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  • 1. Andersson Kallin, Sandra
    et al.
    Lindberg, Eva
    Nilsson Sommar, Johan
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Bossios, Apostolos
    Ekerljung, Linda
    Malinovschi, Andrei
    Middelveld, Roelinde
    Janson, Christer
    Excessive daytime sleepiness in asthma: what are the risk factors?2018In: Journal of Asthma, ISSN 0277-0903, E-ISSN 1532-4303, Vol. 55, no 18, p. 844-850Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: Previous studies have found that excessive daytime sleepiness (EDS) is a more common problem in asthmatic subjects than in the general population. The aim of this study was to investigate whether the prevalence of EDS is increased in asthmatic subjects and, if so, to analyse the occurrence of potential risk factors for EDS in asthmatics.

    METHODS: Cross-sectional epidemiological study. In 2008, a postal questionnaire was sent out to a random sample of 45,000 individuals aged 16-75 years in four Swedish cities.

    RESULTS: Of the 25,160 persons who participated, 7.3% were defined as having asthma. The prevalence of EDS was significantly higher in asthmatic subjects (42.1% vs 28.5%, p<0.001) compared with non-asthmatic subjects. Asthma was an independent risk factor for EDS (adjusted OR 1.29) and the risk of having EDS increased with asthma severity. Risk factors for EDS in subjects with asthma included insomnia (OR, 3.87; 95% CI, 3.10-4.84), chronic rhinosinusitis (OR, 2.00; 95% CI, 1.53-2.62), current smoking (OR, 1.60; 95% CI, 1.15-2.22) and obesity (OR, 1.53; 95% CI, 1.09-2.13).

    CONCLUSIONS: EDS is a common problem among subjects with asthma. Asthma is an independent risk factor for having EDS. Furthermore, subjects with asthma often have other risk factors for EDS, many of them potentially modifiable.

  • 2.
    Andersson Kallin, Sandra
    et al.
    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.
    Sommar, Johan Nilsson
    Umeå Univ, Dept Publ Hlth & Clin Med, Occupat & Environm Med, Umeå, Sweden.
    Bossios, Apostolos
    Univ Gothenburg, Sahlgrenska Acad, Krefting Res Ctr, Dept Internal Med & Clin Nutr, Gothenburg, Sweden.
    Ekerljung, Linda
    Univ Gothenburg, Sahlgrenska Acad, Krefting Res Ctr, Dept Internal Med & Clin Nutr, Gothenburg, Sweden.
    Malinovschi, Andrei
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Physiology.
    Middelveld, Roelinde
    Karolinska Inst, Ctr Allergy Res, Stockholm, Sweden; Karolinska Inst, Inst Environm Med, Stockholm, Sweden.
    Janson, Christer
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Excessive daytime sleepiness in asthma: what are the risk factors?2018In: Journal of Asthma, ISSN 0277-0903, E-ISSN 1532-4303, Vol. 55, no 8, p. 844-850Article in journal (Refereed)
    Abstract [en]

    Objective: Previous studies have found that excessive daytime sleepiness (EDS) is a more common problem in asthmatic subjects than in the general population. The aim of this study was to investigate whether the prevalence of EDS is increased in asthmatic subjects and, if so, to analyse the occurrence of potential risk factors for EDS in asthmatics.

    Methods: Cross-sectional epidemiological study. In 2008, a postal questionnaire was sent out to a random sample of 45,000 individuals aged 16–75 years in four Swedish cities.

    Results: Of the 25,160 persons who participated, 7.3% were defined as having asthma. The prevalence of EDS was significantly higher in asthmatic subjects (42.1% vs. 28.5%, p < 0.001) compared with non-asthmatic subjects. Asthma was an independent risk factor for EDS (adjusted OR 1.29) and the risk of having EDS increased with asthma severity. Risk factors for EDS in subjects with asthma included insomnia (OR, 3.87; 95% CI, 3.10–4.84); chronic rhinosinusitis (OR, 2.00; 95% CI, 1.53–2.62); current smoking (OR, 1.60; 95% CI, 1.15–2.22) and obesity (OR, 1.53; 95% CI, 1.09–2.13).

    Conclusions: EDS is a common problem among subjects with asthma. Asthma is an independent risk factor for having EDS. Furthermore, subjects with asthma often have other risk factors for EDS, many of them potentially modifiable.

  • 3.
    Arnetz, Bengt
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine. Department of Family Medicine, College of Human Medicine, Michigan State University, Grand Rapids, Michigan, USA.
    Arnetz, Judy
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine. Department of Family Medicine, College of Human Medicine, Michigan State University, Grand Rapids, Michigan, USA.
    Harkema, Jack R.
    Morishita, Masako
    Slonager, Kathleen
    Sudan, Sukhesh
    Jamil, Hikmet
    Neighborhood air pollution and household environmental health as it relates to respiratory health and healthcare utilization among elderly persons with asthma2020In: Journal of Asthma, ISSN 0277-0903, E-ISSN 1532-4303, Vol. 57, no 1, p. 28-39Article in journal (Refereed)
    Abstract [en]

    Objective: The study investigated the associations between fine particulate matter (PM2.5; <2.5 mu m in diameter), indoor environment, pulmonary function, and healthcare utilization in a vulnerable group of elderly persons with asthma. We hypothesized that environmental conditions were associated with adverse pulmonary health outcomes.

    Methods: The study involved elderly (n = 76; mean age 64.6 years; 48 women) vulnerable persons in Detroit, Michigan, USA, with physician-diagnosed asthma. Exposure variables included measured outdoor PM2.5, self-rated outdoor and household environmental pollutants. Outcome variables were self-rated and measured pulmonary function, and asthma-related healthcare utilization.

    Results: Mean ambient PM2.5 concentrations during the study was 14.14 +/- (S.D. 6.36) mu g/m(3) during the summer and 14.20 (6.33) during the winter (p = 0.95). In multiple regression analyses, adjusting for age and gender, mean 6-month concentration of PM2.5 was related to shortness of breath (SHOB; standardized beta = 0.26, p = 0.02) and inversely with self-rated respiratory health (SRRH; beta = 0.28, p = 0.02). However, PM2.5 did not predict lung function (FEV1% predicted and FEV1/FVC). However, PM2.5 was related to use of asthma controller drugs (beta = 0.38, p = 0.001). Participants' air pollution ratings predicted total healthcare utilization (beta = 0.33, p = 0.01).

    Conclusions: In elderly persons with asthma, living near heavy industry and busy highways, objective and perceived environmental pollution relate to participants' respiratory health and healthcare utilization. Importantly, air pollution might increase use of asthma controller drugs containing corticosteroids with implication for elderly persons' risk to develop osteoporosis and cardiovascular disease.

  • 4. Chong, Julianne J.
    et al.
    Davidsson, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Pharmacy, Department of Pharmacy.
    Moles, Rebekah
    Saini, Bandana
    What Affects Asthma Medicine Use in Children?: Australian Asthma Educator Perspectives2009In: Journal of Asthma, ISSN 0277-0903, E-ISSN 1532-4303, Vol. 46, no 5, p. 437-444Article, review/survey (Refereed)
    Abstract [en]

    The global burden of childhood asthma is significant. Health care systems are faced with increasing financial costs, while children with asthma and their caretakers are faced with poorer physical health, emotional health, and quality of life. Despite the availability of effective treatment, the quality use of asthma medicines in children remains suboptimal. An investigation was conducted to explore issues related to children's asthma medicine usage from the perspective of the health care professional. Although current literature has elicited the views of caretakers and children, the health care professional viewpoint has been relatively unexplored. Semi-structured qualitative interviews were conducted with a convenience sample of 21 Australian asthma educators. Interviews were audiotaped and transcribed, and transcripts were thematically analyzed with the assistance of NVivo 7. Emergent themes associated with health care professionals, parents, medicines, children, and educational resources were found. Major issues included a lack of information provided to parents, poor parental understanding of medicines, the high cost of medicines and devices, child self-image, the need for more child responsibility over asthma management, and the lack of standardization, access to, and funding for educational resources on childhood asthma. There are multitudes of key issues that may affect asthma medicines usage in children. This research will help inform the development of educational tools on the use of medicines in childhood asthma that can be evaluated for their effectiveness in getting key messages to target audiences such as children, caretakers, and teachers.

  • 5. Covaciu, Corina
    et al.
    Bergstrom, Anna
    Lind, Tomas
    Svartengren, Magnus
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Kull, Inger
    Childhood Allergies Affect Health-Related Quality of Life2013In: Journal of Asthma, ISSN 0277-0903, E-ISSN 1532-4303, Vol. 50, no 5, p. 522-528Article in journal (Refereed)
    Abstract [en]

    Objective. The majority of studies investigating the effects of allergy on the children's health-related quality of life (HRQoL) address one particular allergic disease, using a disease-specific HRQoL instrument. This work aims to assess the comparative impact on HRQoL of several allergic conditions of childhood (asthma, rhinitis, eczema, and food hypersensitivity) in a large, population-based sample of Swedish 8-year-olds. Methods. Data were obtained from a Swedish birth cohort (BAMSE). At the 8-year follow-up, parents of 3236 children completed the standardized generic HRQoL instrument EQ-5D and reported on the children's symptoms of asthma, rhinitis, eczema, and food hypersensitivity. Information on allergic sensitization and lung function was available for a sub-sample of the children (n = 2370 and 2425, respectively). Results. Children in the study population had a median EQ visual analog scale (VAS) of 98 (Inter Quartile Range, IQR, 90-100). The median EQ VAS was significantly lower in children with allergic diseases. Children with asthma had the lowest median EQ VAS (90, IQR 85-98) and reported the highest prevalence of problems of "pain or discomfort" (18.2%, compared to 5.5% in children without asthma). Frequent wheezing and effort-induced wheezing were associated with high prevalence of problems of "anxiety or depression" (23.3% and 15.4%, respectively). Conclusions. Swedish 8-year-olds enjoy a good HRQoL, which though is significantly impacted by allergic diseases and particularly by asthma. Asthma symptoms are important determinants of HRQoL and symptom control should be a major goal in asthma management.

  • 6. Irewall, Tommie
    et al.
    Söderström, Lars
    Lindberg, Anne
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Medicine.
    Stenfors, Nikolai
    High incidence rate of asthma among elite endurance athletes: a prospective 4-year survey2020In: Journal of Asthma, ISSN 0277-0903, E-ISSN 1532-4303Article in journal (Refereed)
    Abstract [en]

    Objective: The prevalence of asthma among elite endurance athletes is high, but less is known about the incidence of asthma among athletes. The aim of this study was to examine the incidence rate of physician-diagnosed asthma among elite endurance athletes.

    Method: An annual postal questionnaire was sent to an open prospective cohort of elite endurance athletes between 2011 and 2015. Athletes from Swedish National teams, students at universities with elite sport partnership, and pupils at Swedish National elite sport schools, competing in cross-country skiing, biathlon, ski orienteering, or orienteering were invited (n = 666). Incidence rate of physician-diagnosed asthma was calculated among those without asthma at baseline (n = 449). Risk factors for incident physician-diagnosed asthma were identified using a multivariate logistic regression analysis.

    Results: Response rate was 88.7% (n = 591) at baseline. The median age of participants was 17 (range 15–36) years at inclusion. The study population included 407 (69%) skiers and 184 (31%) orienteers. The prevalence of asthma at baseline was 23.9% (n = 141). Incidence rate (95% confidence interval [CI]) of physician-diagnosed asthma was 61.2 (45.7–80.3) per 1,000 person-years. Risk factors (odds ratio [OR (95% CI)]) for incident physician-diagnosed asthma were family history of asthma (1.97 [1.04–3.68]), being a skier (3.01 [1.42–7.21]), and wheezing without having a cold (4.15 [1.81–9.26]).

    Conclusion: The incidence rate of physician-diagnosed asthma is high among Swedish elite endurance athletes.

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  • 7.
    Jonsson, M
    et al.
    Center of Occupational and Environmental Medicine, Stockholm County Council, Stockholm.
    Egmar, Ann-Charlotte
    Red Cross University College of Nursing.
    Hallner, E
    Center of Occupational and Environmental Medicine, Stockholm County Council, Stockholm.
    Kull, I
    Institute of Environmental Medicine, Karolinska Institutet, Stockholm.
    Experiences of living with asthma: a focus group study with adolescents and parents of children with asthma2014In: Journal of Asthma, ISSN 0277-0903, E-ISSN 1532-4303, Vol. 51, no 2, p. 185-192Article in journal (Refereed)
    Abstract [en]

    Objective: The goal for asthma treatment is that every individual, so far as possible, shall live without symptoms and exacerbations. Patients and health care professionals sometimes have different perceptions of what is important for achieving good quality of life. This work aims to describe the experiences among adolescents as well as those of parents with young children living with asthma. Methods: Four focus group interviews were performed, two with parents of young children and two with adolescents. The data were qualitatively analyzed, using Systematic Text Condensation. Result: Three themes relevant to the participants’ experiences of living with asthma were presented; strategies, frustrations and expectations. The adolescents wanted to be like their peers and developed their own strategies for self-management of asthma, which included not always taking medication as prescribed. The parents emphasized frustration regarding not being believed, lack of understanding feelings of loneliness, or anxiety. One identified expectation was that the participants wanted to be met with competence and understanding in asthma care from health care professionals. Another expectation expressed among parents was that teachers in nursery and primary schools should have more knowledge and understanding on how to care for children with asthma. Conclusion: Living with asthma leads to developing personal strategies in self-management of asthma. Moreover both parents and adolescents had expectations of being met by competent and understanding health care professionals. Developing a partnership between patients and health care professionals could be a successful way to improve the care of patients with asthma.

  • 8. Kämpe, Mary
    et al.
    Vosough, Maria
    Malinovschi, Andrei
    Alimohammadi, Mohammad
    Alving, Kjell
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Lötvall, Jan
    Middelveld, Roelinde
    Dahlén, Barbro
    Janson, Christer
    Upper airway and skin symptoms in allergic and non-allergic asthma: results from the Swedish GA2LEN study2018In: Journal of Asthma, ISSN 0277-0903, E-ISSN 1532-4303, Vol. 55, no 3, p. 275-283Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Allergic and non-allergic asthma are viewed as separate entities, despite sharing similarities. The aims of this study were to determine differences in symptoms from the upper airways and the skin in allergic and non-allergic asthma. The secondary aims were to identify childhood risk factors and to compare quality of life in the two asthma groups.

    METHODS: This cohort (age 17-76 years) consisted of 575 subjects with allergic or non-allergic asthma and 219 controls. The participants participated in an interview, spirometry, exhaled nitric oxide (NO), skin prick test and responded to the Mini Asthma Quality of Life Questionnaire.

    RESULTS: Self-reported allergic rhinitis was significantly more common in both allergic and non-allergic asthma (82.3% and 40.7%) compared with the controls. The prevalence of chronic rhinosinusitis (CRS) was similar in both asthma groups. Eczema was significantly more common in both asthmatic groups (72.3% and 59.8%) than controls (47.0%) (p < 0.001 and p = 0.012). Severe respiratory infection in childhood and parental allergy were risk factors for both allergic and non-allergic asthma. Quality of life was significantly lower in non-allergic than allergic asthma (p = 0.01).

    CONCLUSION: Concomitant symptoms from the upper airways and the skin were significantly more common in both allergic and non-allergic asthma. This indicates that non-allergic asthma has a systemic component with similarities to what is found in allergic asthma. There were similarities in the childhood risk factor pattern between the two types of asthma but asthma-related quality of life was lower in the non-allergic asthma group.

  • 9.
    Kämpe, Mary
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Vosough, Maria
    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.
    Alimohammadi, Mohammed
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Dermatology and Venereology.
    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.
    Forsberg, Bertil
    Umea Univ, Dept Publ Hlth & Clin Med, Occupat & Environm Med, Umea, Sweden..
    Lotvall, Jan
    Univ Gothenburg, Sahlgrenska Acad, Dept Internal Med & Clin Nutr, Krefting Res Ctr, Gothenburg, Sweden..
    Middelveld, Roelinde
    Karolinska Inst, Ctr Allergy Res, Stockholm, Sweden.;Karolinska Inst, Inst Environm Med, Stockholm, Sweden..
    Dahlen, Barbro
    Karolinska Inst, Unit Heart & Lung Dis, Dept Med, Stockholm, Sweden..
    Janson, Christer
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Upper airway and skin symptoms in allergic and non-allergic asthma: Results from the Swedish GA(2)LEN study2018In: Journal of Asthma, ISSN 0277-0903, E-ISSN 1532-4303, Vol. 55, no 3, p. 275-283Article in journal (Refereed)
    Abstract [en]

    Background: Allergic and non-allergic asthma are viewed as separate entities, despite sharing similarities. The aims of this study were to determine differences in symptoms from the upper airways and the skin in allergic and non-allergic asthma. The secondary aims were to identify childhood risk factors and to compare quality of life in the two asthma groups. Methods: This cohort (age 17-76years) consisted of 575 subjects with allergic or non-allergic asthma and 219 controls. The participants participated in an interview, spirometry, FeNO, skin prick test, and responded to the Mini Asthma Quality of Life Questionnaire. Results: Self-reported allergic rhinitis was significantly more common in both allergic and non-allergic asthma (82.3 and 40.7%) groups compared with the controls. The prevalence of chronic rhinosinusitis (CRS) was similar in both asthma groups. Eczema was significantly more common in both asthmatic groups (72.3 and 59.8%) than controls (47.0%) (p < 0.001 and p = 0.012). Severe respiratory infection in childhood and parental allergy were risk factors for both allergic and non-allergic asthma groups. Quality of life was significantly lower in non-allergic than allergic asthma groups (p = 0.01). Conclusion: Concomitant symptoms from the upper airways and the skin were significantly more common in both allergic and non-allergic asthma. This indicates that non-allergic asthma has a systemic component with similarities to what is found in allergic asthma. There were similarities in the childhood risk factor pattern between the two types of asthma but asthma-related quality of life was lower in the non-allergic asthma group.

  • 10.
    Leander, Mai
    et al.
    Department of Medical Sciences, Occupational and Environmental Medicine, Uppsala, University, Uppsala.
    Cronqvist, Agneta
    Ersta Sköndal University College, Department of Health Care Sciences, Stockholm.
    Janson, Christer
    Department of Medical Sciences, Respiratory Medicine and Allergology, Uppsala University, Uppsala.
    Uddenfeldt, Monica
    Department of Medical Sciences, Occupational and Environmental Medicine, Uppsala, University, Uppsala.
    Rask-Andersen, Anna
    Department of Medical Sciences, Occupational and Environmental Medicine, Uppsala, University, Uppsala.
    Non-respiratory Symptoms and Well-Being in Asthmatics from a General Population Sample2009In: Journal of Asthma, ISSN 0277-0903, E-ISSN 1532-4303, Vol. 46, no 6, p. 552-559Article in journal (Refereed)
    Abstract [en]

    Background. Different instruments have been developed to assess health-related quality of life (HRQL) in asthma patients. However, relatively few studies have assessed HRQL in asthma patients from a general population, and it is still unclear which instrument is most suitable. The purpose of this study was to compare HRQL in clinically verified asthmatics with subjects with respiratory symptoms without asthma and with subjects with no respiratory symptoms from a general population. The generic instrument Gothenburg Quality of Life (GQL) was used. A secondary aim was to study if GQL had any prognostic value in asthma.

    Methods. A cohort of three age groups in Sweden was investigated in 1990 using a respiratory questionnaire and GQL. The cohort consisted of 616 subjects with asthma, 488 subjects with respiratory symptoms but no asthma, and 347 subjects without respiratory symptoms. The participants were also investigated by spirometry and allergy testing. In a follow-up study, subjects were identified who had persistent and improved asthma.

    Results. The prevalence of 28 of the 30 common symptoms in GQL was significantly increased (p < 0.001) in subjects with asthma as compared to non-asthmatics. All symptoms in the domains heart and lung, head, musculoskeletal, tension, and depression were significantly increased among the asthmatics. The asthmatics also rated their physical well-being lower (p < 0.001) than subjects with no respiratory symptoms. Subjects with persistent asthma had a significantly higher prevalence of 7 of the 30 symptoms and lower social well-being than subjects showing improvement in asthma during the follow-up. All differences remained significant after adjusting for age, sex, and smoking habits.

    Conclusion. Subjects with asthma had different symptom-profiles compared to those of non-asthmatics, with a higher prevalence of both respiratory and non-respiratory symptoms. Asthma is also a disease that is related to low well-being. The use of quality-of-life questionnaires such as the GQL may provide useful information for evaluating the non-respiratory aspects of asthma as well as for assessing the impact of disease on health status and well-being.

  • 11.
    Leander, Mai
    et al.
    Ersta Sköndal University College, Department of Health Care Sciences.
    Cronqvist, Agneta
    Ersta Sköndal University College, Department of Health Care Sciences.
    Janson, Christer
    Uddenfeldt, Monica
    Rask-Andersen, Anna
    Non-respiratory symptoms and well-being in asthmatics from a general population sample.2009In: Journal of Asthma, ISSN 0277-0903, E-ISSN 1532-4303, Vol. 46, no 6, p. 552-9Article in journal (Refereed)
    Abstract [en]

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

  • 12.
    Leander, Mai
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Cronqvist, Agneta
    Janson, Christer
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    Uddenfeldt, Monica
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Rask-Andersen, Anna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Non-respiratory symptoms and well-being in asthmatics from a general population sample2009In: Journal of Asthma, ISSN 0277-0903, E-ISSN 1532-4303, Vol. 46, no 6, p. 552-559Article in journal (Refereed)
    Abstract [en]

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

  • 13.
    Leander, Mai
    et al.
    Department of Medical Sciences, Occupational and Environmental Medicine, Uppsala University, Uppsala.
    Janson, Christer
    Department of Medical Sciences, Respiratory Medicine and Allergology, Uppsala University, Uppsala.
    Uddenfeldt, Monica
    Department of Medical Sciences, Occupational and Environmental Medicine, Uppsala University, Uppsala.
    Cronqvist, Agneta
    Department of Health Care Sciences, Ersta Sköndal University College, Stockholm.
    Rask-Andersen, Anna
    Department of Medical Sciences, Occupational and Environmental Medicine, Uppsala University, Uppsala.
    Associations Between Mortality, Asthma, and Health-Related Quality of Life in an Elderly Cohort of Swedes2010In: Journal of Asthma, ISSN 0277-0903, E-ISSN 1532-4303, Vol. 47, no 6, p. 627-632Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    Asthma is a common chronic health condition among the elderly and an important cause of morbidity and mortality. Some studies show that subjective assessments of health-related quality of life (HRQL) are important predictors of mortality and survival. The primary aim of this study was to investigate whether low HRQL was a predictor of mortality in elderly subjects and whether such an association differed between subjects with and without asthma.

    METHODS:

    In 1990, a cohort in middle Sweden was investigated using a respiratory questionnaire. To assess HRQL, the generic instrument Gothenburg Quality of Life (GQL) was used. The participants were also investigated by spirometry and allergy testing. The present study was limited to the subjects in the oldest age group, aged 60-69 years in 1990, and included 222 subjects with clinically verified asthma, 148 subjects with respiratory symptoms but no asthma or other lung diseases, and 102 subjects with no respiratory symptoms. Mortality in the cohort was followed during 1990-2008.

    RESULTS:

    Altogether, 166 of the 472 subjects in the original cohort had died during the follow-up period of 1990-2008. Mortality was significantly higher in men, in older subjects, in smokers, and subjects with a low forced expiratory volume in one second (FEV(1)). There was, however, no difference in mortality between the asthmatic and the nonasthmatic groups. A higher symptoms score for GQL was significantly related to increased mortality. No association between HRQL and mortality was found when limiting the analysis to the asthmatic group, although the asthmatics had a lower symptom score for GQL compared to the other groups.

    CONCLUSION:

    A higher symptom score in the GQL instrument was significantly related to increased mortality, but this association was not found when analyzing the asthmatic group alone. The negative prognostic implications of a low HRQL in the whole group and the fact that the asthmatic group had a lower HRQL than the other group supports the use of HRQL instruments in clinical health assessments.

  • 14.
    Leander, Mai
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Janson, Christer
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    Uddenfeldt, Monica
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Cronqvist, Agneta
    Rask-Andersen, Anna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Associations between mortality, asthma, and health-related quality of life in an elderly cohort of Swedes2010In: Journal of Asthma, ISSN 0277-0903, E-ISSN 1532-4303, Vol. 47, no 6, p. 627-632Article in journal (Refereed)
    Abstract [en]

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

  • 15.
    Leander, Mai
    et al.
    Ersta Sköndal University College, Department of Health Care Sciences.
    Janson, Christer
    Uddenfeldt, Monica
    Cronqvist, Agneta
    Ersta Sköndal University College, Department of Health Care Sciences.
    Rask-Andersen, Anna
    Associations between mortality, asthma, and health-related quality of life in an elderly cohort of Swedes2010In: Journal of Asthma, ISSN 0277-0903, E-ISSN 1532-4303, Vol. 47, no 6, p. 627-32Article in journal (Refereed)
    Abstract [en]

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

  • 16. Leander, Mai
    et al.
    Janson, Christer
    Uddenfeldt, Monika
    Cronqvist, Agneta
    Rask-Andersen, Anna
    Associations Between Mortality, Asthma, and Health-Related Qualityof Life in an Elderly Cohort of Swedes2010In: Journal of Asthma, ISSN 0277-0903, E-ISSN 1532-4303Article in journal (Refereed)
    Abstract [en]

    Background. Asthma is a common chronic health condition among the elderly and an important cause of morbidity and mortality. Some studiesshow that subjective assessments of health-related quality of life (HRQL) are important predictors of mortality and survival. The primary aim ofthis study was to investigate whether low HRQL was a predictor of mortality in elderly subjects and whether such an association differed betweensubjects with and without asthma. Methods. In 1990, a cohort in middle Sweden was investigated using a respiratory questionnaire. To assess HRQL,the generic instrument Gothenburg Quality of Life (GQL) was used. The participants were also investigated by spirometry and allergy testing. Thepresent study was limited to the subjects in the oldest age group, aged 60–69 years in 1990, and included 222 subjects with clinically verified asthma,148 subjects with respiratory symptoms but no asthma or other lung diseases, and 102 subjects with no respiratory symptoms. Mortality in thecohort was followed during 1990–2008. Results. Altogether, 166 of the 472 subjects in the original cohort had died during the follow-up period of1990–2008. Mortality was significantly higher in men, in older subjects, in smokers, and subjects with a low forced expiratory volume in one second(FEV1). There was, however, no difference in mortality between the asthmatic and the nonasthmatic groups. A higher symptoms score for GQLwas significantly related to increased mortality. No association between HRQL and mortality was found when limiting the analysis to the asthmaticgroup, although the asthmatics had a lower symptom score for GQL compared to the other groups. Conclusion. A higher symptom score in the GQLinstrument was significantly related to increased mortality, but this association was not found when analyzing the asthmatic group alone. The negativeprognostic implications of a low HRQL in the whole group and the fact that the asthmatic group had a lower HRQL than the other group supports theuse of HRQL instruments in clinical health assessments.

  • 17. Li, Tian
    et al.
    Zhang, Xin
    Li, Chenghuan
    Bai, Xu
    Zhao, Zhuohui
    Norbäck, Dan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Onset of respiratory symptoms among Chinese students: associations with dampness and redecoration, PM10, NO2, SO2 and inadequate ventilation in the school.2019In: Journal of Asthma, ISSN 0277-0903, E-ISSN 1532-4303, p. 1-10Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To study onset of respiratory symptoms among students in China in relation to the school and the home environment.

    METHODS: A two-year prospective cohort study among 1325 students in eight schools. Air pollution was measured at baseline in the schools. Respiratory symptoms and the home environment were assessed by a questionnaire.

    RESULTS: The 2-year onset was 14.3%, 23.2%, 15.4%, 4.7% and 37.3% for wheeze, daytime attacks of breathlessness, nocturnal cough, nocturnal wheeze/breathlessness and respiratory infections, respectively. The mean concentrations of PM10, SO2, NO2, ozone and CO2 in the classrooms were 129 µg/m3, 68.0 µg/m3, 43.2 µg/m3, 8.6 µg/m3 and 1208 ppm, respectively. Environmental tobacco smoke (ETS), dampness/mold at home and ozone in the classroom were associated with onset of wheeze. Onset of daytime breathlessness was associated with redecoration and dampness/mold at home and CO2 and relative air humidity (RH) in the classrooms. Dampness/mold at home, PM10, CO2 and RH in the classrooms and outdoor PM10, SO2 and NO2 were associated with onset of nocturnal cough. Onset of nocturnal wheeze/breathlessness was associated with dampness/mold at home and RH and PM10 in the classrooms. Respiratory infections were more common at higher levels of outdoor PM10.

    CONCLUSIONS: Air pollution (PM10, ozone, SO2 and NO2) and inadequate ventilation flow in the classrooms (indicated by CO2 > 1000 ppm) and ETS, dampness or mold and chemical emissions from redecoration at home can increase onset of respiratory symptoms.

  • 18. Lim, Fang Lee
    et al.
    Hashim, Zailina
    Md Said, Salmiah
    Than, Leslie Thian Lung
    Hashim, Jamal Hisham
    Norbäck, Dan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Fractional exhaled nitric oxide (FeNO) among office workers in an academic institution, Malaysia - associations with asthma, allergies and office environment.2016In: Journal of Asthma, ISSN 0277-0903, E-ISSN 1532-4303, Vol. 53, no 2, p. 170-178Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: There are few studies on fractional exhaled nitric oxide (FeNO) and respiratory symptoms among adults in tropical areas. The aim was to study associations between FeNO and selected personal factors, respiratory symptoms, allergies, office characteristics and indoor office exposures among office workers (n = 460) from a university in Malaysia.

    METHODS: Information on health was collected by a questionnaire, skin prick test and FeNO measurement. Temperature, relative air humidity, carbon monoxide and carbon dioxide were measured in the offices. Settled dust was vacuumed in the offices and analyzed for endotoxin, (1,3)-β-glucan and house dust mites allergens, namely Dermatophagoides pteronyssinus (Der p 1) and Dermatophagoides farinae (Der f 1). Two-level linear mixed models and multiple logistic regression were used to analyze the associations.

    RESULTS: One-fourth (25.9%) of the office workers had elevated FeNO level (≥25 ppb) and 61.5% had HDM, cat, seafood or pollen allergy. Male gender (p < 0.001), current smoking (p = 0.037), height (p < 0.001) and atopy (p < 0.001) were associated with FeNO. The amount of vacuumed dust was associated with FeNO among atopic subjects (p = 0.009). Asthma and rhinitis symptoms were associated with FeNO (p < 0.05), especially among atopic subjects. In particular, a combination of atopy and elevated FeNO were associated with doctor-diagnosed asthma (p < 0.001), rhinitis (p < 0.001) and airway symptoms last 12 months (p < 0.001).

    CONCLUSION: Gender, smoking, height and atopy are important risk factors for elevated FeNO levels. A combination of allergy testing and FeNO measurement could be useful in respiratory illness epidemiology studies and patient investigations in tropical areas.

  • 19.
    Lind, Nina
    et al.
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Nordin, Maria
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Palmquist, Eva
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Claeson, Anna-Sara
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Millqvist, Eva
    University of Gothenburg, Sweden.
    Nordin, Steven
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Coping and Social Support in Asthma and Allergy: The Västerbotten Environmental Health Study2015In: Journal of Asthma, ISSN 0277-0903, E-ISSN 1532-4303, Vol. 52, no 6, p. 622-629Article in journal (Refereed)
    Abstract [en]

    Objectives: Asthma and allergy are stressful conditions that require coping strategies and social support to reduce stress and enhance health-promoting behavior. However, research is limited regarding coping and social support in asthma and allergy. The aim was to better understand use of different coping strategies and perceived social support in low and high severity (exacerbation frequency) of asthma and allergy. Methods: Population-based data were used to provide ratings of coping strategies (Study I) and social support (Study II) from 124 and 94 participants, respectively, with asthma and/or allergy, categorized as low or high in severity. Problem- and emotion-focused coping strategies were assessed as well as emotional, instrumental and informative social support from seven sources. Results: Study I showed that avoiding certain environments (problem-based coping) and trying to accept one’s situation (emotion-based) were the most commonly used coping strategies. These behaviors did not differ due to severity. Study II showed that more emotional than instrumental and informative support was perceived. The highest rated support sources were the partner, family members, and the healthcare system. More social support was reported in low compared to high asthma/allergy severity. Conclusion: The most commonly used coping strategies in the population of persons with these four types of asthma and allergy are avoiding certain environments and trying to accept one’s situation. More emotional support than instrumental and informative is perceived to be received, and most of the support is received from one’s partner and other family members, and least from authorities and patient associations/support groups.

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  • 20.
    Lisspers, Karin
    et al.
    Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology, Uppsala University, Uppsala, Sweden.
    Ställberg, Björn
    Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology, Uppsala University, Uppsala, Sweden.
    Hasselgren, Mikael
    Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology, Uppsala University, Uppsala, Sweden.
    Johansson, Gunnar
    Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology, Uppsala University, Uppsala, Sweden.
    Svärdsudd, Kurt
    Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology, Uppsala University, Uppsala, Sweden.
    Quality of life and measures of asthma control in primary health care2007In: Journal of Asthma, ISSN 0277-0903, E-ISSN 1532-4303, Vol. 44, no 9, p. 747-751Article in journal (Refereed)
    Abstract [en]

    AIM: To study quality of life and asthma control in primary care. A total of 1,477 patients 15 to 45 years of age received questionnaires regarding asthma control (77% responded) and quality of life, Mini Asthma Quality of Life Questionnaire (MiniAQLQ), (74% responded). Patients using short-acting beta-agonists more than twice in the last week had clinically significant lower MiniAQLQ scores (5.17 versus 5.91). This finding was consistent for night awakenings during the previous week (4.42 versus 5.86), courses of oral corticosteroids (4.82 versus 5.69), and reported emergency consultations during the last 6 months (4.85 versus 5.71). Good asthma control is associated with better quality of life in asthma patients in primary care.

  • 21.
    Lisspers, Karin
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Ställberg, Björn
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm , Centrum för klinisk forskning i D län (CKFD).
    Hasselgren, Mikael
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Johansson, Gunnar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Svärdsudd, Kurt
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Quality of life and measures of asthma control in primary health care2007In: Journal of Asthma, ISSN 0277-0903, E-ISSN 1532-4303, Vol. 44, no 9, p. 747-751Article in journal (Refereed)
    Abstract [en]

    AIM: To study quality of life and asthma control in primary care. A total of 1,477 patients 15 to 45 years of age received questionnaires regarding asthma control (77% responded) and quality of life, Mini Asthma Quality of Life Questionnaire (MiniAQLQ), (74% responded). Patients using short-acting beta-agonists more than twice in the last week had clinically significant lower MiniAQLQ scores (5.17 versus 5.91). This finding was consistent for night awakenings during the previous week (4.42 versus 5.86), courses of oral corticosteroids (4.82 versus 5.69), and reported emergency consultations during the last 6 months (4.85 versus 5.71). Good asthma control is associated with better quality of life in asthma patients in primary care.

  • 22.
    Lisspers, Karin
    et al.
    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, Respiratory Medicine and Allergology.
    Johansson, Gunnar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Svärdsudd, Kurt
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Sex-differences in quality of life and asthma control in Swedish asthma patients2013In: Journal of Asthma, ISSN 0277-0903, E-ISSN 1532-4303, Vol. 50, no 10, p. 1090-1095Article in journal (Refereed)
    Abstract [en]

    Background: To study sex-related differences in quality of life, asthma control and asthma management in different age groups. Methods: A cross-sectional survey and patient record study in primary and secondary care. A total of 1226 patients in primary and 499 in secondary care, ages 18-75 and randomly selected, with a response rate of 71%. Patients were classified into four groups, 18-34, 35-49, 50-64 and 65-75 years. Results: Younger women (18-49 years) had a lower total MiniAQLQ score than men in the same age group (5.41 vs. 5.80, p<0.001), while no significant difference was found between older women and men (50-75 years) (5.08 vs. 5.16, p = 0.42). The sex differences in the younger group remained significant after adjusting for medication, educational level, smoking, body mass index, allergy and depression (p = 0.008). The odds ratios for younger women to have night-awakenings was 1.7 (95% CI 1.07-2.57), for asthma exacerbations 1.9 (95% CI 1.21-2.98) and for not achieving asthma control 1.5 (95% CI 1.00-2.13) when adjusting for smoking, educational level and body mass index. No differences in asthma control were found when comparing older women with men of similar ages. Conclusions: Younger women had lower quality of life and less often asthma control than men in the same age range, while no corresponding sex differences were found between older women and men of similar ages. Female sex hormones could be an important factor affecting these outcomes.

  • 23. Ma'pol, Aminnuddin
    et al.
    Hashim, Jamal Hisham
    Norbäck, Dan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Weislander, Gunilla
    Hashim, Zailina
    Isa, Zaleha Md
    FeNO level and allergy status among school children in Terengganu, Malaysia.2019In: Journal of Asthma, ISSN 0277-0903, E-ISSN 1532-4303, p. 1-8Article in journal (Refereed)
    Abstract [en]

    Background: Almost one third of the world population suffers from allergic conditions. Respiratory symptoms are common in Malaysian children but there are few studies on fractional exhaled nitric oxide (FeNO), inclusive of field clinical test for asthma among children in Malaysia. The aim was to provide insight on factors related to level of FeNO among students in Terengganu, Malaysia. Methods: In total, 487 randomly selected students from eight secondary schools participated (13-14 years old). A Standardized questionnaire was used to obtained information on doctors' diagnosed asthma, current asthma and respiratory symptoms. FeNO measurement and skin prick test (SPT to common allergen) were conducted. Results: The geometric mean FeNO was 16.7 ppb. Totally, 38.4% of students had elevated FeNO level (>20 ppb) and 40.3% had had positive SPT to house dust mites allergens (HDM), Dermatophagoides pteronyssinus (Der p 1), Dermatophagoides farinae (Der f 1) or Felis domisticus (cat). Male gender, height, parental history of allergy, self-reported allergy, and atopy were associated with FeNO. In particular, a combination of sensitization to HDM or cat and elevated FeNO were associated with doctor-diagnosed asthma and self-reported allergy to food, pollen and cat. Conclusion: Asthma, respiratory symptoms and sensitization to HDM and cat are common among students and presence of elevated FeNO levels indicate ongoing airway inflammation.

  • 24. Norqvist, Johan
    et al.
    Eriksson, Linda
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Pulmonary Medicine.
    Söderström, Lars
    Unit of Research , Education and Development - Östersund, Umeå University.
    Lindberg, Anne
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine. Unit of Research , Education and Development - Sunderbyn, Umeå University.
    Stenfors, Nikolai
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine. Unit of Research , Education and Development - Östersund, Umeå University.
    Self-reported physician-diagnosed asthma among Swedish adolescent, adult and former elite endurance athletes2015In: Journal of Asthma, ISSN 0277-0903, E-ISSN 1532-4303, Vol. 52, no 10Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: Asthma is common among elite endurance athletes. Since the first published Swedish studies in 1993, awareness of "skiers' asthma" has increased. The current prevalence of asthma among Swedish skiers is unknown. This paper aims to present the design of a 5-year prospective annual questionnaire study on asthma among Swedish current and former elite endurance athletes, the first cross-sectional results on prevalence, age of onset, and predictors of self-reported physician-diagnosed asthma in the study population.

    METHODS: An annual postal questionnaire is sent to Swedish elite skiers and orienteers during 2011-2015. In 2013, former Swedish Olympic skiers were similarly invited. We present cross-sectional data obtained in 2011 from the adolescents and adults and in 2013 from former skiers. A total of 491 athletes were invited. The results are presented by age, sex and sport. Chi-square test was used for group comparisons. Predictors of asthma were identified using logistic regression.

    RESULTS: Response rate was 82%. Among athletes aged 15-19, 29% of the skiers (38% of the female skiers), and 17% of the orienteers reported asthma (p = 0.071). Among the athletes aged 20-34, 35% of the skiers and 16% of the orienteers reported asthma (p = 0.029). Among the former skiers aged 40-94, 22% reported asthma. Among the active athletes, the onset of asthma was in early adolescence. Logistic regression found increasing age, female sex, allergy, family history of allergy/asthma and being skier predictors of self-reported physician-diagnosed asthma.

    CONCLUSIONS: The prevalence of physician-diagnosed asthma is high among Swedish endurance athletes, especially female adolescent skiers.

  • 25. Russell, Melissa A.
    et al.
    Janson, Christer
    Gomez Real, Francisco
    Johannessen, Ane
    Waatevik, Marie
    Benediktsdottir, Bryndis
    Holm, Mathias
    Lindberg, Eva
    Schlünssen, Vivi
    Raza, Wasif
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Dharmage, Shyamali C.
    Svanes, Cecilie
    Physical activity and asthma: a longitudinal and multi-country study2017In: Journal of Asthma, ISSN 0277-0903, E-ISSN 1532-4303, Vol. 54, no 9, p. 938-945Article in journal (Refereed)
    Abstract [en]

    Objective: To investigate the impact of physical activity on asthma in middle-aged adults, in one longitudinal analysis, and one multi-centre cross-sectional analysis.

    Methods: The Respiratory Health in Northern Europe (RHINE) is a population-based postal questionnaire cohort study. Physical activity, height and weight were self-reported in Bergen, Norway, at RHINE II (1999–2001) and all centres at RHINE III (2010–2012). A longitudinal analysis of Bergen data investigated the association of baseline physical activity with follow-up asthma, incident asthma and symptoms, using logistic and zero-inflated Poisson regression (n = 1782). A cross-sectional analysis of all RHINE III centres investigated the association of physical activity with concurrent asthma and symptoms (n = 13,542) using mixed-effects models. Body mass index (BMI) was categorised (&lt;20, 20–24.99, 25–29.99, 30+ kg/m2) and physical activity grouped by amount and frequency of lighter (no sweating/heavy breathing) and vigorous (sweating/heavy breathing) activity.

    Results: In the Bergen longitudinal analysis, undertaking light activity 3+ times/week at baseline was associated with less follow-up asthma (odds ratio [OR] 0.44, 95% confidence interval [CI] 0.22, 0.89), whilst an effect from undertaking vigorous activity 3+ times/week was not detected (OR 1.22, 95% CI 0.44, 2.76). The associations were attenuated with BMI adjustment. In the all-centre cross-sectional analysis an interaction was found, with the association between physical activity and asthma varying across BMI categories.

    Conclusion: These findings suggest potential longer-term benefit from lighter physical activity, whilst improvement in asthma outcomes from increasing activity intensity was not evident. Additionally, it appears the benefit from physical activity may differ according to BMI.

  • 26. Russell, Melissa A
    et al.
    Janson, Christer
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Real, Francisco Gómez
    Johannessen, Ane
    Waatevik, Marie
    Benediktsdóttir, Bryndis
    Holm, Mathias
    Lindberg, Eva
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Schlünssen, Vivi
    Raza, Wasif
    Dharmage, Shyamali C
    Svanes, Cecilie
    Physical activity and asthma: A longitudinal and multi-country study2017In: Journal of Asthma, ISSN 0277-0903, E-ISSN 1532-4303, Vol. 54, no 9, p. 938-945Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To investigate the impact of physical activity on asthma in middle-aged adults, in one longitudinal analysis, and one multi-centre cross-sectional analysis.

    METHODS: ) and physical activity grouped by amount and frequency of lighter (no sweating/heavy breathing) and vigorous (sweating/heavy breathing) activity.

    RESULTS: In the Bergen longitudinal analysis, undertaking light activity 3+ times/week at baseline was associated with less follow-up asthma (odds ratio [OR] 0.44, 95% confidence interval [CI] 0.22, 0.89), whilst an effect from undertaking vigorous activity 3+ times/week was not detected (OR 1.22, 95% CI 0.44, 2.76). The associations were attenuated with BMI adjustment. In the all-centre cross-sectional analysis an interaction was found, with the association between physical activity and asthma varying across BMI categories.

    CONCLUSION: These findings suggest potential longer-term benefit from lighter physical activity, whilst improvement in asthma outcomes from increasing activity intensity was not evident. Additionally, it appears the benefit from physical activity may differ according to BMI.

  • 27.
    Stridsman, Caroline
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Medicine. Division of Nursing, Department of Health Sciences, Luleå University of Technology, Luleå, Sweden..
    Axelsson, Malin
    Department of Care Sciences, Faculty of Health and Society, Malmö University, Malmö, Sweden..
    Warm, Katja
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Medicine.
    Backman, Helena
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Uncontrolled asthma occurs in all GINA treatment steps and is associated with worse physical health: a report from the OLIN adult asthma cohort2020In: Journal of Asthma, ISSN 0277-0903, E-ISSN 1532-4303, p. 1-10Article in journal (Refereed)
    Abstract [en]

    Objective: To study asthma exacerbations, healthcare utilization and health status among subjects with asthma with different treatment regimens and levels of asthma control.Methods: In 2012-2014, n = 1425 adults from a population-based asthma cohort within the OLIN studies (Obstructive Lung disease in Northern Sweden) were invited to a follow-up including spirometry and a structured interview, n = 1006 participated. Asthma Control Test (ACT) was used to detect uncontrolled asthma, and physical and mental dimensions of health were measured with SF-8. Pharmacological treatment use was classified by Global Initiative for Asthma treatment steps. Out of n = 830 with current asthma, n = 714 answered ACT (57% women, 32-92 years) and were included in the study.Results: Uncontrolled asthma increased per treatment step (no treatment 9.9%, treatment step 1-3 24.1%, and treatment steps 4-5 39.9%, p < 0.001). A higher proportion of subjects with uncontrolled asthma reported exacerbations, healthcare utilization, and worse health status than those with controlled asthma. The proportion of subjects reporting exacerbations, healthcare visits, emergency room visits and regular follow-up visits increased per treatment step. Worse health was associated with uncontrolled asthma, but not with the level of treatment. A higher proportion of women than men reported exacerbations, any healthcare visits, and lower health. Regular follow-up visits to a physician were uncommon (women 21.2% vs. men 14.6%, p = 0.022).Conclusions: Uncontrolled asthma is common in all treatment steps, and is associated with worse health status. However, health status did not differ by treatment steps. Identifying subjects with uncontrolled asthma regardless of treatment regimens should be a priority, thus follow-up visits are important.

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  • 28. Stridsman, Caroline
    et al.
    Axelsson, Malin
    Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
    Warm, Katja
    Backman, Helena
    Uncontrolled asthma occurs in all GINA treatment steps and is associated with worse physical health: a report from the OLIN adult asthma cohort2020In: Journal of Asthma, ISSN 0277-0903, E-ISSN 1532-4303Article in journal (Refereed)
    Abstract [en]

    Objective: To study asthma exacerbations, healthcare utilization and health status among subjects with asthma with different treatment regimens and levels of asthma control. Methods: In 2012-2014, n = 1425 adults from a population-based asthma cohort within the OLIN studies (Obstructive Lung disease in Northern Sweden) were invited to a follow-up including spirometry and a structured interview, n = 1006 participated. Asthma Control Test (ACT) was used to detect uncontrolled asthma, and physical and mental dimensions of health were measured with SF-8. Pharmacological treatment use was classified by Global Initiative for Asthma treatment steps. Out of n = 830 with current asthma, n = 714 answered ACT (57% women, 32-92 years) and were included in the study. Results: Uncontrolled asthma increased per treatment step (no treatment 9.9%, treatment step 1-3 24.1%, and treatment steps 4-5 39.9%, p < 0.001). A higher proportion of subjects with uncontrolled asthma reported exacerbations, healthcare utilization, and worse health status than those with controlled asthma. The proportion of subjects reporting exacerbations, healthcare visits, emergency room visits and regular follow-up visits increased per treatment step. Worse health was associated with uncontrolled asthma, but not with the level of treatment. A higher proportion of women than men reported exacerbations, any healthcare visits, and lower health. Regular follow-up visits to a physician were uncommon (women 21.2% vs. men 14.6%, p = 0.022). Conclusions: Uncontrolled asthma is common in all treatment steps, and is associated with worse health status. However, health status did not differ by treatment steps. Identifying subjects with uncontrolled asthma regardless of treatment regimens should be a priority, thus follow-up visits are important.

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  • 29.
    Stridsman, Caroline
    et al.
    Luleå University of Technology, Department of Health Sciences, Nursing Care. Section of Medicine, The OLIN Unit, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
    Axelsson, Malin
    Department of Care Sciences, Faculty of Health and Society, Malmö University, Malmö, Sweden.
    Warm, Katja
    Section of Medicine, The OLIN Unit, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
    Backman, Helena
    Section of Sustainable Health, The OLIN Unit, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
    Uncontrolled asthma occurs in all GINA treatment steps and is associated with worse physical health: a report from the OLIN adult asthma cohort2020In: Journal of Asthma, ISSN 0277-0903, E-ISSN 1532-4303Article in journal (Refereed)
    Abstract [en]

    Objective: To study asthma exacerbations, healthcare utilization and health status among subjects with asthma with different treatment regimens and levels of asthma control.

    Methods: In 2012–2014, n = 1425 adults from a population-based asthma cohort within the OLIN studies (Obstructive Lung disease in Northern Sweden) were invited to a follow-up including spirometry and a structured interview, n = 1006 participated. Asthma Control Test (ACT) was used to detect uncontrolled asthma, and physical and mental dimensions of health were measured with SF-8. Pharmacological treatment use was classified by Global Initiative for Asthma treatment steps. Out of n = 830 with current asthma, n = 714 answered ACT (57% women, 32–92 years) and were included in the study.

    Results: Uncontrolled asthma increased per treatment step (no treatment 9.9%, treatment step 1–3 24.1%, and treatment steps 4–5 39.9%, p < 0.001). A higher proportion of subjects with uncontrolled asthma reported exacerbations, healthcare utilization, and worse health status than those with controlled asthma. The proportion of subjects reporting exacerbations, healthcare visits, emergency room visits and regular follow-up visits increased per treatment step. Worse health was associated with uncontrolled asthma, but not with the level of treatment. A higher proportion of women than men reported exacerbations, any healthcare visits, and lower health. Regular follow-up visits to a physician were uncommon (women 21.2% vs. men 14.6%, p = 0.022).

    Conclusions: Uncontrolled asthma is common in all treatment steps, and is associated with worse health status. However, health status did not differ by treatment steps. Identifying subjects with uncontrolled asthma regardless of treatment regimens should be a priority, thus follow-up visits are important.

  • 30.
    Sundbom, Fredrik
    et al.
    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.
    Lindberg, Eva
    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.
    Janson, Christer
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Effects of poor asthma control, insomnia, anxiety and depression on quality of life in young asthmatics2016In: Journal of Asthma, ISSN 0277-0903, E-ISSN 1532-4303, Vol. 53, no 4, p. 398-403Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: Asthma-related quality of life has previously been shown to be associated with asthma control. The aims of the present study were to further analyze this correlation, identify other variables with impact on asthma-related quality of life, and investigate the covariance among these variables.

    METHODS: Information was retrieved from a cohort of 369 patients, aged 12-35, with physician-diagnosed asthma requiring anti-inflammatory treatment for at least 3 months per year. Questionnaire data [including the mini Asthma Quality of Life Questionnaire (mAQLQ), Asthma Control Test (ACT), and Hospital Anxiety and Depression Scale (HADS)], quality of sleep, lung function data and blood samples were analyzed. Linear regression models with the mAQLQ score as the dependent scalar variable were calculated.

    RESULTS: ACT was the single variable that had the highest explanatory value for the mAQLQ score (51.5%). High explanatory power was also observed for anxiety and depression (17.0%) and insomnia (14.1%). The population was divided into groups depending on presence of anxiety and depression, uncontrolled asthma, and insomnia. The group that reported none of these conditions had the highest mean mAQLQ score (6.3 units), whereas the group reporting all of these conditions had the lowest mAQLQ score (3.8 units).

    CONCLUSIONS: The ACT score was the single most important variable in predicting asthma-related quality of life. Combining the ACT score with the data on insomnia, anxiety and depression showed considerable additive effects of the conditions. Hence, we recommend the routine use of the ACT and careful attention to symptoms of insomnia, anxiety or depression in the clinical evaluation of asthma-related quality of life.

  • 31.
    Takaoka, Motoko
    et al.
    Kobe College, School of Human Science, Department of Biosphere Sciences.
    Suzuki, Kyoko
    Kobe College, School of Human Science, Department of Biosphere Sciences.
    Norbäck, Dan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine. Uppsala University Hospital.
    Current asthma, respiratory symptoms and airway infections among students in relation to the school and home environment in Japan2017In: Journal of Asthma, ISSN 0277-0903, E-ISSN 1532-4303, Vol. 54, no 6, p. 652-661Article in journal (Refereed)
    Abstract [en]

    Objective: To study associations between the school and home environment and current asthma, respiratory symptoms and airway infections among Japanese students. Methods: Japanese students (12-15 y) (N = 1048) in four schools responded to a questionnaire on respiratory health, allergy and the home environment. Temperature, relative air humidity (RH) and student density (students/m(2) floor area) was measured in the classrooms: dust was collected from floors and in classroom air and analysed for cat (Fel d 1) and dog (Can f 1) allergens. Health associations were analysed by multi-level logistic regression. Results: Doctor's diagnosed asthma was common (13.4%), 8.8% reported cat allergy and 6.1% dog allergy. The median level in floor dust was 41ng/g (IQR 23-92) for Fel d 1 and 101ng/g (IQR 54-101) for Can f 1. The median level in air was 18.6ng/ m(2)/ day (IQR5.9-25.1) for Fel d 1 and 18.6ng/ m(2)/ day (IQR 6.0-13.3) for Can f 1. High RH, high student density and airborne cat allergen was associated with airway infections. In the home environment, recent indoor painting, new floor materials, odour, having cats as pets, window pane condensation in winter, and dampness in floor construction were associated with respiratory illness. Conclusion: High relative air humidity, high student density and airborne cat allergens at school may increase the risk of airway infections. Having cats as pets, chemical emissions from paint and new floor materials, odour and dampness can constitute domestic risk factors for respiratory symptoms while having dogs as pets could be protective.

  • 32.
    Westerik, Janine A. M.
    et al.
    Res Real Life Ltd, Cambridge, England..
    Carter, Victoria
    Optimum Patient Care Ltd, Cambridge, England..
    Chrystyn, Henry
    Res Real Life Ltd, Cambridge, England.;Inhalat Consultancy Ltd, Leeds, W Yorkshire, England..
    Burden, Anne
    Res Real Life Ltd, Cambridge, England..
    Thompson, Samantha L.
    Res Real Life Ltd, Cambridge, England..
    Ryan, Dermot
    Woodbrook Med Ctr, Loughborough, Leics, England.;Univ Edinburgh, Ctr Populat Hlth Sci, Edinburgh EH8 9YL, Midlothian, Scotland..
    Gruffydd-Jones, Kevin
    Haughney, John
    Univ Aberdeen, Acad Primary Care, Polwarth Bldg, Aberdeen AB25 2ZD, Scotland..
    Roche, Nicolas
    Univ Paris 05, Cochin Hosp Grp, AP HP, EA2511, Paris, France..
    Lavorini, Federico
    Careggi Univ Hosp, Dept Expt & Clin Med, Florence, Italy..
    Papi, Alberto
    Univ Ferrara, Dept Med Sci, I-44100 Ferrara, Italy..
    Infantino, Antonio
    Soc Italiana Interdisciplinare Cure Primarie, Special Interest Resp Area, Bari, Italy..
    Roman-Rodriguez, Miguel
    Inst Invest Sanitaria Palma IdisPa, Primary Care Resp Res Unit, Palma De Mallorca, Spain..
    Bosnic-Anticevich, Sinthia
    Univ Sydney, Sydney Med Sch, Sydney, NSW 2006, Australia.;Univ Sydney, Woolcock Inst Med Res, Sydney, NSW 2006, Australia..
    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.
    Henrichsen, Svein Hoegh
    Univ Oslo, Dept Gen Med, N-0316 Oslo, Norway.;Langbolgen Legesenter, London, England..
    van der Molen, Thys
    Univ Groningen, Univ Med Ctr Groningen, Dept Primary Care, Groningen, Netherlands..
    Hutton, Catherine
    Res Real Life Ltd, Cambridge, England..
    Price, David B.
    Res Real Life Ltd, Cambridge, England.;Univ Aberdeen, Acad Primary Care, Polwarth Bldg, Aberdeen AB25 2ZD, Scotland..
    Characteristics of patients making serious inhaler errors with a dry powder inhaler and association with asthma-related events in a primary care setting2016In: Journal of Asthma, ISSN 0277-0903, E-ISSN 1532-4303, Vol. 53, no 3, p. 321-329Article in journal (Refereed)
    Abstract [en]

    Objective: Correct inhaler technique is central to effective delivery of asthma therapy. The study aim was to identify factors associated with serious inhaler technique errors and their prevalence among primary care patients with asthma using the Diskus dry powder inhaler (DPI).

    Methods: This was a historical, multinational, cross-sectional study (2011-2013) using the iHARP database, an international initiative that includes patient- and healthcare provider-reported questionnaires from eight countries. Patients with asthma were observed for serious inhaler errors by trained healthcare providers as predefined by the iHARP steering committee. Multivariable logistic regression, stepwise reduced, was used to identify clinical characteristics and asthma-related outcomes associated with 1 serious errors.

    Results: Of 3681 patients with asthma, 623 (17%) were using a Diskus (mean [SD] age, 51 [14]; 61% women). A total of 341 (55%) patients made 1 serious errors. The most common errors were the failure to exhale before inhalation, insufficient breath-hold at the end of inhalation, and inhalation that was not forceful from the start. Factors significantly associated with 1 serious errors included asthma-related hospitalization the previous year (odds ratio [OR] 2.07; 95% confidence interval [CI], 1.26-3.40); obesity (OR 1.75; 1.17-2.63); poor asthma control the previous 4 weeks (OR 1.57; 1.04-2.36); female sex (OR 1.51; 1.08-2.10); and no inhaler technique review during the previous year (OR 1.45; 1.04-2.02).

    Conclusions: Patients with evidence of poor asthma control should be targeted for a review of their inhaler technique even when using a device thought to have a low error rate.

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  • 33.
    Wireklint, Philip
    et al.
    School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Hasselgren, Mikael
    Örebro University, School of Medical Sciences.
    Montgomery, Scott
    Örebro University, School of Medical Sciences. Clinical Epidemiology Division, Department of Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology and Public Health, University College, London, UK.
    Lisspers, Karin
    Department of Public Health and Caring Sciences, Family Medicine and Preventive medicine, Uppsala University, Uppsala, Sweden.
    Ställberg, Björn
    Department of Public Health and Caring Sciences, Family Medicine and Preventive medicine, Uppsala University, Uppsala, Sweden.
    Janson, Christer
    Department of Medical Sciences, Respiratory, Allergy & Sleep Research, Uppsala University, Uppsala, Sweden.
    Sundh, Josefin
    Örebro University, School of Medical Sciences.
    Factors associated with knowledge of self-management of worsening asthma in primary care patients: a cross-sectional study2020In: Journal of Asthma, ISSN 0277-0903, E-ISSN 1532-4303, p. 1-11Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: Self-management is important for asthma control. We examined associations of patient- and healthcare-related factors with self-reported knowledge of self-management of worsening asthma.

    METHOD: Two asthma patient cohorts from 2012 (n = 527) and 2015 (n = 915) were randomly selected from 54 primary health care centers (PHCC) in central Sweden. Data were collected using patient questionnaires and questionnaires to the PHCCs. Logistic regression analyzed associations of relevant variables with knowledge of self-management of worsening asthma.

    RESULTS: In total, 63% of patients reported moderate to complete knowledge of self-management procedures. The adjusted OR for moderate to complete knowledge relative to high education level was 1.38 [95% CI 1.03-1.85)]; for physician continuity 2.19 (95% CI 1.62-2.96); for a written action plan, 11.9 (95% CI 6.16-22.9); for Step 2 maintenance treatment, 1.53 (95% CI 0.04-2.24); and 2.07 (95% CI 1.44-2.99) for Step 3. An asthma/COPD nurse visit within the previous 12 months was associated with greater knowledge in women but not in men (p for interaction =0.042). Smoking [OR 0.56 (95% CI 0.34-0.95)], co-morbidities ≥1 [OR 0.68 (95% CI 0.49-0.93)], and self-rated moderate/severe disease [OR 0.68 (95% CI 0.51-0.90)] were associated with low self-management knowledge.

    CONCLUSION: Self-reported knowledge of self-management procedures was associated with a higher educational level, physician continuity, a written action plan, advanced treatment and, in women, visiting an asthma/COPD nurse. The results reinforce the importance of implementing guidelines of patient access to a specific physician, a written action plan, and structured education by an asthma/COPD nurse.

  • 34. Xu, Feng
    et al.
    Zou, Zhijun
    Yan, Shuxian
    Li, Fei
    Kan, Haidong
    Norbäck, Dan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Wieslander, Gunilla
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Xu, Jinhua
    Zhao, Zhuohui
    Fractional Exhaled Nitric Oxide in Relation to Asthma, Allergic Rhinitis, and Atopic Dermatitis in Chinese Children2011In: Journal of Asthma, ISSN 0277-0903, E-ISSN 1532-4303, Vol. 48, no 10, p. 1001-1006Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE:

    Fractional exhaled nitric oxide (FeNO) is a non-invasive biomarker of airway inflammation. Our aim was to analyze the interrelationship and differentiate the predicting effects of asthma, allergic rhinitis (AR), and atopic dermatitis (AD) on the FeNO levels in children from mainland China.

    METHODS:

    A case-control study with age- and gender matched 1:1 was designed based on a larger cross-sectional survey on asthma, AR, and AD in Shanghai. A self-administered questionnaire was used to collect information on children's health information. Children with positive reports on physician-diagnosed asthma and/or AR and/or AD were recruited as cases, and children with no report of any of the diseases were designated as controls. The FeNO measurement was performed online, using the NIOX MINO® instrument (Aerocrine AB, Solna, Sweden) at 50 ml/min.

    RESULTS:

    A total of 130 subjects (65 cases and 65 controls, average age = 10 years) were recruited in this study. The average FeNO level was significantly higher in the cases (29.8 ± 1.9 ppb) than that in the controls (13.3 ± 1.7 ppb) (p < .001). Using multiple linear regression analysis controlling for confounding factors, including parental asthma/allergic diseases and home exposure, asthma (β = 0.330, p < .001) and AR (β = 0.157, p = .006) showed significant predicting effects for high FeNO levels, whereas AD was not related to the FeNO levels.

    CONCLUSIONS:

    Both asthma and AR could independently increase the FeNO levels in Chinese schoolchildren. Other diseases besides asthma should be considered when applying FeNO as a screening tool for asthma in Chinese children.

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