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  • 201.
    Thornadtsson, Alexandra
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Research and Development, Gävleborg. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Drca, Nikola
    Karolinska Inst, Dept Med; Karolinska Univ Hosp, Dept Cardiol.
    Ricciardolo, Fabio
    Univ Torino, Div Resp Dis, Dept Clin & Biol Sci, Turin, Italy..
    Högman, Marieann
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Research and Development, Gävleborg. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Increased levels of alveolar and airway exhaled nitric oxide in runners2017In: Upsala Journal of Medical Sciences, ISSN 0300-9734, E-ISSN 2000-1967, Vol. 122, no 2, p. 85-91Article in journal (Refereed)
    Abstract [en]

    Aim: The objective of this study was to apply extended NO analysis for measurements of NO dynamics in the lung, divided into alveolar and airway contribution, in amateur runners and marathoners. Methods: The athletes participated in either a marathon or a half marathon. The athletes self-reported their age, weight, height, training distance per week, competing distance, cardio-pulmonary health, atopic status, and use of tobacco. Measurements of exhaled NO (FENO) with estimation of alveolar NO (CANO) and airway flux (J(aw)NO), ventilation, pulse oximetry, and peak flow were performed before, immediately after, and 1hour after completing the race. Results: At baseline the alveolar NO was higher in amateur runners, 2.91.1ppb (p=0.041), and marathoners, 3.6 +/- 1.9ppb (p=0.002), than in control subjects, 1.4 +/- 0.5ppb. J(aw)NO was higher in marathoners, 0.90 +/- 0.02 nLs(-1) (p=0.044), compared with controls, 0.36 +/- 0.02 nLs(-1), whereas the increase in amateur runners, 0.56 +/- 0.02 nLs(-1), did not attain statistical significance (p=0.165). Immediately after the race there was a decrease in FENO in both amateur runners and marathoners, whereas CANO and J(aw)NO were decreased in marathoners only. Conclusion: Our results support the view that there is an adaptation of the lung to exercise. Thus strenuous exercise increased both airway and alveolar NO, and this might in turn facilitate oxygen uptake.

  • 202.
    Thornadtsson, Alexandra
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Research and Development, Gävleborg.
    Lind, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Research and Development, Gävleborg.
    Weitoft, Tomas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Research and Development, Gävleborg.
    Högman, Marieann
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Altered levels of exhaled nitric oxide in rheumatoid arthritis2018In: Nitric oxide, ISSN 1089-8603, E-ISSN 1089-8611, Vol. 76, p. 1-5Article in journal (Refereed)
    Abstract [en]

    Background: Rheumatoid arthritis (RA) is an autoimmune disorder characterized by bone and joint destruction, but other organ systems can also be involved. Recent studies have suggested that the disease may start in the lungs. Exhaled nitric oxide (FENO) is a marker of inflammation. The aims of the study were to compare the NO parameters between subjects with RA and healthy control subjects, and to examine whether the NO parameters correlated with lung function and disease activity in the subjects with RA. Methods: Subjects with RA (n = 35) were recruited during their regular outpatient visits to the rheumatology department. The nitric oxide (NO) parameters: alveolar NO concentration (CANO), airway compartment diffusing capacity of NO (DawNO), and tissue concentration of NO in the airway wall (CawNO), were algorithmically estimated. Healthy subjects (n = 35) matched by age, gender and height were used as controls. Data are given in median, (quartile 25, 75). Wilcoxon Matched Pairs test was used for group comparisons. Mann-Whitney U test was used to make comparisons between any two groups and for pairwise comparisons. Correlations were tested with Spearman rank order correlation. Results: CANO was significantly lower in the RA subjects compared with healthy subjects; 1.1 (0.5, 1.8) ppb versus 2.4 (2.0, 3.0) ppb, (p < 0.001). CawNO was significantly lower in the RA subjects with 51 (22, 87) ppb versus 120 (76, 162) ppb in the control group. DaWNO was significantly higher at 25 (15, 36) mL/s in the RA group versus the control group's 7.7 (5.3, 10.7) mL/s. Conclusions: There are significant differences between subjects with RA and matched healthy control subjects regarding the exhaled NO parameters. It is unclear if this can be explained by the pathogenesis of RA, consequences of long-term disease, and/or due to drug treatment.

  • 203.
    Thornadtsson, Alexandra
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Research and Development, Gävleborg.
    Malinovschi, Andrei
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Physiology.
    Bröms, Kristina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Research and Development, Gävleborg.
    Lisspers, Karin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Ställberg, Björn
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Janson, Christer
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Högman, Marieann
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Physiology.
    Clinical correlates of alveolar nitric oxide in COPD2018In: European Respiratory Journal, ISSN 0903-1936, E-ISSN 1399-3003, Vol. 52Article in journal (Other academic)
  • 204.
    Timm, Signe
    et al.
    Aarhus Univ, Aarhus, Denmark.
    Frydenberg, Morten
    Aarhus Univ, Aarhus, Denmark.
    Abrahamson, Michael
    Univ Melbourne, Melbourne Sch Populat & Global Hlth, Melbourne, Vic, Australia.
    Bertelsen, Randi
    Univ Bergen, Bergen, Norway.
    Bråbäck, Lennart
    Umeå Univ, Umeå, Sweden.
    Benediktsdottir, Bryndis
    Univ Reykjavik Univ, Reykjavik, Iceland.
    Dharmage, Shyamali
    Univ Melbourne, Melbourne Sch Populat & Global Hlth, Melbourne, Vic, Australia.
    Forsberg, Bertil
    Umeå Univ, Umeå, Sweden.
    Gislason, Thorarinn
    Univ Reykjavik, Reykjavik, Iceland.
    Holm, Mathias
    Sahlgrens Univ Hosp, Gothenburg, Sweden.
    Janson, Christer
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Jogi, Rain
    Univ Tartu, Tartu, Estonia.
    Malinovschi, Andrei
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Physiology.
    Ramos, Jose
    Univ Huelva, Huelva, Spain.
    Sigsgaard, Torben
    Univ Aarhus, Aarhus, Denmark.
    Svanes, Cecilie
    Univ Bergen, Bergen, Norway.
    Schlunssen, Vivi
    Aarhus Univ, Aarhus, Denmark.
    Asthma and selective migration away from farming environments in a three-generation cohort study2018In: European Respiratory Journal, ISSN 0903-1936, E-ISSN 1399-3003, Vol. 52Article in journal (Other academic)
  • 205.
    Timm, Signe
    et al.
    Aarhus Univ, Danish Ramazzini Ctr, Dept Publ Hlth, Bartholins Alle 2,Bldg 1260, DK-8000 Aarhus C, Denmark.
    Frydenberg, Morten
    Aarhus Univ, Danish Ramazzini Ctr, Dept Publ Hlth, Bartholins Alle 2,Bldg 1260, DK-8000 Aarhus C, Denmark.
    Abramson, Michael J.
    Monash Univ, Sch Publ Hlth & Prevent Med, Melbourne, Vic, Australia.
    Bertelsen, Randi J.
    Univ Bergen, Inst Clin Sci, Bergen, Norway.
    Braback, Lennart
    Umea Univ, Dept Publ Hlth & Clin Med, Sect Sustainable Hlth, Umea, Sweden.
    Benediktsdottir, Bryndis
    Univ Iceland, Med Fac, Reykjavik, Iceland;Primary Hlth Care Ctr, Gardabaer, Iceland.
    Gislason, Thorarinn
    Univ Iceland, Med Fac, Reykjavik, Iceland;Landspitali Univ Hosp, Dept Sleep, Reykjavik, Iceland.
    Holm, Mathias
    Sahlgrens Univ Hosp, Sect Occupat & Environm Med, Gothenburg, Sweden.
    Janson, Christer
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Jogi, Rain
    Univ Tartu, Dept Pulmonol ARKS, Tartu, Estonia.
    Johannessen, Ane
    Univ Bergen, Dept Global Publ Hlth & Primary Care, Ctr Int Hlth, Bergen, Norway;Haukeland Hosp, Dept Occupat Med, Bergen, Norway.
    Kim, Jeong-Lim
    Univ Gothenburg, Sahlgrenska Acad, Sect Occupat & Environm Med, Gothenburg, Sweden.
    Malinovschi, Andrei
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Physiology.
    Mishra, Gita
    Univ Queensland, Sch Publ Hlth, Brisbane, Qld 4006, Australia.
    Moratalla, Jesus
    Albacete Univ Hosp, Dept Internal Med, Albacete, Spain.
    Sigsgaard, Torben
    Aarhus Univ, Danish Ramazzini Ctr, Dept Publ Hlth, Bartholins Alle 2,Bldg 1260, DK-8000 Aarhus C, Denmark.
    Svanes, Cecilie
    Univ Bergen, Dept Global Publ Hlth & Primary Care, Ctr Int Hlth, Bergen, Norway;Haukeland Hosp, Dept Occupat Med, Bergen, Norway.
    Schlunssen, Vivi
    Aarhus Univ, Danish Ramazzini Ctr, Dept Publ Hlth, Bartholins Alle 2,Bldg 1260, DK-8000 Aarhus C, Denmark;Natl Res Ctr Working Environm, Copenhagen, Denmark.
    Asthma and selective migration from farming environments in a three-generation cohort study2019In: European Journal of Epidemiology, ISSN 0393-2990, E-ISSN 1573-7284, Vol. 34, no 6, p. 601-609Article in journal (Refereed)
    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.

  • 206.
    Titova, Olga E
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Functional Pharmacology.
    Lindberg, Eva
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Elmstahl, Solve
    Lund Univ, CRC, Dept Hlth Sci, Div Geriatr Med,Skane Univ Hosp, Malmo, Sweden.
    Lind, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiovascular epidemiology.
    Schiöth, Helgi B.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Functional Pharmacology.
    Benedict, Christian
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Functional Pharmacology.
    Associations Between the Prevalence of Metabolic Syndrome and Sleep Parameters Vary by Age2018In: Frontiers in Endocrinology, ISSN 1664-2392, E-ISSN 1664-2392, Vol. 9, article id 234Article in journal (Refereed)
    Abstract [en]

    Objective: To examine whether the relationship between the metabolic syndrome (MetS) and various sleep parameters [sleep duration, symptoms of sleep-disordered breathing (SDB), and sleep disturbances] varies by age. Methods: Waist circumference, blood pressure, triglycerides, high-density lipoprotein cholesterol, and fasting glucose were used to determine MetS status in a cohort (N = 19,691) of middle-aged (aged 45-64 years) and older (aged >= 65 years) subjects. Habitual sleep duration (short, <= 6 h/day; normal, 7-8 h/day; and long >= 9 h/day), sleep disturbances (such as problems with falling and staying asleep), and symptoms of sleep-disordered breathing (SDB, such as snoring and sleep apneas) were measured by questionnaires. Results: Among the participants, 4,941 subjects (25.1%) fulfilled the criteria for MetS. In the entire sample, both short and long sleep durations were associated with higher prevalence of MetS as compared to normal sleep duration. When stratified by age, a similar pattern was observed for middle-aged subjects (<65 years old; prevalence ratio (PR) [95% CI], 1.13 [1.06-1.22] for short sleep and 1.26 [1.06-1.50] for long sleep duration). In contrast, in older individuals (>= 65 years old), only long sleep duration was linked to a higher prevalence of MetS (1.26 [1.12-1.42]; P < 0.01 for sleep duration x age). In the entire cohort, having at least one SDB symptom >= 4 times per week was linked to an increased prevalence of MetS; however, the PR was higher in middle-aged subjects compared with older subjects (1.50 [1.38-1.63] vs. 1.36 [1.26-1.47], respectively; P < 0.001 for SDB x age). Finally, independent of subjects' age, reports of sleep disturbances (i.e., at least one symptom >= 4 times per week) were associated with a higher likelihood of having MetS (1.12 [1.06-1.18]; P > 0.05 for sleep disturbance x age). Conclusion: Our results suggest that age may modify the associations between some sleep parameters and the prevalence of MetS.

  • 207.
    Triebner, Kai
    et al.
    Univ Bergen, Dept Clin Sci, Jonas Lies Veg 87, N-5021 Bergen, Norway;Univ Bergen, Core Facil Metabol, Jonas Lies Veg 87, N-5021 Bergen, Norway.
    Accordini, Simone
    Univ Verona, Dept Diagnost & Publ Hlth, Unit Epidemiol & Med Stat, Inst Biol 2, Str Le Grazie 8, I-37134 Verona, Italy.
    Calciano, Lucia
    Univ Verona, Dept Diagnost & Publ Hlth, Unit Epidemiol & Med Stat, Inst Biol 2, Str Le Grazie 8, I-37134 Verona, Italy.
    Johannessen, Ane
    Haukeland Hosp, Dept Occupat Med, Jonas Lies Vei 65, N-5021 Bergen, Norway;Univ Bergen, Ctr Int Hlth, Jekteviksbakken 31, N-5009 Bergen, Norway.
    Benediktsdottir, Bryndis
    Univ Iceland, Fac Med, Reykjavik, Iceland.
    Bifulco, Ersilia
    Univ Bergen, Dept Clin Sci, Jonas Lies Veg 87, N-5021 Bergen, Norway;Univ Bergen, Core Facil Metabol, Jonas Lies Veg 87, N-5021 Bergen, Norway.
    Demoly, Pascal
    Univ Montpellier, Univ Hosp Montpellier, Dept Pulmonol, Div Allergy, 371 Ave Doyen Gaston Giraud, F-34295 Montpellier, France;Sorbonne Univ, French Natl Inst Hlth & Med Res, Pierre Louis Inst Epidemiol & Publ Hlth, 56 Blvd Vincent Auriol, F-75646 Paris, France.
    Dharmage, Shyamali C.
    Univ Melbourne, Melbourne Sch Populat & Global Hlth, Allergy & Lung Hlth Unit, 207 Bouverie St, Carlton, Vic 3052, Australia.
    Franklin, Karl A.
    Umea Univ, Dept Surg & Perioperat Sci, Koksvagen 11, S-90185 Umea, Sweden.
    Garcia-Aymerich, Judith
    ISGlobal, Doctor Aiguader 88, Barcelona 08003, Spain;Univ Pompeu Fabra, Doctor Aiguader 88, Barcelona 08003, Spain;CIBER Epidemiol & Publ Hlth, Doctor Aiguader 88, Barcelona 08003, Spain.
    Gullon Blanco, Jose Antonio
    Univ Hosp San Agustin, Dept Pneumol, Camino Heros 4, Aviles 33410, Spain.
    Heinrich, Joachim
    Ludwig Maximilian Univ Munich, Inst & Outpatient Clin Occupat Social & Environm, Ziemssenstr 1, D-80336 Munich, Germany.
    Holm, Mathias
    Univ Gothenburg, Dept Occupat & Environm Med, Medicinaregatan 16A, S-41390 Gothenburg, Sweden.
    Jarvis, Debbie
    Imperial Coll, Natl Heart & Lung Inst, 1b Manresa Rd, London SW3 6LR, England.
    Jogi, Rain
    Tartu Univ Hosp, Lung Clin, Dept Lung Med, Riia 167, EE-51014 Tartu, Estonia.
    Lindberg, Eva
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Martinez-Moratalla, Jesus
    Hlth Serv Castilla La Mancha, Pulmonol Serv, Albacete Univ Hosp Complex, Albacete, Spain;Castilla La Mancha Univ, Fac Med Albacete, Albacete, Spain.
    Muniozguren Agirre, Nerea
    Basque Govt, Dept Hlth, Unit Epidemiol & Publ Hlth, Alameda Rekalde 39A, Bilbao 48008, Spain.
    Pin, Isabelle
    Univ Grenoble Alpes, Univ Hosp Grenoble Alpes, French Natl Inst Hlth & Med Res, Inst Adv Biosci,Dept Pediat, CS 10217, F-38043 Grenoble 9, France.
    Probst-Hensch, Nicole
    Swiss Trop & Publ Hlth Inst, Socinstr 58, CH-4002 Basel, Switzerland;Univ Basel, Dept Publ Hlth, Peterspl 1, CH-4001 Basel, Switzerland.
    Raherison, Chantal
    Bordeaux Univ, Bordeaux Populat Hlth Res, U1219, 146 Rue Leo Saignat, F-33076 Bordeaux, France.
    Luis Sanchez-Ramos, Jose
    Univ Huelva, Dept Nursing, Ave Tres Marzo S-N, Huelva 21071, Spain.
    Schlunssen, Vivi
    Aarhus Univ, Dept Publ Hlth, Bartholins Alle 2, DK-8000 Aarhus, Denmark;Natl Res Ctr Working Environm, Lerso Pk Alle 105, DK-2100 Copenhagen, Denmark.
    Svanes, Cecilie
    Haukeland Hosp, Dept Occupat Med, Jonas Lies Vei 65, N-5021 Bergen, Norway;Univ Bergen, Ctr Int Hlth, Jekteviksbakken 31, N-5009 Bergen, Norway.
    Hustad, Steinar
    Univ Bergen, Dept Clin Sci, Jonas Lies Veg 87, N-5021 Bergen, Norway;Univ Bergen, Core Facil Metabol, Jonas Lies Veg 87, N-5021 Bergen, Norway.
    Leynaert, Benedicte
    French Natl Inst Hlth & Med Res, UMR1152, Team Epidemiol, Paris, France.
    Real, Francisco Gomez
    Univ Bergen, Dept Clin Sci, Jonas Lies Veg 87, N-5021 Bergen, Norway;Haukeland Hosp, Dept Gynecol & Obstet, Jonas Lies Veg 65, N-5021 Bergen, Norway.
    Exogenous female sex steroids may reduce lung ageing after menopause: A 20-year follow-up study of a general population sample (ECRHS)2019In: Maturitas, ISSN 0378-5122, E-ISSN 1873-4111, Vol. 120, p. 29-34Article in journal (Refereed)
    Abstract [en]

    Objectives: Menopause involves hypoestrogenism, which is associated with numerous detrimental effects, including on respiratory health. Hormone replacement therapy (HRT) is often used to improve symptoms of menopause. The effects of HRT on lung function decline, hence lung ageing, have not yet been investigated despite the recognized effects of HRT on other health outcomes. Study design: The population-based multi-centre European Community Respiratory Health Survey provided complete data for 275 oral HRT users at two time points, who were matched with 383 nonusers and analysed with a two-level linear mixed effects regression model. Main outcome measures: We studied whether HRT use was associated with the annual decline in forced vital capacity (FVC) and forced expiratory volume in one second (FEV1). Results: Lung function of women using oral HRT for more than five years declined less rapidly than that of nonusers. The adjusted difference in FVC decline was 5.6 mL/y (95%CI: 1.8 to 9.3, p = 0.01) for women who had taken HRT for six to ten years and 8.9 mL/y (3.5 to 14.2, p = 0.003) for those who had taken it for more than ten years. The adjusted difference in FEV1 decline was 4.4 mL/y (0.9 to 8.0, p = 0.02) with treatment from six to ten years and 5.3 mL/y (0.4 to 10.2, p = 0.048) with treatment for over ten years. Conclusions: In this longitudinal population-based study, the decline in lung function was less rapid in women who used HRT, following a dose-response pattern, and consistent when adjusting for potential confounding factors. This may signify that female sex hormones are of importance for lung ageing.

  • 208.
    Triebner, Kai
    et al.
    Univ Bergen, Dept Clin Sci, N-5021 Bergen, Norway..
    Johannessen, Ane
    Univ Bergen, Dept Clin Sci, N-5021 Bergen, Norway..
    Puggini, Luca
    Natl Univ Ireland, Dept Elect Engn, Maynooth, Kildare, Ireland..
    Benediktsdottir, Bryndis
    Univ Iceland, Fac Med, Reykjavik, Iceland..
    Bertelsen, Randi J.
    Univ Bergen, Dept Occupat Med, N-5021 Bergen, Norway..
    Bifulco, Ersilia
    Univ Bergen, Dept Clin Sci, N-5021 Bergen, Norway.;Univ Bergen, Core Facil Metab, N-5021 Bergen, Norway..
    Dharmage, Shyamali C.
    Univ Melbourne, Melbourne Sch Populat Hlth, Allergy & Lung Hlth Unit, Melbourne, Vic 3010, Australia..
    Dratva, Julia
    Swiss Trop & Publ Hlth Inst, Dept Publ Hlth & Epidemiol, Basel, Switzerland.;Univ Basel, CH-4003 Basel, Switzerland..
    Franklin, Karl A.
    Umea Univ, Dept Surg & Perioperat Sci, S-90187 Umea, Sweden..
    Gislason, Thorarinn
    Univ Iceland, Fac Med, Reykjavik, Iceland.;Natl Univ Hosp Iceland, Landspitali, Dept Resp Med & Sleep, Reykjavik, Iceland..
    Holm, Mathias
    Gothenburg Univ, Dept Occupat & Environm Med, S-41124 Gothenburg, Sweden..
    Jarvis, Deborah
    Univ London Imperial Coll Sci Technol & Med, Natl Heart & Lung Inst, Dept Resp Epidemiol Occupat Med & Publ Hlth, London SW7 2AZ, England..
    Leynaert, Benedicte
    Inserm UMR1152 Team Epidemiol, Paris, France..
    Lindberg, Eva
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Malinovschi, Andrei
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Physiology.
    Macsali, Ferenc
    Haukeland Hosp, Dept Gynecol & Obstet, N-5021 Bergen, Norway..
    Norbäck, Dan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Omenaas, Ernst R.
    Univ Bergen, Dept Clin Sci, N-5021 Bergen, Norway..
    Rodriguez, Francisco J.
    Univ Malaga, Dept Appl Math, E-29071 Malaga, Spain..
    Saure, Eirunn
    Univ Bergen, Dept Occupat Med, N-5021 Bergen, Norway..
    Schlunssen, Vivi
    Aarhus Univ, Dept Publ Hlth, DK-8000 Aarhus C, Denmark..
    Sigsgaard, Torben
    Aarhus Univ, Dept Publ Hlth, DK-8000 Aarhus C, Denmark..
    Skorge, Trude D.
    Univ Bergen, Dept Occupat Med, N-5021 Bergen, Norway..
    Wieslander, Gunilla
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Zemp, Elisabeth
    Swiss Trop & Publ Hlth Inst, Dept Publ Hlth & Epidemiol, Basel, Switzerland.;Univ Basel, CH-4003 Basel, Switzerland..
    Svanes, Cecilie
    Univ Bergen, Dept Occupat Med, N-5021 Bergen, Norway..
    Hustad, Steinar
    Univ Bergen, Dept Clin Sci, N-5021 Bergen, Norway.;Univ Bergen, Core Facil Metab, N-5021 Bergen, Norway..
    Real, Francisco Gomez
    Univ Bergen, Dept Clin Sci, N-5021 Bergen, Norway.;Haukeland Hosp, Dept Gynecol & Obstet, N-5021 Bergen, Norway..
    Menopause as a predictor of new-onset asthma: A longitudinal Northern European population study2016In: Journal of Allergy and Clinical Immunology, ISSN 0091-6749, E-ISSN 1097-6825, Vol. 137, no 1, p. 50-+Article in journal (Refereed)
    Abstract [en]

    Background: There is limited and conflicting evidence on the effect of menopause on asthma. Objectives: We sought to study whether the incidence of asthma and respiratory symptoms differ by menopausal status in a longitudinal population-based study with an average follow-up of 12 years. Methods: The Respiratory Health in Northern Europe study provided questionnaire data pertaining to respiratory and reproductive health at baseline (1999-2001) and follow-up (2010-2012). The study cohort included women aged 45 to 65 years at follow-up, without asthma at baseline, and not using exogenous hormones (n = 2322). Menopausal status was defined as nonmenopausal, transitional, early postmenopausal, and late postmenopausal. Associations with asthma (defined by the use of asthma medication, having asthma attacks, or both) and respiratory symptoms scores were analyzed by using logistic (asthma) and negative binomial (respiratory symptoms) regressions, adjusting for age, body mass index, physical activity, smoking, education, and study center. Results: The odds of new-onset asthma were increased in women who were transitional (odds ratio, 2.40; 95% CI, 1.09-5.30), early postmenopausal (odds ratio, 2.11; 95% CI, 1.06-4.20), and late postmenopausal (odds ratio, 3.44; 95% CI, 1.31-9.05) at follow-up compared with nonmenopausal women. The risk of respiratory symptoms increased in early postmenopausal (coefficient, 0.40; 95% CI, 0.06-0.75) and late postmenopausal (coefficient, 0.69; 95% CI, 0.15-1.23) women. These findings were consistent irrespective of smoking status and across study centers. Conclusions: New-onset asthma and respiratory symptoms increased in women becoming postmenopausal in a longitudinal population-based study. Clinicians should be aware that respiratory health might deteriorate in women during reproductive aging.

  • 209.
    Triebner, Kai
    et al.
    Univ Bergen, Core Fac Metab, Bergen, Norway..
    Matulonga, Bobette
    UMR1152, French Natl Inst Hlth & Med Res INSERM, Pathophysiol & Epidemiol Resp Dis, Paris, France..
    Johannessen, Ane
    Univ Bergen, Dept Clin Sci, Bergen, Norway.;Univ Bergen, Dept Global Publ Hlth & Primary Care, Bergen, Norway..
    Suske, Sandra
    Univ Bergen, Core Fac Metab, Bergen, Norway..
    Benediktsdottir, Bryndis
    Univ Iceland, Fac Med, Reykjavik, Iceland..
    Demoly, Pascal
    Univ Hosp Montpellier, Dept Pulmonol, Div Allergy, Montpellier, France..
    Dharmage, Shyamali C.
    Univ Melbourne, Melbourne Sch Populat Hlth, Allergy & Lung Hlth Unit, Melbourne, Vic, Australia..
    Franklin, Karl A.
    Umea Univ, Dept Surg & Perioperat Sci, Umea, Sweden..
    Garcia-Aymerich, Judith
    ISGlobal, Ctr Res Environm Epidemiol, Barcelona Biomed Res Pk, Barcelona, Spain.;Univ Pompeu Fabra, Barcelona, Spain.;CIBER, Epidemiol & Salud Publ, Barcelona, Spain..
    Gullon Blanco, Jose Antonio
    Hosp San Agustin Aviles, Dept Pneumol, Oviedo, Spain..
    Heinrich, Joachim
    Ludwig Maximilians Univ Munchen, Inst & Outpatient Clin Occupat, Social & Environm Med, Munich, Germany..
    Holm, Mathias
    Univ Gothenburg, Dept Occupat & Environm Med, Gothenburg, Sweden..
    Jarvis, Debbie
    Imperial Coll London, Dept Resp Epidemiol Occupat Med & Publ Hlth, London, England..
    Jogi, Rain
    Tartu Univ Clin, Dept Lung Med, Tartu, Estonia..
    Lindberg, Eva
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Moratalla Rovira, Jesus Martinez
    Serv Salud Castilla La Mancha, Serv Neumol, Albacete, Spain..
    Muniozguren Agirre, Nerea
    Gobiemo Vasco Hosp, Dep Salud, Epidemiol, Salud Publ, Galdakao, Spain..
    Pin, Isabelle
    CHU Grenoble Alpes, Antenne Pediatr CIC, Pneumol Pediat, Grenoble, France..
    Probst-Hensch, Nicole
    Swiss Trop & Publ Hlth Inst, Basel, Switzerland.;Univ Basel, Dept Publ Hlth, Basel, Switzerland..
    Puggini, Luca
    Univ Ireland, Dept Elect Engn, Maynooth, Kildare, Ireland..
    Raherison, Chantal
    U1219, Bordeaux Populat Hlth Res Ctr, Bordeaux, France..
    Luis Sanchez-Ramos, Jose
    Univ Huelva, Dept Nursing, Huelva, Spain..
    Schlunssen, Vivi
    Aarhus Univ, Dept Publ Hlth, Aarhus, Denmark.;Nat Res Ctr Working Environm, Copenhagen, Denmark..
    Sunyer, Jordi
    Hosp del Mar, Med Res Inst, Barcelona, Spain..
    Svanes, Cecilie
    Univ Bergen, Ctr Int Hlth, Bergen, Norway.;Haukeland Hosp, Dept Occupat Med, Bergen, Norway..
    Hustad, Steinar
    Univ Bergen, Dept Clin Sci, Bergen, Norway.;Univ Bergen, Core Fac Metab, Bergen, Norway..
    Leynaert, Benedicte
    UMR1152, French Natl Inst Hlth & Med Res INSERM, Team Epidemiol, Paris, France..
    Gomez Real, Francisco
    Univ Bergen, Dept Clin Sci, Bergen, Norway.;Univ Bergen, Dept Gynecol & Obstet, Bergen, Norway..
    Menopause Is Associated with Accelerated Lung Function Decline2017In: American Journal of Respiratory and Critical Care Medicine, ISSN 1073-449X, E-ISSN 1535-4970, Vol. 195, no 8, p. 1058-1065Article in journal (Refereed)
    Abstract [en]

    Rationale: Menopause is associated with changes in sex hormones, which affect immunity, inflammation, and osteoporosis and may impair lung function. Lung function decline has not previously been investigated in relation to menopause. Objectives: To study whether lung function decline, assessed by FVC and FEV1, is accelerated in women who undergo menopause. Methods: The population-based longitudinal European Community Respiratory Health Survey provided serum samples, spirometry, and questionnaire data about respiratory and reproductive health from three study waves (n = 1,438). We measured follicle-stimulating hormone and luteinizing hormone and added information on menstrual patterns to determine menopausal status using latent class analysis. Associations with lung function decline were investigated using linear mixed effects models, adjusting for age, height, weight, pack-years, current smoking, age at completed full-time education, spirometer, and including study center as random effect. Measurements and Main Results: Menopausal status was associated with accelerated lung function decline. The adjusted mean FVC decline was increased by -10.2 ml/yr (95% confidence interval [CI], -13.1 to -7.2) in transitional women and -12.5 ml/yr (95% CI, -16.2 to -8.9) in post-menopausal women, compared with women menstruating regularly. The adjusted mean FEV1 decline increased by -3.8 ml/yr (95% CI, -6.3 to -2.9) in transitional women and -5.2 ml/yr (95% CI, -8.3 to -2.0) in post-menopausal women. Conclusions: Lung function declined more rapidly among transitional and post-menopausal women, in particular for FVC, beyond the expected age change. Clinicians should be aware that respiratory health often deteriorates during reproductive aging.

  • 210.
    Troosters, Thierry
    et al.
    Katholieke Univ Leuven, Dept Rehabil Sci, Leuven, Belgium.
    Langer, Daniel
    Katholieke Univ Leuven, Dept Rehabil Sci, Leuven, Belgium.
    Burtin, Chris
    Hasselt Univ, Fac Rehabil, BIOMED Biomed Res Inst, REVAL Rehabil Res Ctr, Diepenbeek, Belgium.
    Chatwin, Michelle
    Royal Brompton & Harefield NHS Fdn Trust, Acad & Clin Dept Sleep & Breathing, London, England;Royal Brompton & Harefield NHS Fdn Trust, NIHR Resp Biomed Res Unit, London, England.
    Clini, Enrico M.
    Univ Modena & Reggio Emilia, Dept Med & Surg Sci, Modena, Italy;Univ Hosp Modena Policlin, Modena, Italy.
    Emtner, Margareta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Åsenlöf: Physiotheraphy.
    Gosselink, Rik
    Katholieke Univ Leuven, Dept Rehabil Sci, Leuven, Belgium.
    Grant, Kathleen
    Vaud Univ Hosp, Dept Cardioresp Physiotherapy, Lausanne, Switzerland.
    Inal-Ince, Deniz
    Hacettepe Univ, Fac Hlth Sci, Dept Physiotherapy & Rehabil, Ankara, Turkey.
    Lewko, Agnieszka
    Kingston Univ, Fac Hlth Social Care & Educ, Dept Rehabil Sci, London, England;St Georges Univ London, London, England.
    Main, Eleanor
    UCL, Great Ormond St Inst Child Hlth, Physiotherapy Dept, London, England.
    Oberwaldner, Beatrice
    Med Univ, Postgrad Sch, Graz, Austria.
    Tabin, Nathalie
    European Resp Soc, Educ Dept, Lausanne, Switzerland.
    Pitta, Fabio
    State Univ Londrina UEL, Lab Res Resp Physiotherapy LFIP, Dept Physiotherapy, Londrina, Brazil.
    A guide for respiratory physiotherapy postgraduate education: presentation of the harmonised curriculum2019In: European Respiratory Journal, ISSN 0903-1936, E-ISSN 1399-3003, Vol. 53, no 6, article id 1900320Article in journal (Other academic)
  • 211.
    Troosters, Thierry
    et al.
    Katholieke Univ Leuven, Dept Rehabil Sci, Leuven, Belgium.
    Tabin, Nathalie
    European Resp Soc, Educ Dept, Lausanne, Switzerland.
    Langer, Daniel
    Katholieke Univ Leuven, Dept Rehabil Sci, Leuven, Belgium.
    Burtin, Chris
    Hasselt Univ, Fac Rehabil, BIOMED Biomed Res Inst, Reval Rehabil Res Ctr, Diepenbeek, Belgium.
    Chatwin, Michelle
    Royal Brompton & Harefield NHS Fdn Trust, Acad & Clin Dept Sleep & Breathing, London, England.
    Clini, Enrico M.
    Univ Modena & Reggio Emilia, Dept Med & Surg Sci, Modena, Italy;Univ Hosp Modena Policlin, Modena, Italy.
    Emtner, Margareta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Åsenlöf: Physiotheraphy.
    Gosselink, Rik
    Katholieke Univ Leuven, Dept Rehabil Sci, Leuven, Belgium.
    Grant, Kathleen
    Vaud Univ Hosp, Dept Cardioresp Physiotherapy, Lausanne, Switzerland.
    Inal-Inces, Deniz
    Hacettepe Univ, Fac Hlth Sci, Dept Physiotherapy & Rehabil, Ankara, Turkey.
    Lewko, Agnieszka
    Kingston Univ, Fac Hlth Social Care & Educ, Dept Rehabil Sci, London, England;St Georges Univ London, London, England.
    Main, Eleanor
    UCL, Great Ormond St Inst Child Hlth, Physiotherapy Dept, London, England.
    Mitchell, Sharon
    World Heart Federat, Geneva, Switzerland.
    Niculescu, Alexandra
    Univ Oslo, Ctr Educ Measurement CEMO, Fac Educ, Oslo, Norway.
    Oberwaldner, Beatrice
    Med Univ, Postgrad Sch, Graz, Austria.
    Pitta, Fabio
    State Univ Londrina UEL, Lab Res Resp Physiotherapy LFIP, Dept Physiotherapy, Londrina, Brazil.
    Introduction of the harmonised respiratory physiotherapy curriculum2019In: Breathe, ISSN 1810-6838, E-ISSN 2073-4735, Vol. 15, no 2, p. 110-115Article, review/survey (Refereed)
    Abstract [en]

    Building on the core syllabus for postgraduate training in respiratory physiotherapy, published in 2014, the European Respiratory Society (ERS) respiratory physiotherapy task force has developed a harmonised and structured postgraduate curriculum for respiratory physiotherapy training. The curriculum outlines the knowledge, skills and attitudes which must be mastered by a respiratory physiotherapist working with adult or paediatric patients, together with guidance for minimal clinical exposures, and forms of learning and assessment. This article presents the rationale, methodology and content of the ERS respiratory physiotherapy curriculum. The full curriculum can be found in the supplementary material.

  • 212.
    Tsolakis, Nikolaos
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Paediatric Inflammation Research.
    Malinovschi, Andrei
    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, Lung- allergy- and sleep research.
    Alving, Kjell
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Paediatric Inflammation Research.
    Biomarker-assisted characterisation of non-type 2 disease in young asthmatics2018In: European Respiratory Journal, ISSN 0903-1936, E-ISSN 1399-3003, Vol. 52Article in journal (Other academic)
  • 213.
    Tsolakis, Nikolaos
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Paediatric Inflammation Research.
    Malinovschi, Andrei
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Physiology.
    Nordvall, Lennart
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Paediatric Inflammation Research.
    Janson, Christer
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Borres, Magnus P
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Paediatric Inflammation Research.
    Alving, Kjell
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Paediatric Inflammation Research.
    The absence of serum IgE antibodies indicates non-type 2 disease in young asthmatics2018In: Clinical and Experimental Allergy, ISSN 0954-7894, E-ISSN 1365-2222, Vol. 48, no 6, p. 722-730Article in journal (Refereed)
    Abstract [en]

    Background:

    Atopic asthma is associated with elevated type-2 biomarkers such as fraction of exhaled nitric oxide (FeNO) and blood eosinophil (B-Eos) count. However, increased type 2 markers have also been reported in traditionally defined non-atopic asthma.

    Objective:

    To determine a clinically useful level of IgE sensitization for ruling out type 2 asthma. Methods: Asthmatics (N=408; age 10-35years) were analysed using the multi-allergen tests Phadiatop and fx5 (ImmunoCAP). Subjects were grouped based on IgE-antibody concentrations: 0.35kU(A)/L for at least one test (n=326) or <0.35kU(A)/L for both tests (n=82). he latter group was subsequently divided into 2 groups: IgE 0.10-0.34kU(A)/L (n=34) and IgE<0.10kU(A)/L (n=48). The relationships between type 2 biomarkers, and inadequate asthma control (ACT<20), reduced lung function (FEV1<80%), recent asthma attacks and airway hyperresponsiveness (AHR) to methacholine were determined.

    Results:

    In univariate analyses, at least one type 2 marker related to each asthma outcome in subjects with IgE 0.35kU(A)/L. In subjects with IgE 0.10-0.34kU(A)/L, elevated FeNO related to reduced lung function (P=.008) and B-Eos to AHR (P=.03). No associations were found in subjects with IgE<0.10kU(A)/L. In multivariate analysis, a relationship between FeNO and reduced lung function remained in subjects with IgE<0.35kU(A)/L (P=.03).

    Conclusion and Clinical Relevance:

    Clinically relevant elevation of type 2 biomarkers was seen in young asthmatics with IgE antibodies <0.35kU(A)/L, but not those with IgE<0.10kU(A)/L. It seems possible to define non-type 2 asthma through sensitive IgE-antibody measurement.

  • 214.
    Tsolakis, Nikolaos
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Paediatric Inflammation Research.
    Malinovschi, Andrei
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Physiology.
    Nordvall, Lennart
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Paediatric Inflammation Research.
    Janson, Christer
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Mattson, L.
    Thermo Fisher Sci, Uppsala, Sweden..
    Lidholm, J.
    Thermo Fisher Sci, Uppsala, Sweden..
    Borres, M.
    Thermo Fisher Sci, Uppsala, Sweden..
    Alving, Kjell
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Paediatric Inflammation Research.
    Sensitisation to Fel d 2, 4 and 7 is associated with type-2 inflammation in young asthmatics2017In: Allergy. European Journal of Allergy and Clinical Immunology, ISSN 0105-4538, E-ISSN 1398-9995, Vol. 72, p. 340-340Article in journal (Other academic)
  • 215.
    Tsolakis, Nikolaos
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Paediatric Inflammation Research.
    Malinovschi, Andrei
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Physiology.
    Nordvall, Lennart
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Paediatric Inflammation Research.
    Mattsson, Lars
    Thermo Fisher Sci, Uppsala, Sweden.
    Lidholm, Jonas
    Thermo Fisher Scientific, Uppsala, Sweden.
    Pedroletti, C.
    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, Lung- allergy- and sleep research.
    Borres, Magnus P
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Paediatric Inflammation Research.
    Alving, Kjell
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Paediatric Inflammation Research.
    Sensitization to minor cat allergen components is associated with type-2 biomarkers in young asthmatics2018In: Clinical and Experimental Allergy, ISSN 0954-7894, E-ISSN 1365-2222, Vol. 48, no 9, p. 1186-1194Article in journal (Refereed)
    Abstract [en]

    Background: Cat allergy is a major trigger of asthma world-wide. Molecular patterns of cat sensitization vary between individuals, but their relationship to inflammation in asthmatics has not been extensively studied.

    Objective: To investigate the prevalence and levels of IgE antibodies against different cat allergen components and their relationship to type-2 inflammation and total IgE among young asthmatic subjects sensitized to furry animals.

    Methods: Patients with asthma (age 10-35 years; n = 266) and IgE sensitization to cat, dog or horse extract (ImmunoCAP), were analysed for IgE to the cat allergen components Fel d 1 (secretoglobin), Fel d 2 (serum albumin), Fel d 4 and Fel d 7 (lipocalins). Independent associations between IgE-antibody concentrations, and fraction of exhaled nitric oxide (FeNO), blood eosinophil (B-Eos) count, and total IgE were analysed by multiple linear regression after adjustment for possible confounders.

    Results: The level of IgE against Fel d 2 was independently related to FeNO (P = .012) and total IgE (P < .001), and IgE against Fel d 4 associated with B-Eos count (P = .009) and total IgE (P < .001). IgE antibodies against Fel d 1 or cat extract did not independently relate to these inflammatory markers (P = .23-.51).

    Conclusions: Levels of IgE to lipocalin (Fel d 4) and serum albumin (Fel d 2), but not to secretoglobin (Fel d 1) or cat extract, were independently associated with type-2 biomarkers and total IgE in young asthmatics.

    Clinical relevance: We suggest that measurement of IgE to minor cat allergen components may be useful when investigating asthma morbidity in cat allergic subjects.

  • 216.
    Valkonen, M.
    et al.
    Natl Inst Hlth & Welf, Living Environm & Hlth Unit, Kuopio, Finland.;Univ Eastern Finland, Dept Environm & Biol Sci, Kuopio, Finland..
    Täubel, M.
    Natl Inst Hlth & Welf, Living Environm & Hlth Unit, Kuopio, Finland..
    Pekkanen, J.
    Natl Inst Hlth & Welf, Living Environm & Hlth Unit, Kuopio, Finland.;Univ Helsinki, Dept Publ Hlth, Helsinki, Finland..
    Tischer, C.
    Ctr Res Environm Epidemiol CREAL, ISGlobal, Barcelona, Spain.;UPF, Barcelona, Spain.;CIBERESP, Barcelona, Spain..
    Rintala, H.
    Natl Inst Hlth & Welf, Living Environm & Hlth Unit, Kuopio, Finland..
    Zock, J. -P
    Casas, L.
    Katholieke Univ Leuven, Dept Publ Hlth & Primary Care, Ctr Environm & Hlth, Leuven, Belgium.;Res Fdn Flanders FWO, Brussels, Belgium..
    Probst-Hensch, N.
    Swiss Trop & Publ Hlth Inst, Head Dept Epidemiol & Publ Hlth, Basel, Switzerland.;Univ Basel, Dept Publ Hlth, Basel, Switzerland..
    Forsberg, B.
    Umea Univ, Dept Publ Hlth & Clin Med, Occupat & Environm Med, Umea, Sweden..
    Holm, M.
    Sahlgrens Univ Hosp, Dept Occupat & Environm Med, Gothenburg, Sweden..
    Janson, Christer
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Pin, I.
    Univ Grenoble Alpes, INSERM, CHU Grenoble Alpes, U 1209, Grenoble, France..
    Gislason, T.
    Landspitali Univ Hosp E7, Dept Resp Med & Sleep, Reykjavik, Iceland.;Univ Iceland, Fac Med, Reykjavik, Iceland..
    Jarvis, D.
    Imperial Coll, Natl Heart & Lung Inst, Populat Hlth & Occupat Dis, London, England.;Imperial Coll, MRC PHE Ctr Environm & Hlth, London, England..
    Heinrich, J.
    Ludwig Maximillians Univ Munich, Univ Hosp Munich, Inst & Outpatient Clin Occupat Social & Environm, German Ctr Lung Res DZL, Munich, Germany.;German Res Ctr Environm Hlth, Inst Epidemiol 1, Helmholtz Zentrum Munchen, Neuherberg, Germany..
    Hyvärinen, A.
    Natl Inst Hlth & Welf, Living Environm & Hlth Unit, Kuopio, Finland..
    Microbial characteristics in homes of asthmatic and non-asthmatic adults in the ECRHS cohort2018In: Indoor Air, ISSN 0905-6947, E-ISSN 1600-0668, Vol. 28, no 1, p. 16-27Article in journal (Refereed)
    Abstract [en]

    Microbial exposures in homes of asthmatic adults have been rarely investigated; specificities and implications for respiratory health are not well understood. The objectives of this study were to investigate associations of microbial levels with asthma status, asthma symptoms, bronchial hyperresponsiveness (BHR), and atopy. Mattress dust samples of 199 asthmatics and 198 control subjects from 7 European countries participating in the European Community Respiratory Health Survey II study were analyzed for fungal and bacterial cell wall components and individual taxa. We observed trends for protective associations of higher levels of mostly bacterial markers. Increased levels of muramic acid, a cell wall component predominant in Gram-positive bacteria, tended to be inversely associated with asthma (OR's for different quartiles: II 0.71 [0.39-1.30], III 0.44 [0.23-0.82], and IV 0.60 [0.31-1.18] P for trend .07) and with asthma score (P for trend .06) and with atopy (P for trend .02). These associations were more pronounced in northern Europe. This study among adults across Europe supports a potential protective effect of Gram-positive bacteria in mattress dust and points out that this may be more pronounced in areas where microbial exposure levels are generally lower.

  • 217.
    Vultaggio, A.
    et al.
    Careggi Univ Hosp, Dept Biomed, Immunoallergol Unit, Florence, Italy.
    Nencini, F.
    Univ Florence, Ctr Res Transfer & High Educ DENOTHE, Florence, Italy;Univ Florence, Dept Expt & Clin Med, Florence, Italy.
    Carraresi, A.
    Careggi Univ Hosp, Dept Biomed, Immunoallergol Unit, Florence, Italy.
    Pratesi, S.
    Univ Florence, Ctr Res Transfer & High Educ DENOTHE, Florence, Italy;Univ Florence, Dept Expt & Clin Med, Florence, Italy.
    Movérare, Robert
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research. Thermo Fisher Sci, ImmunoDiagnost, Uppsala, Sweden.
    Eriksson, C.
    Thermo Fisher Sci, ImmunoDiagnost, Uppsala, Sweden.
    Venemalm, L.
    Thermo Fisher Sci, ImmunoDiagnost, Uppsala, Sweden.
    Maggi, E.
    Univ Florence, Ctr Res Transfer & High Educ DENOTHE, Florence, Italy;Univ Florence, Dept Expt & Clin Med, Florence, Italy.
    Matucci, A.
    Careggi Univ Hosp, Dept Biomed, Immunoallergol Unit, Florence, Italy.
    IgG4 anti-infliximab in treated patients: Clinical impact and temporal evolution2018In: Allergy. European Journal of Allergy and Clinical Immunology, ISSN 0105-4538, E-ISSN 1398-9995, Vol. 73, no 11, p. 2172-2181Article in journal (Refereed)
    Abstract [en]

    Background: Infliximab (IFX) carries potential risk of immunogenicity with the production of anti-drug antibodies (ADA). ADA may belong to different isotypes and are usually measured by ELISA bridging assay. This test is not designed to detect IgG4 antibodies. The aim was to measure IgG4 anti-IFX antibodies in a cohort of IFX-treated patients and to evaluate their relationship with ADA and their clinical impact.

    Methods: Anti-drug antibodies were detected using a bridging ELISA in the serum of 222 treated patients with different clinical outcomes to IFX. The same samples were analyzed for IgG4 anti-IFX antibodies using an experimental ImmunoCAP assay with reduced serum IgG4 background levels. A longitudinal evaluation was performed in a subgroup of 38 patients to define the temporal evolution of IgG4 anti-IFX.

    Results: IgG4 anti-IFX was found in 26.6% of patients. Eighty of 222 patients were ADA+ (36%) and the majority (57/80, 71.3%) had IgG4 anti-IFX. Two IgG4-positive but ADA-negative patients were identified. IgG4 anti-IFX levels correlated with the serum levels of ADA. IgG4 anti-IFX was more common in both reactive and nonresponder patients than in tolerant/responder patients. Patients who had experienced IgE-mediated reactions displayed significantly higher IgG4 anti-IFX than IgE-negative reactive patients. The majority of patients tested positive for IgG4 anti-IFX after the first seven infusions.

    Conclusions: IgG4 anti-IFX is common in treated patients and a large part of ADA producing patients produce IgG4 antibodies. The IgG4 anti-IFX response does not prevent hypersensitivity reactions to IFX and correlates with the IgE anti-IFX response.

  • 218.
    Walker, Paul P.
    et al.
    Aintree Univ Hosp NHS Fdn Trust, Liverpool, Merseyside, England;Univ Liverpool, Sch Ageing & Chron Dis, Liverpool, Merseyside, England.
    Pompilio, Pasquale P.
    Restech Srl, Milan, Italy.
    Zanaboni, Paolo
    Univ Hosp North Norway, Norwegian Ctr Hlth Res, Tromso, Norway.
    Bergmo, Trine S.
    Univ Hosp North Norway, Norwegian Ctr Hlth Res, Tromso, Norway.
    Prikk, Kaiu
    Tallinn Univ Technol, Technomedicum, Tallinn, Estonia.
    Malinovschi, Andrei
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Physiology.
    Montserrat, Josep M.
    Hosp Clin Barcelona, Barcelona, Spain;Ctr Invest Biomed Red Enfermedades Resp, Madrid, Spain.
    Middlemass, Jo
    Univ Lincoln, Sch Hlth & Social Care, Community & Hlth Res Unit, Lincoln, England.
    Sonc, Silvana
    Hosp Sezana, Sezana, Slovenia.
    Munaro, Giulia
    Elettron Bio Med Spa, Foligno, Italy.
    Marusic, Dorjan
    Hosp Sezana, Sezana, Slovenia.
    Sepper, Ruth
    Tallinn Univ Technol, Technomedicum, Tallinn, Estonia.
    Rosso, Roberto
    Elettron Bio Med Spa, Foligno, Italy.
    Siriwardena, A. Niroshan
    Univ Lincoln, Sch Hlth & Social Care, Community & Hlth Res Unit, Lincoln, England.
    Janson, Christer
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Farre, Ramon
    Univ Barcelona, Inst Invest Biomed August Pi Sunyer, Fac Med & Ciencies Salut, Unitat Biofis & Bioengn, Barcelona, Spain;Ctr Invest Biomed Red Enfermedades Resp, Madrid, Spain.
    Calverley, Peter M. A.
    Univ Liverpool, Sch Ageing & Chron Dis, Liverpool, Merseyside, England.
    Dellaca, Raffaele L.
    Restech Srl, Milan, Italy;Politecn Milano Univ, Dipartimento Elettron Informaz & Bioingn, Piazza Leonardo da Vinci 32, I-20133 Milan, Italy.
    Telemonitoring in Chronic Obstructive Pulmonary Disease (CHROMED): A Randomized Clinical Trial2018In: American Journal of Respiratory and Critical Care Medicine, ISSN 1073-449X, E-ISSN 1535-4970, Vol. 198, no 5, p. 620-628Article in journal (Refereed)
    Abstract [en]

    Rationale: Early detection of chronic obstructive pulmonary disease (COPD) exacerbations using telemonitoring of physiological variables might reduce the frequency of hospitalization.

    Objectives: To evaluate the efficacy of home monitoring of lung mechanics by the forced oscillation technique and cardiac parameters in older patients with COPD and comorbidities.

    Methods: This multicenter, randomized clinical trial recruited 312 patients with Global Initiative for Chronic Obstructive Lung Disease grades II to IV COPD (median age, 71 yr [interquartile range, 66-76 yr]; 49.6% grade II, 50.4% grades III-IV), with a history of exacerbation in the previous year and at least one nonpulmonary comorbidity. Patients were randomized to usual care (n = 158) or telemonitoring (n = 154) and followed for 9 months. All telemonitoring patients self-assessed lung mechanics daily, and in a subgroup with congestive heart failure (n = 37) cardiac parameters were also monitored. An algorithm identified deterioration, triggering a telephone contact to determine appropriate interventions.

    Measurements and Main Results: Primary outcomes were time to first hospitalization (TTFH) and change in the EuroQoL EQ-5D utility index score. Secondary outcomes included: rate of antibiotic/corticosteroid prescription; hospitalization; the COPD Assessment Tool, Patient Health Questionnaire-9, and Minnesota Living with Heart Failure questionnaire scores; quality-adjusted life years; and healthcare costs. Telemonitoring did not affect TTFH, EQ-5D utility index score, antibiotic prescriptions, hospitalization rate, or questionnaire scores. In an exploratory analysis, telemedicine was associated with fewer repeat hospitalizations (-54%; P = 0.017).

    Conclusions: In older patients with COPD and comorbidities, remote monitoring of lung function by forced oscillation technique and cardiac parameters did not change TTFH and EQ-5D.

  • 219.
    Wang, Juan
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Pindus, Mihkel
    Institute of Family Medicine and Public Health, University of Tartu, Estonia..
    Janson, Christer
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Jogi, Rain
    Lung Clinic, Tartu University Hospital, Tartu, Estonia..
    Sigsgaard, Torben
    Department of Public Health, Section for Environment, Occupation and Health, Aarhus University, Danish Ramazzini Center, Aarhus, Denmark. .
    Kim, Jeong Lim
    Occupational and Environmental Medicine, Gothenburg University, Gothenburg, Sweden..
    Holm, Mathias
    Occupational and Environmental Medicine, Gothenburg University, Gothenburg, Sweden..
    Sommer, Johan
    Occupational and Environmental Medicine, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden..
    Orru, Hans
    Institute of Family Medicine and Public Health, University of Tartu, Estonia. Occupational and Environmental Medicine, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden..
    Gunnbjörnsdottir, Maria
    Landspitali University Hospital (E7), 108 Reykjavik, Iceland..
    Gislason, Thorarinn
    Landspitali University Hospital (E7), 108 Reykjavik, Iceland..
    Johannessen, Ane
    Department of Clinical Science, University of Bergen, Bergen, Norway..
    Bertelsen, Randi J.
    Department of Clinical Science, University of Bergen, Bergen, Norway. Department of Occupational Medicine, Haukeland University Hospital, Bergen, Norway..
    Norbäck, Dan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Adult onset and remission of respiratory symptoms, asthma and rhinitis in relation to dampness, mould and mould odour: the RHINE cohortIn: Article in journal (Other academic)
  • 220.
    Wang, Juan
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Pindus, Mihkel
    Univ Tartu, Inst Family Med & Publ Hlth, Tartu, Estonia.
    Janson, Christer
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Sigsgaard, Torben
    Aarhus Univ, Danish Ramazzini Ctr, Sect Environm Occupat & Hlth, Dept Publ Hlth, Aarhus, Denmark.
    Kim, Jeong-Lim
    Gothenburg Univ, Occupat & Environm Med, Gothenburg, Sweden.
    Holm, Mathias
    Gothenburg Univ, Occupat & Environm Med, Gothenburg, Sweden.
    Sommar, Johan
    Umea Univ, Dept Publ Hlth & Clin Med, OCcupat & Environm Med, Umea, Sweden.
    Orru, Hans
    Univ Tartu, Inst Family Med & Publ Hlth, Tartu, Estonia;Umea Univ, Dept Publ Hlth & Clin Med, OCcupat & Environm Med, Umea, Sweden.
    Gislason, Thorarinn
    Landspitali Univ Hosp E7, Reykjavik, Iceland.
    Johannessen, Ane
    Univ Bergen, Ctr Int Hlth, Dept Global Publ Hlth & Primary Care, Bergen, Norway;Haukeland Hosp, Dept Occupat Med, Bergen, Norway.
    Bertelsen, Randi J.
    Univ Bergen, Ctr Int Hlth, Dept Global Publ Hlth & Primary Care, Bergen, Norway;Haukeland Hosp, Dept Occupat Med, Bergen, Norway;Univ Bergen, Dept Clin Sci, Bergen, Norway.
    Norbäck, Dan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Dampness, mould, onset and remission of adult respiratory symptoms, asthma and rhinitis2019In: European Respiratory Journal, ISSN 0903-1936, E-ISSN 1399-3003, Vol. 53, no 5, article id 1801921Article in journal (Refereed)
    Abstract [en]

    Study question: Is dampness and indoor mould associated with onset and remission of respiratory symptoms, asthma and rhinitis among adults?

    Materials and methods: Associations between dampness, mould and mould odour at home and at work and respiratory health were investigated in a cohort of 11 506 adults from Iceland, Norway, Sweden, Denmark and Estonia. They answered a questionnaire at baseline and 10 years later, with questions on respiratory health, home and work environment.

    Results: Baseline water damage, floor dampness, mould and mould odour at home were associated with onset of respiratory symptoms and asthma (OR 1.23-2.24). Dampness at home during follow-up was associated with onset of respiratory symptoms, asthma and rhinitis (OR 1.21-1.52). Dampness at work during follow-up was associated with onset of respiratory symptoms, asthma and rhinitis (OR 1.31-1.50). Combined dampness at home and at work increased the risk of onset of respiratory symptoms and rhinitis. Dampness and mould at home and at work decreased remission of respiratory symptoms and rhinitis.

    The answer to the question: Dampness and mould at home and at work can increase onset of respiratory symptoms, asthma and rhinitis, and decrease remission.

  • 221.
    Westerberg, Elisabet
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Clinical Neurophysiology. Ryhov Cty Hosp, Dept Neurol, Jonkoping, Sweden.
    Molin, Carl Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Clinical Neurophysiology.
    Lindblad, Ida
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Clinical Neurophysiology.
    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, Lung- allergy- and sleep research.
    Rostedt Punga, Anna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Clinical Neurophysiology.
    Physical exercise in Myasthenia Gravis is safe and improves neuromuscular parameters and physical performance-based measures: A pilot study2017In: Muscle and Nerve, ISSN 0148-639X, E-ISSN 1097-4598, Vol. 56, no 2, p. 207-214Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: Due to the shortage of exercise-related research in Myasthenia Gravis (MG), there are no consensus guidelines on physical exercise for MG patients.

    METHODS: In this prospective pilot study, 10 MG patients with mild disease performed supervised aerobic and resistance training twice weekly for 12 weeks. The Myasthenia Gravis Composite (MGC) score, compound motor action potential (CMAP), repetitive nerve stimulation, muscle force, physical performance-based measures, serum levels of interleukin-6, muscle enzymes as well as immuno-microRNAs miR-150-5p and miR-21-5p were assessed before and after the training period.

    RESULTS: Physical exercise was well tolerated, and the MGC score was unchanged. Muscle resistance weights and CMAP amplitudes increased for biceps brachii and rectus femoris muscles, and physical performance-based measures improved. Muscle enzymes remained normal, whereas disease-specific microRNAs miR-150-5p and miR-21-5p were reduced after the training period.

    CONCLUSIONS: We propose that general recommendations regarding physical exercise safely can be applied to well-regulated MG patients.

  • 222.
    Westerdahl, Elisabeth
    et al.
    Orebro Univ, Orebro Univ Hosp, Dept Physiotherapy, CAMTO, Orebro, Sweden;Orebro Univ, Fac Med & Hlth, Orebro, Sweden.
    Arne, Mats
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research. Ctr Clin Res, Karlstad, Sweden.
    Larsson, Matz
    Orebro Univ Hosp, Heart Lung Clin, Orebro, Sweden;Orebro Cty Council, Tobacco Prevent Unit, Orebro, Sweden.
    Engman, Kjell Ola
    Sormland Cty Council, Nykoping, Sweden.
    Spirometry to motivate smoking cessation - a systematic review2018In: European Respiratory Journal, ISSN 0903-1936, E-ISSN 1399-3003, Vol. 52Article in journal (Other academic)
  • 223.
    Westerdahl, Elisabeth
    et al.
    Ctr Assessment Med Technol Orebro, S-70116 Orebro, Region Orebro C, Sweden;Orebro Univ, Fac Med & Hlth, Univ Hlth Care Res Ctr, Dept Physiotherapy, Orebro, Sweden.
    Engman, Kjell Ola
    Sormland Cty Council, Med Advisory Comm, Nykoping, Sweden.
    Arne, Mats
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research. Ctr Clin Res, Karlstad, Region Varmland, Sweden.
    Larsson, Matz
    Lund Univ, Clin Hlth Promot Ctr, Lund, Sweden;Orebro Univ Hosp, Heart Lung & Physiol Clin, Orebro, Sweden;Orebro Univ, Fac Med & Hlth, Sch Med Sci, Orebro, Sweden.
    Spirometry to increase smoking cessation rate: A systematic review2019In: Tobacco Induced Diseases, ISSN 1617-9625, E-ISSN 1617-9625, Vol. 17, article id 31Article, review/survey (Refereed)
    Abstract [en]

    INTRODUCTION Addressing tobacco use is an important issue in general health care. In order to improve smoking cessation advice, spirometry values can be displayed to the smoker to demonstrate possible lung function impairment. The estimate of so-called lung age may show a decrease in lung function associated with smoking. It has been suggested that performing spirometry on patients who smoke but are asymptomatic can be a useful way to show the adverse effects of smoking. The aim of this systematic review was to determine if providing spirometry results in combination with smoking cessation counselling can increase smoking cessation rates compared to what is achieved through counselling alone. METHODS In this systematic review, we included randomized controlled trials (RCTs) evaluating smoking cessation interventions for adult smokers. The systematic search was performed in PubMed, Medline, Cochrane Library, Cinahl, Embase, Amed and PsycInfo. RESULTS The literature search resulted in 946 studies, which, after reading by two independent reviewers, were reduced to seven trials that matched the inclusion criteria. Two RCTs showed significant improvement in smoking cessation when giving patients feedback on spirometry results in combination with smoking cessation counselling, compared to patients who received only smoking cessation counselling. In both studies, the spirometry results were expressed as lung age. In the other five studies no difference was found. Five further published study protocols for ongoing RCT studies in the field have been found, and therefore this systematic overview will likely need to be updated within a few years. CONCLUSIONS Few studies have been undertaken to examine the efficacy of spirometry in increasing smoking quit rates. Studies conducted to date have shown mixed results, and there is currently limited evidence in the literature that smoking cessation counselling that includes feedback from spirometry and a demonstration of lung age promotes quit rates.

  • 224.
    Westerdahl, Elisabeth
    et al.
    Orebro Univ, Fac Med & Hlth, Dept Physiotherapy, Orebro, Sweden;Uppsala Univ, Dept Med Sci, Uppsala, Sweden.
    Osadnik, Christian
    Monash Univ, Dept Physiotherapy, Melbourne, Vic, Australia;Monash Hlth, Monash Lung & Sleep, Melbourne, Vic, Australia.
    Emtner, Margareta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Airway clearance techniques for patients with acute exacerbations of chronic obstructive pulmonary disease: Physical therapy practice in Sweden2019In: Chronic Respiratory Disease, ISSN 1479-9723, E-ISSN 1479-9731, Vol. 16, article id UNSP 1479973119855868Article in journal (Refereed)
    Abstract [en]

    There is considerable global variability in clinical practice regarding the prescription of airway clearance techniques (ACTs) for patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPD). Little is known about the physical therapy practice, and no international guidelines are available. The aim of this survey was to identify current physical therapy practice regarding ACT prescription for patients with AECOPD in Sweden. A cross-sectional, descriptive study was conducted via a Web-based questionnaire, sent to all (n = 70) hospitals that offer physical therapy service for patients with AECOPD in Sweden. Responses were received from 117 physical therapists (76%) across all sites. ACTs were prescribed for more than half of all patients with an AECOPD by 75% of physical therapists. The most frequently used ACTs were positive expiratory pressure (PEP) devices (90%), directed huffing (88%) and cough (71%). Most physical therapists (89%) perceived sputum clearance to be an important aspect of the overall management of patients with AECOPD. The main factors influencing choice of ACT were the 'degree of dyspnoea or work of breathing' and 'access to resources/equipment'. Physical therapists prescribe predominantly PEP-based ACTs for patients with AECOPD in Sweden. Several factors come into consideration that influences the choice of treatment technique.

  • 225.
    Wilkinson, Alexander
    et al.
    East & North Hertfordshire NHS Trust, Stevenage SG1 4AB, Herts, England.
    Hillman, Toby
    Univ Coll London Hosp NHS Fdn Trust, London, England;Royal Coll Physicians, Sustainabil Programme, London, England.
    Hopkinson, Nicholas S.
    Imperial Coll London, Natl Heart & Lung Inst, London, England.
    Janson, Christer
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Smith, James
    Univ Cambridge, Dept Publ Hlth & Primary Care, Cambridge, England.
    Woodcock, Ashley A.
    Univ Manchester, Manchester Acad Hlth Sci Ctr, Div Infect Immun & Resp Med, Manchester, Lancs, England;Manchester Univ NHS Fdn Trust, Manchester, Lancs, England.
    Our patients and our planet-holistic considerations for inhaler choice2019In: The Lancet Respiratory Medicine, ISSN 2213-2600, E-ISSN 2213-2619, Vol. 7, no 3, p. E11-E11Article in journal (Other academic)
  • 226.
    Zakrisson, Ann-Britt
    et al.
    Orebro Univ, Fac Med & Hlth, Dept Univ Healthcare Res Ctr, Orebro, Sweden.
    Arne, Mats
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research. Cty Council Varmland, Ctr Clin Res, Karlstad, Sweden.
    Hasselgren, Mikael
    Orebro Univ, Sch Med Sci, Orebro, Sweden.
    Lisspers, Karin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Ställberg, Björn
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Theander, Kersti
    Cty Council Varmland, Ctr Clin Res, Karlstad, Sweden.
    A complex intervention of self-management for patients with COPD or CHF in primary care improved performance and satisfaction with regard to own selected activities; A longitudinal follow-up2019In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 75, no 1, p. 175-186Article in journal (Refereed)
    Abstract [en]

    Aim: To test a self-management intervention in primary health care (PHC) for patients with chronic obstructive pulmonary disease (COPD) or chronic heart failure (CHF) on self-efficacy, symptoms, functioning, and health.

    Background: Patients with COPD or CHF experience often the same symptoms such as shortness of breath, cough, lack of energy, dry mouth, numbness or tingling in hands and feet, pain and sleeping problems.

    Design: A multicentre randomized control trial.

    Method: The trial was conducted with one intervention group (N = 73) and one control group (N = 77). The trial was performed from September 2013-September 2015 at nine PHC centres in three county councils in Sweden. At baseline patients with COPD and CHF experienced any symptom. Follow-ups were performed after 3 months and 1 year. The intervention was structured on Bandura's theory of self-efficacy in six meetings and individual action plans based on personal problems were performed and discussed.

    Results: At baseline, there were no differences between the groups except for SF-36 social function. After 3 months, the intervention group improved performance and satisfaction with regard to own selected activities, otherwise no differences were found. Conclusion When designing a program, the patient's own difficulties must be taken into consideration if person-centred care is to be established. It is feasible to include both patients with COPD and CHF in the same group in PHC. Healthcare professionals need supervision in pedagogics during intervention in self-management.

  • 227.
    Åberg, Joakim
    et al.
    Orebro Univ, Sch Med Sci, S-70185 Orebro, Sweden.
    Hasselgren, Mikael
    Orebro Univ, Sch Med Sci, S-70185 Orebro, Sweden.
    Montgomery, Scott
    Orebro Univ, Clin Epidemiol & Biostat, S-70182 Orebro, Sweden;Karolinska Inst, Dept Med, Clin Epidemiol Unit, Stockholm, Sweden;UCL, Dept Epidemiol & Publ Hlth, London, England.
    Lisspers, Karin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Ställberg, Björn
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Janson, Christer
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Sundh, Josefin
    Orebro Univ, Sch Med Sci, Dept Resp Med, S-70185 Orebro, Sweden.
    Sex-related differences in management of Swedish patients with a clinical diagnosis of chronic obstructive pulmonary disease2019In: The International Journal of Chronic Obstructive Pulmonary Disease, ISSN 1176-9106, E-ISSN 1178-2005, Vol. 14, p. 961-969Article in journal (Refereed)
    Abstract [en]

    Purpose: Women with chronic obstructive pulmonary disease (COPD) have more symptoms, more exacerbations, lower health status scores, and more comorbidity. However, it is unclear whether management of COPD differs by sex. The aim of the study was to investigate differences by sex in the care of patients with COPD. Patients and methods: The population included 1329 primary and secondary care patients with a doctor ' s diagnosis of COPD in central Sweden. Data were obtained from patient questionnaires and included patient characteristics and data on achieved COPD care. Analyses included cross-tabulations, chi-squared test and multiple logistic regression using several measures in COPD management as dependent variables, female sex as independent variable, and with adjustment for age groups, previous exacerbations, COPD Assessment Test, level of dyspnea assessed by the modified Medical Research Council scale, comorbid conditions, self-rated moderate/severe disease, level of education and body mass index. Results: Women were more likely to receive triple therapy (OR 1.86 (95% CI 1.38-2.51)), to have any maintenance treatment (OR 1.82 (95% CI 1.31-2.55)), to be on sick leave (OR 2.16 (95% CI 1.19-3.93)), to have received smoking cessation support (OR 1.80 (95% CI 1.18-2.75)) and to have had pneumococcal vaccination (OR 1.82 (95% CI 1.37-2.43)), all independently of age, severity of disease or other potential confounders. Conclusion: Management of COPD differs by sex, with women being more actively managed than men. It is unclear whether this is due to patient-or care-related factors.

  • 228.
    Åkerstedt, Torbjorn
    et al.
    Karolinska Inst, Dept Clin Neurosci, Stockholm, Sweden;Stockholm Univ, Stress Res Inst, Stockholm, Sweden.
    Schwarz, Johanna
    Karolinska Inst, Dept Clin Neurosci, Stockholm, Sweden;Stockholm Univ, Stress Res Inst, Stockholm, Sweden.
    Gruber, Georg
    Siesta Grp, Vienna, Austria.
    Theorell-Haglöw, Jenny
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Lindberg, Eva
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Short sleep-poor sleep?: A polysomnographic study in a large population-based sample of women2019In: Journal of Sleep Research, ISSN 0962-1105, E-ISSN 1365-2869, Vol. 28, no 4, article id e12812Article in journal (Refereed)
    Abstract [en]

    There is a lack of studies on the association between total sleep time (TST) and other polysomnographical parameters. A key question is whether a short sleep is an expression of habitual short sleep, or whether it reflects temporary impairment. The purpose of the present study was to investigate the association between TST and amount of sleep stages and sleep continuity measures, in a large population-based sample of women (n = 385), sleeping at home in a normal daily life setting. The results show that sleep efficiency, N1 (min), N2 (min), REM (min), REM% and proportion of long sleep segments, increased with increasing TST, whereas the number of awakenings/hr, the number of arousals/hr, N1% and REM intensity decreased. In addition, longer sleep was more associated with TST being perceived as of "usual" duration and with better subjective sleep quality. TST was not associated with habitual reported sleep duration. It was concluded that short TST of a recorded sleep in a real-life context may be an indicator of poor objective sleep quality for that particular sleep episode. Because individuals clearly perceived this reduction, it appears that self-reports of poor sleep quality often may be seen as indicators of poor sleep quality. It is also concluded that PSG-recorded sleep duration does not reflect habitual reported sleep duration in the present real-life context.

  • 229.
    Ýr Gudnadóttir, Arna
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research. Univ Iceland, Fac Med, Reykjavik, Iceland..
    Olafsdottir, Inga Sif
    Univ Iceland, Fac Med, Reykjavik, Iceland.;Landspitali Univ Hosp, Dept Resp Med & Sleep, Reykjavik, Iceland..
    Middelveld, Roelinde
    Karolinska Inst, Ctr Allergy Res, Stockholm, Sweden.;Karolinska Inst, Inst Environm Med, Stockholm, Sweden..
    Ekerljung, Linda
    Gothenburg Univ, Dept Internal Med & Clin Nutr, Gothenburg, Sweden..
    Forsberg, Bertil
    Umea Univ, Dept Publ Hlth & Clin Med, Occupat & Environm Med, Umea, Sweden..
    Franklin, Karl
    Umea Univ, Dept Surg & Perioperat Sci, Umea, Sweden..
    Lindberg, Eva
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Janson, Christer
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    An investigation on the use of snus and its association with respiratory and sleep-related symptoms: a cross-sectional population study2017In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 7, no 5, article id e015486Article in journal (Refereed)
    Abstract [en]

    Introduction Studies of the health effects of moist oral tobacco, snus, have produced inconsistent results. The main objective of this study is to examine the health effects of snus use on asthma, respiratory symptoms and sleep-related problems, a field that has not been investigated before. Methods and material This cross-sectional study was based on a postal questionnaire completed by 26 697 (59.3%) participants aged 16 to 75 years and living in Sweden. The questionnaire included questions on tobacco use, asthma, respiratory symptoms and sleeping problems. The association of snus use with asthma, respiratory symptoms and sleep-related symptoms was mainly tested in never-smokers (n=16 082). Results The current use of snus in never-smokers was associated with an increased risk of asthma (OR 1.51 (95% CI 1.28 to 1.77)), asthmatic symptoms, chronic bronchitis and chronic rhinosinusitis. This association was not present among ex-snus users. Snoring was independently related to both the former and current use of snus ((OR 1.37 (95% CI 1.12 to 1.68)) and (OR 1.59 (95% CI 1.34 to 1.89), respectively)). A higher risk of difficulty inducing sleep was seen among snus users. Conclusion Snus use was associated with a higher prevalence of asthma, respiratory symptoms and snoring. Healthcare professionals should be aware of these possible adverse effects of snus use.

2345 201 - 229 of 229
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