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  • 1.
    Andersson, Mikael
    et al.
    Department of Neuroscience, Physiotherapy, Uppsala University.
    Stridsman, Caroline
    Luleå University of Technology, Department of Health Sciences, Medical Science.
    Rönmark, Eva
    National Institute for Working Life, Norrbottens Läns Landsting, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, The OLIN Unit, Umeå University, Karolinska Institutet, Lung and Allergy Research.
    Lindberg, Anne
    Norrbottens Läns Landsting, OLIN studies, Sunderby Hospital, Sunderby sjukhus, Luleå, Department of Public Health and Clinical Medicine, Division of Medicine, Umeå University.
    Emtner, Margareta
    Department of Neuroscience, Physiotherapy, Uppsala University.
    Physical activity and fatigue in chronic obstructive pulmonary disease: A population based study2015In: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 109, no 8, p. 1048-1057Article in journal (Refereed)
    Abstract [en]

    Background In subjects with chronic obstructive pulmonary disease (COPD), symptoms of fatigue, concomitant heart disease and low physical activity levels are more frequently described than in subjects without COPD. However, there are no population-based studies addressing the relationship between physical activity, fatigue and heart disease in COPD. The aim was to compare physical activity levels among subjects with and without COPD in a population based study, and to evaluate if concomitant heart disease and fatigue was associated to physical activity. Methods In this, 470 subjects with COPD and 659 subjects without COPD (non-COPD) participated in examinations including structured interview and spirometry. A ratio of the forced expiratory volume in one second (FEV1)/best of forced vital capacity (FVC) and vital capacity (VC) < 0.7 was used to define COPD. Physical activity was assessed with the International Physical Activity Questionnaire (IPAQ), and fatigue with the Functional Assessment of Chronic Illness Therapy - Fatigue scale (FACIT-F). Results The prevalence of low physical activity was higher among subjects with FEV1 < 80% predicted compared to non-COPD subjects (22.4% vs. 14.6%, p=0.041). The factors most strongly associated with low physical activity in subjects with COPD were older age, OR 1.52, (95% CI 1.12 – 2.06), a history of heart disease, OR 2.11 (1.10 - 4.08), and clinically significant fatigue, OR 2.33 (1.31 - 4.13); while obesity was the only significant factor among non-COPD subjects, OR 2.26 (1.17 – 4.35). Conclusion Physical activity levels are reduced when lung function is decreased below 80% of predicted, and the factors associated with low physical activity are different among subject with and without COPD. We propose that the presence of fatigue and heart disease are useful to evaluate when identifying subjects for pulmonary rehabilitation.

  • 2.
    Backman, Helena
    et al.
    Department of Public Health and Clinical Medicine, Division of Occupational and Environmental Medicine/the OLIN unit, Umeå University.
    Eriksson, Berne
    Department of Internal Medicine, Central County Hospital of Halmstad, Halmstad.
    Hedman, Linnea
    Luleå University of Technology, Department of Health Sciences, Nursing Care. Department of Public Health and Clinical Medicine, Division of Occupational and Environmental Medicine/the OLIN unit, Umeå University.
    Stridsman, Caroline
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Jansson, Sven-Arne
    Department of Public Health and Clinical Medicine, Division of Occupational and Environmental Medicine/the OLIN unit, Umeå University.
    Sovijärvi, Anssi
    Department of Clinical Physiology and Nuclear Medicine, HUS Medical Imaging Centre, Helsinki University Central Hospital.
    Lindberg, Anne
    Department of Public Health and Clinical Medicine, Division of Medicine/the OLIN unit, Umeå University.
    Rönmark, Eva
    Department of Public Health and Clinical Medicine, Division of Occupational and Environmental Medicine/the OLIN unit, Umeå University.
    Lundbäck, Bo
    Department of Public Health and Clinical Medicine, Division of Occupational and Environmental Medicine/the OLIN unit, Umeå University.
    Restrictive spirometric pattern in the general adult population: Methods of defining the condition and consequences on prevalence2016In: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 120, p. 116-123Article in journal (Refereed)
    Abstract [en]

    Background

    Attempts have been made to use dynamic spirometry to define restrictive lung function, but the definition of a restrictive spirometric pattern (RSP) varies between studies such as BOLD and NHANES. The aim of this study was to estimate the prevalence and risk factors of RSP among adults in northern Sweden based on different definitions.

    Methods

    In 2008–2009 a general population sample aged 21–86y within the obstructive lung disease in northern Sweden (OLIN) studies was examined by structured interview and spirometry, and 726 subjects participated (71% of invited). The prevalence of RSP was calculated according to three different definitions based on pre-as well as post-bronchodilator spirometry:

    1) FVC < 80% & FEV1/FVC > 0.7

    2) FVC < 80% & FEV1/FVC > LLN

    3) FVC < LLN & FEV1/FVC > LLN

    Results

    The three definitions yielded RSP prevalence estimates of 10.5%, 11.2% and 9.4% respectively, when based on pre-bronchodilator values. The prevalence was lower when based on post-bronchodilator values, i.e. 7.3%, 7.9% and 6.6%. According to definition 1 and 2, the RSP prevalence increased by age, but not according to definition 3. The overlap between the definitions was substantial. When corrected for confounding factors, manual work in industry and diabetes with obesity were independently associated with an increased risk for RSP regardless of definition.

    Conclusions

    The prevalence of RSP was 7–11%. The prevalence estimates differed more depending on the choice of pre- compared to post-bronchodilator values than on the choice of RSP definition. RSP was, regardless of definition, independently associated with manual work in industry and diabetes with obesity.

  • 3.
    Backman, Helena
    et al.
    Department of Public Health and Clinical Medicine, Division of Occupational and Environmental Medicine, The OLIN Unit, Umeå University.
    Eriksson, Berne
    Department of Internal Medicine, Central County Hospital of Halmstad.
    Rönmark, Eva
    National Institute for Working Life, Norrbottens Läns Landsting, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, The OLIN Unit, Umeå University, Karolinska Institutet, Lung and Allergy Research.
    Hedman, Linnea
    OLIN studies, Norrbotten County Council, Department of Public Health and Clinical Medicine, Division of Occupational and Environmental Medicine, The OLIN Unit, Umeå University.
    Stridsman, Caroline
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Jansson, Sven-Arne
    Department of Public Health and Clinical Medicine, Division of Occupational and Environmental Medicine, The OLIN Unit, Umeå University.
    Lindberg, Anne
    Norrbottens Läns Landsting, OLIN studies, Sunderby Hospital, Sunderby sjukhus, Luleå.
    Lundbäck, Bo
    Department of Internal Medicine and Clinical Nutrition, Krefting Research Centre, University of Gothenburg, National Institute of Occupational Health, Medical Division, Umeå, Karolinska Institutet, Lung and Allergy Research, National Institute for Working Life, Centrallasarettet Boden, Lungkliniken, Central Hospital of Norrbotten, Luleå, Boden, The OLIN Study Group.
    Decreased prevalence of moderate to severe COPD over 15 years in northern Sweden2016In: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 114, p. 103-110Article in journal (Refereed)
    Abstract [en]

    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

  • 4.
    Backman, Helena
    et al.
    Department of Public Health and Clinical Medicine, Division of Occupational and Environmental Medicine, The OLIN Unit, Umeå University.
    Hedman, Linnea
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Stridsman, Caroline
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Jansson, Sven-Arne
    Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, The OLIN Unit, Umeå University.
    Lindberg, Anne
    Department of Public Health and Clinical Medicine, Division of Medicine/the OLIN unit, Umeå University.
    Lundbäck, Bo
    Krefting Research Centre, Institute of Medicine, University of Gothenburg.
    Rönmark, Eva
    Department of Public Health and Clinical Medicine, Division of Occupational and Environmental Medicine/the OLIN unit, Umeå University.
    A population-based cohort of adults with asthma: mortality and participation in a long-term follow-up2017In: European Clinical Respiratory Journal, ISSN 2001-8525, Vol. 4, no 1, article id 1334508Article in journal (Refereed)
    Abstract [en]

    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.

  • 5.
    Backman, Helena
    et al.
    Dept of Public Health and Clinical Medicine, Division of Occupational and Environmental Medicine, the OLIN unit, Umeå university, Umeå, Sweden.
    Jansson, Sven-Arne
    Dept of Public Health and Clinical Medicine, Division of Occupational and Environmental Medicine, the OLIN unit, Umeå university, Umeå, Sweden.
    Stridsman, Caroline
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Eriksson, Berne
    Krefting Research Centre, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden, 4 Dept of Internal Medicine, Cen tral County Hospital of Halland, Halmstad, Sweden.
    Hedman, Linnea
    Dept of Public Health and Clinical Medicine, Division of Occupational and Environmental Medicine, the OLIN unit, Umeå university, Umeå, Sweden.
    Eklund, Britt-Marie
    Dept of Public Health and Clinical Medicine, Division of Occupational and Environmental Medicine, the OLIN unit, Umeå university, Umeå, Sweden.
    Sandström, Thomas
    Dept of Public Health and Clinical Medicine, Division of Medicine, Umeå university, Umeå, Sweden.
    Lindberg, Anne
    Dept of Public Health and Clinical Medicine, Division of Occupational and Environmental Medicine, the OLIN unit, Umeå university, Umeå, Sweden.
    Lundbäck, Bo
    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.
    Rönmark, Eva
    Dept of Public Health and Clinical Medicine, Division of Occupational and Environmental Medicine, the OLIN unit, Umeå university.
    Severe asthma: A population study perspective2019In: Clinical and Experimental Allergy, ISSN 0954-7894, E-ISSN 1365-2222, Vol. 49, no 6, p. 819-828Article in journal (Refereed)
    Abstract [en]

    BackgroundSevere 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.

    ObjectiveTo describe characteristics and estimate the prevalence of severe asthma in a large adult population‐based asthma cohort followed for 10‐28 years.

    MethodsN=1006 subjects with asthma participated in a follow‐up during 2012‐14, when 830 (mean age 59y, 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 Program (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.

    ResultsThe 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, >40% had uncontrolled 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 relevanceSevere 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.

  • 6.
    Backman, Helena
    et al.
    Department of Public Health and Clinical Medicine, Division of Occupational and Environmental Medicine, The OLIN Unit, Umeå University.
    Jansson, Sven-Arne
    Department of Public Health and Clinical Medicine, Division of Occupational and Environmental Medicine/the OLIN Unit, Umeå University.
    Stridsman, Caroline
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Muellerova, Hana
    Real-World Evidence&Epidemiology, GSK R&D.
    Wurst, Keele
    Real-World Evidence&Epidemiology, GSK R&D.
    Hedman, Linnea
    Department of Public Health and Clinical Medicine, Division of Occupational and Environmental Medicine/the OLIN Unit, Umeå University.
    Lindberg, Anne
    Department of Public Health and Clinical Medicine, Division of Medicine/the OLIN Unit, Umeå University.
    Rönmark, Eva
    Department of Public Health and Clinical Medicine, Division of Occupational and Environmental Medicine/the OLIN Unit, Umeå University.
    Chronic airway obstruction in a population-based adult asthma cohort: Prevalence, incidence and prognostic factors2018In: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 138, p. 115-122Article in journal (Refereed)
    Abstract [en]

    Background

    Asthma and COPD may overlap (ACO) but information about incidence and risk factors are lacking. This study aimed to estimate prevalence, incidence and risk factors of chronic airway obstruction (CAO) in a population-based adult asthma cohort.

    Methods

    During 1986–2001 a large population-based asthma cohort was identified (n = 2055, 19-72y). Subsamples have participated in clinical follow-ups during the subsequent years. The entire cohort was invited to a clinical follow-up including interview, spirometry, and blood sampling in 2012–2014 when n = 983 subjects performed adequate spirometry. CAO was defined as post-bronchodilator FEV1/FVC<0.7.

    Results

    At study entry, asthmatics with prevalent CAO (11.4%) reported more respiratory symptoms, asthma medication use, and ischemic heart disease than asthmatics without CAO (asthma only). Subjects who developed CAO during follow-up (17.6%; incidence rate of 16/1000/year) had a more rapid FEV1 decline and higher levels of neutrophils than asthma only. Smoking, older age and male sex were independently associated with increased risk for both prevalent and incident CAO, while obesity had a protective effect.

    Conclusions

    In this prospective adult asthma cohort, the majority did not develop CAO. Smoking, older age and male sex were risk factors for prevalent and incident CAO, similar to risk factors described for COPD in the general population.

  • 7.
    Backman, Helena
    et al.
    Department of Public Health and Clinical Medicine, Division of Occupational and Environmental Medicine, The OLIN Unit, Umeå University.
    Räisänen, Petri
    Department of Public Health and Clinical Medicine, Division of Occupational and Environmental Medicine/the OLIN unit, Umeå University.
    Hedman, Linnea
    Department of Public Health and Clinical Medicine, Division of Occupational and Environmental Medicine/the OLIN unit, Umeå University.
    Stridsman, Caroline
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Andersson, Martin
    Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, The OLIN Unit, Umeå University.
    Lindberg, Anne
    Department of Public Health and Clinical Medicine, Division of Medicine/the OLIN unit, Umeå University.
    Lundbäck, Bo
    Krefting Research Centre, Institute of Medicine, University of Gothenburg.
    Rönmark, Eva
    Department of Public Health and Clinical Medicine, Division of Occupational and Environmental Medicine/the OLIN unit, Umeå University.
    Increased prevalence of allergic asthma from 1996 to 2006 and further to 2016: results from three population surveys2017In: Clinical and Experimental Allergy, ISSN 0954-7894, E-ISSN 1365-2222, Vol. 47, no 11, p. 1426-1435Article in journal (Refereed)
    Abstract [en]

    Background

    During the latter half of the 20th century, the prevalence of asthma and many other allergic diseases has increased. Information on asthma prevalence trends among adults after 2010, especially regarding studies separating allergic asthma from non-allergic asthma, is lacking.

    Objective

    The aim was to estimate prevalence trends of current asthma among adults, both allergic and non-allergic, from 1996 to 2016.

    Methods

    Three cross-sectional samples from the same area of Sweden, 20-69 years, participated in surveys with the same questionnaire in 1996 (n=7104 participants, 85% response rate), 2006 (n=6165, 77%) and 2016 (n=5466, 53%), respectively. Allergic rhino-conjunctivitis (ARC) was used as a marker for allergic sensitization to define allergic asthma.

    Results

    The prevalence of current asthma increased from 8.4% (95% CI: 7.8-9.0) in 1996 to 9.9% (95% CI: 9.2-10.6) in 2006 and 10.9% (95% CI: 10.1-11.7) in 2016 (P<.001). Allergic asthma increased from 5.0% (95% CI: 4.5-5.5) in 1996 to 6.0% (95% CI: 5.4-6.6) in 2006 and further to 7.3% (95% CI: 6.6-8.0) in 2016 (P<.001), while the prevalence of non-allergic asthma remained stable around 3.4%-3.8%. The increase in current asthma was most pronounced among women and among the middle-aged. Physician-diagnosed asthma, asthma medication use and ARC also increased significantly, while the prevalence of symptoms common in asthma such as wheeze and attacks of shortness of breath decreased slightly or was stable. The prevalence of current smoking decreased from 27.4% in 1996 to 12.3% in 2016.

    Conclusions and Clinical Relevance

    The prevalence of allergic asthma increased from 1996 to 2006 and further to 2016, while the prevalence of non-allergic asthma remained on a stable prevalence level. The prevalence of symptoms common in asthma decreased slightly or was stable despite a substantial decrease in the prevalence of current smoking. Clinicians should be aware that the previously observed increase in prevalence of allergic asthma is still ongoing.

  • 8.
    Hedman, Linnea
    et al.
    Luleå University of Technology, Department of Health Sciences, Nursing Care. he Obstructive Lung Disease in Northern Sweden Unit, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, Umeå University, Umeå, Sweden.
    Backman, Helena
    The Obstructive Lung Disease in Northern Sweden Unit, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, Umeå University, Umeå, Sweden.
    Stridsman, Caroline
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Bosson, Jenny A.
    Division of Respiratory Medicine, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
    Lundbäck, Magnus
    Karolinska Institutet, Division of Cardiovascular Medicine, Department of Clinical Sciences, Danderyd University Hospital, Stockholm, Sweden.
    Lindberg, Anne
    The Obstructive Lung Disease in Northern Sweden Unit, Division of Medicine, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
    Rönmark, Eva
    The Obstructive Lung Disease in Northern Sweden Unit, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, Umeå University, Umeå, Sweden.
    Ekerljung, Linda
    Krefting Research Center, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Association of Electronic Cigarette Use With Smoking Habits, Demographic Factors, and Respiratory Symptoms2018In: JAMA Network Open, E-ISSN 2574-3805, Vol. 1, no 3, article id e180789Article in journal (Refereed)
    Abstract [en]

    Importance  Increases in total knee arthroplasty (TKA) utilization rates suggest that its indications have been expanded to include patients with less severe symptoms. A recent study challenged the cost-effectiveness of TKA in this group of patients.

    Objective  To determine the association of the 36-Item Short Form Health Survey physical component summary score (SF-36 PCS) with patient satisfaction 2 years after TKA.

    Design, Setting, and Participants  This cohort study reviewed registry data from 2 years of follow-up of patients who underwent unilateral TKA from January 1, 2010, to December 31, 2014, at a single-center tertiary institution in Singapore. Data were acquired on April 27, 2017, and analyzed from August 15, 2017, to December 22, 2017.

    Main Outcomes and Measures  Patient satisfaction and SF-36 PCS. Preoperative disability and postoperative function as measured by the SF-36 PCS were correlated with Δ (2-year end point score minus baseline score) and patient satisfaction, scored on a 6-point Likert scale, with lower scores indicating greater satisfaction.

    Results  Of the 6659 patients, 5234 (78.6%) were female and 5753 (86.4%) were of Chinese ethnicity. Mean (SD) age was 67.0 (7.7) years, and mean (SD) body mass index (calculated as weight in kilograms divided by height in meters squared) was 27.7 (4.6). At 2-year follow-up, the mean (SD) SF-36 PCS score improved from 32.2 (10.1) to 48.2 (9.5) (P < .001). There were 1680 patients (25.2%) who described their satisfaction as excellent, 2574 (38.7%) very good, 1879 (28.2%) good, 382 (5.7%) fair, 96 (1.4%) poor, and 48 (0.7%) terrible. The minimal clinically important difference (change in SF-36 PCS of 10 from baseline) was met in 4515 patients (67.8%), and overall satisfaction was 97.8% (6515 patients). Covariance analysis showed significantly higher satisfaction in patients with preoperative scores of 40 to less than 50. Patients who were unlikely to meet the minimal clinically important difference compared with those who were likely to meet it (SF-36 PCS of ≥42.1 vs <42.1) had significantly higher 2-year satisfaction (mean [SD], 2.15 [0.9] vs 2.23 [1.0]; P = .009).

    Conclusions and Relevance  The findings suggest that a general health score, such as SF-36, is not associated with patient satisfaction 2 years after TKA. Functional assessment, preoperative counseling, and modification of expectations appear to remain vital before TKA.

  • 9.
    Hedman, Linnea
    et al.
    Luleå University of Technology, Department of Health Sciences, Nursing Care. Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, The OLIN Unit, Umeå University, Umeå, Sweden.
    Stridsman, Caroline
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Andersson, Martin
    Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, The OLIN Unit, Umeå University.
    Backman, Helena
    Department of Public Health and Clinical Medicine, Division of Occupational and Environmental Medicine, The OLIN Unit, Umeå University.
    Jansson, Sven-Arne
    Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, The OLIN Unit, Umeå University.
    Rönmark, Eva
    Department of Public Health and Clinical Medicine, Division of Occupational and Environmental Medicine/the OLIN unit, Umeå University.
    Population-based study shows that teenage girls with asthma had impaired health-related quality of life2017In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 106, no 7, p. 1128-1135Article in journal (Refereed)
    Abstract [en]

    Aim

    This study examined the health-related quality of life (HRQoL) of teenagers with and without asthma, including the impact of their sex, allergic conditions, smoking, living conditions and physical activity.

    Methods

    The Obstructive Lung Disease in Northern Sweden (OLIN) studies recruited a cohort of schoolchildren in 2006. The parents of all children aged seven to eight years in three municipalities were invited to complete a questionnaire and 2585 (96%) participated. The cohort was followed up at the ages of 11–12 years and 14–15 years with high participation rates. At 14–15 years, the HRQoL questionnaire KIDSCREEN-10 and Asthma Control Test were added.

    Results

    Girls with current asthma at 14–15 years had a lower mean HRQoL score than girls without asthma (46.4 versus 49.3, p < 0.001), but this was not seen among boys (53.8 versus 52.8, p = 0.373). Poor HRQoL was related to current asthma, uncontrolled asthma and teenage onset of asthma. It was also related to eczema, living in a single-parent household, maternal smoking, daily smoking and inversely related to physical activity.

    Conclusion

    Teenage girls with asthma had lower HRQoL than girls without asthma. Possible interventions to improve HRQoL among teenagers with asthma were identified as follows: increasing asthma control, preventing smoking and promoting physical activity.

  • 10.
    Jansson, Sven-Arne
    et al.
    Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, The OLIN Unit, Umeå University.
    Axelsson, Malin
    Department of Care Sciences, Faculty of Health and Society, Malmö University.
    Hedman, Linnea
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Leander, Mai
    Department of Medical Sciences, Respiratory Medicine and Allergology, Uppsala University.
    Stridsman, Caroline
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Rönmark, Eva
    6Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, The OLIN Unit, Umeå University.
    Subjects with well-controlled asthma have similar health-related quality of life as subjects without asthma2016In: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 120, p. 64-69Article in journal (Refereed)
    Abstract [en]

    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.

    Copyright © 2016 Elsevier Ltd. All rights reserved.

  • 11.
    Johansson Strandkvist, Viktor
    et al.
    Luleå University of Technology, Department of Health Sciences, Health and Rehab. Umeå University, Department of Public Health and Clinical Medicine, Division of Occupational and Environmental Medicine, The OLIN unit.
    Backman, Helena
    Umeå University, Department of Public Health and Clinical Medicine, Division of Occupational and Environmental Medicine, The OLIN unit.
    Andersson, Mikael
    Uppsala University, Department of Neuroscience.
    Larsson, Agneta
    Luleå University of Technology, Department of Health Sciences, Health and Rehab.
    Stridsman, Caroline
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Lindberg, Anne
    Department of Public Health and Clinical Medicine, Division of Medicine/the OLIN unit, Umeå University.
    Hand grip strength is associated with fatigue in COPD2017Conference paper (Refereed)
  • 12.
    Johansson Strandkvist, Viktor
    et al.
    Luleå University of Technology, Department of Health Sciences, Health and Rehab.
    Backman, Helena
    Division of Occupational and Environmental Medicine, Department of Public Health and Clinical Medicine, The Obstructive Lung disease in Northern Sweden Unit, Umeå University.
    Röding, Jenny
    Luleå University of Technology, Department of Health Sciences, Health and Rehab.
    Stridsman, Caroline
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Lindberg, Anne
    Division of Medicine, Department of Public Health and Clinical Medicine, Umeå University.
    Hand grip strength is associated with forced expiratory volume in 1 second among subjects with COPD: report from a population-based cohort study.2016In: The International Journal of Chronic Obstructive Pulmonary Disease, ISSN 1176-9106, E-ISSN 1178-2005, Vol. 11, no 1, p. 2527-2534Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Cardiovascular diseases and skeletal muscle dysfunction are common comorbidities in COPD. Hand grip strength (HGS) is related to general muscle strength and is associated with cardiovascular disease and all-cause mortality, while the results from small selected COPD populations are contradictory. The aim of this population-based study was to compare HGS among the subjects with and without COPD, to evaluate HGS in relation to COPD severity, and to evaluate the impact of heart disease.

    SUBJECTS AND METHODS: Data were collected from the Obstructive Lung disease in Northern Sweden COPD study, where the subjects with and without COPD have been invited to annual examinations since 2005. In 2009-2010, 441 subjects with COPD (postbronchodilator forced expiratory volume in 1 second [FEV1]/vital capacity <0.70) and 570 without COPD participated in structured interviews, spirometry, and measurements of HGS.

    RESULTS: The mean HGS was similar when comparing subjects with and without COPD, but those with heart disease had lower HGS than those without. When compared by Global Initiative for Chronic Obstructive Lung Disease (GOLD) grades, the subjects with GOLD 3-4 had lower HGS than those without COPD in both sexes (females 21.4 kg vs 26.9 kg, P=0.010; males 41.5 kg vs 46.3 kg, P=0.038), and the difference persisted also when adjusted for confounders. Among the subjects with COPD, HGS was associated with FEV1% of predicted value but not heart disease when adjusted for height, age, sex, and smoking habits, and the pattern was similar among males and females.

    CONCLUSION: In this population-based study, the subjects with GOLD 3-4 had lower HGS than the subjects without COPD. Among those with COPD, HGS was associated with FEV1% of predicted value but not heart disease, and the pattern was similar in both sexes.

  • 13.
    Johansson Strandkvist, Viktor
    et al.
    Luleå University of Technology, Department of Health Sciences, Health and Rehabilitation. OLIN-studierna.
    Backman, Helena
    Department of Public Health and Clinical Medicine, Division of Occupational and Environmental Medicine, The OLIN Unit, Umeå University.
    Röding, Jenny
    Luleå University of Technology, Department of Health Sciences, Health and Rehabilitation.
    Stridsman, Caroline
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Lindberg, Anne
    Department of Public Health and Clinical Medicine, Division of Medicine/the OLIN unit, Umeå University.
    Impact of heart disease on hand grip strength in COPD: epidemiological data2016Conference paper (Refereed)
    Abstract [en]

    Background: Hand grip strength (HGS) and heart disease (HD) are related to mortality. Peripheral muscle dysfunction and HD are both frequently observed among subjects with COPD, but the relationship between HGS and HD in COPD is unclear.

    Aim: To evaluate HGS and the impact of HD among subjects with and without COPD.Methods: Data was collected from the OLIN (Obstructive Lung Disease in Northern Sweden) COPD study, where subjects with COPD have been invited to annual examinations since 2005 together with age- and sex-matched subjects without COPD. During 2009, 441 subjects with COPD and 570 without COPD participated in examinations including structured interviews, spirometry and measurements of HGS. COPD was defined as post-bronchodilator FEV1/VC<0.70.

    Results: Both among subjects with and without COPD, and in both sexes, those with HD had significantly lower HGS. The proportion of subjects below estimated normal value for HGS was similar in subjects with and without COPD and in both sexes; among women (35.4 vs. 33.4%, p=0.714) and men (19.1 vs 15.9%, p=0.315). In a linear regression model among subjects with COPD only, HGS was significantly associated with age, beta coefficient (B) = -0.46 (p<0.001), sex, B=19.85 (p<0.001) and FEV1 % of predicted normal value, B=0.06 (p=0.007), but not with HD or smoking habits. When a similar model was estimated among subjects without COPD, HGS was only associated with age and sex.

    Conclusions: In this population-based study, subjects with heart disease had lower hand grip strength regardless if they had COPD or not. Among COPD subjects, hand grip strength was associated with age, sex and FEV1, but not with heart disease.

  • 14.
    Johansson Strandkvist, Viktor
    et al.
    Luleå University of Technology, Department of Health Sciences, Health and Rehab.
    Nyberg, Lars
    Luleå University of Technology, Department of Health Sciences, Health and Rehab.
    Larsson, Agneta
    Luleå University of Technology, Department of Health Sciences, Health and Rehab.
    Röijezon, Ulrik
    Luleå University of Technology, Department of Health Sciences, Health and Rehab.
    Stridsman, Caroline
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Lindberg, Anne
    OLIN studierna Norrbottens läns landsting , Sverige.
    Project: Physical function and postural control among subjects with Chronic Obstructive Pulmonary Disease – epidemiological and laboratory studies2016Other (Other (popular science, discussion, etc.))
  • 15.
    Selberg, Stina
    et al.
    The OLIN Studies, Norrbotten County Council, Luleå.
    Hedman, Linnea
    Luleå University of Technology, Department of Health Sciences, Nursing Care. The OLIN Studies, Norrbotten County Council, Luleå. Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, The OLIN unit, Umeå University, Umeå.
    Jansson, Sven-Arne
    Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, The OLIN unit, Umeå University, Umeå.
    Backman, Helena
    The OLIN Studies, Norrbotten County Council, Luleå. Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, The OLIN unit, Umeå University, Umeå.
    Stridsman, Caroline
    Luleå University of Technology, Department of Health Sciences, Medical Science. Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Asthma control and acute health care visits among young adults with asthma: A population‐based study2019In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648Article in journal (Refereed)
    Abstract [en]

    Aims

    To study asthma control and acute health care visits among young adults with asthma.

    Background

    Despite the access to effective treatment and nursing interventions, poor asthma control is still common among individuals with asthma. However, studies describing clinical characteristics among young adults with asthma are rare.

    Design

    A population‐based cohort study.

    Methods

    In 2015, as a part of the OLIN pediatric cohort I (recruited in 1996 at age 7‐8yr), N=2291 young adults (27‐28 yr) completed a postal questionnaire survey including questions on asthma and respiratory symptoms. Of these, N=280 (12%) were identified as having current asthma and were further studied.

    Results

    Of those with current asthma, women reported respiratory symptoms and smoking to a greater extent than men. Approximately one‐fourth had uncontrolled asthma and acute health care visits due to asthma was reported by 15% of women and 8% of men. Uncontrolled asthma was associated with smoking, lower educational level, use of reliever treatment most days and acute health care visits. Acute health care visits due to asthma were associated with periodic use of regular controller treatment also after adjustment for uncontrolled asthma.

    Conclusion

    The result indicate poor adherence to asthma treatment which may lead to decreased asthma control and acute health care visits.

    Impact

    Most young adults with asthma are diagnosed and treated in primary care, ideally in a team with a nurse. The main findings highlight the need for evidenced‐based nursing interventions, contributing to a more efficient asthma management in primary care.

  • 16.
    Strandkvist, Viktor
    et al.
    Luleå University of Technology, Department of Health Sciences, Health and Rehabilitation. Department of Public Health and Clinical Medicine, The OLIN Unit, Division of Occupational and Environmental Medicine , Umea University.
    Andersson, Mikael
    Department of Neuroscience, Physiotherapy, Uppsala University , Uppsala.
    Backman, Helena
    Department of Public Health and Clinical Medicine, The OLIN Unit, Division of Occupational and Environmental Medicine , Umeå University , Umeå.
    Larsson, Agneta
    Luleå University of Technology, Department of Health Sciences, Health and Rehabilitation.
    Stridsman, Caroline
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Lindberg, Anne
    Department of Public Health and Clinical Medicine, Division of Medicine , Umeå University , Umeå.
    Hand grip strength is associated with fatigue among men with COPD: epidemiological data from northern Sweden2018In: Physiotherapy Theory and Practice, ISSN 0959-3985, E-ISSN 1532-5040Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to investigate if hand grip strength (HGS) is associated with: 1) fatigue, and specifically clinically relevant fatigue (CRF); 2) low physical activity; and 3) fatigue independent of physical activity level, among individuals with and without COPD. Data were collected from the Obstructive Lung Disease in Northern Sweden (OLIN) COPD-study in 2014. HGS was measured with a hand-grip dynamometer, fatigue and physical activity were assessed by questionnaires; FACIT-Fatigue respectively IPAQ. Among individuals with COPD (n = 389), but not without COPD (n = 442), HGS was lower among those with CRF than those without CRF, significantly so among men (p = 0.001) and close to among women (p = 0.051). HGS was not associated with physical activity levels within any of the groups. HGS was associated with fatigue among men, but not women, with COPD independent of physical activity level, age, height, and smoking habits (Beta = 0.190, 95% CI 0.061-0.319, respectively Beta = 0.048, 95% CI-0.056-0.152), while there were no corresponding significant findings among individuals without COPD. In summary, HGS was associated with CRF among individuals with COPD in this population-based study. Among men with COPD, HGS was associated with fatigue independent of physical activity level and common confounders.

  • 17.
    Stridsman, Caroline
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Activity: Fatigue in COPD: A qualitative study of peoples experiences2012Conference paper (Other (popular science, discussion, etc.))
  • 18.
    Stridsman, Caroline
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Activity: Fatigue in COPD and the impact of heart disease comorbidity: a population based study2011Conference paper (Other (popular science, discussion, etc.))
  • 19.
    Stridsman, Caroline
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Activity: Fatigue vid KOL samt påverkan av luftvägssymtom och hjärtsjukdom: en rapport från OLIN-studierna2011Conference paper (Other (popular science, discussion, etc.))
  • 20.
    Stridsman, Caroline
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Aktivitet: Att leva med fatigue vid kroniskt obstruktiv lungsjukdom2011Conference paper (Other (popular science, discussion, etc.))
  • 21.
    Stridsman, Caroline
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Living with chronic obstructive pulmonary disease with focus on fatigue, health and well-being2013Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    The overall aim of this thesis was to describe and evaluate experiences of living with chronic obstructive pulmonary disease (COPD), with focus on fatigue, health and well-being. A mixed method study design was used to reach the overall aim. All studies were based on data from the Obstructive Lung Disease in Northern Sweden (OLIN) COPD study. Papers I (n=1350) and III (n=1089) included participants (aged 35-88 years) with and without a spirometric classification of COPD. Bivariate, multiple logistic regression (I, III), and correlation (III) analyses were performed. Papers II (n=20) and IV (n=10) included participants (aged 59-77 years) with moderate to very severe COPD. Semi-structured interviews were conducted, and data were analysed through qualitative content analysis. The result showed that fatigue was worse among people with COPD compared to people without COPD. Fatigue increased with disease severity, and was already worse in COPD grade I among people with respiratory symptoms compared with the non-COPD group. COPD grade II with respiratory symptoms (OR 1.65) and grade III-IV with respiratory symptoms (OR 2.66) were significant risk factors for clinically significant fatigue when adjusted for sex, age, heart disease, and smoking habits (Paper I). Fatigue was described to mainly be COPD related; it was accepted as a natural consequence of COPD, but it was unexpressed. Fatigue affected and controlled the daily life of these people, and with dyspnea, fatigue was described to be overwhelming. Planning physical activity was the most important strategy to manage fatigue (Paper II). Fatigue had a great impact on both physical and mental dimensions of the health status, irrespective of having COPD or not. Among people with clinically significant fatigue, those with COPD had significantly lower physical health scores. Fairly strong correlations existed between FACIT-Fatigue and physical as well as mental health dimensions in SF-36. Increased fatigue and decreased physical and mental dimensions of health, each predicted mortality, but only among people with COPD (Paper III). Identified aspects for increased well-being for people living with COPD were adjusting to lifelong limitations, handling variations in illness, relying on self-capacity and accessibility to a trustful care. People had to adapt to limitations and live forward by finding a balance between breathing and viability (Paper IV). In conclusion, increased fatigue can be experienced in COPD already at grade I when respiratory symptoms are present, and COPD grade ≥II is a risk factor for clinically significant fatigue. Fatigue is common but seems to be unspoken, and an increased awareness of the symptom is necessary for an early identification. It is therefore important for health care professionals to take fatigue into consideration, to objectively assess and ask patients about it. This is important, since fatigue clearly worsens the health status among people living with COPD, and furthermore is associated with mortality in COPD. To enhance health and well-being, an increased viability may facilitate self-capacity and increase the strength for illness and fatigue management among people living with COPD

  • 22.
    Stridsman, Caroline
    et al.
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Backman, Helena
    Department of Public Health and Clinical Medicine, Division of Occupational and Environmental Medicine, The OLIN Unit, Umeå University.
    Eklund, Britt-Marie
    The OLIN Studies, Norrbotten County Council.
    Rönmark, Eva
    Department of Public Health and Clinical Medicine, Division of Occupational and Environmental Medicine/the OLIN unit, Umeå University.
    Hedman, Linnea
    Luleå University of Technology, Department of Health Sciences, Nursing Care. Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, The OLIN unit, Umeå University.
    Adolescent girls with asthma have worse asthma control and health-related quality of life than boys: A population based study2017In: Pediatric Pulmonology, ISSN 8755-6863, E-ISSN 1099-0496, Vol. 52, no 7, p. 866-872Article in journal (Refereed)
    Abstract [en]

    Background

    Population-based studies investigating health-related quality of life (HRQoL) among asthmatic adolescents are rare. Further, among subjects with asthma, HRQoL may be affected by asthma control and severity.

    Aim

    To investigate HRQoL in relation to asthma control and asthma severity among adolescents.

    Method

    As a part of the population-based OLIN pediatric study, 266 adolescents with current asthma (14-15 yr) were identified. N = 247 completed the DISABKIDS HRQoL asthma module, including the domains impact and worry. The Asthma Control Test (ACT) was used and a disease severity score was calculated based on symptoms and medicine use.

    Results

    The prevalence of current asthma was 11%. Well-controlled asthma was reported by 15% of the adolescents, and 53% had partly controlled asthma. The prevalence of uncontrolled asthma was significantly higher among girls than boys (38% vs 25%), and girls also reported lower HRQoL scores. There was a fairly strong correlation between the ACT and DISABKIDS scores. Independent risk factors for low HRQoL impact (a score <67) were female sex (OR 4.66, 95%CI 1.82-9.54) and decreased ACT scores (1.38, 1.18-1.62). Risk factors for low HRQoL worry (a score <70) were female sex (3.33, 1.41-7.86), decreased ACT scores (1.35, 1.16-1.57), severe asthma (6.23, 1.46-16.50), and having current eczema (2.68, 1.00-7.24).

    Conclusion

    Only a minority of the asthmatic adolescents reported well-controlled asthma, and poor asthma control and female sex were risk factors for low HRQoL. Our results demonstrate that evaluation of asthma control is of great importance for asthma management.

  • 23.
    Stridsman, Caroline
    et al.
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Dahlberg, Elisabeth
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Zandrén, Karin
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Hedman, Linnea
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Asthma in adolescence affects daily life and school attendance: Two cross-sectional population-based studies 10 years apart2017In: Nursing Open, E-ISSN 2054-1058, Vol. 4, no 3, p. 143-148Article in journal (Refereed)
    Abstract [en]

    Aim

    The aim of this study was to study the impact of asthma on daily life, school absenteeism and physical education. In addition, to describe asthma triggers at school.

    Design

    Two cross-sectional population-based studies ten years apart.

    Method

    Within the OLIN-studies, in 2003 (= 3,327) and in 2013 (= 2,345) adolescents (14–15 years) answered an expanded ISAAC questionnaire. Of these, 8% and 11%, respectively with current asthma participated in this study.

    Results

    Between the years 2003–2013, the proportion of adolescents reporting that asthma interfered with daily life had increased, in 2013, girls were significantly more affected than boys. The proportion reporting a worsening of asthma at school had decreased, but it was still over a quarter. The proportion of absenteeism from school and from physical education was at the same level both years. Asthma triggers were described to be poor air quality, poorly cleaned environment, allergens, strong fragrance, rebuilding projects, physical education and stress.

  • 24.
    Stridsman, Caroline
    et al.
    Luleå University of Technology, Department of Health Sciences.
    Lindberg, Anne
    OLIN studies, Sunderby Hospital.
    Skär, Lisa
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Fatigue in chronic obstructive pulmonary disease: a qualitative study of peoples experiences2014In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 28, no 1, p. 130-138Article in journal (Refereed)
    Abstract [en]

    BackgroundFatigue is reported to be one of the most common symptoms among people with chronic obstructive pulmonary disease COPD. However, there is hardly any qualitative research describing how fatigue affects people living with this illness.AimTo describe people's experience of fatigue in daily life when living with moderate to very severe COPD.MethodsA purposive sample of 20 people with COPD stages II–IV was recruited from the Obstructive Lung Disease in Northern Sweden COPD study. Data were collected through semi-structured interviews with participants regarding their experience of fatigue. The interviews were subjected to qualitative content analysis.ResultsOne theme was identified: Reconcile with the dimensions of fatigue, and four categories were identified: To understand the reasons of fatigue, To preserve fatigue unexpressed, When fatigue takes control and How to manage fatigue. Fatigue seems to be an always-present feeling, involving the whole body, raising feelings of hopelessness and controlling one's life. It seems to be accepted as a natural consequence of COPD and may therefore remain unexpressed. Further, when experienced with dyspnoea, fatigue becomes even heavier and more difficult to manage. To gain control of fatigue, people plan daily life and continue with physical activities.ConclusionFatigue affects the daily lives of people with COPD. Perceived with dyspnoea, fatigue was described as overwhelming. Most importantly, fatigue seems to be unexpressed to healthcare professionals and relatives.

  • 25.
    Stridsman, Caroline
    et al.
    Luleå University of Technology, Department of Health Sciences.
    Mullerova, Hana
    WorldWide Epidemiology, GlaxoSmithKline R&D.
    Skär, Lisa
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Lindberg, Anne
    OLIN studies, Norrbotten County Council.
    Fatigue in COPD and the impact of heart disease comorbidity: a population-based study2011Conference paper (Other academic)
    Abstract [en]

    Background: Fatigue is a common symptom among people with COPD. However, there are few studies describing fatigue in COPD and the impact of comorbidity, none of them population based.Aim: To describe fatigue in COPD by disease severity according to GOLD, and the impact of self-reported heart disease.Methods: The Functional Assessment of Chronic Illness Therapy (FACIT)- Fatigue scale was used to assess fatigue; lower scores represent worse fatigue (0-52). Data were collected in 2007 from the Obstructive Lung Disease in Northern Sweden (OLIN) COPD cohort; 564 subjects with COPD, with a distribution of disease severity representative for the general population, and 786 non-COPD subjects.Results: Median FACIT-F score was 44.0 in COPD subjects, significantly lower compared to 46.0 in non-COPD (p=0.006). Score decreased by disease severity: 46.0, 43.7, and 37.5 in GOLD stage I, II, and III-IV (I vs II p=0.020, II vs III-IV p=0.035). There was no significant difference between stage I and non-COPD. In subjects without heart disease, there were lower scores in stage II, 45.0 and III-IV, 38.5 compared to non-COPD, 47.0 (p=0.005 and p=0.205). In subjects with heart disease, only stage III-IV had significantly lower scores than non-COPD, 30.5 vs 42.0 (p=0.030). Subjects with heart disease reported lower scores than those without heart disease at all severities of COPD (non-COPD: 42.0 vs 47.0, p<0.001, stage I: 40.5 vs 48.0, p<0.001, stage II: 40.0 vs 45.0, p=0.008 and stage III-IV: 30.5 vs 38.5, p=0.051).Conclusion: Fatigue increases with GOLD-defined disease severity, but the score is not significantly different from non-COPD until stage II. Heart disease increases fatigue in both COPD and non-COPD.

  • 26.
    Stridsman, Caroline
    et al.
    Luleå University of Technology, Department of Health Sciences.
    Mullerova, Hana
    WorldWide Epidemiology, GlaxoSmithKline R&D.
    Skär, Lisa
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Lindberg, Anne
    OLIN studies, Sunderby Hospital.
    Fatigue in COPD and the impact of respiratory symptoms and heart disease: a population-based study2013In: COPD: Journal of Chronic Obstructive Pulmonary Disease, ISSN 1541-2555, E-ISSN 1541-2563, Vol. 10, no 2, p. 125-132Article in journal (Refereed)
    Abstract [en]

    Background: Fatigue is reported in COPD and in heart disease; however, there are hardly any population based data on the relationship between these conditions. Aim: To describe fatigue in relation to COPD by disease severity and to evaluate the impact of respiratory symptoms and heart disease. Methods: Data were collected in 2007 from the OLIN COPD study; 564 subjects with COPD (FEV1/FVC < 0.70) and a distribution of disease severity representative for the general population, and 786 subjects without COPD. The Functional Assessment of Chronic Illness Therapy (FACIT)—Fatigue scale was used to assess fatigue (0–52); lower scores represent worse fatigue. Results: Median FACIT-F score was 44.0 in COPD defined by merely spirometric criteria and 42.0 in COPD also reporting respiratory symptoms, significantly lower compared to 46.0 in non-COPD (p = 0.006 and p < 0.001), and decreased by disease severity. The score was lower in COPD stage ≥ II and in COPD with respiratory symptoms already from stage I when compared to non-COPD. Subjects with heart disease reported lower scores than those without heart disease in COPD by all stages and in non-COPD. COPD with respiratory symptoms stage ≥II remained a significant risk factor for clinically significant fatigue also when adjusted for gender, age, heart disease and smoking habits (stage II OR 1.65, CI 1.17-2.31 and stage III-IV OR 2.66, CI 1.11-6.36). Conclusion: Fatigue is common in COPD, and is affected by respiratory symptoms and concomitant heart disease. In COPD with respiratory symptoms stage ≥ II, there is an increased risk for clinically significant fatigue.Read More: http://informahealthcare.com/doi/abs/10.3109/15412555.2012.728642?ai=1rzjm&ui=oxk4&af=T&

  • 27.
    Stridsman, Caroline
    et al.
    Luleå University of Technology, Department of Health Sciences.
    Skär, Lisa
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Hedman, Linnea
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Lindberg, Anne
    Fatigue and decreased health can predict mortality in COPD2013Conference paper (Other academic)
  • 28.
    Stridsman, Caroline
    et al.
    Luleå University of Technology, Department of Health Sciences, Medical Science.
    Skär, Lisa
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Hedman, Linnea
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Rönmark, Eva
    Norrbottens Läns Landsting.
    Lindberg, Anne
    OLIN studies, Norrbotten County Council.
    Fatigue affects health status and predicts mortality among subjects with COPD-report from the population-based OLIN COPD study2015In: COPD: Journal of Chronic Obstructive Pulmonary Disease, ISSN 1541-2555, E-ISSN 1541-2563, Vol. 12, no 2, p. 199-206Article in journal (Refereed)
    Abstract [en]

    Background: COPD is associated to increased fatigue, decreased health status and mortality. However, these relationships are rarely evaluated in population-based studies. Aims: To describe the relationship between health status, respiratory symptoms and fatigue among subjects with and without COPD. Further, to evaluate whether fatigue and/or health status predicts mortality in these groups. Methods: Data were collected in 2007 from the population-based OLIN COPD study. Subjects participated in lung function tests and structured interviews, and 434 subjects with and 655 subjects without COPD were identified. Fatigue was assessed by FACIT-Fatigue and health status by the generic SF-36 questionnaire including physical (PCS) and mental (MCS) components. Mortality data until February 2012 were collected. Results: Fatigue greatly impacts the physical and mental dimensions of health status, both among subjects with and without COPD. Among subjects with clinically significant fatigue, COPD subjects had significantly lower PCS-scores compared to non-COPD subjects. Fairly strong correlations were found between FACIT-F, SF-36 PCS and MCS, respectively. In multivariate models adjusting for covariates, increased fatigue, decreased physical and mental dimensions of health status were all associated to mortality in subjects with COPD (OR 1.06, CI 1.02-1.10, OR 1.04, CI 1.01-1.08 and OR 1.06, CI 1.02-1.10), but not in non-COPD. Conclusions: Fatigue and decreased health status were closely related among subjects with and without COPD. Not only physical health status, but also fatigue and mental health predicted mortality among subjects with COPD. Fatigue assessed by FACIT-F, can be a useful instrument of prognostic value in the care of subjects with COPD.

  • 29.
    Stridsman, Caroline
    et al.
    Luleå University of Technology, Department of Health Sciences, Nursing Care. The OLIN Studies.
    Svensson, My
    Department of Public Health and Clinical Medicine, The OLIN Unit/Division of Medicine, Umeå University.
    Johansson Strandkvist, Viktor
    Luleå University of Technology, Department of Health Sciences, Health and Rehabilitation.
    Hedman, Linnea
    Luleå University of Technology, Department of Health Sciences, Nursing Care. Department of Public Health and Clinical Medicine, The OLIN Unit/Division of Occupational and Environmental Medicine, Umeå University.
    Backman, Helena
    Department of Public Health and Clinical Medicine, The OLIN Unit/Division of Occupational and Environmental Medicine, Umeå University.
    Lindberg, Anne
    Department of Public Health and Clinical Medicine, The OLIN Unit/Division of Medicine, Umeå University.
    The COPD Assessment Test (CAT) can screen for fatigue among patients with COPD2018In: Therapeutic advances in respiratory disease, ISSN 1753-4658, Vol. 12, article id 1753466618787380Article in journal (Refereed)
    Abstract [en]

    Background:

    Fatigue is one of the most common symptoms among subjects with chronic obstructive pulmonary disease (COPD), but is rarely identified in clinical practice. The aim of this study was to evaluate the association between fatigue and health-related quality of life (HRQoL) assessed with clinically useful instruments, both among subjects with and without COPD. Further, to investigate the association between fatigue and the COPD Assessment Test (CAT)-energy question.

    Methods:

    Data were collected in 2014 within the population-based OLIN COPD study. Subjects with (n = 367) and without (n = 428) COPD participated in clinical examinations including spirometry and completed questionnaires about fatigue (FACIT-Fatigue, clinically relevant fatigue ⩽43), and HRQoL (EQ-5D-VAS, lower score = worse health; CAT, lower score = fewer symptoms/better health).

    Results:

    Subjects with clinically relevant fatigue had worse HRQoL measured with EQ-5D-VAS, regardless of having COPD or not. Decreasing EQ-5D-VAS scores, any respiratory symptoms and anxiety/depression were associated with clinically relevant fatigue also when adjusted for confounders. Among subjects with COPD, clinically relevant fatigue was associated with increasing total CAT score, and CAT score ⩾10. The proportion of subjects with clinically relevant fatigue increased significantly, with a higher score on the CAT-energy question, and nearly 50% of those with a score of 2, and 70% of those with a score of ⩾3, had clinically relevant fatigue.

    Conclusions:

    Fatigue was associated with respiratory symptoms, anxiety/depression and worse HRQoL when using the clinically useful instruments EQ-5D-VAS and CAT. The CAT-energy question can be used to screen for fatigue in clinical practice, using a cut-off of ⩾2.

  • 30. Stridsman, Caroline
    et al.
    Söderberg, Siv
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Lindberg, Anne
    Norrbottens Läns Landsting.
    Skär, Lisa
    The experience of fatigue in subjects with chronic obstructive pulmonary disease2010Conference paper (Other academic)
    Abstract [en]

    Background: Besides respiratory symptoms, fatigue is reported as one of the most common among people with moderate to severe chronic obstructive pulmonary disease, COPD. Fatigue can be described as anything from tiredness to exhaustion and the most typical is that fatigue does not disappears after rest or sleep. The experience of how fatigue affects the daily life in patients with COPD is hardly described.

  • 31.
    Stridsman, Caroline
    et al.
    Luleå University of Technology, Department of Health Sciences, Medical Science.
    Zingmark, Karin
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Lindberg, Anne
    NLL.
    Skär, Lisa
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Creating a balance between breathing and viability: Experiences of well-being when living with chronic obstructive pulmonary disease2015In: Primary Health Care Research and Development, ISSN 1463-4236, E-ISSN 1477-1128, Vol. 16, no 1, p. 42-52Article in journal (Refereed)
    Abstract [en]

    Aim To describe experiences of well-being among people with moderate to very severe chronic obstructive pulmonary disease (COPD). BACKGROUND: Living with COPD is related to a complex life situation, and quality of life (QOL) is shown to decrease because of respiratory symptoms and fatigue. However, studies describing well-being in COPD as a subjective description of QOL are rare. METHODS: Ten participants with moderate to very severe COPD from the Obstructive Lung Disease in Northern Sweden (OLIN) COPD study were interviewed about their experiences of well-being. A latent qualitative content analysis was used to analyse the data. Findings To achieve well-being despite breathlessness, the participants had to adapt to their limitations and live towards the future. They created a balance between breathing and viability by adjusting to a lifelong limitation, handling variations in illness, relying on self-capacity and accessibility to a trustful care. The participants adjusted to lifelong limitations through acceptance and replacement of former activities. They handled variations in illness by taking advantage of the good days and using emotional adaptation strategies. The participants relied on their own self-capacity, feeling that smoking cessation, physical activity and breathing fresh air increased their well-being. They requested accessibility to a trustful care and highlighted the need for continuous care relationships and access to medications. These findings can enhance health-care professionals' understanding of the possibilities for increased well-being for people living with COPD.

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