Læknablaðið - 15.12.2002, Blaðsíða 15

FRÆÐIGREINAR / LUNGU OG HEILSA
Evrópurannsóknin Lungu og heilsa
(ECRHS): Hverjar eru helstu niðurstöður
fram að þessu í ljósi sérstöðu Islands?
Ágrip
Davíð Gíslason1
Unnur Steina
Björnsdóttir1
Þorsteinn Blöndal2
Þórarinn Gíslason1
Inngangur: Evrópurannsóknin Lungu og heilsa (The
European Community Respiratory Health Survey
(ECRHS)) var fyrsta stóra rannsóknin til að kanna
landfræðilegan mun á asma og ofnæmi hjá ungu full-
orðnu fólki þar sem nákvæmlega sama aðferðafræði
og skilgreiningar voru notaðar á öllum rannsóknar-
setrunum sem komu við sögu. Tilgangur þessarar
yfirlitsgreinar er að rekja helstu niðurstöður rann-
sóknarinnar sem birtar hafa verið fram að þessu, með
sérstöku tilliti til stöðu íslenska þýðisins í samanburði
við hinar þátttökuþjóðirnar.
Efniviður: Farið er yfir niðurstöður sem birtar hafa
verið úr sameiginlegum rannsóknargögnum allra þátt-
tökuþjóðanna. Niðurstöðurnar byggja á úrvinnslu-
gögnum frá -140.000 einstaklingum á aldrinum 20-44
ára (fæðingarár 1946-71) frá 22 þjóðum og 48 rann-
sóknarsetrum, þar sem þátttakendur komu meðal
annars frá Reykjavíkursvæðinu. Peir svöruðu póst-
sendum spurningalista með sjö spurningum um ein-
kenni frá öndunarfærum, asma og lyfjanotkun við
asma. í seinni hluta rannsóknarinnar voru valdir 800
einstaklingar af handahófi á hverju rannsóknarsetri
og þeir svöruðu ítarlegum spurningalistum, fóru í
öndunarpróf, auðreitnipróf með metakólíni og pikk-
próf með 11-12 ofnæmisvökum. Auk þess var dregið
blóð fyrir sértækum IgE mótefnum og heildarmagni
IgE. í seinni hlutanum tóku þátt að einhverju eða
öllu leyti 17 þjóðir og 37 rannsóknarsetur.
'Landspítala Vífilsstöðum,
:Landspítala Hringbraut.
Fyrirspurnir og bréfaskipti:
Davíð Gíslason, Landspítala
Fossvogi. Sími: 543 1005,
davidg@landspitali. is
Lykilorð: asmi, bráöaofnœmi,
faraldsfrœði, nýgengi, algengi,
áhœttuþœttir.
ENGLISH SUMMARY
Gíslason D, Björnsdóttir US, Blöndal Þ, Gíslason Þ
European Community Respiratory Health Survey:
The main results so far with special reference to
lceland
Læknablaðið 2002; 88: 891-907
Introduction: The European Community Respiratory
Health Survey (ECRHS) was the first project embarked on
extensive study of geographical difference between
countries with regards to asthma and atopy incidence in a
young adult population. The same methodology and
definitions were used at all study sites. The purpose of this
article is to review the published results of the ECRHS with
a special emphasis on the findings from the lcelandic
population, and compare these results with those from the
participants from the other nations and study sites.
Methods: Compiled results from all study sites partici-
pating in the ECHRS hereto published were reviewed. The
compiled data are derived from approximately 140.000
individuals aged 20-44 (birth-years 1946-71) from 22
nations and 48 study sites. The lcelandic population was
chosen from the greater Reykjavik metropolitan area.
Subjects responded to seven questions on respiratory
symptoms, diagnosis of asthma and use of asthma
medications. In the latter part of the investigation, 800
individuals were randomly selected from each study site.
They were asked to respond to a detailed questionnaire.
Subsequently spirometry, methacholine challange and skin
prick testing to 11-12 common aeroallergens was
performed. Additionally, allergen specific IgE and total IgE
was measured. Somewhat fewer sites participated in this
latter part: 17 nations and 37 study sites.
Results: The findings are presented from two angles: the
compiled data from all study sites and the results from the
lcelandic population; specifically comparing the lcelandic
data with the participants from the other nations.
The study showed a geographical difference in the
incidence of asthma, bronchial hyper- responsiveness and
other respiratory symptoms. In the first part of the study,
an eight-fold difference in wheezing, six-fold difference in
asthma, ten-fold difference in physician- diagnosed
asthma and a four-foid difference in the prevalence of
allergic rhinitis was found between the study sites.
„English-speaking" nations had the highest prevalence of
respiratory diseases and lceland, Spain, Germany, Italy,
Algeria and India had the lowest incidence. A three-fold
difference in the prevalence of allergy and an eight-fold
difference in bronchial responsiveness were found
between study sites in the latter part of the study. The
incidence of asthma was highest in the lower age groups.
Atopy prevalence (defined as a positive specific IgE for
at least one allergen) was highest in Australia. Other
English speaking nations and Switzerland had prevalence
over 40%. Iceland had the lowest prevalence of atopy
(23.6%) and Greece, Norway and Italy all had a prevalence
of atopy under 30%. Total IgE was highest in Greece,
France, Ireland and Italy (>50kU/L), but was lowest in
lceland (13.2 kU/L).
The article speculates on the possible effects of the
environment on the prevalence of wheezing, bronchial
reactivity and atopy in the different study sites.
Summary: Results from the European Community
Respiratory Health Survey demonstrate a substantial
difference in the prevalence of asthma, bronchial
responsiveness and atopy between study sites. The
prevalence was highest in countries where English is the
native language. Of all study sites, the prevalence was
lowest in lceland. In the articles, possible explanations for
this discrepancy are reviewed.
Keywords: asthma, atopy, epidemiology, incidence,
prevalence, risk factor.
Correspondence: Davíð Gíslason, davidag<Slandspitali.is
Læknablaðið 2002/88 891