| 1. |
- Andreassen, Siw Lillevik, et al.
(författare)
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Impact of pneumonia on hospitalizations due to acute exacerbations of COPD
- 2014
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Ingår i: Clinical Respiratory Journal. - : Wiley. - 1752-6981 .- 1752-699X. ; 8:1, s. 93-99
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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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| 2. |
- Danielsson, Patrik, et al.
(författare)
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The prevalence of chronic obstructive pulmonary disease in Uppsala, Sweden - the Burden of Obstructive Lung Disease (BOLD) study : cross-sectional population-based study
- 2012
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Ingår i: Clinical Respiratory Journal. - 1752-6981 .- 1752-699X. ; 6:2, s. 120-127
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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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| 3. |
- Ekerljung, Linda, 1979, et al.
(författare)
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Incidence and prevalence of adult asthma is associated with low socio-economic status
- 2010
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Ingår i: The Clinical Respiratory Journal. - 1752-6981 .- 1752-699X. ; 4:3, s. 147-56
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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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| 4. |
- Ekerljung, Linda, 1979, et al.
(författare)
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Questionnaire layout and wording influence prevalence and risk estimates of respiratory symptoms in a population cohort
- 2013
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Ingår i: Clinical Respiratory Journal. - : Blackwell Publishing. - 1752-6981 .- 1752-699X. ; 7:1, s. 53-63
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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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| 5. |
- Eriksson, Jonas, 1984, et al.
(författare)
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Update of prevalence of self-reported allergic rhinitis and chronic nasal symptoms among adults in Sweden
- 2012
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Ingår i: The Clinical Respiratory Journal. - 1752-699X .- 1752-6981. ; 6:3, s. 159-168
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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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| 6. |
- Hallin, Runa, et al.
(författare)
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Relation between physical capacity, nutritional status and systemic inflammation in COPD
- 2011
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Ingår i: Clinical Respiratory Journal. - 1752-6981 .- 1752-699X. ; 5:3, s. 136-142
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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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| 7. |
- Jacinto, Tiago, et al.
(författare)
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Setting reference values for exhaled nitric oxide : a systematic review
- 2013
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Ingår i: Clinical Respiratory Journal. - 1752-6981 .- 1752-699X. ; 7:2, s. 113-120
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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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| 8. |
- Ludviksdottir, Dora, et al.
(författare)
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Clinical aspects of using exhaled NO in asthma diagnosis and management
- 2012
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Ingår i: Clinical Respiratory Journal. - : Wiley. - 1752-6981 .- 1752-699X. ; 6:4, s. 193-207
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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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| 9. |
- Midgren, Bengt, et al.
(författare)
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Cheyne-Stokes respiration is not related to quality of life or sleepiness in heart failure
- 2010
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Ingår i: Clinical Respiratory Journal. - : Wiley. - 1752-6981 .- 1752-699X. ; 4:1, s. 30-36
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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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| 10. |
- Måhlin, Carolina, et al.
(författare)
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Vitamin D status and dietary intake in a Swedish COPD population.
- 2014
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Ingår i: The clinical respiratory journal. - : Wiley. - 1752-699X .- 1752-6981. ; 8:1, s. 24-32
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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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| 11. |
- Sundell, Kerstin, et al.
(författare)
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Quality of life in adolescents with asthma, during the transition period from child to adult.
- 2011
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Ingår i: Clinical Respiratory Journal. - 1752-6981. ; 5:4, s. 195-202
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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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| 12. |
- Syk, Jorgen, et al.
(författare)
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Association between self-rated health and asthma : a population-based study
- 2012
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Ingår i: Clinical Respiratory Journal. - 1752-6981 .- 1752-699X. ; 6:3, s. 150-158
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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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| 13. |
- Westerlund, Anna, et al.
(författare)
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Using the Karolinska Sleep Questionnaire to identify obstructive sleep apnea syndrome in a sleep clinic population
- 2014
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Ingår i: Clinical Respiratory Journal. - : Wiley. - 1752-6981 .- 1752-699X. ; 8:4, s. 444-454
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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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| 14. |
- Aronsson, David, et al.
(författare)
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Comparison of central and peripheral airway involvement before and during methacholine, mannitol and eucapnic hyperventilation challenges in mild asthmatics.
- 2011
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Ingår i: Clinical Respiratory Journal. - 1752-6981. ; 5:1, s. 41565-41565
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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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| 15. |
- Bjermer, Leif
(författare)
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Targeting small airways, a step further in asthma management
- 2011
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Ingår i: Clinical Respiratory Journal. - 1752-6981. ; 5:3, s. 131-135
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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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| 16. |
- Brodtkorb, Thor-Henrik, et al.
(författare)
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Cost-effectiveness of clean air administered to the breathing zone in allergic asthma
- 2010
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Ingår i: CLINICAL RESPIRATORY JOURNAL. - 1752-6981. ; 4:2, s. 104-110
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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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| 17. |
- Erjefält, Jonas
(författare)
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The airway epithelium as regulator of inflammation patterns in asthma
- 2010
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Ingår i: Clinical Respiratory Journal. - 1752-6981. ; 4:s1, s. 9-14
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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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| 18. |
- Fjalldal, Sigridur B., et al.
(författare)
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Smoking, stages of change and decisional balance in Iceland and Sweden
- 2011
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Ingår i: The Clinical Respiratory Journal. - 1752-6981. ; 5:2, s. 76-83
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Smoking remains a significant health problem. Smoking interventions are important but selection of successful quitters can be difficult. Objective: To characterise smokers with emphasis on two constructs of the transtheoretical model, the stages of change and decisional balance. Methods: A random sample from adults aged 40 and over in Reykjavik, Iceland, and Uppsala, Sweden. Smokers were defined as being in the stage of pre-contemplation (not thinking of quitting within the next 6 months), contemplation (thinking of quitting within the next 6 months) or preparation (thinking of quitting within the next 30 days, having managed to quit for at least 24 h within the last 12 months). Results: A total of 226 participants were smokers: 72 (32%) were in the pre-contemplation stage, 126 (56%) in the contemplation stage and 28 (12%) in the preparation stage. A younger age, higher body mass index (BMI) and higher educational level were significantly related to being in a more advanced stage. A significant association was observed between decisional balance and stages of change such that decreased importance of the positive aspects of smoking and increased importance of the negative aspects of smoking were independently associated with an increased readiness to quit. Conclusion: The motivated smoker is likely to be young and educated with an above average BMI. A smoker in the contemplation stage is likely to maintain the negative aspects of smoking at a high level. Decreasing the value of the pros of smoking may facilitate the shift towards the stage of preparation.
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| 19. |
- Janson, Christer
(författare)
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The importance of airway remodelling in the natural course of asthma
- 2010
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Ingår i: The Clinical Respiratory Journal. - 1752-6981. ; 4:S1, s. 28-34
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Forskningsöversikt (refereegranskat)abstract
- Introduction: Asthma is associated with airflow limitation and increased decline in lung function. The underlying mechanism for this was probably that persisting inflammation leads to remodelling of the airways. Objectives: To review the importance of different factors which are related to airflow limitation and lung function decline in asthma. Methods: Case report and literature review. Results: Asthma severity, smoking, bronchial hyperresponsiveness and eosinophil inflammation were the variables that were most convincingly related to decline in forced expiratory volume in 1 s (FEV1) in asthma. Treatment with inhaled corticosteroids probably decreased the rate of FEV1 decline, although this was more uncertain because of the lack of randomised double blind studies that show such an effect. Progress in the field of the genetics of asthma may, in the near future, elucidate the role of gene-environment interaction in lung function decline in asthma. Conclusion: Regular treatment with inhaled corticosteroids may partly have a beneficial effect on airway remodelling in asthma. Improved understanding of the processes leading to airway remodelling is, however, important in order to prevent a large number of asthmatics from developing irreversible airflow obstruction. Please cite this paper as: Janson C. The importance of airway remodelling in the natural course of asthma. Clin Respir J 2010; 4 (Suppl. 1): 28-34.
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| 20. |
- Jernlås, Björn, et al.
(författare)
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Diagnostic Yield and Efficacy of Endobronchial Ultrasound-guided Transbronchial Needle Aspiration in Mediastinal Lymphadenopathy.
- 2012
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Ingår i: Clinical Respiratory Journal. - 1752-6981. ; 6, s. 88-95
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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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| 21. |
- Kiotseridis, Hampus, et al.
(författare)
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Quality of life in children and adolescents with respiratory allergy, assessed with a generic and disease-specific instrument
- 2013
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Ingår i: Clinical Respiratory Journal. - 1752-6981. ; 7:2, s. 168-175
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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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| 22. |
- Kämpe, Mary, 1956-, et al.
(författare)
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Experimental and seasonal exposure to birch pollen in allergic rhinitis and allergic asthma with regard to the inflammatory response
- 2010
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Ingår i: The Clinical Respiratory Journal. - : Blackwell Publishing Ltd. - 1752-6981. ; 4:1, s. 37-44
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Tidskriftsartikel (refereegranskat)abstract
- Background and Aims: Seasonal allergy is an interesting model to study the pathophysiological mechanisms involved in allergic inflammation. However, experimental allergen exposure is easier to perform and standardise. The primary aim of this study was to compare the inflammatory responses to high-dose bronchial challenge and natural exposure during birch pollen season. The second aim was to compare the responses of patients with allergic rhinitis and allergic asthma, respectively to both types of allergen exposure. Methods: Fifteen birch pollen-allergic patients (seven with asthma and eight with rhinitis) and five healthy individuals were studied during pollen season and after challenge with birch allergen. Symptoms, medication and peak expiratory flow rate (PEFR) were recorded, and blood samples, spirometry and induced sputum were analysed during season and after challenge. Results: Patients with allergic asthma demonstrated a greater bronchial responsiveness to bronchial provocation with birch allergen than patients with rhinitis (P = 0.04) whereas no difference was found regarding nasal challenge. No significant association was found between the level of responsiveness and the inflammatory response after seasonal exposure. Seasonal exposure was related to a more marked systemic inflammatory blood–eosinophil increase than bronchial challenge [(median) (0.25 vs 0.11 × 109/L, P = 0.03)] and after nasal challenge, respectively [(median) (0.25 vs 0.04 × 109/L, P = 0.003)]. A significant correlation in eosinophil cationic protein in induced sputum was found between the experimental and seasonal exposure (rho = 0.62, P = 0.02). Conclusions: Bronchial allergen challenge with inhalation of birch pollen gives a similar inflammatory response in the airway but less systemic inflammation than seasonal exposure in birch pollen allergic patients with asthma and rhinitis.
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| 23. |
- Petersen, Marian, et al.
(författare)
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Sexual function in male patients with obstructive sleep apnoea.
- 2010
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Ingår i: Clinical Respiratory Journal. - 1752-6981. ; 4:3, s. 186-191
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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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| 24. |
- Petersen, Marian, et al.
(författare)
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Sexual function in male patients with obstructive sleep apnoea after 1 year of CPAP treatment.
- 2013
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Ingår i: Clinical Respiratory Journal. - 1752-6981. ; 7:2, s. 214-219
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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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| 25. |
- Svensson, Gunnar A, et al.
(författare)
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Prognostic factors in lung cancer in a defined geographical area over two decades with a special emphasis on gender.
- 2013
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Ingår i: Clinical Respiratory Journal. - 1752-6981. ; 7:1, s. 91-100
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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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