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Diverging trends of chronic bronchitis and smoking habits between 1998 and 2010

Simone Accordini1*, Angelo Guido Corsico2, Isa Cerveri2, Leonardo Antonicelli3, Francesco Attena4, Roberto Bono5, Lucio Casali6, Marcello Ferrari7, Alessandro Fois8, Pierpaolo Marchetti1, Pietro Pirina8, Roberta Tassinari5, Giuseppe Verlato1 and Roberto de Marco1

Author Affiliations

1 Unit of Epidemiology and Medical Statistics, Department of Public Health and Community Medicine, University of Verona, c/o Istituti Biologici II, Strada Le Grazie 8, 37134, Verona, Italy

2 Division of Respiratory Diseases, IRCCS “San Matteo” Hospital Foundation, University of Pavia, Pavia, Italy

3 Allergy Unit, Department of Internal Medicine, Immuno-Allergic and Respiratory Diseases, Ospedali Riuniti di Ancona, Ancona, Italy

4 Department of Experimental Medicine, Seconda Università di Napoli, Napoli, Italy

5 Department of Public Health and Microbiology, University of Turin, Turin, Italy

6 Chair of Respiratory Diseases, University of Perugia, Perugia, Italy

7 Section of Internal Medicine, University of Verona, Verona, Italy

8 Institute of Respiratory Diseases, University of Sassari, Sassari, Italy

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Respiratory Research 2013, 14:16  doi:10.1186/1465-9921-14-16

Published: 8 February 2013



No study has been carried out on the time trend in the prevalence of chronic bronchitis (CB) in recent years, despite its clinical and epidemiological relevance. We evaluated the trend in CB prevalence during the past decade among young Italian adults.


A screening questionnaire was mailed to general population samples of 20–44 year-old subjects in two cross-sectional surveys: the Italian Study on Asthma in Young Adults (ISAYA) (1998/2000; n = 18,873, 9 centres) and the screening stage of the Gene Environment Interactions in Respiratory Diseases (GEIRD) study (2007/2010; n = 10,494, 7 centres). CB was defined as having cough and phlegm on most days for a minimum of 3 months a year and for at least 2 successive years. The prevalence rates and the risk ratios (RRs) for the association between CB and each potential predictor were adjusted for gender, age, season of response, type of contact, cumulative response rate, and centre.


CB prevalence was 12.5% (95% CI: 12.1-12.9%) in 1998/2000 and 12.6% (95% CI: 11.7-13.7%) in 2007/2010; it increased among never smokers (from 7.6 to 9.1%, p = 0.003), current light smokers (<15 pack-years; from 15.1 to 18.6%, p < 0.001), and unemployed/retired subjects (from 14.3 to 19.1%, p = 0.001). In this decade, the prevalence of current smoking decreased (from 33.6 to 26.9%, p < 0.001), whereas the prevalence of unemployment/premature retirement (from 5.3 to 6.0%, p = 0.005), asthma (from 5.0 to 6.2%, p = 0.003), and allergic rhinitis (from 19.5 to 24.5%, p < 0.001) increased. In both 1998/2000 and 2007/2010, the likelihood of having CB was significantly higher for women, current smokers, asthmatic patients, and subjects with allergic rhinitis. During this period, the strength of the association between CB and current heavy smoking (≥15 pack-years) decreased (RR: from 4.82 to 3.57, p = 0.018), whereas it increased for unemployment/premature retirement (from 1.11 to 1.53, p = 0.019); no change was observed for gender, asthma, and allergic rhinitis.


Despite the significant reduction in current smoking, CB prevalence did not vary among young Italian adults. The temporal pattern of CB prevalence can only be partly explained by the increase of unemployment/premature retirement, asthma and allergic rhinitis, and suggests that other factors could have played a role.

Allergic rhinitis; Asthma; Chronic bronchitis; Cigarette smoking; Epidemiology