantly higher in the upper social classes (OR = 1.23, 95% CI: 1.08-1.39). Active current smoking exposure was positively associated with asthma alone (OR = 1.24, 95% CI: 1.09-1.41) and negatively associated with AR with (OR = 0.69, 95% CI: 0.54-0.88) or without (OR = 0.76, 95% CI: 0.69-0.84) asthma. CONCLUSIONS: Asthma and AR coexist in a substantial percentage of patients; bronchial asthma and AR, when associated, seem to share the same risk factors as AR alone while asthma without AR seems to be a different condition, at least with respect to some relevant risk factors