No change in prevalence of symptoms of COPD between 1996 and 2006 in Finnish adults : a report from the FinEsS Helsinki Study

Background: The age-dependent increase of chronic obstructive pulmonary disease (COPD) prevalence caused by smoking and other inhalational exposures in the general population is well-known worldwide. However, time trends are poorly known, due to lower number of high-quality studies especially following nationwide efforts on diminishing exposure levels. This study aimed to compare the prevalence of COPD symptoms and their major determinants in Finnish adults in 1996 and 2006. Methods: Two identical postal surveys were conducted among two random population samples from Helsinki using identical methodologies in 1996 and 2006, with 6,062 (76%) and 2,449 (62%) participants, respectively. Results: The physician-diagnoses of COPD remained at 3.7%, whereas physician-diagnoses of asthma and use of asthma medicines increased in both genders. Current smoking reduced from 33.4 to 27.3% (p<0.001), and the amount of cigarettes smoked also reduced significantly. The crude prevalence of chronic productive cough was 12.1 and 11.1%, wheezing with dyspnoea without a cold (wheezing triad) 7.3 and 7.7%, and dyspnoea grade II 13.8 and 13.6%, in 1996 and 2006, respectively. Among subjects with physician-diagnosed COPD, the prevalences of chronic productive cough and recurrent wheeze reduced significantly, from 60.6 to 40.7% and 53.5 to 38.5%, respectively. Conclusion: From 1996 to 2006, the prevalence of obstructive airway symptoms common in different phenotypes of COPD did not increase in Finnish adults. This suggests that the upward trend of COPD prevalence might have reached a plateau. Current smoking and the quantities smoked diminished suggesting a wider impact of stronger legislation and smoking-cessation efforts during the Finnish National Programme for COPD.Peer reviewe

Tupakoinnin vähentämisen keinot

Luento kumppanuusseminaarissa 21.10.201

Use of spirometry and recording of smoking habits of COPD patients increased in primary health care during national COPD programme

BACKGROUND: In Finland, a national programme for COPD prevention and treatment was developed in 1998. The main goals of the programme were to diagnose COPD as early as possible and to encourage people to quit smoking. The role of primary health care was emphasized in the programme. Our aim was to investigate the use of spirometry and recording of smoking habits of COPD patients in primary health care before and during the COPD programme. METHODS: We compared patients with respiratory symptoms or diseases visiting primary health care during 1997 (before programme) and 2002 (during programme). Patients with respiratory symptoms were divided into two groups: COPD patients and "others". Patient records were thoroughly investigated and data retrieved from them. RESULTS: There was a significant increase in the whole study group from 8.0% to 38.9% in the use of spirometry (p < 0.001). This increase was significant both in the COPD group (from 32.0% to 79.6%, p < 0.001) and "others" (from 5.6% to 32.8%, p < 0.001). Written information on smoking habits in patient records increased from 16.6% of all patients in 1997 to 53.2% in 2002 (p < 0.001), and in COPD group from 45.0% to 84.3% (p < 0.001). CONCLUSIONS: We observed a significant increase in the use of spirometry and knowledge of smoking habits in COPD patients, which may be a result of the Finnish national COPD programme

北海道とフィンランドのサルコイドーシス : 比較研究の結果

Two comparative Finnish-Japanese sarcoidosis studies were carried out. One study compared the frequencies of sarcoidosis in 1984 in Hokkaido and Finland. We found a significantly and approximately four times higher prevalence and incidence of sarcoidosis in Finland than in Hok kaido ; prevalence 28.2/100,000 in Finland and 7.2/100,000 in Hokkaido ; incidence ll.4/100,000 in Fin land and 2.8/100,000 in Hokkaido, The other study compared the clinical picture and prognosis of sarcoidosis in two large hospital series ; 686 patients in Sapporo and 571 patients in Mjolbolsta, Fin land. The sex ratio was the same with a slight female predominance in both hospitals. The Japanese patients were younger at the time of diagnosis (mean age 30 years in Sapporo compared with 42 years in Mjolbolsta), although 50% of the patients in both series had been detected via rou tine health screening procedures. Among the symptomatic patients the mode of presentation of the disease varied considerably with eye symptoms as the dominating in Sapporo, but with respiratory symptoms and Lofgren\u27s syndrome in Finland. Stage I disease was more frequent in Sapporo, (57% of the patients compared with 48% in Finland) whereas more Finnish patients had parenchymal lesions. Extrapulmonary manifestations of sarcoidosis were more often diagnosed in Sapporo ; main ly because of the eye lesions. The prognosis of pulmonary sarcoidosis in Finland was significantly less favourable than the prognosis of the Japanese patients

SNP Variants in Major Histocompatibility Complex Are Associate with Sarcoidosis Susceptibility - A Joint Analysis in Four European Populations

Sarcoidosis is a multiorgan inflammatory disorder with heritability estimates up to 66%. Previous studies have shown the major histocompatibility complex (MHC) region to be associated with sarcoidosis, suggesting a functional role for antigen-presenting molecules and immune mediators in the disease pathogenesis. To detect variants predisposing to sarcoidosis and to identify genetic differences between patient subgroups, we studied four genes in the MHC Class III region (LTA, TNF, AGER, BTNL2) and HLA-DRA with tag-SNPs and their relation to HLA-DRB1 alleles. We present results from a joint analysis of four study populations (Finnish, Swedish, Dutch, and Czech). Patients with sarcoidosis (n = 805) were further subdivided based on the disease activity and the presence of Lofgren's syndrome. In a joint analysis, seven SNPs were associated with non-Lofgren sarcoidosis (NL; the strongest association with rs3177928, P = 1.79E-07, OR = 1.9) and eight with Lofgren's syndrome [ Lofgren syndrome (LS); the strongest association with rs3129843, P = 3.44E-12, OR = 3.4] when compared with healthy controls (n = 870). Five SNPs were associated with sarcoidosis disease course (the strongest association with rs3177928, P = 0.003, OR = 1.9). The high linkage disequilibrium (LD) between SNPs and an HLA-DRB1 challenged the result interpretation. When the SNPs and HLA-DRB1 alleles were analyzed together, independent association was observed for four SNPs in the HLA-DRA/BTNL2 region: rs3135365 (NL; P = 0.015), rs3177928 (NL; P <0.001), rs6937545 (LS; P = 0.012), and rs5007259 (disease activity; P = 0.002). These SNPs act as expression quantitative trait loci (eQTL) for HLA-DRB1 and/or HLA-DRB5. In conclusion, we found novel SNPs in BTNL2 and HLA-DRA regions associating with sarcoidosis. Our finding further establishes that polymorphisms in the HLA-DRA and BTNL2 have a role in sarcoidosis susceptibility. This multi-population study demonstrates that at least a part of these associations are HLA-DRB1 independent (e.g., not due to LD) and shared across ancestral origins. The variants that were independent of HLA-DRB1 associations acted as eQTL for HLA-DRB1 and/or -DRB5, suggesting a role in regulating gene expression.Peer reviewe

Proteomic Changes of Alveolar Lining Fluid in Illnesses Associated with Exposure to Inhaled Non-Infectious Microbial Particles

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