| 1. |
- Larsson, Kjell
(författare)
-
Tätare uppdateringar behövs av riktlinjer vid astma och KOL
- 2020
-
Ingår i: Läkartidningen. - 0023-7205 .- 1652-7518. ; 117
-
Tidskriftsartikel (populärvet., debatt m.m.)abstract
- Rekommendationer för omhändertagande vid astma och kroniskt obstruktiv lungsjukdom (KOL) uppdateras av Läkemedelsverket cirka vart sjunde år och ligger till grund för diagnostik och behandling framför allt i primärvården. Internationella riktlinjer för omhändertagande av astma (Global initiative for asthma, GINA) och KOL (Global initiative for chronic obstructive lung disease, GOLD) uppdateras årligen för att ny kunskap om behandling snabbt ska nå patienterna.De långa intervallen mellan uppdateringarna innebär att rekommendationerna hinner bli inaktuella innan nästa version publiceras, och Sverige hamnar i otakt med internationella riktlinjer. Farmakologisk behandling uppdateras av regionala läkemedelskommittéer, men rekommendationerna skiljer sig i olika delar av landet och stäms ofta inte av mot internationella riktlinjer, vilket leder till ojämlik behandling över landet. Läkemedelsverkets kunskapsstöd Läkemedelsboken innehöll ett kapitel om astma och KOL där man vid behov kunde uppdatera riktlinjer för primärvården, men detta stöd har lagts ned.Vid astma rekommenderar riktlinjerna kortverkande beta-2-agonister vid behov som enda behandling vid lindrig astma (steg 1) samt som tillägg till underhållsbehandling vid svårare sjukdom vid symtomgenombrott [1]. Som alternativ vid svårare astma (steg 3–5) rekommenderas inhalationssteroider i fast kombination med formoterol (steroid + formoterol) vid behov i stället för kortverkande b2-agonister [1]. Vid lindrig astma ger steroid + formoterol vid behov som enda behandling bättre resultat än endast kortverkande beta-2-agonister vid behov [2-5]. Vidare har steroid + formoterol (inhalerat vid behov) lika god exacerbationsförebyggande effekt som regelbunden behandling med inhalationssteroider och kortverkande beta-2-agonister vid behov trots en betydligt lägre kortisonbelastning [3, 5].I juni 2019 uppdaterades GINA:s astmarekommendationer genomgripande [6]. Här rekommenderas steroid + formoterol vid behov vid alla svårighetsgrader av astma. Kortverkande beta-2-agonister (salbutamol, terbutalin) vid behov är struket som förstahandsalternativ. Data indikerar att endast kortverkande beta-2-agonister vid behov faktiskt ökar risken för svåra exacerbationer och astmarelaterad mortalitet. Genom tillägg av inhalationssteroid till en snabb- och långverkande beta-2-agonist reduceras risken signifikant [6]. Vidare rekommenderas steroid + formoterol vid behov som alternativ till regelbunden behandling med inhalationssteroider på steg 2. Riktlinjerna har redan godkänts i flera länder.Vid KOL-behandling är två viktiga mål att lindra symtom och förebygga exacerbationer. Basbehandlingen för att uppnå detta är långverkande antikolinergika. Tillägg av långverkande beta-2-agonist till långverkande antikolinergika ger ytterligare god effekt på symtom, men en mer blygsam tilläggseffekt på exacerbationer [8]. Vid KOL ges inhalationssteroid i syfte att förebygga exacerbation. Hög nivå av eosinofiler i blod förekommer ofta vid KOL. Nyare forskning visar att blodeosinofili varierar hos patienter med KOL. Inhalationssteroider förebygger exacerbationer mer effektivt hos KOL-patienter med eosinofili, och blodeosinofili kan vägleda den förebyggande behandlingen [9-12]. Kontroll av eosinofiler i blod förespråkas i det senaste GOLD-dokumentet inför val av terapi och nydiagnostiserad KOL. Vid KOL och samtidig eosinofili anges inhalationssteroid + långverkande beta-2-agonist som tänkbart förstahandsalternativ i förebyggande syfte [13].Vi anser att behandling av patienter med astma och/eller KOL i Sverige ska baseras på rekommendationer från Läkemedelverket och att de senaste landvinningarna inom området måste återfinnas i riktlinjerna. Läkemedelsverket bör uppdatera riktlinjerna kontinuerligt, helst årligen. Detta kan göras av en mindre grupp experter genom en begränsad arbetsinsats till låg kostnad. Potentiella bindningar eller jävsförhållanden: Samtliga författare har deltagit i expertgrupp och/eller föreläst/haft utbildningsuppdrag hos företag som verkar inom området.
|
|
| 2. |
- Ludvigsson, Jonas F., 1969-, et al.
(författare)
-
Adaptation of the Charlson Comorbidity Index for Register-Based Research in Sweden
- 2021
-
Ingår i: Clinical Epidemiology. - : Dove Medical Press Ltd.. - 1179-1349. ; 13, s. 21-41
-
Tidskriftsartikel (refereegranskat)abstract
- Purpose: Comorbidity indices are often used to measure comorbidities in register-based research. We aimed to adapt the Charlson comorbidity index (CCI) to a Swedish setting.Methods: Four versions of the CCI were compared and evaluated by disease-specific experts.Results: We created a cohesive coding system for CCI to 1) harmonize the content between different international classification of disease codes (ICD-7,8,9,10), 2) delete incorrect codes, 3) enhance the distinction between mild, moderate or severe disease (and between diabetes with and without end-organ damage), 4) minimize duplication of codes, and 5) briefly explain the meaning of individual codes in writing.Conclusion: This work may provide an integrated and efficient coding algorithm for CCI to be used in medical register-based research in Sweden.
|
|
| 3. |
- Torén, Kjell, et al.
(författare)
-
Restrictive Spirometric Pattern and Preserved Ratio Impaired Spirometry in a Population 50-64 Years.
- 2024
-
Ingår i: Annals of the American Thoracic Society. - 2329-6933 .- 2325-6621.
-
Tidskriftsartikel (refereegranskat)abstract
- RATIONALE: Knowledge regarding prevalence and shared and unique characteristics of Restrictive spirometric pattern (RSP) and Preserved ratio impaired spirometry (PRISm) is lacking for a general population investigated with post-bronchodilator spirometry and computed tomography of the lungs.OBJECTIVES: To investigate shared and unique features for RSP and PRISm.METHODS: In the Swedish CArdioPulmonary bioImage Study (SCAPIS), a general population sample of 28,555 people aged 50 - 64 years (including 14,558 never-smokers) was assessed. The participants answered a questionnaire and underwent computed tomography of the lungs, post-bronchodilator spirometry, and coronary artery calcification score (CACS). Odds ratios (OR) with 95% confidence intervals (CI) were calculated using adjusted logistic regression. RSP was defined as FEV1/FVC≥0.70 and FVC<80%. PRISm was defined as FEV1/FVC≥0.70 and FEV1<80%. A local reference equation was applied.MEASUREMENTS AND RESULTS: The prevalence of RSP and PRISm were 5.1% (95% CI 4.9 - 5.4) and 5.1% (95% CI 4.8 - 5.3), respectively, with similar values seen in never-smokers. For RSP and PRISm, shared features were current smoking, dyspnea, chronic bronchitis, rheumatic disease, diabetes, ischemic heart disease (IHD), bronchial wall thickening, interstitial lung abnormalities (ILA), and bronchiectasis. Emphysema was uniquely linked to PRISm (OR 1.69, 1.36-2.10) vs 1.10 (0.84-1.43) for RSP. CACS≥300 was related to PRISm, but not among among never-smokers.CONCLUSIONS: PRISm and RSP have respiratory, cardiovascular, and metabolic conditions as shared features. Emphysema is only associated with PRISm. Coronary atherosclerosis may be associated with PRISm. Our results indicate that RSP and PRISm may share more features than not. This article is open access and distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.org/licenses/by/4.0/).
|
|
| 4. |
- Ahlford, Marianne, et al.
(författare)
-
Uppsala Underdogs - A Robot Soccer Project
- 2006
-
Rapport (populärvet., debatt m.m.)abstract
- In this paper, we describe the four-legged soccer team Uppsala Underdogs developed by a group of 4th year computer science students at Uppsala University during the fall of 2004. The project is based on the experience from two similar previous projects. This year the emphasis of the project has been on distribution of data and on support for evaluation and reconfiguration of strategies. To support data distribution, a middleware has been developed, which implements a replication algorithm and provides a clean interface for the other software modules (or behaviors). To enable easy reconfiguration of strategies, an automata-based graphical description language has been developed, which can be compiled into code that uses the database and the lower level modules, such as tactics and positioning, to make decisions and control the robot. In addition, a graphical simulator has been developed in which the strategies can be evaluated.
|
|
| 5. |
- Ahmadi, Zainab, et al.
(författare)
-
Agreement of the modified Medical Research Council and New York Heart Association scales for assessing the impact of self-rated breathlessness in cardiopulmonary disease
- 2022
-
Ingår i: ERJ Open Research. - : European Respiratory Society. - 2312-0541. ; 8:1
-
Tidskriftsartikel (refereegranskat)abstract
- 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.
|
|
| 6. |
- Blomberg, Anders, et al.
(författare)
-
Chronic Airflow Limitation, Emphysema and Impaired Diffusing Capacity in Relation to Smoking Habits in a Swedish Middle-Aged Population.
- 2024
-
Ingår i: Annals of the American Thoracic Society. - 2329-6933 .- 2325-6621.
-
Tidskriftsartikel (refereegranskat)abstract
- RATIONALE: Chronic obstructive pulmonary disease (COPD) includes respiratory symptoms and chronic airflow limitation (CAL). In some cases, emphysema and impaired diffusing capacity for carbon monoxide (DLCO) are present, but characteristics and symptoms vary with smoking exposure.OBJECTIVES: To study the prevalence of CAL, emphysema and impaired DLCO in relation to smoking and respiratory symptoms in a middle-aged population.METHODS: We investigated 28,746 randomly invited individuals (52% women) aged 50-64 years across six Swedish sites. We performed spirometry, DLCO, high-resolution computed tomography (HRCT) and asked for smoking habits and respiratory symptoms. CAL was defined as post-bronchodilator forced expiratory volume in 1 second divided by forced expiratory volume (FEV1/FVC)<0.7.RESULTS: The overall prevalence was for CAL 8.8%, for impaired DLCO (DLCOCONCLUSIONS: In this large population-based study of middle-aged people, CAL and impaired DLCO were associated with common respiratory symptoms. Self-reported asthma was not associated with CAL in never-smokers. Our findings suggest that CAL in never-smokers signifies a separate clinical phenotype that may be monitored and, possibly, treated differently from smoking-related COPD. This article is open access and distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.org/licenses/by/4.0/).
|
|
| 7. |
|
|
| 8. |
- Ekström, Magnus, et al.
(författare)
-
Exertional breathlessness related to medical conditions in middle-aged people: the population-based SCAPIS study of more than 25,000 men and women.
- 2024
-
Ingår i: Respiratory research. - : BioMed Central (BMC). - 1465-993X .- 1465-9921. ; 25:1
-
Tidskriftsartikel (refereegranskat)abstract
- Breathlessness is common in the population and can be related to a range of medical conditions. We aimed to evaluate the burden of breathlessness related to different medical conditions in a middle-aged population.Cross-sectional analysis of the population-based Swedish CArdioPulmonary bioImage Study of adults aged 50-64years. Breathlessness (modified Medical Research Council [mMRC]≥2) was evaluated in relation to self-reported symptoms, stress, depression; physician-diagnosed conditions; measured body mass index (BMI), spirometry, venous haemoglobin concentration, coronary artery calcification and stenosis [computer tomography (CT) angiography], and pulmonary emphysema (high-resolution CT). For each condition, the prevalence and breathlessness population attributable fraction (PAF) were calculated, overall and by sex, smoking history, and presence/absence of self-reported cardiorespiratory disease.We included 25,948 people aged 57.5±[SD] 4.4; 51% women; 37% former and 12% current smokers; 43% overweight (BMI 25.0-29.9), 21% obese (BMI≥30); 25% with respiratory disease, 14% depression, 9% cardiac disease, and 3% anemia. Breathlessness was present in 3.7%. Medical conditions most strongly related to the breathlessness prevalence were (PAF 95%CI): overweight and obesity (59.6-66.0%), stress (31.6-76.8%), respiratory disease (20.1-37.1%), depression (17.1-26.6%), cardiac disease (6.3-12.7%), anemia (0.8-3.3%), and peripheral arterial disease (0.3-0.8%). Stress was the main factor in women and current smokers.Breathlessness mainly relates to overweight/obesity and stress and to a lesser extent to comorbidities like respiratory, depressive, and cardiac disorders among middle-aged people in a high-income setting-supporting the importance of lifestyle interventions to reduce the burden of breathlessness in the population.
|
|
| 9. |
- Ekström, Magnus, et al.
(författare)
-
Minimal clinically important differences for Dyspnea-12 and MDP scores are similar at 2 weeks and 6 months : follow-up of a longitudinal clinical study
- 2021
-
Ingår i: The European respiratory journal. - : European Respiratory Society (ERS). - 1399-3003 .- 0903-1936. ; 57:3
-
Tidskriftsartikel (refereegranskat)abstract
- Chronic breathlessness is a dominating symptom that restricts daily life for many people with cardiorespiratory disease [1]. Different dimensions of the symptom, such as the intensity, sensory qualities and emotional responses, can be assessed using the instruments Dyspnea-12 (D-12) [2] and the Multidimensional Dyspnea Profile (MDP) [3], which share similarities in the underlying constructs of what is measured [4] and have emerged as widely used instruments for multi-dimensional measurement of breathlessness
|
|
| 10. |
- Ekström, Magnus P., et al.
(författare)
-
Minimal Clinically Important Differences and Feasibility of Dyspnea-12 and the Multidimensional Dyspnea Profile in Cardiorespiratory Disease
- 2020
-
Ingår i: Journal of Pain and Symptom Management. - : Elsevier. - 0885-3924 .- 1873-6513. ; 60:5, s. 968-975
-
Tidskriftsartikel (refereegranskat)abstract
- Context: Breathlessness is a cardinal symptom in cardiorespiratory disease and consists of multiple dimensions that can be measured using the instruments Dyspnea-12 (D12) and the Multidimensional Dyspnea Profile (MDP). Objectives: The objective of the study is to determine the minimal clinically important differences (MCIDs) of all D12 and MDP summary and subdomain scores as well as the instruments' feasibility in patients with cardiorespiratory disease. Methods: Prospective multicenter cohort study of outpatients with diagnosed cardiorespiratory disease and breathlessness in daily life. D12 and MDP were assessed at baseline, after 30-90 minutes and two weeks. MCIDs were calculated using anchor-based and distributional methods for summary and subdomain scores. Feasibility was assessed as rate of missing data, help required, self-reported difficulty, and completion time. Results: A total 182 outpatients (53.3% women) were included; main diagnoses were chronic obstructive pulmonary disease (COPD; 25%), asthma (21%), heart failure (19%), and idiopathic pulmonary fibrosis (19%). Anchor-based MCIDs were for D12 total score 2.83 (95% CI 1.99-3.66); D12 physical 1.81 (1.29-2.34); D12 affective 1.07 (0.64-1.49); MDP A1 unpleasantness 0.82 (0.56-1.08); MDP perception 4.63 (3.21-6.05), and MDP emotional score 2.37 (1.10-3.64). The estimates were consistent with small-to-moderate effect sizes using distributional analysis, and MCIDs were similar between COPD and non-COPD patients. The instruments were generally feasible and quick to use. Conclusion: D12 and MDP are responsive to change and feasible for use for assessing multidimensional breathlessness in outpatients with cardiorespiratory disease. MCIDs were determined for use as endpoints in clinical trials.
|
|
