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  • 1.
    Adermark, Louise
    et al.
    Dept of Psychiatry and Neurochemistry, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Dept of Pharmacology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Galanti, Maria Rosaria
    Dept of Global Public Health, Karolinska Institutet, Stockholm, Sweden; Centre of Epidemiology and Community Medicine, Stockholm, Sweden.
    Ryk, Charlotta
    Swedish Agency for Health Technology Assessment and Assessment of Social Services (SBU), Stockholm, Sweden.
    Gilljam, Hans
    Dept of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
    Hedman, Linnea
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health. Dept of Health Sciences, Division of Nursing, Luleå University of Technology, Luleå, Sweden.
    Prospective association between use of electronic cigarettes and use of conventional cigarettes: A systematic review and meta-analysis2021In: ERJ Open Research, E-ISSN 2312-0541, Vol. 7, no 3, article id 00976-2020Article, review/survey (Refereed)
    Abstract [en]

    Objective: The aim of this systematic review and meta-analysis was to assess the association between e-cigarette use and subsequent initiation or recurrence of cigarette smoking.

    Data sources: A systematic literature search was finalised on 11 November 2019 using PubMed (including MEDLINE), EMBASE, Cochrane Library, Scopus, PubMed Health, NICE Evidence Search, PROSPERO, CRD and PsycInfo.

    Study selection: Studies were included if meeting the following criteria: reporting empirical results; longitudinal observational design with a minimum of 3 months of follow-up; including general population samples; allowing for the comparison between users and nonusers of e-cigarettes. Studies rated as having high risk of bias were excluded. Studies were independently assessed by at least two authors. The procedures described by PRISMA were followed, and the quality of evidence was rated using GRADE.

    Data synthesis: 30 longitudinal studies from 22 different cohorts assessing e-cigarette use among nonsmokers or never-smokers at baseline, and subsequent use of cigarette smoking at follow-up, were included in this review. A random-effects meta-analysis based on 89076 participants showed a pooled unadjusted odds ratio (OR) of cigarette smoking among baseline nonsmoker e-cigarette users compared with nonusers of 4.68 (CI 3.64–6.02), while the adjusted OR was 3.37 (CI 2.68–4.24). These results were consistent irrespective of whether the outcome was measured as ever-smoking or as past 30-day smoking. The evidence was graded as moderate.

    Conclusions: Use of e-cigarettes may predict the initiation or recurrence of cigarette smoking.

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  • 2.
    Ahmadi, Zainab
    et al.
    Lund University, Faculty of Medicine, Dept of Clinical Sciences Lund, Respiratory Medicine and Allergology, Lund, Sweden.
    Igelström, Helena
    Dept of Neuroscience, Physiotherapy, Uppsala University, Uppsala, Sweden.
    Sandberg, Jacob
    Lund University, Faculty of Medicine, Dept of Clinical Sciences Lund, Respiratory Medicine and Allergology, Lund, Sweden.
    Sundh, Josefin
    Dept of Respiratory Medicine, School of Medical Sciences, Örebro University, Örebro, Sweden.
    Sköld, Magnus
    Respiratory Medicine Unit, Dept of Medicine Solna and Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden; Dept of Respiratory Medicine and Allergy, Karolinska University Hospital Solna, Stockholm, Sweden.
    Janson, Christer
    Dept of Medical Sciences: Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden.
    Blomberg, Anders
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Medicine.
    Bornefalk, Hans
    Hans Bornefalk AB, Vallentuna, Sweden.
    Bornefalk-Hermansson, Anna
    Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden.
    Ekström, Magnus
    Lund University, Faculty of Medicine, Dept of Clinical Sciences Lund, Respiratory Medicine and Allergology, Lund, Sweden.
    Agreement of the modified Medical Research Council and New York Heart Association scales for assessing the impact of self-rated breathlessness in cardiopulmonary disease2022In: ERJ Open Research, E-ISSN 2312-0541, Vol. 8, no 1, article id 00460-2021Article in journal (Refereed)
    Abstract [en]

    Background: The functional impact of breathlessness is assessed using the modified Medical Research Council (mMRC) scale for chronic respiratory disease and with the New York Heart Association Functional Classification (NYHA) scale for heart failure. We evaluated agreement between the scales and their concurrent validity with other clinically relevant patient-reported outcomes in cardiorespiratory disease.

    Methods: Outpatients with stable chronic respiratory disease or heart failure were recruited. Agreement between the mMRC and NYHA scales was analysed using Cramér’s V and Kendall’s tau B tests. Concurrent validity was evaluated using correlations with clinically relevant measures of breathlessness, anxiety, depression, and health-related quality of life. Analyses were conducted for all participants and separately in chronic obstructive pulmonary disease (COPD) and heart failure.

    Results: In a total of 182 participants with cardiorespiratory disease, the agreement between the mMRC and NYHA scales was moderate (Cramér’s V: 0.46; Kendall’s tau B: 0.57) with similar results for COPD (Cramér’s V: 0.46; Kendall’s tau B: 0.66) and heart failure (Cramér’s V: 0.46; Kendall’s tau B: 0.67). In the total population, the scales correlated in similar ways to other patient-reported outcomes.

    Conclusion: In outpatients with cardiorespiratory disease, the mMRC and NYHA scales show moderate to strong correlations and similar associations with other patient-reported outcomes. This supports that the scales are comparable when assessing the impact of breathlessness on function and patient-reported outcomes.

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  • 3.
    Almqvist, Linnéa
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Rönmark, Eva
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Stridsman, Caroline
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Medicine.
    Backman, Helena
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health. Department of Health Sciences, Luleå University of Technology, Luleå, Sweden.
    Lindberg, Anne
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Medicine.
    Lundbäck, Bo
    Hedman, Linnéa
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health. Department of Health Sciences, Luleå University of Technology, Luleå, Sweden.
    Remission of adult-onset asthma is rare: a 15-year follow-up study2020In: ERJ Open Research, E-ISSN 2312-0541, Vol. 6, no 4, article id 00620-2020Article in journal (Refereed)
    Abstract [en]

    Background: There are few long-term clinical follow-up studies of adult-onset asthma. The aim of this article was to study clinical characteristics of adult-onset asthma in relation to remission and persistence of the disease in a 15-year follow-up.

    Methods: A cohort of 309 adults aged 20-60 years with asthma onset during the last 12 months verified by bronchial variability, was recruited between 1995 and 1999 from the general population in northern Sweden. The cohort was followed-up in 2003 (n=250) and between 2012 and 2014 (n=205). Structured interviews and spirometry were performed at recruitment and the follow-ups. Bronchial hyperreactivity (BHR) and skin-prick tests were performed at recruitment and blood samples were collected at the last follow-up. Remission of asthma was defined as no asthma symptoms and no use of asthma medication during the last 12 months.

    Results: Of eight individuals in remission in 2003, five had relapsed between 2012 and 2014 and in total, 23 (11%) were in remission, while 182 had persistent asthma. Those in remission had higher mean forced expiratory volume in 1 s % predicted at recruitment than those with persistent asthma (94.6 versus 88.3, p=0.034), fewer had severe BHR (27.3% versus 50.9%, p=0.037) and they had less body mass index increase (+1.6 versus +3.0, p=0.054). Of those with persistent asthma, 13% had uncontrolled asthma and they had higher levels of blood neutrophils than those with partly controlled or controlled asthma.

    Conclusion: Higher forced expiratory volume in 1 s % predicted and less-severe BHR was associated with remission of adult-onset asthma, but still, the proportion in remission in this 15-year follow-up was low.

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  • 4.
    Andersén, Heidi
    et al.
    Faculty of Medicine and Health Technology, Tampere University Respiratory Research Group, Tampere University, Tampere, Finland; Thoracic Oncology Unit, Karolinska University Hospital, Tema Cancer, Stockholm, Sweden; Oncology Unit, Vaasa Keskussairaala, Vaasa, Finland.
    Ilmarinen, Pinja
    Faculty of Medicine and Health Technology, Tampere University Respiratory Research Group, Tampere University, Tampere, Finland; Dept of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland.
    Honkamäki, Jasmin
    Faculty of Medicine and Health Technology, Tampere University Respiratory Research Group, Tampere University, Tampere, Finland.
    Tuomisto, Leena E.
    Dept of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland.
    Hisinger-Mölkänen, Hanna
    Faculty of Medicine, University of Helsinki, Helsinki, Finland.
    Backman, Helena
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Lundbäck, Bo
    Dept of Internal Medicine, Krefting Research Center, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Rönmark, Eva
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Haahtela, Tari
    Faculty of Medicine, University of Helsinki, Helsinki, Finland.
    Sovijärvi, Anssi
    Faculty of Medicine, University of Helsinki, Helsinki, Finland; Unit of Clinical Physiology, Dept of Clinical Physiology and Nuclear Medicine, HUS Medical Imaging Center, Helsinki University Central Hospital, Helsinki, Finland.
    Lehtimäki, Lauri
    Faculty of Medicine and Health Technology, Tampere University Respiratory Research Group, Tampere University, Tampere, Finland; Allergy Centre, Tampere University Hospital, Tampere, Finland.
    Piirilä, Päivi
    Faculty of Medicine, University of Helsinki, Helsinki, Finland; Unit of Clinical Physiology, Dept of Clinical Physiology and Nuclear Medicine, HUS Medical Imaging Center, Helsinki University Central Hospital, Helsinki, Finland.
    Kankaanranta, Hannu
    Faculty of Medicine and Health Technology, Tampere University Respiratory Research Group, Tampere University, Tampere, Finland; Dept of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland; Dept of Internal Medicine, Krefting Research Center, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    NSAID-exacerbated respiratory disease: a population study2022In: ERJ Open Research, E-ISSN 2312-0541, Vol. 8, no 1, article id 00462Article in journal (Refereed)
    Abstract [en]

    Background: Nonsteroidal anti-inflammatory drugs (NSAIDs) may exacerbate respiratory symptoms. A recent European Academy of Allergy and Clinical Immunology position paper recommended the use of an acronym, N-ERD (NSAID-exacerbated respiratory disease), for this hypersensitivity associated with asthma or chronic rhinosinusitis with or without nasal polyposis. Our aim was to estimate the prevalence of N-ERD and identify factors associated with N-ERD.

    Methods: In 2016, a cross-sectional questionnaire survey of a random adult population of 16 000 subjects aged 20–69 years was performed in Helsinki and Western Finland. The response rate was 51.5%.

    Results: The prevalence was 1.4% for N-ERD, and 0.7% for aspirin-exacerbated respiratory disease (AERD). The prevalence of N-ERD was 6.9% among subjects with asthma and 2.7% among subjects with rhinitis. The risk factors for N-ERD were older age, family history of asthma or allergic rhinitis, long-term smoking and exposure to environmental pollutants. Asthmatic subjects with N-ERD had a higher risk of respiratory symptoms, severe hypersensitivity reactions and hospitalisations than asthmatic subjects without N-ERD. The subphenotype of N-ERD with asthma was most symptomatic. Subjects with rhinitis associated with N-ERD, which would not be included in AERD, had the fewest symptoms.

    Conclusion: We conclude that the prevalence of N-ERD was 1.4% in a representative Finnish adult population sample. Older age, family history of asthma or allergic rhinitis, cumulative exposure to tobacco smoke, secondhand smoke, and occupational exposures increased odds of N-ERD. N-ERD was associated with significant morbidity.

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  • 5.
    Bermúdez Barón, Nicolás
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Kankaanranta, Hannu
    Dept of Internal Medicine and Clinical Nutrition, Krefting Research Centre, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden; Faculty of Medicine and Health Technology, Tampere University, Respiratory Research Group, Tampere University, Tampere, Finland; Dept of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland.
    Hedman, Linnea
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Andersson, Martin
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Stridsman, Caroline
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Medicine.
    Lindberg, Anne
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Medicine.
    Rönmark, Eva
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Backman, Helena
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Body mass index increase: a risk factor for forced expiratory volume in 1 s decline for overweight and obese adults with asthma2022In: ERJ Open Research, E-ISSN 2312-0541, Vol. 8, no 4, article id 00110-2022Article in journal (Refereed)
    Abstract [en]

    Background: With increasing prevalence of overweight and obesity, it is important to study how body mass index (BMI) change may affect lung function among subjects with asthma. There are few prospective studies on this topic, especially with separate analyses of those with normal and high BMI. The aim of the present study was to prospectively study the association between annual BMI change and annual lung function decline, separately among those with normal initial BMI and overweight/obesity, in an adult asthma cohort.

    Methods: A population-based adult asthma cohort was examined at study entry between 1986 and 2001 and at follow-up between 2012 and 2014 (n=945). Annual BMI change was analysed in association with annual decline in forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC) and FEV1 /FVC separately in those with normal weight (BMI 18.5–24.9) and overweight/obese subjects (BMI ⩾25) at study entry. Regression models were used to adjust for sex, age, smoking, inhaled corticosteroids use and occupational exposure to gas, dust or fumes.

    Results: Overweight/obese subjects had lower FEV1 and FVC but slower annual FEV1 and FVC decline compared to those with normal weight. After adjustment through regression modelling, the association between BMI change with FEV1 and FVC decline remained significant for both BMI groups, but with stronger associations among the overweight/obese (FEV1 B[Overweight/obese] =−25 mL versus B[normal weight] = −15 mL). However, when including only those with BMI increase during follow-up, the associations remained significant among those with overweight/obesity, but not in the normal-weight group. No associations were seen for FEV1 /FVC.

    Conclusions: BMI increase is associated with faster FEV1 and FVC decline among overweight and obese adults with asthma in comparison with their normal-weight counterparts.

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  • 6. Bjerg, Anders
    et al.
    Ljungberg, Henrik
    Dierschke, Katrin
    Åkerberg-Krook, Else
    Andersson, Ulla B. K.
    Olin, Anna-Carin
    Lindberg, Elisabeth
    Yuan, Ximing
    Lyström, Jonathan
    Wålinder, Robert
    Victor, Susanne
    Andersson, Martin
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Bertilsson, Helen
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Carleborg, Anna
    Nordlund, Björn
    Shorter time to clinical decision in work-related asthma using a digital tool2020In: ERJ Open Research, E-ISSN 2312-0541, Vol. 6, no 3, article id 00259-2020Article in journal (Refereed)
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  • 7.
    Dehara, Marina
    et al.
    Clinical Epidemiology Division, Dept of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.
    Sachs, Michael C.
    Dept of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Arkema, Elizabeth V.
    Clinical Epidemiology Division, Dept of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.
    Grunewald, Johan
    Respiratory Medicine Division, Dept of Medicine Solna, Karolinska Institutet, Stockholm, Sweden; Center for Molecular Medicine, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden; Respiratory Medicine, Theme Inflammation and Ageing, Karolinska University Hospital, Stockholm, Sweden.
    Blomberg, Anders
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Medicine.
    Modifiable lifestyle risk factors for sarcoidosis: a nested case–control study2023In: ERJ Open Research, E-ISSN 2312-0541, Vol. 9, no 2, article id 00492-2022Article in journal (Refereed)
    Abstract [en]

    Objective: We aimed to investigate whether obesity, tobacco use, alcohol consumption and physical inactivity are associated with sarcoidosis risk.

    Methods: We conducted a matched case–control study nested within the Northern Sweden Health and Disease Study. Incident sarcoidosis cases (n=165) were identified via medical records and matched to controls (n=660) on sub-cohort, sex, birth and questionnaire date (1:4). Data on lifestyle factors were obtained through questionnaires, and physical measurements of height, weight and waist were collected prior to sarcoidosis diagnosis. Conditional logistic regression estimated adjusted odds ratios with 95% confidence intervals (aOR; 95% CI).

    Results: Compared with never-smoking, current smoking was associated with lower sarcoidosis odds (aOR 0.48; 95% CI 0.32–0.71), and former smoking with higher odds (aOR 1.33; 95% CI 0.98–1.81). Snus use was not associated with sarcoidosis. There was an increased odds of sarcoidosis associated with obesity (aOR 1.34; 95% CI 0.94–1.92) but not with overweight (aOR 0.99; 95% CI 0.76–1.30). Compared with those who were physically inactive, those who were active had a 25% higher odds of sarcoidosis (aOR 1.25; 95% CI 0.91–1.72). No association was found with moderate alcohol consumption (aOR 0.95; 95% CI 0.56–1.62). All results were similar when cases diagnosed within 5 years after exposure assessment were excluded, except the aOR for former smoking decreased to 1.1.

    Conclusion: We observed a reduced sarcoidosis risk associated with smoking, which cannot be fully explained by early symptoms of sarcoidosis influencing smoking habits. Results indicate an increased risk associated with obesity, but not overweight, and being physically active.

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  • 8. Emilsson, Össur Ingi
    et al.
    Hägg, Shadi Amid
    Lindberg, Eva
    Franklin, Karl A
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Toren, Kjell
    Benediktsdottir, Bryndis
    Aspelund, Thor
    Real, Francisco Gomez
    Leynaert, Benedicte
    Demoly, Pascal
    Sigsgaard, Torben
    Perret, Jennifer
    Malinovschi, Andrei
    Jarvis, Deborah
    Garcia-Aymerich, Judith
    Gislason, Thorarinn
    Janson, Christer
    Snoring and nocturnal reflux: association with lung function decline and respiratory symptoms2019In: ERJ Open Research, E-ISSN 2312-0541, Vol. 5, no 2, article id 10Article in journal (Refereed)
    Abstract [en]

    Introduction: The study aim was to examine the association of snoring and nocturnal gastro-oesophageal reflux (nGOR) with respiratory symptoms and lung function, and if snoring and/or nGOR associated with a steeper decline in lung function. Methods: Data from the third visit of the European Community Respiratory Health Survey (ECRHS) was used for cross-sectional analysis. Pre- and post-bronchodilator spirometry was performed, and information on sleep, nGOR and respiratory symptoms was collected (n=5715). Habitual snoring and nGOR were assessed by questionnaire reports. Pre-bronchodilator spirometry from ECRHS I, II and III (20 years follow-up) were used to analyse lung function changes by multivariate regression analysis. Results: Snoring and nGOR were independently associated with a higher prevalence of wheeze, chest tightness, breathlessness, cough and phlegm. The prevalence of any respiratory symptom was 79% in subjects with both snoring and nGOR versus 56% in those with neither (p<0.001). Subjects with both snoring and nGOR had more frequent exacerbations (adjusted prevalence 32% versus 19% among "no snoring, no nGOR", p=0.003). Snoring but not nGOR was associated with a steeper decline in forced expiratory volume in 1 s over 10 years after adjusting for confounding factors (change in % predicted -5.53, versus -4.58 among "no snoring", p=0.04) and forced vital capacity (change in % predicted -1.94, versus -0.99 among "no snoring", p=0.03). Conclusions: Adults reporting both habitual snoring and nGOR had more respiratory symptoms and more frequent exacerbations of these symptoms. Habitual snoring was associated with a steeper decline in lung function over time.

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  • 9. Finnegan, Sarah L.
    et al.
    Pattinson, Kyle T. S.
    Sundh, Josefin
    Sköld, Magnus
    Janson, Christer
    Blomberg, Anders
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Medicine.
    Sandberg, Jacob
    Ekström, Magnus
    A common model for the breathlessness experience across cardiorespiratory disease2021In: ERJ Open Research, E-ISSN 2312-0541, Vol. 7, no 2, article id 00818-2020Article in journal (Refereed)
    Abstract [en]

    Introduction: Chronic breathlessness occurs across many different conditions, often independently of disease severity. Yet, despite being strongly linked to adverse outcomes,the consideration of chronic breathlessness as a stand-alone therapeutic target remains limited. Here we use data-driven techniques to identify and confirm the stability of underlying features (factors) driving breathlessness across different cardiorespiratory diseases.

    Methods: Study of questionnaire data on 182 participants with main diagnoses of asthma(21.4%), COPD (24.7%), heart failure (19.2%), idiopathic pulmonary fibrosis (18.7%), other interstitial lung disease (5.5%), and “other diagnoses” (8.8%) were entered into an exploratory factor analysis (EFA). Participants were stratified based on their EFA factor scores. We then examined model stability using six-month follow-up data and established the most compact set of measures describing the breathlessness experience.

    Results: In this dataset, we have identified four stable factors that underlie the experience of breathlessness. These factors were assigned the following descriptive labels: 1) body burden, 2) affect/mood, 3) breathing burden and 4) anger/frustration. Stratifying patients by their scores across the four factors revealed two groups corresponding to high and low burden. These two groups were not related to the primary disease diagnosis and remained stable after six months.

    Discussion: In this work we identified and confirmed the stability of underlying features of breathlessness. Previous work in this domain has been largely limited to single-diagnosis patient groups without subsequent re-testing of model stability. This work provides further evidence supporting disease independent approaches to assess breathlessness. 

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  • 10.
    Genberg, Jenny
    et al.
    Umeå University.
    Davies, Joanna M.
    Ahmadi, Zainab
    Currow, David
    Johnson, Miriam J.
    Tanash, Hanan
    Bajwah, Sabrina
    Ekström, Magnus
    Indications and patterns of use of benzodiazepines and opioids in severe interstitial lung disease: a population based longitudinal study2021In: ERJ Open Research, E-ISSN 2312-0541, Vol. 7, no 1, article id 00716-2020Article in journal (Refereed)
    Abstract [en]

    Background: Despite evidence that opioids might relieve chronic breathlessness, physicians may still be reluctant to prescribe them due to safety concerns. By contrast, benzodiazepine (BDZ) prescribing often seeks to reduce chronic breathlessness despite no evidence of net benefit. Prescribing patterns and indications for these medications in severe interstitial lung disease (ILD) are unknown. Here, our objective was to evaluate the indications, medications and temporal patterns of BDZ and opioid prescriptions in people with oxygen-dependent ILD.

    Methods: This was an observational, population-based, longitudinal study of adults starting long-term oxygen therapy (LTOT) for ILD between 2005 and 2014 in the Swedish National Registry for Respiratory Failure (Swedevox). People dispensed BDZs (n=2000) and opioids (n=2000) from 6 months before start of LTOT throughout follow-up (first of death or study end) were analysed.

    Results: Of 1635 included patients, 651 (39.8%) received BDZs and 710 (43.4%) received opioids during the study period; 373 (22.8%) patients received both. The most frequently prescribed BDZs and opioids were oxazepam (85.6%) and oxycodone (28.7%), respectively. Indications for breathlessness were uncommon for BDZs (1.4%) and opioids (6.4%). During the last year of life, opioid indications for breathlessness increased from 2.5% (12-10 months before death) to 10.2% in the last 3 months of life (p=0.048).

    Conclusions: In oxygen-dependent ILD, opioids are rarely prescribed for breathlessness even in the last months of life, when chronic breathlessness often increases in prevalence and intensity.

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  • 11.
    Gloeckl, Rainer
    et al.
    Institute for Pulmonary Rehabilitation Research, Schoen Klinik Berchtesgadener Land, Schoenau am Koenigssee, Germany; Department for Pulmonary Rehabilitation, Philipps-Universität Marburg, Marburg, Germany.
    Pitta, Fabio
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy.
    Nyberg, Andre
    Laboratory of Research in Respiratory Physiotherapy, State University of Londrina, Londrina, Brazil.
    Optimising upper-limb exercise in patients with COPD: another step towards personalised pulmonary rehabilitation?2024In: ERJ Open Research, E-ISSN 2312-0541, Vol. 10, no 1, article id 01012-2023Article in journal (Other academic)
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  • 12.
    Gyawali, Sanjay
    et al.
    Department of Occupational Medicine, Haukeland University Hospital, Bergen, Norway.
    López-Cervantes, Juan Pablo
    Department of Occupational Medicine, Haukeland University Hospital, Bergen, Norway.
    Jõgi, Nils Oskar
    Department of Occupational Medicine, Haukeland University Hospital, Bergen, Norway.
    Mustafa, Tehmina
    Department of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway.
    Janson, Christer
    Department of Medical Sciences: Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden.
    Holm, Mathias
    Department of Occupational and Environmental Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Modig, Lars
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Cramer, Christine
    Department of Public Health, Research Unit for Environment, Occupation and Health, Danish Ramazzini Centre, Aarhus University, Aarhus, Denmark; Department of Occupational Medicine, Danish Ramazzini Centre, Aarhus University Hospital, Aarhus, Denmark.
    Gislason, Thorarinn
    Department of Sleep, Landspitali University Hospital, Reykjavik, Iceland; University of Iceland, Medical faculty, Reykjavik, Iceland.
    Svanes, Cecilie
    Department of Occupational Medicine, Haukeland University Hospital, Bergen, Norway; Department of Clinical Science, University of Bergen, Bergen, Norway.
    Previous tuberculosis infection associated with increased frequency of asthma and respiratory symptoms in a nordic–baltic multicentre population study2023In: ERJ Open Research, E-ISSN 2312-0541, Vol. 9, no 3, article id 00011-2023Article in journal (Refereed)
    Abstract [en]

    Background: Tuberculosis (TB) infection induces profound local and systemic, immunological and inflammatory changes that could influence the development of other respiratory diseases; however, the association between TB and asthma is only partly understood. Our objective was to study the association of TB with asthma and respiratory symptoms in a Nordic–Baltic population-based study.

    Methods: We included data from the Respiratory Health in Northern Europe (RHINE) study, in which information on general characteristics, TB infection, asthma and asthma-like symptoms were collected using standardised postal questionnaires. Asthma was defined based on asthma medication usage and/or asthma attacks 12 months prior to the study, and/or by a report of ≥three out of five respiratory symptoms in the last 12 months. Allergic/nonallergic asthma were defined as asthma with/without nasal allergy. The associations of TB with asthma outcomes were analysed using logistic regressions with adjustments for age, sex, smoking, body mass index and parental education.

    Results: We included 8379 study participants aged 50–75 years, 61 of whom reported having had TB. In adjusted analyses, participants with a history of TB had higher odds of asthma (OR 1.99, 95% CI 1.13– 3.47). The associations were consistent for nonallergic asthma (OR 2.17, 95% CI 1.16–4.07), but not for allergic asthma (OR 1.20, 95% CI 0.53–2.71).

    Conclusion: We found that in a large Northern European population-based cohort, persons with a history of TB infection more frequently had asthma and asthma symptoms. We speculate that this may reflect longterm effects of TB, including direct damage to the airways and lungs, as well as inflammatory responses.

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  • 13.
    Hansen, Susanne
    et al.
    Respiratory Research Unit, Department of Respiratory Medicine and Infectious Diseases, Bispebjerg Hospital, Copenhagen, Denmark; Centre for Clinical Research and Prevention, Frederiksberg Hospital, Copenhagen, Denmark.
    von Bülow, Anna
    Respiratory Research Unit, Department of Respiratory Medicine and Infectious Diseases, Bispebjerg Hospital, Copenhagen, Denmark.
    Sandin, Patrik
    Quantify Research, Stockholm, Sweden.
    Ernstsson, Olivia
    Quantify Research, Stockholm, Sweden; Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Stockholm, Sweden.
    Janson, Christer
    Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden.
    Lehtimäki, Lauri
    Allergy Centre, Tampere University Hospital, Tampere, Finland; Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
    Kankaanranta, Hannu
    Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland; Krefting Research Centre, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland.
    Ulrik, Charlotte
    Respiratory Research Unit, Department of Respiratory Medicine, Copenhagen University Hospital – Hvidovre, Copenhagen, Denmark.
    Aarli, Bernt Bøgvald
    Department of Clinical Science, University of Bergen, Bergen, Norway; Department of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway.
    Wahl, Hanna Fues
    Quantify Research, Stockholm, Sweden.
    Geale, Kirk
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine. Quantify Research, Stockholm, Sweden.
    Tang, Sheila Tuyet
    Sanofi, Copenhagen, Denmark.
    Wolf, Maija
    Novartis Finland, Espoo, Finland.
    Larsen, Tom
    Novartis Norway, Oslo, Norway.
    Altraja, Alan
    Department of Pulmonology, University of Tartu, Tartu, Estonia; Lung Clinic, Tartu University Hospital, Tartu, Estonia.
    Backman, Helena
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Kilpeläinen, Maritta
    Division of Medicine, Department of Pulmonary Diseases, Turku University Hospital, Turku, Finland; Department of Pulmonary Diseases and Clinical Allergology, University of Turku, Turku, Finland.
    Viinanen, Arja
    Division of Medicine, Department of Pulmonary Diseases, Turku University Hospital, Turku, Finland; Department of Pulmonary Diseases and Clinical Allergology, University of Turku, Turku, Finland.
    Ludviksdottir, Dora
    Landspitali University Hospital and University of Iceland, Reykjavik, Iceland.
    Kauppi, Paula
    Heart and Lung Center, Department of Pulmonary Diseases, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
    Sverrild, Asger
    Respiratory Research Unit, Department of Respiratory Medicine and Infectious Diseases, Bispebjerg Hospital, Copenhagen, Denmark.
    Lehmann, Sverre
    Department of Clinical Science, University of Bergen, Bergen, Norway; Department of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway.
    Backer, Vibeke
    Department of Otorhinolaryngology, Head and Neck Surgery, and Audiology, Rigshospitalet, Copenhagen, Denmark.
    Yasinska, Valentyna
    Department of Respiratory Medicine and Allergy, Karolinska University Hospital, Huddinge, Stockholm, Sweden; Department of Medicine (MedH), Lung and Allergy Research Unit, Karolinska Institutet, Huddinge, Stockholm, Sweden.
    Skjold, Tina
    Department of Pulmonary Medicine, Allergy Center, Aarhus University Hospital, Aarhus, Denmark.
    Karjalainen, Jussi
    Allergy Centre, Tampere University Hospital, Tampere, Finland; Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
    Bossios, Apostolos
    Department of Respiratory Medicine and Allergy, Karolinska University Hospital, Huddinge, Stockholm, Sweden; Department of Medicine (MedH), Lung and Allergy Research Unit, Karolinska Institutet, Huddinge, Stockholm, Sweden; Division of Lung and Airway Research, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Porsbjerg, Celeste
    Respiratory Research Unit, Department of Respiratory Medicine and Infectious Diseases, Bispebjerg Hospital, Copenhagen, Denmark.
    Prevalence and management of severe asthma in the Nordic countries: findings from the NORDSTAR cohort2023In: ERJ Open Research, E-ISSN 2312-0541, Vol. 9, no 2, article id 00687-2022Article in journal (Refereed)
    Abstract [en]

    Background: Real-life evidence on prevalence and management of severe asthma is limited. Nationwide population registries across the Nordic countries provide unique opportunities to describe prevalence and management patterns of severe asthma at population level. In nationwide register data from Sweden, Norway and Finland, we examined the prevalence of severe asthma and the proportion of severe asthma patients being managed in specialist care.

    Methods: This is a cross-sectional study based on the Nordic Dataset for Asthma Research (NORDSTAR) research collaboration platform. We identified patients with severe asthma in adults (aged ≥18 years) and in children (aged 6-17 years) in 2018 according to the European Respiratory Society/American Thoracic Society definition. Patients managed in specialist care were those with an asthma-related specialist outpatient contact (only available in Sweden and Finland).

    Results: Overall, we identified 598 242 patients with current asthma in Sweden, Norway and Finland in 2018. Among those, the prevalence of severe asthma was 3.5%, 5.4% and 5.2% in adults and 0.4%, 1.0%, and 0.3% in children in Sweden, Norway and Finland, respectively. In Sweden and Finland, 37% and 40% of adult patients with severe asthma and two or more exacerbations, respectively, were managed in specialist care; in children the numbers were 56% and 41%, respectively.

    Conclusion: In three Nordic countries, population-based nationwide data demonstrated similar prevalence of severe asthma. In children, severe asthma was a rare condition. Notably, a large proportion of patients with severe asthma were not managed by a respiratory specialist, suggesting the need for increased recognition of severe asthma in primary care.

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  • 14.
    Hanstock, Helen
    et al.
    Swedish Winter Sports Research Centre, Department of Health Sciences, Mid Sweden University, Östersund, Sweden.
    Eklund, Linda
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Pulmonary Medicine. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Medicine.
    Sandström, Thomas
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine. Umeå universitet.
    Stenfors, Nikolai
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Medicine. Umeå universitet.
    No differences in cytokine responses to moderate-intensity exercise in -10°C versus 10°C2022In: ERJ Open Research, E-ISSN 2312-0541, Vol. 8, no suppl 8, article id 214Article in journal (Refereed)
    Abstract [en]

    Training in cold climates is an established risk factor for development of exercise-induced bronchoconstriction and asthma. Inhalation of large volumes of cold and dry air challenges the airways’ capacity to condition inspired air, leading to acute airway injury, and over time, bronchial hyperresponsiveness. We lack evidence-informed guidelines regarding ‘safe’ thresholds for exercise in cold climates, i.e., temperatures (as well as exercise intensities/durations) that do not substantially increase the risk for healthy individuals to develop asthma. This study aimed to investigate the effect of temperature on systemic asthma- and exercise-associated cytokine responses to moderate-intensity exercise among healthy individuals. 31 healthy participants provided written, informed consent to participate in this randomised, crossover trial. On separate days, participants completed a 5 min warm up followed by 30 min running exercise (62-78% VO2peak) in a climate chamber at 10 or -10°C. Blood samples were taken pre and 1 h post-exercise and analysed for 10 cytokines (GM-CSF, IL-10, IL-13, IL-17E, IL-1β, IL-4, IL-5, IL-6, IL-8 and TNF-α) using multiplex ELISA. Values below the lower limit of detection for the assay were excluded. Data from 21 participants were analysed using two-way repeated measures ANOVA. IL-6 and IL-8 increased post-exercise (IL-6: log2 fold change: 0.47±0.67, p=0.001; IL-8: log2 fold change: 0.16±0.27, p=0.001). There were no differences in the response magnitude of any cytokine to exercise in -10 versus 10°C. We conclude that exposure to -10°C does not exacerbate inflammatory responses to moderate-intensity exercise, including for cytokines associated with exercise-induced asthma.

    This article was presented at the 2022 ERS Lung Science Conference, in session “Poster Session 2”.This is an ERS Lung Science Conference abstract. No full-text version is available. Further material to accompany this abstract may be available at www.ers-education.org (ERS member access only).

  • 15.
    Hedman, Linnea
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Almqvist, Linnea
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Bjerg, Anders
    Martina Children’s Hospital, Stockholm, Sweden.
    Andersson, Martin
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Backman, Helena
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Perzanowski, Matthew S.
    Dept of Environmental Health Sciences, Mailman School of Public Health, Columbia University, NY, New York, United States.
    Rönmark, Eva
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Early-life risk factors for development of asthma from 8 to 28 years of age: a prospective cohort study2022In: ERJ Open Research, E-ISSN 2312-0541, Vol. 8, no 4, article id 00074-2022Article in journal (Refereed)
    Abstract [en]

    Background: The objective was to estimate the incidence rate of asthma from age 8 to 28 years and evaluate early-life risk factors for asthma onset at different ages.

    Methods: In 1996, within the Obstructive Lung Disease in Northern Sweden (OLIN) studies, a cohort of 3430 schoolchildren (97% of invited) was recruited at age 8 years to a prospective study about asthma. The cohort was followed annually from age 8 to 19 years and at 28 years by questionnaire surveys (67% of the original cohort participated). Asthma was categorised as never-asthma, onset age ⩽8 years, onset age 9–13 years, onset age 14–19 years or onset age >19 years.

    Results: Of the 3430 individuals in the cohort, 690 (20.1%) reported asthma in any survey. The average incidence rate was 10.0/1000 per year at ⩽8 years, 11.9/1000 per year at 9–13 years, 13.3/1000 per year at 14–19 years and 6.1/1000 per year at >19 years. The incidence was higher among boys until age 10 years, but from age 15 years, it became higher among girls. Family history of asthma, allergic sensitisation and breastfeeding <3 months were associated with asthma onset throughout the study. Low birthweight, maternal smoking during pregnancy, severe respiratory infection, rhinoconjunctivitis and eczema were associated with asthma onset ⩽8 and 9–13 years.

    Conclusions: The incidence of asthma was high during childhood and the teenage period, and decreased substantially during young adulthood. Early-life factors were associated with asthma onset throughout childhood but had also a lasting effect on asthma incidence until adulthood.

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  • 16. Hjalmarsson, Clara
    et al.
    Kjellström, Barbro
    Jansson, Kjell
    Nisell, Magnus
    Kylhammar, David
    Kavianipour, Mohammad
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
    Rådegran, Goran
    Söderberg, Stefan
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Medicine.
    Wikström, Gerhard
    Wuttge, Dirk M.
    Hesselstrand, Roger
    Early risk prediction in idiopathic versus connective tissue disease-associated pulmonary arterial hypertension: call for a refined assessment2021In: ERJ Open Research, E-ISSN 2312-0541, Vol. 7, no 3, article id 00854-2020Article in journal (Refereed)
    Abstract [en]

    Despite systematic screening and improved treatment strategies, the prognosis remains worse in patients with connective tissue disease-associated pulmonary arterial hypertension (CTD-PAH) compared to patients with idiopathic/hereditary pulmonary arterial hypertension (IPAH). We aimed to investigate differences in clinical characteristics, outcome and performance of the European Society of Cardiology (ESC)/ European Respiratory Society (ERS) risk stratification tool in these patient groups. This retrospective analysis included incident patients with CTD-PAH (n=197, of which 64 had interstitial lung disease, ILD) or IPAH (n=305) enrolled in the Swedish PAH Register (SPAHR) 2008-2019. Patients were classified as low, intermediate or high risk at baseline, according to the "SPAHR-equation". One-year survival, stratified by type of PAH, was investigated by Cox proportional regression. At baseline, CTD-PAH patients had lower diffusing capacity for carbon monoxide and lower haemoglobin but, at the same time, lower N-terminal prohormone-brain natriuretic peptide, longer 6 min walk distance, better haemodynamics and more often a low-risk profile. No difference in age, World Health Organisation functional class (WHO-FC) or renal function between groups was found. One-year survival rates were 75, 82 and 83% in patients with CTD-PAH with ILD, CTD-PAH without ILD and IPAH, respectively. The 1-year mortality rates for low-, intermediate- and high-risk groups in the whole cohort were 0, 18 and 34% (p<0.001), respectively. Corresponding percentages for CTD-PAH with ILD, CTD-PAH without ILD and IPAH patients were: 0, 26, 67% (p=0.008); 0, 19, 39% (p=0.004); and 0, 16, 29% (p=0.001), respectively. The ESC/ERS risk assessment tool accurately identified low-risk patients but underestimated the 1-year mortality rate of CTD-PAH and IPAH patients assessed as having intermediate risk at diagnosis.

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  • 17.
    Kirui, Brian K.
    et al.
    School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Santosa, Ailiana
    School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Vanfleteren, Lowie E. G. W.
    COPD Center, Department of Respiratory Medicine and Allergology, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.
    Li, Huiqi
    School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Franzén, Stefan
    School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; National Diabetes Register, Centre of Registers Västra Götaland, Gothenburg, Sweden.
    Stridsman, Caroline
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Medicine.
    Nyberg, Fredrik
    School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Pre-and post-vaccination characteristics and risk factors for COVID-19 outcomes in a Swedish population-based cohort of COPD patients2023In: ERJ Open Research, E-ISSN 2312-0541, Vol. 9, no 3, article id 00711-2022Article in journal (Refereed)
    Abstract [en]

    Rationale: Evidence on risk factors for Coronavirus disease 2019 (COVID-19) outcomes among patients with COPD in relation to COVID-19 vaccination remains limited. The objectives of the present study were to characterise determinants of COVID-19 infection, hospitalisation, intensive care unit (ICU) admission and death in COPD patients in their unvaccinated state compared to when vaccinated.

    Methods: We included all COPD patients in the Swedish National Airway Register (SNAR). Events of COVID-19 infection (test and/or healthcare encounter), hospitalisation, ICU admission and death were identified from 1 January 2020 to 30 November 2021. Using adjusted Cox regression, associations between baseline sociodemographics, comorbidities, treatments, clinical measurements and COVID-19 outcomes, during unvaccinated and vaccinated follow-up time, were analysed.

    Results: The population-based COPD cohort included 87 472 patients, among whom 6771 (7.7%) COVID-19 infections, 2897 (3.3%) hospitalisations, 233 (0.3%) ICU admissions and 882 (1.0%) COVID-19 deaths occurred. During unvaccinated follow-up, risk of COVID-19 hospitalisation and death increased with age, male sex, lower education, non-married status and being foreign-born. Comorbidities increased risk of several outcomes, e.g. respiratory failure for infection and hospitalisation (adjusted hazard ratios (HR) 1.78, 95% CI 1.58–2.02 and 2.51, 2.16–2.91, respectively), obesity for ICU admission (3.52, 2.29–5.40) and cardiovascular disease for mortality (2.80, 2.16–3.64). Inhaled COPD therapy was associated with infection, hospitalisation and death. COPD severity was also associated with COVID-19, especially hospitalisation and death. Although the risk factor panorama was similar, COVID-19 vaccination attenuated HRs for some risk factors.

    Conclusion: This study provides population-based evidence on predictive risk factors for COVID-19 outcomes and highlights the positive implications of COVID-19 vaccination for COPD patients.

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  • 18.
    Kisiel, Marta A.
    et al.
    Dept of Medical Sciences: Environmental and Occupational Medicine, Uppsala University, Uppsala, Sweden.
    Zhou, Xingwu
    Dept of Medical Sciences: Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden; Dept of Medical Sciences: Clinical Physiology, Uppsala University, Uppsala, Sweden.
    Björnsson, Eythor
    Reykjalundur Rehabilitation Hospital, Mosfellsbær, Iceland.
    Holm, Mathias
    Section of Occupational and Environmental Medicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
    Dahlman-Höglund, Anna
    Section of Occupational and Environmental Medicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
    Wang, Juan
    Dept of Medical Sciences: Environmental and Occupational Medicine, Uppsala University, Uppsala, Sweden.
    Svanes, Cecilie
    Dept of Global Public Health and Primary Care, Centre for International Health, University of Bergen, Bergen, Norway; Dept of Occupational Medicine, Haukeland University Hospital, Bergen, Norway.
    Norbäck, Dan
    Dept of Medical Sciences: Environmental and Occupational Medicine, Uppsala University, Uppsala, Sweden.
    Franklin, Karl A.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Malinovschi, Andrei
    Dept of Medical Sciences: Clinical Physiology, Uppsala University, Uppsala, Sweden.
    Johannessen, Ane
    Dept of Global Public Health and Primary Care, Centre for International Health, University of Bergen, Bergen, Norway.
    Schlünssen, Vivi
    Dept of Public Health, Danish Ramazzini Centre, Aarhus University and the National Research Centre for the Working Environment, Copenhagen, Denmark.
    Janson, Christer
    Dept of Medical Sciences: Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden.
    The risk of respiratory tract infections and antibiotic use in a general population and among people with asthma2021In: ERJ Open Research, E-ISSN 2312-0541, Vol. 7, no 4, article id 00429-2021Article in journal (Refereed)
    Abstract [en]

    Aim: The aim of this study was to investigate occupational, environmental, early life and other risk factors associated with respiratory infections and antibiotics use in a general population and among asthmatic individuals.

    Method: This study included 15842 participants of the Respiratory Health in Northern Europe (RHINE) study aged 25–54 years from five Nordic countries, who answered a questionnaire covering respiratory outcomes, exposures, demographic characteristics and numbers of infections and courses of antibiotics in the last 12 months. Multiple logistic regression with and without adjustment for age, sex, smoking status, body mass index and centre were used to study the risk of infection and antibiotics in relation to asthma, and also the association between infection and antibiotics and occupations.

    Results: In the whole population, 11.6% reported having three or more respiratory infections, and 14.7% had used antibiotics because of respiratory tract infections within the last year. Asthmatic participants reported tripled odds for such infections (adjusted OR 2.98, 95% CI 2.53–3.52) and antibiotics use (adjusted OR 3.67, 95% CI 3.18–4.24) as compared to non-asthmatic participants. Both in the general and the asthmatic population, female sex, obesity and exposure to building dampness were associated with respiratory infections. Female sex and current smoking and living in Tartu were associated with antibiotic use. The use of antibiotics was doubled in people hospitalised for severe respiratory infection in childhood.

    Conclusion: In this study we identified several factors associated with increased respiratory infections and use of antibiotics in a general population and among asthmatic individuals. The frequency of respiratory infections and subsequent antibiotic treatment were increased among those with asthma.

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  • 19. Kjellström, Barbro
    et al.
    Sandqvist, Anna
    Umeå University, Faculty of Medicine, Department of Integrative Medical Biology (IMB). Janssen Cilag AB, Solna, Sweden.
    Hjalmarsson, Clara
    Nisell, Magnus
    Nasman, Per
    Ivarsson, Bodil
    Adherence to disease-specific drug treatment among patients with pulmonary arterial hypertension or chronic thromboembolic pulmonary hypertension2020In: ERJ Open Research, E-ISSN 2312-0541, Vol. 6, no 4, article id 00299-2020Article in journal (Refereed)
    Abstract [en]

    Background: Pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH) require lifelong treatment. The aim of the present study was to investigate adherence to disease-specific treatment in patients with PAH or CTEPH.

    Methods: The study comprised an adult population diagnosed with PAH (n=384) or CTEPH (n=187) alive in 2016-2017. The study utilised three registries: the Swedish PAH registry, the National Board of Health and Welfare, and Statistics Sweden. Withdrawals from pharmacies of disease-specific oral treatments were studied. Adherence was assessed as: 1) Number of days covered defined as the difference between the total number of daily dosages dispensed and the total number of days covered; and 2) Manual assessment by two persons that independently reviewed each patient's prescription fill history to detect anomalies or patterns of deteriorating or improving adherence over time.

    Results: The mean age was 61 +/- 16 years, 61% were female and mean time since diagnosis was 4.6 years. Adherence was 62% using the Number of days covered method and 66% by the Manual assessment method. Drug-specific adherence varied from 91% for riociguat to 60% for sildenafil. Good adherence was associated with shorter time since diagnosis in patients with PAH and with lower number of concomitant other chronic treatments in patients with CTEPH. Age, sex, socioeconomic status or number of pulmonary hypertension (PH) treatments were not associated with adherence.

    Conclusion: Adherence to oral disease-specific treatment was 60-66% and associated with time since diagnosis and number of concomitant chronic treatments. Sex, age or socioeconomic factors did not affect adherence.

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  • 20. Kylhammar, David
    et al.
    Hjalmarsson, Clara
    Hesselstrand, Roger
    Jansson, Kjell
    Kavianipour, Mohammad
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
    Kjellström, Barbro
    Nisell, Magnus
    Söderberg, Stefan
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Medicine.
    Rådegran, Göran
    Predicting mortality during long-term follow-up in pulmonary arterial hypertension2021In: ERJ Open Research, E-ISSN 2312-0541, Vol. 7, no 2, article id 00837-2020Article in journal (Refereed)
    Abstract [en]

    The European Society of Cardiology (ESC) and European Respiratory Society (ERS) guideline recommendation of comprehensive risk assessments, which classify patients with pulmonary arterial hypertension (PAH) as having low, intermediate or high mortality risk, has not been evaluated during long-term follow-up in a "real-life" clinical setting. We therefore aimed to investigate the utility of risk assessment in a clinical setting for up to 5 years post diagnosis.

    386 patients with PAH from the Swedish PAH Registry were included. Risk group (low/intermediate/ high) and proportion of low-risk variables were investigated at 3-, 4- and 5-year follow-ups after time of diagnosis. In an exploratory analysis, survival rates of patients with low-intermediate or high-intermediate risk scores were compared.

    A low-risk profile was in multivariate Cox proportional hazards regressions found to be a strong, independent predictor of longer transplant-free survival (p<0.001) at the 3-, 4- and 5-year follow-ups. Also, for the 3-, 4- and 5-year follow-ups, survival rates significantly differed (p<0.001) between the three risk groups. Patients with a greater proportion of low-risk variables had better (p<0.001) survival rates. Patients with a high-intermediate risk score had worse survival rates (p<0.001) than those with a low-intermediate risk score. Results were similar when excluding patients with >= 3 risk factors for heart failure with preserved ejection fraction, atrial fibrillation and/or age >75 years at diagnosis.

    Our findings suggest that the ESC/ERS guideline strategy for comprehensive risk assessments in PAH is valid also during long-term follow-up in a "real-life" clinical setting.

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  • 21.
    Olsson, Max
    et al.
    Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Respiratory Medicine, Allergology and Palliative Medicine, Lund, Sweden.
    Björkelund, Anders J.
    Lund University, Faculty of Science, Centre for Environmental and Climate Science, Lund, Sweden.
    Sandberg, Jacob
    Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Respiratory Medicine, Allergology and Palliative Medicine, Lund, Sweden.
    Blomberg, Anders
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Börjesson, Mats
    Dept of Molecular and Cardiovascular Medicine, Center for Health and Performance, Sahlgrenska Academy, Gothenburg, Sweden; Dept MGAÖ, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Currow, David
    Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, Australia.
    Malinovschi, Andrei
    Dept of Medical Sciences, Clinical Physiology, Uppsala University, Uppsala, Sweden.
    Sköld, Magnus
    Karolinska Institutet, Department of Medicine Solna, Stockholm, Sweden; Department of Respiratory Medicine and Allergy, Karolinska University Hospital, Stockholm, Sweden.
    Wollmer, Per
    Department of Translational Medicine, Lund University, Malmö, Sweden.
    Torén, Kjell
    Occupational and Environmental Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Östgren, Carl Johan
    Centre of Medical Image Science and Visualization, Linköping University, Linköping, Sweden; Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
    Engström, Gunnar
    Lund University, Faculty of Medicine, Department of Clinical Sciences Malmö, Cardiovascular Epidemiology, Malmö, Sweden.
    Ekström, Magnus
    Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Respiratory Medicine, Allergology and Palliative Medicine, Lund, Sweden.
    Factors most strongly associated with breathlessness in a population aged 50–64 years2024In: ERJ Open Research, E-ISSN 2312-0541, Vol. 10, no 2, article id 00582-2023Article in journal (Refereed)
    Abstract [en]

    Background: Breathlessness is a troublesome and prevalent symptom in the population, but knowledge of related factors is scarce. The aim of this study was to identify the factors most strongly associated with breathlessness in the general population and to describe the shapes of the associations between the main factors and breathlessness.

    Methods: A cross-sectional analysis was carried out of the multicentre population-based Swedish CArdioPulmonary bioImage Study (SCAPIS) of adults aged 50 to 64 years. Breathlessness was defined as a modified Medical Research Council breathlessness rating ⩾2. The machine learning algorithm extreme gradient boosting (XGBoost) was used to classify participants as either breathless or nonbreathless using 449 factors, including physiological measurements, blood samples, computed tomography cardiac and lung measurements, lifestyle, health conditions and socioeconomics. The strength of the associations between the factors and breathlessness were measured by SHapley Additive exPlanations (SHAP), with higher scores reflecting stronger associations.

    Results :A total of 28 730 participants (52% women) were included in the study. The strongest associated factors for breathlessness were (in order of magnitude): body mass index (SHAP score 0.39), forced expiratory volume in 1 s (0.32), physical activity measured by accelerometery (0.27), sleep apnoea (0.22), diffusing lung capacity for carbon monoxide (0.21), self-reported physical activity (0.17), chest pain when hurrying (0.17), high-sensitivity C-reactive protein (0.17), recent weight change (0.14) and cough (0.13).

    Conclusion: This large population-based study of men and women aged 50–64 years identified the main factors related to breathlessness that may be prevented or amenable to public health interventions.

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  • 22.
    Pesonen, Ida
    et al.
    Respiratory Medicine Unit, Department of Medicine Solna and Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Respiratory Medicine and Allergy, Karolinska University Hospital, Stockholm, Sweden.
    Johansson, Fredrik
    Medical Library, Danderyd Hospital, Stockholm, Sweden.
    Johnsson, Åse
    Region Västra Götaland, Sahlgrenska University Hospital, Department of Radiology, Gothenburg, Sweden; Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Blomberg, Anders
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Medicine.
    Boijsen, Marianne
    Region Västra Götaland, Sahlgrenska University Hospital, Department of Radiology, Gothenburg, Sweden; Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Brandberg, John
    Region Västra Götaland, Sahlgrenska University Hospital, Department of Radiology, Gothenburg, Sweden; Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Cederlund, Kerstin
    Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden.
    Egesten, Arne
    Respiratory Medicine, Allergology and Palliative Medicine, Department of Clinical Sciences Lund, Lund University and Skåne University Hospital, Lund, Sweden.
    Emilsson, Össur Ingi
    Faculty of Medicine, University of Iceland, Reykjavik, Iceland; Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden.
    Engvall, Jan E.
    CMIV, Centre of Medical Image Science and Visualization, Linköping University, Linköping, Sweden; Department of Clinical Physiology, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
    Frølich, Andreas
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Medicine.
    Hagström, Emil
    Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden; Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden.
    Lindberg, Eva
    Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden.
    Malinovschi, Andrei
    Department of Medical Sciences, Clinical Physiology, Uppsala University, Sweden.
    Stenfors, Nikolai
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Medicine.
    Swahn, Eva
    Department of Cardiology and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
    Tanash, Hanan
    Department of Respiratory Medicine, Skåne University Hospital, Lund University, Malmö, Sweden.
    Themudo, Raquel
    Department of Clinical Science, Intervention and Technology at Karolinska Institute, Division of Medical Imaging and Technology, Stockholm, Sweden; Department of Radiology, Karolinska University Hospital in Huddinge, Stockholm, Sweden.
    Torén, Kjell
    Section of Occupational and Environmental Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Vanfleteren, Lowie E. G. W.
    COPD Center, Department of Respiratory Medicine and Allergology, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Wollmer, Per
    Department of Translational Medicine, Lund University, Lund, Sweden.
    Zaigham, Suneela
    Department of Medical Sciences, Clinical Physiology, Uppsala University, Sweden; Department of Clinical Sciences in Malmö, Lund University, Malmö, Sweden.
    Östgren, Carl Johan
    CMIV, Centre of Medical Image Science and Visualization, Linköping University, Linköping, Sweden; Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
    Sköld, C. Magnus
    Respiratory Medicine Unit, Department of Medicine Solna and Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Respiratory Medicine and Allergy, Karolinska University Hospital, Stockholm, Sweden.
    High prevalence of interstitial lung abnormalities in middle-aged never-smokers2023In: ERJ Open Research, E-ISSN 2312-0541, Vol. 9, no 5, article id 00035-2023Article in journal (Refereed)
    Abstract [en]

    Background: Interstitial lung abnormalities (ILA) are incidental findings on chest computed tomography (CT). These patterns can present at an early stage of fibrotic lung disease. Our aim was to estimate the prevalence of ILA in the Swedish population, in particular in never-smokers, and find out its association with demographics, comorbidities and symptoms.

    Methods: Participants were recruited to the Swedish CArdioPulmonary BioImage Study (SCAPIS), a population-based survey including men and women aged 50–64 years performed at six university hospitals in Sweden. CT scan, spirometry and questionnaires were performed. ILA were defined as cysts, ground-glass opacities, reticular abnormality, bronchiectasis and honeycombing.

    Findings: Out of 29 521 participants, 14 487 were never-smokers and 14 380 were men. In the whole population, 2870 (9.7%) had ILA of which 134 (0.5%) were fibrotic. In never-smokers, the prevalence was 7.9% of which 0.3% were fibrotic. In the whole population, age, smoking history, chronic bronchitis, cancer, coronary artery calcium score and high-sensitive C-reactive protein were associated with ILA. Both ILA and fibrotic ILA were associated with restrictive spirometric pattern and impaired diffusing capacity of the lung for carbon monoxide. However, individuals with ILA did not report more symptoms compared with individuals without ILA.

    Interpretation: ILA are common in a middle-aged Swedish population including never-smokers. ILA may be at risk of being underdiagnosed among never-smokers since they are not a target for screening.

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  • 23.
    Price, Oliver J.
    et al.
    School of Biomedical Sciences, Faculty of Biological Sciences, University of Leeds, Leeds, United Kingdom; Leeds Institute of Medical Research at St James’s, University of Leeds, Leeds, United Kingdom; Department of Respiratory Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom.
    Paixão, Cátia
    Lab3R – Respiratory Research and Rehabilitation Laboratory, School of Health Sciences, University of Aveiro (ESSUA), Aveiro, Portugal; iBiMED – Institute of Biomedicine, University of Aveiro, Aveiro, Portugal; Department of Medical Sciences, University of Aveiro, Aveiro, Portugal.
    Poddighe, Diego
    Department of Rehabilitation Sciences, Research Group for Rehabilitation in Internal Disorders, KU Leuven, Leuven, Belgium.
    Miranda, Sabina
    Pneumology Dept, HUNSC Hospital, Tenerife, Spain.
    Silva, Rui
    Unidade de Cuidados na Comunidade Vallis Longus, ACeS Maia/Valongo, Porto, Portugal.
    Silva, Liliana
    Matosinhos Local Health Unit, Porto, Portugal; CINTESIS – Centre for Health Technology and Services Research, Porto, Portugal.
    Volpato, Eleonora
    Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy; IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy.
    Sylvester, Karl
    Respiratory Physiology, Royal Papworth and Cambridge University Hospitals NHS Foundation Trusts, Cambridge, United Kingdom.
    Nyberg, Andre
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy.
    Šajnić, Andreja
    Department for Respiratory Diseases Jordanovac, University Hospital Center, Zagreb, Croatia.
    Cruz, Joana
    Center for Innovative Care and Health Technology (ciTechCare), School of Health Sciences (ESSLei), Polytechnic of Leiria, Leiria, Portugal.
    ERS international congress 2022: highlights from the allied respiratory professionals assembly2023In: ERJ Open Research, E-ISSN 2312-0541, Vol. 9, no 3, article id 00013-2023Article in journal (Refereed)
    Abstract [en]

    In this article, we provide a brief overview of some of the outstanding sessions that were (co)organised by the Allied Respiratory Professionals Assembly during the 2022 European Respiratory Society International Congress, which was held in a hybrid format. Early Career Members from Assembly 9 summarised the content of the sessions, with the support of the Officers from the four Assembly groups: Respiratory Function Technologists and Scientists (Group 9.01); Physiotherapists (Group 9.02); Nurses (Group 9.03); and Psychologists and Behavioural Scientists (Group 9.04). The sessions covered the following topics: Recent advances in cardiopulmonary exercise and challenge testing; the role and new trends in physiotherapy, exercise and physical activity promotion interventions in chronic respiratory diseases; development of the international curriculum for respiratory nurses and nursing aspects in disease management; and treatment adherence, e-health interventions and post-coronavirus disease 2019 challenges. This Highlights article targets delegates who attended the Congress sessions, as well as those who were unable to attend, and provides valuable insight into the latest scientific data and emerging areas affecting the clinical practice of Allied Respiratory Professionals.

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  • 24.
    Randerath, Winfried
    et al.
    Bethanien Hospital, Clinic of Pneumology and Allergology, Center for Sleep Medicine and Respiratory Care, Institute of Pneumology at the University of Cologne, Solingen, Germany.
    de Lange, Jan
    Dept of Oral and Maxillofacial Surgery, Amsterdam UMC and Academic Center for Dentistry Amsterdam (ACTA), University of Amsterdam, Amsterdam, Netherlands.
    Hedner, Jan
    Sahlgrenska University Hospital, Gothenburg, Sweden.
    Ho, Jean Pierre T. F.
    Dept of Oral and Maxillofacial Surgery, Amsterdam UMC and Academic Center for Dentistry Amsterdam (ACTA), University of Amsterdam, Amsterdam, Netherlands.
    Marklund, Marie E.
    Umeå University, Faculty of Medicine, Department of Odontology.
    Schiza, Sofia
    Sleep Disorders Unit, Dept of Respiratory Medicine, Medical School, University of Crete, Heraklion, Greece.
    Steier, Jörg
    Lane Fox Unit and Sleep Disorders Centre at Guy’s & St Thomas’ NHS Foundation Trust, Centre for Human & Applied Physiological Sciences, King’s College London, London, United Kingdom.
    Verbraecken, Johan
    Antwerp University Hospital and University of Antwerp, Edegem, Belgium.
    Current and novel treatment options for obstructive sleep apnoea2022In: ERJ Open Research, E-ISSN 2312-0541, Vol. 8, no 2, article id 00126-2022Article, review/survey (Refereed)
    Abstract [en]

    Obstructive sleep apnoea is a challenging medical problem due to its prevalence, its impact on quality of life and performance in school and professionally, the implications for risk of accidents, and comorbidities and mortality. Current research has carved out a broad spectrum of clinical phenotypes and defined major pathophysiological components. These findings point to the concept of personalised therapy, oriented on both the distinct clinical presentation and the most relevant pathophysiology in the individual patient. This leads to questions of whether sufficient therapeutic options other than positive airway pressure (PAP) alone are available, for which patients they may be useful, if there are specific indications for single or combined treatment, and whether there is solid scientific evidence for recommendations. This review describes our knowledge on PAP and non-PAP therapies to address upper airway collapsibility, muscle responsiveness, arousability and respiratory drive. The spectrum is broad and heterogeneous, including technical and pharmaceutical options already in clinical use or at an advanced experimental stage. Although there is an obvious need for more research on single or combined therapies, the available data demonstrate the variety of effective options, which should replace the unidirectional focus on PAP therapy.

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  • 25. Russell, Melissa Anne
    et al.
    Dharmage, Shyamali
    Fuertes, Elaine
    Marcon, Alessandro
    Carsin, Anne-Elie
    Pascual Erquicia, Silvia
    Heinrich, Joachim
    Johannessen, Ane
    Abramson, Michael J.
    Amaral, Andre F. S.
    Cerveri, Isa
    Demoly, Pascal
    Garcia-Larsen, Vanessa
    Jarvis, Deborah
    Martinez-Moratalla, Jesus
    Nowak, Dennis
    Palacios-Gomez, Leopoldo
    Squillacioti, Giulia
    Raza, Wasif
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Emtner, Margareta
    Garcia-Aymerich, Judith
    The effect of physical activity on asthma incidence over 10 years: population-based study2021In: ERJ Open Research, E-ISSN 2312-0541, Vol. 7, no 1, article id 00970-2020Article in journal (Refereed)
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  • 26.
    Räisänen, Petri
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health. the OLIN unit, Umeå University, Umeå, Sweden.
    Backman, Helena
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health. The OLIN unit, Umeå University, Umeå, Sweden; Dept of Health Sciences, Luleå University of Technology, Luleå, Sweden.
    Hedman, Linnea
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health. The OLIN unit, Umeå University, Umeå, Sweden; Dept of Health Sciences, Luleå University of Technology, Luleå, Sweden.
    Andersson, Martin
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health. The OLIN unit, Umeå University, Umeå, Sweden.
    Stridsman, Caroline
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Medicine. The OLIN unit, Umeå University, Umeå, Sweden.
    Kankaanranta, Hannu
    Krefting Research Centre, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden; Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland; Dept of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland.
    Ilmarinen, Pinja
    Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland; Dept of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland.
    Andersen, Heidi
    Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
    Piirilä, Päivi
    Unit of Clinical Physiology, HUS Medical Diagnostic Center, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland.
    Lindberg, Anne
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Medicine. The OLIN unit, Umeå University, Umeå, Sweden.
    Lundbäck, Bo
    Krefting Research Centre, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.
    Rönmark, Eva
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health. The OLIN unit, Umeå University, Umeå, Sweden.
    High but stable incidence of adult-onset asthma in northern sweden over the last decades2021In: ERJ Open Research, E-ISSN 2312-0541, Vol. 7, no 3, article id 00262-2021Article in journal (Refereed)
    Abstract [en]

    Background: The prevalence of asthma has increased both among children and adults during the latter half of the 20th century. The prevalence among adults is affected by the incidence of asthma not only in childhood but also in adulthood. Time trends in asthma incidence have been poorly studied.

    Aims: The aim of this study was to review the incidence of adult-onset asthma from 1996 to 2006 and 2006 to 2016 and compare the risk factor patterns.

    Methods: In the Obstructive Lung Disease in Northern Sweden (OLIN) studies, two randomly selected population-based samples in the 20–69-year age group participated in postal questionnaire surveys about asthma in 1996 (n=7104, 85%) and 2006 (n=6165, 77%). A 10-year follow-up of the two cohorts with the same validated questionnaire was performed, and 5709 and 4552 responded, respectively. Different definitions of population at risk were used in the calculations of asthma incidence. The protocol followed a study performed between 1986 and 1996 in the same area.

    Results: The crude incidence rate of physician-diagnosed asthma was 4.4 per 1000 person-years (men 3.8, women 5.5) from 1996 to 2006, and 4.8 per 1000 person-years (men 3.7, women 6.2) from 2006 to 2016. When correcting for possible under-diagnosis at study entry, the incidence rate was 2.4 per 1000 person-years from 1996 to 2006 and 2.6 per 1000 person-years from 2006 to 2016. The incidence rates were similar across age groups. Allergic rhino-conjunctivitis was the main risk factor for incident asthma in both observation periods (risk ratio 2.4–2.6).

    Conclusions: The incidence of adult-onset asthma has been stable over the last two decades and has remained at a similar level since the 1980s. The high incidence contributes to the increase in asthma prevalence.

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  • 27.
    Schyllert, Christian
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Lindberg, Anne
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Medicine.
    Hedman, Linnea
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health. Dept of Health Sciences, Division of Nursing, Luleå University of Technology, Luleå, Sweden.
    Stridsman, Caroline
    3Dept of Health Sciences, Division of Nursing, Luleå University of Technology, Luleå, Sweden..
    Andersson, Martin
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Ilmarinen, Pinja
    Piirilä, Päivi
    Krokstad, Steinar
    Lundbäck, Bo
    Rönmark, Eva
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Backman, Helena
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health. Dept of Health Sciences, Division of Nursing, Luleå University of Technology, Luleå, Sweden.
    Low socioeconomic status relates to asthma and wheeze, especially in women2020In: ERJ Open Research, E-ISSN 2312-0541, Vol. 6, no 3, article id 00258-2019Article in journal (Refereed)
    Abstract [en]

    Low socioeconomic status (SES) has been associated with asthma and wheezing. Occupational group, educational level and income are commonly used indicators for SES, but no single indicator can illustrate the entire complexity of SES. The aim was to investigate how different indicators of SES associate with current asthma, allergic and nonallergic, and asthmatic wheeze.

    In 2016, a random sample of the population aged 20–79 years in Northern Sweden were invited to a postal questionnaire survey, with 58% participating (n=6854). The survey data were linked to the national Integrated Database for Labour Market Research by Statistics Sweden for the previous calendar year, 2015. Included SES indicators were occupation, educational level and income.

    Manual workers had increased risk for asthmatic wheeze, and manual workers in service for current asthma, especially allergic asthma. Primary school education associated with nonallergic asthma, whereas it tended to be inversely associated with allergic asthma. Low income was associated with asthmatic wheeze. Overall, the findings were more prominent among women, and interaction analyses between sex and income revealed that women, but not men, with low income had an increased risk both for asthmatic wheeze and current asthma, especially allergic asthma.

    To summarise, the different indicators of socioeconomic status illustrated various aspects of associations between low SES and asthma and wheeze, and the most prominent associations were found among women.

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  • 28.
    Tanguay, Sophie
    et al.
    Centre de Recherche, Institut Universitaire de Cardiologie et de Pneumologiede Québec, Université Laval, Quebec City, QC, Canada.
    Saey, Didier
    Centre de Recherche, Institut Universitaire de Cardiologie et de Pneumologiede Québec, Université Laval, Quebec City, QC, Canada.
    Marklund, Sarah
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy.
    Nyberg, Andre
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy.
    Gephine, Sarah
    Centre de Recherche, Institut Universitaire de Cardiologie et de Pneumologiede Québec, Université Laval, Quebec City, QC, Canada; Univ. Lille, Univ. Artois, Univ. Littoral Côte d’Opale, ULR 7369 – URePSSS – Unité de Recherche Pluridisciplinaire Sport Santé Société, Lille, France.
    Frykholm, Erik
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy.
    De Brandt, Jana
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy. Hasselt University, Faculty of Rehabilitation Sciences, REVAL – Rehabilitation Research Center, BIOMED Biomedical Research Institute, Diepenbeek, Belgium.
    Burtin, Chris
    Hasselt University, Faculty of Rehabilitation Sciences, REVAL – Rehabilitation Research Center, BIOMED Biomedical Research Institute, Diepenbeek, Belgium.
    Maltais, Francois
    Centre de Recherche, Institut Universitaire de Cardiologie et de Pneumologiede Québec, Université Laval, Quebec City, QC, Canada.
    Reference equations for quadriceps strength, endurance and power: a multicentre study2023In: ERJ Open Research, E-ISSN 2312-0541, Vol. 9, no 4, article id 00313-2023Article in journal (Refereed)
    Abstract [en]

    Introduction: The lack of reference values of lower-limb muscle function hinders the clinical recommendations of its measurement in patients with COPD. Therefore, this study aimed to develop reference equations to predict reference values for quadriceps strength, endurance and power and evaluate their construct validity in patients with COPD.

    Methods: Quadriceps strength, endurance and power were assessed in 158 healthy individuals and 87 patients with COPD. In addition, patients with COPD performed a 6-min walk test (6MWT) and a 1-min sit-to-stand test (1STS). Multiple linear regressions were performed to develop reference equations. The proportion of patients with COPD with reduced quadriceps function was determined, and correlations between quadriceps strength, endurance and power expressed in percentage of predicted values and 6MWT and 1STS performance were used to document the construct validity of the reference equation.

    Results: Except for quadriceps isometric endurance, the proposed reference equations explained 50-70% of the variance of the quadriceps properties in healthy individuals. All quadriceps properties were systematically reduced in a large proportion of patients with COPD compared to healthy individuals. Correlation coefficients between quadriceps properties expressed in percentage of predicted values and 6MWT and 1STS performance ranged between 0.28 and 0.49 (all p<0.05).

    Conclusion: In healthy individuals, age, sex, height and body mass index explained 50-70% of the variance of quadriceps strength, endurance and power. When expressed in percentage of predicted values, these quadriceps properties correlated with 6MWT and 1STS performance, suggesting construct validity of the reference values in patients with COPD.

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  • 29.
    Wang, Gang
    et al.
    Dept of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Sichuan, China; Dept of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.
    Hallberg, Jenny
    Dept of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden; Sachs’ Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden.
    Charalampopoulos, Dimitrios
    MRC Integrative Epidemiology Unit, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom.
    Sanahuja, Maribel Casas
    ISGlobal, Barcelona, Spain; Universitat Pompeu Fabra, Barcelona, Spain; Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Madrid, Spain.
    Breyer-Kohansal, Robab
    Ludwig Boltzmann Institute for Lung Health, Vienna, Austria.
    Langhammer, Arnulf
    Dept of Public Health and Nursing, Faculty of Medicine and Health Sciences, HUNT Research Centre, Norwegian University of Science and Technology (NTNU), Levanger, Norway.
    Granell, Raquel
    MRC Integrative Epidemiology Unit, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom.
    Vonk, Judith M.
    Dept of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands; University Medical Center Groningen, Groningen Research Institute for Asthma and COPD, University of Groningen, Groningen, Netherlands.
    Mian, Annemiek
    The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands; Division of Respiratory Medicine and Allergology, and Neonatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands.
    Olvera, Núria
    Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Madrid, Spain; Institut d’investigacions biomediques August Pi I Sunyer, Barcelona, Spain.
    Laustsen, Lisbeth Mølgaard
    Dept of Public Health, Environment Occupation and Health, Danish Ramazzini Centre, Aarhus University, Aarhus, Denmark.
    Rönmark, Eva
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Abellan, Alicia
    ISGlobal, Barcelona, Spain; Universitat Pompeu Fabra, Barcelona, Spain; Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Madrid, Spain; Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina, Barcelona, Spain.
    Agusti, Alvar
    Institut d’investigacions biomediques August Pi I Sunyer, Barcelona, Spain; Respiratory Institute, Hospital Clinic, Univ. Barcelona, Barcelona, Spain; CIBERESP (ISCiii), Barcelona, Spain.
    Arshad, Syed Hasan
    David Hide Asthma and Allergy Research Centre, Newport, United Kingdom; NIHR Southampton Biomedical Research Centre, University Hospitals Southampton NHS Foundation Trust, Southampton, United Kingdom; Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom.
    Bergström, Anna
    Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Centre for Occupational and Environmental Medicine, Region Stockholm, Stockholm, Sweden.
    Boezen, H. Marike
    Dept of Epidemiology, University Medical Center Groningen, Groningen, Netherlands.
    Breyer, Marie-Kathrin
    Ludwig Boltzmann Institute for Lung Health, Vienna, Austria.
    Burghuber, Otto
    Ludwig Boltzmann Institute for Lung Health, Vienna, Austria; Faculty of Medicine, Sigmund Freud University, Vienna, Austria.
    Bolund, Anneli Clea
    Dept of Public Health, Environment Occupation and Health, Danish Ramazzini Centre, Aarhus University, Aarhus, Denmark.
    Custovic, Adnan
    National Heart and Lung Institute, Imperial College London, London, United Kingdom.
    Devereux, Graham
    Liverpool School of Tropical Medicine, Liverpool, United Kingdom.
    Donaldson, Gavin C.
    National Heart and Lung Institute, Imperial College London, London, United Kingdom.
    Duijts, Liesbeth
    The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands; Division of Respiratory Medicine and Allergology, and Neonatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands; Division of Neonatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands.
    Esplugues, Ana
    Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Madrid, Spain; Nursing Department, Faculty of Nursing and Chiropody, Universitat de València, Valencia, Spain; Epidemiology and Environmental Health Joint Research Unit, FISABIO−Universitat Jaume I−Universitat de València, Valencia, Spain.
    Faner, Rosa
    Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Madrid, Spain.
    Ballester, Ferran
    Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Madrid, Spain; Nursing Department, Faculty of Nursing and Chiropody, Universitat de València, Valencia, Spain; Epidemiology and Environmental Health Joint Research Unit, FISABIO−Universitat Jaume I−Universitat de València, Valencia, Spain.
    Garcia-Aymerich, Judith
    ISGlobal, Barcelona, Spain; Universitat Pompeu Fabra, Barcelona, Spain; Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Madrid, Spain.
    Gehring, Ulrike
    Institute for Risk Assessment Sciences, Utrecht University, Utrecht, Netherlands.
    Haider, Sadia
    National Heart and Lung Institute, Imperial College London, London, United Kingdom.
    Hartl, Sylvia
    Ludwig Boltzmann Institute for Lung Health, Vienna, Austria; Faculty of Medicine, Sigmund Freud University, Vienna, Austria.
    Backman, Helena
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Holloway, John W.
    NIHR Southampton Biomedical Research Centre, University Hospitals Southampton NHS Foundation Trust, Southampton, United Kingdom; Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, United Kingdom.
    Koppelman, Gerard H.
    University Medical Center Groningen, Groningen Research Institute for Asthma and COPD, University of Groningen, Groningen, Netherlands; Dept of Pediatric Pulmonology and Pediatric Allergology, University Medical Center Groningen, Beatrix Children’s Hospital, University of Groningen, Groningen, Netherlands.
    Lertxundi, Aitana
    Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Madrid, Spain; Dept of Preventive Medicine and Public Health, Faculty of Medicine, University of the Basque Country (UPV/EHU), Leioa, Spain; BIODONOSTIA Health Research Institute, Donostia-San Sebastian, Spain.
    Holmen, Turid Lingaas
    Dept of Public Health and General Practice, HUNT Research Center, NTNU, Levanger, Norway.
    Lowe, Lesley
    Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester Academic Health Science Centre, NIHR, Manchester, United Kingdom; Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester, United Kingdom.
    Mensink-Bout, Sara M.
    The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands.
    Murray, Clare S.
    Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester Academic Health Science Centre, NIHR, Manchester, United Kingdom; Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester, United Kingdom.
    Roberts, Graham
    David Hide Asthma and Allergy Research Centre, Newport, United Kingdom; NIHR Southampton Biomedical Research Centre, University Hospitals Southampton NHS Foundation Trust, Southampton, United Kingdom; Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, United Kingdom.
    Hedman, Linnea
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Schlünssen, Vivi
    Dept of Public Health, Environment Occupation and Health, Danish Ramazzini Centre, Aarhus University, Aarhus, Denmark.
    Sigsgaard, Torben
    Dept of Public Health, Environment Occupation and Health, Danish Ramazzini Centre, Aarhus University, Aarhus, Denmark.
    Simpson, Angela
    Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester Academic Health Science Centre, NIHR, Manchester, United Kingdom; Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester, United Kingdom.
    Sunyer, Jordi
    ISGlobal, Barcelona, Spain; Universitat Pompeu Fabra, Barcelona, Spain; IMIM-Parc Salut Mar, Barcelona, Spain.
    Torrent, Maties
    ib-salut, Area de Salut de Menorca, Menorca, Spain.
    Turner, Stephen
    Royal Aberdeen Children’s Hospital NHS Grampian, Aberdeen, United Kingdom.
    Van den Berge, Maarten
    University Medical Center Groningen, Groningen Research Institute for Asthma and COPD, University of Groningen, Groningen, Netherlands; Dept of Pulmonary Diseases, University Medical Center Groningen, University of Groningen, Groningen, Netherlands.
    Vermeulen, Roel C.H.
    Institute for Risk Assessment Sciences, Utrecht University, Utrecht, Netherlands.
    Vikjord, Sigrid Anna Aalberg
    Dept of Public Health and Nursing, Faculty of Medicine and Health Sciences, HUNT Research Centre, Norwegian University of Science and Technology (NTNU), Levanger, Norway; Dept of Medicine and Rehabilitation, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway.
    Wedzicha, Jadwiga A.
    National Heart and Lung Institute, Imperial College London, London, United Kingdom.
    van der Zee, Anke H. Maitland
    Dept of Respiratory Medicine, Amsterdam University Medical Centers (UMC), University of Amsterdam, Amsterdam, Netherlands; Pediatric Respiratory Medicine, Emma Children’s Hospital, Amsterdam UMC, Amsterdam, Netherlands.
    Melén, Erik
    Dept of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden; Sachs’ Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden.
    Spirometric phenotypes from early childhood to young adulthood: a Chronic Airway Disease Early Stratification study2021In: ERJ Open Research, E-ISSN 2312-0541, Vol. 7, no 4, article id 00457-2021Article in journal (Refereed)
    Abstract [en]

    Background: The prevalences of obstructive and restrictive spirometric phenotypes, and their relation to early-life risk factors from childhood to young adulthood remain poorly understood. The aim was to explore these phenotypes and associations with well-known respiratory risk factors across ages and populations in European cohorts.

    Methods: We studied 49334 participants from 14 population-based cohorts in different age groups (⩽10, >10–15, >15–20, >20–25 years, and overall, 5–25 years). The obstructive phenotype was defined as forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC) z-score less than the lower limit of normal (LLN), whereas the restrictive phenotype was defined as FEV1/FVC z-score ⩾LLN, and FVC z-score <LLN.

    Results: The prevalence of obstructive and restrictive phenotypes varied from 3.2–10.9% and 1.8–7.7%, respectively, without clear age trends. A diagnosis of asthma (adjusted odds ratio (aOR=2.55, 95% CI 2.14–3.04), preterm birth (aOR=1.84, 1.27–2.66), maternal smoking during pregnancy (aOR=1.16, 95% CI 1.01–1.35) and family history of asthma (aOR=1.44, 95% CI 1.25–1.66) were associated with a higher prevalence of obstructive, but not restrictive, phenotype across ages (5–25 years). A higher current body mass index (BMI was more often observed in those with the obstructive phenotype but less in those with the restrictive phenotype (aOR=1.05, 95% CI 1.03–1.06 and aOR=0.81, 95% CI 0.78–0.85, per kg·m−2 increase in BMI, respectively). Current smoking was associated with the obstructive phenotype in participants older than 10 years (aOR=1.24, 95% CI 1.05–1.46).

    Conclusion: Obstructive and restrictive phenotypes were found to be relatively prevalent during childhood, which supports the early origins concept. Several well-known respiratory risk factors were associated with the obstructive phenotype, whereas only low BMI was associated with the restrictive phenotype, suggesting different underlying pathobiology of these two phenotypes.

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  • 30.
    Yasinska, Valentyna
    et al.
    Clinical Lung and Allergy Research, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden; Department of Respiratory Medicine, Karolinska University Hospital, Stockholm, Sweden; The Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden.
    Gómez, Cristina
    Department of Respiratory Medicine, Karolinska University Hospital, Stockholm, Sweden; The Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden; Unit of Integrative Metabolomics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Kolmert, Johan
    Department of Respiratory Medicine, Karolinska University Hospital, Stockholm, Sweden; The Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden; Unit of Integrative Metabolomics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Ericsson, Magnus
    Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden; Clinical Pharmacology, Karolinska University Hospital, Stockholm, Sweden; Laboratoire AntiDopage Français, Université Paris-Saclay, Châtenay-Malabry, France.
    Pohanka, Anton
    Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden; Clinical Pharmacology, Karolinska University Hospital, Stockholm, Sweden.
    James, Anna
    Department of Respiratory Medicine, Karolinska University Hospital, Stockholm, Sweden; The Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden; Unit of Integrative Metabolomics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Andersson, Lars I.
    Clinical Lung and Allergy Research, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden; Department of Respiratory Medicine, Karolinska University Hospital, Stockholm, Sweden; The Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden.
    Sparreman-Mikus, Maria
    Clinical Lung and Allergy Research, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden; Department of Respiratory Medicine, Karolinska University Hospital, Stockholm, Sweden; The Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden.
    Sousa, Ana R.
    Respiratory and Speciality Group, GSK, Clinical Sciences, Stockley Park, United Kingdom.
    Riley, John H.
    Respiratory and Speciality Group, GSK, Clinical Sciences, Stockley Park, United Kingdom.
    Bates, Stewart
    Respiratory and Speciality Group, GSK, Clinical Sciences, Stockley Park, United Kingdom.
    Bakke, Per S.
    Institute of Clinical Science, University of Bergen, Bergen, Norway.
    Kermani, Nazanin Zounemat
    National Heart and Lung Institute and Data Science Institute, Imperial College London, London, United Kingdom.
    Caruso, Massimo
    Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy.
    Chanez, Pascal
    Assistance Publique des Hôpitaux de Marseille, Clinique des Bronches, Allergies et Sommeil, Aix Marseille Université, Marseille, France.
    Fowler, Stephen J.
    Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, United Kingdom; Manchester Academic Health Science Centre and NIHR Biomedical Research Centre, Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom.
    Geiser, Thomas
    Department of Pulmonary Medicine, University Hospital, University of Bern, Bern, Switzerland.
    Howarth, Peter H.
    Faculty of Medicine, Southampton University, Southampton, United Kingdom; NIHR Southampton Respiratory Biomedical Research Center, University Hospital Southampton, Southampton, United Kingdom.
    Horváth, Ildikó
    Department of Public Health, Semmelweis University, Budapest, Hungary; National Koranyi Institute for Pulmonology, Budapest, Hungary.
    Krug, Norbert
    Fraunhofer Institute for Toxicology and Experimental Medicine, Hannover, Germany.
    Montuschi, Paolo
    National Heart and Lung Institute and Data Science Institute, Imperial College London, London, United Kingdom; Department of Pharmacology, Faculty of Medicine, Catholic University of the Sacred Heart, Rome, Italy.
    Sanak, Marek
    Department of Internal Medicine, Jagiellonian University Medical College, Krakow, Poland.
    Behndig, Annelie F.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Shaw, Dominick E.
    Nottingham NIHR Biomedical Research Centre, University of Nottingham, Nottingham, United Kingdom.
    Knowles, Richard G.
    Knowles Consulting, Stevenage Bioscience Catalyst, Stevenage, United Kingdom.
    Dahlén, Barbro
    Clinical Lung and Allergy Research, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden; Department of Respiratory Medicine, Karolinska University Hospital, Stockholm, Sweden; The Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden.
    van der Zee, Anke-Hilse Maitland
    Department of Respiratory Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands.
    Sterk, Peter J.
    Department of Respiratory Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands.
    Djukanovic, Ratko
    Faculty of Medicine, Southampton University, Southampton, United Kingdom; NIHR Southampton Respiratory Biomedical Research Center, University Hospital Southampton, Southampton, United Kingdom.
    Adcock, Ian M.
    National Heart and Lung Institute and Data Science Institute, Imperial College London, London, United Kingdom.
    Chung, Kian Fan
    National Heart and Lung Institute and Data Science Institute, Imperial College London, London, United Kingdom.
    Wheelock, Craig E.
    Department of Respiratory Medicine, Karolinska University Hospital, Stockholm, Sweden; The Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden; Unit of Integrative Metabolomics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Dahlén, Sven-Erik
    Clinical Lung and Allergy Research, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden; Department of Respiratory Medicine, Karolinska University Hospital, Stockholm, Sweden; The Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden; Unit of Integrative Metabolomics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Jonsson, Eva Wikström
    Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden; Clinical Pharmacology, Karolinska University Hospital, Stockholm, Sweden.
    Low levels of endogenous anabolic androgenic steroids in females with severe asthma taking corticosteroids2023In: ERJ Open Research, E-ISSN 2312-0541, Vol. 9, no 5, article id 00269-2023Article in journal (Refereed)
    Abstract [en]

    Rationale: Patients with severe asthma are dependent upon treatment with high doses of inhaled corticosteroids (ICS) and often also oral corticosteroids (OCS). The extent of endogenous androgenic anabolic steroid (EAAS) suppression in asthma has not previously been described in detail. The objective of the present study was to measure urinary concentrations of EAAS in relation to exogenous corticosteroid exposure.

    Methods: Urine collected at baseline in the U-BIOPRED (Unbiased Biomarkers for the Prediction of Respiratory Disease outcomes) study of severe adult asthmatics (SA, n=408) was analysed by quantitative mass spectrometry. Data were compared to that of mild-to-moderate asthmatics (MMA, n=70) and healthy subjects (HC, n=98) from the same study.

    Measurements and main results: The concentrations of urinary endogenous steroid metabolites were substantially lower in SA than in MMA or HC. These differences were more pronounced in SA patients with detectable urinary OCS metabolites. Their dehydroepiandrosterone sulfate (DHEA-S) concentrations were <5% of those in HC, and cortisol concentrations were below the detection limit in 75% of females and 82% of males. The concentrations of EAAS in OCS-positive patients, as well as patients on high-dose ICS only, were more suppressed in females than males (p<0.05). Low levels of DHEA were associated with features of more severe disease and were more prevalent in females (p<0.05). The association between low EAAS and corticosteroid treatment was replicated in 289 of the SA patients at follow-up after 12–18 months.

    Conclusion: The pronounced suppression of endogenous anabolic androgens in females might contribute to sex differences regarding the prevalence of severe asthma.

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