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BETA
Forsberg, Bertil
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Publications (10 of 266) Show all publications
Olstrup, H., Johansson, C., Forsberg, B., Tornevi, A., Ekebom, A. & Meister, K. (2019). A Multi-Pollutant Air Quality Health Index (AQHI) Based on Short-Term Respiratory Effects in Stockholm, Sweden. International Journal of Environmental Research and Public Health, 16(1), Article ID E105.
Open this publication in new window or tab >>A Multi-Pollutant Air Quality Health Index (AQHI) Based on Short-Term Respiratory Effects in Stockholm, Sweden
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2019 (English)In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 16, no 1, article id E105Article in journal (Refereed) Published
Abstract [en]

In this study, an Air Quality Health Index (AQHI) for Stockholm is introduced as a tool to capture the combined effects associated with multi-pollutant exposure. Public information regarding the expected health risks associated with current or forecasted concentrations of pollutants and pollen can be very useful for sensitive persons when planning their outdoor activities. For interventions, it can also be important to know the contribution from pollen and the specific air pollutants, judged to cause the risk. The AQHI is based on an epidemiological analysis of asthma emergency department visits (AEDV) and urban background concentrations of NOx, O₃, PM10 and birch pollen in Stockholm during 2001⁻2005. This analysis showed per 10 µg·m⁻3 increase in the mean of same day and yesterday an increase in AEDV of 0.5% (95% CI: -1.2⁻2.2), 0.3% (95% CI: -1.4⁻2.0) and 2.5% (95% CI: 0.3⁻4.8) for NOx, O₃ and PM10, respectively. For birch pollen, the AEDV increased with 0.26% (95% CI: 0.18⁻0.34) for 10 pollen grains·m⁻3. In comparison with the coefficients in a meta-analysis, the mean values of the coefficients obtained in Stockholm are smaller. The mean value of the risk increase associated with PM10 is somewhat smaller than the mean value of the meta-coefficient, while for O₃, it is less than one fifth of the meta-coefficient. We have not found any meta-coefficient using NOx as an indicator of AEDV, but compared to the mean value associated with NO₂, our value of NOx is less than half as large. The AQHI is expressed as the predicted percentage increase in AEDV without any threshold level. When comparing the relative contribution of each pollutant to the total AQHI, based on monthly averages concentrations during the period 2015⁻2017, there is a tangible pattern. The AQHI increase associated with NOx exhibits a relatively even distribution throughout the year, but with a clear decrease during the summer months due to less traffic. O₃ contributes to an increase in AQHI during the spring. For PM10, there is a significant increase during early spring associated with increased suspension of road dust. For birch pollen, there is a remarkable peak during the late spring and early summer during the flowering period. Based on monthly averages, the total AQHI during 2015⁻2017 varies between 4 and 9%, but with a peak value of almost 16% during the birch pollen season in the spring 2016. Based on daily mean values, the most important risk contribution during the study period is from PM10 with 3.1%, followed by O₃ with 2.0%.

Keywords
AQHI, NOx, PM10, asthma, birch pollen, ozone, risk coefficients
National Category
Occupational Health and Environmental Health
Identifiers
urn:nbn:se:umu:diva-154982 (URN)10.3390/ijerph16010105 (DOI)30609753 (PubMedID)
Funder
EU, Horizon 2020
Available from: 2019-01-07 Created: 2019-01-07 Last updated: 2019-01-21Bibliographically approved
Mogensen, I., Alving, K., Dahlen, S.-E., James, A., Forsberg, B., Ono, J., . . . Malinovschi, A. (2019). Fixed airflow obstruction relates to eosinophil activation in asthmatics.. Clinical and Experimental Allergy, 49(2), 155-162
Open this publication in new window or tab >>Fixed airflow obstruction relates to eosinophil activation in asthmatics.
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2019 (English)In: Clinical and Experimental Allergy, ISSN 0954-7894, E-ISSN 1365-2222, Vol. 49, no 2, p. 155-162Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Some asthmatics develop irreversible chronic airflow obstruction, e.g., fixed airflow obstruction (fixed-AO). This is probably a consequence of airway remodeling, but neither its relation to inflammation, nor which asthma biomarkers can be clinically useful are elucidated. We hypothesized that the presence of type-2 inflammation relates to fixed-AO.

OBJECTIVES: Evaluate the presence of four markers for type-2 inflammation in fixed airflow obstruction among asthmatics.

METHODS: This was a cross-sectional study of 403 participants with asthma, aged 17-75 years, from three Swedish centers. Fixed airflow obstruction was defined as forced expiratory volume during the first second (FEV1 ) over forced vital capacity (FVC) being below the lower limit of normal (LLN). The following type-2 inflammation markers were assessed: exhaled nitric oxide (FeNO), serum periostin, serum eosinophil cationic protein (S-ECP) and urinary eosinophil-derived neurotoxin (U-EDN).

RESULTS: Elevated U-EDN (values in the highest tertile, ≥ 65.95 mg/mol creatinine) was more common in subjects with fixed-AO vs. subjects without fixed-AO: 55% vs. 29%, p<0.001. Elevated U-EDN related to increased likelihood of having fixed-AO in both all subjects and never-smoking subjects, with adjusted (adjusted for sex, age group, use of inhaled corticosteroids last week, atopy, early onset asthma, smoking history and packyears) odds ratios (aOR) of 2.38 (1.28-4.41) and 2.51 (1.04-6.07), respectively. In a separate analysis, having both elevated S-ECP (>20 μg/L) and U-EDN was related to having the highest likelihood of fixed-AO (aOR (95% CI) 6.06 (2.32-15.75)). Elevated serum periostin or FeNO did not relate to fixed-AO.

CONCLUSIONS AND CLINICAL RELEVANCE: These findings support that type-2 inflammation, and in particular eosinophil inflammation, is found in asthma with fixed-AO. This could indicate a benefit from eosinophil-directed therapies. Further longitudinal studies are warranted to investigate causality and relation to lung function decline. This article is protected by copyright. All rights reserved.

National Category
Occupational Health and Environmental Health
Identifiers
urn:nbn:se:umu:diva-152938 (URN)10.1111/cea.13302 (DOI)30365193 (PubMedID)
Available from: 2018-10-30 Created: 2018-10-30 Last updated: 2019-02-08Bibliographically approved
Lytras, T., Kogevinas, M., Kromhout, H., Carsin, A.-E., Antó, J. M., Bentouhami, H., . . . Zock, J.-P. (2019). Occupational exposures and incidence of chronic bronchitis and related symptoms over two decades: the European Community Respiratory Health Survey. Occupational and Environmental Medicine
Open this publication in new window or tab >>Occupational exposures and incidence of chronic bronchitis and related symptoms over two decades: the European Community Respiratory Health Survey
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2019 (English)In: Occupational and Environmental Medicine, ISSN 1351-0711, E-ISSN 1470-7926Article in journal (Refereed) Epub ahead of print
Abstract [en]

OBJECTIVES: Chronic bronchitis (CB) is an important chronic obstructive pulmonary disease (COPD)-related phenotype, with distinct clinical features and prognostic implications. Occupational exposures have been previously associated with increased risk of CB but few studies have examined this association prospectively using objective exposure assessment. We examined the effect of occupational exposures on CB incidence in the European Community Respiratory Health Survey.

METHODS: Population samples aged 20-44 were randomly selected in 1991-1993, and followed up twice over 20 years. Participants without chronic cough or phlegm at baseline were analysed. Coded job histories during follow-up were linked to the ALOHA Job Exposure Matrix, generating occupational exposure estimates to 12 categories of chemical agents. Their association with CB incidence over both follow-ups was examined with Poisson models using generalised estimating equations.

RESULTS: 8794 participants fulfilled the inclusion criteria, contributing 13 185 observations. Only participants exposed to metals had a higher incidence of CB (relative risk (RR) 1.70, 95% CI 1.16 to 2.50) compared with non-exposed to metals. Mineral dust exposure increased the incidence of chronic phlegm (RR 1.72, 95% CI 1.43 to 2.06). Incidence of chronic phlegm was increased in men exposed to gases/fumes and to solvents and in women exposed to pesticides.

CONCLUSIONS: Occupational exposures are associated with chronic phlegm and CB, and the evidence is strongest for metals and mineral dust exposure. The observed differences between men and women warrant further investigation.

Keywords
epidemiology, longitudinal studies, respiratory, retrospective exposure assessment
National Category
Occupational Health and Environmental Health
Identifiers
urn:nbn:se:umu:diva-156108 (URN)10.1136/oemed-2018-105274 (DOI)30700596 (PubMedID)
Available from: 2019-02-05 Created: 2019-02-05 Last updated: 2019-02-07
Carsin, A.-E., Fuertes, E., Schaffner, E., Jarvis, D., Antó, J. M., Heinrich, J., . . . Garcia-Aymerich, J. (2019). Restrictive spirometry pattern is associated with low physical activity levels: A population based international study. Respiratory Medicine, 146, 116-123
Open this publication in new window or tab >>Restrictive spirometry pattern is associated with low physical activity levels: A population based international study
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2019 (English)In: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 146, p. 116-123Article in journal (Refereed) Published
Abstract [en]

Introduction: Restrictive spirometry pattern is an under-recognised disorder with a poor morbidity and mortality prognosis. We compared physical activity levels between adults with a restrictive spirometry pattern and with normal spirometry.

Methods: Restrictive spirometry pattern was defined as a having post-bronchodilator FEV1/FVC ≥ Lower Limit of Normal and a FVC<80% predicted in two population-based studies (ECRHS-III and SAPALDIA3). Physical activity was measured using the International Physical Activity Questionnaire. The odds of having low physical activity (<1st study-specific tertile) was evaluated using adjusted logistic regression models.

Results: Subjects with a restrictive spirometry pattern (n = 280/4721 in ECRHS, n = 143/3570 in SAPALDIA) reported lower levels of physical activity than those with normal spirometry (median of 1770 vs 2253 MET·min/week in ECRHS, and 3519 vs 3945 MET·min/week in SAPALDIA). Subjects with a restrictive spirometry pattern were more likely to report low physical activity (meta-analysis odds ratio: 1.41 [95%CI 1.07–1.86]) than those with a normal spirometry. Obesity, respiratory symptoms, co-morbidities and previous physical activity levels did not fully explain this finding.

Conclusion: Adults with a restrictive spirometry pattern were more likely to report low levels of physical activity than those with normal spirometry. These results highlight the need to identify and act on this understudied but prevalent condition.

Place, publisher, year, edition, pages
Elsevier, 2019
Keywords
Restrictive spirometry pattern, Body mass index, Epidemiology, Lung function, Physical activity
National Category
Occupational Health and Environmental Health
Identifiers
urn:nbn:se:umu:diva-154766 (URN)10.1016/j.rmed.2018.11.017 (DOI)2-s2.0-85058942184 (Scopus ID)
Available from: 2019-01-02 Created: 2019-01-02 Last updated: 2019-01-24Bibliographically approved
Accordini, S., Calciano, L., Johannessen, A., Portas, L., Benediktsdóttir, B., Bertelsen, R. J., . . . Svanes, C. (2018). A three-generation study on the association of tobacco smoking with asthma. International Journal of Epidemiology, 47(4), 1106-1117
Open this publication in new window or tab >>A three-generation study on the association of tobacco smoking with asthma
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2018 (English)In: International Journal of Epidemiology, ISSN 0300-5771, E-ISSN 1464-3685, Vol. 47, no 4, p. 1106-1117Article in journal (Refereed) Published
Abstract [en]

Background: Mothers' smoking during pregnancy increases asthma risk in their offspring. There is some evidence that grandmothers' smoking may have a similar effect, and biological plausibility that fathers' smoking during adolescence may influence offspring's health through transmittable epigenetic changes in sperm precursor cells. We evaluated the three-generation associations of tobacco smoking with asthma.

Methods: Between 2010 and 2013, at the European Community Respiratory Health Survey III clinical interview, 2233 mothers and 1964 fathers from 26 centres reported whether their offspring (aged ≤51 years) had ever had asthma and whether it had coexisted with nasal allergies or not. Mothers and fathers also provided information on their parents' (grandparents) and their own asthma, education and smoking history. Multilevel mediation models within a multicentre three-generation framework were fitted separately within the maternal (4666 offspring) and paternal (4192 offspring) lines.

Results: Fathers' smoking before they were 15 [relative risk ratio (RRR) = 1.43, 95% confidence interval (CI): 1.01-2.01] and mothers' smoking during pregnancy (RRR = 1.27, 95% CI: 1.01-1.59) were associated with asthma without nasal allergies in their offspring. Grandmothers' smoking during pregnancy was associated with asthma in their daughters [odds ratio (OR) = 1.55, 95% CI: 1.17-2.06] and with asthma with nasal allergies in their grandchildren within the maternal line (RRR = 1.25, 95% CI: 1.02-1.55).

Conclusions: Fathers' smoking during early adolescence and grandmothers' and mothers' smoking during pregnancy may independently increase asthma risk in offspring. Thus, risk factors for asthma should be sought in both parents and before conception.

Place, publisher, year, edition, pages
Oxford University Press, 2018
Keywords
asthma, mothers’ smoking during pregnancy, grandmothers’ smoking during pregnancy, fathers’ smoking during puberty, multilevel mediation model, Ageing Lungs in European Cohorts (ALEC) Study
National Category
Occupational Health and Environmental Health
Identifiers
urn:nbn:se:umu:diva-145740 (URN)10.1093/ije/dyy031 (DOI)000444559900020 ()29534228 (PubMedID)
Funder
EU, Horizon 2020, GA-633212
Available from: 2018-03-16 Created: 2018-03-16 Last updated: 2018-10-05Bibliographically approved
Nagel, G., Stafoggia, M., Pedersen, M., Andersen, Z. J., Galassi, C., Munkenast, J., . . . Weinmayr, G. (2018). Air pollution and incidence of cancers of the stomach and the upper aerodigestive tract in the European Study of Cohorts for Air Pollution Effects (ESCAPE). International Journal of Cancer, 143(7), 1632-1643
Open this publication in new window or tab >>Air pollution and incidence of cancers of the stomach and the upper aerodigestive tract in the European Study of Cohorts for Air Pollution Effects (ESCAPE)
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2018 (English)In: International Journal of Cancer, ISSN 0020-7136, E-ISSN 1097-0215, Vol. 143, no 7, p. 1632-1643Article in journal (Refereed) Published
Abstract [en]

Air pollution has been classified as carcinogenic to humans. However, to date little is known about the relevance for cancersof the stomach and upper aerodigestive tract (UADT). We investigated the association of long-term exposure to ambient airpollution with incidence of gastric and UADT cancer in 11 European cohorts. Air pollution exposure was assigned by land-useregression models for particulate matter (PM) below 10mm (PM10), below 2.5mm (PM2.5), between 2.5 and 10mm (PMcoarse),PM2.5absorbance and nitrogen oxides (NO2and NOX) as well as approximated by traffic indicators. Cox regression modelswith adjustment for potential confounders were used for cohort-specific analyses. Combined estimates were determined withrandom effects meta-analyses. During average follow-up of 14.1 years of 305,551 individuals, 744 incident cases of gastriccancer and 933 of UADT cancer occurred. The hazard ratio for an increase of 5mg/m3of PM2.5was 1.38 (95% CI 0.99; 1.92)for gastric and 1.05 (95% CI 0.62; 1.77) for UADT cancers. No associations were found for any of the other exposures consid-ered. Adjustment for additional confounders and restriction to study participants with stable addresses did not influencemarkedly the effect estimate for PM2.5and gastric cancer. Higher estimated risks of gastric cancer associated with PM2.5wasfound in men (HR 1.98 [1.30; 3.01]) as compared to women (HR 0.85 [0.5; 1.45]). This large multicentre cohort study showsan association between long-term exposure to PM2.5and gastric cancer, but not UADT cancers, suggesting that air pollutionmay contribute to gastric cancer risk.

Place, publisher, year, edition, pages
John Wiley & Sons, 2018
Keywords
ESCAPE, air pollution, epidemiology, gastric cancer, upper aerodigestive tract cancer
National Category
Occupational Health and Environmental Health
Identifiers
urn:nbn:se:umu:diva-147272 (URN)10.1002/ijc.31564 (DOI)000443392100009 ()29696642 (PubMedID)
Available from: 2018-05-02 Created: 2018-05-02 Last updated: 2018-11-05Bibliographically approved
Raza, W., Forsberg, B., Johansson, C. & Nilsson Sommar, J. (2018). Air pollution as a risk factor in health impact assessments of a travel mode shift towards cycling. Global Health Action, 11(1), Article ID 1429081.
Open this publication in new window or tab >>Air pollution as a risk factor in health impact assessments of a travel mode shift towards cycling
2018 (English)In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 11, no 1, article id 1429081Article, review/survey (Refereed) Published
Abstract [en]

BACKGROUND: Promotion of active commuting provides substantial health and environmental benefits by influencing air pollution, physical activity, accidents, and noise. However, studies evaluating intervention and policies on a mode shift from motorized transport to cycling have estimated health impacts with varying validity and precision.

OBJECTIVE: To review and discuss the estimation of air pollution exposure and its impacts in health impact assessment studies of a shift in transport from cars to bicycles in order to guide future assessments.

METHODS: A systematic database search of PubMed was done primarily for articles published from January 2000 to May 2016 according to PRISMA guidelines.

RESULTS: We identified 18 studies of health impact assessment of change in transport mode. Most studies investigated future hypothetical scenarios of increased cycling. The impact on the general population was estimated using a comparative risk assessment approach in the majority of these studies, whereas some used previously published cost estimates. Air pollution exposure during cycling was estimated based on the ventilation rate, the pollutant concentration, and the trip duration. Most studies employed exposure-response functions from studies comparing background levels of fine particles between cities to estimate the health impacts of local traffic emissions. The effect of air pollution associated with increased cycling contributed small health benefits for the general population, and also only slightly increased risks associated with fine particle exposure among those who shifted to cycling. However, studies calculating health impacts based on exposure-response functions for ozone, black carbon or nitrogen oxides found larger effects attributed to changes in air pollution exposure.

CONCLUSION: A large discrepancy between studies was observed due to different health impact assessment approaches, different assumptions for calculation of inhaled dose and different selection of dose-response functions. This kind of assessments would improve from more holistic approaches using more specific exposure-response functions.

Place, publisher, year, edition, pages
Taylor & Francis, 2018
Keywords
Active commuting, mode shift, emission factors, population exposure, commuters’ exposure, exposure response function, comparative risk assessment
National Category
Occupational Health and Environmental Health
Identifiers
urn:nbn:se:umu:diva-144660 (URN)10.1080/16549716.2018.1429081 (DOI)000424246900001 ()29400262 (PubMedID)
Available from: 2018-02-09 Created: 2018-02-09 Last updated: 2018-06-09Bibliographically approved
Burte, E., Leynaert, B., Bono, R., Brunekreef, B., Bousquet, J., Carsin, A.-E., . . . Jacquemin, B. (2018). Association between air pollution and rhinitis incidence in two European cohorts. Environment International, 115, 257-266
Open this publication in new window or tab >>Association between air pollution and rhinitis incidence in two European cohorts
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2018 (English)In: Environment International, ISSN 0160-4120, E-ISSN 1873-6750, Vol. 115, p. 257-266Article in journal (Refereed) Published
Abstract [en]

The association between air pollution and rhinitis is not well established.

Aim: The aim of this longitudinal analysis was to study the association between modeled air pollution at the subjects' home addresses and self-reported incidence of rhinitis.

Methods: We used data from 1533 adults from two multicentre cohorts' studies (EGEA and ECRHS). Rhinitis incidence was defined as reporting rhinitis at the second follow-up (2011 to 2013) but not at the first follow-up (2000 to 2007). Annual exposure to NO2, PM10 and PM2.5 at the participants' home addresses was estimated using land-use regression models developed by the ESCAPE project for the 2009-2010 period. Incidence rate ratios (IRR) were computed using Poisson regression. Pooled analysis, analyses by city and meta-regression testing for heterogeneity were carried out.

Results: No association between long-term air pollution exposure and incidence of rhinitis was found (adjusted IRR (aIRR) for an increase of 10 mu g center dot m(-3) of NO2: 1.00 [0.91-1.09], for an increase of 5 mu g center dot m(-3) of PM2.5: 0.88 [0.73-1.04]). Similar results were found in the two-pollutant model (aIRR for an increase of 10 mu g center dot m(-3) of NO2: 1.01 [0.87-1.17], for an increase of 5 mu g center dot m(-3) of PM2.5: 0.87 [0.68-1.08]). Results differed depending on the city, but no regional pattern emerged for any of the pollutants.

Conclusions: This study did not find any consistent evidence of an association between long-term air pollution and incident rhinitis.

Place, publisher, year, edition, pages
Elsevier, 2018
National Category
Occupational Health and Environmental Health
Identifiers
urn:nbn:se:umu:diva-146297 (URN)10.1016/j.envint.2018.03.021 (DOI)000432523500028 ()29605678 (PubMedID)
Available from: 2018-04-04 Created: 2018-04-04 Last updated: 2018-06-27Bibliographically approved
Oudin, A., Segersson, D., Adolfsson, R. & Forsberg, B. (2018). Association between air pollution from residential wood burning and dementia incidence in a longitudinal study in Northern Sweden. PLoS ONE, 13(6), Article ID e0198283.
Open this publication in new window or tab >>Association between air pollution from residential wood burning and dementia incidence in a longitudinal study in Northern Sweden
2018 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 13, no 6, article id e0198283Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: There is highly suggestive evidence for an effect of air pollution exposure on dementia-related outcomes, but evidence is not yet present to clearly pinpoint which pollutants are the probable causal agents. The aims of this study was to assess the longitudinal association between exposures of fine ambient particulate matter (PM2.5) from residential wood burning, and vehicle exhaust, with dementia.

METHOD: We used data from the Betula study, a longitudinal study of dementia in Umeå, Northern Sweden. The study size was 1 806 and the participants were followed from study entry (1993-1995) to 2010. Modelled levels of source-specific fine particulate matter at the residential address were combined with information on wood stoves or wood boilers, and with validated data on dementia diagnosis and individual-level characteristics from the Betula study. Cox proportional hazards models were used to estimate Hazard Ratios (HRs) and their 95% CIs for dementia incidence (vascular dementia and Alzheimer's disease), adjusted for individual-level characteristics.

RESULTS: The emission of PM2.5 from local residential wood burning was associated with dementia incidence with a hazard ratio of 1.55 for a 1 μg/m3 increase in PM2.5 (95% Confidence Interval (CI): 1.00-2.41, p-value 0.05). Study participants with an address in an area with the highest quartile of PM2.5 from residential wood burning and who also had a wood-burning stove were more likely to develop dementia than those in the lower three quartiles without a wood-burning stove with hazard ratios of 1.74 (CI: 1.10-2.75, p-value 0.018). Particulate matter from traffic exhaust seemed to be associated with dementia incidence with hazard ratios of 1.66, (CI: 1.16-2.39), p-value 0.006, and 1.41 (CI: 0.97-2.23), p-value 0.07, in the third and fourth quartiles, respectively.

CONCLUSIONS: If the associations we observed are causal, then air pollution from residential wood burning, and air pollution from traffic, might be independent important risk factors for dementia.

Place, publisher, year, edition, pages
Public Library of Science, 2018
National Category
Occupational Health and Environmental Health
Identifiers
urn:nbn:se:umu:diva-149048 (URN)10.1371/journal.pone.0198283 (DOI)29897947 (PubMedID)
Available from: 2018-06-14 Created: 2018-06-14 Last updated: 2018-10-01Bibliographically approved
Mindus, S., Malinovschi, A., Ekerljung, L., Forsberg, B., Gíslason, T., Jõgi, R., . . . Janson, C. (2018). Asthma and COPD overlap (ACO) is related to a high burden of sleep disturbance and respiratory symptoms: results from the RHINE and Swedish GA2LEN surveys. PLoS ONE, 13(4), Article ID e0195055.
Open this publication in new window or tab >>Asthma and COPD overlap (ACO) is related to a high burden of sleep disturbance and respiratory symptoms: results from the RHINE and Swedish GA2LEN surveys
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2018 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 13, no 4, article id e0195055Article in journal (Refereed) Published
Abstract [en]

Background: The term Asthma and COPD Overlap (ACO) describes a condition where asthma and COPD overlap. We aimed to investigate associations between ACO and insomnia and respiratory symptoms, and to investigate the prevalence of ACO and the characteristics of subjects with ACO in two Northern European population studies.

Methods: The study comprised 25 429 subjects aged ≥ 40 years who participated in one of two Northern European general population surveys. Both surveys included questions on asthma, COPD, respiratory and sleep-related symptoms, including difficulty initiating sleep, difficulty maintaining sleep, early-morning awakening, and excessive daytime sleepiness. ACO was defined as having both self-reported asthma and COPD.

Results: The prevalence of ACO was 1.0%. The group with ACO had a higher prevalence of both insomnia and respiratory symptoms than subjects with only asthma or COPD. Having ACO was independently associated with a 2-3 times higher probability of having sleep-related symptoms as compared with the group without asthma or COPD, after adjustment for age, sex, BMI, smoking history and educational level (adjusted odds ratio 2.14-3.36, 95% CI).

Conclusion: Subjects with ACO have a high prevalence of insomnia and respiratory symptoms. To our knowledge, this is the first study to assess the association between sleep-related symptoms and ACO.

Place, publisher, year, edition, pages
Public Library of Science, 2018
National Category
Occupational Health and Environmental Health
Identifiers
urn:nbn:se:umu:diva-146281 (URN)10.1371/journal.pone.0195055 (DOI)000428988800023 ()29608582 (PubMedID)
Available from: 2018-04-03 Created: 2018-04-03 Last updated: 2018-08-06Bibliographically approved
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