Convegno. Salute e ambiente a confronto: l esempio dell area mantovana del destra Secchia. Malattie respiratorie e fattori di rischio ambientali

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1 Convegno Salute e ambiente a confronto: l esempio dell area mantovana del destra Secchia Mantova, 19 marzo 2004 Malattie respiratorie e fattori di rischio ambientali Giovanni Viegi Primo Ricercatore CNR Responsabile Unità di Epidemiologia Ambientale Polmonare, Istituto di Fisiologia Clinica CNR, Pisa Presidente Gruppo di Studio Epidemiologia, Società Italiana di Medicina Respiratoria (SIMeR)

2 BPCO BRONCHITE CRONICA ENFISEMA POLMONARE ostruzione ASMA

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5 Risk Factors that Lead to Asthma Development Host Factors Genetic predisposition Atopy Airway hyperresponsiveness Gender Race/Ethnicity Environmental Factors Indoor allergens Outdoor allergens Occupational sensitizers Tobacco smoke Air Pollution Respiratory Infections Parasitic infections Socioeconomic factors Family size Diet and drugs Obesity

6 Factors that Exacerbate Asthma Allergens Air Pollutants Respiratory infections Exercise and hyperventilation Weather changes Sulfur dioxide Food, additives, drugs

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8 2003

9 European Lung White Book, 2003

10 Mannino et al, Respir Care 2003

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14 CHEST 2003; 123:

15 CHEST 2003; 123:

16 Ricoveri per malattie respiratorie in Italia BPCO Ne o plas ie po lmo nari Polmonite semplice e pleurite Bronchite e asma Inters tizio patie po lmo nari Embo lie po lmo nari Versamento pleurico Pneumotorace Ins uffic ie nza re s pirato ria e edema polmonare

17 Primi 5 DRG medici per ordine di frequenza Parto senza com plicanze Miscellanea app. diger. età >17 aa senza compl. Affezioni mediche del dorso Insufficienza cardiaca e shock Malattia polmonare cronica ostruttiva

18 Viegi et al, Int J Tuberc Lung Dis, 1999

19 Viegi et al, INT J TUBERC LUNG DIS 1999 PREVALENCE (%) OF CHRONIC BRONCHITIS IN ITALY years % ERS 1995 Family Doctor 0 Delta Po Pisa Delta Po Pisa

20 Cerveri et al, Eur Respir J 2003

21 Cerveri et al, Eur Respir J 2003

22 Verlato et al, J Allergy Clin Immunol 2003

23 Dal Negro et al, Respiratory Medicine 2003

24 PART II OF II Dal Negro et al, Respiratory Medicine 2003

25 Lucioni et al, PharmacoEconomics 2004

26 Lucioni et al, PharmacoEconomics 2004

27 Why is the Burden of COPD Increasing? The WHO estimates 1.1 billion smokers worldwide, increasing to 1.6 billion by In low- and middle-income countries, smoking rates are increasing at an alarming rate.

28 The Lancet 2003;362:

29 Ezzati et al, Lancet 2003

30 Ezzati et al, Lancet 2003

31 Part II of II Weiss et al, Eur Respir J 2003

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34 Simoni e al, Eur Respir J 2003

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38 PART III OF III Balmes J, Viegi G. Am J Respir Crit Care Med. 2003

39 PART I OF II TO BE CONTINUED Balmes J..Viegi G, Am J Respir Crit Care Med. 2003

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46 Annesi-Maesano et al, Eur Respir J 2003

47 Sandstrom et al, Eur Respir J 2003

48 Sandstrom et al, Eur Respir J 2003

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50 BARALE ET AL. ENIVORON 1998 BARALE et al. ENVIRONMENTAL and MOLECULAR MUTAGENESIS 1998

51 Petruzzelli et al, Cancer Research, 1998

52 SINTOMI BRONCHITICI: CATARRO PERSISTENTE NO 2 centraline OR= 1.28 ( ) NO 2 camp.passivi OR= 1.25 ( ) Particolato OR= 1.11 ( )

53 PASSAGGIO CAMION 1,8 SINTOMI RESPIRATORI 1,6 OR (IC95%) 1,4 1,2 1, ,02 0,8 mai a volte spesso

54 Viegi,Annesi Eur. Respir.Mon. 1999

55 Jarvis et al, ERJ 1998

56 Simoni e al, Eur Respir J 2003

57 Presence of dampness/mold as risk factor for allergic and respiratory disease Study Symptoms/disease OR 95% CI UK M c Nally et al. (2001) Finland Kilpelainen et al. (2001) Atopic eczema (children) Asthm a (adults) Sweden Engvall (2001) Asthm a symptom s Current cough (adults) Austria Zacharasiewicz et al. (1999) Sweden Norback (1999) W heezing (children) Current asthm a (adults) Poland Jedrychowski (1998) Difficulty of breathing W heezing (children) Germany Nicolai et al. (1998) Norway Nafstad et al. (1998) Bronchial hyperreactivity (children-adolescents) Signs of bronchial obstruction (children) USA Slezak et al. (1998) Asthma (children)

58 To investigate on possible effects on respiratory health of some indoor pollutants (i.e. NO2 (by passive samplers - Palmes tubes - and analyzed by spectrophometric techniques) PM2.5 (by active sampling through a Dorr Oliver-type pre-selector) and ETS)), we performed two special indoor studies: Po Delta indoor study in Northern Italy ( ; subjects=428, houses=140) Pisa indoor study in Central Italy ( ; subjects=761, houses=282)

59 Po Delta and Pisa indoor studies STUDY DESIGN one week winter one week summer EXPOSURE HEALTH EFFECTS in each house: - NO 2 - SPM (<2.5µm) - environmental inventory for each subject: - daily activity pattern - daily acute respiratory symptoms - peak expiratory flow

60 Daily activity pattern (hours) by age groups (yrs) and sex in winter and summer (by Po Delta and Studies). At home Total Indoors a Outdoors In transit Age (N) Mean (SD) Median Mean (SD) Median Mean (SD) Median Mean (SD) Median Winter: 8-14 (94) 15.7 (3.7) (3.2) (1.3) (0.8) (969) 15.5 (4.8) (4.0) (1.8) (1.2) (61) 18.1 (4.7) (4.8) (1.8) (1.0) 0 Summer: 8-14 (30) 14.8 (4.0) (3.5) (2.6) (1.0) (969) 14.2 (5.0) (5.0) (2.2) (1.3) (61) 15.9 (6.1) (6.2) (2.4) (1.2) 0 a home + work/school + other indoor places

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64 RSP-IndEx and NO 2 -IndEx as risk factors for the presence of acute respiratory symptoms - subjects >15 years Dependent variable Factors OR 95% CI winter: ARI NO 2 -IndEx RSP-IndEx ASTH RSP-IndEx BRON RSP-IndEx WFRI RSP-IndEx By logistic regression analysis adjusted for sex, age, active smoking and area of residence; NO 2 - IndEx and RSP-IndEx are computed as concentration x time of exposure; increment: 0=<median value, 1=>median value

65 RSP-IndEx and NO 2 -IndEx as risk factors for PEF variation by logistic regression analysis*, in winter (Po Delta study). Dependent variable Factors Regression coefficient O.R. 95% C.I. for O.R. P All: AMP/MEAN RSP index ^ MAX/MIN RSP index Chronic bronchitics: AMP/MEAN NO 2 index^ MAX/MIN NO 2 index * adjusted for sex, age, height, weight, active smoking, acute respiratory symptoms, chronic asthma and/ bronchitis and/or rhinitis. Increment: 0= second tertile of distribution (8.45, 8.25% in winter and summer respectively) 1= > second tertile of distribution. Increment: 0= second tertile of distribution (106.97, % in winter and summer respectively) 1= > second tertile of distribution. ^ Computed as concentration x time of exposure; increment: 0 = median value, 1 = > median value

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67 Scognamiglio et al, Ann Ist Super Sanità 2003

68 Scognamiglio et al, Ann Ist Super Sanità 2003

69 Scognamiglio et al, Ann Ist Super Sanità 2003

70 Scognamiglio et al, Ann Ist Super Sanità 2003

71 Scognamiglio et al, Ann Ist Super Sanità 2003

72 Scognamiglio et al, Ann Ist Super Sanità 2003

73 Scognamiglio et al, Ann Ist Super Sanità 2003

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75 Kunzli, ERJ 2002