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Original Article
Prevalence of asthma-like symptoms with ageing
  1. Debbie Jarvis1,2,
  2. Roger Newson3,
  3. Christer Janson4,
  4. Angelo Corsico5,
  5. Joachim Heinrich6,
  6. Josep M Anto7,8,9,10,
  7. Michael J Abramson11,
  8. Anne-Marie Kirsten12,
  9. Jan Paul Zock7,8,9,
  10. Roberto Bono13,
  11. Pascal Demoly14,15,
  12. Bénédicte Leynaert16,
  13. Chantal Raherison17,
  14. Isabelle Pin18,19,
  15. Thorarinn Gislason20,21,
  16. Rain Jogi22,
  17. Vivi Schlunssen23,24,
  18. Cecilie Svanes25,26,
  19. John Watkins27,28,
  20. Joost Weyler29,
  21. Antonio Pereira-Vega30,
  22. Isabel Urrutia31,
  23. Jose A Gullón32,
  24. Bertil Forsberg33,
  25. Nicole Probst-Hensch34,
  26. H Marike Boezen35,
  27. Jesús Martinez-Moratalla Rovira36,37,
  28. Simone Accordini38,
  29. Roberto de Marco38,
  30. Peter Burney1,2
  1. 1 Population Health and Occupational Disease, National Heart and Lung Institute, Imperial College, London, UK
  2. 2 MRC-PHE Centre for Environment and Health, Imperial College London, London, UK
  3. 3 Department of Primary Care and Public Health, Imperial College London, London, UK
  4. 4 Department of Medical Sciences: Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
  5. 5 Division of Respiratory Diseases, IRCCS Policlinico San Matteo Foundation, Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy
  6. 6 Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Clinical Center, Ludwig Maximilian University, Comprehensive Pneumology Centre Munich, German Centre for Lung Research, Muenchen, Germany
  7. 7 ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain
  8. 8 Universitat Pompeu Fabra (UPF), Barcelona, Spain
  9. 9 CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
  10. 10 Institut Municipal d’Investigació Mèdica (IMIM), Barcelona, Spain
  11. 11 School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
  12. 12 Pulmonary Research Institute at Lung Clinic Grosshansdorf, Grosshansdorf, Germany
  13. 13 Department of Public Health and Pediatrics, University of Turin, Turin, Italy
  14. 14 University Hospital of Montpellier, Montpellier, France
  15. 15 Sorbonne Universités, Paris, France
  16. 16 Inserm UMR 1152-Equipe Epidémiologie, Université Paris Diderot, Paris, France
  17. 17 Inserm-U1219 Bordeaux Population Health Research Center, Bordeaux University, Bordeaux, France
  18. 18 INSERM, IAB, Team of Environmental Epidemiology applied to Reproduction and Respiratory Health, Grenoble, France
  19. 19 Department of Pédiatrie, CHU de Grenoble Alpes, Grenoble, France
  20. 20 Department of Respiratory Medicine and Sleep, Landspitali, The National University Hospital of Iceland, Reykjavik, Iceland
  21. 21 Faculty of Medicine, University of Iceland, Reykjavik, Iceland
  22. 22 Tartu University Hospital, Lung Clinic, Estonia, Europe
  23. 23 Department of Public Health, Aarhus University, Aarhus, Denmark
  24. 24 National Research Centre for the Working Environment, Copenhagen, Denmark
  25. 25 Centre for International Health, University of Bergen, Bergen, Norway
  26. 26 Department of Occupational Medicine, Haukeland University Hospital, Bergen, Norway
  27. 27 Public Health Wales, Cardiff, Wales
  28. 28 University of Cardiff, Cardiff, Wales
  29. 29 Department of Epidemiology and Social Medicine (ESOC), Faculty of Medicine and Health Sciences, StatUA Statistics Centre, University of Antwerp, Antwerp, Belgium
  30. 30 Respiratory and Allergy Clinical Unit, Universitary Hospitalary Complex, Huelva, Spain
  31. 31 Department of Respiratory, Galdakao Hospital, Galdakao, Spain
  32. 32 Servicio Neumología, Hospital Universitario San Agustín, Avilés, Spain
  33. 33 Public Health and Clinical Medicine, Occupational and Environmental Medicine, University of Umea, Umea, Sweden
  34. 34 Department Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
  35. 35 Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
  36. 36 Servicio de Neumología, Complejo Hospitalario Universitario, Albacete, Spain
  37. 37 Facultad de Medicina Albacete, University of Castilla-La Mancha, Ciudad Real, Spain
  38. 38 Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
  1. Correspondence to Professor Debbie Jarvis, Population Health and Occupational Disease, Imperial College, National Heart and Lung Institute, Emmanuel Kaye Building, London SW3 6LR, UK; d.jarvis{at}imperial.ac.uk

Abstract

Background Change in the prevalence of asthma-like symptoms in populations of ageing adults is likely to be influenced by smoking, asthma treatment and atopy.

Methods The European Community Respiratory Health Survey collected information on prevalent asthma-like symptoms from representative samples of adults aged 20–44 years (29 centres in 13 European countries and Australia) at baseline and 10 and 20 years later (n=7844). Net changes in symptom prevalence were determined using generalised estimating equations (accounting for non-response through inverse probability weighting), followed by meta-analysis of centre level estimates.

Findings Over 20 years the prevalence of ‘wheeze’ and ‘wheeze in the absence of a cold’ decreased (−2.4%, 95% CI −3.5 to −1.3%; −1.5%, 95% CI −2.4 to −0.6%, respectively) but the prevalence of asthma attacks, use of asthma medication and hay fever/nasal allergies increased (0.6%, 95% CI 0.1 to 1.11; 3.6%, 95% CI 3.0 to 4.2; 2.7%, 95% CI 1.7 to 3.7). Changes were similar in the first 10 years compared with the second 10 years, except for hay fever/nasal allergies (increase seen in the first 10 years only). Decreases in these wheeze-related symptoms were largely seen in the group who gave up smoking, and were seen in those who reported hay fever/nasal allergies at baseline.

Interpretation European adults born between 1946 and 1970 have, over the last 20 years, experienced less wheeze, although they were more likely to report asthma attacks, use of asthma medication and hay fever. Decrease in wheeze is largely attributable to smoking cessation, rather than improved treatment of asthma. It may also be influenced by reductions in atopy with ageing.

  • Asthma Epidemiology

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Footnotes

  • Contributors All authors have contributed to the conception or design of the ECRHS or to the acquisition, analysis or interpretation of ECRHS data herein and have contributed to the drafting and revision of the manuscript.

  • Funding ECRHS I:

    The coordination of ECRHS I was supported by the European Commission. The following grants helped fund the local studies.

    Australia: Asthma Foundation of Victoria, Allen and Hanbury’s, Belgium: Belgian Science Policy Office, National Fund for Scientific Research, Denmark: Aarhus (R Dahl, M Iversen), Estonia: Estonian Science Foundation, grant no. 1088, France: Ministère de la Santé, Glaxo France, Insitut Pneumologique d’Aquitaine, Contrat de Plan Etat-Région Languedoc-Rousillon, CNMATS, CNMRT (90MR/10, 91AF/6), Ministre delegué de la santé, RNSP, France; GSF, Germany: Bundes minister für Forschung und Technologie, Greece: The Greek Secretary General of Research and Technology, Fisons, Astra and Boehringer-Ingelheim; Italy: Ministero dell’Università e della Ricerca Scientifica e Tecnologica, CNR, Regione Veneto grant RSF no. 381/05.93, Netherlands Dutch Ministry of Wellbeing, Public Health and Culture and the Netherlands Asthma Foundation, Norway: Norwegian Research Council project no. 101422/310; Portugal: Glaxo Farmacêutica Lda, Sandoz Portugesa, Spain: Fondo de Investigación Sanitaria (#91/0016-060-05/E, 92/0319 and #93/0393), Hospital General de Albacete, Hospital General Juan Ramón Jiménez, Dirección Regional de Salud Pública (Consejería de Sanidad del Principado de Asturias), CIRIT (1997 SGR 00079) and Servicio Andaluz de Salud; Sweden: The Swedish Medical Research Council, the Swedish Heart Lung Foundation, the Swedish Association against Asthma and Allergy; Switzerland: Swiss National Science Foundation grant 4026- 28099; UK: National Asthma Campaign, British Lung Foundation, Department of Health, South Thames Regional Health Authority.

    ECRHS II:

    The coordination of ECRHS II was supported by the European Commission. The following grants helped fund the local studies.

    Australia: National Health and Medical Research Council, Belgium: Antwerp: Fund for Scientific Research (grant code, G.0402.00), University of Antwerp, Flemish Health Ministry; Estonia: Tartu Estonian Science Foundation grant no. 4350, France: (All) Programme Hospitalier de Recherche Clinique—Direction de la Recherche Clinique (DRC) de Grenoble 2000 number 2610, Ministry of Health, Ministère de l’Emploi et de la Solidarité, Direction Génerale de la Santé, Centre Hospitalier Universitaire (CHU) de Grenoble, Bordeaux: Institut Pneumologique d’Aquitaine; Grenoble: Comite des Maladies Respiratoires de l’Isere Montpellier: Aventis (France), Direction Regionale des Affaires Sanitaires et Sociales Languedoc-Roussillon; Paris: Union Chimique Belge-Pharma (France), Aventis (France), Glaxo France, Germany: Erfurt GSF—National Research Centre for Environment and Health, Deutsche Forschungsgemeinschaft (grant code, FR1526/1-1), Hamburg: GSF—National Research Centre for Environment and Health, Deutsche Forschungsgemeinschaft (grant code, MA 711/4-1), Iceland: Reykjavik, Icelandic Research Council, Icelandic University Hospital Fund; Italy: Pavia GlaxoSmithKline Italy, Italian Ministry of University and Scientific and Technological Research (MURST), Local University Funding for Research 1998 and 1999; Turin: Azienda Sanitaria Locale 4 Regione Piemonte (Italy), Azienda Ospedaliera Centro Traumatologico Ospedaliero/Centro Traumatologico Ortopedico—Istituto Clinico Ortopedico Regina Maria Adelaide Regione Piemonte Verona: Ministero dell’Universita e della Ricerca Scientifica (MURST), Glaxo Wellcome SPA, Norway: Bergen: Norwegian Research Council, Norwegian Asthma and Allergy Association, Glaxo Wellcome AS, Norway Research Fund; Spain: Fondo de Investigacion Santarias (grant codes, 97/0035-01, 99/0034-01 and 99/0034 02), Hospital Universitario de Albacete, Consejeria de Sanidad; Barcelona: Sociedad Espanola de Neumologıa y Cirugıa Toracica, Public Health Service (grant code, R01 HL62633-01), Fondo de Investigaciones Santarias (grant codes, 97/0035-01, 99/0034-01 and 99/0034-02), Consell Interdepartamentalde Recerca i Innovacio Tecnologica (grant code, 1999SGR 00241), Instituto de Salud Carlos III; Red de Centros de Epidemiologıa y Salud Publica, C03/09, Red de Bases moleculares y fisiologicas de las Enfermedades Respiratorias, C03/011, and Red de Grupos Infancia y Medio Ambiente G03/176; Huelva: Fondo de Investigaciones Santarias (grant codes, 97/0035-01, 99/0034-01 and 99/0034-02); Galdakao: Basque Health Department Oviedo: Fondo de Investigaciones Sanitaria (97/0035-02, 97/0035, 99/0034-01, 99/0034-02, 99/0034-04, 99/0034-06, 99/350, 99/0034--07), European Commission (EU-PEAL PL01237), Generalitat de Catalunya (CIRIT 1999 SGR 00214), Hospital Universitario de Albacete, Sociedad Española de Neumología y Cirugía Torácica (SEPAR R01 HL62633-01), Red de Centros de Epidemiología y Salud Pública (C03/09), Red de Bases moleculares y fisiológicas de las Enfermedades Respiratorias (C03/011) and Red de Grupos Infancia y Medio Ambiente (G03/176);97/0035-01, 99/0034-01 and 99/0034-02); Sweden: Göteborg, Umea, Uppsala: Swedish Heart Lung Foundation, Swedish Foundation for Health Care Sciences and Allergy Research, Swedish Asthma and Allergy Foundation, Swedish Cancer and Allergy Foundation, Swedish Council for Working Life and Social Research (FAS), Switzerland: Basel Swiss National Science Foundation, Swiss Federal Office for Education and Science, Swiss National Accident Insurance Fund; UK: Ipswich and Norwich: Asthma UK (formerly known as National Asthma Campaign).

    ECRHS III: The coordination of ECRHS III was supported by the Medical Research Council (grant no. 92091).

    The following grants helped fund the local studies.

    Australia: National Health and Medical Research Council, Belgium: Antwerp South, Antwerp City: Research Foundation Flanders (FWO), grant code G.0.410.08.N.10 (both sites), Estonia: Tartu-SF0180060s09 from the Estonian Ministry of Education. France: (All) Ministère de la Santé. Programme Hospitalier de Recherche Clinique (PHRC) National 2010. Bordeaux: INSERM U897 Université Bordeaux Segalen, Grenoble: Comite Scientifique AGIRadom 2011. Paris: Agence Nationale de la Santé, Région Ile de France, domaine d’intérêt majeur (DIM) Germany : Erfurt: German Research Foundation HE 3294/10-1, Hamburg: German Research Foundation MA 711/6-1, NO 262/7-1, Iceland: Reykjavik, The Landspitali University Hospital Research Fund, University of Iceland Research Fund, ResMed Foundation, California, USA, Orkuveita Reykjavikur (Geothermal plant), Vegagerðin (The Icelandic Road Administration, ICERA). Italy: All Italian centres were funded by the Italian Ministry of Health, Chiesi Farmaceutici SpA. In addition, Verona was funded by Cariverona Foundation, Education Ministry (MIUR). Norway: Norwegian Research council grant no 214123, Western Norway Regional Health Authorities grant no 911631, Bergen Medical Research Foundation. Spain: Fondo de Investigación Sanitaria (PS09/02457, PS09/00716, PS09/01511, PS09/02185, PS09/03190), Servicio Andaluz de Salud , Sociedad Española de Neumología y Cirurgía Torácica (SEPAR 1001/2010); Sweden: All centres were funded by The Swedish Heart and Lung Foundation, The Swedish Asthma and Allergy Association, The Swedish Association against Lung and Heart Disease. Fondo de Investigación Sanitaria (PS09/02457), Barcelona: Fondo de Investigación Sanitaria (FIS PS09/00716), Galdakao: Fondo de Investigación Sanitaria (FIS 09/01511), Huelva: Fondo de Investigación Sanitaria (FIS PS09/02185), and Servicio Andaluz de Salud Oviedo: Fondo de Investigación Sanitaria (FIS PS09/03190). Sweden: All centres were funded by The Swedish Heart and Lung Foundation, The Swedish Asthma and Allergy Association, The Swedish Association against Lung and Heart Disease. Swedish Research Council for Health, Working Life and Welfare (FORTE) Göteborg : Also received further funding from the Swedish Council for Working Life and Social Research. Umea also received funding from Vasterbotten Country Council ALF grant. Switzerland: The Swiss National Science Foundation (grant nos 33CSCO-134276/1, 33CSCO-108796, 3247BO-104283, 3247BO-104288, 3247BO-104284, 3247-065896, 3100-059302, 3200-052720, 3200-042532, 4026-028099). The Federal Office for Forest, Environment and Landscape, The Federal Office of Public Health, The Federal Office of Roads and Transport, The Canton’s Government of Aargan, Basel-Stadt, Basel-Land, Geneva, Luzern, Ticino, Valais and Zürich, the Swiss Lung League, the Canton’s Lung League of Basel Stadt/Basel, Landschaft, Geneva, Ticino, Valais and Zurich, SUVA, Freiwillige Akademische Gesellschaft, UBS Wealth Foundation, Talecris Biotherapeutics GmbH, Abbott Diagnostics, European Commission 018996 (GABRIEL), Wellcome Trust WT 084703MA, UK: Medical Research Council (grant no 92091). Support was also provided by the National Institute for Health Research through the Primary Care Research Network.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval Multiple bodies across Europe on three occasions.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Author note Scientific teams: ECRHS I Coordinating Centre (London): PB, S Chinn, C Luczynska†, DJ, E Lai. Project Management Group: PB (Project leader-UK) S Chinn (UK), C Luczynska † (UK), DJ (UK), P Vermeire † (Antwerp), H Kesteloot (Leuven), J Bousquet (Montpellier), D Nowak (Hamburg), J Prichard † (Dublin), RdM† (Verona), B Rijcken (Groningen), JMA (Barcelona), J Sunyer (Barcelona), J Alves (Oporto), G Boman (Uppsala), N Nielsen (Copenhagen), P Paoletti (Pisa). Participating Centres: Australia: Melbourne (MJA, J Kutin), Belgium: Antwerp South, Antwerp Central (P Vermeire, F van Bastelaer) Estonia: Tartu (R. J õ gi), France: Bordeaux (A. Taytard) Grenoble (IP, C Pison), Paris (F Neukirch, R Liard) Montpellier (J Bousquet, J Knani), Germany: Erfurt (H-E Wichmann, JH) Hamburg (H Magnussen, D Nowak), Iceland: Reykjavik (TG, D Gislason) Italy: Pavia (A Marinoni, I.Cerveri) Turin: (M Bugiani, C Bucca, C Romano) Verona: (RdM†, L Cascio, C Campello) Netherlands: Groningen (J Droste, M Kerkhof) Norway: Bergen (A Gulsvik, E Omenaas) Spain: Albacete (J Martinez-Moratalla, E Almar, A Mateos, M Arévalo, A Sánchez, M Vizcaya, X Aguilar, A Teixidó) Barcelona (JMA, M Kogevinas, J Sunyer, F Burgos, J Castellsagué, J Roca, JB Soriano, A Tobías) Galdakao: N Muiñozguren , J Ramos González, A Capelastegui) HKriya v1.08.084 © Exeter Premedia Services (2015)uelva: (J Maldonado Pérez AP-V, J Sánchez) Oviedo (J Quiros, I Huerta, F Payo) Sweden: Göteborg (N Lindholm, P Plaschke) Uppsala:(G Boman, CJ, E Björnsson) Umeå (L Rosenhall, E Norrman B Lundbäck) Switzerland: Basel (U Ackermann- Liebrich, N Küenzli, A Perruchoud) UK: Caerphilly (M Burr†, J Layzell) Ipswich (R Hall) Norwich (B Harrison). ECRHS II Coordinating Centre (London): PB, S Chinn, C Luczynska†, DJ, J Knox. Project Management Group: PB (Project leader-UK) S Chinn (UK), C Luczynska † (UK), DJ (UK), P Vermeire † (Antwerp), J Bousquet (Montpellier), JH (Erfurt), M Wjst (Munich) RdM† (Verona), JMA (Barcelona), J Sunyer (Barcelona) CJ (Uppsala), U Ackermann- Liebrich (Basel), N Kuenzli (University of Basel, and University of Southern California, Los Angeles, USA); F Neukirch (Paris) Participating Centres: Australia: Melbourne (MA, E H Walters, J Raven), Belgium: Antwerp South, Antwerp Central (P Vermeire, JW, M van Sprundel, V Nelen) Estonia: Tartu (R J õ gi, A Soon), France: Bordeaux (A Taytard, CR),) Grenoble (IP, J Ferran-Quentin), Paris (F Neukirch, BL, R Liard, M Zureik) Montpellier (J Bousquet, PJ Bousquet), Germany: Erfurt (JH, M Wjst, C Frye, I Meyer) Hamburg (H Magnussen, D Nowak), Iceland: Reykjavik (TG, E Bjornsson, D Gislason, K B Jörundsdóttir) Italy: Pavia (A Marinoni, S Villani, M Ponzio, F Frigerio, M Comelli, M Grassi, I Cerveri, AC) Turin: (RB, M Bugiani, P Piccioni, E Caria, A Carosso, E Migliore, G Castiglioni) Verona: RdM†, G Verlato, E Zanolin, SA, A Poli, V Lo Cascio, M Ferrari, I Cazzoletti) Netherlands: Groningen (M Kerkhof) Norway: Bergen (A Gulsvik, E Omenaas, CS, B Laerum) Spain: Albacete (JM-MR, E Almar, M Arévalo, C Boix, G González, J M Ignacio García, J Solera, JDamián) Barcelona (JMA, J Sunyer, M Kogevinas, JPZ, X Basagaña, A Jaen, F Burgos, C Acosta) Galdakao: (N Muñozguren, J Ramos, IU, U Aguirre) Huelva: (J Maldonado, AP-V, J L Sanchez) Oviedo (F Payo, I. Huerta, A de la Vega, L Palenciano, J Azofra, A Cañada) Sweden: Göteborg (K. Toren, L Lillienberg, A C Olin, B Balder, A Pfeifer-Nilsson, R Sundberg) Uppsala: (CJ, G Boman, D Norback, G Wieslander, M Gunnbjornsdottir) Umeå (E Norrman, M Soderberg, K A Franklin, B Lundback, BF, L Nystrom) Switzerland: Basel (N Küenzli, B Dibbert, M Hazenkamp, M Brutsche, U Ackermann-Liebrich) UK: Caerphilly (M Burr†, J Layzell) Ipswich (DJ, R Hall, D Seaton) Norwich (DJ, B Harrison). ECRHS III Coordinating Centre (London): DJ, PB, M Tumilty, J PottsProject Management Group: DJ (UK), PB (UK), JH (Erfurt), RdM† (Verona),JMA (Barcelona) CJ (Uppsala), K Toren (Goteburg), T Gislasson (Iceland) T Rochat (Basel), BLeyneart (Paris) CS (Bergen) JW (Antwerp) JPZ (Barcelona) Australia: Melbourne (MA, G Benke, S Dharmage, B Thompson, S Kaushik, M Matheson.Belgium: South Antwerp & Antwerp City (JW, H Bentouhami, V Nelen) Estonia: Tartu (R J õ gi, H Orru) France: Bordeaux (CR, P O Girodet) Grenoble (IP, V Siroux, J Ferran, J L Cracowski) Montpellier (PD, A Bourdin, I Vachier) Paris (BL, D Soussan, D Courbon, C Neukirch, L Alavoine, X Duval, I Poirier) Germany: Erfurt (JH, E Becker, G Woelke, O Manuwald) Hamburg (H Magnussen, D Nowak, A-MK), Iceland: Reykjavik (TG, B Benediktsdottir, D Gislason, E S Arnardottir, M Clausen, G Gudmundsson, L Gudmundsdottir, H Palsdottir, K Olafsdottir, S Sigmundsdottir, K Bara-Jörundsdottir), Italy: Pavia (I Cerveri, AC, A Grosso, F Albicini, E Gini, E M Di Vincenzo, V Ronzoni, S Villani, F Campanella, M Gnesi, F Manzoni, L Rossi, O Ferraro) Turin: (M Bugiani, RB, P Piccioni, R Tassinari, V Bellisario, G Trucco) Verona: (RdM†, SA, L Calciano, L Cazzoletti, M Ferrari, A M Fratta Pasini, F Locatelli, P Marchetti, A Marcon, E Montoli, G Nguyen, M Olivieri, C Papadopoulou, C Posenato, G Pesce, P Vallerio, G Verlato, E Zanolin), Netherlands: Groningen (HMB), Norway: (CS, E Omenaas, A Johannessen, T Skorge, F Gomez Real) Spain: Albacete (JM-MR, E Almar, A Mateos, S García, A Núñez, P López, R Sánchez, E Mancebo) Barcelona:(JMA, JPZ, J Garcia-Aymerich, M Kogevinas, X Basagaña, A E Carsin, F Burgos, C Sanjuas, S Guerra, B Jacquemin, P Davd and Galdakao: N Muñozguren, IU, U Aguirre, S Pascual) Huelva: (J Antonio Maldonado, AP-V, J Luis Sánchez, L Palacios, Oviedo: (F Payo, I Huerta, N Sánchez, M Fernández, B Robles) Sweden: Göteborg (K Torén, M Holm, J-L Kim, A-C Olin, A Dahlman-Höglund), Umea (BF, L Braback, L Modig, B Järvholm, H Bertilsson, K A Franklin, C Wahlgreen) Uppsala: (B Andersson, D Norback, U Spetz Nystrom, G Wieslander, G M Bodinaa Lund, KNisser), Switzerland: Basel (NMP-H, N Künzli, D Stolz, C Schindler, T Rochat, J M.Gaspoz, E Zemp Stutz, M Adam, C Autenrieth, I Curjuric, J Dratva, A Di Pasquale, R Ducret-Stich, E Fischer, L Grize, A Hensel, D Keidel, A Kumar, M Imboden, N Maire, A Mehta, H Phuleria, M Ragettli, M Ritter, E Schaffner, G A Thun, A Ineichen, T Schikowski, M Tarantino, M Tsai, UK:London (PB, DJ, S Kapur, RN, J Potts,) Ipswich: (DJ, M Tumilty, N Innes) Norwich: (DJ, M Tumilty, A Wilson).

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