Prevalence of Chronic Respiratory Diseases, Airflow Obstruction, Sleep Apnea Risk, and Novel Tobacco Use in the Coastal Localities of the Mangalia Municipality: A Cross-Sectional Study of 979 Adults

Background: Spirometric airflow obstruction frequently remains unrecognised in community settings, representing a major diagnostic gap in chronic respiratory disease management. Population-based epidemiological data from Romanian coastal communities–characterised by a highly dynamic population including residents, seasonal workers, and tourists–remain scarce. This study aimed to estimate the prevalence of screening-detected pre-bronchodilator airflow obstruction and chronic respiratory diseases, characterise smoking behaviours including novel tobacco product use, identify individuals at elevated risk for sleep apnea, and examine patterns of preventive care and healthcare utilisation across five Black Sea coastal localities. Methods: A cross-sectional survey was conducted among 979 adults from five coastal localities in Constanța County, Romania, as part of a community-based respiratory screening campaign conducted 11–16 August 2025: Neptun (n = 147), Olimp (n = 178), Saturn (n = 187), Mangalia (n = 257), and Jupiter (n = 210). Data were collected using a structured questionnaire covering 22 domains, including medical diagnoses, spirometric measurements (FEV1/FVC%), sleep quality, snoring, anthropometric parameters, comorbidities, and healthcare utilisation. Airflow obstruction was defined as an FEV1/FVC ratio < 70%. The primary outcome of interest was the prevalence of screening-detected pre-bronchodilator airflow obstruction, including among individuals without a prior respiratory diagnosis. Sleep apnea risk was defined by the co-reporting of habitual snoring and witnessed apneic episodes, used as a two-item screening proxy. Results: Among 979 participants (51.4% female; mean age 47.3 ± 13.5 years), 9.3% had at least one CRD: asthma (4.4%), chronic bronchitis (3.0%), COPD (1.7%), and emphysema (0.3%). CRD prevalence increased with age, from 6.1% in individuals <40 years to 24.2% in those aged 71–80 years. Of 973 participants with spirometry data, 17.9% demonstrated airflow obstruction (FEV1/FVC < 70%), including 15.7% without a prior respiratory diagnosis, representing previously unrecognised airflow limitation rather than confirmed chronic disease. Screening-defined OSA-risk positivity, based on a two-item proxy of habitual snoring and witnessed apnoeic episodes, was identified in 10.9% (n = 107) and was more common among obese participants (19.5% vs. 7.9%; absolute difference 11.6 percentage points; p < 0.001). Current smoking was reported by 35.2%, and 8.9% reported the use of novel tobacco products. Influenza vaccination coverage was 20.0%, while pneumococcal vaccination uptake was 3.4%. Conclusions: One in six adults without a prior respiratory diagnosis demonstrated spirometric airflow limitation, suggesting that opportunistic spirometry in primary care could substantially improve case detection in Romanian coastal communities. OSA risk, assessed by symptom-based screening proxy, was present in 10.9% of participants, with higher BMI as the strongest independent predictor among the variables assessed. High smoking prevalence (35.2%) and critically low pneumococcal vaccination coverage (3.4%) represent additional modifiable public health targets. These findings support a unified community respiratory screening approach incorporating spirometry, sleep apnea risk stratification, and vaccination audit, particularly in primary care settings serving coastal populations with dynamic demographics.