| 11. |
- Axelsson, Malin, et al.
(författare)
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Sleep disturbances and physical inactivity impair health related quality of life in adult asthmatics
- 2017
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Background: Sleep disturbances and physical inactivity have only sparsely been studied in relation to health related quality of life (HRQL) in adult asthmatics. Aim: to investigate sleep disturbances and physical inactivity in relation to HRQL in adult asthmatics. Method: The sample (n=737), aged between 21 and 85 years, selected from the OLIN-studies participated in structured interviews about respiratory health, sleep, physical activity and questionnaires on mental and physical HRQL. Results: Sleep disturbances were more common in asthmatics than in non-asthmatics: snoring (p=0.018), difficulties falling asleep (p=0.025), many nocturnal awakenings (p=0.001), daytime sleepiness (p=0.001), early awakenings (p=0.002). Lower mental HRQL was found in asthmatics with difficulties falling asleep (p=0.001), in asthmatics reporting daytime sleepiness (p=0.010) than asthmatics without sleep disturbances. Lower physical HRQL was found in asthmatics with daytime sleepiness (p=0.002), early awakenings (p=0.001) and many nocturnal awakenings (p=0.039) than asthmatics without these sleep disturbances. Lower physical HRQL was found in physically inactive asthmatics than in physically active asthmatics (p=0.034). Physical activity (p=0.008) and asthma control (p=0.049) were stronger predictors of low physical HRQL than sleep disturbances. Difficulties falling asleep (p=0.001) and many nocturnal awakenings (p=0.04) were identified as negative predictors of mental HRQL while asthma control was a non-significant predictor. Conclusion: Helping adult asthmatics to improve their sleeping habits and to increase their physical activity will have a positive impact on their HRQL. Malin Axelssona, Mai Leanderb, Helena Backmanc, Linnea Hedmanc, Eva Rönmarkc a Department of Care Science, Faculty of Health and Society, Malmö University, Malmö, Sweden b Department of Medical Sciences, Respiratory Medicine and Allergology, Uppsala University, Uppsala, Sweden c Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, The OLIN Unit, Umeå University, Umeå, Sweden
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| 12. |
- 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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| 13. |
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| 14. |
- Backman, Helena, et al.
(författare)
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Chronic airway obstruction in a population-based adult asthma cohort : Prevalence, incidence and prognostic factors
- 2018
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Ingår i: Respiratory Medicine. - : Elsevier. - 0954-6111 .- 1532-3064. ; 138, s. 115-122
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundAsthma and COPD may overlap (ACO) but information about incidence and risk factors are lacking. This study aimed to estimate prevalence, incidence and risk factors of chronic airway obstruction (CAO) in a population-based adult asthma cohort.MethodsDuring 1986–2001 a large population-based asthma cohort was identified (n = 2055, 19-72y). Subsamples have participated in clinical follow-ups during the subsequent years. The entire cohort was invited to a clinical follow-up including interview, spirometry, and blood sampling in 2012–2014 when n = 983 subjects performed adequate spirometry. CAO was defined as post-bronchodilator FEV1/FVC<0.7.ResultsAt study entry, asthmatics with prevalent CAO (11.4%) reported more respiratory symptoms, asthma medication use, and ischemic heart disease than asthmatics without CAO (asthma only). Subjects who developed CAO during follow-up (17.6%; incidence rate of 16/1000/year) had a more rapid FEV1 decline and higher levels of neutrophils than asthma only. Smoking, older age and male sex were independently associated with increased risk for both prevalent and incident CAO, while obesity had a protective effect.ConclusionsIn this prospective adult asthma cohort, the majority did not develop CAO. Smoking, older age and male sex were risk factors for prevalent and incident CAO, similar to risk factors described for COPD in the general population.
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| 15. |
- Backman, Helena, et al.
(författare)
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Decrease in prevalence of COPD in Sweden after decades of decrease in smoking
- 2018
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Ingår i: European Respiratory Journal. - : European Respiratory Society. - 0903-1936 .- 1399-3003. ; 52
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Background: The smoking prevalence in Sweden has steadily decreased during three decades. The prevalence of COPD in Sweden in the 1990s and around the millennium shift was similar to neighboring European countries, i.e. estimated at 11-17%, and of moderate to severe COPD to 7-11%, in ages over 40y.Aim: Has the prevalence of chronic airway obstruction (CAO) and of COPD in Sweden decreased after decades of decreasing smoking prevalence?Methods: Within two large scale population studies in progress, the West Sweden Asthma Study (WSAS) and the Obstructive Lung Disease in Northern Sweden Studies (OLIN), the prevalence of COPD in ages 41-72y was calculated among randomly selected subjects from the general population in 2009-2012. The following post-bronchodilator definitions were used; CAO: FEV1/FVCResults: The prevalence of CAO based on the FEV1/FVCConclusion: As prevalence of COPD defined as chronic airway obstruction before and around the millennium shift was estimated at 11-17% in ages >40 years, the prevalence of COPD has decreased in Sweden, and the decrease in smoking over decades is probably the main causal factor.
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| 16. |
- Backman, Helena, et al.
(författare)
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Decreased prevalence of moderate to severe COPD over 15 years in northern Sweden
- 2016
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Ingår i: Respiratory Medicine. - : Elsevier BV. - 0954-6111 .- 1532-3064. ; 114, s. 103-110
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Tidskriftsartikel (refereegranskat)abstract
- Background: The burden of COPD in terms of mortality, morbidity, costs and prevalence has increased worldwide. Recent results on prevalence in Western Europe are conflicting. In Sweden smoking prevalence has steadily decreased over the past 30 years. Aim: The aim was to study changes in prevalence and risk factor patterns of COPD in the same area and within the same age-span 15 years apart. Material and methods: Two population-based cross-sectional samples in ages 23-72 years participating at examinations in 1994 and 2009, respectively, were compared in terms of COPD prevalence, severity and risk factor patterns. Two different definitions of COPD were used; FEV1/FVC < LLN and FEV1/FVC < 0.7. The severity of COPD was assessed by FEV1, both as % of predicted and in relation to the LLN. Results: The prevalence of COPD decreased significantly from 9.5% to 6.3% (p = 0.030) according to the FEV1/FVC < LLN criterion, while the decrease based on the FEV1/FVC < 0.7 criterion from 10.5% to 8.5% was non-significant. The prevalence of moderate to severe COPD decreased substantially and significantly, and the risk factor pattern was altered in 2009 when, beside age and smoking, also socioeconomic status based on occupation was significantly associated with COPD. Conclusions: Changes in both prevalence and risk factor patterns of COPD were observed between surveys. Following a continuing decrease in smoking habits over several decades, a decrease in the prevalence of moderate to severe COPD was observed from 1994 to 2009 in northern Sweden.
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| 17. |
- Backman, Helena, et al.
(författare)
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Eosinophilic inflammation and lung function decline in a long-term follow-up of a large population-based asthma cohort
- 2018
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Ingår i: European Respiratory Journal. - : European Respiratory Society. - 0903-1936 .- 1399-3003. ; 52
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- The relationship between lung function decline and airway inflammation among asthmatics has important therapeutic implications, but has rarely been studied in large samples or in population-based asthma cohorts.A population-based adult asthma cohort (n=2055) was recruited during 1986-2001 and clinically examined including spirometry. In 2012-2014, all still eligible subjects (n=1425) were invited to a clinical follow-up including spirometry, blood sampling, and a structured interview, and n=1006 participated (55% women, mean age 59y, 32-92y). Linear regression was performed with age, sex, smoking habits, year of first examination, family history of asthma, socioeconomic status, eosinophils (EOS)>=0.3x109/L, and neutrophils (NEUT)>=5.0x109/L as independent variables and pre-bronchodilator FEV1 decline/year (ml and % of predicted [pp], respectively) as dependent. In secondary models, both ICS use at baseline and ICS use at follow-up were also included.The mean annual FEV1 decline in ml (pp) among asthmatics with EOS<0.3, 0.4>EOS>=0.3 and EOS>=0.4x109/L, respectively, was 26ml (0.03pp), 29ml (0.10pp) and 34ml (0.27pp) (p<0.001). In adjusted analyses, EOS>=0.3 was significantly associated with FEV1 decline, both in terms of ml (4ml excess annual decline vs EOS<0.3) and pp. The association between EOS and FEV1 decline in pp, but not ml, remained when additionally adjusted for ICS use. The association with NEUT>=5.0x109/L was less clear.On group level, adult asthmatics with higher levels of eosinophils in blood have a history of excess FEV1 decline compared to asthmatics with lower levels of eosinophil inflammation, independent of other factors such as ICS use.
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| 18. |
- Backman, Helena, et al.
(författare)
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Evaluation of the global lung function initiative 2012 reference values for spirometry in a Swedish population sample
- 2015
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Ingår i: Bmc Pulmonary Medicine. - : Springer Science and Business Media LLC. - 1471-2466. ; 15
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Tidskriftsartikel (refereegranskat)abstract
- Background: The Global Lung Function Initiative 2012 (GLI) reference values are currently endorsed by several respiratory societies but evaluations of applicability for adults resident in European countries are lacking. The aim of this study was to evaluate if the GLI reference values are appropriate for an adult Caucasian Swedish population. Methods: During 2008-2013, clinical examinations including spirometry were performed on general population samples in northern Sweden, in which 501 healthy Caucasian non-smokers were identified. Predicted GLI reference values and Z-scores were calculated for each healthy non-smoking subject and the distributions and mean values for FEV1, FVC and the FEV1/FVC ratio were examined. The prevalence of airway obstruction among these healthy non-smokers was calculated based on the Lower Limit of normal (LLN) criterion (lower fifth percentile) for the FEV1/FVC ratio. Thus, by definition, a prevalence of 5% was expected. Results: The Z-scores for FEV1, FVC and FEV1/FVC were reasonably, although not perfectly, normally distributed, but not centred on zero. Both predicted FEV1 and, in particular, FVC were lower compared to the observed values in the sample. The deviations were greater among women compared to men. The prevalence of airway obstruction based on the LLN criterion for the FEV1/FVC ratio was 9.4% among women and 2.7% among men. Conclusions: The use of the GLI reference values may produce biased prevalence estimates of airway obstruction in Sweden, especially among women. These results demonstrate the importance of validating the GLI reference values in different countries.
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| 19. |
- Backman, Helena, et al.
(författare)
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Increased prevalence of allergic asthma from 1996 to 2006 and further to 2016 : results from three population surveys
- 2017
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Ingår i: Clinical and Experimental Allergy. - : John Wiley & Sons. - 0954-7894 .- 1365-2222. ; 47:11, s. 1426-1435
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundDuring the latter half of the 20th century, the prevalence of asthma and many other allergic diseases has increased. Information on asthma prevalence trends among adults after 2010, especially regarding studies separating allergic asthma from non-allergic asthma, is lacking.ObjectiveThe aim was to estimate prevalence trends of current asthma among adults, both allergic and non-allergic, from 1996 to 2016.MethodsThree cross-sectional samples from the same area of Sweden, 20-69 years, participated in surveys with the same questionnaire in 1996 (n=7104 participants, 85% response rate), 2006 (n=6165, 77%) and 2016 (n=5466, 53%), respectively. Allergic rhino-conjunctivitis (ARC) was used as a marker for allergic sensitization to define allergic asthma.ResultsThe prevalence of current asthma increased from 8.4% (95% CI: 7.8-9.0) in 1996 to 9.9% (95% CI: 9.2-10.6) in 2006 and 10.9% (95% CI: 10.1-11.7) in 2016 (P<.001). Allergic asthma increased from 5.0% (95% CI: 4.5-5.5) in 1996 to 6.0% (95% CI: 5.4-6.6) in 2006 and further to 7.3% (95% CI: 6.6-8.0) in 2016 (P<.001), while the prevalence of non-allergic asthma remained stable around 3.4%-3.8%. The increase in current asthma was most pronounced among women and among the middle-aged. Physician-diagnosed asthma, asthma medication use and ARC also increased significantly, while the prevalence of symptoms common in asthma such as wheeze and attacks of shortness of breath decreased slightly or was stable. The prevalence of current smoking decreased from 27.4% in 1996 to 12.3% in 2016.Conclusions and Clinical RelevanceThe prevalence of allergic asthma increased from 1996 to 2006 and further to 2016, while the prevalence of non-allergic asthma remained on a stable prevalence level. The prevalence of symptoms common in asthma decreased slightly or was stable despite a substantial decrease in the prevalence of current smoking. Clinicians should be aware that the previously observed increase in prevalence of allergic asthma is still ongoing.
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| 20. |
- Backman, Helena, 1979-
(författare)
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Lung function and prevalence trends in asthma and COPD
- 2016
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Asthma and chronic obstructive pulmonary disease (COPD) are common obstructive airway diseases with a substantial burden in terms of morbidity, mortality and costs. Smoking is the single most important risk factor for COPD, and is associated with incident asthma. It is important to know if the prevalence of asthma and COPD is increasing or decreasing in the population in order to effectively allocate health care resources. The definitions of these diseases have varied over time which makes it difficult to measure changes in prevalence. The preferred method is to estimate the prevalence with the same procedures and definitions based on cross-sectional population samples with identical age distributions in the same geographical area at different time points. Measurements of lung function (spirometry) are required to diagnose COPD, and spirometry is used to evaluate disease severity and progress of both asthma and COPD, where observed values are compared to reference values. The most commonly used reference values in Sweden are published during the mid 1980s, and there are few evaluations of how appropriate they are today based on Swedish population samples. The aim of the thesis was to estimate trends in the prevalence of asthma and COPD in relation to smoking habits, and to evaluate and estimate reference values for spirometry.Methods: The project was based on population-based samples of adults from the Obstructive Lung Disease in Northern Sweden (OLIN) studies. Postal questionnaires were sent to large cohorts, recruited in 1992 (n=4851, 20-69 years), 1996 (n=7420, 20-74 years) and 2006 (n=6165, 20-69 years), respectively. The questionnaire included questions on respiratory symptoms and diseases, their comorbidities and several possible risk factors including smoking habits. Structured interviews and spirometry were performed in random samples of the responders to the 1992 and 2006 surveys, of which n=660 (in 1994) and n=623 (in 2009) were within identical age-spans (23-72 years). The trend in asthma prevalence was estimated by comparing the postal questionnaire surveys in 1996 and 2006, and the trend in COPD prevalence was estimated by comparing the samples participating in dynamic spirometry in 1994 and 2009, respectively. The prevalence of COPD was estimated based on two different definitions of COPD. Commonly used reference values for spirometry were evaluated based on randomly sampled healthy non-smokers defined in clinical examinations of participants in the 2006 postal questionnaire (n=501). The main focus of the evaluation was the global lung function initiative (GLI) reference values published in 2012, for which Z-scores and percent of predicted values were analysed. New sex-specific reference values for spirometry were estimated by linear regression, with age and height as predictors. These new OLIN reference values were also evaluated on a sample of healthy non-smokers identified in the population-based West Sweden Asthma Study.Results: Although the prevalence of smoking decreased from 27.4% to 19.1%, p<0.001, between 1996 and 2006, the prevalence of physician-diagnosed asthma increased from 9.4% to 11.6%, p<0.001. The prevalence of symptoms common in asthma such as recurrent wheeze did not change significantly between the surveys or tended to decrease, while bronchitis symptoms such as cough and sputum production decreased significantly. The evaluation of the GLI reference values showed that the predicted values were significantly lower compared to the observed values in Norrbotten, which makes the percent of predicted too high. This was especially true for FVC percent predicted with a mean of 106%. In general, the deviations were more pronounced among women. New OLIN reference values valid for the Norrbotten sample were modelled and showed a high external validity when applied on the sample from western Sweden. The prevalence of moderate to severe COPD decreased substantially over the 15-year period between 1994 and 2009, regardless of definition.Conclusions: In parallel with substantially decreased smoking habits in the population between 1996 and 2006, the prevalence of several airway symptoms decreased while the prevalence of physician-diagnosed asthma increased. These results suggest increased diagnostic activity for asthma, but may also suggest that the asthma prevalence has continued to increase. In contrast to asthma, the prevalence of COPD tended to decrease and moderate to severe COPD decreased substantially. The continuous decrease in smoking in Sweden during several decades prior to the study period is most likely contributing to these results. The evaluation of reference values showed that the GLI reference values were lower than the observed spirometric values in the population, especially for women, why the new up-to date reference values may be of importance for disease evaluation in epidemiology and in the health care as well.
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