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)
BPCO BRONCHITE CRONICA ENFISEMA POLMONARE ostruzione ASMA
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
Factors that Exacerbate Asthma Allergens Air Pollutants Respiratory infections Exercise and hyperventilation Weather changes Sulfur dioxide Food, additives, drugs
www.ersnet.org 2003
European Lung White Book, 2003
Mannino et al, Respir Care 2003
CHEST 2003; 123: 1684-1692
CHEST 2003; 123: 1684-1692
Ricoveri per malattie respiratorie in Italia BPCO 140000 120000 100000 80000 60000 40000 20000 0 1996 1997 1998 1999 2000 2001 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
Primi 5 DRG medici per ordine di frequenza 350000 300000 250000 200000 150000 100000 50000 0 1996 1997 1998 1999 2000 2001 Parto senza com plicanze Miscellanea app. diger. età >17 aa senza compl. Affezioni mediche del dorso Insufficienza cardiaca e shock Malattia polmonare cronica ostruttiva
Viegi et al, Int J Tuberc Lung Dis, 1999
Viegi et al, INT J TUBERC LUNG DIS 1999 PREVALENCE (%) OF CHRONIC BRONCHITIS IN ITALY 16 1980-82 1985-88 1988-91 1991-93 years % 14 12 10 8 6 4 2 ERS 1995 Family Doctor 0 Delta Po Pisa Delta Po Pisa
Cerveri et al, Eur Respir J 2003
Cerveri et al, Eur Respir J 2003
Verlato et al, J Allergy Clin Immunol 2003
Dal Negro et al, Respiratory Medicine 2003
PART II OF II Dal Negro et al, Respiratory Medicine 2003
Lucioni et al, PharmacoEconomics 2004
Lucioni et al, PharmacoEconomics 2004
Why is the Burden of COPD Increasing? The WHO estimates 1.1 billion smokers worldwide, increasing to 1.6 billion by 2025. In low- and middle-income countries, smoking rates are increasing at an alarming rate.
The Lancet 2003;362:847-852
Ezzati et al, Lancet 2003
Ezzati et al, Lancet 2003
Part II of II Weiss et al, Eur Respir J 2003
Simoni e al, Eur Respir J 2003
PART III OF III Balmes J, Viegi G. Am J Respir Crit Care Med. 2003
PART I OF II TO BE CONTINUED Balmes J..Viegi G, Am J Respir Crit Care Med. 2003
Annesi-Maesano et al, Eur Respir J 2003
Sandstrom et al, Eur Respir J 2003
Sandstrom et al, Eur Respir J 2003
BARALE ET AL. ENIVORON 1998 BARALE et al. ENVIRONMENTAL and MOLECULAR MUTAGENESIS 1998
Petruzzelli et al, Cancer Research, 1998
SINTOMI BRONCHITICI: CATARRO PERSISTENTE NO 2 centraline OR= 1.28 (1.01-1.63) NO 2 camp.passivi OR= 1.25 (1.07-1.47) Particolato OR= 1.11 (1.01-1.26)
PASSAGGIO CAMION 1,8 SINTOMI RESPIRATORI 1,6 OR (IC95%) 1,4 1,2 1,37 1 1 1,02 0,8 mai a volte spesso
Viegi,Annesi Eur. Respir.Mon. 1999
Jarvis et al, ERJ 1998
Simoni e al, Eur Respir J 2003
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) 1.40 1.0-1.97 Asthm a (adults) 2.21 1.48-3.28 Sweden Engvall (2001) Asthm a symptom s Current cough (adults) 2.82 5.29 2.7.-2.95 4.99-5.62 Austria Zacharasiewicz et al. (1999) Sweden Norback (1999) W heezing (children) 1.43 1.24-1.65 Current asthm a (adults) 1.8 1.1-3.0 Poland Jedrychowski (1998) Difficulty of breathing W heezing (children) 2.0 1.6 1.2-3.3 1.1-2.5 Germany Nicolai et al. (1998) Norway Nafstad et al. (1998) Bronchial hyperreactivity (children-adolescents) Signs of bronchial obstruction (children) 16.14 3.53-73.73 3.8 2.0-7.2 USA Slezak et al. (1998) Asthma (children) 1.94 1.23-3.04
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 (1991-92; subjects=428, houses=140) Pisa indoor study in Central Italy (1992-94; subjects=761, houses=282)
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
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) 16 21.4 (3.2) 22 0.9 (1.3) 0 0.4 (0.8) 0 15-64 (969) 15.5 (4.8) 15 20.5 (4.0) 22 1.2 (1.8) 0.5 1 (1.2) 1 65+ (61) 18.1 (4.7) 15 19.8 (4.8) 20 1.4 (1.8) 1 0.6 (1.0) 0 Summer: 8-14 (30) 14.8 (4.0) 15 17.9 (3.5) 18 2.1 (2.6) 1 0.6 (1.0) 0 15-64 (969) 14.2 (5.0) 14 18.5 (5.0) 20 1.6 (2.2) 1 1.0 (1.3) 1 65+ (61) 15.9 (6.1) 17 17.3 (6.2) 19 1.7 (2.4) 1 0.8 (1.2) 0 a home + work/school + other indoor places
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 1.50 0.96-2.33 RSP-IndEx 1.70 1.10-2.65 ASTH RSP-IndEx 1.33 1.02-1.75 BRON RSP-IndEx 1.31 1.08-1.58 WFRI RSP-IndEx 1.31 1.10-1.55 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
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 ^ 0.21 1.23 1.03-1.48 0.03 MAX/MIN RSP index 0.23 1.26 1.05-1.51 0.01 Chronic bronchitics: AMP/MEAN NO 2 index^ 0.71 2.03 1.14-3.61 0.02 MAX/MIN NO 2 index 0.61 1.84 1.05-3.24 0.03 * 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, 106.56% 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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Scognamiglio et al, Ann Ist Super Sanità 2003
WWW.ISS.IT Scognamiglio et al, Ann Ist Super Sanità 2003
Scognamiglio et al, Ann Ist Super Sanità 2003
Scognamiglio et al, Ann Ist Super Sanità 2003
Scognamiglio et al, Ann Ist Super Sanità 2003
WWW.ISS.IT Scognamiglio et al, Ann Ist Super Sanità 2003
WWW.ISS.IT Scognamiglio et al, Ann Ist Super Sanità 2003
Kunzli, ERJ 2002