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Kristiansson L, Seiler C, Lundeqvist D, Braman Eriksson A, Sundh J, Hårdstedt M. Symptom Duration, Recurrence, and Long-Term Effects of Swimming-Induced Pulmonary Edema: A 30-Month Follow-Up Study. Chest 2023; 164:1257-1267. [PMID: 37414334 PMCID: PMC10635841 DOI: 10.1016/j.chest.2023.06.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 06/28/2023] [Accepted: 06/29/2023] [Indexed: 07/08/2023] Open
Abstract
BACKGROUND Swimming-induced pulmonary edema (SIPE) has been reported to subside within 24 to 48 h, but comprehensive follow-up studies on symptom duration and long-term effects are missing. RESEARCH QUESTION What are the symptom duration, recurrence, and long-term effects of SIPE? STUDY DESIGN AND METHODS A follow-up study was conducted, based on 165 cases of SIPE from Sweden's largest open-water swimming event with 26,125 individuals participating during 2017-2019. Data on patient characteristics, clinical findings, and symptoms were collected at admission. Telephone interviews at 10 days and 30 months were performed to explore symptom duration, recurrence of SIPE symptoms, need for medical evaluation, and long-term effects of self-assessed general health and physical activity level. RESULTS Follow-up at 10 days was performed for 132 cases and at 30 months for 152 cases. Most of the patients were women, and their mean age was 48 years. At the 10-day follow-up, symptom duration > 2 days after the swimming race was reported by 38%. The most common symptoms were dyspnea and cough. In patients at 30-month follow-up, recurrence of respiratory symptoms during open-water swimming was reported by 28%. In multivariable logistic regression, asthma was independently associated with both symptom duration > 2 days and recurrence of SIPE symptoms (P = .045 and P = .022, respectively). Most participants reported equal or improved general health (93%) and physical activity level (85%) after experiencing SIPE, but 58% had not swum in open water since the event. INTERPRETATION The present large cohort study challenges the established hallmark of SIPE symptom duration < 48 h, whereas SIPE recurrence was in the previously reported range. At 30 months, most patients reported unchanged self-assessed general health and physical activity level. These findings add to our understanding of the course of SIPE and can provide evidence-based information to swimmers and health care professionals.
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Affiliation(s)
- Linda Kristiansson
- Center for Research and Development, Uppsala University/Region Gävleborg, Gävle, Sweden; School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden; Sandviken North Primary Health Care Center, Sandviken, Sweden.
| | - Claudia Seiler
- School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden; Center for Clinical Research, Dalarna-Uppsala University, Falun, Sweden; Department of Anesthesiology and Intensive Care, Falun Hospital, Falun, Sweden
| | | | | | - Josefin Sundh
- Department of Respiratory Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Maria Hårdstedt
- School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden; Center for Clinical Research, Dalarna-Uppsala University, Falun, Sweden; Vansbro Primary Health Care Center, Vansbro, Sweden
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Bashir MBA, Basna R, Hedman L, Backman H, Ekerljung L, Andersén H, Wennergren G, Bhatta L, Lindberg A, Lundbäck B, Kankaanranta H, Rönmark E, Nwaru BI. Interaction of smoking and social status on the risk of respiratory outcomes in a Swedish adult population: A Nordic Epilung study. Respir Med 2023; 211:107192. [PMID: 36906185 DOI: 10.1016/j.rmed.2023.107192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 02/19/2023] [Accepted: 03/03/2023] [Indexed: 03/11/2023]
Abstract
BACKGROUND Evidence abounds on the independent roles of social class and smoking in relation to obstructive airway diseases, but data are sparse on the impact of their interaction. We evaluated whether and to what extent social class and smoking interact in relation to risk of respiratory diseases in adults. METHODS Data from the population-based studies, West Sweden Asthma Study (WSAS, n = 23,753) and Obstructive Lung Disease in Northern Sweden studies (OLIN, n = 6519), were used, constituting randomly selected adults aged 20-75 years. Bayesian network analysis was used to estimate the probability for the interaction between smoking and socioeconomic status in relation to respiratory outcomes. RESULTS Occupational and educational SES modified the association between smoking and the probability of allergic and non-allergic asthma. Former smokers who were at intermediate non manual employees and manual workers in service had higher probability of allergic asthma compared to professionals and executives. Furthermore, former smokers with primary education had higher probability of non-allergic asthma than those with secondary and tertiary education. Similarly, former smokers among professionals and executives had higher probability of non-allergic asthma than manual and home workers and primary educated. Likewise, allergic asthma due to former smoking was higher among highly educated compared to low educated. CONCLUSIONS Beyond their independent roles, socioeconomic status and smoking interact in defining the risk of respiratory diseases. Clearer understanding of this interaction can help to identify population subgroups at most need of public health interventions.
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Affiliation(s)
| | - Rani Basna
- Krefting Research Centre, University of Gothenburg, Gothenburg, Sweden
| | - Linnea Hedman
- Department of Public Health and Clinical Medicine, Section of Sustainable Health/ the OLIN Unit, Umeå University, Umeå, Sweden
| | - Helena Backman
- Department of Public Health and Clinical Medicine, Section of Sustainable Health/ the OLIN Unit, Umeå University, Umeå, Sweden
| | - Linda Ekerljung
- Krefting Research Centre, University of Gothenburg, Gothenburg, Sweden
| | - Heidi Andersén
- Faculty of Medicine and Health Technology, Tampere University Respiratory Research Group, Tampere University, Tampere, Finland; Oncology Unit, Vaasa Keskussairaala, Vaasa, Finland
| | - Göran Wennergren
- Department of Paediatrics, University of Gothenburg, Queen Silvia Children's Hospital, Gothenburg, Sweden
| | - Laxmi Bhatta
- K.G. Jebsen Center for Genetic Epidemiology, Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - Anne Lindberg
- Department of Public Health and Clinical Medicine, Section of Medicine/the OLIN Unit, Umeå University, Umeå, Sweden
| | - Bo Lundbäck
- Krefting Research Centre, University of Gothenburg, Gothenburg, Sweden
| | - Hannu Kankaanranta
- Krefting Research Centre, University of Gothenburg, Gothenburg, Sweden; Department of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland; Tampere University Respiratory Research Group, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Eva Rönmark
- Department of Public Health and Clinical Medicine, Section of Sustainable Health/ the OLIN Unit, Umeå University, Umeå, Sweden
| | - Bright I Nwaru
- Krefting Research Centre, University of Gothenburg, Gothenburg, Sweden; Wallenberg Centre for Molecular and Translational Medicine, University of Gothenburg, Gothenburg, Sweden
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Occupational cold exposure in relation to incident airway symptoms in northern Sweden: a prospective population-based study. Int Arch Occup Environ Health 2022; 95:1871-1879. [PMID: 35641664 PMCID: PMC9630183 DOI: 10.1007/s00420-022-01884-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 05/10/2022] [Indexed: 11/24/2022]
Abstract
Objective To determine if occupational exposure to cold environments is associated with incident airway symptoms in previously healthy workers. Methods A prospective, survey-based, closed-cohort study was conducted on a sample of 5017 men and women between 18 and 70 years of age, living in northern Sweden. Data on occupation, occupational and leisure-time cold exposure, airway symptoms, general health, and tobacco habits were collected during the winters of 2015 (baseline) and 2021 (follow-up). Stepwise multiple logistic regression was used to determine associations between baseline variables and incident airway symptoms. Results For individuals working at baseline, without physician-diagnosed asthma or chronic obstructive pulmonary disease, reporting any occupational cold exposure was associated with incident wheeze (OR 1.41; 95% CI 1.06–1.87) and incident productive cough (OR 1.37; 95% CI 1.06–1.77), but not incident long-standing cough (OR 0.98; 95% CI 0.74–1.29), after adjusting for age, body mass index, daily smoking, and occupational physical workload. Detailed analysis of the occupational cold exposure rating did not reveal clear exposure–response patterns for any of the outcomes. Conclusions Occupational cold exposure was robustly associated with incident wheeze and productive cough in previously healthy workers. This adds further support to the notion that cold air is harmful for the airways, and that a structured risk assessment regarding occupational cold exposure could be considered for inclusion in the Swedish workplace legislation. Further studies are needed to elaborate on exposure–response functions, as well as suggest thresholds for hazardous cold exposure. Supplementary Information The online version contains supplementary material available at 10.1007/s00420-022-01884-2.
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Determinants in the Underdiagnosis of COPD in Spain-CONOCEPOC Study. J Clin Med 2022; 11:jcm11092670. [PMID: 35566796 PMCID: PMC9105961 DOI: 10.3390/jcm11092670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 04/27/2022] [Accepted: 05/06/2022] [Indexed: 11/24/2022] Open
Abstract
Factors such as seeking medical attention for respiratory symptoms and health professionals ordering spirometry come into play in the underdiagnosis of chronic obstructive pulmonary disease (COPD). The objective of this study was to analyze seeking medical attention and the use of spirometry in individuals with chronic respiratory symptoms and to compare these results with those obtained in the 2005 and 2011 surveys. Material and Methods: A cross-sectional, observational, epidemiological study was conducted via phone interview in December 2020 in Spain, with a representative sample from 17 autonomous communities. The study design was identical to that of the studies carried out in 2005 and 2011 to evaluate the changes that have occurred in seeking medical attention and performing spirometry in Spain, as well as the variability between autonomous communities. Results: From 89,601 phone contacts, a total of 6534 respondents were obtained. A total of 24.8% reported having some chronic respiratory symptom, and 17.9% reported a respiratory disease. Only 51.6% of those who had some chronic respiratory symptom had seen their doctor, which was less likely among current smokers (OR: 0.599, 95% CI: 0.467−0.769, p < 0.001) and those living in a rural setting (OR: 0.797, 95% CI: 0.651−0.975, p = 0.027). A total of 68.7% of the individuals who saw a doctor reported having undergone spirometry, most frequently males (OR: 1.535, 95% CI: 2.074−1.136, p < 0.005), former smokers (OR: 1.696, 95% CI: 2.407−1.195, p < 0.003), and those seen by a pulmonologist (OR: 6.151, 95% CI: 8.869−4.265, p < 0.001). With respect to the 2005 survey, more frequent use of spirometry has been observed (42.6 vs. 68.7%), without any change in seeking medical attention for respiratory symptoms. There is a clear variability according to the autonomous community (p < 0.05). Conclusions: Many individuals with chronic respiratory symptoms do not seek medical attention and although the use of spirometry has increased in the past 15 years, it is still an important area that needs improving in the primary care setting, especially among women. Both of these factors can be determinants in the underdiagnosis of COPD and its variability between autonomous communities.
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González-Pérez R, Poza-Guedes P, Pineda F, Castillo M, Sánchez-Machín I. Storage Mite Precision Allergy Molecular Diagnosis in the Moderate-to-Severe T2-High Asthma Phenotype. Int J Mol Sci 2022; 23:ijms23084297. [PMID: 35457116 PMCID: PMC9030016 DOI: 10.3390/ijms23084297] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 04/05/2022] [Accepted: 04/11/2022] [Indexed: 12/30/2022] Open
Abstract
Storage mites (SM) may induce allergic respiratory symptoms in sensitized individuals, in both rural and urban settings. The relationship among specific IgE reactions to determined groups of SM allergens in the coincident asthma pheno-endotypes has not yet been investigated. We aimed to study a Precision Allergy Molecular Diagnosis (PAMD@) model to depict the SM molecular profile in individuals presenting with Type-2 inflammation, in two different (moderate and severe) asthma phenotypes. A customized PAMD@ panel, including SM allergens and their concurrent protein allergenic characterization was investigated. Mite group 2 allergens were most frequently recognized, including Lep d 2 (83.45%), followed by Gly d 2 (69.17%) and Tyr p 2 (47,37%), in 133/164 asthmatic subjects. Blo t 5 and Blo t 21 exhibited significant higher titres in both asthma groups. Although relevant mite group 2 allergens cross-reactivity is suggested, individualized sensitization patterns were relevantly identified. The present PAMD@ panel confirmed the dominance of mite group 2 allergens in moderate-to-severe T2 asthmatics. A broadly heterogeneous molecular repertoire of SM allergens was found in all subjects, regardless of their asthma severity. Blomia tropicalis deserves special attention in certain territories, as diagnostic and/or therapeutic approaches merely based on Pyroglyphidae mites may be insufficient.
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Affiliation(s)
- Ruperto González-Pérez
- Allergy Department, Hospital Universitario de Canarias, 38320 Tenerife, Spain; (P.P.-G.); (I.S.-M.)
- Severe Asthma Unit, Hospital Universitario de Canarias, 38320 Tenerife, Spain
- Correspondence: ; Tel.: +34-922-677237
| | - Paloma Poza-Guedes
- Allergy Department, Hospital Universitario de Canarias, 38320 Tenerife, Spain; (P.P.-G.); (I.S.-M.)
- Severe Asthma Unit, Hospital Universitario de Canarias, 38320 Tenerife, Spain
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Liu Y, Chang X, Liang L, Hou Z, Lu Y. A comparative study of the RuiBreath and NIOX VERO analyzers for detecting fractional exhaled nitric oxide. J Thorac Dis 2021; 13:4418-4426. [PMID: 34422368 PMCID: PMC8339745 DOI: 10.21037/jtd-21-25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 06/23/2021] [Indexed: 11/26/2022]
Abstract
Background Fractional exhaled nitric oxide (FeNO) measurement is a reliable, noninvasive marker of airway inflammation. Portable FeNO analyzers facilitate the assessment of airway inflammation in primary care. Differences between analyzers from different manufacturers are not comparable. Here, we aimed to compare the FeNO values obtained by a new portable device (RuiBreath, Guangzhou Ruipu Medical Technology Co., Ltd, Guangzhou, China) to those obtained by the widely used NIOX VERO portable analyzer (Aerocrine AB, Solna, Sweden) in patients with asthma. Methods This prospective validation study enrolled patients (≥14 years old) with asthma over a 2-month period (July and August 2019) at the Beijing Chao-Yang Hospital. At least one valid FeNO measurement was obtained using each analyzer for all the participants. Results There were 197 participants in this study. The FeNONIOX and FeNORuiBreath values significantly differed (P=0.016). After log-transformation, a difference was found only when the FeNONIOX was <25 ppb (P<0.001). The FeNONIOX and FeNORuiBreath values had a significant correlation (r=0.938, P<0.001), which was confirmed by the Altman-Bland plot. Using a receiver-operating characteristic curve analysis, when using 49 ppb as the cut-off point for the two devices in identifying patients with symptomatic asthma symptoms, the sensitivity and specificity were 0.42 and 0.88, respectively, by NIOX, and 0.40 and 0.89, respectively, by RuiBreath. Conclusions This is the first report of FeNO values obtained by the new portable RuiBreath FeNO analyzer. The FeNORuiBreath values are reliable and directly comparable with the FeNONIOX values.
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Affiliation(s)
- Yalan Liu
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Xiaohong Chang
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Lirong Liang
- Clinical Epidemiology and Tobacco Dependence Treatment Research Department, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Zhaoshen Hou
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Yong Lu
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
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Asthma increased in young adults from 2008-2016 despite stable allergic rhinitis and reduced smoking. PLoS One 2021; 16:e0253322. [PMID: 34166402 PMCID: PMC8224942 DOI: 10.1371/journal.pone.0253322] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 06/03/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Studies have produced inconsistent results on prevalence trends in asthma and allergic rhinitis (AR). We surveyed young adults about asthma in 2008 and 2016 and examined the impact of gender, AR and smoking. METHODS Thirty-thousand randomly selected subjects aged 16-75 years in Western Sweden received postal questionnaires in 2008 and 50,000 in 2016. This study is based on responders aged 16-25 years, 2,143 in 2008 and 2,484 in 2016. RESULTS From 2008-2016 current asthma increased from 9.3% to 11.5% (p = 0.014) and was significant in males without AR (aOR 1.83, 95% CI 1.09-3.07) and male smokers (aOR 3.02, 95% CI 1.12-8.13). In both years the risk of current asthma was reduced by growing up on a farm (aOR 0.26, 95% CI 0.81-0.84 and aOR 0.47, 95% CI 0.23-0.996), independent of a family history of asthma or allergy. AR did not differ significantly from 2008-2016 (22.5% vs 24.4%, p = 0.144). Current smoking decreased from 20.3% to 15.2% (p<0.001), especially in females (23.5% to 16.2%, p<0.001). Female smokers started smoking later and smoked fewer cigarettes in 2016 than 2008. In 2016, 4.8% of the cohort reported using electronic cigarettes. Of those, 60.7% also smoked tobacco and more than two-thirds who used both (67.2%) were heavy smokers. CONCLUSION Current asthma increased in respondents aged 16-25 from 2008-2016, mainly among males without AR and male smokers. Current AR levelled off in this young population, while current smoking decreased among females.
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Andersén H, Ilmarinen P, Honkamäki J, Tuomisto LE, Piirilä P, Hisinger-Mölkänen H, Sovijärvi A, Backman H, Lundbäck B, Rönmark E, Lehtimäki L, Kankaanranta H. Dyspnea has an association with lifestyle: differences between Swedish and Finnish speaking persons in Western Finland. Eur Clin Respir J 2020; 8:1855702. [PMID: 33343838 PMCID: PMC7733976 DOI: 10.1080/20018525.2020.1855702] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background Difference in dyspnea mMRC ≥2 between Finnish speaking and Swedish-speaking populations in Finland has not been previously studied. Methods In February 2016, a respiratory questionnaire was sent to 8000 randomly selected subjects aged 20–69 years in western Finland with a response rate of 52.3%. The registered native language of each subject determined whether questionnaire in Finnish or Swedish was applied. Multiple logistic regression was performed to calculate Odds Ratios (OR) with 95% CI for the simultaneous effects of independent variables on dyspnea mMRC ≥2. Results Of all participants, 2780 (71.9%) were Finnish speakers and 1084 (28.1%) were Swedish speakers. Finnish speakers had a higher prevalence of dyspnea mMRC ≥2 (11.1% vs 6.5% p < 0.001) when compared to Swedish speakers. Finnish speakers smoked more often, had higher BMI, spent less time moving during the day, had more often occupational exposure to vapours, gases, dusts or fumes (VGDF), and had lower socioeconomic status based on occupation. Significant risk factors for dyspnea mMRC ≥2 were COPD (OR = 10.94), BMI >35 (OR = 9.74), asthma (OR = 4.78), female gender (OR = 2.38), older age (OR = 2.20), current smoking (OR = 1.59), and occupational exposure to VGDF (OR = 1.47). Conclusions Swedish speakers had less dyspnea mMRC ≥2 which is explained by a healthier lifestyle. Smoking, obesity, and occupational exposures should be in focus to improve respiratory health.
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Affiliation(s)
- Heidi Andersén
- Thoracic Oncology Unit, Tema Cancer, Karolinska University Hospital, Stockholm, Sweden.,Department of Respiratory Medicine, Vaasa Central Hospital, Vaasa, Finland.,Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Pinja Ilmarinen
- Department of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland
| | - Jasmin Honkamäki
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Leena E Tuomisto
- Department of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland
| | - Päivi Piirilä
- Unit of Clinical Physiology, Department of Clinical Physiology and Nuclear Medicine, HUS Medical Imaging Center, Helsinki University Central Hospital, Helsinki, Finland.,Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | | | - Anssi Sovijärvi
- Unit of Clinical Physiology, Department of Clinical Physiology and Nuclear Medicine, HUS Medical Imaging Center, Helsinki University Central Hospital, Helsinki, Finland.,Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Helena Backman
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Bo Lundbäck
- Department of Internal Medicine, Krefting Research Center, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Eva Rönmark
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Lauri Lehtimäki
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Allergy Centre, Tampere University Hospital, Tampere, Finland
| | - Hannu Kankaanranta
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Department of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland.,Department of Internal Medicine, Krefting Research Center, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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9
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Schyllert C, Lindberg A, Hedman L, Stridsman C, Andersson M, Ilmarinen P, Piirilä P, Krokstad S, Lundbäck B, Rönmark E, Backman H. Low socioeconomic status relates to asthma and wheeze, especially in women. ERJ Open Res 2020; 6:00258-2019. [PMID: 32963998 PMCID: PMC7487352 DOI: 10.1183/23120541.00258-2019] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 05/31/2020] [Indexed: 11/05/2022] Open
Abstract
Low socioeconomic status (SES) has been associated with asthma and wheezing. Occupational group, educational level and income are commonly used indicators for SES, but no single indicator can illustrate the entire complexity of SES. The aim was to investigate how different indicators of SES associate with current asthma, allergic and nonallergic, and asthmatic wheeze. In 2016, a random sample of the population aged 20-79 years in Northern Sweden were invited to a postal questionnaire survey, with 58% participating (n=6854). The survey data were linked to the national Integrated Database for Labour Market Research by Statistics Sweden for the previous calendar year, 2015. Included SES indicators were occupation, educational level and income. Manual workers had increased risk for asthmatic wheeze, and manual workers in service for current asthma, especially allergic asthma. Primary school education associated with nonallergic asthma, whereas it tended to be inversely associated with allergic asthma. Low income was associated with asthmatic wheeze. Overall, the findings were more prominent among women, and interaction analyses between sex and income revealed that women, but not men, with low income had an increased risk both for asthmatic wheeze and current asthma, especially allergic asthma. To summarise, the different indicators of socioeconomic status illustrated various aspects of associations between low SES and asthma and wheeze, and the most prominent associations were found among women.
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Affiliation(s)
- Christian Schyllert
- Dept of Public Health and Clinical Medicine, Section of Sustainable Health/the OLIN unit, Umeå University, Umeå, Sweden
| | - Anne Lindberg
- Dept of Public Health and Clinical Medicine, Division of Medicine, Umeå University, Umeå, Sweden
| | - Linnea Hedman
- Dept of Public Health and Clinical Medicine, Section of Sustainable Health/the OLIN unit, Umeå University, Umeå, Sweden.,Dept of Health Sciences, Division of Nursing, Luleå University of Technology, Luleå, Sweden
| | - Caroline Stridsman
- Dept of Health Sciences, Division of Nursing, Luleå University of Technology, Luleå, Sweden
| | - Martin Andersson
- Dept of Public Health and Clinical Medicine, Section of Sustainable Health/the OLIN unit, Umeå University, Umeå, Sweden
| | - Pinja Ilmarinen
- Dept of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland
| | - Päivi Piirilä
- Unit of Clinical Physiology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Steinar Krokstad
- HUNT Research Centre, Dept of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Levanger, Norway
| | - Bo Lundbäck
- Krefting Research Centre, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Eva Rönmark
- Dept of Public Health and Clinical Medicine, Section of Sustainable Health/the OLIN unit, Umeå University, Umeå, Sweden
| | - Helena Backman
- Dept of Public Health and Clinical Medicine, Section of Sustainable Health/the OLIN unit, Umeå University, Umeå, Sweden.,Dept of Health Sciences, Division of Nursing, Luleå University of Technology, Luleå, Sweden
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10
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Backman H, Jansson SA, Stridsman C, Eriksson B, Hedman L, Eklund BM, Sandström T, Lindberg A, Lundbäck B, Rönmark E. Severe asthma-A population study perspective. Clin Exp Allergy 2020; 49:819-828. [PMID: 30817038 DOI: 10.1111/cea.13378] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 02/05/2019] [Accepted: 02/11/2019] [Indexed: 01/01/2023]
Abstract
BACKGROUND Severe asthma is a considerable challenge for patients, health-care professionals and society. Few studies have estimated the prevalence of severe asthma according to modern definitions of which none based on a population study. OBJECTIVE To describe characteristics and estimate the prevalence of severe asthma in a large adult population-based asthma cohort followed for 10-28 years. METHODS N = 1006 subjects with asthma participated in a follow-up during 2012-14, when 830 (mean age 59 years, 56% women) still had current asthma. Severe asthma was defined according to three internationally well-known criteria: the ATS workshop definition from 2000 used in the US Severe Asthma Research Programme (SARP), the 2014 ATS/ERS Task force definition and the GINA 2017. All subjects with severe asthma according to any of these criteria were undergoing respiratory specialist care and were also contacted by telephone to verify treatment adherence. RESULTS The prevalence of severe asthma according to the three definitions was 3.6% (US SARP), 4.8% (ERS/ATS Taskforce), and 6.1% (GINA) among subjects with current asthma. Although all were using high ICS doses and other maintenance treatment, >90% did not have controlled asthma according to the asthma control test. Severe asthma was related to age >50 years, nasal polyposis, impaired lung function, sensitization to aspergillus, and tended to be more common in women. Further, neutrophils in blood significantly discriminated severe asthma from other asthma. CONCLUSIONS AND CLINICAL RELEVANCE Severe asthma differed significantly from other asthma in terms of demographic, clinical and inflammatory characteristics, results suggesting possibilities for improved treatment regimens of severe asthma. The prevalence of severe asthma in this asthma cohort was 4%-6%, corresponding to approximately 0.5% of the general population.
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Affiliation(s)
- Helena Backman
- Section of Sustainable Health, The OLIN Unit, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Sven-Arne Jansson
- Section of Sustainable Health, The OLIN Unit, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Caroline Stridsman
- Department of Health Sciences, Luleå University of Technology, Luleå, Sweden
| | - Berne Eriksson
- Krefting Research Centre, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.,Deparment of Internal Medicine, Central County Hospital of Halland, Halmstad, Sweden
| | - Linnea Hedman
- Section of Sustainable Health, The OLIN Unit, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Britt-Marie Eklund
- Section of Sustainable Health, The OLIN Unit, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Thomas Sandström
- Section of Medicine, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Anne Lindberg
- Section of Medicine, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Bo Lundbäck
- Section of Sustainable Health, The OLIN Unit, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.,Krefting Research Centre, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Eva Rönmark
- Section of Sustainable Health, The OLIN Unit, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
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11
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Räisänen P, Hedman L, Andersson M, Stridsman C, Lindberg A, Lundbäck B, Rönmark E, Backman H. Non-response did not affect prevalence estimates of asthma and respiratory symptoms - results from a postal questionnaire survey of the general population. Respir Med 2020; 173:106017. [PMID: 33190739 DOI: 10.1016/j.rmed.2020.106017] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 05/06/2020] [Accepted: 05/08/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND A high participation rate is warranted in order to ensure validity in surveys of the general population. However, participation rates in such studies have declined during the last decades. OBJECTIVE To evaluate the reasons for and potential effects of non-response in a large population-based survey about asthma and respiratory symptoms in Northern Sweden. METHODS Within the Obstructive Lung Disease In Norrbotten (OLIN) studies, a random sample of 12,000 adults aged 20-79 was invited to a postal questionnaire survey about asthma, allergic rhino-conjunctivitis and respiratory symptoms in 2016. Three reminders were sent. A random sample of 500 non-responders was invited to a telephone interview. RESULTS The participation rate in the initial mailing was 41.4%, and 9.2%, 5.0%, and 2.6% in the subsequent three reminders and totally 58.3% (n = 6854) responded. Of 500 non-responders selected for telephone interviews, 320 were possible to reach and 272 participated. Male sex, younger age, and current smoking were associated with both late and non-response. The prevalence of asthma and most respiratory symptoms did not differ significantly between responders and non-responders while allergic rhino-conjunctivitis and smoking was more common among non-responders. Reminders increased the participation rate but did not alter risk ratios for smoking and occupational exposures. Reasons for non-response were mainly lack of time and having forgotten to answer. CONCLUSIONS With a response rate of 58.3%, neither the prevalence estimates of asthma, respiratory symptoms nor the associations to risk factors were affected by non-response, while allergic rhino-conjunctivitis and smoking was underestimated in this Swedish population.
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Affiliation(s)
- P Räisänen
- Department of Public Health and Clinical Medicine, Section of Sustainable Health/the OLIN Unit, Umeå University, Umeå, Sweden.
| | - L Hedman
- Department of Public Health and Clinical Medicine, Section of Sustainable Health/the OLIN Unit, Umeå University, Umeå, Sweden; Department of Health Sciences, Luleå University, Luleå, Sweden
| | - M Andersson
- Department of Public Health and Clinical Medicine, Section of Sustainable Health/the OLIN Unit, Umeå University, Umeå, Sweden
| | - C Stridsman
- Department of Public Health and Clinical Medicine, Section of Sustainable Health/the OLIN Unit, Umeå University, Umeå, Sweden
| | - A Lindberg
- Department of Public Health and Clinical Medicine, Section of Medicine/the OLIN Unit, Umeå University, Umeå, Sweden
| | - B Lundbäck
- Department of Public Health and Clinical Medicine, Section of Sustainable Health/the OLIN Unit, Umeå University, Umeå, Sweden; Krefting Research Centre, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - E Rönmark
- Department of Public Health and Clinical Medicine, Section of Sustainable Health/the OLIN Unit, Umeå University, Umeå, Sweden
| | - H Backman
- Department of Public Health and Clinical Medicine, Section of Sustainable Health/the OLIN Unit, Umeå University, Umeå, Sweden; Department of Health Sciences, Luleå University, Luleå, Sweden
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12
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FEV 1 decline in relation to blood eosinophils and neutrophils in a population-based asthma cohort. World Allergy Organ J 2020; 13:100110. [PMID: 32206161 PMCID: PMC7082214 DOI: 10.1016/j.waojou.2020.100110] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 12/13/2019] [Accepted: 02/17/2020] [Indexed: 12/13/2022] Open
Abstract
Background The relationship between lung function decline and eosinophils and neutrophils has important therapeutic implications among asthmatics, but it has rarely been studied in large cohort studies. Objective The aim is to study the relationship between blood eosinophils and neutrophils and FEV1 decline in a long-term follow-up of a population-based adult asthma cohort. Methods In 2012–2014, an adult asthma cohort was invited to a follow-up including spirometry, blood sampling, and structured interviews, and n = 892 participated (55% women, mean age 59 y, 32–92 y). Blood eosinophils, neutrophils and FEV 1 decline were analyzed both as continuous variables and divided into categories with different cut-offs. Regression models adjusted for smoking, exposure to vapors, gas, dust, or fumes (VGDF), use of inhaled and oral corticosteroids, and other possible confounders were utilized to analyze the relationship between eosinophils and neutrophils at follow-up and FEV1 decline. Results The mean follow-up time was 18 years, and the mean FEV 1 decline was 27 ml/year. The annual FEV1 decline was related to higher levels of both blood eosinophils and neutrophils at follow-up, but only the association with eosinophils remained when adjusted for confounders. Further, the association between FEV1 decline and eosinophils was stronger among those using ICS. With EOS <0.3 × 109/L as reference, a more rapid decline in FEV1 was independently related to EOS ≥0.4 × 109/L in adjusted analyses. Conclusions and clinical relevance Besides emphasizing the importance of smoking cessation and reduction of other harmful exposures, our real-world results indicate that there is an independent relationship between blood eosinophils and FEV1 decline among adults with asthma.
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Key Words
- ANOVA, Analysis of variance
- ATS, American Thoracic Society
- Asthma
- BMI, Body mass index
- Cohort
- ECRHS, European Community Respiratory Health Survey
- EOS, Eosinophils
- ERS, European Respiratory Society
- Eosinophils
- FEV1
- FEV1, Forced Expiratory Volume in 1 s
- FEV1pp, FEV1 percent of predicted
- FVC, Forced Expiratory Volume
- GLI, Global Lung function Initiative
- ICS, Inhaled corticosteroids
- IgE, Immunoglobulin E
- L, Liters
- Ml, Milliliters
- N, Number
- NEU, Neutrophils
- Neutrophils
- OCS, Oral corticosteroids
- OLIN, Obstructive Lung Disease in Northern Sweden
- OLS, Ordinary Least Squares
- VGDF, Vapors, gas, dust or fumes
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13
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Irewall T, Söderström L, Lindberg A, Stenfors N. High incidence rate of asthma among elite endurance athletes: a prospective 4-year survey. J Asthma 2020; 58:735-741. [PMID: 32077348 DOI: 10.1080/02770903.2020.1728769] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Objective: The prevalence of asthma among elite endurance athletes is high, but less is known about the incidence of asthma among athletes. The aim of this study was to examine the incidence rate of physician-diagnosed asthma among elite endurance athletes.Method: An annual postal questionnaire was sent to an open prospective cohort of elite endurance athletes between 2011 and 2015. Athletes from Swedish National teams, students at universities with elite sport partnership, and pupils at Swedish National elite sport schools, competing in cross-country skiing, biathlon, ski orienteering, or orienteering were invited (n = 666). Incidence rate of physician-diagnosed asthma was calculated among those without asthma at baseline (n = 449). Risk factors for incident physician-diagnosed asthma were identified using a multivariate logistic regression analysis.Results: Response rate was 88.7% (n = 591) at baseline. The median age of participants was 17 (range 15-36) years at inclusion. The study population included 407 (69%) skiers and 184 (31%) orienteers. The prevalence of asthma at baseline was 23.9% (n = 141). Incidence rate (95% confidence interval [CI]) of physician-diagnosed asthma was 61.2 (45.7-80.3) per 1,000 person-years. Risk factors (odds ratio [OR (95% CI)]) for incident physician-diagnosed asthma were family history of asthma (1.97 [1.04-3.68]), being a skier (3.01 [1.42-7.21]), and wheezing without having a cold (4.15 [1.81-9.26]).Conclusion: The incidence rate of physician-diagnosed asthma is high among Swedish elite endurance athletes.
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Affiliation(s)
- Tommie Irewall
- Department of Public Health and Clinical Medicine, Unit of Research and Development - Östersund, Umeå University, Sweden
| | - Lars Söderström
- Unit of Research, Development and Education, Region Jämtland Härjedalen, Östersund Hospital, Östersund, Sweden
| | - Anne Lindberg
- Department of Public Health and Clinical Medicine, Division of Medicine, Umeå University, Sweden
| | - Nikolai Stenfors
- Department of Public Health and Clinical Medicine, Umeå University, Östersund, Sweden
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14
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Pindus M, Orru H, Jõgi R. Change in the symptom profile treated as asthma - two cross-sectional studies twenty years apart. Respir Res 2020; 21:41. [PMID: 32013984 PMCID: PMC6998351 DOI: 10.1186/s12931-020-1308-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 01/29/2020] [Indexed: 11/10/2022] Open
Abstract
AIMS The aims of the study were to investigate prevalence trends of respiratory symptoms, asthma and asthma treatment among young adults in Estonia and to estimate changes in symptom profile among subjects who self-report asthma attacks or use asthma medications. METHODS Two similar questionnaires on respiratory health were sent to subjects in Tartu, Estonia, aged between 20 and 44 years; first in 1993/94, and then in 2014/15. To study the impact of different respiratory symptoms on asthma diagnosis and treatment, the log-binomial regression was used to estimate the association between 'attack of asthma' (as a proxy for current asthma) and respiratory symptoms as well as asthma treatment and respiratory symptoms, adjusted for age, sex and smoking history. RESULTS Self-reported prevalence of asthma attack, asthma medication use and nasal allergies increased over the twenty years between studies, whereas there was no change in prevalence of asthma-related symptoms, and the prevalence of most respiratory symptoms either decreased, or remained unchanged. For women experiencing asthma attacks, the prevalence of nasal allergies increased and waking with chest tightness decreased. For men using asthma medication, the prevalence of a wheeze without a cold decreased. Women using asthma medication reported decreased prevalence of waking with chest tightness. CONCLUSION Self-reported asthma attacks and asthma medication use has increased in last 20 years, while the prevalence of most respiratory symptoms either decreased or did not change. It is likely that changes in asthma symptom profile have had an impact on the prevalence of asthma and asthma treatment.
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Affiliation(s)
- Mihkel Pindus
- Institute of Family Medicine and Public Health, University of Tartu, Ravila 19, 50411, Tartu, Estonia
| | - Hans Orru
- Institute of Family Medicine and Public Health, University of Tartu, Ravila 19, 50411, Tartu, Estonia. .,Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, Umeå University, SE-901 87, Umeå, Sweden.
| | - Rain Jõgi
- Lung Clinic, Tartu University Hospital, Riia 167, 51014, Tartu, Estonia
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15
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Osei AD, Mirbolouk M, Orimoloye OA, Dzaye O, Uddin SMI, Dardari ZA, DeFilippis AP, Bhatnagar A, Blaha MJ. The association between e-cigarette use and asthma among never combustible cigarette smokers: behavioral risk factor surveillance system (BRFSS) 2016 & 2017. BMC Pulm Med 2019; 19:180. [PMID: 31619218 PMCID: PMC6796489 DOI: 10.1186/s12890-019-0950-3] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 09/25/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND E-cigarette use prevalence has grown rapidly in the US. Despite the popularity of these products, few acute exposure toxicity studies exist, and studies on long-term pulmonary health effects are limited. E-cigarette users who are never combustible cigarette smokers (sole users) constitute a unique group of young adults that may be at increased risk of bronchial hyperreactivity and development of asthma. Given the public health concern about the potential pulmonary health effects of sole e-cigarette use, we aimed to examine the association between e-cigarette use and asthma among never combustible cigarette smokers. METHODS We pooled 2016 and 2017 data of the Behavioral Risk Factor Surveillance System (BRFSS), a large, cross-sectional telephone survey of adults aged 18 years and older in the U.S. We included 402,822 participants without any history of combustible cigarette smoking (defined as lifetime smoking < 100 cigarettes) and with complete self-reported information on key variables. Current e-cigarette use, further classified as daily or occasional use, was the primary exposure. The main outcome, asthma, was defined as self-reported history of asthma. We assess the relationship of sole e-cigarette use with asthma using multivariable logistic regression adjusting for age, sex, race, income, level of education and body mass index. RESULTS Of 402,822 never combustible cigarette smokers, there were 3103 (0.8%) current e-cigarette users and 34,074 (8.5%) with asthma. The median age group of current e-cigarette users was 18-24 years. Current e-cigarette use was associated with 39% higher odds of self-reported asthma compared to never e-cigarette users (Odds Ratio [OR], 1.39; 95% confidence interval: 1.15, 1.68). There was a graded increased odds of having asthma with increase of e-cigarette use intensity. The odds ratio of self-reported asthma increased from 1.31 (95% confidence interval: 1.05, 1.62) in occasional users to 1.73 (95% confidence interval: 1.21, 2.48) in daily e-cigarette users, compared to never e-cigarette users. CONCLUSION Our findings from a large, nationally representative survey suggest increased odds of asthma among never combustible smoking e-cigarette users. This may have potential public health implications, providing a strong rationale to support future longitudinal studies of pulmonary health in young e-cigarette-using adults.
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Affiliation(s)
- Albert D Osei
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, TX, USA.
- Johns Hopkins University, Carnegie 583 JHH, 600 N Wolfe St, Baltimore, MD, 21287, USA.
| | - Mohammadhassan Mirbolouk
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, TX, USA
- Johns Hopkins University, Carnegie 583 JHH, 600 N Wolfe St, Baltimore, MD, 21287, USA
| | - Olusola A Orimoloye
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, TX, USA
- Johns Hopkins University, Carnegie 583 JHH, 600 N Wolfe St, Baltimore, MD, 21287, USA
| | - Omar Dzaye
- Johns Hopkins University, Carnegie 583 JHH, 600 N Wolfe St, Baltimore, MD, 21287, USA
- Department of Radiology and Neuroradiology, Charité, Berlin, Germany
| | - S M Iftekhar Uddin
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, TX, USA
- Johns Hopkins University, Carnegie 583 JHH, 600 N Wolfe St, Baltimore, MD, 21287, USA
| | - Zeina A Dardari
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, TX, USA
- Johns Hopkins University, Carnegie 583 JHH, 600 N Wolfe St, Baltimore, MD, 21287, USA
| | - Andrew P DeFilippis
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, TX, USA
- University of Louisville, Louisville, KY, USA
| | - Aruni Bhatnagar
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, TX, USA
- University of Louisville, Louisville, KY, USA
| | - Michael J Blaha
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, TX, USA
- Johns Hopkins University, Carnegie 583 JHH, 600 N Wolfe St, Baltimore, MD, 21287, USA
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16
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Borna E, Nwaru BI, Bjerg A, Mincheva R, Rådinger M, Lundbäck B, Ekerljung L. Changes in the prevalence of asthma and respiratory symptoms in western Sweden between 2008 and 2016. Allergy 2019; 74:1703-1715. [PMID: 31021427 DOI: 10.1111/all.13840] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 02/06/2019] [Accepted: 02/18/2019] [Indexed: 01/22/2023]
Abstract
BACKGROUND Asthma is a common chronic inflammatory disease of the airways, with a noticeable increase in prevalence during the second half of the 20th century. Recent studies assessing the prevalence trends among adults have been inconsistent. We investigated the changes in the prevalence of asthma, respiratory symptoms, and risk factors between 2008 and 2016 in western Sweden. METHODS The West Sweden Asthma Study (WSAS) is a population-based study which started in 2008 (WSAS I) and then repeated in 2016 (WSAS II) in western Sweden. Randomly selected individuals aged 16-75 years (N = 18 087 in 2008 and N = 24 534 in 2016) completed a questionnaire regarding obstructive lung diseases, respiratory symptoms, potential risk factors, and also questions from the GA2 LEN survey. RESULTS The prevalence of reported ever asthma, physician-diagnosed asthma, use of asthma medication, and current asthma increased significantly from 9.6% to 11%, 8.3% to 10%, 8.6% to 9.8%, and 8.1% to 9.1%, respectively, between 2008 and 2016. There were also increases in the prevalence of respiratory symptoms during the same period. The greatest increase occurred in young adults aged 16-25 years. Female gender, allergic rhinitis, obesity, and family history of asthma remained the strongest risk factors for asthma in 2016 as it was in 2008. CONCLUSION There were moderate increases in asthma and respiratory symptoms in adults in western Sweden between 2008 and 2016, the greatest increase occurring in younger adults. The potential risk factors for asthma remained the same during the study period.
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Affiliation(s)
- Eivind Borna
- Department of Internal Medicine and Clinical Nutrition, Krefting Research Centre, Institute of Medicine Sahlgrenska Academy, University of Gothenburg Gothenburg Sweden
| | - Bright I. Nwaru
- Department of Internal Medicine and Clinical Nutrition, Krefting Research Centre, Institute of Medicine Sahlgrenska Academy, University of Gothenburg Gothenburg Sweden
- Wallenberg Center for Molecular and Translational Medicine University of Gothenburg Gothenburg Sweden
| | - Anders Bjerg
- Department of Internal Medicine and Clinical Nutrition, Krefting Research Centre, Institute of Medicine Sahlgrenska Academy, University of Gothenburg Gothenburg Sweden
- Astrid Lindgren Children’s Hospital Karolinska University Hospital Stockholm Sweden
- Department of Women´s and Children´s Health Karolinska Institutet Stockholm Sweden
| | - Roxana Mincheva
- Department of Internal Medicine and Clinical Nutrition, Krefting Research Centre, Institute of Medicine Sahlgrenska Academy, University of Gothenburg Gothenburg Sweden
- Respiratory Medicine & Allergology Department Sahlgrenska University Hospital Gothenburg Sweden
| | - Madeleine Rådinger
- Department of Internal Medicine and Clinical Nutrition, Krefting Research Centre, Institute of Medicine Sahlgrenska Academy, University of Gothenburg Gothenburg Sweden
| | - Bo Lundbäck
- Department of Internal Medicine and Clinical Nutrition, Krefting Research Centre, Institute of Medicine Sahlgrenska Academy, University of Gothenburg Gothenburg Sweden
| | - Linda Ekerljung
- Department of Internal Medicine and Clinical Nutrition, Krefting Research Centre, Institute of Medicine Sahlgrenska Academy, University of Gothenburg Gothenburg Sweden
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17
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Hisinger-Mölkänen H, Pallasaho P, Haahtela T, Lindqvist A, Sovijärvi A, Piirilä P. The increase of asthma prevalence has levelled off and symptoms decreased in adults during 20 years from 1996 to 2016 in Helsinki, Finland. Respir Med 2019; 155:121-126. [PMID: 31344661 DOI: 10.1016/j.rmed.2019.07.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Revised: 07/11/2019] [Accepted: 07/12/2019] [Indexed: 01/17/2023]
Abstract
BACKGROUND Mortality and hospitalization due to asthma have decreased in many European countries, but asthma symptoms still cause a lot of morbidity and costs. OBJECTIVES We evaluated prevalence trends of asthma, asthma symptoms and allergic rhinoconjunctivitis in adults aged 20-69 years during a 20-year period from 1996 to 2016 in the city of Helsinki, the capital of Finland. METHODS Three cross-sectional postal surveys were conducted in random population samples 10 years apart. In 1996, 2006 and 2016, a total of 6062 (response rate 75.9%), 2449 (61.9%) and 4026 subjects (50.3%) took part, respectively. RESULTS In all responders, the prevalence of physician-diagnosed asthma was 6.6% in 1996, 10% in 2006 and 10.9% in 2016. The prevalence increased from 1996 to 2006, but stabilized from 2006 to 2016, both in men and women and in smokers and non-smokers. The prevalence of current asthma (8.5% in 2006 and 8.8% in 2016) and of asthma with rhinoconjunctivitis (7.6% in 2006 and 7.5% in 2016) remained also at the same level. Allergic rhinoconjunctivitis decreased significantly from 2006 (42.7%) to 2016 (39.0%, p = 0.004). Those with physician diagnosed asthma reported significantly less symptoms in 2016 compared to 2006 and 1996, although there was no change in smoking habits or medication use. Young asthmatics (20-29 years) without rhinoconjunctivitis reported least symptoms. CONCLUSION Previously observed increase of physician-diagnosed asthma prevalence in adults seems to be levelling off in Helsinki, and patients have fewer symptoms than 20 years ago. In addition, allergic rhinoconjunctivitis is less frequent than 10 years earlier. (247 words).
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Affiliation(s)
| | | | - Tari Haahtela
- Skin and Allergy Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Ari Lindqvist
- Clinical Research Unit of Pulmonary Diseases, Helsinki University Hospital, Helsinki, Finland
| | - Anssi Sovijärvi
- HUS Medical Imaging Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Päivi Piirilä
- Unit of Clinical Physiology, HUS Medical Imaging Center, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
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18
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The relation of environmental tobacco smoke (ETS) to chronic bronchitis and mortality over two decades. Respir Med 2019; 154:34-39. [DOI: 10.1016/j.rmed.2019.06.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 06/07/2019] [Accepted: 06/08/2019] [Indexed: 01/15/2023]
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19
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Razzaq S, Nafees AA, Rabbani U, Irfan M, Naeem S, Khan MA, Fatmi Z, Burney P. Epidemiology of asthma and associated factors in an urban Pakistani population: adult asthma study-Karachi. BMC Pulm Med 2018; 18:184. [PMID: 30514250 PMCID: PMC6278017 DOI: 10.1186/s12890-018-0753-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 11/26/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study was conducted in order to determine the prevalence of asthma and associated risk factors in the adult population of Karachi, Pakistan. METHODS This multi-stage, cross-sectional survey was conducted from May 2014-August 2015; comprising 1629 adults in 75 randomly selected clusters in Karachi, Pakistan. Definitions included: 'self-reported asthma', 'reversibility in FEV1' and 'respiratory symptoms and reversibility in FEV1'. RESULTS Prevalence of asthma was 1.8% (self-reported) (95% CI: 1.0-2.6), 11.3% (reversibility in FEV1) (95% CI: 9.4-13.3) and 6.6% (symptoms and reversibility in FEV1) (95% CI: 5.1-8.1). Asthmatics were more likely to belong to the age group ≥38 years according to 'reversibility in FEV1' and 'respiratory symptoms and reversibility in FEV1' (AOR: 1.9, 95% CI: 1.2-3.3) and (AOR: 2.1, 95% CI: 1.1-4.2), respectively. Asthmatics were more likely to report history of allergies (AOR: 1.9, 95% CI: 1.2-2.9) and (AOR: 2.8, 95% CI: 1.7-4.8); and were exposed to environmental tobacco smoke (AOR: 1.6, 95% CI: 1.1-2.5) and (AOR: 1.9, 95% CI: 1.1-3.3) according to 'reversibility in FEV1' and 'respiratory symptoms and reversibility in FEV1', respectively. Asthmatics were more likely to report pack years of smoking ≥5 (AOR: 2.3, 95% CI: 1.1-4.7) according to 'respiratory symptoms and reversibility in FEV1'. CONCLUSION This study reports a high prevalence of asthma among Pakistani adults and calls for developing appropriate public health policies for prevention and control of asthma in the country. Further studies should be conducted to determine the national prevalence as well as follow-up studies to identify preventable causes for adult asthma.
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Affiliation(s)
- Shama Razzaq
- Department of Community Health Sciences, Aga Khan University, Stadium Road, P.O. Box-3500, Karachi, 74800 Pakistan
| | - Asaad Ahmed Nafees
- Department of Community Health Sciences, Aga Khan University, Stadium Road, P.O. Box-3500, Karachi, 74800 Pakistan
- Population Health and Occupational Disease, National Heart and Lung Institute (NHLI), Imperial College London, London, UK
| | - Unaib Rabbani
- Saudi Board Family Medicine, Ministry of Health, Buraidah, Kingdom of Saudi Arabia
| | - Muhammad Irfan
- Department of Medicine, Section of Pulmonology, Aga Khan University, Karachi, Pakistan
| | - Shahla Naeem
- Department of Community Health Sciences, Aga Khan University, Stadium Road, P.O. Box-3500, Karachi, 74800 Pakistan
- Department of Community Health Sciences, Ziauddin University, Karachi, Pakistan
| | - Muhammad Arslan Khan
- Department of Community Health Sciences, Aga Khan University, Stadium Road, P.O. Box-3500, Karachi, 74800 Pakistan
| | - Zafar Fatmi
- Department of Community Health Sciences, Aga Khan University, Stadium Road, P.O. Box-3500, Karachi, 74800 Pakistan
| | - Peter Burney
- Respiratory Epidemiology and Public Health, National Heart & Lung Institute, Imperial College London, London, UK
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20
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Eriksson B, Backman H, Ekerljung L, Axelsson M, Lindberg A, Rönmark E, Lundbäck B. Pattern of Cardiovascular Comorbidity in COPD in a Country with Low-smoking Prevalence: Results from Two-population-based Cohorts from Sweden. COPD 2018; 15:454-463. [PMID: 30475654 DOI: 10.1080/15412555.2018.1535580] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Cardiovascular diseases are the most common comorbidities in COPD, due to common risk factors such as smoking. The prevalence of current smokers in Sweden has decreased over four decades to around 10%. The aim of the present study was to investigate the prevalence, distribution and associations of cardiovascular comorbidities in COPD by disease severity in two large areas of Sweden, both with low-smoking prevalence. Data from clinical examinations in 2009-2012, including spirometry and structured interview, from two large-scale population studies, the West Sweden Asthma Study (WSAS) and the OLIN Studies in Northern Sweden, were pooled. COPD was defined using post-bronchodilator spirometry according to the fixed ratio FEV1/FVC <0.70 and the lower limit of normal (LLN5th percentile) of the ratio of FEV1/FVC. Of the 1839 subjects included, 8.7% and 5.7% had COPD according to the fixed ratio and the LLN criterion. Medication for heart disease or hypertension among those with moderate-to-severe COPD was more common than among those without COPD (fixed ratio definition of COPD: 51% vs. 23%, p < 0.001; LLN definition: 42% vs. 24%, p = 0.002). After adjusting for known risk factors for COPD, including smoking, age, socio-economic status, and occupational exposure for gas, dust and fumes, only heart failure remained significantly, and independently, associated with COPD, irrespective of the definitions of COPD. Though a major decrease in smoking prevalence, the pattern of cardiovascular comorbidities in COPD still remains similar with previously performed studies in Sweden and in other Westernized countries as well.
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Affiliation(s)
- Berne Eriksson
- a Krefting Research Centre , Institute of Medicine, University of Gothenburg , Gothenburg , Sweden.,b Department of Internal Medicine , Central County Hospital of Halmstad , Halmstad , Sweden
| | - Helena Backman
- c Department of Public Health and Clinical Medicine, Division of Occupational and Environmental Medicine/the OLIN unit , Umeå University , Umeå , Sweden
| | - Linda Ekerljung
- a Krefting Research Centre , Institute of Medicine, University of Gothenburg , Gothenburg , Sweden
| | - Malin Axelsson
- d Department of Care Science, Faculty of Health and Society , Malmö University , Malmö , Sweden
| | - Anne Lindberg
- e Department of Public Health and Clinical Medicine, Division of Medicine/the OLIN unit , Umeå University , Umeå , Sweden
| | - Eva Rönmark
- c Department of Public Health and Clinical Medicine, Division of Occupational and Environmental Medicine/the OLIN unit , Umeå University , Umeå , Sweden
| | - Bo Lundbäck
- a Krefting Research Centre , Institute of Medicine, University of Gothenburg , Gothenburg , Sweden.,c Department of Public Health and Clinical Medicine, Division of Occupational and Environmental Medicine/the OLIN unit , Umeå University , Umeå , Sweden
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Hedman L, Backman H, Stridsman C, Bosson JA, Lundbäck M, Lindberg A, Rönmark E, Ekerljung L. Association of Electronic Cigarette Use With Smoking Habits, Demographic Factors, and Respiratory Symptoms. JAMA Netw Open 2018; 1:e180789. [PMID: 30646032 PMCID: PMC6324524 DOI: 10.1001/jamanetworkopen.2018.0789] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
IMPORTANCE There is an ongoing debate about whether electronic cigarettes (e-cigarettes) are the solution to the tobacco epidemic or a new public health threat. Large representative studies are needed to study e-cigarette use in the general population, but hardly any have been published. OBJECTIVES To estimate the prevalence of e-cigarette use and to investigate the association of e-cigarette use with smoking habits, demographic factors, and respiratory symptoms. DESIGN, SETTING, AND PARTICIPANTS Cross-sectional, population-based study of random samples of the population, performed within the Obstructive Lung Disease in Northern Sweden (OLIN) study and West Sweden Asthma Study (WSAS). The same validated questionnaire including identical questions was used in OLIN and WSAS. In 2016, OLIN and WSAS conducted postal questionnaire surveys in random samples of adults aged 20 to 75 years. In OLIN, 6519 participated (response rate, 56.4%); in WSAS, 23 753 participated (response rate, 50.1%). MAIN OUTCOMES AND MEASURES Electronic cigarette use, smoking habits, and respiratory symptoms. RESULTS Of 30 272 participants (16 325 women [53.9%]), 3897 (12.9%) were aged 20 to 29 years; 4242 (14.0%), 30 to 39 years; 5082 (16.8%), 40 to 49 years; 6052 (20.0%), 50 to 59 years; 6628 (21.9%), 60 to 69 years; and 4371 (14.4%), 70 to 75 years. The number of current smokers was 3694 (12.3%), and 7305 (24.4%) were former smokers. The number of e-cigarette users was 529 (2.0%), and e-cigarette use was more common among men (275 of 12 347 [2.2%; 95% CI, 2.0%-2.5%]) than women (254 of 14 022 [1.8%; 95% CI, 1.6%-2.0%]). Among current smokers, 350 of 3566 (9.8%; 95% CI, 8.8%-10.8%) used e-cigarettes compared with 79 of 6875 (1.1%; 95% CI, 0.9%-1.3%) in former smokers and 96 of 15 832 (0.6%; 95% CI, 0.5%-0.7%) in nonsmokers (P < .001). Among e-cigarette users who answered the survey question about cigarette-smoking habits (n = 525), 350 (66.7%; 95% CI, 62.7%-70.7%) were current smokers, 79 (15.0%; 95% CI, 11.9%-18.1%) were former smokers, and 96 (18.3%; 95% CI, 15.0%-21.6%) were nonsmokers (P < .001 for trend). In a regression analysis, e-cigarette use was associated with male sex (odds ratio [OR], 1.35; 95% CI, 1.12-1.62); age groups 20 to 29 years (OR, 2.77; 95% CI, 1.90-4.05), 30 to 39 years (OR, 2.27; 95% CI, 1.53-3.36), 40 to 49 years (OR, 1.65; 95% CI, 1.11-2.44), and 50 to 59 years (OR, 1.47; 95% CI, 1.01-2.12); educational level at primary school (OR, 1.99; 95% CI, 1.51-2.64) and upper secondary school (OR, 1.57; 95% CI, 1.25-1.96); former smoking (OR, 2.37; 95% CI, 1.73-3.24); and current smoking (OR, 18.10; 95% CI, 14.19-23.09). All respiratory symptoms were most common among dual users and former smokers and nonsmokers who used e-cigarettes. CONCLUSIONS AND RELEVANCE Use of e-cigarettes was most common among smokers, and dual users had the highest prevalence of respiratory symptoms. On a population level, this study indicates that the present use of e-cigarettes does not adequately serve as a smoking cessation tool.
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Affiliation(s)
- Linnea Hedman
- The Obstructive Lung Disease in Northern Sweden Unit, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, Umeå University, Umeå, Sweden
- Division of Nursing, Department of Health Sciences, Luleå University of Technology, Luleå, Sweden
| | - Helena Backman
- The Obstructive Lung Disease in Northern Sweden Unit, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, Umeå University, Umeå, Sweden
| | - Caroline Stridsman
- Division of Nursing, Department of Health Sciences, Luleå University of Technology, Luleå, Sweden
| | - Jenny A. Bosson
- Division of Respiratory Medicine, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Magnus Lundbäck
- Karolinska Institutet, Division of Cardiovascular Medicine, Department of Clinical Sciences, Danderyd University Hospital, Stockholm, Sweden
| | - Anne Lindberg
- The Obstructive Lung Disease in Northern Sweden Unit, Division of Medicine, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Eva Rönmark
- The Obstructive Lung Disease in Northern Sweden Unit, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, Umeå University, Umeå, Sweden
| | - Linda Ekerljung
- Krefting Research Center, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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22
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Asthma and Asthma Medication Are Common among Recreational Athletes Participating in Endurance Sport Competitions. Can Respir J 2018; 2018:3238546. [PMID: 30034562 PMCID: PMC6032657 DOI: 10.1155/2018/3238546] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 04/24/2018] [Accepted: 05/13/2018] [Indexed: 12/12/2022] Open
Abstract
Background Asthma prevalence is high among elite endurance athletes, but little is known about its prevalence among competitive recreational athletes. The aim of this study was to determine the prevalence of self-reported asthma and asthma medication use among competitive recreational endurance athletes and their association with training. Methods A web survey on asthma and medication was conducted among 38,603 adult participants of three Swedish endurance competitions (cross-country running, cross-country skiing, and swimming). Results The overall response rate was 29%. The prevalence of self-reported asthma (physician-diagnosed asthma and use of asthma medication in the last 12 months) was 12%. Among those reporting asthma, 23% used inhaled corticosteroids and long-acting beta-agonists daily. We found no association between training volume and daily use of asthma medication, except a trend in relation to short-acting beta-agonists. Independent predictors of self-reported asthma were female sex, allergic rhinitis, previous eczema, family history of asthma, cycling, and training for >5 h 50 min/week. Conclusions The prevalence of self-reported asthma among Swedish competitive recreational endurance athletes appears to be higher than that in the general Swedish population. A large proportion of recreational athletes were reported with asthma use medications, indicating an association between high physical activity and self-reported asthma among competitive recreational athletes.
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Prevalence and trend of COPD from 1995-1997 to 2006-2008: The HUNT study, Norway. Respir Med 2018; 138:50-56. [PMID: 29724393 DOI: 10.1016/j.rmed.2018.03.020] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 03/16/2018] [Accepted: 03/18/2018] [Indexed: 11/23/2022]
Abstract
BACKGROUND COPD is a major cause of morbidity and mortality across the world and new estimates of prevalence and trend are of great importance. We aimed to estimate the prevalence and trend of COPD from 1995-1997 to 2006-2008 in Norwegian adults ≥40 years from the Nord-Trøndelag Health Study. MATERIAL AND METHODS COPD was assessed using a fixed-ratio and lower limit of normal (LLN) criteria. Pre-bronchodilator spirometry was performed during 1995-1997 (n = 7158) and 2006-2008 (n = 8788). The prevalence of COPD was weighted using the inverse probability of selection and predicted probability of response. RESULTS The prevalence of pre-bronchodilator COPD was 16.7% in 1995-1997 and 14.8% in 2006-2008 using fixed-ratio criteria, and 10.4% in 1995-1997 and 7.3% in 2006-2008 using LLN criteria. The prevalence of LLN COPD was higher among men (13.0% in 1995-1997, 7.7% in 2006-2008) than women (8.0% in 1995-1997, 6.9% in 2006-2008). From 1995-1997 to 2006-2008, the prevalence decreased among men but remained relatively stable among women. Over the 11-year period, the cumulative incidence of pre-bronchodilator COPD using LLN criteria was 3.3% and 2.7% among men and women respectively. The prevalence of self-reported asthma and respiratory symptoms increased. CONCLUSIONS The prevalence declined in men but not in women from 1995-1997 to 2006-2008, and was consistently higher among men than women.
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Backman H, Räisänen P, Hedman L, Stridsman C, Andersson M, Lindberg A, Lundbäck B, Rönmark E. Increased prevalence of allergic asthma from 1996 to 2006 and further to 2016-results from three population surveys. Clin Exp Allergy 2017; 47:1426-1435. [DOI: 10.1111/cea.12963] [Citation(s) in RCA: 124] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 05/17/2017] [Accepted: 05/26/2017] [Indexed: 12/13/2022]
Affiliation(s)
- Helena Backman
- Department of Public Health and Clinical Medicine; Division of Occupational and Environmental Medicine/the OLIN unit; Umeå University; Umeå Sweden
| | - Petri Räisänen
- Department of Public Health and Clinical Medicine; Division of Occupational and Environmental Medicine/the OLIN unit; Umeå University; Umeå Sweden
| | - Linnea Hedman
- Department of Public Health and Clinical Medicine; Division of Occupational and Environmental Medicine/the OLIN unit; Umeå University; Umeå Sweden
- Department of Health Sciences; Luleå University; Luleå Sweden
| | | | - Martin Andersson
- Department of Public Health and Clinical Medicine; Division of Occupational and Environmental Medicine/the OLIN unit; Umeå University; Umeå Sweden
| | - Anne Lindberg
- Department of Public Health and Clinical Medicine; Division of Medicine/the OLIN unit; Umeå University; Umeå Sweden
| | - Bo Lundbäck
- Krefting Research Centre; Institute of Medicine; University of Gothenburg; Gothenburg Sweden
| | - Eva Rönmark
- Department of Public Health and Clinical Medicine; Division of Occupational and Environmental Medicine/the OLIN unit; Umeå University; Umeå Sweden
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25
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Backman H, Hedman L, Stridsman C, Jansson SA, Lindberg A, Lundbäck B, Rönmark E. A population-based cohort of adults with asthma: mortality and participation in a long-term follow-up. Eur Clin Respir J 2017; 4:1334508. [PMID: 28680543 PMCID: PMC5492099 DOI: 10.1080/20018525.2017.1334508] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 05/18/2017] [Indexed: 01/24/2023] Open
Abstract
Background and objective: Asthma is a major public health concern. The aim of this study was to characterize a large population-based cohort of adults with asthma, and to study factors associated with all-cause mortality and non-participation in a long-term follow-up. Design: Random and stratified samples from five population-based cohorts were clinically examined during 1986-2001, and all subjects with asthma were included in the study (n = 2055, age 19-72 years, 55% women). Independent associations between different risk factors and (i) mortality and (ii) non-participation in a clinical follow-up in 2012-2014 were estimated. Results: In 1986-2001, 95% reported any wheeze and/or attacks of shortness of breath in the past 12 months, and/or asthma medication use. Over the up to 28 years of follow-up time, the cumulative mortality was 22.7%. Male gender, current smoking, and lower forced expiratory volume in 1 sec of predicted (FEV1% of predicted) were independent risk factors for mortality, while obesity was associated with non-participation in the follow-up. Older ages, ischemic heart disease, and low socioeconomic status were associated with both mortality and non-participation. Conclusions: The risk factors associated with mortality in this adult population-based asthma cohort were similar to those commonly identified in general population samples, i.e. male gender, current smoking, and lower FEV1% of predicted, while obesity was associated with non-participation in a long-term follow-up. Ischemic heart disease, low socioeconomic status, and older ages were associated with both mortality and non-participation.
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Affiliation(s)
- Helena Backman
- Department of Public Health and Clinical Medicine, Division of Occupational and Environmental Medicine/the OLIN Unit, Umeå University, Umeå, Sweden
| | - Linnea Hedman
- Department of Public Health and Clinical Medicine, Division of Occupational and Environmental Medicine/the OLIN Unit, Umeå University, Umeå, Sweden.,Department of Health Sciences, Luleå University, Luleå, Sweden
| | | | - Sven-Arne Jansson
- Department of Public Health and Clinical Medicine, Division of Occupational and Environmental Medicine/the OLIN Unit, Umeå University, Umeå, Sweden
| | - Anne Lindberg
- Department of Public Health and Clinical Medicine, Division of Medicine/the OLIN Unit, Umeå University, Umeå, Sweden
| | - Bo Lundbäck
- Krefting Research Centre, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Eva Rönmark
- Department of Public Health and Clinical Medicine, Division of Occupational and Environmental Medicine/the OLIN Unit, Umeå University, Umeå, Sweden
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26
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Stjernbrandt A, Björ B, Andersson M, Burström L, Liljelind I, Nilsson T, Lundström R, Wahlström J. Neurovascular hand symptoms in relation to cold exposure in northern Sweden: a population-based study. Int Arch Occup Environ Health 2017; 90:587-595. [PMID: 28401298 PMCID: PMC5583276 DOI: 10.1007/s00420-017-1221-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 04/06/2017] [Indexed: 10/26/2022]
Abstract
PURPOSE To describe the self-reported ambient cold exposure in northern Sweden and to relate the level of cumulative cold exposure to the occurrence of sensory and vascular hand symptoms. We hypothesize that cold exposure is positively related to reporting such symptoms. METHODS A questionnaire about cold exposure and related symptoms was sent out to 35,144 subjects aged 18-70 years and living in northern Sweden. RESULTS A total of 12,627 out of 35,144 subjects returned the questionnaire (response rate 35.9%). Subjects living in the rural alpine areas reported more extensive cold exposure both during work and leisure time compared to the urbanized coastal regions. Frostbite in the hands was present in 11.4% of men and 7.1% of women, cold sensitivity was present in 9.7 and 14.4%, and Raynaud's phenomenon was present in 11.0% of men and 14.0% of women. There was a positive association between cumulative cold exposure and neurovascular hand symptoms. CONCLUSION The present study demonstrates that the cold environment in northern Sweden might be an underestimated health risk. Our hypothesis that cold exposure is positively related to reporting of neurovascular hand symptoms was supported by our findings. In addition, such symptoms were common not only in conjunction with an overt cold injury. Our results warrant further study on pathophysiological mechanisms and suggest the need for confirmatory prevalence studies to support national public health planning.
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Affiliation(s)
- Albin Stjernbrandt
- Department of Public Health and Clinical Medicine, Umeå University, 901 87, Umeå, Sweden. .,Occupational and Environmental Medicine, University Hospital of Umeå, 901 85, Umeå, Sweden.
| | - Bodil Björ
- Department of Public Health and Clinical Medicine, Umeå University, 901 87, Umeå, Sweden.,Occupational and Environmental Medicine, University Hospital of Umeå, 901 85, Umeå, Sweden
| | - Martin Andersson
- Department of Public Health and Clinical Medicine, Umeå University, 901 87, Umeå, Sweden.,Occupational and Environmental Medicine, University Hospital of Umeå, 901 85, Umeå, Sweden
| | - Lage Burström
- Department of Public Health and Clinical Medicine, Umeå University, 901 87, Umeå, Sweden
| | - Ingrid Liljelind
- Department of Public Health and Clinical Medicine, Umeå University, 901 87, Umeå, Sweden.,Occupational and Environmental Medicine, University Hospital of Umeå, 901 85, Umeå, Sweden
| | - Tohr Nilsson
- Department of Public Health and Clinical Medicine, Umeå University, 901 87, Umeå, Sweden
| | - Ronnie Lundström
- Department of Public Health and Clinical Medicine, Umeå University, 901 87, Umeå, Sweden.,Department of Radiation Sciences, Umeå University, 901 87, Umeå, Sweden
| | - Jens Wahlström
- Department of Public Health and Clinical Medicine, Umeå University, 901 87, Umeå, Sweden.,Occupational and Environmental Medicine, University Hospital of Umeå, 901 85, Umeå, Sweden
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Restrictive spirometric pattern in the general adult population: Methods of defining the condition and consequences on prevalence. Respir Med 2016; 120:116-123. [DOI: 10.1016/j.rmed.2016.10.005] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 10/05/2016] [Accepted: 10/10/2016] [Indexed: 11/18/2022]
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28
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Sozańska B, Pearce N, Błaszczyk M, Boznański A, Cullinan P. Changes in the prevalence of cigarette smoking and quitting smoking determinants in adult inhabitants of rural areas in Poland between 2003 and 2012. Public Health 2016; 141:178-184. [PMID: 27931996 DOI: 10.1016/j.puhe.2016.09.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Revised: 08/26/2016] [Accepted: 09/18/2016] [Indexed: 11/17/2022]
Abstract
OBJECTIVES We investigate trends in the prevalence of cigarette smoking among adults at all ages in two time points 9 years apart in two neighbouring rural populations and examine social and respiratory health determinants of quitting smoking. STUDY DESIGN Repeated cross-sectional study. METHODS Two cross-sectional surveys were conducted in the same rural area of lower Silesia in Poland in 2003 and 2012. A total of 1328 (91% of adult eligible individuals) in 2003 and 1449 (92% of eligible) in 2012 adult inhabitants were surveyed, 908 people (560 villagers and 348 town inhabitants) participated in both surveys. Participants completed a questionnaire on smoking behaviour, education level and respiratory diseases. RESULTS Current smoking was higher in the villages than the town, among men than women and those with a middle level of education. The prevalence of current smokers decreased over time, although this decline was much more pronounced in the town than in the villages (30.2% vs 23% and 35.5% vs 33.7%, respectively). Men were more likely to stop smoking than women both in villages and in town. The prevalence of current smokers among village women even increased between the two surveys from 27.6% to 29.3%. Respiratory diseases did not influence quitting smoking. CONCLUSIONS The degree of decreasing trend in smoking prevalence varied considerably within neighbouring populations. It was mainly seen in the town and among younger people. Men and those better educated were more willing to quit smoking. The discrepancies between two close rural populations indicates the need for an individual approach when designing programs of tobacco control.
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Affiliation(s)
- B Sozańska
- Wroclaw Medical University, 1st Department of Pediatrics, Allergology and Cardiology, Wroclaw, Poland.
| | - N Pearce
- London School of Hygiene and Tropical Medicine, London, UK; Centre for Public Health Research, Massey University, Wellington, New Zealand
| | - M Błaszczyk
- Faculty of Sociology, University of Wrocław, Wrocław, Poland
| | - A Boznański
- Wroclaw Medical University, 1st Department of Pediatrics, Allergology and Cardiology, Wroclaw, Poland
| | - P Cullinan
- Imperial College (NHLI) and Royal Brompton Hospital, London, UK
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29
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Jansson SA, Axelsson M, Hedman L, Leander M, Stridsman C, Rönmark E. Subjects with well-controlled asthma have similar health-related quality of life as subjects without asthma. Respir Med 2016; 120:64-69. [PMID: 27817817 DOI: 10.1016/j.rmed.2016.09.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 08/25/2016] [Accepted: 09/29/2016] [Indexed: 12/22/2022]
Abstract
BACKGROUND The burden of asthma and rhinitis on health-related quality of life (HRQL) among adults has been assessed mainly in studies of patients seeking health-care, while population-based studies are relatively scarce. The objective of this study was to investigate HRQL among subjects with asthma and rhinitis derived from a random population sample and to identify factors related to impairment of HRQL. METHODS A randomly selected cohort was invited to participate in a postal questionnaire survey. Of those who responded, a stratified sample of 1016 subjects was invited to clinical examinations and interviews, and 737 subjects in ages 21-86 years participated. Of these, 646 completed HRQL questions. HRQL was assessed with the generic SF-36 Health Survey. RESULTS The physical score was lower among subjects with asthma vs. subjects without asthma (p < 0.001). No significant difference was found in the mental score. Subjects with well-controlled asthma had higher physical score compared to subjects with partly and un-controlled asthma (p = 0.002). Actually, subjects with well-controlled asthma had similar physical HRQL as subjects without asthma. Asthmatics who were current smokers had lower physical score compared to those who were non-smokers (p = 0.021). No significant differences in physical or mental scores were found between subjects with and without rhinitis. Subjects with both asthma and rhinitis had lower physical score compared to subjects without these conditions (p < 0.001), but subjects with asthma alone had even worse physical score. CONCLUSIONS The physical score was significantly lower in asthmatics compared to subjects without asthma. Importantly, non-smoking and well-controlled asthmatics have similar HRQL compared to subjects without asthma. Thus, subjects with asthma should be supported to achieve and maintain good asthma control and if they smoke, be offered smoking cessation as means to improve their HRQL.
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Affiliation(s)
- Sven-Arne Jansson
- Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, The OLIN Unit, Umeå University, Umeå, Sweden.
| | - Malin Axelsson
- Department of Care Sciences, Faculty of Health and Society, Malmö University, Malmö, Sweden
| | - Linnea Hedman
- Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, The OLIN Unit, Umeå University, Umeå, Sweden; Department of Health Science, Division of Nursing, Luleå University of Technology, Luleå, Sweden
| | - Mai Leander
- Department of Medical Sciences, Respiratory Medicine and Allergology, Uppsala University, Uppsala, Sweden
| | - Caroline Stridsman
- Department of Health Science, Division of Nursing, Luleå University of Technology, Luleå, Sweden
| | - Eva Rönmark
- Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, The OLIN Unit, Umeå University, Umeå, Sweden
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30
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Rönmark EP, Ekerljung L, Mincheva R, Sjölander S, Hagstad S, Wennergren G, Rönmark E, Lötvall J, Lundbäck B. Different risk factor patterns for adult asthma, rhinitis and eczema: results from West Sweden Asthma Study. Clin Transl Allergy 2016; 6:28. [PMID: 27493721 PMCID: PMC4973051 DOI: 10.1186/s13601-016-0112-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 05/15/2016] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Atopic diseases including asthma, rhinitis and eczema have increased in the second half of the past century. This has been well studied among children and adolescents but with the exception of asthma to a much lesser extent in adults. The adult risk factor pattern of atopic diseases, in particular of eczema, and their relation to allergic sensitization are yet to be fully elucidated. Studies among adults that have compared the risk factor pattern for these conditions in the same material are very few. The objective of this study was to compare the risk factor patterns for asthma, rhinitis and eczema in a randomly selected adult population. METHODS A questionnaire survey on atopic diseases was dispatched by mail to 30,000 randomly selected individuals in West Sweden aged 16-75 years and 62 % participated. A subgroup of 2000 individuals was selected for clinical examinations including blood sampling for specific serum Immunoglobulin E to common airborne allergens and 1172 attended. RESULTS The prevalence of current asthma was 11.8 %, current rhinitis 42.8 %, current eczema 13.5 and 2.3 % had all three conditions while 13.9 % had at least two conditions. No mutual risk factor was identified for all three conditions. Allergic sensitization was a strong risk factor for current asthma (OR 4.1 CI 2.7-6.3) and current rhinitis (OR 5.1 CI 3.8-6.9) but not so for current eczema. Obesity was a risk factor for current asthma and current rhinitis, while farm childhood decreased the risk for current asthma and current rhinitis. Occupational exposure to gas dust or fumes and female sex was associated with an increased risk of current asthma and current eczema. CONCLUSIONS There are different risk factor patterns for asthma, rhinitis and eczema in adults but some risk factors are overlapping between some of the conditions. The effect of mutable risk factors should be assessed further in longitudinal studies.
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Affiliation(s)
- Erik P Rönmark
- Department of Internal Medicine, Krefting Research Centre, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Box 424, 405 30 Gothenburg, Sweden
| | - Linda Ekerljung
- Department of Internal Medicine, Krefting Research Centre, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Box 424, 405 30 Gothenburg, Sweden
| | - Roxana Mincheva
- Department of Internal Medicine, Krefting Research Centre, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Box 424, 405 30 Gothenburg, Sweden
| | | | - Stig Hagstad
- Department of Internal Medicine, Krefting Research Centre, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Box 424, 405 30 Gothenburg, Sweden
| | - Göran Wennergren
- Department of Paediatrics, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Eva Rönmark
- Environmental and Occupational Medicine, The OLIN Unit, Department of Public Health and Clinical Medicine, University of Umeå, Umeå, Sweden
| | - Jan Lötvall
- Department of Internal Medicine, Krefting Research Centre, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Box 424, 405 30 Gothenburg, Sweden
| | - Bo Lundbäck
- Department of Internal Medicine, Krefting Research Centre, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Box 424, 405 30 Gothenburg, Sweden
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31
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Axelsson M, Ekerljung L, Eriksson J, Hagstad S, Rönmark E, Lötvall J, Lundbäck B. Chronic bronchitis in West Sweden - a matter of smoking and social class. Eur Clin Respir J 2016; 3:30319. [PMID: 27421832 PMCID: PMC4947195 DOI: 10.3402/ecrj.v3.30319] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Accepted: 06/20/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Although chronic bronchitis is associated with impaired quality of life, hospitalisations and increased mortality, it has been less in focus after the introduction of the term chronic obstructive pulmonary disease (COPD). There are no recent published data on the prevalence of chronic bronchitis from the Scandinavian countries. AIM The main aim of the present study was to estimate the prevalence of chronic bronchitis in West Sweden by using data from a large-scale epidemiological study of the general population. A further aim was to identify current risk factors for chronic bronchitis in a population with a major decrease in the proportion of smokers. METHODS From the 18,087 questionnaire responders out of 30,000 invited to participate at the West Sweden Asthma Study, 2,000 subjects were randomly selected and invited to detailed clinical examinations performed during 2009-2013. A total of 1,172 subjects aged 17-79 participated in the examinations which included, among others, spirometry and structured interviews. Chronic bronchitis was defined according to reported symptoms. RESULTS The overall prevalence of chronic bronchitis was 7.2% (men 7.6%; women 6.8% ns), and it was 8.7% in subjects older than age 60. Chronic bronchitis was strongly associated with smoking, defined both as current smoking status and pack-years. Other risk factors were increasing age, low socio-economic class and urban living. Of those with chronic bronchitis, 22% fulfilled the GOLD criteria of COPD. CONCLUSION The prevalence of chronic bronchitis was somewhat lower than found by studies in Sweden in the 1980s and the prevalence was now similar in men and women. Although smoking was still the dominating risk factor for chronic bronchitis, the relative importance of smoking had decreased parallel with a decreasing smoking prevalence, while the relative importance of other factors than smoking had increased compared to previous studies.
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Affiliation(s)
- Malin Axelsson
- Department of Care Science, Faculty of Health and Society, Malmö University, Malmö, Sweden
- Department of Internal Medicine and Clinical Nutrition, Krefting Research Centre and Environmental and Occupational Medicine, University of Gothenburg, Gothenburg, Sweden;
| | - Linda Ekerljung
- Department of Internal Medicine and Clinical Nutrition, Krefting Research Centre and Environmental and Occupational Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Jonas Eriksson
- Department of Internal Medicine and Clinical Nutrition, Krefting Research Centre and Environmental and Occupational Medicine, University of Gothenburg, Gothenburg, Sweden
- Halland Region, Kungsbacka Health Centre, Kungsbacka, Sweden
| | - Stig Hagstad
- Department of Internal Medicine and Clinical Nutrition, Krefting Research Centre and Environmental and Occupational Medicine, University of Gothenburg, Gothenburg, Sweden
- Research and Development, Obstructive Lung Disease In Northern Sweden (OLIN) Studies, Norrbotten County Council, Luleå, Sweden
| | - Eva Rönmark
- Research and Development, Obstructive Lung Disease In Northern Sweden (OLIN) Studies, Norrbotten County Council, Luleå, Sweden
- Department of Public Health and Clinical Medicine, Division of Occupation and Environment/The OLIN Unit, University of Umeå, Umeå, Sweden
| | - Jan Lötvall
- Department of Internal Medicine and Clinical Nutrition, Krefting Research Centre and Environmental and Occupational Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Bo Lundbäck
- Department of Internal Medicine and Clinical Nutrition, Krefting Research Centre and Environmental and Occupational Medicine, University of Gothenburg, Gothenburg, Sweden
- Research and Development, Obstructive Lung Disease In Northern Sweden (OLIN) Studies, Norrbotten County Council, Luleå, Sweden
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Axelsson M, Lindberg A, Kainu A, Rönmark E, Jansson SA. Respiratory symptoms increase health care consumption and affect everyday life - a cross-sectional population-based study from Finland, Estonia, and Sweden. Eur Clin Respir J 2016; 3:31024. [PMID: 27238359 PMCID: PMC4884682 DOI: 10.3402/ecrj.v3.31024] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2016] [Accepted: 05/02/2016] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Even though respiratory symptoms are common in the adult population, there is limited research describing their impact on everyday life and association with health care consumption. AIM The main objective of this population-based study was to estimate and compare the prevalence of respiratory symptoms among adults in Finland, Estonia, and Sweden in relation to health care consumption and to identify factors influencing health care consumption. A secondary aim was to assess to which extent the presence of respiratory symptoms affect everyday life. METHOD In the population-based FinEsS studies consisting of random samples of subjects aged 20 to 69 years from Finland (n=1,337), Estonia (n=1,346), and Sweden (n=1,953), data on demographics, respiratory health, and health care consumption were collected by structured interviews. Prevalence was compared and multiple logistic regression analyses were performed. RESULTS Respiratory symptoms were significantly more common in Finland (66.0%) and Estonia (65.2%) than in Sweden (54.1%). Among subjects with respiratory symptoms, the proportion reporting outpatient care during the past year was fairly similar in the three countries, while specialist consultations were more common in Finland (19.1%), and hospitalisations more common in Estonia (15.0%). Finnish and Estonian residency, female sex, and BMI>25 increased the risk for outpatient care consumption. Wheeze and attacks of shortness of breath in the past 12 months, recurrent sputum production, and cough were associated with an increased risk for health care consumption. Increasing number of respiratory symptoms increased the risk for consuming health care. A larger proportion of subjects in Estonia and Sweden experienced their everyday life being affected by respiratory symptoms compared with subjects in Finland. CONCLUSION Respiratory symptoms are common in Finland, Estonia, and Sweden and contribute to a negative impact on everyday life as well as increased health care consumption. The observed differences in health care consumption between countries are probably related to national differences in health care structure.
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Affiliation(s)
- Malin Axelsson
- Department of Care Science, Faculty of Health and Society, Malmö University, Malmö, Sweden;
| | - Anne Lindberg
- Department of Public Health and Clinical Medicine, Division of Medicine, The OLIN Unit, Umeå University, Umeå, Sweden
| | - Annette Kainu
- HUCH Heart and Lung Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Eva Rönmark
- Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, The OLIN Unit, Umeå University, Umeå, Sweden
| | - Sven-Arne Jansson
- Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, The OLIN Unit, Umeå University, Umeå, Sweden
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Ashley-Martin J, Dodds L, Arbuckle TE, Marshall J. Prenatal triclosan exposure and cord blood immune system biomarkers. Int J Hyg Environ Health 2016; 219:454-7. [PMID: 27167448 DOI: 10.1016/j.ijheh.2016.04.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Revised: 04/22/2016] [Accepted: 04/23/2016] [Indexed: 01/01/2023]
Abstract
Triclosan is widely used as an antimicrobial agent and preservative that has been hypothesized to play a role in asthma and allergic disease. The limited body of literature regarding the allergenicity of triclosan has not evaluated prenatal exposure and subsequent potential effects on the developing immune system. The objective of the present study was to determine the association between prenatal urinary triclosan concentrations and cord blood immune system biomarker concentrations. Umbilical cord blood samples were obtained from the Maternal-Infant Research on Environmental Chemicals (MIREC) Biobank and were tested for three immune system biomarkers: immunoglobulin E (IgE), thymic stromal lymphopoietin (TSLP), and interleukin-33 (IL-33). Triclosan concentrations were measured in urine at 6-13 weeks gestation. No statistically significant associations were observed between prenatal triclosan concentrations and elevated concentrations of any immune system biomarker (n=1219 participants). Longitudinal studies are necessary to determine how the observed findings at birth translate into childhood.
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Affiliation(s)
- Jillian Ashley-Martin
- Perinatal Epidemiology Research Unit, Departments of Obstetrics & Gynecology and Pediatrics, Dalhousie University, Halifax, NS B3K 6R8, Canada.
| | - Linda Dodds
- Perinatal Epidemiology Research Unit, Departments of Obstetrics & Gynecology and Pediatrics, Dalhousie University, Halifax, NS B3K 6R8, Canada.
| | - Tye E Arbuckle
- Population Studies Division, Healthy Environments and Consumer Safety Branch, Health Canada, Ottawa, ON K1A 0K9, Canada.
| | - Jean Marshall
- Department of Microbiology & Immunology, Dalhousie University, Halifax, NS B3H 4R2, Canada.
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Backman H, Eriksson B, Rönmark E, Hedman L, Stridsman C, Jansson SA, Lindberg A, Lundbäck B. Decreased prevalence of moderate to severe COPD over 15 years in northern Sweden. Respir Med 2016; 114:103-10. [PMID: 27109819 DOI: 10.1016/j.rmed.2016.03.013] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Revised: 03/07/2016] [Accepted: 03/19/2016] [Indexed: 12/21/2022]
Abstract
BACKGROUND The burden of COPD in terms of mortality, morbidity, costs and prevalence has increased worldwide. Recent results on prevalence in Western Europe are conflicting. In Sweden smoking prevalence has steadily decreased over the past 30 years. AIM The aim was to study changes in prevalence and risk factor patterns of COPD in the same area and within the same age-span 15 years apart. MATERIAL AND METHODS Two population-based cross-sectional samples in ages 23-72 years participating at examinations in 1994 and 2009, respectively, were compared in terms of COPD prevalence, severity and risk factor patterns. Two different definitions of COPD were used; FEV1/FVC < LLN and FEV1/FVC < 0.7. The severity of COPD was assessed by FEV1, both as % of predicted and in relation to the LLN. RESULTS The prevalence of COPD decreased significantly from 9.5% to 6.3% (p = 0.030) according to the FEV1/FVC < LLN criterion, while the decrease based on the FEV1/FVC < 0.7 criterion from 10.5% to 8.5% was non-significant. The prevalence of moderate to severe COPD decreased substantially and significantly, and the risk factor pattern was altered in 2009 when, beside age and smoking, also socio-economic status based on occupation was significantly associated with COPD. CONCLUSIONS Changes in both prevalence and risk factor patterns of COPD were observed between surveys. Following a continuing decrease in smoking habits over several decades, a decrease in the prevalence of moderate to severe COPD was observed from 1994 to 2009 in northern Sweden.
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Affiliation(s)
- Helena Backman
- Dept of Public Health and Clinical Medicine, Division of Occupational and Environmental Medicine, The OLIN Unit, Umeå University, Umeå, Sweden.
| | - Berne Eriksson
- Dept of Internal Medicine, Central County Hospital of Halmstad, Halmstad, Sweden
| | - Eva Rönmark
- Dept of Public Health and Clinical Medicine, Division of Occupational and Environmental Medicine, The OLIN Unit, Umeå University, Umeå, Sweden
| | - Linnea Hedman
- Dept of Public Health and Clinical Medicine, Division of Occupational and Environmental Medicine, The OLIN Unit, Umeå University, Umeå, Sweden
| | | | - Sven-Arne Jansson
- Dept of Public Health and Clinical Medicine, Division of Occupational and Environmental Medicine, The OLIN Unit, Umeå University, Umeå, Sweden
| | - Anne Lindberg
- Dept of Public Health and Clinical Medicine, Division of Medicine, Umeå University, Umeå, Sweden
| | - Bo Lundbäck
- Dept of Public Health and Clinical Medicine, Division of Occupational and Environmental Medicine, The OLIN Unit, Umeå University, Umeå, Sweden; Krefting Research Centre, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
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Lundbäck B, Backman H, Lötvall J, Rönmark E. Is asthma prevalence still increasing? Expert Rev Respir Med 2015; 10:39-51. [DOI: 10.1586/17476348.2016.1114417] [Citation(s) in RCA: 104] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Hagstad S, Backman H, Bjerg A, Ekerljung L, Ye X, Hedman L, Lindberg A, Torén K, Lötvall J, Rönmark E, Lundbäck B. Prevalence and risk factors of COPD among never-smokers in two areas of Sweden - Occupational exposure to gas, dust or fumes is an important risk factor. Respir Med 2015; 109:1439-45. [PMID: 26440676 DOI: 10.1016/j.rmed.2015.09.012] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Revised: 08/28/2015] [Accepted: 09/22/2015] [Indexed: 12/21/2022]
Abstract
BACKGROUND Although active tobacco smoking is the main risk factor for COPD, COPD is not uncommon also among never-smokers. Different study locations along with different spirometric definitions of COPD have historically yielded different prevalence estimates of the disease. AIM To study current prevalence and risk factors of COPD among never-smokers in two areas of Sweden. METHODS Data collected in 2008-2012 within the West Sweden Asthma Study and Obstructive Lung Disease in Northern Sweden Studies was pooled. The study population consisted of 1839 subjects who participated in spirometry and interviews. COPD was defined as post-bronchodilator a) FEV(1)/(F)VC < 0.7, b) FEV(1)/FVC < 0.7 and c) FEV(1)/FVC < lower limit of normal. RESULTS Of the 1839 subjects, 967 (52.6%) were never-smokers. Among the never-smoking subjects, the prevalence of COPD according to definitions a-c was 7.7%, 4.9% and 3.0%, respectively. The corresponding prevalence of GOLD grade ≥2 was 2.0%, 1.4% and 1.3%. No significant difference in prevalence between the two study areas was observed. In never-smokers, occupational exposure to gas, dust or fumes (GDF) was significantly associated with both COPD (OR 1.85, 95% CI 1.03-3.33), and GOLD ≥2 (OR 4.51, 1.72-11.9) according to definition a), after adjusting for age, educational level and exposure to passive smoking at work. CONCLUSION Depending on definition, prevalence of COPD among never-smokers was 3.0-7.7%, whereas GOLD ≥2 was present in 1.3-2.0%. Occupational exposure to GDF remained independently and significantly associated with COPD regardless of spirometric definition of the disease.
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Affiliation(s)
- Stig Hagstad
- Krefting Research Centre, University of Gothenburg, Gothenburg, Sweden; Obstructive Lung Disease In Northern Sweden (OLIN) Studies, Norrbotten County Council, Luleå, Sweden.
| | - Helena Backman
- Obstructive Lung Disease In Northern Sweden (OLIN) Studies, Norrbotten County Council, Luleå, Sweden; Division of Occupational and Environmental Medicine, The OLIN Unit, Umeå University, Sweden
| | - Anders Bjerg
- Krefting Research Centre, University of Gothenburg, Gothenburg, Sweden; Obstructive Lung Disease In Northern Sweden (OLIN) Studies, Norrbotten County Council, Luleå, Sweden
| | - Linda Ekerljung
- Krefting Research Centre, University of Gothenburg, Gothenburg, Sweden
| | - Xiong Ye
- Krefting Research Centre, University of Gothenburg, Gothenburg, Sweden; Department of Respiratory Medicine, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, China; Medical College of Soocuow University, Su Zhou, China
| | - Linnea Hedman
- Obstructive Lung Disease In Northern Sweden (OLIN) Studies, Norrbotten County Council, Luleå, Sweden; Division of Occupational and Environmental Medicine, The OLIN Unit, Umeå University, Sweden
| | - Anne Lindberg
- Division of Medicine, Department of Public Health and Clinical Medicine, Umeå University, Sweden
| | - Kjell Torén
- Section of Occupational and Environmental Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Jan Lötvall
- Krefting Research Centre, University of Gothenburg, Gothenburg, Sweden
| | - Eva Rönmark
- Obstructive Lung Disease In Northern Sweden (OLIN) Studies, Norrbotten County Council, Luleå, Sweden; Division of Occupational and Environmental Medicine, The OLIN Unit, Umeå University, Sweden
| | - Bo Lundbäck
- Krefting Research Centre, University of Gothenburg, Gothenburg, Sweden; Obstructive Lung Disease In Northern Sweden (OLIN) Studies, Norrbotten County Council, Luleå, Sweden
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Bjerg A, Hedman L, Perzanowski M, Wennergren G, Lundbäck B, Rönmark E. Decreased importance of environmental risk factors for childhood asthma from 1996 to 2006. Clin Exp Allergy 2015; 45:146-53. [PMID: 25323476 DOI: 10.1111/cea.12439] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2014] [Revised: 07/23/2014] [Accepted: 09/01/2014] [Indexed: 11/27/2022]
Abstract
BACKGROUND The large increase in asthma prevalence continues in several, but not all areas. Despite the individual risk factors that have been identified, the reasons for the observed trends in prevalence are largely unknown. OBJECTIVE This study sought to characterize what trends in risk factors accompanied trends in asthma prevalence. METHODS Two population-based cohorts of 7- to 8-year-old children from the same Swedish study areas examined by expanded International Study of Asthma and Allergy in Childhood questionnaires were compared 10 years apart. In 1996 and 2006, 3430 (97% participation) and 2585 (96% participation) questionnaires were completed, respectively. A subset was skin-prick-tested: in 1996 and 2006, 2148 (88% participation) and 1700 (90% participation) children, respectively. The adjusted population-attributable fraction (aPAF) was calculated using the prevalence and multivariate odds ratio of each risk factor. RESULTS The prevalence of current asthma and wheeze was similar in 1996 and 2006. Allergic sensitization, however, increased from 21% to 30%. The prevalence of parental asthma increased from 17% to 24%, while respiratory infections and maternal smoking decreased (60% to 29% and 32% to 16%, respectively). The aPAFs of non-environmental risk factors for current asthma increased in 1996-2006: allergic sensitization from 35% to 41%, parental asthma from 27% to 45% and male sex from 20% to 25%. Conversely, the aPAFs of environmental risk factors decreased: respiratory infections from 36% to 32% and damp home and maternal smoking from 14% and 19%, respectively, to near zero in 2006. CONCLUSIONS AND CLINICAL RELEVANCE From 1996 to 2006, the non-environmental risk factors parental asthma, allergic sensitization and male sex had an increasing or constant importance for current asthma in 7- to 8-year-old children. The importance of the environmental exposures damp home, respiratory infections and maternal smoking decreased. This counterbalancing in risk factors may explain the level of prevalence of current asthma.
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Affiliation(s)
- A Bjerg
- Krefting Research Centre, Department of Internal Medicine and Clinical Nutrition, University of Gothenburg, Gothenburg, Sweden; Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, the OLIN Unit, Umeå University, Umeå, Sweden
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Warm K, Hedman L, Lindberg A, Lötvall J, Lundbäck B, Rönmark E. Allergic sensitization is age-dependently associated with rhinitis, but less so with asthma. J Allergy Clin Immunol 2015. [PMID: 26220530 DOI: 10.1016/j.jaci.2015.06.015] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Epidemiologic data describing the association between allergic sensitization and asthma and allergic rhinitis in adults are scarce. OBJECTIVE To determine the prevalence and impact of specific sensitization to airborne allergens on asthma and allergic rhinitis among adults in relation to age. METHODS A random population sample (age 21-86 years) was examined with structured interview and analysis of specific IgE to 9 common airborne allergens. Of those invited, 692 (68%) subjects participated in blood sampling. IgE level of 0.35 U/mL or more to the specific allergen was defined as a positive test result. RESULTS Allergic sensitization decreased with increasing age, both in the population sample and among subjects with asthma and allergic rhinitis. In a multivariate model, sensitization to animal was significantly positively associated with asthma (odds ratio [OR], 4.80; 95% CI, 2.68-8.60), whereas sensitization to both animal (OR, 3.90; 95% CI, 2.31-6.58) and pollen (OR, 4.25; 95% CI, 2.55-7.06) was significantly associated with allergic rhinitis. The association between allergic sensitization and rhinitis was consistently strongest among the youngest age group, whereas this pattern was not found for asthma. The prevalence of allergic sensitization among patients with asthma decreased by increasing age of asthma onset, 86% with asthma onset at age 6 y or less, 56% at age 7 to 19 years, and 26% with asthma onset at age 20 years or more. CONCLUSIONS Sensitization to animal was associated with asthma across all age groups; allergic rhinitis was associated with sensitization to both pollen and animal and consistently stronger among younger than among older adults. Early onset of asthma was associated with allergic sensitization among adults with asthma.
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Affiliation(s)
- Katja Warm
- Division of Medicine, Department of Public Health and Clinical Medicine, the OLIN Unit, Umeå University, Umeå, Sweden
| | - Linnea Hedman
- Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine Unit, the OLIN Unit, Umeå University, Umeå, Sweden
| | - Anne Lindberg
- Division of Medicine, Department of Public Health and Clinical Medicine, the OLIN Unit, Umeå University, Umeå, Sweden
| | - Jan Lötvall
- Krefting Research Centre, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Bo Lundbäck
- Krefting Research Centre, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Eva Rönmark
- Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine Unit, the OLIN Unit, Umeå University, Umeå, Sweden.
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Backman H, Lindberg A, Odén A, Ekerljung L, Hedman L, Kainu A, Sovijärvi A, Lundbäck B, Rönmark E. Reference values for spirometry - report from the Obstructive Lung Disease in Northern Sweden studies. Eur Clin Respir J 2015; 2:26375. [PMID: 26557250 PMCID: PMC4629723 DOI: 10.3402/ecrj.v2.26375] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Revised: 05/28/2015] [Accepted: 06/17/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Abnormal lung function is commonly identified by comparing observed spirometric values to corresponding reference values. It is recommended that such reference values for spirometry are evaluated and updated frequently. The aim of this study was to estimate new reference values for Swedish adults by fitting a multivariable regression model to a healthy non-smoking general population sample from northern Sweden. Further aims were to evaluate the external validity of the obtained reference values on a contemporary sample from south-western Sweden, and to compare them to the Global Lung Function Initiative (GLI) reference values. METHOD Sex-specific multivariable linear regression models were fitted to the spirometric data of n=501 healthy non-smoking adults aged 22-91 years, with age and height as predictors. The models were extended to allow the scatter around the outcome variable to depend on age, and age-dependent spline functions were incorporated into the models to provide a smooth fit over the entire age range. Mean values and lower limits of normal, defined as the lower 5th percentiles, were derived. RESULT This modelling approach resulted in unbiased estimates of the spirometric outcomes, and the obtained estimates were appropriate not only for the northern Sweden sample but also for the south-western Sweden sample. On average, the GLI reference values for forced expiratory volume in one second (FEV1) and, in particular, forced expiratory vital capacity (FVC) were lower than both the observed values and the new reference values, but higher for the FEV1/FVC ratio. CONCLUSION The evaluation based on the sample of healthy non-smokers from northern Sweden show that the Obstructive Lung Disease in Northern Sweden reference values are valid. Furthermore, the evaluation based on the south-western Sweden sample indicates a high external validity. The comparison with GLI brought further evidence to the consensus that, when available, appropriate local population-specific reference values may be preferred.
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Affiliation(s)
- Helena Backman
- The OLIN Unit, Division of Occupational and Environmental Medicine, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Anne Lindberg
- Division of Medicine, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Anders Odén
- Division of Mathematical Sciences, Chalmers University of Technology, Gothenburg, Sweden
| | - Linda Ekerljung
- Krefting Research Centre, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Linnéa Hedman
- The OLIN Unit, Division of Occupational and Environmental Medicine, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Annette Kainu
- HUCH Heart and Lung Center, Peijas Hospital, Helsinki University Central Hospital, Helsinki, Finland
| | - Anssi Sovijärvi
- HUS Medical Imaging Centre, Department of Clinical Physiology and Nuclear Medicine, Helsinki University Central Hospital, Helsinki, Finland
| | - Bo Lundbäck
- The OLIN Unit, Division of Occupational and Environmental Medicine, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
- Krefting Research Centre, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Eva Rönmark
- The OLIN Unit, Division of Occupational and Environmental Medicine, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
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Abstract
OBJECTIVE To study the prevalence of tobacco use among teenagers, to evaluate a tobacco prevention programme and to study factors related to participation in the prevention programme. DESIGN AND SETTING Population-based prospective cohort study. METHOD Within the Obstructive Lung disease in Northern Sweden (OLIN) studies, a cohort study about asthma in schoolchildren started in 2006. All children aged 7-8 years in three municipalities were invited to a questionnaire survey and 2585 (96%) participated. The cohort was followed up at age 11-12 years (n=2612, 95% of invited) and 14-15 years (n=2345, 88% of invited). In 2010, some of the children in the OLIN cohort (n=447) were invited to a local tobacco prevention programme and 224 (50%) chose to participate. RESULTS At the age of 14-15 years, the prevalence of daily smoking was 3.5%. Factors related to smoking were female sex, having a smoking mother, participation in sports and lower parental socioeconomic status (SES). The prevalence of using snus was 3.3% and risk factors were male sex, having a smoking mother, having a snus-using father and non-participation in the prevention programme. In the prevention programme, the prevalence of tobacco use was significantly lower among the participants compared with the controls in the cohort. Factors related to non-participation were male sex, having a smoking mother, lower parental SES and participation in sports. CONCLUSIONS The prevalence of tobacco use was lower among the participants in the tobacco prevention programme compared with the non-participants as well as with the controls in the cohort. However, the observed benefit of the intervention may be overestimated as participation was biased by selection.
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Affiliation(s)
- Linnéa Hedman
- Department of Public Health and Clinical Medicine, Division for Occupational and Environmental Medicine, The OLIN Unit, Umeå University, Umeå, Sweden
| | - Martin Andersson
- Department of Public Health and Clinical Medicine, Division for Occupational and Environmental Medicine, The OLIN Unit, Umeå University, Umeå, Sweden
| | | | - Eva Rönmark
- Department of Public Health and Clinical Medicine, Division for Occupational and Environmental Medicine, The OLIN Unit, Umeå University, Umeå, Sweden
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Wang J, Engvall K, Smedje G, Norbäck D. Rhinitis, asthma and respiratory infections among adults in relation to the home environment in multi-family buildings in Sweden. PLoS One 2014; 9:e105125. [PMID: 25136984 PMCID: PMC4138153 DOI: 10.1371/journal.pone.0105125] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Accepted: 07/21/2014] [Indexed: 11/18/2022] Open
Abstract
Risk factors for rhinitis, asthma and respiratory infections in the home environment were studied by a questionnaire survey. Totally 5775 occupants (≥ 18 years old) from a stratified random sample of multi-family buildings in Sweden participated (46%). 51.0% had rhinitis in the last 3 months (current rhinitis); 11.5% doctor diagnosed asthma; 46.4% respiratory infections in the last 3 months and 11.9% antibiotic medication for respiratory infections in the last 12 months. Associations between home environment and health were analyzed by multiple logistic regression, controlling for gender, age and smoking and mutual adjustment. Buildings constructed during 1960-1975 were risk factors for day time breathlessness (OR = 1.53, 95%CI 1.03-2.29). And those constructed during 1976-1985 had more current rhinitis (OR = 1.43, 95%CI 1.12-1.84) and respiratory infections (OR = 1.46, 95%CI 1.21-1.78). Cities with higher population density had more current rhinitis (p = 0.008) and respiratory infections (p<0.001). Rented apartments had more current rhinitis (OR = 1.23, 95%CI 1.07-1.40), wheeze (OR = 1.20, 95%CI 1.02-1.41), day time breathlessness (OR = 1.31, 95%CI 1.04-1.66) and respiratory infections (OR = 1.13, 95%CI 1.01-1.26). Living in colder parts of the country was a risk factor for wheeze (p = 0.03) and night time breathlessness (p = 0.002). Building dampness was a risk factor for wheeze (OR = 1.42, 95%CI 1.08-1.86) and day time breathlessness (OR = 1.57, 95%CI 1.09-2.27). Building dampness was a risk factor for health among those below 66 years old. Odor at home was a risk factor for doctor diagnosed asthma (OR = 1.49, 95%CI 1.08-2.06) and current asthma (OR = 1.52, 95%CI 1.03-2.24). Environmental tobacco smoke (ETS) was a risk factor for current asthma (OR = 1.53, 95%CI 1.09-2.16). Window panel condensation was a risk factor for antibiotic medication for respiratory infections (OR = 1.41, 95%CI 1.10-1.82). In conclusion, rhinitis, asthma and respiratory infections were related to a number of factors in the home environment. Certain building years (1961-1985), building dampness, window panel condensation and odor in the dwelling may be risk factors.
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Affiliation(s)
- Juan Wang
- Department of Medical Sciences, Uppsala University and University Hospital, Uppsala, Sweden
- * E-mail:
| | - Karin Engvall
- Department of Medical Sciences, Uppsala University and University Hospital, Uppsala, Sweden
| | - Greta Smedje
- Department of Medical Sciences, Uppsala University and University Hospital, Uppsala, Sweden
| | - Dan Norbäck
- Department of Medical Sciences, Uppsala University and University Hospital, Uppsala, Sweden
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