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  • 1. Ekström, Magnus
    et al.
    Bornefalk-Hermansson, Anna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, UCR-Uppsala Clinical Research Center. Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Statistics.
    Cardiovascular and antacid treatment and mortality in oxygen-dependent pulmonary fibrosis: A population-based longitudinal study2016In: Respirology (Carlton South. Print), ISSN 1323-7799, E-ISSN 1440-1843, Vol. 21, no 4, p. 705-711Article in journal (Refereed)
    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.

  • 2.
    Johansson, Henrik
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotherapy. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    Norlander, Katarina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Otolaryngology and Head and Neck Surgery.
    Alving, Kjell
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Hedenström, Hans
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Physiology.
    Janson, Christer
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    Malinovschi, Andrei
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Physiology.
    Nordang, Leif
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Otolaryngology and Head and Neck Surgery.
    Emtner, Margareta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotherapy. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    Exercise test using dry air in random adolescents: temporal profile and predictors of bronchoconstriction2016In: Respirology (Carlton South. Print), ISSN 1323-7799, E-ISSN 1440-1843, Vol. 21, no 2, p. 289-296Article in journal (Refereed)
    Abstract [en]

    Background and objective

    Guidelines recommend exercise tests using dry air to diagnose exercise-induced bronchoconstriction (EIB). Lung function changes subsequent to these tests have not been investigated in a general adolescent population, and it remains unknown whether signs of airway inflammation, measured using exhaled nitric oxide (FeNO), can predict a positive response. The aim of this study was to investigate the temporal aspect of decline in forced expiratory volume in 1 s (FEV1) after an exercise test using dry air, and to investigate predictors of EIB.

    Methods

    From a cross-sectional study on adolescents aged 13–15 years (n = 3838), a random subsample of 146 adolescents (99 with and 47 without self-reported exercise-induced dyspnoea) underwent standardized treadmill exercise tests for EIB while breathing dry air.

    Results

    Of the adolescents, 34% had a positive EIB test (decline of ≥10% in FEV1 from baseline) within 30 min. Of the subjects with EIB, 53% showed the greatest decline in FEV1 at 5 to 10 min (mean decline 18.5%), and the remaining 47% of the subjects showed the greatest decline at 15 to 30 min (mean decline 18.9%) after exercise. Increased FeNO (>20 ppb), female gender and self-reported exercise-induced dyspnoea were independently associated with a positive EIB test.

    Conclusion

    When assessing general adolescents for EIB with exercise test using dry air, there is a temporal variation in the greatest FEV1 decline after exercise. Therefore, lung function should be measured for at least 30 min after the exercise. Increased FeNO, female gender and self-reported exercise-induced dyspnoea can be predictors of a positive EIB test.

  • 3. Koplin, J.
    et al.
    Svanes, C.
    Dharmage, S.
    Schlunssen, V
    Gislason, T.
    Holm, M.
    Braback, L.
    Janson, Christer
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    Real, Gomez F.
    Father'S Smoking and Welding Prior to Conception and Asthma Risk in His Children: A Multi-Generational Analysis of the Respiratory Health in Northern Europe Study2015In: Respirology (Carlton South. Print), ISSN 1323-7799, E-ISSN 1440-1843, Vol. 20, p. 42-42Article in journal (Other academic)
  • 4.
    Lövström, Ludvig
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Physiology.
    Emtner, Margareta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotherapy. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    Alving, Kjell
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Nordvall, Lennart
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Borres, Magnus P
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Janson, Christer
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    Malinovschi, Andrei
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Physiology.
    High levels of physical activity are associated with poorer asthma control in young females but not in males2016In: Respirology (Carlton South. Print), ISSN 1323-7799, E-ISSN 1440-1843, Vol. 21, no 1, p. 79-87Article in journal (Refereed)
    Abstract [en]

    BACKGROUND AND OBJECTIVE: Earlier studies on the levels of physical activity in asthma patients compared with controls have yielded varying results. We have previously reported that high versus moderate levels of physical activity were associated with higher prevalence of wheezing, especially in females. Here we studied the levels of physical activity in young patients with asthma and healthy subjects and their effect on asthma control.

    METHODS: Four hundred eight physician-diagnosed patients with asthma and 118 controls (10-34 years) answered questions concerning frequency and/or duration of physical activity and undertook the Asthma Control Test (ACT), spirometry, methacholine challenges and exhaled nitric oxide measurements.

    RESULTS: Asthma patients were more frequently physically active (P = 0.01) and for longer durations (P = 0.002) than controls. Highly versus moderately physically active patients with asthma had a higher prevalence of not well-controlled asthma (ACT < 20) when physical activity was assessed by frequency (40.6% vs 24.1%, P = 0.001) or duration (39.0% vs 21.7%, P < 0.001). This was only seen in females who had reduced ACT items (P < 0.05). Frequently versus moderately active females had an odds ratio of 4.81 (2.43, 9.51) to have ACT < 20, while no such effect was found in males (OR 1.18 (0.61, 2.30)) and this interaction was statistically significantly associated with gender (P = 0.003). No differences in fraction of exhaled nitric oxide or methacholine reactivity were found between moderately and highly physically active females with asthma.

    CONCLUSION: Young asthma patients were more active than controls. High levels of physical activity were associated with poor asthma control as judged by the ACT in females, but not in males, and this appears unrelated to airway inflammation or responsiveness.

  • 5. Real, Gomez F.
    et al.
    Villani, S.
    Janson, Christer
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Jarvis, D.
    Sunyer, J.
    Heinrich, J.
    Dratva, J.
    Norbäck, Dan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Leynaert, B.
    Koplin, J.
    Dharmage, S.
    Svanes, C.
    Maternal Age at Delivery and Asthma, Atopy and Lung Function in Offspring: A Question of Sex?2015In: Respirology (Carlton South. Print), ISSN 1323-7799, E-ISSN 1440-1843, Vol. 20, p. 42-42Article in journal (Other academic)
  • 6.
    Reddel, Helen K.
    et al.
    Univ Sydney, Woolcock Inst Med Res, Sydney, NSW, Australia..
    De Verdier, Maria Gerhardsson
    AstraZeneca, Gothenburg, Sweden..
    Agusti, Alvar
    Hosp Clin Univ Barcelona, Barcelona, Spain..
    Beasley, Richard
    Med Res Inst New Zealand, Wellington, New Zealand..
    Bel, Elisabeth H.
    Univ Amsterdam, Acad Med Ctr, Amsterdam, Netherlands..
    Hiller, Josh
    QuintilesIMS, London, England..
    Janson, Christer
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    Make, Barry
    Natl Jewish Hlth, Denver, CO USA.;Univ Colorado, Denver, CO 80202 USA..
    Martin, Richard J.
    Natl Jewish Hlth, Denver, CO USA.;Univ Colorado, Denver, CO 80202 USA..
    Pavord, Ian
    Univ Oxford, Oxford, England..
    Postma, Dirkje
    Univ Groningen, Univ Med Ctr Groningen, Groningen, Netherlands..
    Price, David
    Res Real Life, Singapore, Singapore..
    Wong, Diana
    QuintilesIMS, London, England..
    Keen, Christina
    AstraZeneca, Gothenburg, Sweden..
    Gardev, Asparuh
    AstraZeneca, Cambridge, England..
    Rennard, Stephen
    AstraZeneca, Cambridge, England..
    Svereus, Alecka
    AstraZeneca, Gothenburg, Sweden..
    Bansal, Aruna T.
    Acclarogen Ltd, Cambridge, England..
    Brannman, Lance
    AstraZeneca, Gaithersburg, MD USA..
    Karlsson, Niklas
    AstraZeneca, Gothenburg, Sweden..
    Nuevo, Javier
    AstraZeneca, Madrid, Spain..
    Nyberg, Fredrik
    AstraZeneca, Gothenburg, Sweden..
    Wang, Xia
    AstraZeneca, Gaithersburg, MD USA..
    Young, Simon
    AstraZeneca, Cambridge, England..
    Vestbo, Jörgen
    Univ Manchester, Manchester, Lancs, England..
    Suitability of australian electronic medical records to guide the design of the novelty study2017In: Respirology (Carlton South. Print), ISSN 1323-7799, E-ISSN 1440-1843, Vol. 22, no Suppl. 2, p. 113-113, article id TP-022Article in journal (Other academic)
  • 7. Russell, M.
    et al.
    Janson, Christer
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    Real, F.
    Johannessen, A.
    Waatevik, M.
    Benediktsdottir, B.
    Holm, M.
    Lindberg, Eva
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    Schlunssen, V
    Raza, W.
    Svanes, C.
    Dharmage, S.
    Physical Activity and the Association with Asthma and Wheeze in the Respiratory Health in Northern Europe (RHINE) Study2015In: Respirology (Carlton South. Print), ISSN 1323-7799, E-ISSN 1440-1843, Vol. 20, no S2, p. 53-53Article in journal (Other academic)
  • 8. Svanes, C.
    et al.
    Koplin, J.
    Janson, Christer
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    Omenaas, E.
    Fosberg, B.
    Gislason, T.
    Joegi, R.
    Gomez, Real F.
    Schlunssen, V
    Holm, M.
    Johannessen, A.
    Change in Prevalence of Asthma in Three Generations Born 1900-20002015In: Respirology (Carlton South. Print), ISSN 1323-7799, E-ISSN 1440-1843, Vol. 20, p. 67-67Article in journal (Other academic)
  • 9.
    Ólafsdóttir, Inga S.
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    Janson, Christer
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    Lind, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Internal Medicine.
    Hulthe, Johannes
    Gunnbjörnsdóttir, María
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    Sundström, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Serum levels of matrix metalloproteinase-9, tissue inhibitors of metalloproteinase-1 and their ratio are associated with impaired lung function in the elderly: a population-based study2010In: Respirology (Carlton South. Print), ISSN 1323-7799, E-ISSN 1440-1843, Vol. 15, no 3, p. 530-535Article in journal (Refereed)
    Abstract [en]

    BACKGROUND AND OBJECTIVE: Matrix metalloproteinases (MMP) and their inhibitors, tissue inhibitors of metalloproteinases (TIMP), regulate homeostasis and turnover of the extra cellular matrix. The aim of this study was to investigate the associations of serum MMP-9 and TIMP-1 with lung function. METHODS: Spirometry was performed in a population-based sample of 888 subjects aged 70 years. Serum MMP-9 and TIMP-1 concentrations were measured by ELISA. RESULTS: Lower FEV(1) values were associated with higher serum levels of MMP-9 (P = 0.001) and TIMP-1 (P < 0.001), and a higher ratio of MMP-9 to TIMP-1 (P = 0.02). These associations were significant after adjustment for gender, weight, height, BMI, current smoking, pack years of smoking and the time for which samples were frozen. After stratification for gender, the associations between FEV(1) and MMP-9, TIMP-1, and their ratio, were significant in men but not in women. CONCLUSIONS: Lower FEV(1) was significantly but weakly associated with higher serum levels of MMP-9, TIMP-1 and a higher MMP-9/TIMP-1 ratio. This association was stronger in men than in women, suggesting a possible role for extracellular matrix remodelling in the development of impaired lung function. These associations may also partly explain the association between low FEV(1) and cardiovascular disease.

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