A National Asthma Programme was undertaken in Finland from 1994 to 2004 to improve asthma care and prevent an increase in costs. The main goal was to lessen the burden of asthma to individuals and society.
The action programme focused on implementation of new knowledge, especially for primary care. The main premise underpinning the campaign was that asthma is an inflammatory disease and requires anti-inflammatory treatment from the outset. The key for implementation was an effective network of asthma-responsible professionals and development of a post hoc evaluation strategy. In 1997 Finnish pharmacies were included in the Pharmacy Programme and in 2002 a Childhood Asthma mini-Programme was launched.
The incidence of asthma is still increasing, but the burden of asthma has decreased considerably. The number of hospital days has fallen by 54% from 110 000 in 1993 to 51 000 in 2003, 69% in relation to the number of asthmatics (n = 135 363 and 207 757, respectively), with the trend still downwards. In 1993, 7212 patients of working age (9% of 80 133 asthmatics) received a disability pension from the Social Insurance Institution compared with 1741 in 2003 (1.5% of 116 067 asthmatics). The absolute decrease was 76%, and 83% in relation to the number of asthmatics. The increase in the cost of asthma (compensation for disability, drugs, hospital care, and outpatient doctor visits) ended: in 1993 the costs were 218 million euro which had fallen to 213.5 million euro in 2003. Costs per patient per year have decreased 36% (from 1611 euro to 1031 euro).
It is possible to reduce the morbidity of asthma and its impact on individuals as well as on society. Improvements would have taken place without the programme, but not of this magnitude.
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There is little information of lower respiratory symptoms, bronchial hyperresponsiveness and airway inflammation in elite ice hockey players. A total of 88 highly trained ice hockey players and 47 control subjects were studied. All the subjects were subjected to skin-prick tests, resting spirometry examinations and histamine-challenge tests. Adequate induced sputum samples were obtained from 68 of the ice hockey players and from 18 symptom-free control subjects on a separate day. Bronchial hyperresponsiveness in a histamine-challenge test was found in 21 (24%) of the athletes and in five (11%) of the controls. Current asthma (current asthmatic symptoms and increased bronchial responsiveness) was observed in 13 (15%) of the athletes and in one (2%) of the control subjects. Total asthma (current asthma or previously physician-diagnosed asthma) occurred in 19 (22%) of the athletes and in two (4%) of the controls. Atopy, according to skin-prick tests, was observed in 51 (58%) of the athletes and 17 (36%) of the control subjects. The differential cell counts of eosinophils (2.6 versus 0.2%) and neutrophils (80.9 versus 29.9%) in the sputum samples of the ice hockey players were significantly higher than in those of the control subjects. Asthma is common in elite ice hockey players and they show signs of a mixed type of neutrophilic and eosinophilic airway inflammation. Inhalation of cold air associated with exposure to indoor pollutants during intensive training is a possible causative factor.
We studied the prevalence of allergic disorders in an unselected group of 708 adolescents aged 15-17 years. All subjects were physically examined and interviewed by the authors. The prevalence of past or present asthma was 5.7% in boys and 3.1% in girls. The figures for hay fever were 14% and 8%, and for atopic dermatitis (including allergic urticaria) 25% and 30%, respectively. In 24% of all symptomatic subjects, the condition had not been active during the year preceding the study. The sex difference in the prevalence of hay fever was significant. It is associated with higher immediate skin test reactivity in boys. A progressive increase in the frequency of allergic disorders was observed with increasing number of positive skin reactions in both boys and girls. Respiratory allergy was closely related to a positive skin test: 87% of the asthmatics and 83% of all those with allergic rhinitis exhibited at least one positive skin reaction. For atopic dermatitis the association was less pronounced. Nineteen per cent of the population studied had a positive symptom history and a positive skin test to pollens, animal epithelia or dusts indicating a clinically significant relationship. However, 39% of the 346 subjects with a positive skin test, including some with a large number of positive reactions, were completely asymptomatic.
Multinational time-trend analyses of atopic disease have shown that the East-West gradients in prevalence are shrinking. We set out to clarify whether the disparities in the occurrence of atopy and atopic diseases in Finnish and Russian Karelia during the past 10 years have diminished and how the prevalence of atopy has evolved with successive years of birth.
Two surveys with identical methodology were performed in 1997/1998 and 2007. The study population comprised randomly selected adults, aged 25-54 years, from Finnish and Russian Karelia. Serum samples were collected for total and specific IgE measurements. Clinical data were obtained by questionnaires.
Sensitization rates to birch pollen increased from 7.8% to 14.8% (P
We studied the biologic activity of allergen preparations using a method involving skin prick tests in humans and the use of HEP (histamine equivalent prick) units. Results were found to be dependent on the population groups used in assays. If populations are not carefully standardized, results may vary by 1 power of 10. Accuracy can also be improved by the use of suitable allergen standard reference preparations, but such were not available to us. Confidence ranges for the biologic activities were relatively wide and varied with the allergen preparation and the population group. Typically, the 95% confidence range included values from one-fifth to five times the estimated HEP value when the number of subjects in the assay was 30 to 50 persons. When the preparations representing the same source material (e.g., timothy pollen) were assayed simultaneously in one population group of this size, a twofold or larger difference in HEP values generally proved significant. An examination of 43 commercial products showed that allergen preparations with biologic activities declared in HEP units had a more uniform biologic activity than those assayed with traditional methods and units (PNU/ml or weight/volume).
Intensive endurance training has been associated with a high prevalence of symptoms compatible with asthma in elite athletes. It is not known, however, whether there is an association between the type of training for competitive events and the risk of asthma in highly trained athletes.
Two hundred and thirteen track and field athletes, mostly from Finnish national teams, and 124 controls of the same age completed a respiratory symptom questionnaire. Positive answers to physician diagnosed asthma were confirmed by personal interviews. The athletes were divided into two groups depending on whether they were speed and power athletes (n = 106) or long distance runners (n = 107).
According to a logistic regression model the prevalence of physician diagnosed asthma was not associated with age, sex, or a family history of asthma. Long distance runners (OR 6.7; 95% CI 2.1 to 22.1) and speed and power athletes (OR 3.2; 95% CI 0.90 to 11.4) had a higher prevalence of physician diagnosed asthma than control subjects. Physician diagnosed asthma was found in 18 of 107 long distance runners (17%), in nine of 106 speed and power athletes (8%; p = 0.07 (chi 2 test)), and in four of 124 controls (3%; p
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To study whether asthma and allergic rhinitis had increased from 1977 to 1991 and if so, in which subpopulations; to study if structural changes of the society or change in the genetic susceptibility of the population could explain the increase.
Cross-sectional surveys with mailed questionnaires in 1977, 1979 and 1991, data from 1977 and 1979 combined; national mortality statistics.
A nationwide sample of 12-, 14-, 16- and 18- year-olds. Sample sizes were 4335 and 3059, response rates 88% and 77%. Mortality statistics from 1958 to 1990.
Point prevalence rate (%) of self-reported, physician-diagnosed asthma and allergic rhinitis, susceptibility of the population measured by probability of respiratory death.
Prevalence of asthma was 1.0% in 1977-1979 and 2.8% in 1991, that of allergic rhinitis 5.0% and 14.9%. Logistic regression analysis showed that the increase did not differ in socio-demographic subgroups or parents' smoking groups and that changes in the distribution of socio-demographic variables did not explain the difference either. Respiratory deaths in ages 0-4 were fewer in the birth cohorts measured in 1991.
Physician-diagnosed asthma and allergic rhinitis increased three-fold among Finnish adolescents in 1977-1991. Factors which explain the increase affected all subgroups similarly. Such factors could be changes in diagnostic practices and indoor air quality. Increased susceptibility could explain only a small part. It is likely that a major part of this considerable increase is real.
We studied the occurrence of asthma, bronchial wheezing, allergic rhinitis and atopic dermatitis in 295 young men aged 18-19 years. The relationship of these symptoms to the immediate skin test reactivity was also determined. Symptoms indicating past or current allergy and bronchial wheezing were observed in 36%. The cumulative prevalence of asthma was 2.7%, bronchial wheezing 9% in addition, allergic rhinitis (including allergic conjunctivitis) 20%, and atopic dermatitis (including allergic urticaria) 20%. Positive immediate skin prick test reactions were observed in 50% of the population. Allergic rhinitis was most clearly connected with a positive skin test. This study shows that the respiratory disorders, generally considered to be allergic in origin, and atopic dermatitis are more common in Finland than has been assumed. The results are, however, in accordance with the observations made in other industrialized countries. Susceptibility to asthmatic reactions and allergic symptoms should be taken into account, more so than at present, when mudging the capability of a young man to manage compulsory military service.