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Cohort profile: the West Sweden Asthma Study (WSAS): a multidisciplinary population-based longitudinal study of asthma, allergy and respiratory conditions in adults

Journal article
Authors Bright I Nwaru
Linda Ekerljung
Madeleine Rådinger
Anders Bjerg
Roxana Mincheva
Carina Malmhäll
Malin Axelsson
Göran Wennergren
Jan Lötvall
Bo Lundbäck
Published in BMJ open
Volume 9
Issue 6
Pages e027808
ISSN 2044-6055
Publication year 2019
Published at Krefting Research Centre
Institute of Clinical Sciences, Department of Pediatrics
Pages e027808
Language en
Links dx.doi.org/10.1136/bmjopen-2018-027...
www.ncbi.nlm.nih.gov/entrez/query.f...
Keywords adults, allergy, asthma, cohort profile, longitudinal cohort, sweden
Subject categories Respiratory Medicine and Allergy, Epidemiology

Abstract

The West Sweden Asthma Study (WSAS) is a population-representative longitudinal study established to: (1) generate data on prevalence trends, incidence and remission of asthma, allergy and respiratory conditions, (2) elucidate on the risk and prognostic factors associated with these diseases, (3) characterise clinically relevant phenotypes of these diseases and (4) catalyse relevant mechanistic, genomic, genetic and translational investigations.WSAS comprised of randomly selected individuals aged 16 to 75 years who are followed up longitudinally. The first stage involved a questionnaire survey (>42 000 participants) and was undertaken in 2008 and 2016. A random sample (about 8000) of participants in the initial survey undergoes extensive clinical investigations every 8 to 10 years (first investigations in 2009 to 2012, second wave currently ongoing). Measurements undertaken at the clinical investigations involve structured interviews, self-completed questionnaire on personality traits, physical measurements and extensive biological samples.Some of our key findings have shown a 54% increase in the use of asthma medications between the 1990s and 2000s, primarily driven by a five-fold increase in the use of inhaled corticosteroids. About 36% of asthmatics expressed at least one sign of severe asthma indicator, with differential lung performance, inflammation and allergic sensitisation among asthmatics with different signs of severe asthma. Multi-symptom asthmatics were at greater risk of having indicators of severe asthma. In all adults, being raised on a farm was associated with a decreased risk of allergic sensitisation, rhinitis and eczema, but not asthma. However, among adolescents (ie, those 16 to 20 years of age), being raised on a farm decreased the risk of asthma. Personality traits were associated with both beliefs of asthma medication and adherence to treatment.Follow-up of the cohort is being undertaken every 8 to 10 years. The repeated clinical examinations will take place in 2019 to 2022. The cohort data are currently being linked to routine Swedish healthcare registers for a continuous follow-up. Mechanistic, genomic, genetic and translational investigations are ongoing.

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