Traffic exposure associated with allergic asthma and allergic rhinitis in adults. A cross-sectional study in southern Sweden

BACKGROUND: There is conflicting evidence that traffic-related air pollution is a risk factor for allergic conditions. Few studies have investigated this in adults. In adults, a high proportion of asthma, rhinitis and eczema is triggered by non-allergic factors. We investigated traffic as a risk factor for allergic versus non-allergic asthma and rhinitis, and eczema, in adults. A questionnaire from 2000 (n = 9319, 18-77 years) provided individual data about disease outcome and self-reported traffic exposure. Additional exposure assessments were obtained using Geographical Informations Systems (GIS). Residential addresses were linked to the national Swedish Road Database and to a pollutant database with modelled annual means of NOx (Nitrogen Oxids). RESULTS: Living within 100 m from a road with a traffic intensity of >10 cars/min (24 hour mean) was associated with prevalence of current asthma reported to be triggered by allergic factors (OR = 1.83, 95% CI = 1.23-2.72) and with allergic rhinitis (OR = 1.30, 95%CI = (1.05-1.61). No relation was seen with asthma or rhinitis triggered by other factors. Living within 100 m of a road with >10 cars/min was also associated with hand-eczema during the last 12 months (OR = 1.63, 95% CI = 1.19-2.23), but not with allergic eczema or diagnosed hand-eczema. Consistent results were seen using self-reported traffic, but the associations with NOx were less consistent. CONCLUSION: Exposure to traffic was associated with a higher prevalence of allergic asthma and allergic rhinitis, but not with asthma or rhinitis triggered by non-allergic factors. This difference was suggested by the overall pattern, but only clear using GIS-measured traffic intensity as a proxy for traffic exposure. An association was also found with hand-eczema during the last 12 months. We suggest that asthma and rhinitis should not be treated as homogenous groups when estimating effects from traffic in adults

Traffic-related air pollution associated with prevalence of asthma and COPD/chronic bronchitis. A cross-sectional study in Southern Sweden

<p>Abstract</p> <p>Background</p> <p>There is growing evidence that air pollution from traffic has adverse long-term effects on chronic respiratory disease in children, but there are few studies and more inconclusive results in adults. We examined associations between residential traffic and asthma and COPD in adults in southern Sweden. A postal questionnaire in 2000 (n = 9319, 18–77 years) provided disease status, and self-reported exposure to traffic. A Geographical Information System (GIS) was used to link geocoded residential addresses to a Swedish road database and an emission database for NOx.</p> <p>Results</p> <p>Living within 100 m of a road with >10 cars/minute (compared with having no heavy road within this distance) was associated with prevalence of asthma diagnosis (OR = 1.40, 95% CI = 1.04–1.89), and COPD diagnosis (OR = 1.64, 95%CI = 1.11–2.4), as well as asthma and chronic bronchitis symptoms. Self-reported traffic exposure was associated with asthma diagnosis and COPD diagnosis, and with asthma symptoms. Annual average NOx was associated with COPD diagnosis and symptoms of asthma and chronic bronchitis.</p> <p>Conclusion</p> <p>Living close to traffic was associated with prevalence of asthma diagnosis, COPD diagnosis, and symptoms of asthma and bronchitis. This indicates that traffic-related air pollution has both long-term and short-term effects on chronic respiratory disease in adults, even in a region with overall low levels of air pollution.</p

Nasal neutrophil activity and mucinous secretory responsiveness in COPD.

Patients with chronic obstructive pulmonary disease (COPD) frequently report nasal symptoms. In the present study, we have examined whether or not COPD is associated with any nasal inflammation. Plasma exudation evoked by histamine challenges has been employed to improve the recovery of inflammatory indices in nasal lavage fluids. In 23 COPD-patients and 26 healthy subjects, all without history or signs of allergic rhinitis, nasal polyposis, or chronic rhinosinusitis, nasal saline-lavages were performed with and without histamine. alpha2-Macroglobulin, fucose, eosinophil cationic protein (ECP) and myeloperoxidase (MPO) were determined as indices of plasma exudation, mucinous secretion, eosinophil activity and neutrophil activity, respectively. The difference in MPO-levels between the histamine and the saline lavage was greater in COPD patients compared with healthy subjects (P<0·05). Also, COPD patients reporting nasal symptoms presented an increase in MPO at histamine challenge (P<0·05, cf. saline) and greater differences in MPO and fucose, respectively, between the histamine and the saline lavage (P<0·05, cf. patients without symptoms). We conclude that COPD is not associated with any marked nasal inflammation. However, our observation on increased MPO-levels at histamine challenge suggests some degree of increased neutrophil activity in this condition. Furthermore, when associated with nasal symptoms, COPD may be associated with an increased nasal secretory responsiveness

Chronic Obstructive Pulmonary Disease (COPD) Epidemiological and Pan-airway Aspects

Background – Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality worldwide. However, there is little information on the prevalence and particularly on the incidence of COPD. Also, apart from the importance of tobacco smoking and a1-antitrypsin deficiency, information on contributing risk factors for the development of COPD is limited. Hypotheses – 1. Spirometry can be used in primary health care settings to improve diagnosis of COPD. 2. Alcohol intake is associated with COPD. 3. Coronary heart disease (CHD) is common in patients with COPD. 4. A family history of COPD is an independent risk factor for development of COPD. 5. Specific nasal symptoms and nasal symptom-provoking exposures can predict the development of COPD. 6. The nasal mucosa in COPD may feature a specific pathology. Methods – Studies focusing on spirometry assessments, analysis of a marker of alcohol intake (serum carbohydrate deficient transferrin: S-CDT), and register studies (the Swedish Survey on Living Conditions (ULF) linked with the Swedish Inpatient register), as well as respiratory questionnaire surveys were employed. Also, a nasal lavage study comprising histamine-challenges and analysis of markers of neutrophil activity (myeloperoxidase), plasma exudation and secretory/mucinous activity (fucose) was carried out. Results – Spirometry detected many new cases of COPD. A majority of them were unaware of their condition. The prevalence of COPD was 11.5% and 4.5% as assessed by spirometry and questionnaires, respectively. The annual incidence of COPD as assessed by questionnaires (1992 and 2000, respectively) was 0.36%. S-CDT was elevated in COPD and inversely correlated to FEV1. Report of alcohol intake according to the ULF interview in 1988/89 predicted a higher risk of a hospitalisation for COPD from the time point of the ULF interview to the end of 2000. A hospitalisation for CHD during this time was also associated with an increased risk of COPD hospitalisation. A family history of COPD predicted the incidence of a self-reported physician’s diagnosis of COPD. “Thick, yellow discharge” and “a blocked nose”, as well as the nasal symptom provoking factors “damp/cold air” and “tobacco exposure”, also predicted this incidence. Also, an association was observed between self-reported COPD and the incidence of a physician’s diagnosis of nasal polyposis. The difference in myeloperoxidase between a histamine and saline lavage was greater in patients with COPD than in healthy subjects. Furthermore, COPD-patients reporting nasal symptoms presented increased levels of myeloperoxidase at histamine challenge (c.f. saline) and greater differences in myeloperoxidase and fucose, respectively, between the histamine and saline lavage (c.f. patients without symptoms). Conclusions –The prevalence as well as the incidence of COPD in Sweden is high. Underdiagnosis of COPD is considerable and spirometry should be considered in all smokers. High alcohol consumption and CHD may be associated with an increased risk for being hospitalised due to COPD. A family history of COPD and distinct nasal features may be risk factors for the development of COPD. COPD is not associated with any marked nasal inflammation, but nasal pathology may need attention in this condition

Luftvägssjukdomar - enkät från år 1992

The prevalence of various respiratory diseases are increasing in Scandinavia and also in other parts of the world. In this study, an extensive questionnaire on issues related to respiratory diseases, was sent out to residents in the municipality of Malmö and the surrounding area. The questionnaire was 1992 sent to 12 079 individuals, i.e. 1.5% of the formerly population in the municipality of Malmö and the county of Malmöhus. The individuals were selected from the population registry from four age groups (20-29, 30-39, 40-49 and 50-59) with comparable numbers of men and women in each group. After two reminders 8468 (70.1%) individuals had responded to the survey. The questionnaire contained questions such as self-reported asthma, chronic bronchitis, emphysema or allergies, a doctor’s diagnosis of these diseases. It also contained questions regarding if the individual often were bothered by coughing or having trouble with the lungs and nose, such as squeaky breathing and nasal congestion. The questionnaire also included questions about smoking, medication, and if you live near a busy road. A follow-up study was done 2000 and a similar survey was sent out again to 4933 of the individuals who responded to the survey in 1992. The questionnaire was supplemented with issues related to chronic obstructive pulmonary disease. This survey was also sent out to 7000 new individuals in the Malmö area, randomly selected from the population register. In total, 11 933 questionnaires were distributed to individuals aged 18-77 years. Of these individuals 9316 (78.1%) subjects responded to the survey, of which 4280 (86.8%) responded to both the 1992- and 2000-survey. For the individuals who responded to the survey in year 2000, additional data on traffic and air pollution have been added using the geographic coordinates of the registered address, data from the Swedish Transport Administration as well as data from an emission database for nitrogen oxides. Purpose: To investigate the prevalence of and risk factors for respiratory diseases in adults in southern Sweden. 8568 individuals responded in year 1992 on a comprehensive questionnaire concerning respiratory diseases.Prevalensen av olika luftvägssjukdomar ökar i Skandinavien och även i andra delar av världen. I denna studie har en omfattande enkät med frågor som rör luftvägssjukdomar skickats ut till invånare i Malmö kommun med omgivning. Det första utskicket gjordes 1992 till 12 079 individer, dvs. 1.5% av den dåvarande populationen i Malmö kommun och Malmöhus län. Individerna valdes ut från populationsregistret från fyra åldersgrupper (20-29, 30-39, 40-49 samt 50-59) med jämförbart antal kvinnor och män i varje grupp. Efter två påminnelser så hade 8468 (70.1%) individer svarat på enkäten. Enkäten innehöll frågor som självrapporterad astma, kronisk bronkit, emfysem eller allergi, om man har fått en diagnos på dessa sjukdomar av en läkare, samt frågor om man ofta besväras av hosta eller har problem med lungorna och näsan som t.ex. pipig andning och nästäppa. Enkäten innehöll även frågor om rökning, medicinering och om man bor nära en trafikerad väg. År 2000 gjordes en uppföljning och en liknande enkät skickades åter ut till 4933 av de individer som svarade på enkäten 1992. Enkäten som skickades ut år 2000 hade kompletterats med frågor som rör kronisk obstruktiv lungsjukdom. Denna enkät skickades även ut till 7000 nya individer i Malmöområdet som slumpmässigt valts ut från populationsregistret. Totalt skickades 11 933 enkäter ut år 2000 till individer i åldrarna 18-77 år. Av dessa individer svarade 9316 (78.1%) på enkäten, varav 4280 (86.8%) individer svarade på både 1992- och 2000-enkäten. Till individerna som svarade på enkäten år 2000 har ytterligare data om trafik och luftföroreningar lagts till med hjälp av geografiska koordinater för folkbokföringsadress, data från vägverket samt data från en emissionsdatabas för kväveoxider. Syfte: Att undersöka förekomst av och riskfaktorer för olika luftvägssjukdomar i den vuxna befolkningen i södra Sverige. 8568 individer svarade år 1992 på en omfattande enkät med frågor rörande luftvägssjukdomar

Luftvägssjukdomar - enkät från år 2000

The prevalence of various respiratory diseases are increasing in Scandinavia and also in other parts of the world. In this study, an extensive questionnaire on issues related to respiratory diseases, was sent out to residents in the municipality of Malmö and the surrounding area. The questionnaire was 1992 sent to 12 079 individuals, i.e. 1.5% of the formerly population in the municipality of Malmö and the county of Malmöhus. The individuals were selected from the population registry from four age groups (20-29, 30-39, 40-49 and 50-59) with comparable numbers of men and women in each group. After two reminders 8468 (70.1%) individuals had responded to the survey. The questionnaire contained questions such as self-reported asthma, chronic bronchitis, emphysema or allergies, a doctor’s diagnosis of these diseases. It also contained questions regarding if the individual often were bothered by coughing or having trouble with the lungs and nose, such as squeaky breathing and nasal congestion. The questionnaire also included questions about smoking, medication, and if you live near a busy road. A follow-up study was done 2000 and a similar survey was sent out again to 4933 of the individuals who responded to the survey in 1992. The questionnaire was supplemented with issues related to chronic obstructive pulmonary disease. This survey was also sent out to 7000 new individuals in the Malmö area, randomly selected from the population register. In total, 11 933 questionnaires were distributed to individuals aged 18-77 years. Of these individuals 9316 (78.1%) subjects responded to the survey, of which 4280 (86.8%) responded to both the 1992- and 2000-survey. For the individuals who responded to the survey in year 2000, additional data on traffic and air pollution have been added using the geographic coordinates of the registered address, data from the Swedish Transport Administration as well as data from an emission database for nitrogen oxides. Purpose: To investigate the prevalence of and risk factors for respiratory diseases in adults in southern Sweden. 9316 individuals responded in year 2000 to the same questionnaire which was sent out in 1972, supplemented with issues related to chronic obstructive pulmonary disease. Additional data on traffic and air pollution are also collected.Prevalensen av olika luftvägssjukdomar ökar i Skandinavien och även i andra delar av världen. I denna studie har en omfattande enkät med frågor som rör luftvägssjukdomar skickats ut till invånare i Malmö kommun med omgivning. Det första utskicket gjordes 1992 till 12 079 individer, dvs. 1.5% av den dåvarande populationen i Malmö kommun och Malmöhus län. Individerna valdes ut från populationsregistret från fyra åldersgrupper (20-29, 30-39, 40-49 samt 50-59) med jämförbart antal kvinnor och män i varje grupp. Efter två påminnelser så hade 8468 (70.1%) individer svarat på enkäten. Enkäten innehöll frågor som självrapporterad astma, kronisk bronkit, emfysem eller allergi, om man har fått en diagnos på dessa sjukdomar av en läkare, samt frågor om man ofta besväras av hosta eller har problem med lungorna och näsan som t.ex. pipig andning och nästäppa. Enkäten innehöll även frågor om rökning, medicinering och om man bor nära en trafikerad väg. År 2000 gjordes en uppföljning och en liknande enkät skickades åter ut till 4933 av de individer som svarade på enkäten 1992. Enkäten som skickades ut år 2000 hade kompletterats med frågor som rör kronisk obstruktiv lungsjukdom. Denna enkät skickades även ut till 7000 nya individer i Malmöområdet som slumpmässigt valts ut från populationsregistret. Totalt skickades 11 933 enkäter ut år 2000 till individer i åldrarna 18-77 år. Av dessa individer svarade 9316 (78.1%) på enkäten, varav 4280 (86.8%) individer svarade på både 1992- och 2000-enkäten. Till individerna som svarade på enkäten år 2000 har ytterligare data om trafik och luftföroreningar lagts till med hjälp av geografiska koordinater för folkbokföringsadress, data från vägverket samt data från en emissionsdatabas för kväveoxider. Syfte: Att undersöka förekomst av och riskfaktorer för olika luftvägssjukdomar i den vuxna befolkningen i södra Sverige. 9316 individer svarade år 2000 på samma enkät som skickades ut 1972, kompletterad med frågor som rör kronisk obstruktiv lungsjukdom. Till dessa individer finns även ytterligare data om trafik och luftföroreningar

Influence of family history and smoking habits on the incidence of self-reported physician's diagnosis of COPD.

AbstractBackground: The incidence of chronic obstructive pulmonary disease (COPD) is little investigated. This study assessed the incidence of a self-reported physician's diagnosis of chronic bronchitis and/or emphysema (CBE) and/or COPD (CBE/COPD), and investigated the effects of a family history of CBE in 1992 and change in smoking habits (assessed in 1992 and 2000) on this incidence.Methods: A follow-up study in 2000 of 4933 subjects who responded to a respiratory questionnaire study in 1992 was performed. Response rate was 86.8%. Odds ratios (ORs) for incident cases of CBE/COPD were calculated by multiple logistic regression.Results: The cumulative incidence of a physician's diagnosis of CBE/COPD was 2.9%. A family history of CBE predicted incident cases of CBE/COPD, OR 2.7 (95% CI 1.5–5.1). Also continuous smoking, relapse into smoking, or having stopped smoking between 1992 and 2000 had elevated ORs for incident cases of CBE/COPD, 2.6 (1.4–4.7), 7.2 (2.7–18.7), and 2.6 (1.3–5.3), while the OR for ex-smoking in 1992 as well as 2000 was 0.9 (0.4–1.8).Conclusions: A family history of CBE increases the risk for development of CBE/COPD. Sustained smoking cessation over many years may be required to significantly reduce the risk of developing CBE/COPD

Increased serum levels of carbohydrate-deficient transferrin in patients with chronic obstructive pulmonary disease

OBJECTIVE: The reason that only a minority of smokers develop chronic obstructive pulmonary disease (COPD) is still largely unknown. Glycosylation defects are involved in the pathological mechanisms in cystic fibrosis (CF), where chronic progressive obstructive lung disease dominates the clinical picture. Whether defects of protein glycosylation occur in COPD has not previously been examined. Increase in carbohydrate-deficient transferrin (CDT) in serum seems to function as an indicator of general defects of N-glycosylation. Recently, one study observed high serum CDT concentrations in CF patients. We examined whether subjects with COPD also have increased serum CDT levels. METHOD AND RESULTS: A total of 131 randomly selected individuals, 45-64 years of age, underwent a medical examination, spirometry and blood tests. Serum CDT was determined using high performance liquid chromatography. In subjects diagnosed as having COPD (n = 15), multiple logistic regression analyses demonstrated a significant relationship between the diagnosis of COPD and CDT, even after all efforts were made to take the influence of age and smoking into account (odds ratio 3.16, 95% CI 1.11-8.95). Also, in subjects with COPD there was an inverse partial correlation between forced expiratory volume in 1 s (FEV1) and serum CDT (r = -0.81, p = 0.001). CONCLUSION: These results suggest that protein glycosylation defects occur in COPD and, in addition, might be involved in the pathogenetic mechanisms of the disease. It seems that further investigation of the protein glycosylation in COPD is warranted

Detection of chronic obstructive pulmonary disease (COPD) in primary health care: role of spirometry and respiratory symptoms

Objective - To evaluate the role of spirometry and respiratory symptoms in the detection of chronic obstructive pulmonary disease (COPD) in primary health care. Design - A cross-sectional study. Setting - A primary health centre in Landskrona, southern Sweden. Subjects - 164 subjects who in 1992 had answered a postal questionnaire concerning obstructive pulmonary diseases and respiratory symptoms. They were aged 45-64 years, with a mean of 55 years. Main outcome measures - In 1997, the subjects were invited to perform a spirometry and a medical examination and to answer the same questionnaire as in 1992. Subjects with a forced expiratory volume in 1 second (FEV1) <85% of the predicted normal value performed reversibility tests. Results - 131 subjects participated in the examinations. 15 subjects (11.5%) were diagnosed as having COPD. Only three of them had been previously diagnosed as having a respiratory disease. Many commonly occurring respiratory symptoms were associated with a reduction in FEV1. Conclusions - Spirometry examinations in primary health care improve the probability of detecting COPD. A spirometry examination should be considered for patients with respiratory symptoms. It should also be considered for middle-aged smokers, even if they are symptom-free