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Summary: Objective: To examine the incidence of allergic rhinoconjunctivitis and asthma, and to assess allergic rhinoconjunctivitis as a risk factor for incident asthma, we performed a 11-year follow-up postal survey. Methods: The original study population was a random population sample of 8000 inhabitants of Helsinki aged 20–69 years in 1996. Participants in the first postal questionnaire survey, 6062 subjects, were invited to this follow-up study, and provided 4302 (78%) answers out of 5484 traced subjects in 2007. Results: Cumulative incidence of asthma from 1996 to 2007 was 4.0% corresponding to an annual incidence rate of 3.7/1000/year. After exclusion of those with asthma medication or physician-diagnosed chronic bronchitis or COPD at baseline in 1996, the cumulative incidence decreased to 3.5% (incidence rate 3.2/1000/year), and further to 2.7% (2.5/1000/year) when also those reporting recurrent wheeze or shortness of breath during the last year in 1996 were omitted from the population at risk. Remission of asthma occurred in 43 subjects and was 16.9% over 11 years. Cumulative 11-year incidence of allergic rhinoconjunctivitis was 16.9% corresponding to 16.8/1000/year, and cumulative remission was 18.1%. Incidence of allergic rhinoconjunctivitis was significantly lower among those who had lived in the countryside or on a farm during the first 5 years of life, but this was not true for asthma. In multivariate analysis, farm living during the first 5 years of life was protective for the development of allergic rhinoconjunctivitis, OR 0.75 (95%CI 0.57–0.99). Allergic rhinoconjunctivitis was a significant independent risk factor for incident asthma, OR 2.15 (95%CI 1.54–3.02). In the cohort, the prevalence of rhinoconjunctivitis increased from 38.0% in 1996 to 40.9% in 2007, physician-diagnosed asthma from 6.8% to 9.4%, while current smoking decreased from 31.3% to 23.3%. Conclusion: Incidence of allergic rhinoconjunctivitis was higher than in earlier studies, while asthma incidence remained on similar level, both being significantly higher in women. Allergic rhinoconjunctivitis doubled the risk for incident asthma. [Copyright &y& Elsevier]

Summary: We studied, whether asthma diagnosed in childhood or early adulthood affects work ability 20 years later. We used Finnish Defence Force registers, 1986–1990, to select: (1) conscripts with asthma to represent a mild/moderate asthma group (n = 485), (2) asthmatics who were exempted from military service to represent a relatively severe asthma group (n = 393) and (3) a control group (n = 1500) without asthma. A questionnaire consisting of validated questions on asthma and work ability was sent out in 2009. A total of 54% of the men in the first study group, 44% of those in the second study group and 44% of the controls answered. The mean age of the participants was 41 (range 37–51). Self-assessed current work ability compared with lifetime best had decreased in 28.9% of the first asthma group, in 31.1% of the second asthma group, and in 19.7% of the controls (p = 0.0007). Current smoking (OR 2.5), only basic education (OR 2.6), being a manual worker (OR 2.7) and current severe asthma (OR 3.8) associated most strongly with decreased work ability among the asthmatics. Both mild and more severe asthma at the age of around 20 seems to be associated with reduced work ability in 40-year-old males. [Copyright &y& Elsevier]

Summary: Background: During military service young men (age 19–21 years) are exposed to many predisposing factors for asthma. We aimed to study the short-term prognosis of asthma after the military service. Methods: All 216 men with verified asthma in 2004–2005 from the register of the Central Military Hospital were included in the study. A questionnaire was mailed to them in autumn 2007 and the 146 responders (68%) formed the final study population. Asthma severity was evaluated during military service according to the medical records of the subjects and two years later based on the questionnaire using modified GINA guidelines. The results on lung function and allergy tests during military service and asthma history were used as predictors of asthma severity at two-year follow-up. Results: Two groups of asthmatics were identified: those who already had asthma when entering the military service (n =71, 48.6%) and those, who had a new onset of asthma during the service (n =75, 51.4%). Overall asthma was less severe at two-year follow-up than during military service (p =0.036). Both during military service and at two-year follow-up, asthma was milder among the men, who had a new onset of asthma during military service. Atopy (p =0.002), number of positive skin-prick tests (p =0.005) and higher total serum IgE (p =0.001) were significant predictors for persistent asthma at follow-up. Conclusions: Asthma, which had aggravated or started during military service, was significantly less severe two years later. The degree of atopy was a major determinant of the two-year prognosis of asthma after military service. [Copyright &y& Elsevier]

Summary: Background: Some studies show concentrations of exhaled nitric oxide (FENO) in nonatopic asthma and in healthy subjects to be similar, but include asthmatics on inhaled steroids, which is likely to interfere with the results. Aim: Comparison of FENO between nonatopic asthmatics, low-sensitized and high-sensitized atopic asthmatics, and healthy controls. Methods: We studied 85 non-smoking, steroid-naive young men with recently diagnosed symptomatic asthma and 10 healthy controls. FENO was measured according to European Respiratory Society Guidelines. In skin prick tests of 13 common aeroallergens, subjects with a total sum of prick wheals 3–10mm were regarded as low-sensitized and those with >10mm, as high-sensitized. Flow–volume spirometry, standardized histamine challenge, and an exercise test were also carried out. Results: Prick tests revealed 14 subjects to be nonatopic and 71 atopic. In high-sensitized subjects with atopic asthma, the FENO median (25–75 quartiles) was significantly higher, 34.9 (21.3–53.8) parts per billion (ppb), than in subjects with nonatopic asthma, 15.2 (9.7–24.7)ppb (p <0.001), both being significantly higher than in healthy controls, 6.6 (5.2–8.5)ppb (p <0.001). FENO levels were similar in nonatopic and in low-sensitized atopic asthmatics, with no difference between them in bronchial responsiveness to histamine and exercise. Conclusion: Among steroid-naive young male asthmatics, FENO was equally elevated in nonatopic asthma and in low-sensitized atopic asthma but lower than in those with high-sensitized atopic asthma. These differences in FENO between asthma groups parallel the differences in airway function disturbance in terms of responsiveness to histamine or exercise. [Copyright &y& Elsevier]

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)., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

The aim of this part of the FinEsS-studies was to assess whether differences existed in prevalence of asthma, chronic bronchitis, and respiratory symptoms between three Baltic capitals, and to examine risk factor profiles for respiratory conditions. In 1996, a postal survey was performed in these cities with a response rate of 72% in Stockholm, 76% in Helsinki, and 68% in Tallinn. The prevalence of physician-diagnosed asthma was 76% in Stockholm, 6.2% in Helsinki, and 2.3% in Tallinn, while respiratory symptoms were most common in Tallinn. The prevalence of physician-diagnosed chronic bronchitis was 10.6% in Tallinn, 3.4% in Helsinki, and 3.0% in Stockholm. Risk factor analyses revealed a significantly increased risk for those living in Tallinn compared to that of Stockholm for wheezing conditions, OR 1.56-1.69, longstanding cough, OR 1.92 (1.74-2.13), attacks of shortness of breath during the previous 12 months, OR 1.35 (1.20-1.52), and chronic productive cough, OR 1.49 (1.28-1.74). Subjects having symptoms common in asthma were more likely to have physician-diagnosed asthma in Stockholm and Helsinki than in Tallinn, while subjects having bronchitis symptoms had more often physician-diagnosed chronic bronchitis in Tallinn. Prevalence of respiratory symptoms was higher in Tallinn than in Stockholm and Helsinki, while physician-diagnosed asthma was more common in Stockholm and Helsinki. The prevalence of physician-diagnosed chronic bronchitis was three times as high in Tallinn as in Helsinki or Stockholm. Our results also suggest large differences in diagnostic practices between the three countries, while the differences between the capitals in true prevalence of disease may be small.

To assess the prevalence of asthma, chronic bronchitis and respiratory symptoms, and to calculate risk factors for them, we performed a postal survey in Helsinki, the capital of Finland. During the spring of 1996, questionnaires were mailed to a random sample of 8000 individuals aged 20-69. The total response rate was 76%, with 6062 complete answers. The prevalence of having ever had asthma was 7.2%, physician-diagnosed asthma was 6.6% and physician-diagnosed chronic bronchitis was 3.7%. Asthma was significantly more common among women than men, but no gender differences existed in prevalence of chronic bronchitis. The most common respiratory symptom was sputum production when coughing, reported by 27%. During the previous 12 months, wheezing had occurred in 20% and attacks of shortness of breath in 13% of subjects. Generally, the prevalence of different respiratory symptoms were significantly higher among smokers. The most important risk factor for asthma was a family history of asthma (Odds ratio:OR 3.3). Multivariate analysis revealed that being a member of the socioeconomic group, manual workers, was associated with a significantly increased risk for chronic productive cough (OR 1.7), and for wheezing during the previous 12 months (OR 1.7). Manual workers of both genders had the highest prevalence of asthma, chronic productive cough and wheezing during the previous 12 months. The prevalence of asthma in Helsinki was higher than previously found in Finland, and was at a similar level to that of other Nordic countries. In contrast, prevalence of chronic bronchitis was lower than previously shown in Finland.