A platform for collaborations in respiratory research in Sweden
Anchor: intro

Introduction

OLIN is an epidemiological research program about asthma, allergies and chronic obstructive pulmonary disease (COPD). We perform classical epidemiological studies and the methods used include cross-sectional, longitudinal, case-control and clinical studies mainly of general population samples. In total, seven adult cohorts and three paediatric cohorts have been recruited and almost all cohorts have been examined on two or more occasions. Around 50,000 individuals have participated, the youngest are aged 7 years and there is no upper age limit – the oldest individuals were born in 1919. The OLIN studies have so far published more than 200 original and review articles.

Research is conducted along the following lines of research:

  1. Asthma and allergies among adults
  2. Asthma and allergies among children
  3. COPD

The overall aim of the OLIN studies is to prevent obstructive lung diseases. In order to achieve this aim, our research is focused on the following aspects:

  • Prevalence and incidence of asthma, COPD and other obstructive lung diseases and symptoms of the respiratory tract
  • The natural course of diseases, i.e. the development, involving both deterioration and improvement, and the causes of these
  • The effects of early life factors, life style factors, living conditions, as well as various environmental and occupational exposures
  • Consequences of the diseases measured as e.g. health care consumption, health-related quality of life and health economic costs for the individual and the society

The research started in 1985 and since then it has developed from being one research project into a comprehensive range of activities, with links to research groups in several European countries, the U.S.A., Asia, Australia and New Zealand. The OLIN team is multidisciplinary and consists of a broad range of occupations including physicians, nurses, physiotherapists, statisticians, behavioural scientists, and the academic degrees range from master and PhD students to professors. OLIN have a long history of performing large epidemiological studies, both through postal questionnaire surveys and detailed clinical examinations. The clinical examinations have mainly included lung function measurements with dynamic spirometry, bronchial provocation test with methacholine, fraction of exhaled nitric oxide, measurement of height and weight for classification of body mass index (BMI), body composition through bioelectric impedance and various biological and blood samples, including inflammatory markers, allergy testing with specific IgE, and skin prick tests. We have also linked our epidemiological data with information from national registers maintained by Statistics Sweden, The National Board of Health and Welfare and The Swedish Social Insurance Agency.

Anchor: Main sub-projects

Main sub-projects

Anchor: Asthma and allergy among adults

Asthma and allergy among adults

Background

Adult asthma is a common but heterogeneous disease with a history of increasing prevalence, and studies of asthma incidence, remission and prevalence trends and associated risk factors require large population-based studies. Adults with asthma can either have had asthma persisting from childhood, or a more recent onset in adulthood. Adult onset asthma is predominantly non-allergic and more common among women, while childhood asthma is predominantly allergic and more common among boys. The allergic asthma phenotype is typically characterized by type 2 immune response associated with increased IgE levels, and often but not always eosinophilic inflammation and higher levels of fractional exhaled nitric oxide (FeNO), which also are biomarkers predicting treatment response. Less is known about the non-allergic adult asthma phenotype, which typically has worse treatment response. Actually, little is known overall about long-term prognosis for different adult asthma phenotypes, as such studies require large cohort studies with detailed clinical data and long follow-up time. Studies on asthma and allergy in adults have been ongoing within OLIN since 1985, and clinical follow-ups are repeatedly performed. Further, the large data sets have recently been linked to national registers to enable studies of registry-based outcomes including cause-specific mortality, hospitalizations, secondary care visits, medication use, and sick-leave.

Aims

The overarching aim is to identify modifiable risk factors for asthma and allergy in adults, and for different asthma phenotypes, in order to enable preventive measures. Further, knowledge about incidence, remission and prevalence trends is important. We also aim to identify and characterize clinically relevant adult asthma phenotypes, and to determine prognosis for the different phenotypes in terms of severity, persistence and remission of disease, as well as in relation to register linked outcomes such as mortality, hospitalizations, and secondary care utilization.

Group members currently working on the project

Katja Warm
Tomi Myrberg
Malin Axelsson
Petri Räisänen
Linnea Almqvist
Nicolas Bermudez Baron
Sofia Winsa Lindmark
Stina Selberg
Caroline Stridsman
Anne Lindberg
Eva Rönmark
Helena Backman, PI


Anchor: Asthma and allergy among children

Asthma and allergy among children

Background

Asthma and allergic conditions such as rhinitis, eczema and allergic sensitization are common in children and teenagers. There are only a few prospective population-based studies that have followed a cohort from childhood until adulthood. Thus, there is limited knowledge on the long-term prognosis of childhood onset asthma and allergic sensitization, including the importance of co-morbidity with other allergic conditions and clinical characteristics that predict the development and/or persistence of the conditions. Since 1996, the OLIN studies have recruited three pediatric cohorts, ten years apart. We perform repeated cross-sectional surveys in order to study time trends in prevalence; and longitudinal studies to estimate incidence, remission and relapse of asthma and allergic conditions.

Aims

The overall aim is to increase the knowledge about asthma and allergic diseases and their development from childhood until adulthood. Another aim is to identify different trajectories of asthma, allergic conditions and lung function from childhood until adulthood and how they relate to clinical characteristics, environmental exposures, lifestyle factors, age of asthma onset, disease severity, prognosis and co-morbidities.

Group members working on the project

Linnea Almqvist
Joakim Bunne
Rebecca Johansson
Nicolas Bermudez Baron
Maja af Klinteberg
Martin Andersson
Anna Winberg
Anders Bjerg
Eva Rönmark
Linnea Hedman, PI


Anchor: Chronic Obstructive Pulmonary Disease (COPD)

Chronic Obstructive Pulmonary Disease (COPD)

Background

Chronic Obstructive Pulmonary Disease, COPD, is a common disease with an estimated global prevalence of around 10%. The most well-known risk factors in high- and medium income countries are tobacco smoking and increasing age, while globally also exposure from burning biomass. COPD is estimated to be the third most common cause of death and the burden of disease is high both for the patient, health care and society. Still, the underdiagnosis is large and up to 50-70% of all cases with COPD are not identified by health care. Thus, register studies based on data from health care registers and corresponding studies will largely underestimate the burden of disease and provide results with a skewed picture of COPD and the impact of disease. To increase the knowledge regarding risk factors, prognosis, course of disease and thereto associated underlying disease mechanisms, population-based studies are needed.

Within the OLIN-studies, we have recruited a large population-based COPD-cohort together with age- and sex- matched non-obstructive controls (the OLIN COPD study). The study population has been invited to annual examinations and the longitudinal database now includes more than 10 years of follow-up with multiple measurements.

Aims

The overall aim is to increase the knowledge about COPD and the course of the disease at the population level, that is, taking the known underdiagnosis into account. Another aim is to identify different lung function trajectories and how they relate to clinical characteristics, environmental exposure, lifestyle factors, disease severity, prognosis, and comorbidities. In addition, through a translational approach, to study biomarker profiles in relation to disease course and prognosis.

Group members working on the project

Ulf Nilsson
Jonas Eriksson Ström
Tomi Myrberg
Caroline Stridsman
Helena Backman
Anne Lindberg, PI


Anchor: Investigators and study personnel

Investigators and study personnel

Linnea Hedman, head of the OLIN studies, principal investigator of the research line Asthma and Allergy among children, Region Norrbotten, Department of Public Health and Clinical Medicine, Section of Sustainable Health, Umeå University
Eva Rönmark, researcher and pioneer principal investigator, former head of the OLIN studies, Region Norrbotten, Department of Public Health and Clinical Medicine, Section of Sustainable Health, Umeå University
Helena Backman, researcher and principal investigator of the research line Asthma and Allergy among adults, The OLIN studies, Region Norrbotten, Department of Public Health and Clinical Medicine, Section of Sustainable Health, Umeå University
Anne Lindberg, researcher and principal investigator of the research line COPD, The OLIN studies, Region Norrbotten, Department of Public Health and Clinical Medicine, Section of Medicine, Umeå University
Caroline Stridsman, researcher, Department of Public Health and Clinical Medicine, Section of Medicine, Umeå University
Martin Andersson, researcher, Department of Public Health and Clinical Medicine, Section of Sustainable Health, Umeå University
Anna Winberg, researcher, Department of Clinical Sciences, Umeå University
Linnea Almqvist, PhD student, The OLIN studies, Region Norrbotten, and Umeå University
Joakim Bunne, PhD student, The OLIN studies, Region Norrbotten, and Umeå University
Rebecca Johansson, PhD student, The OLIN studies, Region Norrbotten, and Umeå University
Petri Räisänen, PhD student, The OLIN studies, Region Norrbotten, and Umeå University
Sofia Winsa Lindmark, PhD student, The OLIN studies, Region Norrbotten, and Umeå University
Stina Selberg, PhD student, The OLIN studies, Region Norrbotten, and Umeå University
Nicolas Bermudez Baron, PhD student, Umeå University
Johanna Myrhaug, Research nurse, The OLIN studies, Region Norrbotten
Annica Blomqvist, Research nurse, The OLIN studies, Region Norrbotten
Jenny Nilsson, Research nurse, The OLIN studies, Region Norrbotten
Katarina Beckman, Research assistant, The OLIN studies, Region Norrbotten

Anchor: Responsible university or institution

Responsible university or institution

Region Norrbotten and Department of Clinical Medicine and Public Health, Umeå University.

Anchor: Collaborators

Collaborators

West Sweden Asthma Study (WSAS)
• The Nordic EpiLung study
• Seinäjoki Adult Asthma Study, Finland
The Trøndelag Health Study (The HUNT Study), Norway
• The FinEsS Studies
European Respiratory Society
• TPM, University of Virginia, USA
• MP, Columbia University, New York, USA
• Lam, Ho Chi Min, Vietnam
• Anders Blomberg, Umeå University, Sweden

Anchor: Funders

Funders

Swedish Heart-Lung Foundation
Swedish Asthma-Allergy Foundation
Swedish Research Council
FORTE
NordForsk
Region Norrbotten
Umeå University (ALF)
VISARE NORR

Anchor: How to collaborate with OLIN

How to collaborate with OLIN

We welcome potential collaborators to any of our sub-projects. Please contact the project lead (PI) for the sub-project you are interested in or write to any of the contact persons below.

Anchor: contacts

Contacts

Linnea Hedman
Email: linnea.hedman@norrbotten.se

Helena Backman
Email: helena.backman@norrbotten.se

Anne Lindberg
Email: anne.lindberg@umu.se

Anchor: publications

Key publications

Backman H, Blomberg A, Lundquist A, Strandkvist V, Sawalha S, Nilsson U, Eriksson-Ström J, Hedman L, Stridsman C, Rönmark E, Lindberg A. Lung Function Trajectories and Associated Mortality Among Adults with and without Airway Obstruction. Am J Respir Crit Care Med. 2023 Nov 15;208(10):1063-1074.

Rönmark E, Lundbäck B, Jönsson E, Jonsson A-C, Lindström M, Sandström T. Incidence of asthma in adults – report from the Obstructive Lung Disease in Northern Sweden study. Allergy 1997; 52: 1071-78.

Rönmark E, Jönsson E, Platts-Mills TAE, Lundbäck B. Different pattern of risk factors for atopic and nonatopic asthma among children – report from the Obstructive Lung Disease in Northern Sweden Study. Allergy 1999; 54: 926-35.

Perzanowski M, Rönmark E, Platts-Mills TAE, Lundbäck B. Effect of cat and dog ownership on sensitization and development of asthma among preteenage children. Am J Respir Crit Care Med 2002; 166: 696-702.

Jansson S-A, Andersson F, Borg S, Ericsson Å, Jönsson E, Lundbäck B. The costs of COPD in Sweden according to disease severity. Chest 2002; 122: 1994-2002.

Lundbäck B, Lindberg A, Lindström M, Rönmark E, Jonsson A-C, Jönsson E, Larsson L-G, Andersson S, Sandström T, Larsson K. Not 15 but 50% of smokers develop COPD? – Report from the Obstructive Lung Disease in Northern Sweden Studies. Respir Med 2003; 97: 115-22.

Lindberg A, Jonsson A-C, Rönmark E, Lundgren R, Larsson L-G, Lundbäck B. Ten-year cumulative incidence of COPD and risk factors for incident disease in a symptomatic cohort. Chest 2005; 127: 1544-52. 

Rönmark E, Andersson C, Nyström L, Forsberg B, Järvholm B, Lundbäck B. Obesity increases the risk of incident asthma among adults. Eur Respir J 2005; 25: 282-8.

Lindberg A, Bjerg-Bäcklund A, Rönmark E, Larsson LG, Lundbäck B.  Prevalence and underdiagnosis of COPD by disease severity and the attributable fraction of smoking – Report from the Obstructive Lung Disease in Northern Sweden Studies. Respir Med  2006; 100: 264-72.

Rönmark E, Bjerg A, Perzanowski MS, Platts-Mills TAE, Lundbäck B.  Major increase in allergic sensitization in schoolchildren from 1996 to 2006 in northern Sweden. J Allergy Clin Immunol 2009;124:357-63.

Hedman L, Bjerg A, Sundberg S, Forsberg B, Rönmark E. Both environmental tobacco smoke (ETS) and personal smoking are associated to asthma and wheeze among adolescents. Thorax;2011;66:20-5. 

Warm K, Backman H, Lindberg A, Lundbäck B, Rönmark E. Low incidence and high remission of allergic sensitization among adults. J Allergy Clin Immunol. 2012;129:136-42.

Andersson M, Hedman L, Bjerg A, Forsberg B, Lundbäck B, Rönmark E. Remission and persistence of asthma followed from 7 to 19 years of age. Pediatrics 2013;132:e435-42

Backman H, Lindberg A, Odén A, Ekerljung L, Hedman L, Kainu A, Sovijärvi A, Lundbäck B, Rönmark E. Reference values for spirometry – Report from the Obstructive Lung Disease in Northern Sweden (OLIN) studies. European Clinical Respiratory Journal 2015;15:26.

Winberg A, West C, Strinnholm Å, Nordström L, Hedman L, Rönmark E. Assessment of allergy to milk, egg, cod, and wheat in Swedish schoolchildren. A population based cohort study. PLoS One. 2015;10:e0131804.

Perzanowski MS, Ronmark E, James HR, Hedman L, Schuyler AJ, Bjerg A, Lundback B, Platts-Mills TA.Relevance of specific IgE antibody titer to the prevalence, severity, and persistence of asthma among 19-year-olds in northern Sweden.J Allergy Clin Immunol.

Rönmark E, Warm K, Bjerg A, Backman H, Hedman L, Lundbäck B.  High incidence and persistence of airborne allergen sensitization up to age 19 years.  Allergy.  2017;72:723-730.

Backman H, Räisänen P, Hedman L, Stridsman C, Andersson M, Lindberg A, Lundbäck B, Rönmark E. Increased prevalence of allergic asthma from 1996 to 2006 and further to 2016-results from three population surveys. Clin Exp Allergy. 2017;47:1426-1435.

Hedman L, Backman H, Stridsman C, Bosson JA, Lundbäck M, Lindberg A, Rönmark E, Ekerljung L. Association of Electronic Cigarette Use With Smoking Habits, Demographic Factors, and Respiratory Symptoms. JAMA Network Open. 2018;1:e180789.

Backman H, Jansson SA, Stridsman C, Eriksson B, Hedman L, Eklund BM, Sandström T, Lindberg A, Lundbäck B, Rönmark E. Severe asthma-A population study perspective. Clin Exp Allergy. 2019;49:819-828

Backman H, Vanfleteren L, Lindberg A, Ekerljung L, Stridsman C, Axelsson M, Nilsson U, Nwaru B, Sawalha S, Eriksson B, Hedman L, Rådinger M, Jansson S-A, Ullman A, Kankaanranta H, Lötvall J, Rönmark E, Lundbäck E. Decreased COPD prevalence in Sweden after decades of decrease in smoking. Respir Res. 2020;21(1):283. 

Almqvist L, Rönmark E, Stridsman C, Backman H, Lindberg A, Lundbäck B, Hedman L. Remission of adult onset asthma is rare – a 15 year follow-up study. ERJ Open Res 2020; 6(4):00620-2020.

Bunne J, Hedman L, Perzanowski M, Bjerg A, Winberg A, Andersson M, Lundbäck B, Platts-Mills T, Rönmark E. The majority of children sensitized before school-age develop allergic disease before adulthood: a longitudinal population-based study. J Allergy Clin Immunol Pract. 2021 Oct 22:S2213-2198(21)01142-9.

Räisänen P, Backman H, Hedman L, Andersson M, Stridsman C, Kankaanranta H, Ilmarinen P, Andersen H, Piirila P, Lindberg A, Lundbäck B, Rönmark E. High but stable incidence of adult-onset asthma in northern Sweden over the last decades. ERJ Open Res 2021; 7(3):00262-2021.

Anchor: links

Links

WSAS – West Sweden Asthma Study at the University of Gothenburg
Krefting Research Centre