| 1. |
- Sawalha, Sami, et al.
(författare)
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The impact of comorbidities on mortality among men and women with COPD: report from the OLIN COPD study
- 2019
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Ingår i: Therapeutic Advances in Respiratory Disease. - : SAGE Publications. - 1753-4658 .- 1753-4666. ; 13
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Tidskriftsartikel (refereegranskat)abstract
- Background: Comorbidities probably contribute to the increased mortality observed among subjects with chronic obstructive pulmonary disease (COPD), but sex differences in the prognostic impact of comorbidities have rarely been evaluated in population-based studies. The aim of this study was to evaluate the impact of common comorbidities, cardiovascular disease (CVD), diabetes mellitus (DM), and anxiety/depression (A/D), on mortality among men and women with and without airway obstruction in a population-based study. Methods: All subjects with airway obstruction [forced expiratory volume in 1 second (FEV1)/(forced) vital capacity ((F)VC) <0.70, n = 993] were, together with age- and sex-matched referents, identified after examinations of population-based cohorts in 2002-2004. Spirometric groups: normal lung function (NLF) and COPD (post-bronchodilator FEV1/(F)VC <0.70) and additionally, LLN-COPD (FEV1/(F)VC
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| 2. |
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| 3. |
- Allinson, James P, et al.
(författare)
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Changes in lung function in European adults born between 1884 and 1996 and implications for the diagnosis of lung disease: a cross-sectional analysis of ten population-based studies.
- 2022
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Ingår i: The Lancet. Respiratory medicine. - : Elsevier. - 2213-2619 .- 2213-2600. ; 10:1, s. 83-94
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Tidskriftsartikel (refereegranskat)abstract
- During the past century, socioeconomic and scientific advances have resulted in changes in the health and physique of European populations. Accompanying improvements in lung function, if unrecognised, could result in the misclassification of lung function measurements and misdiagnosis of lung diseases. We therefore investigated changes in population lung function with birth year across the past century, accounting for increasing population height, and examined how such changes might influence the interpretation of lung function measurements.In our analyses of cross-sectional data from ten European population-based studies, we included individuals aged 20-94 years who were born between 1884 and 1996, regardless of previous respiratory diagnoses or symptoms. FEV1, forced vital capacity (FVC), height, weight, and smoking behaviour were measured between 1965 and 2016. We used meta-regression to investigate how FEV1 and FVC (adjusting for age, study, height, sex, smoking status, smoking pack-years, and weight) and the FEV1/FVC ratio (adjusting for age, study, sex, and smoking status) changed with birth year. Using estimates from these models, we graphically explored how mean lung function values would be expected to progressively deviate from predicted values. To substantiate our findings, we used linear regression to investigate how the FEV1 and FVC values predicted by 32 reference equations published between 1961 and 2015 changed with estimated birth year.Across the ten included studies, we included 243 465 European participants (mean age 51·4 years, 95% CI 51·4-51·5) in our analysis, of whom 136 275 (56·0%) were female and 107 190 (44·0%) were male. After full adjustment, FEV1 increased by 4·8 mL/birth year (95% CI 2·6-7·0; p<0·0001) and FVC increased by 8·8 mL/birth year (5·7-12·0; p<0·0001). Birth year-related increases in the FEV1 and FVC values predicted by published reference equations corroborated these findings. This height-independent increase in FEV1 and FVC across the last century will have caused mean population values to progressively exceed previously predicted values. However, the population mean adjusted FEV1/FVC ratio decreased by 0·11 per 100 birth years (95% CI 0·09-0·14; p<0·0001).If current diagnostic criteria remain unchanged, the identified shifts in European values will allow the easier fulfilment of diagnostic criteria for lung diseases such as chronic obstructive pulmonary disease, but the systematic underestimation of lung disease severity.The European Respiratory Society, AstraZeneca, Chiesi Farmaceutici, GlaxoSmithKline, Menarini, and Sanofi-Genzyme.
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| 4. |
- Axelsson, Malin, et al.
(författare)
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Differences in diagnostic patterns of obstructive airway disease between areas and sex in Sweden and Finland : The Nordic EpiLung Study
- 2021
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Ingår i: Journal of Asthma. - : Taylor & Francis. - 0277-0903 .- 1532-4303. ; 58:9, s. 1196-1207
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To investigate the current prevalence of physician-diagnosed obstructive airway diseases by respiratory symptoms and by sex in Sweden and Finland. Method: In 2016, a postal questionnaire was answered by 34,072 randomly selected adults in four study areas: Västra Götaland and Norrbotten in Sweden, and Seinäjoki-Vaasa and Helsinki in Finland. Results: The prevalence of asthma symptoms was higher in Norrbotten (13.2%), Seinäjoki-Vaasa (14.8%) and Helsinki (14.4%) than in Västra Götaland (10.7%), and physician-diagnosed asthma was highest in Norrbotten (13.0%) and least in Västra Götaland (10.1%). Chronic productive cough was most common in the Finnish areas (7.7-8.2 % versus 6.3-6.7 %) while the prevalence of physician-diagnosed chronic bronchitis (CB) or chronic obstructive pulmonary disease (COPD) varied between 1.7-2.7% in the four areas. Among individuals with respiratory symptoms, the prevalence of asthma was most common in Norrbotten, while a diagnosis of COPD or CB was most common in Västra Götaland and Seinäjoki-Vaasa. More women than men with respiratory symptoms reported a diagnosis of asthma in Sweden and Seinäjoki-Vaasa but there were no sex differences in Helsinki. In Sweden, more women than men with symptoms of cough or phlegm reported a diagnosis of CB or COPD, while in Finland the opposite was found. Conclusion: The prevalence of respiratory symptoms and corresponding diagnoses varied between and within the countries. The proportion reporting a diagnosis of obstructive airway disease among individuals with respiratory symptoms varied, indicating differences in diagnostic patterns both between areas and by sex.
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| 5. |
- 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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| 6. |
- Bermúdez Barón, Nicolás, et al.
(författare)
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Body mass index increase: a risk factor for forced expiratory volume in 1 s decline for overweight and obese adults with asthma
- 2022
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Ingår i: European Respiratory Journal Open Research (ERJ Open Research). - : European Respiratory Society (ERS). - 2312-0541. ; 8:4
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Tidskriftsartikel (refereegranskat)abstract
- Background With increasing prevalence of overweight and obesity, it is important to study how body mass index (BMI) change may affect lung function among subjects with asthma. There are few prospective studies on this topic, especially with separate analyses of those with normal and high BMI. The aim of the present study was to prospectively study the association between annual BMI change and annual lung function decline, separately among those with normal initial BMI and overweight/obesity, in an adult asthma cohort. Methods A population-based adult asthma cohort was examined at study entry between 1986 and 2001 and at follow-up between 2012 and 2014 (n=945). Annual BMI change was analysed in association with annual decline in forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC) and FEV1/FVC separately in those with normal weight (BMI 18.5-24.9) and overweight/obese subjects (BMI >= 25) at study entry. Regression models were used to adjust for sex, age, smoking, inhaled corticosteroids use and occupational exposure to gas, dust or fumes. Results Overweight/obese subjects had lower FEV1 and FVC but slower annual FEV1 and FVC decline compared to those with normal weight. After adjustment through regression modelling, the association between BMI change with FEV1 and FVC decline remained significant for both BMI groups, but with stronger associations among the overweight/obese (FEV1 B-[Overweight/obese]=-25 mL versus B[ normal weight]= -15 mL). However, when including only those with BMI increase during follow-up, the associations remained significant among those with overweight/obesity, but not in the normal-weight group. No associations were seen for FEV1/FVC. Conclusions BMI increase is associated with faster FEV1 and FVC decline among overweight and obese adults with asthma in comparison with their normal-weight counterparts.
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| 7. |
- Hagstad, Stig, 1978, et al.
(författare)
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COPD among non-smokers - Report from the Obstructive Lung Disease in Northern Sweden (OLIN) studies
- 2012
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Ingår i: Respiratory Medicine. - : Elsevier BV. - 0954-6111 .- 1532-3064. ; 106:7, s. 980-988
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Tidskriftsartikel (refereegranskat)abstract
- Background: In westernized countries smoking and increasing age are the most important risk factors for COPD. Prevalence and risk factors of COPD among non-smokers are not well studied. Aim: To study the prevalence and risk factors of COPD among non-smokers and to determine the proportion of non-smokers among subjects with COPD. Methods: A random sample of 2470 subjects drawn from a population-based postal survey of 10,040 (85-88% participation) adults (aged 20-77) in Norrbotten, Sweden, were invited to structured interviews and lung function tests, and 1897 participated. COPD was classified using the fixed ratio (GOLD) definition and for comparison the lower limit of normal (LLN). Results: The prevalence of airway obstruction was 6.9% among non-smokers and strongly age related. The prevalence of GOLD stage >= II among non-smokers was 15%. Both among subjects with airway obstruction and among subjects with GOLD stage >= II, the proportions of nonsmokers were 20%. Of men with airway obstruction, 14.1% were non-smokers versus 26.8% among women. Non-smokers with GOLD stage >= II had significantly more symptoms and higher co-morbidity than non-smokers without airway obstruction. Sex, area of domicile and exposure to environmental tobacco smoke was not significantly associated to airway obstruction among non-smokers. Using LLN for defining airway obstruction yielded a similar prevalence. Conclusion: The prevalence of airway obstruction among non-smokers was close to 7% and was associated with increasing age. One out of seven men with airway obstruction, defined using the fixed ratio, versus one out of four women had never smoked. (C) 2012 Elsevier Ltd. All rights reserved.
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| 8. |
- Hisinger-Molkanen, H., et al.
(författare)
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The combined effect of exposures to vapours, gases, dusts, fumes and tobacco smoke on current asthma
- 2022
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Ingår i: Clinical Respiratory Journal. - : Wiley. - 1752-6981 .- 1752-699X. ; 16:6, s. 467-474
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Tidskriftsartikel (refereegranskat)abstract
- Smoking, exposure to environmental tobacco smoke (ETS) and occupational exposure to vapours, gases, dusts or fumes (VGDF) increase asthma symptoms. The impact of combined exposure is less well established. We aimed to evaluate the risk of combined exposure to smoking, ETS and VGDF on the prevalence of current asthma and asthma-related symptoms with a postal survey among a random population of 16,000 adults, aged 20-69 years (response rate 51.5%). The 836 responders with physician-diagnosed asthma were included in the analysis. Of them, 81.9% had current asthma defined as physician-diagnosed asthma with current asthma medication use or reported symptoms. There was a consistently increasing trend in the prevalence of current asthma by increased exposure. The highest prevalence of multiple symptoms was in smokers with VGDF exposure (92.1%) compared to the unexposed (73.9%, p = 0.001). In logistic regression analysis, combined exposure to several exposures increased the risk in all analysed symptoms (p = 0.002-0.007). In conclusion, smoking and exposure to ETS or VGDF increased the prevalence of current asthma and multiple symptoms. The combined exposure carried the highest risk. Preventive strategies are called for to mitigate exposure to tobacco smoke and VGDF.
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| 9. |
- Jansson, Sven-Arne, et al.
(författare)
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Hospitalization Due to Co-Morbid Conditions is the Main Cost Driver Among Subjects With COPD-A Report From the Population-Based OLIN COPD Study.
- 2015
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Ingår i: COPD. - : Informa UK Limited. - 1541-2563 .- 1541-2555. ; 12:4, s. 381-389
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Tidskriftsartikel (refereegranskat)abstract
- Abstract Background: Co-morbidities are common in COPD; however, there is a lack of population-based studies evaluating the health economic impact of co-morbid diseases for subjects with COPD. The main objective of this study was to estimate annual direct health-care costs, divided into costs due to non-respiratory and respiratory conditions, comparing subjects with and without COPD. Methods: Subjects with and without COPD derived from population-based cohorts in northern Sweden have been invited to annual examinations involving spirometry and structured interviews since 2005. This paper is based on data from 1472 subjects examined in 2006. COPD classification was based on spirometry. Results: Mean annual costs for both respiratory and non-respiratory conditions were significantly higher for subjects with COPD than non-COPD subjects, in total USD 2139 vs. USD 1276 (p = 0.026), and COPD remained significantly associated with higher costs also after adjustment for common confounders as age, smoking habits, BMI and sex. The mean total cost increased with COPD disease severity and was higher for all severity stages (GOLD) than for non-COPD subjects. Hospitalization due to non-respiratory diseases was the main cost driver in COPD, after adjustment for common confounders amounting to about 46% (unadjusted 62%) of the total COPD-costs. Conclusions: Costs were higher for COPD than non-COPD. In COPD, costs for co-morbid conditions were higher than those for respiratory conditions, and hospitalization due to co-morbid conditions was the main cost driver also when adjusted for common confounders.
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| 10. |
- Lindberg, Anne, et al.
(författare)
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Large underreporting of COPD as cause of death-results from a population-based cohort study
- 2021
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Ingår i: Respiratory Medicine. - : Elsevier BV. - 0954-6111 .- 1532-3064. ; 186
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Tidskriftsartikel (refereegranskat)abstract
- Background: In 2019, WHO estimated COPD to be the third leading cause of death in the world. However, COPD is probably underestimated as cause of death due to the well-known under-diagnosis. Aim: To evaluate the proportion of and factors associated with COPD recorded as cause of death in a long-term follow-up of a population-based COPD cohort. Methods: The study population includes all individuals (n = 551) with COPD defined as chronic airway obstruction (post-bronchodilator FEV1/FVC<0.70) + respiratory symptoms identified after re-examinations of four population-based cohorts. Mortality and underlying or contributing cause of death following ICD-10 classification were collected from the Swedish National Board of Health and Welfares register from date of examination in 2002-04 until 2016. Results: The study sample consisted of 32.3% GOLD 1, 55.9% GOLD 2, and 11.8% GOLD 3-4. The mean follow-up time was 10.3 (SD3.77) years and the cumulative mortality 45.0%. COPD (ICD-10 J43-J44) was recorded on 28.2% (n = 70) of the death certificates (11.1%, 25.7% and 57.1% by GOLD stage), whereof n = 35 had COPD recorded as underlying and n = 35 as contributing cause of death. To have COPD recorded as cause of death was independently associated with ex- and current smoking and a self-reported physician diagnosis of COPD, while male sex, overweight/obesity and higher FEV1% of predicted associated with the absence. Conclusions: COPD was largely underreported cause of death. Even among those with severe/very severe disease, COPD was only mentioned on 57.1% of the death certificates.
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