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Ställberg, Björn, DocentORCID iD iconorcid.org/0000-0001-8497-7326
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Publications (10 of 125) Show all publications
Ellingsen, J., Johansson, G., Larsson, K., Lisspers, K., Malinovschi, A., Ställberg, B., . . . Jansson, C. (2020). Impact of Comorbidities and Commonly Used Drugs on Mortality in COPD - Real-World Data from a Primary Care Setting. The International Journal of Chronic Obstructive Pulmonary Disease, 15, 235-245
Open this publication in new window or tab >>Impact of Comorbidities and Commonly Used Drugs on Mortality in COPD - Real-World Data from a Primary Care Setting
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2020 (English)In: The International Journal of Chronic Obstructive Pulmonary Disease, ISSN 1176-9106, E-ISSN 1178-2005, Vol. 15, p. 235-245Article in journal (Refereed) Published
Abstract [en]

Background: Life expectancy is significantly shorter for patients with chronic obstructive pulmonary disease (COPD) than the general population. Concurrent diseases are known to infer an increased mortality risk in those with COPD, but the effects of pharmacological treatments on survival are less established. This study aimed to examine any associations between commonly used drugs, comorbidities and mortality in Swedish real-world primary care COPD patients.

Methods: Patients with physician-diagnosed COPD from a large primary care population were observed retrospectively, utilizing primary care records and mandatory Swedish national registers. The time to all-cause death was assessed in a stepwise multiple Cox proportional hazards regression model including demography, socioeconomic factors, exacerbations, comorbidities and medication.

Results: During the observation period (1999-2009) 5776 (32.5%) of 17,745 included COPD patients died. Heart failure (hazard ratio [HR]: 1.88, 95% confidence interval [CI]: 1.74-2.04), stroke (HR: 1.52, 95% CI: 1.40-1.64) and myocardial infarction (HR: 1.40, 95% CI: 1.24-1.58) were associated with an increased risk of death. Use of inhaled corticosteroids (ICS; HR: 0.79, 95% CI: 0.66-0.94), beta-blockers (HR: 0.86, 95% CI: 0.76-0.97) and acetylsalicylic acid (ASA; HR: 0.87, 95% CI: 0.77-0.98) was dose-dependently associated with a decreased risk of death, whereas use of long-acting muscarinic antagonists (LAMA; HR: 1.33, 95% CI: 1.14-1.55) and N-acetylcysteine (NAC; HR: 1.26, 95% CI: 1.08-1.48) were dose-dependently associated with an increased risk of death in COPD patients.

Conclusion: This large, retrospective, observational study of Swedish real-world primary care COPD patients indicates that coexisting heart failure, stroke and myocardial infarction were the strongest predictors of death, underscoring the importance of timely recognition and treatment of comorbidities. A decreased risk of death associated with the use of ICS, beta-blockers and ASA, and an increased risk associated with the use of LAMA and NAC, was also found.

Place, publisher, year, edition, pages
DOVE MEDICAL PRESS LTD, 2020
Keywords
observational, LAMA, inhaled corticosteroids, beta-blockers, acetylsalicylic acid, chronic obstructive pulmonary disease
National Category
Respiratory Medicine and Allergy
Identifiers
urn:nbn:se:uu:diva-407514 (URN)10.2147/COPD.S231296 (DOI)000515171300001 ()32099348 (PubMedID)
Funder
AstraZeneca
Available from: 2020-03-25 Created: 2020-03-25 Last updated: 2020-03-25Bibliographically approved
Zakrisson, A.-B., Arne, M., Hasselgren, M., Lisspers, K., Ställberg, B. & Theander, K. (2019). A complex intervention of self-management for patients with COPD or CHF in primary care improved performance and satisfaction with regard to own selected activities; A longitudinal follow-up. Journal of Advanced Nursing, 75(1), 175-186
Open this publication in new window or tab >>A complex intervention of self-management for patients with COPD or CHF in primary care improved performance and satisfaction with regard to own selected activities; A longitudinal follow-up
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2019 (English)In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 75, no 1, p. 175-186Article in journal (Refereed) Published
Abstract [en]

Aim: To test a self-management intervention in primary health care (PHC) for patients with chronic obstructive pulmonary disease (COPD) or chronic heart failure (CHF) on self-efficacy, symptoms, functioning, and health.

Background: Patients with COPD or CHF experience often the same symptoms such as shortness of breath, cough, lack of energy, dry mouth, numbness or tingling in hands and feet, pain and sleeping problems.

Design: A multicentre randomized control trial.

Method: The trial was conducted with one intervention group (N = 73) and one control group (N = 77). The trial was performed from September 2013-September 2015 at nine PHC centres in three county councils in Sweden. At baseline patients with COPD and CHF experienced any symptom. Follow-ups were performed after 3 months and 1 year. The intervention was structured on Bandura's theory of self-efficacy in six meetings and individual action plans based on personal problems were performed and discussed.

Results: At baseline, there were no differences between the groups except for SF-36 social function. After 3 months, the intervention group improved performance and satisfaction with regard to own selected activities, otherwise no differences were found. Conclusion When designing a program, the patient's own difficulties must be taken into consideration if person-centred care is to be established. It is feasible to include both patients with COPD and CHF in the same group in PHC. Healthcare professionals need supervision in pedagogics during intervention in self-management.

Place, publisher, year, edition, pages
WILEY, 2019
Keywords
chronic heart failure, chronic obstructive pulmonary disease, nurses, patient education, primary health care, self-management support
National Category
Nursing
Identifiers
urn:nbn:se:uu:diva-373316 (URN)10.1111/jan.13899 (DOI)000453873300019 ()30375028 (PubMedID)
Available from: 2019-01-16 Created: 2019-01-16 Last updated: 2019-01-16Bibliographically approved
Sulku, J., Jansson, C., Melhus, H., Malinovschi, A., Ställberg, B., Bröms, K., . . . Nielsen, E. I. (2019). A Cross-Sectional Study Assessing Appropriateness Of Inhaled Corticosteroid Treatment In Primary And Secondary Care Patients With COPD In Sweden. The International Journal of Chronic Obstructive Pulmonary Disease, 14, 2451-2460
Open this publication in new window or tab >>A Cross-Sectional Study Assessing Appropriateness Of Inhaled Corticosteroid Treatment In Primary And Secondary Care Patients With COPD In Sweden
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2019 (English)In: The International Journal of Chronic Obstructive Pulmonary Disease, ISSN 1176-9106, E-ISSN 1178-2005, Vol. 14, p. 2451-2460Article in journal (Refereed) Published
Abstract [en]

Purpose: Inhaled corticosteroids (ICS) are often more widely prescribed in the treatment of chronic obstructive pulmonary disease (COPD) than what is recommended in the guidelines. The aim of this study was to evaluate the appropriateness of ICS treatment in COPD patients using the algorithm proposed by the International Primary Care Respiratory Group (IPCRG) and to identify factors associated with ICS treatment.

Patients and methods: Appropriateness of ICS therapy was studied with respect to concomitant asthma, history of exacerbations and blood eosinophils (B-Eos) in a Swedish cohort of primary and secondary care patients with COPD. Factors associated with ICS were investigated using multivariable logistic regression.

Results: Triple treatment was found to be the most common treatment combination, used by 46% of the 561 included patients, and in total 63% were using ICS. When applying the IPCRG algorithm, there was a possible indication for discontinuation of ICS in 55% of the patients with ICS treatment. Of the patients not using ICS, 18% had an indication for starting such treatment. The strongest factors associated with ICS therapy were frequent exacerbations (aOR 8.61, 95% CI 4.06, 20.67), secondary care contacts (aOR 6.99, 95% CI 2.48, 25.28) and very severe airflow limitation (aOR 5.91, 95% CI 1.53, 26.58).

Conclusion: More than half of the COPD patients on ICS met the criteria where withdrawal of the treatment could be tried. There was, however, also a subgroup of patients not using ICS for whom there was an indication for starting ICS treatment. Patients using ICS were characterized by more frequent exacerbations and lower lung function.

Place, publisher, year, edition, pages
DOVE MEDICAL PRESS LTD, 2019
Keywords
ICS, pharmacological management, inappropriate therapy, chronic obstructive pulmonary disease, IPCRG
National Category
Respiratory Medicine and Allergy
Identifiers
urn:nbn:se:uu:diva-397585 (URN)10.2147/COPD.S218747 (DOI)000494042200001 ()
Funder
Swedish Heart Lung Foundation
Available from: 2019-11-25 Created: 2019-11-25 Last updated: 2019-11-25Bibliographically approved
Kritikos, V., Price, D., Papi, A., Infantino, A., Ställberg, B., Ryan, D., . . . Bosnic-Anticevich, S. (2019). A multinational observational study identifying primary care patients at risk of overestimation of asthma control. NPD Bulletin, 29, Article ID 43.
Open this publication in new window or tab >>A multinational observational study identifying primary care patients at risk of overestimation of asthma control
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2019 (English)In: NPD Bulletin, ISSN 1892-8110, E-ISSN 2055-1010, Vol. 29, article id 43Article in journal (Refereed) Published
Abstract [en]

Factors related to the discrepancy between patient-perceived and actual disease control remain unclear. Identifying patients at risk of overestimation of asthma control remains elusive. This study aimed to (i) investigate the relationship between patient-reported and actual level of asthma control (ii), compare the characteristics between patients who believe their asthma is well controlled that accurately report 'well-controlled' asthma with those that do not, and (iii) identify factors associated with inaccurately reported 'well-controlled' asthma. A historical, multinational, cross-sectional study using data from the iHARP (initiative Helping Asthma in Real-life Patients) review service for adults with asthma prescribed fixed-dose combination therapy. Data from 4274 patients were analysed. A major discrepancy between patient-reported and Global Initiative for Asthma defined asthma control was detected; 71.1% of patients who reported 'well-controlled' asthma were inaccurate in their perception despite receiving regular maintenance therapy. Significant differences were noted in age, gender, body mass index, education level, medication use, side effects, attitudes to preventer inhaler use, inhaler technique review and respiratory specialist review between patients who accurately reported 'wellcontrolled' asthma and those who did not. Independent risk factors associated with inaccurately reported 'well-controlled' asthma were: having taken a maximum of 5-12 puffs or more of reliever inhaler on at least one day within the previous 4 weeks; being female; having seen a respiratory specialist more than a year ago (rather than in the previous year); and having required oral corticosteroids for worsening asthma in the previous year. The study highlighted the significant hidden burden associated with under-recognition of poor asthma control, on the part of the patient and the need for targeted interventions designed to address the continuing discrepancy between perceived and actual disease control.

Place, publisher, year, edition, pages
NATURE PUBLISHING GROUP, 2019
National Category
Respiratory Medicine and Allergy
Identifiers
urn:nbn:se:uu:diva-401183 (URN)10.1038/s41533-019-0156-4 (DOI)000502995200001 ()31804501 (PubMedID)
Available from: 2020-01-07 Created: 2020-01-07 Last updated: 2020-01-07Bibliographically approved
Sandelowsky, H., Krakau, I., Modin, S., Ställberg, B. & Nager, A. (2019). COPD patients need more information about self-management: a cross-sectional study in Swedish primary care. Scandinavian Journal of Primary Health Care, 37(4), 459-467
Open this publication in new window or tab >>COPD patients need more information about self-management: a cross-sectional study in Swedish primary care
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2019 (English)In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 37, no 4, p. 459-467Article in journal (Refereed) Published
Abstract [en]

Objective: In Sweden, patients with chronic conditions, such as chronic obstructive pulmonary disease (COPD), often receive education at specialized nurse-led clinics at primary health care centers (PHCCs). Identifying patients' needs for information about COPD is the key to individualized care. This study aimed to assess self-reported needs for information about COPD in primary care patients with either moderate (GOLD 2) or severe (GOLD 3) COPD and identify patient characteristics and exacerbation patterns associated with the findings.

Design: A cross-sectional study.

Setting: Twenty-four PHCCs in Stockholm, Sweden.

Subjects: Randomly selected primary care patients with COPD in GOLD stages 2 and 3 (n = 542).

Main outcome measures: The Lung Information Needs Questionnaire (LINQ) was used to assess perceived information needs. Spirometry results and descriptive, self-reported data on patient factors such as exacerbation history, treatment, smoking, weight/height, comorbidities, health care contacts, education and symptoms were collected.

Results: Overall, the greatest reported needs were for information about self-management and diet. GOLD 2 patients (68%) expressed greater needs for information than GOLD 3 patients (32%). We found significant associations between high information needs and patient-related factors such as 'No assigned GP' (OR = 4.32 [95% CI 2.65-7.05]) and 'No contact with COPD nurse in the past 12 months' (OR = 1.83 [95% CI 1.19-2.81]).

Conclusion: COPD patients felt they knew too little about self-management of their disease. Low information needs were strongly associated with continuity in patient-GP consultations and moderately associated with contact with a COPD nurse. These associations were strongest in patients with moderate COPD.

Place, publisher, year, edition, pages
Taylor & Francis Group, 2019
Keywords
Primary care, COPD, self-management, disease information needs, patient education, general practitioners, cluster randomized controlled trial
National Category
Respiratory Medicine and Allergy Health Care Service and Management, Health Policy and Services and Health Economy Nursing
Identifiers
urn:nbn:se:uu:diva-397797 (URN)10.1080/02813432.2019.1684015 (DOI)000494905800001 ()31694439 (PubMedID)
Funder
Stockholm County Council, LS 1110-1339Stockholm County Council, LS 1301-0078Stockholm County Council, LS 1411-1373AstraZeneca
Available from: 2019-11-27 Created: 2019-11-27 Last updated: 2020-02-20Bibliographically approved
Högman, M., Thornadtsson, A., Bröms, K., Jansson, C., Lisspers, K., Ställberg, B., . . . Malinovschi, A. (2019). Different Relationships between FENO and COPD Characteristics in Smokers and Ex-Smokers. COPD: Journal of Chronic Obstructive Pulmonary Disease, 16(3-4), 227-233
Open this publication in new window or tab >>Different Relationships between FENO and COPD Characteristics in Smokers and Ex-Smokers
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2019 (English)In: COPD: Journal of Chronic Obstructive Pulmonary Disease, ISSN 1541-2555, E-ISSN 1541-2563, Vol. 16, no 3-4, p. 227-233Article in journal (Refereed) Published
Abstract [en]

Exhaled nitric oxide (FENO) is a marker of type-2 inflammation in asthma and is used in its management. However, smokers and ex-smokers have lower FENO values, and the clinical use of FENO values in COPD patients is unclear. Therefore, we investigated if FENO had a relationship to different COPD characteristics in smoking and ex-smoking subjects. Patients with COPD (n = 533, 58% females) were investigated while in stable condition. Measurements of FENO50, blood cell counts, IgE sensitisation and lung function were performed. Medication reconciliation was used to establish medication usage. Smokers (n = 150) had lower FENO50 9 (8, 10) ppb (geometric mean, 95% confidence interval) than ex-smokers did (n = 383) 15 (14, 16) ppb, p < 0.001. FENO50 was not associated with blood eosinophil or neutrophil levels in smokers, but in ex-smokers significant associations were found (r = 0.23, p < 0.001) and (r = -0.18, p = 0.001), respectively. Lower FENO values were associated with lower FEV1% predicted in both smokers (r = 0.17, p = 0.040) and ex-smokers (r = 0.20, p < 0.001). Neither the smokers nor ex-smokers with reported asthma or IgE sensitisation were linked to an increase in FENO50. Ex-smokers treated with inhaled corticosteroids (ICS) had lower FENO50 14 (13, 15) ppb than non-treated ex-smokers 17 (15, 19) ppb, p = 0.024. This was not found in smokers (p = 0.325). FENO is associated with eosinophil inflammation and the use of ICS in ex-smoking COPD subjects, but not in smoking subjects suggesting that the value of FENO as an inflammatory marker is more limited in smoking subjects. The association found between low FENO values and low lung function requires further investigation.

Place, publisher, year, edition, pages
Taylor & Francis Group, 2019
Keywords
Exhaled NO, asthma and COPD, inflammatory mediators, lung function
National Category
Respiratory Medicine and Allergy
Identifiers
urn:nbn:se:uu:diva-398705 (URN)10.1080/15412555.2019.1638355 (DOI)000479665900001 ()31357875 (PubMedID)
Funder
Swedish Heart Lung FoundationSwedish Heart Lung Foundation
Available from: 2019-12-12 Created: 2019-12-12 Last updated: 2019-12-12Bibliographically approved
Lindh, A., Theander, K., Arne, M., Lisspers, K., Lundh, L., Sandelowsky, H., . . . Zakrisson, A.-B. (2019). Errors in inhaler use related to devices and to inhalation technique among patients with chronic obstructive pulmonary disease in primary health care.. Nursing open, 6(4), 1519-1527
Open this publication in new window or tab >>Errors in inhaler use related to devices and to inhalation technique among patients with chronic obstructive pulmonary disease in primary health care.
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2019 (English)In: Nursing open, ISSN 2054-1058, Vol. 6, no 4, p. 1519-1527Article in journal (Refereed) Published
Abstract [en]

Aim: The aim of this study was to describe inhaler use in primary health care patients with chronic obstructive pulmonary disease (COPD) and to categorize these patients into those making errors related to devices, those making errors related to inhalation technique and those making errors related to both.

Design: Observational study.

Methods: COPD nurses used a checklist to assess the use of inhalers by patients with spirometry-verified COPD (N = 183) from primary healthcare centres. The STROBE checklist has been used.

Results: The mean age of the patients was 71 (SD 9) years. Almost half of them (45%) made at least one error; of these, 50% made errors related to devices, 31% made errors related to inhalation technique and 19% made errors related both to devices and to inhalation technique.

Keywords
administration, chronic obstructive, dry powder inhalers, inhalation, inhaler technique, metered‐dose inhalers, patient education, pulmonary disease
National Category
Respiratory Medicine and Allergy
Identifiers
urn:nbn:se:uu:diva-400328 (URN)10.1002/nop2.357 (DOI)31660180 (PubMedID)
Available from: 2019-12-19 Created: 2019-12-19 Last updated: 2020-02-06Bibliographically approved
Lisspers, K., Larsson, K., Janson, C., Ställberg, B., Tsiligianni, I., Gutzwiller, F. S., . . . Johansson, G. (2019). Gender differences among Swedish COPD patients: results from the ARCTIC, a real-world retrospective cohort study. npj Primary Care Respiratory Medicine, 29, Article ID 45.
Open this publication in new window or tab >>Gender differences among Swedish COPD patients: results from the ARCTIC, a real-world retrospective cohort study
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2019 (English)In: npj Primary Care Respiratory Medicine, E-ISSN 2055-1010, Vol. 29, article id 45Article in journal (Refereed) Published
Abstract [en]

The present study aimed to generate real-world evidence regarding gender differences among chronic obstructive pulmonary disease (COPD) patients, especially as regards the diagnosis and outcomes in order to identify areas for improvement and management and optimize the associated healthcare resource allocation. ARCTIC is a large, real-world, retrospective cohort study conducted in Swedish COPD patients and a matched reference population from 52 primary care centers in 2000-2014. The incidence of COPD, prevalence of asthma and other comorbidities, risk of exacerbations, mortality rate, COPD drug prescriptions, and healthcare resource utilization were analyzed. In total, 17,479 patients with COPD were included in the study. During the study period, COPD was more frequent among women (53.8%) and women with COPD experienced more exacerbations vs. men (6.66 vs. 4.66). However, the overall mortality rate was higher in men compared with women (45% vs. 38%), but no difference for mortality due to COPD was seen between genders over the study period. Women seemed to have a greater susceptibility to asthma, fractures, osteoporosis, rheumatoid arthritis, rhinitis, depression, and anxiety, but appeared less likely to have diabetes, kidney diseases, and cardiovascular diseases. Furthermore, women had a greater risk of COPD-related hospitalization and were likely to receive a significantly higher number of COPD drug prescriptions compared with men. These results support the need to reduce disease burden among women with COPD and highlight the role of healthcare professionals in primary care who should consider all these parameters in order to properly diagnose and treat women with COPD.

National Category
Respiratory Medicine and Allergy
Identifiers
urn:nbn:se:uu:diva-400331 (URN)10.1038/s41533-019-0157-3 (DOI)000502995600001 ()31822681 (PubMedID)
Available from: 2019-12-19 Created: 2019-12-19 Last updated: 2020-02-25Bibliographically approved
Högman, M., Thornadtsson, A., Bröms, K., Janson, C., Lisspers, K., Ställberg, B., . . . Malinovschi, A. (2019). Higher alveolar nitric oxide in COPD is related to poorer physical capacity and lower oxygen saturation after physical testing [Letter to the editor]. European Respiratory Journal, 54(2), Article ID 1900263.
Open this publication in new window or tab >>Higher alveolar nitric oxide in COPD is related to poorer physical capacity and lower oxygen saturation after physical testing
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2019 (English)In: European Respiratory Journal, ISSN 0903-1936, E-ISSN 1399-3003, Vol. 54, no 2, article id 1900263Article in journal, Letter (Refereed) Published
Place, publisher, year, edition, pages
EUROPEAN RESPIRATORY SOC JOURNALS LTD, 2019
National Category
Respiratory Medicine and Allergy
Identifiers
urn:nbn:se:uu:diva-394148 (URN)10.1183/13993003.00263-2019 (DOI)000482752200012 ()31073082 (PubMedID)
Available from: 2019-10-04 Created: 2019-10-04 Last updated: 2019-10-04Bibliographically approved
Larsson, K., Janson, C., Ställberg, B., Lisspers, K., Olsson, P., Kostikas, K., . . . Johansson, G. (2019). Impact of COPD diagnosis timing on clinical and economic outcomes: the ARCTIC observational cohort study. The International Journal of Chronic Obstructive Pulmonary Disease, 14, 995-1008
Open this publication in new window or tab >>Impact of COPD diagnosis timing on clinical and economic outcomes: the ARCTIC observational cohort study
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2019 (English)In: The International Journal of Chronic Obstructive Pulmonary Disease, ISSN 1176-9106, E-ISSN 1178-2005, Vol. 14, p. 995-1008Article in journal (Refereed) Published
Abstract [en]

Purpose: Assess the clinical and economic consequences associated with an early versus late diagnosis in patients with COPD.

Patients and methods: In a retrospective, observational cohort study, electronic medical record data (2000-2014) were collected from Swedish primary care patients with COPD. COPD indicators (pneumonia, other respiratory diseases, oral corticosteroids, antibiotics for respiratory infections, prescribed drugs for respiratory symptoms, lung function measurement) registered prior to diagnosis were applied to categorize patients into those receiving early (2 or less indicators) or late diagnosis (3 or more indicators registered >90 days preceding a COPD diagnosis). Outcome measures included annual rate of and time to first exacerbation, mortality risk, prevalence of comorbidities and health care utilization.

Results: More patients with late diagnosis (n=8827) than with early diagnosis (n=3870) had a recent comorbid diagnosis of asthma (22.0% vs 3.9%; P<0.0001). Compared with early diagnosis, patients with late diagnosis had a higher exacerbation rate (hazard ratio [HR] 1.89, 95% confidence interval [CI]: 1.83-1.96; P<0.0001) and shorter time to first exacerbation (HR 1.61, 95% CI: 1.54-1.69; P<0.0001). Mortality was not different between groups overall but higher for late versus early diagnosis, after excluding patients with past asthma diagnosis (HR 1.10, 95% CI: 1.02-1.18; P=0.0095). Late diagnosis was also associated with higher direct costs than early diagnosis.

Conclusion: Late COPD diagnosis is associated with higher exacerbation rate and increased comorbidities and costs compared with early diagnosis. The study highlights the need for accurate diagnosis of COPD in primary care in order to reduce exacerbations and the economic burden of COPD.

Keywords
chronic obstructive pulmonary disease, diagnosis, Sweden, exacerbations, mortality
National Category
Respiratory Medicine and Allergy
Identifiers
urn:nbn:se:uu:diva-384473 (URN)10.2147/COPD.S195382 (DOI)000468106900001 ()
Available from: 2019-06-11 Created: 2019-06-11 Last updated: 2019-06-11Bibliographically approved
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