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Publications (10 of 53) Show all publications
Packham, S., Ödling, M., Bossios, A., Konradsen, J. R. & Stridsman, C. (2024). Adherence to inhaled corticosteroid therapy and treatment escalation in the Swedish adult asthma population. Respiratory Medicine, 231, Article ID 107714.
Open this publication in new window or tab >>Adherence to inhaled corticosteroid therapy and treatment escalation in the Swedish adult asthma population
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2024 (English)In: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 231, article id 107714Article in journal (Refereed) Published
Abstract [en]

Background: Patients with uncontrolled asthma should be evaluated for medication adherence. This study aimed to identify characteristics associated with poor adherence to inhaled corticosteroids (ICS) and to explore adherence prior to treatment escalation.

Methods: This nationwide longitudinal cohort study included adult asthma patients (n = 30880) with a healthcare visit including Asthma Control Test (ACT) and registered in the Swedish National Airway Register between 1 July 2017 and 28 February 2019 (index date). Patient data was crosslinked to other national registers. Treatment steps two years pre- and one year post-index, were identified by prescribed drugs. Poor adherence was defined as Medication Possession Ratio <80 %.

Results: Poor adherence was identified in 73 % of patients in treatment steps 2–5, where of 35 % had uncontrolled asthma (ACT≤19). In adjusted models, poor adherence was associated with better disease control; ACT≤19 (OR 0.78, 95 % CI 0.71–0.84), short-acting β2-agonist (SABA) overuse (0.69, 0.61–0.79) and exacerbations (0.79, 0.70–0.89) in steps 2–3. Among patients with uncontrolled asthma, poor adherence was associated with SABA overuse (1.71, 1.50–1.95), exacerbations (1.29, 1.15–1.46), current smoking (1.38, 1.21–1.57) and inversely associated with asthma management education (0.85, 0.78–0.93. Similar results were observed in steps 4–5. When investigating post-index treatment, 53 % remained stationary, 30 % stepped down and 17 % escalated treatment. Prior to escalation, 49 % had poor adherence.

Conclusions: Poor ICS adherence was associated with better asthma control. Among uncontrolled patients, poor adherence was associated with SABA overuse and exacerbations. Our result highlights the importance of asthma management education to improve adherence in uncontrolled patients.

Place, publisher, year, edition, pages
Elsevier, 2024
Keywords
Inhalation corticosteroid, Medication adherence, Treatment escalation, Uncontrolled asthma
National Category
Respiratory Medicine and Allergy
Identifiers
urn:nbn:se:umu:diva-227570 (URN)10.1016/j.rmed.2024.107714 (DOI)38885815 (PubMedID)2-s2.0-85196151029 (Scopus ID)
Funder
Swedish Heart Lung Foundation, 20220478Swedish Heart Lung Foundation, 20230537Swedish Heart Lung Foundation, 20230473Umeå UniversityRegion VästerbottenRegion StockholmNorrbotten County CouncilSwedish Asthma and Allergy AssociationConsul Berghs FoundationSällskapet Barnavård
Available from: 2024-07-02 Created: 2024-07-02 Last updated: 2024-07-02Bibliographically approved
Backman, H., Sawalha, S., Nilsson, U., Hedman, L., Stridsman, C., Vanfleteren, L. E. G., . . . Lindberg, A. (2024). All-cause and cause-specific mortality by spirometric pattern and sex: a population-based cohort study. Therapeutic Advances in Respiratory Disease, 18(January-December)
Open this publication in new window or tab >>All-cause and cause-specific mortality by spirometric pattern and sex: a population-based cohort study
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2024 (English)In: Therapeutic Advances in Respiratory Disease, ISSN 1753-4658, E-ISSN 1753-4666, Vol. 18, no January-DecemberArticle in journal (Refereed) Published
Abstract [en]

Background: Chronic airway obstruction (CAO) and restrictive spirometry pattern (RSP) are associated with mortality, but sex-specific patterns of all-cause and specific causes of death have hardly been evaluated.

Objectives: To study the possible sex-dependent differences of all-cause mortality and patterns of cause-specific mortality among men and women with CAO and RSP, respectively, to that of normal lung function (NLF).

Design: Population-based prospective cohort study.

Methods: Individuals with CAO [FEV1/vital capacity (VC) < 0.70], RSP [FEV1/VC ⩾ 0.70 and forced vital capacity (FVC) < 80% predicted] and NLF (FEV1/VC ⩾ 0.70 and FVC ⩾ 80% predicted) were identified within the Obstructive Lung Disease in Northern Sweden (OLIN) studies in 2002–2004. Mortality data were collected through April 2016, totally covering 19,000 patient-years. Cox regression and Fine–Gray regression accounting for competing risks were utilized to estimate hazard ratios (HRs) with 95% confidence intervals (CIs) adjusted for age, body mass index, sex, smoking habits and pack-years.

Results: The adjusted hazard for all-cause mortality was higher in CAO and RSP than in NLF (HR, 95% CI; 1.69, 1.31–2.02 and 1.24, 1.06–1.71), and the higher hazards were driven by males. CAO had a higher hazard of respiratory and cardiovascular death than NLF (2.68, 1.05–6.82 and 1.40, 1.04–1.90). The hazard of respiratory death was significant in women (3.41, 1.05–11.07) while the hazard of cardiovascular death was significant in men (1.49, 1.01–2.22). In RSP, the higher hazard for respiratory death remained after adjustment (2.68, 1.05–6.82) but not for cardiovascular death (1.11, 0.74–1.66), with a similar pattern in both sexes.

Conclusion: The higher hazard for all-cause mortality in CAO and RSP than in NLF was male driven. CAO was associated with respiratory death in women and cardiovascular death in men, while RSP is associated with respiratory death, similarly in both sexes.

Place, publisher, year, edition, pages
Sage Publications, 2024
Keywords
cause of death, chronic airway obstruction, epidemiology, mortality, restrictive spirometric pattern
National Category
Cardiac and Cardiovascular Systems Respiratory Medicine and Allergy
Identifiers
urn:nbn:se:umu:diva-222853 (URN)10.1177/17534666241232768 (DOI)001182556500001 ()38465828 (PubMedID)2-s2.0-85187480170 (Scopus ID)
Funder
Swedish Heart Lung FoundationNorrbotten County CouncilVisare NorrSvensk Lungmedicinsk FöreningRegion Västerbotten
Available from: 2024-04-15 Created: 2024-04-15 Last updated: 2024-04-15Bibliographically approved
Hedman, L., Lyytinen, G., Backman, H., Lundbäck, M., Stridsman, C., Lindberg, A., . . . Ekerljung, L. (2024). Electronic cigarette use in relation to changes in smoking status and respiratory symptoms. Tobacco Induced Diseases, 22, Article ID 21.
Open this publication in new window or tab >>Electronic cigarette use in relation to changes in smoking status and respiratory symptoms
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2024 (English)In: Tobacco Induced Diseases, E-ISSN 1617-9625, Vol. 22, article id 21Article in journal (Refereed) Published
Abstract [en]

INTRODUCTION: How e-cigarette use relates to changes in smoking status and respiratory symptoms in the population remains controversial. The aim was to study the association between e-cigarette use and, changes in smoking status and changes in respiratory symptoms.

METHODS: A prospective, population-based study of random samples of the population (age 16–69 years) was performed within The Obstructive Lung Disease in Northern Sweden (OLIN) study and West Sweden Asthma Study (WSAS). A validated postal questionnaire containing identical questions was used in OLIN and WSAS at baseline in 2006–2008 and at follow-up in 2016. In total, 17325 participated on both occasions. Questions about respiratory symptoms and tobacco smoking were included in both surveys, while e-cigarette use was added in 2016.

RESULTS: In 2016, 1.6% used e-cigarettes, and it was significantly more common in persistent tobacco smokers (10.6%), than in those who quit smoking (2.1%), started smoking (7.8%), or had relapsed into tobacco smoking at follow-up (6.4%) (p<0.001). Among current smokers at baseline, tobacco smoking cessation was less common in e-cigarette users than e-cigarette non-users (14.2% vs 47.6%, p<0.001) and there was no association with a reduction in the number of tobacco cigarettes smoked per day. Those who were persistent smokers reported increasing respiratory symptoms. In contrast, the symptoms decreased among those who quit tobacco smoking, but there was no significant difference in respiratory symptoms between quitters with and without e-cigarette use.

CONCLUSIONS: E-cigarette use was associated with persistent tobacco smoking and reporting respiratory symptoms. We found no association between e-cigarette use and tobacco smoking cessation, reduction of number of tobacco cigarettes smoked per day or reduction of respiratory symptoms.

Place, publisher, year, edition, pages
European Publishing, 2024
Keywords
airways, ENDS, epidemiology, prospective, quitting smoking
National Category
Respiratory Medicine and Allergy Public Health, Global Health, Social Medicine and Epidemiology Substance Abuse
Identifiers
urn:nbn:se:umu:diva-221651 (URN)10.18332/tid/176949 (DOI)001164889800001 ()38259663 (PubMedID)2-s2.0-85185288540 (Scopus ID)
Funder
Swedish Heart Lung FoundationSwedish Asthma and Allergy AssociationSwedish Research CouncilRegion VästerbottenRegion Västra GötalandNorrbotten County CouncilVisare Norr
Available from: 2024-03-04 Created: 2024-03-04 Last updated: 2024-03-04Bibliographically approved
Lindh, A., Giezeman, M., Theander, K., Zakrisson, A.-B., Westerdahl, E. & Stridsman, C. (2024). Factors associated with patient education in patients with chronic obstructive pulmonary disease (COPD): a primary health care register-based study. The International Journal of Chronic Obstructive Pulmonary Disease, 19, 1069-1077
Open this publication in new window or tab >>Factors associated with patient education in patients with chronic obstructive pulmonary disease (COPD): a primary health care register-based study
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2024 (English)In: The International Journal of Chronic Obstructive Pulmonary Disease, ISSN 1176-9106, E-ISSN 1178-2005, Vol. 19, p. 1069-1077Article in journal (Refereed) Published
Abstract [en]

Purpose: Patient education in chronic obstructive pulmonary disease (COPD) is recommended in treatment strategy documents, since it can improve the ability to cope with the disease. Our aim was to identify the extent of and factors associated with patient education in patients with COPD in a primary health care setting.

Patients and Methods: In this nationwide study, we identified 29,692 COPD patients with a registration in the Swedish National Airway Register (SNAR) in 2019. Data on patient education and other clinical variables of interest were collected from SNAR. The database was linked to additional national registers to obtain data about pharmacological treatment, exacerbations and educational level.

Results: Patient education had been received by 44% of COPD patients, 72% of whom had received education on pharmacological treatment including inhalation technique. A higher proportion of patients who had received education were offered smoking cessation support, had performed spirometry and answered the COPD Assessment Test (CAT), compared with patients without patient education. In the adjusted analysis, GOLD grade 2 (OR 1.29, 95% CI 1.18–1.42), grade 3 (OR 1.41, 95% CI 1.27–1.57) and grade 4 (OR 1.79, 95% CI 1.48–2.15), as well as GOLD group E (OR 1.17, 95% CI 1.06–1.29), ex-smoking (OR 1.70, 95% CI 1.56–1.84) and current smoking (OR 1.45, 95% CI 1.33–1.58) were positively associated with having received patient education, while cardiovascular disease (OR 0.92, 95% CI 0.87–0.98) and diabetes (OR 0.93, 95% CI 0.87–1.00) were negatively associated with receipt of patient education.

Conclusion: Fewer than half of the patients had received patient education, and the education had mostly been given to those with more severe COPD, ex-and current smokers and patients with fewer comorbidities. Our study highlights the need to enhance patient education at an earlier stage of the disease.

Place, publisher, year, edition, pages
Dove Medical Press, 2024
Keywords
chronic obstructive pulmonary disease, inhaler use, patient education, primary health care, register study
National Category
Respiratory Medicine and Allergy
Identifiers
urn:nbn:se:umu:diva-225515 (URN)10.2147/COPD.S455080 (DOI)001226297800001 ()38765768 (PubMedID)2-s2.0-85193677033 (Scopus ID)
Funder
Swedish Heart Lung Foundation, 20200548
Available from: 2024-06-04 Created: 2024-06-04 Last updated: 2024-06-04Bibliographically approved
Backman, H., Winsa-Lindmark, S., Hedman, L., Kankaanranta, H., Warm, K., Lindberg, A., . . . Stridsman, C. (2024). The interplay between obesity and blood neutrophils in adult-onset asthma. Respiratory Medicine, 222, Article ID 107529.
Open this publication in new window or tab >>The interplay between obesity and blood neutrophils in adult-onset asthma
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2024 (English)In: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 222, article id 107529Article in journal (Refereed) Published
Abstract [en]

Highlights:

  • Severe obesity strongly associates to blood neutrophils in adult-onset asthma.
  • B-neutrophils may partly mediate associations between obesity and asthma control.
  • Clinical evaluation of adult-onset asthma should include assessing B-neutrophils.
Place, publisher, year, edition, pages
Elsevier, 2024
National Category
Respiratory Medicine and Allergy
Identifiers
urn:nbn:se:umu:diva-219818 (URN)10.1016/j.rmed.2024.107529 (DOI)38215999 (PubMedID)2-s2.0-85182381912 (Scopus ID)
Available from: 2024-01-22 Created: 2024-01-22 Last updated: 2024-01-22Bibliographically approved
Konradsen, J. R., Selberg, S., Ödling, M., Sundbaum, J. K., Bossios, A. & Stridsman, C. (2024). Treatable traits and exacerbation risk in patients with uncontrolled asthma prescribed GINA step 1–3 treatment: a nationwide asthma cohort study. Respirology (Carlton South. Print)
Open this publication in new window or tab >>Treatable traits and exacerbation risk in patients with uncontrolled asthma prescribed GINA step 1–3 treatment: a nationwide asthma cohort study
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2024 (English)In: Respirology (Carlton South. Print), ISSN 1323-7799, E-ISSN 1440-1843Article in journal (Refereed) Epub ahead of print
Abstract [en]

Background and Objective: Uncontrolled asthma in patients treated for mild/moderate disease could be caused by non-pulmonary treatable traits (TTs) that affect asthma control negatively. We aimed to identify demographic characteristics, behavioural (smoking) and extrapulmonary (obesity, comorbidities) TTs and the risk for future exacerbations among patients with uncontrolled asthma prescribed step 1–3 treatment according to the Global Initiative for Asthma (GINA).

Methods: Twenty-eight thousand five hundred eighty-four asthma patients (≥18 y) with a registration in the Swedish National Airway Register between 2017 and 2019 were included (index-date). The database was linked to other national registers to obtain information on prescribed drugs 2-years pre-index and exacerbations 1-year post-index. Asthma treatment was classified into step 1–3 or 4–5, and uncontrolled asthma was defined based on symptom control, exacerbations and lung function.

Results: GINA step 1–3 included 17,318 patients, of which 9586 (55%) were uncontrolled (UCA 1–3). In adjusted analyses, UCA 1–3 was associated with female sex (OR 1.34, 95% CI 1.27–1.41), older age (1.00, 1.00–1.00), primary education (1.30, 1.20–1.40) and secondary education (1.19, 1.12–1.26), and TTs such as smoking (1.25, 1.15–1.36), obesity (1.23, 1.15–1.32), cardiovascular disease (1.12, 1.06–1.20) and depression/anxiety (1.13, 1.06–1.21). Furthermore, UCA 1–3 was associated with future exacerbations; oral corticosteroids (1.90, 1.74–2.09) and asthma hospitalization (2.55, 2.17–3.00), respectively, also when adjusted for treatment step 4–5.

Conclusion: Over 50% of patients treated for mild/moderate asthma had an uncontrolled disease. Assessing and managing of TTs such as smoking, obesity and comorbidities should be conducted in a holistic manner, as these patients have an increased risk for future exacerbations.

Place, publisher, year, edition, pages
John Wiley & Sons, 2024
Keywords
asthma control, asthma treatment, comorbidities, exacerbations, treatable traits, uncontrolled asthma
National Category
Respiratory Medicine and Allergy
Identifiers
urn:nbn:se:umu:diva-226498 (URN)10.1111/resp.14774 (DOI)001243542900001 ()38859634 (PubMedID)2-s2.0-85195566444 (Scopus ID)
Funder
Swedish Heart Lung Foundation, 20220478Swedish Heart Lung Foundation, 20200548Norrbotten County CouncilRegion StockholmStiftelsen Frimurare Barnhuset i StockholmConsul Berghs FoundationSwedish Asthma and Allergy Association
Available from: 2024-06-19 Created: 2024-06-19 Last updated: 2024-06-19
Stridsman, C., Martinsen, Ø., Selberg, S., Ödling, M. & Konradsen, J. R. (2024). Uncontrolled asthma in school-aged children: a nationwide specialist care study. Journal of Allergy and Clinical Immunology: Global, 3(2), Article ID 100227.
Open this publication in new window or tab >>Uncontrolled asthma in school-aged children: a nationwide specialist care study
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2024 (English)In: Journal of Allergy and Clinical Immunology: Global, ISSN 2772-8293, Vol. 3, no 2, article id 100227Article in journal (Refereed) Published
Abstract [en]

Background: Uncontrolled asthma (UCA) is different from severe asthma and can be identified in children across all ranges of prescribed treatment.

Objective: Our aim was to characterize uncontrolled childhood asthma in pediatric specialist care.

Methods: We performed a nationwide cross-sectional study of 5497 children (aged 6-17 years) with asthma who were treated by pediatricians at outpatient clinics during 2019 and registered in the Swedish National Airway Register. UCA was defined as an Asthma Control Test score of 19 or lower and/or 2 or more exacerbations in the past year and/or an FEV1 value less than 80% predicted. Treatment was categorized from step 1 to step 5 according to the Global Initiative for Asthma.

Results: UCA was identified in 1690 children (31%), of whom 64% had an Asthma Control Test score of 19 or lower, 20% had recurrent exacerbations, and 31% had an FEV1 value less than 80% predicted. UCA was associated with female sex (odds ratio [OR] = 1.29 [95% CI = 1.15-1.45]), older age (OR = 1.02 [95% CI = 1.00-1.04]), obesity (OR = 1.43 [95% CI = 1.12-1.83]), and more treatment using steps 1 and 2 as a reference (step 3, OR = 1.28 [95% CI = 1.12-1.46]); steps 4-5, OR = 1.32 [95% CI = 1.10-1.57]). UCA in children prescribed treatment steps 1 and 2 (group UCA1-2) occurred in 28% of all children at this treatment step (n = 887). Children in group UCA1-2 had exacerbations more frequently than did those children with UCA who were prescribed steps 4 and 5 treatment (24% vs 15% [P =.001]).

Conclusion: UCA was common and associated with female sex, increasing age, obesity, and higher Global Initiative for Asthma treatment step. Surprisingly, UCA was also common in children prescribed less than the maximum treatment, and those children could be considered undertreated patients.

Place, publisher, year, edition, pages
Elsevier, 2024
Keywords
Asthma, asthma control, asthma management, asthma phenotypes, asthma treatment, children, exacerbations, obesity, pulmonary function, school-aged asthma, severe asthma, uncontrolled asthma, undertreated asthma
National Category
Respiratory Medicine and Allergy
Identifiers
urn:nbn:se:umu:diva-222229 (URN)10.1016/j.jacig.2024.100227 (DOI)2-s2.0-85186507084 (Scopus ID)
Funder
Swedish Heart Lung Foundation, 20200548Swedish Asthma and Allergy AssociationNorrbotten County Council
Available from: 2024-03-15 Created: 2024-03-15 Last updated: 2024-03-15Bibliographically approved
Warm, K., Hedman, L., Stridsman, C., Lindberg, A., Rönmark, E. & Backman, H. (2023). Age-related differences in associations between uncontrolled asthma, comorbidities and biomarkers in adult-onset asthma. Journal of Asthma, 60(12), 2224-2232
Open this publication in new window or tab >>Age-related differences in associations between uncontrolled asthma, comorbidities and biomarkers in adult-onset asthma
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2023 (English)In: Journal of Asthma, ISSN 0277-0903, E-ISSN 1532-4303, Vol. 60, no 12, p. 2224-2232Article in journal (Refereed) Published
Abstract [en]

Objective: Adult-onset asthma is a recognized but heterogeneous phenotype and has been described to associate with poor asthma control. Knowledge about associations between clinical characteristics including comorbidities and control of adult-onset asthma is limited, especially in older populations. We aimed to study how clinical biomarkers and comorbidities are associated with uncontrolled asthma among middle-aged and older individuals with adult-onset asthma.

Methods: Clinical examinations including structured interview, asthma control test (ACT), spirometry, skin prick test (SPT), blood sampling, and measurement of exhaled fractional nitric oxide (FeNO) was performed in a population-based adult-onset asthma cohort in 2019–2020 (n = 227, 66.5% female). Analyses were performed among all included, and separately in middle-aged (37–64 years, n = 120) and older (≥65 years, n = 107) participants.

Results: In bivariate analysis, uncontrolled asthma (ACT ≤ 19) was significantly associated with a blood neutrophil count ≥5/µl, BMI ≥30, and several comorbidities. In multivariable regression analysis, uncontrolled asthma was associated with neutrophils ≥5/µl (OR 2.35; 95% CI 1.11–4.99). In age-stratified analysis, BMI ≥30 (OR 3.04; 1.24–7.50), eosinophils ≥0.3/µl (OR 3.17; 1.20–8.37), neutrophils ≥5/µl (OR 4.39; 1.53–12.62) and allergic rhinitis (OR 5.10; 1.59–16.30) were associated with uncontrolled asthma among the middle-aged. Among the older adults, uncontrolled asthma was only associated with comorbidities: chronic rhinitis (OR 4.08; 1.62–10.31), ischemic heart disease (OR 3.59; 1.17–10.98), malignancy (OR 3.10; 1.10–8.73), and depression/anxiety (OR 16.31; 1.82–146.05).

Conclusions: In adult-onset asthma, comorbidities were strongly associated with uncontrolled asthma among older adults, while clinical biomarkers including eosinophils and neutrophils in blood were associated with uncontrolled asthma among middle-aged.

Place, publisher, year, edition, pages
Taylor & Francis, 2023
Keywords
eosinophils, Epidemiology, inflammation, neutrophils, phenotype, risk factors
National Category
Respiratory Medicine and Allergy
Identifiers
urn:nbn:se:umu:diva-212319 (URN)10.1080/02770903.2023.2231078 (DOI)001023055300001 ()37405375 (PubMedID)2-s2.0-85164694186 (Scopus ID)
Funder
Forte, Swedish Research Council for Health, Working Life and WelfareSwedish Heart Lung FoundationSwedish Research CouncilUmeå UniversityRegion VästerbottenNorrbotten County CouncilSwedish Asthma and Allergy AssociationVisare Norr
Available from: 2023-07-25 Created: 2023-07-25 Last updated: 2023-12-19Bibliographically approved
Vanfleteren, L. E. G., Lindberg, A., Zhou, C., Nyberg, F. & Stridsman, C. (2023). Exacerbation risk and mortality in global initiative for chronic obstructive lung disease group A and B patients with and without exacerbation history. American Journal of Respiratory and Critical Care Medicine, 208(2), 163-175
Open this publication in new window or tab >>Exacerbation risk and mortality in global initiative for chronic obstructive lung disease group A and B patients with and without exacerbation history
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2023 (English)In: American Journal of Respiratory and Critical Care Medicine, ISSN 1073-449X, E-ISSN 1535-4970, Vol. 208, no 2, p. 163-175Article in journal (Refereed) Published
Abstract [en]

Rationale: Risk stratification of patients according to chronic obstructive pulmonary disease severity is clinically important and forms the basis of therapeutic recommendations. No studies have examined the association for Global Initiative for Chronic Obstructive Lung Disease (GOLD) group A and group B patients with (A1 and B1, respectively) and without (A0 and B0, respectively) an exacerbation in the past year with future exacerbations, hospitalizations, and mortality in perspective with the new GOLD ABE classification.

Objectives: The aim was to examine the association between GOLD A0, A1, B0, B1, and E patients and future exacerbations, respiratory and cardiovascular hospitalizations, and mortality.

Methods: In this nationwide cohort study, we identified patients with a diagnosis of chronic obstructive pulmonary disease, aged ⩾30 years, and registered in the Swedish National Airway Register between January 2017 and August 2020. Patients were stratified in GOLD groups A0, A1, B0, B1, and E and were followed until January 2021 for exacerbations, hospitalizations, and mortality in national registries.

Measurements and Main Results: The 45,350 eligible patients included 25% A0, 4% A1, 44% B0, 10% B1, and 17% E. Moderate exacerbations, all-cause and respiratory hospitalizations, and all-cause and respiratory mortality increased by GOLD group A0-A1-B0-B1-E, except for moderate exacerbations, which were higher in A1 than in B0. Group B1 had a substantially higher hazard ratio for future exacerbation (2.56; 95% confidence interval [95% CI] 2.40-2.74), all-cause hospitalization (1.28; 1.21-1.35), and respiratory hospitalization (1.44; 1.27-1.62), but not all-cause (1.04; 0.91-1.18) or respiratory (1.13; 0.79-1.64) mortality than group B0. The exacerbation rate for group B1 was 0.6 events per patient-year versus 0.2 for group B0 (rate ratio, 2.55; 95% CI, 2.36-2.76). Results were similar for group A1 versus group A0.

Conclusions: Stratification of GOLD A and B patients with one or no exacerbation in the past year provides valuable information on future risk, which should influence treatment recommendations for preventive strategies.

Place, publisher, year, edition, pages
American Thoracic Society, 2023
Keywords
COPD, COPD management, exacerbation, GOLD classification, registry
National Category
Respiratory Medicine and Allergy
Identifiers
urn:nbn:se:umu:diva-212307 (URN)10.1164/rccm.202209-1774OC (DOI)37040482 (PubMedID)2-s2.0-85164847423 (Scopus ID)
Available from: 2023-07-25 Created: 2023-07-25 Last updated: 2023-07-25Bibliographically approved
Backman, H., Blomberg, A., Lundquist, A., Strandkvist, V., Sawalha, S., Nilsson, U., . . . Lindberg, A. (2023). Lung function trajectories and associated mortality among adults with and without airway obstruction. American Journal of Respiratory and Critical Care Medicine, 208(10), 1063-1074
Open this publication in new window or tab >>Lung function trajectories and associated mortality among adults with and without airway obstruction
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2023 (English)In: American Journal of Respiratory and Critical Care Medicine, ISSN 1073-449X, E-ISSN 1535-4970, Vol. 208, no 10, p. 1063-1074Article in journal (Refereed) Published
Abstract [en]

Rationale: Spirometry is essential for diagnosis and assessment of prognosis in COPD.

Objectives: To identify FEV1 trajectories and their determinants, based on annual spirometry measurements among individuals with and without airway obstruction. Furthermore, to assess mortality in relation to trajectories.

Methods: In 2002-04, individuals with airway obstruction (AO) (FEV1/VC<0.70, n=993) and age- and sex-matched non-obstructive (NO) referents were recruited from population-based cohorts. Annual spirometries until 2014 were utilized in joint-survival Latent Class Mixed Models to identify lung function trajectories. Mortality data were collected during 15 years of follow-up.

Results: Three trajectories were identified among the AO-cases and two among the NO referents. Trajectory membership was driven by baseline FEV1%predicted (%pred) in both groups and additionaly, pack-years in AO and current smoking in NO. Longitudinal FEV1%pred level depended on baseline FEV1%pred, pack-years and obesity. The trajectories were distributed: 79.6% T1AO FEV1-high with normal decline, 12.8% T2AO FEV1-high with rapid decline, and 7.7% T3AO FEV1-low with normal decline (mean 27, 72 and 26 mL/year) among AO-individuals, and 96.7% T1NO FEV1-high with normal decline and 3.3% T2NO FEV1-high with rapid decline (mean 34 and 173 mL/year) among referents. Hazard for death was increased for T2AO (HR1.56) and T3AO (HR3.45) vs. T1AO, and for T2NO (HR2.99) vs. T1NO.

Conclusions: Three different FEV1 trajectories were identified among those with airway obstruction and two among the referents, with different outcomes in terms of FEV1-decline and mortality. The FEV1 trajectories among airway obstructive and the relationship between low FVC and trajectory outcome are of particular clinical interest.

Place, publisher, year, edition, pages
American Thoracic Society, 2023
Keywords
prognosis, chronic obstructive pulmonary disease, FEV1, natural history
National Category
Respiratory Medicine and Allergy
Research subject
Lung Medicine; Epidemiology
Identifiers
urn:nbn:se:umu:diva-212976 (URN)10.1164/rccm.202211-2166oc (DOI)001099650500015 ()37460250 (PubMedID)2-s2.0-85183557430 (Scopus ID)
Funder
Swedish Heart Lung FoundationUmeå UniversityVisare NorrNorrbotten County CouncilSvensk Lungmedicinsk FöreningRegion Västerbotten
Available from: 2023-08-17 Created: 2023-08-17 Last updated: 2024-04-08Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0001-6622-3838

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