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Honkamaki, J., Hisinger-Molkanen, H., Ilmarinen, P., Piirila, P., Tuomisto, L. E., Andersen, H., . . . Kankaanranta, H. (2019). Age- and gender-specific incidence of new asthma diagnosis from childhood to late adulthood. Respiratory Medicine, 154, 56-62
Open this publication in new window or tab >>Age- and gender-specific incidence of new asthma diagnosis from childhood to late adulthood
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2019 (English)In: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 154, p. 56-62Article in journal (Refereed) Published
Abstract [en]

Background: Asthma is currently divided into different phenotypes, with age at onset as a relevant differentiating factor. In addition, asthma with onset in adulthood seems to have a poorer prognosis, but studies investigating age-specific incidence of asthma with a wide age span are scarce.

Objective: To evaluate incidence of asthma diagnosis at different ages and differences between child- and adult-diagnosed asthma in a large population-based study, with gender-specific analyzes included.

Methods: In 2016, a respiratory questionnaire was sent to 8000 randomly selected subjects aged 20-69 years in western Finland. After two reminders, 4173 (52.3%) subjects responded. Incidence rate of asthma was retrospectively estimated based on the reported age of asthma onset. Adult-diagnosed asthma was defined as a physician-diagnosis of asthma made at >= 18 years of age.

Results: Among those with physician-diagnosed asthma, altogether, 63.7% of subjects, 58.4% of men and 67.8% of women, reported adult-diagnosed asthma. Incidence of asthma diagnosis was calculated in 10-year age groups and it peaked in young boys (0-9 years) and middle-aged women (40-49 years) and the average incidence rate during the examined period between 1946 and 2015 was 2.2/1000/year. Adult-diagnosed asthma became the dominant phenotype among those with physician-diagnosed asthma by age of 50 years and 38 years in men and women, respectively.

Conclusions: Asthma is mainly diagnosed during adulthood and the incidence of asthma diagnosis peaks in middle-aged women. Asthma diagnosed in adulthood should be considered more in clinical practice and management guidelines.

Place, publisher, year, edition, pages
Elsevier, 2019
Keywords
Asthma, Incidence, Prevalence, Gender, Adult, Phenotype
National Category
Respiratory Medicine and Allergy
Identifiers
urn:nbn:se:umu:diva-161842 (URN)10.1016/j.rmed.2019.06.003 (DOI)000474821800009 ()31212122 (PubMedID)
Available from: 2019-08-08 Created: 2019-08-08 Last updated: 2019-08-08Bibliographically approved
Selberg, S., Hedman, L., Jansson, S.-A., Backman, H. & Stridsman, C. (2019). Asthma control and acute health care visits among young adults with asthma: A population-based study. Journal of Advanced Nursing
Open this publication in new window or tab >>Asthma control and acute health care visits among young adults with asthma: A population-based study
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2019 (English)In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648Article in journal (Refereed) Epub ahead of print
Abstract [en]

AIMS: To study asthma control and acute health care visits among young adults with asthma.

BACKGROUND: Despite the access to effective treatment and nursing interventions, poor asthma control is still common among individuals with asthma. However, studies describing clinical characteristics among young adults with asthma are rare.

DESIGN: A population-based cohort study.

METHODS: In 2015, as a part of the OLIN pediatric cohort I (recruited in 1996 at age 7-8yr), N=2291 young adults (27-28 yr) completed a postal questionnaire survey including questions on asthma and respiratory symptoms. Of these, N=280 (12%) were identified as having current asthma and were further studied.

RESULTS: Of those with current asthma, women reported respiratory symptoms and smoking to a greater extent than men. Approximately one-fourth had uncontrolled asthma and acute health care visits due to asthma was reported by 15% of women and 8% of men. Uncontrolled asthma was associated with smoking, lower educational level, use of reliever treatment most days and acute health care visits. Acute health care visits due to asthma were associated with periodic use of regular controller treatment also after adjustment for uncontrolled asthma.

CONCLUSION: The result indicate poor adherence to asthma treatment which may lead to decreased asthma control and acute health care visits.

IMPACT: Most young adults with asthma are diagnosed and treated in primary care, ideally in a team with a nurse. The main findings highlight the need for evidenced-based nursing interventions, contributing to a more efficient asthma management in primary care. This article is protected by copyright. All rights reserved.

Place, publisher, year, edition, pages
John Wiley & Sons, 2019
Keywords
asthma, health services, nurses, nursing, patient care, primary healthcare, quantitative research, smoking, treatment adherence and compliance, young adult
National Category
Respiratory Medicine and Allergy Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-162645 (URN)10.1111/jan.14174 (DOI)31441107 (PubMedID)
Available from: 2019-08-26 Created: 2019-08-26 Last updated: 2019-09-02
Bjerg, A., Winberg, A., Johansson, R., Berthold, M., Borres, M., Hedman, L., . . . Rönmark, E. (2019). Sensitization to animal allergen components in relation to asthma among young adults in Northern Sweden. Paper presented at Congress of the European-Academy-of-Allergy-and-Clinical-Immunology (EAACI), JUN 01-05, 2019, Lisbon, PORTUGAL. Allergy. European Journal of Allergy and Clinical Immunology, 74, 291-291
Open this publication in new window or tab >>Sensitization to animal allergen components in relation to asthma among young adults in Northern Sweden
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2019 (English)In: Allergy. European Journal of Allergy and Clinical Immunology, ISSN 0105-4538, E-ISSN 1398-9995, Vol. 74, p. 291-291Article in journal, Meeting abstract (Other academic) Published
Place, publisher, year, edition, pages
John Wiley & Sons, 2019
National Category
Respiratory Medicine and Allergy Immunology in the medical area
Identifiers
urn:nbn:se:umu:diva-162872 (URN)000480254002114 ()
Conference
Congress of the European-Academy-of-Allergy-and-Clinical-Immunology (EAACI), JUN 01-05, 2019, Lisbon, PORTUGAL
Note

Supplement: 106

Special Issue: SI 

Meeting Abstract: PD0533

Available from: 2019-09-05 Created: 2019-09-05 Last updated: 2019-09-05Bibliographically approved
Backman, H., Jansson, S.-A., Stridsman, C., Eriksson, B., Hedman, L., Eklund, B.-M., . . . Rönmark, E. (2019). Severe asthma: A population study perspective. Clinical and Experimental Allergy, 49(6), 819-828
Open this publication in new window or tab >>Severe asthma: A population study perspective
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2019 (English)In: Clinical and Experimental Allergy, ISSN 0954-7894, E-ISSN 1365-2222, Vol. 49, no 6, p. 819-828Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Severe asthma is a considerable challenge for patients, health care professionals and society. Few studies have estimated the prevalence of severe asthma according to modern definitions of which none based on a population study.

OBJECTIVE: To describe characteristics and estimate the prevalence of severe asthma in a large adult population-based asthma cohort followed for 10-28 years.

METHODS: N=1006 subjects with asthma participated in a follow-up during 2012-14, when 830 (mean age 59y, 56% women) still had current asthma. Severe asthma was defined according to three internationally well-known criteria: the ATS workshop definition from 2000 used in the US Severe Asthma Research Program (SARP), the 2014 ATS/ERS Task force definition and the GINA 2017. All subjects with severe asthma according to any of these criteria were undergoing respiratory specialist care, and were also contacted by telephone to verify treatment adherence.

RESULTS: The prevalence of severe asthma according to the three definitions was 3.6% (US SARP), 4.8% (ERS/ATS Taskforce), and 6.1% (GINA) among subjects with current asthma. Although all were using high ICS doses and other maintenance treatment, >40% had uncontrolled asthma according to the asthma control test. Severe asthma was related to age >50 years, nasal polyposis, impaired lung function, sensitization to aspergillus, and tended to be more common in women. Further, neutrophils in blood significantly discriminated severe asthma from other asthma.

CONCLUSIONS AND CLINICAL RELEVANCE: Severe asthma differed significantly from other asthma in terms of demographic, clinical and inflammatory characteristics, results suggesting possibilities for improved treatment regimens of severe asthma. The prevalence of severe asthma in this asthma cohort was 4-6%, corresponding to approximately 0.5% of the general population.

Place, publisher, year, edition, pages
John Wiley & Sons, 2019
Keywords
IgE, asthma, eosinophils, epidemiology, lung function, neutrophils
National Category
Public Health, Global Health, Social Medicine and Epidemiology Respiratory Medicine and Allergy
Identifiers
urn:nbn:se:umu:diva-157380 (URN)10.1111/cea.13378 (DOI)000475694600009 ()30817038 (PubMedID)
Available from: 2019-03-18 Created: 2019-03-18 Last updated: 2019-09-09Bibliographically approved
Sawalha, S., Hedman, L., Backman, H., Stenfors, N., Rönmark, E., Lundback, B. & Lindberg, A. (2019). The impact of comorbidities on mortality among men and women with COPD: report from the OLIN COPD study. THERAPEUTIC ADVANCES IN RESPIRATORY DISEASE, 13, Article ID 1753466619860058.
Open this publication in new window or tab >>The impact of comorbidities on mortality among men and women with COPD: report from the OLIN COPD study
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2019 (English)In: THERAPEUTIC ADVANCES IN RESPIRATORY DISEASE, ISSN 1753-4658, Vol. 13, article id 1753466619860058Article in journal (Refereed) Published
Abstract [en]

Background: Comorbidities probably contribute to the increased mortality observed among subjects with chronic obstructive pulmonary disease (COPD), but sex differences in the prognostic impact of comorbidities have rarely been evaluated in population-based studies. The aim of this study was to evaluate the impact of common comorbidities, cardiovascular disease (CVD), diabetes mellitus (DM), and anxiety/depression (A/D), on mortality among men and women with and without airway obstruction in a population-based study. Methods: All subjects with airway obstruction [forced expiratory volume in 1 second (FEV1)/(forced) vital capacity ((F)VC) <0.70, n = 993] were, together with age- and sex-matched referents, identified after examinations of population-based cohorts in 2002-2004. Spirometric groups: normal lung function (NLF) and COPD (post-bronchodilator FEV1/(F)VC <0.70) and additionally, LLN-COPD (FEV1/(F)VC <lower limit of normal). Mortality data was collected until December 2015. Results: In COPD, the prevalence of CVD and DM was higher in men, whereas the prevalence of A/D was higher in women. The cumulative mortality was significantly higher in COPD than NLF, and higher in men than women in both groups. Among women with COPD, CVD and A/D but not DM increased the risk of death independent of age, body mass index, smoking habits, and disease severity, whereas among men DM and A/D but not CVD increased the risk for death. When the LLN criterion was applied, the pattern was similar. Conclusion: There were sex-dependent differences regarding the impact of comorbidities on prognosis in COPD. Even though the prevalence of CVD was higher in men, the impact of CVD on mortality was higher in women, and despite higher prevalence of A/D in women, the impact on mortality was similar in both sexes. The reviews of this paper are available via the supplemental material section.

Place, publisher, year, edition, pages
SAGE PUBLICATIONS LTD, 2019
Keywords
chronic airflow obstruction, co-morbidity, epidemiology, mortality, sex
National Category
Respiratory Medicine and Allergy
Identifiers
urn:nbn:se:umu:diva-162339 (URN)10.1177/1753466619860058 (DOI)000478856400001 ()31291820 (PubMedID)
Available from: 2019-08-16 Created: 2019-08-16 Last updated: 2019-08-16Bibliographically approved
Pakkasela, J., Ilmarinen, P., Honkamaki, J., Tuomisto, L. E., Andersen, H., Piirila, P., . . . Lehtimaki, L. (2018). Age at asthma diagnosis in subjects with and without allergic rhinitis. Paper presented at 28th International Congress of the European-Respiratory-Society (ERS), SEP 15-19, 2018, Paris, FRANCE. European Respiratory Journal, 52
Open this publication in new window or tab >>Age at asthma diagnosis in subjects with and without allergic rhinitis
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2018 (English)In: European Respiratory Journal, ISSN 0903-1936, E-ISSN 1399-3003, Vol. 52Article in journal, Meeting abstract (Other academic) Published
Abstract [en]

Background: Onset of allergic asthma has a strong association with childhood. Much less is known about adult onset asthma and its association with allergy.

Objectives: To assess the proportion of allergic and non-allergic asthma in adulthood in relation to the age at asthma diagnosis.

Methods: Postal questionnaires were sent to 8000 randomly selected recipients aged 20-69 years in Finland in 2016. The participation rate was 52% (n=4173). Asthma was classified allergic when a physician-diagnosed asthma and a physician-diagnosed allergic rhinitis were both reported.

Results: The prevalence of physician-diagnosed asthma and allergic rhinitis were 11% (n=445) and 18%, respectively. Mean ages at diagnosis of allergic asthma and non-allergic asthma were 19 and 35 years, respectively. Among subjects with asthma diagnosis at ages 0-19, 20-39 and 50-69 years, 67%, 55% and 23%, respectively, were allergic. For non-allergic asthma, the incidence rate of asthma was lowest in children and young adults (0.7/1000/year). It increased after middle age and was highest in older age groups (2.4/1000/year in 50-59 years old).

Conclusions: The study results support the well-recognized fact that childhood asthma is mostly allergic. To our knowledge, this is the first study to show that the proportion of allergic asthma steadily declines with advancing age at asthma diagnosis and non-allergic asthma becomes the dominant phenotype with asthma diagnosed in middle age.

Place, publisher, year, edition, pages
European Respiratory Society, 2018
National Category
Respiratory Medicine and Allergy
Identifiers
urn:nbn:se:umu:diva-155987 (URN)10.1183/13993003.congress-2018.PA1154 (DOI)000455567101223 ()
Conference
28th International Congress of the European-Respiratory-Society (ERS), SEP 15-19, 2018, Paris, FRANCE
Note

Supplement: 62

Meeting Abstract: PA1154

Available from: 2019-02-07 Created: 2019-02-07 Last updated: 2019-02-07Bibliographically approved
Hedman, L., Backman, H., Stridsman, C., Bosson, J. A., Lundbäck, M., Lindberg, A., . . . Ekerljung, L. (2018). Association of Electronic Cigarette Use With Smoking Habits, Demographic Factors, and Respiratory Symptoms. JAMA NETWORK OPEN, 1(3), Article ID e180789.
Open this publication in new window or tab >>Association of Electronic Cigarette Use With Smoking Habits, Demographic Factors, and Respiratory Symptoms
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2018 (English)In: JAMA NETWORK OPEN, ISSN 2574-3805, Vol. 1, no 3, article id e180789Article in journal (Refereed) Published
Abstract [en]

IMPORTANCE There is an ongoing debate about whether electronic cigarettes (e-cigarettes) are the solution to the tobacco epidemic or a new public health threat. Large representative studies are needed to study e-cigarette use in the general population, but hardly any have been published. OBJECTIVES To estimate the prevalence of e-cigarette use and to investigate the association of e-cigarette use with smoking habits, demographic factors, and respiratory symptoms. DESIGN, SETTING, AND PARTICIPANTS Cross-sectional, population-based study of random samples of the population, performed within the Obstructive Lung Disease in Northern Sweden (OLIN) study and West Sweden Asthma Study (WSAS). The same validated questionnaire including identical questions was used in OLIN and WSAS. In 2016, OLIN and WSAS conducted postal questionnaire surveys in random samples of adults aged 20 to 75 years. In OLIN, 6519 participated (response rate, 56.4%); in WSAS, 23 753 participated (response rate, 50.1%). MAIN OUTCOMES AND MEASURES Electronic cigarette use, smoking habits, and respiratory symptoms. RESULTS Of 30 272 participants (16 325 women [53.9%]). 3897 (12.9%) were aged 20 to 29 years; 4242 (14.0%). 30 to 39 years; 5082 (16.8%). 40 to 49 years; 6052 (20.0%), 50 to 59 years; 6628 (21.9%), 60 to 69 years; and 4371(14.4%), 70 to 75 years. The number of current smokers was 3694 (12.3%), and 7305 (24.4%) were former smokers. The number of e-cigarette users was 529 (2.0%). and e-cigarette use was more common among men (275 of 12 347 [2.2%; 95% CI, 2.0%-2.5%]) than women (254 of 14 022 [1.8%; 95% CI, 1.6%-2.0%]). Among current smokers. 350 of 3566 (9.8%; 95% CI, 8.8%10.8%) used e-cigarettes compared with 79 of 6875 (1.1%; 95% CI, 0.9%-1.3%) in former smokers and 96 of 15 832 (0.6%; 95% CI, 0.5%-0.7%) in nonsmokers (P < .001). Among e-cigarette users who answered the survey question about cigarette-smoking habits (n = 525). 350 (66.7%; 95% CI, 62.7%-70.7%) were current smokers, 79 (15.0%; 95% CI, 11.9%-18.1%) were former smokers, and 96 (18.3%; 95% CI, 15.0%-21.6%) were nonsmokers (P < .001 for trend). In a regression analysis, e-cigarette use was associated with male sex (odds ratio [OR], 1.35; 95% CI. 1.12-1.62); age groups 20 to 29 years (OR. 2.77; 95% CI, 1.90-4.05), 30 to 39 years (OR, 2.27; 95% CI, 1.53-3.36), 40 to 49 years (OR, 1.65; 95% CI, 1.11-2.44). and 50 to 59 years (OR, 1.47; 95% CI, 1.01-2.12); educational level at primary school (OR, 1.99; 95% CI, 1.51-2.64) and upper secondary school (OR, 1.57; 95% CI, 1.25-1.96); former smoking (OR. 2.37; 95% CI, 1.73-3.24); and current smoking (OR. 18.10; 95% CI, 14.19-23.09). All respiratory symptoms were most common among dual users and former smokers and nonsmokers who used e-cigarettes. CONCLUSIONS AND RELEVANCE Use of e-cigarettes was most common among smokers, and dual users had the highest prevalence of respiratory symptoms. On a population level, this study indicates that the present use of e-cigarettes does not adequately serve as a smoking cessation tool.

Place, publisher, year, edition, pages
American Medical Association, 2018
National Category
Public Health, Global Health, Social Medicine and Epidemiology Substance Abuse
Identifiers
urn:nbn:se:umu:diva-154863 (URN)10.1001/jamanetworkopen.2018.0789 (DOI)000452641400010 ()
Available from: 2019-01-03 Created: 2019-01-03 Last updated: 2019-01-03Bibliographically approved
Backman, H., Jansson, S.-A., Stridsman, C., Muellerova, H., Wurst, K., Hedman, L., . . . Rönmark, E. (2018). Chronic airway obstruction in a population-based adult asthma cohort: Prevalence, incidence and prognostic factors. Respiratory Medicine, 138, 115-122
Open this publication in new window or tab >>Chronic airway obstruction in a population-based adult asthma cohort: Prevalence, incidence and prognostic factors
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2018 (English)In: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 138, p. 115-122Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Asthma and COPD may overlap (ACO) but information about incidence and risk factors are lacking. This study aimed to estimate prevalence, incidence and risk factors of chronic airway obstruction (CAO) in a population-based adult asthma cohort.

METHODS: /FVC<0.7.

RESULTS: decline and higher levels of neutrophils than asthma only. Smoking, older age and male sex were independently associated with increased risk for both prevalent and incident CAO, while obesity had a protective effect.

CONCLUSIONS: In this prospective adult asthma cohort, the majority did not develop CAO. Smoking, older age and male sex were risk factors for prevalent and incident CAO, similar to risk factors described for COPD in the general population.

Place, publisher, year, edition, pages
W.B. Saunders Ltd, 2018
Keywords
ACO, Asthma, Epidemiology, Longitudinal study, Risk factors
National Category
Respiratory Medicine and Allergy
Identifiers
urn:nbn:se:umu:diva-147915 (URN)10.1016/j.rmed.2018.03.036 (DOI)000432442400017 ()29724382 (PubMedID)2-s2.0-85045212522 (Scopus ID)
Available from: 2018-05-22 Created: 2018-05-22 Last updated: 2018-06-27Bibliographically approved
Backman, H., Ekerljung, L., Eriksson, B., Stridsman, C., Mincheva, R., Hedman, L., . . . Lundback, B. (2018). Decrease in prevalence of COPD in Sweden after decades of decrease in smoking. Paper presented at 28th International Congress of the European-Respiratory-Society (ERS), SEP 15-19, 2018, Paris, FRANCE. European Respiratory Journal, 52
Open this publication in new window or tab >>Decrease in prevalence of COPD in Sweden after decades of decrease in smoking
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2018 (English)In: European Respiratory Journal, ISSN 0903-1936, E-ISSN 1399-3003, Vol. 52Article in journal, Meeting abstract (Other academic) Published
Abstract [en]

Background: The smoking prevalence in Sweden has steadily decreased during three decades. The prevalence of COPD in Sweden in the 1990s and around the millennium shift was similar to neighboring European countries, i.e. estimated at 11-17%, and of moderate to severe COPD to 7-11%, in ages over 40y.

Aim: Has the prevalence of chronic airway obstruction (CAO) and of COPD in Sweden decreased after decades of decreasing smoking prevalence?

Methods: Within two large scale population studies in progress, the West Sweden Asthma Study (WSAS) and the Obstructive Lung Disease in Northern Sweden Studies (OLIN), the prevalence of COPD in ages 41-72y was calculated among randomly selected subjects from the general population in 2009-2012. The following post-bronchodilator definitions were used; CAO: FEV1/FVC<LLN and FEV1/FVC<0.7; moderate to severe CAO: FEV1/FVC<LLN with FEV1<LLN, and FEV1/FVC<0.7 with FEV1<80% of predicted. In line with the GOLD 2017 guidelines, both CAO and respiratory symptoms were required for the diagnosis of COPD.

Results: The prevalence of CAO based on the FEV1/FVC<LLN and FEV1/FVC<0.7 criteria, respectively, was 6.4% and 10.3%, while the corresponding prevalence of COPD was 5.6% and 8.4%. The prevalence of moderate to severe CAO was 4.0% (LLN-criterion) and 5.0% (fixed ratio-criterion) and of moderate to severe COPD 3.8% and 4.4%, respectively. Main risk factors for both CAO and COPD were smoking, male sex and increasing age.

Conclusion: As prevalence of COPD defined as chronic airway obstruction before and around the millennium shift was estimated at 11-17% in ages >40 years, the prevalence of COPD has decreased in Sweden, and the decrease in smoking over decades is probably the main causal factor.

Place, publisher, year, edition, pages
European Respiratory Society, 2018
National Category
Respiratory Medicine and Allergy
Identifiers
urn:nbn:se:umu:diva-155981 (URN)10.1183/13993003.congress-2018.OA1935 (DOI)000455567100075 ()
Conference
28th International Congress of the European-Respiratory-Society (ERS), SEP 15-19, 2018, Paris, FRANCE
Note

Supplement: 62

Meeting Abstract: OA1935

Available from: 2019-02-07 Created: 2019-02-07 Last updated: 2019-02-07Bibliographically approved
Andersson, M., Backman, H., Nordberg, G., Hagenbjörk, A., Hedman, L., Eriksson, K., . . . Rönmark, E. (2018). Early life swimming pool exposure and asthma onset in children: a case-control study. Environmental health, 17, Article ID 34.
Open this publication in new window or tab >>Early life swimming pool exposure and asthma onset in children: a case-control study
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2018 (English)In: Environmental health, ISSN 1476-069X, E-ISSN 1476-069X, Vol. 17, article id 34Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Trichloramine exposure in indoor swimming pools has been suggested to cause asthma in children. We aimed to investigate the risk of asthma onset among children in relation to individual trichloramine exposure.

METHODS: A longitudinal nested case-control study of 337 children with asthma (cases) and 633 controls aged 16-17 years was performed within a population-based cohort from The Obstructive Lung Disease in Northern Sweden studies (OLIN). Year of asthma onset and exposure time at different ages were obtained in telephone interviews. Trichloramine concentrations in the pool buildings were measured. Skin prick test results for inhalant allergens were available from previous examinations of the cohort. The risk for asthma was analyzed in relation to the cumulative trichloramine exposure before onset of asthma.

RESULTS: Swimming pool exposure in early life was associated with a significantly higher risk of pre-school asthma onset. A dose-response relationship between swimming pool exposure and asthma was indicated in children with asthma onset at 1 year of age. Children who were both sensitized and exposed had a particularly high risk.

CONCLUSIONS: Early life exposure to chlorinated swimming pool environments was associated with pre-school asthma onset.

Place, publisher, year, edition, pages
BioMed Central, 2018
Keywords
Asthma, Children, Swimming, Trichloramine
National Category
Occupational Health and Environmental Health
Identifiers
urn:nbn:se:umu:diva-146654 (URN)10.1186/s12940-018-0383-0 (DOI)000429733700001 ()29642932 (PubMedID)
Available from: 2018-04-16 Created: 2018-04-16 Last updated: 2018-06-09Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-0553-8067

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