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Epidemiology of an underdiagnosed disease

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Title: Epidemiology of an underdiagnosed disease


1
The OLIN Story
by
Bo Lundbäck
2
(No Transcript)
3
far away in the periphery of Europe
4
  • The OLIN Studies
  • mainly epidemiologic studies of
  • asthma, COPD, OSAS and allergy
  • - in progress since 1985
  • 50 000 subjects from children to
  • elderly are or have been participating


5
  • The OLIN Studies
  • mainly epidemiologic studies of
  • asthma, COPD, OSAS and allergy
  • - in progress since 1985
  • 50 000 subjects from children to
  • elderly are or have been participating


The methods include cross-sectional,
longitudinal och case-referent studies but
also clinical studies and studies of heath
economics
6
  • The OLIN Studies
  • mainly epidemiologic studies of
  • asthma, COPD, OSAS and allergy
  • - in progress since 1985
  • 50 000 subjects from children to
  • elderly are or have been participating


The methods include cross-sectional,
longitudinal och case-referent studies but
also clinical studies and studies of heath
economics
From the OLIN Studies so far 10 completed
PhD-theses, in addition 7 PhD-theses partly based
on OLIN-data, and gt 10 from closely co-working
projects gtgt 100 original articles and review
papers
7
A Quarter of a Century
8
A Quarter of a Century
How did it start?
9
In school books in early 1980s
10
In school books in early 1980s Asthma
prevalence 2
11
In school books in early 1980s Asthma
prevalence 2 and so was chronic bronchitis
12
Aims at start in 1985 How common are OADs? -
asthma? - chronic bronchitis? and its
obstructive form? - airway allergies? And what
are their main determinants? -
13
Aims at start in 1985 How common are OADs? -
asthma? - chronic bronchitis? and its
obstructive form? - airway allergies? And what
are their main determinants? A prevalence study
in three stages - A cross-sectional postal
questionnaire survey - Structured interviews and
lung function tests - Validation studies
including methacholine tests
14
Aims at start in 1985 How common are OADs? -
asthma? - chronic bronchitis? and its
obstructive form? - airway allergies? And what
are their main determinants? A prevalence study
in three stages - A cross-sectional postal
questionnaire survey - Structured interviews and
lung function tests - Validation studies
including methacholine tests Asthma prevalence
not 2 but 6
15
The first years were turbulent
16
The first years were turbulent
  • The Central Hospitals chief physician
  • Such studies have not been done in Sweden
    previously
  • and should not be done here, and not by us

17
Supporters and contributors during the first
years Position during the early years Ola
Dahlin Vice chairman of the county/province
council Hugo Hagstad MD, Head of Respiratory
Medicine Dept, Boden Anders Lindman MD, Chief
physician of Primary Care, Boden Urban Janlert
MD, Community Medicine, Luleå Mai
Lindström SRN anaestesia nurse/research
assistant Karin Lundbäck SRN anaestesia
nurse/research assistant
18
Supporters and contributors during the first
years Position during the early years Ola
Dahlin Vice chairman of the province council
Hugo Hagstad MD, Head of Respiratory Medicine
Dept, Boden Anders Lindman MD, Chief physician
of Primary Care, Boden Urban Janlert MD,
Community Medicine, Luleå Mai Lindström SRN
anaestesia nurse/research assistant Karin
Lundbäck SRN anaestesia nurse/research
assistant Leif Rosenhall MD, PhD, Head of
Respir Med Dept, Umeå Univ Hosp Nils Stjernberg
MD, PhD, researcher/physician at NIOH,
Umeå Elsy Jönsson MSc, statistician at NIOH,
responsible for the data base Lennarth
Nyström MSc, statistician at University of
Umeå Richard Forrest MD, PhD, internal med,
medical English writing Anders Odén PhD,
statistician at University of Gothenburg Ann-Chri
stin Jonsson SRN primary care/research
assistant Eva Rönmark SRN anaestesia, health
educator/research assistant
19
Supporters and contributors during the first
years Position during the early years Ola
Dahlin Vice chairman of the province council
Hugo Hagstad MD, Head of Respiratory Medicine
Dept, Boden Anders Lindman MD, Chief physician
of Primary Care, Boden Urban Janlert MD,
Community Medicine, Luleå Mai Lindström SRN
anaestesia nurse/research assistant Karin
Lundbäck SRN anaestesia nurse/research
assistant Leif Rosenhall MD, PhD, Head of
Respir Med Dept, Umeå Univ Hosp Nils Stjernberg
MD, PhD, researcher/physician at NIOH,
Umeå Elsy Jönsson MSc, statistician at NIOH
Lennarth Nyström MSc, statistician at
University of Umeå Richard Forrest MD, PhD,
internal med, medical English writing Anders
Odén PhD, statistician at University of
Gothenburg Ann-Christin Jonsson SRN primary
care/research assistant Eva Rönmark SRN
anaestesia, health educator/research assistent
20
The OLIN Studies continued
21
Supporters and advicers during the first years
Position during the early years Gunnar
Boman Professor of respiratory medicine, Univ of
Uppsala Bengt-Eric Skoogh Professor of
respiratory medicine, Univ of Gothenburg Amund
Gulsvik Professor of respiratory medicine, Univ
of Bergen , Norway Per Bakke MD, Dept of
respiratory medicine, Univ of Bergen , Norway
22
The OLIN Studies continued
Nordic Scientific Advisory Board since 1989
23
The OLIN Studies 1992
  • Can an increase in asthma prevalence be
  • documented? - And if so, why?
  • New cohort recruited same age as in 1985 same
    areas
  • An increase of 1-unit over 7 years was found

24
The OLIN Studies 1992
  • Can an increase in asthma prevalence be
  • documented? - And if so, why?
  • New cohort recruited same age as in 1985 same
    areas
  • An increase of 1-unit over 7 years was found
  • Further, our first study of asthma incidence

25
The OLIN Studies 1992
  • Can an increase in asthma prevalence be
  • documented? - And if so, why?
  • New cohort recruited same age as in 1985 same
    areas
  • An increase of 1-unit over 7 years was found
  • Further, our first study of asthma incidence
  • Enlargement of the study base from 6610 to
  • approximarely 24000
  • Decision of the studies long term nature

26
Supporters during the first ten years
Position during the early years Gunnar
Boman Professor of respiratory medicine, Univ of
Uppsala Bengt-Eric Skoogh Professor of
respiratory medicine, Univ of Gothenburg Amund
Gulsvik Professor of respiratory medicine, Univ
of Bergen , Norway Per Bakke MD, dept of
respiratory medicine, Univ of Bergen , Norway
Tore Öberg Head of the economy department at
the province government Ulf Öhman Director of
the province government Per Malmberg
Professor head of Medical /Lung Dept, NIOH,
Stockholm Göran Sundlöf Associate prof head
of Department of Medicine, Central Hospital
of Norrbotten, Boden Håkan Forsberg MD, PhD,
Dept of Medicine, Central Hosp of Norrbotten,
Boden Staffan Andersson MD, PhD, Dept of Clin
Physiol , Central Hosp of Norrbotten, B-n
27
The OLIN Studies 1995-1996
28
The OLIN Studies 1995-1996
  • Start of the European Community Concerted Action
    on the Epidemiology of COPD
  • Co-work between Pisa, OLIN, Bergen and
  • Gronnigen, Barcelona, Paris and London
  • headed by Carlo Giuntini and Giovanni Viegi ,
    Pisa

29
The OLIN Studies 1995-1996
  • Start of the European Community Concerted Action
    on the Epidemiology of COPD
  • Co-work between Pisa, OLIN, Bergen and
  • Gronnigen, Barcelona, Paris and London
  • headed by Carlo Giuntini and Giovanni Viegi ,
    Pisa
  • Start of the FinEsS studies
    on the epidemiology of asthma, allergy,
    COPD, chronic bronchitis and respiratory symptoms
    in Finland, Estonia and Sweden
  • Sample size 64 000 subjects in eight centers

30
The OLIN Studies 1995-1996
  • Prospective case-referent study of indoor,
    outdoor and occupational environment on asthma
    based on incident cases of asthma and matched
    controls (OLIN V) Co-work between OLIN, NIOH and
    University of Umeå

31
The OLIN Studies 1995-1996
  • Prospective case-referent study of indoor,
    outdoor and occupational environment on asthma
    based on incident cases of asthma and matched
    controls (OLIN V) Co-work between OLIN, NIOH
    and University of Umeå
  • Result Obesity is a risk factor in both men and
    women, and for both allergic and non-allergic
    asthma (ERJ 2005)

32
The OLIN Studies 1995-1996
  • Prospective case-referent study of indoor,
    outdoor and occupational environment on asthma
    based on incident cases of asthma and matched
    controls (OLIN V) Co-work between OLIN, NIOH and
    University of Umeå
  • Result Obesity is a risk factor in both men and
    women, and for both allergic and non-allergic
    asthma (ERJ 2005)
  • Enlarged questionnaire survey and clinical
    follow-ups of the OLIN Studies 1st cohort (OLIN
    VI)
  • Aims
  • asthma incidence (2/1000/y), risk factors,
    remission (1/100/y)
  • COPD first sufficiently powered studies on
    prevalence, incidence, risk factors
  • Not 15 but 50 of smokers develop COPD

33
The OLIN Studies 1995-1996
  • Start of the first OLIN paediatric study (OLIN
    VII)
  • Combines clinical and environmental epidemiology
  • with molecular epidemiology
  • Prospective study of all children in primary
    school classas 1 and 2 in Luleå, Piteå and
    Kiruna, n3525
  • Annual follow-ups, both open and closed cohort

34
The OLIN Studies 1995-1996
  • Start of the first OLIN paediatric study (OLIN
    VII)
  • Combines clinical and environmental epidemiology
  • with molecular epidemiology
  • Prospective study of all children in primary
    school classas 1 and 2 in Luleå, Piteå and
    Kiruna, n3525
  • Annual follow-ups, both open and closed cohort
  • Collaboration with UVa, Charlottesville, USA,
    i.e.
  • Thomas Platts-Mills and his staff

35
Matthew Perzanowski, USA in sub-urban Kiruna,
now associate professor at University of
Columbia, New York City, leaving for work by
skiing when finalizing his PhD thesis in Sweden
in 2003 titled Molecular epidemiology
of allergen exposure, sensitization and asthma in
school children - Obstructive Lung Disease in
Northern Sweden - Thesis V ISBN
91-7305-376-7 University of Umeå, Sweden with
affiliation to The OLIN Studies,
Luleå, Karolinska Institutet, Stockholm, and
particularly University of Virginia,
Charlottesville, USA
36
  • The OLIN Studies of adults 2002-2004
  • Clinical follow-ups including lung function of
    all previously clinically examined adult cohorts
    Aims incidence and
    determinants of COPD
  • rapid decline in lung function
  • ETS and COPD
  • interaction of risks of COPD
  • overlap syndrome (OSAS and COPD)
  • health economic studies of asthma and COPD
    long term outcome of asthma

37
  • The OLIN Studies of adults 2002-2004
  • Clinical follow-ups including lung function of
    all previously clinically examined adult cohorts
    Aims incidence and
    determinants of COPD
  • rapid decline in lung function
  • ETS and COPD
  • interaction of risks of COPD
  • overlap syndrome (OSAS and COPD)
  • health economic studies of asthma and COPD
    l ong term outcome of asthma
  • The OLIN Studies 2005
  • Start of the prospective OLIN COPD Study

38
  • The OLIN 2006 surveys
  • Has the prevalence and incidence of asthma and
    symptoms increased over the past 10 or 20 years?
  • In adults?
  • The OLIN-FinEsS-cohort from 1996 re-investigated
  • A new cohort of 8000 was recruited
  • In children?
  • The paediatric OLIN-cohort from 1996
    re-investigated
  • A new cohort with the same age distribution (7-8
    y olds) from the same areas was recruited

39
Supporters during the first years Gunnar
Boman Professor of respiratory medicine, Univ of
Uppsala Bengt-Eric Skoogh Professor of
respiratory medicine, Univ of Gothenburg Amund
Gulsvik Professor of respiratory medicine, Univ
of Bergen , Norway Per Bakke MD, dept of
respiratory medicine, Univ of Bergen , Norway
Tore Öberg Head of the economy department at
the province government Ulf Öhman Director
of the province government Per Malmberg
Professor head of Medical Dept, NIOH,
Stockholm Göran Sundlöf Associate prof head
of Department of Medicine, Central Hospital
of Norrbotten, Boden Håkan Forsberg MD, PhD,
Dept of Medicine, Central Hosp of Norrbotten,
Boden Staffan Andersson MD, PhD, Dept of Clin
Physiol , Central Hosp of Norrbotten, B-n Kjell
Larsson Professor at Inst of Environmental
Med, Karolinska Institutet Sven-Erik
Dahlén Professor at Inst of Environmental Med,
Karolinska Institutet Jan Lötvall Professor,
chair, Krefting Research Centre, Univ of
Gothenburg
40
  • The OLIN Studies First published Swedish results
    of
  •  
  • Prevalence of adult asthma using methods
    including validation of results
  • Incidence of asthma in adults
  •  
  • - Remission of asthma in adults
  •  
  • - Incidence of asthma in children
  •  
  • Incidence of allergic sensitisation in children
  • Prevalence of COPD
  • Prevalence of COPD using different international
    guidelines
  • Incidence of COPD
  • Long term (20 y) follow-up of COPD

41
  • The OLIN Studies First published Swedish results
    of
  •  
  • Prevalence of adult asthma using methods
    including validation of results
  • Lundbäck et al, ERJ 1991 Eur J Epidemiol 1992
    Allergy 1993
  • Incidence of asthma in adults
  •   Rönmark et al, Allergy 1997 (Lundbäck et al,
    Respir Med 2001)
  • - Remission of asthma in adults
  •   Rönmark et al, Thorax 1999
  • - Incidence of asthma in children
  •   Rönmark et al, Pediatrics 2001 Perzanowski et
    al, AJRCCM 2002
  • Incidence of allergic sensitisation in children
  • Rönmark et al, JACI 2003
  • Prevalence of COPD
  • Lundbäck et al, Respir Med 2003
  • Prevalence of COPD using different international
    guidelines
  • Lindberg et al, Respiration 2005
  • Incidence of COPD
  • Lindberg et at, Chest 2005 Chest 2006
  • Long term follow-up (20 y) of COPD

42
  • Norrbotten, Sweden
  • Half of smokers develop COPD sooner or later.1
  • 1-2 smokers of 100 develop COPD every year the
    corresponding proportion among never smokers is
    1-2 of 1000.2
  • One fourth of incident cases of COPD has a rapid
    decline in lung function.3
  • Different phenotypes of COPD have different
    prognosis. 4
  • The annual societal costs in Sweden of COPD
    amounts to about 10 billion SEK. 5

1 Lundbäck B, Respir Med 2003 2 Lindberg A,
Chest 2007. 3 Lindberg A, Chest 2005
4 Lundbäck B, COPD 2009. 5 Jansson S-A,
Chest 2002
43
Topics that require research collaboration with
other centres include
44
Phenotyping of asthma and COPD
45
Phenotyping of asthma and COPD
Genetics of COPD (and asthma)
46
Phenotyping of asthma and COPD
Genetics of COPD (and asthma)
Allergic sensitisation and inflammation
47
Phenotyping of asthma and COPD
Genetics of COPD (and asthma)
Studies requiring pooled data, examples cancer
in allergy smoking COPD
cancer
Allergic sensitisation and inflammation
48
Phenotyping of OAD West Sweden Asthma
Study University of Gothenburg

49
Phenotyping of OAD West Sweden Asthma
Study University of Gothenburg Geneticis of
OAD Juha Keres network, Karolinska
Institutet

50
Phenotyping of OAD West Sweden Asthma
Study University of Gothenburg Geneticis of
OAD Juha Keres network, Karolinska
Institutet Genetics of COPD De Code, Reykjavik

51
Molecular epidemiology in pediatric asthma and
allergy Asthma and Allergy Research Centre, UVa,
Charlottesville and School of Public
Health, Columbia University, NY
52
Molecular epidemiology in pediatric asthma and
allergy Asthma and Allergy Research Centre, Uva,
Charlottesville and School of Public
Health, Columbia University, NY
Molecular epidemiology in pediatric asthma and
allergy University of Otago, Wellington, New
Zealand
53
Studies of pooled data mainly within the FinEsS
Studies and the West Sweden
Studies
1996 8000 invited per center, 20 69
years old 2006-2010 follow-up studies studies
of new cohorts in progress
54
Krefting Research Centre In progress
West Sweden Asthma Study planned West
Sweden COPD Study Jan Lötvall Bo Lundbäck Göran
Wennergren Kjell Torén

55
  • Research co-operation within
    large scale studies
  • FinEsS
  • ECRHS/Rhine
  • GA2LEN
  • Supervision at (among others)
  • - Hanoi Medical University, Vietnam
  • - Yogjakarta University, Indonesia
  • University of Helsinki, Finland
  • Estonian Inst for Health Development
  • Collaboration within research
  • organisations, mainly
  • European Respiratory Society (ERS)
  • Eur Academy of Allergy Clin Immunol (EAACI)
  • Nordic Respiratory Academy (NORA)

56
Nordic Scientific Advisory Board (status 2009)
Sweden Gunnar Boman, Uppsala (since
1989) Bengt-Erik Skoogh, Gtbg (since 1991)
Claes-Göran Löfdahl, Lund (since 1991) Christer
Janson, Uppsala (since 1991) Kjell Larsson,
Sthlm (since 1992) Sven Larsson, Gtbg (since
1996) Bengt Järvholm, Umeå (since
1996) Sven-Erik Dahlén, Sthlm Barbro Dahlén,
Sthlm Karl Franklin, Umeå Kerstin Löfdahl, Gtbg
Juha Kere, Sthlm Jan
Lötvall, Gtbg Gunilla Hedlin, Sthlm Leif
Bjermer, Lund Kjell Torén, Gtbg Ellinor Ädelroth,
Umeå
Norway Jacob Boe, Oslo (1996) Amund Gulsvik,
Bergen (1996) Per Bakke, Bergen Ernst Omenaas,
Bergen Denmark Ronald Dahl, Aarhus Birthe
Hellkvist, Aarhus Finland Anssi Sovijärvi,
Helsinki Iceland Eva Halapi, Reykjavik
57
The main contributors of the OLIN studies
network
The OLIN Study Group in Luleå, Univ. of Umeå ,
Gothenburg, Luleå Karolinska Institutet,
Stockholm, Previous co-workers, all
categories Leif Rosenhall, Nils Stjernberg Elsy
Jönsson, Lennarth Nyström Mai Lindström, Karin
Lundbäck Anne Lundkvist, Karin Östling, Eva
Lundgren, Lena Gustafsson, Kerstin
Björnström-Kemi, Aina Johnsson Berit Borggren,
Karin Öhman (and
many others) Current team of research
assistants Ann-Christine Jonsson, Sigrid
Sundberg Ola Bernhof, Britt-Marie Eklund, Helena
Backman PhD-fellows Martin Andersson, Caroline
Stridsman, Berne Eriksson, Katja Warm, Stig
Hagstad Involved post docs Sven-Arne Jansson,
Ulf Hedlund Linnea Hedman, Anders Bjerg,
Lars-Gunnar Larsson Current external
contributors, among others Staffan Andersson ,
Thomas Sandström, Juha Kere, Kjell
Larsson, Anders Blomberg Steering committee Eva
Rönmark Anne Lindberg Bo Lundbäck
Many thanks for fruitful co-work to University
of Virginia, Charlottesville, and University of
Columbia, New York, USA Thomas Platts-Mills,
Matthew Perzanowski, John Vaughan, Natalie
Custis, Judith Woodfolk, David Riposo, Elisabeth
Erwin CNR and Univ of, Pisa, Italy Carlo
Giuntini, Giovanni Viegi, Laura Carrozzi, Univ
of Bergen, Norway Amund Gulsvik, Per Bakke,
Univ of Helsinki, Finland Tallinn,
Estonia Anssi Sovijärvi, Paula Pallasaho, Jyrki
Kotaniemi, Ari Lindqvist, Annette Kainu, Maria
Juusela Lii Jannus-Pruljan, Helle-Mai Loit, Mari
Meren Univ of Hanoi, Vietnam Yogjakarta,
Indonesia Hoang Thi Lam Firdy Perema Funded
mainly by Swedish Research Council, Heart-Lung
Foundation Vårdal, Northern Sweden University
Region Swedish Asthma and Allergy
Foundation Swedish Cancer - Allergy
Foundation Norrbottens local health
authority NIH European Unions grants vid
research net works Additional support mainly
from GSK, Phadia, ALK, AstraZeneca and Boehringer
Ing
58
A Quarter of a Century
59
A Quarter of a Century
is a long time
60
The OLIN Studies will go on
61
The OLIN Studies will go on
Thank you for listening !
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