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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
Salomonsson, M., Malinovschi, A., Kalm-Stephens, P., Dahlin, J. S., Janson, C., Alving, K. & Hallgren, J. (2019). Circulating mast cell progenitors correlate with reduced lung function in allergic asthma. Clinical and Experimental Allergy, 49(6), 874-882
Open this publication in new window or tab >>Circulating mast cell progenitors correlate with reduced lung function in allergic asthma
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2019 (English)In: Clinical and Experimental Allergy, ISSN 0954-7894, E-ISSN 1365-2222, Vol. 49, no 6, p. 874-882Article in journal (Refereed) Published
Abstract [en]

Background

Studies using mouse models have revealed that mast cell progenitors are recruited from the blood circulation to the lung during acute allergic airway inflammation. The discovery of a corresponding human mast cell progenitor population in the blood has enabled to study the relation of circulating mast cell progenitors in clinical settings.

Objectives

To explore the possible association between the frequency of mast cell progenitors in the blood circulation and allergic asthma, we assessed the relation of this recently identified cell population with asthma outcomes and inflammatory mediators in allergic asthmatic patients and controls.

Methods

Blood samples were obtained, and spirometry was performed on 38 well‐controlled allergic asthmatic patients and 29 controls. The frequency of blood mast cell progenitors, total serum IgE and 180 inflammation‐ and immune‐related plasma proteins were quantified.

Results

Allergic asthmatic patients and controls had a similar mean frequency of blood mast cell progenitors, but the frequency was higher in allergic asthmatic patients with reduced FEV1 and PEF (% of predicted) as well as in women. The level of fibroblast growth factor 21 (FGF‐21) correlated positively with the frequency of mast cell progenitors, independent of age and gender, and negatively with lung function. The expression of FcεRI on mast cell progenitors was higher in allergic asthmatic patients and correlated positively with the level of total IgE in the controls but not in the asthmatic patients.

Conclusion

Elevated levels of circulating mast cell progenitors are related to reduced lung function, female gender and high levels of FGF‐21 in young adults with allergic asthma.

Keywords
allergic asthma, asthma, lung function, mast cell progenitors, mast cells
National Category
Immunology
Identifiers
urn:nbn:se:uu:diva-379233 (URN)10.1111/cea.13388 (DOI)000475694600015 ()30892731 (PubMedID)
Funder
Swedish Heart Lung Foundation, 20150379Swedish Asthma and Allergy Association, F2016-0045VinnovaSwedish Research Council, 2014-03293Swedish Research Council, 2016-00803Swedish Foundation for Strategic Research , RB13-0196Swedish Heart Lung Foundation, 20160618
Available from: 2019-03-26 Created: 2019-03-26 Last updated: 2019-09-20Bibliographically approved
Amaral, R., Pereira, A. M., Jacinto, T., Malinovschi, A., Janson, C., Alving, K. & Fonseca, J. A. (2019). Comparison of hypothesis- and data-driven asthma phenotypes in NHANES 2007-2012: the importance of comprehensive data availability. Clinical and Translational Allergy, 9, Article ID 17.
Open this publication in new window or tab >>Comparison of hypothesis- and data-driven asthma phenotypes in NHANES 2007-2012: the importance of comprehensive data availability
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2019 (English)In: Clinical and Translational Allergy, ISSN 2045-7022, E-ISSN 2045-7022, Vol. 9, article id 17Article in journal (Refereed) Published
Abstract [en]

Background

Half of the adults with current asthma among the US National Health and Nutrition Examination Survey (NHANES) participants could be classified in more than one hypothesis-driven phenotype. A data-driven approach applied to the same subjects may allow a more useful classification compared to the hypothesis-driven one.

Aim

To compare previously defined hypothesis-driven with newly derived data-driven asthma phenotypes, identified by latent class analysis (LCA), in adults with current asthma from NHANES 2007-2012.

Methods

Adults (18years) with current asthma from the NHANES were included (n=1059). LCA included variables commonly used to subdivide asthma. LCA models were derived independently according to age groups: <40 and 40years old.

Results

Two data-driven phenotypes were identified among adults with current asthma, for both age groups. The proportions of the hypothesis-driven phenotypes were similar among the two data-driven phenotypes (p>0.05). Class A <40years (n=285; 75%) and Class A 40years (n=462; 73%), respectively, were characterized by a predominance of highly symptomatic asthma subjects with poor lung function, compared to Class B <40years (n=94; 25%) and Class B 40years (n=170; 27%). Inflammatory biomarkers, smoking status, presence of obesity and hay fever did not markedly differ between the phenotypes.

Conclusion

Both data- and hypothesis-driven approaches using clinical and physiological variables commonly used to characterize asthma are suboptimal to identify asthma phenotypes among adults from the general population. Further studies based on more comprehensive disease features are required to identify asthma phenotypes in population-based studies.

Keywords
Asthma, Phenotypes, Population-based study, Unsupervised analysis
National Category
Respiratory Medicine and Allergy
Identifiers
urn:nbn:se:uu:diva-380449 (URN)10.1186/s13601-019-0258-7 (DOI)000461351800001 ()
Available from: 2019-03-28 Created: 2019-03-28 Last updated: 2019-12-19Bibliographically approved
Perez-Bogerd, S., Michils, A., Malinovschi, A. & Van Muylem, A. (2019). COPD patients with peripheral airway obstruction reversibility identified by exhaled nitric oxide. Journal of Breath Research, 13(3), Article ID 036002.
Open this publication in new window or tab >>COPD patients with peripheral airway obstruction reversibility identified by exhaled nitric oxide
2019 (English)In: Journal of Breath Research, ISSN 1752-7155, E-ISSN 1752-7163, Vol. 13, no 3, article id 036002Article in journal (Refereed) Published
Abstract [en]

Rationale:

Besides its role as an inflammatory marker in asthma, fractional exhaled nitric oxide (FENO) provides information on the extent of the airway obstruction process through evaluating its change after bronchodilation.

Objective:

To investigate whether FENO change after bronchodilation can identify different sites of airway obstruction in COPD patients.

Methods:

FENO, FEV(1 )and the slopes (S) of the alveolar plateau of the single breath washout test (SBWT) were measured in 61 stable COPD patients (FEV1 34.5% predicted) before and after the inhalation of 400 mu g salbutamol. SBWT used Helium (He), and sulfur-hexafluoride (SF6). Obstruction relief occurring in pre-acinar and intra-acinar small airways is expected to decrease S-He and S-F6 , respectively. Indices changes (Delta) after bronchodilation were expressed as a percentage of pre-bronchodilation values.

Results:

FENO stability (vertical bar Delta FENO vertical bar <= 11%) was observed in 19 patients [-2.7(6.7)%] [mean (SD)] (NO = group); Delta FENO > 11% [+37.4(27.7)%] in 20 patients (NO+group) and Delta FENO < -11% in 22 patients [-31.2(9.8)%] (NO- group). A similar Delta FEV1 (p = 0.583; [+9.4(9.6)%]) was found in the three groups. In NO = and NO+ groups, neither S-He nor S-SF6 changed; in NO- both S-He [-12.4(27.5)%, p = 0.007] and S-SF6 [ -20.2(20.4)%, p < 0.001] significantly decreased.

Conclusion:

Different patterns of FENO response to beta(2) -agonists were observed in COPD most likely depending on the extent of the dilation process. A profile of airway obstruction with an extensive beta(2) -agonist response down to lung periphery is identified by FENO reduction after acute bronchodilation in 30% of COPD patients. The clinical relevance of this profile requires further investigation.

Keywords
FENO, bronchodilation, single breath washout test, beta(2)-agonist, SABA
National Category
Respiratory Medicine and Allergy
Identifiers
urn:nbn:se:uu:diva-382239 (URN)10.1088/1752-7163/ab0a14 (DOI)000463138100002 ()30802891 (PubMedID)
Available from: 2019-05-16 Created: 2019-05-16 Last updated: 2019-05-16Bibliographically approved
Nerpin, E., Olivieri, M., Gislason, T., Olin, A. C., Nielsen, R., Johannessen, A., . . . Malinovschi, A. (2019). Determinants of fractional exhaled nitric oxide in healthy men and women from the European Community Respiratory Health Survey III. Clinical and Experimental Allergy, 49(7), 969-979
Open this publication in new window or tab >>Determinants of fractional exhaled nitric oxide in healthy men and women from the European Community Respiratory Health Survey III
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2019 (English)In: Clinical and Experimental Allergy, ISSN 0954-7894, E-ISSN 1365-2222, Vol. 49, no 7, p. 969-979Article in journal (Refereed) Published
Abstract [en]

Introduction

The fractional exhaled nitric oxide (FENO) is a marker for type 2 inflammation used in diagnostics and management of asthma. In order to use FENO as a reliable biomarker, it is important to investigate factors that influence FENO in healthy individuals. Men have higher levels of FENO than women, but it is unclear whether determinants of FENO differ by sex.

Objective

To identify determinants of FENO in men and women without lung diseases. Method Fractional exhaled nitric oxide was validly measured in 3881 healthy subjects that had answered the main questionnaire of the European Community Respiratory Health Survey III without airways or lung disease.

Results

Exhaled NO levels were 21.3% higher in men compared with women P < 0.001. Being in the upper age quartile (60.3-67.6 years), men had 19.2 ppb (95% CI: 18.3, 20.2) higher FENO than subjects in the lowest age quartile (39.7-48.3 years) P = 0.02. Women in the two highest age quartiles (54.6-60.2 and 60.3-67.6 years) had 15.4 ppb (14.7, 16.2), P = 0.03 and 16.4 ppb (15.6, 17.1), P = FENO, compared with the lowest age quartile. Height was related to 8% higher FENO level in men (P < 0.001) and 5% higher FENO levels in women (P = 0.008). Men who smoked had 37% lower FENO levels and women had 30% lower levels compared with never-smokers (P < 0.001 for both). Men and women sensitized to both grass and perennial allergens had higher FENO levels compared with non-sensitized subjects 26% and 29%, P Fractional exhaled nitric oxide levels were higher in men than women. Similar effects of current smoking, height, and IgE sensitization were found in both sexes. FENO started increasing at lower age in women than in men, suggesting that interpretation of FENO levels in adults aged over 50 years should take into account age and sex.

Keywords
fractional exhaled nitric oxide, healthy population, IgE sensitization, smoking
National Category
Respiratory Medicine and Allergy
Identifiers
urn:nbn:se:uu:diva-390981 (URN)10.1111/cea.13394 (DOI)000474610200004 ()30934155 (PubMedID)
Funder
Forte, Swedish Research Council for Health, Working Life and WelfareSwedish Heart Lung FoundationSwedish Asthma and Allergy Association
Available from: 2019-08-19 Created: 2019-08-19 Last updated: 2019-12-19Bibliographically 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
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Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-4098-7765

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