[Show abstract][Hide abstract] ABSTRACT: RATIONALE
Spirometry is the objective measurement to detect airway obstruction. In some patients respiratory symptoms related to airway obstruction are not present, when airway obstruction is detected by spirometry.
Aim of the present study was to detect early airway obstruction in an adult population sample in a primary care setting.
Seventeen general practitioners were involved and 912 patients were asked to participate in the study, between January and June 2014: of them, 583 (323M), aged 40-92 yrs, accepted and were investigated through a respiratory questionnaire, the mMRC dyspnoea scale, and spirometry through the Quark PFT (Cosmed, Italy) spirometer. Smoking habits, BMI, respiratory symptoms, doctor respiratory diagnoses, dyspnoea score, and forced expirograms were obtained. Based on answers on doctor diagnosis, we identified 4 subgroups: doctor COPD diagnosis (COPD); doctor Asthma diagnosis (A); Asthma COPD Overlap Syndrome (ACOS); no respiratory diagnosis (NRD).
For screening purposes, a FEV1/FVC<70% was considered a marker of airway obstruction. Severity was determined by FEV1 level: I mild (FEV1≥80% of predicted); II moderate (50-79%), III severe (30-49%); IV more severe (<30%).
One hundred and ninety subjects were current smokers, 235 ex smokers and 155 non smokers. Prevalence rates of cough, sputum, wheezing and dyspnoea were 27%, 26%, 32%, 44%, respectively. Prevalence rates of COPD, A, and ACOS were 12.5%, 7.8%, and 3.6%, respectively.
In the overall sample 16.3% (95) showed airway obstruction: of them, 26% mild, 56% moderate, 17% severe, 1% very severe. Among obstructed subjects 12% did not report any respiratory symptom and were distributed among FEV1 levels I-III.
Those reporting neither respiratory symptoms nor respiratory doctor diagnosis were 60% in level I; 43% in level II; 44% in level III; none in level IV. In obstructed vs not obstructed individuals, a higher frequency of smokers (χ2=.002) and a higher mMRC score (χ2<.05) were found. A significant association among cough, sputum, wheezing, dyspnoea and obstruction was found (χ2<.001).
In a logistic model, wheezing (p=.001), sputum (p=.036), smoking habits (p=.028), and older age (p=.0001) were the best predictors of airway obstruction.
We found an elevated prevalence of airway obstruction in our sample of primary care adults associated with elevated respiratory symptoms prevalence and smoking. However, a high prevalence of subjects without symptoms or medical diagnoses was found among obstructed patients, indicating the need of implementing spirometry in family practice as early diagnosis tool.
[Show abstract][Hide abstract] ABSTRACT: Asthma and obesity are important and growing health issues worldwide. Obesity is considered a risk factor for asthma, due to the induction of changes in airway mechanics and altered airway inflammation.
We cross-sectionally investigated the effect of increased weight on pulmonary function in a large population sample of healthy children, aged 10-17 yrs living in Palermo, Italy. Explanatory effect of weight on lung function variables were evaluated by multiple linear regression models, taking into account height, gender, and age-class.
Among the 2,393 subjects, FVC and FEV1 were positively correlated to weight. Multiple regression models showed that the weight beta coefficient for FEV1 was significantly lower with respect to that for FVC (0.005 and 0.009 l/kg, respectively), indicating a different magnitude in explanatory effect of weight on FVC and FEV1. Both FEV1/FVC and FEF25-75%/FVC ratios were negatively correlated to weight, while FEF25-75% was not significantly correlated. Similar results were obtained also when 807 symptomatic subjects were introduced in the model through a sensitivity analysis.
In healthy children, the disproportionate increase of FEV1 and FVC with weight produces airflow decrease and consequently apparent poorer lung function independently from respiratory disease status.
PLoS ONE 05/2015; 10(5):e0127154. DOI:10.1371/journal.pone.0127154 · 3.23 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: AIMS: Here, we present results from a prospective pilot study that was aimed at surveying changes in daily cigarette consumption in smokers making their first purchase at vape shops. Modifications in products purchase were also noted.
DESIGN: Participants were instructed how to charge, fill, activate and use their e-cigarettes (e-cigs). Participants were encouraged to use these products in the anticipation of reducing the number of cig/day smoked.
SETTINGS: Staff from LIAF contacted 10 vape shops in the province of the city of Catania (Italy) that acted as sponsors to the 2013 No Tobacco Day.
PARTICIPANTS: 71 adult smokers (≥18 years old) making their first purchase at local participating vape shops were asked by professional retail staff to complete a form.
MEASUREMENTS: Their cigarette consumption was followed-up prospectively at 6 and 12 months. Details of products purchase (i.e., e-cigs hardware, e-liquid nicotine strengths and flavours) were also noted.
FINDINGS: Retention rate was elevated, with 69% of participants attending their final follow-up visit. At 12 month, 40.8% subjects could be classified as quitters, 25.4% as reducers and 33.8% as failures. Switching from standard refillables (initial choice) to more advanced devices (MODs) was observed in this study (from 8.5% at baseline to 18.4% at 12 month) as well as a trend in decreasing thee-liquid nicotine strength, with more participants adopting low nicotine strength (from 49.3% at baseline to 57.1% at 12 month).
CONCLUSIONS: We have found that smokers purchasing e-cigarettes from vape shops with professional advice and support can achieve high success rates.
International Journal of Environmental Research and Public Health 04/2015; 12(4):3428-3438. DOI:10.3390/ijerph120403428 · 2.06 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Rhinitis and conjunctivitis are common diseases worldwide that are frequently associated. Nevertheless, the risk factors for rhinoconjunctivitis are not well-described and the impact of conjunctivitis on rhinitis and asthma in children remains unknown. This study explored the different risk factors and evaluated the burden of rhinoconjunctivitis among adolescents.
This was a cross-sectional study conducted on a random sample of schoolchildren, aged 10-17 years, using skin prick tests and a self-administered questionnaire on respiratory health investigating the impact of rhinitis and rhinoconjunctivitis on daily activities.
A complete evaluation was obtained for 2,150 children. The prevalence of rhinitis alone was 18.2% and rhinitis associated with conjunctivitis was 20.5%. Rhinoconjunctivitis was more frequently associated with females, a parental history of atopy, domestic exposure to mold/dampness, passive smoke exposure, and reported truck traffic in residential streets. Moreover, rhinoconjunctivitis was associated with a higher level of allergic sensitization. The prevalence of current asthma was 1.7% in subjects without rhinitis or rhinoconjunctivitis, 5.1% in rhinitis and 10.7% in rhinoconjunctivitis. In a logistic model, rhinoconjunctivitis yielded a 2-fold risk for current asthma with respect to rhinitis. Subjects with rhinoconjunctivitis had poorer quality of life (QoL); there was an impact on daily activities in 4.6% of rhinitis and 10.7% of rhinoconjunctivitis.
Ocular symptoms increase the role of rhinitis as a risk factor for asthma and its impact on daily activities in children.
[Show abstract][Hide abstract] ABSTRACT: The interaction between IgE antibodies and allergens is a key event in triggering an allergic reaction. The characterization of this region provides information of paramount importance for diagnosis and therapy. Par j 2 Lipid Transfer Protein is one of the most important allergens in southern Europe and a wellestablished marker of sensitization in Parietaria pollen allergy. The main aim of this study was to map the IgE binding regions of this allergen and to study the pattern of reactivity of individual Parietaria-allergic patients. By means of gene fragmentation, six overlapping peptides were expressed in Escherichia coli, and their IgE binding activity was evaluated by immunoblotting in a cohort of 79 Parietaria-allergic patients. Our results showed that Pj-allergic patients display a heterogeneous pattern of IgE binding to the different recombinant fragments, and that patients reacted simultaneously against several protein domains spread all the over the molecule, even in fragments which do not contain structural features resembling the
native allergen. Our results reveal the presence of a large number of linear and conformational epitopes on the Par j 2 sequence, which probably explains the high allergenic activity of this allergen.
[Show abstract][Hide abstract] ABSTRACT: Indoor air pollution is estimated to be greater in indoor than in outdoor environment. Tobacco smoke may significantly contribute to indoor air pollution and domestic smoking is correlated to indoor airborne particulates with aerodynamic diameter<2.5µg (PM2.5). Heavy metals, such as Cd and Tl, are present in tobacco and dispersed in the environment by tobacco combustion. In the context of RESPIRA Project, we performed outdoor/indoor measurements of PM2.5 by gravimetric sampling in 73 houses in the Mediterranean Area of South Italy. Gravimetric Teflon filters were analyzed for PM metal content by inductively coupled plasma (ICP) optical emission spectrometry and ICP mass spectrometry for obtaining Cd and Tl concentration. The presence/absence of smokers in each dwelling was investigated by a questionnaire fulfilled by householders. The relationships of indoor/outdoor concentrations were not significant for both Cd and Tl. Conversely, the indoor Cd/Tl correlation was highly significant (R2=.812, p<.0001) showing that both metals in indoor PM2.5 have a common indoor source. Higher concentration of PM2.5 such as of Cd and Tl was associated to the presence of smokers at home: PM2.5 was (median and interquartile range) 24.2 µg/m3 (16.9-41.5) for smoker and 15.7 (10.9-22.5) for non-smoker houses (p<.0001); Cd was 0.148 ng/m3 (0.081-0.449) and 0.032 (0.028-0.080) respectively (p=.0002); Tl 0.069 ng/m3 (0.042-0.146) and 0.020 (0.008-0.042, p<.0001) (Mann-Whitney U-test for nonparametric data). These results suggest that the levels of cadmium and thallium in PM2.5 are markers of third-hand smoking
RESPIRA Project was funded by Operational Cross-border Program Italy-Malta 2007-13 code A1.2.3-72.
European Respiratory Society Annual congress 2014, Munich; 09/2014
[Show abstract][Hide abstract] ABSTRACT: Aim of the study was to evaluate the influence of living in highly polluted areas in Malta and in Sicily on reported allergic respiratory diseases in children. Malta has a very high population density while the petrochemical industry located close to Gela is one of the main sources of industrial air pollution in Sicily. In the context of RESPIRA Project, we evaluated 2,047 schoolchildren (972 M), aged 10-15 yrs, selected from 12 junior high schools of Southern Sicily (n=1,189 evaluated subjects) and 6 of Malta (n=858). Children′s parents fulfilled an ISAAC respiratory questionnaire. Rhinitis in the last 12 months was reported by 6.6% in Italy and 7.9% in Malta (p=.05); wheeze in the last 12 months (W12m) by 7.4% in Italy and 12.7% in Malta (p<.0001); doctor diagnosed asthma (DDA) by 7.9% in Italy and 18.1% in Malta (p<.0001). Current asthma (CA), defined as DDA + W12m, was reported by 3.0% in Italy and 7.8.% in Malta (p<.0001). Use of drugs for asthma in the last 12 months was reported by 4.9% in Italy and 12.1% in Malta (p<.0001). In a logistic model, when correcting for asthmatic bronchitis in the first two years of life, parental atopy, early and current passive smoke exposure, mould/dampness at home, personal history for rhinitis, socioeconomic status and presence of pets at home, children living in Malta showed a higher risk factor for CA with respect to those living in Southern Sicily (OR 2.48, IC 1.32-4.70, p=.005). In conclusion, children living in Malta are at higher risk for developing allergic respiratory diseases with respect to those living in Southern Sicily
Funded by Cross-border Program Italy-Malta 2007-2013 code A1.2.3-72.
European Respiratory Society Annual Congress 2014, Munich; 09/2014
[Show abstract][Hide abstract] ABSTRACT: Introduction: The RESPIRA study was performed in the Health District of Gela (Southern Sicily) and Malta in 2012/3 in 11-14 years old schoolchildren (n=2,047) by means of standard respiratory questionnaires (ISAAC),and clinical exam of case and control subjects. Aims and Objectives: To measure total serum IgE levels in cases (n=127, Male=45) and controls (n=142, Male=64), and specific IgEs in cases (n=90, male=53), and controls (n=82, males=38). Materials and Methods: Cases reported wheeze and/or use of asthma medications in the last 12 months, while controls answered negatively to both and also to rhinitis in the last 12 months. The method used for Specific IgE's (sIgE) was that supplied by R-Biopharm (R-Biopharm AG, Landwehrstr. 54, D-64293 Darmstadt, Germany). The method was Enzyme Sorbent Test (EAST). The method used for Total IgE (tIgE) was by ELISA supplied by Genetic Diagnostics (Genesis Diagnostics Ltd, Eden Research Park, Henry Crabb Road, Littleport, Cambridgeshire, United Kingdom). Results: Total Serum IgE (n=269) was raised(>144 IU/l) in 45/127 cases versus 25/142 controls (p=0.0001). In Males 30/76 of cases vs 11/64 controls (p=0.005), while in Females cases 15/51 vs 14/78, (p=0.14). Positive specific IgE (>0.34 U/ml) was noted in at least one allergen in 54/90 cases vs 30/82 controls (p=0.002). HDM was positive in 27/90 cases vs 12/82 controls (p=0.0001), Parietaria positive 12/90 cases vs 2/82 controls (p=0.011), cat 22/90 vs 13/82 controls (p=0.19) in whole sample, while in male subgroup 14/53 of cases were positive vs 4/38 controls (p=0.06). Dog 9/90 cases vs 8/82 controls (p=0.86). Olive positive in 13/90 cases vs 8/82 controls (p=0.48). Alternaria positive in 6/90 cases vs 2/82 controls (p=0.28). Goldenrod Solidago Virgaurea positive in 2/90 cases vs 1/82 controls, and Cladosporium 0/90 cases, 1/82 controls. Conclusion: Positive Total serum IgE, and specific IGE to HDM and Parietaria in all patients were significantly higher in Cases than in control subjects. IGE to moulds and dog allergen was not significantly different. Positive cat IgE was close to statistical significance in males only. RESPIRA Study was funded by Operational Cross-border Program Italy
European Respiratory Society Annual congress - 2014, Munich; 09/2014
[Show abstract][Hide abstract] ABSTRACT: Introduction: The RESPIRA study was performed in the Health District of Gela (Southern Sicily) and Malta in 2012/3 in 11-14 years old schoolchildren (n=2,047) by means of standard respiratory questionnaires (ISAAC) and clinical exam of case and control subjects. Aims and Objectives: To assess sensitivity to common allergens in cases and controls in these southern Mediterranean islands. Materials and Methods: Cases (n=137, M=84) reported wheeze and/or use of asthma medications in the last 12 months, while controls (n=159, M=70) answered negatively to both and also to rhinitis in the last 12 months. Results: A positive skin test (>=3mm) for at least one allergen tested was found in 80/137 cases and 51/159 controls (p=0.0001). House Dust Mite (cases 62/137, controls 28/159, p=0.001), Parietaria (22/137, 10/159, p=0.008), Alternaria (19/137, 9/159, p=0.018), and Blattella (12/137, 5/159, p=0.046) were more frequently positive in cases than in controls. Olive (25/137, 19/159, p=0.142), cat (17/137, 11/159, P=0.116), and dog (9/137, 5/159, p=0.182) did not show a significant difference between cases and controls. Grass pollen sensitization was slightly higher in controls (10/137, 13/159). There was a significant difference by gender in a 2x4 chi 2 comparing positives amongst cases and controls. HDM; Males (cases 41/84 Controls 15/70), females (Cases 21/53, Con 13/89) p=0.011, Olive; in Males (CAS 19/84, Con 10/70) Females (Cas6/53, con 9/89) p=0.007, Cat; Males (Cas.12/84, Con 6/70) Females (Cas.5/53 and 5/89) p=0.019 and for Dog; Males (CAS 7/84 and 2/70) and Females (Cases 2 /53 and 4/89 p=0.017. Conclusion: Skin prick sensitivity to common Mediterranean aero-allergens in asthma patients vs controls was significantly higher in 11-14 year old Males when compared to females. RESPIRA Study was funded by Operational Cross-border Program Italy
European Respiratory Society - annual congress 2014, Munich; 09/2014
[Show abstract][Hide abstract] ABSTRACT: The Respira project: Difference in levels of indoor biological pollutants in schools and homes in Southern Sicily and Malta
Valeria Longo1, David Bilocca2, Chris Zammit2, Martin Balzan2, Fabio Cibella1, Steve Montefort2, Giovanni Viegi1 and Paolo Colombo1
+ Author Affiliations
1Istituto di Biomedicina ed Immunologia Molecolare, Consiglio Nazionale delle Ricerche, Palermo, Italy
2Department of Medicine, Mater Dei Hospital, Msida, Malta
Guidelines in asthma and allergic disease highlighted the importance of indoor levels of allergens and LPS evaluation, to identify the “threshold value” in sensitization and symptom onset. The RESPIRA Project has provided a monitoring study of LPS and four allergens (Derp1, Feld1, Alta1 and Phlp5) in Sicily and Malta.
Methods: Dust samples were collected by vacuum sampling from schools (12 in Sicily and 6 in Malta – 3 classrooms per each school). From a population sample of 2,047 schoolchildren (11-14 years) a subsample of subjects with and without symptoms of allergic diseases was selected and their houses evaluated (74 in Sicily and 81 in Malta). LPS evaluation was determined by chromogenic LAL assay and allergen quantization was performed by Elisa assays.
Results: In Sicily (Health District of Gela), data show a higher level of LPS in schools than in houses (p<0.0001); 70% of houses have a concentration of Der p 1 above the threshold value of sensitization (≥1 µg allergen/g dust) and, in any case, higher in dwellings than in schools (p<0.0001). In Malta no statistical difference in LPS concentration was recorded between houses and schools; on the other hand Der p 1 and Fel d 1 allergens are present in higher amount in Maltese dwelling. No differences were reported for Alt a 1 and Phl p 5. Finally, the comparison between LPS and allergens distribution between Sicily and Malta shows i) a significant higher LPS concentration in Italian schools (p<0.0001); ii) higher Fel d 1 concentration in Maltese schools; iii) higher Der p 1 concentration in Italian houses. Funded by Operational Programme Italia-Malta 2007-2013, RESPIRA Project #A.1.2.3-72.
European Respiratory Society Annual congress 2014, Munich; 09/2014
[Show abstract][Hide abstract] ABSTRACT: Pollutants in particulate matter (PM) are associated with respiratory disorders. Data on indoor concentration of elemental chemical pollutants in highly polluted areas is scanty. In the context of RESPIRA Project, we evaluated both outdoor and indoor concentrations of air pollutants in the Mediterranean area. Gravimetric samples of PM with aerodynamic diameter<2.5 µm were collected on Teflon filters. Concentration of ICP-MS extracted component was measured in 84 sites of South of Sicily (41 in Gela, close to a petrochemical complex, 43 in rural area) and 54 in Malta. Similarly. Indoor measures were performed in 73 houses in Sicily (35 in Gela, 38 in rural area) and in 46 of Malta. Outdoor Vanadium (V) concentrations (median and interquartile range, ng/m3) were: 1.77 (0.60-4.30) in Malta, 1.51 (0.72-2.89) in Gela, and 0.29 (0.11-0.69) in Rural Area (p<.0001); Nickel (Ni): 1.37 (0.65-2.74), 0.82 (0.45-1.37), and 0.29 (0.17-0.55, p<.0001); Sulphur (S) 210 (73-683), 705 (334-1,078), 203 (148-384, p=.0004). Home Indoor V concentrations were 1.34 (0.38-6.70) in Malta, 1.03 (0.44-2.04) in Gela, and 0.16 (0.10-0.44) in Rural Area (p<.0001); Ni: 1.10 (0.52-3.35), 0.61 (0.40-1.16), and 0.28 (0.19-0.35, p<.0001); S: 324 (71-728), 662 (379-1,090), and 257 (187-437, p=.0007). Outdoor/indoor relationships for the investigated elements were tested. V: R2=.665, p<.0001. Ni: R2=.750, p<.0001. S: R2=.587, p<.0001. In conclusion, significantly higher indoor concentration of atmospheric pollutants exist in highly polluted areas. These, in absence of indoor sources, depend on outdoor concentrations
RESPIRA Project was funded by Operational Cross-border Program Italy-Malta 2007-2013 code A1.2.3-72.
European Respiratory society annual congress 2014, Munich; 09/2014
[Show abstract][Hide abstract] ABSTRACT: Low vitamin D is involved in allergic asthma and rhinitis. IL-31 and IL-33 correlate with Th2-associated cytokines in allergic disease. We investigated whether low vitamin D is linked with circulating IL-31 and IL-33 in children with allergic disease of the airways. 25-Hydroxyvitamin D [25(OH) Vit D], IL-31, and IL-33 plasma levels were measured in 28 controls (HC), 11 allergic rhinitis (AR) patients, and 35 allergic asthma with rhinitis (AAR) patients. We found significant lower levels of 25(OH) Vit D in AR and in AAR than in HC. IL-31 and IL-33 plasma levels significantly increased in AAR than HC. IL-31 and IL-33 positively correlated in AR and AAR. 25(OH) Vit D deficient AAR had higher levels of blood eosinophils, exacerbations, disease duration, and total IgE than patients with insufficient or sufficient 25(OH) Vit D. In AAR 25(OH) Vit D levels inversely correlated with total allergen sIgE score and total atopy index. IL-31 and IL-33 did not correlate with 25(OH) Vit D in AR and AAR. In conclusion, low levels of 25(OH) Vit D might represent a risk factor for the development of concomitant asthma and rhinitis in children with allergic disease of the airways independently of IL-31/IL-33 Th2 activity.
Mediators of Inflammation 06/2014; 2014(3):520241. DOI:10.1155/2014/520241 · 3.24 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Both severe asthma and obesity are growing health problems. Severe asthma leads to a poor quality of life. The relationship among BMI, comorbidities, and severe asthma control in adults is still unclear. The aim of the study is to better understand the effect of the comorbidities as atopy, type II diabetes, OSAS, gastroesophageal reflux, hypertension, cardiovascular diseases, osteoporosis, infections, and psychological factors with BMI on asthma control in a cohort of adult severe asthmatics. One hundred and two patients were enrolled in a cross-sectional study assessing asthma control, treatments, pulmonary function, inflammatory markers, and comorbidities. Patients were divided into 3 classes according to BMI: normal weight, overweight, and obese. We found that the optimal state of asthma control is lower. whereas the score of Asthma Control Questionnaire, the number of asthma exacerbations during last year, the oral corticosteroids requirement during the previous year, and the LABA treatments are higher in obese than in overweight and normal weight severe asthmatics. The number of subjects with type II diabetes and OSAS are higher among obese and overweight patients than in normal weight asthmatics. In conclusion, BMI represents per se a factor for the deterioration in disease control in severe asthma.
BioMed Research International 05/2014; 2014:607192. DOI:10.1155/2014/607192 · 1.58 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Respiratory allergic symptoms impact on social life and school activities, influencing the patient's mood states. We evaluated the relationships between allergic respiratory diseases and depressive/anxious mood in a large sample of Italian middle school students, using the partial directed acyclic graph (P-DAG).
We studied 1283 subjects aged 10-13. A health respiratory questionnaire including questions relevant to socioeconomic status (HCI) and a test for depression and anxiety were administered. All subjects performed spirometry and skin prick tests.
A causal role of rhinitis on depression was found: the likelihood of being depressed increased from 11.2 to 17.7%, when rhinitis was present. Moreover, a direct effect of low HCI on depressive mood was shown (p < 0.0001) as well as the correlation between anxiety and depression (p < 0.0001). Gender was not a direct causal factor for depressive mood, but their relation was mediated through anxious mood. Anxiety appeared to have a stronger association with depression than gender. Allergic sensitization was significantly related to both asthma and rhinitis (p < 0.0001, respectively). Asthma and rhinitis were also directly associated (p < 0.0001). Conversely, asthma was not directly associated with depressive mood, but their relation was mediated through rhinitis. Body mass index (BMI) and impaired lung function (IPF) were not associated with the other variables.
The use of this novel approach to analyzing the dynamic relationships allowed us to find a causal role of rhinitis on depressive state. Moreover, anxious condition and low socioeconomic status contributed to induce depressive mood.