Eva Rönmark

Health-related quality of life is related to COPD disease severity

BackgroundThe aim of this study was to evaluate the association between health-related quality of life (HRQL) and disease severity using lung function measures.MethodsA survey was performed in subjects with COPD in Sweden. 168 subjects (70 women, mean age 64.3 years) completed the generic HRQL questionnaire, the Short Form 36 (SF-36), the disease-specific HRQL questionnaire; the St Georges Respiratory Questionnaire (SGRQ), and the utility measure, the EQ-5D. The subjects were divided into four severity groups according to FEV1 per cent of predicted normal using two clinical guidelines: GOLD and BTS. Age, gender, smoking status and socio-economic group were regarded as confounders.ResultsThe COPD severity grades affected the SGRQ Total scores, varying from 25 to 53 (GOLD p = 0.0005) and from 25 to 45 (BTS p = 0.0023). The scores for SF-36 Physical were significantly associated with COPD severity (GOLD p = 0.0059, BTS p = 0.032). No significant association were noticed for the SF-36, Mental Component Summary scores and COPD severity. Scores for EQ-5D VAS varied from 73 to 37 (GOLD I-IV p = 0.0001) and from 73 to 50 (BTS 0-III p = 0.0007). The SGRQ Total score was significant between age groups (p = 0.0047). No significant differences in HRQL with regard to gender, smoking status or socio-economic group were noticed.ConclusionThe results show that HRQL in COPD deteriorates with disease severity and with age. These data show a relationship between HRQL and disease severity obtained by lung function.

Different pattern of risk factors for atopic and nonatopic asthma among children – report from the Obstructive Lung Disease in Northern Sweden Study

Background: A cross‐sectional study was performed among 7–8‐year‐old schoolchildren during the winter of 1996 in three municipalities in the most northern province of Sweden, Norrbotten. The study was the starting point of a longitudinal study of asthma, rhinitis, eczema, and type‐1 allergy, and provided data on prevalence and risk factors for these conditions. The aim of the present study was to validate the classification of asthma based on a parental questionnaire, and to examine risk factors for atopic and nonatopic asthma.

Major increase in allergic sensitization in schoolchildren from 1996 to 2006 in northern Sweden

BACKGROUND Time trends for allergic sensitization are poorly known. OBJECTIVE To compare the trends in prevalence of allergic sensitization and associated risk factors in children. METHODS Two cohorts of children (age 7-8 years) were invited for skin prick tests (SPTs) 10 years apart, 1996 and 2006. The participation rates were 2148 (88%) and 1700 (90%), respectively. The methods were identical, and 10 common airborne allergens were used. An expanded International Study of Allergy and Asthma in Children questionnaire about symptoms and possible risk factors for allergic conditions was completed by the parents. RESULTS The prevalence of any positive SPT increased from 21% in 1996 to 30% in 2006 (P < .001). The pattern of sensitization remained similar, and sensitization to cat was most common both years, 13% and 19%, respectively. Sensitization to mites and mold was uncommon in both surveys. A family history of allergy was a significant risk factor for a positive SPT both years (odds ratio, 1.7). Factors that in 1996 had a protective effect, such as rural living and having several siblings, had lost this effect in 2006. The prevalence of most risk factors remained similar, but respiratory infections and smoking among parents decreased significantly. During the same period, there was no significant increase in the prevalence of current wheeze (11.9% to 12.4%, P = .636) or symptoms of rhinitis or eczema. CONCLUSION The prevalence of allergic sensitization increased significantly from 1996 to 2006, whereas no increase in clinical symptoms was found. The parallel decrease in parental smoking and respiratory infections indicate a different influence of environmental factors on allergic sensitization and clinical symptoms, respectively.

Asthma, type-1 allergy and related conditions in 7- and 8-year-old children in Northern Sweden: prevalence rates and risk factor pattern

As a first step in an intervention study of asthma and allergic diseases among school children, a cross-sectional study was performed during Winter 1996 in three towns (Kiruna, Luleå and Piteå) in the northernmost province of Sweden, Norrbotten. The cross-sectional study aimed to measure the prevalence of asthma, type-1 allergy and allergic diseases in order to make it possible to measure the incidence of the diseases, conditions and symptoms related to the diseases. Another aim was to perform a screening for possible risk factors. All children enrolled in the first and second classes at school, 7 and 8 years old, were invited to take part in this study. The ISAAC questionnaire with added questions about symptoms, morbidity, heredity and environment was distributed by the schools to the parents. The response rate was 97%, and 3431 completed questionnaires were returned. The children in two of the municipalities were also invited to skin test, and 2149 (88%) were tested with 10 common airborne allergens. The results showed that 7% of the children were currently using or had used asthma medicines during the last 12 months. Six percent had asthma diagnosed by a physician, and 4% were using inhaled corticosteroids. The prevalence of wheezing during the last 12 months was 12%, rhinitis without colds 14%, and eczema 27%, while 21% had a positive skin test. The respiratory symptoms and conditions were significantly greater in boys and, further, they were most prevalent in Kiruna in the very north, though not significantly. Type-1 allergy and asthma had different risk factor patterns. The main risk factors for asthma were a family history of asthma (OR = 3.2) followed by past or present house dampness (OR = 1.9), male sex (OR = 1.7) and a smoking mother (OR = 1.6). In Kiruna, when none of these three risk factors were present, none of the children had asthma, but when all three were present, 38% of these children were using asthma medicines.

Degree and clinical relevance of sensitization to common allergens among adults: a population study in Helsinki, Finland

Background We aimed to assess the prevalence of allergic sensitization and multiple sensitization, risk factors, and the clinical impact of being sensitized in the adult population of Helsinki, Finland.

Asthma during the primary school ages – prevalence, remission and the impact of allergic sensitization

Background:  Childhood is the most important time for asthma development. The aims of this study were to study changes in prevalence of asthma and wheeze, remission of asthma and changes in risk factor pattern from age 7–8 to age 11–12 in a cohort of school children.

Different sensitization profile for asthma, rhinitis, and eczema among 7-8-year-old children: report from the Obstructive Lung Disease in Northern Sweden studies.

Sensitization to different airborne allergens in relation to asthma, rhinitis, and eczema has been studied. A cross‐sectional study was performed among 7–8‐year‐old children living in northern Sweden. The ISAAC‐questionnaire with additional questions were sent to the parents, and 3431 (97%) participated. Two‐thirds of the children were invited to undergo a skin test with 10 common airborne allergens, and 2148 (88%) participated. The prevalence rates of all three diseases were significantly higher among the children who were sensitized to any of the tested allergens. Among asthmatics, 40% were sensitized to cat, 34% to dog, 28% to horse, 23% to birch and 16% to timothy. The corresponding figures for rhinitis were: cat 49%, dog 33%, horse 37%, birch 46%, timothy 32%; and for eczema: cat 29%, dog 21%, horse 15%, birch 20%, and timothy 11%. Only a few children were sensitized to mites or moulds. The main risk factors for all three diseases were type‐1 allergy and a family history of the disease. Independently from other risk factors, sensitization to dog (OR 2.4) and horse (OR 2.2) were significant risk factors for asthma. Sensitization to birch (OR 6.0), horse (OR 4.1), and timothy (OR 2.8) were significant risk factors for rhinitis, while birch (OR 2.4), dog (OR 2.0) and cat (OR 1.6) were significant risk factors for eczema. Despite a large over‐lapping of the diseases the pattern of sensitization was different for asthma, rhinitis and eczema. Sensitization to cat was most common among all children, but sensitization to dog and horse was associated with the highest risk for asthma, and sensitization to birch showed the highest risk for rhinitis and eczema. The different risk factor pattern for the often coexisting diseases; asthma, rhinitis, and eczema, may indicate differences in the etiology.

Four-year incidence of allergic sensitization among schoolchildren in a community where allergy to cat and dog dominates sensitization: Report from the obstructive lung disease in northern sweden study group

BACKGROUND Exposure to high levels of cat allergen might prevent sensitization. OBJECTIVE We sought to measure the incidence of allergic sensitization among schoolchildren living in a dust mite- and cockroach-free environment and the associated risk factors. METHODS In 1996, a longitudinal cohort was established in northern Sweden, including 2454 children aged 7 to 8 years. Children were skin tested, and the testing was repeated 4 years later. Questionnaires were completed yearly. Participation was 88% both in 1996 and 2000. RESULTS The prevalence of positive skin test results increased from 20.6% at age 7 and 8 years to 30.4% at age 11 and 12 years, a cumulative incidence of 13.8%, and was significantly higher among boys. The incidence was highest for cat (6.0%), timothy grass (5.9%), dog (4.9%), and birch (3.6%). A family history of allergy was the major risk factor for both a positive skin test response at age 7 and 8 years (odds ratio [OR], 1.69; 95% CI, 1.36-2.10) and for development of a positive skin test response over the next 4 years (OR, 1.67; 95% CI, 1.23-2.28). A significant inverse association between cat and dog ownership and the prevalence of type 1 allergy was found, particularly for those children who had lived with a cat both before age 7 and 8 years and during the next 4 years (OR, 0.44; 95% CI, 0.31-0.61). A similar pattern, although not significant, was found for incident cases. CONCLUSION The high incidence of type 1 allergy at this age was similar to reports from communities with mite and cockroach allergen. Despite cat and dog being the most common allergens of sensitization, keeping these animals at home was not associated with an increased risk for sensitization.

Agreement between parental and self-completed questionnaires about asthma in teenagers

In studies of asthma in children, a common method is for the parents to complete questionnaires about their childs asthma symptoms. With longitudinal studies of asthma, children reach an age when they can complete the questionnaire themselves. The aim of this paper was to compare the prevalence of asthma symptoms as well as the agreement between responses to an asthma questionnaire completed by teenagers and their parents. As a part of the Obstructive Lung Disease in Northern Sweden Study (OLIN) pediatric study, where 3345, 13–14‐yr‐old children completed an asthma questionnaire, 294 (84%) randomly selected parents also completed the questionnaire, which included the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire. There were no significant differences in the prevalence of wheeze in the last 12 months, ever asthma, or physician diagnosed asthma as reported by the parents compared with the teenagers. However, the teenagers reported a significantly higher prevalence of wheeze during or after exercise. The absolute agreement was generally very high while the level of agreement (kappa‐value) was slightly lower. The highest results in both absolute agreement and kappa‐value, were reached by the questions on diagnosis of asthma (98.9% and 0.93), use of asthma medicines (95.5% and 0.78), and whether the child ever had had asthma (97.2% and 0.86), respectively. In conclusion, the agreement between the parents’ and the teenagers’ responses to the asthma questionnaire was good. The change in methodology from parental to self‐completion of the questionnaire did not affect the results in the study.

Correct Use of Three Powder Inhalers: Comparison Between Diskus, Turbuhaler, and Easyhaler

A Phase IV, 4-week, open, randomized multicenter parallel group trial compared correct use and acceptability of Diskus®, Turbuhaler®, and Easyhaler® powder inhalers among 326 inhaler naive asthmatics/symptomatics. The subjects were asked to read the instruction leaflet before taking one dose at the first visit. The correct use was evaluated when the subject took the dose. After that, the subjects were instructed in correct use. The use of the devices was also videotaped at every visit, and independent referees judged correct use. Acceptability was evaluated by a questionnaire. At the first visit, the proportions of subjects who used the devices correctly were as follows: Easyhaler, 45%; Diskus, 43%; and Turbuhaler, 51%. The corresponding figures at the last visit were 84%, 89%, and 81%. The differences at any visit were not statistically significant. Acceptability was greater for Easyhaler and Diskus for three of eight items throughout the study, all pertaining to receiving the powder from the device and control of the inhalation of the powder. Patient education in the use of devices is important, because only half of the subjects used the devices correctly, and still after 4 weeks 10–20% could not use the devices satisfactorily, regardless of which device.