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  • 1.
    Adermark, Louise
    et al.
    Dept of Psychiatry and Neurochemistry, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Dept of Pharmacology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Galanti, Maria Rosaria
    Dept of Global Public Health, Karolinska Institutet, Stockholm, Sweden; Centre of Epidemiology and Community Medicine, Stockholm, Sweden.
    Ryk, Charlotta
    Swedish Agency for Health Technology Assessment and Assessment of Social Services (SBU), Stockholm, Sweden.
    Gilljam, Hans
    Dept of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
    Hedman, Linnea
    Luleå University of Technology, Department of Health, Learning and Technology, Nursing and Medical Technology. Dept of Public Health and Clinical Medicine, Division Sustainable health, The OLIN Unit, Umeå University, Umeå, Sweden.
    Prospective association between use of electronic cigarettes and use of conventional cigarettes: a systematic review and meta-analysis2021In: ERJ Open Research, E-ISSN 2312-0541, Vol. 7, no 3, p. 00976-2020Article in journal (Refereed)
    Abstract [en]

    Objective The aim of this systematic review and meta-analysis was to assess the association between e-cigarette use and subsequent initiation or recurrence of cigarette smoking.Data sources A systematic literature search was finalised on 11 November 2019 using PubMed (including MEDLINE), EMBASE, Cochrane Library, Scopus, PubMed Health, NICE Evidence Search, PROSPERO, CRD and PsycInfo.Study selection Studies were included if meeting the following criteria: reporting empirical results; longitudinal observational design with a minimum of 3 months of follow-up; including general population samples; allowing for the comparison between users and nonusers of e-cigarettes. Studies rated as having high risk of bias were excluded. Studies were independently assessed by at least two authors. The procedures described by PRISMA were followed, and the quality of evidence was rated using GRADE.Data synthesis 30 longitudinal studies from 22 different cohorts assessing e-cigarette use among nonsmokers or never-smokers at baseline, and subsequent use of cigarette smoking at follow-up, were included in this review. A random-effects meta-analysis based on 89 076 participants showed a pooled unadjusted odds ratio (OR) of cigarette smoking among baseline nonsmoker e-cigarette users compared with nonusers of 4.68 (CI 3.64–6.02), while the adjusted OR was 3.37 (CI 2.68–4.24). These results were consistent irrespective of whether the outcome was measured as ever-smoking or as past 30-day smoking. The evidence was graded as moderate.Conclusions Use of e-cigarettes may predict the initiation or recurrence of cigarette smoking.

  • 2.
    Almqvist, Linnéa
    et al.
    Public health and clinical medicine, Sustainable helath, the OLIN unit, Umeå University, Umeå, Sweden.
    Backman, Helena
    Public health and clinical medicine, Sustainable helath, the OLIN unit, Umeå University, Umeå, Sweden.
    Stridsman, Caroline
    Department of Public Health and Clinical Medicine, Division of Medicine, The OLIN Unit, Umeå University, Umeå, Sweden.
    Lindberg, Anne
    Department of Public Health and Clinical Medicine, Division of Medicine, The OLIN Unit, Umeå University, Umeå, Sweden.
    Lundbäck, Bo
    Krefting Research centre, Department of Internal Medicine, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden.
    Rönmark, Eva
    Public health and clinical medicine, Sustainable helath, the OLIN unit, Umeå University, Umeå, Sweden.
    Hedman, Linnea
    Luleå University of Technology, Department of Health Sciences, Nursing and Medical technology. Public health and clinical medicine, Sustainable helath, the OLIN unit, Umeå University.
    Clinical outcome of adult onset asthma in a 15 year follow-up2020In: European Respiratory Journal, ISSN 0903-1936, E-ISSN 1399-3003, Vol. 56, no Suppl 64, article id 1396Article in journal (Other academic)
    Abstract [en]

    Background: Adult onset asthma is poorly studied and there are few long-term clinical follow-up studies.

    Aim: To study clinical characteristics of adult onset asthma in a 15-year follow-up.

    Method: Within the Obstructive Lung Disease in Northern Sweden (OLIN) studies, a cohort of n=309 subjects with adult onset asthma (aged 20-60 years) was recruited during 1995-99. The cohort was followed up in 2012-14 (n=205). Structured interviews and clinical examinations including spirometry were performed at both recruitment and follow-up. Skin prick tests were performed at recruitment and blood samples for cell counts and IgE at the follow-up. Asthma control was classified according to GINA 2006.

    Results: At follow-up n=182 (89%) still had asthma, while n=23 (11%) were in remission. Among individuals with persistent asthma, mean pre-bronchodilator FEV1 percent of predicted was 89.0 at follow-up, similar as recruitment 88.3. At recruitment 16.5% were smokers, and of these, 86.7% had quit smoking at follow-up. At follow-up, 39% had blood neutrophils ≥4.0x109/L, 23% had blood eosinophils ≥0.3x109/L, and 28% had specific IgE>0.35 IU/ml to any airborne allergen. Any respiratory symptoms were reported by 90% and 31% used medium or high dose inhaled corticosteroids (ICS), 20% low dose ICS whereas 20% had no treatment. 55% had controlled asthma, 32% partly controlled and 13% uncontrolled asthma.

    Conclusion: In this 15-year follow-up of adult onset asthma, the majority had persistent asthma. Smoking and high proportion using ICS may contribute to the stable lung function. Still, it should be noted that merely around every other had well controlled asthma.

  • 3.
    Almqvist, Linnéa
    et al.
    Dept of Public Health and Clinical Medicine, Section of Sustainable Health, The OLIN Unit, Umeå University, Umeå, Sweden.
    Rönmark, Eva
    Dept of Public Health and Clinical Medicine, Section of Sustainable Health, The OLIN Unit, Umeå University, Umeå, Sweden.
    Stridsman, Caroline
    Dept of Public Health and Clinical Medicine, Division of Medicine, The OLIN Unit, Umeå University, Umeå, Sweden.
    Backman, Helena
    Luleå University of Technology, Department of Health Sciences, Nursing and Medical technology. Dept of Public Health and Clinical Medicine, Section of Sustainable Health, The OLIN Unit, Umeå University, Umeå, Sweden.
    Lindberg, Anne
    Dept of Public Health and Clinical Medicine, Division of Medicine, The OLIN Unit, Umeå University, Umeå, Sweden.
    Lundbäck, Bo
    Krefting Research Centre, Institute of Medicine, University of Gothenburg, Gothenborg, Sweden.
    Hedman, Linnéa
    Luleå University of Technology, Department of Health Sciences, Nursing and Medical technology. Dept of Public Health and Clinical Medicine, Section of Sustainable Health, The OLIN Unit, Umeå University, Umeå, Sweden.
    Remission of adult-onset asthma is rare: a 15-year follow-up study2020In: ERJ Open Research, E-ISSN 2312-0541, Vol. 6, no 4, article id 00620-2020Article in journal (Refereed)
    Abstract [en]

    Background There are few long-term clinical follow-up studies of adult-onset asthma. The aim of this article was to study clinical characteristics of adult-onset asthma in relation to remission and persistence of the disease in a 15-year follow-up.

    Methods A cohort of 309 adults aged 20–60 years with asthma onset during the last 12 months verified by bronchial variability, was recruited between 1995 and 1999 from the general population in northern Sweden. The cohort was followed-up in 2003 (n=250) and between 2012 and 2014 (n=205). Structured interviews and spirometry were performed at recruitment and the follow-ups. Bronchial hyperreactivity (BHR) and skin-prick tests were performed at recruitment and blood samples were collected at the last follow-up. Remission of asthma was defined as no asthma symptoms and no use of asthma medication during the last 12 months.

    Results Of eight individuals in remission in 2003, five had relapsed between 2012 and 2014 and in total, 23 (11%) were in remission, while 182 had persistent asthma. Those in remission had higher mean forced expiratory volume in 1 s % predicted at recruitment than those with persistent asthma (94.6 versus 88.3, p=0.034), fewer had severe BHR (27.3% versus 50.9%, p=0.037) and they had less body mass index increase (+1.6 versus +3.0, p=0.054). Of those with persistent asthma, 13% had uncontrolled asthma and they had higher levels of blood neutrophils than those with partly controlled or controlled asthma.

    Conclusion Higher forced expiratory volume in 1 s % predicted and less-severe BHR was associated with remission of adult-onset asthma, but still, the proportion in remission in this 15-year follow-up was low.

  • 4.
    Antoniewicz, Lukasz
    et al.
    Division of Internal Medicine, Department of Clinical Sciences, Karolinska Institutet, Danderyd University Hospital, Stockholm, Sweden.
    Brynedal, Amelie
    Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
    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, Umeå, Sweden.
    Lundbäck, Magnus
    Division of Cardiovascular Medicine, Department of Clinical Sciences, Karolinska Institutet, Danderyd University Hospital, Stockholm, Sweden.
    Bosson, Jenny A
    Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
    Acute Effects of Electronic Cigarette Inhalation on the Vasculature and the Conducting Airways2019In: Cardiovascular Toxicology, ISSN 1530-7905, E-ISSN 1559-0259, Vol. 19, no 5, p. 441-450Article in journal (Refereed)
    Abstract [en]

    The use of electronic cigarettes has increased exponentially since its introduction onto the global market in 2006. However, short- and long-term health effects remain largely unknown due to the novelty of this product. The present study examines the acute effects of e-cigarette aerosol inhalation, with and without nicotine, on vascular and pulmonary function in healthy volunteers. Seventeen healthy subjects inhaled electronic cigarette aerosol with and without nicotine on two separate occasions in a double-blinded crossover fashion. Blood pressure, heart rate, and arterial stiffness measured by pulse wave velocity and pulse wave analysis were assessed at baseline, and then at 0 h, 2 h, and 4 h following exposure. Dynamic spirometry and impulse oscillometry were measured following vascular assessments at these time points, as well as at 6 h following exposure. e-Cigarette aerosol with nicotine caused a significant increase in heart rate and arterial stiffness. Furthermore, e-cigarette aerosol-containing nicotine caused a sudden increase in flow resistance as measured by impulse oscillometry, indicating obstruction of the conducting airways. Both aerosols caused an increase in blood pressure. The present study indicates that inhaled e-cigarette aerosol with nicotine has an acute impact on vascular and pulmonary function. Thus, chronic usage may lead to long-term adverse health effects. Further investigation is warranted.

  • 5.
    Axelsson, Malin
    et al.
    Faculty of Health and Society, Department of Care Science, Malmö University, Malmö, Sweden.
    Ilmarinen, Pinja
    Department of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland.
    Backman, Helena
    Luleå University of Technology, Department of Health Sciences, Nursing and Medical technology. Department of Public Health and Clinical Medicine, Section of Sustainable Health/the OLIN unit, Umeå University, Umeå, Sweden.
    Ekerljung, Linda
    Krefting Research Centre, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.
    Hedman, Linnea
    Luleå University of Technology, Department of Health Sciences, Nursing and Medical technology. Department of Public Health and Clinical Medicine, Section of Sustainable Health/the OLIN unit, Umeå University, Umeå, Sweden.
    Langhammer, Arnulf
    HUNT Research Centre, Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Levanger, Norway; Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway.
    Lindberg, Anne
    Department of Public Health and Clinical Medicine, Division of Medicine, Umeå University, Umeå, Sweden.
    Lindqvist, Ari
    Clinical Research Unit of Pulmonary Diseases, Helsinki University Hospital, Helsinki University and Clinical Research Institute HUCH Ltd, Helsinki, Finland.
    Nwaru, Bright I.
    Krefting Research Centre, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden; Wallenberg Center for Molecular and Translational Medicine, University of Gothenburg, Gothenburg, Sweden.
    Pallasaho, Paula
    Espoo City Primary Health Care Services, Finland.
    Sovijärvi, Anssi
    Unit of Clinical Physiology, HUS Medical Imaging Center, Helsinki University Hospital, and University of Helsinki, Finland.
    Vähätalo, Iida
    Department of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland.
    Kankaanranta, Hannu
    Department of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland; Krefting Research Centre, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden; Faculty of Medicine and Health Technology, University of Tampere, Tampere, Finland.
    Hisinger-Mölkänen, Hanna
    University of Helsinki, Helsinki, Finland.
    Piirilä, Päivi
    Unit of Clinical Physiology, HUS Medical Imaging Center, Helsinki University Hospital, and University of Helsinki, Finland.
    Rönmark, Eva
    Department of Public Health and Clinical Medicine, Section of Sustainable Health/the OLIN unit, Umeå University, Umeå, Sweden.
    Differences in diagnostic patterns of obstructive airway disease between areas and sex in Sweden and Finland: The Nordic EpiLung Study2021In: Journal of Asthma, ISSN 0277-0903, E-ISSN 1532-4303, Vol. 58, no 9, p. 1196-1207Article in journal (Refereed)
    Abstract [en]

    Objective: To investigate the current prevalence of physician-diagnosed obstructive airway diseases by respiratory symptoms and by sex in Sweden and Finland. Method: In 2016, a postal questionnaire was answered by 34,072 randomly selected adults in four study areas: Västra Götaland and Norrbotten in Sweden, and Seinäjoki-Vaasa and Helsinki in Finland. Results: The prevalence of asthma symptoms was higher in Norrbotten (13.2%), Seinäjoki-Vaasa (14.8%) and Helsinki (14.4%) than in Västra Götaland (10.7%), and physician-diagnosed asthma was highest in Norrbotten (13.0%) and least in Västra Götaland (10.1%). Chronic productive cough was most common in the Finnish areas (7.7-8.2 % versus 6.3-6.7 %) while the prevalence of physician-diagnosed chronic bronchitis (CB) or chronic obstructive pulmonary disease (COPD) varied between 1.7-2.7% in the four areas. Among individuals with respiratory symptoms, the prevalence of asthma was most common in Norrbotten, while a diagnosis of COPD or CB was most common in Västra Götaland and Seinäjoki-Vaasa. More women than men with respiratory symptoms reported a diagnosis of asthma in Sweden and Seinäjoki-Vaasa but there were no sex differences in Helsinki. In Sweden, more women than men with symptoms of cough or phlegm reported a diagnosis of CB or COPD, while in Finland the opposite was found. Conclusion: The prevalence of respiratory symptoms and corresponding diagnoses varied between and within the countries. The proportion reporting a diagnosis of obstructive airway disease among individuals with respiratory symptoms varied, indicating differences in diagnostic patterns both between areas and by sex.

  • 6.
    Backman, Helena
    et al.
    Luleå University of Technology, Department of Health Sciences, Nursing and Medical technology. Department of Public Health and Clinical Medicine, Umeå university.
    Bhatta, Laxmi
    Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Trondheim, Norway.
    Hedman, Linnea
    Luleå University of Technology, Department of Health Sciences, Nursing and Medical technology. Department of Public Health and Clinical Medicine, Umeå university.
    Brumpton, Ben
    Department of Public Health and Nursing, NTNU, Norwegian University of Science. Technology and Clinic of Thoracic and Occupational Medicine, St. Olavs Hospital, Trondheim, Norway.
    Vähätalo, Iida
    Department of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland.
    Lassman-Klee, Paul G
    Unit of Clinical Physiology, Helsinki University Central Hospital. University of Helsinki, Helsinki, Finland.
    Nwaru, Bright
    Krefting Research center, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.
    Mai, Xiao-Mei
    Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Trondheim, Norway.
    Vikjord, Sigrid Anna
    HUNT Research Centre, Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Levanger, Norway.
    Lindberg, Anne
    Department of Public Health and Clinical Medicine, Umeå university, Umeå, Sweden.
    Lundbäck, Bo
    Krefting Research center, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.
    Rönmark, Eva
    Department of Public Health and Clinical Medicine, Umeå university, Umeå, Sweden.
    Langhammer, Arnulf
    HUNT Research Centre, Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Levanger, Norway.
    Respiratory symptoms as risk factors for mortality – the Nordic EpiLung Study2020In: European Respiratory Journal, ISSN 0903-1936, E-ISSN 1399-3003, Vol. 56, no Suppl 64, article id 1423Article in journal (Other academic)
    Abstract [en]

    Background: Little is known on associations between respiratory symptoms and mortality.

    Aim: To study whether respiratory symptoms are risk factors for all-cause, respiratory, cardiovascular (CV), and cancer mortality in Sweden and Norway.

    Methods: In 1995-1997, population samples (20-69y) were surveyed about respiratory symptoms, and n=7,104 (85.3% of invited, median age 45y) and n=54,240 (70.1%, 44y) participated within the OLIN Studies in Northern Sweden and the HUNT Study in Norway. Mortality was studied until December 31st 2015. Hazard ratios (HR) for associations between respiratory symptoms and mortality were estimated by Cox regression models adjusted for age, sex, educational level, and smoking habits.

    Results: The cumulative 20-year mortality was 14.5% in OLIN and 12.6% in HUNT. Dyspnea (mMRC grade≥2) (HR 1.9, 95%CI 1.6-2.2 in OLIN and 1.6, 1.5-1.7 in HUNT), chronic productive cough (1.5, 1.3-1.8 and 1.5, 1.3-1.6), and wheeze (1.3, 1.1-1.5 and 1.3, 1.2-1.4) were associated with increased risk of all-cause mortality. Women reported dyspnea and wheeze more frequently than men in both countries, but the association with mortality was similar in both sexes. Causes of death were studied in OLIN, where dyspnea associated with increased risk of respiratory (3.6, 2.1-6.1), CV (2.1, 1.6-2.7), and cancer (1.3, 1.0-1.8) mortality. Chronic productive cough was associated with increased risk of respiratory (2.4, 1.3-4.3) and cancer (1.6, 1.2-2.2) mortality, while wheeze was associated with increased risk of respiratory (3.5, 2.1-5.7) and CV (1.3, 1.0-1.6) mortality.

    Conclusions: Common respiratory symptoms were similarly associated with increased risk of mortality in adults in Sweden and Norway.

  • 7.
    Backman, Helena
    et al.
    Section for Sustainable Health, Umeå University, Umeå, Sweden.
    Blomberg, Anders
    Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
    Lundquist, Anders
    Department of Statistics, Umeå School of Business, Economics and Statistics (USBE), Umeå University, Umeå, Sweden.
    Strandkvist, Viktor
    Luleå University of Technology, Department of Health, Learning and Technology, Health, Medicine and Rehabilitation.
    Sawalha, Sami
    Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
    Nilsson, Ulf
    Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
    Eriksson-Ström, Jonas
    Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
    Hedman, Linnea
    Section for Sustainable Health, Umeå University, Umeå, Sweden.
    Stridsman, Caroline
    Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
    Rönmark, Eva
    Section for Sustainable Health, Umeå University, Umeå, Sweden.
    Lindberg, Anne
    Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
    Lung Function Trajectories and Associated Mortality Among Adults with and without Airway Obstruction2023In: American Journal of Respiratory and Critical Care Medicine, ISSN 1073-449X, E-ISSN 1535-4970, Vol. 208, no 10, p. 1063-1074Article in journal (Refereed)
  • 8.
    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.

  • 9.
    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.

  • 10.
    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.

  • 11.
    Backman, Helena
    et al.
    Luleå University of Technology, Department of Health Sciences, Nursing and Medical technology. Dept of Public Health and Clinical Medicine, Section of Sustainable Health/the OLIN Unit, Umeå University, Umeå, Sweden.
    Lindberg, Anne
    Dept of Public Health and Clinical Medicine, Section of Medicine, Umeå University, Umeå, Sweden.
    Hedman, Linnea
    Luleå University of Technology, Department of Health Sciences, Nursing and Medical technology. Dept of Public Health and Clinical Medicine, Section of Sustainable Health/the OLIN Unit, Umeå University, Umeå, Sweden.
    Stridsman, Caroline
    Luleå University of Technology, Department of Health Sciences, Nursing and Medical technology. Dept of Public Health and Clinical Medicine, Section of Medicine, Umeå University, Umeå, Sweden.
    Jansson, Sven-Arne
    Dept of Public Health and Clinical Medicine, Section of Sustainable Health/the OLIN Unit, Umeå University, Umeå, Sweden.
    Sandström, Thomas
    Dept of Public Health and Clinical Medicine, Section of Medicine, Umeå University, Umeå, Sweden.
    Lundbäck, Bo
    Dept 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.
    Rönmark, Eva
    Dept of Public Health and Clinical Medicine, Section of Sustainable Health/the OLIN Unit, Umeå University, Umeå, Sweden.
    FEV1 decline in relation to blood eosinophils and neutrophils in a population-based asthma cohort2020In: World Allergy Organization Journal, ISSN 1731-3317, E-ISSN 1939-4551, Vol. 13, no 3, article id 100110Article in journal (Refereed)
    Abstract [en]

    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.

  • 12.
    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.

  • 13.
    Backman, Helena
    et al.
    Luleå University of Technology, Department of Health Sciences, Nursing and Medical technology. Umeå university, Public Health and Clinical Medicine, section for Sustainable Health/the OLIN unit.
    Stridsman, Caroline
    Umeå University, Public Health and Clinical Medicine, section for Medicine/the OLIN unit, Luleå, Sweden.
    Jansson, Sven-Arne
    Umeå University, Public Health and Clinical Medicine, section for Sustainable Health/the OLIN unit, Luleå, Sweden.
    Hedman, Linnea
    Luleå University of Technology, Department of Health Sciences, Nursing and Medical technology. Umeå university, Public Health and Clinical Medicine, section for Sustainable Health/the OLIN unit.
    Kankaanranta, Hannu
    Department of Respiratory Medicine, Seinäjoki Central Hospital. Faculty of Medicine and Health Technology, University of Tampere, Seinäjoki, Finland.
    Lindberg, Anne
    Umeå University, Public Health and Clinical Medicine, section for Medicine/the OLIN unit, Umeå, Sweden.
    Lundback, Bo
    Krefting Research Centre, Institute of Medicine, University of Gothenburg, Gothenburg, Gothenburg, Sweden.
    Rönmark, Eva
    Umeå University, Public Health and Clinical Medicine, section for Medicine/the OLIN unit, Luleå, Sweden.
    Risk factors for severe asthma among adults with asthma2020In: European Respiratory Journal, ISSN 0903-1936, E-ISSN 1399-3003, Vol. 56, no Suppl 64, article id 4642Article in journal (Other academic)
    Abstract [en]

    Background: Severe asthma is a considerable challenge for patients, health care professionals and society, but there are few long-term studies on risk factors for severe asthma.

    Aim: To identify baseline risk factors of severe asthma in a longitudinal adult asthma cohort study.

    Methods: An adult asthma cohort was identified in 1986-2001 by clinical examinations of population samples within the OLIN studies in northern Sweden. The examinations included structured interviews, spirometry with reversibility testing, skin prick testing and metacholine challenge. The cohort was followed up in 2012-2014 when n=1006 participated (mean age 59y). Adjusted Risk Ratios (RR) for baseline factors as risk factors for GINA defined severe asthma (SA) at follow-up (n=51) were estimated by Poisson regression.

    Results: Older age, impaired lung function, increased reversibility and hyperreactivity, asthmatic wheeze, persistent wheeze, nighttime awakenings due to respiratory symptoms, and dyspnea were significant baseline risk factors for SA. Allergic sensitization, smoking, occupational groups or BMI did not predict SA. When adjusted for age, sex and smoking, post-bronchodilator FEV1/FVC<0.7, both present at baseline (RR 4.2, 95%CI 1.8-9.9) and developed during follow-up (2.9, 1.6-5.3), increased the risk. Also FEV1<80% at baseline associated with SA (2.9, 1.6-5.2). Triggers for respiratory symptoms at baseline such as tobacco smoke (2.1, 1.2-3.7) and physical activity (3.5, 1.5-81) associated with SA at follow-up, while pollen and furry animals did not.

    Conclusion: Among adults with asthma, impaired lung function, wheeze, dyspnea and nighttime awakenings due to respiratory symptoms are important long-term risk factors for severe asthma.

  • 14.
    Backman, Helena
    et al.
    Department of Public Health and Clinical Medicine, Section of Sustainable Health/the OLIN Unit, Umeå University, Umeå, Sweden.
    Vanfleteren, Lowie
    COPD Center, Sahlgrenska University Hospital, University of Gothenburg, Göteborg, Sweden.
    Lindberg, Anne
    Dept of Public Health and Clinical Medicine, Section of Medicine, Umeå University, Umeå, Sweden.
    Ekerljung, Linda
    Krefting Research Centre, Institute of Medicine, University of Gothenburg, Göteborg, Sweden.
    Stridsman, Caroline
    Luleå University of Technology, Department of Health Sciences, Nursing and Medical technology. Dept of Public Health and Clinical Medicine, Section of Medicine, Umeå University, Umeå, Sweden.
    Axelsson, Malin
    Department of Care Science, Faculty of Health and Society, Malmö University, Malmö, Sweden.
    Nilsson, Ulf
    Dept of Public Health and Clinical Medicine, Section of Medicine, Umeå University, Umeå, Sweden.
    Nwaru, Bright I.
    Krefting Research Centre, Institute of Medicine, University of Gothenburg, Göteborg, Sweden. Wallenberg Centre for Molecular and Translational Medicine, Institute of Medicine, University of Gothenburg, Göteborg, Sweden.
    Sawalha, Sami
    Dept of Public Health and Clinical Medicine, Section of Medicine, Umeå University, Umeå, Sweden.
    Eriksson, Berne
    Krefting Research Centre, Institute of Medicine, University of Gothenburg, Göteborg, Sweden. Department of Medicine, Halmstad Central County Hospital, Halmstad, Sweden.
    Hedman, Linnea
    Luleå University of Technology, Department of Health Sciences, Nursing and Medical technology. Department of Public Health and Clinical Medicine, Section of Sustainable Health/the OLIN Unit, Umeå University, Umeå, Sweden.
    Rådinger, Madeleine
    Krefting Research Centre, Institute of Medicine, University of Gothenburg, Göteborg, Sweden.
    Jansson, Sven-Arne
    Department of Public Health and Clinical Medicine, Section of Sustainable Health/the OLIN Unit, Umeå University, Umeå, Sweden.
    Ullman, Anders
    COPD Center, Sahlgrenska University Hospital, University of Gothenburg, Göteborg, Sweden.
    Kankaanranta, Hannu
    Krefting Research Centre, Institute of Medicine, University of Gothenburg, Göteborg, Sweden. Department of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland. Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
    Lötvall, Jan
    Krefting Research Centre, Institute of Medicine, University of Gothenburg, Göteborg, Sweden.
    Rönmark, Eva
    Department of Public Health and Clinical Medicine, Section of Sustainable Health/the OLIN Unit, Umeå University, Umeå, Sweden.
    Lundbäck, Bo
    Krefting Research Centre, Institute of Medicine, University of Gothenburg, Göteborg, Sweden.
    Decreased COPD prevalence in Sweden after decades of decrease in smoking2020In: Respiratory Research, ISSN 1465-9921, E-ISSN 1465-993X, Vol. 21, article id 283Article in journal (Refereed)
    Abstract [en]

    Background

    COPD has increased in prevalence worldwide over several decades until the first decade after the millennium shift. Evidence from a few recent population studies indicate that the prevalence may be levelling or even decreasing in some areas in Europe. Since the 1970s, a substantial and ongoing decrease in smoking prevalence has been observed in several European countries including Sweden. The aim of the current study was to estimate the prevalence, characteristics and risk factors for COPD in the Swedish general population. A further aim was to estimate the prevalence trend of COPD in Northern Sweden from 1994 to 2009.

    Methods

    Two large random population samples were invited to spirometry with bronchodilator testing and structured interviews in 2009–2012, one in south-western and one in northern Sweden, n = 1839 participants in total. The results from northern Sweden were compared to a study performed 15 years earlier in the same area and age-span. The diagnosis of COPD required both chronic airway obstruction (CAO) and the presence of respiratory symptoms, in line with the GOLD documents since 2017. CAO was defined as post-bronchodilator FEV1/FVC < 0.70, with sensitivity analyses based on the FEV1/FVC < lower limit of normal (LLN) criterion.

    Results

    Based on the fixed ratio definition, the prevalence of COPD was 7.0% (men 8.3%; women 5.8%) in 2009–2012. The prevalence of moderate to severe (GOLD ≥ 2) COPD was 3.5%. The LLN based results were about 30% lower. Smoking, occupational exposures, and older age were risk factors for COPD, whereof smoking was the most dominating risk factor. In northern Sweden the prevalence of COPD, particularly moderate to severe COPD, decreased significantly from 1994 to 2009, and the decrease followed a decrease in smoking.

    Conclusions

    The prevalence of COPD has decreased in Sweden, and the prevalence of moderate to severe COPD was particularly low. The decrease follows a major decrease in smoking prevalence over several decades, but smoking remained the dominating risk factor for COPD.

  • 15.
    Bashir, M.
    et al.
    Gothenburg University, Gothenburg, Sweden.
    Basna, R.
    Krefting research centre, University of Gothenburg, Gothenburg, Sweden.
    Hedman, Linnea
    Luleå University of Technology, Department of Health, Learning and Technology, Nursing and Medical Technology.
    Backman, H.
    Department of public health and clinical medicine, section of sustainable health/ the OLIN unit, Umeå University, Umeå, Sweden.
    Ekerljung, L.
    Krefting research centre, University of Gothenburg, Gothenburg, Sweden.
    Wennergren, G.
    Department of Paediatrics, University of Gothenburg, Queen Silvia Children's Hospital, Gothenburg, Sweden.
    Lindberg, A.
    Department of Public Health and Clinical Medicine, Section of Medicine/the OLIN unit, Umeå University, Umeå, Sweden.
    Kankaanranta, H.
    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.
    Rönmark, E.
    Department of public health and clinical medicine, section of sustainable health/ the OLIN unit, Umeå University, Umeå, Sweden.
    Nwaru, B. I.
    Krefting research centre, University of Gothenburg, Gothenburg, Sweden; Wallenberg Centre for Molecular and Translational Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.
    Interactive effect of socioeconomic status and smoking on the risk of allergic and nonallergic asthma among certain occupation groups – Results from two Swedish large adult populations: A Nordic Epilung study2023In: Special Issue: Abstracts from the European Academy of Allergy and Clinical Immunology Hybrid Congress, 1‐3 July 2022, John Wiley & Sons, 2023, Vol. 78, p. 220-220, article id 001190Conference paper (Other academic)
  • 16.
    Bashir, Muwada Bashir Awad
    et al.
    Krefting Research Centre, Institute of Medicine, University of Gothenburg, SE-405 30, Gothenburg, Sweden.
    Basna, Rani
    Krefting Research Centre, Institute of Medicine, University of Gothenburg, SE-405 30, Gothenburg, Sweden.
    Zhang, Guo-Qiang
    Krefting Research Centre, Institute of Medicine, University of Gothenburg, SE-405 30, Gothenburg, Sweden.
    Backman, Helena
    Section of Sustainable Health/the OLIN Unit, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
    Lindberg, Anne
    Section of Medicine/the OLIN Unit, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
    Ekerljung, Linda
    Krefting Research Centre, Institute of Medicine, University of Gothenburg, SE-405 30, Gothenburg, Sweden.
    Axelsson, Malin
    Department of Care Science, Faculty of Health and Society, Malmö University, Malmö, Sweden.
    Hedman, Linnea
    Luleå University of Technology, Department of Health, Learning and Technology, Nursing and Medical Technology.
    Vanfleteren, Lowie
    COPD Center, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden.
    Lundbäck, Bo
    Krefting Research Centre, Institute of Medicine, University of Gothenburg, SE-405 30, Gothenburg, Sweden.
    Rönmark, Eva
    Section of Sustainable Health/the OLIN Unit, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
    Nwaru, Bright I.
    Krefting Research Centre, Institute of Medicine, University of Gothenburg, SE-405 30, Gothenburg, Sweden; Wallenberg Centre for Molecular and Translational Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.
    Computational phenotyping of obstructive airway diseases: protocol for a systematic review2022In: Systematic Reviews, E-ISSN 2046-4053, Vol. 11, no 1, article id 216Article, review/survey (Refereed)
    Abstract [en]

    Background: Over the last decade, computational sciences have contributed immensely to characterization of phenotypes of airway diseases, but it is difficult to compare derived phenotypes across studies, perhaps as a result of the different decisions that fed into these phenotyping exercises. We aim to perform a systematic review of studies using computational approaches to phenotype obstructive airway diseases in children and adults.

    Methods and analysis: We will search PubMed, Embase, Scopus, Web of Science, and Google Scholar for papers published between 2010 and 2020. Conferences proceedings, reference list of included papers, and experts will form additional sources of literature. We will include observational epidemiological studies that used a computational approach to derive phenotypes of chronic airway diseases, whether in a general population or in a clinical setting. Two reviewers will independently screen the retrieved studies for eligibility, extract relevant data, and perform quality appraisal of included studies. A third reviewer will arbitrate any disagreements in these processes. Quality appraisal of the studies will be undertaken using the Effective Public Health Practice Project quality assessment tool. We will use summary tables to describe the included studies. We will narratively synthesize the generated evidence, providing critical assessment of the populations, variables, and computational approaches used in deriving the phenotypes across studies

    Conclusion: As progress continues to be made in the area of computational phenotyping of chronic obstructive airway diseases, this systematic review, the first on this topic, will provide the state of the art on the field and highlight important perspectives for future works.

    Ethics and dissemination: No ethical approval is needed for this work is based only on the published literature and does not involve collection of any primary or human data.

  • 17.
    Bermúdez Barón, Nicolás
    et al.
    Department of Public Health and Clinical Medicine, Section of Sustainable Health, The OLIN Unit, Umeå University, Umeå, Sweden.
    Lindberg, Anne
    Department of Public Health and Clinical Medicine, Section of Medicine, The OLIN Unit, Umeå University, Umeå, Sweden.
    Stridsman, Caroline
    Department of Public Health and Clinical Medicine, Section of Medicine, The OLIN Unit, Umeå University, Umeå, Sweden.
    Andersson, Martin
    Department of Public Health and Clinical Medicine, Section of Sustainable Health, The OLIN Unit, Umeå University, Umeå, Sweden.
    Hedman, Linnea
    Luleå University of Technology, Department of Health, Learning and Technology, Nursing and Medical Technology. Department of Public Health and Clinical Medicine, Section of Sustainable Health, The OLIN Unit, Umeå University, Umeå, Sweden.
    Vikjord, Sigrid Anna
    HUNT Research Centre, Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway.
    Kankaanranta, Hannu
    Department of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland; Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
    Lundbäck, Bo
    Department of Public Health and Clinical Medicine, Section of Medicine, The OLIN Unit, Umeå University, Umeå, Sweden; Department of Internal Medicine and Clinical Nutrition, Krefting Research Centre, University of Gothenburg Institute of Medicine, Göteborg, Sweden.
    Rönmark, Eva
    Department of Public Health and Clinical Medicine, Section of Sustainable Health, The OLIN Unit, Umeå University, Umeå, Sweden.
    Backman, Helena
    Department of Public Health and Clinical Medicine, Section of Sustainable Health, The OLIN Unit, Umeå University, Umeå, Sweden.
    Among respiratory symptoms, wheeze associates most strongly with impaired lung function in adults with asthma: a long-term prospective cohort study2021In: BMJ Open Respiratory Research, E-ISSN 2052-4439, Vol. 8, no 1, article id e000981Article in journal (Refereed)
    Abstract [en]

    Background Asthma is a common disease and a major public health concern. Respiratory symptoms are related to its prognosis, which in turn associates with lung function. Still this association on a long-term basis is not entirely understood.

    Aim To study the association of the type and number of respiratory symptoms with FEV1 and FEV1 decline in women and men with asthma.

    Method A population-based cohort of adults with asthma was examined at study entry between 1986 and 2001 and at follow-up between 2012 and 2014, and n=977 had valid measurements of FEV1 on both occasions. Data regarding respiratory symptoms at study entry (recurrent wheeze, dyspnoea, longstanding cough and productive cough) were analysed in relation to FEV1 and annual decline in FEV1, both unadjusted and adjusted for other potentially associated factors by linear regression.

    Results For both sexes recurrent wheeze and dyspnoea were associated with lower FEV1 at study entry and follow-up, while productive cough was associated with lower FEV1 only at follow-up. No associations were found between the type of symptoms and annual decline in FEV1. In adjusted analyses, the association between recurrent wheeze and lower FEV1 both at study entry and follow-up remained significant among women. Also, the association between a higher number of symptoms with lower FEV1 both at study entry and follow-up were present for both sexes and remained after adjustment.

    Conclusions Particularly recurrent wheeze and a higher number of respiratory symptoms may predict lower lung function also in the long run among women and men with asthma.

  • 18.
    Bunne, Joakim
    et al.
    Department of Public Health and Clinical Medicine, Division of Occupational and Environmental Medicine, the OLIN Unit, Umeå University.
    Moberg, Helena
    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, Division of Occupational and Environmental Medicine, the OLIN Unit, Umeå University.
    Andersson, Martin
    Department of Public Health and Clinical Medicine, Division of Occupational and Environmental Medicine, the OLIN Unit, Umeå University.
    Bjerg, Anders
    Department of Women's and Children's Health, Karolinska Institutet.
    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.
    Increase of allergic sensitization in schoolchildren: two cohorts compared 10 years apart2017In: The Journal of Allergy and Clinical Immunology: In Practice, ISSN 2213-2198, Vol. 5, no 2, p. 457-463Article in journal (Refereed)
    Abstract [en]

    Background

    Time trends of incidence of allergic sensitization are unknown and recent trends of prevalence and risk factors are lacking.

    Objective

    To estimate the incidence, prevalence, remission, risk factors, and time trends for allergic sensitization among schoolchildren followed from age 7 to 8 years to age 11 to 12 years.

    Methods

    In 2006, all children in grades 1 and 2 aged 7 to 8 years in 2 municipalities in northern Sweden were invited to a questionnaire survey and to skin prick testing to 10 common airborne allergens. The cohort was reexamined in 2010, with additional blood sampling for specific IgE. Participation rates were 90% (n = 1700) at age 7 to 8 years and 85% (n = 1657) at age 11 to 12 years. The results were compared with a cohort examined by identical methods 10 years earlier.

    Results

    The prevalence of positive skin prick test result to any allergen increased from 30% at age 7 to 8 years to 41% at age 11 to 12 years (P < .001). The cumulative 4-year incidence was 18%, while remission was low. Sensitization to pollen and furred animals was most common. A family history of allergy was significantly associated with incident sensitization, whereas the presence of furred animals at home was negatively associated. The prevalence at age 7 to 8 years and at age 11 to 12 years and the 4-year incidence were all significantly higher compared with the cohort examined 10 years earlier.

    Conclusions

    The prevalence of allergic sensitization increased by age as a consequence of a high incidence and a low remission. The trends of increasing incidence and prevalence among schoolchildren imply future increases in the prevalence of allergic diseases.

  • 19.
    Hedman, Linnea
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Aktivitet: Riskfaktorer för incidens av astma under tonåren2012Conference paper (Other (popular science, discussion, etc.))
    Download full text (pdf)
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  • 20.
    Hedman, Linnea
    Umeå University, Department of Public Health and Clinical Medicine, Occupational Medicine.
    Epidemiological studies of asthma and allergic diseases in teenagers: methodological aspects and tobacco use. The Obstructive Lung Disease in Northern Sweden - Thesis X.2010Doctoral thesis, comprehensive summary (Other academic)
  • 21.
    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.

  • 22.
    Hedman, Linnea
    et al.
    Department of public health and clinical medicine, Division of sustainable health, Umeå University; The OLIN studies, Norrbotten County Council, Luleå, Sweden.
    Backman, Helena
    Department of public health and clinical medicine, Division of sustainable health, Umeå University; The OLIN studies, Norrbotten County Council, Luleå, Sweden.
    Stridsman, Caroline
    Luleå University of Technology, Department of Health Sciences, Nursing Care. The OLIN studies, Norrbotten County Council, Luleå, Sweden.
    Lindberg, Anne
    Department of public health and clinical medicine, Division of medicine, Umeå University; The OLIN studies, Norrbotten County Council, Luleå, Sweden.
    Lundbäck, Bo
    Krefting research center, Institute of medicine, University of Gothenburg, Gothenburg, Sweden.
    Rönmark, Eva
    Department of public health and clinical medicine, Division of sustainable health, Umeå University; The OLIN studies, Norrbotten County Council, Luleå, Sweden.
    E-cigarette use is most common in persistent smokers in a Swedish prospective population study2019In: European Respiratory Journal, ISSN 0903-1936, E-ISSN 1399-3003, Vol. 54, no 63, article id OA3313Article in journal (Other academic)
  • 23.
    Hedman, Linnea
    et al.
    Luleå University of Technology, Department of Health Sciences, Nursing and Medical technology. Department of Public Health and Clinical Medicine, Section of Sustainable Health, The OLIN Unit, Umeå University Faculty of Medicine, Umeå, Sweden.
    Backman, Helena
    Luleå University of Technology, Department of Health Sciences, Nursing and Medical technology. Department of Public Health and Clinical Medicine, Section of Sustainable Health, The OLIN Unit, Umeå University Faculty of Medicine, Umeå, Sweden.
    Stridsman, Caroline
    Department of Public Health and Clinical Medicine, Division of Medicine, Umeå University Faculty of Medicine, Umeå, Sweden.
    Lundbäck, Magnus
    Department of Clinical Sciences, Danderyd Hospital, Karolinska Institute, Stockholm, Sweden.
    Andersson, Martin
    Department of Public Health and Clinical Medicine, Section of Sustainable Health, The OLIN Unit, Umeå University Faculty of Medicine, Umeå, Sweden.
    Rönmark, Eva
    Department of Public Health and Clinical Medicine, Section of Sustainable Health, The OLIN Unit, Umeå University Faculty of Medicine, Umeå, Sweden.
    Predictors of electronic cigarette use among Swedish teenagers: a population-based cohort study2020In: BMJ Open, E-ISSN 2044-6055, Vol. 10, no 12, article id 040683Article in journal (Refereed)
    Abstract [en]

    Objectives

    The aim was to identify predictors of electronic cigarette (e-cigarette) use among teenagers.

    Design and setting

    A prospective population-based cohort study of schoolchildren in northern Sweden.

    Participants

    In 2006, a cohort study about asthma and allergic diseases among schoolchildren started within the Obstructive Lung Disease in Northern Sweden studies. The study sample (n=2185) was recruited at age 7–8 years, and participated in questionnaire surveys at age 14–15 and 19 years. The questionnaire included questions about respiratory symptoms, living conditions, upper secondary education, physical activity, diet, health-related quality of life, parental smoking and parental occupation. Questions about tobacco use were included at age 14–15 and 19 years.

    Primary outcome

    E-cigarette use at age 19 years.

    Results

    At age 19 years, 21.4% had ever tried e-cigarettes and 4.2% were current users. Among those who were daily tobacco smokers at age 14–15 years, 60.9% had tried e-cigarettes at age 19 years compared with 19.1% of never-smokers and 34.0% of occasional smokers (p<0.001). Among those who had tried e-cigarettes, 28.1% were never smokers both at age 14–15 and 19 years, and 14.4% were never smokers among the current e-cigarette users. In unadjusted analyses, e-cigarette use was associated with daily smoking, use of snus and having a smoking father at age 14–15 years, as well as with attending vocational education, physical inactivity and unhealthy diet. In adjusted analyses, current e-cigarette use was associated with daily tobacco smoking at age 14–15 years (OR 6.27; 95% CI 3.12 to 12.58), attending a vocational art programme (OR 2.22; 95% CI 1.04 to 4.77) and inversely associated with eating a healthy diet (OR 0.74; 95% CI 0.59 to 0.92).

    Conclusions

    E-cigarette use was associated with personal and parental tobacco use, as well as with physical inactivity, unhealthy diet and attending vocational upper secondary education. Importantly, almost one-third of those who had tried e-cigarettes at age 19 years had never been tobacco smokers.

  • 24.
    Hedman, Linnea
    et al.
    Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, The OLIN Unit, Umeå University.
    Bjerg, Anders
    OLIN studies, Norrbotten County Council.
    Lundbäck, Bo
    Department of Internal Medicine and Clinical Nutrition, Krefting Research Centre, University of Gothenburg.
    Rönmark, Eva
    Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, The OLIN Unit, Umeå University.
    Conventional epidemiology underestimates the incidence of asthma and wheeze – a longitudinal population-based study among teenagers2012In: Clinical and Translational Allergy, ISSN 2045-7022, E-ISSN 2045-7022, Vol. 2Article in journal (Refereed)
  • 25.
    Hedman, Linnea
    et al.
    Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, The OLIN Unit, Umeå University.
    Bjerg, Anders
    OLIN studies, Norrbotten County Council.
    Perzanowski, Matthew
    Department of Environmental Health Sciences, Columbia University, New York.
    Rönmark, Eva
    Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, The OLIN Unit, Umeå University.
    Good agreement between parental and self-completed questionnaires about allergic diseases and environmental factors in teenagers2010In: Journal of Clinical Epidemiology, ISSN 0895-4356, E-ISSN 1878-5921, Vol. 63, no 7, p. 783-789Article in journal (Refereed)
  • 26.
    Hedman, Linnea
    et al.
    OLIN studies, Norrbotten County Council.
    Bjerg, Anders
    OLIN studies, Norrbotten County Council.
    Perzanowski, Matthew
    Department of Environmental Health Sciences, Columbia University, New York.
    Sundberg, Sigrid
    OLIN studies, Norrbotten County Council.
    Rönmark, Eva
    Karolinska Institutet, Lung and Allergy Research.
    Factors related to tobacco use2007In: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 101, no 3, p. 496-502Article in journal (Refereed)
  • 27.
    Hedman, Linnea
    et al.
    Luleå University of Technology, Department of Health, Learning and Technology, Nursing and Medical Technology. Department of Public Health and Clinical Medicine, Division Sustainable Health, The OLIN Unit, Umeå University, Umeå, Sweden.
    Galanti, Maria
    Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden; Centre of Epidemiology and Community Medicine, Stockholm, Sweden.
    Ryk, Lotta
    Swedish Agency for Health Technology Assessment and Assessment of Social Services (SBU), Stockholm, Sweden.
    Gilljam, Hans
    Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
    Adermark, Louise
    Department of Psychiatry and Neurochemistry, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Pharmacology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Electronic cigarette use and smoking cessation in cohort studies and randomized trials: A systematic review and meta-analysis2021In: Tobacco Prevention & Cessation, ISSN 2459-3087, Vol. 7, no 62, article id 142320Article in journal (Refereed)
    Abstract [en]

    Introduction: The aim of this systematic review and meta-analysis was to assess the association between e-cigarette use and subsequent smoking cessation in cohort studies and randomized controlled trials (RCT).

    Methods: A systematic literature search was finalized 11 November 2019 using EMBASE, Cochrane Library, Scopus, PubMed Health, NICE evidence search, PROSPERO, CRD, PsycInfo, and PubMed including Medline. Inclusion criteria were: reporting empirical results; longitudinal observational design with a minimum of 3 months of follow-up; including general population samples; and allowing for comparison between users and non-users of e-cigarettes. Studies rated as having high risk of bias were excluded. The procedures described by PRISMA were followed, and the quality of evidence was rated using GRADE.

    Results: Twenty-eight longitudinal, peer-reviewed publications from 26 cohort studies, and eight publications from seven RCTs assessing the association between e-cigarette use and smoking cessation were included in this review. A randomeffects meta-analysis based on 39147 participants in cohort studies showed a pooled unadjusted odds ratio (OR) for smoking cessation among baseline e-cigarette users compared with baseline non-users of 0.97 (95% CI: 0.67–1.40), while the adjusted OR was 0.90 (95% CI: 0.63–1.27). The pooled odds ratio for smoking cessation in RCTs was 1.78 (95% CI: 1.41–2.25). The evidence for cohort studies was graded as very low and for RCTs as low.

    Conclusions: We did not find quality evidence for an association between e-cigarette use and smoking cessation. Although RCTs tended to support a more positive association between e-cigarette use and smoking cessation than the cohort studies, the grading of evidence was consistently low.

  • 28.
    Hedman, Linnea
    et al.
    The OLIN Studies, Sunderby Central Hospital of Norrbotten, Luleå, Sweden.
    Lindgren, Berit
    Luleå University of Technology, Department of Health Sciences. The OLIN Studies, Sunderby Central Hospital of Norrbotten, Luleå, Sweden.
    Perzanowski, Matthew
    The OLIN Studies, Sunderby Central Hospital of Norrbotten, Luleå, Sweden;Department of Environmental Health Sciences, Columbia University, New York, USA.
    Rönmark, Eva
    The OLIN Studies, Sunderby Central Hospital of Norrbotten, Luleå, Sweden;Lung and Allergy Research, National Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Agreement between parental and self-completed questionnaires about asthma in teenagers2005In: Pediatric Allergy and Immunology, ISSN 0905-6157, E-ISSN 1399-3038, Vol. 16, no 2, p. 176-181Article in journal (Refereed)
    Abstract [en]

    In studies of asthma in children, a common method is for the parents to complete questionnaires about their child's asthma symptoms. With longitudinal studies of asthma, children reach an age when they can complete the questionnaire themselves. The aim of this paper was to compare the prevalence of asthma symptoms as well as the agreement between responses to an asthma questionnaire completed by teenagers and their parents. As a part of the Obstructive Lung Disease in Northern Sweden Study (OLIN) pediatric study, where 3345, 13-14-yr-old children completed an asthma questionnaire, 294 (84%) randomly selected parents also completed the questionnaire, which included the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire. There were no significant differences in the prevalence of wheeze in the last 12 months, ever asthma, or physician diagnosed asthma as reported by the parents compared with the teenagers. However, the teenagers reported a significantly higher prevalence of wheeze during or after exercise. The absolute agreement was generally very high while the level of agreement (kappa-value) was slightly lower. The highest results in both absolute agreement and kappa-value, were reached by the questions on diagnosis of asthma (98.9% and 0.93), use of asthma medicines (95.5% and 0.78), and whether the child ever had had asthma (97.2% and 0.86), respectively. In conclusion, the agreement between the parents' and the teenagers' responses to the asthma questionnaire was good. The change in methodology from parental to self-completion of the questionnaire did not affect the results in the study.

  • 29.
    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.

  • 30.
    Jansson, Sven-Arne
    et al.
    Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, The OLIN Unit, Umeå University, Umeå, Sweden.
    Axelsson, Malin
    Department of Care Sciences, Faculty of Health and Society, Malmö University, Malmö, Sweden.
    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, Umeå, Sweden.
    Leander, Mai
    Department of Medical Sciences, Respiratory Medicine and Allergology, Uppsala University, Uppsala, Sweden.
    Stridsman, Caroline
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Rönmark, Eva
    Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, The OLIN Unit, Umeå University, Umeå, Sweden.
    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.

  • 31.
    Jansson, Sven-Arne
    et al.
    Department of Public Health and Clinical Medicine, Section of Sustainable Health, The OLIN unit, Umeå University, Umeå, Sweden.
    Hedman, Linnea
    Luleå University of Technology, Department of Health, Learning and Technology, Nursing and Medical Technology. Department of Public Health and Clinical Medicine, Section of Sustainable Health, The OLIN unit, Umeå University.
    Stridsman, Caroline
    Luleå University of Technology, Department of Health Sciences, Nursing Care. Department of Public Health and Clinical Medicine, Division of Medicine, Umeå University, Umeå, Sweden.
    Axelsson, Malin
    Department of Care Science, Faculty of Health and Society, Malmö University, Malmö, Sweden.
    Kriit, Hedi Katre
    Department of Public Health and Clinical Medicine, Section of Sustainable Health, Umeå University, Umeå, Sweden.
    Lindberg, Anne
    Department of Public Health and Clinical Medicine, Division of Medicine, Umeå University, Umeå, Sweden.
    Lundbäck, Bo
    Krefting Research Centre, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.
    Rönmark, Eva
    Department of Public Health and Clinical Medicine, Section of Sustainable Health, The OLIN unit, Umeå University, Umeå, Sweden.
    Backman, Helena
    Department of Public Health and Clinical Medicine, Section of Sustainable Health, The OLIN unit, Umeå University, Umeå, Sweden.
    Life-years lost due to asthma2019In: European Respiratory Journal, ISSN 0903-1936, E-ISSN 1399-3003, Vol. 54, no Suppl. 63, article id PA5063Article in journal (Other academic)
  • 32.
    Jansson, Sven-Arne
    et al.
    Department of Public Health and Clinical Medicine, Section of Sustainable Health, The OLIN unit, Umeå University, Umeå, Sweden.
    Hedman, Linnea
    Luleå University of Technology, Department of Health Sciences, Nursing and Medical technology. Department of Public Health and Clinical Medicine, Section of Sustainable Health, The OLIN unit, Umeå University.
    Stridsman, Caroline
    Luleå University of Technology, Department of Health Sciences, Nursing Care. Department of Public Health and Clinical Medicine, Division of Medicine, Umeå University, Umeå, Sweden.
    Axelsson, Malin
    Department of Care Science, Faculty of Health and Science, Malmö University, Malmö, Sweden.
    Lindberg, Anne
    Department of Public Health and Clinical Medicine, Division of Medicine, Umeå University, Umeå, Sweden.
    Lundbäck, Bo
    Krefting Research Centre, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.
    Rönmark, Eva
    Department of Public Health and Clinical Medicine, Section of Sustainable Health, The OLIN unit, Umeå University, Umeå, Sweden.
    Backman, Helena
    Department of Public Health and Clinical Medicine, Section of Sustainable Health, The OLIN unit, Umeå University, Umeå, Sweden.
    Life-years lost due to asthma and COPD2020In: European Respiratory Journal, ISSN 0903-1936, E-ISSN 1399-3003, Vol. 56, no Suppl 64, article id 1400Article in journal (Other academic)
    Abstract [en]

    Background: Quality-adjusted life-years (QALYs) is commonly used in health-economic evaluations. QALY-weights combine health status and time into one measure.

    Aims: To investigate the association between multimorbidity and QALY-weights among adults with asthma and COPD.

    Methods: Within the OLIN-studies in northern Sweden, a random sample was invited to a postal questionnaire survey. A random sample of 1016 responders was invited to clinical examinations and interviews in 2009 (737 participated, ages 21-86 years), of which 605 completed the health-related quality of life (HRQL) questionnaire SF-36. QALY-weights were derived from the SF-36 data using the SF-6D tool via the standard gamble method. The SF-6D scores are equivalent to QALY-weights with low values representing poor health and the score one representing perfect health.

    Results: Of the 605 participants, 74 had current asthma, 81 had COPD (FEV1/FVC<0.7), 66 had heart disease, 30 had diabetes, 30 had rheumatic disease, and 160 had hypertension. There was an association between an increasing number of morbid conditions and lower QALY-weights (p<0.001). The mean QALY-weight tended to be lower among subjects with asthma compared to COPD, 0.77 and 0.81, respectively (p=0.078). Subjects with COPD and two or more non-respiratory conditions had significantly lower QALY-weights compared to subjects with COPD alone (0.75 vs.0.83, p=0.016). No significant difference in QALY-weights was found among asthmatics with versus without other non-respiratory conditions.

    Conclusions: Subjects with asthma tended to have lower QALY-weights compared to subjects with COPD. Having two or more non-respiratory conditions affected the QALY-weight negatively among subjects with COPD but not among subjects with asthma.

  • 33.
    Rankin, Gregory D.
    et al.
    Department of Public Health and Clinical Medicine, Division of Medicine/Respiratory Medicine and Allergy, Umeå University, Umeå, Sweden.
    Wingfors, Håkan
    Swedish Defence Research Agency, CBRN Defence and Security, Umeå, Sweden.
    Uski, Oskari
    Department of Public Health and Clinical Medicine, Division of Medicine/Respiratory Medicine and Allergy, Umeå University, Umeå, Sweden.
    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, Umeå, Sweden.
    Hammarström, Barbro Ekstrand
    Swedish Defence Research Agency, CBRN Defence and Security, Umeå, Sweden.
    Bosson, Jenny
    Department of Public Health and Clinical Medicine, Division of Medicine/Respiratory Medicine and Allergy, Umeå University, Umeå, Sweden.
    Lundbäck, Magnus
    Karolinska Institutet, Department of Clinical Sciences, Division of Cardiology, Danderyd University Hospital, Stockholm, Sweden.
    The toxic potential of a fourth-generation E-cigarette on human lung cell lines and tissue explants2019In: Journal of Applied Toxicology, ISSN 0260-437X, E-ISSN 1099-1263, Vol. 39, no 8, p. 1143-1154Article in journal (Refereed)
    Abstract [en]

    The use of electronic cigarettes (E-cigs) is rapidly increasing. The latest generation of E-cigs is highly customizable, allowing for high heating coil temperatures. The aim of this study was to assess the toxic potential of a fourth-generation E-cig. Aerosols generated from E-liquid with (24 mg/mL) and without nicotine, using a fourth-generation E-cig, were chemically analysed and compared with cigarette smoke (K3R4F). Human lung epithelial cell lines and distal lung tissue explants were exposed to E-cig vapour extract (EVE) and cigarette smoke extract for 24 hours and assessed for viability, inflammation, oxidative stress and genotoxicity. E-cig aerosols contained measurable levels of volatile organic compounds, aldehydes and polycyclic aromatic hydrocarbons, in general, to a much lesser extent than cigarette smoke. Higher levels of certain carbonyls, e.g. formaldehyde, were detected in the E-cig aerosols. EVEs decreased cell viability of BEAS-2B cells, whereas little effect was seen in A549 cells and distal lung tissue. The nicotine-containing EVE caused a greater decrease in cell viability and significant increase in DNA damage than the nicotine-free EVE. Increased cytotoxicity, reactive oxygen species production and genotoxicity were seen with cells and tissue exposed to cigarette smoke extract compared with EVEs. Although E-cig aerosols were less toxic than cigarette smoke, it was not benign. Moreover, the EVE containing nicotine was more toxic than the nicotine-free EVE. More research is needed on the short- and long-term health effects of vaping and the usage of newly emerging E-cig devices to evaluate better the potential negative effects of E-cigs on human health.

  • 34.
    Räisänen, P.
    et al.
    Department of Public Health and Clinical Medicine, Section of Sustainable Health/the OLIN Unit, Umeå University, Umeå, Sweden.
    Hedman, Linnea
    Luleå University of Technology, Department of Health Sciences, Nursing and Medical technology. Department of Public Health and Clinical Medicine, Section of Sustainable Health/the OLIN Unit, Umeå University, Umeå, Sweden.
    Andersson, M.
    Department of Public Health and Clinical Medicine, Section of Sustainable Health/the OLIN Unit, Umeå University, Umeå, Sweden.
    Stridsman, C.
    Department of Public Health and Clinical Medicine, Section of Sustainable Health/the OLIN Unit, Umeå University, Umeå, Sweden.
    Lindberg, A.
    Department of Public Health and Clinical Medicine, Section of Medicine/the OLIN Unit, Umeå University, Umeå, Sweden.
    Lundbäck, B.
    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.
    Rönmark, E.
    Department of Public Health and Clinical Medicine, Section of Sustainable Health/the OLIN Unit, Umeå University, Umeå, Sweden.
    Backman, Helena
    Luleå University of Technology, Department of Health Sciences, Nursing and Medical technology. Department of Public Health and Clinical Medicine, Section of Sustainable Health/the OLIN Unit, Umeå University, Umeå, Sweden.
    Non-response did not affect prevalence estimates of asthma and respiratory symptoms - results from a postal questionnaire survey of the general population2020In: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 173, article id 106017Article in journal (Refereed)
    Abstract [en]

    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.

  • 35.
    Räisänen, Petri
    et al.
    Dept of Public Health and Clinical Medicine, Section of Sustainable Health, the OLIN unit, Umeå University, Umeå, Sweden.
    Backman, Helena
    Luleå University of Technology, Department of Health Sciences, Nursing and Medical technology. Dept of Public Health and Clinical Medicine, Section of Sustainable Health, the OLIN unit, Umeå University, Umeå, Sweden.
    Hedman, Linnea
    Luleå University of Technology, Department of Health Sciences, Nursing and Medical technology. Dept of Public Health and Clinical Medicine, Section of Sustainable Health, the OLIN unit, Umeå University, Umeå, Sweden.
    Andersson, Martin
    Dept of Public Health and Clinical Medicine, Section of Sustainable Health, the OLIN unit, Umeå University, Umeå, Sweden.
    Stridsman, Caroline
    Dept of Public Health and Clinical Medicine, Section of Medicine, the OLIN unit, Umeå University, Umeå, Sweden.
    Kankaanranta, Hannu
    Krefting Research Centre, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden; Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland; Dept of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland.
    Ilmarinen, Pinja
    Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland; Dept of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland.
    Andersen, Heidi
    Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
    Piirilä, Päivi
    Unit of Clinical Physiology, HUS Medical Diagnostic Center, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland.
    Lindberg, Anne
    Dept of Public Health and Clinical Medicine, Section of Medicine, the OLIN unit, Umeå University, Umeå, Sweden.
    Lundbäck, Bo
    Krefting Research Centre, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.
    Rönmark, Eva
    Dept of Public Health and Clinical Medicine, Section of Sustainable Health, the OLIN unit, Umeå University, Umeå, Sweden.
    High but stable incidence of adult-onset asthma in northern Sweden over the last decades2021In: ERJ Open Research, E-ISSN 2312-0541, Vol. 7, no 3, article id 00262-2021Article in journal (Refereed)
    Abstract [en]

    Background: The prevalence of asthma has increased both among children and adults during the latter half of the 20th century. The prevalence among adults is affected by the incidence of asthma not only in childhood but also in adulthood. Time trends in asthma incidence have been poorly studied.

    Aims: The aim of this study was to review the incidence of adult-onset asthma from 1996 to 2006 and 2006 to 2016 and compare the risk factor patterns.

    Methods: In the Obstructive Lung Disease in Northern Sweden (OLIN) studies, two randomly selected population-based samples in the 20-69-year age group participated in postal questionnaire surveys about asthma in 1996 (n=7104, 85%) and 2006 (n=6165, 77%). A 10-year follow-up of the two cohorts with the same validated questionnaire was performed, and 5709 and 4552 responded, respectively. Different definitions of population at risk were used in the calculations of asthma incidence. The protocol followed a study performed between 1986 and 1996 in the same area.

    Results: The crude incidence rate of physician-diagnosed asthma was 4.4 per 1000 person-years (men 3.8, women 5.5) from 1996 to 2006, and 4.8 per 1000 person-years (men 3.7, women 6.2) from 2006 to 2016. When correcting for possible under-diagnosis at study entry, the incidence rate was 2.4 per 1000 person-years from 1996 to 2006 and 2.6 per 1000 person-years from 2006 to 2016. The incidence rates were similar across age groups. Allergic rhino-conjunctivitis was the main risk factor for incident asthma in both observation periods (risk ratio 2.4-2.6).

    Conclusions: The incidence of adult-onset asthma has been stable over the last two decades and has remained at a similar level since the 1980s. The high incidence contributes to the increase in asthma prevalence.

  • 36.
    Rönmark, Eva
    et al.
    Department of Public Health and Clinical Medicine, Division of Occupational and Environmental Medicine/the OLIN unit, Umeå University.
    Warm, Katja
    Department of Public Health and Clinical Medicine, Division of Occupational and Environmental Medicine, The OLIN Unit, Umeå University; Division of Medicine, The OLIN Unit, Umeå University, Umeå, Sweden.
    Bjerg, Anders Munch
    Department of Women's and Children's Health, Karolinska Institutet.
    Backman, Helena
    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, Division of Occupational and Environmental Medicine, The OLIN Unit, Umeå University, Umeå, Sweden.
    Lundbäck, Bo
    Krefting Research Centre, Institute of Medicine, University of Gothenburg.
    High incidence and persistence of airborne allergen sensitization up to age 19 years2017In: Allergy. European Journal of Allergy and Clinical Immunology, ISSN 0105-4538, E-ISSN 1398-9995, Vol. 72, no 5, p. 723-730Article in journal (Refereed)
    Abstract [en]

    Background

    Longitudinal population-based studies about the natural history of allergic sensitization are rare. The aim was to study incidence and persistence of airborne allergen sensitization up to young adulthood and risk factors for early and late onset of sensitization.

    Methods

    All children aged 7–8 years in two municipalities in Northern Sweden were invited to a parental questionnaire and skin prick tests (SPTs) to ten airborne allergens, and 2148 (88%) participated. The protocol was repeated at age 11–12 and 19 years, and 1516 participated in all three examinations.

    Results

    Prevalence of any positive SPT increased from 20.6% at age 7–8 years to 30.6% at 11–12 years, and 42.1% at 19 years. Animals were the primary sensitizers at age 7–8 years, 16.3%, followed by pollen, 12.4%. Mite and mold sensitization was low. Mean annual incidence of any positive SPT varied between 2.8 and 3.4/100 per year, decreased by age for animal, and was stable for pollen. Sensitization before age 7–8 years was independently associated with family history of allergy, OR 2.1 (95% CI 1.6–2.8), urban living, OR 1.9 (95% CI 1.2–2.9), and male sex, OR 1.3 (95% CI 1.0–1.7), and negatively associated with birth order, OR 0.8 (95% CI 0.7–1.0), and furry animals at home, OR 0.7 (95% CI 0.7–0.9). Incidence after age 11–12 years was associated only with family history of allergy. Multisensitization at age 19 years was significantly associated with early age at sensitization. Remission of sensitization was uncommon.

    Conclusion

    The increasing prevalence of allergic sensitization by age was explained by high incidence and persistence. After age 11–12 years, the factors urban living, number of siblings, and male sex lost their importance.

  • 37.
    Sawalha, Sami
    et al.
    Department of Public Health and Clinical Medicine, Division of Medicine, Umeå University, Umeå, SwedenDivision of Respiratory Medicine, Sunderby Hospital, Luleå, Sweden.
    Hedman, Linnea
    Luleå University of Technology, Department of Health Sciences, Nursing Care. Department of Public Health and Clinical Medicine, The OLIN unit, Section of Sustainable Health, Umeå University, Umeå.
    Backman, Helena
    Department of Public Health and Clinical Medicine, The OLIN unit, Section of Sustainable Health, Umeå University, Umeå, .
    Stenfors, Nikolai
    Department of Public Health and Clinical Medicine, The OLIN unit, Section of Sustainable Health, Umeå University, Umeå, .
    Rönmark, Eva
    Department of Public Health and Clinical Medicine, The OLIN unit, Section of Sustainable Health, Umeå University, Umeå, Sweden.
    Lundbäck, Bo
    Krefting Research center, Institution of Medicine, University of Gothenburg, Gothenburg, Sweden.
    Lindberg, Anne
    Department of Public Health and Clinical Medicine, Division of Medicine, Umeå University, Umeå, Sweden.
    The impact of comorbidities on mortality among men and women with COPD: report from the OLIN COPD study2019In: Therapeutic Advances in Respiratory Disease, ISSN 1753-4658, E-ISSN 1753-4666, Vol. 13, p. 1-10Article in journal (Refereed)
    Abstract [en]

    Background: Comorbidities probably contribute to the increased mortality observed among subjects with chronic obstructive pulmonary disease (COPD), but sex differences in the prognostic impact of comorbidities have rarely been evaluated in population-based studies. The aim of this study was to evaluate the impact of common comorbidities, cardiovascular disease (CVD), diabetes mellitus (DM), and anxiety/depression (A/D), on mortality among men and women with and without airway obstruction in a population-based study.

    Methods: All subjects with airway obstruction [forced expiratory volume in 1 second (FEV1)/(forced) vital capacity ((F)VC) <0.70, n = 993] were, together with age- and sex-matched referents, identified after examinations of population-based cohorts in 2002–2004. Spirometric groups: normal lung function (NLF) and COPD (post-bronchodilator FEV1/(F)VC <0.70) and additionally, LLN-COPD (FEV1/(F)VC <lower limit of normal). Mortality data was collected until December 2015.

    Results: In COPD, the prevalence of CVD and DM was higher in men, whereas the prevalence of A/D was higher in women. The cumulative mortality was significantly higher in COPD than NLF, and higher in men than women in both groups. Among women with COPD, CVD and A/D but not DM increased the risk of death independent of age, body mass index, smoking habits, and disease severity, whereas among men DM and A/D but not CVD increased the risk for death. When the LLN criterion was applied, the pattern was similar.

    Conclusion: There were sex-dependent differences regarding the impact of comorbidities on prognosis in COPD. Even though the prevalence of CVD was higher in men, the impact of CVD on mortality was higher in women, and despite higher prevalence of A/D in women, the impact on mortality was similar in both sexes.

  • 38.
    Schyllert, Christian
    et al.
    Department of Public Health and Clinical Medicine, Section of Sustainable Health, The OLIN Unit, Umeå University, 901 87, Umeå, Sweden.
    Andersson, Martin
    Department of Public Health and Clinical Medicine, Section of Sustainable Health, The OLIN Unit, Umeå University, 901 87, Umeå, Sweden.
    Backman, Helena
    Luleå University of Technology, Department of Health Sciences, Nursing and Medical technology. Department of Public Health and Clinical Medicine, Section of Sustainable Health, The OLIN Unit, Umeå University, 901 87, Umeå, Sweden.
    Lindberg, Anne
    Department of Public Health and Clinical Medicine, Division of Medicine, The OLIN Unit, Umeå University, 901 87, Umeå, Sweden.
    Rönmark, Eva
    Department of Public Health and Clinical Medicine, Section of Sustainable Health, The OLIN Unit, Umeå University, 901 87, Umeå, Sweden.
    Hedman, Linnea
    Luleå University of Technology, Department of Health Sciences, Nursing and Medical technology. Department of Public Health and Clinical Medicine, Section of Sustainable Health, The OLIN Unit, Umeå University, 901 87, Umeå, Sweden.
    Childhood onset asthma is associated with lower educational level in young adults – A prospective cohort study2021In: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 186, article id 106514Article in journal (Refereed)
    Abstract [en]

    Background

    Asthma is associated with low socioeconomic status among both children and adults, and adolescents with asthma report more school absenteeism than those without. However, it is unclear whether asthma in childhood and adolescence affects socioeconomic status in adulthood.

    Methods

    Within the Obstructive Lung disease In Northern Sweden Studies, all children in grade 1 and 2 in three municipalities were invited to a questionnaire survey, 97% participated (n=3430). They were followed annually until age 19, and thereafter at age 28 years. In this study, participants at ages 8y, 12y, 19y and 28y (n=2017) were included. Asthma was categorized into childhood onset (up to age 12y) and adolescent onset (from 12 to 19y). Data for assessment of socioeconomic status was collected at 28y and included educational level, occupation, and occupational exposure to gas, dust and/or fumes (GDF).

    Results

    Childhood onset asthma was associated with having compulsory school as the highest educational level at age 28y, also after adjustment for sex, smoking and BMI at age 19y and socioeconomic factors in childhood (OR 4.84 95%CI 2.01-11.65), and the pattern was the same among men and women. However, we found no significant associations between asthma in childhood or adolescence and socioeconomic groups, occupational groups or occupational exposure to GDF at age 28y.

    Conclusions

    Even though asthma in high-income countries, such as Sweden, is well recognised and treated, this study highlight that childhood onset asthma may have a negative long-term effect with regard to educational level in young adulthood.

  • 39.
    Schyllert, Christian
    et al.
    Department of Public Health and Clinical Medicine, Division of Occupational and Environmental Medicine, The OLIN unit, Umea University, Sweden.
    Andersson, Martin
    Department of Public Health and Clinical Medicine, Division of Occupational and Environmental Medicine, The OLIN unit, Umea University, Sweden.
    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, Umea University, Sweden.
    Ekström, Magnus
    Department of Respiratory Medicine and Allergology, Institution for Clinical Sciences, Lund University, Sweden.
    Backman, Helena
    Department of Public Health and Clinical Medicine, Division of Occupational and Environmental Medicine, The OLIN Unit, Umeå University, Sweden.
    Lindberg, Anne
    Department of Public Health and Clinical Medicine, Division of Medicine/the OLIN unit, Umeå University, Sweden.
    Rönmark, Eva
    Department of Public Health and Clinical Medicine, Division of Occupational and Environmental Medicine/the OLIN unit, Umeå University, Sweden.
    Job titles classified into socioeconomic and occupational groups identify subjects with increased risk for respiratory symptoms independent of occupational exposure to vapour, gas, dust, or fumes2018In: European Clinical Respiratory Journal, ISSN 2001-8525, Vol. 5, no 1, article id 1468715Article in journal (Refereed)
    Abstract [en]

    Objectives: To evaluate the ability of three different job title classification systems to identify subjects at risk for respiratory symptoms and asthma by also taking the effect of exposure to vapours, gas, dust, and fumes (VGDF) into account. Background: Respiratory symptoms and asthma may be caused by occupational factors. There are different ways to classify occupational exposure. In this study, self-reported occupational exposure to vapours, gas, dust and fumes was used as well as job titles classifed into occupational and socioeconomic Groups according to three different systems. Design: This was a large population-based study of adults aged 30-69 years in Northern Sweden (n = 9,992, 50% women). Information on job titles, VGDF-exposure, smoking habits, asthma and respiratory symptoms was collected by a postal survey. Job titles were used for classification into socioeconomic and occupational groups based on three classification systems; Socioeconomic classification (SEI), the Nordic Occupations Classification 1983 (NYK), and the Swedish Standard Classification of Occupations 2012 (SSYK). Associations were analysed by multivariable logistic regression. Results: Occupational exposure to VGDF was a risk factor for all respiratory symptoms and asthma (odds ratios (ORs) 1.3-2.4). Productive cough was associated with the socioeconomic groups of manual workers (ORs 1.5-2.1) and non-manual employees (ORs 1.6-1.9). These groups include occupations such as construction and transportation workers, service workers, nurses, teachers and administration clerks which by the SSYK classification were associated with productive cough (ORs 2.4-3.7). Recurrent wheeze was significantly associated with the SEI group manual workers (ORs 1.5-1.7). After adjustment for also VGDF, productive cough remained significantly associated with the SEI groups manual workers in service and non-manual employees, and the SSYK-occupational groups administration, service, and elementary occupations. Conclusions: In this cross-sectional study, two of the three different classification systems, SSYK and SEI gave similar results and identified groups with increased risk for respiratory symptoms while NYK did not give conclusive results. Furthermore, several associations were independent of exposure to VGDF indicating that also other job-related factors than VGDF are of importance.

  • 40.
    Schyllert, Christian
    et al.
    Umeå University, Umeå, Sweden.
    Andersson, Martin
    Umeå University, Umeå, Sweden.
    Lindberg, Anne
    Umeå University, Umeå, Sweden.
    Rönmark, Eva
    Umeå University, Umeå, Sweden.
    Hedman, Linnea
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Childhood asthma affects job and education in young adults2018In: European Respiratory Journal, ISSN 0903-1936, E-ISSN 1399-3003, Vol. 52, no suppl 62, article id OA298Article in journal (Other academic)
  • 41.
    Schyllert, Christian
    et al.
    Department of Public Health and Clinical Medicine, Section of Sustainable Health, The OLIN Unit, Umeå University, Umeå, Sweden.
    Lindberg, Anne
    Department of Public Health and Clinical Medicine, Division of Medicine, Umeå University, Umeå, Sweden.
    Hedman, Linnea
    Luleå University of Technology, Department of Health, Learning and Technology, Nursing and Medical Technology. Department of Public Health and Clinical Medicine, Section of Sustainable Health, The OLIN Unit, Umeå University, Umeå, Sweden.
    Stridsman, Caroline
    Department of Public Health and Clinical Medicine, Division of Medicine, Umeå University, Umeå, Sweden.
    Andersson, Martin
    Department of Public Health and Clinical Medicine, Section of Sustainable Health, The OLIN Unit, Umeå University, Umeå, Sweden.
    Andersén, Heidi
    Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
    Piirilä, Päivi
    Unit of Clinical Physiology, HUS-Medical Diagnostic Center, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland.
    Nwaru, Bright I.
    Krefting Research Centre, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden; Wallenberg Centre for Molecular and Translational Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.
    Krokstad, Steinar
    HUNT Research Centre, Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Levanger, Norway.
    Rönmark, Eva
    Department of Public Health and Clinical Medicine, Section of Sustainable Health, The OLIN Unit, Umeå University, Umeå, Sweden.
    Backman, Helena
    Department of Public Health and Clinical Medicine, Section of Sustainable Health, The OLIN Unit, Umeå University, Umeå, Sweden.
    Socioeconomic inequalities in asthma and respiratory symptoms in a high-income country: changes from 1996 to 20162023In: Journal of Asthma, ISSN 0277-0903, E-ISSN 1532-4303, Vol. 60, no 1, p. 185-194Article in journal (Refereed)
    Abstract [en]

    Objective: Low socioeconomic status based both on educational level and income has been associated with asthma and respiratory symptoms, but changes over time in these associations have rarely been studied. The aim was to study the associations between educational or income inequality and asthma and respiratory symptoms among women and men over a 20-year period in northern Sweden. Methods: The study was performed within the Obstructive Lung disease in Northern Sweden (OLIN) research program. Mailed questionnaire surveys were administered to a random sample of adults (20-69 years of age) living in Sweden, in 1996, 2006 and 2016. Data on educational level and income were collected from the national integrated database for labor market research. Results: The educational inequality associated with asthma and asthmatic wheeze tended to decrease from 1996 to 2016, while it increased for productive cough, the latter among men not among women. The income inequality decreased for productive cough, especially for women, while no clear overall trends were found for asthmatic wheeze and asthma, apart from a decrease in income inequality regarding asthma among men. Conclusion: The patterns for socioeconomic inequality differed for asthma and wheeze compared to productive cough, and the results emphasize that education and income do not mirror the same aspects of socioeconomic inequality in a high-income country. Our findings are important for decision makers, not the least on a political level, as reduced inequality, e.g. through education, could lead to reduced morbidity.

  • 42.
    Schyllert, Christian
    et al.
    Dept of Public Health and Clinical Medicine, Section of Sustainable Health/the OLIN unit, Umeå University, Umeå, Sweden.
    Lindberg, Anne
    Dept of Public Health and Clinical Medicine, Division of Medicine, Umeå University, Umeå, Sweden.
    Hedman, Linnea
    Luleå University of Technology, Department of Health Sciences, Nursing and Medical technology. Dept of Public Health and Clinical Medicine, Section of Sustainable Health/the OLIN unit, Umeå University, Umeå, Sweden.
    Stridsman, Caroline
    Luleå University of Technology, Department of Health Sciences, Nursing and Medical technology.
    Andersson, Martin
    Dept of Public Health and Clinical Medicine, Section of Sustainable Health/the OLIN unit, Umeå University, Umeå, Sweden.
    Ilmarinen, Pinja
    Dept of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland.
    Piirilä, Päivi
    Unit of Clinical Physiology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
    Krokstad, Steinar
    HUNT Research Centre, Dept of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Levanger, Norway.
    Lundbäck, Bo
    Krefting Research Centre, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.
    Rönmark, Eva
    Dept of Public Health and Clinical Medicine, Section of Sustainable Health/the OLIN unit, Umeå University, Umeå, Sweden.
    Backman, Helena
    Luleå University of Technology, Department of Health Sciences, Nursing and Medical technology. Dept of Public Health and Clinical Medicine, Section of Sustainable Health/the OLIN unit, Umeå University, Umeå, Sweden.
    Low socioeconomic status relates to asthma and wheeze, especially in women2020In: ERJ Open Research, E-ISSN 2312-0541, Vol. 6, no 3, article id 00258-2019Article in journal (Refereed)
    Abstract [en]

    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.

  • 43.
    Schyllert, Christian
    et al.
    Umeå University, Department of Public Health and Clinical Medicine, Section of Sustainable Health/the OLIN unit, Luleå, Sweden.
    Lindberg, Anne
    Umeå University, Department of Public Health and Clinical Medicine, Section of Medicine/the OLIN unit, Luleå, Sweden.
    Hedman, Linnea
    Luleå University of Technology, Department of Health Sciences, Nursing and Medical technology. Umeå University, Department of Public Health and Clinical Medicine, Section of Sustainable Health/the OLIN unit.
    Stridsman, Caroline
    Umeå University, Department of Public Health and Clinical Medicine, Section of Medicine/the OLIN unit, Luleå, Sweden.
    Bhatta, Laxmi
    Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Levanger, Norway.
    Kankaanranta, Hannu
    Department of Respiratory Medicine, Seinäjoki Central Hospital, and Faculty of Medicine and Health Technology, University of Tampere, Seinäjoki, Finland.
    Piirila, Päivi
    Unit of Clinical Physiology, HUS Medical Imaging Center, Helsinki University Hospital, and University of Helsinki, Helsinki, Finland.
    Lundback, Bo
    Krefting Research Centre, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.
    Ronmark, Eva
    Umeå University, Department of Public Health and Clinical Medicine, Section of Sustainable Health/the OLIN unit, Luleå, Sweden.
    Backman, Helena
    Luleå University of Technology, Department of Health Sciences, Nursing and Medical technology. Umeå University, Department of Public Health and Clinical Medicine, Section of Sustainable Health/the OLIN unit.
    Risk factor pattern for asthma in 1996, 2006 and 2016 in Sweden – the OLIN and Nordic EpiLung studies2020In: European Respiratory Journal, ISSN 0903-1936, E-ISSN 1399-3003, Vol. 56, no Suppl 64, article id 425Article in journal (Other academic)
    Abstract [en]

    Background: During the second half of the 20th century the prevalence of asthma has increased and smoking habits and socioeconomy has changed in Sweden.

    Aim: To analyze risk factor patterns for current asthma in 1996, 2006 and 2016.

    Methods: Three cross-sectional random samples from the same area of Sweden, 20-69 years, participated in population surveys with the same validated questionnaire in 1996 (n=7104 participants, 85% response rate), 2006 (n=6165, 77%) and 2016 (n=5466, 53%). Current asthma was defined as physician-diagnosed asthma with symptoms common in asthma and/or asthma medication use during the last 12 months. Socioeconomic classification was based on occupation. Risk factors for current asthma were analyzed by multivariable logistic regression.

    Results: A family history of asthma yielded the highest odds ratios (OR) all three years with ORs 3.19-3.66. Data on occupational exposure to gas, dust or fumes (GDF) was not available in 1996, but associated with current asthma in both 2006 (1.86, 1.51-2.30) and 2016 (1.70, 1.37-2.10). Ex-smoking was a risk factor in 1996 (1.39, 1-12-1.73) and 2006 (1.38, 1.11-1.71) but not in 2016 (1.15, 0.92-1.44). Manual workers in service and industry, non-manual employees and self-employed had increased risk for current asthma in 2016, but not in 1996 or 2006, compared to professionals and executives.

    Conclusion: The risk factor pattern for asthma among adults has changed in Sweden from 1996 to 2016. While occupational exposure to GDF was a prominent and constant risk factor for asthma, ex-smoking lost significance in 2016, and socioeconomic differences with regard to occupation emerged.

  • 44.
    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, 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 1365-2648, Vol. 75, no 12, p. 3525-3534Article 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.

  • 45.
    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.

  • 46.
    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.

  • 47.
    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)
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  • 48.
    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.

  • 49.
    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, E-ISSN 1753-4666, 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.

  • 50.
    Strinnholm, Åsa
    et al.
    Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, The OLIN Unit, Umeå University.
    Hedman, Linnea
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Winberg, Anna
    Department of Clinical Sciences, Pediatrics, Umeå University.
    Jansson, Sven-Arne
    Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, The OLIN Unit, Umeå University.
    Lindh, Viveka
    Department of Clinical Sciences, Pediatrics, Umeå University.
    Rönmark, Eva
    Department of Public Health and Clinical Medicine, Division of Occupational and Environmental Medicine/the OLIN unit, Umeå University.
    Health Related Quality of Life among schoolchildren aged 12–13 years in relation to food hypersensitivity phenotypes: a population-based study2017In: Clinical and Translational Allergy, ISSN 2045-7022, E-ISSN 2045-7022, Vol. 7, no 1, article id 20Article in journal (Refereed)
    Abstract [en]

    Background

    While Health Related Quality of Life has been investigated among children with IgE-mediated food allergy, less is known about quality of life among children with other types of hypersensitivity to food. The aim of this study was to investigate Health Related Quality of Life (HRQL) in children with and without food hypersensitivity. Further, we compared HRQL between children with different phenotypes of food hypersensitivity.

    Methods

    In a large population-based cohort of schoolchildren in Northern Sweden, the parents of 2612 (96% of invited) completed a questionnaire. All 125 (5%) children who reported complete elimination of milk, egg, fish or wheat due to food hypersensitivity were invited to a clinical examination and 94 children participated. Of these, 75 children also completed a generic (KIDSCREEN-52) and a disease-specific HRQL questionnaire (FAQLQ-TF). Thereafter, these children were categorised into the different phenotypes: current food allergy, outgrown food allergy, and lactose intolerance. Additionally, 209 children with unrestricted diets answered the generic questionnaire.

    Results

    The median score of all KIDSCREEN-52 domains were above the population norm of 50 both in children with and without food hypersensitivity. No significant differences in distribution in generic or disease-specific HRQL were found between children with or without food hypersensitivity. There were no significant differences in HRQL between children with different phenotypes of food hypersensitivity. However, children with current food allergy tended to have the lowest HRQL. Further, poor HRQL defined as ≥75th percentile for the disease specific score was significantly more common in the current food allergy phenotype in the domain Emotional impact and the total FAQLQ, compared to the other phenotypes.

    Conclusions

    In this population-based study, 12–13 year old children reported good HRQL regardless of having food hypersensitivity or not. However, the children with the current phenotype reported lower HRQL than the other phenotypes.

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