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The OLIN Story

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

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  1. The OLIN Story by Bo Lundbäck

  2. far away in the periphery of Europe

  3. 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

  4. 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

  5. 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

  6. A Quarter of a Century

  7. A Quarter of a Century Howdid it start?

  8. In schoolbooks in early 1980:s

  9. In schoolbooks in early 1980:s Asthmaprevalence 2%

  10. In schoolbooks in early 1980:s Asthmaprevalence 2% and so waschronicbronchitis

  11. Aims at start in 1985: Howcommon are OADs? - asthma? - chronicbronchitis? and itsobstructive form? - airwayallergies? And what are theirmain determinants? -

  12. 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

  13. 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%

  14. The first yearswere turbulent

  15. 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”

  16. 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

  17. 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

  18. 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

  19. The OLIN Studies continued

  20. 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

  21. The OLIN Studies continued… Nordic ScientificAdvisory Board since 1989

  22. 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

  23. 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

  24. 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

  25. 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

  26. The OLIN Studies 1995-1996

  27. 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

  28. 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

  29. 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

  30. 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)

  31. 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”

  32. 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

  33. 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

  34. 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

  35. 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

  36. 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

  37. 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

  38. 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

  39. 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

  40. 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)

  41. 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

  42. Topics that require research collaboration with other centres include

  43. Phenotyping of asthma and COPD

  44. Phenotyping of asthma and COPD Genetics of COPD (and asthma)

  45. Phenotyping of asthma and COPD Genetics of COPD (and asthma) Allergic sensitisation and inflammation

  46. Phenotyping of asthma and COPD Genetics of COPD (and asthma) Studies requiringpooled data, examples: cancer in allergy smoking COPD cancer Allergic sensitisation and inflammation

  47. Phenotyping of OAD West Sweden Asthma Study University of Gothenburg

  48. Phenotyping of OAD West Sweden Asthma Study University of Gothenburg Geneticis of OAD Juha Kere´s network, Karolinska Institutet

  49. 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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