| 1. |
- Hedman, Linnea, et al.
(författare)
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Receiving support to quit smoking and quit attempts among smokers with and without smoking related diseases : Findings from the EUREST-PLUS ITC Europe Surveys
- 2018
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Ingår i: Tobacco Induced Diseases. - Heraklion : European Publishing. - 1617-9625. ; 16
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Tidskriftsartikel (refereegranskat)abstract
- INTRODUCTION Having a chronic disease either caused or worsened by tobacco smoking does not always translate into quitting smoking. Although smoking cessation is one of the most cost-effective medical interventions, it remains poorly implemented in healthcare settings. The aim was to examine whether smokers with chronic and respiratory diseases were more likely to receive support to quit smoking by a healthcare provider or make a quit attempt than smokers without these diseases.METHODS This population-based study included a sample of 6011 adult smokers in six European countries. The participants were interviewed face-to-face and asked questions on sociodemographic characteristics, current diagnoses for chronic diseases, healthcare visits in the last 12 months and, if so, whether they had received any support to quit smoking. Questions on smoking behavior included nicotine dependence, motivation to quit smoking and quit attempts in the last 12 months. The results are presented as weighted percentages with 95% confidence intervals (CI) and as adjusted odds ratios with 95% CI based on logistic regression analyses.RESULTS Smokers with chronic respiratory disease, those aged 55 years and older, as well as those with one or more chronic diseases were more likely to receive smoking cessation advice from a healthcare professional. Making a quit attempt in the last year was related to younger age, high educational level, higher motivation to quit, lower nicotine dependence and having received advice to quit from a healthcare professional but not with having chronic diseases. There were significant differences between countries with smokers in Romania consistently reporting more support to quit as well as quit attempts.CONCLUSIONS Although smokers with respiratory disease did indeed receive smoking cessation support more often than smokers without disease, many smokers did not receive any advice or support to quit during a healthcare visit.
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| 2. |
- Dolinska, Monika, et al.
(författare)
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Characterization of the bone marrow niche in patients with chronic myeloid leukemia identifies CXCL14 as a new therapeutic option
- 2023
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Ingår i: Blood. - : American Society of Hematology. - 0006-4971 .- 1528-0020. ; 142:1, s. 73-89
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Tidskriftsartikel (refereegranskat)abstract
- Although tyrosine kinase inhibitors (TKIs) are effective in treating chronic myeloid leukemia (CML), they often fail to eradicate the leukemia-initiating stem cells (LSCs), causing disease persistence and relapse. Evidence indicates that LSC persistence may be because of bone marrow (BM) niche protection; however, little is known about the underlying mechanisms. Herein, we molecularly and functionally characterize BM niches in patients with CML at diagnosis and reveal the altered niche composition and function in these patients. Long -term culture initiating cell assay showed that the mesenchymal stem cells from patients with CML displayed an enhanced supporting capacity for normal and CML BM CD34+CD38- cells. Molecularly, RNA sequencing detected dysregulated cytokine and growth factor expression in the BM cellular niches of patients with CML. Among them, CXCL14 was lost in the BM cellular niches in contrast to its expression in healthy BM. Restoring CXCL14 significantly inhibited CML LSC maintenance and enhanced their response to imatinib in vitro, and CML engraftment in vivo in NSG-SGM3 mice. Importantly, CXCL14 treatment dramatically inhibited CML engraftment in patient-derived xenografted NSG-SGM3 mice, even to a greater degree than imatinib, and this inhibition persisted in patients with suboptimal TKI response. Mechanistically, CXCL14 upregulated inflammatory cytokine signaling but downregulated mTOR signaling and oxidative phosphorylation in CML LSCs. Together, we have discovered a suppressive role of CXCL14 in CML LSC growth. CXCL14 might offer a treatment option targeting CML LSCs.
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| 3. |
- Lindberg, Anne, et al.
(författare)
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Large underreporting of COPD as cause of death-results from a population-based cohort study
- 2021
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Ingår i: Respiratory Medicine. - : Elsevier BV. - 0954-6111 .- 1532-3064. ; 186
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Tidskriftsartikel (refereegranskat)abstract
- Background: In 2019, WHO estimated COPD to be the third leading cause of death in the world. However, COPD is probably underestimated as cause of death due to the well-known under-diagnosis. Aim: To evaluate the proportion of and factors associated with COPD recorded as cause of death in a long-term follow-up of a population-based COPD cohort. Methods: The study population includes all individuals (n = 551) with COPD defined as chronic airway obstruction (post-bronchodilator FEV1/FVC<0.70) + respiratory symptoms identified after re-examinations of four population-based cohorts. Mortality and underlying or contributing cause of death following ICD-10 classification were collected from the Swedish National Board of Health and Welfares register from date of examination in 2002-04 until 2016. Results: The study sample consisted of 32.3% GOLD 1, 55.9% GOLD 2, and 11.8% GOLD 3-4. The mean follow-up time was 10.3 (SD3.77) years and the cumulative mortality 45.0%. COPD (ICD-10 J43-J44) was recorded on 28.2% (n = 70) of the death certificates (11.1%, 25.7% and 57.1% by GOLD stage), whereof n = 35 had COPD recorded as underlying and n = 35 as contributing cause of death. To have COPD recorded as cause of death was independently associated with ex- and current smoking and a self-reported physician diagnosis of COPD, while male sex, overweight/obesity and higher FEV1% of predicted associated with the absence. Conclusions: COPD was largely underreported cause of death. Even among those with severe/very severe disease, COPD was only mentioned on 57.1% of the death certificates.
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| 4. |
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| 5. |
- Lindberg, Sara, et al.
(författare)
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Expanded HILUS Trial: A Pooled Analysis of Risk Factors for Toxicity From Stereotactic Body Radiation Therapy of Central and Ultracentral Lung Tumors
- 2023
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Ingår i: INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS. - 0360-3016 .- 1879-355X. ; 117:5, s. 1222-1231
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: Stereotactic body radiation therapy for tumors near the central airways implies high-grade toxic effects, as concluded from the HILUS trial. However, the small sample size and relatively few events limited the statistical power of the study. We therefore pooled data from the prospective HILUS trial with retrospective data from patients in the Nordic countries treated outside the prospective study to evaluate toxicity and risk factors for high-grade toxic effects. Methods and Materials: All patients were treated with 56 Gy in 8 fractions. Tumors within 2 cm of the trachea, the mainstem bronchi, the intermediate bronchus, or the lobar bronchi were included. The primary endpoint was toxicity, and the secondary endpoints were local control and overall survival. Clinical and dosimetric risk factors were analyzed for treatment-related fatal toxicity in univariable and multivariable Cox regression analyses.Results: Of 230 patients evaluated, grade 5 toxicity developed in 30 patients (13%), of whom 20 patients had fatal bronchopul-monary bleeding. The multivariable analysis revealed tumor compression of the tracheobronchial tree and maximum dose to the mainstem or intermediate bronchus as significant risk factors for grade 5 bleeding and grade 5 toxicity. The 3-year local control and overall survival rates were 84% (95% CI, 80%-90%) and 40% (95% CI, 34%-47%), respectively.Conclusions: Tumor compression of the tracheobronchial tree and high maximum dose to the mainstem or intermediate bronchus increase the risk of fatal toxicity after stereotactic body radiation therapy in 8 fractions for central lung tumors. Simi-lar dose constraints should be applied to the intermediate bronchus as to the mainstem bronchi.
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| 6. |
- Malinovschi, Andrei, 1978-, et al.
(författare)
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Consequences of Using Post- or Prebronchodilator Reference Values in Interpreting Spirometry
- 2023
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Ingår i: American Journal of Respiratory and Critical Care Medicine. - : American Thoracic Society. - 1073-449X .- 1535-4970. ; 208:4, s. 461-471
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Tidskriftsartikel (refereegranskat)abstract
- RATIONALE: Post-bronchodilator (BD) spirometry is used for diagnosis of chronic obstructive pulmonary disease (COPD). However, pre-BD reference values are used for spirometry interpretation.OBJECTIVES: To compare the resulting prevalence rates of abnormal spirometry and study the consequences of using pre- or post-BD reference values generated within the Swedish CArdioPulmonary bioImage Study (SCAPIS) when interpreting post-BD spirometry in a general population.METHODS: SCAPIS reference values for post-BD and pre-BD spirometry were based on 10,156 and 1,498 never-smoking, healthy participants, respectively. We studied the associations of abnormal spirometry, defined by using pre- or post-BD reference values, with respiratory burden in the SCAPIS general population (28,851 individuals).MEASUREMENTS AND MAIN RESULTS: Bronchodilation resulted in higher predicted median and lower limit of normal (LLN) for FEV1/FVC ratio. The prevalence of post-BD FEV1/FVC < pre-bronchodilator LLN was 4.8% and that of post-BD FEV1/FVC < post-bronchodilator LLN was 9.9% for the general population. An additional 5.1% was identified as having an abnormal post-BD FEV1/FVC ratio and this group had more respiratory symptoms, emphysema (13.5% vs. 4.1%, p<0.001) and self-reported physician-diagnosed COPD (2.8% vs. 0.5%, p<0.001) than subjects with post-BD FEV1/FVC ratio > LLN for both pre- and post-bronchodilation).CONCLUSIONS: Pre- and post-bronchodilator spirometry reference values differ with regard to FEV1/FVC ratio. Use of post-bronchodilator reference values doubled the population prevalence of airflow obstruction; this was related to a higher respiratory burden. Using post-bronchodilator reference values when interpreting post-bronchodilator spirometry might enable identification of individuals with mild disease and be clinically relevant.
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| 7. |
- Torén, Kjell, 1952, et al.
(författare)
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Chronic airflow limitation and its relation to respiratory symptoms among ever-smokers and never-smokers: a cross-sectional study
- 2020
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Ingår i: Bmj Open Respiratory Research. - : BMJ. - 2052-4439. ; 7:1
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Tidskriftsartikel (refereegranskat)abstract
- Background The diagnosis of chronic obstructive pulmonary disease is based on the presence of persistent respiratory symptoms and chronic airflow limitation (CAL). CAL is based on the ratio of forced expiratory volume in 1 s to forced vital capacity (FEV1:FVC) after bronchodilation, and FEV1:FVC less than the fifth percentile is often used as a cut-off for CAL. The aim was to investigate if increasing percentiles of FEV1:FVC were associated withany respiratory symptom(cough with phlegm, dyspnoea or wheezing) in a general population sample of never-smokers and ever-smokers. Methods In a cross-sectional study comprising 15 128 adults (50-64 years), 7120 never-smokers and 8008 ever-smokers completed a respiratory questionnaire and performed FEV(1)and FVC after bronchodilation. We calculated theirz-scores for FEV1:FVC and defined the fifth percentile using the Global Lung Function Initiative (GLI) reference value, GLI(5)and increasing percentiles up to GLI(25). We analysed the associations between different strata of percentiles and prevalence ofany respiratory symptomusing multivariable logistic regression for estimation of OR. Results Among all subjects, regardless of smoking habits, the odds ofany respiratory symptomwere elevated up to the GLI(15-20)strata. Among never-smokers, the odds ofany respiratory symptomwere elevated at GLI(<5)(OR 3.57, 95% CI 2.43 to 5.23) and at GLI(5-10)(OR 2.57, 95% CI 1.69 to 3.91), but not at higher percentiles. Among ever-smokers, the odds ofany respiratory symptomwere elevated from GLI(<5)(OR 4.64, 95% CI 3.79 to 5.68) up to GLI(>= 25)(OR 1.33, 95% CI 1.00 to 1.75). Conclusions The association between percentages of FEV1:FVC and respiratory symptoms differed depending on smoking history. Our results support a higher percentile cut-off for FEV1:FVC for never-smokers and, in particular, for ever-smokers.
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| 8. |
- Torén, Kjell, 1952, et al.
(författare)
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The ratio FEV1/FVC and its association to respiratory symptoms-A Swedish general population study
- 2021
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Ingår i: Clinical Physiology and Functional Imaging. - : Wiley. - 1475-0961 .- 1475-097X. ; 41:2, s. 181-191
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Tidskriftsartikel (refereegranskat)abstract
- Chronic airflow limitation (CAL) can be defined as fixed ratio of forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC) any respiratory symptom. In a cross-sectional general population study, 15,128 adults (50-64 years of age), 7,120 never-smokers and 8,008 ever-smokers completed a respiratory questionnaire and performed FEV1 and FVC after bronchodilation. We calculated different ratios of FEV1/FVC from 0.40 to 1.0 using 0.70 as reference category. We analysed odds ratios (OR) between different ratios and any respiratory symptom using adjusted multivariable logistic regression. Among all subjects, regardless of smoking habits, the lowest odds for any respiratory symptom was at FEV1/FVC = 0.82, OR 0.48 (95% CI 0.41-0.56). Among never-smokers, the lowest odds for any respiratory symptom was at FEV1/FVC = 0.81, OR 0.53 (95% CI 0.41-0.70). Among ever-smokers, the odds for any respiratory symptom was lowest at FEV1/FVC = 0.81, OR 0.43 (95% CI 0.16-1.19), although the rate of inclining in odds was small in the upper part, that is FEV1/FVC = 0.85 showed similar odds, OR 0.45 (95% CI 0.38-0.55). We concluded that the odds for any respiratory symptoms continuously decreased with higher FEV1/FVC ratios and reached a minimum around 0.80-0.85, with similar results among never-smokers. These results indicate that the optimal threshold associated with respiratory symptoms may be higher than 0.70 and this should be further investigated in prospective longitudinal studies.
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| 9. |
- Toren, Kjell, et al.
(författare)
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Vital capacity and COPD : the Swedish CArdioPulmonary bioImage Study (SCAPIS)
- 2016
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Ingår i: The International Journal of Chronic Obstructive Pulmonary Disease. - : DOVE MEDICAL PRESS LTD. - 1176-9106 .- 1178-2005. ; 11, s. 927-933
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Tidskriftsartikel (refereegranskat)abstract
- Background: Spirometric diagnosis of chronic obstructive pulmonary disease (COPD) is based on the ratio of forced expiratory volume in 1 second (FEV1)/vital capacity (VC), either as a fixed value <0.7 or below the lower limit of normal (LLN). Forced vital capacity (FVC) is a proxy for VC. The first aim was to compare the use of FVC and VC, assessed as the highest value of FVC or slow vital capacity (SVC), when assessing the FEV1/VC ratio in a general population setting. The second aim was to evaluate the characteristics of subjects with COPD who obtained a higher SVC than FVC. Methods: Subjects (n=1,050) aged 50-64 years were investigated with FEV1, FVC, and SVC after bronchodilation. Global Initiative for Chronic Obstructive Lung Disease (GOLD) COPDFVC was defined as FEV1/FVC <0.7, GOLDCOPD(VC) as FEV1/VC <0.7 using the maximum value of FVC or SVC, LLNCOPDFVC as FEV1/FVC below the LLN, and LLNCOPDVC as FEV1/VC below the LLN using the maximum value of FVC or SVC. Results: Prevalence of GOLDCOPD(FVC) was 10.0% (95% confidence interval [CI] 8.2-12.0) and the prevalence of LLNCOPDFVC was 9.5% (95% CI 7.8-11.4). When estimates were based on VC, the prevalence became higher; 16.4% (95% CI 14.3-18.9) and 15.6% (95% CI 13.5-17.9) for GOLDCOPD(VC) and LLNCOPDVC, respectively. The group of additional subjects classified as having COPD based on VC, had lower FEV1, more wheeze and higher residual volume compared to subjects without any COPD. Conclusion: The prevalence of COPD was significantly higher when the ratio FEV1/VC was calculated using the highest value of SVC or FVC compared with using FVC only. Subjects classified as having COPD when using the VC concept were more obstructive and with indications of air trapping. Hence, the use of only FVC when assessing airflow limitation may result in a considerable under diagnosis of subjects with mild COPD.
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| 10. |
- Almqvist, Linnéa, et al.
(författare)
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Clinical outcome of adult onset asthma in a 15 year follow-up
- 2020
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Ingår i: European Respiratory Journal. - : European Respiratory Society (ERS). - 0903-1936 .- 1399-3003. ; 56:Suppl 64
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Background: Adult onset asthma is poorly studied and there are few long-term clinical follow-up studies.Aim: To study clinical characteristics of adult onset asthma in a 15-year follow-up.Method: Within the Obstructive Lung Disease in Northern Sweden (OLIN) studies, a cohort of n=309 subjects with adult onset asthma (aged 20-60 years) was recruited during 1995-99. The cohort was followed up in 2012-14 (n=205). Structured interviews and clinical examinations including spirometry were performed at both recruitment and follow-up. Skin prick tests were performed at recruitment and blood samples for cell counts and IgE at the follow-up. Asthma control was classified according to GINA 2006.Results: At follow-up n=182 (89%) still had asthma, while n=23 (11%) were in remission. Among individuals with persistent asthma, mean pre-bronchodilator FEV1 percent of predicted was 89.0 at follow-up, similar as recruitment 88.3. At recruitment 16.5% were smokers, and of these, 86.7% had quit smoking at follow-up. At follow-up, 39% had blood neutrophils ≥4.0x109/L, 23% had blood eosinophils ≥0.3x109/L, and 28% had specific IgE>0.35 IU/ml to any airborne allergen. Any respiratory symptoms were reported by 90% and 31% used medium or high dose inhaled corticosteroids (ICS), 20% low dose ICS whereas 20% had no treatment. 55% had controlled asthma, 32% partly controlled and 13% uncontrolled asthma.Conclusion: In this 15-year follow-up of adult onset asthma, the majority had persistent asthma. Smoking and high proportion using ICS may contribute to the stable lung function. Still, it should be noted that merely around every other had well controlled asthma.
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| 11. |
- Almqvist, Linnéa, et al.
(författare)
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Remission of adult-onset asthma is rare: a 15-year follow-up study
- 2020
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Ingår i: Erj Open Research. - : European Respiratory Society (ERS). - 2312-0541. ; 6:4
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Tidskriftsartikel (refereegranskat)abstract
- Background: There are few long-term clinical follow-up studies of adult-onset asthma. The aim of this article was to study clinical characteristics of adult-onset asthma in relation to remission and persistence of the disease in a 15-year follow-up. Methods: A cohort of 309 adults aged 20-60 years with asthma onset during the last 12 months verified by bronchial variability, was recruited between 1995 and 1999 from the general population in northern Sweden. The cohort was followed-up in 2003 (n=250) and between 2012 and 2014 (n=205). Structured interviews and spirometry were performed at recruitment and the follow-ups. Bronchial hyperreactivity (BHR) and skin-prick tests were performed at recruitment and blood samples were collected at the last follow-up. Remission of asthma was defined as no asthma symptoms and no use of asthma medication during the last 12 months. Results: Of eight individuals in remission in 2003, five had relapsed between 2012 and 2014 and in total, 23 (11%) were in remission, while 182 had persistent asthma. Those in remission had higher mean forced expiratory volume in 1 s % predicted at recruitment than those with persistent asthma (94.6 versus 88.3, p=0.034), fewer had severe BHR (27.3% versus 50.9%, p=0.037) and they had less body mass index increase (+1.6 versus +3.0, p=0.054). Of those with persistent asthma, 13% had uncontrolled asthma and they had higher levels of blood neutrophils than those with partly controlled or controlled asthma. Conclusion: Higher forced expiratory volume in 1 s % predicted and less-severe BHR was associated with remission of adult-onset asthma, but still, the proportion in remission in this 15-year follow-up was low.
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| 12. |
- Andersson, Mikael, et al.
(författare)
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Physical activity and fatigue in chronic obstructive pulmonary disease : A population based study
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- IntroductionDyspnea with exertion and fatigue are the cardinal symptoms of chronic obstructive pulmonary disease (COPD); impaired muscle function and reduced exercise capacity are also frequently associated with COPD. We aimed to assess the physical activity levels, in a population based sample study, of subjects with and without COPD. We also aimed to investigate the factors associated with low physical activity in these groups.MethodsIn this study, 470 subjects with COPD (FEV1/FVC< 0.70) and 569 subjects without COPD (Non-COPD) were analyzed. Physical activity was assessed with the International Physical Activity Questionnaire (IPAQ). Fatigue was investigated with the Functional Assessment of Chronic Illness Therapy - Fatigue scale (FACIT-F). An interview questionnaire was used to record the sample characteristics and history of heart disease. Binary logistic regression was used to investigate the factors associated with low physical activity.ResultsLow physical activity was significantly more prevalent in GOLD grade ≥II COPD subjects, and this prevalence was higher than that for Non-COPD subjects (22.4 vs. 14.6%, p = 0.016). The strongest factors associated with low physical activity in COPD subjects were a history of heart disease, OR (CI 95%) 2.11 (1.10 - 4.08), and clinically significant fatigue, OR 2.33 (1.31 - 4.13); obesity was the only significant factor in Non-COPD subjects, OR 2.26 (1.17 – 4.35).ConclusionPhysical activity levels are reduced for COPD grade II and higher, and the factors associated with lower levels of physical activity are different for the COPD group compared to the Non-COPD group. We propose that measurements of fatigue and a history of heart disease are useful tools to include when screening subjects for pulmonary rehabilitation.
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| 13. |
- Andersson, Mikael, et al.
(författare)
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Physical activity and fatigue in chronic obstructive pulmonary disease - A population based study
- 2015
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Ingår i: Respiratory Medicine. - : Elsevier BV. - 0954-6111 .- 1532-3064. ; 109:8, s. 1048-1057
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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.
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| 14. |
- Axelsson, Malin, et al.
(författare)
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Differences in diagnostic patterns of obstructive airway disease between areas and sex in Sweden and Finland : The Nordic EpiLung Study
- 2021
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Ingår i: Journal of Asthma. - : Taylor & Francis. - 0277-0903 .- 1532-4303. ; 58:9, s. 1196-1207
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To investigate the current prevalence of physician-diagnosed obstructive airway diseases by respiratory symptoms and by sex in Sweden and Finland. Method: In 2016, a postal questionnaire was answered by 34,072 randomly selected adults in four study areas: Västra Götaland and Norrbotten in Sweden, and Seinäjoki-Vaasa and Helsinki in Finland. Results: The prevalence of asthma symptoms was higher in Norrbotten (13.2%), Seinäjoki-Vaasa (14.8%) and Helsinki (14.4%) than in Västra Götaland (10.7%), and physician-diagnosed asthma was highest in Norrbotten (13.0%) and least in Västra Götaland (10.1%). Chronic productive cough was most common in the Finnish areas (7.7-8.2 % versus 6.3-6.7 %) while the prevalence of physician-diagnosed chronic bronchitis (CB) or chronic obstructive pulmonary disease (COPD) varied between 1.7-2.7% in the four areas. Among individuals with respiratory symptoms, the prevalence of asthma was most common in Norrbotten, while a diagnosis of COPD or CB was most common in Västra Götaland and Seinäjoki-Vaasa. More women than men with respiratory symptoms reported a diagnosis of asthma in Sweden and Seinäjoki-Vaasa but there were no sex differences in Helsinki. In Sweden, more women than men with symptoms of cough or phlegm reported a diagnosis of CB or COPD, while in Finland the opposite was found. Conclusion: The prevalence of respiratory symptoms and corresponding diagnoses varied between and within the countries. The proportion reporting a diagnosis of obstructive airway disease among individuals with respiratory symptoms varied, indicating differences in diagnostic patterns both between areas and by sex.
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| 15. |
- Axelsson, Malin, et al.
(författare)
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Respiratory symptoms increase health care consumption and affect the everyday life : a cross-sectional population-based study from Finland, Estonia and Sweden
- 2016
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Ingår i: European Clinical Respiratory Journal. - : Co-Action. - 2001-8525. ; 3
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Tidskriftsartikel (refereegranskat)abstract
- Background: Even though respiratory symptoms are common in the adult population, there is limited research describing their impact on everyday life and association with health care consumption. Aim: The main objective of this population-based study was to estimate and compare the prevalence of respiratory symptoms among adults in Finland, Estonia, and Sweden in relation to health care consumption and to identify factors influencing health care consumption. A secondary aim was to assess to which extent the presence of respiratory symptoms affect everyday life. Method: In the population-based FinEsS studies consisting of random samples of subjects aged 20 to 69 years from Finland (n 1,337), Estonia (n 1,346), and Sweden (n 1,953), data on demographics, respiratory health, and health care consumption were collected by structured interviews. Prevalence was compared and multiple logistic regression analyses were performed. Results: Respiratory symptoms were significantly more common in Finland (66.0%) and Estonia (65.2%) than in Sweden (54.1%). Among subjects with respiratory symptoms, the proportion reporting outpatient care during the past year was fairly similar in the three countries, while specialist consultations were more common in Finland (19.1%), and hospitalisations more common in Estonia (15.0%). Finnish and Estonian residency, female sex, and BMI 25 increased the risk for outpatient care consumption. Wheeze and attacks of shortness of breath in the past 12 months, recurrent sputum production, and cough were associated with an increased risk for health care consumption. Increasing number of respiratory symptoms increased the risk for consuming health care. A larger proportion of subjects in Estonia and Sweden experienced their everyday life being affected by respiratory symptoms compared with subjects in Finland. Conclusion: Respiratory symptoms are common in Finland, Estonia, and Sweden and contribute to a negative impact on everyday life as well as increased health care consumption. The observed differences in health care consumption between countries are probably related to national differences in health care structure.
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| 16. |
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| 17. |
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| 18. |
- Axelsson, Malin, 1964-, et al.
(författare)
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Underdiagnosis and misclassification of COPD in Sweden - A Nordic Epilung study
- 2023
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Ingår i: Respiratory Medicine. - : Elsevier. - 0954-6111 .- 1532-3064. ; 217
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: The prevalence of COPD tends to level off in populations with decreasing prevalence of smoking but the extent of underdiagnosis in such populations needs further investigation.Aim: To investigate underdiagnosis and misclassification of COPD with a focus on socio-economy, lifestyle determinants and healthcare utilization.Method: The 1839 participants were selected from two ongoing large-scale epidemiological research programs: The Obstructive Lung Disease in Northern Sweden Studies and the West Sweden Asthma Study. COPDGOLD was defined according to the fixed post-bronchodilator spirometric criteria FEV1/FVC<0.70 in combination with respiratory symptoms. Results: Among the 128 participants who fulfilled the criteria for COPDGOLD, the underdiagnosis was 83.6% (n = 107) of which 57.9% were men. The undiagnosed participants were younger, had higher FEV1% of predicted and less frequently a family history of bronchitis. One in four of the undiagnosed had utilized healthcare and had more frequently utilized healthcare due to a burden of respiratory symptoms than the general population without COPD. Underdiagnosis was not related to educational level. Misclassification of COPD was characterized by being a woman with low education, ever smoker, having respiratory symptoms and having a previous asthma diagnosis.Conclusion: In the high income country Sweden, the underdiagnosis of COPD was highly prevalent. Reduced underdiagnosis can contribute to risk factor modification, medical treatment and self-management strategies in early stages of the disease, which may prevent disease progression and improve the quality of life among those affected. Therefore, there is a need to increase the use of spirometry in primary care to improve the diagnostic accuracy.
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| 19. |
- Backman, Helena, et al.
(författare)
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A population-based cohort of adults with asthma: mortality and participation in a long-term follow-up
- 2017
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Ingår i: European Clinical Respiratory Journal. - : Informa UK Limited. - 2001-8525. ; 4
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Tidskriftsartikel (refereegranskat)abstract
- Background and objective: Asthma is a major public health concern. The aim of this study was to characterize a large population-based cohort of adults with asthma, and to study factors associated with all-cause mortality and non-participation in a long-term follow-up. Design: Random and stratified samples from five population-based cohorts were clinically examined during 1986-2001, and all subjects with asthma were included in the study (n = 2055, age 19-72 years, 55% women). Independent associations between different risk factors and (i) mortality and (ii) non-participation in a clinical follow-up in 2012-2014 were estimated. Results: In 1986-2001, 95% reported any wheeze and/or attacks of shortness of breath in the past 12 months, and/or asthma medication use. Over the up to 28 years of follow-up time, the cumulative mortality was 22.7%. Male gender, current smoking, and lower forced expiratory volume in 1 sec of predicted (FEV1% of predicted) were independent risk factors for mortality, while obesity was associated with non-participation in the follow-up. Older ages, ischemic heart disease, and low socioeconomic status were associated with both mortality and non-participation. Conclusions: The risk factors associated with mortality in this adult population-based asthma cohort were similar to those commonly identified in general population samples, i.e. male gender, current smoking, and lower FEV1% of predicted, while obesity was associated with non-participation in a long-term follow-up. Ischemic heart disease, low socioeconomic status, and older ages were associated with both mortality and non-participation.
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| 20. |
- Backman, Helena, et al.
(författare)
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All-cause and cause-specific mortality by spirometric pattern and sex - a population-based cohort study
- 2024
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Ingår i: THERAPEUTIC ADVANCES IN RESPIRATORY DISEASE. - : Sage Publications. - 1753-4658 .- 1753-4666. ; 18
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Tidskriftsartikel (refereegranskat)abstract
- Background: Chronic airway obstruction (CAO) and restrictive spirometry pattern (RSP) are associated with mortality, but sex-specific patterns of all-cause and specific causes of death have hardly been evaluated. Objectives: To study the possible sex-dependent differences of all-cause mortality and patterns of cause-specific mortality among men and women with CAO and RSP, respectively, to that of normal lung function (NLF). Design: Population-based prospective cohort study. Methods: Individuals with CAO [FEV1/vital capacity (VC) < 0.70], RSP [FEV1/VC >= 0.70 and forced vital capacity (FVC) < 80% predicted] and NLF (FEV1/VC >= 0.70 and FVC >= 80% predicted) were identified within the Obstructive Lung Disease in Northern Sweden (OLIN) studies in 2002-2004. Mortality data were collected through April 2016, totally covering 19,000 patient-years. Cox regression and Fine-Gray regression accounting for competing risks were utilized to estimate hazard ratios (HRs) with 95% confidence intervals (CIs) adjusted for age, body mass index, sex, smoking habits and pack-years. Results: The adjusted hazard for all-cause mortality was higher in CAO and RSP than in NLF (HR, 95% CI; 1.69, 1.31-2.02 and 1.24, 1.06-1.71), and the higher hazards were driven by males. CAO had a higher hazard of respiratory and cardiovascular death than NLF (2.68, 1.05-6.82 and 1.40, 1.04-1.90). The hazard of respiratory death was significant in women (3.41, 1.05-11.07) while the hazard of cardiovascular death was significant in men (1.49, 1.01-2.22). In RSP, the higher hazard for respiratory death remained after adjustment (2.68, 1.05-6.82) but not for cardiovascular death (1.11, 0.74-1.66), with a similar pattern in both sexes. Conclusion: The higher hazard for all-cause mortality in CAO and RSP than in NLF was male driven. CAO was associated with respiratory death in women and cardiovascular death in men, while RSP is associated with respiratory death, similarly in both sexes.
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| 21. |
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| 22. |
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| 23. |
- Backman, Helena, et al.
(författare)
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Chronic airway obstruction in a population-based adult asthma cohort : Prevalence, incidence and prognostic factors
- 2018
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Ingår i: Respiratory Medicine. - : Elsevier. - 0954-6111 .- 1532-3064. ; 138, s. 115-122
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundAsthma and COPD may overlap (ACO) but information about incidence and risk factors are lacking. This study aimed to estimate prevalence, incidence and risk factors of chronic airway obstruction (CAO) in a population-based adult asthma cohort.MethodsDuring 1986–2001 a large population-based asthma cohort was identified (n = 2055, 19-72y). Subsamples have participated in clinical follow-ups during the subsequent years. The entire cohort was invited to a clinical follow-up including interview, spirometry, and blood sampling in 2012–2014 when n = 983 subjects performed adequate spirometry. CAO was defined as post-bronchodilator FEV1/FVC<0.7.ResultsAt study entry, asthmatics with prevalent CAO (11.4%) reported more respiratory symptoms, asthma medication use, and ischemic heart disease than asthmatics without CAO (asthma only). Subjects who developed CAO during follow-up (17.6%; incidence rate of 16/1000/year) had a more rapid FEV1 decline and higher levels of neutrophils than asthma only. Smoking, older age and male sex were independently associated with increased risk for both prevalent and incident CAO, while obesity had a protective effect.ConclusionsIn this prospective adult asthma cohort, the majority did not develop CAO. Smoking, older age and male sex were risk factors for prevalent and incident CAO, similar to risk factors described for COPD in the general population.
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| 24. |
- Backman, Helena, et al.
(författare)
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Decrease in prevalence of COPD in Sweden after decades of decrease in smoking
- 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
- Background: The smoking prevalence in Sweden has steadily decreased during three decades. The prevalence of COPD in Sweden in the 1990s and around the millennium shift was similar to neighboring European countries, i.e. estimated at 11-17%, and of moderate to severe COPD to 7-11%, in ages over 40y.Aim: Has the prevalence of chronic airway obstruction (CAO) and of COPD in Sweden decreased after decades of decreasing smoking prevalence?Methods: Within two large scale population studies in progress, the West Sweden Asthma Study (WSAS) and the Obstructive Lung Disease in Northern Sweden Studies (OLIN), the prevalence of COPD in ages 41-72y was calculated among randomly selected subjects from the general population in 2009-2012. The following post-bronchodilator definitions were used; CAO: FEV1/FVCResults: The prevalence of CAO based on the FEV1/FVCConclusion: As prevalence of COPD defined as chronic airway obstruction before and around the millennium shift was estimated at 11-17% in ages >40 years, the prevalence of COPD has decreased in Sweden, and the decrease in smoking over decades is probably the main causal factor.
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| 25. |
- Backman, Helena, et al.
(författare)
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Decreased COPD prevalence in Sweden after decades of decrease in smoking
- 2020
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Ingår i: Respiratory Research. - : Springer Nature. - 1465-9921 .- 1465-993X. ; 21
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundCOPD has increased in prevalence worldwide over several decades until the first decade after the millennium shift. Evidence from a few recent population studies indicate that the prevalence may be levelling or even decreasing in some areas in Europe. Since the 1970s, a substantial and ongoing decrease in smoking prevalence has been observed in several European countries including Sweden. The aim of the current study was to estimate the prevalence, characteristics and risk factors for COPD in the Swedish general population. A further aim was to estimate the prevalence trend of COPD in Northern Sweden from 1994 to 2009.MethodsTwo large random population samples were invited to spirometry with bronchodilator testing and structured interviews in 2009–2012, one in south-western and one in northern Sweden, n = 1839 participants in total. The results from northern Sweden were compared to a study performed 15 years earlier in the same area and age-span. The diagnosis of COPD required both chronic airway obstruction (CAO) and the presence of respiratory symptoms, in line with the GOLD documents since 2017. CAO was defined as post-bronchodilator FEV1/FVC < 0.70, with sensitivity analyses based on the FEV1/FVC < lower limit of normal (LLN) criterion.ResultsBased on the fixed ratio definition, the prevalence of COPD was 7.0% (men 8.3%; women 5.8%) in 2009–2012. The prevalence of moderate to severe (GOLD ≥ 2) COPD was 3.5%. The LLN based results were about 30% lower. Smoking, occupational exposures, and older age were risk factors for COPD, whereof smoking was the most dominating risk factor. In northern Sweden the prevalence of COPD, particularly moderate to severe COPD, decreased significantly from 1994 to 2009, and the decrease followed a decrease in smoking.ConclusionsThe prevalence of COPD has decreased in Sweden, and the prevalence of moderate to severe COPD was particularly low. The decrease follows a major decrease in smoking prevalence over several decades, but smoking remained the dominating risk factor for COPD.
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