Different Labelling of Obstructive Airway Diseases in Estonia, Finland, and Sweden

Abstract

Large differences in prevalence of asthma have been reported between westernised countries and the former Eastern European countries, and still no consensus about the reasons for the differences exists. The aim of this study was to assess diagnostic labelling of obstructive airway diseases, comparing subjects with respiratory symptoms and the diagnoses obtained in Estonia, Finland, and Sweden. A postal questionnaire was sent to population-based random samples, and 44,483 (76%) answers were obtained from the 58,661 invited in 1996. Among men, current smoking was most common in Estonia, 60%, followed by Finland, 39%, and Sweden, 28%. In all three countries, 30% of women were current smokers. Most respiratory symptoms including wheezing were most common in Estonia, also among non-smokers. The prevalence of asthma was 2.0% and chronic bronchitis 10.7% in Estonia, while the opposite was found in Sweden with an asthma prevalence of 7.8% and a chronic bronchitis prevalence of 3.1%. The pattern in Finland was similar to that of Sweden. The same differences between the three countries were found also among young subjects. The total proportion of diagnosed obstructive lung diseases in subjects with respiratory symptoms was similar, but the diagnosis of asthma was considerably more common in Finland and Sweden. Chronic bronchitis was favoured in Estonia, also among young adults irrespectively of what symptoms were present. In a multivariate model with correction for confounders, the risk (OR) for having a diagnosis of asthma was 5.65 (95% CI: 4.86-6.56) when living in Sweden, and 3.51 (95% CI: 3.00-4.12) in Finland, whereas risk for chronic bronchitis was 0.28 (0.25-0.31) and 0.22 (0.19-0.25), respectively, compared to Estonia. The study indicates differences in diagnostic practices of obstructive lung diseases between the three countries.

Heredity of food allergies in an unselected child population: An epidemiological survey from Finland

“…Although the FA testing of the children mostly occurred before our questionnaire survey, the parents’ reports on their own physician‐diagnosed allergies are likely to be an adequate source of data. The prevalences of parental asthma (non‐allergic and allergic) agree well with figures found for the same age groups in another Finnish cohort (28). The parents were born between the 1950s and the 1980s, an era when FAs were rarely diagnosed in early childhood.…”

Occupational irritants and asthma: an Estonian cross-sectional study of 34 000 adults

“….15 years after the end of the Soviet era and after Estonia entered the European Union in 2004. Nonetheless, asthma may remain underdiagnosed in our population [23], leading to a potential misclassification bias. However, one strength of the current study was the relatively precise data on asthma (diagnosis confirmation by a physician, current disease status and use of asthma medication) for such a large population.…”

“…It has been suggested that differences in diagnostic practices in relation to the influence of the former Soviet Union partly explain the lower prevalence of physiciandiagnosed asthma in Estonia compared with western European countries [23]. However, economic, environmental and lifestyle conditions have been evolving rapidly in Estonia since the fall of the socialist system [24].…”

Understanding the pathophysiology of severe asthma to generate new therapeutic opportunities

“…2,5,16 Early-onset severe asthma has a high incidence of accompanying atopy with associated disorders, such as eczema, food allergy, and rhinitis, 17 whereas late-onset asthma is characterized by less atopy 6 but a greater association with occupational exposures 18 and a clinical presentation that is frequently confused with that of chronic bronchitis with frequent infectious exacerbations. 19 From a clinical perspective, lack of adherence to treatment is an important cause for increased asthma severity. There is now strong evidence that a high proportion of patients with severe disease can see improvement through attention to treatment adherence.…”