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

^* From the Pulmonary Environmental Epidemiology Unit (Dr. Viegi, Ms. Angino, and Ms. Baldacci), National Research Council, Institute of Clinical Physiology, Pisa, Italy; the Cardiothoracic Department (Drs. Matteelli and Carrozzi), University Hospital, Pisa, Italy; and the Worldwide Epidemiology Department (Dr. Soriano), GlaxoSmithKline Research & Development, Upper Providence, PA.

Correspondence to: Giovanni Viegi, MD, Pulmonary Environmental Epidemiology Unit, CNR Institute of Clinical Physiology Via Trieste, 41, 56126 Pisa, Italy; e-mail: viegig{at}ifc.cnr.it

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.

Key Words: asthma • COPD • epidemiology • morbidity • obstructive lung disease • Venn diagram

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