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Kisiel, M., Zhou, X., Sundh, J., Ställberg, B., Lisspers, K., Malinovschi, A., . . . Janson, C. (2020). Data-driven questionnaire-based cluster analysis of asthma in Swedish adults. npj Primary Care Respiratory Medicine, 30, Article ID 14.
Open this publication in new window or tab >>Data-driven questionnaire-based cluster analysis of asthma in Swedish adults
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2020 (English)In: npj Primary Care Respiratory Medicine, E-ISSN 2055-1010, Vol. 30, article id 14Article in journal (Refereed) Published
Abstract [en]

The aim of this study was to identify asthma phenotypes through cluster analysis. Cluster analysis was performed using self-reported characteristics from a cohort of 1291 Swedish asthma patients. Disease burden was measured using the Asthma Control Test (ACT), the mini Asthma Quality of Life Questionnaire (mini-AQLQ), exacerbation frequency and asthma severity. Validation was performed in 748 individuals from the same geographical region. Three clusters; early onset predominantly female, adult onset predominantly female and adult onset predominantly male, were identified. Early onset predominantly female asthma had a higher burden of disease, the highest exacerbation frequency and use of inhaled corticosteroids. Adult onset predominantly male asthma had the highest mean score of ACT and mini-AQLQ, the lowest exacerbation frequency and higher proportion of subjects with mild asthma. These clusters, based on information from clinical questionnaire data, might be useful in primary care settings where the access to spirometry and biomarkers is limited.

Place, publisher, year, edition, pages
NATURE PUBLISHING GROUP, 2020
National Category
Respiratory Medicine and Allergy
Identifiers
urn:nbn:se:uu:diva-410892 (URN)10.1038/s41533-020-0168-0 (DOI)000526433300002 ()32249767 (PubMedID)
Funder
Swedish Heart Lung FoundationSwedish Asthma and Allergy Association
Available from: 2020-05-25 Created: 2020-05-25 Last updated: 2020-05-25Bibliographically approved
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
Sundbom, F., Malinovschi, A., Lindberg, E., Almqvist, C. & Janson, C. (2020). Insomnia symptoms and asthma control: Interrelations and importance of comorbidities. Clinical and Experimental Allergy, 50(2), 170-177
Open this publication in new window or tab >>Insomnia symptoms and asthma control: Interrelations and importance of comorbidities
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2020 (English)In: Clinical and Experimental Allergy, ISSN 0954-7894, E-ISSN 1365-2222, Vol. 50, no 2, p. 170-177Article in journal (Refereed) Published
Abstract [en]

Background

Insomnia symptoms are common with asthma. The aim of the study was to analyse the associations between insomnia symptoms and asthma control, asthma severity, and asthma‐related comorbidity in a community‐based population.

Methods

Adults (n = 23 875, ages 18‐45) from the community‐based LifeGene study answered a questionnaire on insomnia symptoms, airway symptoms, asthma diagnosis, asthma medication, and asthma‐related comorbidities (chronic rhinosinusitis, gastro‐oesophageal reflux, anxiety, depression, or obesity).

Results

Of the participants, 1272 (5.3%) had asthma. The prevalence of any insomnia symptom was higher in participants with uncontrolled asthma (n = 201) than with controlled or partially controlled asthma (32.2% vs 19.9% and 20.1%, respectively, P < .01). There was no significant difference in the prevalence of insomnia symptoms between subjects with controlled asthma and subjects without asthma. Subjects with asthma and any asthma‐related comorbidity reported more insomnia symptoms (29.0% vs 22.4%, P < .01) compared to asthmatics without comorbidity. Moreover, the prevalence was highest among subjects reporting both uncontrolled asthma and any asthma‐related comorbidity (45.1%, P < .01). Uncontrolled asthma remained significantly associated with insomnia symptoms (OR 1.72 (1.15‐2.56)) after adjusting for age, sex, BMI, smoking history, comorbidities, physical activity, and educational level, while medication level was not. Among asthma‐related comorbidities, chronic rhinosinusitis (OR 1.62 (1.20‐2.19)), obesity (1.87 (1.07‐3.25)), and depression (OR 1.85 (1.34‐2.55)) were independently associated with insomnia symptoms.

Conclusion

Uncontrolled asthma was significantly associated with insomnia symptoms, while controlled or partially controlled asthma was not. Asthma‐related comorbidity is of great importance, and asthma control seems to be more important than asthma severity for insomnia symptoms.

Keywords
asthma, asthma control, comorbidity, epidemiology, sleep
National Category
Respiratory Medicine and Allergy
Identifiers
urn:nbn:se:uu:diva-379139 (URN)10.1111/cea.13517 (DOI)000497284000001 ()31631397 (PubMedID)
Available from: 2019-03-12 Created: 2019-03-12 Last updated: 2020-04-06Bibliographically approved
Donoso, F., Hedenström, H., Malinovschi, A. & Engstrand Lilja, H. (2020). Pulmonary function in children and adolescents after esophageal atresia repair. Pediatric Pulmonology, 55(1), 206-213
Open this publication in new window or tab >>Pulmonary function in children and adolescents after esophageal atresia repair
2020 (English)In: Pediatric Pulmonology, ISSN 8755-6863, E-ISSN 1099-0496, Vol. 55, no 1, p. 206-213Article in journal (Refereed) Published
Abstract [en]

Introduction

Respiratory morbidity after esophageal atresia (EA) is common. The aims of this study were to assess pulmonary function, to identify risk factors for pulmonary function impairment (PFI), and to investigate the relations between respiratory morbidity, defined as medical treatment for respiratory symptoms or recent pneumonia and PFI after EA repair.

Material and Methods

Single center retrospective observational study including patients with EA who participated in the follow‐up program for 8‐ or 15‐year old patients from 2014 to 2018 and performed pulmonary function testing by body plethysmography, dynamic spirometry, impulse oscillometry, and diffusing capacity of the lungs. Univariate and multiple stepwise logistic regression with PFI as outcome were performed. Anastomotic leak, episodes of general anesthesia, extubation day, birth weight, age at follow up, gross classification, and abnormal reflux index were independent variables.

Results

In total, 47 patients were included. PFI was found in 19 patients (41%) and 16 out of 19 patients (84%) had an obstructive pattern. Respiratory morbidity was found in 23 (52%, NA = 3) of the patients with no correlation to PFI. Birth weight, age at follow‐up, and episodes of general anesthesia were identified as risk factors for PFI.

Conclusion

Respiratory morbidity and PFI were common in children and adolescents after EA repair. The major component of PFI was obstruction of the airways. The risk for PFI increased with lower birth weight and older age at follow up. The poor correlation between respiratory morbidity and PFI motivates the need of clinical follow up including pulmonary function tests.

National Category
Respiratory Medicine and Allergy Surgery
Research subject
Pediatric Surgery
Identifiers
urn:nbn:se:uu:diva-405373 (URN)10.1002/ppul.24517 (DOI)000486950100001 ()31535483 (PubMedID)
Available from: 2020-02-27 Created: 2020-02-27 Last updated: 2020-04-06Bibliographically approved
Blöndal, V., Sundbom, F., Borres, M. P., Högman, M., Alving, K., Malinovschi, A. & Janson, C. (2020). Study of atopic multimorbidity in subjects with rhinitis using multiplex allergen component analysis. Clinical and Translational Allergy, 10(1), Article ID 6.
Open this publication in new window or tab >>Study of atopic multimorbidity in subjects with rhinitis using multiplex allergen component analysis
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2020 (English)In: Clinical and Translational Allergy, ISSN 2045-7022, E-ISSN 2045-7022, Vol. 10, no 1, article id 6Article in journal (Refereed) Published
Abstract [en]

Background Rhinitis is a common problem within the population. Many subjects with rhinitis also have atopic multimorbidity, such as asthma and eczema. The purpose of this investigation was to compare subjects with only rhinitis to those that have rhinitis, asthma and/or eczema in relation to immunoglobulin E (IgE) sensitization, inflammatory markers, family history, lung function and body mass index (BMI). Methods A total of 216 adult subjects with rhinitis from the European Community Respiratory Health Survey II were investigated with multiplex component allergen analysis (103 allergen components), total IgE, C-reactive protein, eosinophilic cationic protein, fractional exhaled nitric oxide and spirometry. Rhinitis, eczema, asthma and parental allergy were questionnaire-assessed. Results Of the 216 participants with rhinitis, 89 also had asthma and/or eczema. Participants with rhinitis that also had asthma or eczema were more likely to be IgE-sensitized (3.44, odds ratio, OR: 95% CI 1.62-7.30, adjusted for sex, age, mother's allergy, total IgE and forced expiratory volume (FEV1)). The number of IgE-positive components was independently associated with atopic multimorbidity (1.11, OR: 95% Cl 1.01-1.21) adjusted for sex, age, mother's allergy, total IgE and FEV1. When analysing different types of sensitization, the strongest association with atopic multimorbidity was found in participants that were IgE-sensitized both to perennial and seasonal allergens (4.50, OR: 95% CI 1.61-12.5). Maternal allergy (2.75, OR: 95% CI 1.15-4.46), high total IgE (2.38, OR: 95% CI 1.21-4.67) and lower FEV1 (0.73, OR: 95% CI 0.58-0.93) were also independently associated with atopic multimorbidity, while no association was found with any of the other inflammatory markers. Conclusion IgE polysensitization, to perennial and seasonal allergens, and levels of total IgE seem to be the main determinants of atopic multimorbidity in subjects with rhinitis. This indicates that disease-modifying treatment that targets IgE sensitization may be of value when decreasing the risk of developing atopic multimorbidity.

Place, publisher, year, edition, pages
BMC, 2020
Keywords
Rhinitis, Asthma, Eczema, Atopic multimorbidity, Multiplex component analysis
National Category
Respiratory Medicine and Allergy
Identifiers
urn:nbn:se:uu:diva-407351 (URN)10.1186/s13601-020-0311-6 (DOI)000517216300001 ()32110380 (PubMedID)
Funder
Swedish Heart Lung FoundationVinnovaSwedish Asthma and Allergy AssociationVårdal Foundation
Available from: 2020-05-28 Created: 2020-05-28 Last updated: 2020-05-28Bibliographically 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
Pape, K., Svanes, C., Malinovschi, A., Benediktsdottir, B., Lodge, C., Janson, C., . . . Schlunssen, V. (2019). Agreement of offspring-reported parental smoking status: the RHINESSA generation study. BMC Public Health, 19, Article ID 94.
Open this publication in new window or tab >>Agreement of offspring-reported parental smoking status: the RHINESSA generation study
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2019 (English)In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 19, article id 94Article in journal (Refereed) Published
Abstract [en]

Background:

With increasing interest in exposure effects across generations, it is crucial to assess the validity of information given on behalf of others.

Aims:

To compare adult's report of their parent's smoking status against parent's own report and examine predictors for discrepant answers.

Methods:

We studied 7185 offspring (18-51 years) and one of their parents, n = 5307 (27-67 years) participating in the Respiratory Health in Northern Europe, Spain and Australia (RHINESSA) generation study. Information about parent's smoking status during offspring's childhood and mother's smoking status during pregnancy was obtained by questionnaires from parents and their offspring. We calculated sensitivity, specificity and Cohen's Kappa [kappa] for agreement using parent's own report as the gold standard. We performed logistic regression to examine if offspring's sex, age, educational level, asthma status, own smoking status or parental status, as well as the parent's sex and amount of smoking during childhood predicted disagreement.

Results:

The sensitivity for offspring's correct report of parent's smoking status during childhood (0-10 years) was 0.82 (95% CI 0.81-0.84), specificity was 0.95 (95% CI 0.95-0.96) and a good agreement was observed, kappa = 0.79 (95% CI 0.78-0.80). Offspring's report of mothers' smoking status during pregnancy showed a lower sensitivity, 0.66 (95% CI 0.60-0.71), a slightly lower specificity, 0.92 (95% CI 0.90-0.95) and a good agreement, kappa = 0.61 (95% CI 0.55-0.67). In multivariate logistic regression analysis, offspring not having children was a predictor for discrepant answers (odds ratio [OR] 2.11 [95% CI 1.21-3.69]). Low amount of parents' tobacco consumption, < 10 cigarettes/day (OR 2.72 [95% CI 1.71-4.31]) also predicted disagreement compared to >= 10 cigarettes per day, and so did offspring's reports of fathers' smoking status (OR 1.73 [95% CI 1.09-2.74]) compared to mothers' smoking status. Offspring's sex, asthma status, educational level, smoking status or age was not related to discrepant answers.

Conclusions:

Adults report their parent's smoking status during their childhood, as well as their mother' smoking status when pregnant with them, quite accurately. In the absence of parents' direct report, offspring's reports could be valuable.

Keywords
Generation study, Validation study, Tobacco smoking, Self-report, Smoking during pregnancy, Parental smoking, Agreement, Sensitivity, Specificity
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:uu:diva-379236 (URN)10.1186/s12889-019-6414-0 (DOI)000459898400003 ()30665381 (PubMedID)
Funder
Forte, Swedish Research Council for Health, Working Life and WelfareEU, Horizon 2020, 633212
Available from: 2019-03-19 Created: 2019-03-19 Last updated: 2019-12-19Bibliographically approved
Timm, S., Frydenberg, M., Abramson, M. J., Bertelsen, R. J., Braback, L., Benediktsdottir, B., . . . Schlunssen, V. (2019). Asthma and selective migration from farming environments in a three-generation cohort study. European Journal of Epidemiology, 34(6), 601-609
Open this publication in new window or tab >>Asthma and selective migration from farming environments in a three-generation cohort study
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2019 (English)In: European Journal of Epidemiology, ISSN 0393-2990, E-ISSN 1573-7284, Vol. 34, no 6, p. 601-609Article in journal (Refereed) Published
Abstract [en]

Individuals raised on a farm appear to have less asthma than individual raised elsewhere. However, selective migration might contribute to this as may also the suggested protection from farm environment. This study investigated if parents with asthma are less likely to raise their children on a farm. This study involved three generations: 6045 participants in ECRHS/RHINE cohorts (born 1945-1973, denoted G1), their 10,121 parents (denoted G0) and their 8260 offspring participating in RHINESSA (born 1963-1998, denoted G2). G2-offspring provided information on parents not participating in ECRHS/RHINE. Asthma status and place of upbringing for all three generations were reported in questionnaires by G1 in 2010-2012 and by G2 in 2013-2016. Binary regressions with farm upbringing as outcome were performed to explore associations between parental asthma and offspring farm upbringing in G0-G1 and G1-G2. Having at least one parent with asthma was not associated with offspring farm upbringing, either in G1-G2 (RR 1.11, 95% CI 0.81-1.52) or in G0-G1 (RR 0.99, 0.85-1.15). G1 parents with asthma born in a city tended to move and raise their G2 offspring on a farm (RR 2.00, 1.12-3.55), while G1 parents with asthma born on a farm were less likely to raise their G2 offspring on a farm (RR 0.34, 0.11-1.06). This pattern was not observed in analyses of G0-G1. This study suggests that the protective effect from farm upbringing on subsequent asthma development could not be explained by selective migration. Intriguingly, asthmatic parents appeared to change environment when having children.

Keywords
Asthma, Farming, Selective migration, ECRHS, RHINE, RHINESSA
National Category
Respiratory Medicine and Allergy
Identifiers
urn:nbn:se:uu:diva-384058 (URN)10.1007/s10654-019-00491-9 (DOI)000466919800009 ()30729356 (PubMedID)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare
Available from: 2019-06-20 Created: 2019-06-20 Last updated: 2019-12-19Bibliographically approved
Jansson, C., Malinovschi, A., Amaral, A. F. S., Accordini, S., Bousquet, J., Buist, A. S., . . . Jarvis, D. (2019). Bronchodilator reversibility in asthma and COPD: findings from three large population studies. European Respiratory Journal, 54(3), Article ID 1900561.
Open this publication in new window or tab >>Bronchodilator reversibility in asthma and COPD: findings from three large population studies
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2019 (English)In: European Respiratory Journal, ISSN 0903-1936, E-ISSN 1399-3003, Vol. 54, no 3, article id 1900561Article in journal (Refereed) Published
Abstract [en]

Bronchodilator response (BDR) testing is used as a diagnostic method in obstructive airway diseases. The aim of this investigation was to compare different methods for measuring BDR in participants with asthma and chronic obstructive pulmonary disease (COPD) and to study to the extent to which BDR was related to symptom burden and phenotypic characteristics. Forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC) were measured before and 15 min after 200 mu g of salbutamol in 35 628 subjects aged >= 16 years from three large international population studies. The subjects were categorised in three groups: current asthma (n=2833), COPD (n=1146) and no airway disease (n=31 649). Three definitions for flow-related reversibility (increase in FEV1) and three for volume-related reversibility (increase in FVC) were used. The prevalence of bronchodilator reversibility expressed as increase FEV1 >= 12% and 200 mL was 17.3% and 18.4% in participants with asthma and COPD, respectively, while the corresponding prevalence was 5.1% in those with no airway disease. In asthma, bronchodilator reversibility was associated with wheeze (OR 1.36, 95% CI 1.04-1.79), atopy (OR 1.36, 95% CI 1.04-1.79) and higher exhaled nitric oxide fraction, while in COPD neither flow- nor volume-related bronchodilator reversibility was associated with symptom burden, exacerbations or health status after adjusting for pre-bronchodilator FEV1. Bronchodilator reversibility was at least as common in participants with COPD as those with asthma. This indicates that measures of reversibility are of limited value for distinguishing asthma from COPD in population studies. However, in asthma, bronchodilator reversibility may be a phenotypic marker.

Place, publisher, year, edition, pages
EUROPEAN RESPIRATORY SOC JOURNALS LTD, 2019
National Category
Respiratory Medicine and Allergy
Identifiers
urn:nbn:se:uu:diva-396637 (URN)10.1183/13993003.00561-2019 (DOI)000489163100030 ()31221806 (PubMedID)
Funder
EU, Horizon 2020, 633212SSwedish Heart Lung Foundation, 20170303
Available from: 2019-11-07 Created: 2019-11-07 Last updated: 2019-11-07Bibliographically approved
Tsolakis, N., Nordvall, L., Janson, C., Rydell, N., Malinovschi, A. & Alving, K. (2019). Characterization of a subgroup of non-type 2 asthma with cow's milk hypersensitivity in young subjects. Clinical and Translational Allergy, 9, Article ID 12.
Open this publication in new window or tab >>Characterization of a subgroup of non-type 2 asthma with cow's milk hypersensitivity in young subjects
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2019 (English)In: Clinical and Translational Allergy, ISSN 2045-7022, E-ISSN 2045-7022, Vol. 9, article id 12Article in journal (Refereed) Published
Abstract [en]

Background: Asthma with atopy is often characterized by type 2 inflammation but less progress has been made in defining non-type 2 asthma. We have previously identified a subgroup of young non-atopic asthmatics with perceived food hypersensitivity and poor asthma control. Objective: Our aim was to further characterize this subgroup of non-type 2 asthmatics, including the use of a broad panel of inflammation-related proteins. Methods: Sex-and age-matched subjects (10-35 years old) were divided into three groups with regard to history of asthma and atopy: non-atopic asthmatics with perceived cow's milk hypersensitivity but with IgE antibodies < 0.35 kU(A)/L (NAA; n = 24), non-atopic controls with IgE < 0.35 kU(A)/L (NAC; n = 24), and atopic asthmatics with IgE >= 0.35 kU(A)/L (AA; n = 29). Serum or plasma were analysed using the multi-allergen tests Phadiatop and fx5 (Immuno-CAP), a multiplex immunoassay comprising 92 inflammation-related proteins (Proseek Inflammation), and an ELISA for human neutrophil lipocalin (S-HNL). Fraction of exhaled nitric oxide (FeNO), blood eosinophil (B-Eos) count, C-reactive protein (CRP), airway responsiveness to methacholine - (PD20), and asthma-related quality of life (mAQLQ) were also measured. Results: NAA had lower FeNO (p < 0.001) and B-Eos count (p < 0.001), but scored worse on mAQLQ (p = 0.045) compared with AA. NAA displayed higher levels of matrix metalloproteinase-1 (MMP-1) compared with both NAC (p = 0.011) and AA (p = 0.001), and lower - PD20 compared with NAC (p < 0.001). In NAA, S-HNL correlated negatively with -PD20 (rho = -0.048, p < 0.05) and CRP correlated negatively with mAQLQ (rho = -0.439, p < 0.05). Conclusion: In a subgroup of non-atopic young asthmatics with perceived cow's milk hypersensitivity we observed poor asthma-related quality of life, airway hyperresponsiveness, and clinically relevant non-type 2 inflammation. MMP-1 was elevated in this group, which deserves further studies.

Place, publisher, year, edition, pages
BMC, 2019
National Category
Respiratory Medicine and Allergy
Identifiers
urn:nbn:se:uu:diva-380493 (URN)10.1186/s13601-019-0250-2 (DOI)000460910600001 ()30834110 (PubMedID)
Funder
Swedish Foundation for Strategic Research Swedish Heart Lung FoundationSwedish Asthma and Allergy Association
Available from: 2019-03-28 Created: 2019-03-28 Last updated: 2019-12-19Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-4098-7765

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