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  • 1. Larsson, Lars
    et al.
    Boethius, Göran
    Uddenfeldt, Monica
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy.
    Differences in utilization of asthma drugs between two neighbouring Swedish provinces: relation to symptom reporting1993In: European Respiratory Journal, ISSN 0903-1936, E-ISSN 1399-3003, Vol. 6, p. 198-203Article in journal (Refereed)
  • 2.
    Leander, Mai
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Janson, Christer
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    Uddenfeldt, Monica
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Cronqvist, Agneta
    Rask-Andersen, Anna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Associations between mortality, asthma, and health-related quality of life in an elderly cohort of Swedes2010In: Journal of Asthma, ISSN 0277-0903, E-ISSN 1532-4303, Vol. 47, no 6, p. 627-632Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Asthma is a common chronic health condition among the elderly and an important cause of morbidity and mortality. Some studies show that subjective assessments of health-related quality of life (HRQL) are important predictors of mortality and survival. The primary aim of this study was to investigate whether low HRQL was a predictor of mortality in elderly subjects and whether such an association differed between subjects with and without asthma. METHODS: In 1990, a cohort in middle Sweden was investigated using a respiratory questionnaire. To assess HRQL, the generic instrument Gothenburg Quality of Life (GQL) was used. The participants were also investigated by spirometry and allergy testing. The present study was limited to the subjects in the oldest age group, aged 60-69 years in 1990, and included 222 subjects with clinically verified asthma, 148 subjects with respiratory symptoms but no asthma or other lung diseases, and 102 subjects with no respiratory symptoms. Mortality in the cohort was followed during 1990-2008. RESULTS: Altogether, 166 of the 472 subjects in the original cohort had died during the follow-up period of 1990-2008. Mortality was significantly higher in men, in older subjects, in smokers, and subjects with a low forced expiratory volume in one second (FEV(1)). There was, however, no difference in mortality between the asthmatic and the nonasthmatic groups. A higher symptoms score for GQL was significantly related to increased mortality. No association between HRQL and mortality was found when limiting the analysis to the asthmatic group, although the asthmatics had a lower symptom score for GQL compared to the other groups. CONCLUSION: A higher symptom score in the GQL instrument was significantly related to increased mortality, but this association was not found when analyzing the asthmatic group alone. The negative prognostic implications of a low HRQL in the whole group and the fact that the asthmatic group had a lower HRQL than the other group supports the use of HRQL instruments in clinical health assessments.

  • 3.
    Leander, Mai
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Lampa, Erik
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Janson, Christer
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    Svärdsudd, Kurt
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Uddenfeldt, Monica
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Rask-Andersen, Anna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Determinants for a low health-related quality of life in asthmatics2012In: Upsala Journal of Medical Sciences, ISSN 0300-9734, E-ISSN 2000-1967, Vol. 117, no 1, p. 57-66Article in journal (Refereed)
    Abstract [en]

    People with asthma suffer from impaired health-related quality of life (HRQL) but the determinants of HRQL among asthmatics are not completely understood. The aim of this study was to study determinants of low HRQL in asthmatics and to study whether the determinants of HRQL differ between sexes and age groups.

    A cohort of three age groups in Sweden was investigated in 1990 using a respiratory questionnaire. To study quality of life, the generic instrument Gothenburg Quality of Life was used. The participants were also investigated with interviews, spirometry and allergy testing. Asthma was diagnosed in 616 subjects.

    Fifty-eight percent (n=359) of the subjects were women. Twenty-four percent were smokers, 22% ex-smokers and 54% were non-smokers. Women were more likely than men to report poor health-related quality of life. Respiratory symptoms severity was another independent determinant of a lower quality of life as well as airway responsiveness to irritants. Current and former smokers also reported lower quality of life. Finally, absenteeism from school and work was associated with lower quality of life.

    Factors such as sex, smoking habits, airway responsiveness to irritants, respiratory symptom severity, allergy, and absenteeism from school and work were associated with low HRQL in asthmatics.

  • 4.
    Rask-Andersen, Anna
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Uddenfeldt, Monica
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Lampa, Erik
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Janson, Christer
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    Determinant of persistent asthma and new asthma onset in a longitudinal study with special reference to atopic sensitization2011In: American Journal of Respiratory and Critical Care Medicine, ISSN 1073-449X, E-ISSN 1535-4970, Vol. 183, p. A4307-Article in journal (Other academic)
    Abstract [en]

    Our knowledge about atopy as a longitudinal predictor of asthma is limited. The purpose of this study was to investigate the prognosis of asthma and risk factors for asthma onset, especially sensitization of specific allergens in a population sample.

    A cohort responded to a respiratory questionnaire in 1990 and 2003. At baseline, 1851 subjects who, in the screening questionnaire, reported respiratory symptoms and 447 controls were investigated with interviews, spirometry and skin prick test. A total of 721 asthmatics and 976 subjects without respiratory disease were clinically verified. At follow-up in 2003, 340 subjects with persistent asthma and 186 subjects with asthma remission were identified while 76 subjects reported new asthma onset.

    Sensitisation to pets and a high symptom score were significant determinants of persistent asthma (Odds Ratio [ORs] 3.2 [95% CI 1.9-5.6], and 5.7 [2.5-13.3] respectively), and onset of asthma, (ORs 2.6 [1.1-6.0], and 1.7 [1.2-2.3], respectively). A high self-reported responsiveness to airway irritants (OR 1.6 [1.1-2.2]), and more asthma medications (OR 2.0 [1.3-2.9]) were additional risk factors for persistent asthma at the follow-up. Belonging to the older age group decreased the risk both of having persistent asthma and asthma onset.

    In conclusion, asthmatics sensitised to pets have a more severe outcome than asthmatics not sensitised to pets. Sensitisation to pets was also a strong predictor for onset of asthma. Our study also indicates that special attention should be given to asthmatics that report having severe symptoms and problems with airway irritants as such patients are more likely to have persistent problems.

  • 5.
    Uddenfeldt, Monica
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    A Longitudinal Study of Asthma: Risk Factors and Prognosis2010Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    The aim of this thesis was to identify risk factors for the onset of adult asthma. Other objectives were to study determinants of smoking habits and the association between sensitization and outcome of asthma.

    In 1990, a questionnaire was distributed to 12,732 individuals from three age groups (16, 30-39 and 60-69 years) in two counties of Sweden. In a second phase, 2538 subjects who had reported respiratory symptoms and 600 controls were invited to clinical investigations, 81% participated. At the follow-up in 2003 subjects of the remaining cohort (11,282) were re-invited. Analyses are based on the 67% (n=7563) who responded to both questionnaires 1990 and 2003.

    In 2003, 17.2% of the young adults, 11.4% of the middle-aged and 10.3% of the elderly reported having, or having had, asthma. A total of 791 subjects reported onset of asthma during the 13-year study period. Lifestyle factors such as smoking, obesity, hard physical training and a low consumption of fruit and fish were constant risk factors for onset of asthma after adjusting for socioeconomic group. A smoker’s risk of asthma onset was increased by 37%. The impact of risk factors differed between the age-groups. BMI had a significantly higher impact in the middle-aged and elderly.

    In subjects participating in the clinical investigations in 1990, sensitization to pets, were determinants of both persistent asthma and onset of asthma in 2003. The risk for persistent asthma was threefold. The risk for onset of asthma was more than doubled.

    Smoking at baseline in 1990 was the strongest determinant of being a smoker in 2003. Allergic sensitization and clinically verified asthma were not associated with smoking habits in 2003. No differences in changing smoking habits could be identified between smokers with or without asthma.

    In conclusion, modifiable lifestyle factors are important risk factors for adult onset asthma. The co-occurrence and interplay between asthma and cigarette smoking is still puzzling.

     

    List of papers
    1. Differences in utilization of asthma drugs between two neighbouring Swedish provinces: relation to symptom reporting
    Open this publication in new window or tab >>Differences in utilization of asthma drugs between two neighbouring Swedish provinces: relation to symptom reporting
    1993 (English)In: European Respiratory Journal, ISSN 0903-1936, E-ISSN 1399-3003, Vol. 6, p. 198-203Article in journal (Refereed) Published
    Keywords
    asthma, chronic bronchitis, epidemiology, obstructive airways symptoms, anti-asthma drugs
    National Category
    Respiratory Medicine and Allergy
    Research subject
    Lung Medicine
    Identifiers
    urn:nbn:se:uu:diva-133046 (URN)
    Available from: 2010-11-01 Created: 2010-11-01 Last updated: 2017-12-12
    2. High BMI is related to higher incidence of asthma, while a fish and fruit diet is related to a lower: results from a long-term follow-up study of three age groups in Sweden
    Open this publication in new window or tab >>High BMI is related to higher incidence of asthma, while a fish and fruit diet is related to a lower: results from a long-term follow-up study of three age groups in Sweden
    Show others...
    2010 (English)In: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 104, no 7, p. 972-980Article in journal (Refereed) Published
    Abstract [en]

    The causes of the worldwide increase in asthma seen during the last decades remain largely unexplained, but lifestyle and diet are suggested to play important roles. In this follow up of a large-scale population sample in Sweden, we wanted to identify modifiable risk factors for the cumulative incidence over a 13-year follow-up period. In 1990, a self-administered questionnaire was completed by 12,560 individuals from three age groups (16, 30-39 and 60-69 years of age) in two counties of Sweden. In 2003, the eligible subjects (n = 11,282) were sent a new postal questionnaire. In total 8150 (response rate 73%) answered the questionnaire. The prevalence of asthma in 2003 had increased in all ages. In the young adults, the asthma prevalence rose from 11.3% in 1990 to 25.0% in 2003. Adult asthma onset was identified in 791 of the participants. Smoking [RR (95% CI) = 1.37 (1.12-1.68)], BMI [1.49 (1.25-1.77 per inter quartile range)], and nocturnal gastro-oesophageal reflux (GOR) [2.16 (1.72-2.72)] were significant independent risk factors for the cumulative incidence of asthma. The impact of risk factors differed between the age groups where BMI and GOR had a significantly higher impact in the middle aged and the elderly (p < 0.05). High consumption of fruit and fish was protective especially in the elderly [0.52 (0.35-0.77)]. No significant difference was found in the impact of risk factors between men and women. Weight loss, smoking cessation and a diet rich in fruit and fish may be of importance in preventing onset of adult asthma.

    Keywords
    Asthma epidemiology; BMI; Diet; Longitudinal studies; Risk factors; Smoking
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:uu:diva-126476 (URN)10.1016/j.rmed.2009.12.013 (DOI)000279377200007 ()20171076 (PubMedID)
    Available from: 2010-06-15 Created: 2010-06-15 Last updated: 2017-12-12Bibliographically approved
    3. Determinant of persistent asthma and new asthma onset in a longitudinal study with special reference to atopic sensitization
    Open this publication in new window or tab >>Determinant of persistent asthma and new asthma onset in a longitudinal study with special reference to atopic sensitization
    2011 (English)In: American Journal of Respiratory and Critical Care Medicine, ISSN 1073-449X, E-ISSN 1535-4970, Vol. 183, p. A4307-Article in journal, Meeting abstract (Other academic) Published
    Abstract [en]

    Our knowledge about atopy as a longitudinal predictor of asthma is limited. The purpose of this study was to investigate the prognosis of asthma and risk factors for asthma onset, especially sensitization of specific allergens in a population sample.

    A cohort responded to a respiratory questionnaire in 1990 and 2003. At baseline, 1851 subjects who, in the screening questionnaire, reported respiratory symptoms and 447 controls were investigated with interviews, spirometry and skin prick test. A total of 721 asthmatics and 976 subjects without respiratory disease were clinically verified. At follow-up in 2003, 340 subjects with persistent asthma and 186 subjects with asthma remission were identified while 76 subjects reported new asthma onset.

    Sensitisation to pets and a high symptom score were significant determinants of persistent asthma (Odds Ratio [ORs] 3.2 [95% CI 1.9-5.6], and 5.7 [2.5-13.3] respectively), and onset of asthma, (ORs 2.6 [1.1-6.0], and 1.7 [1.2-2.3], respectively). A high self-reported responsiveness to airway irritants (OR 1.6 [1.1-2.2]), and more asthma medications (OR 2.0 [1.3-2.9]) were additional risk factors for persistent asthma at the follow-up. Belonging to the older age group decreased the risk both of having persistent asthma and asthma onset.

    In conclusion, asthmatics sensitised to pets have a more severe outcome than asthmatics not sensitised to pets. Sensitisation to pets was also a strong predictor for onset of asthma. Our study also indicates that special attention should be given to asthmatics that report having severe symptoms and problems with airway irritants as such patients are more likely to have persistent problems.

    Keywords
    asthma, longitudinal study, allergens, allergy tests, skin prick test, prognosis
    National Category
    Respiratory Medicine and Allergy
    Research subject
    Occupational and Environmental Medicine
    Identifiers
    urn:nbn:se:uu:diva-133142 (URN)
    Available from: 2010-11-02 Created: 2010-11-02 Last updated: 2017-12-12Bibliographically approved
    4. Smoking habits are not influenced by respiratory health and allergic status
    Open this publication in new window or tab >>Smoking habits are not influenced by respiratory health and allergic status
    2010 (English)Manuscript (preprint) (Other academic)
    Publisher
    p. 50
    Keywords
    Asthma, smoking, longitudinal study
    National Category
    Respiratory Medicine and Allergy
    Research subject
    Occupational and Environmental Medicine
    Identifiers
    urn:nbn:se:uu:diva-133048 (URN)
    Available from: 2010-11-02 Created: 2010-11-01 Last updated: 2017-06-16Bibliographically approved
  • 6.
    Uddenfeldt, Monica
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm , Centre for Research and Development, Gävleborg.
    Janson, Christer
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    Lampa, Erik
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Leander, Mai
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Norbäck, Dan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Larsson, Lars
    Rask-Andersen, Anna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    High BMI is related to higher incidence of asthma, while a fish and fruit diet is related to a lower: results from a long-term follow-up study of three age groups in Sweden2010In: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 104, no 7, p. 972-980Article in journal (Refereed)
    Abstract [en]

    The causes of the worldwide increase in asthma seen during the last decades remain largely unexplained, but lifestyle and diet are suggested to play important roles. In this follow up of a large-scale population sample in Sweden, we wanted to identify modifiable risk factors for the cumulative incidence over a 13-year follow-up period. In 1990, a self-administered questionnaire was completed by 12,560 individuals from three age groups (16, 30-39 and 60-69 years of age) in two counties of Sweden. In 2003, the eligible subjects (n = 11,282) were sent a new postal questionnaire. In total 8150 (response rate 73%) answered the questionnaire. The prevalence of asthma in 2003 had increased in all ages. In the young adults, the asthma prevalence rose from 11.3% in 1990 to 25.0% in 2003. Adult asthma onset was identified in 791 of the participants. Smoking [RR (95% CI) = 1.37 (1.12-1.68)], BMI [1.49 (1.25-1.77 per inter quartile range)], and nocturnal gastro-oesophageal reflux (GOR) [2.16 (1.72-2.72)] were significant independent risk factors for the cumulative incidence of asthma. The impact of risk factors differed between the age groups where BMI and GOR had a significantly higher impact in the middle aged and the elderly (p < 0.05). High consumption of fruit and fish was protective especially in the elderly [0.52 (0.35-0.77)]. No significant difference was found in the impact of risk factors between men and women. Weight loss, smoking cessation and a diet rich in fruit and fish may be of importance in preventing onset of adult asthma.

  • 7.
    Uddenfeldt, Monica
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Janson, Christer
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    Lampa, Erik
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Rask-Andersen, Anna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Smoking habits are not influenced by respiratory health and allergic status2010Manuscript (preprint) (Other academic)
1 - 7 of 7
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