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- Backman, Helena, et al.
(författare)
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Eosinophilic inflammation and lung function decline in a long-term follow-up of a large population-based asthma cohort
- 2018
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Ingår i: European Respiratory Journal. - : European Respiratory Society. - 0903-1936 .- 1399-3003. ; 52
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- The relationship between lung function decline and airway inflammation among asthmatics has important therapeutic implications, but has rarely been studied in large samples or in population-based asthma cohorts.A population-based adult asthma cohort (n=2055) was recruited during 1986-2001 and clinically examined including spirometry. In 2012-2014, all still eligible subjects (n=1425) were invited to a clinical follow-up including spirometry, blood sampling, and a structured interview, and n=1006 participated (55% women, mean age 59y, 32-92y). Linear regression was performed with age, sex, smoking habits, year of first examination, family history of asthma, socioeconomic status, eosinophils (EOS)>=0.3x109/L, and neutrophils (NEUT)>=5.0x109/L as independent variables and pre-bronchodilator FEV1 decline/year (ml and % of predicted [pp], respectively) as dependent. In secondary models, both ICS use at baseline and ICS use at follow-up were also included.The mean annual FEV1 decline in ml (pp) among asthmatics with EOS<0.3, 0.4>EOS>=0.3 and EOS>=0.4x109/L, respectively, was 26ml (0.03pp), 29ml (0.10pp) and 34ml (0.27pp) (p<0.001). In adjusted analyses, EOS>=0.3 was significantly associated with FEV1 decline, both in terms of ml (4ml excess annual decline vs EOS<0.3) and pp. The association between EOS and FEV1 decline in pp, but not ml, remained when additionally adjusted for ICS use. The association with NEUT>=5.0x109/L was less clear.On group level, adult asthmatics with higher levels of eosinophils in blood have a history of excess FEV1 decline compared to asthmatics with lower levels of eosinophil inflammation, independent of other factors such as ICS use.
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- Backman, Helena, et al.
(författare)
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FEV1 decline in relation to blood eosinophils and neutrophils in a population-based asthma cohort
- 2020
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Ingår i: World Allergy Organization Journal. - : Elsevier. - 1939-4551. ; 13:3
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Tidskriftsartikel (refereegranskat)abstract
- Background: The relationship between lung function decline and eosinophils and neutrophils has important therapeutic implications among asthmatics, but it has rarely been studied in large cohort studies.Objective: The aim is to study the relationship between blood eosinophils and neutrophils and FEV1 decline in a long-term follow-up of a population-based adult asthma cohort.Methods: In 2012-2014, an adult asthma cohort was invited to a follow-up including spirometry, blood sampling, and structured interviews, and n = 892 participated (55% women, mean age 59 y, 32-92 y). Blood eosinophils, neutrophils and FEV 1 decline were analyzed both as continuous variables and divided into categories with different cut-offs. Regression models adjusted for smoking, exposure to vapors, gas, dust, or fumes (VGDF), use of inhaled and oral corticosteroids, and other possible confounders were utilized to analyze the relationship between eosinophils and neutrophils at follow-up and FEV1 decline.Results: The mean follow-up time was 18 years, and the mean FEV 1 decline was 27 ml/year. The annual FEV1 decline was related to higher levels of both blood eosinophils and neutrophils at follow-up, but only the association with eosinophils remained when adjusted for confounders. Further, the association between FEV1 decline and eosinophils was stronger among those using ICS. With EOS <0.3 × 109/L as reference, a more rapid decline in FEV1 was independently related to EOS ≥0.4 × 109/L in adjusted analyses.Conclusions and clinical relevance: Besides emphasizing the importance of smoking cessation and reduction of other harmful exposures, our real-world results indicate that there is an independent relationship between blood eosinophils and FEV1 decline among adults with asthma.
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- Backman, Helena, et al.
(författare)
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Severe asthma : A population study perspective
- 2019
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Ingår i: Clinical and Experimental Allergy. - : John Wiley & Sons. - 0954-7894 .- 1365-2222. ; 49:6, s. 819-828
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Tidskriftsartikel (refereegranskat)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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- Högberg, Sofie, et al.
(författare)
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Time-dependent deposition of micro- and nanofibers in straight model airways
- 2012
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Ingår i: Journal of Fluids Engineering. - : ASME International. - 0098-2202 .- 1528-901X. ; 134:5, s. 051208-1
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Tidskriftsartikel (refereegranskat)abstract
- In this paper, we increase the understanding of the influence of the breathing pattern on the fate of inhaled non-spherical micro and nanoparticles and examine the accuracy of replacing the cyclic flow field with a quasi-steady flow. This is done with new analysis and numerical simulations on straight model airways using a previously developed discrete model for fiber motion. For the conditions studied, maximum deposition is obtained when fibers are released at the start of the inspiratory cycle, and minimum is received at the peak of inhalation. A quasi-steady solution generally provides a relatively good approximation to cyclic flow if an average velocity over one residence time of the particles moving with the mean fluid velocity is used. For a batch type, supply of particles deposition is favored in light activity breathing as compared to heavy breathing and the inclusion of a short pause after the inhalation results in an increased deposition in the terminal bronchiole. During zero-flow over the time of a breathing pause, spherical 10 nm particles experience considerable deposition in the distal airways, whereas only a few percent of larger and/ or fibrous nanoparticles were deposited. Hence, size and shape are crucial variables for deposition for no flow conditions. Common for all breathing parameters examined was that minimum deposition was obtained for the spherical 1 µm-particles and the fibrous 100 nm-particles. The former is expected from studies on spherical particles, and the latter is in agreement with results from a recent publication on steady inspiration.
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- Lindahl, Karin Beland, et al.
(författare)
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The Swedish forestry model : more of everything?
- 2017
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Ingår i: Forest Policy and Economics. - : Elsevier. - 1389-9341 .- 1872-7050. ; 77, s. 44-55
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Tidskriftsartikel (refereegranskat)abstract
- "The Swedish forestry model" refers to the forest regime that evolved following the 1993 revision of the Swedish Forestry Act. It is key to Swedish forest politics and used to capture the essence of a sustainable way of managing forests. However, the ideas, institutions and practices comprising the model have not been comprehensively analyzed previously. Addressing this knowledge gap, we use frame analysis and a Pathways approach to investigate the underlying governance model, focusing on the way policy problems are addressed, goals, implementation procedures, outcomes and the resulting pathways to sustainability. We suggest that the institutionally embedded response to pressing sustainability challenges and increasing demands is expansion, inclusion and integration: more of everything. The more-of-everything pathway is influenced by ideas of ecological modernization and the optimistic view that existing resources can be increased. Our findings suggest that in effect it prioritizes the economic dimension of sustainability. While broadening out policy formulation it closes down the range of alternative outputs, a shortcoming that hampers its capacity to respond to current sustainability challenges. Consequently, there is a need for a broad public debate regarding not only the role of forests in future society, but also the operationalization of sustainable development.
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- Nilsson, Anders, et al.
(författare)
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Sustainability communication in the mining industry : a pre-study
- 2013
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- This report is based on a pre‐study aiming to provide an overview of what andhow the largest mining companies, internationally and in Sweden, communicate in terms of sustainability on their websites. The report presents a broad understanding of what large mining companies ‘say’ when it comes to sustainability. Conceptually, the study draws on writings in the areas of organizational communication, institutional theory and sustainability accounting. Methodologically, the study is based on qualitative textual analyses, to some extent aided by the text analytic tool Leximancer. The main findings of the study are that while most companies communicate all relevant sustainability issues and all the global leaders publish sustainability reports with the Global Reporting Initiative level A+, all companies distinctively communicate sustainability in unique ways. In this report, these similarities and differences in sustainability communication are retold in four main tensions and four main stories.
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