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

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

  • 2.
    Axelsson, Malin
    et al.
    Department of Care Science, Faculty of Health and Society, Malmö University, Malmö. Krefting Research Centre, Institute of Medicine, University of Gothenburg, Gothenburg, 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 .
    Vanfleteren, Lowie
    Centre for COPD Research, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.
    Stridsman, Caroline
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Ekerljung, Linda
    Krefting Research Centre, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.
    Eriksson, Berne
    Research and Development, Region of Halland, Halmstad, Sweden.
    Nwaru, Bright
    Krefting Research Centre, Institute of Medicine, University of Gothenburg, Wallenberg Centre for Molecular and Translational Medicine, 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.
    Kankaanranta, Hannu
    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/the OLIN unit, Umeå University, Umeå, Sweden.
    Lundbäck, Bo
    Krefting Research Centre, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.
    Underdiagnosis and misclassification of COPD in Sweden2020In: European Respiratory Journal, ISSN 0903-1936, E-ISSN 1399-3003, Vol. 56, no Suppl 64, article id 1395Article in journal (Other academic)
    Abstract [en]

    Introduction: The prevalence of COPD seems to have leveled or decreased in some high income countries. Worldwide, population studies using spirometry have found substantial underdiagnosis of COPD.

    Aim: To investigate underdiagnosis and misclassification of COPD in Sweden.

    Methods: A randomly selected sample (n=1839; age 21-78 years; women 52.6%) was derived from two large scale population studies in Sweden, the West Sweden Asthma Study (WSAS) and the Obstructive Lung Disease in Northern Sweden (OLIN) Studies. Examinations including spirometry and structured interviews were conducted 2009-2012. COPD was defined following GOLD 2017: post-bronchodilator FEV1/FVC<0.70 and presence of respiratory symptoms. The subjects were asked if prior to the study they had been diagnosed with COPD, chronic bronchitis, emphysema, asthma, and if they used medicines for airway diseases.

    Results: Of those with COPD (GOLD) identified at the clinical examinations, 24% had, prior to the study, been diagnosed with COPD, emphysema, or chronic bronchitis (COPD-cluster), while 46% had been diagnosed with the COPD-cluster, asthma, or used medicines for airway disease (any OAD). The corresponding figures for those fulfilling the criteria of COPD GOLD grade ≥2 were 39% (COPD-cluster) and 62% (any OAD). Among the subjects who, prior to the study, had been diagnosed with COPD, 78% fulfilled the criteria of COPD, but among those who had been diagnosed as having any of the diseases in the COPD-cluster, 31% fulfilled the criteria of COPD.

    Conclusion: The proportion of underdiagnosis of COPD is still large in Sweden. Some misclassification of COPD was also found. The results reflect underuse of spirometry in primary care.

  • 3.
    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)
  • 4.
    Backman, Helena
    et al.
    Dept of Public Health and Clinical Medicine, Division of Occupational and Environmental Medicine, the OLIN unit, Umea university, Umea, Sweden.
    Ekerljung, Linda
    Krefting Research Centre, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.
    Eriksson, Berne
    Krefting Research Centre, Institute of Medicine, University of Gothenburg, & Dept of Internal Medicine, Central County Hospital of Halland, Gothenburg, Sweden.
    Stridsman, Caroline
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Mincheva, Roxana
    Krefting Research Centre, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.
    Hedman, Linnea
    Dept of Public Health and Clinical Medicine, Division of Occupational and Environmental Medicine, the OLIN unit, Umea university, Umea, Sweden.
    Hagstad, Stig
    Krefting Research Centre, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.
    Lindberg, Anne
    Dept of Public Health and Clinical Medicine, Division of Medicine, Umea university, Umea, Sweden.
    Ullman, Anders
    Center for COPD research, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Rönmark, Eva
    Dept of Public Health and Clinical Medicine, Division of Occupational and Environmental Medicine, the OLIN unit, Umea university, Umea, Sweden.
    Lundback, Bo
    Krefting Research Centre, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.
    Decrease in prevalence of COPD in Sweden after decades of decrease in smoking2018In: European Respiratory Journal, ISSN 0903-1936, E-ISSN 1399-3003, Vol. 52, no suppl 62, article id OA1935Article in journal (Other academic)
  • 5.
    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.

  • 6.
    Backman, Helena
    et al.
    Department of Public Health and Clinical Medicine, Division of Occupational and Environmental Medicine, The OLIN Unit, Umeå University.
    Eriksson, Berne
    Department of Internal Medicine, Central County Hospital of Halmstad.
    Rönmark, Eva
    National Institute for Working Life, Norrbottens Läns Landsting, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, The OLIN Unit, Umeå University, Karolinska Institutet, Lung and Allergy Research.
    Hedman, Linnea
    OLIN studies, Norrbotten County Council, Department of Public Health and Clinical Medicine, Division of Occupational and Environmental Medicine, The OLIN Unit, Umeå University.
    Stridsman, Caroline
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Jansson, Sven-Arne
    Department of Public Health and Clinical Medicine, Division of Occupational and Environmental Medicine, The OLIN Unit, Umeå University.
    Lindberg, Anne
    Norrbottens Läns Landsting, OLIN studies, Sunderby Hospital, Sunderby sjukhus, Luleå.
    Lundbäck, Bo
    Department of Internal Medicine and Clinical Nutrition, Krefting Research Centre, University of Gothenburg, National Institute of Occupational Health, Medical Division, Umeå, Karolinska Institutet, Lung and Allergy Research, National Institute for Working Life, Centrallasarettet Boden, Lungkliniken, Central Hospital of Norrbotten, Luleå, Boden, The OLIN Study Group.
    Decreased prevalence of moderate to severe COPD over 15 years in northern Sweden2016In: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 114, p. 103-110Article in journal (Refereed)
    Abstract [en]

    Background The burden of COPD in terms of mortality, morbidity, costs and prevalence has increased worldwide. Recent results on prevalence in Western Europe are conflicting. In Sweden smoking prevalence has steadily decreased over the past 30 years. Aim The aim was to study changes in prevalence and risk factor patterns of COPD in the same area and within the same age-span 15 years apart. Material and methods Two population-based cross-sectional samples in ages 23-72 years participating at examinations in 1994 and 2009, respectively, were compared in terms of COPD prevalence, severity and risk factor patterns. Two different definitions of COPD were used; FEV1/FVC

  • 7.
    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.

  • 8.
    Backman, Helena
    et al.
    Department of Public Health and Clinical Medicine, Division of Occupational and Environmental Medicine/the OLIN unit, Umeå University, Umeå, Sweden.
    Hedman, Linnea
    Umea Univ, Dept Publ Hlth & Clin Med, Div Occupat & Environm Med, OLIN unit, Umea, Sweden.
    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, Umeå, Sweden.
    Sandström, Thomas
    Department of Public Health and Clinical Medicine, Division of Medicine, 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
    Umea Univ, Dept Publ Hlth & Clin Med, Div Occupat & Environm Med, OLIN unit, Umea, Sweden.
    Eosinophilic inflammation and lung function decline in a long-term follow-up of a large population-based asthma cohort2018In: European Respiratory Journal, ISSN 0903-1936, E-ISSN 1399-3003, Vol. 52, no suppl 62, article id OA294Article in journal (Other academic)
  • 9.
    Backman, Helena
    et al.
    Dept of Public Health and Clinical Medicine, Division of Occupational and Environmental Medicine, the OLIN unit, Umeå university, Umeå, Sweden.
    Jansson, Sven-Arne
    Dept of Public Health and Clinical Medicine, Division of Occupational and Environmental Medicine, the OLIN unit, Umeå university, Umeå, Sweden.
    Stridsman, Caroline
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Eriksson, Berne
    Krefting Research Centre, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden, 4 Dept of Internal Medicine, Cen tral County Hospital of Halland, Halmstad, Sweden.
    Hedman, Linnea
    Dept of Public Health and Clinical Medicine, Division of Occupational and Environmental Medicine, the OLIN unit, Umeå university, Umeå, Sweden.
    Eklund, Britt-Marie
    Dept of Public Health and Clinical Medicine, Division of Occupational and Environmental Medicine, the OLIN unit, Umeå university, Umeå, Sweden.
    Sandström, Thomas
    Dept of Public Health and Clinical Medicine, Division of Medicine, Umeå university, Umeå, Sweden.
    Lindberg, Anne
    Dept of Public Health and Clinical Medicine, Division of Occupational and Environmental Medicine, the OLIN unit, Umeå university, Umeå, Sweden.
    Lundbäck, Bo
    Dept of Public Health and Clinical Medicine, Division of Occupational and Environmental Medicine, the OLIN unit, Umeå university, Umeå, Sweden Krefting Research Centre, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.
    Rönmark, Eva
    Dept of Public Health and Clinical Medicine, Division of Occupational and Environmental Medicine, the OLIN unit, Umeå university.
    Severe asthma: A population study perspective2019In: Clinical and Experimental Allergy, ISSN 0954-7894, E-ISSN 1365-2222, Vol. 49, no 6, p. 819-828Article in journal (Refereed)
    Abstract [en]

    BackgroundSevere asthma is a considerable challenge for patients, health care professionals and society. Few studies have estimated the prevalence of severe asthma according to modern definitions of which none based on a population study.

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

    MethodsN=1006 subjects with asthma participated in a follow‐up during 2012‐14, when 830 (mean age 59y, 56% women) still had current asthma. Severe asthma was defined according to three internationally well‐known criteria: the ATS workshop definition from 2000 used in the US Severe Asthma Research Program (SARP), the 2014 ATS/ERS Task force definition and the GINA 2017. All subjects with severe asthma according to any of these criteria were undergoing respiratory specialist care, and were also contacted by telephone to verify treatment adherence.

    ResultsThe prevalence of severe asthma according to the three definitions was 3.6% (US SARP), 4.8% (ERS/ATS Taskforce), and 6.1% (GINA) among subjects with current asthma. Although all were using high ICS doses and other maintenance treatment, >40% had uncontrolled asthma according to the asthma control test. Severe asthma was related to age >50 years, nasal polyposis, impaired lung function, sensitization to aspergillus, and tended to be more common in women. Further, neutrophils in blood significantly discriminated severe asthma from other asthma.

    Conclusions and clinical relevanceSevere asthma differed significantly from other asthma in terms of demographic, clinical and inflammatory characteristics, results suggesting possibilities for improved treatment regimens of severe asthma. The prevalence of severe asthma in this asthma cohort was 4‐6%, corresponding to approximately 0.5% of the general population.

  • 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.
    Department of Public Health and Clinical Medicine, Umeå university, Umeå, Sweden.
    Stridsman, Caroline
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Hedman, Linnea
    Department of Public Health and Clinical Medicine, Umeå university, Umeå, Sweden.
    Lindberg, Anne
    Department of Public Health and Clinical Medicine, Umeå university, Umeå, Sweden.
    Andersson, Martin
    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.
    Characterization of adults with asthma per GINA treatment steps2019In: European Respiratory Journal, ISSN 0903-1936, E-ISSN 1399-3003, Vol. 54, no suppl. 63, article id PA4417Article in journal (Other academic)
  • 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.
    Eriksson, Berne
    et al.
    Krefting Research Centre, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburgh, Sweden.
    Stridsman, Caroline
    Luleå University of Technology, Department of Health Sciences, Nursing Care. Department of Public Health and Clinical Medicine, Section of Medicine, University of Umeå, Umeå, Sweden.
    Nilsson, Ulf
    Department of Public Health and Clinical Medicine, Section of Medicine, University of Umeå, Umeå, Sweden.
    Strandkvist, Viktor
    Luleå University of Technology, Department of Health, Learning and Technology, Health, Medicine and Rehabilitation. Dept of Public Health and Clinical Medicine, Division of Occupational and Environmental Medicine, the OLIN unit, Umeå university, Umeå, Sweden.
    Backman, Helena
    Dept of Public Health and Clinical Medicine, Division of Occupational and Environmental Medicine, the OLIN unit, Umeå university, Umeå, Sweden.
    High prevalence of COPD among adults with heart disease2019In: European Respiratory Journal, ISSN 0903-1936, E-ISSN 1399-3003, Vol. 54, no suppl. 63, article id OA293Article in journal (Other academic)
  • 16.
    Hedman, Linnea
    et al.
    The OLIN studies, Norrbotten county council; Department of public health and clinical medicine, Occupational and environmental medicine, Umeå University, Luleå, Sweden.
    Backman, Helena
    Norrbotten Cty Council, OLIN Studies, Lulea, Sweden; Umea Univ, Dept Publ Hlth & Clin Med Occupat & Environm Med, Lulea, Sweden.
    Stridsman, Caroline
    Luleå University of Technology, Department of Health Sciences, Nursing Care. The OLIN studies, Norrbotten county council, Luleå, Sweden.
    Andersson, Martin
    Department of public health and clinical medicine, Occupational and environmental medicine, Umeå University, Sweden., Umeå, Sweden.
    Lindberg, Anne
    Luleå University of Technology, Department of Health, Learning and Technology, Health, Medicine and Rehabilitation. The OLIN studies, Norrbotten county council; Department of public health and clinical medicine, Division of respiratory medicine, Umeå University., Umeå, Sweden.
    Rönmark, Eva
    The OLIN studies, Norrbotten county council; Department of public health and clinical medicine, Occupational and environmental medicine, Umeå University, Luleå, Sweden.
    Late Breaking Abstract - E-cigarette use among Swedish teenagers2018In: European Respiratory Journal, ISSN 0903-1936, E-ISSN 1399-3003, Vol. 52, no suppl 62, article id OA5220Article in journal (Other academic)
  • 17.
    Hedman, Linnea
    et al.
    Department of public health and clinical medicine, The OLIN unit, Umeå University, Umeå, Sweden.
    Backman, Helena
    Department of public health and clinical 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, The OLIN unit, Umeå University, Umeå, Sweden.
    Rönmark, Eva
    Department of public health and clinical medicine, The OLIN unit, Umeå University, Umeå, Sweden.
    Incidence and risk factors for asthma from childhood to young adulthood2018In: European Respiratory Journal, ISSN 0903-1936, E-ISSN 1399-3003, Vol. 52, no suppl 62, article id PA1147Article in journal (Other academic)
  • 18.
    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.

  • 19.
    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)
  • 20.
    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.

  • 21.
    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.

  • 22.
    Jansson, Sven-Arne
    et al.
    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.
    Andersson, Maria
    AstraZeneca Nordic-Baltic, Södertälje, Sweden.
    Telg, Gunilla
    AstraZeneca Nordic-Baltic, Södertälje, Sweden.
    Lindberg, Anne
    Department of Public Health and Clinical Medicine, Division of Medicine, Umeå University, Umeå, Sweden.
    Stridsman, Caroline
    Luleå University of Technology, Department of Health Sciences, Nursing and Medical technology.
    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.
    Severe asthma is related to high societal costs and decreased health related quality of life2020In: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 162, article id 105860Article in journal (Refereed)
    Abstract [en]

    Background

    The aim of the present study was to estimate the societal costs and the key cost drivers for patients with severe asthma in Sweden. In addition, health-related quality of life (HRQOL) and morbidity of patients with severe asthma is described.

    Methods

    The study population comprised adults with severe asthma recruited from a large asthma cohort within the Obstructive Lung Disease in Northern Sweden (OLIN) studies. During 2017, patients were interviewed quarterly over telephone regarding their resource utilization and productivity losses.

    Results

    Estimated mean annual asthma-related costs per patient with severe asthma amounted to €6,500, of which approximately €2400 and €4100 were direct and indirect costs, respectively. The main cost drivers for direct costs were hospitalizations followed by drugs: approximately €1000 and €800, respectively. Patients on treatment with regular oral corticosteroids (OCS) had greater direct costs compared with those without regular OCS treatment. Co-morbid conditions were common and the costs were substantial also for co-morbid conditions, with a total cost of approximately €4200. The OCS group had significantly lower HRQOL compared to the non-OCS group.

    Conclusions

    The societal costs due to severe asthma were substantial. Costs for co-morbid conditions contributed substantially to both direct and indirect costs. The direct costs were significantly higher in the maintenance OCS-group compared to the non-maintenance OCS-group. These results indicate a need for improved management and treatment regimens for patients with severe asthma.

  • 23.
    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)
  • 24.
    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.

  • 25.
    Johansson Strandkvist, Viktor
    et al.
    Luleå University of Technology, Department of Health Sciences, Health and Rehab. Umeå University, Department of Public Health and Clinical Medicine, Division of Occupational and Environmental Medicine, The OLIN unit.
    Backman, Helena
    Umeå University, Department of Public Health and Clinical Medicine, Division of Occupational and Environmental Medicine, The OLIN unit.
    Andersson, Mikael
    Uppsala University, Department of Neuroscience.
    Larsson, Agneta
    Luleå University of Technology, Department of Health Sciences, Health and Rehab.
    Stridsman, Caroline
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Lindberg, Anne
    Department of Public Health and Clinical Medicine, Division of Medicine/the OLIN unit, Umeå University.
    Hand grip strength is associated with fatigue in COPD2017Conference paper (Refereed)
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  • 26.
    Johansson Strandkvist, Viktor
    et al.
    Luleå University of Technology, Department of Health Sciences, Health and Rehab.
    Backman, Helena
    Division of Occupational and Environmental Medicine, Department of Public Health and Clinical Medicine, The Obstructive Lung disease in Northern Sweden Unit, Umeå University.
    Röding, Jenny
    Luleå University of Technology, Department of Health Sciences, Health and Rehab.
    Stridsman, Caroline
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Lindberg, Anne
    Division of Medicine, Department of Public Health and Clinical Medicine, Umeå University.
    Hand grip strength is associated with forced expiratory volume in 1 second among subjects with COPD: report from a population-based cohort study.2016In: The International Journal of Chronic Obstructive Pulmonary Disease, ISSN 1176-9106, E-ISSN 1178-2005, Vol. 11, no 1, p. 2527-2534Article in journal (Refereed)
    Abstract [en]

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

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

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

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

  • 27.
    Johansson Strandkvist, Viktor
    et al.
    Luleå University of Technology, Department of Health Sciences, Health and Rehabilitation. OLIN-studierna.
    Backman, Helena
    Department of Public Health and Clinical Medicine, Division of Occupational and Environmental Medicine, The OLIN Unit, Umeå University.
    Röding, Jenny
    Luleå University of Technology, Department of Health Sciences, Health and Rehabilitation.
    Stridsman, Caroline
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Lindberg, Anne
    Department of Public Health and Clinical Medicine, Division of Medicine/the OLIN unit, Umeå University.
    Impact of heart disease on hand grip strength in COPD: epidemiological data2016Conference paper (Refereed)
    Abstract [en]

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

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

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

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

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  • 28.
    Johansson Strandkvist, Viktor
    et al.
    Luleå University of Technology, Department of Health Sciences, Health and Rehab.
    Nyberg, Lars
    Luleå University of Technology, Department of Health Sciences, Health and Rehab.
    Larsson, Agneta
    Luleå University of Technology, Department of Health Sciences, Health and Rehab.
    Röijezon, Ulrik
    Luleå University of Technology, Department of Health Sciences, Health and Rehab.
    Stridsman, Caroline
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Lindberg, Anne
    OLIN studierna Norrbottens läns landsting , Sverige.
    Project: Physical function and postural control among subjects with Chronic Obstructive Pulmonary Disease – epidemiological and laboratory studies2016Other (Other (popular science, discussion, etc.))
  • 29.
    Karlsson Sundbaum, Johanna
    et al.
    Luleå University of Technology, Department of Health, Learning and Technology, Health, Medicine and Rehabilitation.
    Konradsen, Jon R.
    Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden.
    Vanfleteren, Lowie E.G.W.
    COPD Center, Department of Respiratory Medicine and Allergology, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Axelsson Fisk, Sten
    Department of Clinical Sciences Lund, Obstetrics and Gynaecology, Lund University and Ystad Hospital, Lund, Sweden.
    Pedroletti, Christophe
    Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden.
    Sjöö, Yvonne
    The Swedish National Airway Register, Gothenburg, Sweden.
    Syk, Jörgen
    Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden; Academic Primary Health Care Centre, Stockholm, Sweden; Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
    Sterner, Therese
    Department of Occupational and Environmental Dermatology, Skåne University Hospital, Lund University, Malmö, Sweden.
    Lindberg, Anne
    Department of Public Health and Clinical Medicine, Umeå University, Devision of Medicine/ The OLIN- unit, Umeå University, Umeå, Sweden.
    Tunsäter, Alf
    Department of Respiratory Medicine and Allergology, Skåne University Hospital, Lund University, Lund, Sweden.
    Nyberg, Fredrik
    School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Ekberg-Jansson, Ann
    COPD Center, Department of Respiratory Medicine and Allergology, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Stridsman, Caroline
    Department of Public Health and Clinical Medicine, Umeå University, Devision of Medicine/ The OLIN- unit, Umeå University, Umeå, Sweden.
    Uncontrolled asthma predicts severe COVID-19: a report from the Swedish National Airway Register2022In: Therapeutic Advances in Respiratory Disease, ISSN 1753-4658, E-ISSN 1753-4666, Vol. 16Article in journal (Refereed)
    Abstract [en]

    Background: Severe asthma increases the risk of severe COVID-19 outcomes such as hospitalization and death. However, more studies are needed to understand the association between asthma and severe COVID-19.

    Methods: A cohort of 150,430 adult asthma patients were identified in the Swedish National Airway Register (SNAR) from 2013 to December 2020. Data on body mass index, smoking habits, lung function, and asthma control test (ACT) were obtained from SNAR, and uncontrolled asthma was defined as ACT ⩽19. Patients with severe COVID-19 were identified following hospitalization or in death certificates based on ICD-10 codes U07.1 and U07.2. The Swedish Prescribed Drug register was used to identify comorbidities and data from Statistics Sweden for educational level. Multivariate logistic regression analyses were used to estimate associations with severe COVID-19.

    Results: Severe COVID-19 was identified in 1067 patients (0.7%). Older age (OR = 1.04, 95% CI = 1.03–1.04), male sex (1.42, 1.25–1.61), overweight (1.56, 1.27–1.91), obesity (2.12, 1.73–2.60), high-dose inhaled corticosteroids in combination with long-acting β-agonists (1.40, 1.22–1.60), dispensed oral corticosteroids ⩾2 (1.48, 1.25–1.75), uncontrolled asthma (1.64, 1.35–2.00), cardiovascular disease (1.20, 1.03–1.40), depression (1.47, 1.28–1.68), and diabetes (1.52, 1.29–1.78) were associated with severe COVID-19, while current smoking was inversely associated (0.63, 0.47–0.85). When comparing patients who died from COVID-19 with those discharged alive from hospital until 31 December 2020, older age, male sex, and current smoking were associated with COVID-19 death.

    Conclusion: Patients with uncontrolled asthma and high disease burden, including increased asthma medication intensity, should be identified as risk patients for severe COVID-19. Furthermore, current smoking is strongly associated with COVID-19 death in asthma.

  • 30.
    Karlsson Sundbaum, Johanna
    et al.
    Luleå University of Technology, Department of Health, Learning and Technology, Health, Medicine and Rehabilitation.
    Vanfleteren, Lowie E.G.W.
    COPD Center, Department of Respiratory Medicine and Allergology, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.
    Konradsen, Jon R.
    Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden.
    Nyberg, Fredrik
    School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.
    Ekberg-Jansson, Ann
    Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.
    Stridsman, Caroline
    Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.
    Severe COVID-19 among patients with asthma and COPD: a report from the Swedish National Airway Register2021In: Therapeutic Advances in Respiratory Disease, ISSN 1753-4658, E-ISSN 1753-4666, Vol. 15, article id 175346662110497Article in journal (Refereed)
    Abstract [en]

    Background: Patients with obstructive lung diseases may be at risk of hospitalization and/or death due to COVID-19.

    Aim: To estimate the frequency of severe COVID-19, and COVID-19-related mortality in a well-defined large population of patients with asthma and chronic inflammatory lung disease (COPD). Further to assess the frequency of asthma and COPD as registered comorbidities at discharge from hospital, and in death certificates.

    Methods: At the start of the pandemic, the Swedish National Airway Register (SNAR) included 271,404 patients with a physician diagnosis of asthma and/or COPD. In September 2020, after the first COVID-19 wave in Sweden, the database was linked with the National Patient Register (NPR), the Swedish Intensive Care Register and the Swedish Cause of Death Register, which all provide data about COVID-19 based on International Classification of Diseases (ICD-10) codes. Severe COVID-19 was defined as hospitalization and/or intensive care or death due to COVID-19.

    Results: Among patients in SNAR, 0.5% with asthma, and 1.2% with COPD were identified with severe COVID-19. Among patients  < 18 years with asthma, only 0.02% were severely infected. Of hospitalized adults, 14% with asthma and 29% with COPD died. Further, of patients in SNAR, 56% with asthma and 81% with COPD were also registered in the NPR, while on death certificates the agreement was lower (asthma 24% and COPD 71%).

    Conclusion: The frequency of severe COVID-19 in asthma and COPD was relative low. Mortality for those hospitalized was double as high in COPD compared to asthma. Comorbid asthma and COPD were not always identified among patients with severe COVID-19.

  • 31.
    Nilsson, Ulf
    et al.
    Department of Public Health and Clinical Medicine, Section of Medicine, Umeå University, Umeå, Sweden.
    Mills, Nicholas
    BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom.
    Backman, Helena
    Department of Public Health and Clinical Medicine, Section of Medicine, Umeå University, Umeå, Sweden.
    Stridsman, Caroline
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Hedman, Linnea
    Department of Public Health and Clinical Medicine, The OLIN unit, Section of Sustainable Health, Umeå University, Umeå, Sweden.
    Rönmark, Eva
    Department of Public Health and Clinical Medicine, The OLIN unit, Section of Sustainable Health, Umeå University, Umeå, Sweden.
    Blomberg, Anders
    Department of Public Health and Clinical Medicine, Section of Medicine, Umeå University, Umeå, Sweden.
    Lindberg, Anne
    Department of Public Health and Clinical Medicine, Section of Medicine, Umeå University, Umeå, Sweden.
    Elevated cardiac troponin predicts 11-year mortality in COPD2020In: European Respiratory Journal, ISSN 0903-1936, E-ISSN 1399-3003, Vol. 56, no Suppl 64, article id 1439Article in journal (Other academic)
    Abstract [en]

    Background: Ischemic heart disease (IHD) is a common multimorbidity in individuals with COPD. High sensitive cardiac troponin I (hs-cTnI) has been shown to predict short-term mortality, but longer follow-ups has rarely been performed in population-cohorts.

    Aim: To evaluate the predictive value of elevated hs-cTnI on mortality among individuals with COPD compared with normal lung function (NLF).

    Methods: In 2002-04, subjects with FEV1/VC <0.70 (COPD, n=993) and age and sex-matched referents withoutCOPD were identified from OLIN’s population-based cohorts. In 2005, structured interviews, post-bronchodilator spirometry, blood sampling and ECG were performed in individuals with COPD (n=599) and NLF (n=756). Hs-cTnI was analysed in serum and concentrations ≥5 ng/L were defined as elevated. Mortality data were collected until 2016.

    Results: In 2005, the prevalence of reported IHD and elevated hs-cTnI was higher in COPD than NLF (16.2% vs 11.9% p=.02 and 31.1% vs 25.0% p=.01). The cumulative mortality was higher in COPD than NLF, both overall (36.5% vs 19.2% p<.001), and when restricting comparison to individuals with hs-cTnI≥5 (59.1% vs 34.9% p<.001). In a Cox-regression model adjusting for common confounders including reported IHD and ischemic ECG changes, hs-cTnI≥5 was associated with an increased risk for death in COPD (HR 1.41, 95%CI 1.03-1.93), but not in NLF (HR 0.84 95%CI 0.58-1.22). The increased risk remained after adjusting for FEV1% predicted.

    Conclusion: Elevated hs-cTnI was associated with increased mortality over a 11 -year follow-up among individuals with COPD, but not among those with NLF in this population-based study. The use of troponin could identify individuals with stable COPD at the highest risk of death.

  • 32.
    Nilsson, Ulf
    et al.
    Department of Public Health and Clinical Medicine, Section of Medicine, Umeå University Hospital, B41, 90185, Umeå, Sweden.
    Mills, Nicholas L.
    BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK. Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK.
    McAllister, David A.
    Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK.
    Backman, Helena
    Department of Public Health and Clinical Medicine, The OLIN unit, Section of Sustainable Health, Umeå University, Umeå, Sweden.
    Stridsman, Caroline
    Luleå University of Technology, Department of Health Sciences, Nursing and Medical technology.
    Hedman, Linnea
    Department of Public Health and Clinical Medicine, The OLIN unit, Section of Sustainable Health, Umeå University, Umeå, Sweden.
    Rönmark, Eva
    Department of Public Health and Clinical Medicine, The OLIN unit, Section of Sustainable Health, Umeå University, Umeå, Sweden.
    Fujisawa, Takeshi
    BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK.
    Blomberg, Anders
    Department of Public Health and Clinical Medicine, Section of Medicine, Umeå University Hospital, B41, 90185, Umeå, Sweden.
    Lindberg, Anne
    Department of Public Health and Clinical Medicine, Section of Medicine, Umeå University Hospital, B41, 90185, Umeå, Sweden.
    Cardiac biomarkers of prognostic importance in chronic obstructive pulmonary disease2020In: Respiratory Research, ISSN 1465-9921, E-ISSN 1465-993X, Vol. 21, article id 162Article in journal (Refereed)
    Abstract [en]

    Background

    Ischemic heart disease is common in COPD and associated with worse prognosis. This study aimed to investigate the presence and prognostic impact of biomarkers of myocardial injury and ischemia among individuals with COPD and normal lung function, respectively.

    Methods

    In 2002–04, all individuals with airway obstruction (FEV1/VC < 0.70, n = 993) were identified from population-based cohorts, together with age and sex-matched non-obstructive referents. At re-examination in 2005, spirometry, Minnesota-coded ECG and analyses of high-sensitivity cardiac troponin I (hs-cTnI) were performed in individuals with COPD (n = 601) and those with normal lung function (n = 755). Deaths were recorded until December 31st, 2010.

    Results

    Hs-cTnI concentrations were above the risk stratification threshold of ≥5 ng/L in 31.1 and 24.9% of those with COPD and normal lung function, respectively. Ischemic ECG abnormalities were present in 14.8 and 13.4%, while 7.7 and 6.6% had both elevated hs-cTnI concentrations and ischemic ECG abnormalities. The 5-year cumulative mortality was higher in those with COPD than those with normal lung function (13.6% vs. 7.7%, p < 0.001). Among individuals with COPD, elevated hs-cTnI both independently and in combination with ischemic ECG abnormalities were associated with an increased risk for death (adjusted hazard ratio [HR]; 95% confidence interval [CI] 2.72; 1.46–5.07 and 4.54; 2.25–9.13, respectively). Similar associations were observed also among individuals with COPD without reported ischemic heart disease.

    Conclusions

    In this study, elevated hs-cTnI concentrations in combination with myocardial ischemia on the electrocardiogram were associated with a more than four-fold increased risk for death in a population-based COPD-cohort, independent of disease severity.

  • 33.
    Raisanen, Petri
    et al.
    Dept of Public Health and Clinical Medicine, Division of Occupational and Environmental Medicine, the OLIN unit, Umea university, Umeå, Sweden.
    Backman, Helena
    Dept of Public Health and Clinical Medicine, Division of Occupational and Environmental Medicine, the OLIN unit, Umea university, Umeå, Sweden.
    Jansson, Sven-Arne
    Umea Univ, OLIN Unit, Div Occupat & Environm Med, Dept Publ Hlth & Clin Med, Umea, Sweden.
    Hedman, Linnea
    Dept of Public Health and Clinical Medicine, Division of Occupational and Environmental Medicine, the OLIN unit, Umea university, Umeå, Sweden.
    Stridsman, Caroline
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Lundbäck, Bo
    Krefting Research Centre, Institute of Medicine, University of Gothenburg , Gotenburg, Sweden.
    Lindberg, Anne
    Dept of Public Health and Clinical Medicine, Division of Medicine, Umeå university , Umeå, Sweden.
    Rönmark, Eva
    Dept of Public Health and Clinical Medicine, Division of Occupational and Environmental Medicine, the OLIN unit, Umea university , Umeå, Sweden.
    Male sex, younger age and smoking contribute to low participating rate in an epidemiological study of asthma and respiratory symptoms2018In: European Respiratory Journal, ISSN 0903-1936, E-ISSN 1399-3003, Vol. 52, no suppl 62, article id PA1159Article in journal (Other academic)
  • 34.
    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.

  • 35.
    Schyllert, Christian
    et al.
    Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
    Hedman, Linnea
    Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
    Stridsman, Caroline
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Ilmarinen, Pinja
    Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland.
    Piirilä, Päivi
    Clinical Physiology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
    Krokstad, Steinar
    Public Health and General Practice, Norwegian University of Science and Technology, Levanger, Norway.
    Lundbäck, Bo
    Krefting Research Centre, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.
    Lindberg, Anne
    Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
    Rönmark, Eva
    Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
    Backman, Helena
    Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
    Low income rather than low education is associated with respiratory symptoms in northern Sweden2019In: European Respiratory Journal, ISSN 0903-1936, E-ISSN 1399-3003, Vol. 54, no suppl 63, article id PA2779Article in journal (Other academic)
  • 36.
    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.

  • 37.
    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.

  • 38.
    Strandkvist, Viktor
    et al.
    Luleå University of Technology, Department of Health Sciences, Health and Rehabilitation. Department of Public Health and Clinical Medicine, The OLIN Unit, Division of Occupational and Environmental Medicine , Umea University.
    Andersson, Mikael
    Department of Neuroscience, Physiotherapy, Uppsala University , Uppsala.
    Backman, Helena
    Department of Public Health and Clinical Medicine, The OLIN Unit, Division of Occupational and Environmental Medicine , Umeå University , Umeå.
    Larsson, Agneta
    Luleå University of Technology, Department of Health Sciences, Health and Rehabilitation.
    Stridsman, Caroline
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Lindberg, Anne
    Department of Public Health and Clinical Medicine, Division of Medicine , Umeå University , Umeå.
    Hand grip strength is associated with fatigue among men with COPD: epidemiological data from northern Sweden2020In: Physiotherapy Theory and Practice, ISSN 0959-3985, E-ISSN 1532-5040, Vol. 36, no 3, p. 408-416Article in journal (Refereed)
    Abstract [en]

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

  • 39.
    Strandkvist, Viktor
    et al.
    Luleå University of Technology, Department of Health Sciences, Health and Rehabilitation. The OLIN-studies, The County Council of Norrbotten, Luleå, Sweden.
    Stridsman, Caroline
    Luleå University of Technology, Department of Health Sciences, Nursing Care. The OLIN-studies, The County Council of Norrbotten, Luleå, Sweden.
    Röding, Jenny
    Luleå University of Technology, Department of Health Sciences, Health and Rehabilitation.
    Lindberg, Anne
    The OLIN-studies, The County Council of Norrbotten, Luleå, Sweden. Department of Public Health and Clinical Medicine, Division of Medicine, Umeå University, Umeå, Sweden.
    Hand muscle strength in COPD: A population based study2013In: European Respiratory Journal, ISSN 0903-1936, E-ISSN 1399-3003, Vol. 42, no Suppl 57, article id P3446Article in journal (Refereed)
    Abstract [en]

    Background: Skeletal muscle dysfunction is a known systemic- or extra pulmonary effect in COPD. The relationship between the severity of the disease according to GOLD’s spirometric criteria and muscle dysfunction is however not clearly explored.

    Aim: To investigate hand grip strength (HGS) in subjects with COPD compared to subjects without airflow obstruction.

    Method: Lung function and HGS was measured according to validated methods in the years of 2009-2010 within the Obstructive Lung Disease in Northern Sweden (OLIN) COPD-study. HGS, was measured with a hand-held dynamometer (Jamar®) in kilogram-strength (kgf), which has been shown to correlate strongly with both upper- and lower extremity strength. The sample included 441 subjects with COPD according to GOLD criteria (FEV1/FVC<0.70) and 571 non-COPD subjects in the same ages.

    Results: Among men, HGS was lower in GOLD III-IV, mean=31.4 kgf, compared to GOLD II, mean=37.2 kgf (p=0.009), GOLD I, mean=36.9 kgf (p=0.024), and subjects without COPD, mean=37.6 kgf (p=0.024). Among women no such correlation was found. In the whole sample, HGS, did not differ significantly between subjects with and without COPD, or COPD stages according to GOLD. No correlation was found between percent predicted FEV1 but a strong and positive relationship was found between the crude value of FEV1 and HGS (pearson's r=0.67).

    Conclusion: Among men, GOLD III-IV was associated with a lower HGS, however not among women.

  • 40.
    Stridsman, Caroline
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Activity: Fatigue in COPD: A qualitative study of peoples experiences2012Conference paper (Other (popular science, discussion, etc.))
  • 41.
    Stridsman, Caroline
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Activity: Fatigue in COPD and the impact of heart disease comorbidity: a population based study2011Conference paper (Other (popular science, discussion, etc.))
  • 42.
    Stridsman, Caroline
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Activity: Fatigue vid KOL samt påverkan av luftvägssymtom och hjärtsjukdom: en rapport från OLIN-studierna2011Conference paper (Other (popular science, discussion, etc.))
  • 43.
    Stridsman, Caroline
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Aktivitet: Att leva med fatigue vid kroniskt obstruktiv lungsjukdom2011Conference paper (Other (popular science, discussion, etc.))
  • 44.
    Stridsman, Caroline
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Living with chronic obstructive pulmonary disease with focus on fatigue, health and well-being2013Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

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

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  • 45.
    Stridsman, Caroline
    et al.
    Luleå University of Technology, Department of Health Sciences, Nursing Care. Section of Medicine, The OLIN Unit, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
    Axelsson, Malin
    Department of Care Sciences, Faculty of Health and Society, Malmö University, Malmö, Sweden.
    Warm, Katja
    Section of Medicine, The OLIN Unit, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
    Backman, Helena
    Section of Sustainable Health, The OLIN Unit, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
    Uncontrolled asthma occurs in all GINA treatment steps and is associated with worse physical health: a report from the OLIN adult asthma cohort2021In: Journal of Asthma, ISSN 0277-0903, E-ISSN 1532-4303, Vol. 58, no 5, p. 586-595Article in journal (Refereed)
    Abstract [en]

    Objective: To study asthma exacerbations, healthcare utilization and health status among subjects with asthma with different treatment regimens and levels of asthma control.

    Methods: In 2012–2014, n = 1425 adults from a population-based asthma cohort within the OLIN studies (Obstructive Lung disease in Northern Sweden) were invited to a follow-up including spirometry and a structured interview, n = 1006 participated. Asthma Control Test (ACT) was used to detect uncontrolled asthma, and physical and mental dimensions of health were measured with SF-8. Pharmacological treatment use was classified by Global Initiative for Asthma treatment steps. Out of n = 830 with current asthma, n = 714 answered ACT (57% women, 32–92 years) and were included in the study.

    Results: Uncontrolled asthma increased per treatment step (no treatment 9.9%, treatment step 1–3 24.1%, and treatment steps 4–5 39.9%, p < 0.001). A higher proportion of subjects with uncontrolled asthma reported exacerbations, healthcare utilization, and worse health status than those with controlled asthma. The proportion of subjects reporting exacerbations, healthcare visits, emergency room visits and regular follow-up visits increased per treatment step. Worse health was associated with uncontrolled asthma, but not with the level of treatment. A higher proportion of women than men reported exacerbations, any healthcare visits, and lower health. Regular follow-up visits to a physician were uncommon (women 21.2% vs. men 14.6%, p = 0.022).

    Conclusions: Uncontrolled asthma is common in all treatment steps, and is associated with worse health status. However, health status did not differ by treatment steps. Identifying subjects with uncontrolled asthma regardless of treatment regimens should be a priority, thus follow-up visits are important.

  • 46.
    Stridsman, Caroline
    et al.
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Backman, Helena
    Umeå University, Department of Public Health and Clinical Medicine, The OLIN-unit, Umeå, Sweden.
    Eklund, Britt-Marie
    The OLIN-studies, Luleå, Sweden.
    Hedman, Linnea
    Umeå University, Department of Public Health and Clinical Medicine, The OLIN-unit, Umeå, Sweden.
    Rönmark, Eva
    Umeå University, Department of Public Health and Clinical Medicine, The OLIN-unit, Umeå, Sweden.
    Health status among adult asthmatics - a population-based study2018In: European Respiratory Journal, ISSN 0903-1936, E-ISSN 1399-3003, Vol. 52, no suppl 62, article id PA2072Article in journal (Other academic)
  • 47.
    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.

  • 48.
    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.

  • 49.
    Stridsman, Caroline
    et al.
    Luleå University of Technology, Department of Health Sciences.
    Lindberg, Anne
    OLIN studies, Sunderby Hospital.
    Skär, Lisa
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Fatigue in chronic obstructive pulmonary disease: a qualitative study of peoples experiences2014In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 28, no 1, p. 130-138Article in journal (Refereed)
    Abstract [en]

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

  • 50.
    Stridsman, Caroline
    et al.
    Luleå University of Technology, Department of Health Sciences.
    Mullerova, Hana
    WorldWide Epidemiology, GlaxoSmithKline R&D.
    Skär, Lisa
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Lindberg, Anne
    OLIN studies, Norrbotten County Council.
    Fatigue in COPD and the impact of heart disease comorbidity: a population-based study2011Conference paper (Other academic)
    Abstract [en]

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

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