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Stenfors, Nikolai
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Sawalha, S., Hedman, L., Backman, H., Stenfors, N., Rönmark, E., Lundback, B. & Lindberg, A. (2019). The impact of comorbidities on mortality among men and women with COPD: report from the OLIN COPD study. Therapeutic Advances in Respiratory Disease, 13, Article ID 1753466619860058.
Open this publication in new window or tab >>The impact of comorbidities on mortality among men and women with COPD: report from the OLIN COPD study
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2019 (English)In: Therapeutic Advances in Respiratory Disease, ISSN 1753-4658, Vol. 13, article id 1753466619860058Article in journal (Refereed) Published
Abstract [en]

Background: Comorbidities probably contribute to the increased mortality observed among subjects with chronic obstructive pulmonary disease (COPD), but sex differences in the prognostic impact of comorbidities have rarely been evaluated in population-based studies. The aim of this study was to evaluate the impact of common comorbidities, cardiovascular disease (CVD), diabetes mellitus (DM), and anxiety/depression (A/D), on mortality among men and women with and without airway obstruction in a population-based study.

Methods: All subjects with airway obstruction [forced expiratory volume in 1 second (FEV1)/(forced) vital capacity ((F)VC) <0.70, n = 993] were, together with age- and sex-matched referents, identified after examinations of population-based cohorts in 2002-2004.

Spirometric groups: normal lung function (NLF) and COPD (post-bronchodilator FEV1/(F)VC <0.70) and additionally, LLN-COPD (FEV1/(F)VC <lower limit of normal). Mortality data was collected until December 2015. Results: In COPD, the prevalence of CVD and DM was higher in men, whereas the prevalence of A/D was higher in women. The cumulative mortality was significantly higher in COPD than NLF, and higher in men than women in both groups. Among women with COPD, CVD and A/D but not DM increased the risk of death independent of age, body mass index, smoking habits, and disease severity, whereas among men DM and A/D but not CVD increased the risk for death. When the LLN criterion was applied, the pattern was similar.

Conclusion: There were sex-dependent differences regarding the impact of comorbidities on prognosis in COPD. Even though the prevalence of CVD was higher in men, the impact of CVD on mortality was higher in women, and despite higher prevalence of A/D in women, the impact on mortality was similar in both sexes. The reviews of this paper are available via the supplemental material section.

Place, publisher, year, edition, pages
Sage Publications, 2019
Keywords
chronic airflow obstruction, co-morbidity, epidemiology, mortality, sex
National Category
Respiratory Medicine and Allergy
Identifiers
urn:nbn:se:umu:diva-162339 (URN)10.1177/1753466619860058 (DOI)000478856400001 ()31291820 (PubMedID)
Available from: 2019-08-16 Created: 2019-08-16 Last updated: 2019-10-15Bibliographically approved
Lennelöv, E., Irewall, T., Naumburg, E., Lindberg, A. & Stenfors, N. (2019). The Prevalence of Asthma and Respiratory Symptoms among Cross-Country Skiers in Early Adolescence. Canadian Respiratory Journal, 2019, Article ID 1514353.
Open this publication in new window or tab >>The Prevalence of Asthma and Respiratory Symptoms among Cross-Country Skiers in Early Adolescence
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2019 (English)In: Canadian Respiratory Journal, ISSN 1916-7245, Vol. 2019, article id 1514353Article in journal (Refereed) Published
Abstract [en]

Objective: To determine the prevalence of asthma and respiratory symptoms among Swedish cross-country skiers in early adolescence in comparison to a population-based reference group of similar ages.

Methods: A postal questionnaire on asthma, asthma medication, allergy, respiratory symptoms, and physical activity was distributed to Swedish competitive cross-country skiers aged 12–15 years (n = 331) and a population-based reference group (n = 1000). The level of asthma control was measured by the Asthma Control Test.

Results: The response rate was 27% (n = 87) among skiers and 29% (n = 292) in the reference group. The prevalence of self-reported asthma (physician-diagnosed asthma and use of asthma medication in the last 12 months) and the prevalence of reported wheezing during the last 12 months were 23% and 25%, respectively, among skiers, which were significantly higher than the values reported in the reference group (12% and 14%). Skiers exercised more hours/week than the reference group. Among adolescents with self-reported asthma, neither the usage of asthma medications nor the level of asthma control according to the Asthma Control Test differed between skiers and the reference group.

Conclusions: Adolescent competitive cross-country skiers have an increased prevalence of respiratory symptoms and asthma compared to nonskiers.

Place, publisher, year, edition, pages
Hindawi Publishing Corporation, 2019
National Category
Respiratory Medicine and Allergy
Identifiers
urn:nbn:se:umu:diva-165207 (URN)10.1155/2019/1514353 (DOI)000493514500001 ()31636769 (PubMedID)2-s2.0-85072988852 (Scopus ID)
Available from: 2019-11-14 Created: 2019-11-14 Last updated: 2019-11-28Bibliographically approved
Näsman, A., Irewall, T., Hållmarker, U., Lindberg, A. & Stenfors, N. (2018). Asthma and Asthma Medication Are Common among Recreational Athletes Participating in Endurance Sport Competitions. Canadian Respiratory Journal, 2018, Article ID 3238546.
Open this publication in new window or tab >>Asthma and Asthma Medication Are Common among Recreational Athletes Participating in Endurance Sport Competitions
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2018 (English)In: Canadian Respiratory Journal, ISSN 1198-2241, Vol. 2018, article id 3238546Article in journal (Refereed) Published
Abstract [en]

Background: Asthma prevalence is high among elite endurance athletes, but little is known about its prevalence among competitive recreational athletes. The aim of this study was to determine the prevalence of self-reported asthma and asthma medication use among competitive recreational endurance athletes and their association with training.

Methods: A web survey on asthma and medication was conducted among 38,603 adult participants of three Swedish endurance competitions (cross-country running, cross-country skiing, and swimming).

Results: The overall response rate was 29%. The prevalence of self-reported asthma (physician-diagnosed asthma and use of asthma medication in the last 12 months) was 12%. Among those reporting asthma, 23% used inhaled corticosteroids and long-acting beta-agonists daily. We found no association between training volume and daily use of asthma medication, except a trend in relation to short-acting beta-agonists. Independent predictors of self-reported asthma were female sex, allergic rhinitis, previous eczema, family history of asthma, cycling, and training for >5 h 50 min/week.

Conclusions: The prevalence of self-reported asthma among Swedish competitive recreational endurance athletes appears to be higher than that in the general Swedish population. A large proportion of recreational athletes were reported with asthma use medications, indicating an association between high physical activity and self-reported asthma among competitive recreational athletes.

Place, publisher, year, edition, pages
Hindawi Publishing Corporation, 2018
National Category
Respiratory Medicine and Allergy
Identifiers
urn:nbn:se:umu:diva-151199 (URN)10.1155/2018/3238546 (DOI)000437172400001 ()30034562 (PubMedID)
Available from: 2018-09-04 Created: 2018-09-04 Last updated: 2019-05-20Bibliographically approved
Stenfors, N., Liaaen, E. D. & Henriksen, A. H. (2018). No difference in long term survival in patients hospitalized for pneumonic versus non-pneumonic acute exacerbations of COPD [Letter to the editor]. Clinical Respiratory Journal, 12(3), 1305-1306
Open this publication in new window or tab >>No difference in long term survival in patients hospitalized for pneumonic versus non-pneumonic acute exacerbations of COPD
2018 (English)In: Clinical Respiratory Journal, ISSN 1752-6981, E-ISSN 1752-699X, Vol. 12, no 3, p. 1305-1306Article in journal, Letter (Refereed) Published
Place, publisher, year, edition, pages
Wiley-Blackwell, 2018
National Category
Respiratory Medicine and Allergy
Identifiers
urn:nbn:se:umu:diva-146578 (URN)10.1111/crj.12636 (DOI)000428344400062 ()28371483 (PubMedID)
Available from: 2018-06-26 Created: 2018-06-26 Last updated: 2018-06-26Bibliographically approved
Eriksson, L. M., Irewall, T., Lindberg, A. & Stenfors, N. (2018). Prevalence, age at onset, and risk factors of self-reported asthma among Swedish adolescent elite cross-country skiers. Scandinavian Journal of Medicine and Science in Sports, 28(1), 180-186
Open this publication in new window or tab >>Prevalence, age at onset, and risk factors of self-reported asthma among Swedish adolescent elite cross-country skiers
2018 (English)In: Scandinavian Journal of Medicine and Science in Sports, ISSN 0905-7188, E-ISSN 1600-0838, Vol. 28, no 1, p. 180-186Article in journal (Refereed) Published
Abstract [en]

The objective of the study was to compare the prevalence of self-reported physician-diagnosed asthma and age at asthma onset between Swedish adolescent elite skiers and a reference group and to assess risk factors associated with asthma. Postal questionnaires were sent to 253 pupils at the Swedish National Elite Sport Schools for cross-country skiing, biathlon, and ski-orienteering (skiers) and a random sample of 500 adolescents aged 16-20, matched for sport school municipalities (reference). The response rate was 96% among the skiers and 48% in the reference group. The proportion of participants with self-reported physician-diagnosed asthma was higher among skiers than in the reference group (27 vs 19%, P=.046). Female skiers reported a higher prevalence of physician-diagnosed asthma compared to male skiers (34 vs 20%, P=.021). The median age at asthma onset was higher among skiers (12.0 vs 8.0years; P<.001). Female sex, family history of asthma, nasal allergy, and being a skier were risk factors associated with self-reported physician-diagnosed asthma. Swedish adolescent elite cross-country skiers have a higher asthma prevalence and later age at asthma onset compared to a reference population. Being an adolescent, elite skier is an independent risk factor associated with asthma.

Place, publisher, year, edition, pages
WILEY, 2018
Keywords
asthma, epidemiology, athlete, skiing
National Category
Respiratory Medicine and Allergy
Identifiers
urn:nbn:se:umu:diva-144355 (URN)10.1111/sms.12879 (DOI)000422630100019 ()28314090 (PubMedID)
Available from: 2018-02-05 Created: 2018-02-05 Last updated: 2019-05-17Bibliographically approved
Eriksson, L., Schagatay, F., Sjöström, R., Soderstrom, L., Hanstock, H., Sandström, T. & Stenfors, N. (2018). Symptoms of moderate exercise in subzero temperatures - An experimental exposure study. Paper presented at 28th International Congress of the European-Respiratory-Society (ERS), SEP 15-19, 2018, Paris, FRANCE. European Respiratory Journal, 52
Open this publication in new window or tab >>Symptoms of moderate exercise in subzero temperatures - An experimental exposure study
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2018 (English)In: European Respiratory Journal, ISSN 0903-1936, E-ISSN 1399-3003, Vol. 52Article in journal, Meeting abstract (Other academic) Published
Abstract [en]

Humans react to cold with various symptoms. Previous studies enquiring about symptoms during cold exposure have for the most part been population based studies using questionnaries and have focused on a narrow spectrum of symptoms. The purpose of this study was to study the effect of cold air and physical exercise on a wide range of symptoms in healthy individuals.

A total of 31 healthy subjects were experimentally exposed to +10 °C and -10 °C in an environmental chamber for one hour, on two separate occasions. During each exposure, subjects performed an intermittent moderate-intensity running protocol between 62-78% of maximal oxygen consumption (VO2 max). At five timepoints, before, during and after the exposures, subjects were asked about 18 symptoms and their intensity. The Borg CR10 scale was used to rate the intensity from 0 to 11, where 0 meant "none" and 11 meant "maximal". The sum of all five Borg CR10-scores were added together to form a single score for each exposure. Paired Wilcoxon signed-rank test was used for analysis. Data are presented as medians.

Symptoms of cough, eye irritation, physical discomfort, and cold extremities were present only at -10 °C. Compared to exercise in +10 °C, exercise in -10 °C induced significantly higher summed symptom scores for eye irritation 2.0 vs 0.5 (p=0.011), rhinitis 12.0 vs 8.0 (p=0.000), nasal irritation 3.5 vs 0.5 (p=0.001), cold face 7.0 vs 1.0 (p=0.000), physical discomfort 6.5 vs 0.0 (p=0.000), and cold extremities 10.0 vs 0.5 (p=0.000).

In healthy subjects, moderate-intensity exercise in -10 °C can induce and enhance the intensity of a wide range of symptoms. Symptoms of the lower airways were infrequent and mild.

Place, publisher, year, edition, pages
European Respiratory Society, 2018
National Category
Respiratory Medicine and Allergy
Identifiers
urn:nbn:se:umu:diva-156010 (URN)10.1183/13993003.congress-2018.PA4514 (DOI)000455567106165 ()
Conference
28th International Congress of the European-Respiratory-Society (ERS), SEP 15-19, 2018, Paris, FRANCE
Note

Supplement: 62

Meeting Abstract: PA4514

Available from: 2019-02-01 Created: 2019-02-01 Last updated: 2019-02-01Bibliographically approved
Sawalha, S., Hedman, L., Backman, H., Rönmark, E., Lundbäck, B., Stenfors, N. & Lindberg, A. (2018). The impact of comorbidities on mortality in COPD, report from the OLIN COPD study.. Paper presented at 28th International Congress of the European-Respiratory-Society (ERS), SEP 15-19, 2018, Paris, FRANCE. European Respiratory Journal, 52
Open this publication in new window or tab >>The impact of comorbidities on mortality in COPD, report from the OLIN COPD study.
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2018 (English)In: European Respiratory Journal, ISSN 0903-1936, E-ISSN 1399-3003, Vol. 52Article in journal, Meeting abstract (Other academic) Published
Abstract [en]

Comorbidities contribute to the increased mortality observed among subjects with COPD, but the prognostic impact and possible sex differences have rarely been evaluated in population-based studies.

Aim: To evaluate the impact of common comorbidities; cardiovascular disease (CVD), diabetes mellitus (DM) and anxiety/depression (A/D), on mortality in a population-based study of subjects with (COPD) and without airway obstruction.

Methods: All subjects with airway obstruction (FEV1/(F)VC<0.70, n=993), were, together with age- and sex matched referents, identified after examinations of population-based cohorts in 2002-04. Spirometric groups: Normal Lung Function (NLF), COPD; post- bronchodilator fixed ratio (GOLD) and lower limit of normal (LLN). Mortality data were collected until December 2015.

Results: The cumulative mortality was significantly higher in GOLD-COPD than NLF, and higher in men than women in both groups. CVD, DM and A/D independently increased the risk for death (Hazard Ratio; 95% CI, 1.50-1.59; 1.07-2.11) in GOLD-COPD when adjusted for age, sex, smoking habits, BMI and FEV1% predicted, while in NLF A/D (1.54; 1.03-2.30) but not CVD (1.20; 0.87-1.65) or DM (1.46; 0.95-2.26). Among women with GOLD-COPD, CVD and A/D but not DM increased the risk for death, while among men DM and A/D, but not CVD. When the LLN-criterion was applied, the significantly increased risk for death associated with comorbidities remained among men, but not among women.

Conclusion: CVD, DM and A/D increased the risk for death in GOLD-COPD, but there seems to be sex-dependent differences in prognosis associated with comorbidities, also in relation to different spirometric criteria for COPD.

Place, publisher, year, edition, pages
European Respiratory Society, 2018
Identifiers
urn:nbn:se:umu:diva-155994 (URN)10.1183/13993003.congress-2018.PA2269 (DOI)000455567102374 ()
Conference
28th International Congress of the European-Respiratory-Society (ERS), SEP 15-19, 2018, Paris, FRANCE
Note

Supplement: 62

Meeting Abstract: PA2269

Available from: 2019-02-07 Created: 2019-02-07 Last updated: 2019-02-07Bibliographically approved
Huber, D., Henriksson, R., Jakobsson, S., Stenfors, N. & Mooe, T. (2016). Implementation of a telephone-based secondary preventive intervention after acute coronary syndrome (ACS): participation rate, reasons for non-participation and 1-year survival. Trials, 17, Article ID 85.
Open this publication in new window or tab >>Implementation of a telephone-based secondary preventive intervention after acute coronary syndrome (ACS): participation rate, reasons for non-participation and 1-year survival
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2016 (English)In: Trials, ISSN 1745-6215, E-ISSN 1745-6215, Vol. 17, article id 85Article in journal (Refereed) Published
Abstract [en]

Background: Acute coronary syndrome (ACS) is a major cause of death from a non-communicable disease. Secondary prevention is effective for reducing morbidity and mortality, but evidence-based targets are seldom reached and new interventional methods are needed. The present study is a feasibility study of a telephone-based secondary preventive programme in an unselected ACS cohort. Methods: The NAILED (Nurse-based Age-independent Intervention to Limit Evolution of Disease) ACS trial is a prospective randomized controlled trial. All eligible patients admitted for ACS were randomized to usual follow-up by a general practitioner or telephone follow-up by study nurses. The intervention was made by continuous telephone contact, with counseling on healthy living and titration of medicines to reach target values for blood pressure and blood lipids. Exclusion criteria were limited to physical inability to follow the study design or participation in another study. Results: A total of 907 patients were assessed for inclusion. Of these, 661 (72.9 %) were included and randomized, 100 (11 %) declined participation, and 146 (16.1 %) were excluded. The main reasons for exclusion were participation in another trial, dementia, and advanced disease. "Excluded" and "declining" patients were significantly older with more co-morbidity, decreased functional status, and had more seldom received education above compulsory school level than "included" patients. Non-participants had a higher 1-year mortality than participants. Conclusions: Nurse-led telephone-based follow-up after ACS can be applied to a large proportion in an unselected clinical setting. Reasons for non-participation, which were associated with increased mortality, include older age, multiple co-morbidities, decreased functional status and low level of education.

Keywords
Secondary prevention, Acute coronary syndrome, Myocardial infarction, Cardiovascular disease, Implementation, Telemedicine, Telephone, Nurse-based, Mortality, Randomized controlled trial
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-117814 (URN)10.1186/s13063-016-1203-x (DOI)000370030500001 ()
Available from: 2016-04-08 Created: 2016-03-04 Last updated: 2019-04-26Bibliographically approved
Behndig, A. F., Shanmuganathan, K., Whitmarsh, L., Stenfors, N., Brown, J. L., Frew, A. J., . . . Wilson, S. J. (2015). Effects of controlled diesel exhaust exposure on apoptosis and proliferation markers in bronchial epithelium: an in vivo bronchoscopy study on asthmatics, rhinitics and healthy subjects. BMC Pulmonary Medicine, 15, Article ID 99.
Open this publication in new window or tab >>Effects of controlled diesel exhaust exposure on apoptosis and proliferation markers in bronchial epithelium: an in vivo bronchoscopy study on asthmatics, rhinitics and healthy subjects
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2015 (English)In: BMC Pulmonary Medicine, ISSN 1471-2466, E-ISSN 1471-2466, Vol. 15, article id 99Article in journal (Refereed) Published
Abstract [en]

Background: Epidemiological evidence demonstrates that exposure to traffic-derived pollution worsens respiratory symptoms in asthmatics, but controlled human exposure studies have failed to provide a mechanism for this effect. Here we investigated whether diesel exhaust (DE) would induce apoptosis or proliferation in the bronchial epithelium in vivo and thus contribute to respiratory symptoms.

Methods: Moderate (n = 16) and mild (n = 16) asthmatics, atopic non-asthmatic controls (rhinitics) (n = 13) and healthy controls (n = 21) were exposed to filtered air or DE (100 μg/m 3 ) for 2 h, on two separate occasions. Bronchial biopsies were taken 18 h post-exposure and immunohistochemically analysed for pro-apoptotic and anti-apoptotic proteins (Bad, Bak, p85 PARP, Fas, Bcl-2) and a marker of proliferation (Ki67). Positive staining was assessed within the epithelium using computerized image analysis.

Results: No evidence of epithelial apoptosis or proliferation was observed in healthy, allergic or asthmatic airways following DE challenge.

Conclusion: In the present study, we investigated whether DE exposure would affect markers of proliferation and apoptosis in the bronchial epithelium of asthmatics, rhinitics and healthy controls, providing a mechanistic basis for the reported increased airway sensitivity in asthmatics to air pollutants. In this first in vivo exposure investigation, we found no evidence of diesel exhaust-induced effects on these processes in the subject groups investigated.

National Category
Respiratory Medicine and Allergy
Identifiers
urn:nbn:se:umu:diva-108459 (URN)10.1186/s12890-015-0096-x (DOI)000360043000001 ()26303256 (PubMedID)
Available from: 2015-09-22 Created: 2015-09-11 Last updated: 2018-06-07Bibliographically approved
Norqvist, J., Eriksson, L., Söderström, L., Lindberg, A. & Stenfors, N. (2015). Self-reported physician-diagnosed asthma among Swedish adolescent, adult and former elite endurance athletes. Journal of Asthma, 52(10)
Open this publication in new window or tab >>Self-reported physician-diagnosed asthma among Swedish adolescent, adult and former elite endurance athletes
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2015 (English)In: Journal of Asthma, ISSN 0277-0903, E-ISSN 1532-4303, Vol. 52, no 10Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: Asthma is common among elite endurance athletes. Since the first published Swedish studies in 1993, awareness of "skiers' asthma" has increased. The current prevalence of asthma among Swedish skiers is unknown. This paper aims to present the design of a 5-year prospective annual questionnaire study on asthma among Swedish current and former elite endurance athletes, the first cross-sectional results on prevalence, age of onset, and predictors of self-reported physician-diagnosed asthma in the study population.

METHODS: An annual postal questionnaire is sent to Swedish elite skiers and orienteers during 2011-2015. In 2013, former Swedish Olympic skiers were similarly invited. We present cross-sectional data obtained in 2011 from the adolescents and adults and in 2013 from former skiers. A total of 491 athletes were invited. The results are presented by age, sex and sport. Chi-square test was used for group comparisons. Predictors of asthma were identified using logistic regression.

RESULTS: Response rate was 82%. Among athletes aged 15-19, 29% of the skiers (38% of the female skiers), and 17% of the orienteers reported asthma (p = 0.071). Among the athletes aged 20-34, 35% of the skiers and 16% of the orienteers reported asthma (p = 0.029). Among the former skiers aged 40-94, 22% reported asthma. Among the active athletes, the onset of asthma was in early adolescence. Logistic regression found increasing age, female sex, allergy, family history of allergy/asthma and being skier predictors of self-reported physician-diagnosed asthma.

CONCLUSIONS: The prevalence of physician-diagnosed asthma is high among Swedish endurance athletes, especially female adolescent skiers.

Place, publisher, year, edition, pages
Taylor & Francis, 2015
Keywords
Airway symptoms, epidemiology, medication, orienteers, risk factors, skiers
National Category
Respiratory Medicine and Allergy
Identifiers
urn:nbn:se:umu:diva-112530 (URN)10.3109/02770903.2015.1038389 (DOI)000366245800010 ()26288032 (PubMedID)
Available from: 2015-12-09 Created: 2015-12-09 Last updated: 2018-06-07Bibliographically approved
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