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  • Andersson, Mikael, et al. (författare)
  • Physical activity and fatigue in chronic obstructive pulmonary disease - A population based study
  • 2015
  • Ingår i: Respiratory Medicine. - 0954-6111 .- 1532-3064. ; 109:8, s. 1048-1057
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: In subjects with chronic obstructive pulmonary disease (COPD), symptoms of fatigue, concomitant heart disease and low physical activity levels are more frequently described than in subjects without COPD. However, there are no population-based studies addressing the relationship between physical activity, fatigue and heart disease in COPD. The aim was to compare physical activity levels among subjects with and without COPD in a population based study, and to evaluate if concomitant heart disease and fatigue was associated to physical activity. Methods: In this, 470 subjects with COPD and 659 subjects without COPD (non-COPD) participated in examinations including structured interview and spirometry. A ratio of the forced expiratory volume in one second (FEV1)/best of forced vital capacity (FVC) and vital capacity (VC) <0.7 was used to define COPD. Physical activity was assessed with the International Physical Activity Questionnaire (IPAQ), and fatigue with the Functional Assessment of Chronic Illness Therapy - Fatigue scale (FACIT-F). Results: The prevalence of low physical activity was higher among subjects with FEV1 <80% predicted compared to non-COPD subjects (22.4% vs. 14.6%, p = 0.041). The factors most strongly associated with low physical activity in subjects with COPD were older age, OR 1.52, (95% CI 1.12-2.06), a history of heart disease, OR 2.11 (1.10-4.08), and clinically significant fatigue, OR 2.33 (1.31-4.13); while obesity was the only significant factor among non-COPD subjects, OR 2.26 (1.17-4.35). Conclusion: Physical activity levels are reduced when lung function is decreased below 80% of predicted, and the factors associated with low physical activity are different among subject with and without COPD. We propose that the presence of fatigue and heart disease are useful to evaluate when identifying subjects for pulmonary rehabilitation.
  • Bakke, PS, et al. (författare)
  • Recommendations for epidemiological studies on COPD
  • 2011
  • Ingår i: European Respiratory Journal. - 1399-3003. ; 38:6, s. 1261-1277
  • Tidskriftsartikel (refereegranskat)abstract
    • The prevalence of chronic obstructive pulmonary disease (COPD) has been extensively studied, especially in Western Europe and North America. Few of these data are directly comparable because of differences between the surveys regarding composition of study populations, diagnostic criteria of the disease and definitions of the risk factors. Few community studies have examined phenotypes of COPD and included other ways of characterising the disease beyond that of spirometry. The objective of the present Task Force report is to present recommendations for the performance of general population studies in COPD in order to facilitate comparable and valid estimates on COPD prevalence by various risk factors. Diagnostic criteria in epidemiological settings, and standardised methods to examine the disease and its potential risk factors are discussed. The paper also offers practical advice for planning and performing an epidemiological study on COPD. The main message of the paper is that thorough planning is worth half the study. It is crucial to stick to standardised methods and good quality control during sampling. We recommend collecting biological markers, depending on the specific objectives of the study. Finally, studies of COPD in the population at large should assess various phenotypes of the disease.
  • Berthold, Malin, et al. (författare)
  • Association of Sensitization to Specific Pet Allergen Components with Asthma Symptoms in School Children
  • 2015
  • Ingår i: Journal of Allergy and Clinical Immunology. - Elsevier. - 0091-6749. ; 135:2, s. AB22-AB22
  • Tidskriftsartikel (övrigt vetenskapligt)abstract
    • Animal sensitization is a known determinant of asthma in children. The objective was to study the association of asthma with sensitization to pet allergen components in schoolchildren. Methods: A random sample of 696 children (11-12 y) from a Swedish population-based cohort was analyzed for sensitization (≥0.1 kUA/L) to cat, dog and horse dander extracts using ImmunoCAP. Sensitized children were further analyzed for IgE antibodies to animal allergen components using ImmunoCAP ISAC112. An expanded ISAAC questionnaire was completed by the parents. Results: Of 259 animal-sensitized children (37%) the majority (75%) were sensitized to more than one species. Among the 11 % (n=77) with current asthma 69 % were sensitized to at least one animal extract, as compared to one third of children without current asthma (p<0.001). Current asthma and asthma symptoms upon contact with cats were associated with co-sensitization to Fel d 1 and Fel d 4. Already at moderate levels of IgE antibodies to Fel d 4 (1-15 ISU), at which level most children were sensitized also to Fel d 1, the prevalence of asthma symptoms upon contact with cats was significantly increased. Dog-sensitized children were commonly sensitized to several dog components, and the greatest risk for asthma was seen in children co-sensitized to Can f 5 and Can f 1/f 2. Conclusions: Among Northern Swedish schoolchildren furry animals were the main perennial sensitizers. Asthma symptoms were associated with sensitizations to multiple components within an animal species. In particular, cat Fel d 4 sensitization was strongly related to asthma symptoms.
  • Bjerg, Anders, et al. (författare)
  • A population-based study of animal component sensitization, asthma, and rhinitis in schoolchildren
  • 2015
  • Ingår i: Pediatric Allergy and Immunology. - 0905-6157. ; 26:6, s. 557-563
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Animal sensitization is a major determinant of asthma in children. Component-resolved studies of unselected pediatric populations are lacking. The aim was to describe sensitization to animal components and the association with asthma and rhinitis in animal-sensitized schoolchildren. Methods: A random sample of 696 children (11-12years) from a Swedish population-based cohort was tested for sensitization to cat, dog, and horse dander using ImmunoCAP. Sera from animal-sensitized children were further analyzed by microarray including three allergen components from cat, four from dog, and two from horse. The parents completed an expanded ISAAC questionnaire. Results: Of 259 animal-sensitized children (0.1 kU(A)/l), 51% were sensitized to all three, 23% to two, and 25% to one species. Current asthma and asthma symptoms following contact with cats were associated with co-sensitization to Fel d 1 and Fel d 4. This association was seen already at moderate-level sensitization (1-15 ISU) to Fel d 4, at which level most children were sensitized to Fel d 1, as well. In dog-sensitized children, the majority was sensitized to more than one dog component, and co-sensitization to Can f 5 and Can f 1/f 2 conferred the greatest risk for asthma. Sensitization to the highly cross-reactive serum albumins was uncommon and not associated with asthma. Conclusions: Among schoolchildren in northern Sweden, where mite allergy is uncommon, furry animals were the primary perennial sensitizers. Asthma was associated with higher levels of component sensitization, and sensitization to more than one component from the same animal conferred the greatest risk.
  • Bjerg, Anders, et al. (författare)
  • Time trends in asthma and wheeze in Swedish children 1996-2006 : prevalence and risk factors by sex
  • 2010
  • Ingår i: Allergy. European Journal of Allergy and Clinical Immunology. - 0105-4538. ; 65:1, s. 48-55
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Recent data suggest that the previously rising trend in childhood wheezing symptoms has plateaued in some regions. We sought to investigate sex-specific trends in wheeze, asthma, allergic conditions, allergic sensitization and risk factors for wheeze.Methods: We compared two population-based cohorts of 7 to 8-year olds from the same Swedish towns in 1996 and 2006 using parental expanded ISAAC questionnaires. In 1996, 3430 (97%) and in 2006, 2585 (96%) questionnaires were completed. A subset was skin prick tested: in 1996, 2148 (88%) and in 2006, 1700 (90%) children participated.Results: No significant change in the prevalence of current wheeze (P = 0.13), allergic rhinitis (P = 0.18) or eczema (P = 0.22) was found despite an increase in allergic sensitization (20.6-29.9%, P < 0.01). In boys, however, the prevalence of current wheeze (12.9-16.4%, P < 0.01), physician-diagnosed asthma (7.1-9.3%, P = 0.03) and asthma medication use increased. In girls the prevalence of current symptoms and conditions tended to decrease. The prevalence of all studied risk factors for wheeze and asthma increased in boys relative to girls from 1996 to 2006, thus increasing the boy-to-girl prevalence ratio in risk factors.Conclusions: The previously reported increase in current wheezing indices has plateaued in Sweden. Due to increased diagnostic activity, physician diagnoses continue to increase. Time trends in wheezing symptoms differed between boys and girls, and current wheeze increased in boys. This was seemingly explained by the observed increases in the prevalence of risk factors for asthma in boys compared with girls. In contrast to the current symptoms of wheeze, rhinitis or eczema, the prevalence of allergic sensitization increased considerably.
  • Ekerljung, Linda, et al. (författare)
  • No further increase of incidence of asthma: Incidence, remission and relapse of adult asthma in Sweden
  • 2008
  • Ingår i: Respiratory Medicine. - 0954-6111. ; 102:12, s. 1730-1736
  • Tidskriftsartikel (refereegranskat)abstract
    • BACKGROUND: Knowledge about time trends of disease patterns in society is essential for planning and prioritizing health care resources. Longitudinal population-based studies on asthma are scarce but provide an opportunity to assess incidence, remission and relapse of asthma, and their determinants, which were the objectives of the present study.METHODS: A postal questionnaire was sent on two occasions, 1996 and 2006, to a randomly selected sample of subjects aged 20-69 years in 1996. The response rates were 72% and 83%, respectively, and in total 4479 subjects participated in both surveys. The questionnaire included questions on asthma, respiratory symptoms and possible determinants. Logistic regression was used to assess determinants.RESULTS: Cumulative incidence of asthma was 2.4% (men 1.9%; women 2.8%, p=0.06). Family histories of asthma (OR 2.31, CI 95% 1.42-3.76), rhinitis (OR 2.25, CI 95% 1.43-3.53) and being an ex-smoker (OR 2.17, CI 95% 1.27-3.71) were determinants for incident asthma. The 10-year remission of asthma was 14.6% and inversely associated with rhinitis. Relapse was found in 38% of eligible subjects.CONCLUSIONS: The current study with high participation rates concludes that the incidence of asthma among adults has been stable in Sweden for the past two decades. Remission was associated with mild disease at study start. Relapse in adults has rarely been reported previously and provide new insight in the course of asthma. Low remission and high relapse further support the view of asthma as a chronic disease; possibly representing fluctuations of the disease over time.
  • Eriksson, J., et al. (författare)
  • Cigarette smoking is associated with high prevalence of chronic rhinitis and low prevalence of allergic rhinitis in men
  • 2013
  • Ingår i: Allergy. - 0105-4538. ; 68:3, s. 347-354
  • Tidskriftsartikel (refereegranskat)abstract
    • Background The harmful effects of tobacco smoke on human health, including respiratory health, are extensive and well documented. Previous data on the effect of smoking on rhinitis and allergic sensitization are inconsistent. We sought to investigate how smoking correlates with prevalence of allergic and chronic rhinitis among adults in Sweden. Methods The study population comprised 27879 subjects derived from three large randomly selected cross-sectional population surveys conducted in Sweden between 2006 and 2008. The same postal questionnaire on respiratory health was used in the three surveys, containing questions about obstructive respiratory diseases, rhinitis, respiratory symptoms and possible determinants of disease, including smoking habits. A random sample from one of the cohorts underwent a clinical examination including skin prick testing. Results Smoking was associated with a high prevalence of chronic rhinitis in both men and women and a low prevalence of allergic rhinitis in men. These associations were dose dependent and remained when adjusted for a number of possible confounders in multiple logistic regression analysis. Prevalence of chronic rhinitis was lowest in nonsmokers and highest in very heavy smokers (18.5% vs 34.5%, P<0.001). Prevalence of sensitization to common airborne allergens was lower in current smokers (25.9%, P=0.008) and ex-smokers (28.2%, P=0.022) than in nonsmokers (38.5%). Conclusion We found that smoking was associated with a high prevalence of chronic rhinitis in both sexes and a low prevalence of allergic rhinitis in men. The associations were dose dependent and remained when adjusting for several possible confounders.
  • Eriksson, Jonas, et al. (författare)
  • Rhinitis phenotypes correlate with different symptom presentation and risk factor patterns of asthma.
  • 2011
  • Ingår i: Respiratory medicine. - 1532-3064. ; 105:11, s. 1611-21
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Asthma and rhinitis frequently coexist, but no population study has previously determined the relationship between nasal comorbidities and symptom expression and risk factors of asthma.Methods: In 2008, a postal questionnaire on respiratory health was sent to 30 000 randomly selected subjects aged 16-75 years in West Sweden; 29218 could be traced and 18 087 (62%) responded. The questionnaire included questions on asthma, rhinitis, chronic rhinosinusitis, respiratory symptoms and possible determinants.Results: Prevalence of allergic rhinitis in asthma was 63.9% and of asthma in allergic rhinitis 19.8%. Prevalence of chronic rhinosinusitis in asthma was 8.4% and of asthma in chronic rhinosinusitis 24.4%. Asthma subjects with chronic rhinitis, or chronic rhinosinusitis, had more symptoms of asthma and bronchitis than those without rhinitis (p < 0.001). There was an obvious trend of higher ORs for various environmental exposures including occupational exposure to dust, gases and fumes (OR 2.32 vs. OR 1.44), visible mould at home (OR 1.72 vs. OR 1.27) and water damage at home (OR 1.82 vs. OR 1.06) for asthma with chronic rhinosinusitis than for asthma with allergic rhinitis. Family history of allergy yielded a higher OR for asthma with allergic rhinitis than with asthma with chronic rhinosinusitis (OR 7.15 vs. OR 4.48).Conclusion: Considerable overlap between asthma and nasal comorbidities was documented, confirming a close relationship between nasal disease and asthma. Allergic rhinitis, chronic rhinitis and chronic rhinosinusitis were associated with different risk factor patterns and symptom expression of asthma. Thus, different nasal comorbidities may reflect different phenotypes of asthma. (C) 2011 Elsevier Ltd. All rights reserved.
  • Hedlund, Ulf, et al. (författare)
  • Occupational exposure to dust, gases and fumes, a family history of asthma and impaired respiratory health
  • 2008
  • Ingår i: Scandinavian Journal of Work Environment & Health. - 0355-3140. ; 34:5, s. 381-386
  • Tidskriftsartikel (refereegranskat)abstract
    • Objectives: This study assessed the impact of occupational exposure to dust, gases, and fumes on respiratory symptoms, obstructive lung diseases, or the use of asthma medication among persons with and without a family history of asthma. Methods: A population-based cohort was followed for 10 years. This study included all 1739 men and 1594 women occupationally active at the first survey. Exposure and respiratory health were assessed from questionnaires. Multiple logistic regression was used to estimate the effects in relation to occupational groups, with age, gender, and smoking habits as possible confounders, using both cross-sectional and longitudinal analyses. The susceptibility to impaired respiratory health was determined from a family history of asthma. Results: A family history of asthma was reported by 27% of the men and 34% of the women. Both occupational exposure and a family history of asthma were associated with impaired respiratory health. The etiologic fractions showed that up to about 70% of the symptoms could be explained by a family history of asthma among those exposed to low levels of air pollutants, as well as among those with high exposure. However, high exposure contributed up to 35% of the symptoms both among those with and among those without a family history of asthma. The study indicates that the relative risk of occupational exposure to pollutants is similar for both persons with and those without a family history of asthma. Conclusions: The relative risk for impaired respiratory health after exposure to occupational air pollutants seems to be similar for persons with and those without a susceptibility to impaired respiratory health.
  • Lötvall, Jan, et al. (författare)
  • West Sweden Asthma Study: Prevalence trends over the last 18 years argue no recent increase in asthma.
  • 2009
  • Ingår i: Respiratory research. - 1465-993X. ; 10:1
  • Tidskriftsartikel (refereegranskat)abstract
    • Asthma prevalence has increased over the last fifty years, but the more recent changes have not been conclusively determined. Studies in children indicate that a plateau in the prevalence of asthma may have been reached, but this has not yet been confirmed in adults. Epidemiological studies have suggested that the prevalence of asthma in adults is approximately 7-10% in different parts of the western world. We have now performed a large-scale epidemiological evaluation of the prevalence of asthma and respiratory symptoms in adults between the ages of 16-75 in West Sweden. Thirty thousand randomly chosen individuals were sent a detailed questionnaire focusing on asthma and respiratory symptoms, as well possible risk factors. Sixty-two percent of the contacted individuals responded to the questionnaire. Asthma prevalence, defined as asthma diagnosed by a physician, was 8.3%. Moreover, the prevalence of respiratory symptoms was lower compared to previous studies. The most common respiratory symptom was any wheeze (16.6%) followed by sputum production (13.3%). In comparison with studies performed 18 years ago, the prevalence of asthma has not increased, and the prevalence of most respiratory symptoms has decreased. Therefore, our data argues that the continued increase in asthma prevalence that has been observed over the last half century is over.
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