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) Past Member of Planning Group, Global Alliance against chronic Respiratory Diseases (GARD)

Mortality

A B

CNR Epidemiological surveys

PO DELTA PISA

Materials and methods I Po Delta area, North Italy 1st cross-sectional study (PD1): - carried out in , before operation of a large oil-burning thermoelectric power plant subjects (78% of expected, age 8-64 yr) 2nd cross-sectional study (PD2): - performed in subjects (age 8-73 yr) Pisa, Central Italy 1st cross-sectional survey (PI1): - performed in subjects (77% of expected, age 5-90 yr) 2nd cross-sectional study (PI2): - carried out in , after the construction of a new highway connecting Pisa to Florence 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)

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 Materials and methods IV Spirometry

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, Chest 2000

Viegi, Chest 2004

Viegi, Eur J Epidemiol 1994

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 m from the road, moderately exposed subjects living in the buffer area m and unexposed are those living between 250 and 800 m from the road. Pisa Study

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

Indoor air pollution

Arch Environ Health 2002

Simoni, J Expo Anal Environ Epidemiol 2004

Risks to get respiratory symptoms

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

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

sub 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

Bousquet, ERJ 2010 Eur Respir J Nov;36(5):

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 Past-President, European Respiratory Society (ERS) Member of Planning Group, Global Alliance against chronic Respiratory Diseases (GARD) Chief Medical Officers Meeting Italian Presidency of European Council Rome, October 6, 2014 “Burden of chronic respiratory disease in Europe” Giovanni Viegi

COMODHES STUDY

Maio, Curr Med Res Opin 2014

Maio, Curr Med Res Opin 2014

Viegi & coll. Risk charts for COPD (National Institute of Health)

Viegi & coll. Risk charts for COPD (National Institute of Health)

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: 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

Review Articles

Part I of II Cough Phlegm Wheeze Attacks of wheeze Chronic bronchitis Emphysema Asthma MEN

MALES Viegi’s part

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 ( ), in ISAYA ( ) and GEIRD ( ) surveys in Italy according to climatic region

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) ) Asma corrente Rinite allergica de Marco, Cerveri et al; ERJ 2012

 ISAYA Study;  6 Italian centres  214 subjects with current asthma followed up for 9 years

CHANGES IN ASTHMA CONTROL ISAYA Study 147 subjects with active asthma at follow-up Controlled asthma Uncontrolled asthma Partially controlled asthma 41% 28% 31% 1999 (at baseline) 2009 (follow-up) 23% 27% Controlled asthma Uncontrolled asthma Partially controlled asthma 50%

Prevalence of reported doctor diagnosis of COPD, CB and Emphysema in ITALY * GEIRD GEIRD age Prevalence % (95% CI) ( ) ( ) ( ) ( ) 8.5 ( ) * 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