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A Longitudinal Study of Asthma: Risk Factors and Prognosis
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
2010 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

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

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

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

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

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

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

 

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis , 2010. , p. 52
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 622
Keyword [en]
asthma epidemiology, longitudinal studies, obstructive airway symptoms, risk factors, BMI, diet, smoking, allergic sensitization, atopy
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:uu:diva-133218ISBN: 978-91-554-7948-0 (print)OAI: oai:DiVA.org:uu-133218DiVA, id: diva2:360508
Public defence
2010-12-16, Enghoffsalen, Ing 50, Akademiska Sjukhuset, Uppsala, 13:15 (Swedish)
Opponent
Supervisors
Available from: 2010-11-24 Created: 2010-11-03 Last updated: 2011-01-13Bibliographically approved
List of papers
1. Differences in utilization of asthma drugs between two neighbouring Swedish provinces: relation to symptom reporting
Open this publication in new window or tab >>Differences in utilization of asthma drugs between two neighbouring Swedish provinces: relation to symptom reporting
1993 (English)In: European Respiratory Journal, ISSN 0903-1936, E-ISSN 1399-3003, Vol. 6, p. 198-203Article in journal (Refereed) Published
Keyword
asthma, chronic bronchitis, epidemiology, obstructive airways symptoms, anti-asthma drugs
National Category
Respiratory Medicine and Allergy
Research subject
Lung Medicine
Identifiers
urn:nbn:se:uu:diva-133046 (URN)
Available from: 2010-11-01 Created: 2010-11-01 Last updated: 2017-12-12
2. High BMI is related to higher incidence of asthma, while a fish and fruit diet is related to a lower: results from a long-term follow-up study of three age groups in Sweden
Open this publication in new window or tab >>High BMI is related to higher incidence of asthma, while a fish and fruit diet is related to a lower: results from a long-term follow-up study of three age groups in Sweden
Show others...
2010 (English)In: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 104, no 7, p. 972-980Article in journal (Refereed) Published
Abstract [en]

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

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

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

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

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

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

Keyword
asthma, longitudinal study, allergens, allergy tests, skin prick test, prognosis
National Category
Respiratory Medicine and Allergy
Research subject
Occupational and Environmental Medicine
Identifiers
urn:nbn:se:uu:diva-133142 (URN)
Available from: 2010-11-02 Created: 2010-11-02 Last updated: 2017-12-12Bibliographically approved
4. Smoking habits are not influenced by respiratory health and allergic status
Open this publication in new window or tab >>Smoking habits are not influenced by respiratory health and allergic status
2010 (English)Manuscript (preprint) (Other academic)
Publisher
p. 50
Keyword
Asthma, smoking, longitudinal study
National Category
Respiratory Medicine and Allergy
Research subject
Occupational and Environmental Medicine
Identifiers
urn:nbn:se:uu:diva-133048 (URN)
Available from: 2010-11-02 Created: 2010-11-01 Last updated: 2017-06-16Bibliographically approved

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