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The OLIN Story. by. Bo Lundbäck. far away in the periphery of Europe. R. U. S. S. I. A. U. S. A. A. C. I. R. F. A. Norrbotten. Stockholm. Göteborg. The OLIN Studies mainly epidemiologic studies of asthma, COPD, OSAS and allergy - in progress since 1985

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The OLIN Story

by

Bo Lundbäck


far away

in the periphery

of Europe


R

U

S

S

I

A

U

S

A

A

C

I

R

F

A

Norrbotten

Stockholm

Göteborg

  • 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


R

U

S

S

I

A

U

S

A

A

C

I

R

F

A

Norrbotten

Stockholm

Göteborg

  • 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


R

U

S

S

I

A

U

S

A

A

C

I

R

F

A

Norrbotten

Stockholm

Göteborg

  • 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

> 10 from closely co-working projects

>> 100 original articles and review papers


A Quarter of a Century


A Quarter of a Century

Howdid it start?


In schoolbooks in early 1980:s


In schoolbooks in early 1980:s

Asthmaprevalence 2%


In schoolbooks in early 1980:s

Asthmaprevalence 2%

and so waschronicbronchitis


Aims at start in 1985:

Howcommon are OADs?

- asthma?

- chronicbronchitis?

and itsobstructive form?

- airwayallergies?

And what are theirmain determinants?

-


Aims at start in 1985:

Howcommon are OADs?

- asthma?

- chronicbronchitis?

and itsobstructive form?

- airwayallergies?

And what are theirmain determinants?

A prevalencestudy in threestages

- A cross-sectional postal questionnairesurvey

- Structuredinterviews and lungfunction tests

- Validation studies includingmethacholine tests


Aims at start in 1985:

Howcommon are OADs?

- asthma?

- chronicbronchitis?

and itsobstructive form?

- airwayallergies?

And what are theirmain determinants?

A prevalencestudy in threestages

- A cross-sectional postal questionnairesurvey

- Structuredinterviews and lungfunction tests

- Validation studies includingmethacholine tests

Asthmaprevalence not 2 but 6%


The first yearswere turbulent


The first yearswere turbulent

  • The Central Hospital´schiefphysician:

  • ”Such studies have not beendone in Sweden previously

  • and should not be donehere, and not by us”


Supporters and contributorsduring the first years

Position during the earlyyears

Ola Dahlin Vice chairman of the county/provincecouncil

Hugo Hagstad MD, Head of Respiratory Medicine Dept, Boden

Anders Lindman MD, Chiefphysician of Primary Care, Boden

Urban Janlert MD, Community Medicine, Luleå

Mai Lindström SRN anaestesianurse/researchassistant

Karin Lundbäck SRN anaestesianurse/researchassistant


Supporters and contributorsduring the first years

Position during the earlyyears

Ola Dahlin Vice chairman of the provincecouncil

Hugo Hagstad MD, Head of Respiratory Medicine Dept, Boden

Anders Lindman MD, Chiefphysician of Primary Care, Boden

Urban Janlert MD, Community Medicine, Luleå

Mai Lindström SRN anaestesianurse/researchassistant

Karin Lundbäck SRN anaestesianurse/researchassistant

Leif Rosenhall MD, PhD, Head of Respir Med Dept, Umeå UnivHosp 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-Christin Jonsson SRN primarycare/researchassistant

Eva Rönmark SRN anaestesia, healtheducator/researchassistant


Supporters and contributorsduring the first years

Position during the earlyyears

Ola Dahlin Vice chairman of the provincecouncil

Hugo Hagstad MD, Head of Respiratory Medicine Dept, Boden

Anders Lindman MD, Chiefphysician of Primary Care, Boden

Urban Janlert MD, Community Medicine, Luleå

Mai Lindström SRN anaestesianurse/researchassistant

Karin Lundbäck SRN anaestesianurse/researchassistant

Leif Rosenhall MD, PhD, Head of Respir Med Dept, Umeå UnivHosp 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 primarycare/researchassistant

Eva Rönmark SRN anaestesia, healtheducator/research assistent



Supporters and advicersduring the first years

Position during the earlyyears

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


The OLIN Studies continued…

Nordic ScientificAdvisory Board since 1989


The olin studies 1992
The OLIN Studies 1992 –

Can an increase in asthmaprevalence be

documented? - And if so, why?

New cohortrecruited; same age as in 1985; same areas

An increase of 1%-unit over 7 yearswasfound


The olin studies 19921
The OLIN Studies 1992 –

Can an increase in asthmaprevalence be

documented? - And if so, why?

New cohortrecruited; same age as in 1985; same areas

An increase of 1%-unit over 7 yearswasfound

Further, our first study of asthmaincidence


The olin studies 19922
The OLIN Studies 1992 –

Can an increase in asthmaprevalence be

documented? - And if so, why?

New cohortrecruited; same age as in 1985; same areas

An increase of 1%-unit over 7 yearswasfound

Further, our first study of asthmaincidence

Enlargement of the studybase from 6610 to

approximarely 24000

Decision of the studies long term nature


Supporters during the first ten years

Position during the earlyyears

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 economydepartment at the provincegovernment

Ulf Öhman Director of the provincegovernment

Per Malmberg Professor & head of Medical /LungDept, NIOH, Stockholm

Göran SundlöfAssociate 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 ClinPhysiol , Central Hosp of Norrbotten, B-n



The olin studies 1995 1996
The OLIN Studies 1995-1996

Start of the European Community Concerted Action on the Epidemiology of COPD

Co-workbetween Pisa, OLIN, Bergen and

Gronnigen, Barcelona, Paris and London

headed by Carlo Giuntiniand Giovanni Viegi , Pisa


The olin studies 1995 19961
The OLIN Studies 1995-1996

Start of the European Community Concerted Action on the Epidemiology of COPD

Co-workbetween Pisa, OLIN, Bergen and

Gronnigen, Barcelona, Paris and London

headed by Carlo Giuntiniand Giovanni Viegi , Pisa

Start of the FinEsS studies on the epidemiology of asthma, allergy, COPD, chronicbronchitis and respiratory symptoms in Finland, Estonia and Sweden

Samplesize: 64 000 subjects in eight centers


The olin studies 1995 19962
The OLIN Studies 1995-1996

Prospectivecase-referentstudy of indoor, outdoor and occupationalenvironment on asthmabased on incident cases of asthma and matchedcontrols(OLIN V) Co-workbetween OLIN, NIOH and University of Umeå


The olin studies 1995 19963
The OLIN Studies 1995-1996

Prospectivecase-referentstudy of indoor, outdoor and occupationalenvironment on asthmabased on incident cases of asthma and matchedcontrols(OLIN V) Co-workbetween OLIN, NIOH and University of Umeå

Result: Obesity is a risk factor in both men and women, and for bothallergic and non-allergicasthma (ERJ 2005)


The olin studies 1995 19964
The OLIN Studies 1995-1996

Prospectivecase-referentstudy of indoor, outdoor and occupationalenvironment on asthmabased on incident cases of asthma and matchedcontrols(OLIN V) Co-workbetween OLIN, NIOH and University of Umeå

Result: Obesity is a risk factor in both men and women, and for bothallergic and non-allergicasthma (ERJ 2005)

Enlargedquestionnairesurvey and clinicalfollow-ups of the OLIN Studies 1st cohort(OLIN VI)

Aims:

asthma:incidence (2/1000/y), risk factors, remission (1/100/y)

COPD: first sufficientlypowered studies on prevalence, incidence, risk factors

”Not 15% but 50% of smokersdevelop COPD”


The olin studies 1995 19965
The OLIN Studies 1995-1996

Start of the first OLIN paediatricstudy (OLIN VII)

Combinesclinical and environmentalepidemiology

with molecularepidemiology

Prospectivestudy of all children in primaryschoolclassas 1 and 2 in Luleå, Piteå and Kiruna, n=3525

Annualfollow-ups, bothopen and closedcohort


The olin studies 1995 19966
The OLIN Studies 1995-1996

Start of the first OLIN paediatricstudy (OLIN VII)

Combinesclinical and environmentalepidemiology

with molecularepidemiology

Prospectivestudy of all children in primaryschoolclassas 1 and 2 in Luleå, Piteå and Kiruna, n=3525

Annualfollow-ups, bothopen and closedcohort

Collaboration with UVa, Charlottesville, USA, i.e.

Thomas Platts-Mills and his staff


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


The OLIN Studies of adults 2002-2004

Clinical follow-upsincludinglungfunction of all previouslyclinicallyexaminedadultcohortsAims: incidence and determinants of COPD

rapid decline in lungfunction

ETS and COPD

interaction of risks of COPD

overlapsyndrome (OSAS and COPD)

healtheconomic studies of asthma and COPD long term outcome of asthma


The OLIN Studies of adults 2002-2004

Clinical follow-upsincludinglungfunction of all previouslyclinicallyexaminedadultcohortsAims: incidence and determinants of COPD

rapid decline in lungfunction

ETS and COPD

interaction of risks of COPD

overlapsyndrome (OSAS and COPD)

healtheconomic studies of asthma and COPD l ong term outcome of asthma

The OLIN Studies 2005

Start of the prospective OLIN COPD Study


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 wasrecruited

  • In children?

    • The paediatricOLIN-cohort from 1996 re-investigated

    • A new cohort with the same age distribution (7-8 y olds) from the same areas wasrecruited


  • 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 economydepartment at the provincegovernment

    Ulf Öhman Director of the provincegovernment

    Per Malmberg Professor & head of Medical Dept, NIOH, Stockholm

    Göran SundlöfAssociate 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 ClinPhysiol , 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


    • 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

    • Population study based health economics of asthma and COPD


    • 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

      • Lundbäck et al, COPD 2009

  • Population study based health economics of asthma and COPD

  • Jansson et al, Chest 2002 (COPD); Respir Med 2007 (asthma)


    • 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



    Phenotyping

    of asthma and COPD


    Phenotyping

    of asthma and COPD

    Genetics of COPD (and asthma)


    Phenotyping

    of asthma and COPD

    Genetics of COPD (and asthma)

    Allergic sensitisation and inflammation


    Phenotyping

    of asthma and COPD

    Genetics of COPD (and asthma)

    Studies requiringpooled data, examples:

    cancer in allergy

    smoking COPD

    cancer

    Allergic sensitisation and inflammation


    Phenotyping of OAD

    West Sweden Asthma Study

    University of Gothenburg


    Phenotyping of OAD

    West Sweden Asthma Study

    University of Gothenburg

    Geneticis of OAD

    Juha Kere´s network,

    Karolinska Institutet


    Phenotyping of OAD

    West Sweden Asthma Study

    University of Gothenburg

    Geneticis of OAD

    Juha Kere´s network,

    Karolinska Institutet

    Genetics of COPD

    De Code,

    Reykjavik


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    Molecular epidemiology

    in pediatric asthma and allergy

    Asthma and Allergy Research Centre,

    UVa, Charlottesville

    and

    School of Public Health,

    Columbia University, NY


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    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


    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


    Krefting Research Centre

    In progress: West Sweden

    Asthma Study

    planned:

    West Sweden

    COPD Study

    Jan Lötvall

    Bo Lundbäck

    Göran Wennergren

    Kjell Torén


    • Research co-operationwithinlargescale studies

    • FinEsS

    • ECRHS/Rhine

    • GA2LEN

    • Supervision at (amongothers):

    • - Hanoi Medical University, Vietnam

    • - Yogjakarta University, Indonesia

    • University of Helsinki, Finland

    • EstonianInst for Health Development

    • Collaboration within research

    • organisations, mainly

    • European Respiratory Society (ERS)

    • Eur Academy of Allergy & ClinImmunol (EAACI)

    • Nordic Respiratory Academy (NORA)


    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


    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

    Norrbotten´s local health authority

    NIH & European Unions grants vid research net works

    Additional support mainly from

    GSK, Phadia, ALK, AstraZeneca and Boehringer Ing


    A Quarter of a Century


    A Quarter of a Century

    is a long time



    The OLIN Studies will go on

    Thank you for listening !


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