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  • 1.
    AbdulWahab, Atqah
    et al.
    Department of Pediatrics, Hamad Medical Corporation, Doha, Qatar; Weill Cornell Medicine‑Qatar, Doha, Qatar.
    Zahraldin, Khalid
    Department of Pediatrics, Hamad Medical Corporation, Doha, Qatar.
    Sid Ahmed, Mazen
    Örebro University, School of Science and Technology. Department of Laboratory Medicine and Pathology, Microbiology Division, Hamad Medical Corporation, Doha, Qatar.
    Abu Jarir, Sulieman
    Departments of Internal Medicine, Hamad Medical Corporation, Doha, Qatar.
    Muneer, Mohammed
    Plastic Surgery, Hamad Medical Corporation, Doha, Qatar.
    Mohamed, Shehab F.
    Departments of Internal Medicine, Hamad Medical Corporation, Doha, Qatar.
    Hamid, Jemal M.
    Department of Laboratory Medicine and Pathology, Microbiology Division, Hamad Medical Corporation, Doha, Qatar.
    Hassan, Abubaker A. I.
    Departments of Internal Medicine, Hamad Medical Corporation, Doha, Qatar.
    Ibrahim, Emad Bashir
    Weill Cornell Medicine‑Qatar, Doha, Qatar; Department of Laboratory Medicine and Pathology, Microbiology Division, Hamad Medical Corporation, Doha, Qatar.
    The emergence of multidrug-resistant Pseudomonas aeruginosa in cystic fibrosis patients on inhaled antibiotics2017In: Lung India, ISSN 0970-2113, E-ISSN 0974-598X, Vol. 34, no 6, p. 527-531Article in journal (Refereed)
    Abstract [en]

    Introduction: Multidrug-resistant Pseudomonas aeruginosa (MDR-PA) is an important and growing issue in the care of patients with cystic fibrosis (CF), and a major cause of morbidity and mortality.

    Objective: The objective of the study was to describe the frequency of MDR-PA recovered from the lower respiratory samples of pediatric and adult CF patients, and its antibiotic resistance pattern to commonly used antimicrobial agents including beta-lactams, aminoglycosides, and fluoroquinolones.

    Materials and Methods: The lower respiratory isolates of P. aeruginosa were obtained from inpatients and outpatients CF clinics from a tertiary care teaching hospital for the period from October 2014 to September 2015. The identification and antimicrobial susceptibility for all the isolates were performed by using the BD Phoenix (TM) and E-test in compliance with Clinical and Laboratory Standards Institute (CLSI) guidelines.

    Results: A total of 61 P. aeruginosa samples were isolated from thirty CF patients from twenty families. Twelve sputum samples were positive for MDR-PA (seven nonmucoid and five mucoid isolates) from five CF patients (five families) with moderate-to-very severe lung disease given MDR-PA frequency of 19.7%. The median age of the study group was 20 (range 10-30) years. Three CF patients were on chronic inhaled tobramycin and two on nebulized colistin. The antimicrobial patterns of isolates MDR-PA showed the highest rate of resistance toward each gentamycin, amikacin, and cefepime (100%), followed by 91.7% to ciprofloxacin, 75% to tobramycin, 58.3% to meropenem, and 50% to piperacillin-tazobactam. None of the isolates were resistant to colistin during the study period.

    Conclusion: The study results emphasize that the emergence of a significant problem in the clinical isolates of P. aeruginosa in CF patients that dictate appropriate attention to the antibiotic management after proper surveillance.

  • 2.
    Abrahamsson, Thomas R.
    et al.
    Dept Clin & Expt Med, Div Pediat, Linköping University, Linköping, Sweden.
    Jakobsson, Hedvig E.
    Dept Microbiol Tumor & Cell Biol, Karolinska Institute, Stockholm, Sweden.
    Andersson, Anders F.
    Sch Biotechnol, Sci Life Lab, KTH Royal Inst Technol, Stockholm, Sweden.
    Björksten, Bengt
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Inst Environm Med, Karolinska Institute, Stockholm, Sweden.
    Engstrand, Lars
    Sch Biotechnol, Sci Life Lab, KTH Royal Inst Technol, Stockholm, Sweden.
    Jenmalm, Maria C.
    Dept Clin & Expt Med, Div Pediat, Linköping University, Linköping, Sweden.; Unit Autoimmun & Immune Regulat, Dept Clin & Expt Med, Div Clin Immunol, Linköping University, Linköping, Sweden.
    Gut microbiota diversity and atopic disease: Does breast-feeding play a role? Reply2013In: Journal of Allergy and Clinical Immunology, ISSN 0091-6749, E-ISSN 1097-6825, Vol. 131, no 1, p. 248-249Article in journal (Refereed)
  • 3. Abrahamsson, Thomas R.
    et al.
    Jakobsson, Ted
    Björkstén, Bengt
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Oldaeus, Göran
    Jenmalm, Maria C.
    No effect of probiotics on respiratory allergies: a seven-year follow-up of a randomized controlled trial in infancy2013In: Pediatric Allergy and Immunology, ISSN 0905-6157, E-ISSN 1399-3038, Vol. 24, no 6, p. 556-561Article in journal (Refereed)
    Abstract [en]

    Background: Supplementation with the probioticLactobacillus reuteri reduced the incidence of IgE-associated allergic disease in infancy. This treatment might therefore also reduce the risk of asthma and allergic rhinoconjunctivitis in school age.

    Objective: To evaluate whether perinatal and infant supplementation withL.reuteri reduced the prevalence of respiratory allergic disease in school age and to explore whether this supplementation was associated with any long-term side effects.

    Methods: A randomized, placebo-controlled trial with oral supplementation withL.reuteriATCC 55730 (1x10(8)CFU) during the last month of gestation and through the first year of life comprising 232 families with allergic disease, of whom 184 completed a 7-yr follow-up. The primary outcomes at 7yr of age were allergic disease and skin prick test reactivity (ClinicalTrials.govID NCT01285830).

    Results: The prevalence of asthma (15% in the probiotic vs. 16% in placebo group), allergic rhinoconjunctivitis (27% vs. 20%), eczema (21% vs. 19%) and skin prick test reactivity (29% vs. 26%) was similar in the probiotic and placebo group. Growth indices and gastrointestinal symptoms were similar in the two groups. No severe adverse events were reported.

    Conclusion: The effect ofL.reuteri on sensitization andIgE-associated eczema in infancy did not lead to a lower prevalence of respiratory allergic disease in school age. Thus, the effect ofL.reuteri on the immune system seems to be transient. Administration ofL.reuteri during the last weeks of gestation and in infancy was not associated with any long-term side effects.

  • 4.
    Ahlroth Pind, Caroline
    et al.
    Centre for Clinical Research, Uppsala University, Västmanland County Hospital, Västerås, Sweden; Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden.
    Ställberg, Björn
    Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine, Uppsala University, Uppsala, Sweden.
    Lisspers, Karin
    Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine, Uppsala University, Uppsala, Sweden.
    Sundh, Josefin
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Respiratory Medicine.
    Kisiel, Marta A.
    Department of Medical Sciences, Occupational and Environmental Medicine, Uppsala University, Uppsala, Sweden.
    Sandelowsky, Hanna
    NVS, Section for Family Medicine and Primary Care, Karolinska Institutet, Stockholm, Sweden; Academic Primary Care Centre, Region Stockholm, Sweden; Department of Medicine, Clinical Epidemiology Division, Karolinska Institute, Stockholm, Sweden.
    Nager, Anna
    NVS, Section for Family Medicine and Primary Care, Karolinska Institutet, Stockholm, Sweden.
    Hasselgren, Mikael
    Örebro University, School of Medical Sciences. Centre for Clinical Research and Education, Karlstad, Sweden.
    Montgomery, Scott
    Department of Medicine, Clinical Epidemiology Division, Karolinska Institute, Stockholm, Sweden; Clinical Epidemiology and Biostatistics, School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden; Department of Epidemiology and Public Health, University College London, London, UK.
    Janson, Christer
    Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden.
    Pharmacological treatment of asthma in Sweden from 2005 to 20152023In: Journal of Asthma, ISSN 0277-0903, E-ISSN 1532-4303Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: Despite access to effective therapies many asthma patients still do not have well-controlled disease. This is possibly related to underuse of inhaled corticosteroids (ICS) and overuse of short-acting β2-agonists (SABA). Our aim was to investigate longitudinal trends and associated factors in asthma treatment.

    METHODS: Two separate cohorts of adults with physician-diagnosed asthma were randomly selected from 14 hospitals and 56 primary health centers in Sweden in 2005 (n = 1182) and 2015 (n = 1225). Information about symptoms, maintenance treatment, and use of rescue medication was collected by questionnaires. Associations between treatment and sex, age, smoking, education, body mass index (BMI), physical activity, allergic asthma, and symptom control were analyzed using Pearson's chi2-test. Odds ratios (ORs) were calculated using logistic regression.

    RESULTS: Maintenance treatment with ICS together with long-acting β2-agonists (LABA) and/or montelukast increased from 39.2% to 44.2% (p = 0.012). The use of ICS + LABA as-needed increased (11.1-18.9%, p < 0.001), while SABA use decreased (46.4- 41.8%, p = 0.023). Regular treatment with ICS did not change notably (54.2-57.2%, p = 0.14). Older age, former smoking, and poor symptom control were related to treatment with ICS + LABA/montelukast. In 2015, 22.7% reported daily use of SABA. A higher step of maintenance treatment, older age, obesity, shorter education, current smoking, allergic asthma, low or very high physical activity, and a history of exacerbations were associated with daily SABA use.

    CONCLUSIONS: The use of ICS + LABA both for maintenance treatment and symptom relief has increased over time. Despite this, the problem of low use of ICS and high use of SABA remains.

  • 5.
    Ahmadi, Zainab
    et al.
    Lund University, Faculty of Medicine, Dept of Clinical Sciences Lund, Respiratory Medicine and Allergology, Lund, Sweden.
    Igelström, Helena
    Dept of Neuroscience, Physiotherapy, Uppsala University, Uppsala, Sweden.
    Sandberg, Jacob
    Lund University, Faculty of Medicine, Dept of Clinical Sciences Lund, Respiratory Medicine and Allergology, Lund, Sweden.
    Sundh, Josefin
    Örebro University, School of Medical Sciences. Dept of Respiratory Medicine.
    Sköld, Magnus
    Respiratory Medicine Unit, Dept of Medicine Solna and Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden; Dept of Respiratory Medicine and Allergy, Karolinska University Hospital Solna, Stockholm, Sweden.
    Janson, Christer
    Dept of Medical Sciences: Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden.
    Blomberg, Anders
    Dept of Public Health and Clinical Medicine, Section of Medicine, Umeå University, Umeå, Sweden.
    Bornefalk, Hans
    Hans Bornefalk AB, Vallentuna, Sweden.
    Bornefalk-Hermansson, Anna
    Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden.
    Ekström, Magnus
    Lund University, Faculty of Medicine, Dept of Clinical Sciences Lund, Respiratory Medicine and Allergology, Lund, Sweden.
    Agreement of the modified Medical Research Council and New York Heart Association scales for assessing the impact of self-rated breathlessness in cardiopulmonary disease2022In: ERJ Open Research, E-ISSN 2312-0541, Vol. 8, no 1, article id 00460Article in journal (Refereed)
    Abstract [en]

    Background: The functional impact of breathlessness is assessed using the modified Medical Research Council (mMRC) scale for chronic respiratory disease and with the New York Heart Association Functional Classification (NYHA) scale for heart failure. We evaluated agreement between the scales and their concurrent validity with other clinically relevant patient-reported outcomes in cardiorespiratory disease.

    Methods: Outpatients with stable chronic respiratory disease or heart failure were recruited. Agreement between the mMRC and NYHA scales was analysed using Cramér's V and Kendall's tau B tests. Concurrent validity was evaluated using correlations with clinically relevant measures of breathlessness, anxiety, depression, and health-related quality of life. Analyses were conducted for all participants and separately in chronic obstructive pulmonary disease (COPD) and heart failure.

    Results: In a total of 182 participants with cardiorespiratory disease, the agreement between the mMRC and NYHA scales was moderate (Cramér's V: 0.46; Kendall's tau B: 0.57) with similar results for COPD (Cramér's V: 0.46; Kendall's tau B: 0.66) and heart failure (Cramér's V: 0.46; Kendall's tau B: 0.67). In the total population, the scales correlated in similar ways to other patient-reported outcomes.

    Conclusion: In outpatients with cardiorespiratory disease, the mMRC and NYHA scales show moderate to strong correlations and similar associations with other patient-reported outcomes. This supports that the scales are comparable when assessing the impact of breathlessness on function and patient-reported outcomes.

  • 6.
    Ahmadi, Zainab
    et al.
    Lund University, Lund, Sweden.
    Sundh, Josefin
    Örebro University, School of Medical Sciences.
    Hermansson, Anna B.
    Uppsala University Hospital, Uppsala, Sweden.
    Ekström, Magnus
    Lund University, Lund, Sweden.
    Does Long-Term Oxygen Therapy 24 H/day Improve Survival Compared To 15 H/day In Hypoxemic Chronic Obstructive Pulmonary Disease?2016In: American Journal of Respiratory and Critical Care Medicine, ISSN 1073-449X, E-ISSN 1535-4970, Vol. 193Article in journal (Refereed)
  • 7.
    Akner, Gunnar
    Örebro University, School of Health and Medical Sciences.
    Undernäringstillstånd vid KOL2006In: KOL: kroniskt obstruktiv lungsjukdom / [ed] Kjell Larsson, Stockholm: Studentlitteratur , 2006, 2, p. 227-237Chapter in book (Other academic)
  • 8.
    Annika, Lindh
    et al.
    Örebro University, School of Health Sciences.
    Theander, K.
    Arne, M.
    Lisspers, K.
    Lundh, L.
    Sandelowsky, H.
    Ställberg, B.
    Thors Adolfsson, E.
    Westerdahl, Elisabeth
    Örebro University, School of Health Sciences. Örebro University Hospital.
    Zakrisson, Ann-Britt
    Örebro University, School of Health Sciences. Örebro University Hospital.
    A descriptive study of incorrect inhalation technique in patients with COPD in primary care2018Conference paper (Refereed)
  • 9.
    Annika, Lindh
    et al.
    Örebro University, School of Health Sciences. Centre for clinical research, County Council of Värmland, Karlstad, Sweden.
    Theander, Kersti
    Centre for clinical research, County Council of Värmland, Karlstad, Sweden.
    Arne, Mats
    Centre for clinical research, County Council of Värmland, Karlstad, Sweden; Department of Medical Sciences, Respiratory, Allergy & Sleep Research, Uppsala University, Karlstad, Sweden.
    Lisspers, Karin
    Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine, Uppsala University, Uppsala, Sweden.
    Lundh, Lena
    Academic Primary Health Care Centre, Stockholm, Sweden; Karolinska Institute, NVS, Division of Family Medicine and Primary Care, Stockholm, Stockholm, Sweden.
    Sandelowsky, Hanna
    Academic Primary Health Care Centre, Stockholm, Sweden; Karolinska Institute, NVS, Division of Family Medicine and Primary Care, Stockholm, Stockholm, Sweden.
    Ställberg, Björn
    Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine, Uppsala University, Uppsala, Sweden.
    Adolfsson, Eva Thors
    Primary health care, Region Västmanland, Västerås, Sweden.
    Westerdahl, Elisabeth
    Örebro University, School of Health Sciences. Örebro University Hospital.
    Zakrisson, Ann-Britt
    Örebro University, School of Health Sciences. Örebro University Hospital. University Healthcare Research Center.
    Description of inhalation technique in patients with COPD in primary care2018In: European Respiratory Journal, ISSN 0903-1936, E-ISSN 1399-3003, Vol. 52, no Suppl. 62, article id PA2070Article in journal (Other academic)
    Abstract [en]

    Introduction: A recent systematic review showed that only about one third of the patients had a correct inhalation technique and the number had not improved the last 40 years¹.

    Aim: The aim was to describe errors, separated into errors related to devices and errors related to inhalation technique, that occur when patients with COPD inhale medications.

    Method: In this descriptive study, patients with a COPD diagnosis were recruited from a randomized controlled trial performed 2015-2016 in primary care in four county councils in Sweden. A COPD nurse assessed the inhalation technique using a checklist with errors related to devices and to inhalation technique with possibility to write additional comments.

    Results: In total, 167 patients using 287 inhalers were assessed, 52% (n = 86) were female, mean age 71 years. A total of 163 errors were noted in the checklist, of which 87 were related to inhalation technique and 76 were related to devices. Except from this the COPD nurse had written comments regarding 53 errors that were not included in the checklist. At least one error (range: 1-7 errors) was made by 46% (n = 76) of the patients.

    Conclusion: The results show that many patients do not use the device correctly. Both errors related to inhalation technique and related to devices were present. This implies that there is a need to focus on both aspects when teaching patients how to inhale their medication. The checklist used in this study needs to be further improved.

  • 10.
    Annika, Lindh
    et al.
    Örebro University, School of Health Sciences.
    Theander, Kersti
    Arne, Mats
    Lisspers, Karin
    Lundh, Lena
    Sandelowsky, Hanna
    Ställberg, Björn
    Thors Adolfsson, Eva
    Zakrisson, Ann-Britt
    Örebro University, School of Health Sciences. Örebro University Hospital.
    Incorrect inhalation technique is common in patients with COPD in primary care2018Conference paper (Refereed)
    Abstract [en]

    The results show that many patients don’t use the inhaler correctly. Errors related to inhalation technique were twice as common as those related to devices. When teaching patients to use the inhalers it seems like there is a need to focus more on the inhalation technique itself. The checklist used in this study needs to be further improved.

  • 11.
    Annika, Lindh
    et al.
    Örebro University, School of Health Sciences. Centre for Clinical Research and Education, Region Värmland, Sweden.
    Theander, Kersti
    Centre for Clinical Research and Education, Region Värmland, Sweden.
    Arne, Mats
    Centre for Clinical Research and Education, Region Värmland, Sweden; Department of Medical Sciences, Respiratory, Allergy & Sleep Research, Uppsala University, Sweden.
    Lisspers, Karin
    Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine, Uppsala University, Sweden.
    Lundh, Lena
    Academic Primary Health Care Centre, Stockholm, Sweden; Karolinska Institute, NVS, Division of Family Medicine and Primary Care, Stockholm, Sweden.
    Sandelowsky, Hanna
    Academic Primary Health Care Centre, Stockholm, Sweden; Karolinska Institute, NVS, Division of Family Medicine and Primary Care, Stockholm, Sweden.
    Ställberg, Björn
    Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine, Uppsala University, Sweden.
    Westerdahl, Elisabeth
    Örebro University, School of Medical Sciences. Örebro University Hospital. University Health Care Research Center.
    Zakrisson, Ann-Britt
    Örebro University, School of Health Sciences. Örebro University Hospital. University Health Care Research Center.
    One additional educational session in inhaler use to patients with COPD in primary health care: A controlled clinical trial2022In: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 105, no 9, p. 2969-2975Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To investigate whether one additional educational session about inhaler use, delivered to patients with COPD in primary healthcare, could affect the patients' skills in inhaler use. Specifically, to study the effects on errors related to handling the device, to inhalation technique, and to both.

    METHODS: This nonrandomized controlled clinical trial included 64 patients who used devices and made errors. COPD nurses assessed inhaler use using a checklist and educated patients. Intervention group received one additional educational session after two weeks.

    RESULTS: At baseline, patients in the IG had more devices (n = 2,1) compared to patients in the CG (n = 1,6) (p = 0.003). No other statistically significant differences were seen at baseline. At follow-up, intervention group showed a lower proportion of patients who made errors related to handling the device (p = 0.006). No differences were seen in the other categories.

    CONCLUSION: One additional educational session in inhaler use for patients with COPD was effective in reducing the proportion of patients making errors related to handling of their devices.

    PRACTICE IMPLICATIONS: Categorization of errors might help healthcare professionals to assess the suitability of patients' devices, tailor patient education, and thus improve patient health.

  • 12.
    Appelberg, Jonas
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Medical Sciences, Clinical Physiology, Uppsala, Sweden.
    Ventilation and Lung Volume During Sleep and in Obstructive Sleep Apnea2003Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Obstructive sleep apnea (OSA) appears to affect up to 5% of the population. The extent to what pulmonary function awake and during sleep relates to obstructive breathing and hypoxemia during sleep in these patients is unclear. The aim of this study was to investigate respiratory function in patients with varying degree of snoring and OSA and to analyse regional lung aeration during sleep.

    In all, 35 healthy subjects and 90 patients with snoring and OSA were studied. The ventilatory response to CO2 (VRCO2) was measured. Lung function tests were performed. A technique based on computed tomography was developed to study lung aeration during sleep.

    Patients with OSA displayed a higher VRCO2 in comparison to healthy subjects and snorers (p<0.01). Increased closing volume and reduced expiratory reserve volume (ERV) were found in patients with OSA (p<0.001). In a multiple regression analysis, ERV was an independent predictor of nocturnal apnea (R2=0.13; p=0.001) and desaturation frequency (R2=0.11; p<0.01). In both healthy subjects and OSA patients, lung aeration was reduced during sleep by 0.10 ml gas/g tissue in the dorsal lung region (p<0.05 and p<0.01). OSA patients had a significantly lower gas/tissue ratio in comparison to healthy subjects both awake (-23%; p<0.04) and during sleep (-25%; p<0.04). In a univariate analysis, functional residual capacity (FRC) correlated with the change in lung aeration from wakefulness to sleep (r=-0.78; p<0.001). In patients with OSA, ERV (r=-0.69; p<0.05) and sleep time (r=0.69; p<0.05) correlated with the fall in lung aeration.

    In conclusion, patients with OSA display an increased ventilatory response to CO2, reduced ERV and increased closing volume. ERV predicts nocturnal apnea and desaturation frequency to a similar extent as obesity. Lung aeration is reduced in the dorsal region during sleep and patients with OSA display a lower amount of gas in comparison to healthy subjects. Decrease in lung volumes, promoting airway closure, and loss of muscle tone contributed to the altered lung function during sleep.

  • 13. Appelberg, Jonas
    et al.
    Lindberg, -
    Snarkning och obstruktivt sömnapnésyndrom2009In: Sömn / [ed] Jan Ulfberg, Nora: Circad bok , 2009Chapter in book (Other (popular science, discussion, etc.))
  • 14.
    Appelberg, Jonas
    et al.
    Department of Clinical Physiology/Mid Sweden's Research and Development Centre, Västernorrland County Council, Sundsvall Hospital, Sundsvall, Sweden; Department of Clinical Sciences, Clinical Physiology, University Hospital, Uppsala, Sweden.
    Nordahl, Gunnar
    Department of Clinical Physiology/Mid Sweden's Research and Development Centre, Västernorrland County Council, Sundsvall Hospital, Sundsvall, Sweden; Department of Clinical Sciences, Clinical Physiology, University Hospital, Uppsala, Sweden.
    Jansson, Christer
    Västernorrland County Council, Sundsvall Hospital, Sundsvall, Sweden; Department of Clinical Sciences, Clinical Physiology, Pulmonary Medicine, University Hospital, Uppsala, Sweden.
    Lung volume and its correlation to nocturnal apnoea and desaturation2000In: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 94, no 3, p. 233-239Article in journal (Refereed)
    Abstract [en]

    The cross-sectional area of the upper airway is known to be lung volume dependent. If, and to what extent, lung volume variables correlate to nocturnal obstructive apnoeas and oxygen desaturations independently of other factors known to affect lung volumes and sleep disordered breathing is still unclear. A total of 92 subjects were examined by ambulatory recording of nocturnal obstructive apnoeas and desaturations. Sixty-nine of the subjects had a history of snoring and 23 were healthy subjects without complaints of snoring and daytime sleepiness. All subjects performed static and dynamic spirometry for measurements of lung volumes. To evaluate the correlation between lung volume variables and apnoea index (AI) and oxygen desaturation index (ODI), simple and multiple regression analysis was performed. Expiratory reserve volume (ERV) was found to be lower in subjects with snoring and apnoeas (ERV = 1.0 l) than in non-snoring subjects (ERV = 1.7 l), (P<0.001). Forced expiratory volume in 1 sec (FEV1)/vital capacity (VC) was slightly, but significantly (P = 0.031), lower in subjects with snoring and nocturnal apnoeas and desaturations. In the multiple regression analysis ERV was found to be independently correlated to both AI (R2=0.13; P=0.001) and ODI (R2 = 0.11; P = 0.002). Multiple regression analysis also revealed that ERV, body mass index (BMI) and habitual smoking together accounted for 43% of the variation in AI and 48% of the variation in ODI. We find a significant independent association between ERV and nocturnal obstructive apnoea and oxygen desaturation frequency. Our results indicate that ERV is correlated to these events to a similar extent, as is obesity. 

  • 15.
    Appelberg, Jonas
    et al.
    Department of Clinical Physiology/Mid-Sweden Research and Development Centre, Sundsvall Hospital, Sundsvall, Sweden; Department of Clinical Physiology, Uppsala University, Uppsala, Sweden.
    Sundström, G.
    Department of Clinical Physiology/Mid-Sweden Research and Development Centre, Sundsvall Hospital, Sundsvall, Sweden.
    Ventilatory response to CO2 in patients with snoring, obstructive hypopnoea and obstructive apnoea1997In: Clinical Physiology, ISSN 0144-5979, E-ISSN 1365-2281, Vol. 17, no 5, p. 497-507Article in journal (Refereed)
    Abstract [en]

    Obstructive sleep apnoea (OSA) is caused by an obstruction of the upper airway. Sufficient sensitivity to CO2 in the respiratory centre is known to be a critical factor for adequate tone in the upper airway muscles. The hypothesis of this study is, therefore, that the ventilatory response to CO2 is reduced in patients with OSA. Twenty-six patients who suffered from snoring, 19 snoring patients with obstructive hypopnoea (OH) and 33 snoring patients with obstructive apnoea (OA), were studied. The control group consisted of 25 subjects from a random sample with no history of snoring or daytime sleepiness. Tests of the hyperoxic and hypoxic ventilatory response to CO2 were performed, as well as static and dynamic spirometry. Subjects in the OA group displayed a higher hyperoxic (VE/FetCO2hy = 12.6 l min-1/%) and hypoxic (VE/FetCO2ho = 15.7 l min-1/%) ventilatory response to CO2 than patients with obstructive hypopnoea (VE/FetCO2hy = 8.6 l min-1/%; VE/FetCO2ho = 15.2 l min-1/%), snorers (VE/FetCO2hy = 8.4 l min-1/%; VE/FetCO2ho = 12.7 l min-1/%) and non-snorers (VE/FetCO2hy = 7.6 l min-1/%; VE/FetCOho = 9.6 l min-1/%). Multiple regression analysis reveals that neck circumference, apnoea index, oxygen desaturation index, PCO2 and sex (male gender) are correlated with VE/FetCO2hy (R2 = 0.43). Multiple regression analysis also reveals that ERV (expiratory reserve volume) and sex (male gender) are correlated with VE/FetCO2ho (R2 = 0.21). Arguing against the hypothesis, patients with OSA displayed an increased hyperoxic and hypoxic ventilatory response to CO2. Nocturnal apnoea frequency and the obesity factor in OSA may have contributed to these results. 

  • 16.
    Athlin, Åsa
    et al.
    Örebro University, School of Medical Sciences.
    Giezeman, Maaike
    Örebro University, School of Medical Sciences. Centre foClinical Research, Region Värmland, Karlstad, Sweden.
    Hasselgren, Mikael
    Örebro University, School of Medical Sciences.
    Montgomery, Scott
    Örebro University, School of Medical Sciences. Clinical Epidemiology Division, Department of Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology and Public Health, University College, London, UK.
    Lisspers, Karin
    Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine, Uppsala University, Uppsala, Sweden.
    Ställberg, Björn
    Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine, Uppsala University, Uppsala, Sweden.
    Janson, Christer
    Department of Medical Sciences, Respiratory, Allergy & Sleep Research, Uppsala University, Uppsala, Sweden.
    Sundh, Josefin
    Örebro University, School of Medical Sciences. Department of Respiratory Medicine.
    Prediction of Mortality Using Different COPD Risk Assessments: A 12-Year Follow-Up2021In: The International Journal of Chronic Obstructive Pulmonary Disease, ISSN 1176-9106, E-ISSN 1178-2005, Vol. 16, p. 665-675Article in journal (Refereed)
    Abstract [en]

    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.

  • 17.
    Athlin, Åsa
    et al.
    Örebro University, School of Medical Sciences.
    Lisspers, Karin
    Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine, Uppsala University, Uppsala, Sweden.
    Hasselgren, Mikael
    Örebro University, School of Medical Sciences. Centre for Clinical Research and Education, Region Värmland, Karlstad, Sweden.
    Ställberg, Björn
    Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine, Uppsala University, Uppsala, Sweden.
    Janson, Christer
    Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden.
    Montgomery, Scott
    Örebro University, School of Medical Sciences. Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden; Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology and Public Health, University College London, London, UK.
    Giezeman, Maaike
    Örebro University, School of Medical Sciences. Centre for Clinical Research and Education, Region Värmland, Karlstad, Sweden.
    Kisiel, Marta
    Department of Medical Sciences, Occupational and Environment Medicine, Uppsala University, Uppsala, Sweden.
    Nager, Anna
    Division of Family Medicine and Primary Care, Inst NVS, Karolinska Institutet, Stockholm, Sweden.
    Sandelowsky, Hanna
    Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden; Division of Family Medicine and Primary Care, Inst NVS, Karolinska Institutet, Stockholm, Sweden; Academic Primary Health Care Centre, Region Stockholm, Stockholm, Sweden.
    Arne, Mats
    Centre for Clinical Research and Education, Region Värmland, Karlstad, Sweden; Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden.
    Sundh, Josefin
    Örebro University, School of Medical Sciences. Department of Respiratory Medicine.
    Diagnostic spirometry in COPD is increasing, a comparison of two Swedish cohorts2023In: npj Primary Care Respiratory Medicine, E-ISSN 2055-1010, Vol. 33, no 1, article id 23Article in journal (Refereed)
    Abstract [en]

    Spirometry should be used to confirm a diagnosis of chronic obstructive pulmonary disease (COPD). This test is not always performed, leading to possible misdiagnosis. We investigated whether the proportion of patients with diagnostic spirometry has increased over time as well as factors associated with omitted or incorrectly interpreted spirometry. Data from medical reviews and a questionnaire from primary and secondary care patients with a doctors' diagnosis of COPD between 2004 and 2010 were collected. Data were compared with a COPD cohort diagnosed between 2000 and 2003. Among 703 patients with a first diagnosis of COPD between 2004 and 2010, 88% had a diagnostic spirometry, compared with 59% (p < 0.001) in the previous cohort. Factors associated with not having diagnostic spirometry were current smoking (OR 2.21; 95% CI 1.36-3.60), low educational level (OR 1.81; 1.09-3.02) and management in primary care (OR 2.28; 1.02-5.14). The correct interpretation of spirometry results increased (75% vs 82%; p = 0.010). Among patients with a repeated spirometry, 94% had a persistent FEV1/FVC or FEV1/VC ratio <0.70.

  • 18.
    Belfrage, Björn
    et al.
    Västra Götaland Primary Health Care, Närhälsan Dals‐Ed Health Center, Ed, Sweden.
    Hansson, Anders
    FoUU‐centrum in Fyrbodal, Research Unit and Section for General Practice, Vänersborg, Sweden.
    Bake, Björn
    Department of Respiratory Medicine and Allergology, Sahlgrenska Academy, University of Gothenburg, , Gothenburg, Sweden.
    Performance and interpretation of spirometry among Swedish hospitals2014In: Clinical Respiratory Journal, ISSN 1752-6981, E-ISSN 1752-699X, Vol. 10, no 5, p. 567-573Article in journal (Refereed)
    Abstract [en]

    Background and Aims

    It is unclear to what extent spirometric performance and interpretation is standardized in Sweden. The aim of this study was to find out how spirometry is performed and interpreted in large Swedish hospitals.

    Methods

    In telephone interviews, technicians and physicians working with lung function measurements at 21 large Swedish hospitals were interviewed about routines for spirometry.

    Results

    Answers were obtained from 37 of the 42 departments contacted revealing differences in the spirometric routines. Some departments lack a written method description, and three different prediction equations were used among the departments. Different ways of calculating the forced expiratory volume in 1 s (FEV1)/vital capacity (VC) ratio (FEV%) were found and also differences in performance and interpretation of the reversibility test. When diagnosing chronic obstructive pulmonary disease, none of the departments reported using an individualized diagnostic limit of FEV1/VC based on age, sex and height.

    Conclusion

    There is a need for standardization of performance and interpretation of the spirometry test in Sweden and probably also in other countries.

  • 19.
    Berge, M.
    et al.
    Department of Otolaryngology, Örebro University Hospital, Örebro, Sweden.
    Bertilsson, L.
    Department of Laboratory Medicine, Örebro University Hospital, Örebro, Sweden.
    Hultgren, Olof
    Örebro University, School of Medical Sciences. Department Clinical Immunology and Transfusion Medicine.
    Hugosson, Svante
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department Clinical Immunology and Transfusion Medicine.
    Saber, Amanj
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department Clinical Immunology and Transfusion Medicine.
    Qualitative and quantitative comparison of allergen component-specific to birch and grass analyzed by ImmunoCAP assay and Euroline immunoblot test2023In: European annals of allergy and clinical immunology, E-ISSN 1764-1489, Vol. 55, no 2, p. 68-77Article in journal (Refereed)
    Abstract [en]

    Background: In the diagnostic work up of allergy, determining allergen component-specific immunoglobulin E (IgE) is important for diagnosis, prognosis and choice of treatment.

    Objective: The purpose of this study was to evaluate the performance of the immunoblotting assay (Euroline) in detection of IgE antibodies against timothy grass and birch pollen allergen components compared to fluorescent enzyme assay (ImmunoCAP, Phadia 250).

    Methods: A total of 128 serum samples from patients allergic to timothy grass and birch pollen were analysed. The levels of IgE antibodies to timothy grass and birch pollen were measured using Euroline DPA-Dx pollen 1 and ImmunoCAP assay. The two methods were then compared on binary (positive vs negative), semi-quantitative (IgE classes) and quantitative (concentration) levels. The two methods were also compared to results from skin prick testing.

    Results: The Euroline method showed a positive percentage agreement of 93% and negative percentage agreement of 94% with an overall accuracy of 94% when compared to ImmunoCAP. Kappa analysis showed moderate strength of agreement between the methods in determining IgE classes for 7/11 components tested. All components showed a positive correlation when analysed using Spearman's rank correlation.

    Conclusions: Overall, we found that there is good correlation between the Euroline and ImmunoCAP methods in measuring IgE sensitization.

  • 20.
    Berge, Martin
    et al.
    Department of Otolaryngology, Örebro University Hospital, Örebro, Sweden.
    Bertilsson, Lena
    Department of Laboratory Medicine, Örebro University Hospital, Örebro, Sweden.
    Hultgren, Olof
    Örebro University, School of Medical Sciences. Department of Laboratory Medicine, Örebro University Hospital, Örebro, Sweden; Department Clinical Immunology and Transfusion Medicine, Faculty of Medicine and Health Örebro University, Örebro, Sweden.
    Hugosson, Svante
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Otolaryngology, Örebro University Hospital, Örebro, Sweden.
    Saber, Amanj
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Otolaryngology, Örebro University Hospital, Örebro, Sweden.
    Pre-treatment allergen-specific IgE analysis and outcomes of allergen immunotherapy2022In: European annals of allergy and clinical Immunology, ISSN 1764-1489, Vol. 54, no 5, p. 218-228Article in journal (Refereed)
    Abstract [en]

    Background:  Patients show varied results to allergen immunotherapy (AIT. The reason for this variability is unclear.

    Objective: To describe the relationship between AIT efficacy and demographic characteristics, as well as pre-treatment plasma levels of specific IgE-antibodies to grass and birch pollen.

    Methods: A retrospective study was performed based on medical records of 128 patients who received AIT. The patients completed a questionnaire and pre-AIT plasma levels of allergen-specific IgE to grass and birch pollen were measured using EUROLINE DPA-Dx pollen 1 method. Results. Seventy percent of patients classified their allergic symptoms as less severe after AIT. Twenty-seven percent had received AIT targeting only grass pollen, 19% targeting only birch pollen, and 55% targeting both grass and birch. A total of 35 different IgE profiles were found across our study population. On comparison of the demographic characteristics and concentration of allergen-specific IgE-antibodies, no statistically significant differences could be found.

    Conclusions: The majority of patients rated their allergic symptoms as less severe after AIT. No clear relationship could be demonstrated between pre-treatment allergen-specific IgE concentration, or demographic characteristics, and effect of AIT. There may be other factors underlying the different responses to AIT.

  • 21.
    Björklund, Filip
    et al.
    Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Respiratory Medicine, Allergology, and Palliative Medicine, Lund, Sweden.
    Palm, Andreas
    Uppsala University, Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala, Sweden; Region of Gävleborg, Gävle Hospital, Centre for Research and Development, Gävle, Sweden.
    Gorani, Jwan Abdulrazak
    Department of Medicine, Blekinge Hospital, Karlskrona, Sweden.
    Ahmadi, Zainab
    Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Respiratory Medicine, Allergology, and Palliative Medicine, Lund, Sweden.
    Sundh, Josefin
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Respiratory Medicine.
    Haglöw, Jenny Theorell
    Uppsala University, Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala, Sweden.
    Ljunggren, Mirjam
    Uppsala University, Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala, Sweden.
    Grote, Ludger
    Sahlgrenska University Hospital, Department of Pulmonary Medicine, Gothenburg, Sweden; Sahlgrenska Academy, Center for Sleep and Wake Disorders, Gothenburg, Sweden.
    Wadell, Karin
    Umeå University, Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå, Sweden.
    Ekström, Magnus
    Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Respiratory Medicine, Allergology, and Palliative Medicine, Lund, Sweden.
    Breathlessness and exercise performance to predict mortality in long-term oxygen therapy2023In: European Respiratory Journal, ISSN 0903-1936, E-ISSN 1399-3003, Vol. 62, no Suppl. 67, article id PA3762Article in journal (Other academic)
    Abstract [en]

    Background: Patients with chronic respiratory failure treated with long-term oxygen therapy (LTOT) often have severe breathlessness, impaired exercise performance, and high but variable mortality that is difficult to predict. We aimed to evaluate breathlessness and exercise performance upon starting LTOT as predictors of overall and short-term mortality.

    Methods: This was a longitudinal, population-based study of patients who initiated LTOT between 2015-2018 in Sweden. Breathlessness was measured using the Dyspnea Exertion Scale, and exercise performance using the 30s-Sit-To-Stand test. Associations with overall and three-month mortality were analyzed using Cox-regression. Subgroup analyses were performed for patients with COPD and ILD respectively. The predictive capacity of models was assessed using a C-statistic.

    Results: A total of 441 patients (57.6% female, aged 75.4±8.3 years) were analyzed. Both breathlessness and exercise performance were independently associated with overall mortality in the crude models, but only exercise performance remained independently associated with overall mortality when models were adjusted for other predictors, when three-month mortality was analyzed, or when breathlessness and exercise capacity were analyzed concurrently. The multivariable model including exercise performance but not breathlessness provided a relatively high predictive capacity for overall mortality, C-statistic 0.756 (95% CI 0.702-0.810). Similar results were seen in the COPD and ILD subgroups.

    Conclusion: Exercise performance as measured by the 30s-STS may be useful to identify patients with higher mortality on LTOT for optimized management and follow-up.

  • 22.
    Björklund, Filip
    et al.
    Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Respiratory Medicine, Allergology, and Palliative Medicine, Lund, Sweden.
    Palm, Andreas
    Uppsala University, Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala, Sweden.
    Gorani, Jwan Abdulrazak
    Department of Medicine, Blekinge Hospital, Karlskrona, Sweden.
    Ahmadi, Zainab
    Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Respiratory Medicine, Allergology, and Palliative Medicine, Lund, Sweden.
    Sundh, Josefin
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Respiratory Medicine.
    Theorell-Haglöw, Jenny
    Uppsala University, Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala, Sweden.
    Ljunggren, Mirjam
    Uppsala University, Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala, Sweden.
    Grote, Ludger
    Sahlgrenska University Hospital, Department of Pulmonary Medicine, Gothenburg, Sweden; Sahlgrenska Academy, Center for Sleep and Wake Disorders, Gothenburg, Sweden.
    Wadell, Karin
    Umeå University, Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå, Sweden.
    Ekström, Magnus
    Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Respiratory Medicine, Allergology, and Palliative Medicine, Lund, Sweden.
    Breathlessness and exercise performance to predict mortality in long-term oxygen therapy: The population-based DISCOVERY study2023In: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 216, article id 107306Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Patients with chronic respiratory failure treated with long-term oxygen therapy (LTOT) often have severe breathlessness, impaired exercise performance, and high but variable mortality that is difficult to predict. We aimed to evaluate breathlessness and exercise performance upon starting LTOT as predictors of overall and short-term mortality.

    METHODS: This was a longitudinal, population-based study of patients who initiated LTOT between 2015 and 2018 in Sweden. Breathlessness was measured using the Dyspnea Exertion Scale, and exercise performance using the 30s-Sit-To-Stand test. Associations with overall and three-month mortality were analyzed using Cox-regression. Subgroup analyses were performed for patients with chronic obstructive pulmonary disease (COPD) and interstitial lung disease (ILD) respectively. The predictive capacity of models was assessed using a C-statistic.

    RESULTS: A total of 441 patients (57.6% female, aged 75.4 ± 8.3 years) were analyzed, of whom 141 (32%) died during a median follow-up of 260 (IQR 75-460) days. Both breathlessness and exercise performance were independently associated with overall mortality in the crude models, but only exercise performance remained independently associated with overall mortality when models were adjusted for other predictors, when short-term mortality was analyzed, or when breathlessness and exercise capacity were analyzed concurrently. The multivariable model including exercise performance but not breathlessness provided a relatively high predictive capacity for overall mortality, C-statistic 0.756 (95% CI 0.702-0.810). Similar results were seen in the COPD and ILD subgroups.

    CONCLUSION: Exercise performance as measured by the 30s-STS may be useful to identify patients with higher mortality on LTOT for optimized management and follow-up.

  • 23. Björkstén, Bengt
    Pediatric Allergy Research: are we on the right track?2014In: Pediatric Allergy and Immunology, ISSN 0905-6157, E-ISSN 1399-3038, Vol. 25, no 1, p. 4-6Article in journal (Other academic)
  • 24.
    Björsell, Tove
    et al.
    Department of Infectious Diseases, Karlstad Hospital, Karlstad, Sweden; Centre for Clinical Research and Education, Region Värmland, Karlstad, Sweden; Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
    Sundh, Josefin
    Department of Respiratory Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Lange, Anna
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Infectious Diseases.
    Ahlm, Clas
    Department of Clinical Microbiology, Umeå University, Umeå, Sweden.
    Forsell, Mattias N. E.
    Department of Clinical Microbiology, Umeå University, Umeå, Sweden.
    Tevell, Staffan
    Örebro University, School of Medical Sciences. Department of Infectious Diseases, Karlstad Hospital, Karlstad, Sweden; Centre for Clinical Research and Education, Region Värmland, Karlstad, Sweden.
    Blomberg, Anders
    Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
    Edin, Alicia
    Anesthesiology and Intensive Care Medicine, Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden.
    Normark, Johan
    Department of Clinical Microbiology, Umeå University, Umeå, Sweden; Wallenberg Centre for Molecular Medicine, Umeå University, Umeå, Sweden.
    Cajander, Sara
    Örebro University, School of Medical Sciences. Department of Infectious Diseases, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Risk factors for impaired respiratory function post COVID-19: A prospective cohort study of nonhospitalized and hospitalized patients2023In: Journal of Internal Medicine, ISSN 0954-6820, E-ISSN 1365-2796, Vol. 293, no 5, p. 600-614Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Severe COVID-19 increases the risk for long-term respiratory impairment, but data after mild COVID-19 are scarce. Our aims were to determine risk factors for reduced respiratory function 3-6 months after COVID-19 infection and to investigate if reduced respiratory function would relate to impairment of exercise performance and breathlessness.

    METHODS: Patients with COVID-19 were enrolled at the University Hospitals of Umeå and Örebro, and Karlstad Central Hospital, Sweden. Disease severity was defined as mild (nonhospitalized), moderate (hospitalized with or without oxygen treatment), and severe (intensive care). Spirometry, including diffusion capacity (DLCO ), was performed 3-6 months after hospital discharge or study enrollment (for nonhospitalized patients). Breathlessness (defined as ≥1 according to the modified Medical Research Council scale) and functional exercise capacity (1-min sit-to-stand test; 1-MSTST) were assessed.

    RESULTS: Between April 2020 and May 2021, 337 patients were enrolled in the study. Forced vital capacity and DLCO were significantly lower in patients with severe COVID-19. Among hospitalized patients, 20% had reduced DLCO , versus 4% in nonhospitalized. Breathlessness was found in 40.6% of the participants and was associated with impaired DLCO . A pathological desaturation or heart rate response was observed in 17% of participants during the 1-MSTST. However, this response was not associated with reduced DLCO .

    CONCLUSION: Reduced DLCO was the major respiratory impairment 3-6 months following COVID-19, with hospitalization as the most important risk factor. The lack of association between impaired DLCO and pathological physiological responses to exertion suggests that these physiological responses are not primarily related to decreased lung function.

  • 25.
    Bornehag, Carl-Gustaf
    et al.
    Public Health Sciences, Karlstad University, Karlstad, Sweden.
    Nanberg, E.
    Department of Chemistry and Biomedical Science, Karlstad University, Karlstad, Sweden.
    Phthalate exposure and asthma in children2010In: International Journal of Andrology, ISSN 0105-6263, E-ISSN 1365-2605, Vol. 33, no 2, p. 333-345Article, review/survey (Refereed)
    Abstract [en]

    During the last decades more than 100 000 new chemicals have been introduced to the environment. Many of these new chemicals and many common consumer products that include these have been shown to be toxic in animal studies and an increasing body of evidence suggests that they are also impacting human health. Among the suspect chemicals, the endocrine disrupting chemicals (EDCs) are of particular concern. One such chemical group is the phthalates, used in soft poly vinyl chloride (PVC) material and in a huge number of consumer products. During the same period of time that the prevalence of these modern chemicals has increased, there has been a remarkable increase in several chronic illnesses, including asthma and allergy in children. In this article we outline the scientific knowledge on phthalate exposure for asthma and airway diseases in children by examining epidemiological and experimental peer review data for potential explanatory mechanisms. Epidemiological data point to a possible correlation between phthalate exposure and asthma and airway diseases in children. Experimental studies present support for an adjuvant effect on basic mechanisms in allergic sensitization by several phthalates. Despite variations in the experimental design and reported result in the individual studies, a majority of published reports have identified adjuvant effects on Th2 differentiation, production of Th2 cytokines and enhanced levels of Th2 promoted immunoglobulins (mainly IgG1 but also IgE) in mice. A limited amount of data do also suggest phthalate-induced enhancement of mast cell degranulation and eosinophilic infiltration which are important parts in the early inflammation phase. Thus, some of the early key mechanisms in the pathology of allergic asthma could possibly be targeted by phthalate exposure. But the important questions of clinical relevance of real life exposure and identification of molecular targets that can explain interactions largely remain to be answered

  • 26.
    Bouhuis, Dennis
    et al.
    School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Giezeman, Maaike
    Örebro University, School of Medical Sciences. Centre for Clinical Research and Education, Karlstad, Sweden.
    Hasselgren, Mikael
    Örebro University, School of Medical Sciences. Centre for Clinical Research and Education, Karlstad, Sweden.
    Janson, Christer
    Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden.
    Kisiel, Marta A.
    Department of Medical Sciences, Occupational and Environmental Medicine, Uppsala University, Uppsala, Sweden.
    Lisspers, Karin
    Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine, Uppsala University, Uppsala, Sweden.
    Montgomery, Scott
    Örebro University, School of Medical Sciences. Clinical Epidemiology and Biostatistics, School of Medical Sciences, Faculty of Medicine and Health, Örebro, Sweden; Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology and Public Health, University College, London, UK.
    Nager, Anna
    Department of Neurobiology, Care Sciences and Society, Division of Family Medicine and Primary Care, Karolinska Institutet, Stockholm, Sweden.
    Sandelowsky, Hanna
    Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden; Department of Neurobiology, Care Sciences and Society, Division of Family Medicine and Primary Care, Karolinska Institutet, Stockholm, Sweden; Academic Primary Health Care Centre, Stockholm, Sweden.
    Ställberg, Björn
    Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine, Uppsala University, Uppsala, Sweden.
    Sundh, Josefin
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Respiratory Medicine.
    Factors Associated with the Non-Exacerbator Phenotype of Chronic Obstructive Pulmonary Disease2023In: The International Journal of Chronic Obstructive Pulmonary Disease, ISSN 1176-9106, E-ISSN 1178-2005, Vol. 18, p. 483-492Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Patients with chronic obstructive pulmonary disease (COPD) and no exacerbations may need less maintenance treatment and follow-up. The aim was to identify factors associated with a non-exacerbator COPD phenotype.

    METHODS: Cross-sectional analysis of 1354 patients from primary and secondary care, with a doctor's diagnosis of COPD. In 2014, data on demographics, exacerbation frequency and symptoms using COPD Assessment Test (CAT) were collected using questionnaires and on spirometry and comorbid conditions by record review. The non-exacerbator phenotype was defined as having reported no exacerbations the previous six months. Multivariable logistic regression with the non-exacerbator phenotype as dependent variable was performed, including stratification and interaction analyses by sex.

    RESULTS: The non-exacerbator phenotype was found in 891 (66%) patients and was independently associated with COPD stage 1 (OR [95% CI] 5.72 [3.30-9.92]), stage 2 (3.42 [2.13-5.51]) and stage 3 (2.38 [1.46-3.88]) compared with stage 4, and with CAT score <10 (3.35 [2.34-4.80]). Chronic bronchitis and underweight were inversely associated with the non-exacerbator phenotype (0.47 [0.28-0.79]) and (0.68 [0.48-0.97]), respectively. The proportion of non-exacerbators was higher among patients with no maintenance treatment or a single bronchodilator. The association of COPD stage 1 compared with stage 4 with the non-exacerbator phenotype was stronger in men (p for interaction 0.048). In women, underweight and obesity were both inversely associated with the non-exacerbator phenotype (p for interaction 0.033 and 0.046 respectively), and in men heart failure was inversely associated with the non-exacerbator phenotype (p for interaction 0.030).

    CONCLUSION: The non-exacerbator phenotype is common, especially in patients with no maintenance treatment or a single bronchodilator, and is characterized by preserved lung function, low symptom burden, and by absence of chronic bronchitis, underweight and obesity and heart failure. We suggest these patients may need less treatment and follow-up, but that management of comorbid conditions is important to avoid exacerbations.

  • 27.
    Bouhuis, Dennis
    et al.
    School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Giezeman, Maaike
    Örebro University, School of Medical Sciences.
    Janson, Christer
    Department of Medical Sciences, Respiratory, Allergy & Sleep Research, Uppsala University, Uppsala, Sweden.
    Kisiel, Marta Alina
    Department of Medical Sciences, Environmental and Occupational Medicine, Uppsala University, Uppsala, Sweden.
    Lisspers, Karin
    Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine, Uppsala University, Uppsala, Sweden.
    Montgomery, Scott
    Örebro University, School of Medical Sciences. Clinical Epidemiology Division, Department of Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology and Public Health, University College London, London, UK.
    Nager, Anna
    Department of Neurobiology, Care Sciences and Society, Division of Family Medicine and Primary Care, Karolinska Institutet, Stockholm, Sweden.
    Sandelowsky, Hanna
    Clinical Epidemiology Division, Department of Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Neurobiology, Care Sciences and Society, Division of Family Medicine and Primary Care, Karolinska Institutet, Stockholm, Sweden.
    Ställberg, Björn
    Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine, Uppsala University, Uppsala, Sweden.
    Sundh, Josefin
    Örebro University, School of Medical Sciences. Department of Respiratory Medicine.
    Factors associated with self-assessed asthma severity2022In: Journal of Asthma, ISSN 0277-0903, E-ISSN 1532-4303, Vol. 59, no 4, p. 691-696Article in journal (Refereed)
    Abstract [en]

    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.

  • 28.
    Brew, Bronwyn K.
    et al.
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden; National Perinatal Epidemiology and Statistics Unit, Centre for Big Data Research in Health and School of Clinical Medicine, University of New South Wales, Kensington, New South Wales, Australia.
    Osvald, Emma Caffrey
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden; Pediatric Allergy and Pulmonology Unit, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden.
    Gong, Tong
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden.
    Hedman, Anna M.
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden.
    Holmberg, Kirsten
    Child Health and Parenting (CHAP), Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Larsson, Henrik
    Örebro University, School of Medical Sciences. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden.
    Ludvigsson, Jonas F.
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden; Department of Pediatrics, Örebro University Hospital, Örebro, Sweden; .
    Mubanga, Mwenya
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden.
    Smew, Awad I.
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden.
    Almqvist, Catarina
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden; Pediatric Allergy and Pulmonology Unit, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden.
    Paediatric asthma and non-allergic comorbidities: A review of current risk and proposed mechanisms2022In: Clinical and Experimental Allergy, ISSN 0954-7894, E-ISSN 1365-2222, Vol. 15, no 9, p. 1035-1047Article, review/survey (Refereed)
    Abstract [en]

    It is increasingly recognized that children with asthma are at a higher risk of other non-allergic concurrent diseases than the non-asthma population. A plethora of recent research has reported on these comorbidities and progress has been made in understanding the mechanisms for comorbidity. The goal of this review was to assess the most recent evidence (2016-2021) on the extent of common comorbidities (obesity, depression and anxiety, neurodevelopmental disorders, sleep disorders and autoimmune diseases) and the latest mechanistic research, highlighting knowledge gaps requiring further investigation. We found that the majority of recent studies from around the world demonstrate that children with asthma are at an increased risk of having at least one of the studied comorbidities. A range of potential mechanisms were identified including common early life risk factors, common genetic factors, causal relationships, asthma medication and embryologic origins. Studies varied in their selection of population, asthma definition and outcome definitions. Next, steps in future studies should include using objective measures of asthma, such as lung function and immunological data, as well as investigating asthma phenotypes and endotypes. Larger complex genetic analyses are needed, including genome-wide association studies, gene expression-functional as well as pathway analyses or Mendelian randomization techniques; and identification of gene-environment interactions, such as epi-genetic studies or twin analyses, including omics and early life exposure data. Importantly, research should have relevance to clinical and public health translation including clinical practice, asthma management guidelines and intervention studies aimed at reducing comorbidities.

  • 29.
    Brocki, Barbara Cristina
    et al.
    Department of Occupational Therapy and Physiotherapy, Aalborg University Hospital, Aalborg, Denmark.
    Westerdahl, Elisabeth
    Örebro University, School of Health Sciences. Örebro University Hospital. Department of Physiotherapy.
    Andreasen, Jane
    Department of Occupational Therapy and Physiotherapy, Aalborg University Hospital, Aalborg, Denmark; Public Health and Epidemiology Group, Department of Health, Science and Technology, Aalborg University, Aalborg, Denmark.
    Andreasen, Jan Jesper
    Department of Cardiothoracic Surgery, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
    Can the Melbourne Scoring Scale be used to assess postoperative pulmonary complications in high-risk patients following lung resection?2018In: European Respiratory Journal, ISSN 0903-1936, E-ISSN 1399-3003, Vol. 52, no Suppl. 62, article id PA1423Article in journal (Other academic)
    Abstract [en]

    Objectives: Postoperative pulmonary complications (PPC) are common following lung resections, but there is no consensus in the literature on the definition of a clinically relevant PPC. This study aimed to use the Melbourne Scoring Scale (MGS) to determine the frequency and predictors of PPC in patients scheduled for lung resection on suspicion of or due to cancer.

    Methods: In a prospective observational design, we assessed 87 consecutive patients following lung resections in Aalborg University Hospital, Denmark. Patients were preoperatively classified as being at high PPC-risk (n= 68) or low PPC-risk (n=19), based on the presence of one or more of the items: FEV1 or carbon monoxide diffusion capacity (DLCO) ≤70%, age ≥70 years or scheduled pneumonectomy. Data on PPC was collected daily and re-evaluated two weeks postoperatively. Multivariate regression analysis was used to evaluate variables associated with PPC.

    Results: The actual frequency of PPC according to the MGS was 11% (n=10), all cases within the predefined high-risk group, with pneumonia accounting for 10% of the cases. We found that preoperative FEV1 and DLCO ≤60% were significantly associated with a higher PPC risk (area under the ROC curve 0.851), 95% CI 2.2-56.6 and 1.1-36.8 for FEV1 and DLCO, respectively.

    Conclusions: The MGS can be used to identify patients at high risk of postoperative clinically relevant PPC after lung resections, in particular in patients with preoperative values of FEV1 ≤ 60% or DLCO ≤ 60%. More research is needed to evaluate the effect of preventable interventions targeting patients at high-risk of developing PPC.

  • 30.
    Bråbäck, L
    et al.
    Mid-Sweden Research and Development Centre, Department of Paediatrics, Sundsvall Hospital, Sundsvall, Sweden.
    Appelberg, Jonas
    Department of Clinical Physiology and Clinical Chemistry, Sundsvall Hospital, Sundsvall, Sweden.
    Jansson, U
    Department of Clinical Chemistry, Sundsvall Hospital, Sundsvall, Sweden.
    Kälvesten, L
    Granloholm Health Centre.
    Changes in prevalence and severity of asthma among schoolchildren ina Swedish district between 1985 and 19952000In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 89, no 4, p. 465-470Article in journal (Refereed)
    Abstract [en]

    The same questionnaire and study design was used in two surveys of asthma among all thechildren attending the 9-y compulsory school in Sundsvall in 1985 (n= 10 527) and 1995(n= 9 165). A detailed questionnaire was distributed by post to the parents of all children who hadanswered in the affirmative to a simple screening question on asthmatic symptoms at the beginningof the autumn term. The questionnaire contained detailed questions on symptoms and asthmamanagement. Our findings indicated a moderate increase in reported asthma-like symptoms andphysician-diagnosed asthma between 1985 and 1995. The severity of symptoms was unchanged,despite a large community-based asthma campaign and a tenfold increase in the number ofchildren receiving inhaled steroids. A validation analysis included an interview by a physician, askin prick test, determination of specific IgE antibodies and spirometry. The oral interviewssuggested that undertreatment was common. Many children had adequate medication at home, butthis medication was not used properly. Finally, all 13–14-y-old children also replied to written andvideo questionnaires from the International Study of Asthma and Allergies in Childhood (ISAAC).It is likely that differences in study design explained the much higher prevalence of wheezing inthis part of the study.

  • 31.
    Caffrey Osvald, Emma
    et al.
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Pediatric Allergy and Pulmonology Unit at Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden.
    Gong, Tong
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Lundholm, Cecilia
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Larsson, Henrik
    Örebro University, School of Medical Sciences. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Katie Brew, Bronwyn
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Centre for Big Data Research in Health and School of Women's and Children's Health, University of New South Wales, AGSM Building, Kensington, NSW, Australia.
    Almqvist, Catarina
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Pediatric Allergy and Pulmonology Unit at Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden.
    Parental socioeconomic status and asthma in children: using a population-based cohort and family design2022In: Clinical and Experimental Allergy, ISSN 0954-7894, E-ISSN 1365-2222, Vol. 52, no 1, p. 94-103Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The observed association between the parental socioeconomic status (SES, measured as education/income) and asthma or wheezing in offspring may be explained by confounding of unmeasured factors (shared genes and family environment). We aimed to study the association between parental SES and asthma/wheeze using cousin-comparison.

    METHOD: Data was collected on individuals born in Sweden 2001-2013. Parental SES (education and income) was gathered from Statistics Sweden. Asthma/wheeze was identified using national health registers. The association between parental SES at birth and incident asthma/wheeze was estimated using Cox regression also comparing differently exposed cousins. The association between parental SES at five years and current asthma was estimated using logistic regression.

    RESULTS: Included were 955 371 individuals. Mothers with compulsory school only (lowest education group) compared to those with further education (highest education group) was associated with incident asthma/wheeze below one year of age HRadj=1.45(1.38-1.52) and over one year of age HRadj=1.17(1.13-1.20). The corresponding estimates for the lowest income group were HRadj=1.61(1.54-1.69) and HRadj=0.94(0.92-0.97) respectively. In maternal cousin-comparisons, the associations for asthma/wheeze over one year of age was HRadj=1.21(1.05-1.40) for compulsory school only and HRadj=0.94 (0.84-1.07) for the lowest income group. The ORadj for current asthma at five years was 1.05(1.00-1.11) for mother's compulsory school only and 0.98(0.94-1.02) for mother's lowest income group. Results for estimates were similar for father's SES.

    CONCLUSION: We confirm an association between low parental SES (measured as education) and asthma/wheeze. Cousin-comparison suggests that this association is not wholly due to confounding of unknown familial factors, therefore supporting a causal relationship. The relationship between parental income and asthma/wheeze is less clear. This study is important for understanding risk factors for asthma/wheeze and for future prevention strategies. Further research is warranted to investigate the possible mechanisms for association between parental education and asthma/wheeze.

  • 32.
    Canova, Cristina
    et al.
    Dept Mol Med, Lab Publ Hlth & Populat Studies, Univ Padua, Padua, Italy.
    Pitter, Gisella
    Dept Mol Med, Lab Publ Hlth & Populat Studies, Univ Padua, Padua, Italy.
    Ludvigsson, Jonas F.
    Örebro University Hospital. Dept Med Epidemiol & Biostat, Karolinska Inst, Stockholm, Sweden.; Dept Pediat, Örebro University Hospital, Örebro, Sweden.
    Romor, Pierantonio
    Reg Hlth Informat Syst, Informat Sistema Enti Locali INSIEL SpA, Udine, Italy.
    Zanier, Loris
    Epidemiol Serv, Hlth Directorate Friuli Venezia Giulia Reg, Udine, Italy.
    Zanotti, Renzo
    Dept Mol Med, Lab Publ Hlth & Populat Studies, Univ Padua, Padua, Italy.
    Simonato, Lorenzo
    Dept Mol Med, Lab Publ Hlth & Populat Studies, Univ Padua, Padua, Italy.
    Coeliac disease and asthma association in children: the role of antibiotic consumption2015In: European Respiratory Journal, ISSN 0903-1936, E-ISSN 1399-3003, Vol. 46, no 1, p. 115-122Article in journal (Refereed)
    Abstract [en]

    The relationship between coeliac disease and asthma has been scarcely investigated. Infant antibiotic exposure has been linked to both diseases. We evaluated the association between childhood coeliac disease and asthma and the role of antibiotics in the first year of life. We followed a cohort of children born in 1995-2011 in the Friuli-Venezia Giulia region (Italy). Prescriptions for antibiotics in the first year of life and subsequent treated asthma were retrieved from drug prescription records; coeliac disease incident cases were identified from pathology reports, hospital discharges and exemption from prescription charges for clinical tests.We estimated incidence rate ratios (IRRs) using multivariate Poisson regression models. Among the 143 144 children, we identified 717 coeliac children and 34 969 asthmatics. Children with asthma were at increased risk of coeliac disease (IRR 1.46, 95% CI 1.25-1.67). Restricting the analysis to asthma that occurred before the diagnosis of coeliac disease, the excess risk disappeared, except for coeliac disease diagnosed after 5 years of age (IRR 1.37, 95% CI 1.09-1.71). Antibiotics were not a confounding factor in these associations. Childhood treated asthma and coeliac disease are significantly associated. This association is not confounded by antibiotic exposure in the first year of life and may be explained by other shared risk factors.

  • 33.
    Cantarutti, Anna
    et al.
    National Centre for Healthcare Research and Pharmacoepidemiology, Milan, Italy; Laboratory of Healthcare Research & Pharmacoepidemiology, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy.
    Barbiellini Amidei, Claudio
    Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy.
    Valsecchi, Camilla
    Laboratory of Healthcare Research & Pharmacoepidemiology, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy.
    Scamarcia, Antonio
    Pedianet Project, Padua, Italy.
    Corrao, Giovanni
    National Centre for Healthcare Research and Pharmacoepidemiology, Milan, Italy; Laboratory of Healthcare Research & Pharmacoepidemiology, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy.
    Gregori, Dario
    Division of Pediatric Infectious Diseases, Department of Woman’s and Child’s Health, University of Padua, Padua, Italy.
    Giaquinto, Carlo
    Univ Padua, Div Pediat Infect Dis, Dept Womans & Childs Hlth, I-35131 Padua, Italy..
    Ludvigsson, Jonas F.
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Pediatrics, Örebro University Hospital, Örebro, Sweden; Division of Epidemiology and Public Health, University of Nottingham School of Medicine, Nottingham, UK; Celiac Disease Center, Department of Medicine, Columbia University College of Physicians and Surgeons, New York NY, USA.
    Canova, Cristina
    Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy.
    Association of Treated and Untreated Gastroesophageal Reflux Disease in the First Year of Life with the Subsequent Development of Asthma2021In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 18, no 18, article id 9633Article in journal (Refereed)
    Abstract [en]

    Introduction: Gastroesophageal reflux disease (GERD) as well as its treatment with acid-suppressive medications have been considered possible risk factors for the development of asthma, but few studies have disentangled the role of GERD with that of its treatment. The present study aimed at estimating the association of treated and untreated GERD in the first year of life with the risk of asthma.

    Methods: Retrospective cohort study including all children born between 2004 and 2015 registered in Pedianet, an Italian primary care database. We analyzed the association of children exposed to GERD (both treated and untreated) in the first year of life with the risk of developing clinically assessed asthma (clinical asthma) after 3 years. Secondary outcomes included asthma identified by anti-asthmatic medications (treated asthma) and wheezing after 3 years. Hazard ratios (HR) and 95% confidence intervals (CI) were estimated comparing children with and without GERD, stratifying by treatment with acid-suppressive medications.

    Results: Out of 86,381 children, 1652 (1.9%) were affected by GERD in the first year of life, of which 871 (53%) were treated with acid-suppressive medications. Compared with controls, children with GERD were at increased risk of clinical asthma (HR: 1.40, 95% CI 1.15-1.70). Risks were similar between treated and untreated GERD (p = 0.41). Comparable results were found for treated asthma, but no risk increase was seen for wheezing.

    Discussion: Early-life GERD was associated with subsequent childhood asthma. Similar risks among children with treated and untreated GERD suggest that acid-suppressive medications are unlikely to play a major role in the development asthma.

  • 34.
    Carlstedt, Fredrik
    et al.
    Primary Care Research Centre, County Council of Värmland, Karlstad, Sweden.
    Lazowska, Dagmara
    Primary Care Research Centre, County Council of Värmland, Karlstad, Sweden.
    Bornehag, Carl-Gustaf
    Public Health Science, Karlstad University, Karlstad, Sweden.
    Olin, Anna-Carin
    Occupational and Environmental Medicine, Institute of Medicine, Sahlgrenska Academy, Gothenburg, Sweden.
    Hasselgren, Mikael
    Primary Care Research Centre, County Council of Värmland, Karlstad, Sweden; Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology, Uppsala University, Uppsala, Sweden.
    Exhaled nitric oxide and urinary EPX levels in infants: a pilot study2011In: Clinical and Molecular Allergy, E-ISSN 1476-7961, Vol. 9Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Objective markers of early airway inflammation in infants are not established but are of great interest in a scientific setting. Exhaled nitric oxide (FeNO) and urinary eosinophilic protein X (uEPX) are a two such interesting markers.

    OBJECTIVE: To investigate the feasibility of measuring FeNO and uEPX in infants and their mothers and to determine if any relations between these two variables and environmental factors can be seen in a small sample size. This was conducted as a pilot study for the ongoing Swedish Environmental Longitudinal Mother and child Asthma and allergy study (SELMA).

    METHODS: Consecutive infants between two and six months old and their mothers at children's health care centres were invited, and 110 mother-infant pairs participated. FeNO and uEPX were analysed in both mothers and infants. FeNO was analyzed in the mothers online by the use of the handheld Niox Mino device and in the infants offline from exhaled air sampled during tidal breathing. A 33-question multiple-choice questionnaire that dealt with symptoms of allergic disease, heredity, and housing characteristics was used.

    RESULTS: FeNO levels were reduced in infants with a history of upper respiratory symptoms during the previous two weeks (p < 0.002). There was a trend towards higher FeNO levels in infants with windowpane condensation in the home (p < 0.05). There was no association between uEPX in the infants and the other studied variables.

    CONCLUSION: The use of uEPX as a marker of early inflammation was not supported. FeNO levels in infants were associated to windowpane condensation. Measuring FeNO by the present method may be an interesting way of evaluating early airway inflammation. In a major population study, however, the method is difficult to use, for practical reasons.

  • 35.
    Choi, Hyunok
    et al.
    Department of Environmental Health, Harvard School of Public Health, Boston MA, United States.
    Schmidbauer, Norbert
    Norwegian Institute for Air Research, Kjeller, Norway.
    Sundell, Jan
    Department of Building Science, School of Architecture, Tsinghua University, Beijing, China.
    Hasselgren, Mikael
    Primary Care Research Unit, County Council of Värmland, Karlstad, Sweden.
    Spengler, John
    Department of Environmental Health, Harvard School of Public Health, Boston MA, United States.
    Bornehag, Carl-Gustaf
    Public Health Sciences, Karlstad University, Karlstad, Sweden; SP Technical Research Institute of Sweden, Borås, Sweden.
    Common household chemicals and the allergy risks in pre-school age children2010In: PLOS ONE, E-ISSN 1932-6203, Vol. 5, no 10, article id e13423Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The risk of indoor exposure to volatile organic compounds (VOCs) on allergic airway diseases in children remains unknown.

    OBJECTIVE: We examined the residential concentrations of VOCs, emitted from building materials, paints, furniture, and other lifestyle practices and the risks of multiple allergic diseases as well as the IgE-sensitization in pre-school age children in Sweden.

    METHODS: In a case-control investigation (198 case children with asthma and allergy and 202 healthy controls), air samples were collected in the room where the child slept. The air samples were analyzed for the levels of eight classes of VOCs.

    RESULTS: A natural-log unit of summed propylene glycol and glycol ethers (PGEs) in bedroom air (equal to interquartile range, or 3.43 - 15.65 µg/m(3)) was associated with 1.5-fold greater likelihood of being a case (95% CI, 1.1 - 2.1), 1.5-fold greater likelihood of asthma (95% CI, 1.0 - 2.3), 2.8-fold greater likelihood of rhinitis (95% CI, 1.6 - 4.7), and 1.6-fold greater likelihood of eczema (95% CI, 1.1 - 2.3), accounting for gender, secondhand smoke, allergies in both parents, wet cleaning with chemical agents, construction period of the building, limonene, cat and dog allergens, butyl benzyl phthalate (BBzP), and di(2-ethylhexyl)phthalate (DEHP). When the analysis was restricted to the cases, the same unit concentration was associated with 1.8-fold greater likelihood of IgE-sensitization (95% CI, 1.1 - 2.8) compared to the non-IgE sensitized cases. No similar associations were found for the other classes of VOCs.

    CONCLUSION: We propose a novel hypothesis that PGEs in indoor air exacerbate and/or induce the multiple allergic symptoms, asthma, rhinitis and eczema, as well as IgE sensitization respectively.

  • 36.
    Davidsson, Åke
    Örebro University, School of Medicine, Örebro University, Sweden.
    Allergidagen med temat: "Födoämnesöverkänslighet"2014In: Lung och alllergiforum, ISSN 2000-5237, no 4, p. 29-33Article in journal (Other (popular science, discussion, etc.))
  • 37.
    Davidsson, Åke
    et al.
    Departments of Otorhinolaryngology, Medical Center Hospital, Örebro, Sweden.
    Danielsen, Arild
    Department of Otorhinolaryngology, Head & Neck Surgery, Haukeland University Hospital, Bergen, Norway.
    Viale, Guiseppe
    Department of Pathology and Laboratory Medicine, European Institute of Oncology, University of Milan School of Medicine, Milan, Italy.
    Olofsson, Jan
    Department of Otorhinolaryngology, Head & Neck Surgery, Haukeland University Hospital, Bergen, Norway.
    Dell'Orto, Patrizia
    Department of Pathology and Laboratory Medicine, European Institute of Oncology, University of Milan School of Medicine, Milan, Italy.
    Pellegrini, Caterina
    Department of Pathology and Laboratory Medicine, European Institute of Oncology, University of Milan School of Medicine, Milan, Italy.
    Karlsson, Mats G.
    Departments of Pathology, Medical Center Hospital, Örebro, Sweden.
    Hellquist, Henrik B.
    Department of Pathology II, University Hospital, Linköping, Sweden.
    Positive identification in situ of mRNA expression of IL-6, and IL-12, and the chemotactic cytokine RANTES in patients with chronic sinusitis and polypoid disease. Clinical relevance and relation to allergy1996In: Acta Oto-Laryngologica, ISSN 0001-6489, E-ISSN 1651-2251, Vol. 116, no 4, p. 604-610Article in journal (Refereed)
    Abstract [en]

    Interleukins 6 (IL-6) and 12 (IL-12), and the chemoattractant chemokine RANTES were studied in ethmoidal mucosa, using reverse transcriptase polymerase chain reaction. The 49 patients had chronic sinusitis or nasal/paranasal polyposis, and some also allergy. To the best of our knowledge, this is the first study that demonstrates RANTES and IL-12 on mRNA level in human sinonasal mucosa in situ. mRNA for IL-6, IL-12 and RANTES were detected in 2, 8 and 6 patients with chronic sinusitis, respectively, and in mucosa from patients with polyposis a positive expression was observed in 4, 14 and 10 cases. There were no statistically significant differences. Analysing the entire group of 49 patients, disregarding type of mucosal disease, the number of patients with positive RANTES was significantly higher than that for IL-6. Similarly, IL-12 positivity was more frequently expressed than IL-6. mRNA for IL-6 was expressed in only 2 of the allergic patients. The cytokine production studied thus seems to be unrelated to the clinically defined entities. There is thus a local production in human diseased sinonasal mucosa of RANTES, as well as of IL-6 and IL-12. The local production of RANTES is an important prerequisite for recruitment and migration of inflammatory cells into the tissue. IL-12 is a co-stimulator of antigen-specific responses of established T helper 1 (Th1) clones, and regulates the responsiveness of the clones to a number of T cell growth factors. The study supports a shift towards Th1 cells in these disease entities.

  • 38.
    Davidsson, Åke
    et al.
    Örebro Medical Center Hospital, Örebro, Sweden .
    Karlsson, Mats G.
    Örebro Medical Center Hospital, Örebro, Sweden .
    Hellquist, H. B.
    Allergen-induced changes of B-cell phenotypes in patients with allergic rhinitis1994In: Rhinology, ISSN 0300-0729, E-ISSN 1996-8604, Vol. 32, no 4, p. 184-190Article in journal (Refereed)
    Abstract [en]

    We investigated sub-populations of B-lymphocytes in nasal mucosa and peripheral blood of 17 patients with seasonal allergic rhinitis (birch pollen) and 10 controls. The study included provocation with allergen during the non-pollen season, during which no participant used medication. Samples were also taken during the pollen season. Subsets of B-cells as expressed by different CD antigens were investigated by immunohistochemistry on frozen sections and by flow cytometry of peripheral blood. Nasal CD23+ B-cells decreased in allergic patients during provocation, indicating that mature virgin CD23+ B-cells switch into a memory B-cell phenotype with loss of CD23 expression. This indicates differentiation towards cells that can represent a local source for IgE synthesis. No decrease was observed during the pollen season when the patients used medication. Serum IgE was significantly higher in allergic patients on all occasions. The observed up-regulation of CD40 expression on peripheral blood B-cells in allergic patients during the pollen season clearly indicate B-cell activation. Furthermore, a relative increase of CD19+ B-cells was observed in peripheral blood during provocation. Upregulation (by IL-4) of CD40 on B-cells which then may be stimulated by gp39 (CD40 ligand) can constitute an early and important event in the IgE-mediated allergic reaction.

  • 39.
    Ekström, Magnus
    et al.
    Department of Clinical Sciences, Division of Respiratory Medicine & Allergology, Lund University, Lund, Sweden .
    Ahmadi, Zainab
    Department of Clinical Sciences, Division of Respiratory Medicine & Allergology, Lund University, Lund, Sweden.
    Sundh, Josefin
    Örebro University, School of Medical Sciences. Department of Respiratory Medicine.
    Further Need for Evidence in Long-Term Oxygen Therapy2018In: Annals of the American Thoracic Society, ISSN 2329-6933, E-ISSN 2325-6621, Vol. 15, no 4, p. 511-512Article in journal (Refereed)
  • 40.
    Ekström, Magnus
    et al.
    Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Respiratory Medicine and Allergology, Lund, Sweden.
    Bornefalk, Hans
    Hans Bornefalk AB, Vallentuna, Sweden.
    Sköld, C. Magnus
    Respiratory Medicine Unit, Department of Medicine Solna and Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Respiratory Medicine and Allergy, Karolinska University Hospital Solna, Stockholm, Sweden.
    Janson, Christer
    Department of Medical Sciences: Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden.
    Blomberg, Anders
    Department of Public Health and Clinical Medicine, Section of Medicine, Umeå University, Umeå, Sweden.
    Sandberg, Jacob
    Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Respiratory Medicine and Allergology, Lund, Sweden.
    Bornefalk-Hermansson, Anna
    Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden.
    Currow, David C.
    IMPACCT, Faculty of Health, University of Technology Sydney, Ultimo, Sydney, Australia.
    Johnson, Miriam J.
    Wolfson Palliative Care Research Centre, University of Hull, Hull, UK.
    Sundh, Josefin
    Örebro University, School of Medical Sciences. Department of Respiratory Medicine.
    Minimal clinically important differences for Dyspnea-12 and MDP scores are similar at 2 weeks and 6 months: follow-up of a longitudinal clinical study2021In: European Respiratory Journal, ISSN 0903-1936, E-ISSN 1399-3003, Vol. 57, article id 2002823Article in journal (Refereed)
  • 41.
    Ekström, Magnus
    et al.
    Department of Clinical Sciences, Lund, Respiratory Medicine and Allergology, Faculty of Medicine, Lund University, Lund, Sweden; Department of Medicine, Blekinge Hospital, Karlskrona, Sweden.
    Bornefalk, Hans
    Hans Bornefalk AB, Vallentuna, Sweden.
    Sköld, Magnus
    Respiratory Medicine Unit, Department of Medicine Solna and Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden.
    Janson, Christer
    Department of Medical Sciences: Respiratory Medicine, Uppsala University, Uppsala, Sweden.
    Blomberg, Anders
    Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
    Sandberg, Jacob
    Jämjö Primary Health Care Central, Karlskrona, Sweden; Department of Clinical Sciences, Lunds Universitet, Lund, Sweden.
    Bornefalk-Hermansson, Anna
    Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden.
    Igelström, Helena
    Department of Neuroscience, Uppsala University, Uppsala, Sweden.
    Sundh, Josefin
    Örebro University, School of Medical Sciences. Department of Respiratory Medicine.
    Validation of the Swedish Multidimensional Dyspnea Profile (MDP) in outpatients with cardiorespiratory disease2019In: BMJ Open Respiratory Research, E-ISSN 2052-4439, Vol. 6, no 1, article id UNSP e000381Article in journal (Refereed)
    Abstract [en]

    Introduction: Breathlessness is a cardinal symptom in cardiorespiratory disease. An instrument for measuring different aspects of breathlessness was recently developed, the Multidimensional Dyspnea Profile (MDP). This study aimed to validate the MDP in terms of the underlying factor structure, internal consistency, test-retest reliability and concurrent validity in Swedish outpatients with cardiorespiratory disease.

    Methods: Outpatients with stable cardiorespiratory disease and breathlessness in daily life were recruited. Factor structure of MDP was analysed using confirmatory factor analysis; internal consistency was analysed using Cronbach's alpha; and test-retest reliability was analysed using intraclass correlation coefficients (ICCs) for patients with unchanged breathlessness between assessments (baseline, after 30-90 min and 2 weeks). Concurrent validity was evaluated using correlations with validated scales of breathlessness, anxiety, depression and health-related quality of life.

    Results: In total, 182 outpatients with cardiorespiratory disease and breathlessness in daily life were included; 53.3% were women; main diagnoses were chronic obstructive pulmonary disease (24.7%), asthma (21.4%), heart failure (19.2%) and idiopathic pulmonary fibrosis (18.7%). The MDP total, immediate perception and emotional response scores, and individual item scores showed expected factor structure and acceptable measurement properties: internal consistency (Cronbach's alpha, range 0.80-0.93); test-retest reliability at 30-90 min and 2 weeks (ICC, range 0.67-0.91); and concurrent validity. There was no evidence of a learning effect. Findings were similar between diagnoses.

    Discussion: MDP is a valid instrument for multidimensional measurement of breathlessness in Swedish outpatients across cardiorespiratory diseases.

  • 42.
    Ekström, Magnus
    et al.
    Division of Respiratory Medicine and Allergology, Department of Clinical Sciences, Lund University, Lund, Sweden.
    Sundh, Josefin
    Örebro University, School of Medical Sciences. Department of Respiratory Medicine, Örebro University Hospital, Örebro, Sweden.
    Swedish translation and linguistic validation of the multidimensional dyspnoea profile2016In: European clinical respiratory journal, ISSN 2001-8525, Vol. 3, p. 1-4, article id 32665Article in journal (Refereed)
    Abstract [en]

    Background: Dyspnoea, the feeling of breathing discomfort, consists of multiple dimensions that can vary in intensity, including the level of unpleasantness, qualities or descriptors of the sensation, emotional responses, and impact on function. No validated instrument for multidimensional measurement of dyspnoea is available in Swedish. The Multidimensional Dyspnea Profile (MDP) was recently developed to measure the unpleasantness, sensory qualities, and emotional responses of dyspnoea across diseases and settings. We aimed to take forward a Swedish version of the MDP.

    Methods: Translation and linguistic validation of the MDP was conducted in collaboration with a specialised company in the field (Mapi, Lyon, France). The structured process involved forward and backward translations by two independent certified translators, input from an in-country linguistic consultant, the developers, and three respiratory physicians. Understandability and acceptability were evaluated through in-depth interviews with five patients with dyspnoea in accordance with international guidelines.

    Results and Conclusion: A Swedish version of the MDP was obtained and linguistically validated. The MDP includes 11 rated items: the immediate unpleasantness of the sensation, the presence and intensity of five sensory qualities, and the intensity of five emotional responses to dyspnoea. The time period of measurement is specified by the user. The MDP is copyrighted by the developers but can be used free of charge in the context of non-funded academic research.

    Conclusion: The MDP is the first instrument for measuring multiple dimensions of dyspnoea available in Swedish and should be validated across diseases and settings. Multidimensional measurement is essential for improved assessment and management of dyspnoea in research and clinical care.

  • 43.
    Ekström, Magnus
    et al.
    Department of Clinical Sciences, Division of Respiratory Medicine & Allergology, Lund University, Lund, Sweden.
    Sundh, Josefin
    Örebro University, School of Medical Sciences. Department of Respiratory Medicine, Örebro University Hospital, Örebro, Sweden.
    Larsson, Kjell
    Lung and Airway Research, The National Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Patient reported outcome measures in chronic obstructive pulmonary disease: Which to use?2016In: Expert Review of Respiratory Medicine, ISSN 1747-6348, Vol. 10, no 3, p. 351-362Article, review/survey (Refereed)
    Abstract [en]

    Patient-reported outcomes (PROs), such as symptoms and perceived health status, are essential in chronic obstructive pulmonary disease (COPD) for determining disease severity, impact on daily life, effect of treatment and recovery from exacerbations. This field has evolved rapidly and there are a plethora of instruments assessing different PROs. The aim of this review is to provide an understanding of the concept of PROs in COPD. The PROs reflect important aspects of COPD which have a direct impact on daily life. Common symptoms such as dyspnea, cough, phlegm, anxiety, fatigue, and pain and as well as physical function and the risk for and occurrence of acute exacerbations should be assessed both in the clinic and in research. Besides impact on daily life, some of the PROs are related to disease progress and mortality. Construction of composite variables including different disease specific and generic PROs provide a general estimation of health status.

  • 44.
    Ekström, Magnus
    et al.
    Department of Respiratory Medicine and Allergology, Institution for Clinical Sciences, Lund University, Lund, Sweden .
    Sundh, Josefin
    Örebro University, School of Medical Sciences. Department of Respiratory Medicine, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Schiöler, Linus
    Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden .
    Lindberg, Eva
    Uppsala University, Uppsala, Sweden .
    Rosengren, Annika
    Sahlgrenska University Hospital, Gothenburg, Sweden; University of Gothenburg, Gothenburg, Sweden.
    Bergström, Göran
    Sahlgrenska University Hospital, Gothenburg, Sweden; University of Gothenburg, Gothenburg, Sweden.
    Angerås, Oskar
    Sahlgrenska University Hospital, Gothenburg, Sweden; University of Gothenburg, Gothenburg, Sweden.
    Hedner, Jan
    University of Gothenburg, Gothenburg, Sweden.
    Brandberg, John
    University of Gothenburg, Gothenburg, Sweden.
    Bake, Björn
    University of Gothenburg, Gothenburg, Sweden .
    Torén, Kjell
    Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden .
    Absolute lung size and the sex difference in breathlessness in the general population2018In: PLOS ONE, E-ISSN 1932-6203, Vol. 13, no 1, article id e0190876Article in journal (Refereed)
    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.

  • 45.
    Eliason, Gabriella
    et al.
    Örebro University, School of Health and Medical Sciences.
    Abdel-Halim, S.
    Örebro University, School of Health and Medical Sciences.
    Arvidsson, B.
    Kadi, Fawzi
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Piehl-Aulin, Karin
    Örebro University, School of Health and Medical Sciences.
    Physical performance and muscular characteristics in different stages of COPD2009In: Scandinavian Journal of Medicine and Science in Sports, ISSN 0905-7188, E-ISSN 1600-0838, Vol. 19, no 6, p. 865-870Article in journal (Refereed)
    Abstract [en]

    This study has examined exercise capacity and muscle morphology in patients with different severities of chronic obstructive pulmonary disease (COPD). Twenty-three patients and 12 healthy matched controls were recruited. Based on the severity of airflow obstruction, patients were divided into two subgroups. Exercise capacity was determined using a 6-min walk test. Muscle fiber composition, fiber area and number of satellite cells/muscle fiber were determined in muscle biopsies using immunohistochemistry. A progressive decline in exercise capacity was noted with ascending disease severity. Furthermore, a correlation between reduction in exercise capacity and changes in muscle fiber composition was observed in COPD. The group with severe and very severe COPD had a lower proportion of type I and a higher proportion of type IIa fibers compared with the other groups. In severe and very severe COPD, a reduction in fiber area of type IIa fibers was also seen. The number of satellite cells/muscle fiber did not differ between the groups. In conclusion, a decline in exercise capacity occurs already in mild and moderate COPD, indicating that the 6-min walk test is a reliable indicator of disease severity. Furthermore, changes in skeletal muscle morphology are associated with disease severity while muscle regenerative capacity is not altered.

  • 46.
    Eliasson, Gabriella
    et al.
    Department of Respiratory Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Janson, Christer
    Department of Medical Sciences, Respiratory; Allergy and Sleep Research, Uppsala University, Uppsala, Sweden.
    Johansson, Gunnar
    Department of Public Health and Caring Science, Family Medicine and Preventive Medicine, Uppsala University, Uppsala, Sweden.
    Larsson, Kjell
    Division for Lung and Airway Research, Institute of Environmental Medicine, Stockholm, Sweden.
    Lindén, Anders
    Division for Lung and Airway Research, Institute of Environmental Medicine, Stockholm, Sweden; Karolinska Severe COPD Center, Department of Respiratory Medicine, Karolinska University Hospital, Stockholm, Sweden.
    Löfdahl, Claes-Göran
    Department of Respiratory Medicine and Allergology, Lund University, Lund, Sweden.
    Sandström, Thomas
    Department of Public Health and Clinical Medicine, Division of Medicine, Umeå University, Umeå, Sweden.
    Sundh, Josefin
    Örebro University, School of Medical Sciences. Department of Respiratory Medicine.
    Comorbid conditions as predictors of mortality in severe COPD - an eight-year follow-up cohort study2023In: European Clinical Respiratory Journal, ISSN 2001-8525, Vol. 10, no 1, article id 2181291Article in journal (Refereed)
    Abstract [en]

    Purpose: Co-morbidities are common in chronic obstructive pulmonary disease (COPD) and are associated with increased morbidity and mortality. The aim of the present study was to explore the prevalence of several comorbid conditions in severe COPD, and to investigate and compare their associations with long-term mortality.

    Methods: In May 2011 to March 2012, 241 patients with COPD stage 3 or 4 were included in the study. Information was collected on sex, age, smoking history, weight and height, current pharmacological treatment, number of exacerbations the recent year and comorbid conditions. At December 31st, 2019, mortality data (all-cause and cause specific) were collected from the National Cause of Death Register. Data were analyzed using Cox-regression analysis with gender, age, previously established predictors of mortality and comorbid conditions as independent variables, and all-cause mortality and cardiac and respiratory mortality, respectively, as dependent variables.

    Results: Out of 241 patients, 155 (64%) were deceased at the end of the study period; 103 patients (66%) died of respiratory disease and 25 (16%) of cardiovascular disease. Impaired kidney function was the only comorbid condition independently associated with increased all-cause mortality (HR (95% CI) 3.41 (1.47-7.93) p=0.004) and respiratory mortality (HR (95%CI) 4.63 (1.61 to 13.4), p = 0.005). In addition, age >= 70, BMI <22 and lower FEV1 expressed as %predicted were significantly associated with increased all-cause and respiratory mortality.

    Conclusion: In addition to the risk factors high age, low BMI and poor lung function; impaired kidney function appears to be an important risk factor for mortality in the long term, which should be taken into account in the medical care of patients with severe COPD.

  • 47.
    Ericson, Anna
    et al.
    Uppsala University, Uppsala, Sweden.
    Ställberg, Björn
    Uppsala University, Uppsala, Sweden.
    Janson, Christer
    Uppsala University, Uppsala, Sweden.
    Sundh, Josefin
    Örebro University, School of Medicine, Örebro University, Sweden. Department Respiratory Medicine, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Montgomery, Scott
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Kampe, Mary
    Uppsala University, Uppsala, Sweden.
    Efraimsson, Eva Osterlund
    Dalarna University, Falun, Sweden.
    Patients' evaluation on asthma severity was related to level of asthma control and quality of life over seven years follow-up2013In: European Respiratory Journal, ISSN 0903-1936, E-ISSN 1399-3003, Vol. 42, no 57, article id 2744Article in journal (Other academic)
  • 48.
    Finnegan, Sarah L.
    et al.
    Wellcome Centre for Integrative Neuroimaging and Nuffield Division of Anaesthetics, Nuffield Dept of Clinical Neurosciences, University of Oxford, Oxford, UK.
    Pattinson, Kyle T. S.
    Wellcome Centre for Integrative Neuroimaging and Nuffield Division of Anaesthetics, Nuffield Dept of Clinical Neurosciences, University of Oxford, Oxford, UK.
    Sundh, Josefin
    Örebro University, School of Medical Sciences. Department of Respiratory Medicine.
    Sköld, Magnus
    Respiratory Medicine Unit, Dept of Medicine Solna and Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden; Dept of Respiratory Medicine and Allergy, Karolinska University Hospital, Stockholm, Sweden.
    Janson, Christer
    Dept of Medical Sciences: Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden.
    Blomberg, Anders
    Dept of Public Health and Clinical Medicine, Section of Medicine, Umeå University, Umeå, Sweden.
    Sandberg, Jacob
    Respiratory Medicine and Allergology, Dept of Clinical Sciences, Faculty of Medicine, Lund University, Lund, Sweden.
    Ekström, Magnus
    Respiratory Medicine and Allergology, Dept of Clinical Sciences, Faculty of Medicine, Lund University, Lund, Sweden.
    A common model for the breathlessness experience across cardiorespiratory disease2021In: ERJ Open Research, E-ISSN 2312-0541, Vol. 7, no 2, article id 00818-2020Article in journal (Refereed)
    Abstract [en]

    Chronic breathlessness occurs across many different conditions, often independently of disease severity. Yet, despite being strongly linked to adverse outcomes, the consideration of chronic breathlessness as a stand-alone therapeutic target remains limited. Here we use data-driven techniques to identify and confirm the stability of underlying features (factors) driving breathlessness across different cardiorespiratory diseases.

    Questionnaire data on 182 participants with main diagnoses of asthma (21.4%), COPD (24.7%), heart failure (19.2%), idiopathic pulmonary fibrosis (18.7%), other interstitial lung disease (2.7%), and "other diagnoses" (13.2%) were entered into an exploratory factor analysis (EFA). Participants were stratified based on their EFA factor scores. We then examined model stability using 6-month follow-up data and established the most compact set of measures describing the breathlessness experience.

    In this dataset, we have identified four stable factors that underlie the experience of breathlessness. These factors were assigned the following descriptive labels: 1) body burden, 2) affect/mood, 3) breathing burden and 4) anger/frustration. Stratifying patients by their scores across the four factors revealed two groups corresponding to high and low burden. These two groups were not related to the primary disease diagnosis and remained stable after 6 months.

    In this work, we identified and confirmed the stability of underlying features of breathlessness. Previous work in this domain has been largely limited to single-diagnosis patient groups without subsequent re-testing of model stability. This work provides further evidence supporting disease independent approaches to assess breathlessness.

  • 49. Forsberg, A.
    et al.
    Abrahamsson, T. R.
    Björkstén, Bengt
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Jenmalm, M. C.
    Pre- and post-natal Lactobacillus reuteri supplementation decreases allergen responsiveness in infancy2013In: Clinical and Experimental Allergy, ISSN 0954-7894, E-ISSN 1365-2222, Vol. 43, no 4, p. 434-442Article in journal (Refereed)
    Abstract [en]

    Background: We have previously shown that Lactobacillus reuteri supplementation from pregnancy week 36 and to the infant through the first year of life decreased the prevalence of IgE-associated eczema at 2 years. The underlying immunological mechanisms are unknown, however.

    Objective: To investigate the immunomodulatory effect of probiotic supplementation on allergen- and mitogen-induced immune responses in children until 2 years of age.

    Methods: Blood mononuclear cells were collected at birth, 6, 12 and 24 months from 61 children (29 probiotic and 32 placebo treated) and cultured with ovalbumin, birch and cat extract and Phytohaemagglutinin (PHA). Cytokine and chemokine secretion was determined using an in-house multiplexed Luminex assay and ELISA. Real-time PCR was performed to investigate the Ebi3, Foxp3, GATA-3 and T-bet mRNA expression.

    Results: Probiotic treatment was associated with low cat-induced Th2-like responses at 6 months (IL-5, P=0.01, and IL-13, P=0.009), with a similar trend for IL-5 at 12 months (P=0.09). Cat-induced IFN- responses were also lower after probiotic than after placebo treatment at 24 months (P=0.007), with similar findings for the anti-inflammatory IL-10 at birth (P=0.001) and at 12 months (P=0.009). At 24 months, Th2-associated CCL22 levels were lower in the probiotic than in the placebo group after birch stimulation (P=0.02), with a similar trend after ovalbumin stimulation (P=0.07). Lower CCL22 levels were recorded at 12 and 24 months (P=0.03 and P=0.01) after PHA stimulation.

    Conclusion and Clinical Relevance: Lactobacillus reuteri supplementation decreases allergen responsiveness and may enhance immunoregulatory capacity during infancy. L. reuteri supplementation from week 36 and during the first year of life significantly decreases IgE-associated eczema and lowers allergen and mitogen responsiveness.

  • 50.
    Forsberg, Anna
    et al.
    Div Clin Immunol, Unit Autoimmun & Immune Regulat, Dept Clin & Expt Med, Linköping Univ, Linköping, Sweden..
    Abrahamsson, Thomas R.
    Div Pediat, Dept Clin & Expt Med, Linköping Univ, Linköping, Sweden.
    Björksten, Bengt
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Inst Environm Med, Karolinska Inst, Stockholm, Sweden.
    Jenmalm, Maria C.
    Div Clin Immunol, Unit Autoimmun & Immune Regulat, Dept Clin & Expt Med, Linköping Univ, Linköping, Sweden.
    Pre- and postnatal administration of Lactobacillus reuteri decreases TLR2 responses in infants2014In: Clinical and Translational Allergy, ISSN 2045-7022, E-ISSN 2045-7022, Vol. 4, article id 21Article in journal (Refereed)
    Abstract [en]

    Background: Mice models indicate that intact Toll like receptor (TLR) signaling may be essential for the allergy protective effects of diverse bacterial exposure observed in clinical trials and epidemiological studies. Probiotic supplementation with Lactobacillus reuteri from pregnancy week 36 and to the infant through the first year of life decreased the prevalence of IgE-associated eczema at two years (ClinicalTrials. gov NCT01285830). The effect of this supplementation on innate immune responses to bacterial products and the expression of associated TLRs were explored.

    Methods: Blood mononuclear cells were collected at birth, 6, 12 and 24 months from 61 infants and cultured with TLR2, 4 and 9 ligands. Cytokine and chemokine secretion was determined as well as TLR2, 4 and 9 mRNA expression. Results: Probiotic supplementation was associated with decreased LTA (lipoteichoic acid) induced CCL4, CXCL8, IL-1 beta and IL-6 responses at 12 months and decreased CCL4 and IL-1 beta secretion at 24 months. TLR2 mRNA expression was not affected by probiotic treatment.

    Conclusions: Decreased responses to TLR2, the main receptor for LTA from Gram positive bacteria, in probiotic treated children seem to be dependent on factors downstream of TLR mRNA expression.

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