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Sundh, Josefin
Publications (10 of 36) Show all publications
Heddini, A., Sundh, J., Ekström, M. & Janson, C. (2019). Effectiveness trials: critical data to help understand how respiratory medicines really work?. European Clinical Respiratory Journal, 6(1), Article ID 1565804.
Open this publication in new window or tab >>Effectiveness trials: critical data to help understand how respiratory medicines really work?
2019 (English)In: European Clinical Respiratory Journal, ISSN 2001-8525, Vol. 6, no 1, article id 1565804Article, review/survey (Refereed) Published
Abstract [en]

Most of the information about the benefits, safety aspects, and cost effectiveness of pharmacological treatment in the respiratory field has been obtained from traditional efficacy studies, such as randomised controlled trials (RCT). The highly controlled environment of an RCT does not always reflect everyday practice. The collection, analysis, and application of effectiveness data to generate Real World Evidence (RWE) through pragmatic trials or observational studies therefore has the potential to improve decision making by regulators, payers, and clinicians. Despite calls for more RWE, effectiveness data are not widely used in decision making in the respiratory field. Recent advances in data capture, curation, and storage combined with new analytical tools have now made it feasible for effectiveness data to become routine sources of evidence to supplement traditional efficacy data. In this paper, we will examine some of the current data gaps, diverse types of effectiveness data, look at proposed frameworks for the positioning of effectiveness data, as well as provide examples from therapeutic areas. We will give examples of both previous effectiveness studies and studies that are ongoing within the respiratory field. Effectiveness data hold the potential to address several evidentiary gaps related to the effectiveness, safety, and value of treatments in patients with respiratory diseases.

Place, publisher, year, edition, pages
Taylor & Francis Group, 2019
Keywords
Effectiveness, real-world evidence, pragmatic trials, evidence-base, efficacy RCT, levels of evidence, respiratory disease, asthma, COPD, co-morbidity
National Category
Respiratory Medicine and Allergy
Identifiers
urn:nbn:se:oru:diva-72437 (URN)10.1080/20018525.2019.1565804 (DOI)000457088000001 ()30728925 (PubMedID)
Available from: 2019-02-14 Created: 2019-02-14 Last updated: 2019-02-14Bibliographically approved
Lindgren, H., Hasselgren, M., Montgomery, S., Lisspers, K., Ställberg, B., Janson, C. & Sundh, J. (2019). Factors associated with well-controlled asthma: A cross-sectional study [Letter to the editor]. Allergy. European Journal of Allergy and Clinical Immunology
Open this publication in new window or tab >>Factors associated with well-controlled asthma: A cross-sectional study
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2019 (English)In: Allergy. European Journal of Allergy and Clinical Immunology, ISSN 0105-4538, E-ISSN 1398-9995Article in journal, Letter (Refereed) Epub ahead of print
Place, publisher, year, edition, pages
Munksgaard Forlag, 2019
National Category
Respiratory Medicine and Allergy
Identifiers
urn:nbn:se:oru:diva-75593 (URN)10.1111/all.13976 (DOI)000479801000001 ()31298735 (PubMedID)
Funder
Swedish Heart Lung FoundationSwedish Asthma and Allergy Association
Note

Funding Agencies:

County councils of the Uppsala-Örebro Health Care region

Bror Hjerpstedts Foundation  

Center for Clinical Research, Dalarna  

Region Örebro County through ALF 

Available from: 2019-08-16 Created: 2019-08-16 Last updated: 2019-08-29Bibliographically approved
Sundh, J., Bornefalk-Hermansson, A., Ahmadi, Z., Blomberg, A., Janson, C., Currow, D. C., . . . Ekström, M. (2019). REgistry-based randomized controlled trial of treatment and Duration and mortality in long-term OXygen therapy (REDOX) study protocol. BMC Pulmonary Medicine, 19(1), Article ID 50.
Open this publication in new window or tab >>REgistry-based randomized controlled trial of treatment and Duration and mortality in long-term OXygen therapy (REDOX) study protocol
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2019 (English)In: BMC Pulmonary Medicine, ISSN 1471-2466, E-ISSN 1471-2466, Vol. 19, no 1, article id 50Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: Long-term oxygen therapy (LTOT) during 15 h/day or more prolongs survival in patients with chronic obstructive pulmonary disease (COPD) and severe hypoxemia. No randomized controlled trial has evaluated the net effects (benefits or harms) from LTOT 24 h/day compared with 15 h/day or the effect in conditions other than COPD. We describe a multicenter, national, phase IV, non-superiority, registry-based, randomized controlled trial (R-RCT) of LTOT prescribed 24 h/day compared with 15 h/day. The primary endpoint is all-cause-mortality at 1 year. Secondary endpoints include cause-specific mortality, hospitalizations, health-related quality of life, symptoms, and outcomes in interstitial lung disease.

METHODS/DESIGN: Patients qualifying for LTOT are randomized to LTOT 24 h/day versus 15 h/day during 12 months using the Swedish Register for Respiratory Failure (Swedevox). Planned sample size in this pragmatic study is 2126 randomized patients. Clinical follow-up and concurrent treatments are according to routine clinical practice. Mortality, hospitalizations, and incident diseases are assessed using national Swedish registries with expected complete follow-up. Patient-reported outcomes are assessed using postal questionnaire at 3 and 12 months.

DISCUSSION: The R-RCT approach combines the advantages of a prospective randomized trial and large clinical national registries for enrollment, allocation, and data collection, with the aim of improving the evidence-based use of LTOT.

TRIAL REGISTRATION: Clinical Trial registered with www.clinicaltrials.gov , Title: REgistry-based Treatment Duration and Mortality in Long-term OXygen Therapy (REDOX); ID: NCT03441204.

Place, publisher, year, edition, pages
BioMed Central, 2019
Keywords
Chronic obstructive pulmonary disease, Health-related quality of life, Hospitalizations, Hypoxaemia, Interstitial lung disease, Long-term oxygen therapy, Mortality, Oxygen duration, Register-based randomized controlled trial, Symptoms
National Category
Respiratory Medicine and Allergy
Identifiers
urn:nbn:se:oru:diva-72876 (URN)10.1186/s12890-019-0809-7 (DOI)000459873800001 ()30808321 (PubMedID)2-s2.0-85062262637 (Scopus ID)
Funder
Swedish Heart Lung FoundationSwedish Society of MedicineThe Crafoord FoundationSwedish Society for Medical Research (SSMF)
Note

Funding Agency:

Emil and Wera Cornell Foundation

Available from: 2019-03-04 Created: 2019-03-04 Last updated: 2019-06-19Bibliographically approved
Sandberg, J., Lansing, R., Anderberg, P., Currow, D., Sundh, J., Ahmadi, Z., . . . Ekström, M. (2019). Relating Experienced To Recalled breathlessness Observational (RETRO) study: a prospective study using a mobile phone application. BMJ Open Respiratory Research, 6(1), Article ID UNSP e000370.
Open this publication in new window or tab >>Relating Experienced To Recalled breathlessness Observational (RETRO) study: a prospective study using a mobile phone application
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2019 (English)In: BMJ Open Respiratory Research, E-ISSN 2052-4439, Vol. 6, no 1, article id UNSP e000370Article in journal (Refereed) Published
Abstract [en]

Background: Breathlessness, the subjective sensation of breathing discomfort, is common and appears in the daily life of people with cardiorespiratory diseases. Physicians often rely on patient's history based on symptom recall. The relation between recalled and experienced breathlessness is still poorly understood. This paper presents the protocol for a study primarily aimed at evaluating the relationship between experienced breathlessness and (1) recalled breathlessness and (2) predicted future breathlessness.

Methods: A mobile phone application will be used to collect data during daily life. Medically stable participants, >= 18 years of age with mean daily breathlessness of Numerical Rating Scale (NRS) 3/10 and able to use a mobile phone with internet will rate their breathlessness intensity on a 0-10 NRS prompted the user several times daily for 1 week. Participants will recall their breathlessness each day and week. Multivariable random effects regression models will be used for statistical analyses.

Results: Results of the study will be submitted for publication in peer-reviewed journals and presented at relevant conferences.

Discussion: This protocol describes a study aimed at investigating previously unknown areas of the experience and recall of breathlessness using a new method of data collection.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2019
National Category
Respiratory Medicine and Allergy
Identifiers
urn:nbn:se:oru:diva-75279 (URN)10.1136/bmjresp-2018-000370 (DOI)000471138900012 ()30956800 (PubMedID)2-s2.0-85062026982 (Scopus ID)
Funder
Swedish Society of MedicineSwedish Heart Lung FoundationSwedish Society for Medical Research (SSMF)
Note

Funding Agencies:

Scientific Committee of Blekinge County Council

Swedish Respiratory Society

Wera and Emil Cornell Foundation

Available from: 2019-07-24 Created: 2019-07-24 Last updated: 2019-07-24Bibliographically approved
Åberg, J., Hasselgren, M., Montgomery, S., Lisspers, K., Ställberg, B., Janson, C. & Sundh, J. (2019). Sex-related differences in management of Swedish patients with a clinical diagnosis of chronic obstructive pulmonary disease. The International Journal of Chronic Obstructive Pulmonary Disease, 14, 961-969
Open this publication in new window or tab >>Sex-related differences in management of Swedish patients with a clinical diagnosis of chronic obstructive pulmonary disease
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2019 (English)In: The International Journal of Chronic Obstructive Pulmonary Disease, ISSN 1176-9106, E-ISSN 1178-2005, Vol. 14, p. 961-969Article in journal (Refereed) Published
Abstract [en]

Purpose: Women with chronic obstructive pulmonary disease (COPD) have more symptoms, more exacerbations, lower health status scores, and more comorbidity. However, it is unclear whether management of COPD differs by sex. The aim of the study was to investigate differences by sex in the care of patients with COPD.

Patients and methods: The population included 1329 primary and secondary care patients with a doctor ' s diagnosis of COPD in central Sweden. Data were obtained from patient questionnaires and included patient characteristics and data on achieved COPD care. Analyses included cross-tabulations, chi-squared test and multiple logistic regression using several measures in COPD management as dependent variables, female sex as independent variable, and with adjustment for age groups, previous exacerbations, COPD Assessment Test, level of dyspnea assessed by the modified Medical Research Council scale, comorbid conditions, self-rated moderate/severe disease, level of education and body mass index.

Results: Women were more likely to receive triple therapy (OR 1.86 (95% CI 1.38-2.51)), to have any maintenance treatment (OR 1.82 (95% CI 1.31-2.55)), to be on sick leave (OR 2.16 (95% CI 1.19-3.93)), to have received smoking cessation support (OR 1.80 (95% CI 1.18-2.75)) and to have had pneumococcal vaccination (OR 1.82 (95% CI 1.37-2.43)), all independently of age, severity of disease or other potential confounders.

Conclusion: Management of COPD differs by sex, with women being more actively managed than men. It is unclear whether this is due to patient-or care-related factors.

Place, publisher, year, edition, pages
DOVE Medical Press Ltd., 2019
Keywords
gender, triple inhaled therapy, maintenance treatment, sick leave, smoking support, pneumococcal vaccination
National Category
Respiratory Medicine and Allergy
Identifiers
urn:nbn:se:oru:diva-74345 (URN)10.2147/COPD.S193311 (DOI)000467097300001 ()
Available from: 2019-05-21 Created: 2019-05-21 Last updated: 2019-05-21Bibliographically approved
Ekström, M., Sundh, J., Schiöler, L., Lindberg, E., Rosengren, A., Bergström, G., . . . Torén, K. (2018). Absolute lung size and the sex difference in breathlessness in the general population. PLoS ONE, 13(1), Article ID e0190876.
Open this publication in new window or tab >>Absolute lung size and the sex difference in breathlessness in the general population
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2018 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 13, no 1, article id e0190876Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Breathlessness is associated with major adverse health outcomes and is twice as common in women as men in the general population. We evaluated whether this is related to their lower absolute lung volumes.

METHODS: Cross-sectional analysis of the population-based Swedish CardioPulmonarybioImage Study (SCAPIS) Pilot, including static spirometry and diffusing capacity (n = 1,013; 49% women). Breathlessness was measured using the modified Medical Research Council (mMRC) scale and analyzed using ordinal logistic regression adjusting for age, pack-years of smoking, body mass index, chronic airway limitation, asthma, chronic bronchitis, depression and anxiety in all models.

RESULTS: Breathlessness was twice as common in women as in men; adjusted odds ratio (OR) 2.20 (95% confidence interval, 1.32-3.66). Lower absolute lung volumes were associated with increased breathlessness prevalence in both men and women. The sex difference in breathlessness was unchanged when adjusting for lung function in %predicted, but disappeared when controlling for absolute values of total lung capacity (OR 1.12; 0.59-2.15), inspiratory capacity (OR 1.26; 0.68-2.35), forced vital capacity (OR 0.84; 0.42-1.66), forced expiratory volume in one second (OR 0.70; 0.36-1.35) or lung diffusing capacity (OR 1.07; 0.58-1.97).

CONCLUSION: In the general population, the markedly higher prevalence of breathlessness in women is related to their smaller absolute lung volumes.

Place, publisher, year, edition, pages
San Francisco, USA: Public Library of Science, 2018
National Category
Public Health, Global Health, Social Medicine and Epidemiology Respiratory Medicine and Allergy
Identifiers
urn:nbn:se:oru:diva-64039 (URN)10.1371/journal.pone.0190876 (DOI)000419403800132 ()29304074 (PubMedID)2-s2.0-85040084358 (Scopus ID)
Funder
Swedish Heart Lung FoundationKnut and Alice Wallenberg FoundationSwedish Research CouncilVINNOVAForte, Swedish Research Council for Health, Working Life and WelfareSwedish Society of Medicine
Note

Funding Agencies:

Sahlgrenska University Hospital  

Swedish state 

Swedish Respiratory Society

Scientific Committee of Blekinge County Council  

Wera and Emil Cornell Foundation 

Available from: 2018-01-12 Created: 2018-01-12 Last updated: 2018-08-16Bibliographically approved
Stegberg, M., Hasselgren, M., Montgomery, S., Lisspers, K., Ställberg, B., Janson, C. & Sundh, J. (2018). Changes in smoking prevalence and cessation support, and factors associated with successful smoking cessation in Swedish patients with asthma and COPD. European Clinical Respiratory Journal, 5, Article ID 1421389.
Open this publication in new window or tab >>Changes in smoking prevalence and cessation support, and factors associated with successful smoking cessation in Swedish patients with asthma and COPD
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2018 (English)In: European Clinical Respiratory Journal, ISSN 2001-8525, Vol. 5, article id 1421389Article in journal (Refereed) Published
Abstract [en]

Introduction: Our aim was to investigate changes in smoking prevalence, smoking cessation support and factors associated with successful smoking cessation in patients with asthma and COPD.

Methods: Questionnaires about available smoking cessation resources were completed by 54 primary health-care centers and 14 hospitals in central Sweden in 2005 and 2012. Patient data were collected using record reviews and patients questionnaires for two cohorts of randomly selected asthma and COPD patients in 2005 (n = 2306; with a follow up in 2012), and in 2014/ 2015 (n = 2620). Smoking prevalence, available individual and group smoking cessation support, and factors associated with successful smoking cessation were explored.

Results: Smoking prevalence decreased from 11% to 6% (p < 0.0001) in patients with asthma but was almost unchanged in patients with COPD (28 to 26%, p = 0.37). Smoking cessation support increased from 53% to 74% (p = 0.01). A high cardiovascular risk factor level, including diabetes mellitus and hypertension was associated with improved smoking cessation in patients with asthma (OR (95% CI) 3.87 (1.04-14.4), p = 0.04). A higher magnitude success was observed in men with asthma (OR (95% CI) 27.9 (1.73-449), p = 0.02). More highly educated women with asthma had successful greater smoking cessation (4.76 (1.22-18.7), p = 0.04). No significant associations were found in COPD.

Conclusions: The smoking prevalence in patients with asthma but not in COPD has almost halved in Sweden during a 7-year period. The availability of smoking cessation support has increased. Suggested factors related to successful smoking cessation are higher level of education in women with asthma and cardiovascular risk factors in men and women with asthma.

Place, publisher, year, edition, pages
Taylor & Francis Group, 2018
Keywords
Smoking prevalence, smoking cessation support, primary care, secondary care, cardiovascular risk factors, high educational level
National Category
Respiratory Medicine and Allergy
Identifiers
urn:nbn:se:oru:diva-64414 (URN)10.1080/20018525.2017.1421389 (DOI)000419510300001 ()29321831 (PubMedID)
Available from: 2018-01-19 Created: 2018-01-19 Last updated: 2018-08-20Bibliographically approved
Sundh, J., Ahmadi, Z. & Ekström, M. (2018). Daily duration of long-term oxygen therapy and risk of hospitalization in oxygen-dependent COPD patients. The International Journal of Chronic Obstructive Pulmonary Disease, 13
Open this publication in new window or tab >>Daily duration of long-term oxygen therapy and risk of hospitalization in oxygen-dependent COPD patients
2018 (English)In: The International Journal of Chronic Obstructive Pulmonary Disease, ISSN 1176-9106, E-ISSN 1178-2005, Vol. 13Article in journal (Refereed) Published
Abstract [en]

Introduction: Long-term oxygen therapy (LTOT) improves survival and may reduce hospital admissions in patients with chronic obstructive pulmonary disease (COPD) and severe hypoxemia, but the impact of daily duration of LTOT on hospitalization rate is unknown. We aimed to estimate the association between the daily duration of LTOT (24 vs 15 h/d) and hospital admissions in patients with LTOT due to COPD.

Materials and methods: A population-based, cohort study included patients who started LTOT due to COPD between October 1, 2005 and June 30, 2009 in the Swedish national register for respiratory failure (Swedevox). Time to first hospitalization from all causes and from respiratory or nonrespiratory disease, using the National Patient Registry, was analyzed using Fine-Gray regression, adjusting for potential confounders.

Results: A total of 2,249 patients with COPD (59% women) were included. LTOT 24 h/d was prescribed to 539 (24%) and LTOT 15-16 h/d to 1,231 (55%) patients. During a median follow-up of 1.1 years (interquartile range, 0.6-2.1 years), 1,702 (76%) patients were hospitalized. No patient was lost to follow-up. The adjusted rate of all-cause hospitalization was similar between LTOT 24 and 15 16 h/d (subdistribution hazard ratio [SHR] 0.96; [95% CI] 0.84-1.08), as was cause-specific hospitalizations analyzed for respiratory disease (SHR: 1.00; 95% CI: 0.86-1.17) and nonrespiratory disease (SHR: 0.92; 95% CI: 0.75.-1.14).

Conclusion: LTOT prescribed for 24 h/d was not associated with decreased hospitalization rates compared with LTOT for 15-16 h/d in patients with oxygen-dependent COPD. The results should be validated in a randomized controlled trial.

Place, publisher, year, edition, pages
DOVE Medical Press Ltd., 2018
Keywords
long-term oxygen therapy, chronic obstructive pulmonary disease, duration, hospitalization, cohort study, hypoxemia, hospital admission, respiratory disease, nonrespiratory disease
National Category
Respiratory Medicine and Allergy
Identifiers
urn:nbn:se:oru:diva-68781 (URN)10.2147/COPD.S167523 (DOI)000442909800003 ()
Available from: 2018-09-06 Created: 2018-09-06 Last updated: 2018-09-06Bibliographically approved
Ekström, M., Ahmadi, Z. & Sundh, J. (2018). Further Need for Evidence in Long-Term Oxygen Therapy [Letter to the editor]. Annals of the American Thoracic Society, 15(4), 511-512
Open this publication in new window or tab >>Further Need for Evidence in Long-Term Oxygen Therapy
2018 (English)In: Annals of the American Thoracic Society, ISSN 2329-6933, E-ISSN 2325-6621, Vol. 15, no 4, p. 511-512Article in journal, Letter (Refereed) Published
Place, publisher, year, edition, pages
American Thoracic Society, 2018
National Category
Respiratory Medicine and Allergy
Identifiers
urn:nbn:se:oru:diva-64846 (URN)10.1513/AnnalsATS.201801-023LE (DOI)000429248100022 ()29384689 (PubMedID)2-s2.0-85045389435 (Scopus ID)
Funder
Swedish Society of MedicineSwedish Heart Lung FoundationSwedish Society for Medical Research (SSMF)
Available from: 2018-02-07 Created: 2018-02-07 Last updated: 2018-09-06Bibliographically approved
Giezeman, M., Hasselgren, M., Lisspers, K., Ställberg, B., Montgomery, S., Janson, C. & Sundh, J. (2018). Influence of comorbid heart disease on dyspnea and health status in patients with COPD - a cohort study. The International Journal of Chronic Obstructive Pulmonary Disease, 13, 3857-3865
Open this publication in new window or tab >>Influence of comorbid heart disease on dyspnea and health status in patients with COPD - a cohort study
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2018 (English)In: The International Journal of Chronic Obstructive Pulmonary Disease, ISSN 1176-9106, E-ISSN 1178-2005, Vol. 13, p. 3857-3865Article in journal (Refereed) Published
Abstract [en]

Purpose: The aim of this study was to examine the changing influence over time of comorbid heart disease on symptoms and health status in patients with COPD.

Patients and methods: This is a prospective cohort study of 495 COPD patients with a baseline in 2005 and follow-up in 2012. The study population was divided into three groups: patients without heart disease (no-HD), those diagnosed with heart disease during the study period (new-HD) and those with heart disease at baseline (HD). Symptoms were measured using the mMRC. Health status was measured using the Clinical COPD Questionnaire (CCQ) and the COPD Assessment Test (CAT; only available in 2012). Logistic regression with mMRC $2 and linear regression with CCQ and CAT scores in 2012 as dependent variables were performed unadjusted, adjusted for potential confounders, and additionally adjusted for baseline mMRC, respectively, CCQ scores.

Results: Mean mMRC worsened from 2005 to 2012 as follows: for the no-HD group from 1.8 (+/- 1.3) to 2.0 (+/- 1.4), (P=0.003), for new-HD from 2.2 (+/- 1.3) to 2.4 (+/- 1.4), (P=0.16), and for HD from 2.2 (+/- 1.3) to 2.5 (+/- 1.4), (P=0.03). In logistic regression adjusted for potential confounding factors, HD (OR 1.71; 95% CI: 1.03-2.86) was associated with mMRC $ 2. Health status worsened from mean CCQ as follows: for no-HD from 1.9 (+/- 1.2) to 2.1 (+/- 1.3) with (P=0.01), for new-HD from 2.3 (+/- 1.5) to 2.6 (+/- 1.6) with (P=0.07), and for HD from 2.4 (+/- 1.1) to 2.5 (+/- 1.2) with (P=0.57). In linear regression adjusted for potential confounders, HD (regression coefficient 0.12; 95% CI: 0.04-5.91) and new-HD (0.15; 0.89-5.92) were associated with higher CAT scores. In CCQ functional state domain, new-HD (0.14; 0.18-1.16) and HD (0.12; 0.04-0.92) were associated with higher scores. After additional correction for baseline mMRC and CCQ, no statistically significant associations were found.

Conclusion: Heart disease contributes to lower health status and higher symptom burden in COPD but does not accelerate the worsening over time.

Place, publisher, year, edition, pages
DOVE Medical Press Ltd., 2018
Keywords
COPD Assessment Test, CAT, Clinical COPD Questionnaire, CCQ, modified Medical Research Council dyspnea score, mMRC, ischemic heart disease, heart failure
National Category
Respiratory Medicine and Allergy
Identifiers
urn:nbn:se:oru:diva-70781 (URN)10.2147/COPD.S175641 (DOI)000452171700001 ()
Available from: 2018-12-17 Created: 2018-12-17 Last updated: 2018-12-17Bibliographically approved
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