| 1. |
- Backman, Helena, et al.
(author)
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Severe asthma : A population study perspective
- 2019
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In: Clinical and Experimental Allergy. - : John Wiley & Sons. - 0954-7894 .- 1365-2222. ; 49:6, s. 819-828
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Journal article (peer-reviewed)abstract
- BackgroundSevere asthma is a considerable challenge for patients, health care professionals and society. Few studies have estimated the prevalence of severe asthma according to modern definitions of which none based on a population study.ObjectiveTo describe characteristics and estimate the prevalence of severe asthma in a large adult population‐based asthma cohort followed for 10‐28 years.MethodsN=1006 subjects with asthma participated in a follow‐up during 2012‐14, when 830 (mean age 59y, 56% women) still had current asthma. Severe asthma was defined according to three internationally well‐known criteria: the ATS workshop definition from 2000 used in the US Severe Asthma Research Program (SARP), the 2014 ATS/ERS Task force definition and the GINA 2017. All subjects with severe asthma according to any of these criteria were undergoing respiratory specialist care, and were also contacted by telephone to verify treatment adherence.ResultsThe prevalence of severe asthma according to the three definitions was 3.6% (US SARP), 4.8% (ERS/ATS Taskforce), and 6.1% (GINA) among subjects with current asthma. Although all were using high ICS doses and other maintenance treatment, >40% had uncontrolled asthma according to the asthma control test. Severe asthma was related to age >50 years, nasal polyposis, impaired lung function, sensitization to aspergillus, and tended to be more common in women. Further, neutrophils in blood significantly discriminated severe asthma from other asthma.Conclusions and clinical relevanceSevere asthma differed significantly from other asthma in terms of demographic, clinical and inflammatory characteristics, results suggesting possibilities for improved treatment regimens of severe asthma. The prevalence of severe asthma in this asthma cohort was 4‐6%, corresponding to approximately 0.5% of the general population.
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| 2. |
- Backman, Helena, et al.
(author)
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Severe asthma among adults : Prevalence and clinical characteristics
- 2018
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In: European Respiratory Journal. - : European Respiratory Society. - 0903-1936 .- 1399-3003. ; 52
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Journal article (other academic/artistic)abstract
- Background: Severe asthma is a considerable challenge for patients, health care professionals and society. Few studies have estimated the prevalence of severe asthma according to modern definitions of which none based on a population study.Methods: We estimated the prevalence and studied characteristics of severe asthma in a large adult population-based asthma cohort followed for 10-28 years in northern Sweden: 1006 subjects participated in a follow-up during 2012-14, when 830 (82.5%) still had current asthma (mean age 59y, 32-92y, 56% women). Severe asthma was defined according to three internationally well-known criteria: the US SARP, ATS/ERS and GINA. All subjects with severe asthma were undergoing respiratory specialist care, and were also contacted by telephone to verify adherence to treatment.Results: The prevalence of severe asthma according to the three definitions was 3.6% (US SARP), 4.8% (ERS/ATS), and 6.1% (GINA) among subjects with current asthma. Although all were using high ICS doses and other maintenance treatment, >40% had uncontrolled asthma and <10% had controlled asthma according to the ACT. Severe asthma was related to age >50 years, nasal polyposis, decreased FEV1, not fully reversible airway obstruction, sensitization to aspergillus, elevated neutrophils and partly to eosinophils, and tended to be more common in women.Conclusion: The prevalence of severe asthma in this asthma cohort was 4-6%, corresponding to approximately 0.5% of the population in northern Sweden. A substantial proportion of those with severe asthma had uncontrolled disease, and severe asthma differed significantly from other asthma in terms of both clinical and inflammatory characteristics.
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| 3. |
- Jansson, Sven-Arne, et al.
(author)
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Societal costs of severe asthma in Sweden
- 2018
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In: European Respiratory Journal. - : European Respiratory Society. - 0903-1936 .- 1399-3003. ; 52
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Journal article (other academic/artistic)abstract
- Background: Severe asthma is a disabling and costly disease, often poorly controlled despite high-dosage controller medications.Aims: We estimated societal costs from an adult severe asthma cohort, derived from a large-scale population survey in northern Sweden.Methods: Severe asthma was defined by US SARP criteria, and high-dosage inhaled corticosteroids (ICS) were defined by GINA 2014 criteria. The study sample was identified from general population cohorts examined within the OLIN (Obstructive Lung Disease in Northern Sweden) studies (n=1,006). Patient reported asthma-related direct (outpatient care, medicines, hospitalisations) and indirect (sick leave, early retirement) resource consumption were collected by quarterly pre-defined telephone interviews during one year. Unit costs from 2017 were applied.Results: In total, 32 patients with severe asthma (mean age 60.7y, 13 patients >65) were included. The mean annual total cost per patient was approximately €6,300. Two thirds of the costs (63%) was indirect costs (approximately €4,000). The main cost drivers in direct costs were hospitalisations and drugs: approximately €1,000 and €700, respectively. The main cost driver of indirect costs was productivity loss due to early retirement: €3,400. Patients who had received regular oral corticosteroid (OCS) treatment had greater costs compared with those without regular OCS treatment. In comparison with a previous Swedish study based on a sample of all asthmatics from the general population, a greater mean annual total cost per patient was observed.Conclusions: In this severe asthma population in Sweden, societal costs were substantial. The results indicate a need for improved treatment regimens for patients with severe asthma.
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| 4. |
- Stridsman, Caroline, et al.
(author)
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Adolescent girls with asthma have worse asthma control and health-related quality of life than boys : A population based study
- 2017
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In: Pediatric Pulmonology. - : John Wiley & Sons. - 8755-6863 .- 1099-0496. ; 52:7, s. 866-872
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Journal article (peer-reviewed)abstract
- BackgroundPopulation-based studies investigating health-related quality of life (HRQoL) among asthmatic adolescents are rare. Further, among subjects with asthma, HRQoL may be affected by asthma control and severity.AimTo investigate HRQoL in relation to asthma control and asthma severity among adolescents.MethodAs a part of the population-based OLIN pediatric study, 266 adolescents with current asthma (14-15 yr) were identified. N = 247 completed the DISABKIDS HRQoL asthma module, including the domains impact and worry. The Asthma Control Test (ACT) was used and a disease severity score was calculated based on symptoms and medicine use.ResultsThe prevalence of current asthma was 11%. Well-controlled asthma was reported by 15% of the adolescents, and 53% had partly controlled asthma. The prevalence of uncontrolled asthma was significantly higher among girls than boys (38% vs 25%), and girls also reported lower HRQoL scores. There was a fairly strong correlation between the ACT and DISABKIDS scores. Independent risk factors for low HRQoL impact (a score <67) were female sex (OR 4.66, 95%CI 1.82-9.54) and decreased ACT scores (1.38, 1.18-1.62). Risk factors for low HRQoL worry (a score <70) were female sex (3.33, 1.41-7.86), decreased ACT scores (1.35, 1.16-1.57), severe asthma (6.23, 1.46-16.50), and having current eczema (2.68, 1.00-7.24).ConclusionOnly a minority of the asthmatic adolescents reported well-controlled asthma, and poor asthma control and female sex were risk factors for low HRQoL. Our results demonstrate that evaluation of asthma control is of great importance for asthma management.
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| 5. |
- Stridsman, Caroline, et al.
(author)
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Health status among adult asthmatics - a population-based study
- 2018
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In: European Respiratory Journal. - : European Respiratory Society. - 0903-1936 .- 1399-3003. ; 52
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Journal article (other academic/artistic)abstract
- Background: Women with asthma seem to report a worse health status then men. However, other factors associated to health have rarely been studied in population-based samples.Aim: To determine factors associated with generic health in a population-based adult asthma cohort.Methods: In 2012-2014, n=1425 subjects from a population-based adult asthma cohort (the OLIN-studies) were invited to a clinical follow-up including spirometry, blood sampling, a structured interview, and the SF-8 health survey, evaluating both physical and mental health. N=1006 subjects participated, of which n=830 had current asthma. Of these, n=816 answered the SF-8 and were further studied (56% women, 32-92yr).Results: In adjusted analyses, worse physical health was associated with female sex, increasing age, BMI, blood neutrophils ≥5*109/L, and health care contacts due to respiratory symptoms last 12 months, but not with blood eosinophils ≥0.3*109/L or eczema. A positive phadiatop (≥0.35kU/L) was associated with better physical health. Worse mental health was associated with female sex, increasing BMI, eczema and health care contacts due to respiratory symptoms last 12 months, but not with increasing age, blood eosinophils ≥0.3*109/L, blood neutrophils ≥5*109/L, or a positive phadiatop (≥0.35kU/L).Conclusion: Among adult asthmatics, female sex, a higher BMI and health care visits due to respiratory symptoms were associated with a worse health. Eczema was only associated with worse mental health, and blood neutrophils ≥5*109/L with physical health. Subjects with allergic asthma seem to have better physical health than those with non-allergic asthma.
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