| 1. |
- Hammar, Katarina Stenberg, et al.
(författare)
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Subnormal levels of vitamin D are associated with acute wheeze in young children
- 2014
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Ingår i: Acta Paediatrica. - : Wiley. - 0803-5253 .- 1651-2227. ; 103:8, s. 856-861
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Tidskriftsartikel (refereegranskat)abstract
- Aim: This study evaluated risk factors for acute wheeze in preschool children and investigated whether subnormal levels of vitamin D were associated with increased risk for acute wheeze, atopy or viral/bacterial respiratory infections. Methods: We recruited 130 children with acute wheeze, aged 6 months to 4 years, from paediatric emergency departments in Stockholm, Sweden, and 101 age-matched controls with no history of wheeze or sensitisation to airborne allergens. Parents answered standardised questionnaires, and blood samples were analysed for specific IgE to airborne and food allergens and levels of 25 hydroxyvitamin D (25(OH)D). Nasopharyngeal virus samples were collected during the emergency department visit in the group of children with wheeze, and a subset were also tested for bacteria. Results: Vitamin D insufficiency (25(OH)D < 75 nmol/L (30 ng/mL)) was associated with an odds ratio of 2.7 (95% confidence interval 1.1-6.2) for acute wheeze. However, no association was found between vitamin D insufficiency and atopy, presence of virus or bacteria or recurrent infections. Children older than 24 months were particularly at risk of subnormal vitamin D levels, irrespective of wheezing history. Conclusion: Our findings support the hypothesis that subnormal levels of vitamin D are associated with acute wheeze in young children.
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| 2. |
- Karlsson Sundbaum, Johanna, et al.
(författare)
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Uncontrolled asthma predicts severe COVID-19: a report from the Swedish National Airway Register.
- 2022
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Ingår i: Therapeutic advances in respiratory disease. - : SAGE Publications. - 1753-4666 .- 1753-4658. ; 16
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Tidskriftsartikel (refereegranskat)abstract
- Severe asthma increases the risk of severe COVID-19 outcomes such as hospitalization and death. However, more studies are needed to understand the association between asthma and severe COVID-19.A cohort of 150,430 adult asthma patients were identified in the Swedish National Airway Register (SNAR) from 2013 to December 2020. Data on body mass index, smoking habits, lung function, and asthma control test (ACT) were obtained from SNAR, and uncontrolled asthma was defined as ACT ⩽19. Patients with severe COVID-19 were identified following hospitalization or in death certificates based on ICD-10 codes U07.1 and U07.2. The Swedish Prescribed Drug register was used to identify comorbidities and data from Statistics Sweden for educational level. Multivariate logistic regression analyses were used to estimate associations with severe COVID-19.Severe COVID-19 was identified in 1067 patients (0.7%). Older age (OR=1.04, 95% CI=1.03-1.04), male sex (1.42, 1.25-1.61), overweight (1.56, 1.27-1.91), obesity (2.12, 1.73-2.60), high-dose inhaled corticosteroids in combination with long-acting β-agonists (1.40, 1.22-1.60), dispensed oral corticosteroids ⩾2 (1.48, 1.25-1.75), uncontrolled asthma (1.64, 1.35-2.00), cardiovascular disease (1.20, 1.03-1.40), depression (1.47, 1.28-1.68), and diabetes (1.52, 1.29-1.78) were associated with severe COVID-19, while current smoking was inversely associated (0.63, 0.47-0.85). When comparing patients who died from COVID-19 with those discharged alive from hospital until 31 December 2020, older age, male sex, and current smoking were associated with COVID-19 death.Patients with uncontrolled asthma and high disease burden, including increased asthma medication intensity, should be identified as risk patients for severe COVID-19. Furthermore, current smoking is strongly associated with COVID-19 death in asthma.
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| 3. |
- Lindholm, Torun, et al.
(författare)
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Infants and toddlers remembering and forgetting of a stressful medical procedure
- 2009
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Ingår i: Journal of Pediatric Psychology. - : Oxford University Press (OUP). - 0146-8693 .- 1465-735X. ; 34:2, s. 205-216
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To examine whether a distressing medical procedure leaves lasting impressions in young children’s memories. Methods: Children 12- to 78-weeks old (Nfl172) received inhalation treatment through a face mask or underwent other interventions at a pediatric emergency department. They were randomized to be presented with neutral cues and cues from the inhalation 1 week or 6 months after the target event. Children’s reactions at cue presentation were scored from videotapes. Results: Across the age span tested, children treated with inhalation showed higher distress than controls when presented with cues from inhalation 1 week, but not 6 months after target treatment. Conclusions: Stress during medical procedures in preverbal children may develop as a result of prior experience of such procedures. These memories typically seem to fade within 6 months.
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| 4. |
- Pedroletti, Christophe
(författare)
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Exhaled nitric oxide in schoolchildren with asthma
- 2004
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: The fraction of nitric oxide in exhaled air (FENO) is believed to reflect the degree of allergic inflammation present in the lower airways. The diffusing capacity of NO in the airways (DawNO) and the concentration of this gas in the airway wall (FawNO) can be evaluated by determining FENO with different exhalation flow-rates. FENO measurements could be used for studies of the link between nasal and bronchial inflammation in children with allergic rhinitis and asthma. Aims: The aims of studies I and II were to determine the optimal exhalation flow-rate for measurement of FENO, as well as the levels of DawNO and FawNO in healthy and asthmatic schoolchildren of different ages. Studies III and IV were designed to investigate the possible effects (as reflected by FENO values) of either a nasal challenge with an allergen or nasal treatment with a steroid on bronchial inflammation in allergic schoolchildren suffering from mild-to moderate asthma and rhinitis. Methods: 15 schoolchildren with asthma and 15 healthy controls participated in studies I and 11; 19 asthmatic children allergic to cats and 10 healthy controls were examined in study III; and 40 children with allergies to animal dander, asthma and mild-to moderate rhinitis participated in study IV. In study III the children were challenged by inserting a cat allergen extract into their nose; while in study IV the subjects were randomly allocated to receive nasal treatment with either mometasone furoate or a placebo. FENO was measured using chemiluminescence at different exhalation flow-rates in studies I and 11 and at a standardised flow-rate of 50 ml/s in studies III and IV. In studies III and IV allergic inflammation was also assessed by measuring the percentage of eosinophils among blood leukocytes and the ECP level in nasal lavage. Results: In order to achieve optimal reproducibility and maximal ability to discriminate between allergic and healthy children, together with patient comfort, the effect of varying the exhalation flowrate on measurement of FENO was tested and a standard flow-rate of 50 ml/s chosen for routine use. Elevated levels of DawNO and FawNO were observed in the asthmatic children, while a positive correlation between DawNO and the volume of the respiratory dead space was seen only in healthy children. The FENO values were correlated with the percentage of blood eosinophils in both studies III and IV. We did not observe any increase in FENO following nasal challenge with an allergen. Nor was FENO decreased by nasal treatment with steroids, even though there was a decrease in the level of ECP in nasal lavage in this treated group. Conclusions: An exhalation flow-rate of 50 ml/s should be used routinely in connection with measurement of FENO during a single-breath exhalation by schoolchildren. The increased DawNO value in asthmatic children may be related to the total area of the mucosal surface releasing NO, so that allergic inflammation in the peripheral airways might be associated with an increase in this parameter. The exhaled level of NO was not influenced by nasal challenge with an allergen or nasal treatment with steroids. Thus, our present findings do not support a direct relationship between nasal and bronchial inflammation in mild-to-moderate allergic airway disease.
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| 5. |
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| 6. |
- Stridsman, Caroline, et al.
(författare)
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The first years of the Swedish National Airway register
- 2020
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Ingår i: European Respiratory Journal. - : ERS Publications. - 0903-1936 .- 1399-3003. ; 56:Suppl 64
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Background: The Swedish National Airway Register (SNAR) was initiated to improve and ensure quality of care for patients with asthma and COPD.Aim: To describe the register design of SNAR and unique patients between the years of 2014 until 2019.Methods: SNAR has been ongoing since 2013 and includes patients with asthma (both children and adults) and COPD from primary and secondary care (both in- and outpatients). Data about healthcare provider, symptoms, comorbidities, additional investigations (i.e. spirometry) and prescribed treatment is registered. The registrations are performed manually by healthcare professionals, or directly transmitted from medical records to a web-based platform.Results: In 2019, 853 primary care clinics, 125 secondary care clinics (whereof 62 pediatric clinics) and 24 inpatient wards were linked to the register. Data was directly transmitted from medical records of about 80% of the clinics, and manually by 20%. The register includes in total 205833 unique patients with asthma and 80372 with COPD. Registrations of new patients and follow-up visits in 2019 applied 73788 patients with asthma (58% women, mean age 44yr) whereof 10190 were <11yr and 6248 were 12-17yr, 33276 with COPD (57% women, mean age 73yr), and 5013 with both asthma and COPD (ACO) (61% women, mean age 71yr). In COPD, the proportion of patients in GOLD 1-4 were; GOLD1 15%, GOLD2 55%, GOLD3 25% GOLD4 5%. During 2019, 1506 registered patients with asthma and 3791 with COPD died.Conclusion: The SNAR has cumulatively registered over 280000 individuals and provides a unique insight into the care of patients with asthma and COPD in Sweden.
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| 7. |
- Vanfleteren, Lowie, et al.
(författare)
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Room for improvement for smoking cessation support in asthma and COPD - a perspective from the Swedish National Airway Register
- 2020
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Ingår i: European Respiratory Journal. - : ERS Publications. - 0903-1936 .- 1399-3003. ; 56:Suppl 64
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Background: The prevalence of smoking has decreased in the general population and is nowadays around 7% in Sweden. The Swedish National Airway Register (SNAR) gives a unique opportunity to study obstructive lung diseases and related factors such as smoking habits.Aim: To provide a survey of data registered in SNAR and to report the prevalence of smoking and offered smoking cessation support among patients with asthma and COPD.Methods: In 2019, registrations of new patients and follow-up visits from primary and secondary care included 3845 adolescents with asthma (aged 12-17yr), 43721 adults with asthma, and 29945 with COPD with complete data about smoking habits. Smoking cessation support was defined as offered nicotine replacement therapy or motivational interviewing. The registrations were performed manually by healthcare professionals, or directly transmitted from medical records to a web-based platform.Results: The proportion of current smokers was 1.7% among adolescents with asthma (girls 2.4% vs. boys 1.1% p=0.003), 12.3% among adults with asthma (women 12.9% vs. men 11.3%, p<0.001) and 36.7% in COPD (women 37.9% vs. men 35.0%, p<0.001). Smoking cessation support was offered to 26.5% of the adolescents with asthma (girls 31.0% vs. boys 19.2%, p=0.440), 38.7% of the adults with asthma (women 39.3% vs. men 37.7%, p=0.260), and to 49.6% of those with COPD (women 49.3% vs. men 50.0%, p=0.430).Conclusion: In Sweden, a substantial proportion of patients with diagnosed asthma or COPD continue to smoke, with room for improvment for smoking cessation support.
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