Background: asthma underdiagnosis was reported in many recent studies, in particular in older subjects. Aim: to assess the risk factors associated with asthma underdiagnosis in two Italian general population samples. Methods: two general population samples living in Pisa (Central Italy, urban/suburban area) and Po Delta (North Italy, rural area) participated in some cross-sectional studies between 1980 and 2011. Through a questionnaire on health status and risk factors, Pisa sample was investigated in 1985-1988, 1991-1993 and 2009-2011; Po Delta sample was investigated in 1980-1982 and 1988-1991. Individuals reporting asthma symptoms or diagnosis in the previous studies were recently enrolled in a study about severe/uncontrolled asthma (AGAVE study, 2011-2014) using the same study tool. For these analyses, subjects were classified as: remittent (if they didn’t report asthma symptoms in the AGAVE study) (REM); persistent symptomatic (if they reported asthma symptoms but not diagnosis in both previous and AGAVE studies) (SPERS); persistent asthmatic (if they reported asthma diagnosis and symptoms in both previous and AGAVE studies) (APERS). Statistical analyses were performed to assess the risk factors associated with SPERS, a condition interpreted as asthma underdiagnosis. Results: 668 subjects participated in the AGAVE study: 18.6% SPERS, 55.1% REM, 26.3% APERS. Through bivariate analyses, with respect to REM and APERS, SPERS showed a significantly higher frequency of older age, obesity, smoking habits, passive smoke exposure, sleep apnea; moreover, they had a significantly lower level of education. APERS and SPERS, with respect to REM, had a significantly higher frequency of occupational exposure. APERS, with respect to REM and SPERS, showed a significantly higher frequency of living in Pisa area (than in Po Delta area), recurrent respiratory infections, allergic rhinitis, COPD, bronchiectasis, anxiety/depression. A multinomial logistic regression analysis, taking into account REM as reference category, confirmed a strong relationship among SPERS and smoking habits (OR, 95% CI 2.66, 1.42-4.99), older age (2.14, 1.04-4.40 for age >65 yrs), recurrent respiratory infections (2.55, 1.23-5.30), passive smoke exposure (2.57, 1.43-4.62) and sleep apnea (2.60, 1.36-4.99). Moreover, APERS showed a strong relationship with living in Pisa area (vs Po Delta area), (2.22, 1.28-3.83), current respiratory infections (3.92, 2.07-7.41) and allergic rhinitis (3.86, 2.48-5.99). Conclusions: in general population there is higher risk of asthma underdiagnosis in smokers, older subjects, subjects with passive smoke exposure, respiratory infections and sleep apnoea; living in urban/suburban area, respiratory infections and allergic rhinitis are related to persistent asthma. These notions should influence prevention and management strategies.

Viegi, G., Maio, S., Baldacci, S., Sarno, G., Cerrai, S., Martini, F., et al. (2017). Underdiagnosis of asthma and associated risk factors in Italian general population samples. AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE.

Underdiagnosis of asthma and associated risk factors in Italian general population samples

Maio, S;
2017-01-01

Abstract

Background: asthma underdiagnosis was reported in many recent studies, in particular in older subjects. Aim: to assess the risk factors associated with asthma underdiagnosis in two Italian general population samples. Methods: two general population samples living in Pisa (Central Italy, urban/suburban area) and Po Delta (North Italy, rural area) participated in some cross-sectional studies between 1980 and 2011. Through a questionnaire on health status and risk factors, Pisa sample was investigated in 1985-1988, 1991-1993 and 2009-2011; Po Delta sample was investigated in 1980-1982 and 1988-1991. Individuals reporting asthma symptoms or diagnosis in the previous studies were recently enrolled in a study about severe/uncontrolled asthma (AGAVE study, 2011-2014) using the same study tool. For these analyses, subjects were classified as: remittent (if they didn’t report asthma symptoms in the AGAVE study) (REM); persistent symptomatic (if they reported asthma symptoms but not diagnosis in both previous and AGAVE studies) (SPERS); persistent asthmatic (if they reported asthma diagnosis and symptoms in both previous and AGAVE studies) (APERS). Statistical analyses were performed to assess the risk factors associated with SPERS, a condition interpreted as asthma underdiagnosis. Results: 668 subjects participated in the AGAVE study: 18.6% SPERS, 55.1% REM, 26.3% APERS. Through bivariate analyses, with respect to REM and APERS, SPERS showed a significantly higher frequency of older age, obesity, smoking habits, passive smoke exposure, sleep apnea; moreover, they had a significantly lower level of education. APERS and SPERS, with respect to REM, had a significantly higher frequency of occupational exposure. APERS, with respect to REM and SPERS, showed a significantly higher frequency of living in Pisa area (than in Po Delta area), recurrent respiratory infections, allergic rhinitis, COPD, bronchiectasis, anxiety/depression. A multinomial logistic regression analysis, taking into account REM as reference category, confirmed a strong relationship among SPERS and smoking habits (OR, 95% CI 2.66, 1.42-4.99), older age (2.14, 1.04-4.40 for age >65 yrs), recurrent respiratory infections (2.55, 1.23-5.30), passive smoke exposure (2.57, 1.43-4.62) and sleep apnea (2.60, 1.36-4.99). Moreover, APERS showed a strong relationship with living in Pisa area (vs Po Delta area), (2.22, 1.28-3.83), current respiratory infections (3.92, 2.07-7.41) and allergic rhinitis (3.86, 2.48-5.99). Conclusions: in general population there is higher risk of asthma underdiagnosis in smokers, older subjects, subjects with passive smoke exposure, respiratory infections and sleep apnoea; living in urban/suburban area, respiratory infections and allergic rhinitis are related to persistent asthma. These notions should influence prevention and management strategies.
2017
Viegi, G., Maio, S., Baldacci, S., Sarno, G., Cerrai, S., Martini, F., et al. (2017). Underdiagnosis of asthma and associated risk factors in Italian general population samples. AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE.
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/10447/301144
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