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 - 12/11/20

Doi : 10.1016/j.rmed.2020.106160

Paul G. Lassmann-Klee ^a,^⁎ , Päivi L. Piirilä ^a, Ben Brumpton ^b,^c, Matz Larsson ^d, Britt-Marie Sundblad ^e, Jaak Põlluste ^f,^{^{1
Deceased July 2020.}}, Maria Juusela ^g, Annamari Rouhos ^h, Mari Meren ^f,ⁱ, Ari Lindqvist ^a, Hannu Kankaanranta ^j,^k,^l, Helena Backman ^m,ⁿ, Arnulf Langhammer ^o, Eva Rönmark ^m, Bo Lundbäck ^l, Anssi R.A. Sovijärvi ^a
^a Unit of Clinical Physiology, Helsinki University Central Hospital and University of Helsinki, Finland
^b Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
^c Clinic of Thoracic and Occupational Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
^d Clinical Health Promotion Centre, University of Lund, and Örebro University Hospital, Örebro, Sweden
^e Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden
^f National Institute for Health Development, Tallinn, Estonia
^g The Finnish Institute of Lung Health, FILHA, Helsinki, Finland
^h Department of Pulmonary Medicine, Heart and Lung Center, Helsinki University Central Hospital and University of Helsinki, Finland
ⁱ The North Estonia Medical Centre, Tallinn, Estonia
^j Department of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland
^k Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
^l Krefting Research Centre, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
^m Department of Public Health and Clinical Medicine, Division of Sustainable Health, The OLIN Unit, Umeå University, Umeå, Sweden
ⁿ Department of Health Sciences, Luleå University of Technology, Luleå, Sweden
^o 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

^∗Corresponding author. Unit of Clinical Physiology, Helsinki University Central Hospital, PO Box 340, 00029, HUS/Helsinki, Finland.Unit of Clinical PhysiologyHelsinki University Central HospitalPO Box 340HUS/Helsinki00029Finland

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.

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Highlights

•	F_ENO can measure eosinophilic airway inflammation in asthma.
•	Asthma prevalence and risk varies between countries due to differences in risk factors.
•	Populations in Sweden and Finland have a higher asthma risk than in Estonia.
•	The findings support the west-east disparity hypothesis of allergic diseases.
•	Atopic sensitisation increases the risk of asthma.

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Keywords : Asthma, F_ENO, Atopy, Skin prick test

Abbreviations : CI, F_ENO, FEV₁, IQR, OR, SPT

Plan

Introduction

Materials and methods

Study populations

Questionnaire and clinical interview

Prevalence of symptoms and diagnoses

Fractional exhaled nitric oxide: F_ENO

Between country comparisons for asthma

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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 - 12/11/20

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