| 1. |
- Accordini, Simone, et al.
(författare)
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The Role of Smoking in Allergy and Asthma : Lessons from the ECRHS
- 2012
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Ingår i: Current Allergy and Asthma Reports. - : Springer Science and Business Media LLC. - 1529-7322 .- 1534-6315. ; 12:3, s. 185-191
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Forskningsöversikt (refereegranskat)abstract
- The European Community Respiratory Health Survey is an international multicenter cohort study of asthma, allergy, and lung function that began in the early-1990s with recruitment of population-based samples of 20- to 44-year-old adults, mainly in Europe. The aims of the study are broad ranging but include assessment of the role of in utero exposure to tobacco smoke, exposure to environmental tobacco smoke, and active smoking on the incidence, prevalence, and prognosis of allergy and asthma. Cross-sectional and longitudinal analyses looking at these associations have been conducted, sometimes only using information collected in one country, and on other occasions using information collected in all the participating centers. This article summarizes the results from these various publications from this large epidemiologic study.
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| 2. |
- Emilsson, O. I., et al.
(författare)
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Biomarkers for Gastroesophageal Reflux in Respiratory Diseases
- 2013
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Ingår i: Gastroenterology Research and Practice. - : Hindawi Limited. - 1687-6121 .- 1687-630X.
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Forskningsöversikt (refereegranskat)abstract
- Gastroesophageal reflux (GER) is commonly associated with respiratory symptoms, either through a vagal bronchoconstrictive reflex or through microaspiration of gastric contents. No diagnostic test is available, however, to diagnose when respiratory illnesses are caused by GER and when not, but research in this field has been moving forward. Various biomarkers in different types of biosamples have been studied in this context. The aim of this review is to summarize the present knowledge in this field. GER patients with respiratory diseases seem to have a different biochemical profile from similar patients without GER. Inflammatory biomarkers differ in asthmatics based on GER status, tachykinins are elevated in patients with GER-related cough, and bile acids are elevated in lung transplant patients with GER. However, studies on these biomarkers are often limited by their small size, methods of analysis, and case selections. The two pathogenesis mechanisms are associated with different respiratory illnesses and biochemical profiles. A reliable test to identify GER-induced respiratory disorders needs to be developed. Bronchoalveolar lavage is too invasive to be of use inmost patients. Exhaled breath condensate samples need further evaluation and standardization. The newly developed particles in exhaled air measurements remain to be studied further.
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| 3. |
- Fedorowski, Artur, et al.
(författare)
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Cardiorespiratory dysautonomia in post-COVID-19 condition: Manifestations, mechanisms and management
- 2023
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Ingår i: Journal of Internal Medicine. - : John Wiley & Sons. - 0954-6820 .- 1365-2796. ; 294:5, s. 548-562
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Forskningsöversikt (refereegranskat)abstract
- A significant proportion of COVID-19 patients experience debilitating symptoms for months after the acute infection. According to recent estimates, approximately 1 out of 10 COVID-19 convalescents reports persistent health issues more than 3 months after initial recovery. This 'post-COVID-19 condition' may include a large variety of symptoms from almost all domains and organs, and for some patients it may mean prolonged sick-leave, homestay and strongly limited activities of daily life. In this narrative review, we focus on the symptoms and signs of post-COVID-19 condition in adults - particularly those associated with cardiovascular and respiratory systems, such as postural orthostatic tachycardia syndrome or airway disorders - and explore the evidence for chronic autonomic dysfunction as a potential underlying mechanism. The most plausible hypotheses regarding cellular and molecular mechanisms behind the wide spectrum of observed symptoms - such as lingering viruses, persistent inflammation, impairment in oxygen sensing systems and circulating antibodies directed to blood pressure regulatory components - are discussed. In addition, an overview of currently available pharmacological and non-pharmacological treatment options is presented.
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| 4. |
- Heddini, Andreas, et al.
(författare)
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Effectiveness trials : critical data to help understand how respiratory medicines really work?
- 2019
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Ingår i: European Clinical Respiratory Journal. - : Taylor & Francis Group. - 2001-8525. ; 6:1
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Forskningsöversikt (refereegranskat)abstract
- Most of the information about the benefits, safety aspects, and cost effectiveness of pharmacological treatment in the respiratory field has been obtained from traditional efficacy studies, such as randomised controlled trials (RCT). The highly controlled environment of an RCT does not always reflect everyday practice. The collection, analysis, and application of effectiveness data to generate Real World Evidence (RWE) through pragmatic trials or observational studies therefore has the potential to improve decision making by regulators, payers, and clinicians. Despite calls for more RWE, effectiveness data are not widely used in decision making in the respiratory field. Recent advances in data capture, curation, and storage combined with new analytical tools have now made it feasible for effectiveness data to become routine sources of evidence to supplement traditional efficacy data. In this paper, we will examine some of the current data gaps, diverse types of effectiveness data, look at proposed frameworks for the positioning of effectiveness data, as well as provide examples from therapeutic areas. We will give examples of both previous effectiveness studies and studies that are ongoing within the respiratory field. Effectiveness data hold the potential to address several evidentiary gaps related to the effectiveness, safety, and value of treatments in patients with respiratory diseases.
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| 5. |
- Janson, Christer, et al.
(författare)
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Eosinophilic airway diseases : basic science, clinical manifestations and future challenges
- 2022
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Ingår i: European Clinical Respiratory Journal. - : Informa UK Limited. - 2001-8525. ; 9:1
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Forskningsöversikt (refereegranskat)abstract
- Eosinophils have a broad range of functions, both homeostatic and pathological, mediated through an array of cell surface receptors and specific secretory granules that promote interactions with their microenvironment. Eosinophil development, differentiation, activation, survival and recruitment are closely regulated by a number of type 2 cytokines, including interleukin (IL)-5, the key driver of eosinophilopoiesis. Evidence shows that type 2 inflammation, driven mainly by interleukin (IL)-4, IL-5 and IL-13, plays an important role in the pathophysiology of eosinophilic airway diseases, including asthma, chronic rhinosinusitis with nasal polyps, eosinophilic granulomatosis with polyangiitis and hypereosinophilic syndrome. Several biologic therapies have been developed to suppress type 2 inflammation, namely mepolizumab, reslizumab, benralizumab, dupilumab, omalizumab and tezepelumab. While these therapies have been associated with clinical benefits in a range of eosinophilic diseases, their development has highlighted several challenges and directions for future research. These include the need for further information on disease progression and identification of treatable traits, including clinical characteristics or biomarkers that will improve the prediction of treatment response. The Nordic countries have a long tradition of collaboration using patient registries and Nordic asthma registries provide unique opportunities to address these research questions. One example of such a registry is the NORdic Dataset for aSThmA Research (NORDSTAR), a longitudinal population-based dataset containing all 3.3 million individuals with asthma from four Nordic countries (Denmark, Finland, Norway and Sweden). Large-scale, real-world registry data such as those from Nordic countries may provide important information regarding the progression of eosinophilic asthma, in addition to clinical characteristics or biomarkers that could allow targeted treatment and ensure optimal patient outcomes.
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| 6. |
- Janson, Christer
(författare)
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Phenotypes of obstructive lung disease
- 2008
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Ingår i: Clinical respiratory journal. - 1752-6981. ; 2:1, s. 88-91
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Forskningsöversikt (refereegranskat)abstract
- Recently, there has been much emphasis on the fact that there are many different phenotypes in asthma and chronic obstructive pulmonary disease (COPD). The aim of this review is to investigate some aspects of phenotyping in these two diseases. Epidemiological studies show a quite different risk factor pattern in allergic and non-allergic asthma. Several studies also indicated that there are pathophysiological differences between these two types of asthma: such as eosinophil inflammation in allergic and neutrophil predominance in non-allergic asthma. Neutrophil inflammation may also be a marker of severe asthma. At least one study indicates that non-allergic asthmatics are less responsive to inhaled corticosteroids than allergic asthmatics. Recently, it has been emphasized that COPD also has manifestations other than lung function decline and that this also needs to be taken into account in severity characterisation. Dyspnea, weight loss, psychological status and co-morbidity are factors that seem to be of large prognostic importance independently of the level of airflow obstruction in COPD. Progress has been made in understanding how asthma develops, but effective measures for primary preventions is still lacking. Better phenotyping in asthma will hopefully enable us to make progress in this area. Phenotyping is also important for assessment of prognosis in both asthma and COPD.
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| 7. |
- Janson, Christer, et al.
(författare)
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Scientific rationale for the possible inhaled corticosteroid intraclass difference in the risk of pneumonia in COPD
- 2017
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Ingår i: The International Journal of Chronic Obstructive Pulmonary Disease. - 1176-9106 .- 1178-2005. ; 12, s. 3055-3064
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Forskningsöversikt (refereegranskat)abstract
- Inhaled corticosteroids (ICSs) treatment combined with long-acting β2-adrenoceptor agonists (LABAs) reduces the risk of exacerbations in COPD, but the use of ICSs is associated with increased incidence of pneumonia. There are indications that this association is stronger for fluticasone propionate than for budesonide. We have examined systematic reviews assessing the risk of pneumonia associated with fluticasone propionate and budesonide COPD therapy. Compared with placebo or LABAs, we found that fluticasone propionate was associated with 43%–78% increased risk of pneumonia, while only slightly increased risk or no risk was found for budesonide. We have evaluated conceivable mechanisms which may explain this difference and suggest that the higher pneumonia risk with fluticasone propionate treatment is caused by greater and more protracted immunosuppressive effects locally in the airways/lungs. These effects are due to the much slower dissolution of fluticasone propionate particles in airway luminal fluid, resulting in a slower uptake into the airway tissue and a much longer presence of fluticasone propionate in airway epithelial lining fluid.
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| 8. |
- Janson, Christer
(författare)
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Sidorök giftigare än huvudrök
- 2006
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Ingår i: Läkartidningen. ; :13, s. 1012-
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Forskningsöversikt (populärvet., debatt m.m.)
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| 9. |
- Janson, Christer
(författare)
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The importance of airway remodelling in the natural course of asthma
- 2010
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Ingår i: The Clinical Respiratory Journal. - 1752-6981. ; 4:S1, s. 28-34
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Forskningsöversikt (refereegranskat)abstract
- Introduction: Asthma is associated with airflow limitation and increased decline in lung function. The underlying mechanism for this was probably that persisting inflammation leads to remodelling of the airways. Objectives: To review the importance of different factors which are related to airflow limitation and lung function decline in asthma. Methods: Case report and literature review. Results: Asthma severity, smoking, bronchial hyperresponsiveness and eosinophil inflammation were the variables that were most convincingly related to decline in forced expiratory volume in 1 s (FEV1) in asthma. Treatment with inhaled corticosteroids probably decreased the rate of FEV1 decline, although this was more uncertain because of the lack of randomised double blind studies that show such an effect. Progress in the field of the genetics of asthma may, in the near future, elucidate the role of gene-environment interaction in lung function decline in asthma. Conclusion: Regular treatment with inhaled corticosteroids may partly have a beneficial effect on airway remodelling in asthma. Improved understanding of the processes leading to airway remodelling is, however, important in order to prevent a large number of asthmatics from developing irreversible airflow obstruction. Please cite this paper as: Janson C. The importance of airway remodelling in the natural course of asthma. Clin Respir J 2010; 4 (Suppl. 1): 28-34.
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| 10. |
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