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Zetterström, Olle
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Publications (10 of 40) Show all publications
Vogt, H., Bråbäck, L., Zetterström, O., Zara, K., Fälth-Magnusson, K. & Nilsson, L. (2013). Asthma heredity, cord blood IgE and asthma-related symptoms and medication in adulthood: a long-term follow-up in a Swedish birth cohort. PLoS ONE, 8(6), e66777.
Open this publication in new window or tab >>Asthma heredity, cord blood IgE and asthma-related symptoms and medication in adulthood: a long-term follow-up in a Swedish birth cohort
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2013 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 8, no 6, p. e66777.-Article in journal (Refereed) Published
Abstract [en]

Cord blood IgE has previously been studied as a possible predictor of asthma and allergic diseases. Results from different studies have been contradictory, and most have focused on high-risk infants and early infancy. Few studies have followed their study population into adulthood. This study assessed whether cord blood IgE levels and a family history of asthma were associated with, and could predict, asthma medication and allergy-related respiratory symptoms in adults.

A follow-up was carried out in a Swedish birth cohort comprising 1701 consecutively born children. In all, 1661 individuals could be linked to the Swedish Prescribed Drug Register and the Medical Birth Register, and 1227 responded to a postal questionnaire. Cord blood IgE and family history of asthma were correlated with reported respiratory symptoms and dispensed asthma medication at 32–34 years.

Elevated cord blood IgE was associated with a two- to threefold increased risk of pollen-induced respiratory symptoms and dispensed anti-inflammatory asthma medication. Similarly, a family history of asthma was associated with an increased risk of pollen-induced respiratory symptoms and anti-inflammatory medication. However, only 8% of the individuals with elevated cord blood IgE or a family history of asthma in infancy could be linked to current dispensation of anti-inflammatory asthma medication at follow-up.

Elevated cord blood IgE and a positive family history of asthma were associated with reported respiratory symptoms and dispensed asthma medication in adulthood, but their predictive power was poor in this long-time follow-up.

Keywords
birth cohort, cord blood, family history, prediction, prescription
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:liu:diva-85156 (URN)10.1371/journal.pone.0066777 (DOI)000320846500104 ()
Note

The status of this article was on the day of the defence date Manuscript.

Available from: 2012-11-07 Created: 2012-11-07 Last updated: 2017-12-07Bibliographically approved
Boyle, R. J., Pedroletti, C., Wickman, M., Bjermer, L., Valovirta, E., Dahl, R., . . . Warner, J. O. (2012). Nocturnal temperature controller laminar airflow for treating atopic asthma: a randomised controlled trial. Thorax, 67(3), 215-221
Open this publication in new window or tab >>Nocturnal temperature controller laminar airflow for treating atopic asthma: a randomised controlled trial
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2012 (English)In: Thorax, ISSN 0040-6376, E-ISSN 1468-3296, Vol. 67, no 3, p. 215-221Article in journal (Refereed) Published
Abstract [en]

   Objective To determine whether environmental control using nocturnal temperature controlled laminar airflow (TLA) treatment could improve the quality of life of patients with persistent atopic asthma. <br> <br>Design Randomised, double-blind, placebo-controlled, parallel-group trial. <br> <br>Setting Nineteen European asthma clinics. <br> <br>Participants 312 patients aged 7-70 with inadequately controlled persistent atopic asthma. <br> <br>Main outcome measure Proportion of patients with an increase of &gt;= 0.5 points in asthma quality of life score after 1 year of treatment. <br> <br>Results TLA devices were successfully installed in the bedrooms of 282 (90%) patients included in the primary efficacy analysis. There was a difference in treatment response rate between active (143 of 189, 76%) and placebo (56 of 92, 61%) groups, difference 14.8% (95% CI 3.1 to 26.5, p=0.02).(3) In patients aged &gt;= 12, on whom the study was powered, the difference in response rate was similar-active 106 of 143 (74%), placebo 42 of 70 (60%), difference 14.1% (0.6 to 27.7, p=0.059). There was a difference between groups in fractional exhaled nitric oxide change of -7.1 ppb (-13.6 to -0.7, p=0.03). Active treatment was associated with less increase in cat-specific IgE than placebo. There was no difference in adverse event rates between treatment groups. <br> <br>Conclusion Inhalant exposure reduction with TLA improves quality of life, airway inflammation and systemic allergy in patients with persistent atopic asthma. TLA may be a treatment option for patients with inadequately controlled persistent atopic asthma.

Place, publisher, year, edition, pages
BMJ Publishing Group, 2012
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-74496 (URN)10.1136/thoraxjnl-2011-200665 (DOI)000300625300008 ()
Note

funding agencies|Airsonett AB||National Institute for Health Research||National Institute for Health Research Biomedical Research Centre||MRC||Asthma UK Centre in Allergic Mechanisms of Asthma||

Available from: 2012-01-30 Created: 2012-01-30 Last updated: 2017-12-08
Brodtkorb, T.-H., Zetterström, O. & Tinghög, G. (2010). Cost-effectiveness of clean air administered to the breathing zone in allergic asthma. CLINICAL RESPIRATORY JOURNAL, 4(2), 104-110
Open this publication in new window or tab >>Cost-effectiveness of clean air administered to the breathing zone in allergic asthma
2010 (English)In: CLINICAL RESPIRATORY JOURNAL, ISSN 1752-6981, Vol. 4, no 2, p. 104-110Article in journal (Refereed) Published
Abstract [en]

Introduction: Airsonett Airshower (AA) is a novel non-pharmaceutical treatment for patients with perennial allergic asthma that uses a laminar airflow directed to the breathing zone of patients during sleep. It has been shown that AA treatment in addition to optimized standard therapy significantly increases asthma-related quality of life among adolescent asthmatics. However, the cost-effectiveness of AA treatment has not yet been assessed. As reimbursement decisions are increasingly guided by results from the cost-effectiveness analysis, such information is valuable for health-care policy-makers. Objective: The objective of this study was to estimate the cost-effectiveness of adding AA treatment with allergen-free air during night sleep to optimized standard therapy for adolescents with perennial allergic asthma compared with placebo. Materials and Methods: A probabilistic Markov model was developed to estimate costs and health outcomes over a 5-year period. Costs and effects are presented from a Swedish health-care perspective (QALYs). The main outcome of interest was cost per QALY gained. Results: The Airshower strategy resulted in a mean gain of 0.25 QALYs per patient, thus yielding a cost per QALY gained of under 35 000 as long as the cost of Airshower is below 8200. Conclusions: Adding AA treatment to optimized standard therapy for adolescents with perennial allergic asthma compared with placebo is generating additional QALYs at a reasonable cost. However, further studies taking more detailed resource use and events such as exacerbations into account would be needed to fully evaluate the cost-effectiveness of AA treatment. Please cite this paper as: Brodtkorb T-H, Zetterstrom O and Tinghog G. Cost-effectiveness of clean air administered to the breathing zone in allergic asthma.

Keywords
asthma, cost-effectiveness, decision modeling, quality of life
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-54712 (URN)10.1111/j.1752-699X.2009.00156.x (DOI)000275766600007 ()
Available from: 2010-04-06 Created: 2010-04-06 Last updated: 2015-09-22
Lindskog, S., Blomlof, J., Persson, I., Niklason, A., Hedin, A., Ericsson, L., . . . Blomlof, L. (2010). Validation of an Algorithm for Chronic Periodontitis Risk Assessment and Prognostication: Analysis of an Inflammatory Reactivity Test and Selected Risk Predictors. Journal of Periodontology, 81(6), 837-847
Open this publication in new window or tab >>Validation of an Algorithm for Chronic Periodontitis Risk Assessment and Prognostication: Analysis of an Inflammatory Reactivity Test and Selected Risk Predictors
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2010 (English)In: Journal of Periodontology, ISSN 0022-3492, E-ISSN 1943-3670, Vol. 81, no 6, p. 837-847Article in journal (Refereed) Published
Abstract [en]

Background: Patients with severe forms of chronic periodontitis present with varying degrees of decreased inflammatory reactivity. A previously reported algorithm for chronic periodontitis risk assessment and prognostication is based on the analysis of some 20 risk predictors. One of these predictors is a skin provocation test that assesses the individual patient's reactivity to a lipid A challenge. The aim of this report was to analyze results from validation data for the algorithm with respect to the contribution of results of the skin provocation test as a risk predictor for the progression of chronic periodontitis and to compare these results with the contribution from other predictors, namely smoking, angular bony destruction, furcation involvement, abutment teeth, and endodontic pathology.

Methods: Data from a previously reported clinical validation sample were used for the analysis, including the calculation of quality measures and explanatory values using different types of regression analysis and non-parametric testing.

Results: Smoking, endodontic pathology, abutment teeth, angular bony destruction, and furcation involvement presented with individual explanatory values for periodontitis progression between 4% and 13% and highly significant parameter estimates. Explanatory values for the results of the skin provocation test ranged between 2.6% and 5.1% depending on the disease severity group, with a positive predictive value of 82% for the identification of high-risk patients.

Conclusion: The skin provocation test provided a clinically significant contribution to the quality of analysis with the periodontitis risk and prognostication algorithm, in particular in the selection of high-risk patients for in-depth individual tooth analysis.

Place, publisher, year, edition, pages
American Academy of Periodontology, 2010
Keywords
Disease progression, inflammation, periodontitis, prognosis, risk assessment, risk factor
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-72297 (URN)10.1902/jop.2010.090483 (DOI)000283021200005 ()
Available from: 2011-11-24 Created: 2011-11-24 Last updated: 2017-12-08
Lindskog, S., Blomlof, J., Persson, I., Niklason, A., Hedin, A., Ericsson, L., . . . Blomlof, L. (2010). Validation of an Algorithm for Chronic Periodontitis Risk Assessment and Prognostication: Risk Predictors, Explanatory Values, Measures of Quality, and Clinical Use. JOURNAL OF PERIODONTOLOGY, 81(4), 584-593
Open this publication in new window or tab >>Validation of an Algorithm for Chronic Periodontitis Risk Assessment and Prognostication: Risk Predictors, Explanatory Values, Measures of Quality, and Clinical Use
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2010 (English)In: JOURNAL OF PERIODONTOLOGY, ISSN 0022-3492, Vol. 81, no 4, p. 584-593Article in journal (Refereed) Published
Abstract [en]

Background: The American Academy of Periodontology has recently stated that, "[risk assessment will become] increasingly important in periodontal treatment planning and should be part of every comprehensive dental and periodontal evaluation." (J Periodontol 2006;77:1608). Unaided risk assessment and prognostication show significant variability because chronic periodontitis is a multifactorial disease. This report summarizes the clinical validation of an algorithm for chronic periodontitis risk assessment and prognostication. The algorithm is a Web-based analytic tool that integrates some 20 risk predictors and calculates scores indicating levels of risk for chronic periodontitis for the dentition (Level I) and, if an elevated risk is found, prognosticates disease progression tooth by tooth (Level II). Methods: An independent clinical validation sample was generated in an open, prospective clinical trial and analyzed in a predetermined validation plan. Results: The analyses identified two threshold scores above which significant progression of periodontitis was found. Based on these scores, sufficiently high explanatory values with significant and increasing parameter estimates for increasing risk were established in Level I, justifying detailed analysis tooth by tooth in Level II. Subsequent prognostication of chronic periodontitis in Level II was found to be accompanied by clinically relevant measures of quality in relation to rates of disease progression. Three score intervals representing increasing levels of periodontitis progression were identified corresponding to increasing levels of significant annual marginal bone loss. Conclusions: The predictors included in the algorithm reflect a relevant selection for periodontitis risk assessment. Risk assessment and prognostication with the algorithm provides the clinician with a validated, reliable, consistent, and objective tool supporting treatment planning.

Place, publisher, year, edition, pages
American Academy of Periodontology, 2010
Keywords
Algorithm, disease progression, periodontitis, prognosis, risk assessment, risk factor
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-61184 (URN)10.1902/jop.2010.090529 (DOI)000283020800017 ()
Available from: 2010-11-05 Created: 2010-11-05 Last updated: 2013-03-26
Pedroletti, C., Millinger, E., Dahlen, B., Soderman, P. & Zetterström, O. (2009). Clinical effects of purified air administered to the breathing zone in allergic asthma: A double-blind randomized cross-over trial. RESPIRATORY MEDICINE, 103(9), 1313-1319
Open this publication in new window or tab >>Clinical effects of purified air administered to the breathing zone in allergic asthma: A double-blind randomized cross-over trial
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2009 (English)In: RESPIRATORY MEDICINE, ISSN 0954-6111, Vol. 103, no 9, p. 1313-1319Article in journal (Refereed) Published
Abstract [en]

Background: Exposure to inhaled allergens is a pathogenetic factor in allergic asthma. However, most studies that previously looked at air cleaning devices have shown little or no effect on patients with perennial allergic asthma. Aims and objectives: We examined a novel treatment using temperature regulated laminar airflow with a very low particle concentration directed to the breathing zone of teenagers and young adults with mild to moderate allergic asthma during night steep. We hypothesised that the decreased allergen exposure during the night would have an effect on bronchial inflammation and quality of life. Method: Twenty-two patients (mean 18.8 years) were randomized to start with active or placebo treatment for 10 weeks. At( patients received both active and placebo treatment with unfiltered air, with a 2-week wash-out period in between treatments. Maintenance treatment with inhaled corticosteroids was unaltered during the trial period. Health related quality of life (miniAQLQ) was the primary effectiveness measure. Exhaled nitric oxide (FeNO) and spirometry were also investigated. Results: Active treatment resulted in an improved miniAQLQ compared to placebo (mean score 0.54, p andlt; 0.05, n = 20). An effect on bronchial, inflammation was also detected with significantly tower FeNO values during the active treatment period (mean -6.95 ppb, p andlt; 0.05, n = 22). Both effects were evident after 5 weeks. The change in lung function was not statistically significant. Conclusion: Clean air, administered directly to the breathing zone during steep, can have a positive effect on bronchial. inflammation and quality of life in patients with perennial allergic asthma.

Keywords
Asthma, Controlled environment, Quality of life, Exhaled nitric oxide
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-20740 (URN)10.1016/j.rmed.2009.03.020 (DOI)
Available from: 2009-09-18 Created: 2009-09-18 Last updated: 2013-03-26
Roel, E., Zetterström, O., Trell, E. & Faresjö, T. (2009). Why are some children with early onset of asthma getting better over the years? - Diagnostic failure or salutogenetic factors. International Journal of Medical Sciences, 6(6), 348-357
Open this publication in new window or tab >>Why are some children with early onset of asthma getting better over the years? - Diagnostic failure or salutogenetic factors
2009 (English)In: International Journal of Medical Sciences, ISSN 1449-1907, E-ISSN 1449-1907, Vol. 6, no 6, p. 348-357Article in journal (Refereed) Published
Abstract [en]

Among children earlier having been identified with a hospital or primary care diagnosis of asthma at least once between 0-7 years of age, almost 40 % of their parents reported in the ISAAC-questionnaire as never having had asthma (NA). These are further analysed and compared with the persisting asthma cases (A) in this study. All these childrens medical records were scrutinized concerning their asthma diagnose retrospectively. The aim of this study was to analyse possible factors related to the outcome in an Asthma diagnosis reassessment by parental questionnaire at the age of ten of the children earlier having been identified with a hospital or primary health care diagnosis of asthma at least once between 0-7 years of age in a total birth-year cohort in a defined Swedish geographical area. A multiple logistic analysis revealed four significant and independent factors associated to the improvement/non-report of asthma at the age of ten. These factors were; not having any past experiences of allergic symptoms (pless than0.0001), only having one or two visits at the hospital for asthma diagnosis in the 0-7 interval (p=0.001), not living in a flat but a villa at the age of ten (p=0.029) and no previous perception of mist or mould damage in the house (p=0.052). In the early postnatal stage, obstructive and bronchospastic symptoms typical of asthma may be unspecific, and those cases not continuing to persisting disease tend to have identifiable salutogenetic factors of constitutional rather than environmental nature, namely, an overall reduced allergic predisposition.

Keywords
asthma diagnosis; childhood asthma; diagnose setting; follow-up; salutogenetic factors
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-53929 (URN)10.7150/ijms.6.348 (DOI)000273405400008 ()
Note

Original Publication: Eduardo Roel, Olle Zetterström, Erik Trell and Tomas Faresjö, Why are some children with early onset of asthma getting better over the years? - Diagnostic failure or salutogenetic factors, 2009, INTERNATIONAL JOURNAL OF MEDICAL SCIENCES, (6), 6, 348-357. http://www.medsci.org/v06p0348.htm Licensee: Ivyspring International Publisher http://www.biolsci.org/

Available from: 2010-02-12 Created: 2010-02-12 Last updated: 2017-12-12
Zetterström, O., Dahl, R., Lindqvist, A. & Olsson, P. (2008). Comparable morning versus evening administration of once-daily mometasone furoate dry powder inhaler. Respiratory Medicine, 102(10), 1406-1411
Open this publication in new window or tab >>Comparable morning versus evening administration of once-daily mometasone furoate dry powder inhaler
2008 (English)In: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 102, no 10, p. 1406-1411Article in journal (Refereed) Published
Abstract [en]

Background: The control of daytime and nighttime symptoms is an important measure of effectiveness of asthma therapy, especially, when administered once-daily. Objective: To evaluate the efficacy of evening and morning administrations of mometasone furoate administered via a dry powder inhaler (MF-DPI) 400 μg once-daily (QD) to show equivalence. Methods: Open-label, randomized, parallel-group study in adult patients with mild to moderate asthma with a ≥3-month history of ICS use. Patients received MF-DPI 400 μg QD either in the morning (AM) or evening (PM) for 12 weeks. The primary measure was the change in asthma symptoms from baseline to week 12. Secondary outcomes included response to treatment, adherence, inhaler device evaluation, use of rescue medication, urinary cortisol levels, and differential white blood cell count. Results: A total of 1537 patients were randomized, the efficacy population comprised 543 and 479 patients in the MF-DPI QD morning and evening groups, respectively. Mean improvements from baseline in daytime symptom scores at week 12 with morning and evening administration of MF-DPI 400 μg were -0.11 ± 0.59 and -0.12 ± 0.68, respectively (95% CI, -0.095 to 0.061) and the corresponding improvements in nighttime symptom scores were -0.08 ± 0.59 and -0.07 ± 0.50, respectively (95% CI, -0.067 to 0.068). Use of rescue medication was the same in both groups (1 puff/day). MF-DPI QD was well tolerated regardless of time of administration. Conclusions: This open-label study did not identify differences between morning and evening dosing of MF-DPI 400 μg QD. A better effect of evening dosing compared to morning dosing found in previous double-blind placebo-controlled studies could not be confirmed. © 2008 Elsevier Ltd. All rights reserved.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-43424 (URN)10.1016/j.rmed.2008.04.024 (DOI)73824 (Local ID)73824 (Archive number)73824 (OAI)
Available from: 2009-10-10 Created: 2009-10-10 Last updated: 2017-12-13
Casas, R., Lindau, C., Zetterström, O. & Duchén, K. (2008). Downregulation of CXCR6 and CXCR3 in lymphocytes from birch-allergic patients. Scandinavian Journal of Immunology, 68(3), 351-361
Open this publication in new window or tab >>Downregulation of CXCR6 and CXCR3 in lymphocytes from birch-allergic patients
2008 (English)In: Scandinavian Journal of Immunology, ISSN 0300-9475, E-ISSN 1365-3083, Vol. 68, no 3, p. 351-361Article in journal (Refereed) Published
Abstract [en]

Preferential expression of chemokine receptors on Th1 or Th2 T-helper cells has mostly been studied in cell lines generated in vitro or in animal models, however, results are less well characterized in humans. We determined T-cell responses through chemokine receptor expression on lymphocytes, and cytokine secretion in plasma from birch-allergic and healthy subjects. The expression of CCR2, CCR3, CCR4, CCR5, CCR7, CXCR3, CXCR4, CXCR6, IL-12 and IL-18R receptors was studied on CD4+ and CD8+ cells from birch-allergic (n = 14) and healthy (n = 14) subjects by flow cytometry. The concentration of IL-4, IL-5, IL-10, IL-12, IFN-γ and TNF-α cytokines was measured in plasma from the same individuals using a cytometric bead array human cytokines kit. The similar expression of CCR4 in T cells from atopic and healthy individuals argues against the use of the receptor as an in vivo marker of Th2 immune responses. Reduced percentages of CD4+ cells expressing IL-18R, CXCR6 and CXCR3 were found in the same group of samples. TNF-α, IFN-γ, IL-10, IL-5, IL-4 and IL-12 cytokines were elevated in samples from allergic individuals. Reduced expression of Th1-associated chemokine receptors together with higher levels of Th1, Th2 and anti-inflammatory cytokines in samples from allergic patients indicate that immune responses in peripheral blood in atopic diseases are complex and cannot be simplified to the Th1/Th2 paradigm. Not only the clinical picture of atopic diseases but also the clinical state at different time points of the disease might influence the results of studies including immunological markers associated with Th1- or Th2-type immune responses. © 2008 The Authors.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-43218 (URN)10.1111/j.1365-3083.2008.02146.x (DOI)72982 (Local ID)72982 (Archive number)72982 (OAI)
Available from: 2009-10-10 Created: 2009-10-10 Last updated: 2017-12-13
Zara, K., Hellman, B.-M. & Zetterström, O. (2008). Pain estimation caused by adrenaline injectors for the treatment of anaphylaxis. The recommendation to practice the use prior to acute allergic reaction is supported by a cross-sectional study. Läkartidningen, 105(19), 1388-1390
Open this publication in new window or tab >>Pain estimation caused by adrenaline injectors for the treatment of anaphylaxis. The recommendation to practice the use prior to acute allergic reaction is supported by a cross-sectional study
2008 (English)In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 105, no 19, p. 1388-1390Article in journal (Refereed) Published
Keywords
Adrenergic Agonists/*administration & dosage Adult Anaphylaxis/*drug therapy Anti-Allergic Agents/*administration & dosage Cross-Sectional Studies *Emergency Treatment Epinephrine/*administration & dosage Female Humans Injections, Intramuscular/adverse ef
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-43425 (URN)73826 (Local ID)73826 (Archive number)73826 (OAI)
Available from: 2009-10-10 Created: 2009-10-10 Last updated: 2017-12-13
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