The Proportional Venn Diagram of Obstructive Lung Disease in the Italian General Population

doi:10.1378/chest.126.4.1093

Chest

Volume 126, Issue 4, October 2004, Pages 1093-1101

https://doi.org/10.1378/chest.126.4.1093 Get rights and content

Study objectives:

The Venn diagram of obstructive lung disease (OLD) has been recently quantified. We aimed to quantify the proportion of the general population with OLD, and the intersections of physician-diagnosed asthma, chronic bronchitis (CB), and emphysema in two Italian general population samples, in relationship to airflow obstruction (AO) determined through spirometry.

Design and participants:

We analyzed data from two prospective studies (4,353 patients) carried out in the rural area of Po River delta from 1988 to 1991 and in the urban area of Pisa from 1991 to 1993.

Results:

Prevalence rates of asthma, CB, and emphysema were 5.3%, 1.5%, and 1.2% in the Po delta, and 6.5%, 2.5%, and 3.6% in Pisa. A double Venn diagram, which was used to quantify the distribution of CB, emphysema, and asthma in relation to the presence/absence of AO, identified 15 categories. Isolated AO was the most frequent category (Po delta, 11.0%; Pisa, 6.7%), followed by asthma only without AO (Po delta, 3.3%; Pisa, 4.3%). The combination of the three OLD conditions was the only category that always showed higher prevalence rates for those with AO (Po delta, 0.20%; Pisa, 0.16%) than for those without AO (Po delta, 0.04%; Pisa, 0.05%). Of those with either OLD or AO, there were 61.4% in Po delta and 38.2% in Pisa with isolated AO, 24.8% and 41.9%, respectively, with an OLD without AO, and 13.8% and 19.9%, respectively, with simultaneous OLD and AO. For both genders, the frequency of isolated asthma decreased with age, while that of isolated AO, CB-emphysema, and the combination of asthma and CB-emphysema increased.

Conclusion:

About 18% of the Italian general population samples either reported the presence of OLD or showed spirometric signs of AO. We confirmed that the Venn diagram of OLD can be quantified in the general population by extending the mutually exclusive disease categories (including a concomitant diagnosis of asthma, CB, or emphysema) to 15.

Section snippets

Materials and Methods

Data were collected during the second cross-sectional survey of the two prospective studies carried out in the rural area of the Po delta from 1988 to 1991 (2,841 subjects; age range, 8 to 75 years) and in the urban area of Pisa from 1991 to 1993 (2,841 subjects; age range, 8 to 97 years). Both surveys were performed using the same standard protocol already described in previous articles.¹¹¹³¹⁶²¹²²²³²⁴ A brief description is reported below.

For each subject, information on respiratory symptoms,

Results

The characteristics of study populations are reported in Table 1. The Po delta sample was larger than the Pisa sample, with men and women being equally distributed in both samples (women in the Po delta, 50.8%; women in Pisa, 49.6%). The mean age for subjects from the Po delta was 36.3 years, and about 6 years older in Pisa (ie, 42.1 years; p < 0.001). Smoking habit was significantly different between the two populations (p = 0.003). There was a higher prevalence of current smokers and a lower

Discussion

In Italy, about 18% of people from two large general population samples have signs of AO or report at least one of the three OLD conditions. Furthermore, asthma, CB, and emphysema largely coexist, especially in the elderly. This indicates that general practitioners tend to group the diagnoses of asthma and COPD together. In addition, our proportional Venn diagrams describe the prevalence rates of OLD and AO in the general population through 15 mutually exclusive groups. This different

ACKNOWLEDGMENT

The authors thank P. Bondesan and S. Gargiulo for help in data collection in the Po delta survey, G. Lazzeri, B. Belli, C. Medda, A. Giuliani, F. Martini, and T. Carracino, and Drs. M. Vellutini, P. Modena, M. Desideri, F. Maggiorelli, E. Diviggiano, and M. Pedreschi for help in data collection in the Pisa survey, and P. Silvi for editorial and secretarial assistance. We also wish to acknowledge F. Di Pede and Drs. F. Pistelli and M. Simoni, PhD, for their statistical assistance and suggestions

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: This work was supported in part by the National Research Council, Targeted Project “Prevention and Control Disease Factors-SP2-contract N 91.00171.PF41,” the Italian Electric Power Authority (ENEL)-National Research Council Project “Interactions of energy system with human health and environment” (Rome, Italy), and by an educational grant from GlaxoSmithKline, Greenford, Middlesex, UK.

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Chest

Clinical InvestigationsCOPDThe Proportional Venn Diagram of Obstructive Lung Disease in the Italian General Population

Study objectives:

Design and participants:

Results:

Conclusion:

Section snippets

Materials and Methods

Results

Discussion

ACKNOWLEDGMENT

Lancet

Chest

Chest

Chest

Chest

Chest

Respir Med

Chest

Optimal assessment and management of chronic obstructive pulmonary disease (COPD): the European Respiratory Society Task Force

Eur Respir J

Epidemiology of chronic obstructive pulmonary disease

Eur Respir J

Epidemiology of chronic obstructive pulmonary disease (COPD)

Respiration

Epidemiology of asthma

Differences in airway inflammation in patients with fixed airflow obstruction due to asthma or chronic obstructive pulmonary disease

Am J Respir Crit Care Med

Standards for the diagnosis and care of patients with chronic obstructive pulmonary disease: American Thoracic Society

Am J Respir Crit Care Med

Manual of the international statistical classification of diseases, injuries and causes of death (vol I). 9th revision

International statistical classification of diseases and related health problems. 10th revision

Mortality in and prevalence of chronic obstructive pulmonary disease in different parts of Europe

Monaldi Arch Chest Dis

Prevalence rates of respiratory symptoms and diseases in general population samples of North and Central Italy

Int J Tuberc Lung Dis

Terminology, definitions and classification of chronic pulmonary emphysema and related conditions

Thorax

Prevalence rates of respiratory symptoms in Italian general population samples, exposed to different levels of air pollution

Environ Health Perspect

Obstructive lung disease in northern Sweden: respiratory symptoms assessed in a postal survey

Eur Respir J

The prevalence of COPD: using smoking rates to estimate disease frequency in the general population

Chest

Prevalence of airway obstruction in a general population sample: European Respiratory Society vs American Thoracic Society definition

Chest

Clinical Investigations
COPD
The Proportional Venn Diagram of Obstructive Lung Disease in the Italian General Population