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Objective: To assess the impact of occupational exposure to irritants or sensitizers on the occurrence, recrudescence and worsening of asthma and to identify unrecognized cases of work related asthma (WRA) including Work-Exacerbated Asthma (WEA) and Occupational Asthma (OA), in a general asthma clinic population sample., Setting, Design and Participants: The study was a population-based cross sectional survey. 1289 asthmatic subjects (from 15 to 46 yrs old) living in a vast district of Tuscany (Italy) were identified from the Medical Reimbursement Register of the National Health System. 893 subjects agreed to take part in the study. Subjects who were currently working or had worked in past were classified in different categories of occupational risk exposure (No, Low or High) according to the italian standard classification for industries and job titles, associated with the judgment of occupational hygiene experts., Results: 41% of subjects worked in industries and in job titles at risk for exposure to airway irritants and/or sensitizers, 48.6% reported an occupational exposure to gases, dust and fumes, more males than females. Prevalence of WEA and OA was higher in subjects who worked at higher risk exposure; these subjects reported a higher prevalence of markers of asthma severity (asthma control, level of treatment, FEV1) than subjects without WRA. Risk of WEA was significantly associated to female gender, older age, and self-reported exposure, while risk of OA was associated to job title with higher exposure risk to occupational asthmogens., Conclusions: Our study shows a high prevalence of WRA (especially WEA) associated with employment in industries and job titles at risk for airways sensitizers and/or irritants; data also support a role for occupational exposure in determining a poor asthma control and a higher level of asthma severity., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Background: Few epidemiological surveys on general population samples estimated changes in prevalence of respiratory symptoms/diseases over a long time interval; our study aims to quantify the temporal changes in the prevalence rates of asthma, allergic rhinitis and Chronic Obstructive Pulmonary Disease (COPD) after 25 years from baseline., Methods: A general population sample participated in 3 cross-sectional surveys carried out in Central Italy (Pisa) in 1985-88 (n = 3865), 1991-93 (n = 2841), 2009-11 (n = 1620). 2276 (47%) subjects participated in at least 1 survey, 1723 (35.5%) in at least 2 surveys and 849 (17.5%) in all the 3 surveys. All subjects filled in a standardized questionnaire about health status and risk factors; a sub-sample performed spirometry. Chi-square test was used to compare adjusted prevalence rates of respiratory symptoms/diseases and descriptive characteristics among the surveys. Generalised estimating equations (GEE) were used to analyze the association between respiratory symptoms/diseases and risk factors., Results: There was an increasing trend in prevalence rates of all respiratory symptoms/diseases throughout the surveys: current asthma attacks (1st-3rd survey prevalence: 3.4-7.2%), allergic rhinitis (16.2-37.4%), usual phlegm (8.7-19.5%) and COPD (2.1-6.8%) more than doubled. The GEE model confirmed these increasing trends, indicating higher risk of having respiratory symptoms/diseases in the second and third surveys., Conclusions: While asthma and allergic rhinitis increasing trends were confirmed, with respect to other international studies, also a COPD increasing prevalence rates was shown., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Aim: To evaluate the impact of a medical education course (MEC) on the behaviour of general practitioners (GPs) to treat asthma and allergic rhinitis (AR)., Methods: Data on 1820 patients (mean age 41 yrs ± 17 yrs) with asthma or AR were collected by 107 Italian GPs: 50% attended a MEC and 50% didn't (group B). The adherence for AR and asthma treatment was evaluated according to ARIA and GINA guidelines (GL)., Results: AR and asthma were diagnosed in 78% and 56% of patients; 34% had concomitant AR and asthma. Regardless of the MEC, the adherence to GL was significantly higher for AR than for asthma treatment (52 versus 19%). Group B GPs were more compliant to ARIA guidelines in the treatment of mild AR, whereas group A were more compliant in the treatment of moderate-severe AR; the adherence didn't differ between the groups for AR patients with comorbid asthma. Adherence to GINA GL for asthma treatment did not differ between GPs of groups A and B, independently from concomitant AR. Though insignificantly, group A were more compliant to GINA GL in the treatment of patients with only severe persistent asthma (63 versus 46%) as group B were for patients with severe persistent asthma and concomitant AR., Conclusions: GPs often tend to treat patients independently from GL. The impact of a single MEC did not improve adherence to GL in treating less severe AR and asthma patients, while there was a trend towards the opposite attitude in more severe AR patients without concomitant asthma., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Background: Research and practice indicate that a sizeable amount of prescribed drugs is never used., Aim: To assess the habitual up-take of medicines in subjects with respiratory symptoms/diseases or impaired lung function in general population samples., Methods: Data regard 4010 subjects (8-88 years) from the rural area of Po River Delta (North Italy) and the urban area of Pisa (North-Central Italy). Analyses concern the habitual use of any or specific medicines (broncho-pulmonary, anti-allergic, cardio-vascular, diuretic) in subjects with asthma, chronic bronchitis/emphysema (COPD), COPD or chronic cough/phlegm (COPDsx), and airways obstruction (AO, FEV(1)/FVC<70%)., Results: Asthma, COPD, COPDsx, and AO were present in 6%, 5%, 21%, and 13% of cases, respectively. Only 37% and 21% of subjects with respiratory symptoms/diseases used any or specific medicines, respectively. The subjects with COPD exhibited the highest prevalence of assumption (59% for any drug, 38% for specific medicines), followed by asthmatics (42% and 30%), and subjects with AO (40% and 25%). After accounting for sex, age, residence area, smoking habit, education, and presence of comorbidity, the conditions significantly related to any medicine up-take were COPD (OR 1.65, 95% CI 1.08-2.53) and asthma (OR 1.47, 95% CI 1.01-2.12). Only asthma resulted significantly associated with the use of specific drugs (OR 3.11, 95% CI 1.94-4.97). Drug use was higher in the urban than in the rural area., Conclusion: The results indicate that most people in the general population do not use drugs, in spite of reported respiratory disorders. The underuse of medicines seems lower in the urban area.

Objectives: To study the role of individual and occupational risk factors for asthma in furniture workers., Methods: 296 workers were examined (258 men, 38 women) with a questionnaire of respiratory symptoms and diseases, baseline spirometry, bronchial provocative test with methacholine, and skin prick tests. Non-specific bronchial hyperreactivity was defined as when a provocative dose with a fall of 20% in forced expiratory volume in 1 second (PD20FEV1) was < 0.8 mg and atopy in the presence of at least one positive response to skin prick tests. Workers were subdivided into spray painters (exposed to low concentrations of diisocyanates and solvents), woodworkers (exposed to wood dusts), and assemblers (control group)., Results: The prevalences of attacks of shortness of breath with wheezing and dyspnoea were higher in spray painters (13.5% and 11.5% respectively) than in woodworkers (7.7% and 6.3%) or in assemblers (1.6% and 1.6%); prevalences of chronic cough, asthma, and rhinitis were also slightly but not significantly higher in spray painters and in woodworkers than in assemblers. The difference in the prevalence of respiratory symptoms among the job titles was due to the atopic subjects, who showed a higher prevalence of chronic cough, wheeze, shortness of breath with wheeze, dyspnoea, and asthma in spray painters than in the other groups. The prevalence of non-specific bronchial hyperreactivity in subjects who performed bronchial provocative tests was 17.7%, with no significant difference among groups. Asthma symptoms were significantly associated with non-specific bronchial hyperreactivity. Asthma-like symptoms plus non-specific bronchial hyperreactivity was found in 4% of assemblers, 10% of woodworkers, and 13.3% of spray painters (chi 2 = 2.6, NS). Multiple logistic analysis taking into account individual (smoke, atopy, age) and occupational (job titles) risk factors confirmed that spray painters had higher prevalence of chronic cough than assemblers, and a trend in increasing the prevalence of shortness of breath with wheeze, dyspnoea, and asthma., Conclusions: Painters in the furniture industry, particularly atopic subjects, are at higher risk of asthma-like symptoms than other job titles. In these workers asthma-like symptoms are more sensitive than non-specific bronchial hyperreactivity in detecting a negative effect of the occupational exposure.

The role of peak expiratory flow (PEF) monitoring in the diagnosis of occupational asthma has recently been assessed by several studies, which agree that this procedure should always be used to confirm the relationship between symptoms and occupational exposure. Some specific issues should be satisfied: a minimum number of four PEF measurements in a day; several weeks of monitoring in and out of work; and the presence of specific patterns of PEF changes. The sensitivity and specificity of PEF monitoring to detect occupational asthma, in comparison with the specific challenge test in the laboratory (the "gold standard") have been shown to be fairly high, although many authors believe that PEF monitoring cannot substitute for the specific challenge test. Limitations include: the low sensitivity of PEF to detect mild changes in airway calibre with respect to forced expiratory volume in one second (FEV1); the blunting effect of pharmacological treatment; the episodic and irregular exposure to the sensitizer in the workplace; and the compliance and honesty of the subject. Further studies are required to select the best indices of daily and day-to-day variability to be used in the evaluation of PEF changes between work and out-of-work periods.

In order to assess the distribution of asthma in Italy in the 1980s, we have compared the findings of three general population surveys carried out in the North and the Centre of the country. Two cross-sectional investigations were performed in the Po Delta area (North Italy), 6 yrs apart: 1) 3,285 subjects, aged 8-64 yrs, in 1980-1982 (PD1); and 2) 2,841 subjects, aged 8-73 yrs, in 1988-1991 (PD2). One cross-sectional survey was carried out in Pisa (Central Italy): 3,866 subjects, aged 5-90 yrs, in 1985-1988 (PI1). For this analysis we have used data from the standardized questionnaires of those subjects between 18-64 yrs, who were currently employed. The prevalence rate of ever asthma was 3.3-5.5%, that of current asthma 1.3-2.9%; almost all of the diagnoses were confirmed by a doctor. Taking into account only doctor-confirmed asthma, the age of onset of manifestations was most frequently over 18 yrs (41-79%). It also occurred more frequently after the onset of employment. As regards smoking, whilst most asthmatic males were current or former smokers (70-86%), most asthmatic females were nonsmokers. However, the situation changed in PD2, where females showed the same pattern as males. Considering asthmatic subjects with skin-prick test reactivity (data available only in PD2), the vast majority (67% in males, 75% in females) had an age of disease onset under 18 yrs. In conclusion, the prevalence of asthma in Italy in the 1980s was similar to that in other European countries and was affected by atopy and smoking differently in the two sexes.(ABSTRACT TRUNCATED AT 250 WORDS)

The single-breath carbon monoxide diffusing capacity (DLCOsb) was measured together with ventilatory lung function tests as part of a survey of a general population sample living in Northern Italy (n = 2,481). Based on answers to an interviewer-administered questionnaire, subjects free of respiratory symptoms or diseases were identified. Data from subjects who had never regularly smoked cigarettes were used to derive reference equations for the test indexes, and data from the remaining subjects who had smoked were used to derive regression equations incorporating a term expressing cigarette consumption (cube root of pack-years) and a term indicating current smoking decrement, in order to obtain expected DLCOsb percent predicted. Neither number of cigarettes smoked daily or duration of smoking, in smokers, nor duration of smoking or years since quitting smoking, in ex-smokers, entered significantly the multiple-regression model. The mean values of DLCOsb were only slightly affected by the increasing degree of airway obstruction. When subjects with confirmed asthma were analyzed, after stratifying for different levels of FEV1/FVC ratio, increased mean value of DLCOsb (over 100%) was found in those with an FEV1/FVC ratio between 75 and 65%. This cross-sectional analysis suggests that there is a decrease in DLCOsb with cumulative cigarette consumption even in healthy subjects. Further, it confirms the clinical observations of high DLCOsb values in asthmatic patients, at least in those with an initial degree of chronic airflow obstruction.

The prevalence rates of asthma and asthma symptoms were investigated in a general population sample (n = 3,289) living in a rural area of northern Italy. The subjects received a standard questionnaire and performed lung function tests with automated equipment. The overall prevalence rate of reported diagnosis of asthma was 5%. In young nonsmokers of both sexes the prevalence rates of reported diagnoses were higher than those of symptoms whilst the reverse occurred in older age groups. The prevalence rates decreased from childhood to young adults and increased again in older age groups. In smokers, reported diagnoses and symptoms increased with age and the prevalence rates of symptoms were always higher than those of diagnoses. Smokers with symptoms and reported diagnoses had lower lung function parameters than those with only symptoms. The distribution of asthma symptoms in our population indicates the importance of cigarette smoke and other environmental factors in the expression of the disease.