la salute del respiro: una attualità nazionale ernesto pozzi

La Salute del Respiro: una attualit nazionale

Ernesto PozziClinica Malattie Apparato RespiratorioFondazione IRCCS Policlinico San MatteoUniversit diPaviaLa Salute del Respiro, epidemiologia, costi sanitari ed implicazioni sociali delle malattie respiratorie croniche ostruttive e delle allergopatie respiratorieMilano, 26 gennaio 2007

Of the six leading causes of death in the United States, only COPD has been increasing steadily since 1970 Jemal A. et al. JAMA 2005

EPIDEMIOLOGICAL PERSPECTIVES

Mortality rates will increase by 50% over the next 15 years Lopez, ERJ 2006COPD


CHANGING GLOBAL DEMOGRAPHICSPeople > 60yrMortality rates will increase by 50% over the next 15 years Lopez, ERJ 2006


MORTALITY IN FEMALES

Mortality rates will increase by 50% over the next 15 years Lopez, ERJ 2006

COPD Mortality by GenderU.S. 1980-2000Number Deaths x 1000Source: US Centers for Disease Control and Prevention, 2002

Machado et alAJRCCM 2006Differences in survival, men vs women, after initiating long-term oxygen terapy


CONTINUED USE OF TOBACCOLow rates of smoking cessation (~30%) Young smokers (particularly females) Smoking in non-developed countriesMortality rates will increase by 50% over the next 15 years Lopez, ERJ 2006

NET CHANGE IN ACTIVE SMOKING % PER 10 YRS ECRHS I 1990-94; ECRHS II 1998-2002(9053 subjects, age range 20-44 years at ECRHS I)

Janson, Cerveri and ECRHS group ERJ 2006

NET CHANGE IN PASSIVE SMOKING % PER 10 YRS ECRHS I 1990-94; ECRHS II 1998-2002(9053 subjects, age range 20-44 years at ECRHS I)

Janson, Cerveri and ECRHS group ERJ 2006

Global Epidemiology of Smoking


OTHER RISK FACTORSOccupationPollutionIndooroutdoorMortality rates will increase by 50% over the next 15 years Lopez, ERJ 2006

AIR POLLUTION AND LUNG FUNCTION IN THE ECRHSRationale: Long term effects of air pollution on lung function have not been studied across European adult populations before, and in particular evidence for effects on change in lung function among adults is weak.Gotschi, Sunyier and ECRHS group Lancet, submitted

Geographical distribution of ECRHS centres

PM2.5 levels across ECRHS centres

PM2.5 levels across ECRHS centres

AIR POLLUTION AND LUNG FUNCTION IN THE ECRHS

Measurements and Main Results:No significant associations were found between PM2.5 and any of the lung function measures neither for lung function level nor for change in lung function.Conclusions: The heterogeneity of the studied populations in combination with limitations of the cross-community comparison approach are plausible explanations of the observed null-findings.Future studies on long term effects of air pollution on lung function should be based on within-community comparisons. Gotschi, Sunyier and ECRHS group Lancet, submitted

COPD PREVALENCEPrevalenza di COPD in aumento costante >10% tra la popolazione > 40 anni Chapman et al. ERJ 2006

Prevalenza di COPD 3.6% tra la popolazione di eta 20-45 years de Marco et al. Thorax 2004

INCIDENCE OF COPD ACCORDING TO THE HISTORY OF CHRONIC COUGH AND PHLEGM

De Marco, Cerveri et al AJRCCM 2006


GLOBAL BURDENHospitalizations Number and duration ComorbidityMortality rates will increase by 50% over the next 15 years Lopez, ERJ 2006

Aumento del numero dei ricoveri per BPCOdal 1999 al 2003 in Italia

DRG 88 = malattia polmonare cronica ostruttivaDRG 87 = edema polmonare e insufficienza respiratoriaDRG 475 = diagnosi relative all'apparato respiratorio con respirazione assistita

EXACERBATIONS AS A STARTING POINT OF PROACTIVE COPD MANAGEMENT

Zoia et al, Resp Med 2005

Without diagnosisWith diagnosisPatients with and without previous diagnosisEXACERBATIONS AS A STARTING POINT OF PROACTIVE COPD MANAGEMENT

Grafico3

280

720

Foglio1

Stage 1Stage 2Stage 3Stage 4

%17272132

Stage 1Stage 2Stage 3Stage 4Total

FVC11188636377

1414132123

FEV18767423854

695222

FEV1/FVC6160534654

6981213

PaO27469675765

794910

PaCO23736394540

55666

asse210036394540

Without diagnosisWith diagnosis

2872

Without diagnosis

with chronic symptoms

without chronic symptomsnever reportedreported to GP

84646

Whit



01486

Foglio1

0

0

0

0

Foglio2

01406060705

01409090905

01305080406

021020120906

02302201301006

FVC

FEV1

FEV1/FVC

PaO2

PaCO2

%

Foglio3

0606070

0909090

0508040

02012090

0220130100

FEV1

FEV1/FVC

PaO2

%

mmHg

00

00

0

0

0

00

0

0

0 14

Percentage of patients with and without spirometryEXACERBATIONS AS A STARTING POINT OF PROACTIVE COPD MANAGEMENT

Grafico1

440

560

grafici1


%17272132

Stage 1Stage 2Stage 3Stage 4Total

FVC11188636377

1414132123

FEV18767423854

695222

FEV1/FVC6160534654

6981213

PaO27469675765

794910

PaCO23736394540

55666

asse210036394540

Without diagnosisWith diagnosis

2872

Without diagnosis



84646

Whit diagnosis



01486

grafici1

0

0

0

0

Grafici2

01406060705

01409090905

01305080406

021020120906

02302201301006

FVC

FEV1

FEV1/FVC

PaO2

PaCO2

%

terapia

0606070

0909090

0508040

02012090

0220130100

FEV1

FEV1/FVC

PaO2

%

mmHg

00

00

0

0

0

00

0

0

0 14

WithWithout

FEV15555

2418

FVC7778

2517

FEV1/FVC5454

1214

PaO26371

109

PaCO24139

75

asse20100

Spirometry

NoYesNo

445644

Undiagnosed

NoYes

928

Diagnosed

NoYes

3674

0000241210

000018149

FEV1

FEV1/FVC

PaO2

%

00

00

00

00

00

00


Long-acting220

Combination2621

Other211

No therapy765

13152755


Long-acting15130

Combination154078

Other1574

No therapy544019

100100100

Stage 1Stage 2 & 3Stage 3 with exacerbationsStage 4

Long-acting400

Combination with ICS4421

Other301

No therapy1215

2352755


Long-acting1700

Combination178078

Other1304

No therapy522019

100100100

17verde80rosso78rosso

Stage 1Stage 2&3Stage 3 with exacerbations & Stage 4Stage 4 with respiratory failure

O2019

Long-acting400

Combination41510

Other310

No therapy1260

23221055


O20590

Long-acting1700

Combination1768100

Other1350

No therapy52270

100100100

0000

0000

0000

0000

Long-acting

Combination

Other

No therapy

0000

0000

0000

0000

Long-acting

Combination with ICS

Other

No therapy

00000

00000

00000

00000

O2

Long-acting

Combination

Other

No therapy

EXACERBATIONS AS A STARTING POINT OF PROACTIVE COPD MANAGEMENT

Grafico2

2872

5347

4654

n 33

n 85

n 118

Co-morbidity

Total sample

46%

53%

28%

Fem+tot

19891990199119921993199419951996199719981999

Femmine5,3761,9125,5711,6495,2821,4255,2041,4995,6361,2416,278

Totale17,43018,45918,38517,65917,22818,01016,77616,20217,79418,05918,479

CoMorbid

Without previous diagnosisWith previous diagnosisWhole group

Co-morbid94554

Totale3385118

Without previous diagnosisWith previous diagnosisWhole group

Co-morbidity285346

Total sample724754

CoMorbid

Co-morbidity

Total sample

Foglio2

Foglio3

MBD0007AD07.xls

Grafico4

19891989198919891989198919891989198919891989198919895376174301989

19911991199119911991199119911991199119911991199119915571183851991

19931993199319931993199319931993199319931993199319935282172281993

19951995199519951995199519951995199519951995199519955204167761995

19971997199719971997199719971997199719971997199719975636177941997

19991999199919991999199919991999199919991999199919996278184791999

492 ENFISEMA

493 ASMA

494 BRONCHIECTASIA

496 OSTRUZIONI CRONICHE DELLE VIE RESPIRATORIE NON CLASSIFICATE ALTROVE

Totale complessivo maschi

491 BRONCHITE CRONICA

492 ENFISEMA

493 ASMA

494 BRONCHIECTASIA


Totale complessivo femmine


492 ENFISEMA

Femmine

Totale


Grafico1

19891989198919891989198919891989198919891989198919895376174301989

19911991199119911991199119911991199119911991199119915571183851991

19931993199319931993199319931993199319931993199319935282172281993

19951995199519951995199519951995199519951995199519955204167761995

19971997199719971997199719971997199719971997199719975636177941997

19991999199919991999199919991999199919991999199919996278184791999

492 ENFISEMA

493 ASMA

494 BRONCHIECTASIA




492 ENFISEMA

493 ASMA

494 BRONCHIECTASIA




492 ENFISEMA

Femmine

Totale


trend numeri BPCO-asma

19891990199119921993199419951996199719981999

491 BRONCHITE CRONICA977310571105091007510417109078928855110580102859230

492 ENFISEMA10721049106610278968771015880899887943

493 ASMA117111081084881901749894803707608584

494 BRONCHIECTASIA4344313335433939544133

496 OSTRUZIONI CRONICHE DELLE VIE RESPIRATORIE NON CLASSIFICATE ALTROVE1166107712081028598501159015946258091995

Totale complessivo maschi1322513849138981304412847130771246611867128651263012785


492 ENFISEMA413413342352308345336298352316325

493 ASMA881804729768675676747696581633616

494 BRONCHIECTASIA3543323230475442385350


Totale complessivo femmine62576522630062645957635859515834621766706894

491 BRONCHITE CRONICA14,12915,29815,13314,69115,06215,93313,06312,67115,53515,47214,078

492 ENFISEMA1,4851,4621,4081,3791,2041,2221,3511,1781,2511,2031,268

493 ASMA2,0521,9121,8131,6491,5761,4251,6411,4991,2881,2411,200

BPCO17,43018,45918,38517,65917,22818,01016,77616,20217,79418,05918,479

494 BRONCHIECTASIA7887636565909381929483

496 OSTRUZIONI CRONICHE DELLE VIE RESPIRATORIE NON CLASSIFICATE ALTROVE1,7381,6121,7811,5248977652,2692,2729161,2903,050

Totale complessivo19,48220,37120,19819,30818,80419,43518,41717,70119,08219,30019,679

solo ASMA controllo2,0521,9121,8131,6491,5761,4251,6411,4991,2881,2411,200

trend numeri BPCO-asma

000000

000000

000000

000000

000000

000000

000000

000000

000000

000000

000000


492 ENFISEMA

493 ASMA

494 BRONCHIECTASIA



Trend 1989-99 morti maschi per patologie correlate alla BPCO

Trend BPCO ASMA Nuovo

000000

000000

000000

000000

000000

000000

000000

000000

000000

000000

000000


492 ENFISEMA

493 ASMA

494 BRONCHIECTASIA



Trend 1989-99 morti femmine per patologie correlate alla BPCO

BPCO tot per fasce di et

000000

000000

000000

000000

000000

000000

000000

000000

000000

000000

000000


492 ENFISEMA

493 ASMA

494 BRONCHIECTASIA


Totale complessivo

Trend 1989-99 morti ITALIA per patologie correlate alla BPCO

BPCO maschi per fasce di et

19891990199119921993199419951996199719981999


492 ENFISEMA10721049106610278968771015880899887943

493 ASMA117111081084881901749894803707608584

494 BRONCHIECTASIA4344313335433939544133


Totale complessivo maschi1322513849138981304412847130771246611867128651263012785


492 ENFISEMA413413342352308345336298352316325

493 ASMA881804729768675676747696581633616

494 BRONCHIECTASIA3543323230475442385350


Totale complessivo femmine62576522630062645957635859515834621766706894

491 BRONCHITE CRONICA14,12915,29815,13314,69115,06215,93313,06312,67115,53515,47214,078

492 ENFISEMA1,4851,4621,4081,3791,2041,2221,3511,1781,2511,2031,268

Femmine53761,91255711,64952821,42552041,49956361,2416278

BPCO17,43018,45918,38517,65917,22818,01016,77616,20217,79418,05918,479

494 BRONCHIECTASIA7887636565909381929483

496 OSTRUZIONI CRONICHE DELLE VIE RESPIRATORIE NON CLASSIFICATE ALTROVE1,7381,6121,7811,5248977652,2692,2729161,2903,050

Totale complessivo19,48220,37120,19819,30818,80419,43518,41717,70119,08219,30019,679

solo ASMA controllo2,0521,9121,8131,6491,5761,4251,6411,4991,2881,2411,200

BPCO maschi per fasce di et

492 ENFISEMA

493 ASMA

494 BRONCHIECTASIA




492 ENFISEMA

493 ASMA

494 BRONCHIECTASIA




492 ENFISEMA

Femmine

BPCO


BPCO femmine per fasce di et

492 ENFISEMA

493 ASMA

494 BRONCHIECTASIA




492 ENFISEMA

493 ASMA

494 BRONCHIECTASIA




492 ENFISEMA

Femmine

BPCO


andamento casi BPCO

ANNO0-45-910-1415-1920-2425-2930-3435-3940-4445-4950-5455-5960-6465-6970-7475-7980-8485-89>90

1989 totale morti BPCO137712141518265363189423951179023304400449631121563











0-45-910-1415-1920-2425-2930-3435-3940-4445-4950-5455-5960-6465-6970-7475-7980-8485-89>90

1989 tasso grezzo morti BPCO0.460.220.180.270.290.330.450.681.391.745.3012.2229.0264.08129.18242.03425.15658.38930.29











andamento casi BPCO

00000000000

00000000000

00000000000

00000000000

00000000000

00000000000

00000000000

00000000000

1989 tasso grezzo morti BPCO











Trend annuale 1989-99 dei tassi grezzi di mortalit BPCO in Italia

andam. BPCO e IR

ANNO0-45-910-1415-1920-2425-2930-3435-3940-4445-4950-5455-5960-6465-6970-7475-7980-8485-89>90

1989 totale morti BPCO maschi9443671216304115133075313591768321329831814722











0-45-910-1415-1920-2425-2930-3435-3940-4445-4950-5455-5960-6465-6970-7475-7980-8485-89>90

1989 tasso grezzo morti BPCO maschi0.610.250.200.130.240.310.600.841.582.298.6919.9049.26110.52233.96449.51805.031274.001701.59











andam. BPCO e IR

00000000000

00000000000

00000000000

00000000000

00000000000

00000000000

00000000000

00000000000

1989 tasso grezzo morti BPCO maschi











Trend annuale 1989-99 tassi grezzi mortalit BPCO Italia maschi

asma

ANNO0-45-910-1415-1920-2425-2930-3435-3940-4445-4950-5455-5960-6465-6970-7475-7980-8485-89>90

1989 totale morti BPCO femmine43398861023223893198431562118715131298841











0-45-910-1415-1920-2425-2930-3435-3940-4445-4950-5455-5960-6465-6970-7475-7980-8485-89>90

1989 tasso grezzo morti BPCO femmine0.290.200.160.410.330.360.300.521.201.192.085.1611.3327.5653.63107.60220.25392.99669.69











asma

00000000000

00000000000

00000000000

00000000000

00000000000

00000000000

00000000000

00000000000

1989 tasso grezzo morti BPCO femmine











Trend annuale 1989-99 tassi grezzi mortalit BPCO Italia femmine

MDC 4 - MALATTIE E DISTURBI DELL'APPARATO RESPIRATORIO1995199619971998$1,9992000

088MMALATTIA POLMONARE CRONICA OSTRUTTIVA95,883120,140121,395132,096$132,510126,927

TOTALE MDC 4455,915553,966568,118619,608$635,008614,897

TOTALE GENERALE7,380,9269,024,8929,120,8569,838,940$9,626,1549,299,266

percentuale MDC4 sul totale SDO6.2%6.1%6.2%6.3%6.6%6.6%

88percentuale sulla MDC421.0%21.7%21.4%21.3%20.9%20.6%

88percentuale sul totale generale1.3%1.3%1.3%1.3%1.4%1.4%

1995199619971998$1,9992000

percentuale DRG 88 sul totale dimissioni per acuti MDC421.03%21.69%21.37%21.32%20.87%20.64%

percentuale DRG 88 sul totale dimissioni per acuti1.30%1.33%1.33%1.34%1.38%1.36%

percentuale MDC4 sul totale SDO6.18%6.14%6.23%6.30%6.60%6.61%

0.21030893920.0129906464

0.21687251560.0133120707

0.21367920040.013309606

0.21319285740.0134258365

0.20867453640.0137656223

0.2064199370.0136491418

percentuale DRG 88 sul totale dimissioni per acuti MDC4

percentuale DRG 88 sul totale dimissioni per acuti

Percentuale DRG 88 sul totale MDC4

Percentuale DRG 88 sul totale SDO

Andamento 1995-2000 dimissioni per acuti con DRG 88

0.0617693498

0.0613820088

0.062287794

0.0629750766

0.065966948

0.0661231757

percentuale MDC4 sul totale SDO

Andamento 1995-2000 dimissioni per acuti MDC4 sul totale SDO

1995199619971998$1,9992000

08787 EDEMA POLMONARE E INSUFFICIENZA RESPIRATORIA11,08412,94412,10312,861$14,11826,495

08888 MALATTIA POLMONARE CRONICA OSTRUTTIVA95,883120,140121,395132,096$132,510126,927

101101 ALTRE DIAGNOSI RELATIVE ALL'APPARATO RESPIRATORIO, CON CC8,79912,38114,50019,262$19,43513,609

102102ALTRE DIAGNOSI RELATIVE ALL'APPARATO RESPIRATORIO, SENZA CC16,66618,71518,42219,903$19,62514,766

475475 DIAGNOSI RELATIVE ALL'APPARATO RESPIRATORIO CON RESPIRAZIONE ASSISTITA3,9437,87510,43313,115$14,53315,628

08787 EDEMA POLMONARE E INSUFFICIENZA RESPIRATORIA2.4%2.3%2.1%2.1%2.2%4.3%

08888 MALATTIA POLMONARE CRONICA OSTRUTTIVA21.0%21.7%21.4%21.3%20.9%20.6%

101101 ALTRE DIAGNOSI RELATIVE ALL'APPARATO RESPIRATORIO, CON CC1.9%2.2%2.6%3.1%3.1%2.2%

102102 ALTRE DIAGNOSI RELATIVE ALL'APPARATO RESPIRATORIO, SENZA CC3.7%3.4%3.2%3.2%3.1%2.4%

475DIAGNOSI RELATIVE ALL'APPARATO RESPIRATORIO CON RESPIRAZIONE ASSISTITA0.9%1.4%1.8%2.1%2.3%2.5%

TOTALE MDC 4455,915553,966568,118619,608$635,008614,897

11084958838799166663943

1294412014012381187157875

12103121395145001842210433

12861132096192621990313115

14118132510194351962514533

26495126927136091476615628

87 EDEMA POLMONARE E INSUFFICIENZA RESPIRATORIA

88 MALATTIA POLMONARE CRONICA OSTRUTTIVA

101 ALTRE DIAGNOSI RELATIVE ALL'APPARATO RESPIRATORIO, CON CC

102ALTRE DIAGNOSI RELATIVE ALL'APPARATO RESPIRATORIO, SENZA CC

475 DIAGNOSI RELATIVE ALL'APPARATO RESPIRATORIO CON RESPIRAZIONE ASSISTITA

Trend 1995-2000 DRG relativi a BPCO insufficienza respiratoria

0.02431154930.21030893920.01929965020.03655505960.0086485419

0.0233660550.21687251560.02234974710.03378366180.0142156739

0.02130367280.21367920040.02552286670.03242636210.0183641427

0.0207566720.21319285740.03108739720.03212192220.0211666086

0.02223279080.20867453640.03060591360.03090512250.0228863258

0.04308851730.2064199370.0221321620.02401377790.0254156387

87 EDEMA POLMONARE E INSUFFICIENZA RESPIRATORIA

88 MALATTIA POLMONARE CRONICA OSTRUTTIVA

101 ALTRE DIAGNOSI RELATIVE ALL'APPARATO RESPIRATORIO, CON CC

102 ALTRE DIAGNOSI RELATIVE ALL'APPARATO RESPIRATORIO, SENZA CC

DIAGNOSI RELATIVE ALL'APPARATO RESPIRATORIO CON RESPIRAZIONE ASSISTITA

Trend 1995-2000 percentuali sul totale DRG relativi a BPCO insufficienza respiratoria

MDC4MALATTIE E DISTURBI DELL'APPARATO RESPIRATORIO1995199619971998$1,999

DRG 96BRONCHITE E ASMA, ETA' > 17 CON CC10,12713,07115,60517,102$18,004

DRG 97BRONCHITE E ASMA, ETA' > 17 SENZA CC30,51235,12837,20137,390$37,440

DRG 98BRONCHITE E ASMA, ETA' < 1835,08639,61442,23047,798$51,791

totalebronchite e asma77,72089,80997,033104,288109,234

percentuale bronchite e asma nella MDC417.0%16.2%17.1%16.8%17.2%

totaleMDC4455,915553,966568,118619,608$635,008

percentuale della MDC4 sul totale6.18%6.14%6.23%6.30%6.60%

totaletutte le dimissioni ospedaliere ordinarie7,380,9269,024,8929,120,8569,838,940$9,626,154

19951996199719981999

096BRONCHITE E ASMA, ETA' > 17 CON CC10,12713,07115,60517,10218,004

097BRONCHITE E ASMA, ETA' > 17 SENZA CC30,51235,12837,20137,39037,440

098BRONCHITE E ASMA, ETA' < 1835,08639,61442,23047,79851,791

totale bronchite e asma77,72089,80997,033104,288109,234

percentuale bronchite e asma in MDC417.0%16.2%17.1%16.8%17.2%

percentuale MDC4 su totale6.2%6.1%6.2%6.3%6.6%

10127305123508677720

13071351283961489809

15605372014223097033

171023739047798104288

180043744051791109234

096 BRONCHITE E ASMA, ETA' > 17 CON CC

097 BRONCHITE E ASMA, ETA' > 17 SENZA CC

098 BRONCHITE E ASMA, ETA' < 18

098 totale bronchite e asma

Variazioni 1995-1999 SDO Italia asma-bronchite

0.17047037280.0617693498

0.16212005790.0613820088

0.17079726390.062287794

0.16831286880.0629750766

0.17201988010.065966948

percentuale bronchite e asma in MDC4

percentuale MDC4 su totale

Variazioni percentuali DRG asma-bronchite 1995-1999 Italia

Epidemiologia della BPCORicoveri in regime ordinario

SDO - Ministero della Salute, 2005

Diagnosi principalen. dimissionidegenza mediaMalattia polmonare cronica ostruttiva12018810.01Bronchite cronica ostruttiva, riacutizzata880839.77Insufficienza respiratoria7005413.15Bronchite cronica ostruttiva, non riacutizzata2297812.00Bronchite, non specificata se acuta o cronica42164.69Bronchite cronica semplice232810.04Bronchite cronica non specificata20399.36Bronchite cronica mucopurulenta125610.33

COPD Exacerbations : Mortality Hospital stay60 days180 days1 year2 yearsMortality (%)605040302010011%20%33%43%49%Connors AF Jr et al. Am J Respir Crit Care Med. 1996;154:959-671016 pts with severe COPD exacerbation (PaCO2 > 50 mm Hg)

Total costs ( billion) of respiratory diseases in Europe in 2000

Piano sanitario nazionale2006-2008

ASTHMA PREVALENCE IN ADULTS:GOOD NEWS? Weiland and Pearce Editorial Thorax 2004

THE EPIDEMIC HAS ENDED,OR HAS IT ? Shafazand and Colice Editorial Chest 2004

THE PREVALENCE OF ASTHMA IS NO LONGER INCREASING IN SOME COUNTRIES Anderson Editorial BMJ 2005

Trend dellasma negli adulti non in ulteriore aumento in parecchie nazioni

INCREASE IN DIAGNOSED ASTHMA BUT NOT IN SYMPTOMS IN THE EUROPEAN COMMUNITY RESPIRATORY HEALTH SURVEYChinn,Jarvis, Burney,Cerveri et al Thorax 2004

NET CHANGE IN IN PREVALENCE ( per 10 years of follow-up) OFSYMPTOMS, DIAGNOSED ASTHMA, AND CURRENT MEDICATION IN THE ECRHSChinn, Cerveri and ECRHS group Thorax 2004* p = 0.011 ** p

. Either increased use of effective treatments has led to decreased morbidity among asthmatic subjects or those with mild disease have become more likely to label themselves as asthmatic Chinn, Cerveri and ECRHS group Thorax 2004

INCREASE IN DIAGNOSED ASTHMA BUT NOT IN SYMPTOMS IN THE ECRHS

NET CHANGE IN PREVALENCE ( per 10 years of follow-up) OF DIAGNOSED ASTHMA AND NASAL RHINITIS IN THE ECRHS (11169 subjects )Chinn, Cerveri and ECRHS group Thorax 2004

PREVALENCE IN ECRHS I: 24% PREVALENCE IN ECRHS I: 26%PREVALENCE IN ECRHS I: 26%PREVALENCE IN ECRHS I: 5%

.An increase in reported nasal allergies was observed that was greater in the youngest age group. It is not possible to be certain whether it is explained by biological changes occurring at particular ages or by factors occurring earlier in life that make this younger cohort more suceptible..

Chinn, Cerveri and ECRHS group Thorax 2004

INCREASE IN DIAGNOSED ASTHMA BUT NOT IN SYMPTOMS IN THE ECRHS

3.6%3.2%1.9%2.5%ASTHMA ATTACKS AND ANTI-ASTHMATIC TREATMENT IN ITALY (1993 AND 2000)Verlato,Cerveri et al, J Allergy Clin Immunol 2003

NASAL ALLERGIESIN ITALY (1993 AND 2000)

Nasal allergiesP < 0.001

15.4%18.3%

Grafico1

15.910.9

19.30.91

Crude prevalence (95% CI)

Grafico2

15.916.91515.9

19.320.218.319.3

Nasal allergies


Foglio1

199215.916.91515.910.9

199919.320.218.319.30.91

Foglio1

010.9

00.91


Foglio2

Foglio3

Non aumento in Italia di attacchi di asma negli anni 90

Nuovi farmaci, miglior strategia globale di trattamento, di accesso alle strutture sanitarie e di controllo degli allergeni indoor determinanti di una minore espressione della malattia

Ancora attenzione particolarmente focalizzata alla rinite allergica

CONCLUSIONI

EPIDEMIOLOGIA DELLASMA

Stabilizzazione dovuta al miglioramento dei trattamenti antiasmaticiPlateau per raggiunto sviluppo della patologia in tutti i soggetti suscettibili (Saturation: massimo effetto del cambiamento dellesposizione ambientale negli individui suscettibili)

ALLERGIC RHINITIS AND ASTHMA COMORBIDITY IN A SURVEY OF YOUNG ADULTS IN ITALY About 60 % of asthmatics reported AR

Subjects with AR had eightfold risk of having asthma compared to subjects without ARBugiani and ECRHS group, Allergy 2005

Tumor necrosis factor polymorphisms and asthma in two international population-based cohorts ( ECRHS and SAPALDIA studies) Castro Giner, ECRHS and Sapaldia groupsAJRCCM, submitted

ECRHS

SAPALDIAAge 18-44Age 18-44All agesSubjects(number)365935726071Gender(% males)485050Mean age(years SD)3473384111Asthma Symptoms(%)3.72.922.89Physician diagnosed asthma (%)6.556.196.2Atopy(%)22.5218.1116.2

ASTHMA SEVERITY IN THE GENERAL POPULATION

According to GINA 2006 Classification(ECRHS II; 1999-2002) de Marco ECRHS group JACI 2006

Grafico1

102

388

69

143

154

Foglio1

mild20

moderate5

severe2

mild42

moderate34

severe6

remission102

intermittent388

mild69

moderate143

severe154

Foglio1

Foglio2

Foglio3

No burden no productivity losses no use of hospital services

Light burden up to 12 lost working days or up to 3 days per months limited no use of hospital services

Heavy burden > 12 lost working days or > 3 days per months limited or use of hospital servicesTHE BURDEN OF ASTHMA REMAINS SUBSTANTIAL IN EUROPE A DECADE AFTER THE GINA GUIDELINES (ECRHS II; 1999-2002)Accordini, Cerveri and ECRHS group Allergy 2007

THE BURDEN OF ASTHMA REMAINS SUBSTANTIAL IN EUROPE A DECADE AFTER THE GINA GUIDELINES (ECRHS II; 1999-2002) Accordini, Cerveri and ECRHS group Allergy 2007

Light burden up to 12 lost working days or up to 3 days per months limited no use of hospital services

Heavy burden > 12 lost working days or > 3 days per months limited or use of hospital servicesFEV1 % predicted

REAL-WORLD EVALUATION OF ASTHMA CONTROL AND TREATMENT(REACT): Findings from a national Web-based survey

(1812 patients with moderate to severe asthma using standard asthma medications)45% Controlled asthma55% Uncontrolled asthmaPeters et alJACI 2007

Grafico4

0.45

0.55

Foglio1

45%

55%

Foglio1

0

0

Foglio2

Foglio3

PREVALENCE OF ASTHMA TREATMENT ADHERENCEAT ECRHS I AND II

ECRHS I 1992-3ECRHS II 1998-2002

Corsico,Cerveri and ECRHS group Resp Med 2007

Grafico6

60.967.6

64.476.4

54.753.4

44.456.1

ECRHS I

ECRHS II

Geographic Macroarea

Prevalence (%)

Foglio1

Current smokingFollow up8.81.2

CountryCentreCentreECRHS IECRHS IIn

SpainBarcelonaBarcelona (E)45.838.8457

NorwayBergenBergen (N)41.837.1595

GermanyHamburgHamburg (D)38.632511

IcelandReykjavikReykjavik (IS)38.528.4241

ItalyPaviaPavia (I)3830.7138

FranceParisParis (F)34.932.8337

SwitzerlandBaselBasel (CH)33.830.4303

NetherlandsGeleenGeleen (NL)33.326.1447

EstoniaTartuTartu (EST)30.743.9433

BelgiumAntwerp SouthAntwerp South (B)24.620.5296

United KingdomIpswichIpswich (UK)24.319.6192

SwedenUppsalaUppsala (S)23.713.7271

AustraliaMelbourneMelbourne (AUS)2320.5482

United StatesPortlandPortland (USA)15.312.2196

All subjects33.928.79053

Random Sample

Current Severity (%)

Mild intermittent62.1

Mild persistent9.9

Moderate persistent14.2

Severe persistent13.8


ECRHS IECRHS IINYears of Follow up

Mediterranean60.967.61798.7 0.6

Continental64.476.42168.8 0.7

Nordic54.753.43808.6 0.6

Extra-Europe44.456.11965.6 0.8

Foglio1

00

00

00

00

00

00

00

00

00

00

00

00

00

00

ECRHS I

ECRHS II

Prevalence (%)

Foglio2

0

0

0

0

Foglio3

00

00

00

00

ECRHS I

ECRHS II


Prevalence (%)

Utilizzo farmaci R03 (antiasmatici)Bisogno terapeutico teoricoITALIACAMPANIAEMILIALOMBARDIADDD = dose media mantenimento giornalieraDati Fondazione SKF

Prevalence of asthma treatment compliance in stable conditions

la salute del respiro: una attualità nazionale ernesto pozzi

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