Parallel gradients in FENO and in the prevalences of asthma and atopy in adult general populations of Sweden, Finland and Estonia - A Nordic EpiLung study

Paul G Lassmann-Klee; Päivi L Piirilä; Ben Brumpton; Matz Larsson; Britt-Marie Sundblad; Jaak Põlluste; Maria Juusela; Annamari Rouhos; Mari Meren; Ari Lindqvist; Hannu Kankaanranta; Helena Backman; Arnulf Langhammer; Eva Rönmark; Bo Lundbäck; Anssi R A Sovijärvi

doi:10.1016/j.rmed.2020.106160

Parallel gradients in F_ENO and in the prevalences of asthma and atopy in adult general populations of Sweden, Finland and Estonia - A Nordic EpiLung study

Respir Med. 2020 Nov:173:106160. doi: 10.1016/j.rmed.2020.106160. Epub 2020 Sep 17.

Authors

Paul G Lassmann-Klee¹, Päivi L Piirilä², Ben Brumpton³, Matz Larsson⁴, Britt-Marie Sundblad⁵, Jaak Põlluste⁶, Maria Juusela⁷, Annamari Rouhos⁸, Mari Meren⁹, Ari Lindqvist², Hannu Kankaanranta¹⁰, Helena Backman¹¹, Arnulf Langhammer¹², Eva Rönmark¹³, Bo Lundbäck¹⁴, Anssi R A Sovijärvi²

Affiliations

¹ Unit of Clinical Physiology, Helsinki University Central Hospital and University of Helsinki, Finland. Electronic address: paul.klee@fu-berlin.de.
² Unit of Clinical Physiology, Helsinki University Central Hospital and University of Helsinki, Finland.
³ Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Trondheim, Norway; Clinic of Thoracic and Occupational Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.
⁴ Clinical Health Promotion Centre, University of Lund, and Örebro University Hospital, Örebro, Sweden.
⁵ Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden.
⁶ National Institute for Health Development, Tallinn, Estonia.
⁷ The Finnish Institute of Lung Health, FILHA, Helsinki, Finland.
⁸ Department of Pulmonary Medicine, Heart and Lung Center, Helsinki University Central Hospital and University of Helsinki, Finland.
⁹ National Institute for Health Development, Tallinn, Estonia; The North Estonia Medical Centre, Tallinn, Estonia.
¹⁰ Department of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland; Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland; Krefting Research Centre, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.
¹¹ Department of Public Health and Clinical Medicine, Division of Sustainable Health, The OLIN Unit, Umeå University, Umeå, Sweden; Department of Health Sciences, Luleå University of Technology, Luleå, Sweden.
¹² HUNT Research Centre, Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Levanger, Norway and Central Norway Regional Health Authority, Trondheim, Norway.
¹³ Department of Public Health and Clinical Medicine, Division of Sustainable Health, The OLIN Unit, Umeå University, Umeå, Sweden.
¹⁴ Krefting Research Centre, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.

PMID: 33011446
DOI: 10.1016/j.rmed.2020.106160

Abstract

The prevalence of asthma is higher in Sweden and Finland than in neighbouring eastern countries including Estonia. Corresponding difference in bronchial eosinophilic inflammation could be studied by F_ENO measurements. We aimed to compare F_ENO in adult general populations of Sweden, Finland, and Estonia, to test the plausibility of the west-east disparity hypothesis of allergic diseases. We conducted clinical interviews (N = 2658) with participants randomly selected from the general populations in Sweden (Stockholm and Örebro), Finland (Helsinki), and Estonia (Narva and Saaremaa), and performed F_ENO (n = 1498) and skin prick tests (SPT) in 1997-2003. The median (interquartile range) of F_ENO (ppb) was 15.5 (9.3) in Sweden, 15.4 (13.6) in Finland and 12.5 (9.6) in Estonia. We found the lowest median F_ENO values in the Estonian centres Saaremaa 13.1 (9.5) and Narva 11.8 (8.6). In the pooled population, asthma was associated with F_ENO ≥25 ppb, odds ratio (OR) 3.91 (95% confidence intervals: 2.29-6.32) after adjusting for SPT result, smoking, gender and study centre. A positive SPT test increased the likelihood of asthma OR 3.19 (2.02-5.11). Compared to Saaremaa, the likelihood of having asthma was higher in Helsinki OR 2.40 (1.04-6.02), Narva OR 2.45 (1.05-6.19), Örebro OR 3.38 (1.59-8.09), and Stockholm OR 5.54 (2.18-14.79). There was a higher prevalence of asthma and allergic airway inflammation in adult general populations of Sweden and Finland compared to those of Estonia. Atopy and elevated F_ENO level were independently associated with an increased risk of asthma. In conclusion, the findings support the earlier west-east disparity hypothesis of allergic diseases.

Keywords: Asthma; Atopy; F(ENO); Skin prick test.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Asthma / diagnosis
Asthma / epidemiology*
Bronchi
Cohort Studies
Eosinophilia
Estonia / epidemiology
Female
Finland / epidemiology
Humans
Inflammation
Male
Prevalence
Skin Tests / methods*
Surveys and Questionnaires
Sweden / epidemiology