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RESPIRATORY HEALTH IN NOTHERN EUROPE

The RHINE study group is a network created by the scientists from Iceland, Norway, Sweden, Denmark and Estonia who are involved in the European Community Respiratory Health Survey (ECRHS).


ECRHS I

The ECRHS I study was conducted in 1990 to 1994 in order to estimate the variation in the prevalence of asthma and allergy in young adults in Europe and other parts of the world (1). Secondary aims were to estimate variations in exposure to risk factors for asthma: to measure their association with asthma and to estimate the variation in treatment practice for asthma in the International community.

The results of the ECRHS have been summarised in a review (2). The ECRHS has shown that there are large geographical differences in the prevalence of asthma and allergy with high prevalence rates in English speaking countries and low prevalence rates in the Mediterranean region and Eastern Europe (See figure).

The prevalence of asthma in young adults (20-44 years) in different parts of the world:

Analyses of risk factors have highlighted the importance of occupational exposure and allergy against indoor allergens (mite and cat). Analysis of treatment practices has confirmed that the treatment of asthma varies widely between countries and that asthma is often undertreated.


The RHINE study group are now engaged in two projects the RHINE study and the ECRHS II.

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The RHINE II Study

The Respiratory Health in Northern Europe (RHINE) is a follow-up study of participants from seven Northern European centres who participated in European Community Respiratory Health Survey (ECRHS) stage I. The target population for the RHINE study were all subjects (n=21,802) from Reykjavik in Iceland, Bergen in Norway, Umeå, Uppsala and Göteborg in Sweden, Aarhus in Denmark and Tartu in Estonia that participated in stage 1 of the ECRHS (response rate 83.7%). The eligible subjects were sent a postal questionnaire in 1999-2001. In total 16,191 (74.3%) subjects answered the questionnaire.This questionnaire includes questions on respiratory symptoms, asthma, rhinitis, bronchitis, smoking, indoor environment, occupation, early life exposure and sleep disorders.


The aims of the RHINE study are:

1.  To assess the incidence and remission rate of asthma and allergic rhinitis and to      determine risk factors in a representative Nordic population sample.

2.  To assess the influence of occupational and home related environmental exposure      on the development of asthma and allergic rhinitis in Northern Europe.

3.  To investigate the association between the menstrual cycle and asthmatic      symptoms in women.

4.   To assess the incidence and remission of sleep disturbances and determine risk       factors including atopy and asthma.

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ECRHS II

The ECRHS II is a follow-up survey of subjects from 14 countries who participated in the clinical phase of ECRHS I (3,4). The study is funded by the European Commission, as well as other sources of funding, as part of their Quality of Life Programme.The participants answered a detailed structured interview about symptoms, exposure to known or suspected risk factors for asthma, occupation and health service utilisation. Blood was taken for measurement of specific IgE to house dust mite, grass, cat and Cladosporium and DNA extraction (not all centres). Spirometry and methacholine challenge was performed. Health related quality of life was assessed by self completed questionnaires: SF-36 and AQLQ. In a sub-sample home visits were made to measure exposure to house dust mites and cat allergens. Throughout the study outdoor exposure to PM2.5, PM10 and NO2 was measured in the centres participating in the study.


The aims of the ECRHS II study are:

1. To determine the incidence and prognosis of asthma and allergy in adults.

2. To determine and describe the distribution of risk factors associated with the     incidence and prognosis of asthma and allergy.

3. To identify subgroups within the population who may be more susceptible to
    environmental risk factors of asthma and allergy and measure their excess risk.

4. To establish a bank of blood samples for genetic information on asthma and allergy.


Additional protocols in the Nordic centres of the ECRHS II

In the centres in the Northern European countries (Iceland, Norway, Sweden and Estonia) participating in the ECRHS II participants are also asked to fill in a sleep questionnaire, a questionnaire on symptoms of anxiety and depression (HAD) and a questionnaire on symptoms related to the sick building syndrome.

Subjects who made methacholine challenge were asked to rate the level of dyspnea on the Borg scale and inspiratory capacity was measured.
In Göteborg and Uppsala the participants were invited to perform exhaled nitric oxide measurements.

In Reykjavik, Uppsala and Tartu a sub-sample of the participants were invited to participate in an extended indoor air study including measurements of volatile organic compounds (VOC) and airborne micro-organisms.


ECRHS III

The ECRHS III is a follow-up of participants from ECRHS I and II that was conducted between 2011 and 2013. The study basically uses the same methods as the previous studies but some now features have been included:

Sleep questionnaire

Sun light exposure questionnaire

Body composition measured with bio impedance

Spirometry before and after bronchodilation


RHINE III

The RHINE III is a questionnaire based survey of participants from RHINE II. The protocol is again almost the same as in RHINE II but with some additions:

Waist circumference

Body silhouettes

Comorbidities like inflammatory bowel isease

Asthma and allergy in children

A detailed questionnaire on women’s health


Time table

 2001

 The RHINE II study completed

 2002

 The RHINE II study data set complete The protocol paper of the  ECRHS II published (3) The ECRHS II completed

 2003

 The ECRHS II data set complete

 2011

 The RHINE III study completed

 2013

 The ECRHS III study completed

 2014

 The first RHINE III papers published (5,6)



References

1. Burney PG, Luczynska C, Chinn S, Jarvis D. The European Community Respiratory Health Survey. Eur Respir J 1994: 7: 954-960.

2. Janson C , Anto J, Burney P, Chinn S, de Marco R, Heinrich J, Jarvis D, Kuenzli N,Leynaert B, Luczynska C, Neukirch F, Svanes C, Sunyer J, Wjst M The European Community Respiratory Health Survey (ECRHS) so far: what are the main results?
Eur Respir
J 2001; 18: 598-611.

3. The European Community Respiratory Health Survey Steering Committee. The European Community Respiratory Health Survey II. Eur Respir J 2002; 20: 1071–1079.

4. ECRHS, European Community Respiratory Health Survey.http://www.ecrhs.org

5. Johannessen A, Verlato G, Benediktsdottir B, Forsberg B, Franklin K, Gislason T, Holm M, Janson C, Jögi R, Lindberg E, Macsali F, Omenaas E, Gomez Real F, Waatevik Saure E, Schlünssen V, Sigsgaard T, Duelien Skorge T, Svanes C, Torén K, Waatevik M, Miodini Nilsen R, de Marco R. Longterm follow-up in European respiratory health studies – patterns and implications. BMC Pulm Med 2014;14:63.

6. Timm S, Svanes C, Janson C, Sigsgaard T, Johannessen A, Gislason T, Jogi R, Omenaas ER, Forsberg B, Toren K, Holm M, Bråbäck L, Schlünssen V. Place of upbringing in early childhood as related to inflammatory bowel diseases in adulthood - a population-based cohort study in Northern Europe. Eur J Epidemiol  2014;
29:429-437.




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