| 1. |
- Arvidsson, Monica, 1955, et al.
(författare)
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Allergen specific immunotherapy attenuates early and late phase reactions in lower airways of birch pollen asthmatic patients: a double blind placebo-controlled study
- 2004
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Ingår i: Allergy. ; 59:1
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Few placebo-controlled studies have examined the effect of allergen specific immunotherapy (SIT) on early and late phase asthmatic reactions. In this placebo-controlled study we have investigated the effect of 1 year of SIT with standardized birch pollen extract on early and late phase asthmatic reactions in adult asthmatic patients. METHODS: Nineteen patients with a history of birch-pollen-induced seasonal symptoms from upper and lower airways, positive skin prick test and in vitro specific immunoglobulin E to birch pollen extract were included. Allergen and methacholine bronchial challenges were performed and blood samples obtained for analyses of total eosinophil count and eosinophil cationic protein (ECP) in serum, before and after 1 year of immunotherapy treatment. RESULTS: All patients developed early and 16 of 19 both early and late phase asthmatic reactions. A significant increase in allergen dose was required to evoke early asthmatic reaction in the immunotherapy group (P < 0.01) after 1 year of treatment. The difference between the groups was significant (P < 0.01). Also the size of late asthmatic reaction was significantly reduced in the SIT group compared with placebo treated patients (P < 0.01). Twenty-four hours after allergen challenge methacholine sensitivity, number of total eosinophils and ECP increased significantly in the placebo (P < 0.02, P < 0.05 and P < 0.05 respectively), but not in the SIT group. CONCLUSION: Allergen SIT with standardized birch pollen extract decreased early and late asthmatic responses following bronchial challenge in pollen allergic patients, thus confirming anti-inflammatory effect of the treatment.
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| 2. |
- Arvidsson, Monica, 1955, et al.
(författare)
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Early and late phase asthmatic response in lower airways of cat-allergic asthmatic patients - a comparison between experimental and environmental allergen challenge
- 2007
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Ingår i: Allergy. - 0105-4538. ; 62:5, s. 488-94
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Tidskriftsartikel (refereegranskat)abstract
- Background: Standardized experimental allergen challenges are usually adopted to investigate the effect of allergen exposure on the lower airways. Environmental (natural) allergen challenges are used less often, mainly because of difficulties in standardizing the method, safety reasons and costs. The aim of this study was to investigate the relationship between an experimental and an environmental bronchial challenge. For this reason a natural challenge model was developed. Methods: Sixty-two patients with a history of cat allergen-induced symptoms involving the lower airways, positive skin prick test, positive in vitro specific IgE to cat allergen and bronchial hyper-responsiveness were included. All 62 patients underwent an experimental challenge in the laboratory followed by an environmental allergen challenge. Results: All 62 patients developed an early asthmatic response [>/=20% fall in forced expiratory volume in 1 s (FEV(1))] in the experimental challenge and 60% (37/62) during the environmental challenge. A late asthmatic response (>/=15% fall in FEV(1) within 3-24 h) was seen in 56% (35/62) of the patients after the experimental challenge. Following the environmental challenge 47% (29/62) of the patients developed a late response. Thirty-four per cent (21/62) of the patients developed a late response in both challenge models and 31% (19/62) did not develop a late response in any model. Thus, there was consistency in 65% (40/62) of the patients in both challenge models. Conclusion: We found consistency in the pattern of response to inhaled allergen between the two challenge models and we believe that experimental bronchial challenge is likely to reflect the development of relevant inflammation in the lower airways after low-dose allergen exposure in the environment.
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| 3. |
- Arvidsson, Monica, 1955, et al.
(författare)
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Effect of 2-year placebo-controlled immunotherapy on airway symptoms and medication in patients with birch pollen allergy
- 2002
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Ingår i: J Allergy Clin Immunol. ; 109:5 Pt 1
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Birch pollen is a common allergen in northern, central, and eastern Europe. Earlier studies of specific immunotherapy using birch pollen extract were not placebo-controlled or were only preseasonal. Long-term, placebo-controlled studies with subcutaneously administered standardized birch pollen extract are lacking. OBJECTIVE: The aim of this study was to evaluate the effect of immunotherapy with birch pollen extract on airway symptoms and use of medication in adult birch pollen-allergic patients in a double-blind, placebo-controlled trial. METHODS: Forty-nine patients with histories of birch pollen allergy from the upper and lower airways, positive skin prick test and conjunctival provocation test results, and in vitro specific IgE to birch pollen (Betula verrucosa ) extract were included. Immunotherapy with birch pollen extract was given during 2 consecutive years in a double-blind, randomized, placebo-controlled study. Clinical symptom scores from the upper and lower airways and use of rescue medication were registered throughout the pollen season. RESULTS: Forty-six patients reached the maintenance dose and were maintained on that dose during the 2-year study. The median symptom scores during the 1997 and 1998 seasons were 1.3 and 2.6, respectively, in the specific immunotherapy group and 2.1 and 4.3, respectively, in the placebo group. The differences between the groups were significant (P =.05 in 1997 and P =.005 in 1998). The placebo group used significantly more rescue medication during both seasons than the specific immunotherapy group (P =.004 for 1997 and P =.004 for 1998). CONCLUSION: Specific immunotherapy with birch pollen extract is an effective and safe treatment for reducing clinical allergy symptoms and medication use in birch pollen-allergic patients during the pollen season.
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| 4. |
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| 5. |
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| 6. |
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| 7. |
- Hansson Scherman, Marianne, 1944, et al.
(författare)
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Drug compliance and identity: reasons for non-compliance. Experiences of medication from persons with asthma/allergy.
- 2004
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Ingår i: Patient education and counseling. - : Elsevier BV. - 0738-3991. ; 54:1, s. 3-9
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Tidskriftsartikel (refereegranskat)abstract
- The aim of the study was to describe patient experiences of medication. Patients with asthma/allergy were interviewed in depth twice with 8 years between. The interviews were analysed according to the phenomenographic approach and three categories, one with four sub-categories, were identified: 'access to medicine is important to relieve discomfort and to avoid fear', 'medicine damages your body and your identity without curing the illness' (because 'you can become immune or addicted', 'the ability of your body to heal itself is weakened', 'your body's own signals are camouflaged' and 'you become stigmatised') and 'production and distribution of medicine is a profit-seeking commercial undertaking which is not primarily aimed at curing the patient'. Medication experiences were stable over time. Sociological and biological survival must be compared in an open discussion along with the patient's and health professional's different reasons for how they take or prescribe medication.
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| 8. |
- Hansson Scherman, Marianne, 1944, et al.
(författare)
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Refusing to be ill: a longitudinal study of patients' experiences of asthma/allergy.
- 2002
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Ingår i: Disability and rehabilitation. - : Informa UK Limited. - 0963-8288 .- 1464-5165. ; 24:6, s. 297-307
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: The purpose of this study was to search for a deeper understanding of the ways patients with asthma/allergy experience their illness situation. METHOD: Thirty patients with a history of airway symptoms on allergen exposure and a positive skin prick test were included in the study. They took part in open-ended interviews in their homes twice at an interval of eight years, according to the phenomenographic approach. RESULTS: Fourteen different categories of experience were identified: 'knowing for oneself, 'body related', 'environment related', 'psychosomatic', 'magic', 'fatalism', 'compliance with medication', 'alternative medicine', 'health care', 'provocation', 'avoidance', 'normalization', 'normification' and 'pursuing life'. The analysis also showed that these categories, to varying degrees, were an expression of a desire to retain an ordinary healthy identity and its value. The longitudinal results showed that with time the patients distanced themselves from the medical perspective and found their own ways of thinking and acting in relation to their ill health, which is seen as strengthening for the identity. CONCLUSIONS: The different, individual ways patients with asthma/allergy developed in relation to the illness situation have a preserving effect on the identity, which ought to be considered in patient education and rehabilitation.
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| 9. |
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| 10. |
- Hellgren, Johan, 1965, et al.
(författare)
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Quality of life in non-infectious rhinitis and asthma
- 2004
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Ingår i: Rhinology. ; 42:4
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Tidskriftsartikel (refereegranskat)abstract
- In this study we evaluated how the quality of life in subjects with asthma was affected by a history of non-infectious rhinitis. The study comprised 180 persons with asthma and 156 controls, who answered the Short Form 36 quality of life questionnaire. Both the asthma subjects and the controls were stratified according to a history of non-infectious rhinitis (NIR). The global physical quality of life score (PCS) was significantly lower for all the asthma subjects regardless of their previous history of NIR compared to controls (NIR positive asthma, -8, p=O,001, NIR negative asthma, -9, p=0, 001). The subjects with asthma and a positive history of NIR obtained significantly lower scores for their global mental quality of life (MCS) than the controls (46 vs 51, p=0.004). The subjects with asthma and a negative history of NIR obtained MCS scores that were similar to those of the controls (50 and 51, p=0.9). In this population based study, the physical Qol of the subjects with asthma was lower regardless of a previous history of NIR compared to controls. A positive history of NIR in asthma was however associated with a poorer mental Qol.
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| 11. |
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| 12. |
- Hytönen, Ann-Marie, et al.
(författare)
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Haplotypes of the interleukin-4 receptor alpha chain gene associate with susceptibility to and severity of atopic asthma
- 2004
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Ingår i: Clin Exp Allergy. ; 34:10
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Tidskriftsartikel (refereegranskat)abstract
- Summary Background Development of asthma is likely to depend on a complex interaction between environmental and genetic factors. Several groups have suggested the gene of the IL-4 receptor alpha chain (IL4R) as a candidate gene for the development of asthma, although association with single polymorphisms has shown contradicting results. Objective We chose to analyse IL4R gene haplotypes and assess their possible relevance in susceptibility to asthma and to certain clinical phenotypes. Methods IL4R gene haplotypes were analysed, based on the three markers C-3223T, Q551R and I50V, using the expectation-maximization algorithm, in 170 atopic asthma patients and 350 controls, all adult Swedish Caucasians. Results Our data showed significantly higher levels of soluble IL-4R (sIL-4R) in asthma patients compared with controls (P<0.0001). Furthermore, we showed a significant association between the IL4R haplotype containing the alleles T-3223, V50 and R551 (TVR) of the IL4R gene, and susceptibility to atopic asthma, with a frequency of 6.5% in the patients compared with 1% in the controls (P<0.0005). A subgroup of patients with heterozygous or homozygous state for the T-3223, V50 and R551 alleles, also had lower levels of sIL-4R in their circulation compared with patients with homozygous state in the C-3223, I50 and Q551 alleles (P<0.05) and showed less severe asthma according to lung function test (P<0.05). Analysis of single markers showed the T-3223 IL4R allele to associate with lower serum levels of sIL-4 receptor (P<0.0001) and patients carrying the T allele also had more symptoms of active asthma (wheezing, P<0.01; coughing, P<0.05 and breathing difficulties, P<0.01). Conclusion Our data suggest that asthmatic patients with low levels of sIL-4 receptor may represent a genetically distinct subgroup of atopic asthma. TVR haplotype analyses confirm the importance of IL4R as a candidate gene for susceptibility to asthma. This finding may have implications for the understanding of the pathogenesis of asthma and possibly for the development of more specific therapies.
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| 13. |
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| 14. |
- Löwhagen, Olle, 1938
(författare)
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[Asthma--a disease difficult to define. Patients can receive correct treatment by means of differential diagnosis criteria]. Astma - en svårdefinierad sjukdom
- 2005
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Ingår i: Läkartidningen.. ; 102:50
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Tidskriftsartikel (refereegranskat)abstract
- Asthma is a well defined disease in international consensus reports. However, in clinical praxis patients are often presenting asthma-like symptoms that are not explained by asthma and not by chronic obstructive pulmonary disease (COPD), the later being reported as the most common differential diagnosis. In an asthma and allergy clinic the most common differential diagnoses are asthma-like disorders, of which sensory hyperreactivity (SHR) can be identified by a capsaicin inhalation test. This review presents aspects on the investigation of adult patients with airway symptoms based on 20 years of clinical studies. It is pointed out that a careful asthma investigation strictly following diagnostic criteria is the first step. After this further diagnostic steps may be taken, especially as sensory mechanisms are often involved. Sensory hyperreactivity may also be present in patients with "classical" asthma sometimes explaining the lack of effect of asthma medication.
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| 15. |
- Löwhagen, Olle, 1938
(författare)
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Diagnosis of asthma - a new approach
- 2012
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Ingår i: Allergy. - : Wiley. - 0105-4538. ; 67:6, s. 713-717
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Forskningsöversikt (refereegranskat)abstract
- Current definition of asthma involves four cornerstones: inflammation, hyperresponsiveness, bronchoconstriction, and symptoms. In research, the symptoms have had the slightest attention. According to international guidelines, the asthma symptoms are episodic breathlessness, wheeze, cough, tightness of the chest, and shortness of breath. As there are several symptoms, a primary question is how they are related to bronchoconstriction, the main clinical feature of asthma. Symptoms and lung function tests are regularly used for the evaluation of clinical health status and effect of treatment. However, there is no or poor correlation between these two variables, which means that they represent different mechanisms. Reduced lung function, such as a low FEV1, represents bronchial constriction, what do the symptoms represent? Some symptoms such as breathlessness and shortness of breath seem not to be evidence-based asthma symptoms. Focusing on bronchial obstruction is important in view of the potential risk of asthma attacks, but nonobstructive symptoms occur frequently and may also cause severe discomfort and poor quality of life. Interpreting all symptoms as signs of bronchoconstriction (asthma) may lead to misinterpretation when assessing health status and effect of treatment. Although a soft variable, the strength of symptoms is that they are representing various mechanisms. The physiological preconditions for control and defense of respiration must be considered in the diagnostic process, regardless of inflammation, allergy, psychology, or other etiological factors. Based on studies on dyspnea in cardiopulmonary diseases, including asthma and asthma-like disorders, there seems to be a continuous spectrum of symptoms and mechanisms integrated in a single asthma syndrome.
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| 16. |
- Löwhagen, Olle, 1938
(författare)
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Diagnosis of asthma - new theories
- 2015
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Ingår i: Journal of Asthma. - : Informa UK Limited. - 0277-0903 .- 1532-4303. ; 52:6, s. 538-544
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Recent studies have shown a remarkably high frequency of poorly controlled asthma. Several reasons for this treatment failure have been discussed, however, the basic question of whether the diagnosis is always correct has not been considered. Followup studies have shown that in many patients asthma cannot be verified despite ongoing symptoms. Mechanisms other than bronchial obstruction may therefore be responsible. The current definition of asthma may also include symptoms that are related to mechanisms other than bronchial obstruction, the clinical hallmark of asthma. Aim: Based on a review of the four cornerstones of asthma inflammation, hyperresponsiveness, bronchial obstruction and symptoms the aim was to present some new aspects and suggestions related to the diagnosis of adult nonallergic asthma. Conclusion: Recent studies have indicated that "classic" asthma may sometimes be confused with asthmalike disorders such as airway sensory hyperreactivity, small airways disease, dysfunctional breathing, nonobstructive dyspnea, hyperventilation and vocal cord dysfunction. This confusion may be one explanation for the high proportion of misdiagnosis and treatment failure. The current diagnosis, focusing on bronchial obstruction, may be too "narrow". As there may be common mechanisms a broadening to include also nonobstructive disorders, forming an asthma syndrome, is suggested. Such broadening requires additional diagnostic steps, such as qualitative studies with analysis of reported symptoms, noneffort demanding methods for determining lung function, capsaicin test for revealing airway sensory hyperreactivity, careful evaluation of the therapeutic as well as diagnostic effect of corticosteroids and testing of suggested theories.
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| 17. |
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| 18. |
- Löwhagen, Olle, 1938, et al.
(författare)
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Physiotherapy in asthma using the new Lotorp method
- 2014
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Ingår i: Complementary Therapies in Clinical Practice. - : Elsevier BV. - 1744-3881. ; 20:4, s. 276-279
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Tidskriftsartikel (refereegranskat)abstract
- Background: Physiotherapy in bronchial asthma has given various results. Aim: To test a new method focusing on breathing exercise and massage of the thoracic muscles. Patients and methods: Twenty-eight adult patients with a physician-diagnosed asthma were studied during 6 weeks. All patients were prescribed asthma medication. The new method [active group, n = 17) was compared with physical training (control group, n = 12). Results: PEF was significantly improved (p = 0.001) in the active group, however, FEV1 showed no significant change. The symptoms "tightness of the chest", "difficult breathing in", "air hunger", and the individually dominating symptom (p = 0.001) were significantly reduced in the active group. Exercise-induced breathing troubles and chest expansion were also significantly reduced. Conclusion: Physiotherapy including breathing exercise and massage of the thoracic muscles (the Lotorp method) in patients with physician-diagnosed asthma resulted in significantly reduced respiratory symptoms during rest and exercise and increased chest expansion. The improvements may be due to an increased mobility of the chest and diaphragm. (C) 2014 Elsevier Ltd. All rights reserved.
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| 19. |
- Millqvist, Eva, 1949, et al.
(författare)
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Combining a beta2-agonist with a face mask to prevent exercise-induced bronchoconstriction
- 2000
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Ingår i: Allergy. ; 55:7, s. 672-5
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: In this study, we aimed to test the effect of combining a P2-agonist with a heat- and moisture-exchanging cellulose face mask in patients with bronchoconstriction induced by exercise in cold air. METHODS: Nine allergic, asthmatic patients with a history of adverse reaction to exercise were tested on an ergometric bicycle at a temperature of approximately -10 degrees C. They were in turn given no treatment, given premedication with a beta2-agonist, allowed to breathe through a heat- and moisture-exchanging cellulose face mask, and given both premedication and the face mask. After each treatment regimen, they were subjected to provocation with exercise and cold air. RESULTS: The decrease in FEV, was greatest with no therapy (mean maximal change: 27%), and this diminished when the face mask was used (mean maximal change: 12%,) or premedication with a 32-agonist was given (mean maximal change: 7%); no decrease in FEV1 occurred with the combination of agonist and face mask. CONCLUSIONS: The results suggest that different mechanisms are involved in the pathophysiology of exercise- induced bronchoconstriction (EIB). This finding may be of importance for asthmatic athletes who train and compete in a cold climate and are affected by small changes in their lung function.
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| 20. |
- Nordin, S., et al.
(författare)
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A short chemical sensitivity scale for assessment of airway sensory hyperreactivity
- 2004
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Ingår i: Int Arch Occup Environ Health. ; 77:4
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES. A short version of the 21-item Chemical Sensitivity Scale (CSS), called the Chemical Sensitivity Scale for Sensory Hyperreactivity (CSS-SHR), was developed and evaluated for the quantifying of self-reported affective reactions to and behavioral disruptions in daily activities by odorous/pungent substances among patients with sensory hyperreactivity (SHR) for clinical and epidemiological studies. METHODS. Twenty-two patients with clinically diagnosed SHR and 124 control participants responded to the CSS and to additional questions about chemical sensitivity for the evaluation of the CSS-SHR. RESULTS. Eleven of the 21 items of the CSS were selected, on statistical grounds, to constitute the CSS-SHR, which was found to generate approximately normal distributions, have good test-retest reliability (r(xy)=0.87), satisfying internal consistency (r(alpha)=0.76-0.84) and predictive and concurrent validity, and to be uni-dimensional. The metric properties of the CSS-SHR were, despite its few items, comparable with those of the CSS. A proposed diagnostic cut-off score for SHR demonstrated a high correct classification rate (92%) for the CSS-SHR. CONCLUSIONS. The favorable metric properties of the CSS-SHR and its sensitivity/specificity suggests that it is useful for clinical diagnosis and epidemiological study of sensory hyperreactivity in combination with other diagnostic tools.
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| 21. |
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| 22. |
- Riise, Gerdt C., 1956, et al.
(författare)
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Bronchial brush biopsies for studies of epithelial inflammation in stable asthma and nonobstructive chronic bronchitis
- 1996
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Ingår i: Eur Respir J. - 0903-1936. ; 9:8, s. 1665-71
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Tidskriftsartikel (refereegranskat)abstract
- Recently, bronchial brush biopsy (BBB) has been introduced as a complimentary method to bronchial forceps biopsy for the study of bronchial epithelial cells. We wanted to determine whether epithelial inflammatory cells in bronchial brush biopsies can reflect mucosal inflammation assessed indirectly by levels of cellular activation markers in bronchial lavage fluid. We studied 15 healthy controls, 11 asthmatics with regular steroid inhalation therapy, 13 asthmatics without steroids, and 10 smokers with nonobstructive chronic bronchitis. Differential counts of epithelial and inflammatory cells were made from the BBB material. Bronchial lavage levels of eosinophil cationic protein (ECP), myeloperoxidase (MPO), tryptase, hyaluronan and interleukin-8 (IL-8) were measured as indirect markers for inflammatory cell activation. We found an increased percentage of eosinophil granulocytes in the BBB from the steroid-untreated asthmatic patients (1.16%) in comparison to the other groups (0.11%, 0.09% and 0.02%, respectively; p<0.01). In the steroid-untreated asthmatic patients, the percentage of eosinophils correlated with ECP in bronchial lavage fluid (r=0.73; p<0.01), indicating that the BBB method can reflect the degree of eosinophilic activation. A negative correlation was found for the percentage of eosinophils in BBB with levels of provocative concentration of methacholine causing a 20% fall in forced expiratory volume in one second (PC20) for the asthmatic patients in the study (r= -0.67; p<0.003). The bronchial brush biopsy method appears to give information on the changes present in superficial bronchial epithelium in inflammatory airways disease. These changes appear to relate to the degree of inflammatory activity and disease severity in asthma.
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| 23. |
- Riise, Gerdt C., 1956, et al.
(författare)
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Circulating leukocyte adhesion molecules in stable asthma and nonobstructive chronic bronchitis
- 1995
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Ingår i: Allergy. - 0105-4538. ; 50:8, s. 693-8
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Tidskriftsartikel (refereegranskat)abstract
- Leukocyte adhesion molecules have been associated with airway inflammatory diseases such as asthma and obstructive chronic bronchitis. Lately, it has become possible to measure circulating forms of cell adhesion molecules (cCAMs) in body fluids. Elevated serum levels have been found in acute asthma and in obstructive chronic bronchitis. We investigated whether the patterns of cICAM-1, cVCAM-1, and cE-selectin could serve as markers for airway inflammation in stable asthma and stable nonobstructive chronic bronchitis. Small-volume bronchial lavage (BL) and serum from 15 controls, 13 asthmatics without steroid inhalation therapy, 11 asthmatics with regular steroid inhalation therapy, and 10 smokers with chronic bronchitis were analyzed. We found cICAM-1, cVCAM-1, and cE-selectin to be present in serum from patients with stable asthma and stable nonobstructive chronic bronchitis. Only cICAM-1 was found in BL fluid. No differences were seen between the subject groups for either cCAM, but levels of ECP were increased in the non-steroid-treated asthmatic group. Subject atopy or smoking did not increase the cCAM levels. In conclusion, the degree of airway inflammation in stable nonobstructive chronic bronchitis and stable asthma does not appear to be well associated with circulating ICAM-1, cVCAM-1, and cE-selectin.
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| 24. |
- Ringsberg, Karin C., 1945, et al.
(författare)
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Diagnosis of asthma in primary health care: a pilot study
- 2014
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Ingår i: Journal of allergy. - : Hindawi Limited. - 1687-9783 .- 1687-9791. ; 2014, s. 898965-898965
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Tidskriftsartikel (refereegranskat)abstract
- Some patients with an asthma diagnosis have a poor controlled asthma. One explanation may be an incorrect diagnosis. Aim. The aim of the study was to diagnose and classify patients with non-infectious lower respiratory tract problems in primary health care using internationally applied diagnostic criteria and diagnostic tests. Patients and Methods. New adult patients visiting a primary health care centre due to lower airway problems were included. The diagnostic tests included FEV1, FVC, PEF, two questionnaires, methacholine test, and skin prick test. Results. The patients (n = 43) could be divided into four groups: asthma (28%), asthma-like disorder (44%), idiopathic cough (12%), and a nonreversible bronchial obstructive group (16%). The asthma and asthma-like groups showed similar patterns of airway symptoms and trigger factors, not significantly separated by a special questionnaire. Phlegm, heavy breathing, chest pressure/pain, cough, and wheezing were the most common symptoms. Physical exercise and scents were the dominating trigger factors. Conclusions. Nonobstructive asthma-like symptoms seem to be as common as bronchial asthma in primary health care. Due to the similarities in symptoms and trigger factors the study supports the hypothesis that asthma and nonobstructive asthma-like disorders are integrated in the same "asthma syndrome," including different mechanisms, not only bronchial obstruction.
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| 25. |
- Sundberg, Rosita, 1944, et al.
(författare)
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A randomized controlled study of a computerized limited education program among young adults with asthma
- 2005
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Ingår i: Respir Med. ; 99:3
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Tidskriftsartikel (refereegranskat)abstract
- The aim of the study was to assess the effectiveness of a computerized limited asthma education program, designed to suit young people. The study was conducted with 97 young adults (18-25 years) with asthma, 48 were randomized to the intervention group and 49 to the control group, and they were followed for 12 months. The intervention group completed an interactive computer program of 30-min duration providing information about asthma, mechanisms, trigger factors, allergies and medication use, which was followed by a 30-min discussion with a specialized asthma nurse. The control group followed the routine schedule for asthma outpatients. The outcomes of the study were number of hospital admissions, emergency visits, asthma symptoms, knowledge about asthma, lung function and quality of life. No effect was found regarding admission to hospital, emergency visits, prevalence of respiratory symptoms, knowledge of asthma or quality of life. However, forced exhaled volume in 1s (FEV(1)) increased significantly, mainly among the atopic subjects. In conclusion, an intervention with a limited asthma education program did not show an effect on asthma symptoms, asthma knowledge or quality of life parameters.
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| 26. |
- Ternesten-Hasséus, Ewa, 1956, et al.
(författare)
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Inhalation method determines outcome of capsaicin inhalation in patients with chronic cough due to sensory hyperreactivity
- 2006
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Ingår i: Pulm Pharmacol Ther. ; 19:3, s. 172-8
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: For patients with idiopathic chronic cough, a subgroup is recognised with respiratory symptoms induced by scents and chemicals. The diagnosis of sensory hyperreactivity (SHR) has been suggested for this group of patients and can be made using a capsaicin inhalation test. The aim of the present study was to compare the results of inhaling capsaicin by tidal breathing with those obtained by the dosimeter method regarding repeatability, agreement, and ability to distinguish patients with SHR from healthy controls. METHODS: A total of 15 patients with chronic cough due to SHR and 15 healthy control subjects underwent a randomised cross-over protocol and were provoked in a double-blind, randomised fashion with vehicle and two concentrations of inhaled capsaicin, using either the tidal breathing or dosimeter method, in a total of four challenges opportunities, two with each method. RESULTS: Patients coughed more and showed more respiratory symptoms than healthy controls with each dose of capsaicin. Compared with tidal breathing, inhalation of capsaicin with the dosimeter method caused a significantly greater number of coughs and respiratory symptoms in both patients and controls. Among the patients, the mean number of coughs after inhalation of 1mL of capsaicin 0.4mumol/L from the first provocation with tidal breathing was 12 (95% CI: 7; 17) and after inhalation from the first provocation with the dosimeter method 32 (95% CI: 19; 46) (P<0.05). Both methods showed good repeatability and similar ability to distinguish patients with SHR from healthy control subjects. CONCLUSIONS: For patients with SHR, capsaicin cough sensitivity is increased and repeatable. The dosimeter method caused more coughs and other respiratory symptoms than the tidal breathing method, indicating that the methods cannot be used interchangeably. Knowledge of the type of inhalation device used, the particle size, the airflow rate and the inspiratory flow rate are essential when comparing different studies of capsaicin-induced cough.
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| 27. |
- Ternesten-Hasséus, Ewa, 1956, et al.
(författare)
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Quality of life and capsaicin sensitivity in patients with airway symptoms induced by chemicals and scents: a longitudinal study
- 2007
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Ingår i: Environ Health Perspect. - : Environmental Health Perspectives. - 0091-6765. ; 115:3, s. 425-9
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: It is common in asthma and allergy clinics to see patients presenting with upper and lower airway symptoms that are induced by chemicals and scents and not explained by allergic or asthmatic reactions. Previous studies have shown that these patients often have increased cough sensitivity to inhaled capsaicin; such sensitivity is known to reflect the airway sensory reactivity. The aim of this study was to evaluate the duration of symptoms induced by chemicals and scents and to measure health-related quality of life (HRQL) in patients with chemically induced airway symptoms. We also wished to determine and compare repeatability of the cough response to capsaicin inhalation, and to evaluate the patients' airway sensory reactivity in a long-term perspective. PARTICIPANTS: Seventeen patients with a history of at least 12 months of airway symptoms induced by chemicals and scents were followed over 5 years with repeated questionnaires, measurements of HRQL, and capsaicin inhalation tests. RESULTS: The symptoms persisted and did not change significantly over time, and the patients had a reduced HRQL that did not change during the 5-year period. The capsaicin sensitivity was increased at the start of the study, the cough sensitivity was long-lasting, and the repeatability of the capsaicin inhalation test was considered to be good in a long-term perspective. CONCLUSIONS: Upper and lower airway symptoms induced by chemicals and scents represent an entity of chronic diseases, different from asthma or chronic obstructive pulmonary disease, with persistent symptoms, a reduced HRQL, and unchanged sensory hyperreactivity.
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| 28. |
- Ternesten-Hasséus, Ewa, 1956, et al.
(författare)
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Sensitivity to methacholine and capsaicin in patients with unclear respiratory symptoms
- 2002
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Ingår i: Allergy. ; 57:6
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Capsaicin, the pungent ingredient in red pepper, is known to stimulate coughing via the sensory nervous system. Earlier studies showed that patients with airway symptoms induced by chemicals and strong scents cough more after inhalation of capsaicin than healthy control subjects and this has been interpreted as a hyperreactivity of airway sensory nerves. Our aim was to study airway sensitivity to inhaled capsaicin and the occurrence of airway symptoms induced by strong scents in patients who underwent a bronchial methacholine test, primarily because of suspected asthma. METHODS: Fifty-two consecutive patients referred for testing with methacholine were also provoked with inhaled capsaicin in increasing concentrations. Cough sensitivity to capsaicin was compared with that in 40 healthy control subjects. RESULTS: The patients coughed significantly more compared with the healthy control subjects with each dose of capsaicin (P < 0.0001). Twelve patients (23%) had a positive methacholine test, and of these, nine were diagnosed with asthma. There was no difference in capsaicin sensitivity between patients sensitive or insensitive to methacholine. CONCLUSIONS: The majority of the patients had no increased sensitivity to methacholine but did demonstrate sensory hyperreactivity (SHR). SHR appears to be a common diagnosis in investigations of patients with obscure airway symptoms.
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| 29. |
- Torén, Kjell, 1952, et al.
(författare)
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Self-reported asthma was biased in relation to disease severity while reported year of asthma onset was accurate
- 2006
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Ingår i: J Clin Epidemiol.. ; 59:1
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND AND OBJECTIVES: The aims of the study were to assess the accuracy of self-reported asthma and notified year of asthma onset. METHODS: The study was performed on a sample of 365 subjects, 18-60 years old, with clinically diagnosed onset of asthma between 1983 and 1986. All subjects were investigated 10 years later, in 1996, with a respiratory questionnaire about the items of asthma and year of onset. The material was analyzed with logistic regression models. RESULTS: Of the 289 subjects who returned the questionnaire, asthma was reconfirmed in 251 subjects. In a logistic regression model, asthma severity was significantly associated with confirmation of asthma. The median difference between the "true" year of onset and the reported year 10 years later, the recall period was zero, with a 10th to 90th interpercentile range of -2 to 6 years. The recall period was not associated with asthma severity, bronchial hyperresponsiveness, smoking, atopy, or sex. CONCLUSION: Self-reported asthma is biased in relation to disease severity, meaning that subjects with mild disease were less prone to report their asthma. Reported year of asthma onset among adults seems to be rather accurate, with no obvious dependent misclassifications.
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| 30. |
- Weinfeld, Dan, et al.
(författare)
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Capsaicin cough sensitivity in allergic asthmatic patients increases during the birch pollen season.
- 2002
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Ingår i: Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology. - 1081-1206. ; 89:4, s. 419-24
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: A change in neural responsiveness may occur as the result of allergic inflammation in the lower airways as well as in the upper airways. In the lower airways, capsaicin cough sensitivity is known to reflect sensory neural reactivity. OBJECTIVE: The aim of this study was to establish whether allergic inflammation changes airway neural sensory reactivity during prolonged allergen exposure. METHODS: Ten nonsmoking patients with birch pollen-allergic asthma performed a capsaicin inhalation challenge twice, once in the off-pollen season and once during the pollen season. The number of coughs and symptoms induced by capsaicin were recorded and compared with those of healthy control subjects. RESULTS: The response to capsaicin, expressed as number of coughs, increased in a dose-dependent manner during both tests. Before the season, the response was similar to that of healthy control subjects, but during the pollen season, the reactivity was significantly increased. Variations in forced expiratory volume in 1 second were not significant before and after each challenge, and values did not change during the pollen season as compared with the winter season. CONCLUSIONS: Sensory reactivity in allergic asthmatic patients may be increased during prolonged allergen exposure as during the pollen season. This finding suggests that allergic inflammation in the lower and/or upper airways may trigger neurogenic mechanisms of significant clinical importance.
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