The aim of this study was to assess the influence of some risk factors for onset and remission of allergic rhinitis and asthma in Swedish adults. A random sample of 1,370 subjects, age 20 to 44 yr ...was investigated by means of postal questionnaires in 1990 and 1993. Skin prick tests were conducted in 1991-1992. The association between risk factors and onset or remission of allergic rhinitis and asthma was estimated using multivariate logistic regression analysis. Onset of allergic rhinitis was associated with sensitization to birch (odds ratio OR = 6.5), Parietaria (OR = 7.4); and pets (OR = 3.0) and with female sex (OR = 1.9). Onset of asthma was associated with allergic rhinitis (OR = 4.9), sensitization to pets (OR = 2.4); and with smoking (OR = 3.0). Onset of asthma was strongly associated with allergic rhinitis among atopics (OR = 5.7), but onset of asthma and rhinitis also tended to be related among nonatopics (OR = 3.5). A strong association between smoking and onset of asthma was found among nonatopics (OR = 5.7). In conclusion, sensitization to pollens and pets were risk factors for onset of allergic rhinitis, whereas allergic rhinitis, sensitization to pets, and smoking were risk factors for onset of asthma.
To study the prevalence of reported sleep disturbances and the association between these complaints and psychological status, 529 randomly selected subjects aged 20-45 years were questioned about ...their sleep symptoms and psychological status by means of questionnaires. In this young population, feeling refreshed in the morning almost every day was reported by only 15.3%. Females reported a significantly longer mean total sleep time (TST) than males (F: 425 +/- 58 minutes, M: 403 +/- 50 minutes; p < 0.01). Despite this, the difference compared with the reported need of sleep was greater in females (56 +/- 62 minutes) than in males (40 +/- 51 minutes) (p < 0.05). Difficulties maintaining sleep (DMS, > or = 3/week) (F: 20.1%, M: 10.4%; p < 0.01), the absence of feeling refreshed in the morning (F: 36.2%, M: 26.8%; p < 0.05), and excessive daytime sleepiness (EDS) (F: 23.3%, M: 15.9%; p < 0.05) were significantly more common among females. According to the Hospital Anxiety and Depression scale, females suffered from anxiety more frequently than males (F: 32.8%, M: 18.9%; p < 0.001). An association was found between anxiety and many sleep disturbances. After making adjustments for age, smoking, snoring, gender and psychological status by means of multiple regression, the gender differences mentioned above remained significant. We conclude that despite a longer TST, females report insufficient sleep, EDS, DMS, and the absence of feeling refreshed in the morning more frequently than males. The higher prevalence of anxiety among females alone cannot explain the gender differences in sleep disturbances seen in this population.
COPD is a common cause of morbidity and mortality. The aim of this study was to explore patients' experiences, self-reported needs, and needs-driven strategies to cope with self-management of COPD.
...In this phenomenological study, 10 participants with mild to severe COPD were interviewed 1-2 times, until data saturation was reached. In total, 15 in-depth interviews were conducted, recorded, transcribed, and analyzed.
COPD negatively affected participants' physical and psychosocial well-being, their family relationships, and social life. They described their experiences of COPD like fighting a war without weapons in an ever-shrinking world with a loss of freedom at most levels, always fearing possible breathlessness. Fourteen needs were identified and eight clusters of needs-driven strategies that participants used to cope with self-management of COPD. Coping with the reality of COPD, a life-threatening disease, meant coping with dyspnea, feelings of suffocation, indescribable smoking addiction, anxiety, and lack of knowledge about the disease. Reduced participation in family and social life meant loss of ability to perform usual and treasured activities. Having a positive mindset, accepting help and assuming healthy lifestyle was important, as well as receiving continuous professional health care services. The participants' needs-driven strategies comprised conducting financial arrangements, maintaining hope, and fighting their smoking addiction, seeking knowledge about COPD, thinking differently, facing the broken chain of health care, and struggling with accepting support. Procrastination and avoidance were also evident. Finally, the study also found that participants experienced a perpetuating cycle of dyspnea, anxiety, and fear of breathlessness due to COPD which could lead to more severe dyspnea and even panic attacks.
COPD negatively affects patients' physical and psychosocial well-being, family relationships and, social life. Identifying patients' self-reported needs and needs-driven strategies can enable clinicians to empower patients by educating them to improve their self-management.
Summary
Background
Many clinical and epidemiological studies have measured the prevalence of IgE sensitization using skin tests and/or serum‐specific IgE. Most of them have been done in only one ...country using a battery of selected allergens relevant to that country. In multi‐centre studies, the number of tested allergens is often limited by the cost. It is therefore difficult to compare prevalence of sensitized subjects between studies.
Objective
To define the number and the type of allergen that should be tested in order to characterize a person as sensitized.
Method
Subjects were selected from the European Community Respiratory Health Survey I. All subjects underwent skin prick tests to nine of the most common allergens. In addition, two local allergens were tested in some centres.
Result
Using nine allergens, 35.6% of the 11 355 subjects were sensitized. The prevalence of sensitization increased with the number of tested allergens. Seven allergens enabled the identification of almost all sensitized subjects, adding another one inducing, in most countries, an increase of prevalence under 0.5%. Adding one local allergen to the battery of tests increased the overall estimated prevalence by only 1%. This increase was not seen in Ireland and was less marked in the United Kingdom (0.3%) but was greater in France (2.6%), Australia (2.5%) and Belgium (1.9%).
Conclusion
Seven selected allergens (Dermatophagoides pteronyssinus, cat, grass, birch, olive pollen, Alternaria and Cladosporium) allow the identification of almost all sensitized subjects in epidemiologic studies. Inclusion of local allergen should be considered in a standard panel for international studies.
Background: In the European Community Respiratory Health Survey (ECRHS) I, the lowest prevalence of asthma and atopy was found in Reykjavík (Iceland) and Tartu (Estonia). The aim of this study was ...to compare home environments in Reykjavík and Tartu to a town with a higher prevalence of asthma and atopy (Uppsala, Sweden) in an attempt to identify factors in the indoor environment that could explain these differences.
Method: A random sample of 129 ECRHS II participants was included in this analysis at each of the three study centres. The subjects answered a questionnaire, blood was analysed for specific immunoglobulin E, a methacholine test was performed and home indoor measurements were taken.
Results: The prevalence of atopy was 11.9% in Reykjavík, 35.5% in Uppsala and 28.2% in Tartu (P < 0.04). The level of indoor cat allergen was significantly lower in Reykjavík compared with Uppsala (P = 0.05). No mite allergens were identified in the 41 homes investigated in Reykjavík, while this was the case in 16% and 72% of the households in Uppsala and Tartu, respectively (P = 0.001). A positive association was found between asthma symptoms and cat allergen levels odds ratio 1.53 (95% confidence interval 1.04–2.24), while the levels of viable moulds were significantly associated with increased bronchial responsiveness.
Conclusions: Indoor exposure to allergens, moulds and bacteria was lower in Reykjavík than in the Swedish and Estonian centres. This finding indicates that the lower prevalence of allergic sensitization in Reykjavík may partly be related to lower indoor allergen exposure.
Please cite this paper as: Gunnbjörnsdóttir MI, Norbäck D, Björnsson E, Soon A, Jarvis D, Jõgi R, Gislason D, Gislason T and Janson C. Indoor environment in three North European cities in relationship to atopy and respiratory symptoms. The Clinical Respiratory Journal 2009; 3: 85–94.
Objective: Familial hypercholesterolemia (FH) is traditionally defined as a monogenic disease characterized by severely elevated LDL-C (low-density lipoprotein cholesterol) levels. In practice, FH is ...commonly a clinical diagnosis without confirmation of a causative mutation. In this study, we sought to characterize and compare monogenic and clinically defined FH in a large sample of Icelanders.
Approach and Results: We whole-genome sequenced 49 962 Icelanders and imputed the identified variants into an overall sample of 166 281 chip-genotyped Icelanders. We identified 20 FH mutations in LDLR, APOB, and PCSK9 with combined prevalence of 1 in 836. Monogenic FH was associated with severely elevated LDL-C levels and increased risk of premature coronary disease, aortic valve stenosis, and high burden of coronary atherosclerosis. We used a modified version of the Dutch Lipid Clinic Network criteria to screen for the clinical FH phenotype among living adult participants (N=79 058). Clinical FH was found in 2.2% of participants, of whom only 5.2% had monogenic FH. Mutation-negative clinical FH has a strong polygenic basis. Both individuals with monogenic FH and individuals with mutation-negative clinical FH were markedly undertreated with cholesterol-lowering medications and only a minority attained an LDL-C target of <2.6 mmol/L (<100 mg/dL; 11.0% and 24.9%, respectively) or <1.8 mmol/L (<70 mg/dL; 0.0% and 5.2%, respectively), as recommended for primary prevention by European Society of Cardiology/European Atherosclerosis Society cholesterol guidelines.
Conclusions: Clinically defined FH is a relatively common phenotype that is explained by monogenic FH in only a minority of cases. Both monogenic and clinical FH confer high cardiovascular risk but are markedly undertreated.
The aim of the present study was to compare the cellular pattern and structural changes in the airway walls of atopic and nonatopic patients with asthma. Bronchial biopsy specimens were obtained from ...13 atopic subjects with asthma, nine nonatopic patients with asthma, and seven healthy control subjects and investigated using immunohistochemical methods. The number of eosinophils increased in both asthma groups, but significantly more in the atopic group. The number of mast cells increased similarly in the two asthma groups, whereas the number of neutrophils increased only in the nonatopic asthma group. The number of T-lymphocytes (CD3-, CD4-, CD8-, CD-25-positive cells) was higher in patients with atopic asthma compared with nonatopic asthma. Interleukin-4 (IL-4) and IL-5-positive cells were more frequently found in the atopic asthma group, whereas cells staining for IL-8 were more frequent in the nonatopic group. The degree of epithelial damage was significantly higher in the atopic asthma group compared with the control subjects and the nonatopic asthmatics. The tenascin and laminin layer was significantly thicker in the atopic group compared with the group of nonatopic asthmatics. In the atopic group, there was a significant negative correlation between epithelial integrity (defined as the relative length of intact epithelium) and the eosinophil count and also between the number of CD25-positive cells and epithelial integrity. The number of mast cells correlated positively with the thickness of tenascin- and laminin-positive layers. In conclusion, we provide evidence of different patterns of involvement of inflammatory cells in atopic and nonatopic patients with asthma. There were also structural differences in the bronchial mucous membrane between atopic asthma and nonatopic asthma. This suggests that there are differences in the extent of the immunopathologic response of these clinically distinct forms of asthma.
Coughing was studied in relation to different disorders and objective variables indicative of airway inflammation.
A random sample of 800 persons, aged 20 to 44 years, was chosen from a larger cohort ...of participants in the European Community Respiratory Health Survey in Uppsala Sweden; of these, 623 participated. This sample was enriched with 201 individuals who reported asthma-related symptoms or the use of asthma medication.
The study comprised a structured interview, including questions about habitual (productive and nonproductive) and nocturnal coughing and spirometry, methacholine challenge, peak flow diary, skin prick tests, and measurements of blood eosinophil count and serum eosinophil cationic protein (S-ECP).
A significant positive correlation was found between productive coughing and asthma (adjusted odds ratios OR=2.0), allergic rhinitis (OR=1.9), gastroesophageal reflux (OR=4.4), smoking (OR=1.9), and anxiety (OR=1.8), while nonproductive coughing was related to female gender (OR=1.8) and anxiety (OR=1.7). Nocturnal coughing was positively correlated to female gender (OR=1.8), smoking (OR=1.9), and asthma (OR=2.2). Bronchial hyperresponsiveness was positively related to productive coughing (p<0.001), nonproductive coughing, and nocturnal coughing (p<0.05). S-ECP was significantly higher in individuals with nonproductive coughing compared with subjects without habitual coughing (p<0.01).
We conclude that habitual coughing has a significant association with different disease categories.
This phenomenological study was aimed at exploring principal physicians' (participants') experience of attending to COPD patients and motivating their self-management, in light of the GOLD clinical ...guidelines of COPD therapy.
Interviews were conducted with nine physicians, who had referred patients to PR, five general practitioners (GPs) and four lung specialists (LSs). The interviews were recorded, transcribed, and analyzed through a process of deconstruction and reconstruction.
The participants experienced several ethical dilemmas in being principal physicians of COPD patients and motivating their self-management; primarily in the balancing act of adhering to the Hippocratic Oath of promoting health and saving lives, while respecting their patients' choice regarding non-adherence eg, by still smoking. It was also a challenge to deal with COPD as a nicotine addiction disease, deal with patients' denial regarding the harm of smoking and in motivating patient mastery of the disease. The participants used various strategies to motivate their patients' self-management such as active patient education, enhancing the patients' inner motivation, by means of an interdisciplinary approach, involving the patients' significant other when appropriate, and by proposing PR.
The findings indicate that being a principal physician of COPD patients and motivating their self-management is a balancing act, involving several dilemmas. Patients' nicotine addiction and physicians' ethical obligations are likely to create ethical dilemmas as the physician is obligated to respect the patients' will, even though it contradicts what is best for the patient. The participants suggest strategies to motivate COPD patients' self-management.
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