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Personnel

• Linda Bagrade
• Guna Casno
• Dr Marcis Leja
• Inga Novikova
• Dina Sebre
• Assistant Professor Vija Svabe

In the ninetieths, last century, something happened in Latvia – or maybe in the whole world? We, children pulmonologists and allergologists, noticed that prevalence of asthma in children is increasing. There was new theoretical basis, new asthma clinical criteria and medicine. We ourselves made National Asthma Guidelines, taking example from other countries and begun to teach new allergologists. But we did not organise prevalence studies.

And then arrived professor Bjorksten – with offer to take part in International Study of Asthma and Allergy in Children. ISAAC Phase One was performed by Marcis Leja, who organised special institution for that purpose – Human Ecology Institute. From 1994 till 1995 with help of paediatricians in two centres – Riga and Rural Latvia two age groups of children completed questionnaires about asthma and allergies.

ISAAC PHASE ONE IN LATVIA

Having been involved in number of ecology-related epidemiology projects in our country, we got excited of the ISAAC Project idea as well as the possibility for our country to participate in the project. We have been impressed by the enthusiasm of our later regional co-ordinator Professor Bengt Björksten and were happy to work with him as well as other ISAAC investigators. Close to half of the population of our country is concentrated in and around its capital – Riga. By considering the potential disease epidemiology differences between urban and rural regions we decided to achieve the maximum goal – to run a centre either in Riga or in the rural part of the country. And we were happy indeed that the set goal was achieved! There are three major issues to be pointed out – the expertise, the epidemiology, and the involvement.

THE EXPERTISE

For Latvia, having been separated from the western world for many years by the Soviet Union, this was one of the first great opportunities to get involved in a well-designed truly global research project. The design of the study, thorough translation process of the questionnaires to the local language, data entry and many other issues – all this was a great educational process for ourselves to apply this knowledge for further study design by ourselves already following the involvement to ISAAC.

THE EPIDEMIOLOGY

I recall the provocative statement of our regional co-ordinator Bengt Björksten that the key to the pathogenesis of allergies is laying in the Baltic region due to rapid changes in the lifestyle being determined by the political situation. Once westernized Baltic States were forced to accept the Soviet lifestyle in the 20-ies of the previous century; and then once more rapid changes to the westernized style of life by 90-ies – this has definitely left an influence. Even though the pathogenesis of allergic and many other diseases have not been finally elucidated until today, there is much truth in this consideration. We do find differences in the prevalence not only in allergic disease, but also other diseases, including inflammatory bowel disease, Barrett’s oesophagus, etc.; in addition we observe changing epidemiology of these diseases. And there is much space and need to run well-designed epidemiology studies with these and other diseases – similar to what ISAAC has completed in asthma and allergy.

THE INVOLVEMENT

Although this was a great chance for Latvia to run ISAAC, the practical issues behind this were completely different. This was the time when the government had cut down the funding for research to close than nothing, and this was requiring huge energy and a little bit of success to get the study completed. We acknowledge our sponsors, in particular, the Riga Commercial Port as well as Latvian Council of Science to get the project on track. Nevertheless this would not have been possible without the active involvement of a group of enthusiastic people, at that time being joined by the ECO club of the former Riga Medical Institute. My special thanks to paediatrician- allergologist Ieva C?rule and our technical manager – Uldis Ziedi?š.

M?rcis Leja
National co-ordinator of ISAAC Phase I in Latvia
Associate professor at the Faculty of Medicine, University of Latvia
Head of the Dept. of Research, Riga East University hospital

ISAAC PHASE TWO & THREE IN LATVIA

The next stage was, when Marcis Leja decided to become a gastroenterologist and not to continue with ISAAC. Our colleges in Latvian Children Clinical University Hospital trusted me to attend instruction about ISAAC Phase Two in Linkoping and further – all organisations.

Professor Bengt Bjorksten, regional coordinator of ISAAC for Northern and Eastern Europe, certified me as a national coordinator in Latvia of ISAAC Phase 2 and 3 studies. He told that European Union decided to support the ISAAC studies as a Concerted Action and there will be funds to cover the costs for skin prick reagents and we may borrow the necessary equipment from Linkoping University Hospital Pulmonology department that will allow as performing lung function tests with hypertonic saline. That information answered all essential questions and confirmed that it is considered as important to include Riga in this major European and Global collaborative effort.

In ISAAC Phase Two we had one centre – Riga, we worked from 1999 till 2001 in 11 schools and collaborators were: Dina Sebre, Guna Casno, Inga Novikova, Linda Bagrade, all – postgraduate students in paediatrics, from Children Clinical University Hospital, Riga, Vienibas gatve 45. Parents completed questionnaires, skin was examined, skin prick tests performed and bronchial responsiveness to hypertonic saline examined.

ISAAC Phase Three in Latvia (year 2004) was as repetition of Phase One, but not so successful. Only one collaborator helped me – Dina Sebre – now paediatrician – allergologist . She hoped that study could be part of her thesis, but she did not continue. 1354 13 – 14 year olds were involved and 425 6 – 7 year olds (but they were no accepted), so we have results only about adolescents. It is interesting, that prevalence of asthma has a very small increase – in ten years – from 8.3% to 10, 5%. I suppose – maybe it is because of poorly developed industry in Latvia and it is good?

Now we are using GINA Guidelines for asthma diagnosing and treatment. But our most serious problem is “wheezing disorders in preschool children” and my personal (as pulmonologist) – cystic fibrosis.

Vija Svabe
Docent (or assistant professor)
Pediatrics Chair, Riga Stradins University
Dzirciema str 16, Riga, LATVIA
Paediatrician, pulmonologist, allergologist
Pulmonology department, Children Clinical University Hospital