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  • 1.
    Leander, Mai
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Health-Related Quality of Life in Asthma2010Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Health-related quality of life (HRQL) has become an important outcome in asthma, since traditional outcomes, such as respiratory symptoms and pulmonary function, might not entirely express the patient’s perception of the limitations caused by the disease. The aim of this thesis was to study HRQL in asthma and to analyse if HRQL was related to asthma onset and prognosis. Other aims were to identify determinants of low HRQL in clinically-verified asthmatics, and to study whether low HRQL was a predictor of mortality.

    In 1990, a self-administered questionnaire was completed by 12,560 individuals from three age groups (16, 30-39, and 60-69 years) in two counties of Sweden. In a second phase, all subjects who reported a history of obstructive respiratory symptoms (n = 1,851) and 600 randomly-selected controls were invited to a clinical investigation including spirometry, allergy testing, and assessment of HRQL with the Gothenburg Quality of Life instrument. In 2003, the eligible subjects in the cohort (n=11,282) were sent a new questionnaire. Mortality data in the cohort was followed up during 1990–2008 using data from the National Board of Health and Welfare Mortality Database.

    The 616 subjects with clinically-verified asthma 1990 had significantly lower HRQL than subjects without asthma. In the 2003 follow-up, the 305 subjects with persistent asthma had a lower HRQL than the 155 subjects who showed improvement in asthma during the follow-up. Subjects who had developed asthma by the follow-up had a significantly lower HRQL at baseline than those who did not develop asthma. Significant determinants of quality of life in asthma were female sex, smoking habits, higher airway responsiveness to irritants, respiratory symptom severity, positive skin prick test, and absenteeism from work or school. Low HRQL was related to increased mortality, but this association was not found when analyzing the asthmatic group alone.

    In conclusion, measurements of HRQL are of value for evaluating both the impact and progression of asthma.

    List of papers
    1. Non-respiratory symptoms and well-being in asthmatics from a general population sample
    Open this publication in new window or tab >>Non-respiratory symptoms and well-being in asthmatics from a general population sample
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    2009 (English)In: Journal of Asthma, ISSN 0277-0903, E-ISSN 1532-4303, Vol. 46, no 6, p. 552-559Article in journal (Refereed) Published
    Abstract [en]

    BACKGROUND: Different instruments have been developed to assess health-related quality of life (HRQL) in asthma patients. However, relatively few studies have assessed HRQL in asthma patients from a general population, and it is still unclear which instrument is most suitable. The purpose of this study was to compare HRQL in clinically verified asthmatics with subjects with respiratory symptoms without asthma and with subjects with no respiratory symptoms from a general population. The generic instrument Gothenburg Quality of Life (GQL) was used. A secondary aim was to study if GQL had any prognostic value in asthma. METHODS: A cohort of three age groups in Sweden was investigated in 1990 using a respiratory questionnaire and GQL. The cohort consisted of 616 subjects with asthma, 488 subjects with respiratory symptoms but no asthma, and 347 subjects without respiratory symptoms. The participants were also investigated by spirometry and allergy testing. In a follow-up study, subjects were identified who had persistent and improved asthma. RESULTS: The prevalence of 28 of the 30 common symptoms in GQL was significantly increased (p < 0.001) in subjects with asthma as compared to non-asthmatics. All symptoms in the domains heart and lung, head, musculoskeletal, tension, and depression were significantly increased among the asthmatics. The asthmatics also rated their physical well-being lower (p < 0.001) than subjects with no respiratory symptoms. Subjects with persistent asthma had a significantly higher prevalence of 7 of the 30 symptoms and lower social well-being than subjects showing improvement in asthma during the follow-up. All differences remained significant after adjusting for age, sex, and smoking habits. CONCLUSION: Subjects with asthma had different symptom-profiles compared to those of non-asthmatics, with a higher prevalence of both respiratory and non-respiratory symptoms. Asthma is also a disease that is related to low well-being. The use of quality-of-life questionnaires such as the GQL may provide useful information for evaluating the non-respiratory aspects of asthma as well as for assessing the impact of disease on health status and well-being.

    Keywords
    asthma, GQL, quality of life, generic instrument, prognostic
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:uu:diva-108009 (URN)10.1080/02770900902866743 (DOI)000268707700005 ()19657894 (PubMedID)
    Available from: 2009-09-03 Created: 2009-09-03 Last updated: 2017-12-13Bibliographically approved
    2. Health-related quality of life predicts onset of asthma in a longitudinal population study
    Open this publication in new window or tab >>Health-related quality of life predicts onset of asthma in a longitudinal population study
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    2009 (English)In: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 103, no 2, p. 194-200Article in journal (Refereed) Published
    Abstract [en]

    BACKGROUND: Health-related quality of life (HRQL) has been increasingly used as an outcome measure in asthma, but less is known about the prognostic implication of low health-related quality of life. The purpose of this study was to investigate if a set of quality of life measures could predict onset of asthma. METHODS: In the baseline study 391 subjects without asthma answered a respiratory questionnaire and the Gothenburg Quality of Life (GQL) instrument in 1990. The GQL questionnaire included two parts: (1) the prevalence of HRQL-related symptoms and (2) well-being scores for physical, mental and social dimensions. The participants were also investigated with spirometry and allergy testing. In 2003, the same respiratory questionnaire that had been used in 1990 was sent. There were 290 responders, of whom 22 subjects had developed asthma. RESULTS: Participants who had developed asthma by the follow-up had a higher prevalence of sleep disturbances (30% vs. 10%), problems with chest pain (16% vs. 2%), depression (40% vs. 20%) difficulty relaxing (40% vs. 13%) and constipation (25% vs. 2%) at baseline than participants who did not develop asthma (p<0.05). Subjects who developed asthma also scored significantly lower on well-being variables as sleep, energy, mood, patience, memory, appetite, fitness and sense of appreciation outside home. These differences remained after adjusting for age, sex, smoking habits, asthma heredity, socioeconomic groups and building dampness. CONCLUSION: Participants with low health-related quality of life at baseline were more likely to report having developed asthma 12 years later.

    Keywords
    Quality of life, asthma
    National Category
    Respiratory Medicine and Allergy
    Research subject
    Occupational and Environmental Medicine
    Identifiers
    urn:nbn:se:uu:diva-102474 (URN)10.1016/j.rmed.2008.09.015 (DOI)000263187100006 ()19046862 (PubMedID)
    Available from: 2009-05-07 Created: 2009-05-07 Last updated: 2017-12-13Bibliographically approved
    3. Associations Between Mortality, Asthma, and Health-Related Qualityof Life in an Elderly Cohort of Swedes
    Open this publication in new window or tab >>Associations Between Mortality, Asthma, and Health-Related Qualityof Life in an Elderly Cohort of Swedes
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    2010 (English)In: Journal of Asthma, ISSN 0277-0903, E-ISSN 1532-4303Article in journal (Refereed) Published
    Abstract [en]

    Background. Asthma is a common chronic health condition among the elderly and an important cause of morbidity and mortality. Some studiesshow that subjective assessments of health-related quality of life (HRQL) are important predictors of mortality and survival. The primary aim ofthis study was to investigate whether low HRQL was a predictor of mortality in elderly subjects and whether such an association differed betweensubjects 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. Thepresent 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 thecohort was followed during 1990–2008. Results. Altogether, 166 of the 472 subjects in the original cohort had died during the follow-up period of1990–2008. Mortality was significantly higher in men, in older subjects, in smokers, and subjects with a low forced expiratory volume in one second(FEV1). There was, however, no difference in mortality between the asthmatic and the nonasthmatic groups. A higher symptoms score for GQLwas significantly related to increased mortality. No association between HRQL and mortality was found when limiting the analysis to the asthmaticgroup, although the asthmatics had a lower symptom score for GQL compared to the other groups. Conclusion. A higher symptom score in the GQLinstrument was significantly related to increased mortality, but this association was not found when analyzing the asthmatic group alone. The negativeprognostic 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 theuse of HRQL instruments in clinical health assessments.

    Keywords
    asthma, generic instrument, GQL, mortality, quality of life
    National Category
    Public Health, Global Health, Social Medicine and Epidemiology
    Research subject
    Occupational and Environmental Medicine
    Identifiers
    urn:nbn:se:uu:diva-129463 (URN)
    Available from: 2010-08-16 Created: 2010-08-16 Last updated: 2017-12-12
    4. Determinants for a low health-related quality of life in asthmatics
    Open this publication in new window or tab >>Determinants for a low health-related quality of life in asthmatics
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    2012 (English)In: Upsala Journal of Medical Sciences, ISSN 0300-9734, E-ISSN 2000-1967, Vol. 117, no 1, p. 57-66Article in journal (Refereed) Published
    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.

    Keywords
    asthma, GQL, quality of life, generic instrument, prognostic
    National Category
    Public Health, Global Health, Social Medicine and Epidemiology
    Research subject
    Occupational and Environmental Medicine
    Identifiers
    urn:nbn:se:uu:diva-129457 (URN)10.3109/03009734.2011.638730 (DOI)000300304000010 ()
    Available from: 2010-08-16 Created: 2010-08-16 Last updated: 2017-12-12Bibliographically approved
  • 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.
    Leander, Mai
    et al.
    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.
    Franklin, Karl
    Gislason, Thorarinn
    Oudin, Anna
    Svanes, Cecilie
    Toren, Kjell
    Janson, Christer
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    Impact of anxiety and depression on respiratory symptoms2014In: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 108, no 11, p. 1594-1600Article in journal (Refereed)
    Abstract [en]

    Psychological factors such as anxiety and depression are prevalent in patients with asthma. The purpose of this study was to investigate the relationship between respiratory symptoms and psychological status and to estimate the importance of psychological status in comparison with other factors that are known to be associated with respiratory symptoms. This study included 2270 subjects aged 20-44 (52% female) from Sweden, Iceland, and Norway. Each participant underwent a clinical interview including questions on respiratory symptoms. Spirometry and methacholine challenge were performed. Symptoms of depression and anxiety were measured using the Hospital Anxiety and Depression Scale (HADS). Eighty-two percent of the subjects reported no anxiety or depression whatsoever, 11% reported anxiety, 2.5% depression and 4% reported both anxiety and depression. All respiratory symptoms, such as wheezing, breathlessness and nightly symptoms, were more common, at a statistically significant level, in participants who had depression and anxiety, even after adjusting for confounders (ORs 1.33-1.94). The HADS score was the most important determinant for nightly symptoms and attacks of breathlessness when at rest whereas bronchial responsiveness was the most important determinant for wheezing, and breathlessness when wheezing. The probability of respiratory symptoms related to HADS score increased with increasing HADS score for all respiratory symptoms. In conclusion, there is a strong association between respiratory symptoms and psychological status. There is therefore a need for interventional studies designed to improve depression and anxiety in patients with respiratory symptoms.

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