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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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slide1

The OLIN Story

by

Bo Lundbäck

slide3

far away

in the periphery

of Europe

slide4

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
slide5

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

slide6

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

slide8

A Quarter of a Century

Howdid it start?

slide11

In schoolbooks in early 1980:s

Asthmaprevalence 2%

and so waschronicbronchitis

slide12

Aims at start in 1985:

Howcommon are OADs?

- asthma?

- chronicbronchitis?

and itsobstructive form?

- airwayallergies?

And what are theirmain determinants?

-

slide13

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

slide14

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%

slide16

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”
slide17

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

slide18

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

slide19

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

slide21

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

slide22

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

slide26

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

slide35

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

slide36
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

slide37
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

slide38
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
slide39

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

slide40

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
slide41

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)
slide42

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

slide44

Phenotyping

of asthma and COPD

slide45

Phenotyping

of asthma and COPD

Genetics of COPD (and asthma)

slide46

Phenotyping

of asthma and COPD

Genetics of COPD (and asthma)

Allergic sensitisation and inflammation

slide47

Phenotyping

of asthma and COPD

Genetics of COPD (and asthma)

Studies requiringpooled data, examples:

cancer in allergy

smoking COPD

cancer

Allergic sensitisation and inflammation

slide48

Phenotyping of OAD

West Sweden Asthma Study

University of Gothenburg

slide49

Phenotyping of OAD

West Sweden Asthma Study

University of Gothenburg

Geneticis of OAD

Juha Kere´s network,

Karolinska Institutet

slide50

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

slide51

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Stockholm

Göteborg

Molecular epidemiology

in pediatric asthma and allergy

Asthma and Allergy Research Centre,

UVa, Charlottesville

and

School of Public Health,

Columbia University, NY

slide52

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Stockholm

Göteborg

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

slide53

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

slide54

Krefting Research Centre

In progress: West Sweden

Asthma Study

planned:

West Sweden

COPD Study

Jan Lötvall

Bo Lundbäck

Göran Wennergren

Kjell Torén

slide55

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)
slide56

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

slide57

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

slide61

The OLIN Studies will go on

Thank you for listening !