uu.seUppsala University Publications
Change search
Link to record
Permanent link

Direct link
BETA
Bornefalk Hermansson, Anna
Alternative names
Publications (10 of 26) Show all publications
Ekström, M., Ahmadi, Z., Bornefalk Hermansson, A. & Currow, D. (2017). Oxygen For Breathlessness In Patients With COPD Who Do Not Qualify For Home Oxygen Therapy: An Updated Cochrane Analysis. Paper presented at International Conference of the American-Thoracic-Society (ATS), MAY 19-24, 2017, Washington, AFGHANISTAN. American Journal of Respiratory and Critical Care Medicine, 195, Article ID A5450.
Open this publication in new window or tab >>Oxygen For Breathlessness In Patients With COPD Who Do Not Qualify For Home Oxygen Therapy: An Updated Cochrane Analysis
2017 (English)In: American Journal of Respiratory and Critical Care Medicine, ISSN 1073-449X, E-ISSN 1535-4970, Vol. 195, article id A5450Article in journal, Meeting abstract (Other academic) Published
National Category
Respiratory Medicine and Allergy
Identifiers
urn:nbn:se:uu:diva-332905 (URN)000400372505252 ()
Conference
International Conference of the American-Thoracic-Society (ATS), MAY 19-24, 2017, Washington, AFGHANISTAN
Available from: 2017-11-06 Created: 2017-11-06 Last updated: 2017-11-06Bibliographically approved
Ekström, M. & Bornefalk-Hermansson, A. (2016). Cardiovascular and antacid treatment and mortality in oxygen-dependent pulmonary fibrosis: A population-based longitudinal study. Respirology (Carlton South. Print), 21(4), 705-711
Open this publication in new window or tab >>Cardiovascular and antacid treatment and mortality in oxygen-dependent pulmonary fibrosis: A population-based longitudinal study
2016 (English)In: Respirology (Carlton South. Print), ISSN 1323-7799, E-ISSN 1440-1843, Vol. 21, no 4, p. 705-711Article in journal (Refereed) Published
Abstract [en]

BACKGROUND AND OBJECTIVE: Severe idiopathic pulmonary fibrosis is associated with an increased risk of cardiovascular disease and gastro-oesophageal reflux, which may influence prognosis. We evaluated associations between cardiovascular and antacid medications, and mortality, in oxygen-dependent pulmonary fibrosis (PF) of unknown cause.

METHODS: Prospective population-based study of adults starting long-term oxygen therapy (LTOT) for PF in Sweden 2005-2009. PF of unknown cause was defined by excluding patients with known or probable secondary PF. Time-dependent associations between medications and all-cause mortality were analysed using extended Cox regression, adjusting for potential confounders including age, sex, vital capacity, blood gases, body mass index, performance status, comorbidity and concurrent medications.

RESULTS: Of 462 included patients, 329 (71%) died under observation. No patient was lost to follow-up. Angiotensin-converting enzyme inhibitors or angiotensin receptor blockers (ACEI/ARB) were associated with reduced adjusted mortality (HR 0.63; 0.47-0.85) and antiplatelet drugs with increased mortality (HR 1.49; 1.11-2.00), largely driven by higher mortality in women. There were no associations with mortality for antacid treatments, β-blockers, diuretics or statins.

CONCLUSION: In oxygen-dependent PF, treatment with ACEI/ARB was associated with improved survival, antiplatelet drugs with decreased survival, whereas there was no association between antacid, β-blocker, diuretic or statin treatment and survival.

Keywords
cardiovascular disease; clinical epidemiology; clinical respiratory medicine; interstitial lung disease; lung fibrosis
National Category
Respiratory Medicine and Allergy
Identifiers
urn:nbn:se:uu:diva-282869 (URN)10.1111/resp.12781 (DOI)000374688900018 ()27009834 (PubMedID)
Available from: 2016-04-07 Created: 2016-04-07 Last updated: 2017-11-30Bibliographically approved
Ahmadi, Z., Sundh, J., Bornefalk Hermansson, A. & Ekström, M. (2016). Does Long-Term Oxygen Therapy 24 H/day Improve Survival Compared To 15 H/day In Hypoxemic Chronic Obstructive Pulmonary Disease?. Paper presented at International Conference of the American-Thoracic-Society (ATS), MAY 13-18, 2016, San Francisco, CA. American Journal of Respiratory and Critical Care Medicine, 193
Open this publication in new window or tab >>Does Long-Term Oxygen Therapy 24 H/day Improve Survival Compared To 15 H/day In Hypoxemic Chronic Obstructive Pulmonary Disease?
2016 (English)In: American Journal of Respiratory and Critical Care Medicine, ISSN 1073-449X, E-ISSN 1535-4970, Vol. 193Article in journal (Refereed) Published
National Category
Respiratory Medicine and Allergy
Identifiers
urn:nbn:se:uu:diva-315138 (URN)000390749606650 ()
Conference
International Conference of the American-Thoracic-Society (ATS), MAY 13-18, 2016, San Francisco, CA
Available from: 2017-02-09 Created: 2017-02-09 Last updated: 2017-11-29Bibliographically approved
Ekström, M., Ahmadi, Z., Bornefalk Hermansson, A., Abernethy, A. & Currow, D. (2016). Oxygen for breathlessness in patients with chronic obstructive pulmonary disease who do not qualify for home oxygen therapy. Cochrane Database of Systematic Reviews (11), Article ID CD006429.
Open this publication in new window or tab >>Oxygen for breathlessness in patients with chronic obstructive pulmonary disease who do not qualify for home oxygen therapy
Show others...
2016 (English)In: Cochrane Database of Systematic Reviews, ISSN 1469-493X, E-ISSN 1469-493X, no 11, article id CD006429Article, review/survey (Refereed) Published
Abstract [en]

Background: Breathlessness is a cardinal symptom of chronic obstructive pulmonary disease (COPD). Long-term oxygen therapy (LTOT) is given to improve survival time in people with COPD and severe chronic hypoxaemia at rest. The efficacy of oxygen therapy for breathlessness and health-related quality of life (HRQOL) in people with COPD and mild or no hypoxaemia who do not meet the criteria for LTOT has not been established. Objectives: To determine the efficacy of oxygen versus air in mildly hypoxaemic or non-hypoxaemic patients with COPD in terms of (1) breathlessness; (2) HRQOL; (3) patient preference whether to continue therapy; and (4) oxygen-related adverse events. Search methods: We searched the Cochrane Airways Group Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and Embase, to 12 July 2016, for randomised controlled trials (RCTs). We handsearched the reference lists of included articles. Selection criteria: We included RCTs of the effects of non-invasive oxygen versus air on breathlessness, HRQOL or patient preference to continue therapy among people with COPD and mild or no hypoxaemia (partial pressure of oxygen (PaO2) >7.3 kPa) who were not already receiving LTOT. Two review authors independently assessed articles for inclusion in the review. Data collection and analysis: Two review authors independently collected and analysed data. We assessed risk of bias by using the Cochrane 'Risk of bias tool'. We pooled effects recorded on different scales as standardised mean differences (SMDs) with 95% confidence intervals (CIs) using random-effects models. Lower SMDs indicated decreased breathlessness and reduced HRQOL. We performed subanalyses and sensitivity analyses and assessed the quality of evidence according to the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach. Main results: Compared with the previous review, which was published in 2011, we included 14 additional studies (493 participants), excluded one study and included data for meta-analysis of HRQOL. In total, we included in this review 44 studies including 1195 participants, and we included 33 of these (901 participants) in the meta-analysis. We found that breathlessness during exercise or daily activities was reduced by oxygen compared with air (32 studies; 865 participants; SMD -0.34, 95% CI -0.48 to -0.21; I-2 = 37%; low-quality evidence). This translates to a decrease in breathlessness of about 0.7 points on a 0 to 10 numerical rating scale. In contrast, we found no effect of short-burst oxygen given before exercise (four studies; 90 participants; SMD 0.01, 95% CI -0.26 to 0.28; I-2 = 0%; low-quality evidence). Oxygen reduced breathlessness measured during exercise tests (25 studies; 442 participants; SMD-0.34, 95% CI -0.46 to -0.22; I-2 = 29%; moderate-quality evidence), whereas evidence of an effect on breathlessness measured in daily life was limited (two studies; 274 participants; SMD -0.13, 95% CI, -0.37 to 0.11; I-2 = 0%; low-quality evidence). Oxygen did not clearly affectHRQOL (five studies; 267 participants; SMD 0.10, 95% CI -0.06 to 0.26; I-2 = 0%; low-quality evidence). Patient preference and adverse events could not be analysed owing to insufficient data. Authors' conclusions: We are moderately confident that oxygen can relieve breathlessness when given during exercise to mildly hypoxaemic and non-hypoxaemic people with chronic obstructive pulmonary disease who would not otherwise qualify for home oxygen therapy. Most evidence pertains to acute effects during exercise tests, and no evidence indicates that oxygen decreases breathlessness in the daily life setting. Findings show that oxygen does not affect health-related quality of life.

Keywords
Dyspnea [etiology, therapy], Home Care Services, Oxygen Inhalation Therapy [methods], Pulmonary Disease, Chronic Obstructive [complications, Randomized Controlled Trials as Topic, Humans
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-314311 (URN)10.1002/14651858.CD006429.pub3 (DOI)000389600100025 ()
Funder
Swedish Heart Lung FoundationSwedish Society of Medicine
Available from: 2017-02-01 Created: 2017-02-01 Last updated: 2017-11-29Bibliographically approved
Ekström, M., Bornefalk-Hermansson, A., Abernethy, A. & Currow, D. (2015). Low-dose opioids should be considered for symptom relief also in advanced chronic obstructive pulmonary disease (COPD) [Letter to the editor]. Evidence-Based Medicine, 20(1), 39, Article ID 10.1136/ebmed-2014-110130.
Open this publication in new window or tab >>Low-dose opioids should be considered for symptom relief also in advanced chronic obstructive pulmonary disease (COPD)
2015 (English)In: Evidence-Based Medicine, ISSN 1356-5524, E-ISSN 1473-6810, ISSN 1356-5524, Vol. 20, no 1, p. 39-, article id 10.1136/ebmed-2014-110130Article in journal, Letter (Refereed) Published
National Category
Respiratory Medicine and Allergy
Identifiers
urn:nbn:se:uu:diva-253440 (URN)10.1136 (DOI)
Available from: 2015-05-27 Created: 2015-05-27 Last updated: 2017-12-04
Ahmadi, Z., Bornefalk-Hermansson, A., Franklin, K. A., Midgren, B. & Ekstrom, M. P. (2014). Hypo- and hypercapnia predict mortality in oxygen-dependent chronic obstructive pulmonary disease: a population-based prospective study. Respiratory research (Online), 15, 30
Open this publication in new window or tab >>Hypo- and hypercapnia predict mortality in oxygen-dependent chronic obstructive pulmonary disease: a population-based prospective study
Show others...
2014 (English)In: Respiratory research (Online), ISSN 1465-9921, E-ISSN 1465-993X, Vol. 15, p. 30-Article in journal (Refereed) Published
Abstract [en]

Background: The prognostic role of the arterial blood gas tension of carbon dioxide (PaCO2) in severe Chronic Obstructive Pulmonary Disease (COPD) remains unknown. The aim of this study was to estimate the association between PaCO2 and mortality in oxygen-dependent COPD. Methods: National prospective study of patients starting long-term oxygen therapy (LTOT) for COPD in Sweden between October 1, 2005 and June 30, 2009, with all-cause mortality as endpoint. The association between PaCO2 while breathing air, PaCO2 (air), and mortality was estimated using Cox regression adjusted for age, sex, arterial blood gas tension of oxygen (PaO2), World Health Organization performance status, body mass index, comorbidity, and medications. Results: Of 2,249 patients included, 1,129 (50%) died during a median 1.1 years (IQR 0.6-2.0 years) of observation. No patient was lost to follow-up. PaCO2 (air) independently predicted adjusted mortality (p < 0.001). The association with mortality was U-shaped, with the lowest mortality at approximately PaCO2 (air) 6.5 kPa and increased mortality at PaCO2 (air) below 5.0 kPa and above 7.0 kPa. Conclusion: In oxygen-dependent COPD, PaCO2 (air) is an independent prognostic factor with a U-shaped association with mortality.

Keywords
COPD, LTOT, Mortality, PaCO2, Hypercapnia, Carbon dioxide, Respiratory failure, Survival
National Category
Respiratory Medicine and Allergy
Identifiers
urn:nbn:se:uu:diva-225103 (URN)10.1186/1465-9921-15-30 (DOI)000334703500001 ()
Available from: 2014-05-27 Created: 2014-05-27 Last updated: 2017-12-05Bibliographically approved
Ekstrom, M. P., Bornefalk-Hermansson, A., Abernethy, A. P. & Currow, D. C. (2014). Safety of benzodiazepines and opioids in very severe respiratory disease: national prospective study. BMJ. British Medical Journal, 348, g445
Open this publication in new window or tab >>Safety of benzodiazepines and opioids in very severe respiratory disease: national prospective study
2014 (English)In: BMJ. British Medical Journal, E-ISSN 1756-1833, Vol. 348, p. g445-Article in journal (Refereed) Published
Abstract [en]

Objective To evaluate the safety of benzodiazepines and opioids in patients with very severe chronic obstructive pulmonary disease (COPD). Design Population based longitudinal consecutive cohort study. Setting Centres prescribing long term oxygen therapy in Sweden. Patients 2249 patients starting long term oxygen therapy for COPD in Sweden between 2005 and 2009 in the national Swedevox Register. Main outcome measures Effects of benzodiazepines and opioids on rates of admission to hospital and mortality, adjusted for age, sex, arterial blood gases, body mass index (BMI), performance status, previous admissions, comorbidities, and concurrent drugs. Results 1681 (76%) patients were admitted to hospital, and 1129 (50%) died under observation. No patient was lost to follow-up. Benzodiazepines and opioids were not associated with increased admission: hazard ratio 0.98 (95% confidence interval, 0.87 to 1.10) and 0.98 (0.86 to 1.10), respectively. Benzodiazepines were associated with increased mortality (1.21, 1.05 to 1.39) with a dose response trend. Opioids also had a dose response relation with mortality: lower dose opioids (<= 30 mg oral morphine equivalents a day) were not associated with increased mortality (1.03, 0.84 to 1.26) in contrast with higher dose opioids (1.21, 1.02 to 1.44). Concurrent benzodiazepines and opioids in lower doses were not associated with increased admissions (0.86, 0.53 to 1.42) or mortality (1.25, 0.78 to 1.99). Associations were not modified by being naive to the drugs or by hypercapnia. Conclusions Lower dose opioids are not associated with increased admissions or deaths in patients with COPD and might be safe for symptom reduction in severe respiratory disease.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-219963 (URN)10.1136/bmj.g445 (DOI)000330647900012 ()
Available from: 2014-03-12 Created: 2014-03-09 Last updated: 2017-12-05Bibliographically approved
Lampa, E., Lind, L., Lind, M. P. & Bornefalk-Hermansson, A. (2014). The identification of complex interactions in epidemiology and toxicology: a simulation study of Boosted Regression Trees. Environmental health, 13, 57
Open this publication in new window or tab >>The identification of complex interactions in epidemiology and toxicology: a simulation study of Boosted Regression Trees
2014 (English)In: Environmental health, ISSN 1476-069X, E-ISSN 1476-069X, Vol. 13, p. 57-Article in journal (Refereed) Published
Abstract [en]

Background: There is a need to evaluate complex interaction effects on human health, such as those induced by mixtures of environmental contaminants. The usual approach is to formulate an additive statistical model and check for departures using product terms between the variables of interest. In this paper, we present an approach to search for interaction effects among several variables using boosted regression trees. Methods: We simulate a continuous outcome from real data on 27 environmental contaminants, some of which are correlated, and test the method's ability to uncover the simulated interactions. The simulated outcome contains one four-way interaction, one non-linear effect and one interaction between a continuous variable and a binary variable. Four scenarios reflecting different strengths of association are simulated. We illustrate the method using real data. Results: The method succeeded in identifying the true interactions in all scenarios except where the association was weakest. Some spurious interactions were also found, however. The method was also capable to identify interactions in the real data set. Conclusions: We conclude that boosted regression trees can be used to uncover complex interaction effects in epidemiological studies.

National Category
Probability Theory and Statistics Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:uu:diva-228915 (URN)10.1186/1476-069X-13-57 (DOI)000340001300001 ()24993424 (PubMedID)
Available from: 2014-07-22 Created: 2014-07-22 Last updated: 2017-12-05Bibliographically approved
Johnston, N., Bornefalk-Hermansson, A., Schenck-Gustafsson, K., Held, C., Goodman, S. G., Yan, A. T. & Bierman, A. S. (2013). Do clinical factors explain persistent sex disparities in the use of acute reperfusion therapy in STEMI in Sweden and Canada?. European heart journal. Acute cardiovascular care., 2(4), 350-358
Open this publication in new window or tab >>Do clinical factors explain persistent sex disparities in the use of acute reperfusion therapy in STEMI in Sweden and Canada?
Show others...
2013 (English)In: European heart journal. Acute cardiovascular care., ISSN 2048-8726, Vol. 2, no 4, p. 350-358Article in journal (Refereed) Published
Abstract [en]

AIMS:

This study examined clinical factors associated with sex differences in the use of acute reperfusion therapy (fibrinolysis or primary percutaneous coronary intervention) in ST-elevation myocardial infarction (STEMI) patients, and the interaction between sex and these factors in Sweden and Canada.

METHODS:

Patients with STEMI in Sweden (n=32,676 from the Register of Information and Knowledge about Swedish Heart Intensive Care Admissions) were compared with similar patients in Canada (n=3375 from the Canadian Global Registry of Acute Coronary Events) for the period 2004-2008.

RESULTS:

Unadjusted vs. age-adjusted odds ratios (OR) for no reperfusion (women vs. men) were for Sweden 1.57 (95% CI 1.49-1.64) vs. 1.14 (95% CI 1.08-1.20), and for Canada 1.61 (95% CI 1.39-1.87) vs. OR 1.18 (95% CI 1.01-1.39). Sex differences persisted after multivariable adjustments (including prehospital delay, atypical symptoms, diabetes), factors for which no interaction with sex was found. Among women <60 years, adjusting for atypical symptoms in Canada and angiographic data in Sweden made the greatest contribution to explaining observed sex differences.

CONCLUSIONS:

In both countries, acute reperfusion therapy in STEMI was used less often in women than in men. Factors associated with these sex differences appear to differ between older and younger women. Targeted interventions are needed to optimize care for women with STEMI, as well as sex- and age-stratified reporting of quality indicators to assess their effectiveness.

National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:uu:diva-225703 (URN)10.1177/2048872613496940 (DOI)24338294 (PubMedID)
Available from: 2014-06-05 Created: 2014-06-05 Last updated: 2017-12-05Bibliographically approved
Ekstrom, M. P., Bornefalk Hermansson, A. & Strom, K. E. (2013). Effects of Cardiovascular Drugs on Mortality in Severe Chronic Obstructive Pulmonary Disease: A Time-Dependent Analysis. American Journal of Respiratory and Critical Care Medicine, 187(7), 715-720
Open this publication in new window or tab >>Effects of Cardiovascular Drugs on Mortality in Severe Chronic Obstructive Pulmonary Disease: A Time-Dependent Analysis
2013 (English)In: American Journal of Respiratory and Critical Care Medicine, ISSN 1073-449X, E-ISSN 1535-4970, Vol. 187, no 7, p. 715-720Article in journal (Refereed) Published
Abstract [en]

Rationale:

Cardiovascular drugs may improve survival in chronic obstructive pulmonary disease (COPD). However, previous studies did not account for major sources of bias, and drug effects have not been evaluated in severe COPD.

Objectives:

To estimate the time-dependent effects of cardiovascular drugs on survival in oxygen-dependent COPD, accounting for immortal and immeasurable time bias.

Methods:

Prospective national study of patients starting long-term oxygen therapy for COPD in Sweden between 1 October 2005 and 30 June 2009. Effects on mortality were estimated using extended Cox regression adjusted for age, sex, Pa-O2, Pa-CO2, World Health Organization performance status, body mass index, comorbidity, and concomitant medications. Immortal and immeasurable time bias was addressed by analyzing all medications as time-dependent variables and accounting for hospitalized time, respectively.

Measurements and Main Results:

Time-dependent effects of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, antiplatelet drugs, beta-blockers, and statins on all-cause mortality were measured. Of the 2,249 included patients, 1,129 (50%) died under observation. No patient was lost to follow-up. The adjusted time-dependent model was compatible with reduced mortality for antiplatelet drugs (hazard ratio [HR], 0.86; 95% CI, 0.75-0.99; P = 0.030) and trends for angiotensin-converting enzyme inhibitors or angiotensin receptor blockers (HR, 0.90; 95% CI, 0.79-1.04; P = 0.166) and statins (HR, 0.86; 95% CI, 0.72-1.03; P = 0.105), whereas beta-blockers increased mortality (HR, 1.19; 95% CI, 1.04-1.37; P = 0.010). Conclusions: This study supports that antiplatelet drugs improve survival

Keywords
chronic obstructive pulmonary disease, long-term oxygen therapy, survival, comorbidity
National Category
Clinical Medicine
Identifiers
urn:nbn:se:uu:diva-282859 (URN)10.1164/rccm.201208-1565OC (DOI)23328521 (PubMedID)
Available from: 2016-04-07 Created: 2016-04-07 Last updated: 2017-08-22Bibliographically approved
Organisations

Search in DiVA

Show all publications