78 research outputs found
Exhaled Nitric Oxide in a Population Sample of Adults
Background: The relationship between exhaled nitric oxide (FENO) and the diagnosis of asthma in the general adult population is not completely clear. Objectives: To investigate the association between FENO and asthma, after controlling for atopy and rhinitis, in a general population sample of adults (mean age 43 years). Methods: The cohort of subjects was a sample of subjects who gave their consent to participate in the European Community Respiratory Health Survey II study. Results: Atopy, rhinitis and current asthma were positively and current smoking was negatively associated with FENO. Multivariate analysis showed that asthma had a significant predictive effect on FENO (β = 0.53; 95% CI 0.21–0.84, p = 0.001), and the increase in FENO was significantly associated with the risk of current asthma (OR = 1.07, 95% CI 1.00–1.14) by the logistic regression model. Receiver-operater characteristic curve showed that FENO ≧18.5 ppb had the best combination of sensitivity (69.2%) and specificity (71%), with a positive predictive value of 24% and a negative predictive value of 95%, for the diagnosis of asthma. Conclusions: Measuring FENO seems to be suitable as an adjunct to questionnaire in the evaluation of asthma in the general population
The Coexistence of asthma and Chronic Ostructive Pulmonary Disease (COPD): prevalence and risk factors in young, middle-aged and elderly people from the general population
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.</br
Seventy years of asthma in Italy: age, period and cohort effects on incidence and remission of self-reported asthma from 1940 to 2010
Background: It is well known that asthma prevalence has been increasing all over the world in the last decades. However, few data are available on temporal trends of incidence and remission of asthma.
Objective: To evaluate the rates of asthma incidence and remission in Italy from 1940 to 2010.
Methods: The subjects were randomly sampled from the general Italian population between 1991 and 2010 in the three population-based multicentre studies: ECRHS, ISAYA, and GEIRD. Individual information on the history of asthma (age at onset, age at the last attack, use of drugs for asthma control, co-presence of hay-fever) was collected on 35,495 subjects aged 20–84 and born between 1925–1989. Temporal changes in rates of asthma incidence and remission in relation to age, birth cohort and calendar period (APC) were modelled using Poisson regression and APC models.
Results: The average yearly rate of asthma incidence was 2.6/1000 (3,297 new cases among 1,263,885 person-years). The incidence rates have been linearly increasing, with a percentage increase of +3.9% (95%CI: 3.1–4.5), from 1940 up to the year 1995, when the rates begun to level off. The stabilization of asthma incidence was mainly due to a decrease in the rates of atopic asthma after 1995, while non-atopic asthma has continued to increase. The overall rate of remission was 43.2/1000person-years, and it did not vary significantly across generations, but was associated with atopy, age at asthma onset and duration of the disease.
Conclusions: After 50 years of a continuous upward trend, the rates of asthma incidence underwent a substantial stabilization in the late 90s. Despite remarkable improvements in the treatment of asthma, the rate of remission did not change significantly in the last seventy years. Some caveats are required in interpreting our results, given that our estimates are based on self-reported events that could be affected by the recall bias
Latitude variation in the prevalence of asthma and allergic rhinitis in Italy: results from the GEIRD study
BACKGROUND: Earlier studies have pointed out a great variability in the prevalence of asthma and
asthma-like symptoms in different geo-climatic areas. AIM: To test the association between latitude and
prevalence of asthma and allergic rhinitis in Italian young adults. METHODS: In the frame of
Gene-Environment Interaction in Respiratory Diseases study, a postal screening questionnaire on
respiratory health and exposure to environmental factors was administered to 18,357 randomly selected
subjects aged 20-44 years in 7 centres: 3 in Northern (Torino, Pavia, Verona), 2 in Central (Ancona,
Perugia) and 2 in Southern Italy (Salerno, Sassari). RESULTS: 10,494 (57.2%) subjects responded to the
questionnaire. The prevalence of self-reported doctor-diagnosed asthma and allergic rhinitis in the lifespan
was 10.2% and 26.9%, respectively, and was significantly different across the centres (p<0.05). After
adjusting for sex, age, potential risk factors for respiratory diseases and design confounders, the prevalence
of asthma (OR: 1.07 per 1°latitude decrease, p<0.001), asthma-like symptoms (wheezing, chest tightness,
asthma attacks: OR ranging from 1.04 to 1.06, p<0.05) and allergic rhinitis (OR: 1.03, p=0.04) showed a
significant north-to-south trend. Similarly, a 1°C increment in temperature was significantly associated with
asthma (OR: 1.10, p<0.001) and asthma-like symptoms (OR from 1.07 to 1.10, p<0.05), but not with allergic
rhinitis (OR=1.02, p=0.190). CONCLUSION: The prevalence of asthma and allergic rhinitis increased
moving southwards in Italy, suggesting that prolonged exposure to different geo-climatic conditions may
affect the onset of asthma and allergic respiratory diseases
Trends in the prevalence of asthma and allergic rhinitis in Italy between 1991 and 2010
The prevalence of asthma increased worldwide until the 1990s, but since then there
has been no clear temporal pattern.
The present study aimed to assess time trends in the prevalence of current asthma, asthma-like
symptoms and allergic rhinitis in Italian adults from 1990 to 2010.
The same screening questionnaire was administered by mail or phone to random samples of
the general population (age 20–44 yrs) in Italy, in the frame of three multicentre studies: the
European Community Respiratory Health Survey (ECRHS) (1991–1993; n56,031); the Italian
Study on Asthma in Young Adults (ISAYA) (1998–2000; n518,873); and the Gene Environment
Interactions in Respiratory Diseases (GEIRD) study (2007–2010; n510,494). Time trends in
prevalence were estimated using Poisson regression models in the centres that repeated the
survey at different points in time.
From 1991 to 2010, the median prevalence of current asthma, wheezing and allergic rhinitis
increased from 4.1% to 6.6%, from 10.1% to 13.9% and from 16.8% to 25.8%, respectively. The
prevalence of current asthma was stable during the 1990s and increased (relative risk 1.38, 95%
CI 1.19–1.59) from 1998–2000 to 2007–2010, mainly in subjects who did not report allergic rhinitis.
The prevalence of allergic rhinitis has increased continuously since 1991.
The asthma epidemic is not over in Italy. During the past 20 yrs, asthma prevalence has
increased by 38%, in parallel with a similar increase in asthma-like symptoms and allergic rhiniti
Respiratory symptoms in children living near busy roads and their relationship to vehicular traffic: results of an Italian multicenter study (SIDRIA 2)
BACKGROUND: Epidemiological studies have provided evidence that exposure to vehicular traffic increases the prevalence of respiratory symptoms and may exacerbate pre-existing asthma in children. Self-reported exposure to road traffic has been questioned as a reliable measurement of exposure to air pollutants. The aim of this study was to investigate whether there were specific effects of cars and trucks traffic on current asthma symptoms (i.e. wheezing) and cough or phlegm, and to examine the validity of self-reported traffic exposure. METHODS: The survey was conducted in 2002 in 12 centers in Northern, Center and Southern Italy, different in size, climate, latitude and level of urbanization. Standardized questionnaires filled in by parents were used to collect information on health outcomes and exposure to traffic among 33,632 6-7 and 13-14 years old children and adolescents. Three questions on traffic exposure were asked: the traffic in the zone of residence, the frequency of truck and of car traffic in the street of residence. The presence of a possible response bias for the self-reported traffic was evaluated using external validation (comparison with measurements of traffic flow in the city of Turin) and internal validations (matching by census block, in the cities of Turin, Milan and Rome). RESULTS: Overall traffic density was weakly associated with asthma symptoms but there was a stronger association with cough or phlegm (high traffic density OR = 1.24; 95% CI: 1.04, 1.49). Car and truck traffic were independently associated with cough or phlegm. The results of the external validation did not support the existence of a reporting bias for the observed associations, for all the self-reported traffic indicators examined. The internal validations showed that the observed association between traffic density in the zone of residence and respiratory symptoms did not appear to be explained by an over reporting of traffic by parents of symptomatic subjects. CONCLUSION: Children living in zones with intense traffic are at higher risk for respiratory effects. Since population characteristics are specific, the results of validation of studies on self-reported traffic exposure can not be generalized
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