| 1. |
- Al-Shamkhi, Nasrin, et al.
(author)
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Important non-disease-related determinants of exhaled nitric oxide levels in mild asthma – results from the Swedish GA2LEN study
- 2016
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In: Clinical and Experimental Allergy. - : Wiley. - 0954-7894 .- 1365-2222. ; 46:9, s. 1185-1193
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Journal article (peer-reviewed)abstract
- Background: Fractional exhaled nitric oxide (FeNO) has a potential clinical role in asthma management. Constitutive factors such as age, height and gender, as well as individual characteristics, such as IgE sensitization and smoking, affect the levels of FeNO in population-based studies. However, their effect on FeNO in subjects with asthma has been scarcely studied. Objective: To study the effects on FeNO of these commonly regarded determinants, as demonstrated in healthy subjects, as well as menarche age and parental smoking, in a population of asthmatics. Material and Methods: Fractional exhaled nitric oxide was measured in 557 subjects with asthma from the Swedish GA2LEN study. Allergic sensitization was assessed by skin prick tests to most common aeroallergens. Upper airway comorbidities, smoking habits, smoking exposure during childhood and hormonal status (for women) were questionnaire-assessed. Results: Male gender (P < 0.001), greater height (P < 0.001) and sensitization to both perennial allergens and pollen (P < 0.001) are related to higher FeNO levels. Current smoking (P < 0.001) and having both parents smoking during childhood, vs. having neither (P < 0.001) or only one parent smoking (P = 0.002), are related to lower FeNO. Women with menarche between 9 and 11 years of age had lower FeNO than those with menarche between 12 and 14 years of age (P = 0.03) or 15 and 17 years of age (P = 0.003). Conclusions and Clinical relevance: Interpreting FeNO levels in clinical practice is complex, and constitutional determinants, as well as smoking and IgE sensitisation, are of importance in asthmatic subjects and should be accounted for when interpreting FeNO levels. Furthermore, menarche age and parental smoking during childhood and their effects on lowering FeNO deserve further studies. © 2016 John Wiley & Sons Ltd
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| 2. |
- Andersson, Karin, 1972, et al.
(author)
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Survivin controls biogenesis of microRNA in smokers: A link to pathogenesis of rheumatoid arthritis.
- 2017
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In: Biochimica et biophysica acta. - : Elsevier BV. - 0006-3002. ; 1863:3
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Journal article (peer-reviewed)abstract
- MicroRNAs (miRs) represent a part of epigenetic control of autoimmunity gaining increasing attention in rheumatoid arthritis (RA). Since cigarette smoking plays important role in RA pathogenesis and reprograms transcriptional profile of miRNAs, we ask if the onco-protein survivin, a novel biomarker of RA, may provide a link between smoking and miRNA. Studying survivin expression in leukocytes of 144 female RA patients we observed that smoking patients had higher survivin transcription and a remarkable spreading of survivin isoforms. This was associated with restricted pattern and low production of miRs. Additionally, miRNA processing enzymes Dicer and DGRC8 were decreased in the patients with survivin isoform spreading. The direct contribution of survivin in miRs biogenesis was confirmed by a massive increase of miRs production following inhibition of survivin in leukocyte cultures. Dicer is shown to mediate these effects of survivin. Chromatin immunoprecipitation analysis demonstrated binding of survivin to the Dicer promoter region. Dicer expression increased 5-folds following survivin inhibition. Taken together, this study presents experimental evidence of a novel cellular function of survivin, control of miRs biogenesis. Up-regulation of survivin in smokers suggests its role as effector of the adverse epigenetic control in RA.
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| 3. |
- Axelsson, Malin, et al.
(author)
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Boost self-efficacy for better health outcomes in adult asthmatics!
- 2017
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Conference paper (other academic/artistic)abstract
- Boost self-efficacy for better health outcomes in adult asthmatics! Authors: Axelsson Malin1, Ekerljung Linda 2, Lundbäck Bo2 1Department of Care Science, Faculty of Health and Society, Malmö University, Malmö, Sweden 2Krefting Research Centre, Department of Internal Medicine and Clinical Nutrition, University of Gothenburg, Gothenburg, Sweden Introduction: Self- efficacy i.e. confidence in ability to handle challenges in everyday life could influence how individuals suffering from long-term disease such as asthma manage the disease, the medication treatment and symptoms, which in turn could influence both disease progression and health-related quality of life (HRQL). Aim: to explore the function of concerns with asthma medication and asthma control as mediators between self-efficacy and HRQL. Method: Adult asthmatics (n=479, 60% women) aged between 19 and 78 years selected from West Sweden Asthma Study completed questionnaires on self-efficacy, concerns with asthma medication, asthma control and HRQL. Two path models with self-efficacy as independent variable, mental and physical HRQL as dependent variables and concerns with asthma medication and asthma control as mediators were conducted. Results: In both path models, self-efficacy was negatively associated with concerns with asthma medication (β= -.130, p=0.005) and positively associated with asthma control (β =.100, p=0.027). In both path models, the effect of concerns with asthma medication on both mental and physical HRQL went through that of asthma control (β=-.138, p=0.003). Both concerns with asthma medication and asthma control mediated the effect of self-efficacy on both mental (β =.132, p=0.002) and physical HRQL (β =.455, p=0.001). Conclusion: Adult asthmatics with lower self-efficacy need support to strengthen their self-efficacy and assistance to overcome their concerns with the asthma medication in order to improve their asthma control. Better self-efficacy and reduced concerns with asthma medication will increase asthma control, which in turn most likely will have a positive effect on both mental and physical HRQL in adult asthmatics.
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| 4. |
- Axelsson, Malin, 1964, et al.
(author)
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Chronic bronchitis in West Sweden - a matter of smoking and social class
- 2016
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In: European Clinical Respiratory Journal. - : Informa UK Limited. - 2001-8525. ; 3
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Journal article (peer-reviewed)abstract
- Background: Although chronic bronchitis is associated with impaired quality of life, hospitalisations and increased mortality, it has been less in focus after the introduction of the term chronic obstructive pulmonary disease (COPD). There are no recent published data on the prevalence of chronic bronchitis from the Scandinavian countries. Aim: The main aim of the present study was to estimate the prevalence of chronic bronchitis in West Sweden by using data from a large-scale epidemiological study of the general population. A further aim was to identify current risk factors for chronic bronchitis in a population with a major decrease in the proportion of smokers. Methods: From the 18,087 questionnaire responders out of 30,000 invited to participate at the West Sweden Asthma Study, 2,000 subjects were randomly selected and invited to detailed clinical examinations performed during 2009-2013. A total of 1,172 subjects aged 17-79 participated in the examinations which included, among others, spirometry and structured interviews. Chronic bronchitis was defined according to reported symptoms. Results: The overall prevalence of chronic bronchitis was 7.2% (men 7.6%; women 6.8% ns), and it was 8.7% in subjects older than age 60. Chronic bronchitis was strongly associated with smoking, defined both as current smoking status and pack-years. Other risk factors were increasing age, low socio-economic class and urban living. Of those with chronic bronchitis, 22% fulfilled the GOLD criteria of COPD. Conclusion: The prevalence of chronic bronchitis was somewhat lower than found by studies in Sweden in the 1980s and the prevalence was now similar in men and women. Although smoking was still the dominating risk factor for chronic bronchitis, the relative importance of smoking had decreased parallel with a decreasing smoking prevalence, while the relative importance of other factors than smoking had increased compared to previous studies.
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| 5. |
- Axelsson, Malin, et al.
(author)
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Consider personality, medication adherence and asthma control in efforts to improve health-related quality of life in adult asthmatics!
- 2017
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Conference paper (other academic/artistic)abstract
- Consider personality, medication adherence and asthma control in efforts to improve health-related quality of life in adult asthmatics! Authors: Axelsson Malin1, Ekerljung Linda2, Lundbäck Bo2 1Department of Care Science, Faculty of Health and Society, Malmö University, Malmö, Sweden 2Krefting Research Centre, Department of Internal Medicine and Clinical Nutrition, University of Gothenburg, Gothenburg, Sweden Introduction: Asthma is a common respiratory disease, which often requires regular medication treatment. In individuals with asthma, assessments of health-related quality of life (HRQL) serve as an essential health outcome as they capture personal perspectives and experiences of everyday life with asthma and the ongoing medication treatment. Personality, adherence to medication treatment and asthma control are important influential factors of HRQL in adult individuals with asthma. However, these factors have rarely been investigated together. Therefore, the aim was to elucidate associations between personality, adherence, asthma control and HRQL in adult asthmatics. Methods: Adult asthmatics (n=337) with prescribed regular asthma medication treatment selected from West Sweden Asthma Study, participated by completing questionnaires on personality, adherence to asthma medication treatment, asthma control and HRQL. Two path models with the personality traits Neuroticism and Conscientiousness as independent variables, HRQL as dependent variable and adherence and asthma control as mediators were tested. Results: In the first path model, Neuroticism was negatively associated with adherence to asthma medication treatment and the mediated effect of adherence on HRQL went through that of perceived asthma control. In the second path model, both adherence and perceived asthma control functioned as mediators between Conscientiousness and HRQL. In this model, the effect of adherence on HRQL also went through that of perceived asthma control. Conclusion: Improving adherence in adult asthmatics scoring higher on the personality trait Neuroticism or lower on the personality trait Conscientiousness would most likely have a positive impact on their perceived asthma control, which in turn would increase their HRQL. In efforts to improve HRQL in adult asthmatics, individual differences, adherence to asthma medication treatment and perceived asthma control need to be taken into consideration
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| 6. |
- Axelsson, Malin, et al.
(author)
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Differences in diagnostic patterns of obstructive airway disease between areas and sex in Sweden and Finland : The Nordic EpiLung Study
- 2021
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In: Journal of Asthma. - : Taylor & Francis. - 0277-0903 .- 1532-4303. ; 58:9, s. 1196-1207
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Journal article (peer-reviewed)abstract
- Objective: To investigate the current prevalence of physician-diagnosed obstructive airway diseases by respiratory symptoms and by sex in Sweden and Finland. Method: In 2016, a postal questionnaire was answered by 34,072 randomly selected adults in four study areas: Västra Götaland and Norrbotten in Sweden, and Seinäjoki-Vaasa and Helsinki in Finland. Results: The prevalence of asthma symptoms was higher in Norrbotten (13.2%), Seinäjoki-Vaasa (14.8%) and Helsinki (14.4%) than in Västra Götaland (10.7%), and physician-diagnosed asthma was highest in Norrbotten (13.0%) and least in Västra Götaland (10.1%). Chronic productive cough was most common in the Finnish areas (7.7-8.2 % versus 6.3-6.7 %) while the prevalence of physician-diagnosed chronic bronchitis (CB) or chronic obstructive pulmonary disease (COPD) varied between 1.7-2.7% in the four areas. Among individuals with respiratory symptoms, the prevalence of asthma was most common in Norrbotten, while a diagnosis of COPD or CB was most common in Västra Götaland and Seinäjoki-Vaasa. More women than men with respiratory symptoms reported a diagnosis of asthma in Sweden and Seinäjoki-Vaasa but there were no sex differences in Helsinki. In Sweden, more women than men with symptoms of cough or phlegm reported a diagnosis of CB or COPD, while in Finland the opposite was found. Conclusion: The prevalence of respiratory symptoms and corresponding diagnoses varied between and within the countries. The proportion reporting a diagnosis of obstructive airway disease among individuals with respiratory symptoms varied, indicating differences in diagnostic patterns both between areas and by sex.
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| 7. |
- Axelsson, Malin, et al.
(author)
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Personality and unachieved treatment goals related to poor adherence to asthma medication in a newly developed adherence questionnaire : a population-based study
- 2016
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In: Multidisciplinary Respiratory Medicine. - : BioMed Central. - 1828-695X .- 2049-6958. ; 11:42
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Journal article (peer-reviewed)abstract
- Background Health-care professionals have a responsibility to be attentive to patients’ adherence behavior but it could be difficult to identify poor adherence in the context of clinical practice. Assessment of personality could be used to identify individuals who are in need for support with their adherence behavior. To our knowledge, existing adherence questionnaires are not based on individuals reflecting asthmatics in the general population and there is limited research describing adherence with asthma medication in relation to personal goals with the treatment. The aim was to develop and validate an adherence questionnaire in adult individuals with asthma from the general population and to assess adherence in relation to personality traits and goals with the asthma medication using the developed questionnaire. Methods The study was conducted in three phases: 1. A preliminary postal 46-item questionnaire was refined after psychometric testing (n = 157). 2. The questionnaire was validated (n = 104). 3. The developed adherence questionnaire was analyzed in relation to personality traits and achieved goals with the asthma medication. Adult respondents with physician diagnosed asthma using asthma medications were selected from the population-based West Sweden Asthma Study. The respondents completed the Neuroticism, Extraversion and Openness to Experience Five-Factor Inventory and the Medication Adherence Report Scale and stated their goals with the asthma medication. Data were analyzed using t-tests, correlations, multiple regression and principal component analysis. Results A final questionnaire was developed consisting of ten items organized in three subscales - “medication routines”, “self-adjusting the medication” and “concerns about side-effects”. Two of the subscales - “medication routines” and “self-adjusting the medication” – were associated with the Medication Adherence Report Scale. The subscale “medication routines” was associated with the personality traits – Conscientiousness and Neuroticism and unachieved goals with the asthma medication. Conclusions The developed questionnaire appears to be useful for measuring adherence to asthma medication in adult individuals with asthma. The study suggests that both individual differences and personal treatment goals need to be addressed in efforts to promote adherence to asthma medication treatment.
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| 8. |
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| 9. |
- Axelsson, Malin, 1964, et al.
(author)
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The significance of asthma follow-up consultations for adherence to asthma medication, asthma medication beliefs and asthma control
- 2015
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In: Nursing Research and Practice. - : Hindawi Limited. - 2090-1429 .- 2090-1437. ; 2015
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Journal article (peer-reviewed)abstract
- Objective. The aim was to investigate adherence to asthma medication treatment, medication beliefs, and asthma control in relation to asthma follow-up consultations in asthmatics in the general population. A further aim was to describe associations between adherence, medication beliefs, and asthma control.Method. In the population-based West Sweden Asthma Study, data allowing calculation of adherence for 4.5 years based on pharmacy records were obtained from 165 adult asthmatics. Additional data were collected through questionnaires and structured interviews.Results. The mean adherence value for filled prescriptions for regular asthma medication was 68% (median 55.3%) but varied over the year under study. Adherence to combination inhalers with corticosteroids and long-acting beta2agonists was higher than adherence to single inhalers with corticosteroids only. More than one-third of participants reported not having seen an asthma nurse or physician for several years. Regular asthma follow-up consultations were associated with both higher adherence and the belief that asthma medication was necessary but were not associated with asthma control.Conclusions. Adherence to asthma medication treatment was low and varied over the year under study. The current study suggests that quality improvements in asthma care are needed if adherence to asthma medication is to be improved.
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