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Aim: To evaluate the impact of chronic bronchitis in patients identified among subjects at risk of chronic obstructive pulmonary disease (COPD) but currently free from any known chronic respiratory disorder, visiting a general practitioner for an acute respiratory episode.Method: A multicentre, cross-sectional survey carried out in primary care.Results: Primary care practitioners (n=772) examined 14,030 patients with acute cough (male: 56.9%, age 50.6 ± 16.5 years). Of these, 3,615 were at risk of COPD (>40 years and tobacco use >10 pack-years) and constituted the study population: 79.8% reported current symptoms of chronic bronchitis. Compared to patients without chronic bronchitis, they were older, more frequently exposed to occupational pollutants or to passive smoking, had more tobacco use (p < 0.001), reported dyspnoea > Grade 2 more frequently, and had poorer quality of life as assessed by the EuroQOL-5D questionnaire. Conclusions:In this survey, previously unrecognised chronic bronchitis was diagnosed in a high proportion of at-risk patients with acute respiratory episodes. Chronic bronchitis was associated with significantly poorer health status. Acute respiratory illness could be an appropriate opportunity for screening those patients at risk of COPD with lung function testing.

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Stretching halfway between the Canadian Great Lakes and the Atlantic Ocean, the Saguenay-St. Lawrence Marine Park is subject to environmental issues being exposed to untreated or uncontrolled point and non-point sources of anthropogenic contamination. This article provides a first estimation of chemical and microbial contamination entering the marine park from the discharges of local municipal effluents and the inputs of tributaries in the summer period. Suspended particulate matter (SPM), nutrients, particulate carbon (PC) and nitrogen, trace metals, and fecal coliform bacteria were determined in surface brackish waters at upstream boundaries, in freshwater of 11 tributaries, and in nine sewage effluents from small communities settled along the marine park. Most tributaries have SPM < 10 mg L(-1) and contributed to a total of ~47 tons day(-1), thus representing a small proportion of daily SPM transported by Saguenay River (200 tons day(-1)) and St. Lawrence River (6.3 × 10(3) tons day(-1)). As expected, untreated sewage effluents showed high fecal contamination (0.2-6.0 × 10(6) CFU 100 mL(-1)), high NO x levels (4-33 μmol L(-1)) and high concentrations of particulate organic carbon (7-62 mg L(-1)). However, all tributaries had low coliforms (<230 CFU 100 mL(-1)), low PC (0.3-1.1 mg L(-1)), and low nutrients (NO(x) < 3.3 μmol L(-1)), with the exception of the Moulin-à-Baude River, a small tributary (2.3 × 10(5) m(3) day(-1)) clearly contaminated by human activities. Detailed analysis of 14 metals and metalloids in SPM did not show any clear contamination trend between sewage effluents and tributaries, except for Grandes-Bergeronnes River, where most trace metals appeared to be greater than for other rivers. Regarding global inputs, results showed that despite their relatively high pollutants load, inputs from local sewages and small tributaries remained minor contributors compared with upstream inputs, i.e., Saguenay River and St. Lawrence River. However, we illustrate that some local hydrodynamic factors in bays and inlets must be taken into account when evaluating risks associated with sewage discharges.