Lifetime environmental tobacco smoke exposure and the risk of chronic obstructive pulmonary disease

BACKGROUND: Exposure to environmental tobacco smoke (ETS), which contains potent respiratory irritants, may lead to chronic airway inflammation and obstruction. Although ETS exposure appears to cause asthma in children and adults, its role in causing COPD has received limited attention in epidemiologic studies. METHODS: Using data from a population-based sample of 2,113 U.S. adults aged 55 to 75 years, we examined the association between lifetime ETS exposure and the risk of developing COPD. Participants were recruited from all 48 contiguous U.S. states by random digit dialing. Lifetime ETS exposure was ascertained by structured telephone interview. We used a standard epidemiologic approach to define COPD based on a self-reported physician diagnosis of chronic bronchitis, emphysema, or COPD. RESULTS: Higher cumulative lifetime home and work exposure were associated with a greater risk of COPD. The highest quartile of lifetime home ETS exposure was associated with a greater risk of COPD, controlling for age, sex, race, personal smoking history, educational attainment, marital status, and occupational exposure to vapors, gas, dusts, or fumes during the longest held job (OR 1.55; 95% CI 1.09 to 2.21). The highest quartile of lifetime workplace ETS exposure was also related to a greater risk of COPD (OR 1.36; 95% CI 1.002 to 1.84). The population attributable fraction was 11% for the highest quartile of home ETS exposure and 7% for work exposure. CONCLUSION: ETS exposure may be an important cause of COPD. Consequently, public policies aimed at preventing public smoking may reduce the burden of COPD-related death and disability, both by reducing direct smoking and ETS exposure

The Po River delta epidemiological study: Use of medicines in a general population sample of North Italy

Purpose - To provide information on the actual use of medicines in a general population sample. Methods - Information was collected in a general population sample of North Italy (1946 subjects; 938 males, 1008 females) by an interviewer-administered questionnaire. Results - Of the subjects 25.9% took habitually at least one medicine, whereas 11.1% used medic aments only occasionally. The use of medicines was significantly higher in females than in males (p < 0.001), but only in 15-44-year-old females, because of the use of oral contraceptives. The use of medicines increased with ageing (OR = 1.80, p < 0.001). The highest use of habitual medicaments was found in subjects of 55 + years of both sexes. In both sexes, the medicines classified in the cardiovascular therapeutic group were the most frequently used. The use of gastrointestinal and cardiovascular medicines was significantly higher in males than in females (p < 0.001). In males, the use of habitual medicines was significantly (p < 0.001) higher in current smokers and ex-smokers than in never smokers. Only 23% of allergic subjects used antiallergic medicines, and only 35% of subjects with respiratory symptoms/diseases used medicines classified into the bronchopulmonary therapeutic group. The percentage of subjects who reported cardiovascular symptoms/diseases and used medicines classified in the cardiovascular therapeutic group was greater (62%). Conclusions - We stress the importance of data collection in general population samples by questionnaires to investigate the actual use of medicines. This may give a more accurate estimate of medicine use than is possible from pharmacy sales or hospital records. Copyright (C) 2000 John Wiley & Sons, Ltd

The po river Delta (North Italy) indoor epidemiological study: Effects of pollutant exposure on acute respiratory symptoms and respiratory function in adults

The authors studied the effects of relatively low doses of nitrogen dioxide and respirable suspended particulate matter (i.e., &lt; 2.5 μ) on acute respiratory symptoms and on peak expiratory flow in 383 adults (15–72 yr of age) who lived in the Po River Delta area, located near Venice. During 2 wk—1 wk in winter and 1 wk in summer—the authors monitored each participant's house to measure nitrogen dioxide (in parts per billion) and respirable suspended particulate (μg/m3) concentration. Information on sex, age, height, weight, daily activity patterns, active and passive smoking, chronic respiratory diseases, daily peak expiratory flow, and presence of acute respiratory symptoms during the weeks monitoring occurred were also collected. Peak expiratory flow variation was studied as mean amplitude percentage (i.e., amplitude/mean) and percentage of diurnal variation (maximum/minimum). The exposure indices to nitrogen dioxide (nitrogen dioxide-index of exposure) and to respirable suspended particulate matter (respirable suspended particulate matter-index of exposure) were computed as the product of pollutant concentration and time of exposure. The authors considered indices as “low” or “high” on the basis of the median value. The median nitrogen dioxide was 20 ppb in winter and 14 ppb in summer; the highest nitrogen dioxide levels occurred in the kitchen in the winter (33 ppb) and summer (20 ppb). The median respirable suspended particulate matter was 68 μg/m3 in winter and 45 μg/m3 in summer. Only in winter were there significant associations between bronchitic/asthmatic symptoms and “high” nitrogen dioxide and respirable suspended particulate matter indices. In subjects who did not smoke, a significant influence of the “high” respirable suspended particulate matter-index of exposure was also observed in summer. With respect to peak expiratory flow and its variability, respirable suspended particulate matter-index of exposure was associated with an increase of both amplitude/mean and maximum/mean; however, with respect to the nitrogen dioxide-index of exposure, the association was significant only in subjects with chronic respiratory diseases (i.e., asthma and bronchitis). These relationships were significant only in winter. In conclusion, the results of the current study indicate that there is an association between relatively low doses of pollutants and acute respiratory symptoms and peak expiratory flow in adults. © 2002 Taylor &amp; Francis Group, LLC

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 serum IgE are helpful to exclude allergic asthma or rhinitis level of total

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 · 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

Genetic structure of the human population in the Po delta

The genetic structure of the population of Ferrara Province in the Po delta in Italy was investigated using χ 2 analysis, kinship analysis, analysis of correspondences, and geographical mapping of principal components of gene frequencies. χ 2 Analysis tests for Hardy-Weinberg equilibrium and for heterogeneity of gene and phenotype frequencies; kinship analysis tests for association between indicators of genetic and geographic proximity; analysis of correspondences relates localities and genetic systems in an eigenvectorial space; and geographic mapping displays the principal components of gene frequencies in the real space. In 1,364 adults in 26 residential units, seven presumably neutral isoenzyme systems were typed; ACP 1, ESD, GLO I, GPT, PGD, PGM 1 and PGP. It was found that average kinship for these neutral systems is correlated with geographic distance in this small area, but not as strongly as kinship for beta-thalassemia. A north-south gradient was observed for ESD. Analysis of correspondences indicated GPT, PGM 1, and GLO I as the systems contributing most to differentiaton within the province. The maps obtained from principal components of gene frequencies were consistent with the migrational history of the area