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  • 1.
    Andersen, Grethe Neumann
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Reumatologi.
    Nilsson, Kenneth
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Lungmedicin.
    Pourazar, Jamshid
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Lungmedicin.
    Hackett, Tillie-Louise
    Kazzam, Elsadig
    Blomberg, Anders
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Lungmedicin.
    Waldenström, Anders
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin.
    Warner, Jane
    Rantapää-Dahlqvist, Solbritt
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Reumatologi.
    Mincheva-Nilsson, Lucia
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk mikrobiologi, Klinisk immunologi.
    Sandström, Thomas
    Bronchoalveolar matrix metalloproteinase 9 relates to restrictive lung function impairment in systemic sclerosis.2007Ingår i: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 101, nr 10, s. 2199-2206Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Systemic sclerosis (SSc) is frequently associated with interstitial lung disease (ILD) often leading to lung fibrosis. In this study we investigated whether matrix metalloproteinase 9 (MMP-9) and its natural inhibitor; the tissue inhibitor of matrix metalloproteinase 1 (TIMP-1), would be associated with remodelling in ILD in SSc. Levels of total MMP-9, pro-MMP-9 and TIMP-1 were measured in bronchoalveolar lavage (BAL) fluid from nine SSc patients with ILD, seven SSc patients without ILD and 16 age- and sex-matched healthy controls. Total MMP-9 and pro-MMP-9 levels were significantly elevated in SSc patients with ILD, compared to levels in SSc patients without ILD and healthy controls. In SSc patients with ILD calculated active MMP-9 levels were significantly higher than in SSc patients without ILD and tended to be higher than in healthy controls. TIMP-1 levels were elevated in both patient groups compared to healthy controls. Total-, pro- and active MMP-9 levels as well as pro-MMP-TIMP-1 and active MMP-9/TIMP-1 ratios were inversely associated with total lung capacity. The present study suggests that MMP-9 plays a pathophysiological role in the remodelling in ILD and lung fibrosis associated with SSc, and may represent a new therapeutic target in this condition.

  • 2. Andersson, Mikael
    et al.
    Stridsman, Caroline
    Emtner, Margareta
    Lindberg, Anne
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Rönmark, Eva
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Physical activity and fatigue in chronic obstructive pulmonary disease - A population based study2015Ingår i: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 109, nr 8, s. 1048-1057Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: In subjects with chronic obstructive pulmonary disease (COPD), symptoms of fatigue, concomitant heart disease and low physical activity levels are more frequently described than in subjects without COPD. However, there are no population-based studies addressing the relationship between physical activity, fatigue and heart disease in COPD. The aim was to compare physical activity levels among subjects with and without COPD in a population based study, and to evaluate if concomitant heart disease and fatigue was associated to physical activity.

    METHODS: In this, 470 subjects with COPD and 659 subjects without COPD (non-COPD) participated in examinations including structured interview and spirometry. A ratio of the forced expiratory volume in one second (FEV1)/best of forced vital capacity (FVC) and vital capacity (VC) < 0.7 was used to define COPD. Physical activity was assessed with the International Physical Activity Questionnaire (IPAQ), and fatigue with the Functional Assessment of Chronic Illness Therapy - Fatigue scale (FACIT-F).

    RESULTS: The prevalence of low physical activity was higher among subjects with FEV1 < 80% predicted compared to non-COPD subjects (22.4% vs. 14.6%, p = 0.041). The factors most strongly associated with low physical activity in subjects with COPD were older age, OR 1.52, (95% CI 1.12-2.06), a history of heart disease, OR 2.11 (1.10-4.08), and clinically significant fatigue, OR 2.33 (1.31-4.13); while obesity was the only significant factor among non-COPD subjects, OR 2.26 (1.17-4.35).

    CONCLUSION: Physical activity levels are reduced when lung function is decreased below 80% of predicted, and the factors associated with low physical activity are different among subject with and without COPD. We propose that the presence of fatigue and heart disease are useful to evaluate when identifying subjects for pulmonary rehabilitation.

  • 3.
    Backman, Helena
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Eriksson, Berne
    Hedman, Linnea
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin. Department of Health Sciences, Division of Nursing, Luleå University of Technology, Luleå, Sweden.
    Stridsman, Caroline
    Jansson, Sven-Arne
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Sovijärvi, Anssi
    Lindberg, Anne
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Rönmark, Eva
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Lundbäck, Bo
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin. Krefting Research Centre, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.
    Restrictive spirometric pattern in the general adult population: methods of defining the condition and consequences on prevalence2016Ingår i: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 120, s. 116-123Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Attempts have been made to use dynamic spirometry to define restrictive lung function, but the definition of a restrictive spirometric pattern (RSP) varies between studies such as BOLD and NHANES. The aim of this study was to estimate the prevalence and risk factors of RSP among adults in northern Sweden based on different definitions.

    METHODS: In 2008-2009 a general population sample aged 21-86y within the obstructive lung disease in northern Sweden (OLIN) studies was examined by structured interview and spirometry, and 726 subjects participated (71% of invited). The prevalence of RSP was calculated according to three different definitions based on pre-as well as post-bronchodilator spirometry: 1) FVC < 80% & FEV1/FVC > 0.7 2) FVC < 80% & FEV1/FVC > LLN 3) FVC < LLN & FEV1/FVC > LLN RESULTS: The three definitions yielded RSP prevalence estimates of 10.5%, 11.2% and 9.4% respectively, when based on pre-bronchodilator values. The prevalence was lower when based on post-bronchodilator values, i.e. 7.3%, 7.9% and 6.6%. According to definition 1 and 2, the RSP prevalence increased by age, but not according to definition 3. The overlap between the definitions was substantial. When corrected for confounding factors, manual work in industry and diabetes with obesity were independently associated with an increased risk for RSP regardless of definition.

    CONCLUSIONS: The prevalence of RSP was 7-11%. The prevalence estimates differed more depending on the choice of pre- compared to post-bronchodilator values than on the choice of RSP definition. RSP was, regardless of definition, independently associated with manual work in industry and diabetes with obesity.

  • 4.
    Backman, Helena
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin. The OLIN Unit, Umeå University, Umeå, Sweden..
    Eriksson, Berne
    Rönmark, Eva
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin. The OLIN Unit, Umeå University, Umeå, Sweden..
    Hedman, Linnea
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin. The OLIN Unit, Umeå University, Umeå, Sweden..
    Stridsman, Caroline
    Dept of Health Sciences, Luleå University, Luleå, Sweden..
    Jansson, Sven-Arne
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin. The OLIN Unit, Umeå University, Umeå, Sweden..
    Lindberg, Anne
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Lundbäck, Bo
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin. The OLIN Unit, Umeå University, Umeå, Sweden; Krefting Research Centre, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden..
    Decreased prevalence of moderate to severe COPD over 15 years in northern Sweden2016Ingår i: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 114, s. 103-110Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: The burden of COPD in terms of mortality, morbidity, costs and prevalence has increased worldwide. Recent results on prevalence in Western Europe are conflicting. In Sweden smoking prevalence has steadily decreased over the past 30 years.

    AIM: The aim was to study changes in prevalence and risk factor patterns of COPD in the same area and within the same age-span 15 years apart.

    MATERIAL AND METHODS: Two population-based cross-sectional samples in ages 23-72 years participating at examinations in 1994 and 2009, respectively, were compared in terms of COPD prevalence, severity and risk factor patterns. Two different definitions of COPD were used; FEV1/FVC < LLN and FEV1/FVC < 0.7. The severity of COPD was assessed by FEV1, both as % of predicted and in relation to the LLN.

    RESULTS: The prevalence of COPD decreased significantly from 9.5% to 6.3% (p = 0.030) according to the FEV1/FVC < LLN criterion, while the decrease based on the FEV1/FVC < 0.7 criterion from 10.5% to 8.5% was non-significant. The prevalence of moderate to severe COPD decreased substantially and significantly, and the risk factor pattern was altered in 2009 when, beside age and smoking, also socio-economic status based on occupation was significantly associated with COPD.

    CONCLUSIONS: Changes in both prevalence and risk factor patterns of COPD were observed between surveys. Following a continuing decrease in smoking habits over several decades, a decrease in the prevalence of moderate to severe COPD was observed from 1994 to 2009 in northern Sweden.

  • 5.
    Backman, Helena
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Jansson, Sven-Arne
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Stridsman, Caroline
    Department of Health Sciences, Luleå University, Luleå, Sweden.
    Muellerova, Hana
    Real-World Evidence&Epidemiology, GSK R&D, Uxbridge, UK.
    Wurst, Keele
    Real-World Evidence&Epidemiology, GSK R&D, Uxbridge, UK.
    Hedman, Linnea
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin. Department of Health Sciences, Luleå University, Luleå, Sweden.
    Lindberg, Anne
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Rönmark, Eva
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Chronic airway obstruction in a population-based adult asthma cohort: Prevalence, incidence and prognostic factors2018Ingår i: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 138, s. 115-122Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Asthma and COPD may overlap (ACO) but information about incidence and risk factors are lacking. This study aimed to estimate prevalence, incidence and risk factors of chronic airway obstruction (CAO) in a population-based adult asthma cohort.

    METHODS: /FVC<0.7.

    RESULTS: decline and higher levels of neutrophils than asthma only. Smoking, older age and male sex were independently associated with increased risk for both prevalent and incident CAO, while obesity had a protective effect.

    CONCLUSIONS: In this prospective adult asthma cohort, the majority did not develop CAO. Smoking, older age and male sex were risk factors for prevalent and incident CAO, similar to risk factors described for COPD in the general population.

  • 6. Bjerg, Anders
    et al.
    Eriksson, Jonas
    Ólafsdóttir, Inga Sif
    Middelveld, Roelinde
    Franklin, Karl
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Forsberg, Bertil
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Larsson, Kjell
    Torén, Kjell
    Dahlén, Sven-Erik
    Janson, Christer
    The association between asthma and rhinitis is stable over time despite diverging trends in prevalence2015Ingår i: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 109, nr 3, s. 312-319Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Despite the well-known association between asthma and rhinitis, in Swedish adults the prevalence of rhinitis rose from 22% to 31% between 1990 and 2008 while asthma prevalence was unchanged. We tested whether the association of rhinitis with asthma was stable over time using the same population-based databases.

    METHODS: Two surveys of adults (20-44 years) living in three regions of Sweden, carried out in 1990 (n = 8982) and 2008 (n = 9156) were compared. Identical questions regarding respiratory symptoms, asthma and rhinitis were used. Asthmatic wheeze: Wheeze with breathlessness apart from colds. Current asthma: Asthma attacks and/or asthma medication use.

    RESULTS: Subjects with rhinitis had level time trends in asthmatic wheeze, current asthma and most nocturnal respiratory symptoms between 1990 and 2008, adjusted for age, sex, area and smoking. Any wheeze however decreased slightly. In never-smokers asthma symptoms were similarly associated with rhinitis in 1990 and 2008: any wheeze OR 4.0 vs. 4.4 (p = 0.339); asthmatic wheeze OR 6.0 vs. 5.9 (p = 0.937); and current asthma OR 9.6 vs. 7.7 (p = 0.213). In the whole population there were decreases in the asthma symptoms most closely associated to smoking, which decreased by half 1990-2008. Conversely current asthma, which was strongly associated with rhinitis and not with smoking, increased (p < 0.001).

    CONCLUSIONS: The association of rhinitis with asthma was stable between 1990 and 2008. The pattern in the time trends of asthma outcomes strongly suggests that decreased smoking counterbalanced the driving effect of increased rhinitis on asthma prevalence. The findings illustrate the public health benefits of decreased smoking.

  • 7.
    Bosson, Jenny
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Lungmedicin.
    Pourazar, Jamshid
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Lungmedicin.
    Forsberg, Bertil
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Ädelroth, Ellinor
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Lungmedicin.
    Sandström, Thomas
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Lungmedicin.
    Blomberg, Anders
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Lungmedicin.
    Ozone enhances the airway inflammation initiated by diesel exhaust.2007Ingår i: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 101, nr 6, s. 1140-1146Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Exposure to air pollution is associated with adverse health effects, with particulate matter (PM) and ozone (O(3)) both indicated to be of considerable importance. Diesel engine exhaust (DE) and O(3) generate substantial inflammatory effects in the airways. However, as yet it has not been determined whether a subsequent O(3) exposure would add to the diesel-induced airway inflammatory effects. Healthy subjects underwent two separate exposure series: A 1-h DE exposure at a PM-concentration of 300 microg/m(3), followed after 5h by a 2-h exposure to filtered air and 0.2 ppm O(3), respectively. Induced sputum was collected 18 h after the second exposure. A significant increase in the percentage of neutrophils (PMN) and concentration of myeloperoxidase (MPO) was seen in sputum post DE+O(3) vs. DE+air (p<0.05 and <0.05, respectively). Significant associations were observed between the responses in MPO concentration and total PMN cells (p=0.001), and also between MPO and matrix metalloproteinase-9 (MMP-9) (p<0.001). The significant increase of PMN and MPO after the DE+O(3) exposures, compared to DE+air, denotes an O(3)-induced magnification of the DE-induced inflammation. Furthermore, the correlation between responses in MPO and number of PMNs and MMP-9 illustrate that the PMNs are activated, resulting in a more potent inflammatory response. The present study indicates that O(3) exposure adds significantly to the inflammatory response that is established by diesel exhaust. This interaction between exposure to particulate pollution and O(3) in sequence should be taken into consideration when health effects of air pollution are considered.

  • 8. Carsin, Anne-Elie
    et al.
    Fuertes, Elaine
    Schaffner, Emmanuel
    Jarvis, Debbie
    Antó, Josep M.
    Heinrich, Joachim
    Bellisario, Valeria
    Svanes, Cecilie
    Keidel, Dirk
    Imboden, Medea
    Weyler, Joost
    Nowak, Dennis
    Martinez-Moratalla, Jesus
    Gullón, José-Antonio
    Sanchez Ramos, José Luis
    Caviezel, Seraina
    Beckmeyer-Borowko, Anna
    Raherison, Chantal
    Pin, Isabelle
    Demoly, Pascal
    Cerveri, Isa
    Accordini, Simone
    Gislason, Thorarinn
    Toren, Kjell
    Department of Public Health and Community Medicine, Institute of Medicine, Goteburg, Sweden..
    Forsberg, Bertil
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Janson, Christer
    Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden..
    Jogi, Rain
    Emtner, Margareta
    Gómez Real, Francisco
    Raza, Wasif
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Leynaert, Bénédicte
    Pascual, Silvia
    Guerra, Stefano
    Dharmage, Shyamali C.
    Probst-Hensch, Nicole
    Garcia-Aymerich, Judith
    Restrictive spirometry pattern is associated with low physical activity levels: A population based international study2019Ingår i: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 146, s. 116-123Artikel i tidskrift (Refereegranskat)
    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.

  • 9. Ekerljung, Linda
    et al.
    Rönmark, Eva
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin. Obstructive Lung Disease In Northern Sweden (OLIN) Studies, Department of Medicine, Sunderby Central Hospital of Norrbotten, Luleå, Sweden.
    Larsson, Kjell
    Sundblad, Britt-Marie
    Bjerg, Anders
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin. Obstructive Lung Disease In Northern Sweden (OLIN) Studies, Department of Medicine, Sunderby Central Hospital of Norrbotten, Luleå, Sweden.
    Ahlstedt, Staffan
    Dahlén, Sven-Erik
    Lundbäck, Bo
    No further increase of incidence of asthma: incidence, remission and relapse of adult asthma in Sweden2008Ingår i: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 102, nr 12, s. 1730-1736Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Knowledge about time trends of disease patterns in society is essential for planning and prioritizing health care resources. Longitudinal population-based studies on asthma are scarce but provide an opportunity to assess incidence, remission and relapse of asthma, and their determinants, which were the objectives of the present study.

    METHODS: A postal questionnaire was sent on two occasions, 1996 and 2006, to a randomly selected sample of subjects aged 20-69 years in 1996. The response rates were 72% and 83%, respectively, and in total 4479 subjects participated in both surveys. The questionnaire included questions on asthma, respiratory symptoms and possible determinants. Logistic regression was used to assess determinants.

    RESULTS: Cumulative incidence of asthma was 2.4% (men 1.9%; women 2.8%, p=0.06). Family histories of asthma (OR 2.31, CI 95% 1.42-3.76), rhinitis (OR 2.25, CI 95% 1.43-3.53) and being an ex-smoker (OR 2.17, CI 95% 1.27-3.71) were determinants for incident asthma. The 10-year remission of asthma was 14.6% and inversely associated with rhinitis. Relapse was found in 38% of eligible subjects.

    CONCLUSIONS: The current study with high participation rates concludes that the incidence of asthma among adults has been stable in Sweden for the past two decades. Remission was associated with mild disease at study start. Relapse in adults has rarely been reported previously and provide new insight in the course of asthma. Low remission and high relapse further support the view of asthma as a chronic disease; possibly representing fluctuations of the disease over time.

  • 10. Eriksson, Berne
    et al.
    Lindberg, Anne
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Muellerova, Hana
    Rönmark, Eva
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Lundback, Bo
    Association of heart diseases with COPD and restrictive lung function - Results from a population survey2013Ingår i: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 107, nr 1, s. 98-106Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Introduction: Few studies have explored the association of COPD, based on GOLD definition, with heart diseases. The relationship between restrictive lung function impairment and heart diseases is still poorly studied on a population level. Objectives: To explore the association of COPD and restrictive lung function impairment, respectively, with heart diseases in the general population. Design: This is a cross-sectional study of 642 randomly selected 22- to 72-year-old subjects in northern Sweden. COPD was defined according to GOLD. Restrictive lung function was defined as pre-bronchodilator FVC <80% of predicted value and FEV1/FVC >= 0.7. Results: The prevalence of ischemic heart disease was 4% in subjects with normal spirometry, 13% in subjects with COPD, and 21% in those with restrictive lung function. The prevalence of heart diseases increased with COPD severity. On the other hand, the prevalence of COPD was particularly high in the group reporting myocardial infarction. In subjects reporting different heart diseases, the prevalence of restrictive lung function was high. In multivariate analyses including age, sex, smoking habits, family history of obstructive airway disease, body mass index, and socio-economic status as independent variables, COPD was associated with ischemic heart disease (odds ratio [OR] 2.61; 95% confidence interval [CI] 1.12-6.08) and ischemic heart disease with COPD (OR 2.40; 95% CI 1.03-5.61). Conclusion: The study shows a strong association between COPD and cardiovascular diseases and indicates a strong association between restrictive lung function and heart diseases. Both obstructive and restrictive lung function impairments were common among subjects with heart diseases and vice versa.

  • 11. Eriksson, Jonas
    et al.
    Bjerg, Anders
    Lotvall, Jan
    Wennergren, Goran
    Rönnmark, Eva
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Toren, Kjell
    Lundback, Bo
    Rhinitis phenotypes correlate with different symptom presentation and risk factor patterns of asthma2011Ingår i: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 105, nr 11, s. 1611-1621Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Asthma and rhinitis frequently coexist, but no population study has previously determined the relationship between nasal comorbidities and symptom expression and risk factors of asthma.

    Methods: In 2008, a postal questionnaire on respiratory health was sent to 30 000 randomly selected subjects aged 16-75 years in West Sweden; 29218 could be traced and 18 087 (62%) responded. The questionnaire included questions on asthma, rhinitis, chronic rhinosinusitis, respiratory symptoms and possible determinants.

    Results: Prevalence of allergic rhinitis in asthma was 63.9% and of asthma in allergic rhinitis 19.8%. Prevalence of chronic rhinosinusitis in asthma was 8.4% and of asthma in chronic rhinosinusitis 24.4%. Asthma subjects with chronic rhinitis, or chronic rhinosinusitis, had more symptoms of asthma and bronchitis than those without rhinitis (p < 0.001). There was an obvious trend of higher ORs for various environmental exposures including occupational exposure to dust, gases and fumes (OR 2.32 vs. OR 1.44), visible mould at home (OR 1.72 vs. OR 1.27) and water damage at home (OR 1.82 vs. OR 1.06) for asthma with chronic rhinosinusitis than for asthma with allergic rhinitis. Family history of allergy yielded a higher OR for asthma with allergic rhinitis than with asthma with chronic rhinosinusitis (OR 7.15 vs. OR 4.48).

    Conclusion: Considerable overlap between asthma and nasal comorbidities was documented, confirming a close relationship between nasal disease and asthma. Allergic rhinitis, chronic rhinitis and chronic rhinosinusitis were associated with different risk factor patterns and symptom expression of asthma. Thus, different nasal comorbidities may reflect different phenotypes of asthma. (C) 2011 Elsevier Ltd. All rights reserved.

  • 12.
    Franklin, Karl
    et al.
    Umeå universitet, Medicinsk fakultet, Folkhälsa och klinisk medicin, Lungmedicin. Lungmedicin.
    Gustafson, Torbjörn
    Umeå universitet, Medicinsk fakultet, Folkhälsa och klinisk medicin, Lungmedicin. Lungmedicin.
    Ranstam, Jonas
    Ström, Kerstin
    Survival and future need of long-term oxygen therapy for chronic obstructive pulmonary disease--gender differences.2007Ingår i: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 101, nr 7, s. 1506-1511Artikel i tidskrift (Refereegranskat)
  • 13.
    Gustafson, Torbjörn
    et al.
    Umeå universitet, Medicinsk fakultet, Folkhälsa och klinisk medicin, Lungmedicin. Lungmedicin.
    Dahlman-Höglund, Anna
    Nilsson, Kenneth
    Ström, Kerstin
    Tornling, Göran
    Torén, Kjell
    Occupational exposure and severe pulmonary fibrosis.2007Ingår i: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 101, nr 10, s. 2207-2212Artikel i tidskrift (Refereegranskat)
  • 14.
    Gustafson, Torbjörn
    et al.
    Department of Medicine, Skellefteå Hospital, SE-931 86 Skellefteå, Sweden.
    Löfdahl, Kerstin
    Department of Respiratory Medicine and Allergology, Sahlgrenska University Hospital, SE-413 45 Göteborg, Sweden.
    Ström, Kerstin
    Department of Respiratory Medicine, Blekinge Hospital, SE-371 85 Karlskrona, Sweden.
    A model of quality assessment in patients on long-term oxygen therapy2009Ingår i: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 103, nr 2, s. 209-215Artikel i tidskrift (Refereegranskat)
  • 15. Hagstad, Stig
    et al.
    Backman, Helena
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin. Obstructive Lung Disease In Northern Sweden (OLIN) Studies, Norrbotten County Council, Luleå, Sweden.
    Bjerg, Anders
    Ekerljung, Linda
    Ye, Xiong
    Hedman, Linnea
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin. Obstructive Lung Disease In Northern Sweden (OLIN) Studies, Norrbotten County Council, Luleå, Sweden.
    Lindberg, Anne
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Lungmedicin. Unit of Research , Education and Development - Luleå, Umeå University .
    Torén, Kjell
    Lötvall, Jan
    Rönmark, Eva
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin. Obstructive Lung Disease In Northern Sweden (OLIN) Studies, Norrbotten County Council, Luleå, Sweden.
    Lundbäck, Bo
    Prevalence and risk factors of COPD among never-smokers in two areas of Sweden: Occupational exposure to gas, dust or fumes is an important risk factor2015Ingår i: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 109, nr 11, s. 1439-1445Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Although active tobacco smoking is the main risk factor for COPD, COPD is not uncommon also among never-smokers. Different study locations along with different spirometric definitions of COPD have historically yielded different prevalence estimates of the disease.

    AIM: To study current prevalence and risk factors of COPD among never-smokers in two areas of Sweden.

    METHODS: Data collected in 2008-2012 within the West Sweden Asthma Study and Obstructive Lung Disease in Northern Sweden Studies was pooled. The study population consisted of 1839 subjects who participated in spirometry and interviews. COPD was defined as post-bronchodilator a) FEV1/(F)VC < 0.7, b) FEV1/FVC < 0.7 and c) FEV1/FVC < lower limit of normal.

    RESULTS: Of the 1839 subjects, 967 (52.6%) were never-smokers. Among the never-smoking subjects, the prevalence of COPD according to definitions a-c was 7.7%, 4.9% and 3.0%, respectively. The corresponding prevalence of GOLD grade ≥2 was 2.0%, 1.4% and 1.3%. No significant difference in prevalence between the two study areas was observed. In never-smokers, occupational exposure to gas, dust or fumes (GDF) was significantly associated with both COPD (OR 1.85, 95% CI 1.03-3.33), and GOLD ≥2 (OR 4.51, 1.72-11.9) according to definition a), after adjusting for age, educational level and exposure to passive smoking at work.

    CONCLUSION: Depending on definition, prevalence of COPD among never-smokers was 3.0-7.7%, whereas GOLD ≥2 was present in 1.3-2.0%. Occupational exposure to GDF remained independently and significantly associated with COPD regardless of spirometric definition of the disease.

  • 16. Hagstad, Stig
    et al.
    Ekerljung, Linda
    Lindberg, Anne
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Backman, Helena
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Rönmark, Eva
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Lundback, Bo
    COPD among non-smokers: Report from the Obstructive Lung Disease in Northern Sweden (OLIN) studies2012Ingår i: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 106, nr 7, s. 980-988Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: In westernized countries smoking and increasing age are the most important risk factors for COPD. Prevalence and risk factors of COPD among non-smokers are not well studied. Aim: To study the prevalence and risk factors of COPD among non-smokers and to determine the proportion of non-smokers among subjects with COPD. Methods: A random sample of 2470 subjects drawn from a population-based postal survey of 10,040 (85-88% participation) adults (aged 20-77) in Norrbotten, Sweden, were invited to structured interviews and lung function tests, and 1897 participated. COPD was classified using the fixed ratio (GOLD) definition and for comparison the lower limit of normal (LLN). Results: The prevalence of airway obstruction was 6.9% among non-smokers and strongly age related. The prevalence of GOLD stage >= II among non-smokers was 15%. Both among subjects with airway obstruction and among subjects with GOLD stage >= II, the proportions of nonsmokers were 20%. Of men with airway obstruction, 14.1% were non-smokers versus 26.8% among women. Non-smokers with GOLD stage >= II had significantly more symptoms and higher co-morbidity than non-smokers without airway obstruction. Sex, area of domicile and exposure to environmental tobacco smoke was not significantly associated to airway obstruction among non-smokers. Using LLN for defining airway obstruction yielded a similar prevalence. Conclusion: The prevalence of airway obstruction among non-smokers was close to 7% and was associated with increasing age. One out of seven men with airway obstruction, defined using the fixed ratio, versus one out of four women had never smoked. (C) 2012 Elsevier Ltd. All rights reserved.

  • 17.
    Hedman, Linnéa
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Bjerg Bäcklund, Anders
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Lungmedicin.
    Perzanowski, Matthew
    Sundberg, Sigrid
    Rönmark, Eva
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Factors related to tobacco use among teenagers2007Ingår i: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 101, nr 3, s. 496-502Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    AIM: To examine tobacco use among teenagers, identify factors related to tobacco use, as well as evaluate the outcome of a smoking prevention program.

    METHODS: From age 7/8 to 14/15, annual questionnaires about asthma and allergy have been completed in the OLIN paediatric study in Northern Sweden. From 12/13 years, questions about tobacco use, i.e. smoking and snuff, were added. A smoking prevention program was performed during 2 years.

    RESULTS: Any tobacco use increased from 5.0% at age 12/13 years, to 14.4% at age 14/15. At age 14/15 years, the prevalence of tobacco use was significantly higher among boys than girls (16.7 and 12.0%, respectively). More girls than boys smoked (8.9 and 2.8%, respectively), while use of snuff was more common among the boys (15.6 and 4.2%, respectively). Significant risk factors for smoking were any of the family members currently smoking, OR 6.1 (95% CI 4.0-9.3) and a physician-diagnosed asthma at the age of 14/15 years, OR 1.9 (95% CI 1.2-3.0). A protective factor against tobacco use was participation in sports, OR 0.3 (95% CI 0.2-0.4). The prevention program did not result in less tobacco use, although it may have delayed smoking initiation.

    CONCLUSION: The patterns of tobacco use differed significantly between boys and girls. Though any tobacco use was more common among boys, girls were more likely to smoke, and boys were more likely to use snuff. Having asthma did not prevent the teenagers from smoking. Since having a smoking family member was the major risk factor for tobacco use, prevention programs should be directed at smoking families in addition to the individuals.

  • 18. Holm, Mathias
    et al.
    Schiöler, Linus
    Andersson, Eva
    Forsberg, Bertil
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Gislason, Thorarinn
    Janson, Christer
    Jogi, Rain
    Schlünssen, Vivi
    Svanes, Cecilie
    Torén, Kjell
    Predictors of smoking cessation: a longitudinal study in a large cohort of smokers2017Ingår i: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 132, s. 164-169Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: There are few studies on predictors of smoking cessation in general populations. We studied the smoking cessation rate in relation to several potential predictors, with special focus on respiratory and cardiovascular disease.

    Methods: Smokers (n = 4636) from seven centres in Northern Europe, born between 1945 and 1973, who answered a questionnaire in 1999–2001 (the RHINE study) were followed up with a new questionnaire in 2010–2012. Altogether 2564 answered the questionnaire and provided complete data on smoking. Cox regression analyses were performed to calculate hazard ratios (HRs).

    Results: A total of 999 subjects (39%) stopped smoking during the study period. The smoking cessation rate was 44.9/1000 person-years. Smoking cessation was more common with increasing age, higher education and fewer years of smoking. Asthma, wheeze, hay fever, chronic bronchitis, diabetes and hypertension did not significantly predict smoking cessation, but smokers hospitalized for ischaemic heart disease during the study period were more prone to stopping smoking (HR 3.75 [2.62–5.37]).

    Conclusions: Successful smoking cessation is common in middle-aged smokers, and is associated with few smoking years and higher education. A diagnosis of respiratory disease does not appear to motivate people to quit smoking, nor do known cardiovascular risk factors; however, an acute episode of ischaemic heart disease encouraged smoking cessation in our study population.

  • 19. Honkamaki, Jasmin
    et al.
    Hisinger-Molkanen, Hanna
    Ilmarinen, Pinja
    Piirila, Paivi
    Tuomisto, Leena E.
    Andersen, Heidi
    Huhtala, Heini
    Sovijarvi, Anssi
    Backman, Helena
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Lundbäck, Bo
    Rönmark, Eva
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Lehtimaki, Lauri
    Kankaanranta, Hannu
    Age- and gender-specific incidence of new asthma diagnosis from childhood to late adulthood2019Ingår i: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 154, s. 56-62Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Asthma is currently divided into different phenotypes, with age at onset as a relevant differentiating factor. In addition, asthma with onset in adulthood seems to have a poorer prognosis, but studies investigating age-specific incidence of asthma with a wide age span are scarce.

    Objective: To evaluate incidence of asthma diagnosis at different ages and differences between child- and adult-diagnosed asthma in a large population-based study, with gender-specific analyzes included.

    Methods: In 2016, a respiratory questionnaire was sent to 8000 randomly selected subjects aged 20-69 years in western Finland. After two reminders, 4173 (52.3%) subjects responded. Incidence rate of asthma was retrospectively estimated based on the reported age of asthma onset. Adult-diagnosed asthma was defined as a physician-diagnosis of asthma made at >= 18 years of age.

    Results: Among those with physician-diagnosed asthma, altogether, 63.7% of subjects, 58.4% of men and 67.8% of women, reported adult-diagnosed asthma. Incidence of asthma diagnosis was calculated in 10-year age groups and it peaked in young boys (0-9 years) and middle-aged women (40-49 years) and the average incidence rate during the examined period between 1946 and 2015 was 2.2/1000/year. Adult-diagnosed asthma became the dominant phenotype among those with physician-diagnosed asthma by age of 50 years and 38 years in men and women, respectively.

    Conclusions: Asthma is mainly diagnosed during adulthood and the incidence of asthma diagnosis peaks in middle-aged women. Asthma diagnosed in adulthood should be considered more in clinical practice and management guidelines.

  • 20.
    Janaudis-Ferreira, Tania
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Sjukgymnastik.
    Wadell, Karin
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Sjukgymnastik.
    Sundelin, Gunnevi
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Sjukgymnastik.
    Lindström, Britta
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Sjukgymnastik.
    Thigh muscle strength and endurance in patients with COPD compared with healthy controls.2006Ingår i: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 100, nr 8, s. 1451-1457Artikel i tidskrift (Refereegranskat)
  • 21.
    Jansson, Sven-Arne
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Axelsson, Malin
    Hedman, Linnea
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin. Department of Health Science, Division of Nursing, Luleå University of Technology, Luleå, Sweden.
    Leander, Mai
    Stridsman, Caroline
    Rönmark, Eva
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Subjects with well-controlled asthma have similar health-related quality of life as subjects without asthma2016Ingår i: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 120, s. 64-69Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: The burden of asthma and rhinitis on health-related quality of life (HRQL) among adults has been assessed mainly in studies of patients seeking health-care, while population-based studies are relatively scarce. The objective of this study was to investigate HRQL among subjects with asthma and rhinitis derived from a random population sample and to identify factors related to impairment of HRQL.

    METHODS: A randomly selected cohort was invited to participate in a postal questionnaire survey. Of those who responded, a stratified sample of 1016 subjects was invited to clinical examinations and interviews, and 737 subjects in ages 21-86 years participated. Of these, 646 completed HRQL questions. HRQL was assessed with the generic SF-36 Health Survey.

    RESULTS: The physical score was lower among subjects with asthma vs. subjects without asthma (p < 0.001). No significant difference was found in the mental score. Subjects with well-controlled asthma had higher physical score compared to subjects with partly and un-controlled asthma (p = 0.002). Actually, subjects with well-controlled asthma had similar physical HRQL as subjects without asthma. Asthmatics who were current smokers had lower physical score compared to those who were non-smokers (p = 0.021). No significant differences in physical or mental scores were found between subjects with and without rhinitis. Subjects with both asthma and rhinitis had lower physical score compared to subjects without these conditions (p < 0.001), but subjects with asthma alone had even worse physical score.

    CONCLUSIONS: The physical score was significantly lower in asthmatics compared to subjects without asthma. Importantly, non-smoking and well-controlled asthmatics have similar HRQL compared to subjects without asthma. Thus, subjects with asthma should be supported to achieve and maintain good asthma control and if they smoke, be offered smoking cessation as means to improve their HRQL.

  • 22.
    Jansson, Sven-Arne
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Backman, Helena
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Stenling, Anna
    AstraZeneca Nordic-Baltic, Department of Health Economics, SE-151 85 Södertälje, Sweden.
    Lindberg, Anne
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Rönmark, Eva
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Lundbäck, Bo
    Health economic costs of COPD in Sweden by disease severity: has it changed during a ten years period?2013Ingår i: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 107, nr 12, s. 1931-1938Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVES: The objectives of the presented study were to estimate societal costs of COPD in Sweden, the relationship between costs and disease severity, and possible changes in the costs during the last decade.

    METHODS: Subjects with COPD derived from the general population in Northern Sweden were interviewed by telephone regarding their resource utilisation and productivity losses four times quarterly during 2009-10. Mean annual costs were estimated for each severity stage of COPD.

    RESULTS: A strong relationship was found between disease severity and costs. Estimated mean annual costs per subject of mild, moderate, severe and very severe COPD amounted to 596 (SEK 5686), 3245 (SEK 30,957), 5686 (SEK 54,242), and 17,355 euros (SEK 165,569), respectively. The main cost drivers for direct costs were hospitalisations (for very severe COPD) and drugs (all other severity stages). The main cost driver for indirect costs was productivity loss due to sick-leave (for mild COPD) and early retirement (all other severity stages). Costs appeared to be lower in 2010 than in 1999 for subjects with severe and very severe COPD, but higher for those with mild and moderate COPD.

    CONCLUSION: Our results show that costs of COPD are strongly related to disease severity, and scaling the data to the whole Swedish population indicates that the total costs in Sweden amounted to 1.5 billion euros (SEK 13.9 bn) in 2010. In addition, costs have decreased since 1999 for subjects with severe and very severe COPD, but increased for those with mild and moderate COPD.

  • 23.
    Jansson, Sven-Arne
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Rönmark, Eva
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Forsberg, Bertil
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Löfgren, Curt
    Lindberg, Anne
    Lundbäck, Bo
    The economic consequences of asthma among adults in Sweden.2007Ingår i: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 101, nr 11, s. 2263-70Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVES: Asthma is a common disease in most countries. The objective of this study was to estimate the societal costs for subjects with asthma. METHODS: Telephone interviews regarding resource utilization were made in a representative sample of 115 randomly selected subjects with asthma derived from a large population study of obstructive airway diseases. Direct and indirect costs were measured, and the costs were also transformed with the estimated prevalence of asthma in Sweden. RESULTS: Average annual costs were SEK 15919 (USD 1592; EUR 1768) per subject with asthma in the ages between 25 and 56 years. The direct and indirect costs were SEK 4931 (31.0%) and SEK 10988 (69.0%), respectively, and were highly dependent of age and disease severity. Assuming that the prevalence is representative for Sweden as a whole, the asthmatics would amount to 226000 in the ages between 25 and 56 years, corresponding to an overall prevalence in Sweden of 6-7%. The total costs of asthma for the society amounted thus to SEK 3.7 billion in these ages. CONCLUSIONS: The total costs of asthma for the society could be estimated at 3.7 billion SEK in the age range of 25-56 years, and thus approximately twice as high in the whole population of Sweden. The costs were strongly dependent on disease severity and increasing age.

  • 24. Jerning, Camilla
    et al.
    Martinander, Emma
    Bjerg, Anders
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Lungmedicin.
    Ekerljung, Linda
    Franklin, Karl
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Järvholm, Bengt
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Larsson, Kjell
    Malinovschi, Andrei
    Middelveld, Roelinde
    Emtner, Margareta
    Janson, Christer
    Asthma and physical activity: a population based study results from the Swedish GA(2)LEN survey2013Ingår i: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 107, nr 11, s. 1651-1658Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Having asthma has in previous reports been related to a lower physical activity level. At the same time the prevalence of asthma among elite athletes is high. The aim of this study was to investigate the association between physical activity level and asthma.

    METHODS: A postal questionnaire was completed by 25,610 individuals in Sweden. Current asthma was defined as having had an asthma attack during the last 12 months or current use of asthma medication. The participants were asked how often and for how many hours a week they were physically active.

    RESULTS: In the population 1830 subjects (7.1%) had current asthma. There was no significant difference in the proportion of subjects that reported being inactive or slightly physically active between asthmatic and non-asthmatics (57 vs. 58%) while the proportion of subjects that were vigorously physically active (≥2 times a week and ≥7 h per week) was higher among the subjects with asthma (6.7 vs. 4.8%, p < 0.0001). Being vigorously physically active was independently related to current asthma (OR (95% CI)) 1.40 (1.11-1.77)), wheeze (1.39 (1.17-1.65)), wheeze and breathlessness (1.68 (1.38-2.04)), and wheezing without having a cold (1.39 (1.13-1.71)). The association between being vigorously physically active and wheeze was significantly stronger in women compared to men.

    CONCLUSIONS: There was no difference in the proportion of subjects with a reported low level of physical activity between asthmatics and non-asthmatics. Health care professionals should, however, be aware of the increased prevalence of asthma and asthma-related symptoms in vigorously physically active subjects.

  • 25. Larsson, Britt-Marie
    et al.
    Grunewald, Johan
    Sköld, C Magnus
    Lundin, Anders
    Sandström, Thomas
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Lungmedicin.
    Eklund, Anders
    Svartengren, Magnus
    Limited airway effects in mild asthmatics after exposure to air pollution in a road tunnel2010Ingår i: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 104, nr 12, s. 1912-1918Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Ambient air pollution is a contributing factor to respiratory morbidity and mortality and asthmatics are a particularly vulnerable population. The aim of the study was to investigate whether acute exposure to traffic related air pollution in a road tunnel would increase bronchial responsiveness in mild asthmatics, and if this would be accompanied by increased measures of inflammatory markers in the airways assessed by nasal lavage (NAL) and induced sputum. Fourteen mild asthmatics (7 treated with inhaled corticosteroids) were exposed for 2 h in a road tunnel and a control environment, respectively, separated by at least 3 weeks. Symptoms and peak expiratory flow (PEF) were recorded. Seven hours following exposure sessions, subjects underwent measurements of fraction of exhaled nitric oxide (FENO), spirometry, and a bronchial provocation test. NAL, induced sputum and blood samples were collected. The median PM(2.5) and PM(10) levels during the exposure occasions in the road tunnel were 80 (range 41-93) μg/m(3) and 183 (72-213) μg/m(3) respectively. Irritative symptoms from the airways increased and PEF decreased after road tunnel exposure. Increased levels of IL-10, IL-12 and TNF-α were observed in NAL fluid from subjects without ongoing inhaled corticosteroid treatment. Forced expiratory volume in 1 s (FEV(1)) and the degree of bronchial responsiveness in asthmatics did not change significantly after tunnel exposure. We conclude that asthmatics exhibit increased symptoms, decreased PEF and signs of inflammatory response in the upper airways, after a 2 h road tunnel exposure. Our findings may further emphasize asthmatics as a vulnerable group to common air pollutants.

  • 26.
    Leander, Mai
    et al.
    Uppsala Univ, Dept Med Sci Occupat & Environm Med, SE-75185 Uppsala, Sweden.
    Lampa, Erik
    Uppsala Univ, Dept Med Sci Occupat & Environm Med, SE-75185 Uppsala, Sweden.
    Rask-Andersen, Anna
    Uppsala Univ, Dept Med Sci Occupat & Environm Med, SE-75185 Uppsala, Sweden.
    Franklin, Karl
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Gislason, Thorarinn
    Landspitali, Dept Resp Med & Sleep, Reykjavik, Iceland.
    Oudin, Anna
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Svanes, Cecilie
    Univ Bergen, Inst Med, Bergen Resp Res Grp, Bergen, Norway.
    Toren, Kjell
    Med Univ Gothenburg, Sect Occupat & Environm Med, S-40530 Gothenburg, Sweden.
    Janson, Christer
    Uppsala Univ, Dept Med Sci Resp Med & Allergol, SE-75185 Uppsala, Sweden.
    Impact of anxiety and depression on respiratory symptoms2014Ingår i: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 108, nr 11, s. 1594-1600Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Psychological factors such as anxiety and depression are prevalent in patients with asthma. The purpose of this study was to investigate the relationship between respiratory symptoms and psychological status and to estimate the importance of psychological status in comparison with other factors that are known to be associated with respiratory symptoms. This study included 2270 subjects aged 20-44 (52% female) from Sweden, Iceland, and Norway. Each participant underwent a clinical interview including questions on respiratory symptoms. Spirometry and methacholine challenge were performed. Symptoms of depression and anxiety were measured using the Hospital Anxiety and Depression Scale (HADS). Eighty-two percent of the subjects reported no anxiety or depression whatsoever, 11% reported anxiety, 2.5% depression and 4% reported both anxiety and depression. All respiratory symptoms, such as wheezing, breathlessness and nightly symptoms, were more common, at a statistically significant level, in participants who had depression and anxiety, even after adjusting for confounders (ORs 1.33-1.94). The HADS score was the most important determinant for nightly symptoms and attacks of breathlessness when at rest whereas bronchial responsiveness was the most important determinant for wheezing, and breathlessness when wheezing. The probability of respiratory symptoms related to HADS score increased with increasing HADS score for all respiratory symptoms. In conclusion, there is a strong association between respiratory symptoms and psychological status. There is therefore a need for interventional studies designed to improve depression and anxiety in patients with respiratory symptoms.

  • 27. Liaaen, Erik Dyb
    et al.
    Henriksen, Anne H
    Stenfors, Nikolai
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Lungmedicin.
    A Scandinavian audit of hospitalizations for chronic obstructive pulmonary disease2010Ingår i: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 104, nr 9, s. 1304-1309Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    In Scandinavia no large audits of hospitalizations for chronic obstructive pulmonary disease (COPD) have been performed, and data on adherence to national guidelines are scarce. The aims of the present study were to audit hospitalizations for COPD exacerbations in three Scandinavian hospitals with respect to incidence, patient population and standards of hospital care. Retrospectively all hospitalizations in the Departments of Internal and Respiratory Medicine in Ostersund Hospital (Sweden), Aalesund Hospital (Norway) and Trondheim University Hospital (Norway) from Jan 1 to Dec 31, 2005, with discharge ICD-10 diagnoses J43-J44, J96 + J44 or J13-18 + j44 were registered. A total of 1144 admissions (731 patients) were identified from patient administrative systems and medical charts. Among the admitted patients 27% were >80 years old, >50% had COPD stage III or IV, and 14% had respiratory acidosis at admittance. Patients with 3 or more admissions (13%) during 2005 accounted for 36% of all hospitalizations. One third of the patients were current smokers. Non-invasive ventilation was used in 14% of the admissions, with large variation between centres. In-hospital mortality was 3.7%. In this first large Scandinavian audit of COPD-hospitalizations, all centres had low in-hospital mortality. We consider this as an indication of good clinical practice in the three studied centres and possibly due to the frequent use of non-invasive ventilation.

  • 28.
    Lindberg, Anne
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Bakke, Per S.
    Virchow, Johann Christian
    Lundback, Bo
    The impact of exacerbations among subjects with COPD, what can we learn from 'big data'?2018Ingår i: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 145, s. 226-227Artikel i tidskrift (Övrigt vetenskapligt)
  • 29.
    Lindberg, Anne
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Lungmedicin.
    Bjerg Bäcklund, Anders
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Rönmark, Eva
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Larsson, Lars-Gunnar
    Lundbäck, Bo
    Prevalence and underdiagnosis of COPD by disease severity and the attributable fraction of smoking Report from the Obstructive Lung Disease in Northern Sweden Studies.2006Ingår i: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 100, nr 2, s. 264-272Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: There is a lack of epidemiological data on COPD by disease severity. We have estimated the prevalence and underdiagnosis of COPD by disease severity defined by the British Thoracic Society (BTS) and Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines. The impact of smoking was evaluated by the population attributable fraction of smoking in COPD. METHODS: A random sample of 1500 responders of the third postal survey performed in 1996 of the Obstructive Lung Disease in Northern Sweden (OLIN) Studies' first cohort (6610 subjects recruited in 1985) were invited to structured interview and spirometry. One thousand two hundred and thirty-seven subjects (82%) performed spirometry. RESULTS: The prevalence of mild BTS-COPD was 5.3%, moderate 2.2%, and severe 0.6% (GOLD-COPD: mild 8.2%, moderate 5.3%, severe 0.7%, and very severe 0.1%). All subjects with severe COPD were symptomatic, corresponding figures among mild COPD were 88% and 70% (BTS and GOLD), Subjects with severe BTS-COPD reported a physician-diagnosis consistent with COPD in 50% of cases, in mild BTS-COPD 19%, while in mild GOLD-COPD only 5% of cases. The major risk factors, age and smoking, had a synergistic effect on the COPD-prevalence. The Odds Ratio (OR) for having COPD among smokers aged 76-77 years was 59 and 34 (BTS and GOLD) when non-smokers aged 46-47 was used as reference population. CONCLUSIONS: Most subjects with COPD have a mild disease. The underdiagnosis is related to disease-severity. Though being symptomatic, only a half of the subjects with severe COPD are properly labelled. Smoking and increasing age were the major risk factors and acted synergistic.

  • 30.
    Lindberg, Anne
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Sawalha, Sami
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Hedman, Linnea
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Larsson, Lars-Gunnar
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Lundback, Bo
    Rönmark, Eva
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Subjects with COPD and productive cough have an increased risk for exacerbations and death2015Ingår i: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 109, nr 1, s. 88-95Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Chronic bronchitis is related to worse general health status, exacerbations and mortality among subjects with COPD. Also less longstanding cough and phlegm may be related to worse prognosis in COPD but this has rarely been evaluated in population-based studies. Aim: To evaluate the relationship between productive cough, exacerbations and mortality among subjects with and without COPD. Method: All subjects with COPD (n = 993) were identified together with sex-and age matched reference subjects without obstructive lung function impairment from four population-based cohorts in 2002-04. Baseline spirometry and structured interview including data on exacerbations last 12 months were used in this study (n = 1986) together with mortality data collected until February 2012. Results: Productive cough was more common in COPD than non-COPD (42.8 vs. 23.5%, p < 0.001), more common in men than women, but associated to exacerbations in both sexes. COPD-subjects with productive cough had the highest risk for exacerbations in both sexes and they had a significantly increased risk for death (HR 1.48, 95% CI 1.13-1.94) also when adjusted for sex, age, BMI, smoking habits and heart disease. Conclusion: Productive cough was common and increased the risk for exacerbations in both sexes, in both COPD and non-COPD. COPD-subjects with productive cough had the highest risk for exacerbations and a significantly higher risk for death also after adjustment for common risk factors.

  • 31. Lundbäck, Bo
    et al.
    Backman, Helena
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Virchow, Johann Christian
    Inhaled corticosteroids and pneumonia risk: revised knowledge2017Ingår i: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 131, s. 247-248Artikel i tidskrift (Refereegranskat)
  • 32. Lundbäck, Bo
    et al.
    Lindberg, Anne
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Lindström, Maj
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Rönmark, Eva
    Jonsson, Ann-Christin
    Jönsson, Elsy
    Larsson, Lars-Gunnar
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Andersson, Staffan
    Sandström, Thomas
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Larsson, Kjell
    Not 15 but 50 percent of smokers develop COPD?: Report from the Obstructive Lung Disease in Northern Sweden Studies2003Ingår i: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 97, nr 2, s. 114-122Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: The prevalence of chronic obstructive pulmonary disease (COPD) according to guidelines of today seems considerably higher than has been reported also in recent literature. AIM: To estimate the prevalence of COPD as defined by British Thoracic Society (BTS) criteria and the recent global initiative for chronic obstructive lung disease (GOLD) criteria. Further aims were to assess the proportion of underdiagnosis and of symptoms in subjects with COPD, and to study risk factors for COPD. METHODS: In 1996, 5892 of the Obstructive Lung Disease in Northern Sweden (OLIN) Study's first cohort could be traced to a third follow-up survey, and 5189 completed responses (88%) were received corresponding to 79% of the original cohort from December 1985. Of the responders, a random sample of 1500 subjects were invited to a structured interview and a lung function test, and 1237 of the invited completed a lung function test with acceptable quality. RESULTS: In ages >45 years, the prevalence of COPD according to the BTS guidelines was 8%, while it was 14% according to the GOLD criteria. The absolutely dominating risk factors were increasing age and smoking, and approximately a half of elderly smokers fulfilled the criteria for COPD according to both the BTS and the GOLD criteria. Family history of obstructive airway disease was also a risk factor, while gender was not. Of those fulfilling the BTS criteria for COPD, 94% were symptomatics, 69% had chronic productive cough, but only 31% had prior to the study been diagnosed as having either chronic bronchitis, emphysema, or COPD. The corresponding figures for COPD according GOLD were 88, 51, and 18%. CONCLUSIONS: In ages >45 years, the prevalence of COPD according to the BTS guidelines was 8%, and it was 14% according to the GOLD criteria. Fifty percent of elderly smokers had developed COPD. The large majority of subjects having COPD were symptomatic, while the proportion of those diagnosed as having COPD or similar diagnoses was small.

  • 33. Lundbäck, Bo
    et al.
    Rönmark, Eva
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Lindberg, Anne
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Lungmedicin.
    Jonsson, Ann-Christin
    Larsson, Lars-Gunnar
    James, Mark
    Asthma control over 3 years in a real-life study2009Ingår i: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 103, nr 3, s. 348-355Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    This was a 3-year "real-life" study, during which patients' medication was increased and decreased to achieve sustained asthma control. Patients (282) were randomised to receive treatment with SAL 50microg, FP 250microg, or SFC 50/250microg via a Diskustrade mark inhaler, bid. A 12-month double-blind period was followed by a 2-year open phase. The physician increased or decreased patients' medication to achieve and maintain asthma control at regular clinical assessments using criteria based on the asthma treatment guidelines. On completion 73% (168/229) of the subjects were receiving SFC to maintain control of their asthma, compared with 21% (49/229) receiving FP and 5% (12/229) receiving SAL. Odds ratio for requiring increased treatment were 2.66 (p=0.002) for patients initially randomised to FP and 9.38 (p<0.0001) SAL, compared with SFC. Time until 25% of patients first required an increase in study medication was 6months for patients initially treated with SAL compared to 12months for FP and 21months for SFC. Symptoms and use of rescue medication improved first, followed rapidly by PEF with the greatest improvements occurring over the first year. Airway hyperresponsiveness continued to improve throughout the study. The majority of patients achieved and maintained control of asthma over a 3-year period with physician-driven medication changes. Patients treated with SFC were more likely to achieve control than patients treated with FP or SAL alone. Continuing improvements in airway hyperresponsiveness indicate the importance of maintaining treatment after clinical control of symptoms and lung function are achieved.

  • 34. Lundbäck, Bo
    et al.
    Rönmark, Eva
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Lindberg, Anne
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Lungmedicin.
    Jonsson, Ann-Christin
    Larsson, Lars-Gunnar
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Lungmedicin.
    Pétavy, Frank
    James, Mark
    Control of mild to moderate asthma over 1-year with the combination of salmeterol and fluticasone propionate.2006Ingår i: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 100, nr 1, s. 2-10Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: The aim of this study was to assess asthma control using salmeterol plus fluticasone propionate (FP) in combination (SFC) versus salmeterol or FP as monotherapy in patients with mild to moderate asthma. METHODS: In this randomised, double-blind, parallel-group study, 322 symptomatic patients were recruited, of which 282 were randomised to receive either salmeterol (50 microg), FP (250 microg), or SFC (50 microg/250 microg), via a single Diskus inhaler twice daily for 12 months. Outcome variables included the number of patients requiring an increase in study medication and the number experiencing 2 exacerbations during the 12-month treatment period. Airway hyper-responsiveness (AHR) and lung function tests were performed at clinic visits. Peak expiratory flow, rescue medication use, symptom scores and adverse events were recorded in diary cards. RESULTS: Fewer patients required an increase in study medication with SFC (10.5%) than with either FP (34.8%) or salmeterol (61.1%) (P<0.001). Significantly fewer patients experienced 2 exacerbations with SFC (4.2%), compared with FP (17.4%; P<0.01) or salmeterol (40%; P<0.001). SFC improved AHR to a significantly greater extent than FP (methacholine PC20=1.8 mg/ml vs. 1.1 mg/ml; P<0.05) or salmeterol (methacholine PC20=1.8 mg/ml vs. 0.7 mg/ml; P<0.001). CONCLUSIONS: The protection against exacerbations may be attributed to better control of inflammation, AHR and lung function parameters achieved with salmeterol and FP in combination, compared with either treatment alone.

  • 35.
    Lundell, Sara
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Holmner, Åsa
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper.
    Rehn, Börje
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Nyberg, Andre
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Wadell, Karin
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Telehealthcare in COPD: a systematic review and meta-analysis on physical outcomes and dyspnea2015Ingår i: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 109, nr 1, s. 11-26Artikel, forskningsöversikt (Refereegranskat)
    Abstract [en]

    Background: Only a minority of patients with chronic obstructive pulmonary disease (COPD) have access to pulmonary rehabilitation (PR). Home-based solutions such as telehealthcare, have been used in efforts to make PR more available. The aim of this systematic review was to investigate the effects of telehealthcare on physical activity level, physical capacity and dyspnea in patients with COPD, and to describe the interventions used. 

    Methods: Randomized controlled trials were identified through database searches, reference lists and included authors. Articles were reviewed based on eligibility criteria by three authors. Risk of bias was assessed by two authors. Standardized mean differences (SMD) or mean differences (MD) with 95% CI were calculated. Forest plots were used to present data visually.

    Results: Nine studies (982 patients) were included. For physical activity level, there was a significant effect favoring telehealthcare (MD, 64.7 min; 95% CI, 54.4-74.9). No difference between groups was found for physical capacity (MD, -1.3 m; 95% CI, -8.1-5.5) and dyspnea (SMD, 0.088; 95% CI, -0.056-0.233). Telehealthcare was promoted through phone calls, websites or mobile phones, often combined with education and/or exercise training. Comparators were ordinary care, exercise training and/or education. 

    Conclusions: The use of telehealthcare may lead to improvements in physical activity level, although the results should be interpreted with caution given the heterogeneity in studies. This is an important area of research and further studies of the effect of telehealthcare for patients with COPD would be beneficial.

  • 36.
    Lâm, Hoàng Thi
    et al.
    Unit of Lung & Allergy Research, National Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Rönmark, Eva
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Tu'ò'ng, Nguyen Văn
    Department of Scientific Research, Hanoi Medical University, Hanoi, Viet Nam.
    Ekerljung, Linda
    Department of Internal Medicine, Krefting Research Centre, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Chúc, Nguyen Thi Kim
    Epidemiological Field Laboratory of Bavi, Hanoi Medical University, Hanoi, Viet Nam.
    Lundbäck, Bo
    Unit of Lung & Allergy Research, National Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Increase in asthma and a high prevalence of bronchitis: results from a population study among adults in urban and rural Vietnam2011Ingår i: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 105, nr 2, s. 177-185Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The prevalence of asthma in adults may have increased in both urban and rural Vietnam, as the few previous estimates have found 2% of adults having asthma. Half of men in Hanoi and two-thirds in Bavi were smokers versus a few percent of women in both areas. Bronchitic symptoms were common in both men and women.

  • 37. Löfdahl, Magnus J
    et al.
    Roos-Engstrand, Ester
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Lungmedicin.
    Pourazar, Jamshid
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Lungmedicin.
    Bucht, Anders
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Lungmedicin.
    Dahlen, Barbro
    Elmberger, Göran
    Blomberg, Anders
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Lungmedicin.
    Sköld, C Magnus
    Increased intraepithelial T-cells in stable COPD2008Ingår i: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 102, nr 12, s. 1812-1818Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: The airway epithelium is the first line of defence in the response to inhaled particles and irritants. Chronic obstructive pulmonary disease (COPD) is an inflammatory disease characterised by an irreversible loss of lung function, with cigarette smoking as a major risk factor. Here, we address intraepithelial T-cells in COPD, as these cells are a distinct T-cell subtype thought to have important regulatory functions. We hypothesised that intraepithelial T-cells play a role in the response to lung irritants and that the T-cell populations would be altered and associated with signs of inflammation in COPD.

    METHODS: Bronchoscopy with endobronchial mucosal biopsy sampling was performed in 22 patients (mean age; 57) with stable COPD (median FEV(1)% predicted: 51). Age- and smoking- matched smokers (S) with normal lung function (n=14) and age-matched non-smokers (NS) (n=15) served as controls. Airway inflammation was recorded visually using bronchitis index (BI). Biopsy specimens were processed into glycol methacrylate resin and inflammatory cells were stained immunohistochemically.

    RESULTS: The number of intraepithelial CD4+ T-cells were significantly higher in COPD patients compared to smokers as well as trend towards significance in non-smokers (p=0.005 and p=0.036, respectively), whereas intraepithelial CD8+ T-cells number were increased in patients with COPD compared to non-smokers (p=0.017). Both patients with COPD and smokers had a higher BI than non-smokers (p<0.001 for both).

    CONCLUSIONS: The present data suggest a role for intraepithelial CD4+ and CD8+ T-cells in stable COPD and indicate that T-cells are of importance in the long-term inflammatory response in COPD or, alternatively, play a regulatory role.

  • 38. Nielsen, Rune
    et al.
    Kankaanranta, Hannu
    Bjermer, Leif
    Lange, Peter
    Arnetorp, Sofie
    Hedegaard, Morten
    Stenling, Anna
    AstraZeneca Nordic-Baltic, Department of Health Economics, Södertälje, Sweden.
    Mittmann, Nicole
    Cost effectiveness of adding budesonide/formoterol to tiotropium in COPD in four Nordic countries2013Ingår i: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 107, nr 11, s. 1709-1721Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: Assess the cost effectiveness of budesonide/formoterol (BUD/FORM) Turbuhaler(®)+tiotropium (TIO) HandiHaler(®) vs. placebo (PBO)+TIO in patients with chronic obstructive pulmonary disease (COPD) eligible for inhaled corticosteroids/long-acting β2-agonists (ICS/LABA).

    METHODS: The cost-effectiveness analysis was based on the 12-week, randomised, double-blind CLIMB trial. The study included 659 patients with pre-bronchodilator forced expiratory volume in 1 s ≤ 50% and ≥1 exacerbation requiring systemic glucocorticosteroids or antibiotics the preceding year. Patients received BUD/FORM 320/9 μg bid + TIO 18 μg qd or PBO bid + TIO 18 μg qd. Effectiveness was defined as the number of severe exacerbations (hospitalisation/emergency room visit/systemic glucocorticosteroids) avoided. A sub-analysis included antibiotics in the definition of an exacerbation. Resource use from CLIMB was combined with Danish (DKK), Finnish (€), Norwegian (NOK) and Swedish (SEK) unit costs (2010). The incremental cost-effectiveness ratios (ICERs) for BUD/FORM + TIO vs. PBO + TIO were estimated using descriptive statistics and uncertainty around estimates using bootstrapping. Analyses were conducted from the societal and healthcare perspectives in Denmark, Finland, Norway and Sweden.

    RESULTS: From a societal perspective, the ICER was estimated at €174/severe exacerbation avoided in Finland while BUD/FORM + TIO was dominant in the other countries. From the healthcare perspective, ICERs were DKK 1580 (€212), €307 and SEK 1573 (€165) per severe exacerbation avoided for Denmark, Finland and Sweden, respectively, while BUD/FORM + TIO was dominant in Norway. Including antibiotics decreased ICERs by 8-15%. Sensitivity analyses showed that results were overall robust.

    CONCLUSION: BUD/FORM + TIO represents a clinical and economic benefit to health systems and society for the treatment of COPD in the Nordic countries. (ClinicalTrials.gov Identifier: NCT00496470).

  • 39. Olin, A C
    et al.
    Stenfors, Nikolai
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Lungmedicin. Department for Respiratory Medicine and Allergy, University Hospital and Medical Division, National Institute for Working Life, Umeå.
    Torén, K
    Blomberg, Anders
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Lungmedicin. Department for Respiratory Medicine and Allergy, University Hospital and Medical Division, National Institute for Working Life, Umeå.
    Helleday, Ragnberth
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Lungmedicin. Department for Respiratory Medicine and Allergy, University Hospital and Medical Division, National Institute for Working Life, Umeå.
    Ledin, M C
    Ljungkvist, G
    Ekman, A
    Sandström, Thomas
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Lungmedicin. Department for Respiratory Medicine and Allergy, University Hospital and Medical Division, National Institute for Working Life, Umeå.
    Nitric oxide (NO) in exhaled air after experimental ozone exposure in humans2001Ingår i: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 95, nr 6, s. 491-495Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    We hypothesized that ozone, a common air pollutant, potent in producing airway inflammation, would increase the production of exhaled nitric oxide (NO). If so, measurement of exhaled NO could potentially be a valuable tool in population studies of air pollution effects. Eleven healthy non-smoking volunteers were exposed to 0.2 ppm ozone (O3) and filtered air for 2h on two separate occasions. Exhaled NO and nasal NO were measured before and on five occasions following the exposures. Changes in exhaled and nasal NO after ozone exposure were adjusted for changes after air exposure. There was a slight decrease in exhaled NO (-0.6; -3.1-1.2 ppb) (median and 95% confidence interval) and of nasal NO (-57; -173-75 ppb) directly after the ozone exposure. No significant changes in exhaled or nasal NO were however found 6 or 24 h after the exposure. Within the examined group, an O3 exposure level proven to induce an airway inflammation caused no significant changes in exhaled or nasal NO levels. Hence, the current study did not yield support for exhaled NO as a useful marker of ozone-induced oxidative stress and airway inflammation after a single exposure. This contrasts with data for workers exposed to repeated high peaks of ozone. The potential for exhaled NO as a marker of oxidative stress therefore deserves to be further elucidated.

  • 40.
    Pallasaho, P.
    et al.
    Division of Allergology, Skin and Allergy Hospital, Department of Medicine, Helsinki University Central Hospital, Helsinki, Finland; Finnish Institute of Occupational Health, Helsinki, Finland.
    Juusela, M.
    Division of Allergology, Skin and Allergy Hospital, Department of Medicine, Helsinki University Central Hospital, Helsinki, Finland; Division of Clinical Physiology and Nuclear Medicine, Laboratory Department, Helsinki University Central Hospital, Helsinki, Finland.
    Lindqvist, A.
    Research Unit of Pulmonary Diseases, Department of Medicine, Helsinki University Central Hospital, Helsinki, Finland; Clinical Research Institute HUCH Ltd., Helsinki, Finland.
    Sovijarvi, A.
    Division of Clinical Physiology and Nuclear Medicine, Laboratory Department, Helsinki University Central Hospital, Helsinki, Finland.
    Lundback, B.
    Department of Internal Medicine, Krefting Research Center, Sahlgrenska Academy, University of Gothenburg, Sweden; Obstructive Lung disease in Northern Sweden (OLIN) Studies, Department of Medicine, Sunderby Central Hospital of Norrbotten, Sweden.
    Rönnmark, Eva
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin.
    Allergic rhinoconjunctivitis doubles the risk for incident asthma: Results from a population study in Helsinki, Finland2011Ingår i: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 105, nr 10, s. 1449-1456Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: To examine the incidence of allergic rhinoconjunctivitis and asthma, and to assess allergic rhinoconjunctivitis as a risk factor for incident asthma, we performed a 11-year follow-up postal survey.

    Methods: The original study population was a random population sample of 8000 inhabitants of Helsinki aged 20-69 years in 1996. Participants in the first postal questionnaire survey, 6062 subjects, were invited to this follow-up study, and provided 4302 (78%) answers out of 5484 traced subjects in 2007.

    Results: Cumulative incidence of asthma from 1996 to 2007 was 4.0% corresponding to an annual incidence rate of 3.7/1000/year. After exclusion of those with asthma medication or physician-diagnosed chronic bronchitis or COPD at baseline in 1996, the cumulative incidence decreased to 3.5% (incidence rate 3.2/1000/year), and further to 2.7% (2.5/1000/year) when also those reporting recurrent wheeze or shortness of breath during the last year in 1996 were omitted from the population at risk. Remission of asthma occurred in 43 subjects and was 16.9% over 11 years. Cumulative 11-year incidence of allergic rhinoconjunctivitis was 16.9% corresponding to 16.8/1000/year, and cumulative remission was 18.1%. Incidence of allergic rhinoconjunctivitis was significantly lower among those who had lived in the countryside or on a farm during the first 5 years of life, but this was not true for asthma. In multivariate analysis, farm living during the first 5 years of life was protective for the development of allergic rhinoconjunctivitis, OR 0.75 (95%Cl 0.57-0.99). Allergic rhinoconjunctivitis was a significant independent risk factor for incident asthma, OR 2.15 (95%Cl 1.54-3.02). In the cohort, the prevalence of rhinoconjunctivitis increased from 38.0% in 1996 to 40.9% in 2007, physician-diagnosed asthma from 6.8% to 9.4%, while current smoking decreased from 31.3% to 23.3%.

    Conclusion: Incidence of allergic rhinoconjunctivitis was higher than in earlier studies, while asthma incidence remained on similar level, both being significantly higher in women. Allergic rhinoconjunctivitis doubled the risk for incident asthma.

  • 41.
    Pourazar, Jamshid
    et al.
    Umeå universitet, Medicinsk fakultet, Folkhälsa och klinisk medicin, Lungmedicin.
    Frew, Anthony J
    Blomberg, Anders
    Umeå universitet, Medicinsk fakultet, Folkhälsa och klinisk medicin, Lungmedicin.
    Helleday, Ragnberth
    Umeå universitet, Medicinsk fakultet, Folkhälsa och klinisk medicin, Lungmedicin.
    Kelly, Frank J
    Wilson, Susan
    Sandström, Thomas
    Umeå universitet, Medicinsk fakultet, Folkhälsa och klinisk medicin, Lungmedicin.
    Diesel exhaust exposure enhances the expression of IL-13 in the bronchial epithelium of healthy subjects.2004Ingår i: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 98, nr 9, s. 821-825Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Epidemiological studies have demonstrated adverse health effects of environmental pollution. Diesel exhaust (DE) is an important contributor to ambient particulate matter pollution. DE exposure has been shown to induce a pronounced inflammatory response in the airways, with an enhanced epithelial expression of IL-8, and Gro-α in healthy subjects. The present investigation was aimed to further characterise the epithelial response to DE in vivo, with particular reference to possible TH2 response, in non-atopic healthy subjects. To determine this response, 15 healthy, non-atopic non-smoking subjects with normal lung function were exposed to DE (PM10 300 μg/m3) and filtered air during 1 h on two separate randomised occasions. Bronchoscopy sampling of bronchial mucosal biopsies was performed 6 h after exposure. Immunohistochemical staining were performed using mAb for IL-10, IL-13 and IL-18 expression. DE exposure induced a significant increase in the expression of IL-13 in the bronchial epithelium cells, 2.1 (1.35–4.88) Md (Q1–Q3) vs. air 0.94 (0.53–1.23); P=0.009. No significant changes were seen in IL-10 and IL-18 expression. This finding suggests an TH2-inflammatory response in the airways of non-atopic healthy individuals.

  • 42.
    Rönmark, Eva
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för hållbar hälsa.
    Virchow, Johann Christian
    Lundbäck, Bo
    Longitudinal studies based on the general population: Important studies becoming rare nowadays2019Ingår i: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 158, s. 114-115Artikel i tidskrift (Refereegranskat)
  • 43.
    Sehlstedt, Maria
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Lungmedicin.
    Andersen, Grethe Neumann
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Reumatologi.
    Nilsson, Kenneth
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Lungmedicin.
    Blomberg, Anders
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Lungmedicin.
    Mincheva-Nilsson, Lucia
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk mikrobiologi, Klinisk immunologi.
    Waldenström, Anders
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Rantapää-Dahlqvist, Solbritt
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Reumatologi.
    Sandström, Thomas
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Lungmedicin.
    Suppressed signal transduction in the bronchial epithelium of patients with systemic sclerosis2009Ingår i: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 103, nr 2, s. 301-308Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    INTRODUCTION: Systemic sclerosis (SSc) is an autoimmune disorder, which frequently affects the lungs, with manifestations of interstitial lung disease (ILD) with lung fibrosis and of pulmonary hypertension. The pathogenesis remains largely unrecognised.

    OBJECTIVE: The aim of this study was to elucidate the inflammation in the bronchial mucosa in patients with SSc.

    SUBJECTS AND METHODS: Twenty-three subjects diagnosed with SSc participated. Twelve of the SSc patients showed signs of ILD, four were smokers and seven were treated with oral corticosteroids. Seventeen non-smoking, age- and sex-matched healthy subjects served as controls. Bronchoscopy was performed to sample endobronchial mucosal biopsies, which were immunohistochemically stained using a panel of antibodies against inflammatory markers.

    RESULTS: The number of neutrophils was significantly elevated in the submucosa of SSc patients, regardless of ILD, or whether the subject was smoking or using oral corticosteroids. No up-regulation of neutrophil chemoattractants or cytokines was seen in the bronchial epithelium. The signal transduction pathways and adhesion molecule expression tended to be suppressed or unchanged in SSc patients compared with controls.

    CONCLUSION: It is concluded that SSc is associated with a chronic neutrophilic inflammation in the bronchial mucosal, with signs of suppressed signal transduction, regardless of the presence of interstitial lung disease.

  • 44.
    Stenfors, Nikolai
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Lungmedicin.
    Self-reported symptoms and bronchial hyperresponsiveness in elite cross-country skiers.2010Ingår i: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 104, nr 11, s. 1760-1763Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    INTRODUCTION: Respiratory symptoms in relationship to exercise, bronchial hyperresponsiveness (BHR), and exercise-induced asthma (EIA) are very common in elite winter athletes. Symptom-based screening for BHR would facilitate selection of athletes with possible EIA. OBJECTIVES: The aim of the present study was to evaluate the diagnostic accuracy of self-reported symptoms as predictors of BHR in an unselected population of adult elite cross-country skiers. METHODS: Forty-six Swedish adult skiers competing at national or international level were included. They had a mean (SD) training volume in the past 12 months of 593 (122) hours. Twenty-four subjects had previous physician-diagnosed asthma. The European Community Respiratory Health Survey questionnaire was used to evaluate the presence of respiratory symptoms. BHR was defined as bronchoconstriction to either eucapnic voluntary hyperventilation, dry powder mannitol or methacholine provocation. RESULTS: The "classical" EIA symptom of shortness of breath post-exercise was reported by 17% of all skiers. Eight subjects (17%) had BHR. None of the self-reported respiratory symptoms had high positive predictive values. However, symptoms caused by grass or pollen had high negative predictive values. DISCUSSION: EIA in elite winter athletes cannot accurately be based only on self-reported symptoms but requires verification with objective testing of BHR. Bronchoprovocation of elite winter athletes reporting respiratory symptoms in rest or because of exercise will probably reveal a high proportion of athletes without BHR. CLINICAL TRIAL: EUDRA-CT number 2006-005822-21.

  • 45.
    Stenfors, Nikolai
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Lungmedicin. Department of Respiratory Medicine and Allergy, University Hospital, Umeå.
    Pourazar, Jamshid
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Lungmedicin. Department of Respiratory Medicine and Allergy, University Hospital, Umeå.
    Blomberg, Anders
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Lungmedicin. Department of Respiratory Medicine and Allergy, University Hospital, Umeå.
    Krishna, M T
    Mudway, I
    Helleday, Ragnberth
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Lungmedicin. Department of Respiratory Medicine and Allergy, University Hospital, Umeå.
    Kelly, F J
    Frew, A J
    Sandström, Thomas
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Lungmedicin. Department of Respiratory Medicine and Allergy, University Hospital, Umeå.
    Effect of ozone on bronchial mucosal inflammation in asthmatic and healthy subjects2002Ingår i: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 96, nr 5, s. 352-358Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Epidemiological studies suggestthat asthmatics are more affected by ozone than healthy people. This study tested three hypotheses (1) that short-term exposure to ozone induces inflammatory cell increases and up-regulation of vascular adhesion molecules in airway lavages and bronchial tissue 6 h after ozone exposure in healthy subjects; (2) these responses are exaggerated in subjects with mild allergic asthma; (3) ozone exacerbates pre-existent allergic airways inflammation. We exposed 15 mild asthmatic and 15 healthy subjects to 0.2 ppm of ozone or filtered air for 2 h on two separate occasions. Airway lavages and bronchial biopsies were obtained 6 h post-challenge. We found that ozone induced similar increases in bronchial wash neutrophils in both groups, although the neutrophil increase in the asthmatic group was on top of an elevated baseline. In healthy subjects, ozone exposure increased the expression of the vascular endothelial adhesion molecules P-selectin and ICAM- 1, as well as increasing tissue neutrophil and mast cell numbers. The asthmatics showed allergic airways inflammation at baseline but ozone did not aggravate this at the investigated time point. At 6 h post-ozone-exposure, we found no evidence that mild asthmatics were more responsive than healthy to ozone in terms of exaggerated neutrophil recruitment or exacerbation of pre-existing allergic inflammation. Further work is needed to assess the possibility of a difference in time kinetics between healthy and asthmatic subjects in their response to ozone.

  • 46. Sundberg, Rosita
    et al.
    Torén, Kjell
    Franklin, Karl A
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi. Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Lungmedicin.
    Gislason, Thorarinn
    Omenaas, Ernst
    Svanes, Cecilie
    Janson, Christer
    Asthma in men and women: Treatment adherence, anxiety, and quality of sleep2010Ingår i: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 104, nr 3, s. 337-344Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The aim of this study was to compare female and male asthmatics with special emphasis on reported adherence, anxiety, and quality of sleep. The study included 470 subjects with current asthma from the Nordic countries, who took part in the European Community Respiratory Health Survey (ECRHS) II. Subjects were investigated with a structured clinical interview, including questions on the presence of respiratory symptoms and therapy. They were also asked to fill in the self-reported Hospital Anxiety Depression scale and the Basic Nordic Sleep Questionnaire. Inhaled corticosteroids (OR=0.55) and a doctor's appointment in the last 12 months (OR=0.54) implied a significantly reduced risk for non-adherence in normal situations. At exacerbation in asthma, women had a significantly decreased risk for non-adherence (OR=0.46). Female gender and anxiety were independent risk factors for both insomnia (OR=3.67 and 2.53, respectively) and daytime sleepiness (OR=2.53 and 2.04, respectively). Women with asthma have a more positive attitude towards their medication, have a higher reported adherence, and use inhaled corticosteroids more often than men. At the same time women report more often anxiety and insomnia than men. Awareness of sex differences in the manifestations and attitudes towards treatment of asthma is important in order to improve asthma management.

  • 47. Tariq, K.
    et al.
    Schofield, J. P. R.
    Nicholas, B. L.
    Burg, D.
    Brandsma, J.
    Bansal, A. T.
    Wilson, S. J.
    Lutter, R.
    Fowler, S. J.
    Bakke, .
    Caruso, M.
    Dahlen, B.
    Horvath, I.
    Krug, N.
    Montuschi, P.
    Sanak, M.
    Sandström, Thomas
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för medicin. Respiratory Medicine Unit, Umeå University, Umeå, Sweden.
    Geiser, T.
    Pandis, I.
    Sousa, A. R.
    Adcock, I. M.
    Shaw, D. E.
    Auffray, C.
    Howarth, P. H.
    Sterk, P. J.
    Chung, K. F.
    Skipp, P. J.
    Dimitrov, B.
    Djukanovic, R.
    Sputum proteomic signature of gastro-oesophageal reflux in patients with severe asthma2019Ingår i: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 150, s. 66-73Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Gastro-oesophageal reflux disease (GORD) has long been associated with poor asthma control without an established cause-effect relationship. 610 asthmatics (421 severe/88 mild-moderate) and 101 healthy controls were assessed clinically and a subset of 154 severe asthmatics underwent proteomic analysis of induced sputum using untargeted mass spectrometry, LC-IMS-MSE. Univariate and multiple logistic regression analyses (MLR) were conducted to identify proteins associated with GORD in this cohort. When compared to mild/moderate asthmatics and healthy individuals, respectively, GORD was three-and ten-fold more prevalent in severe asthmatics and was associated with increased asthma symptoms and oral corticosteroid use, poorer quality of life, depression/anxiety, obesity and symptoms of sino-nasal disease. Comparison of sputum proteomes in severe asthmatics with and without active GORD showed five differentially abundant proteins with described roles in antimicrobial defences, systemic inflammation and epithelial integrity. Three of these were associated with active GORD by multiple linear regression analysis: Ig lambda variable 1-47 (p = 0.017) and plasma protease C1 inhibitor (p = 0.043), both in lower concentrations, and lipocalin-1 (p = 0.034) in higher concentrations in active GORD. This study provides evidence which suggests that reflux can cause subtle perturbation of proteins detectable in the airways lining fluid and that severe asthmatics with GORD may represent a distinct phenotype of asthma.

  • 48.
    Torén, Kjell
    et al.
    Section of Occupational and Environmental Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Andersson, Martin
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Olin, Anna-Carin
    Section of Occupational and Environmental Medicine, Sahlgrenska Academy, University of Gothenburg, Box 414, SE-405 30, Gothenburg, Sweden; Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Blanc, Paul D.
    Division of Occupational and Environmental Medicine, Department of Medicine, University of California, San Francisco, CA, USA.
    Järvholm, Bengt
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Airflow limitation classified with the fixed ratio or the lower limit of normal and cause-specific mortality: a prospective study2018Ingår i: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 144, s. 36-41Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: There is controversy as to whether airflow limitation should be defined as forced expiratory volume in 1 s (FEV1)/vital capacity (VC) < 0.7 or as FEV1/VC< the lower limit of normal (LLN). The aim was to examine whether different definitions of airflow limitation differ in predicting mortality.

    METHODS: Longitudinal prospective study of a national cohort of Swedish workers (199,408 men; 7988 women), aged 20-64 years with spirometry without bronchodilation at baseline followed from 1979 until death, or censorship at 2010. Airflow limitation (AL) by Global Obstructive Lung Disease criteria, ALGOLD, was defined as FEV1/VC < 0.7; ALLLN as FEV1/VC < LLN. All all-cause, COPD and cardiovascular disease mortality was analyzed among men and women in relation to ALGOLD and ALLLN, adjusted for age and smoking.

    RESULTS: Among men, all-cause mortality risks were similar by airflow limitation criteria: ALGOLD RR = 1.32, 95% CI 1.26-1.38; ALLLN, RR = 1.37, 95% CI 1.31-1.44. The risk estimates were also similar by airflow limitation definition for cardiovascular mortality and for COPD mortality. Among women, all-cause mortality was also similar by airflow limitation criteria, but significantly higher as compared to men: ALGOLD RR = 2.10, 95% CI 1.66-2.66; ALLLN, RR = 2.09, 95% CI 1.66-2.62. Also cardiovascular and COPD mortality by airflow limitation criteria was significantly higher among women as compared to men.

    CONCLUSIONS: Defined either as FEV1/VC < 0.7 or as FEV1/VC < LLN, airflow limitation predicted excess mortality risk of similar magnitude. Mortality in relation to airflow limitation was higher among women compared to men.

  • 49.
    Wadell, Karin
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Sjukgymnastik.
    Janaudis-Ferreira, Tania
    Arne, M.
    Lisspers, K.
    Ställberg, B.
    Emtner, M.
    Hospital-based pulmonary rehabilitation in patients with COPD in Sweden-A national survey2013Ingår i: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 107, nr 8, s. 1195-1200Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Pulmonary rehabilitation (PR) is an evidence-based, multidisciplinary and cost-effective intervention that leads to improved health in patients with chronic obstructive pulmonary disease, COPD. However, the availability of PR programs varies between and within different countries. The aim of this study was to investigate the availability and content of hospital-based PR programs in patients with COPD in Sweden. A cross-sectional descriptive design was applied using a web-based questionnaire which was sent out to all hospitals in Sweden. The questionnaire consisted of 32 questions that concerned availability and content of PR in patients with COPD during 2011. Seventy out of 71 hospitals responded the electronic survey. Forty-six (66%) hospitals offered PR for patients with COPD. Around 75% of the hospitals in southern and middle parts of Sweden and 33% of the hospitals in the northern part offered PR. Thirty-four percent of the patients declined participation. A total number of 1355 patients participated in PR which represents 0.2% of the COPD population in Sweden. All hospitals had exercise training as major component and 76% offered an educational program. Not even half a percent of the patients with COPD in Sweden took part in a hospital-based PR program during 2011. There was a considerable geographic discrepancy in availability over the country. To enable a greater part of the increasing number of patients with COPD to take part in this evidence-based treatment, there is a need of evaluating other settings of PR programs; in primary care, at home and/or over the internet.

  • 50.
    Wadell, Karin
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Sjukgymnastik.
    Sundelin, Gunnevi
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Sjukgymnastik.
    Henriksson-Larsén, Karin
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Idrottsmedicin.
    Lundgren, Rune
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Lungmedicin.
    High intensity physical training in water: an effective training modality for patients with COPD2004Ingår i: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 98, nr 5, s. 428-438Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The aim of this study was to examine the effect of high intensity physical group training in water and on land for patients with COPD with regard to physical capacity and health related quality of life (HRQoL). A controlled, semi-randomised study was conducted where 30 patients were randomised to training either in water or on land. Thirteen patients constituted a control group. Forty-three outpatients, with moderate to severe COPD (27w/16m), from two local hospitals in northern Sweden, were included in the study. High intensity physical group training in water (water group) or on land (land group) was performed for 12weeks, three times per week, 45min per session. The control group received no intervention. Pre- and post-intervention, all patients performed incremental and endurance shuttle walking tests (ISWT and ESWT), cycle ergometer tests and responded questionnaires about HRQoL (St. Georges Respiratory Questionnaire--SGRQ and SF-36). The patients trained with a mean heart rate of 80-90% of peak heart rate. Both training groups increased the distance walked, i.e. land group in ISWT (25m) and water group in ESWT (179m). The water group increased the distance in ESWT significantly more that both the land and the control groups. Both training groups increased the time cycled (40-85s) and work load (10-20W) in the cycle ergometer test. The control group deteriorated in HRQoL according to total score in SGRQ while the training groups remained constant. The water group improved their activity score in SGRQ and their physical health score in SF-36 and those improvements were significant as compared to the land and the control groups. In conclusion, high intensity physical group training in water is of benefit for patients with COPD. It was in some areas found to be even more effective regarding improvements in physical capacity and experienced physical health compared to the same kind of training on land.

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