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- Wang, Gang, et al.
(författare)
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Assessment of chronic bronchitis and risk factors in young adults : results from BAMSE
- 2020
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Ingår i: European Respiratory Journal. - Stockholm : Karolinska Institutet, Dept of Clinical Science and Education, Södersjukhuset. - 0903-1936 .- 1399-3003.
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Chronic bronchitis is associated with substantial morbidity among elderly adults, but little is known about its prevalence and risk factors in young adults. Our aim was to assess the prevalence and early life risk factors for chronic bronchitis in young adults. METHODS: Questionnaire data and clinical measures from the 24-year follow-up of the Swedish BAMSE cohort were used. We assessed chronic bronchitis (CB) as the combination of cough and mucus production in the morning during winter. Environmental and clinical data from birth and onwards were used for analyses of risk factors. RESULTS: At the 24-year follow-up, 75% (n=3064) participants completed the questionnaire and 2030 performed spirometry. The overall prevalence of CB was 5.5% (n=158) with similar estimates in males and females. Forty-nine percent of CB cases experienced more than 3 self-reported respiratory infections in the last year compared to 18% in non-CB subjects (p<0.001), and 37% of cases were current smokers (versus 19%). Statistically significant lower post-FEV(1)/FVC were observed in CB compared to non-CB subjects (mean z-score -0.06 versus 0.13, p=0.027). Daily smoking (adjusted Odds Ratio, aOR=3.85, p<0.001), air pollution exposure (black carbon during ages 1-4 years old, aOR=1.71 per 1 μg·m(3) increase, p=0.009) and exclusive breast-feeding during four months or more (aOR=0.66, p=0.044) were associated with CB. CONCLUSION: Chronic bronchitis in young adults is associated with recurrent respiratory infections. Besides smoking, our results support role of early life exposures, such as air pollution and exclusive breast-feeding, for respiratory health later in life.
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| 2. |
- Wang, Gang, et al.
(författare)
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Early-life risk factors for reversible and irreversible airflow limitation in young adults : findings from the BAMSE birth cohort
- 2021
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Ingår i: Thorax. - : BMJ Publishing Group Ltd. - 0040-6376 .- 1468-3296. ; 76:5, s. 503-507
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Tidskriftsartikel (refereegranskat)abstract
- We aimed to determine prevalence and early-life risk factors for reversible and irreversible airflow limitation in young adults from the general population. Among young adults in their 20s, the prevalence was 5.3% for reversible airflow limitation and 2.0% for irreversible airflow limitation. While parental asthma was the only risk factor for development of reversible airflow limitation, the risk factors for development of irreversible airflow limitation were current asthma, childhood respiratory tract infections and asthma, and exposure to air pollution.
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| 3. |
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| 4. |
- Um-Bergström, Petra
(författare)
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From youth to adult : studies on chronic airway obstruction with special reference to events in the neonatal period
- 2019
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Introduction: In western countries, 6-12% of all pregnancies end preterm, i.e. before 37 weeks of gestation. After the introduction of antenatal corticosteroids and improvements of neonatal intensive care, survival rates for children born preterm have increased worldwide. In Sweden, 80% of infants born extremely preterm, i.e. before 28 weeks of gestation, survive. There is, however, an association between preterm birth and later sequelae. Pulmonary complications, such as bronchopulmonary dysplasia (BPD), may result in lung function impairment later in life. It has also been demonstrated that a significant proportion, around 20-25%, of patients with chronic obstructive pulmonary disease (COPD) have never smoked, suggesting other risk factors for developing chronic airway obstruction in adulthood. As there are now more survivors reaching adult life, individuals born preterm are expected to be an increasing group of patients in the future, contributing to the non- smoking proportion of patients with COPD. The overall aim of this thesis was therefore to extensively characterise clinical, functional and mechanistic aspects of pulmonary outcomes in adolescence and in adult age in individuals born preterm with and without BPD. Patients and methods: Individuals born before 32 weeks of gestation between 1992 and 1998 in Stockholm County were investigated both in adolescence (n= 51) and at adult age (n= 49). Half of the individuals born preterm had a diagnosis of BPD. In adult age two control groups of patients with allergic asthma (n= 23) and healthy individuals (n=24) were included. Information on perinatal data, medical history and health related quality of life (HRQoL) was collected. Lung function was measured using dynamic spirometry, body plethysmography diffusing capacity for carbon monoxide (DLCO), impulse oscillometry (IOS) and lung clearance index (LCI) for ventilation inhomogeneity. Bronchoscopy was performed in adults (mean age 20.0 years) including sampling of the large (bronchial wash), and small airways (bronchoalveolar lavage, BAL). Results: Both adolescents and adults with BPD demonstrated airway obstruction in contrast to individuals born preterm without BPD, but both groups had more airway hyper- responsiveness compared to healthy controls. In adulthood, the preterm group had lower DLCO irrespective of BPD status, but only those with BPD had signs of inhomogeneous ventilation. Adults with BPD reported fewer physical symptoms than asthmatic controls, despite lower lung function in the former group. Both preterm groups reported lower scores in the mental component summary of a questionnaire compared to healthy controls. In contrast to the asthmatic group, no eosinophilic inflammation was seen in the preterm group. In BAL, the preterm BPD group showed an increased proportion of activated cytotoxic T cells (CD8+), a decreased proportion of T helper cells (CD4+), and, as a consequence, a decreased CD4/CD8 ratio, when compared to the healthy controls. T-cell subsets in BAL correlated with measures of airflow limitation in individuals with BPD. Further, in bronchial wash, elevated proportion of lymphocytes was observed. A correlationof lymphocyte count with measures of airflow obstruction in the preterm born individuals was seen predominantly in males. Conclusions: Individuals born preterm with a history of BPD have obstructive airflow limitations engaging the small airways. Lymphocytes may have a sex-specific role, as an increased amount was found in the large airways in males with BPD. The increased proportion of cytotoxic (CD8+) T cells in BAL resemble features of COPD, and are compatible with the hypothesis that T-cells may play a mechanistic role in development of airway obstruction in adults with a history of BPD. 5
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| 5. |
- Um-Bergström, Petra, et al.
(författare)
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Lung function development after preterm birth in relation to severity of Bronchopulmonary dysplasia
- 2017
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Ingår i: BMC Pulmonary Medicine. - : BIOMED CENTRAL LTD. - 1471-2466. ; 17
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Tidskriftsartikel (refereegranskat)abstract
- Background: Bronchopulmonary dysplasia (BPD) is a strong risk factor for respiratory morbidity in children born preterm. Our aims were to evaluate lung function in adolescents born preterm with and without a history of BPD, and to assess lung function change over time from school age.Methods: Fifty-one individuals born in Stockholm, Sweden between gestational ages 24 to 31 weeks (23 neonatally diagnosed with respiratory distress syndrome (RDS) but not BPD, and 28 graded as mild (n = 17), moderate (n = 7) or severe (n = 4) BPD) were examined in adolescence (13-17 years of age) using spirometry, impulse oscillometry (IOS), plethysmography, and ergospirometry. Comparison with lung function data from school age (6-8 years of age) was also performed.Results: Adolescents with a history of BPD had lower forced expiratory volume in 1 s (FEV1) compared to those without BPD (-0.61 vs.-0.02 z-scores, P < 0.05), with lower FEV1 values significantly associated with BPD severity (P for trend 0.002). Subjects with severe BPD had higher frequency dependence of resistance, R5-20, (P < 0.001 vs. non-BPD subjects) which is an IOS indicator of peripheral airway involvement. Between school age and adolescence, FEV1/FVC z-scores decreased in all groups and particularly in the severe BPD group (from -1.68 z-scores at 6-8 years to -2.74 z-scores at 13-17 years, p < 0.05 compared to the non-BPD group).Conclusions: Our results of spirometry and IOS measures in the BPD groups compared to the non-BPD group suggest airway obstruction including involvement of peripheral airways. The longitudinal result of a decrease in FEV1/FVC in the group with severe BPD might implicate a route towards chronic airway obstruction in adulthood.
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