Chapter 7
Respiratory Diseases and Health Disorders Related to Indoor and Outdoor Air Pollution Francesco Di Nardo and Patrizia Laurenti
Introduction Among all the diseases of the lungs and airways, chronic respiratory diseases are the major concern to public health. Chronic respiratory diseases are a group of chronic conditions that can affect all age groups, last many years, and greatly limit the physical abilities of people suffering from them. Together, asthma and chronic obstructive pulmonary disease (COPD), the two most important respiratory diseases, are likely to affect more than 500 million people all over the world. For the control of these diseases, which have extremely high direct and indirect costs, the most cost-effective interventions are often represented by the removal of the risk factors and by people health education. Tobacco smoke is the most important risk factor, accounting for about 42 % of all cases. Indoor and outdoor air pollutants also account for an important part of the burden of respiratory diseases and are discussed extensively, together with their effects on health, given their important role in the pathogenesis of these diseases (especially in Africa and Asia), and the growing concern worldwide for the environmental pollution. The most common air pollutants are typical of the crowded urban areas and the poorly ventilated indoor environments and are different from the airborne toxic substances that are historically linked to the work-related COPD (although occupational exposure still causes about 12 % of all the cases of the disease). Also, allergic conditions, which are a risk factor for asthma, and respiratory allergens, which are among the most dangerous asthma triggers, are discussed in this chapter. Here, we lastly discuss an emerging disease, the obstructive sleep apnea syndrome (OSAS), which is estimated to affect more than 100 million people worldwide. Lung cancer and tuberculosis are other F. Di Nardo () · P. Laurenti Institute of Public Health, Section of Hygiene, Università Cattolica del Sacro Cuore, L.go F. Vito 1, 00168 Rome, Italy e-mail:
[email protected] P. Laurenti e-mail:
[email protected] © Springer International Publishing Switzerland 2015 S. Boccia et al. (eds.), A Systematic Review of Key Issues in Public Health, DOI 10.1007/978-3-319-13620-2_7
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lung disorders characterized by a significant burden of disease, but they are discussed in other chapters of this book. Box 1 Characteristics of Included Studies A search for reviews on respiratory diseases epidemiology, respiratory diseases burden, and respiratory diseases cost-effective treatments was performed by means of a snowball search on the main scientific databases (Cochrane Database, Pubmed-Medline, SCOPUS, Scholar). The publication date of the retrieved reviews ranges from 1997 to 2013. The most recent data on respiratory diseases were extracted from institutional databases (World Health Organization, WHO). The publication date of the data on respiratory diseases ranges from 2004 to 2013 and was retrieved in the form of excel spreadsheets and analyzed with SPSS 13.0 software for Windows.
Asthma and Respiratory Allergies Asthma is a chronic inflammatory disorder of the airways characterized by recurrent attacks of breathlessness, wheezing, chest tightness, and cough. Its symptoms vary in severity and frequency from person to person and may occur several times in a day or week in affected individuals. Physical activity, allergens, smoke, air pollutants, and cold air may trigger an asthma attack. Symptoms may get worse at night or in the early morning. During an asthma attack, the hyperresponsiveness of the airways leads to airflow obstruction which is usually reversible (either spontaneously or with treatment). However, despite a low fatality rate, asthma affects more than 200 million people and recurrent asthma symptoms may cause sleeplessness, daytime fatigue, reduced activity levels and school, and work absenteeism [1, 2]. Respiratory allergies are often associated with asthma. They are now estimated to affect about 400 million people all over the world, and although their symptoms are usually mild, their manifestations can be fatal [3].
Epidemiology WHO estimates that 235 million people currently suffer from asthma, and these estimates may be too conservative. Asthma is the most common chronic disease among children. According to the Centers for Disease Control and Prevention (CDC), its prevalence is higher in the 0–17-year age group (9.5 %) compared to the group of subjects aged 18 or more (7.7 %) and among females (9.2 vs. 7.0 %). Asthma prevalence decreases with income, being 11.2 % in people with incomes less than 100 % of the poverty level, 8.7 % for persons with incomes from 100 % to less than 200 % of the poverty level, and 7.3 % for persons with incomes at least 200 % of the poverty
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level [4]. Asthma is estimated to affect above 10 % of the populations of North American countries and Australia, while Russia, China, and the Pacific countries report the lowest prevalence (
