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, Unità di Ricerca di Epidemiologia
Ambientale Polmonare,
Istituto di Fisiologia Clinica CNR, Pisa
. Professore di “Effetti dell’inquinamento sulla salute”, Corso di Laurea
in Scienze Ambientali, Università 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)
Mortality
700
565 559
535 532 522
506
500
tumori
482 477 479
454 433
A
MCV
410 401 400
400
332 329 325 318
300
200
313 312 308 309 309 298 298 293
290 284 285 287 279 280
266 266 262 260
100
0
86 78 73 71 73 71
65 69 71 72 68 59 61 68 54 55 54 56
700
479 481 462 461
449 435
417 407 409
400
382 365
351 341 333
278 274 271 261
300
200
227 234 235 239 236 228 233 224 220 212 217 228 218 213 213 210 208
204
100
2008
2007
2006
2003
2002
2001
Anno
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
0
1990
Δ Tassi std per 100.000
600
500
B
Δ Tumori-MAR
2009
Tassi std per 100.000
600
MAR
CNR
Epidemiological
surveys
PO DELTA
PISA
Materials and methods I
Po Delta area, North Italy
Pisa, Central Italy
• 1st cross-sectional study (PD1):
• 1st cross-sectional survey (PI1):
- carried out in 1980-82, before
operation of a large oil-burning
thermoelectric power plant
- performed in 1985-88
- 3855 subjects (77% of expected, age
5-90 yr)
- 3284 subjects (78% of expected,
age 8-64 yr)
• 2nd cross-sectional study (PD2): •2nd cross-sectional study (PI2):
- performed in 1988-91
- 2841 subjects (age 8-73 yr)
- carried out in 1991-93, after the
construction of a new highway
connecting Pisa to Florence
- 2841 subjects (age 8-97 yr)
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)
Materials and methods IV
Spirometry
•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
Baldacci et al, J Environ Pathol Toxicol Oncol 1997
Prevalence, incidence of respiratory
symptoms/diseases and risk factors
(1999)
Viegi, Int J Tuberc Lung Dis 1999
Viegi, Int J Tuberc Lung Dis 1999
Viegi, Chest 2000
Viegi, Chest 2004
Viegi, Eur J Epidemiol 1994
Pisa Study
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.
Guerra, Allergy 2005
Lung function
Methods
Natural cubic spline models over the whole age range
two “breakpoints” to split the growth, plateau and decline phases
Pistelli, AJRCCM 2000
Pistelli, Respir Med 2007
Viegi, Chest 2001
Pistelli, Respir Med 2008
Bronchial hyperresponsiveness
Paoletti, AJRCCM 1995
Maio, Chest 2009
Maio, Chest 2009
Indoor air pollution
Arch Environ Health 2002
Simoni, J Expo Anal Environ Epidemiol 2004
Risks to get respiratory symptoms
Simoni, J Expo Anal Environ Epidemiol 2004
Risks to get elevated maximum amplitude and diurnal
variation of peak expiratory flow (PEF)
Simoni, J Expo Anal Environ Epidemiol 2004
Mutagenetic evaluations
Barale, Environ Mol Mut 1998
Petruzzelli, Cancer Research, 1998
Petruzzelli, Cancer Research, 1998
Skin prick test and IgE
Baldacci, Allergy 1996
SEASD Study
Simoni, Clin Chem Lab Med 2006
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 difficoltà di
respiro a riposo.
OLD, diagnosi di asma e/o
bronchite cronica/enfisema
Medicine consumption
2004-2005
1660 sub.
8-81 years
Simoni, Respir Med 2008
AIFA funded projects
Baldacci, Respir Med 2012
Maio, Curr Med Res Opin 2012
Maio, J Asthma 2012
GARD and
Italian Ministry funded projects
Eur Respir J. 2010 Nov;36(5):995-1001
Bousquet, ERJ 2010
Chief Medical Officers Meeting
Italian Presidency of European Council
Rome, October 6, 2014
“Burden of chronic respiratory disease in
Europe”
Giovanni Viegi
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)
COMODHES STUDY
Maio, Curr Med Res Opin 2014
Maio, Curr Med Res Opin 2014
Maio, Curr
Med Res Opin
2014
Risk charts for COPD
(National Institute of Health)
Viegi & coll.
Risk charts for COPD
(National Institute of Health)
Viegi & coll.
Community Acquired Pneumonia
(CAP)
Viegi, Respir Med 2006
Task Force participations
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.
Pellegrino, Eur Respir J 2005
Maio, Eur Respir J 2012
Maio, Eur Respir J 2012
Review Articles
Asthma
Emphysema
Chronic
bronchitis
Attacks of
wheeze
Wheeze
Phlegm
Cough
MEN
Part I of II
Viegi’s part
MALES
Smoking cessation
Carrozzi, Int J Environ Res Public Health 2014
Other epidemiological
research groups connected to
SIMeR
HESE Study
Simoni, Eur Respir J 2010
Simoni, Pediatr Allergy Immunol 2011
Am J Respir Crit Care Med 1994
SIDRIA
Studi Italiani sui Disturbi Respiratori
nell’Infanzia e l’Ambiente
Centres who participated in ECRHS (1991-93), in ISAYA (1998-00)
and GEIRD (2008-10) surveys in Italy according to climatic region
UD
VR
PV
TO
MO
FE
PI
Mediterranean area
SS
Continental area
AN
TR
SA
Centres participating to:
ECRHS
ISAYA
GEIRD
SR
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)
)
30
25,8
Prevalenza
25
18,8
20
16,7
1998-2000 (ISAYA)
15
2008-2010 (GEIRD)
10
5
1991-1993 (ECRHS)
6,6
4,4
4,6
0
Asma corrente
1
Rinite allergica
2
de Marco, Cerveri et al; ERJ 2012
 ISAYA Study;1998-2000
 6 Italian centres
 214 subjects with current asthma followed up for 9 years
CHANGES IN ASTHMA CONTROL
1999-2009
ISAYA Study
147 subjects with active asthma at follow-up
1999
(at baseline)
Partially controlled
asthma
41%
Controlled asthma
28%
31%
2009
(follow-up)
Partially controlled
asthma
50%
Uncontrolled asthma
Controlled asthma
27%
23%
Uncontrolled asthma
Prevalence of reported doctor diagnosis of COPD, CB and
Emphysema in ITALY *
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)
* Survey carried out on random samples from the general population of Verona,
Pavia, Torino, Sassari and Palermo.
De Marco, Cerveri et Plos One 2013
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
“Grazie per l’invito e
per l’attenzione”
Giovanni Viegi