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Original Research: PHYSIOLOGIC TESTING |

Urban Residence Is Associated With Bronchial Hyperresponsiveness in Italian General Population Samples

Sara Maio, BSc; Sandra Baldacci, BSc; Laura Carrozzi, MD; Eva Polverino, MD; Anna Angino; Francesco Pistelli, MD; Francesco Di Pede; Marzia Simoni, BSc; Duane Sherrill, BSc; Giovanni Viegi, MD
Author and Funding Information

*From the Pulmonary Environmental Epidemiology Unit (Ms. Maio, Ms. Baldacci, Ms. Angino, Ms. Simoni, and Mr. Di Pede, and Dr. Polverino), Institute of Clinical Physiology, National Research Council, Pisa, Italy; Cardiopulmonary Department (Drs. Carrozzi and Pistelli), University and Hospital, Pisa, Italy; College of Public Health (Mr. Sherrill), University of Tucson, Tucson, AZ; and Institute of Biomedicine and Molecular Immunology (Dr. Viegi), National Research Council, Palermo, Italy.

Correspondence to: Giovanni Viegi, MD, CNR Institute of Clinical Physiology, Via Trieste 41, 56126 Pisa, Italy; e-mail: viegig@ifc.cnr.it


The authors have no financial or other potential conflicts of interest to disclose.

This work was supported, in part, by the National Research Council, Targeted Project, Prevention and Control Disease Factors-SP2, contract No. 91.00171.PF41; the Italian Electric Power Authority-CNR Project, Interactions of Energy System With Human Health and Environment; and by the Italian Medicines Agency (AIFA) within the Independent Drug Research Program, contract No. FARM5JYS5A.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/misc/reprints.shtml).


Chest. 2009;135(2):434-441. doi:10.1378/chest.08-0252
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Background:  The role of different risk factors for bronchial hyperresponsiveness (BHR), such as gender, atopy, IgE, and environmental factors (smoking, occupational exposure, infections), has been described. Indoor and outdoor pollution play an important role too, but few studies have analyzed the association with BHR. The aim of this study was to assess the effect of urban residence on BHR.

Methods:  We studied two general population samples enrolled in two cross-sectional epidemiological studies performed in Northern Italy (Po Delta, rural area) and Central Italy (Pisa, urban area). We analyzed 2,760 subjects (age range, 8 to 74 years). We performed analysis of variance and logistic regression analysis using ln slope of the dose-response curve of the methacholine challenge test as dependent variable, and sex, age, smoking habits, respiratory symptoms, skin-prick test results, IgE value, residence, and airway caliber as independent variables.

Results:  The mean value of ln slope of the dose-response curve adjusted for initial airways caliber (by baseline FEV1 percentage of predicted value) was significantly higher in female subjects, in smokers, in subjects with respiratory symptoms, in younger and older ages, in subjects with high values of IgE, and in subjects with positive skin-prick test results. After controlling for the independent effects of all these variables, living in urban area was an independent risk factor for having BHR (odds ratio, 1.41; 95% confidence interval, 1.13 to 1.76).

Conclusion:  Living in urban area is a risk factor for increased bronchial responsiveness.

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