| 1. |
- Allinson, James, et al.
(författare)
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Collating data from major European population studies - The CADSET (Chronic airway disease early stratification) clinical research collaboration
- 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: European population cohorts continue to expand our understanding of chronic airways disease and inter-study collaboration may help address the inevitable limitations of study size, duration, era and geography. Towards this aim, CADSET has collated data from ten major general population European cohorts: Asklepios; Copenhagen City Heart Study; Copenhagen General Population Study; ECRHS; HUNT; LEAD; Lifelines, OLIN, Rotterdam Study and WSAS. We included males and females aged 20 to 95 years with baseline demographic and spirometry data.Results: Data from 262,829 individuals (44% male) from multiple European countries provided good coverage across all adult ages (Fig.1A). Recruitment occurred in every year from 1976 through 2020. 23% were current-smokers and 42% were never-smokers, a pattern varying with advancing age (Fig.1B). The prevalence of airflow limitation varied according to whether lower limit of normal (LLN) or <0.70 thresholds were applied, increasing with age if the latter was used (Fig.1C).Interpretation: These results fit with previous reports, however the size, geographical reach and span of recruitment provided by this collaboration provides a unique opportunity to explore chronic airways disease development. Together, we are now pursuing research questions previously beyond the scope of individual cohort studies.
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| 2. |
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| 3. |
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| 4. |
- 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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| 5. |
- 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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| 6. |
- Backman, Helena, et al.
(författare)
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Risk factors for severe asthma among adults with asthma
- 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: Severe asthma is a considerable challenge for patients, health care professionals and society, but there are few long-term studies on risk factors for severe asthma.Aim: To identify baseline risk factors of severe asthma in a longitudinal adult asthma cohort study.Methods: An adult asthma cohort was identified in 1986-2001 by clinical examinations of population samples within the OLIN studies in northern Sweden. The examinations included structured interviews, spirometry with reversibility testing, skin prick testing and metacholine challenge. The cohort was followed up in 2012-2014 when n=1006 participated (mean age 59y). Adjusted Risk Ratios (RR) for baseline factors as risk factors for GINA defined severe asthma (SA) at follow-up (n=51) were estimated by Poisson regression.Results: Older age, impaired lung function, increased reversibility and hyperreactivity, asthmatic wheeze, persistent wheeze, nighttime awakenings due to respiratory symptoms, and dyspnea were significant baseline risk factors for SA. Allergic sensitization, smoking, occupational groups or BMI did not predict SA. When adjusted for age, sex and smoking, post-bronchodilator FEV1/FVC<0.7, both present at baseline (RR 4.2, 95%CI 1.8-9.9) and developed during follow-up (2.9, 1.6-5.3), increased the risk. Also FEV1<80% at baseline associated with SA (2.9, 1.6-5.2). Triggers for respiratory symptoms at baseline such as tobacco smoke (2.1, 1.2-3.7) and physical activity (3.5, 1.5-81) associated with SA at follow-up, while pollen and furry animals did not.Conclusion: Among adults with asthma, impaired lung function, wheeze, dyspnea and nighttime awakenings due to respiratory symptoms are important long-term risk factors for severe asthma.
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| 7. |
- Backman, Helena, et al.
(författare)
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Severe asthma among adults : Prevalence and clinical characteristics
- 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: 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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| 9. |
- Hisinger-Molkanen, Hanna, et al.
(författare)
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Asthma in adults : association of asthma symptoms and age at asthma diagnosis
- 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: Asthma may begin at any age. However, knowledge about the relationship between age at asthma diagnosis and asthma symptoms is still scarce.Objectives: To test the hypothesis that among adults, asthma diagnosed in adulthood is associated with more symptoms than asthma diagnosed in childhood.Methods: A FinEsS postal survey was conducted in a random sample of 16000 20-69-year-old adults in Finland in 2016. Age 18 years was chosen to delineate child and adult-diagnosed asthma. Current asthma was defined as physician-diagnosed asthma and asthma medication use, attacks of breathlessness or wheezing in the past year.Results: Of responders (8199, 51,5%), 692 reported current asthma and age at diagnosis. Adult-diagnosed asthma was reported by 445 (64.3%) and child-diagnosed by 247 (35.7%) responders. Those with adult-diagnosed asthma had more attacks of breathlessness in the past year (82.9% vs. 74.1%, p=0.006), dyspnea (mMRC grade ≥2) (34.4% vs. 18.8%, p<0.001) and sputum production in the past three consecutive months (40.0% vs. 27.5%, p=0.001). Of responders with adult and child-diagnosed asthma, 22.5% and 28.3% were current smokers, and 91.7% and 84.2% used asthma medication, respectively. In a logistic regression model, risk factors for attacks of breathlessness were adult-diagnosis (OR=1.8, 95% CI 1.1-3.0) and exercising <2 times a week (OR=2.0, 1.2-3.2).Conclusion: Asthmatics with adult-diagnosed asthma had significantly more symptoms even though they smoked less and used asthma medication more often compared to those with child-diagnosed asthma. Recognizing adult onset asthma in clinical practise is important to direct precise clinical care and achieve better asthma control.
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| 10. |
- Honkamaki, Jasmin, et al.
(författare)
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Age at asthma diagnosis and probability of remission in a population-based study
- 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: Child-onset asthma is known to remit with high probability but remission in adult-onset asthma seems to be less common. Reports of association between remission and asthma onset age in adulthood are scarce.Objectives: To study if age at asthma diagnosis and gender are associated to remission rate in adult asthma population.Methods: In 2016, a random sample of 16 000 subjects aged 20-69 years from Helsinki and Western Finland were sent a FinEsS-questionnaire. Asthma was categorized by reported age when diagnosed with asthma by a physician: child (0-11 years) adolescent-young-adult (12-39 years) and late-adult-diagnosed (40-69 years). Remission was defined as a physician diagnosed asthma but not having had asthma symptoms, wheezing or use of asthma medication in the past 12 months.Results: 8199 subjects (51.5%) responded to the postal questionnaire. Remission was most common in child-diagnosed (30.2%), followed by adolescent-young-adult-diagnosed (17.9%) and least common in late-adult-diagnosed asthma (5.0%) (p<0.001). In males, the corresponding proportions were 36.7%, 20.0% and 3.4%, and in females 20.4%, 16.6% and 5.9%, respectively (p<0.001 for gender difference). In binary logistic regression, significant risk factors of non-remission were diagnosis at adolescent-young-adulthood- (OR=2.2, 95% CI 1.4-3.4) or late-adulthood- (OR=11.1, 4.8-25.4), asthma-COPD overlap (ACO) (OR=5.6, 1.3-24.5), allergic rhinitis (OR=2.3, 1.5-3.5) and family history of asthma (OR=1.9, 1.2-2.8). Results remained similar after exclusion of ACO.Conclusion: Remission was rare (5%) in adults diagnosed with asthma after age 40 years in both sexes. Causes of poor prognosis in adult-onset asthma need to be further elucidated.
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| 11. |
- James, Hayley R, et al.
(författare)
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IgE Antibodies to Mammalian Allergens Are a Major Risk Factor for Prevalence, Severity, and Persistence of Asthma in Northern Sweden
- 2015
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Ingår i: Journal of Allergy and Clinical Immunology. - : Elsevier. - 0091-6749 .- 1097-6825. ; 135:2, s. AB22-AB22
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- IgE to mammalian allergens can contribute significantly to asthma risk. Studying the details of the relationship between animal sensitization and asthma is simpler in an environment where mite, fungal, and cockroach allergens make little or no contribution to asthma risk. Methods: Quantitative assays for IgE to eight allergens were carried out on 963 sera from 19-year-olds in a population-based cohort in northern Sweden, and associations with questionnaire data from ages 7, 12, and 19 on asthma symptoms, diagnosis, and treatment were tested. Results: Overall, 79 (53%) of the students with a physician diagnosis of asthma were positive to one or more of the mammalian allergens (cat, dog, or horse danders) tested. Of the allergens assessed, only mammalian allergens, birch, and timothy grass pollen showed a significant relationship with asthma diagnosis. Multivariate analysis showed that high titer (>17.5 IU/ml) IgE to any mammalian allergen had the strongest relationship with asthma at age 19 (odds ratio 5.1 [3.0-8.6]). Furthermore, IgE to mammalian allergens gave an odds ratio of 8.5 [4.9-15] for asthma that started before age 12 and was still present at age 19. Sensitization to Fel d 1 and Fel d 4 was strongly associated with asthma and significantly reduced in cat owners. Conclusions: Sensitization to cat and dog related allergens, and specifically to the components Fel d 1 and Fel d 4, is a major risk factor for the persistence and severity of asthma in an area where these are the only significant perennial allergens.
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| 12. |
- King, Carina, et al.
(författare)
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COVID-19—a very visible pandemic
- 2020
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Ingår i: The Lancet. - : Elsevier. - 0140-6736 .- 1474-547X. ; 396:10248, s. 15-15
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Tidskriftsartikel (refereegranskat)
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| 13. |
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| 14. |
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| 15. |
- Räisänen, Petri, et al.
(författare)
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Male sex, younger age and smoking contribute to low participating rate in an epidemiological study of asthma and respiratory symptoms
- 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: High participation rate is warranted in order to ensure the validity in epidemiological study results. However, participation rates in population based studies have declined during the last decades.Aim: To evaluate the causes and potential effects of non-response in a large population based survey about asthma and respiratory symptoms in Northern Sweden.Methods: In 2016 a random sample of 12000 adults in ages 20-79 were invited to a postal questionnaire survey about asthma, rhinitis and respiratory symptoms. Three reminders were sent out. A random sample of 500 non-responders was identified for a telephone interview.Results: The participation rate in the initial mailing was 40.6%, and 9.0%, 4.9%, and 2.6% in the subsequent reminders; in total 57.1% (n=6854) participated. Of the 500 non-responders, 320 were possible to reach and 272 participated in the interviews. The prevalence of respiratory symptoms did not differ significantly between responders and non-responders. Male sex, younger age, and smoking were associated with both late and non-response. Even if more subjects with asthma or allergic rhinitis were late and non-responders the prevalence estimates of these conditions were not substantially affected. However, 11.7% of participants and 18.0% of non-responders were smokers (p <0.001). Reasons for non-participation were mainly lack of time and having forgotten to answer.Conclusion: With a response rate of 57.1%, our prevalence estimates of asthma and respiratory symptom were not biased while smoking was underestimated in this Swedish population.
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| 16. |
- Räisänen, Petri, et al.
(författare)
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No increase in incidence of asthma among adults
- 2020
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Ingår i: European Respiratory Journal. - : European Respiratory Society. - 0903-1936 .- 1399-3003. ; 56
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
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| 17. |
- Rönnebjerg, Lina, et al.
(författare)
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Health-psychologic features and health-related quality of life in persons with severe asthma
- 2021
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Ingår i: European Respiratory Journal. - : European Respiratory Society. - 0903-1936 .- 1399-3003. ; 58:Suppl 65
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Introduction: Little is known about health-psychologic features and health-related quality of life (HRQoL) in persons with severe asthma. Hence, the aim was to explore these features among persons with severe asthma.Methods: In the population-based West Sweden Asthma Study, 68 persons with severe asthma completed questionnaires on HRQoL (SF-8), asthma control (ACT), general self-efficacy (GSE), beliefs about medications (BMQ), anxiety and depression (HADS). Severe asthma was based on GINA treatment steps 4/5. Sub-groups were compared with the Mann-Whitney U test and associations were explored using the Spearman’s r.Results: Women with severe asthma reported worse mental HRQoL and indicated more symptoms of anxiety on HADS compared to men with severe asthma. Persons with severe asthma and ACT<20 reported worse physical HRQoL and perceived their medication as more necessary than those with severe asthma and ACT≥20. Among persons with severe asthma, physical HRQoL was associated with ACT-score (r=.613, p>.001). Mental HRQoL was associated with symptoms of anxiety (r=-.670, p>.001), depression (r=-.499, p>.001), self-efficacy (r=.344, p=.004) and concerns of asthma medication side effects (r=-.340, p=.006) within the same group.Conclusions: Health-psychologic features and HRQoL were different between sub groups of severe asthma. Use of questionnaires in asthma management in healthcare might be helpful to identify these sub-groups and provide improved and preventive care.
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| 18. |
- Schyllert, Christian, 1983-, et al.
(författare)
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Risk factor pattern for asthma in 1996, 2006 and 2016 in Sweden – the OLIN and Nordic EpiLung studies
- 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: During the second half of the 20th century the prevalence of asthma has increased and smoking habits and socioeconomy has changed in Sweden.Aim: To analyze risk factor patterns for current asthma in 1996, 2006 and 2016.Methods: Three cross-sectional random samples from the same area of Sweden, 20-69 years, participated in population surveys with the same validated questionnaire in 1996 (n=7104 participants, 85% response rate), 2006 (n=6165, 77%) and 2016 (n=5466, 53%). Current asthma was defined as physician-diagnosed asthma with symptoms common in asthma and/or asthma medication use during the last 12 months. Socioeconomic classification was based on occupation. Risk factors for current asthma were analyzed by multivariable logistic regression.Results: A family history of asthma yielded the highest odds ratios (OR) all three years with ORs 3.19-3.66. Data on occupational exposure to gas, dust or fumes (GDF) was not available in 1996, but associated with current asthma in both 2006 (1.86, 1.51-2.30) and 2016 (1.70, 1.37-2.10). Ex-smoking was a risk factor in 1996 (1.39, 1-12-1.73) and 2006 (1.38, 1.11-1.71) but not in 2016 (1.15, 0.92-1.44). Manual workers in service and industry, non-manual employees and self-employed had increased risk for current asthma in 2016, but not in 1996 or 2006, compared to professionals and executives.Conclusion: The risk factor pattern for asthma among adults has changed in Sweden from 1996 to 2016. While occupational exposure to GDF was a prominent and constant risk factor for asthma, ex-smoking lost significance in 2016, and socioeconomic differences with regard to occupation emerged.
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