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  • Arkema, EV, et al. (författare)
  • Sarcoidosis incidence and prevalence: a nationwide register-based assessment in Sweden
  • 2016
  • Ingår i: The European respiratory journal. - : European Respiratory Society (ERS). - 1399-3003 .- 0903-1936. ; 48:6, s. 1690-1699
  • Tidskriftsartikel (refereegranskat)abstract
    • Our objective was to estimate the contemporary incidence and prevalence of sarcoidosis using Swedish population-based register data.Adults with any sarcoidosis-coded visit were identified from the National Patient Register (hospitalisations 1964–2013 and outpatient care 2001–2013). Demographic and medication dispensing data were retrieved from national registers. We estimated the prevalence of sarcoidosis in 2013 overall and by county of residence. The incidence of sarcoidosis during 2003–2012 was estimated by sex, age, education level and year of diagnosis. Case definitions were varied to test their robustness.More than 16 000 individuals had a history of sarcoidosis in 2013. When defined as two or more sarcoidosis-coded visits, the prevalence was 160 per 100 000. Using different definitions, the prevalence ranged from 152 (requiring a specialist visit) to 215 per 100 000 (only one visit required). The highest prevalence was observed in northern less densely populated counties. The incidence was 11.5 per 100 000 per year and varied by −10% to +30% depending on case definition. The incidence peaked in males aged 30–50 years and in females aged 50–60 years, but did not differ by education level and was stable over time.This study represents the largest epidemiological investigation of sarcoidosis using population-based individual-level data. Age at diagnosis in men was 10 years younger than in women and geographical variation was observed.
  • Ayres, JG, et al. (författare)
  • Climate change and respiratory disease : European Respiratory Society position statement
  • 2009
  • Ingår i: European Respiratory Journal. - : European Respiratory Society (ERS). - 0903-1936 .- 1399-3003. ; 34:2, s. 295-302
  • Tidskriftsartikel (refereegranskat)abstract
    • Climate change will affect individuals with pre-existing respiratory disease, but the extent of the effect remains unclear. The present position statement was developed on behalf of the European Respiratory Society in order to identify areas of concern arising from climate change for individuals with respiratory disease, healthcare workers in the respiratory sector and policy makers. The statement was developed following a 2-day workshop held in Leuven (Belgium) in March 2008. Key areas of concern for the respiratory community arising from climate change are discussed and recommendations made to address gaps in knowledge. The most important recommendation was the development of more accurate predictive models for predicting the impact of climate change on respiratory health. Respiratory healthcare workers also have an advocatory role in persuading governments and the European Union to maintain awareness and appropriate actions with respect to climate change, and these areas are also discussed in the position statement.
  • Bachert, C, et al. (författare)
  • Staphylococcus aureus and its IgE-inducing enterotoxins in asthma: current knowledge
  • 2020
  • Ingår i: The European respiratory journal. - : European Respiratory Society (ERS). - 1399-3003 .- 0903-1936. ; 55:4
  • Tidskriftsartikel (refereegranskat)abstract
    • While immunoglobulin (Ig) E is a prominent biomarker for early-onset, its levels are often elevated in non-allergic late-onset asthma. However, the pattern of IgE expression in the latter is mostly polyclonal, with specific IgEs low or below detection level albeit with an increased total IgE. In late-onset severe asthma patients, specific IgE to Staphylococcal enterotoxins (se-IgE) can frequently be detected in serum, and has been associated with asthma, with severe asthma defined by hospitalisations, oral steroid use and decrease in lung function. Recently,se-IgE was demonstrated to even predict the development into severe asthma with exacerbations over the next decade.Staphylococcus aureusmanipulates the airway mucosal immunology at various levelsviaits proteins, including superantigens, serine-protease-like proteins (Spls), or protein A (SpA) and possibly others. Release of IL-33 from respiratory epithelium and activation of innate lymphoid cells (ILCs)viaits receptor ST2, type 2 cytokine release from those ILCs and T helper (Th) 2 cells, mast cell degranulation, massive local B-cell activation and IgE formation, and finally eosinophil attraction with consequent release of extracellular traps, adding to the epithelial damage and contributing to disease persistenceviaformation of Charcot–Leyden crystals are the most prominent hallmarks of the manipulation of the mucosal immunity byS. aureus. In summary,S. aureusclaims a prominent role in the orchestration of severe airway inflammation and in current and future disease severity. In this review, we discuss current knowledge in this field and outline the needs for future research to fully understand the impact ofS. aureusand its proteins on asthma.
  • Backman, Helena, et al. (författare)
  • Decrease in prevalence of COPD in Sweden after decades of decrease in smoking
  • 2018
  • Ingår i: European Respiratory Journal. - : European Respiratory Society. - 0903-1936 .- 1399-3003. ; 52
  • Tidskriftsartikel (övrigt vetenskapligt)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.
  • Backman, Helena, et al. (författare)
  • Eosinophilic inflammation and lung function decline in a long-term follow-up of a large population-based asthma cohort
  • 2018
  • Ingår i: European Respiratory Journal. - : European Respiratory Society. - 0903-1936 .- 1399-3003. ; 52
  • Tidskriftsartikel (övrigt vetenskapligt)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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