While asthma and allergic rhinitis increasing trends were confirmed, with respect to other international studies, also a COPD increasing prevalence rates was shown.

No abstract

A study of indoor air exposures and acute respiratory effects in adults was conducted in the Po Delta (rural) and Pisa (urban) areas of Italy. Indoor exposures were monitored for nitrogen dioxide (NO 2 ) and particulate matter o2.5 mm (PM 2.5 ) for 1 week during the winter or summer in a total of 421 houses (2/3 in Pisa). Information on house characteristics, subjects' daily activity pattern and presence of acute respiratory symptoms was collected by a standardized questionnaire. Peak expiratory flow (PEF) maneuvers were performed by adult subjects four times daily; maximum amplitude and diurnal variation were taken into account. Indices of NO 2 and PM 2.5 exposures were computed as the product of weekly mean pollutant concentration by the time of daily exposure. Mean levels of pollutants were significantly higher in winter than in summer, regardless of the area. The relationship between exposure indices and acute respiratory symptoms was investigated only in winter. In spite of a slightly lower indoor level in the urban than in the rural area in winter (NO 2 : 15 vs. 22 ppb; PM 2.5 : 67 vs. 76 mg/m 3 ), prevalence rates of acute respiratory symptoms were significantly higher in the urban than in the rural area. Acute respiratory illnesses with fever were significantly associated with indices of NO 2 (odds ratio (OR) ¼ 1.66; 95% CI ¼ 1.08À2.57) and PM 2.5 exposures (OR ¼ 1.62; 95% CI ¼ 1.04À2.51), while bronchitic/asthmatic symptoms were associated only with PM 2.5 (OR ¼ 1.39; 95% CI ¼ 1.17À1.66). PEF variability was positively related only to PM 2.5 exposure index (OR ¼ 1.38; 95% CI ¼ 1.24À1.54, for maximum amplitude; OR ¼ 1.37; 95% CI ¼ 1.23À1.53, for diurnal variation). In conclusion, indoor pollution exposures were associated with the presence of acute respiratory symptoms and mild lung function impairment in a rural and an urban area of Northern-Central Italy.

Background: Few population-based studies on the effects of environmental exposure variation exist. Aim: Assessing respiratory symptom/disease incidence related to risk factor exposure changes. Methods: A longitudinal general population sample from two surveys (PISA2:1991(PISA2: -1993 PISA3:2009 PISA3: -2011; no. ¼ 970), aged �20 years at baseline, completed a questionnaire on respiratory symptoms/diseases, risk factor exposure and performed spirometry. 18-year follow-up cumulative incidence of respiratory symptoms/diseases and longitudinal changes (persistence, incidence, remittance) in risk factor exposure were computed. Results: Cumulative incidence values were: 3.2% (corresponding to a 1.8‰/year incidence rate), asthma; 6.6% (3.8‰/year), asthma attacks; 4.5% (2.6‰/year), wheeze; 31.7% (21.0‰/year), allergic rhinitis-AR; 7.6% (4.4‰/year), chronic obstructive pulmonary disease-COPD; 16.1% (9.7‰/year), usual cough; 18.5% (11.3‰/ year), usual phlegm; 30.7% (20.1‰/year), dyspnoea 1þ; 13.9% (8.3‰/year), airway obstruction. The following associations emerged among respiratory symptom/disease cumulative incidence and risk factor exposure changes: a two-to-five fold higher risk for COPD, phlegm, cough, dyspnoea, asthma attacks, airway obstruction in persistent smokers; a two-to-three fold higher risk for COPD in remittent smokers; a two-fold higher risk for AR, phlegm and a four-fold higher risk for asthma in subjects with persistent occupational exposure; a two-fold higher risk for cough, phlegm, dyspnoea, AR in subjects with incident occupational exposure; a two-fold higher risk for AR, asthma attacks, COPD in subjects with incident traffic exposure. Conclusions: Our study showed noteworthy respiratory symptom/disease incidence values and indicated that lifestyle and environmental exposure changes can differently influence onset. This information could be useful for primary prevention strategies in order to reduce the chronic disease burden in the general population.