[Risk factors of chronic obstructive pulmonary disease]. / Fattori di rischio per broncopneumopatia cronica ostruttiva.

Many personal and environmental risk factors are associated to increased prevalence and severity of chronic obstructive pulmonary disease (COPD). In this review, we shortly describe most of these risk factors, aiming at defining each factor as causative or modifier of the natural history of the disease. It is clear that the environmental risk factors do have an outstanding relevance for both the initiation and the evolution of COPD. This review focuses on the crucial importance of prevention in order to decrease the public health burden of COPD in the western countries during the next decades.

[Air pollution and cardiac and respiratory function in three groups of patients]. / Inquinamento atmosferico e funzionalità cardiaca e respiratoria in tre gruppi di pazienti.

The association between exposure to urban air pollution and cardiac or respiratory impairments in susceptible subjects was evaluated in a panel study including 11 patients with chronic obstructive pulmonary disease (COPD), 7 with ischemic heart disease (IHD), and 11 asthmatics resident in Rome (Italy). Patients underwent repeated 24 h Holter EKG monitoring, 12 h pulse oximetry at night and spirometry examinations during 1999 summer and winter. Multiple linear regression models for repeated individual measures (fixed-effect) were used to analyse the relationship between average daily concentrations of pollutants (PM10-2.5, PM2.5 NO2 and O3) and outcome variables, controlling for meteorological conditions, survey period, and week-ends. In the BPCO panel, increasing ambient PM2.5 levels were associated with increased heart rate and decreased respiratory function. In the asthmatic panel, inverse associations between pulmonary function and both NO2 and PM10-2.5 concentrations were observed, as well as direct association between ambient NO2 concentrations and NO in exhaled breath. In the IHD panel an increase of hearth rate variability associated with increasing concentration of PM2.5 was observed.

[Asthma and allergies in childhood in Rome: Italian contribution to the ISAAC II]. / Asma e allergie in età pediatrica a Roma: il contributo italiano a ISAAC II.

A study about the frequency of respiratory and allergic disorders in childhood was carried out in Rome, during the 2000-2001 school year. This survey represents the Italian contribution to the second phase of the International Study on Asthma and Allergies in Childhood (ISAAC Phase Two). A properly filled in ISAAC Phase II questionnaire was returned by parents of 1,760 children attending the fifth grade in primary school (83.5% of the target). Prick tests were performed to provide an objective measure of atopy, defined as skin reactivity to one or more allergens. The presence of visible flexural dermatitis was determined through skin examination. Lifetime prevalence for asthma, allergic rhinitis and eczema was 12.4%, 13.2% and 15.1%, respectively. Period prevalence in the last 12 months was 7.0% for attacks of wheezing or whistling in the chest, 9.1% for rhinitis symptoms, and 9.5% for dermatitis symptoms. A total of 1.6% of the children under examination had a visible flexural dermatitis. Of the children who performed prick test, 31.8% was skin positive at least to one of the adopted allergens. An international comparison with the results of other ISAAC Phase Two studies (conducted in Albania, Germany, Hong Kong, UK and Sweden) has shown that Rome and Hong Kong were the areas with the highest prevalence rate for atopy, but had comparatively low proportions of asthmatic subjects. This inconsistency suggests that factors other than atopy could be responsible for the geographic epidemiological distribution of asthma.

Characteristics of early transient, persistent, and late onset wheezers at 9 to 11 years of age.

STUDY OBJECTIVE: To investigate the early determinants and characteristics of different phenotypes of wheeze in children on the basis of questionnaire data, lung function, and prick tests. DESIGN: Cross-sectional survey. Setting. Rome and Fiumicino municipalities in Lazio region, Italy, within the ISAAC phase II project. SUBJECTS: Sample of 2107 9-11 year old schoolchildren (response rate 83.5%). RESULTS: We divided children into four mutually exclusive groups according to onset of wheeze: 154 early transient (birth to age 2), 51 persistent (birth to age 2 and current), 66 late onset (current only), and 1,446 control subjects (no early or current wheeze). Logistic regression models have shown that a family history of asthma and allergies is strongly associated with persistent and late onset wheezing; exposure to parental smoking--both during pregnancy and during the child's first year of life--is related to persistent wheezing; all children with wheezing show a significantly greater risk to have current respiratory symptoms other than wheeze compared with control subjects; current allergic rhinoconjunctivitis symptoms and atopy are related with both persistent and late onset wheeze. Multiple linear regression models show that forced expiratory rates at 25% to 75% of vital capacity (FEF25-75) and the ratio between forced expiratory volume in 1 second and forced vital capacity (FEV1/FVC) are significantly lower both in early transient (-305 mL/s, -1.7%) and persistent (-298 mL/s, -3.2%) wheezers; FEV1/FVC is significantly reduced in late onset wheezers too (-2.0%). CONCLUSIONS: The strength of the association of family history and exposure to parental smoking varies with the three wheezing phenotypes. Moreover, early, persistent and late onset wheezers have different clinical characteristics in terms of their respiratory health and atopic status.