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Sökning: L773:1752 6981 OR L773:1752 699X

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1.
  • Midgren, Bengt, et al. (författare)
  • Cheyne-Stokes respiration is not related to quality of life or sleepiness in heart failure
  • 2010
  • Ingår i: Clinical Respiratory Journal. - : Wiley. - 1752-6981 .- 1752-699X. ; 4:1, s. 30-36
  • Tidskriftsartikel (refereegranskat)abstract
    • Background and aims: The effects of central sleep apnea in Cheyne-Stokes respiration on sleep-related symptoms and quality of life are not very well established. We aimed to investigate whether Cheyne-Stokes respiration is related to health-related quality of life. We also studied the impact on daytime sleepiness and nocturnal dyspnea. Methods: Included were 203 consecutive patients, stabilized following in-hospital treatment for decompensated congestive heart failure. They underwent overnight cardiorespiratory sleep apnea recordings in hospital and answered a set of questions on symptoms and health-related quality of life questionnaires in the form of the Nottingham Health Profile and the Minnesota Living with Heart Failure Questionnaire. After excluding seven patients with predominantly obstructive apneas and 14 with insufficient recordings, 182 patients were included in the final analysis. Results: One third of the patients had an apnea-hypopnea index (AHI) of > 30. Falling asleep in front of the television was the only symptom related to (AHI). Nocturnal dyspnea, daytime sleepiness, generic quality of life or disease-specific quality of life were not related to AHI. Conclusions: Cheyne-Stokes respiration was not associated with health-related quality of life, daytime sleepiness or nocturnal dyspnea among patients stabilized following treatment for congestive heart failure. Please cite this paper as: Midgren B, Mared L, Franklin KA, Berg S, Erhardt L and Cline C. Cheyne-Stokes respiration is not related to quality of life or sleepiness in heart failure. The Clinical Respiratory Journal 2009; DOI:10.1111/j.1752-699X.2009.00139.x.
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2.
  • Dellborg, Catharina, 1956, et al. (författare)
  • Impact of home mechanical ventilation on health-related quality of life in patients with chronic alveolar hypoventilation: a prospective study.
  • 2008
  • Ingår i: Clinical Respiratory Journal. - 1752-6981 .- 1752-699X. ; 2:1, s. 26-35
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Nocturnal ventilatory support by nasal positive pressure ventilation (NPPV) is an established treatment method in patients with chronic alveolar hypoventilation (CAH). The knowledge about its long-term effects on health-related quality of life (HRQL) is limited. Methods: In a prospective, longitudinal, single-strand study, patients with CAH caused by non-COPD conditions, consecutively recruited among referral patients in three Swedish university hospital pulmonary departments, were examined at baseline and after 9 months (n = 35) and 8 years (n = 11) on NPPV treatment. Both volume pre-set and pressure pre-set ventilators were used. Patients completed a battery of condition-specific and generic HRQL questionnaires at baseline and follow-up. Spirometry and blood gases were measured. Compliance with treatment, side effects and patient satisfaction were evaluated. Results: After 9 months of NPPV, improvements were seen primarily not only in sleep-related domains, but also in emotional behaviour, ambulation and sleep/rest functioning as measured with the Sickness Impact Profile (SIP). Improvements in sleep-related symptoms were related to effectiveness in ventilation, evaluated by morning PaCO2, and remained by 8 years. Mental well-being was stable over time, while emotional distress improved by 8 years. Satisfaction with treatment was high in spite of frequent side effects. Conclusion: NPPV improves HRQL, particularly in condition-specific areas. Improvements are related to effectiveness in ventilation. Side effects are common, but compliance is good And patient satisfaction is high.
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3.
  • Löfdahl, Claes-Göran (författare)
  • COPD and co-morbidities, with special emphasis on cardiovascular conditions
  • 2008
  • Ingår i: CLINICAL RESPIRATORY JOURNAL. - 1752-6981 .- 1752-699X. ; 2, s. 59-63
  • Konferensbidrag (refereegranskat)abstract
    • The concept of COPD as a systemic disease has been widely accepted in the past several years. In parallel, it has been emphasised that COPD morbidity and mortality is strongly related to co-morbid conditions. This review summarises some recent studies showing that in patients with COPID, the prevalence of cardiac failure is manifested in 10%-46% of the patients, and that up to 40% of patients with cardiac failure show evidence of COPD, about half of them not earlier diagnosed. Recent data also show an increased risk for arteriosclerotic manifestations in COPD patients, and cardiac complications are common causes of death in COPD patients. Other manifestations of the metabolic syndrome, as diabetes, are also over-represented in patients. It is also a well-established fact that a low FEV1 is a risk factor for cardiovascular diseases and events. Mechanistically, a systemic inflammation in COPD could be a link to cardiovascular events. COPD raises inflammatory parameters and local anti-inflammatory treatment seems to have a potential to decrease the systemic inflammation and also to decrease cardiovascular events.
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4.
  • Sundell, Kerstin, et al. (författare)
  • Quality of life in adolescents with asthma, during the transition period from child to adult.
  • 2011
  • Ingår i: Clinical Respiratory Journal. - 1752-6981. ; 5:4, s. 195-202
  • Tidskriftsartikel (refereegranskat)abstract
    • Aim: The present investigation was designed to evaluate the health-related quality of life (HRQOL) of adolescents with asthma between the age of 16 and 21, when they are transferred from paediatric to adult care. Methods: In this prospective study, 156 teenagers (69 females) with asthma were screened employing spirometry, a histamine challenge, skin prick test for allergy and filled out the 'Living with Asthma Questionnaire' both at the time of entry into the study and after 2 and 5 years of follow-up. An exercise test and questions concerning regular performed exercise were carried out at baseline and 5 years later. Results: At all three time-points, the HRQOL of the men was generally better than that of the women. At the same time, the HRQOL of both genders was significantly better, both in terms of the overall scores (P < 0.001) as well as the scores for most of the individual domains, in connection with the 5-year follow-up. The young women who exercised regularly at the time of their entry exhibited better HRQOL at this time than those who did not (P < 0.001), whereas regular exercise had no impact on the HRQOL of the young men. The women with severe asthma demonstrated a poorer HRQOL than those suffering from mild-to-moderate asthma. Conclusion: The HRQOL of adolescents with asthma improves with age. The pronounced positive correlation between regular exercise and HRQOL in female adolescents with asthma revealed here deserves special attention in the care of young women and deserves further exploration.
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5.
  • Andersson, Ingalill, et al. (författare)
  • Vitamin and mineral status in elderly patients with chronic obstructive pulmonary disease
  • 2007
  • Ingår i: Clinical Respiratory Journal. - : Blackwell Publishing. - 1752-6981 .- 1752-699X. ; 1:1, s. 23-29
  • Tidskriftsartikel (refereegranskat)abstract
    • Introduction: Eating problems are common in patients with chronic obstructive pulmonary disease (COPD), and intake of micronutrients might be lower than recommended. Objective: To study dietary intake, serum and urinary concentration of trace elements and vitamins in elderly underweight patients with established severe COPD. Methods: Outpatients at a university clinic for lung medicine, with COPD, 70-85 years old, with no other serious disease, and with a body mass index (BMI) of similar to 20 kg/m(2) and an FEV(1) of < 50 % predicted were recruited. Body composition and bone density were evaluated with dual energy X-ray absorptiometry. Dietary intake was studied by a trained dietitian using diet-history interview. Blood and urine samples were analysed for various vitamins and trace elements. Results: Seventeen of 30 recruited patients took part. Osteoporosis or osteopaenia was found in 16 patients. Dietary intake of energy and macronutrients was in line with recommendations for healthy individuals. Intake of protein did not meet recommendations for COPD patients. Intake of polyunsaturated fatty acids was lower than recommended and intake of saturated fatty acids was higher than recommended. Mean intake of vitamin D and folic acid was far below recommendations. Serum concentrations for folic acid and methylmalonate and plasma concentrations for homocysteine were below normal in several patients. Conclusion: Intake of vitamin D and calcium is often low in older COPD patients, which might contribute to osteoporosis. Low intake of folic acid might also be a problem. The results support prophylaxis with calcium, vitamin D and folic acid.
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6.
  • Bjerg, Anders, et al. (författare)
  • Asthma in school age : prevalence and risk factors by time and by age
  • 2008
  • Ingår i: Clinical Respiratory Journal. - Oxford : Blackwell Publishing. - 1752-6981 .- 1752-699X. ; 2:Suppl 1, s. 123-126
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Childhood is the most important age for asthma development. Recent reports indicate that the prevalence of asthma. in children has plateaued after having increased for decades.Aims: To study prevalence and risk factor patterns of asthma by age and by time.Methods: In 1996, all children in grade 1-2 (age 7-8) in three cities ill Northern Sweden were invited to an expanded International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire. A total of 3430 children (97%) participated yearly until 2000 (age 11-12). A subset (n = 2454) was invited to skill-prick testing in 1996 and 2000 with 88% and 90% participation. In 2006, another cohort (n = 2704) was identified and studied by identical methods with 96% participation. A total of 1700 children (90% of invited) were skin-prick tested.Results and comments: From age 7-8 to 11-12, the prevalence of physician-diagnosed asthma increased, 5.7%-7.7% (P<0.01) while current wheeze decreased, 11.7%-9.4% (P < 0.01), indicating a less diverse spectrum of symptoms with age. The yearly remission from asthma was 10% (lasting remission 5%), largely determined by allergic sensitisation. Allergic sensitisation (OR 5) and a family history of asthma (OR 3) were important risk factors for asthma at age 7-8 and 11-12. However, several other significant risk factors at age 7-8 (low birth weight, respiratory infections and house dampness) lost importance until age 11-12. Maternal and paternal asthma were equally important risk factors (OR 3-4) at age 7-8. Sibling asthma was only a marker of parental disease.Future perspectives: Through comparison with the 2006 cohort, trends in prevalence and in risk factors from 1996 to 2006 will be studied.
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7.
  • Danielsson, Patrik, et al. (författare)
  • The prevalence of chronic obstructive pulmonary disease in Uppsala, Sweden - the Burden of Obstructive Lung Disease (BOLD) study : cross-sectional population-based study
  • 2012
  • Ingår i: Clinical Respiratory Journal. - 1752-6981 .- 1752-699X. ; 6:2, s. 120-127
  • Tidskriftsartikel (refereegranskat)abstract
    • Objectives:  To estimate chronic obstructive pulmonary disease (COPD) prevalence in Uppsala and the impact of risk factors on disease prevalence using the standardised methods of the Burden of Obstructive Lung Disease (BOLD) study initiative. Methods:  Randomly selected participants, aged 40 years or more (n = 548) responded to a questionnaire regarding smoking habits, respiratory symptoms, medical history, and exposure to airway irritants. Spirometry, with a post-bronchodilator test, was performed and COPD defined as post-bronchodilatory forced expiratory volume in 1 s (FEV(1) )/forced vital capacity (FVC) < 0.70 or FEV(1) /FVC < lower limit of normality (LLN). Circulatory inflammatory markers were measured. Results:  COPD prevalence was 16.2%, which was the fourth lowest prevalence of COPD, compared with 12 other BOLD centres. Main risk factors for COPD were increasing age [odds ratio (OR) = 2.08 per 10 years] and smoking (OR = 1.33 per 10 pack years). Higher education was protective (OR = 0.70 per 5 years). Previous tuberculosis was an almost significant risk factor for COPD (P = 0.08). Subjects with COPD reported more respiratory symptoms but only 29% had previous doctor diagnosed COPD, asthma, chronic bronchitis or emphysema. Participants with COPD had higher levels of C-reactive protein (P = 0.01), but no difference was observed in interleukin 6 (IL-6) levels. Using LLN instead of the fixed FEV(1) /FVC ratio reduced the prevalence of COPD to 10%. Conclusion:  COPD prevalence in Uppsala was similar to other BOLD centres in high-income countries. Apart from known COPD risk factors (age, smoking, lower educational level), a history of tuberculosis may be associated with COPD even in high-income countries. COPD remains under-diagnosed, as only 29% of subjects with COPD had a previously diagnosed lung disorder.
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8.
  • Ekerljung, Linda, 1979, et al. (författare)
  • FinEsS-Stockholm and the Stockholm adult asthma study
  • 2008
  • Ingår i: The clinical respiratory journal. - 1752-6981. ; 22 Suppl 1, s. 127-128
  • Forskningsöversikt (refereegranskat)abstract
    • Abstract Two major studies on asthma and respiratory symptoms are presently in progress in Stockholm. The FinEsS-studies has been ongoing since 1996, with a follow-up study preformed in 2006 and a new cohort selected in 2007. The FinEsS studies focus on prevalence and incidence of asthma and respiratory symptoms in a general population. Clinical follow-up surveys will also target COPD. Further aims include remission and relapse of disease and symptoms and their determinants. The Stockholm adult Asthma Study (SaAS) began in the spring of 2007 and data is being collected presently. The SaAS study focus on the medical care and medication given to asthmatics in Stockholm, and the study population consists of asthmatics found in the two Swedish cohort studies.
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9.
  • Ekerljung, Linda, 1979, et al. (författare)
  • Incidence and prevalence of adult asthma is associated with low socio-economic status
  • 2010
  • Ingår i: The Clinical Respiratory Journal. - 1752-6981 .- 1752-699X. ; 4:3, s. 147-56
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Low socio-economic status is often related to health problems; however, previous studies on asthma, usually cross-sectional, yield inconsistent results. In this study, longitudinal and cross-sectional data on the association between socio-economic status and asthma as well as respiratory symptoms among adults are presented. Methods: A postal questionnaire was sent on two occasions, 1996 and 2006, to a randomly selected sample of subjects aged 20–69 years in 1996. In total, 4479 subjects participated in both surveys. The questionnaire included questions on asthma, respiratory symptoms and possible determinants. Logistic regression analysis, adjusted for potential confounders, was used to study the association between asthma, respiratory symptoms and socio-economic status. Results: Manual workers in service had the highest prevalence and cumulative incidence for all investigated symptoms and asthma. Despite a large decrease in smokers, the increase in incident bronchitic symptoms was higher than the increase of incident asthma and incident asthmatic symptoms. Low socio-economic status, rhinitis and a family history of asthma were risk factors for having and developing asthma and respiratory symptoms. Conclusion: Low socio-economic status is significantly associated with an increased risk for prevalent and incident asthma and respiratory symptoms in this longitudinal population-based survey. The increase in risk was most pronounced in manual workers. Several studies have recently shown an association between low socio-economic status and respiratory symptoms and we conclude that asthma can not be considered as a disease that mainly affects the middle and upper socio-economic classes.
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10.
  • Ekerljung, Linda, 1979, et al. (författare)
  • Questionnaire layout and wording influence prevalence and risk estimates of respiratory symptoms in a population cohort
  • 2013
  • Ingår i: Clinical Respiratory Journal. - : Blackwell Publishing. - 1752-6981 .- 1752-699X. ; 7:1, s. 53-63
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective: Results of epidemiological studies are greatly influenced by the chosen methodology. The study aims to investigate how two frequently used questionnaires (Qs), with partly different layout, influence the prevalence of respiratory symptoms.Study Design and Setting: A booklet containing two Qs, the Global Allergy and Asthma European Network Q and the Obstructive Lung Disease in Northern Sweden Q, was mailed to 30 000 subjects aged 16-75 years in West Sweden; 62% responded. Sixteen questions were included in the analysis: seven identical between the Qs, four different in set-up and five with the same layout but different wording. Comparisons were made using differences in proportions, observed agreement and Kappa statistics.Results: Identical questions yielded similar prevalences with high observed agreement and kappa values. Questions with different set-up or differences in wording resulted in significantly different prevalences with lower observed agreement and kappa values. In general, the use of follow-up questions, excluding subjects answering no to the initial question, resulted in 2.9-6.7% units lower prevalence.Conclusion: The question set-up has great influences on epidemiological results, and specifically questions that are set up to be excluded based on a previous no answer leads to lower prevalence compared with detached questions. Therefore, Q layout and exact wording of questions has to be carefully considered when comparing studies.
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11.
  • Eriksson, Jonas, 1984, et al. (författare)
  • Update of prevalence of self-reported allergic rhinitis and chronic nasal symptoms among adults in Sweden
  • 2012
  • Ingår i: The Clinical Respiratory Journal. - 1752-699X .- 1752-6981. ; 6:3, s. 159-168
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Allergic rhinitis (AR) is the most common immunologic disease, and it renders a considerable burden on both sufferers and society. The prevalence of AR has been increasing worldwide over the past century. The aim of this study was to assess the present prevalence, risk factor patterns and comorbidity of self-reported AR and chronic nasal symptoms in different age groups in Stockholm, Sweden. Methods: A postal questionnaire was sent on two occasions, in 2006 to a population aged 30-80 years, randomly selected 10 years previously, and in 2007 to a randomly selected sample of subjects aged 20-69 years. The response rates were 83% and 68%, respectively, and in total, 9792 subjects participated. The questionnaire included questions on self-reported AR, asthma, respiratory and nasal symptoms and possible determinants. Results: The prevalence of self-reported AR was 28.0% (men 26.6%, women 29.1%, P<0.01) similar to 10 years previously and 33.6% in ages 30-40 years. Allergic heredity [odds ratio (OR) 4.76, confidence interval (CI) 95% 4.25-5.33], physician-diagnosed asthma (OR 5.29, CI 95% 4.49-6.24) and occupational exposure to dust, gases and fumes (OR 1.49, CI 95% 1.30-1.72) were determinants for AR. Prevalence of chronic nasal congestion was 16.1% and of chronic rhinorrhea 14.1%. Conclusions: As a basis for understanding the disease, as well as in planning and prioritising health-care resources, the study provides information about the current prevalence and determinants of self-reported AR and chronic nasal symptoms. Further, comparing with previous studies, the present study suggests that a plateau in the prevalence of AR may have been reached in Sweden. Please cite this paper as: Eriksson J, Ekerljung L, Rönmark E, Dahlén B, Ahlstedt S, Dahlén S-E and Lundbäck B. Update of prevalence of self-reported allergic rhinitis and chronic nasal symptoms among adults in Sweden
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12.
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13.
  • Hallin, Runa, et al. (författare)
  • Relation between physical capacity, nutritional status and systemic inflammation in COPD
  • 2011
  • Ingår i: Clinical Respiratory Journal. - 1752-6981 .- 1752-699X. ; 5:3, s. 136-142
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Decreased physical capacity, weight loss, fat-free mass depletion and systemic inflammation are frequently observed in patients with chronic obstructive pulmonary disease (COPD).Objective: Our aim was to examine relations between physical capacity, nutritional status, systemic inflammation and disease severity in COPD.Method: Forty nine patients with moderate to severe COPD were included in the study. Spirometry was preformed. Physical capacity was determined by a progressive symptom limited cycle ergo meter test, incremental shuttle walking test, 12-minute walk distance and hand grip strength test. Nutritional status was investigated by anthropometric measurements, (weight, height, arm and leg circumferences and skinfold thickness) and bioelectrical impedance assessment was performed. Blood samples were analyzed for C-reactive protein (CRP) and fibrinogen.Result: Working capacity was positively related to forced expiratory volume in 1 s (FEV(1)) (p < 0.001), body mass index and fat free mass index (p = 0.01) and negatively related to CRP (p = 0.02) and fibrinogen (p = 0.03). Incremental shuttle walk test was positively related to FEV(1) (p < 0.001) and negatively to CRP (p = 0.048). Hand grip strength was positively related to fat free mass index, and arm and leg circumferences. Fifty to 76% of the variation in physical capacity was accounted for when age, gender, FEV(1), fat free mass index and CRP were combined in a multiple regression model.Conclusion: Physical capacity in chronic obstructive pulmonary disease is related to lung function, body composition and systemic inflammation. A depiction of all three aspects of the disease might be important when targeting interventions in chronic obstructive pulmonary disease.
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14.
  • Hillerdal, Gunnar, et al. (författare)
  • Treatment of malignant pleural mesothelioma with liposomized doxorubicine : prolonged time to progression and good survival. A Nordic study
  • 2008
  • Ingår i: The Clinical Respiratory Journal. - 1752-6981 .- 1752-699X. ; 2:2, s. 80-85
  • Tidskriftsartikel (refereegranskat)abstract
    • Introduction: Malignant pleural mesothelioma (MPM) has a poor prognosis and there is limited effect of treatment. Lately, pemetrexed and cisplatin have been established as the standard treatment. Objectives: The present study was planned in 1998, when there was no standard treatment. Single-dose doxorubicine had, in small studies, accomplished remissions, and the Scandinavian Mesothelioma Groups therefore decided to test a liposomized form of this drug, which had shown limited toxicity but good efficacy in a few small studies. Methods: Fifty-four evaluable patients with histologically verified and inoperable MPM were treated with liposomized doxorubicine 40 mg/m2, every 4 weeks for six cycles. Results: In all, 29 patients (54%) received at least six treatments. The quality of life remained good during the study. Hematologic toxicity was very low. Palmo–plantar erythema occurred in 11 patients (20%), thereof 7 grade II but none was severe and none was dose-limiting. There were four partial responses (7%). The median time to progression (TTP) was 5 months, the median survival was 12 months, and at 24 months, 22% were still alive. Conclusion: Liposomized doxorubicine has a low toxicity and is well tolerated; there were a remarkably long TTP and a good survival. Thus, despite the low response rate, liposomized doxorubicine remains an interesting drug for the treatment of malignant mesothelioma.
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15.
  • Jacinto, Tiago, et al. (författare)
  • Setting reference values for exhaled nitric oxide : a systematic review
  • 2013
  • Ingår i: Clinical Respiratory Journal. - 1752-6981 .- 1752-699X. ; 7:2, s. 113-120
  • Forskningsöversikt (refereegranskat)abstract
    • Background The values obtained when the fraction of exhaled nitric oxide (FeNO) is measured are affected by several factors that are specific to the individual patient, making interpretation difficult, especially in the initial assessment of patients with respiratory symptoms. Methods Systematic review of studies on FeNO reference values and individual-specific factors that influence them. Results From 3739 references, 15 studies were included. Four studies included children and adolescents. In nine studies, samples were selected from the general population. Most studies reported objective measures for atopy (nine studies), but not for smoking status (one). Significant determinants of FeNO values reported were age and height (seven studies), atopy (six), smoking (four), weight (four), sex (three) and race (three). Additional factors were included in eight studies. R2 was reported in only five studies. The logarithmic transformation of FeNO was inadequately described in seven studies. Conclusion There are several equations for FeNO reference values that may be used in clinical practice, although the factors they include and the statistical methods they use vary considerably. We recommend the development of standard methods for the evaluation of normal FeNO data and that reference equations should be formulated based on a predetermined physiological model.
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16.
  • Janson, Christer, et al. (författare)
  • Risk factors associated with allergic and non-allergic asthma in adolescents
  • 2007
  • Ingår i: Clinical Respiratory Journal. - : Wiley. - 1752-6981 .- 1752-699X. ; 1:1, s. 16-22
  • Tidskriftsartikel (refereegranskat)abstract
    • Introduction: Risk factors for asthma have been investigated in a large number of studies in adults and children, with little progress in the primary and secondary prevention of asthma. The aim of this investigation was to investigate risk factors associated with allergic and non-allergic asthma in adolescents. Methods: In this study, 959 schoolchildren (13-14 years old) answered a questionnaire and performed exhaled nitric oxide ( NO) measurements. All children (n = 238) with reported asthma, asthma-related symptoms and/or increased NO levels were invited to a clinical follow-up which included a physician evaluation and skin-prick testing. Results: Asthma was diagnosed in 96 adolescents, whereof half had allergic and half non-allergic asthma. Children with both allergic and non-allergic asthma had a significantly higher body mass index (BMI) (20.8 and 20.7 vs. 19.8 kg/m(2)) (p < , 0.05) and a higher prevalence of parental asthma (30% and 32% vs. 16%) (p < , 0.05). Early-life infection (otitis and croup) [adjusted odds ratio ( OR) (95% confidence interval (CI)): 1.99(1.02-3.88) and 2.80 (1.44-5.42), respectively], pets during the first year of life [2.17 (1.16-4.04)], window pane condensation [2.45 (1.11-5.40)] and unsatisfactory school cleaning [(2.50 (1.28-4.89)] was associated with non-allergic but not with allergic asthma. Conclusion: This study indicates the importance of distinguishing between subtypes of asthma when assessing the effect of different risk factors. While the risk of both allergic and non-allergic asthma increased with increasing BMI, associations between early-life and current environmental exposure were primarily found in relation to non-allergic asthma.
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17.
  • Lindberg, A, et al. (författare)
  • The Obstructive Lung Disease in Northern Sweden Chronic Obstructive Pulmonary Disease Study: design, the first year participation and mortality
  • 2008
  • Ingår i: The clinical respiratory journal. - 1752-6981. ; 22 Suppl 1, s. 64-71
  • Tidskriftsartikel (refereegranskat)abstract
    • BACKGROUND: Most epidemiological data on chronic obstructive pulmonary disease (COPD) are cross-sectional, and the longitudinal course of disease on population bases is incompletely described. AIM: To describe an epidemiological study designed to follow the longitudinal course of disease in chronic obstructive lung disease, COPD, including co-morbidity and mortality and further, to evaluate the impact of COPD on quality of life and health economics. MATERIALS AND METHODS: From the Obstructive Lung Disease in Northern Sweden studies database cohorts I-IV, all subjects with COPD according to the Global Initiative for Chronic Obstructive Lung Disease spirometric criteria, FEV(1)/FVC < 0.70 (n = 993), were identified together with a similar size age- and gender-matched control group. The study population was invited to a yearly examination starting in year 2005. The examinations included structured interview, spirometry with reversibility testing, oxygen saturation and health-related quality of life questionnaires. RESULTS: On the first year, 83% of the population was examined, and the subjects unable to attend the examination were interviewed by telephone. Altogether, 91% of the original study population participated (95% of all subjects were alive at the end of the first year). Mortality was significantly higher among subjects with COPD, 5.1%, compared with controls, 3.0% (P = 0.018). CONCLUSION: The study design including cases of COPD representative of COPD by disease severity in the general population and a similar sized control group, together with a high participation rate in the first study year, creates excellent conditions for evaluating the impact of COPD on population bases, and to follow the longitudinal course of disease in COPD.
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18.
  • Lundbäck, Bo, 1948, et al. (författare)
  • General population-based cohorts for studies of lung health in adults in Sweden
  • 2008
  • Ingår i: Clinical Respiratory Journal. - Oxford : Blackwell Publishing. - 1752-6981 .- 1752-699X. ; 2:Suppl 1, s. 2-9
  • Tidskriftsartikel (refereegranskat)abstract
    • Epidemiological population-based studies about lung health in Sweden have mostly been focused on obstructive airway diseases. From the 1960s to the 1980s, the epidemiological studies were cross-sectional, aiming at the study of the prevalence of asthma, chronic bronchitis and respiratory symptoms and their associations with mainly demographic data. With the exception of highly stratified samples, for instance the men born on 1913 in Gothenburg and cohorts of occupational groups or work places, general population-based cohorts for studies of lung health in adults are still not very common. Two large-scale studies of lung health have been in progress in Sweden for more than 20 years; the Obstructive Lung Disease in Northern Sweden (OLIN) Studies, which started in 1985, and the Swedish part of European Community Respiratory Health Survey (ECRHS) since 1989 with the follow-Lip survey labelled Respirator), Health in Northern Europe (RHINE). During the 1990s the comparative studies between Finland, Estonia and Sweden (The FinEsS Studies) started. These and other studies will be reviewed in the following exemplifying change of aims and study designs over time as well as change of focus of risk factors under study.
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19.
  • Rönmark, Eva, et al. (författare)
  • The Obstructive Lung Disease in Northern Sweden (OLIN) longitudinal paediatric study I : the first 10 years
  • 2008
  • Ingår i: Clinical Respiratory Journal. - Oxford : Blackwell Publishing. - 1752-6981 .- 1752-699X. ; 2:Suppl 1, s. 26-33
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Prospective studies of asthma and allergic conditions based oil the general population are scare.Aim: To summarize the methods and main results from a prospective study among school children.Methods: In 1996, a cohort of 3525 children aged 7/8 years in Northern Sweden were invited to a questionnaire survey using an expanded ISAAC protocol, and 97% participated. The cohort has been followed up yearly with high participation rate. Skin prick tests were conducted 1996, 2000 and 2006/2007. Allergens in dust from homes and schools have been analyzed. Sub samples have participated in interviews, lung function tests, bronchial hyper reactivity test, and analyses of IgE and IgG antibodies in serum.Results: The prevalence of asthma was 6% at age 7-8 years and increased by age. The incidence of physician-diagnosed asthma after the age of 7-8 years was around 1/100/year. The prevalence of positive skin prick test increased from 21% at age 7-8 to 30% at age 11-12 years. Remission of allergic sensitization was rare, while asthma remission was 5% yearly. The main risk factor for asthma and allergic sensitization increased in importance with increasing age. Allergic and non-allergic asthma had different risk factor pattern. Environmental risk factors decreased in impact after the age of 7. Avoidance of pets at home did not protect from asthma or allergic sensitization.Conclusion: The study includes important sources of data for further longitudinal analyses that will contribute to the understanding of the development and the nature of asthma and allergic sensitization.
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20.
  • Syk, Jorgen, et al. (författare)
  • Association between self-rated health and asthma : a population-based study
  • 2012
  • Ingår i: Clinical Respiratory Journal. - 1752-6981 .- 1752-699X. ; 6:3, s. 150-158
  • Tidskriftsartikel (refereegranskat)abstract
    • Introduction: Self-rated health (SRH) is a relevant measure of health as it can predict morbidity, mortality and health-care use. Studies have shown an association between poor SRH and elevated levels of circulating inflammatory cytokines. It is therefore interesting to learn more about the association between asthma, a chronic inflammatory disease with a recognised systemic component and SRH.Objectives: To compare SRH ratings in respondents with and without current asthma. A second aim was to compare SRH with quality-of-life ratings in the same groups.Methods: In 1995, we randomly selected 8200 persons =18 years from the population of Stockholm County, Sweden and mailed them a questionnaire. A total of 5355 persons (67.5%) responded. Respondents were divided in two groups, those with and those without current asthma. The groups were further divided by sex and age (1844 and =45 years). SRH was measured with the question How do you rate your general health status? and quality of life with the Gothenburg Quality of Life Instrument and the Ladder of Life.Results: Respondents with asthma rated their health significantly worse than did those without asthma, except women aged 1844 years. SRH was associated at least as strong as quality of life to asthma with the advantage of being easier to apply (only one item).Conclusion: Information on SRH is easy to obtain and represents an important dimension of health status that potentially can be used as a complement to identify patients who need extra attention to manage their asthma and its consequences.
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21.
  • Syk, Jörgen, et al. (författare)
  • Relationship between exhaled nitric oxide and IgE sensitisation in patients with asthma : influence of steroid treatment
  • 2009
  • Ingår i: Clinical Respiratory Journal. - 1752-6981 .- 1752-699X. ; 3:3, s. 143-151
  • Tidskriftsartikel (refereegranskat)abstract
    • Introduction: The influence of the degree of immunoglobulin E (IgE) sensitisation on the fraction of expired nitric oxide (FENO) in asthma patients being treated with inhaled corticosteroids (ICS) is not well known. Objectives: To investigate the relationship between IgE sensitisation and FENO, and the effect of a step-up in ICS treatment on this relationship, in patients with allergic asthma. Methods: A primary health care centre recruited 20 non-smoking patients with perennial allergic asthma (18 years-50 years, six male) outside the pollen season. At every visit (0, 2, 4, 8 weeks), FENO was measured and an exposure questionnaire was completed. ICS dose was adjusted according to FENO (>= 22 ppb prescribed increase in ICS). Quantitative analyses of serum IgE (eight common aeroallergens) confirmed allergy. Results: At baseline, FENO and the sum of IgE antibody titres for perennial allergens correlated significantly (r = 0.47, P = 0.04). After a step-up in ICS treatment, this correlation had disappeared. Nine patients had persistently elevated FENO at last visit (mean 35 ppb vs 16 ppb). This group was more frequently exposed to relevant allergens or colds (89% vs 27% of patients, P < 0.05) and had higher IgE antibody titres (perennial allergens) compared with the normalised group (mean 28.9 kU/L vs 10.7 kU/L, P < 0.05). Conclusion: Serum IgE against perennial allergens and FENO correlate in patients with allergic asthma. However, this relationship disappears after a high-dose ICS regimen, suggesting that FENO relates to bronchial inflammation and not IgE levels per se. High degree of IgE sensitisation together with allergen exposure may lead to ICS-resistant airways inflammation. Please cite this paper as: Syk J, Unden AL and Alving K. Relationship between exhaled nitric oxide and IgE sensitisation in patients with asthma: influence of steroid treatment. The Clinical Respiratory Journal 2009; 3: 143-151.
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22.
  • Zetterquist, Wilhelm, et al. (författare)
  • Increased exhaled nitrite in children with allergic asthma is not related to nitric oxide formation
  • 2008
  • Ingår i: The Clinical Respiratory Journal. - 1752-6981 .- 1752-699X. ; 2:3, s. 166-174
  • Tidskriftsartikel (refereegranskat)abstract
    • Introduction: Nitrite sampled from the upper airways could originate from inflammation-induced nitric oxide (NO), as reports of elevated nitrite in exhaled breath condensate (EBC) from asthmatics suggest, but also through bacterial action in the pharyngo-oral tract. Objectives: To correlate EBC nitrite and nitrate to exhaled NO (FENO, fraction Of expired NO) and other markers of disease activity in children with allergic asthma and thereby further investigate their role and origin. Materials and methods: EBC was collected from 27 asthmatic subjects (ages 6-17 years, all immunoglobulin E-positive for aeroallergens) and 21 age-matched non-atopic healthy controls for fluorometric analysis of nitrite and nitrate. These markers were compared with measurements of FENO, blood eosinophil count (EOS), methacholine reactivity (PD20) and baseline spirometry. Results: EBC nitrite, in contrast to nitrate, was significantly increased (P < , 0.01) in the asthmatic children. They also had increased levels of FENO (P < , 0.001) and EOS (P < , 0.001) along with decreased PD20 (P < , 0-001) and FEV1/FVC (p < , 0.01). However, there was no correlation between EBC nitrite and FENO (r = 0.05) or any other marker of disease activity in the asthmatic children, whereas between the other markers correlations could be established. Conclusion: EBC nitrite is elevated in childhood asthma but the lack of correlation to FENO and other markers, together with simultaneously normal levels of nitrate, make its origin as a metabolite of inflammation-induced NO questionable.
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23.
  • Andreassen, Siw Lillevik, et al. (författare)
  • Impact of pneumonia on hospitalizations due to acute exacerbations of COPD
  • 2014
  • Ingår i: Clinical Respiratory Journal. - : Wiley. - 1752-6981 .- 1752-699X. ; 8:1, s. 93-99
  • Tidskriftsartikel (refereegranskat)abstract
    • BACKGROUND AND AIMS: Pneumonia is often diagnosed among patients hospitalized with acute exacerbations of chronic obstructive pulmonary disease (AECOPD). The aims of this study were to find the proportion of patients with pneumonia among admissions due to AECOPD and whether pneumonia has impact on the length of stay (LOS), usage of non-invasive ventilation (NIV) or the in-hospital mortality.METHODS: Retrospectively, all hospitalizations in 2005 due to AECOPD in the Departments of Internal and Respiratory Medicine in one Swedish and two Norwegian hospitals were analyzed. A total of 1144 admittances (731 patients) were identified from patient administrative systems. Pneumonic AECOPD (pAECOPD) was defined as pneumonic infiltrates on chest X-ray and C-reactive protein (CRP) value of ≥40 mg/L, and non-pneumonic AECOPD (npAECOPD) was defined as no pneumonic infiltrate on X-ray and CRP value of <40 at admittance.RESULTS: In admissions with pAECOPD (n = 237), LOS was increased (median 9 days vs 5 days, P < 0.001) and usage of NIV was more frequent (18.1% vs 12.5%, P = 0.04), but no significant increase in the in-hospital mortality (3.8% vs 3.6%) was found compared to admissions with npAECOPD. A higher proportion of those with COPD GOLD stage I-II had pAECOPD compared to those with COPD GOLD stage III-IV (28.2% vs 18.7%, P = 0.001).CONCLUSIONS: In-hospital morbidity, but not mortality, was increased among admissions with pAECOPD compared to npAECOPD. This may, in part, be explained by the extensive treatment with antibiotics and NIV in patients with pAECOPD.
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24.
  • Belfrage, B., et al. (författare)
  • Performance and interpretation of spirometry among Swedish hospitals
  • 2016
  • Ingår i: Clinical Respiratory Journal. - : Wiley. - 1752-6981 .- 1752-699X. ; 10:5, s. 567-573
  • Tidskriftsartikel (refereegranskat)abstract
    • Background and Aims: It is unclear to what extent spirometric performance and interpretation is standardized in Sweden. The aim of this study was to find out how spirometry is performed and interpreted in large Swedish hospitals. Methods: In telephone interviews, technicians and physicians working with lung function measurements at 21 large Swedish hospitals were interviewed about routines for spirometry. Results: Answers were obtained from 37 of the 42 departments contacted revealing differences in the spirometric routines. Some departments lack a written method description, and three different prediction equations were used among the departments. Different ways of calculating the forced expiratory volume in 1 s (FEV1)/vital capacity (VC) ratio (FEV%) were found and also differences in performance and interpretation of the reversibility test. When diagnosing chronic obstructive pulmonary disease, none of the departments reported using an individualized diagnostic limit of FEV1/VC based on age, sex and height. Conclusion: There is a need for standardization of performance and interpretation of the spirometry test in Sweden and probably also in other countries. © 2014 John Wiley & Sons Ltd
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25.
  • Fritz, Ildikó, et al. (författare)
  • Lung cancer in young women in southern Sweden : A descriptive study
  • 2018
  • Ingår i: Clinical Respiratory Journal. - : Wiley. - 1752-6981 .- 1752-699X. ; 12:4, s. 1565-1571
  • Tidskriftsartikel (refereegranskat)abstract
    • Introduction: Lung cancer, a common malignancy and cause of cancer-related deaths, is strongly linked to several environmental exposures, and thus primarily affects the elderly. Formerly a man's disease, its incidence is rising among women, and lung cancer is now more common in women than men in Sweden. Women are particularly over-represented among young patients. While overall cancer mortality in Europe is decreasing, female lung cancer mortality is increasing. Objectives: We describe the epidemiological presentation of lung cancer in young Swedish women, aiming to pinpoint its risk factors for young women. Methods: 1159 women with newly diagnosed lung cancer in southern Sweden 1997-2015 answered questionnaires on their lifestyles and personal and family medical histories. We identified those below age 50. Results: 70 (6.0%) of 1159 women were below age 50. Most (n = 49, 70.0%) were aged 45-50; eight (11.4%) were below age 40. The most common lung cancer subtype was adenocarcinoma (n = 33, 47.1%). 12.9% (n = 9) had carcinoid tumors. Most women reported both first- and second-hand tobacco smoke exposure (n = 54, 77.1%); 2.9% (n = 2) reported neither. 17.1% (n = 12) were never-smokers. 34.3% (n = 24) reported frequent X-ray radiation exposure. 78.6% reported at least one near relative with cancer. 25.7% reported relatives with lung cancer. Conclusions: Lung cancer remains rare in young women, and tobacco smoke exposure is the single greatest risk factor, even for never-smokers. Thus, avoiding tobacco smoke exposure remains the most important preventive measure against lung cancer for young women in Sweden and elsewhere.
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26.
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27.
  • Hisinger-Molkanen, H., et al. (författare)
  • The combined effect of exposures to vapours, gases, dusts, fumes and tobacco smoke on current asthma
  • 2022
  • Ingår i: Clinical Respiratory Journal. - : Wiley. - 1752-6981 .- 1752-699X. ; 16:6, s. 467-474
  • Tidskriftsartikel (refereegranskat)abstract
    • Smoking, exposure to environmental tobacco smoke (ETS) and occupational exposure to vapours, gases, dusts or fumes (VGDF) increase asthma symptoms. The impact of combined exposure is less well established. We aimed to evaluate the risk of combined exposure to smoking, ETS and VGDF on the prevalence of current asthma and asthma-related symptoms with a postal survey among a random population of 16,000 adults, aged 20-69 years (response rate 51.5%). The 836 responders with physician-diagnosed asthma were included in the analysis. Of them, 81.9% had current asthma defined as physician-diagnosed asthma with current asthma medication use or reported symptoms. There was a consistently increasing trend in the prevalence of current asthma by increased exposure. The highest prevalence of multiple symptoms was in smokers with VGDF exposure (92.1%) compared to the unexposed (73.9%, p = 0.001). In logistic regression analysis, combined exposure to several exposures increased the risk in all analysed symptoms (p = 0.002-0.007). In conclusion, smoking and exposure to ETS or VGDF increased the prevalence of current asthma and multiple symptoms. The combined exposure carried the highest risk. Preventive strategies are called for to mitigate exposure to tobacco smoke and VGDF.
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28.
  • Ivarsson, Bodil, et al. (författare)
  • Adherence and medication belief in patients with pulmonary arterial hypertension or chronic thromboembolic pulmonary hypertension : A nationwide population-based cohort survey
  • 2018
  • Ingår i: Clinical Respiratory Journal. - : Wiley. - 1752-6981 .- 1752-699X. ; 12:6, s. 2029-2035
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH) are rare diseases with a gradual decline in physical health. Adherence to treatment is crucial in these very symptomatic and life threatening diseases. Objective: To describe PAH and CTEPH patients experience of their self-reported medication adherence, beliefs about medicines and information about treatment. Methods: A quantitative, descriptive, national cohort survey that included adult patients from all PAH-centres in Sweden. All patients received questionnaires by mail: The Morisky Medication Adherence Scale (MMAS-8) assesses treatment-related attitudes and behaviour problems, the Beliefs about Medicines Questionnaire-Specific scale (BMQ-S) assesses the patient's perception of drug intake and the QLQ-INFO25 multi-item scale about medical treatment information. Results: The response rate was 74% (n = 325), mean age 66 ± 14 years, 58% were female and 69% were diagnosed with PAH and 31% with CTEPH. Time from diagnosis was 4.7 ± 4.2 years. More than half of the patients (57%) reported a high level of adherence. There was no difference in the patients' beliefs of the necessity of the medications to control their illness when comparing those with high, medium or low adherence. Despite high satisfaction with the information, concerns about potential adverse effects of taking the medication were significantly related to adherence. Conclusions: Treatment adherence is relatively high but still needs improvement. The multi-disciplinary PAH team should, together with the patient, seek strategies to improve adherence and prevent concern.
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29.
  • Ludviksdottir, Dora, et al. (författare)
  • Clinical aspects of using exhaled NO in asthma diagnosis and management
  • 2012
  • Ingår i: Clinical Respiratory Journal. - : Wiley. - 1752-6981 .- 1752-699X. ; 6:4, s. 193-207
  • Forskningsöversikt (refereegranskat)abstract
    • Background Current guidelines recommend tailoring of asthma management according to disease control, which is largely defined by increased symptoms and deterioration in lung function. These features do not reflect the severity nor the type of the asthmatic airway inflammation. Fractional exhaled nitric oxide (FENO) is a simple, non-invasive and cost-effective online test applicable in both adults and children. In addition to symptoms and lung function measurements, FENO reflects airway eosinophilia and hence allows online assessment of the corticosteroid-sensitive T helper 2 type airway inflammation in asthmatic patients. FENO can thus be applied to aid asthma diagnosis and treatment monitoring both in clinical practice and for research purposes. Objectives The scope of this review is to provide an overview of the most important clinical studies using FENO in asthma management and to summarise the implications of FENO measurements in clinical practice. Results and Conclusion In several studies, FENO measurements provided additional information on aspects of asthma including phenotyping, corticosteroid-responsiveness and disease control. Thus, if correctly applied and interpreted, FENO can aid asthma diagnosis, identify patients at risk of exacerbation and support customized treatment decisions. A simple and reliable tool to quantify peripheral nitric oxide will further aid to identify patients with small airways inflammation.
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30.
  • Måhlin, Carolina, et al. (författare)
  • Vitamin D status and dietary intake in a Swedish COPD population.
  • 2014
  • Ingår i: The clinical respiratory journal. - : Wiley. - 1752-699X .- 1752-6981. ; 8:1, s. 24-32
  • Tidskriftsartikel (refereegranskat)abstract
    • Emerging evidence indicates that patients with chronic obstructive pulmonary disease (COPD) have a poorer vitamin D status than the general population, possibly affecting several comorbidities. In northern latitudes, these problems could be even more accentuated wintertime because of the low ultraviolet B radiation.
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31.
  • Nyberg, Andre, et al. (författare)
  • Low-load/high-repetition elastic band resistance training in patients with COPD : a randomized, controlled, multicenter trial
  • 2015
  • Ingår i: Clinical Respiratory Journal. - : John Wiley & Sons. - 1752-6981 .- 1752-699X. ; 9:3, s. 278-288
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: High-repetitive resistance training is recommended to increase peripheral muscular endurance in healthy adults, however the effects of resistance training with this design on exercise capacity and health-related quality of life (HRQOL) in patients with chronic obstructive pulmonary disease (COPD) is unknown.Objective: Investigate if low load / high repetition elastic band resistance training (RT) could improve functional capacity, muscular function, endurance cycle capacity or HRQOL in patients with COPD.Methods: A prospective, randomized controlled multicentre trial was constructed with concealed allocation, blinded outcome assessment, and intention-to-treat analysis. A total of 44 patients with moderate to very severe COPD (FEV1 44.6% predicted) were included. Patients were randomized to either the experimental group receiving eight weeks of RT (3 sessions/week) in combination with patient education (four occasions) or the control group receiving the patient education alone.Results: At post-tests, the between-group differences were in favor of the experimental group on the 6 minute walk test (mean difference (95% confidence interval)): 34 meters (14 to 54) and the 6 minute pegboard and ring test (20 rings (3 to 37). No difference between groups was found on the chronic respiratory disease questionnaire (0.1 (-0.2 to 0.4). On secondary outcomes, results were in favor of the experimental group regarding upper extremity endurance capacity, muscular function and depression but no difference was seen between groups on endurance cycle capacity and HRQOL.Conclusion: RT can increase functional capacity and muscular function but not cycle endurance capacity and HRQOL in patients with moderate to severe COPD.
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32.
  • Pajediene, Evelina, et al. (författare)
  • Sleep patterns among patients with chronic fatigue: A polysomnography-based study
  • 2018
  • Ingår i: Clinical Respiratory Journal. - : WILEY. - 1752-6981 .- 1752-699X. ; 12:4, s. 1389-1397
  • Tidskriftsartikel (refereegranskat)abstract
    • ObjectivesThe purpose of this study was to detect treatable sleep disorders among patients complaining of chronic fatigue by using sleep questionnaires and polysomnography. MethodsPatients were referred to hospital for investigations and rehabilitation because of a suspected diagnosis of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). The criteria for further referral to full-night polysomnography (PSG) were symptoms of excessive daytime sleepiness and/or tiredness in the questionnaires. ResultsOf a total of 381 patients, 78 (20.5%) patients underwent PSG: 66 women and 12 men, mean age 48.6years, standard deviation 9.9years. On the basis of the PSG, 31 (40.3%) patients were diagnosed with obstructive sleep apnoea, 7 (8.9%) patients with periodic limb movement disorder, 32 (41.0%) patients with restless legs syndrome and 54 (69.3%) patients had one or more other sleep disorder. All patients were grouped into those who fulfilled the diagnostic criteria for ME/CFS (n=55, 70.5%) and those who did not (n=23, 29.5%). The latter group had significantly higher respiratory (P=.01) and total arousal (P=.009) indexes and a higher oxygen desaturation index (P=.009). ConclusionsMore than half of these chronic fatigue patients, who also have excessive daytime sleepiness and/or tiredness, were diagnosed with sleep disorders such as obstructive sleep apnoea, periodic limb movement disorder and/or restless legs syndrome. Patients with such complaints should undergo polysomnography, fill in questionnaires and be offered treatment for sleep disorders before the diagnose ME/CFS is set.
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33.
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34.
  • Westerdahl, Elisabeth, 1964-, et al. (författare)
  • Deep breathing exercises with positive expiratory pressure in patients with multiple sclerosis : a randomized controlled trial
  • 2016
  • Ingår i: Clinical Respiratory Journal. - Hoboken, USA : John Wiley & Sons. - 1752-6981 .- 1752-699X. ; 10:6, s. 698-706
  • Tidskriftsartikel (refereegranskat)abstract
    • Introduction: Breathing exercises with positive expiratory pressure are often recommended to patients with advanced neurological deficits, but the potential benefit in multiple sclerosis (MS) patients with mild and moderate symptoms has not yet been investigated in randomized controlled trials.Objectives: To study the effects of 2 months of home-based breathing exercises for patients with mild to moderate MS on respiratory muscle strength, lung function, and subjective breathing and health status outcomes.Methods: Forty-eight patients with MS according to the revised McDonald criteria were enrolled in a randomized controlled trial. Patients performing breathing exercises (n = 23) were compared with a control group (n = 25) performing no breathing exercises. The breathing exercises were performed with a positive expiratory pressure device (10-15 cmH2 O) and consisted of 30 slow deep breaths performed twice a day for 2 months. Respiratory muscle strength (maximal inspiratory and expiratory pressure at the mouth), spirometry, oxygenation, thoracic excursion, subjective perceptions of breathing and self-reported health status were evaluated before and after the intervention period.Results: Following the intervention, there was a significant difference between the breathing group and the control group regarding the relative change in lung function, favoring the breathing group (vital capacity: P < 0.043; forced vital capacity: P < 0.025). There were no other significant differences between the groups.Conclusion: Breathing exercises may be beneficial in patients with mild to moderate stages of MS. However, the clinical significance needs to be clarified, and it remains to be seen whether a sustainable effect in delaying the development of respiratory dysfunction in MS can be obtained.
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35.
  • Westerlund, Anna, et al. (författare)
  • Using the Karolinska Sleep Questionnaire to identify obstructive sleep apnea syndrome in a sleep clinic population
  • 2014
  • Ingår i: Clinical Respiratory Journal. - : Wiley. - 1752-6981 .- 1752-699X. ; 8:4, s. 444-454
  • Tidskriftsartikel (refereegranskat)abstract
    • Introduction: In Scandinavia, portable monitoring has virtually replaced standard polysomnography for diagnosis of obstructive sleep apnea syndrome (OSAS). Because waiting times for specialized OSAS care remain long, an accurate screening tool to exclude low-risk patients from diagnostic testing would be valuable. Objectives: To examine the diagnostic accuracy of the Karolinska Sleep Questionnaire (KSQ) for OSAS. Methods: Consecutive patients, 30-66 years old, attending a large sleep clinic in Sweden for OSAS evaluation completed the KSQ and underwent in-home portable monitoring and medical history evaluation. OSAS was defined as apnea-hypopnea index >= 5 with symptoms of disease. We calculated sensitivity and specificity of apnea/snoring and sleepiness indices of the KSQ. Retrospectively, we combined six KSQ items (snoring, breathing cessations, disturbed sleep, etc.) and four clinical variables (age, sex, body mass index, smoking status) predictive of OSAS into a new instrument, which we also evaluated. Instrument score ranged between 0 and 21; a higher score indicated more severe symptoms. Results: Of 103 patients, 62 were diagnosed with OSAS. Sensitivity and specificity of the indices were 0.56 and 0.68 (apnea/snoring), and 0.37 and 0.71 (sleepiness). The new instrument performed optimally at a score of 9. Sensitivity was 0.76 (95% confidence interval 0.63-0.86) and specificity 0.88 (0.74-0.96). Between 19.4% and 50.5% of patients were unaware of having apnea/snoring symptoms. Conclusions: Diagnostic accuracy of the apnea/snoring and sleepiness indices for OSAS was poor but could be improved by combining clinical and KSQ items. The usefulness of the apnea/snoring index and the combined instrument was questionable because of extensive symptom unawareness.
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36.
  • Aronsson, David, et al. (författare)
  • Comparison of central and peripheral airway involvement before and during methacholine, mannitol and eucapnic hyperventilation challenges in mild asthmatics.
  • 2011
  • Ingår i: Clinical Respiratory Journal. - 1752-6981. ; 5:1, s. 41565-41565
  • Tidskriftsartikel (refereegranskat)abstract
    • Introduction: Testing for airway hyperresponsiveness with indirect stimuli as exercise or mannitol has been proposed to better reflect underlying airway inflammation, as compared with methacholine (MCh), believed to act directly on airway smooth muscle cells. Objective: To investigate whether different direct and indirect stimuli induces different patterns of obstruction, recorded as central and peripheral resistance, and to see whether baseline resistance could predict a positive response to direct or indirect provocation. Methods: Thirty-four mild asthmatics and 15 controls underwent MCh, mannitol and eucapnic voluntary hyperventilation (EVH) challenge tests. The response was evaluated with spirometry and impulse oscillometry (IOS). Results: Twenty-three out of 34 asthmatics were positive to either EVH (22) or mannitol (13). Those positive to mannitol had a significant increased baseline value of IOS parameters such as ΔR5-R20 and AX. Twelve of the asthmatics had a 10% fall or more in forced expiratory volume in 1 s (FEV(1) ) in all three challenge tests. However, the response pattern measured by IOS did not differ between the tests. When the limit for a positive mannitol provocation was set to 10% fall in FEV(1) , 16 out of 19 mannitol-positive patients were also positive to EVH. Conclusion: Even in mild asthmatics, a substantial number had a positive indirect test. Mannitol FEV(1) provocative dose to decrease FEV(1) by 10% from baseline (PD10) was closely associated to EVH10%. No difference in bronchoconstrictive pattern could be seen between the different provocation tests, but those positive to mannitol had more peripheral airway involvement at baseline. This supports the idea that peripheral airway involvement is an important predictor of asthma airway reactivity. Please cite this paper as: Aronsson D, Tufvesson E, Bjermer L. Comparison of central and peripheral airway involvement before and during methacholine, mannitol and eucapnic hyperventilation challenges in mild asthmatics. Clin Respir J 2011; 5: 10-18.
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37.
  • Berg, Sören (författare)
  • Obstructive sleep apnoea syndrome: current status
  • 2008
  • Ingår i: Clinical Respiratory Journal. - 1752-6981. ; 2:4, s. 197-201
  • Forskningsöversikt (refereegranskat)abstract
    • Introduction: Obstructive sleep apnoea syndrome (OSAS) is a prevalent condition that covaries with cardiovascular complications and most likely with arterial hypertension and diabetes mellitus. Objective: The present paper is a review of the current status of OSAS. Results: Definitions and diagnostic criteria as well as known risk factors, prevalence, symptoms, covariance with other diseases and consequences as traffic accidents are described. OSAS is characterised by daytime sleepiness symptoms that range from mild to severe. Risk factors such as anatomical upper airway abnormalities, overweight, smoking, excessive alcohol intake and use of muscle relaxants are related to the development of sleep apnoea. Various diagnostic procedures and treatment modalities are considered. Overnight polysomnography is the reference standard for sleep apnoea recording. Treatment modalities include mechanical [continuous positive airway pressure (CPAP), oral appliances], surgical, pharmacological and 'conservative' lifestyle modifications. Finally, Nordic accrediation guidelines for sleep medicine clinics and sleep medicine specialists are described. Conclusion: The diagnosis of OSAS should be performed with a polygraph, and the first-line treatment of moderate to severe OSAS is CPAP. Lastly, compliance for this treatment should be optimised with regular clinical controls.
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38.
  • Bjermer, Leif (författare)
  • Targeting small airways, a step further in asthma management
  • 2011
  • Ingår i: Clinical Respiratory Journal. - 1752-6981. ; 5:3, s. 131-135
  • Forskningsöversikt (refereegranskat)abstract
    • Introduction: During the last decade, small airway (SA) involvement in asthma and Chronic Obstructive Pulmonary Disease (COPD) have reached increasing attention. Originally referred to as the 'silent zone', SA may not be that silent after all. Important clinical correlates are asthma exacerbations and airways remodelling, exercise asthma and nocturnal asthma. Thus, to control pathology in the SA has become a desirable goal in asthma management. Objectives: The scope of this review is to give a brief overview of the current status on SA in asthma, how to monitor and to diagnose SA inflammation and finally highlight some important treatment strategies. Results/Conclusion: New tools have been developed to monitor SA function; these implies the use of imaging techniques and respiratory physiology, targeting SA function. Fractional exhaled nitric oxide and the combined use of hyperresponsiveness testing with impulsoscillometry is another option. The introduction of ultrafine aerosols has provided new tools for to treat SA inflammation. The challenge for the future will be to define the optimal particle size and device for maximal deposition in entire lung, including the small airways. Moreover, we also need strategies for increasing the therapeutic ratio, i.e. increasing lung deposition without increasing systemic side effects. Another challenge is to design and to perform clinical trials, targeting effects in SA, proving the clinical importance of SA treatment in a large number of patients. The latter also imply education of our medical authorities, communicating that asthma is more than a beta-2 agonist responsive central airway disorder of the lungs.
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39.
  • Erjefält, Jonas (författare)
  • The airway epithelium as regulator of inflammation patterns in asthma
  • 2010
  • Ingår i: Clinical Respiratory Journal. - 1752-6981. ; 4:s1, s. 9-14
  • Forskningsöversikt (refereegranskat)abstract
    • Introduction: Asthma is a complex, heterogeneous and mutifactorial disease and represents a major health problem in Westernised countries. The airway epithelium, with its direct physical contact with luminal triggers, has a major role in determining the nature of inflammation that develops in asthmatic airways. Objective: The present review aims to provide a brief overview of the numerous ways the airway epithelium can affect and influence the histopathological picture in asthma. Results and Conclusion: The ways the epithelium aggravates inflammation range from acute responses to luminal triggers such as allergens and infections to the multipathogenic events occurring as a consequence of repeated epithelial damage-repair responses. The airway epithelium also facilitates the selective migration of leukocytes into the airway lumen, a process that is important in regulating inflammatory cell homeostasis. The fact that only some of the important leukocyte subtypes participate in this process cause translational problems and difficulties in the interpretation of luminal samples. To further reveal the nature of the multifaceted involvement of the airway epithelium in inflamed asthmatic airways emerges as a promising goal for identifying new therapeutic strategies. Please cite this paper as: Erjefalt JS. The airway epithelium as regulator of inflammation patterns in asthma. Clin Respir J 2010; 4 (Suppl. 1): 9-14.
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40.
  • Jernlås, Björn, et al. (författare)
  • Diagnostic Yield and Efficacy of Endobronchial Ultrasound-guided Transbronchial Needle Aspiration in Mediastinal Lymphadenopathy.
  • 2012
  • Ingår i: Clinical Respiratory Journal. - 1752-6981. ; 6, s. 88-95
  • Tidskriftsartikel (refereegranskat)abstract
    • Introduction: Endobronchial ultrasound transbronchial needle aspiration (EBUS-TBNA) is an emerging minimally invasive option for pathologic examination of intrathoracic lymphadenopathy as well as for staging lung cancer. Objectives: To evaluate the diagnostic yield and possible learning curve effects on diagnostic performance using EBUS-TBNA in mediastinal lymphadenopathy. Methods: A retrospective analysis was performed on 243 consecutive patients who underwent EBUS-TBNA over a four year period. Demographic and clinical data and pathology results were analyzed for different time frames in order to evaluate potential learning curve effects. The procedures were performed by two experienced bronchoscopists at a single university medical centre. Results: Samples were representative in 83% (200/243) of the patients. The overall diagnostic yield was 66% (n = 161/243). The diagnostic accuracy of EBUS-TBNA for detecting malignancy was 98.0% and for lung cancer 98.5%. The sensitivity, specificity, positive (PPV) and negative (NPV) predictive values for lung cancer stage ≥N1 and malignant disease were 100% for the first three studied periods and slightly less favourable in the most recent study period. Representative samples were obtained more frequently in the latter study periods (p < 0.001). Conclusion: EBUS-TBNA is a safe method with a learning curve that is easily overcome, although previous experience with ultrasound may be necessary. The diagnostic yield of EBUS-TBNA is in accordance with previously reported yield of standard cervical mediastinoscopy. At present, however, the relationship between EBUS-TBNA and mediastinoscopy appears to be complementary rather than substitutive.
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41.
  • Kiotseridis, Hampus, et al. (författare)
  • Quality of life in children and adolescents with respiratory allergy, assessed with a generic and disease-specific instrument
  • 2013
  • Ingår i: Clinical Respiratory Journal. - 1752-6981. ; 7:2, s. 168-175
  • Tidskriftsartikel (refereegranskat)abstract
    • Introduction: Respiratory allergic disorders like rhinitis and asthma are common conditions that not only affect target organs, but complicate the daily life of affected children and adolescents. Objectives: The aim of this study was to investigate the QoL (quality of life) in children with grass pollen allergy in and out of grass pollen season. Methods: We used the Pediatric Allergic Disease Quality of Life Questionnaire (PADQLQ), a disease-specific questionnaire including both asthma and rhinitis symptoms. We also used the DISABKIDS (a European project which aims at enhancing the quality of life and the independence of children with chronic health conditions and their families) questionnaire, a generic questionnaire covering non-organ-specific effects of disease. Results: Ninety-eight children 718 years old with grass pollen allergy were included. Eighty-nine children (91%) completed the study. The QoL was significantly decreased during pollen season assessed both with DISABKIDS and PADQLQ. The correlation between the questionnaires was 0.73. Not only the physical domain score (P=0.00093) but also the emotional domain score (P=0.034) was significantly lowered. Children with multiple manifestations (asthma and rhinitis) had lower QoL than children with rhinitis alone (P=0.01). Multiple regression analysis showed a highly significant impact on QoL for symptoms from nose, eyes and lungs. They were equally important (standardized coefficient 047, 0.47 and 0.46, respectively). Conclusion: The QoL in children and adolescents with respiratory allergy deteriorates during pollen season. This was shown both with generic (DISABKIDS) and disease-specific instrument (PADQLQ). Please cite this paper as: Kiotseridis H, Cilio CM, Bjermer L, Aurivillius M, Jacobsson H, Dahl angstrom and Tunsater A. Quality of life in children and adolescents with respiratory allergy, assessed with a generic and disease-specific instrument. Clin Respir J 2013; 7: 168175.
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42.
  • Petersen, Marian, et al. (författare)
  • Sexual function in male patients with obstructive sleep apnoea.
  • 2010
  • Ingår i: Clinical Respiratory Journal. - 1752-6981. ; 4:3, s. 186-191
  • Tidskriftsartikel (refereegranskat)abstract
    • OBJECTIVE: Our objective was to investigate general and functional aspects of sexuality in male patients with a confirmed diagnosis of obstructive sleep apnoea (OSA) and compare the results with normative data. MATERIALS AND METHODS: We investigated 308 male patients (age 30-69) admitted to a sleep laboratory and receiving a diagnosis of OSA, using questions drawn from two self-administered questionnaires on sexuality [Fugl-Meyer Life satisfaction checklist (LiSat) and Brief Sexual Function Inventory (BSFI)]. RESULTS: We found that both general (Fugl-Meyer LiSat) and functional (BSFI) aspects of sexuality were worse in patients with (untreated) OSA when compared with normative data. Both aspects were dependent on age, obesity, social factors and concomitant medication but not on the severity of OSA as reflected by the apnoea-hypopnoea index or subjective sleepiness. CONCLUSION: We conclude that although sexual dysfunction is more prevalent in OSA patients than in the general population, it is a complex problem relating more to age, obesity, social factors and comorbidity than to the severity of OSA.
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43.
  • Petersen, Marian, et al. (författare)
  • Sexual function in male patients with obstructive sleep apnoea after 1 year of CPAP treatment.
  • 2013
  • Ingår i: Clinical Respiratory Journal. - 1752-6981. ; 7:2, s. 214-219
  • Tidskriftsartikel (refereegranskat)abstract
    • OBJECTIVE: Our objective was to investigate what impact 1 year of effective nocturnal continuous positive airway pressure (CPAP) treatment had on general and functional aspects of sexuality in male patients with a confirmed diagnosis of obstructive sleep apnoea (OSA). METHODS: Before and after 1 year of CPAP treatment, a total of 207 CPAP-compliant male patients (age 26-77) received a survey with questions drawn from two self-administered questionnaires on sexuality - Life Satisfaction 11 (LiSat-11) and brief sexual function inventory (BSFI). For assessment of daytime sleepiness, we used the Epworth sleepiness scale (ESS). RESULTS: Response rate was 76%. We found no significant changes in satisfaction with relation to partner or life as a whole, but satisfaction with sexual life (LiSat-11) and both general and functional aspects of sexuality (BSFI) were significantly improved after 1 year of CPAP treatment. ESS score decreased significantly after 1 year of CPAP treatment. CONCLUSION: One year of CPAP treatment improves all aspects of sexual function in male patients with OSA. Our data indirectly suggest that organic factors are the most likely explanation to these improvements.
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44.
  • Svensson, Gunnar A, et al. (författare)
  • Prognostic factors in lung cancer in a defined geographical area over two decades with a special emphasis on gender.
  • 2013
  • Ingår i: Clinical Respiratory Journal. - 1752-6981. ; 7:1, s. 91-100
  • Tidskriftsartikel (refereegranskat)abstract
    • Introduction: Many studies over recent decades report an increasing incidence of lung cancer in female patients. Female gender is often reported as a good prognostic factor. Objectives: The aim of the present study was to investigate prognostic factors with a special emphasis on gender. Methods: During 1989-2008, 1497 patients in eastern Scania, a part of southern Sweden with 202 000 inhabitants, were referred to one Central Hospital and prospectively registered. All patients were grouped into four 5-year periods and analysed for occurrence of lung cancer, patient performance status, types and stages of lung cancer and the relation to gender. Results: The incidence of lung cancer more than doubled in women. The proportion of adenocarcinomas increased in females and males to 57 % (p=0.028) and 42 % (p=0.001), respectively, while the frequency of small cell lung carcinomas (SCLCs) decreased in both genders to approximately 14 %. Females had significantly more frequent stage 1 (16.6 %) and higher surgery rate (23.1 %) than males (12 % and 18.2 %, respectively). Females showed a higher 5-year survival rate than males (20.1 % and 11.5 %, respectively; p<0.001). Patients with non-small cell lung carcinoma (NSCLC) had a higher 5-year survival rate than those with SCLC (16.5 % and 7.5 %, respectively; p<0.01); however there was no significant survival difference in females between NSCLC and SCLC. Conclusion: Female patients exhibited longer survival than males for both NSCLC and SCLC, and this was not explained by a higher frequency of stage 1 or surgery in NSCLC. © 2012 Blackwell Publishing Ltd.
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45.
  • Tufvesson, Ellen, et al. (författare)
  • Levels of cysteinyl-leukotrienes in exhaled breath condensate are not due to saliva contamination
  • 2010
  • Ingår i: Clinical Respiratory Journal. - 1752-6981. ; 4:2, s. 83-88
  • Tidskriftsartikel (refereegranskat)abstract
    • Background and Aims: Saliva contamination has been suggested to be a major contributor to levels of cysteinyl leukotrienes in exhaled breath condensate (EBC). The aim of this study was to compare the levels of cysteinyl-leukotrienes (CysLT) and alpha-amylase activity in EBC to induced sputum and saliva collected from the same subjects (asthmatics and control). We thereby aimed to find out whether saliva contamination could be a plausible explanation to the levels found in EBC or not. Methods: EBC, saliva and induced sputum were collected from 11 asthmatic and 19 healthy adults. These samples were analyzed for CysLT concentration and alpha-amylase activity. Results: No significant correlation was found between CysLT concentration and alpha-amylase activity in EBC, saliva or sputum. In addition, we show that the saliva contamination (measured as alpha-amylase activity) was negligible, as the relative amount of saliva CysLT was only 0.6% of that found in EBC. The amount of CysLT correlated between all three compartments (EBC, saliva and sputum), but no similar correlation was seen for the alpha-amylase activity in EBC compared to saliva and sputum. The levels of CysLT were higher in asthmatic patients compared to healthy controls in EBC, saliva and sputum. Conclusion: We conclude that the amount of CysLT in EBC cannot be explained by saliva contamination. Please cite this paper as: Tufvesson E, van Weele LJ, Ekedahl H and Bjermer L. Levels of cysteinyl-leukotrienes in exhaled breath condensate are not due to saliva contamination. The Clinical Respiratory Journal 2010; 4: 83-88.
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46.
  • Westergren-Thorsson, Gunilla, et al. (författare)
  • Pathological airway remodelling in inflammation
  • 2010
  • Ingår i: Clinical Respiratory Journal. - 1752-6981. ; 4:s1, s. 1-8
  • Forskningsöversikt (refereegranskat)abstract
    • Introduction: Airway remodelling refers to a wide pattern of patophysiological mechanisms involving smooth muscle cell hyperplasia, increase of activated fibroblasts and myofibroblasts with deposition of extracellular matrix. In asthma, it includes alterations of the epithelial cell layer with goblet cell hyperplasia, thickening of basement membranes, peri-bronchial and peri-broncheolar fibrosis. Moreover, airway remodelling occurs not only in asthma but also in several pulmonary disorders such as chronic obstructive pulmonary disease, idiopathic pulmonary fibrosis and systemic sclerosis. Asthma treatment with inhaled corticosteroids does not fully prevent airway remodelling and thus have restricted influence on the natural course of the disease. Objectives: This review highlights the role of different fibroblast phenotypes and potential origins of these cells in airway remodelling. Results: During inflammatory conditions, such as asthma, fibroblasts can differentiate into an active, more contractile phenotype termed myofibroblast, with expression of stress fibres and alpha-smooth muscle actin. The origin of myofibroblasts has lately been debated, and three sources have been identified: recruitment and differentiation of resident tissue fibroblasts; fibrocytes - circulating progenitor cells; and epithelial-mesenchymal transition. Conclusion: It is clear that airway mesenchymal cells, including fibroblasts/myofibroblasts, are more dynamic in terms of differentiation and origin than has previously been recognised. Considering that these cells are key players in the remodelling process, it is of utmost importance to characterise specific markers for the various fibroblast phenotypes and to explore factors that drive the differentiation to develop future diagnostic and therapeutic tools for asthma patients. Please cite this paper as: Westergren-Thorsson G, Larsen K, Nihlberg K, Andersson-Sjoland A, Hallgren O, Marko-Varga G and Bjermer L. Pathological airway remodelling in inflammation. Clin Respir J 2010; 4 (Suppl. 1): 1-8.
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47.
  • Bonde, Ellen, 1968, et al. (författare)
  • Dissociation of dysfunctional breathing and odour intolerance among adults in a general-population study.
  • 2013
  • Ingår i: The clinical respiratory journal. - 1752-699X. ; 7:2, s. 176-182
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Many patients present with a mixture of respiratory problems such as shortness of breath, heavy breathing, coughing and odour intolerance. If these patients are diagnosed as asthma, it might sometimes be a false diagnosis. Concepts such as sensory hyperreactivity, hyperventilation, asthma-like symptoms, odour intolerance and dysfunctional breathing are used to refer to these patients. Non-respiratory symptoms such as headache, fatigue and bloating are sometimes also part of the clinical picture. Our aim was to use factor analysis to increase our understanding of breathing-related symptoms in a general-population frame. Methods: A respiratory questionnaire was answered by 10108 subjects in a general-population sample. Items aiming to identify individuals with breathing-related symptoms and asthma were included. We used factor analysis with Varimax rotation to extract discriminatory components (i.e. groups of symptoms), based on the questionnaire items. The aim was to find groups of items (factors) as distinct as possible, still allowing overlap and showing the importance of each item in the separated factor. Results: Five distinct factors were identified in the factor analysis, representing dysfunctional breathing, odour intolerance, asthma, bronchitis and a group with mixed symptoms, respectively. These five factors explained 55% of the variance. Conclusions: Based on our findings, we conclude that non-asthmatic breathing-related symptoms may be separated into at least two categories in a general population, odour intolerance and dysfunctional breathing. These two categories seem to be two distinct groups of subjects with breathing-related symptoms and may represent different clinical entities separated from asthma and bronchitis. Please cite this paper as: Bonde E, Andersson E, Brisman J, Eklöf M, Ringsberg KC and Torén K. Dissociation of dysfunctional breathing and odour intolerance among adults in a general-population study. Clin Respir J 2012; DOI: 10.1111/j.1752-699X.2012.00299.x.
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48.
  • Juusela, Maria, et al. (författare)
  • Bronchial hyperresponsiveness in an adult population in Helsinki: decreased FEV(1) , the main determinant.
  • 2013
  • Ingår i: The clinical respiratory journal. - 1752-699X. ; 7:1, s. 34-44
  • Tidskriftsartikel (refereegranskat)abstract
    • Introduction: Bronchial hyperresponsiveness (BHR) elevates the risk for development of respiratory symptoms and accelerates the decline in forced expiratory volume in the first second (FEV(1) ). We thus aimed to assess the prevalence, determinants and quantity of BHR in Helsinki. Objectives: This study involved 292 randomly selected subjects age 26-66years, women comprising 58%. Methods: Following a structured interview, a spirometry, a bronchodilation test, and a skin-prick test, we assessed a bronchial challenge test with inhaled histamine using a dosimetric tidal breathing method. Results included the provocative dose inducing a decrease in FEV(1) by 15% (PD(15) FEV(1) ) and the dose-response slope. For statistical risk factor-analyses, the severity of BHR was considered; PD(15) values ≤1.6mg (BHR) and ≤0.4mg [moderate or severe BHR (BHR(ms) )] served as cut-off levels. Results: BHR presented in 21.2% and BHR(ms) in 6.2% of the subjects. FEV(1) <80% of predicted [odds ratio (OR) 4.09], airway obstruction (FEV(1) /forced vital capacity<88% of predicted) (OR 4.33) and history of respiratory infection at age <5 (OR 2.65) yielded an increased risk for BHR as ORs in multivariate analysis. For BHR(ms) , the determinants were decreased FEV(1) below 80% of predicted (OR 27.18) and airway obstruction (OR 6.16). Respiratory symptoms and asthma medication showed a significant association with BHR. Conclusions: Of the adult population of Helsinki, 21% showed BHR to inhaled histamine. The main determinants were decreased FEV(1) and airway obstruction. Quantitative assessment of BHR by different cut-off levels provides a tool for characterization of phenotypes of airway disorders in epidemiologic and clinical studies. Please cite this paper as: Juusela M, Pallasaho P, Sarna S, Piirilä P, Lundbäck B and Sovijärvi A. Bronchial hyperresponsiveness in an adult population in Helsinki: decreased FEV(1) , the main determinant. Clin Respir J 2012; DOI:10.1111/j.1752-699X.2011.00279.x.
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49.
  • Björnsson, Eyþór, et al. (författare)
  • Airway hyperresponsiveness, peak flow variability and inflammatory markers in non-asthmatic subjects with respiratory infections
  • 2007
  • Ingår i: Clinical Respiratory Journal. - : Wiley. - 1752-6981. ; 1:1, s. 42-50
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective: The aim of this study was to characterise non-asthmatic subjects with asthma-like symptoms during a common cold, particularly in relation to airway hyperresponsiveness (AHR). Materials and Methods: Subjects with acute respiratory infections and a group of controls (n = 20 + 20), age 20-65 years, underwent bronchial provocations with methacholine, adenosine and cold air. All were non-smokers and had no history of asthma or heart disease. Those with infection had asthma-like symptoms (> , 2). Measurements of exhaled nitric oxide (eNO), serum levels of eosinophil cationic protein (ECP), eosinophil peroxidase, myeloperoxidase and human neutrophil lipocalin were made at each provocation. A 17-day symptom and peak flow diary was calculated. Results: No differences between the two groups were found, regarding responsiveness to methacholine, adenosine or cold air challenge, as well as the inflammatory markers measured. In the infected group, the mean (standard deviation) ECP was higher in those with AHR to methacholine or cold air [15.7 (6.5) and 11.4 (4.2) mg/L, respectively; P < , 0.05], furthermore, eNO was higher in the infected group [116 ( 54) and 88 ( 52) nL/min, respectively, P = 0.055]. The infected group had, at all times, more symptoms and higher peak flow, with a decrease in the symptoms (P = 0.02) and a tendency to change in peak flow variation (P = 0.06). Conclusion: AHR does not seem to be the main cause of asthma-like symptoms in adults with infectious wheezing. Peak flow variation and symptom prevalence during the post-infection period may imply airway pathology different from AHR.
  •  
50.
  • Brodtkorb, Thor-Henrik, et al. (författare)
  • Cost-effectiveness of clean air administered to the breathing zone in allergic asthma
  • 2010
  • Ingår i: CLINICAL RESPIRATORY JOURNAL. - 1752-6981. ; 4:2, s. 104-110
  • Tidskriftsartikel (refereegranskat)abstract
    • Introduction: Airsonett Airshower (AA) is a novel non-pharmaceutical treatment for patients with perennial allergic asthma that uses a laminar airflow directed to the breathing zone of patients during sleep. It has been shown that AA treatment in addition to optimized standard therapy significantly increases asthma-related quality of life among adolescent asthmatics. However, the cost-effectiveness of AA treatment has not yet been assessed. As reimbursement decisions are increasingly guided by results from the cost-effectiveness analysis, such information is valuable for health-care policy-makers. Objective: The objective of this study was to estimate the cost-effectiveness of adding AA treatment with allergen-free air during night sleep to optimized standard therapy for adolescents with perennial allergic asthma compared with placebo. Materials and Methods: A probabilistic Markov model was developed to estimate costs and health outcomes over a 5-year period. Costs and effects are presented from a Swedish health-care perspective (QALYs). The main outcome of interest was cost per QALY gained. Results: The Airshower strategy resulted in a mean gain of 0.25 QALYs per patient, thus yielding a cost per QALY gained of under 35 000 as long as the cost of Airshower is below 8200. Conclusions: Adding AA treatment to optimized standard therapy for adolescents with perennial allergic asthma compared with placebo is generating additional QALYs at a reasonable cost. However, further studies taking more detailed resource use and events such as exacerbations into account would be needed to fully evaluate the cost-effectiveness of AA treatment. Please cite this paper as: Brodtkorb T-H, Zetterstrom O and Tinghog G. Cost-effectiveness of clean air administered to the breathing zone in allergic asthma.
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