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| 2. |
- Backman, Helena, et al.
(författare)
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A population-based cohort of adults with asthma: mortality and participation in a long-term follow-up
- 2017
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Ingår i: European Clinical Respiratory Journal. - : Informa UK Limited. - 2001-8525. ; 4
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Tidskriftsartikel (refereegranskat)abstract
- Background and objective: Asthma is a major public health concern. The aim of this study was to characterize a large population-based cohort of adults with asthma, and to study factors associated with all-cause mortality and non-participation in a long-term follow-up. Design: Random and stratified samples from five population-based cohorts were clinically examined during 1986-2001, and all subjects with asthma were included in the study (n = 2055, age 19-72 years, 55% women). Independent associations between different risk factors and (i) mortality and (ii) non-participation in a clinical follow-up in 2012-2014 were estimated. Results: In 1986-2001, 95% reported any wheeze and/or attacks of shortness of breath in the past 12 months, and/or asthma medication use. Over the up to 28 years of follow-up time, the cumulative mortality was 22.7%. Male gender, current smoking, and lower forced expiratory volume in 1 sec of predicted (FEV1% of predicted) were independent risk factors for mortality, while obesity was associated with non-participation in the follow-up. Older ages, ischemic heart disease, and low socioeconomic status were associated with both mortality and non-participation. Conclusions: The risk factors associated with mortality in this adult population-based asthma cohort were similar to those commonly identified in general population samples, i.e. male gender, current smoking, and lower FEV1% of predicted, while obesity was associated with non-participation in a long-term follow-up. Ischemic heart disease, low socioeconomic status, and older ages were associated with both mortality and non-participation.
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| 3. |
- Lindberg, Anne, et al.
(författare)
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From COPD epidemiology to studies of pathophysiological disease mechanisms : challenges with regard to study design and recruitment process
- 2017
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Ingår i: European Clinical Respiratory Journal. - : Taylor & Francis. - 2001-8525. ; 4
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Tidskriftsartikel (refereegranskat)abstract
- Background: Chronic obstructive pulmonary disease (COPD) is a largely underdiagnosed disease including several phenotypes. In this report, the design of a study intending to evaluate the pathophysiological mechanism in COPD in relation to the specific phenotypes non-rapid and rapid decline in lung function is described together with the recruitment process of the study population derived from a population based study.Method: The OLIN COPD study includes a population-based COPD cohort and referents without COPD identified in 2002–04 (n = 1986), and thereafter followed annually since 2005. Lung function decline was estimated from baseline in 2002–2004 to 2010 (first recruitment phase) or to 2012/2013 (second recruitment phase). Individuals who met the predefined criteria for the following four groups were identified; group A) COPD grade 2–3 with rapid decline in FEV1 and group B) COPD grade 2–3 without rapid decline in FEV1 (≥60 and ≤30 ml/year, respectively), group C) ever-smokers, and group D) non-smokers with normal lung function. Groups A–C included ever-smokers with >10 pack years. The intention was to recruit 15 subjects in each of the groups A-D.Results: From the database groups A–D were identified; group A n = 37, group B n = 29, group C n = 41, and group D n = 55. Fifteen subjects were recruited from groups C and D, while this goal was not reached in the groups A (n = 12) and B (n = 10). The most common reasons for excluding individuals identified as A or B were comorbidities contraindicating bronchoscopy, or inflammatory diseases/immune suppressive medication expected to affect the outcome.Conclusion: The study is expected to generate important results regarding pathophysiological mechanisms associated with rate of decline in lung function among subjects with COPD and the in-detail described recruitment process, including reasons for non-participation, is a strength when interpreting the results in forthcoming studies.
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| 5. |
- Ryan, Dermot, et al.
(författare)
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Use of electronic medical records and biomarkers to manage risk and resource efficiencies
- 2017
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Ingår i: EUROPEAN CLINICAL RESPIRATORY JOURNAL. - : TAYLOR & FRANCIS LTD. - 2001-8525. ; 4, s. 1-12
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Tidskriftsartikel (refereegranskat)abstract
- The migration from paper to electronic medical records (EMRs) was motivated by the administrative need to record, retrieve and process increasing amounts of clinical data in the 1980s. In the intervening period, there has been growing recognition of the potential of such records for achieving care efficiencies, informing clinical decision making and real-life research. EMRs can be used to characterise patient groups, management approaches and differential outcomes. Characterisation can also help with identification of potential biomarkers for future risk determination and likely treatment response. The future heralds even greater opportunities through integration of clinical records and a range of technology-based solutions within a more complete electronic health record (EHR). Through application of algorithms based on identified risk predictors and disease determinants, clinical records could also be used to enable risk stratification of patients to optimise targeted interventions, conserving resources to achieve individual patient and system-wide benefit. In this review, we reflect on the evolution of the EMR and EHR and discuss current and emerging opportunities, particularly with respect to biomarkers and targeting of innovative biologic interventions. We also consider some of the critical issues associated with realising the potential of the EHR as a clinical aid and research tool in an age of emerging technologies.
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| 6. |
- Saers, Johannes, et al.
(författare)
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Respiratory symptoms among Swedish soldiers after military service abroad: association with time spent in a desert environment
- 2017
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Ingår i: European Clinical Respiratory Journal. - : Informa UK Limited. - 2001-8525. ; 4:1
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: The aim of this paper was to study whether Swedish soldiers who have served abroad had a higher prevalence of respiratory symptoms than the general population and, if this was the case, also to study whether this was associated with time spent in a desert environment. Methods: The prevalence of respiratory symptoms among 1,080 veterans from Kosovo and Afghanistan was compared with that in almost 27,000 subjects from a general population sample, using propensity score matching and logistic regression. Results: The prevalence of wheeze (16.3 vs. 12.3%), wheeze without a cold (11.1 vs. 8.0%), nocturnal coughing (26.6 vs. 20.1%) and chronic bronchitis (12.3 vs. 6.8%) was significantly higher among soldiers than controls (p < 0.05). A dose-response-related association was found between time spent in a desert environment and wheeze, wheeze with breathlessness and wheeze when not having a cold. Having been exposed to desert storms was related to nocturnal cough and chronic bronchitis. Conclusion: Swedish soldiers who had served abroad had a higher prevalence of wheeze and cough than a control group from the general population. The association between being exposed to a desert environment and respiratory symptoms indicates that further protective measures should be introduced for military personnel serving in a desert environment.
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| 7. |
- Sundh, Josefin, 1972-, et al.
(författare)
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Characterization of secondary care for COPD in Sweden
- 2017
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Ingår i: European Clinical Respiratory Journal. - : Taylor & Francis. - 2001-8525. ; 4, s. 1-8
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Only a selected proportion of chronic obstructive pulmonary disease (COPD) patients are managed in secondary care. The aim of this study was to characterize disease severity, treatment and structure of secondary care for COPD in Sweden.Methods: Information was collected from 29 of 33 existing secondary care units of respiratory medicine in Sweden, using both individual data from 373 consecutively enrolled COPD patients with Global initiative on Obstructive Lung Disease (GOLD) stage III-IV and a structural questionnaire about available resources at the units. Patient data included exacerbations, health status assessed by COPD Assessment Test (CAT), lung function, comorbid conditions, pharmacological treatment and vaccinations. Structural data included available smoking cessation support, multi-disciplinary rehabilitation, physical training, patient education and routine follow-up after exacerbations at the respective unit. All patients were reclassified according to the GOLD 2014 group AD classification. Multiple linear regression investigated associations of available resources with number of exacerbations and CAT score.Results: According to GOLD 2014, 87% of the population were GOLD D and 13% were GOLD C. Triple inhaled therapy were prescribed in 88% of the patients. Over 75% of the units had resources for smoking cessation, multidisciplinary rehabilitation, physical training and patient education. Routine follow-up after exacerbations was available in 35% of the units. Being managed at units with access to structured patient education was associated with statistically significantly fewer exacerbations (adjusted regression coefficient (95% confidence interval) -0.79 (-1.39 to -0.19), p = 0.010).Conclusion: Most stage III-IV COPD patients managed at secondary care respiratory units in Sweden have maximized inhaled therapy and high risk disease even when reclassified according to GOLD 2014. Most units have access to smoking cessation, rehabilitation and patient education. Patients managed at units with structured patient education have a lower exacerbation risk.
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| 8. |
- Sundh, Josefin, 1972-, et al.
(författare)
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Factors influencing pharmacological treatment in COPD : a comparison of 2005 and 2014
- 2017
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Ingår i: European Clinical Respiratory Journal. - : Informa UK Limited. - 2001-8525. ; 4:1
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: The aim was to investigate how the pattern of pharmacological treatment in Swedish patients with chronic obstructive pulmonary disease (COPD) has changed over a decade, and to identify factors associated with treatment.Methods: Data on patient characteristics and pharmacological treatment were collected using questionnaires from two separate cohorts of randomly selected primary and secondary care patients with a doctor’s diagnosis of COPD in central Sweden, in 2005 (n = 1111) and 2014 (n = 1329). Cross-tabulations and chi-square tests were used to compare maintenance treatment in 2005 and 2014, and to investigate the distribution of treatment by the 2017 Global Initiative for Obstructive Lung Disease (GOLD) ABCD groups. Multinomial logistic regression was used to analyze associations with the major types of recommended treatments: bronchodilator therapy, combined long-acting beta-2-antagonists (LABA) + inhaled corticosteroids (ICS), and triple inhaled therapy.Results: The proportion of patients with no maintenance treatment, with only LABA + ICS, and with sole ICS statistically significantly decreased (36 vs. 31%, 16 vs. 12% and 5 vs. 2%, respectively), and the proportion with triple inhaled therapy statistically significantly increased (29 vs. 40%). In 2014, triple inhaled therapy was the most common treatment in all GOLD groups except group A. In 2014, previous frequent exacerbations [OR (95% CI) 2.34 (1.62 to 3.36)], worse COPD Assessment Test score [1.07 (1.05 to 1.09)], female sex [2.13 (1.56 to 2.91)], and access to a specific responsible doctor [1.95 (1.41 to 2.69)] were associated with triple inhaled therapy. Current smoking [0.40 (0.28 to 0.57)] and overweight [0.62 (0.41 to 0.93)] were inversely associated with triple inhaled therapy.Conclusions: Over the last decade, triple inhaled therapy has increased, and no maintenance treatment, ICS, or LABA + ICS has decreased. Triple inhaled therapy is the most common treatment and is associated with previous exacerbations, higher symptom level, female sex, and having a specific responsible doctor.
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