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  • 1.
    Axelsson, Malin
    et al.
    Högskolan Väst, Avd för specialistsjuksköterskeutbildning.
    Emilsson, Maria
    Högskolan Väst, Avd för specialistsjuksköterskeutbildning.
    Brink, Eva
    Högskolan Väst, Avd för specialistsjuksköterskeutbildning.
    Lundgren, J.
    University of Gothenburg, Department of Psychology.
    Torén, K.
    University of Gothenburg, Sahlgrenska Academy, Department of Community Medicine.
    Lötvall, J.
    University of Gothenburg, Sahlgrenska Academy, Department of Internal Medicine.
    Personality, adherence, asthma control and health-related quality of life in young adult asthmatics2009In: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 103, no 7, p. 1033-1040Article in journal (Refereed)
    Abstract [en]

    Background

    Striving for improved adherence and asthma control is of vital concern in today's asthma management. Several influential factors have been identified, but the importance of personality traits has been insufficiently explored. The aim was first to determine whether personality traits in young adult asthmatics are related to asthma control and health-related quality of life (HRQL), and second to examine the influences of personality traits on adherence to regular asthma medication treatment.

    Methods

    Young adult asthmatics, 22 years of age (n = 268) completed questionnaires. Statistical analyses were performed.

    Results

    The personality traits Negative Affectivity and Impulsivity correlated negatively with asthma control, whereas in women Hedonic Capacity correlated positively with asthma control. Negative Affectivity, Impulsivity, Hedonic Capacity, Alexithymia and asthma control predicted the mental dimension of HRQL. Asthma control and physical activity predicted the physical dimension of HRQL. Among respondents with regular asthma medication (n = 109), Impulsivity correlated negatively with adherence. In men, Antagonism and Alexithymia were associated with low adherence. Additionally, Alexithymia, Hedonic Capacity and Negative Affectivity showed non-linear relationships with adherence, meaning that initially increased scores on these personality traits scales were associated with increased adherence but higher scores did not increase adherence. Respondents who were prescribed a single inhaler combining ICS and LABA reported higher adherence than those with monotherapies.

    Conclusion

    These data suggest that personality can influence how asthma patients adhere to asthma medication treatment, and report their control and HRQL. Tools determining personality traits may be useful in the future in individualizing management of asthma patients.

  • 2.
    Berggren, F.
    et al.
    AstraZeneca RandD Lund, Lund, Lund University Centre for Health Economics (LUCHE), Lund.
    Ekstrom, T.
    A cost-effectiveness study comparing the as-needed use of formoterol (Oxis®) and terbutaline (Bricanyl®) in patients with moderate to severe asthma2001In: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 95, no 9, p. 753-758Article in journal (Refereed)
    Abstract [en]

    This study evaluated the economic and health-related consequences of the as-needed use of a long-acting ß2-agonist with fast onset (formoterol,Oxis® Turbuhaler® 4.5 µg) versus a short-acting ß2-agonist (terbutaline, Bricanyl® Turbuhaler® 0.5 mg) in patients with moderate to severe asthma. A multi-national (Sweden, Norway, The Netherlands and Greece), multi-centre (35 centres), randomized, double-blind clinical trial was conducted using 362 patients on inhaled steroids during a 12-week period. The effectiveness results were pooled and the total costs included estimates for ß2-agonists, inhaled steroids, oral steroids, physician visits and sick-leave. The 182 patients in the formoterol group had 14404 days of exposure and 29 severe exacerbations, and the 180 patients in the terbutaline group had 13655 days of exposure and 48 severe exacerbations. The terbutaline group had 62% more severe exacerbations than the formoterol group (P=0.039), based on exposure time. Per patient, the calculated total costs were SEK 3386 for the formoterol group and SEK 3709 for the terbutaline group over the 12-week period. The conclusion is that the use of Oxis® Turbuhaler® instead of Bricanyl® Turbuhaler® for as-needed treatment is a more effective treatment generating cost savings from a societal perspective. © 2001 Harcourt Publishers Ltd.

  • 3.
    Ekström, T
    et al.
    Östergötlands Läns Landsting.
    Johansson, KE
    Östergötlands Läns Landsting, Anaesthesiology and Surgical Centre, Department of Surgery UHL.
    Effects of anti-reflux surgery on chronic cough and asthma in patients with gastro-oesophageal reflux disease2000In: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 94, no 12, p. 1166-1170Article in journal (Refereed)
    Abstract [en]

    This two-group prospective study evaluated the effect of anti-reflux surgery (fundoplication) on 24 patients with severe gastro-oesophageal reflux disease (GORD) and concomitant asthma (n = 13) or chronic cough (n = 11). Twenty-four hour oesophageal pH monitoring and lung function tests (FEV1, FVC) were done before and within 1 year after anti-reflux surgery. A diary was kept by the patient during the 4-week period prior to surgery and during 4-week periods 6 and 12 months postoperatively, with daily monitoring of peak expiratory flow rate, respiratory and reflux symptoms and medication. In non-asthmatic patients, coughing was reduced by 47% and 80% during the day and night, respectively, 12 months after surgery (Pless than0.01). Concomitant hoarseness and expectoration were also significantly reduced (Pless than0.05). No effect on lung function was seen. In patients with asthma, small, non-significant reductions in asthma symptom scores and consumption of rescue medication were seen Twenty-two patients were completely free from their GORD symptoms after surgery. In conclusion, anti-reflux surgery in patients with GORD had a more favourable effect on concomitant cough than concomitant asthma

  • 4. Franklin, K A
    et al.
    Svanborg, Eva
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Neurophysiology. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Neurology.
    The accuracy of subjective sleep time in sleep apnoea recordings.2000In: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 94, p. 569-573Article in journal (Refereed)
  • 5.
    Jogi, R.
    et al.
    Jõgi, R., Department of Medical Sciences, Respiratory Medicine and Allergology, Uppsala University, Akademiska sjukhuset, Uppsala, Sweden, Foundation Tartu University Clinics Lung Clinic, Tartu, Estonia.
    Björkstén, Bengt
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Pediatrics . Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Paediatrics in Linköping.
    Boman, G.
    Department of Medical Sciences, Respiratory Medicine and Allergology, Uppsala University, Akademiska sjukhuset, Uppsala, Sweden, Asthma Research Centre, Uppsala University, Uppsala, Sweden.
    Jonson, Carl-Oscar
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Pediatrics .
    Serum eosinophil cationic protein (S-ECP) in a population with low prevalence of atopy2002In: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 96, no 7, p. 525-529Article in journal (Refereed)
    Abstract [en]

    The study is a part of the European Community Respiratory Health Survey. A random sample (n=351) of 20-44-year olds and persons of the same age with asthma-like symptoms or current asthma medication according to a postal questionnaire (n=95) were studied. Interview was taken, methacholine challenge was done and ECP, total and specific IgE were measured from serum. The median S-ECP value was 8.0 µg/l in the random sample. The geometric mean of S-ECP was higher in subjects with, than without atopy (10.2. vs 8.9 µg/l, P < 0.01) and in subjects with bronchial hyperresponsiveness (BHR) than in subjects without BHR (9.9 vs 8.0 µg/l, P <0.01).The levels correlated weakly to forced expiratory volume in one second (FEV1) (r=0.13, P <0.01) and were not independently correlated with respiratory symptoms, asthma or FEV1 after adjusting for BHR, IgE, sensitisation and smoking. Our results indicate that the level of eosinophil activation is low in a population with a low prevalence of atopy even when BHR is common. © 2002 Published by Elsevier Science Ltd.

  • 6.
    Jones, A Wayne
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Division of clinical chemistry.
    Fransson, Monika
    Maldonado-Holmertz, Elisa
    Does consumption of ethanol distort measurements of exhaled nitric oxide?2005In: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 99, no 2, p. 196-199Article in journal (Refereed)
    Abstract [en]

    Background: Measuring FENO is a novel and non-invasive way to monitor airway inflammation (e.g. asthma). This clinical study was designed to investigate whether drinking ethanol might distort FENO measurements. Methods: Twenty healthy subjects drank 0.40 g ethanol/kg body weight in 15 min. Measurement of FENO started ∼ 30 min before drinking and at various times afterwards for 4 h post-dosing. Ethanol concentrations were determined in venous blood by gas chromatography and in end-exhaled breath by infra-red spectrometry. Results: The within subject standard deviation for determination of FENO was 1.3 ppb, corresponding to a CV of 7.7%. The mean change in FENO from pre-drinking levels during the 4 h testing was statistically significant (P

  • 7.
    Lindberg, Malou
    et al.
    Department of Research and Development in Primary Care, Mjölby, Sweden.
    Ahlner, Johan
    Department of Research and Development in Primary Care, Mjölby, Sweden.
    Möller, M.
    Department of Research and Development in Primary Care, Mjölby, Sweden.
    Ekström, T.
    Department of Research and Development in Primary Care, Mjölby, Sweden.
    Asthma nurse practice: a resource-effective approach in asthma management1999In: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 93, no 8, p. 584-588Article in journal (Refereed)
    Abstract [en]

    The objective of this study was to evaluate the efficacy of an Asthma Nurse Practice (ANP) in primary health care.

    A 12-month (September 1994–August 1995) open, prospective intervention study with pre- and post-test comparisons was performed on patients with asthma treated at a primary care centre in Sweden.

    Sixty-three patients with mild or moderate asthma participated and medication, structured follow-up and education in self-management at an ANP were assessed over a 12-month period.

    The main outcome measures assessed were pulmonary function, eosinophil cationic protein (ECP) in serum, respiratory symptoms, patient knowledge of asthma and emergency visits.

    ANP in primary health care increased patient knowledge of asthma and medication. The number of patients with nocturnal symptoms decreased significantly. Pulmonary function was improved: vital capacity (VC) 98–106, forced expiratory volume in 1 sec (FEV1) 93–100 and peak expiratory flow (PEF) 98–115% of predicted (P<0·001). Variation in PEF fell from 21 to 12% (P<0·001). ECP was significantly reduced. Visits to the emergency room were 60% fewer during the year of intervention (P<0·01).

    In conclusion, patients attending an Asthma Nurse Practice, comprising a structured programme for asthma management, improve their knowledge and asthma control.

  • 8.
    Naidu-Sjöswärd, Kerstin
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Anaesthesiology. Östergötlands Läns Landsting, Anaesthesiology and Surgical Centre, Department of Intensive Care UHL.
    Mounira, H
    Davidsson, Anette
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Clinical Physiology. Östergötlands Läns Landsting, Heart Centre, Department of Clinical Physiology.
    Söderkvist, Peter
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Division of cell biology.
    Schmekel, Birgitta
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Clinical Physiology. Östergötlands Läns Landsting, Heart Centre, Department of Clinical Physiology.
    Single-isomer R-salbutamol is not superior to racemate regarding protection for bronchial hyperresponsiveness2004In: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 98, no 10, p. 990-Article in journal (Refereed)
    Abstract [en]

    Bronchial hyper-reactivity (BHR) has been suggested to follow cessation of regular medication with racemic salbutamol. This study aimed at investigating the effects from medication with R,S- and R-salbutamol on bronchial response to provocation with isocapnic hyperventilation of cold air (IHCA). Twenty-six patients with mild to moderate asthma were enrolled in a double-blind, randomised, cross-over study. Bronchial response to provocation was measured before and after 1 week's medication. Doses of 0.63 mg R-salbutamol or 1.25 mg R/S-salbutamol were inhaled three times daily during medication-weeks and a wash-out week intervened. Tests were performed 6 h after the last dose of test drug. Impulse oscillometry and forced expiratory volume during one second were methods used to identify bronchial response to provocation. Two patients withdrew from the investigation due to side-effects, one from R- the other from R,S-salbutamol. Comparable resting bronchial conditions were indicated by differences in baseline lung function values of <2% between study days. No statistically significant medication-dependent differences in BHR could be demonstrated between treatment groups. However, 15 patients exhibited higher (P=0.03) post-treatment BHR after pure R-salbutamol than after R,S-salbutamol. Furthermore, plasma concentrations of R-salbutamol tended to be lower (P=0.08) after medication with R- than after R,S-salbutamol despite equal doses of R-salbutamol given during the two separate treatment periods. We also found that considerable amounts of S-salbutamol were retrieved in plasma after medication with pure R-salbutamol. We conclude that we were unable to demonstrate favourable effects of R-salbutamol over R,S-salbutamol regarding response to provocation with IHCA after regular medication of 1 week's duration.

  • 9.
    Nayeri, Fariba
    et al.
    Linköping University, Department of Molecular and Clinical Medicine, Infectious Diseases. Linköping University, Faculty of Health Sciences.
    Millinger, Eva
    Linköping University, Department of Medicine and Care, Pulmonary Medicine. Linköping University, Faculty of Health Sciences.
    Nilsson, Ingela
    Departments of Clinical Chemistry, County Hospital, Kalmar, Sweden.
    Zetterström, Olle
    Linköping University, Department of Molecular and Clinical Medicine, Allergy Centre. Linköping University, Faculty of Health Sciences.
    Brudin, Lars
    Departments of Clinical Physiology, County Hospital, Kalmar, Sweden.
    Forsberg, Pia
    Linköping University, Department of Molecular and Clinical Medicine, Infectious Diseases. Linköping University, Faculty of Health Sciences.
    Exhaled breath condensate and serum levels of hepatocyte growth factor in pneumonia2002In: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 96, no 2, p. 115-119Article in journal (Refereed)
    Abstract [en]

    Hepatocyte growth factor (HGF) is a protein produced by mesenchymal cells in many organs, which can stimulate epithelial growth. An enhanced production and concentration of HGF is observed after injuries. The lung is one of the major sources of HGF. By cooling exhaled air, a condensate is formed containing molecules from bronchi and alveoli. In order to investigate HGF concentration and time course in pneumonia, paired serum and exhaled breath condensate was collected from 10 patients with pneumonia, 10 patients with non-respiratory infections and 11 healthy controls. The concentration of HGF was measured by an immunoassay kit. In the acute phase HGF-levels in breath condensate and serum were significantly higher in the patients with pneumonia compared to the control groups. Similar concentrations in breath condensate were seen in healthy controls and in patients with non-respiratory infections. In the patients with pneumonia a decrease in serum HGF was seen already after 4–7 days while HGF values in breath condensate remained elevated even after 4–6 weeks. These results might imply local production of HGF in the lungs and a long repair and healing process after pneumonia.

  • 10.
    Nyström Kronander, Ulla
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Allergy Centre. Östergötlands Läns Landsting, Centre for Medicine, Allergy Centre UHL.
    Falkenberg, Melcher
    Linköping University, Department of Department of Health and Society. Linköping University, Faculty of Health Sciences.
    Zetterström, Olle
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Allergy Centre. Östergötlands Läns Landsting, Centre for Medicine, Allergy Centre UHL.
    Prevalence and incidence of asthma related to waist circumference and BMI in a Swedish community sample2004In: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 98, no 11, p. 1108-1116Article in journal (Refereed)
    Abstract [en]

    Both asthma and obesity have become more common in affluent societies during the recent decades and several studies have shown a correlation between the presence of asthma and obesity. In order to further study this association we have investigated a population from a community in southern Sweden, where almost all inhabitants had their body indices measured as part of a study on diabetes at a primary care centre. An asthma unit working with a structured care programme for asthma was available. This organisation enabled us to study whether body mass index and waist circumference was associated with having or developing asthma. There was a significant association between both overweight, increased waist circumference and asthma, P

  • 11.
    Ringsberg, K.C.
    et al.
    Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Bjarneman, P.
    Bjärneman, P., Asthma and Allergy Centre Sahlgrenska University Hospital, 413 45 Göteborg, Sweden.
    Lowhagen, O.
    Löwhagen, O., Asthma and Allergy Centre Sahlgrenska University Hospital, 413 45 Göteborg, Sweden.
    Oden, A.
    Odén, A., Consultant Statistician, Valler, 442 92 Romelanda, Sweden.
    Toren, K.
    Torén, K., Occupational and Environmental Medicine, Sahlgrenska University Hospital, 413 45 Göteborg, Sweden.
    Differences in trigger factors and symptoms between patients with asthma-like symptoms and patients with asthma: Development of a basis for a questionnaire2002In: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 96, no 5, p. 305-311Article in journal (Refereed)
    Abstract [en]

    Patients with asthma-like symptoms but with negative asthma tests are often misdiagnosed as having asthma and treated as asthmatics. They describe their trigger factors and symptoms very similar to those of patients with asthma. The aim of the study was to analyze differences in symptoms and trigger factors between asthma-like patients and asthmatics in order to elaborate a basis for a questionnaire for epidemiological and clinical use. A questionnaire with 54 questions about trigger factors and 137 questions about symptoms was sent to 40 patients with asthma-like symptoms and 40 with asthma, all consecutively selected from patients referred to an out-patient clinic for asthma and allergy for investigation of suspected asthma. Data were analyzed statistically in two steps using multiple logistic regression analysis. Significant differences were seen in several trigger factors and symptoms after the first analysis. After the second analysis, seven out of the 54 trigger factors and 22 out of the 137 symptoms emerged as those that most significantly discriminated between the two patient groups. These trigger factors and symptoms can be the basis of a new questionnaire with high discriminating power. Before using it, it is important to evaluate the best combination of variables, add some demographic variables and to test the reliability and validity of this new questionnaire. © 2002 Elsevier Science Ltd.

  • 12.
    Schmekel, Birgitta
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Clinical Physiology. Östergötlands Läns Landsting, Heart Centre, Department of Clinical Physiology.
    Ahlner, Johan
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Clinical Pharmacology. Östergötlands Läns Landsting, Centre for Laboratory Medicine, Department of Clinical Pharmacology.
    Malmström, M
    Venge, P
    Eosinophil cationic protein (ECP) in saliva: A new marker of disease activity in bronchial asthma2001In: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 95, no 8, p. 670-675Article in journal (Refereed)
    Abstract [en]

    Eosinophil cells play a crucial role in the pathogenesis of asthma, and concentration of eosinophil cationic protein (ECP) in serum has been used to monitor activity of the disease. Our aim was to determine the feasibility and usefulness of measuring ECP in saliva and to use it as a marker of the disease. Thirty-eight patients with asthma and 16 healthy volunteers were included in this study. Repeatability of measurements of ECP in saliva was acceptable [intra-class correlation coefficients (Ri) = 0.74 and coefficients of repeatability (CR) = 0.37 in five healthy subjects]. Levels of ECP in saliva were higher in asthmatics than in volunteers (P < 0.01). There was a significant inverse association between a surrogate variable reflecting disease activity (i.e. change over a few weeks in dose of inhaled corticosteroid required by a change in clinical status of asthma) and a change over the same time period in salivary ECP in 19 patients with stable asthma (r = -0.64, P = 0.02). Our findings indicate that levels of salivary ECP are elevated in patients with asthma and associated with presumed activity of disease as recorded by alteration of taken dose of inhaled corticosteroid. ⌐ 2001 Harcourt Publishers Ltd.

  • 13.
    Schmekel, Birgitta
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Clinical Physiology. Östergötlands Läns Landsting, Heart Centre, Department of Clinical Physiology.
    Seveus, L
    Xu, S Y
    Venge, Per
    Human neutrophil lipocalin (HNL) and myeloperoxidase (MPO). Studies of lung lavage fluid and lung tissue2000In: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 94, no 6, p. 564-568Article in journal (Refereed)
    Abstract [en]

    Myeloperoxidase (MPO) and human neutrophil lipocalin (HNL) are proteins which are stored in neutrophil granulocytes, in the primary and secondary granules, respectively. These granules or their contents of MPO and HNL are secreted upon activation of the cells, and measurement of these soluble markers in biological fluids, such as bronchoalveolar lavage (BAL), has been proposed to mirror the degree of neutrophil activity in the tissue. We conducted a BAL study in 10 healthy volunteers, with the aim to evaluate the intra-individual variability of the concentration of HNL and MPO recovered in sequential aspirations, during a time period when the concentrations of HNL and MPO in BAL fluids were considered to have equilibrated with those in the underlying tissues. The concentrations of HNL were less variable than those of MPO (coefficients of variability 0.33+/-0.07 vs. 0.92+/-0.28,P+/-0.01). Suggesting HNL to be a more useful marker of neutrophil activity within the airspace. The specificity of HNL as a selective index of neutrophil cells was confirmed by means of immunohistochemical staining of uninvolved lung tissue specimens obtained from patients referred to pulmonectomy due to carcinoma. While HNL was located only to intracellular spaces of neutrophils, MPO was in addition located to other cells as well. We speculate that the dynamic changes of pressure across the membranes and flow of solutes during a lavage process might mobilize particulate matter and adherent cells, some of which may be loaded with MPO, and that this may introduce larger variability in the recovery of MPO than of HNL. We conclude that using HNL as a soluble indicator of neutrophil presence is more feasible than using MPO.

  • 14.
    Strömberg, Tomas
    et al.
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Biomedical Instrumentation.
    Gustafsson, P M
    Hälsouniversitetet Linköping .
    Breathing pattern variability during bronchial histamine and methacholine challenges in asthmatics1996In: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 90, no 5, p. 287-296Article in journal (Refereed)
  • 15.
    Strömberg, Tomas
    et al.
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Biomedical Instrumentation.
    Gustafsson, P M
    Hälsouniversitetet Linköping .
    Hyperventilation during bronchial challenges in asthmatics: reproducibility and assessment of contributing factors1996In: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 90, no 5, p. 297-306Article in journal (Refereed)
  • 16.
    Ställberg, B.
    et al.
    Trosa Health Care Centre, Trosa, Sweden, Dept. of Public Health/Caring Sci., University of Uppsala, Uppsala, Sweden.
    Nyström Kronander, Ulla
    Linköping University, Department of Clinical and Experimental Medicine, Allergy Centre. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Allergy Center.
    Olsson, P.
    Sjöbo Health Care Centre, Sjöbo, Sweden.
    Gottberg, L.
    Dept. Respiratory Medicine/Allergy, University Hospital of Huddinge, Huddinge, Sweden.
    Rönmark, E.
    The OLIN Studies, Sunderby Central Hosp. of Norrbotten, Luleå, Sweden, Dept. Respiratory Medicine/Allergy, University of Umeå, Umeå, Sweden, Lung and Allergy Research, National Institute of Environ. Med., Karolinska Institute, Stockholm, Sweden.
    Lundbäck, B.
    The OLIN Studies, Sunderby Central Hosp. of Norrbotten, Luleå, Sweden, Lung and Allergy Research, National Institute of Environ. Med., Karolinska Institute, Stockholm, Sweden.
    Living with asthma in Sweden - The ALMA study2003In: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 97, no 7, p. 835-843Article in journal (Refereed)
    Abstract [en]

    Background: Recently performed studies have found a number of limitations in the daily lives of asthmatics, and a large disparity between the perception of the sufferers and what health care professionals believe matters to asthmatics. Aim: What matters to Swedish asthma patients, what medicines do they use, and are they compliant with given prescriptions? A further aim was to compare perceptions about asthma and asthma management in asthmatics and among Swedish general practitioners (GP). Design: A structured telephone interview of a representative sample of Swedish asthmatics, and a mailed questionnaire survey among GPs from different parts of Sweden. Methods: Screening by telephone of a random sample of 10,350 subjects aged 18-45. Of those, 240 were subsequently selected for a detailed structured telephone interview about their asthma. A mailed structured questionnaire containing similar questions to those asked of the asthmatics was sent to 600 GPs, and 139 returned completed answers. Results: 16% of the asthmatics reported (asthma) symptoms occurring every day during the previous month. Nocturnal symptoms at least twice per week were reported by 19%. Both these were reported by considerably higher proportions of the asthmatics than the GPs had expected. A large majority classified their disease as mild or very mild, although great majority reported frequent symptoms. Activities or situations which caused symptoms of asthma often or "now and then" were physical exertion, 67%, bad weather, 59%, contact with animals/pets, 58%, and visits to cafés or restaurants, 36%, and several asthmatics avoided these activities due to their asthma. Conclusion: A great majority of asthmatics report a large number of symptoms and limitations in their daily living in proportions which were roughly expected by the GPs. © 2003 Elsevier Science Ltd. All rights reserved.

  • 17.
    Venkata Ramanarao, Parasa
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Microbiology and Molecular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Karolinska Inst, Sweden.
    Forsslund, Helena
    Karolinska Inst, Sweden.
    Enger, Tobias
    Karolinska Inst, Sweden.
    Lorenz, Daniel
    Karolinska Inst, Sweden.
    Kullberg, Susanna
    Karolinska Inst, Sweden.
    Eklund, Anders
    Karolinska Inst, Sweden.
    Skold, Magnus
    Karolinska Inst, Sweden.
    Wahlstrom, Jan
    Karolinska Inst, Sweden.
    Grunewald, Johan
    Karolinska Inst, Sweden.
    Brighenti, Susanna
    Karolinska Inst, Sweden.
    Enhanced CD8(+) cytolytic T cell responses in the peripheral circulation of patients with sarcoidosis and non-Lofgrens disease2018In: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 138, p. S38-S44Article in journal (Refereed)
    Abstract [en]

    Background: The role of CD4(+) T cells in the immunopathogenesis of pulmonary sarcoidosis is well-established, while less is known about the phenotype and function of CD8(+) cytolytic T cells (CTLs). Methods: CD8(+) CTLs were explored in peripheral blood and bronchoalveolar lavage (BAL) samples obtained from up to 25 patients with sarcoidosis and 25 healthy controls. The proportion of CTLs was assessed by the expression of cytolytic effector molecules perforin, granzyme B and granulysin in CD8(+) T cells, using flow cytometry. Cytolytic function in blood lymphocytes was assessed using a standard 51Cr-release assay. Patients with Lofgrens syndrome (LS) and an acute disease onset, were compared to non-LS patients with an insidious onset. Results: Higher proportions of peripheral CD8(+) CTLs expressing perforin and granzyme B were observed in sarcoidosis compared to healthy controls. Blood CTLs from non-LS patients had significantly higher expression of perforin, granzyme B and granulysin compared to matched BAL, while LS patients maintained lower levels of effector molecules in both compartments. Mitogen-stimulated peripheral lymphocytes from sarcoidosis patients, particularly from the non-LS group, showed a higher target cell lysis compared to controls. Conclusion: These results demonstrated enhanced peripheral CD8(+) CTL responses in sarcoidosis, especially in non-LS patients who have an increased risk of chronic disease. Further comprehensive clinical studies are warranted to increase our understanding of CD8(+) CTL responses in sarcoidosis.

  • 18. Xu, Junyang
    et al.
    Jiang, Fengxia
    Nayeri, Fariba
    Linköping University, Department of Molecular and Clinical Medicine, Infectious Diseases. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Medicine, Department of Infectious Diseases in Östergötland.
    Zetterström, Olle
    Linköping University, Department of Molecular and Clinical Medicine, Allergy Centre. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Medicine, Allergy Centre UHL.
    Apoptotic eosinophils in sputum from asthmatic patients correlate negatively with levels of IL-5 and eotaxin2007In: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 101, no 7, p. 1447-1454Article in journal (Refereed)
    Abstract [en]

    Background: Eosinophilic inflammation of the airways is a key characteristic of asthma. A defect in eosinophil apoptosis might contribute to the chronic tissue eosinophilia associated with asthma. Objective: Our purpose was to examine whether the occurrence of apoptotic eosinophils in induced sputum from asthmatic patients correlate with interleukin (IL)-5 and eotaxin. Methods: Thirty stable and 30 exacerbated asthmatic patients were recruited. Twenty healthy subjects were enrolled as a control group. Induced sputum was obtained from asthmatic patients and from control subjects. The number of apoptotic eosinophils in sputum was assessed by flow cytometry. In sputum supernatant, eosinophil cationic protein (ECP) was measured by sensitive radioimmunoassay, and IL-5 and eotaxin by sandwich enzyme linked immunosorbant assay. Results: Levels of eosinophils, apoptotic eosinophils, IL-5, ECP and eotaxin from asthmatic patients were higher than those from healthy subjects. Thirty exacerbated asthmatics showed higher proportions of eosinophils (median 29.3%, range 13.4%-40.9%), more detectable levels of IL-5 (50.44, 32.99-67.01 pg/ml) and eotaxin (644.6, 197.4-937.7 pg/ml) in their sputum than the patients with stable asthma (P < 0.05). There were significant inverse correlations between the levels of sputum IL-5 and the proportion of sputum eosinophil apoptosis in patients with exacerbated and stable asthma (r = - 0.85 and -0.79, P < 0.01 and P < 0.05, respectively). Also inverse correlations were found between the levels of eotaxin and the proportion of sputum eosinophil apoptosis in exacerbated (r = - 0.85, P < 0.01), or stable asthma (r = - 0.69, P < 0.05). Additional positive corrlations between the levels of sputum IL-5 and eotaxin in either exacerbatated (r = 0.93, P < 0.01) or stable asthma (r = 0.82, P < 0.05) were observed. Conclusions: Apoptosis of eosinophils might be suppressed by proinflammatory cytokines and chemokines such as IL-5 and eotaxin leading to their accumulation in the lung. Stimulation of eosinophils in airway with IL-5 and eotaxin may play a crucial role in allergic inflammation. © 2007 Elsevier Ltd. All rights reserved.

  • 19.
    Zetterström, Olle
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Allergy Centre . Linköping University, Department of Clinical and Experimental Medicine, Allergy Centre .
    Buhl, R.
    Mainz University Hospital, Mainz, Germany.
    Mellem, H.
    Ullevål Hospital, Oslo, Norway.
    Andersson, F.
    Clinical Science, AstraZeneca R and D, Lund, Sweden.
    The whole story: Treatment outcomes with Symbicort®2002In: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 96, no SUPPL. 1Article, review/survey (Refereed)
    Abstract [en]

    Asthma is a chronic inflammatory disorder of the airways that has a considerable socioeconomic impact. Asthma management guidelines have been introduced to help provide better long-term control of asthma. Although recommended guidelines may increase the direct medication costs, the overall direct costs of asthma may be reduced due to fewer exacerbations. In addition, indirect costs due to lost productivity and mortality are reduced and patients have an improved quality of life. Inhaled corticosteroids are first-line therapy in the treatment of persistent asthma. Against this background, we have assessed the cost-effectiveness of Symbicort® (budesonide and formoterol in a single inhaler), a treatment that provides better control of asthma compared with budesonide alone. While the prescribing costs of Symbicort® were found to be higher than for budesonide alone, these were partially offset by reduced costs due to fewer asthma exacerbations and a reduced need for other medications. Combined long-term therapy with budesonide and formoterol also improves patient quality of life compared with budesonide alone. Two other factors associated with asthma treatment success and cost-effectiveness are patient/physician education and good patient adherence to prescribed therapy. The introduction of a single inhaler that is easy to use in simple treatment regimens may improve patient adherence to prescribed medication, thus resulting in improved asthma control and fewer exacerbations. Treatment with Symbicort® is more cost-effective than treatment with budesonide alone. © 2002 Elsevier Science Ltd.

  • 20.
    Zetterström, Olle
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Allergy Centre. Östergötlands Läns Landsting, Centre for Medicine, Allergy Centre UHL.
    Buhl, R
    Mellem, H
    Andersson, F
    The whole story: treatment outcomes with Symbicort?2002In: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 96, no Supplement A, p. 29-35Article in journal (Refereed)
    Abstract [en]

    Asthma is a chronic inflammatory disorder of the airways that has a considerable socioeconomic impact. Asthma management guidelines have been introduced to help provide better long-term control of asthma. Although recommended guidelines may increase the direct medication costs, the overall direct costs of asthma may be reduced due to fewer exacerbations. In addition, indirect costs due to lost productivity and mortality are reduced and patients have an improved quality of life. Inhaled corticosteroids are first-line therapy in the treatment of persistent asthma. Against this background, we have assessed the cost-effectiveness of Symbicort(R) (budesonide and formoterol in a single inhaler), a treatment that provides better control of asthma compared with budesonide alone. While the prescribing costs of Symbicort(R) were found to be higher than for budesonide alone, these were partially offset by reduced costs due to fewer asthma exacerbations and a reduced need for other medications. Combined long-term therapy with budesonide and formoterol also improves patient quality of life compared with budesonide alone. Two other factors associated with asthma treatment success and cost-effectiveness are patient/physician education and good patient adherence to prescribed therapy. The introduction of a single inhaler that is easy to use in simple treatment regimens may improve patient adherence to prescribed medication, thus resulting in improved asthma control and fewer exacerbations. Treatment with Symbicort(R) is more cost-effective than treatment with budesonide alone.

  • 21.
    Zetterström, Olle
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Allergy Centre . Östergötlands Läns Landsting, Centre for Medicine, Allergy Centre UHL.
    Dahl, R.
    Department of Respiratory Medicine Aarhus University Hospital, Denmark.
    Lindqvist, A.
    Department of Medicine Helsinki University Central Hospital, Helsinki, Finland.
    Olsson, P.
    Centre for Allergy Research Karolinska Institutet, Stockholm, Sweden.
    Comparable morning versus evening administration of once-daily mometasone furoate dry powder inhaler2008In: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 102, no 10, p. 1406-1411Article in journal (Refereed)
    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.

  • 22.
    Zetterström, Olle
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of health and environment. Östergötlands Läns Landsting, Centre for Medicine, Allergy Centre UHL.
    Lähelmä, S
    Keski-Karhu, J
    Silvasti, M
    Östling-Kulling, E
    Ahonen, A
    Salbutamol via EasyhalerR is at least a effective as salbutamol via TurbuhalerR in the treatment of histamine-induced bronchoconstriction.2000In: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 94, p. 1097-1102Article in journal (Refereed)
1 - 22 of 22
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