| 1. |
- Athlin, Åsa, 1971-, et al.
(författare)
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Prediction of Mortality Using Different COPD Risk Assessments : A 12-Year Follow-Up
- 2021
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Ingår i: The International Journal of Chronic Obstructive Pulmonary Disease. - : Dove Medical Press Ltd.. - 1176-9106 .- 1178-2005. ; 16, s. 665-675
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: A multidimensional approach in the risk assessment of chronic obstructive pulmonary disease (COPD) is preferable. The aim of this study is to compare the prognostic ability for mortality by different COPD assessment systems; spirometric staging, classification by GOLD 2011, GOLD 2017, the age, dyspnea, obstruction (ADO) and the dyspnea, obstruction, smoking, exacerbation (DOSE) indices.Patients and Methods: A total of 490 patients diagnosed with COPD were recruited from primary and secondary care in central Sweden in 2005. The cohort was followed until 2017. Data for categorization using the different assessment systems were obtained through questionnaire data from 2005 and medical record reviews between 2000 and 2003. Kaplan-Meier survival analyses and Cox proportional hazard models were used to assess mortality risk. Receiver operating characteristic curves estimated areas under the curve (AUC) to evaluate each assessment systems´ ability to predict mortality.Results: By the end of follow-up, 49% of the patients were deceased. The mortality rate was higher for patients categorized as stage 3-4, GOLD D in both GOLD classifications and those with a DOSE score above 4 and ADO score above 8. The ADO index was most accurate for predicting mortality, AUC 0.79 (95% CI 0.75-0.83) for all-cause mortality and 0.80 (95% CI 0.75-0.85) for respiratory mortality. The AUC values for stages 1-4, GOLD 2011, GOLD 2017 and DOSE index were 0.73, 0.66, 0.63 and 0.69, respectively, for all-cause mortality.Conclusion: All of the risk assessment systems predict mortality. The ADO index was in this study the best predictor and could be a helpful tool in COPD risk assessment.
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| 2. |
- Bouhuis, Dennis, et al.
(författare)
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Factors associated with self-assessed asthma severity
- 2022
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Ingår i: Journal of Asthma. - : Marcel Dekker. - 0277-0903 .- 1532-4303. ; 59:4, s. 691-696
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Asthma severity can be estimated as the level of medication needed to achieve asthma control or by the patient's subjective assessment. Factors associated with self-assessed asthma severity are still incompletely explored.AIM: The aim was to study factors associated with self-assessed moderate or severe asthma.METHOD: In total, 1828 randomly selected asthma patients from primary (69%) and secondary (31%) care, completed a questionnaire including items about patient characteristics, comorbidity, the Asthma Control Test (ACT), emergency care visits and a scale for self-assessed asthma severity. Logistic regression was used to analyze associations with the dependent variable, self-assessed moderate or severe asthma in the entire study population and stratified by sex.RESULTS: Of the patients, 883 (45%) reported having moderate or severe asthma. Factors independently associated with self-assessed moderate or severe asthma were age >60 years (OR [95% CI] 1.98 [1.37-2.85]), allergic rhino-conjunctivitis (1.43 [1.05-1.95]), sinusitis (1.45 [1.09-1.93]), poor asthma control as measured by ACT <20 (5.64 [4.45-7.16]) and emergency care visits the previous year (2.52 [1.90-3.34]). Lower level of education was associated with self-assessed moderate/severe asthma in women (1.16 [1.05-2.43]) but not in men (0.90 [0.65-1.25]), p for interaction = .012.CONCLUSION: Poor asthma control, allergic rhino-conjunctivitis, recent sinusitis and older age were independently associated with self-assessed moderate or severe asthma. Important implications are that comorbid conditions of the upper airways should always be considered as part of asthma management, and that elderly patients may need extra attention.
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| 3. |
- Gagatek, Sebastian Grzegorz, et al.
(författare)
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Validation of clinical clusters for long-term mortality in two European COPD cohorts
- 2020
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Ingår i: European Respiratory Journal. - : European Respiratory Society. - 0903-1936 .- 1399-3003. ; 56:Suppl. 64
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Introduction: Chronic Obstructive Pulmonary Disease (COPD) is a heterogeneous disease with a variable mortality risk. A simple clinical algorithm has been validated for short-term mortality by Burgel et al. (ERJ 2017).Aim: To study if Burgel’s clinical algorithm is valid to predict long-term mortality.Methods: Data from two COPD cohorts, the Swedish PRAXIS Study (PS) (n=784, mean age (SD) 64.0 years (7.5), 42% males) and the Rotterdam Study (RS) (n=735, mean age (SD) 72 years (9.2), 57% males), with 9-years of follow-up data including mortality was used. The five clinical clusters were derived from baseline data on age, body mass index, dyspnea grade (mMRC), FEV 1 (%pred) and comorbidity (cardiovascular disease or diabetes). Mortality risk was estimated by unadjusted Cox models.Results: The distribution of clinical clusters (1-5) was: 29%/45%/8%/6%/12% in PS and 23%/26%/36%/0/15% in RS. The cumulative proportion of deaths after 9-years of follow-up was highest among COPD clusters 1 (65%) and 4 (72%), and lowest among cluster 5 (10%) in the PS cohort. In RS, Cluster 1 (44%) had the highest cumulative mortality and cluster 5 (5%) the lowest. Compared to cluster 5, the meta-analysed hazard ratio (HR) (95%CI) for cluster 1 was 9.95 (6.52–15.19) and for cluster 4, 13.49 (6.41–28.38). The meta-analysed HR for clusters 2 and 3, compared with cluster 5, were: 2.80 (1.77 – 4.36) and 4.73 (3.02 – 7.42), respectively.Conclusions: Burgel’s clinical clusters can be used to predict long-term mortality risk. Clusters 1 and 4 are associated with the poorest prognosis, cluster 5 with best prognosis and clusters 2 and 3 with intermediate prognosis in two independent COPD cohorts from Sweden and Netherlands.
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| 4. |
- Gagatek, Sebastian, et al.
(författare)
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Validation of Clinical COPD Phenotypes for Prognosis of Long-Term Mortality in Swedish and Dutch Cohorts
- 2022
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Ingår i: COPD. - : Informa Healthcare. - 1541-2555 .- 1541-2563. ; 19:1, s. 330-338
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Tidskriftsartikel (refereegranskat)abstract
- Chronic obstructive pulmonary disease (COPD) is a heterogeneous disease with variable mortality risk. The aim of our investigation was to validate a simple clinical algorithm for long-term mortality previously proposed by Burgel et al. in 2017. Subjects with COPD from two cohorts, the Swedish PRAXIS study (n = 784, mean age (standard deviation (SD)) 64.0 years (7.5), 42% males) and the Rotterdam Study (n = 735, mean age (SD) 72 years (9.2), 57% males), were included. Five clinical clusters were derived from baseline data on age, body mass index, dyspnoea grade, pulmonary function and comorbidity (cardiovascular disease/diabetes). Cox models were used to study associations with 9-year mortality. The distribution of clinical clusters (1-5) was 29%/45%/8%/6%/12% in the PRAXIS study and 23%/26%/36%/0%/15% in the Rotterdam Study. The cumulative proportion of deaths at the 9-year follow-up was highest in clusters 1 (65%) and 4 (72%), and lowest in cluster 5 (10%) in the PRAXIS study. In the Rotterdam Study, cluster 1 (44%) had the highest cumulative mortality and cluster 5 (5%) the lowest. Compared with cluster 5, the meta-analysed age- and sex-adjusted hazard ratio (95% confidence interval) for cluster 1 was 6.37 (3.94-10.32) and those for clusters 2 and 3 were 2.61 (1.58-4.32) and 3.06 (1.82-5.13), respectively. Burgel's clinical clusters can be used to predict long-term mortality risk. Clusters 1 and 4 are associated with the poorest prognosis, cluster 5 with the best prognosis and clusters 2 and 3 with intermediate prognosis in two independent cohorts from Sweden and the Netherlands.
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| 5. |
- Kisiel, Marta A., 1984-, et al.
(författare)
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Quality of life and asthma control related to hormonal transitions in women's lives
- 2022
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Ingår i: Journal of Asthma. - : Marcel Dekker. - 0277-0903 .- 1532-4303. ; 59:9, s. 1869-1877
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: The aim was to investigate if menstruation and use of exogenous sex hormones influence self-reported asthma related quality of life (QoL) and asthma control.Methods: The study is based on two asthma cohorts randomly selected in primary and secondary care. A total of 622 female patients 18-65 years were included and classified as premenopausal ≤46 years (n = 338) and peri/postmenopausal 47-65 years (n = 284). Questionnaire data from 2012 and 2014 with demographics, asthma related issues and sex hormone status. Outcome measures were Mini Asthma Quality of Life Questionnaire (Mini-AQLQ) and asthma control including Asthma Control Test (ACT) and exacerbations last six months.Results: Premenopausal women with menstruation related asthma worsening, perimenstrual asthma (PMA) (9%), had a clinically relevant lower Mini-AQLQ mean score 4.9 vs. 5.8 (p < 0.001), lower asthma control with ACT score <20, 72% vs. 28% (p < 0.001) and higher exacerbation frequency 44% vs. 20% (p = 0.004) compared with women without PMA. Women with irregular menstruation had higher exacerbation frequency than women with regular menstruation (p = 0.023). Hormonal contraceptives had no impact on QoL and asthma control. Peri/postmenopausal women with menopausal hormone therapy (MHT) had a clinically relevant lower Mini-AQLQ mean score compared to those without MHT, 4.9 vs 5.4 (p < 0.001), but no differences in asthma control.Conclusion: Women with PMA had lower QoL and more uncontrolled asthma than women without PMA. Peri/postmenopausal women with MHT had lower QoL than women without MHT. Individual clinical management of women with asthma may benefit from information about their sex hormone status.
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| 6. |
- Kisiel, Marta, 1984-, et al.
(författare)
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Data-driven questionnaire-based cluster analysis of asthma in Swedish adults
- 2020
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Ingår i: npj Primary Care Respiratory Medicine. - : Nature Research. - 2055-1010. ; 30:1
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to identify asthma phenotypes through cluster analysis. Cluster analysis was performed using self-reported characteristics from a cohort of 1291 Swedish asthma patients. Disease burden was measured using the Asthma Control Test (ACT), the mini Asthma Quality of Life Questionnaire (mini-AQLQ), exacerbation frequency and asthma severity. Validation was performed in 748 individuals from the same geographical region. Three clusters; early onset predominantly female, adult onset predominantly female and adult onset predominantly male, were identified. Early onset predominantly female asthma had a higher burden of disease, the highest exacerbation frequency and use of inhaled corticosteroids. Adult onset predominantly male asthma had the highest mean score of ACT and mini-AQLQ, the lowest exacerbation frequency and higher proportion of subjects with mild asthma. These clusters, based on information from clinical questionnaire data, might be useful in primary care settings where the access to spirometry and biomarkers is limited.
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| 7. |
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| 8. |
- Wireklint, Philip, et al.
(författare)
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Factors associated with knowledge of self-management of worsening asthma in primary care patients : a cross-sectional study
- 2021
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Ingår i: Journal of Asthma. - : Taylor & Francis. - 0277-0903 .- 1532-4303. ; 58:8, s. 1087-1093
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: Self-management is important for asthma control. We examined associations of patient- and healthcare-related factors with self-reported knowledge of self-management of worsening asthma.METHOD: Two asthma patient cohorts from 2012 (n = 527) and 2015 (n = 915) were randomly selected from 54 primary health care centers (PHCC) in central Sweden. Data were collected using patient questionnaires and questionnaires to the PHCCs. Logistic regression analyzed associations of relevant variables with knowledge of self-management of worsening asthma.RESULTS: In total, 63% of patients reported moderate to complete knowledge of self-management procedures. The adjusted OR for moderate to complete knowledge relative to high education level was 1.38 [95% CI 1.03-1.85)]; for physician continuity 2.19 (95% CI 1.62-2.96); for a written action plan, 11.9 (95% CI 6.16-22.9); for Step 2 maintenance treatment, 1.53 (95% CI 0.04-2.24); and 2.07 (95% CI 1.44-2.99) for Step 3. An asthma/COPD nurse visit within the previous 12 months was associated with greater knowledge in women but not in men (p for interaction =0.042). Smoking [OR 0.56 (95% CI 0.34-0.95)], co-morbidities ≥1 [OR 0.68 (95% CI 0.49-0.93)], and self-rated moderate/severe disease [OR 0.68 (95% CI 0.51-0.90)] were associated with low self-management knowledge.CONCLUSION: Self-reported knowledge of self-management procedures was associated with a higher educational level, physician continuity, a written action plan, advanced treatment and, in women, visiting an asthma/COPD nurse. The results reinforce the importance of implementing guidelines of patient access to a specific physician, a written action plan, and structured education by an asthma/COPD nurse.
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