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20 anni di Epidemiologia delle Malattie Respiratorie Dr. Giovanni Viegi. Direttore f.f., Istituto di Biomedicina e Immunologia Molecolare Alberto Monroy CNR, Palermo. Responsabile Scientifico, Unit di Ricerca di Epidemiologia Ambientale Polmonare, Istituto di Fisiologia Clinica CNR, Pisa. Professore di Effetti dellinquinamento sulla salute, Corso di Laurea in Scienze Ambientali, Universit di Pisa. September 2006-September 2007 Past President, European Respiratory Society (ERS). 2006-11 Past Member of Planning Group, Global Alliance against chronic Respiratory Diseases (GARD) Slide 2 Mortality Slide 3 Slide 4 A B Slide 5 CNR Epidemiological surveys Slide 6 PO DELTA PISA Slide 7 Materials and methods I Po Delta area, North Italy 1st cross-sectional study (PD1): - carried out in 1980-82, before operation of a large oil-burning thermoelectric power plant - 3284 subjects (78% of expected, age 8-64 yr) 2nd cross-sectional study (PD2): - performed in 1988-91 - 2841 subjects (age 8-73 yr) Pisa, Central Italy 1st cross-sectional survey (PI1): - performed in 1985-88 -3855 subjects (77% of expected, age 5-90 yr) 2nd cross-sectional study (PI2): - carried out in 1991-93, after the construction of a new highway connecting Pisa to Florence - 2841 subjects (age 8-97 yr) Slide 8 Materials and methods II PD study Modified NHBLI questionnaire developed by CNR Special Project on chronic obstructive lung disease (COLD), containing > 70 questions regarding respiratory symptoms, diseases and risk factors Lung function tests Skin prick tests, total serum IgE, bronchial responsiveness to methacholine challenge (PD2) PI study Modified NHBLI questionnaire developed by CNR Special Project on chronic obstructive lung disease (COLD), containing a new part on daily activity pattern Lung function tests (PI2) Skin prick tests, total serum IgE, bronchial responsiveness to methacholine challenge (PI2) Mutagenetic determinations (sister chromatid exchanges, micronuclei), hemoglobin and DNA adducts to benzo(a)pyrene (PI2) Slide 9 Po River Delta Lung function: American Thoracic Society protocol 47804S Hewlett Packard pneumotachograph Pisa Lung function (2nd survey only): American Thoracic Society protocol Water sealed spirometer Baires, Biomedin Materials and methods IV Spirometry Slide 10 Baldacci et al, J Environ Pathol Toxicol Oncol 1997 Slide 11 Prevalence, incidence of respiratory symptoms/diseases and risk factors Slide 12 (1999) Slide 13 Viegi, Int J Tuberc Lung Dis 1999 Slide 14 Slide 15 Slide 16 Viegi, Chest 2000 Slide 17 Slide 18 Viegi, Chest 2004 Slide 19 Slide 20 Viegi, Eur J Epidemiol 1994 Slide 21 Figure 2 Classification of subjects based on the distance of each home from the main road. Zoomed map representing the classification of subjects according to the distance of each home from the main road. Highly exposed subjects are those living in the buffer area 0-100 m from the road, moderately exposed subjects living in the buffer area 100-250 m and unexposed are those living between 250 and 800 m from the road. Pisa Study Slide 22 Slide 23 Slide 24 Guerra, Allergy 2005 Slide 25 Lung function Slide 26 Methods Natural cubic spline models over the whole age range two breakpoints to split the growth, plateau and decline phases Slide 27 Pistelli, AJRCCM 2000 Slide 28 Slide 29 Pistelli, Respir Med 2007 Slide 30 Slide 31 Viegi, Chest 2001 Slide 32 Slide 33 Slide 34 Slide 35 Pistelli, Respir Med 2008 Slide 36 Bronchial hyperresponsiveness Slide 37 Slide 38 Paoletti, AJRCCM 1995 Slide 39 Slide 40 Slide 41 Slide 42 Slide 43 Maio, Chest 2009 Slide 44 Slide 45 Indoor air pollution Slide 46 Slide 47 Arch Environ Health 2002 Slide 48 Slide 49 Slide 50 Simoni, J Expo Anal Environ Epidemiol 2004 Slide 51 Risks to get respiratory symptoms Slide 52 Risks to get elevated maximum amplitude and diurnal variation of peak expiratory flow (PEF) Simoni, J Expo Anal Environ Epidemiol 2004 Slide 53 Mutagenetic evaluations Slide 54 Slide 55 Barale, Environ Mol Mut 1998 Slide 56 Slide 57 Petruzzelli, Cancer Research, 1998 Slide 58 Slide 59 Skin prick test and IgE Slide 60 Slide 61 Baldacci, Allergy 1996 Slide 62 Slide 63 SEASD Study Slide 64 Slide 65 Simoni, Clin Chem Lab Med 2006 Slide 66 Slide 67 Studio SEASD Population attributable risk (PAR%): eliminando entrambe le esposizioni al partner e al lavoro si potrebbe ridurre il rischio di sintomi e malattie respiratorie considerate: da un minimo del 5% per fischi e diagnosi di asma ad un massimo del 24% per difficolt di respiro a riposo. OLD, diagnosi di asma e/o bronchite cronica/enfisema Slide 68 Medicine consumption Slide 69 Slide 70 2004-2005 1660 sub. 8-81 years Slide 71 Simoni, Respir Med 2008 Slide 72 AIFA funded projects Slide 73 Slide 74 Baldacci, Respir Med 2012 Slide 75 Slide 76 Maio, Curr Med Res Opin 2012 Slide 77 Slide 78 Maio, J Asthma 2012 Slide 79 GARD and Italian Ministry funded projects Slide 80 Bousquet, ERJ 2010 Eur Respir J. 2010 Nov;36(5):995-1001 Slide 81 Slide 82 Acting Director, CNR Institute of Biomedicine and Molecular Immunology Alberto Monroy, Palermo, Italy Head, Pulmonary Environmental Epidemiology Unit, CNR Institute of Clinical Physiology, Pisa, Italy Professor of Health Effects of Pollution, School of Environmental Sciences, University of Pisa, Italy 2006-07 Past-President, European Respiratory Society (ERS) 2006-11 Member of Planning Group, Global Alliance against chronic Respiratory Diseases (GARD) Chief Medical Officers Meeting Italian Presidency of European Council Rome, October 6, 2014 Burden of chronic respiratory disease in Europe Giovanni Viegi Slide 83 COMODHES STUDY Slide 84 Maio, Curr Med Res Opin 2014 Slide 85 Slide 86 Maio, Curr Med Res Opin 2014 Slide 87 Viegi & coll. Risk charts for COPD (National Institute of Health) Slide 88 Viegi & coll. Risk charts for COPD (National Institute of Health) Slide 89 Community Acquired Pneumonia (CAP) Slide 90 Slide 91 Viegi, Respir Med 2006 Slide 92 Slide 93 Task Force participations Slide 94 Optimal assessment and management of chronic obstructive pulmonary disease (COPD). ERS Consensus Statement Siafakas NM, Vermeire P, Pride NB, Paoletti P., on behalf of the Task Force .Viegi G, De Backer W, Georgopoulos D, McNee W, Russi E, Stanescu D. Weitzenblum E, Howard P, Del Donno M, Donner H, Lode H, Lofdahl CG, Olivieri D, Robert D, et al Eur Respir J 1995; 8:1398-1420 The pharmacoepidemiology of COPD: recent advances and methodological discussion. Burney P, Suissa S, Soriano JB, Vollmer WM, Viegi G, Sullivan SD, Fabbri LM, Sin DD, Ernst P, Coultas D, Bourbeau J, Mapel DW, Weiss K, McLaughlin T, Price D, Sturkenboom MC, Taylor R, Hagan GW Eur Respir J 2003;43:1s-44s. Slide 95 Slide 96 Slide 97 Slide 98 Slide 99 Pellegrino, Eur Respir J 2005 Slide 100 Slide 101 Slide 102 Slide 103 Slide 104 Maio, Eur Respir J 2012 Slide 105 Slide 106 Review Articles Slide 107 Part I of II Cough Phlegm Wheeze Attacks of wheeze Chronic bronchitis Emphysema Asthma MEN Slide 108 MALES Viegis part Slide 109 Slide 110 Slide 111 Slide 112 Slide 113 Smoking cessation Slide 114 Slide 115 Slide 116 Slide 117 Carrozzi, Int J Environ Res Public Health 2014 Slide 118 Other epidemiological research groups connected to SIMeR Slide 119 HESE Study Slide 120 Simoni, Eur Respir J 2010 Slide 121 Slide 122 Simoni, Pediatr Allergy Immunol 2011 Slide 123 Am J Respir Crit Care Med 1994 Slide 124 SIDRIA Studi Italiani sui Disturbi Respiratori nellInfanzia e lAmbiente Slide 125 Centres who participated in ECRHS (1991-93), in ISAYA (1998-00) and GEIRD (2008-10) surveys in Italy according to climatic region Slide 126 Prevalenza di asma corrente e rinite allergica in Italia dal 1991 al 2010 (4 centri :Pavia, Torino, Verona, Sassari) (popolazione generale adulti tra 20 e 45 anni) ) Asma corrente Rinite allergica de Marco, Cerveri et al; ERJ 2012 Slide 127 ISAYA Study;1998-2000 6 Italian centres 214 subjects with current asthma followed up for 9 years Slide 128 CHANGES IN ASTHMA CONTROL 1999-2009 ISAYA Study 147 subjects with active asthma at follow-up Controlled asthma Uncontrolled asthma Partially controlled asthma 41% 28% 31% 1999 (at baseline) 2009 (follow-up) 23% 27% Controlled asthma Uncontrolled asthma Partially controlled asthma 50% Slide 129 Prevalence of reported doctor diagnosis of COPD, CB and Emphysema in ITALY * GEIRD 2008-2011 GEIRD 2008-2011 age Prevalence % (95% CI) 20-44 5.1 (4.5-5.6) 45-64 8.4 (7.3-9.7) 65-84 14.1 (11.3-17.3) 20-84 8.5 (7.9-9.1) 8.5 (7.9-9.1) * Survey carried out on random samples from the general population of Verona, Pavia, Torino, Sassari and Palermo. De Marco, Cerveri et Plos One 2013 Slide 130 Pisa Po Delta team: main collaborators of Giovanni Viegi Carlo Giuntini (retired) Giuseppe Pistelli () Tristano Sapigni () Paolo Paoletti Piera Fazzi (retired) Francesco Di Pede (retired) Laura Carrozzi Marzia Simoni Francesco Pistelli Sandra Baldacci Matteo Bottai Sara Maio Sonia Cerrai Giuseppe Sarno Paola Modena Marzia Pedreschi Mariella Vellutini Emilio Diviggiano Licia Ballerin Patrizia Biavati Umberto Mammini () Roberto Barale Gabriella Matteelli Antonio Scognamiglio Anna Angino Franca Martini Patrizia Silvi Slide 131 Slide 132 Grazie per linvito e per lattenzione Giovanni Viegi