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

Prevalence and determinants of respiratory symptoms, asthma, chronic bronchitis and allergic sensitization in Helsinki : A comparison between Finland, Sweden and Estonia : The FinEsS studies - Helsinki I

Objectives: To assess the prevalence and risk factor profiles of respiratory symptoms, asthma and chronic bronchitis in Helsinki, and to compare these results with those for Sweden and Estonia. Other important aims were to evaluate the prevalence and determinants of type 1 sensitization in Helsinki. Materials and methods: This presentation is a part of a large epidemiological study in Finland, Estonia and Sweden (FinEsS). The first part of the study consisted of a postal questionnaire in 1995-1996 distributed to subjects in eight study centres. The study population in each centre was a population-based random sample designed to be representative of the general population. The original study sample in Helsinki consisted of 8000 subjects aged 20-69 years, 6062 (76%) of whom participated. Comparisons between countries were based on a narrower age group, 20-64 years, since 64 years was the upper age limit used in the original study in Estonia. Thus, altogether 58 661 subjects aged 20-64 years were invited to participate in Finland, Sweden and Estonia, and 44 483 (76%) did so. The second part of the study was a clinical study with a structured interview, lung function measurements and skin-prick tests with 15 common allergens. This thesis reports only the results of the prick tests in Helsinki. Of the 1200 subjects invited to participate in Helsinki, 643 (54%) consented. Skin-prick tests were performed on subjects ≤ 60 years of age; thus, a total of 498 tests were done. Results: In Helsinki, the prevalence of physician-diagnosed asthma was 6.6% and of physician-diagnosed chronic bronchitis 3.7% among subjects aged 20-69 years. Comparison of the results between Finland, Sweden and Estonia in subjects 20-64 years of age revealed the highest prevalence of physician-diagnosed asthma in Sweden, 7.8%, while the prevalence in Finland was 5.9% and in Estonia 2.0% (p<0.001). The prevalence of physician-diagnosed asthma among those aged 20-29 years was 7.9% in Stockholm, 6.3% in Helsinki and 2.8% in Tallinn. Asthma-related symptoms were most common in Estonia, and among those with typical asthma symptoms the diagnosis of asthma was least likely in Estonia. Physician-diagnosed chronic bronchitis was reported to be 10.7% in Estonia, 3.1% in Sweden and 2.9% in Finland among subjects aged 20-64 years (p<0.001). Among those aged 20-29 years, 7.6% in Tallinn reported physician-diagnosed chronic bronchitis, while the prevalence estimates were 1.4% in Stockholm and 1.3% in Helsinki. The prevalence of smoking was similar for women in all three countries, around 30%, but large differences in smoking habits were present among men; 60% of Estonian, 39% of Finnish and 28% of Swedish men smoked. Skin-prick tests in Helsinki revealed a high prevalence of sensitization, 46.9%. For subjects aged 26-39 years, the prevalence was highest, 56.8%, and 23.7% were sensitized to at least four allergens. The most common sensitizing allergen was the dog. Sensitization to multiple allergens was associated with a high prevalence of asthma and allergic rhinitis. Conclusions: Compared with earlier Finnish studies, a higher prevalence of asthma and a lower prevalence of chronic bronchitis were found in Helsinki. The prevalence of physician-diagnosed chronic bronchitis was low in Helsinki, with only one-fifth of subjects fulfilling the symptom criteria for chronic bronchitis reporting having a diagnosis of chronic bronchitis. The prevalences of asthma and chronic bronchitis were similar in Finland and Sweden, but in Estonia physician-diagnosed asthma was less common and physician-diagnosed chronic bronchitis more common, particularly among young subjects. Further analyses revealed that the diagnosis of asthma was favoured in Finland and Sweden, while the diagnosis of chronic bronchitis was more likely in Estonia for subjects with the same symptoms. Allergic sensitization was common in Helsinki. Our findings of multiple sensitization also speak in favour of evaluating the degree of sensitization when assessing allergies.Aikuisväestön astma on yleistynyt Suomessa ja sitä sairastaa 6-7% aikuisista. Allergiataipumus on aikuisilla myös lisääntynyt: 47% helsinkiläisistä on ihopistokokeiden perusteella herkistyneitä yleisille allergiaa aiheuttaville tekijöille. Kroonisen keuhkoputkitulehduksen esiintyvyys, 3-4%, on puolestaan laskenut aiempaan nähden, toisaalta vain 19% tähän viittaavia oireita ilmoittaneista oli saanut diagnoosin. Väitöstyö kuuluu FinEsS-tutkimusprojektiin, jonka tarkoituksena on selvittää ja seurata keuhko-oireiden, ahtauttavien keuhkosairauksien ja allergisen herkistymisen esiintyvyyttä ja riskitekijöitä Suomessa, Ruotsissa ja Virossa. Tutkimus alkoi postikyselyllä syksyn 1995 ja kevään 1996 välisenä aikana kahdeksassa tutkimuskohteessa, joita olivat Helsingin ja Lapin lisäksi Tukholma, Örebro, Pohjois-Ruotsin Norrbotten, Tallinna, Saaremaa ja Narva. Kohderyhmänä Helsingissä oli 8000:n iältään 20-69-vuotiaan aikuisen satunnaisotos, josta 6062 (76%) osallistui. Väitöstyössä verrattiin eri alueiden tuloksia keskenään erityisesti riskitekijöiden ja diagnoosikäytäntöjen suhteen ikäryhmässä 20-64-vuotiaat yhteensä 44 483 vastauksen perusteella (76% kutsutuista). Jatkotutkimuksena Helsingissä tehtiin vuosien 2001-2003 aikana satunnaisesti valituille tutkittaville haastattelu, allergiataipumuksen selvittämiseksi prick-ihopistokoe 15 allergeenilla ja keuhkotoimintakokeita kuten spirometria ja bronkodilataatiokoe, histamiinialtistuskoe, uloshengityksen typpioksidipitoisuuden mittaus ja hengitysäänianalyysi. Ihopistokoe tehtiin yhteensä 498 tutkittavalle. Keuhkotoimintakokeiden tuloksia ei esitetä tässä väitöstyössä. Astma on viime vuosikymmeninä yleistynyt Suomessa muiden länsimaiden tasolle. Verratessa kaikkien tutkimuskeskusten tuloksia lääkärin toteaman astman esiintyvyys oli 7.8% Ruotsissa, 5.9% Suomessa ja 2.0% Virossa ikäryhmässä 20-64-vuotiaat (p<0.001). Astmaoireet olivat kuitenkin yleisimpiä Virossa ja kävi ilmi, että merkittävä osa astmatyyppisistä oireista ilmoittaneista oli siellä saanut kroonisen keuhkoputkitulehduksen diagnoosin. Lääkärin toteamaa kroonista keuhkoputkitulehdusta ilmoitti sairastavansa 3.1% Ruotsissa, 2.9% Suomessa ja 10.7% Virossa samassa ikäryhmässä (p<0.001). Vastaavanlaiset erot olivat todettavissa 20-30-vuotiailla. Tulokset viittaavat siihen, että 90-luvun puolivälissä diagnoosikäytännöt poikkesivat toisistaan verrattaessa Viroa Suomeen ja Ruotsiin. Kroonisen keuhkoputkitulehduksen osalta esiintyi alidiagnostiikkaa Suomessa ja Ruotsissa. Ihopistokokeen perusteella herkistyneiden osuus Helsingissä oli 47% ja ikäryhmässä 26-39-vuotiaat 57%. Koira, kissa ja koivu olivat suuruusjärjestyksessä yleisimmät reaktioita aiheuttaneet allergeenit. Alle 40-vuotiaiden ikäryhmässä 42% herkistyneistä reagoi vähintään neljälle allergeenille vastaten neljäsosaa koko ikäryhmästä. Positiivisten ihotestitulosten lukumäärän lisääntyessä allergisen nuhan ja astman esiintyvyys kasvoi tilastollisesti merkitsevästi (p<0.001)

Allergic multimorbidity is associated with self-reported anaphylaxis in adults-A cross-sectional questionnaire study

Background Anaphylaxis has increased over the last two decades in Europe, reaching an estimated prevalence of 0.3% and an incidence of 1.5-7.9 per 100,000 person-years. Allergic multimorbidity is associated with asthma severity, yet its role in anaphylaxis is not fully understood. Our aim was to study association between allergic multimorbidity and anaphylaxis in adults. Methods We used population-based data from the Finnish Allergy Barometer Study (n = 2070, age range: 5-75). Food allergy (FA), atopic dermatitis (AD), allergic rhinitis (AR) and allergic conjunctivitis (AC), were defined from a self-completed questionnaire. A logistic regression adjusted on potential confounders (sex, age, smoking status) was applied to estimate the anaphylaxis risk associated with allergic multimorbidity. Results 1319 adults with at least one allergic disease (FA, AD, AR, AC) with/without asthma (AS) were included. Of these, 164 had self-reported anaphylaxis [mean (SD, min-max) 54 (14, 22-75) years, 17% men]. AS, FA, AR, AC, or AD were reported by 86.0%, 62.2%, 82.3%, 43.3%, and 53.7% of subjects with anaphylaxis and respectively by 67.8%, 29.5%, 86.2%, 29.4%, and 34.4% of subjects without anaphylaxis. Compared with subjects exhibiting only one allergic disease, the risk of anaphylaxis increased with the number of allergic diseases; adjusted odds ratios (OR) [CI95%] for two, three, four and five coinciding allergic diseases were 1.80 [0.79-4.12], 3.35 [1.47-7.66], 7.50 [3.25-17.32], and 13.5 [5.12-33.09], respectively. The highest risk of anaphylaxis (6.47 [4.33-9.92]) was associated with FA + AS or their various variations with AR/AC/AD embodied, when compared with AR, AC, and AS separately or their combinations. Conclusions Anaphylaxis was positively associated with the number of allergic diseases a subject exhibited and with subgroups including FA and/or AS. The results can be applied when estimating the risk of anaphylaxis for individual patients.Peer reviewe

Smoking, environmental tobacco smoke and occupational irritants increase the risk of chronic rhinitis

Background: Allergic and non-allergic rhinitis cause a lot of symptoms in everyday life. To decrease the burden more information of the preventable risk factors is needed. We assessed prevalence and risk factors for chronic nasal symptoms, exploring the effects of smoking, environmental tobacco smoke, exposure to occupational irritants, and their combinations. Methods: In 2016, a postal survey was conducted among a random population sample of 8000 adults in Helsinki, Finland with a 50.5% response rate. Results: Smoking was associated with a significant increase in occurrence of chronic rhinitis (longstanding nasal congestion or runny nose), but not with self-reported or physician diagnosed allergic rhinitis. The highest prevalence estimates of nasal symptoms, 55.1% for chronic rhinitis, 49.1% for nasal congestion, and 40.7% for runny nose, were found among smokers with occupational exposure to gases, fumes or dusts. Besides active smoking, also exposure to environmental tobacco smoke combined with occupational exposure increased the risk of nasal symptoms. Conclusions: Smoking, environmental tobacco smoke, and occupational irritants are significant risk factors for nasal symptoms with an additive pattern. The findings suggest that these factors should be systematically inquired in patients with nasal symptoms for appropriate preventive measures. (192 words).Peer reviewe

The increase of asthma prevalence has levelled off and symptoms decreased in adults during 20 years from 1996 to 2016 in Helsinki, Finland

Background: Mortality and hospitalization due to asthma have decreased in many European countries, but asthma symptoms still cause a lot of morbidity and costs. Objectives: We evaluated prevalence trends of asthma, asthma symptoms and allergic rhinoconjunctivitis in adults aged 20-69 years during a 20-year period from 1996 to 2016 in the city of Helsinki, the capital of Finland. Methods: Three cross-sectional postal surveys were conducted in random population samples 10 years apart. In 1996, 2006 and 2016, a total of 6062 (response rate 75.9%), 2449 (61.9%) and 4026 subjects (50.3%) took part, respectively. Results: In all responders, the prevalence of physician-diagnosed asthma was 6.6% in 1996, 10% in 2006 and 10.9% in 2016. The prevalence increased from 1996 to 2006, but stabilized from 2006 to 2016, both in men and women and in smokers and non-smokers. The prevalence of current asthma (8.5% in 2006 and 8.8% in 2016) and of asthma with rhinoconjunctivitis (7.6% in 2006 and 7.5% in 2016) remained also at the same level. Allergic rhinoconjunctivitis decreased significantly from 2006 (42.7%) to 2016 (39.0%, p=0.004). Those with physician diagnosed asthma reported significantly less symptoms in 2016 compared to 2006 and 1996, although there was no change in smoking habits or medication use. Young asthmatics (20-29 years) without rhinoconjunctivitis reported least symptoms. Conclusion: Previously observed increase of physician-diagnosed asthma prevalence in adults seems to be levelling off in Helsinki, and patients have fewer symptoms than 20 years ago. In addition, allergic rhinoconjunctivitis is less frequent than 10 years earlier. (247 words).Peer reviewe

Asbestos, Asbestosis, and Cancer: Helsinki Criteria for Diagnosis and Attribution 2014

The report summarizes the current, up-to-date information on the methods for managing and eliminating asbestos-related diseases.1

Does lung function predict the risk of disability pension? An 11-year register-based follow-up study

Background Spirometry is widely used in medical surveillance in occupational health and as a diagnostic test for obstructive and restrictive lung disease. We evaluated the effect of spirometry parameters on the risk of all-cause disability pension in a follow-up study of an occupationally active general population-based cohort. Methods We measured the pulmonary function of 3386 currently working participants of the Health 2000 Survey in the clinical phase at baseline using spirometry. We obtained the retirement events of the cohort from the nationwide register for 2000-2011. Cox proportional hazards models were used to determine disability pensions. Results At baseline, we identified 111 (3.3%) participants with obstructive spirometry, 95 (2.8%) with restrictive spirometry, and 3180 controls without restriction or obstruction. The age, sex, educational level, body-mass index, co-morbidities (1 or >= 2), and the smoking-adjusted hazard ratio of disability pension was 1.07 (95% confidence interval, CI 0.64-1.78) for those with obstructive spirometry, and 1.44 (95% CI 0.89-2.32) for those with restrictive spirometry. As continuous variables, and divided into quartiles, the risk of the lowest quartile of forced ventilation capacity (FVC)% of predicted was 1.49 (95%CI 1.10-2.01) and forced expiratory volume in one second (FEV1)% of predicted 1.66 (95%CI: 1.23-2.24) in comparison to the highest quartile in the adjusted models. Conclusions Obstructive or restrictive spirometry did not predict disability pension when dichotomized classified variables (normal compared to abnormal) were used. As continuous variables and when divided into quartiles, lower lung volumes showed an increase in the risk of disability pension. Physicians should take this into account when they use spirometry as a prognostic factor of work disability.</p

Young men with asthma : Prognosis and effect on work ability

Asthma is a significant growing health problem of the working-age population and may start already in childhood or early adulthood. Therefore, despite current treatment options, asthma can potentially affect work ability, and occupational exposure to dust gases and fumes can influence asthma prognosis. The main aim of this study was to evaluate the impact of asthma on work ability and the effect of occupational exposure on current asthma status in approximately 40-year-old men with asthma since youth. The current goal to extend careers makes this study highly relevant. We found that both men with mild asthma and men with relatively severe asthma in youth had diminished self-reported work ability, and decreased work life participation, compared with men without asthma in youth. Among the asthmatics currently smoking, lower educational level, a blue-collar occupation and current severe asthma had the strongest associations with decreased work ability. Exposure to irritants, based on Job Exposure Matrix, and selfreported occupational exposure to abnormal temperatures also associated with poorer work ability. Occupational health care professionals should pay attention and support the work ability of those with asthma since youth. This joint work of the Finnish Institute of Occupational Health and the Finnish Defence Forces was founded by the Finnish Work Environment Fund

The combined effect of exposures to vapours, gases, dusts, fumes and tobacco smoke on current asthma

Smoking, exposure to environmental tobacco smoke (ETS) and occupational exposure to vapours, gases, dusts or fumes (VGDF) increase asthma symptoms. The impact of combined exposure is less well established. We aimed to evaluate the risk of combined exposure to smoking, ETS and VGDF on the prevalence of current asthma and asthma-related symptoms with a postal survey among a random population of 16,000 adults, aged 20-69 years (response rate 51.5%). The 836 responders with physician-diagnosed asthma were included in the analysis. Of them, 81.9% had current asthma defined as physician-diagnosed asthma with current asthma medication use or reported symptoms. There was a consistently increasing trend in the prevalence of current asthma by increased exposure. The highest prevalence of multiple symptoms was in smokers with VGDF exposure (92.1%) compared to the unexposed (73.9%, p = 0.001). In logistic regression analysis, combined exposure to several exposures increased the risk in all analysed symptoms (p = 0.002-0.007). In conclusion, smoking and exposure to ETS or VGDF increased the prevalence of current asthma and multiple symptoms. The combined exposure carried the highest risk. Preventive strategies are called for to mitigate exposure to tobacco smoke and VGDF.Peer reviewe