1
|
Luo L. The clinical characteristics of patients with asthma exposed to different environmental risk factors: A cross-sectional study. Immun Inflamm Dis 2023; 11:e923. [PMID: 37382266 DOI: 10.1002/iid3.923] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 06/02/2023] [Accepted: 06/07/2023] [Indexed: 06/30/2023] Open
Abstract
BACKGROUND Smoking, biomass, and occupational exposure are the main environmental risk factors for asthma. The purpose of this study was to analyze the clinical characteristics of exposure to these risk factors in patients with asthma. METHODS This cross-sectional study enrolled patients with asthma from an outpatient department according to the Global Initiative for Asthma. Demographics, forced expiratory volume in 1 s (FEV1), FEV1%pred, FEV1/forced vital capacity (FVC), laboratory tests, asthma control test (ACT), asthma control questionnaire (ACQ) scores, and the inhaled corticosteroid (ICS) dose were recorded. A generalized linear mixed model was used to adjust for potential confounders. RESULTS A total of 492 patients with asthma were included in this study. Of these patients, 13.0% were current smokers, 9.6% were former smokers, and 77.4% were never smokers. Compared with never smokers, the current and former smokers had a longer duration of asthma; lower ACT scores, FEV1, FEV1%pred, and FEV1/FVC; and higher ACQ scores, IgE, FeNO, blood eosinophils, and ICS dose (p < .05). In addition, the patients exposed to biomass alone were older; had higher exacerbation in the past year; a longer duration of asthma; and lower FEV1, FEV1%pred, FEV1/FVC, IgE, and FeNO compared with smoking or occupational exposure alone. Compared with smoking exposure alone, patients with occupational exposure alone had a longer duration of asthma and lower FEV1, FEV1%pred, FVC, IgE, FeNO, and ICS dose (p < .05). CONCLUSIONS There are significant differences in the clinical characteristics of patients with asthma depending on the smoking status. In addition, significant differences also observed among smoking, biomass, and occupational exposure.
Collapse
Affiliation(s)
- Laiheng Luo
- Department of Respiratory Medicine, Jiangxi Province Hospital of Integrated Chinese and Western Medicine, Nanchang, Jiangxi, China
| |
Collapse
|
2
|
Kamga A, Rochefort-Morel C, Guen YL, Ouksel H, Pipet A, Leroyer C. Asthma and smoking: A review. Respir Med Res 2022; 82:100916. [DOI: 10.1016/j.resmer.2022.100916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 04/25/2022] [Accepted: 04/28/2022] [Indexed: 11/25/2022]
|
3
|
Jöud A, Nilsson-Condori E, Schmidt L, Ziebe S, Vassard D, Mattsson K. Infertility, pregnancy loss and assisted reproduction in women with asthma: a population-based cohort study. Hum Reprod 2022; 37:2932-2941. [PMID: 36215654 PMCID: PMC9712942 DOI: 10.1093/humrep/deac216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Revised: 08/10/2022] [Indexed: 12/14/2022] Open
Abstract
STUDY QUESTION Is the chance of childbirth, and risk of infertility, pregnancy loss and need for assisted reproduction different for women with asthma compared to women without asthma? SUMMARY ANSWER Women with asthma had comparable chances of giving birth compared to the reference population, however, their risk of both infertility and pregnancy loss, as well their need for medically assisted reproduction, was higher. WHAT IS KNOWN ALREADY Reproductive dysfunction has been reported among women with asthma, including longer time to pregnancy, increased risk of pregnancy loss and a higher need of medically assisted reproduction, but their risk of clinical infertility is unknown. STUDY DESIGN, SIZE, DURATION This longitudinal register-based cohort study included all women with a healthcare visit for delivery, infertility, pregnancy loss or induced abortion in the southernmost county in Sweden, over the last 20 years. PARTICIPANTS/MATERIALS, SETTING, METHODS Using the Skåne Healthcare Register, we identified all women aged 15-45 between 1998 and 2019, who received a diagnosis of asthma before their first reproductive outcome (n = 6445). Chance of childbirth and risk of infertility, pregnancy loss and assisted reproduction were compared to a healthcare seeking population of women without any asthma (n = 200 248), using modified Poisson regressions. MAIN RESULTS AND THE ROLE OF CHANCE The chance of childbirth was not different between women with asthma versus those without, adjusted risk ratio (aRR) = 1.02, 95% CI: 1.01-1.03. The risk of seeking care for infertility was increased, aRR = 1.29, 95% CI: 1.21-1.39, and women with asthma more often needed assisted reproduction aRR = 1.34 95% CI: 1.18-1.52. The risk of suffering a pregnancy loss was higher, aRR = 1.21, 95% CI: 1.15-1.28, and induced abortions were more common, aRR = 1.15, 95% CI: 1.11-1.20, among women with asthma. LIMITATIONS, REASONS FOR CAUTION The study was an observational study based on healthcare visits and lacked detailed anthropometric data, thus residual confounding cannot be excluded. Only women with a healthcare visit for a reproductive outcome were included, which cannot be translated into pregnancy intention. A misclassification, presumed to be non-differential, may arise from an incorrect or missing diagnosis of asthma or female infertility, biasing the results towards the null. WIDER IMPLICATIONS OF THE FINDINGS This study points towards reproductive dysfunction associated with asthma, specifically in regards to the ability to maintain a pregnancy and the risk of needing medically assisted reproduction following clinical infertility, but reassuringly the chance of subsequently giving birth was not lower for these women. STUDY FUNDING/COMPETING INTEREST(S) This article is part of the ReproUnion collaborative study, co-financed by EU Interreg ÖKS, Capital Region of Denmark, Region Skåne and Ferring Pharmaceuticals. The authors have no competing interests to disclose. TRIAL REGISTRATION NUMBER N/A.
Collapse
Affiliation(s)
- Anna Jöud
- Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Faculty of Medicine, Lund University, Medicon Village, Lund, Sweden
| | | | - Lone Schmidt
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Søren Ziebe
- The Fertility Clinic, Copenhagen University Hospital, Copenhagen Ø, Denmark
| | - Ditte Vassard
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Kristina Mattsson
- Correspondence address. Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Faculty of Medicine, Lund University, Medicon Village, Building 402 (2nd Flour), Scheelev. 2, SE-223 83 Lund, Sweden. Tel: +46-070-826-32-36; E-mail:
| |
Collapse
|
4
|
Feng L, Lv X, Wang Y, Chu S, Dai Z, Jing H, Tong Z, Liao X, Liang L. Developments in smoking cessation interventions for patients with chronic obstructive pulmonary disease in the past 5 years: a scoping review. Expert Rev Respir Med 2022; 16:749-764. [PMID: 35916493 DOI: 10.1080/17476348.2022.2108797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Smoking cessation is the most effective strategy for slowing the progression of chronic obstructive pulmonary disease (COPD). However, COPD patients find it difficult to quit smoking with standard cessation interventions. AREAS COVERED A scoping review of smoking cessation for COPD patients was conducted by searching the MEDLINE, Embase, and Cochrane Library databases for all studies published between 1 January 2016 and 22 September 2021. Four themes were set up and 47 studies were included eventually. The majority of the included studies (61.7%, 29/47) investigated efficacy and effectiveness, including new strategies for extended treatment and mobile health (mHealth) delivery approach. Studies examining accessibility and utilization (31.9%, 15/47), safety (10.6%, 5/47), and health economics (6.4%, 3/47) were also reviewed. The quality of the included randomized controlled trials was also evaluated. EXPERT OPINION Pharmacotherapy combined with behavioral interventions delivered via mHealth may be a promising strategy to help COPD smokers quit. However, the overall quality of the current studies is poor, making it challenging for clinicians to make informed decisions. Future high-quality studies are needed to provide conclusive evidence on the optimal pharmacotherapies and the most cost-effective comprehensive smoking cessation interventions, particularly those integrated into disease management for smokers with COPD.
Collapse
Affiliation(s)
- Lin Feng
- Department of Research on Tobacco Dependence Therapies, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Xiaoshuang Lv
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Yingquan Wang
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Shuilian Chu
- Department of Research on Tobacco Dependence Therapies, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Zeqi Dai
- Center for Evidence Based Chinese Medicine, Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, 100010, China
| | - Hang Jing
- Department of Research on Tobacco Dependence Therapies, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Zhaohui Tong
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Xing Liao
- Center for Evidence Based Chinese Medicine, Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, 100010, China
| | - Lirong Liang
- Department of Research on Tobacco Dependence Therapies, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| |
Collapse
|
5
|
Finocchio E, Olivieri M, Nguyen G, Bortolami O, Marchetti P, Vesentini R, Torroni L, Spiteri G, Locatelli F, Moretti F, Fois A, Pirina P, Ferrari M, Verlato G. Effects of Respiratory Disorders on Smoking Cessation and Re-Initiation in an Italian Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18030903. [PMID: 33494306 PMCID: PMC7908144 DOI: 10.3390/ijerph18030903] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 01/18/2021] [Accepted: 01/19/2021] [Indexed: 11/22/2022]
Abstract
The present study aims to prospectively assess the influence of respiratory disorders on smoking cessation and re-initiation. Three population-based Italian cohorts answered a questionnaire on respiratory health and smoking habits during 1998–2001 and after a mean follow-up (SD) of 9.1 (0.8) years. Out of 1874 current smokers and 1166 ex-smokers at baseline, 965 (51.5%) and 735 (63.0%) reported their smoking status at follow-up. From current smokers, 312 had stopped smoking at follow-up, while 86 ex-smokers had resumed smoking. People reporting asthma at baseline were more likely to stop smoking than the other subjects (48.6% vs. 31.7%), while people reporting allergic rhinitis or chronic cough/phlegm had a higher probability to resume smoking (16.7% vs. 10.5% and 20.7% vs. 10.4%, respectively). In the multivariable logistic model, smoking relapse strongly decreased with increasing abstinence duration in people without chronic cough/phlegm (OR for ≥7.5 years vs. <7.5 years = 0.23, 95% CI 0.20–0.27), while no effect was detected in people with chronic cough/phlegm (p for interaction = 0.039). Smoking cessation was enhanced in asthmatic subjects, while people with allergic rhinitis or chronic cough/phlegm were at higher risk to resume smoking. Chronic cough/phlegm blunted the decrease in smoking resumption associated with longer abstinence duration.
Collapse
Affiliation(s)
- Eliana Finocchio
- Unit of Epidemiology & Medical Statistics, Department of Diagnostics & Public Health, University of Verona, 37134 Verona, Italy; (E.F.); (G.N.); (O.B.); (P.M.); (R.V.); (L.T.); (F.L.); (G.V.)
| | - Mario Olivieri
- Unit of Occupational Medicine, Department of Diagnostics & Public Health, University of Verona, 37134 Verona, Italy;
- Correspondence: ; Tel.: +39-045-8124921
| | - Giang Nguyen
- Unit of Epidemiology & Medical Statistics, Department of Diagnostics & Public Health, University of Verona, 37134 Verona, Italy; (E.F.); (G.N.); (O.B.); (P.M.); (R.V.); (L.T.); (F.L.); (G.V.)
| | - Oscar Bortolami
- Unit of Epidemiology & Medical Statistics, Department of Diagnostics & Public Health, University of Verona, 37134 Verona, Italy; (E.F.); (G.N.); (O.B.); (P.M.); (R.V.); (L.T.); (F.L.); (G.V.)
| | - Pierpaolo Marchetti
- Unit of Epidemiology & Medical Statistics, Department of Diagnostics & Public Health, University of Verona, 37134 Verona, Italy; (E.F.); (G.N.); (O.B.); (P.M.); (R.V.); (L.T.); (F.L.); (G.V.)
| | - Roberta Vesentini
- Unit of Epidemiology & Medical Statistics, Department of Diagnostics & Public Health, University of Verona, 37134 Verona, Italy; (E.F.); (G.N.); (O.B.); (P.M.); (R.V.); (L.T.); (F.L.); (G.V.)
| | - Lorena Torroni
- Unit of Epidemiology & Medical Statistics, Department of Diagnostics & Public Health, University of Verona, 37134 Verona, Italy; (E.F.); (G.N.); (O.B.); (P.M.); (R.V.); (L.T.); (F.L.); (G.V.)
| | - Gianluca Spiteri
- Unit of Occupational Medicine, Department of Diagnostics & Public Health, University of Verona, 37134 Verona, Italy;
| | - Francesca Locatelli
- Unit of Epidemiology & Medical Statistics, Department of Diagnostics & Public Health, University of Verona, 37134 Verona, Italy; (E.F.); (G.N.); (O.B.); (P.M.); (R.V.); (L.T.); (F.L.); (G.V.)
| | - Francesca Moretti
- Unit of Hygiene, Department of Diagnostics & Public Health, University of Verona, 37134 Verona, Italy;
| | - Alessandro Fois
- Unit of Lung Disease, Department of Clinical and Experimental Medicine, University of Sassari, 07100 Sassari, Italy; (A.F.); (P.P.)
| | - Pietro Pirina
- Unit of Lung Disease, Department of Clinical and Experimental Medicine, University of Sassari, 07100 Sassari, Italy; (A.F.); (P.P.)
| | - Marcello Ferrari
- Unit of Respiratory Diseases, Department of Medicine, University of Verona, 37134 Verona, Italy;
| | - Giuseppe Verlato
- Unit of Epidemiology & Medical Statistics, Department of Diagnostics & Public Health, University of Verona, 37134 Verona, Italy; (E.F.); (G.N.); (O.B.); (P.M.); (R.V.); (L.T.); (F.L.); (G.V.)
| |
Collapse
|
6
|
Underner M, Peiffer G, Perriot J, Jaafari N. [Smoking cessation in asthmatic patients and its impact]. Rev Mal Respir 2021; 38:87-107. [PMID: 33414027 DOI: 10.1016/j.rmr.2020.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 06/18/2020] [Indexed: 02/08/2023]
Abstract
INTRODUCTION The prevalence of smoking in asthmatic patients is similar to, or even higher than in the general population. OBJECTIVES This systematic review addresses (1) the effects of smoking on asthma, (2) smoking cessation strategies in asthmatic patients, and (3) the consequences of smoking cessation for people with asthma. RESULTS Active or passive smoking can promote the development of asthma. The few studies on smoking cessation in asthma confirm the efficacy of validated smoking cessation strategies in these patients (nicotine replacement therapy, varenicline, bupropion, cognitive and behavioural therapies). Smoking cessation in parents with asthmatic children is essential and is based on the same strategies. Electronic cigarettes may be a useful help to quit smoking in some patients. Smoking cessation is beneficial in asthmatic smokers and associated with (1) a reduction of asthma symptoms, acute exacerbations, bronchial hyperresponsiveness, and bronchial inflammation, (2) decreased use of rescue medications and in doses of inhaled corticosteroids, (3) improved asthma control, quality of life, and lung function. CONCLUSION In asthmatic patients, it is essential to assess smoking status and health professionals must assist them to quit smoking.
Collapse
Affiliation(s)
- M Underner
- Unité de recherche clinique, centre hospitalier Henri-Laborit, université de Poitiers, 86021 Poitiers, France.
| | - G Peiffer
- Service de pneumologie, hôpital de Mercy, CHR Metz-Thionville, 57085 Metz cedex 3, France
| | - J Perriot
- Dispensaire Émile-Roux, CLAT 63, centre de tabacologie, 63100 Clermont-Ferrand, France
| | - N Jaafari
- Unité de recherche clinique, centre hospitalier Henri-Laborit, université de Poitiers, 86021 Poitiers, France
| |
Collapse
|
7
|
Rasmussen M, Hovhannisyan K, Adami J, Tønnesen H. Characteristics of Patients in Treatment for Alcohol and Drug Addiction Who Succeed in Changing Smoking, Weight, and Physical Activity: A Secondary Analysis of an RCT on Combined Lifestyle Interventions. Eur Addict Res 2021; 27:123-130. [PMID: 33080594 PMCID: PMC8006577 DOI: 10.1159/000510608] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 07/07/2020] [Indexed: 01/26/2023]
Abstract
INTRODUCTION Patients addicted to alcohol or drug often have additional unhealthy lifestyles, adding to the high mortality and morbidity in this patient group. Therefore, it is important to consider lifestyle interventions as part of the usual addiction treatment. OBJECTIVE The aim was to identify predictors of successful changes in lifestyle risk factors among patients in treatment for alcohol or drug addiction. METHODS We conducted a secondary analysis of a trial using a 6-week intensive integrated lifestyle intervention: The very integrated program (VIP). Patients were recruited in Addiction Centres Malmö and Psychiatry Skåne, Sweden. The primary outcome was successful changes in lifestyle, measured as quitting tobacco, exercising 30 min per day, and not being over- or underweight after 6 weeks and 12 months. RESULTS A total of 212 patients were included in the RCT, and 128 were included in this secondary analysis: 108 at 6 weeks and 89 at 12 months of follow-up. A total of 69 patients were respondents at both follow-ups. The follow-up rates were 51 and 42%, respectively. More education, having at least 2 lifestyle risk factors and having a high quality of life were predictors of a successful change in lifestyle after 6 weeks. After 12 months, the predictors for a successful outcome were having 3 or more risk factors, while an education level up to 3 years was a negative predictor. CONCLUSIONS Having several unhealthy lifestyles in addition to alcohol and drug addiction was a significant predictor of successful lifestyle changes in the short- and long term after the VIP for lifestyle interventions. Likewise, education was significant. The results should be considered in future development and research among this vulnerable group of patients.
Collapse
Affiliation(s)
- Mette Rasmussen
- Department of Health Sciences, Clinical Health Promotion Centre, WHO-CC, Lund University, Lund, Sweden,Clinical Health Promotion Centre, WHO-CC, The Parker Institute, University of Copenhagen, Copenhagen, Denmark,*Mette Rasmussen, Department of Health Sciences, Clinical Health Promotion Unit, WHO-CC, Lund University, Södra Förstadsgatan 35, SE–20502 Malmö (Sweden),
| | - Karen Hovhannisyan
- Clinical Health Promotion Centre, WHO-CC, The Parker Institute, University of Copenhagen, Copenhagen, Denmark
| | | | - Hanne Tønnesen
- Department of Health Sciences, Clinical Health Promotion Centre, WHO-CC, Lund University, Lund, Sweden,Clinical Health Promotion Centre, WHO-CC, The Parker Institute, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
8
|
Sandelowsky H, Krakau I, Modin S, Ställberg B, Johansson SE, Nager A. Patient outcomes following GPs' educations about COPD: a cluster randomized controlled trial. NPJ Prim Care Respir Med 2020; 30:44. [PMID: 33060615 PMCID: PMC7566632 DOI: 10.1038/s41533-020-00204-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 09/23/2020] [Indexed: 11/24/2022] Open
Abstract
This study aimed to compare patient outcomes following case method learning and traditional lectures as methods for continuing medical education (CME) about chronic obstructive pulmonary disease (COPD) for general practitioners (GPs) in Sweden. In a pragmatic cluster randomized controlled trial, COPD patients (n = 425; case method group n = 209, traditional lectures group n = 216) from 24 primary health care centers replied to questionnaires prior to and 18 months after a 2 × 2-h CME was given to GPs (n = 255). We measured changes in the scores of the Clinical COPD Questionnaire (CCQ), symptoms, needs for disease information, exacerbations, smoking, and use of pulmonary rehabilitation. The changes over time were similar for both CME methods. Patients who had used pulmonary rehabilitation increased from 13.2 to 17.8% (P = 0.04), and prevalence of smoking decreased from 28.9 to 25.1% (P = 0.003). In conclusion, neither of the used CME methods was superior than the other regarding patient outcomes. CME's primary value may lay in improving GPs' adherence to guidelines, which should lead to long-term positive changes in patient health.
Collapse
Affiliation(s)
- Hanna Sandelowsky
- Karolinska Institutet, Department of Medicine, Division of Clinical Epidemiology, SE-171 76, Stockholm, Sweden.
- Academic Primary Health Care Centre, Stockholm County Council, Box 45436, SE-104 31, Stockholm, Sweden.
- Karolinska Institutet, NVS, Section for Family Medicine and Primary Care, Alfred Nobels Allé 23, Huddinge, SE-141 83, Stockholm, Sweden.
| | - Ingvar Krakau
- Karolinska Institutet, Department of Medicine, Division of Clinical Epidemiology, SE-171 76, Stockholm, Sweden
| | - Sonja Modin
- Karolinska Institutet, NVS, Section for Family Medicine and Primary Care, Alfred Nobels Allé 23, Huddinge, SE-141 83, Stockholm, Sweden
| | - Björn Ställberg
- Uppsala University, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine, Box 564, SE-751 22, Uppsala, Sweden
| | - Sven-Erik Johansson
- Lund University, Center for Primary Health Care Research, Department of Clinical Sciences, SE-205 02, Malmö, Sweden
| | - Anna Nager
- Karolinska Institutet, NVS, Section for Family Medicine and Primary Care, Alfred Nobels Allé 23, Huddinge, SE-141 83, Stockholm, Sweden
| |
Collapse
|
9
|
Kisiel MA, Zhou X, Sundh J, Ställberg B, Lisspers K, Malinovschi A, Sandelowsky H, Montgomery S, Nager A, Janson C. Data-driven questionnaire-based cluster analysis of asthma in Swedish adults. NPJ Prim Care Respir Med 2020; 30:14. [PMID: 32249767 PMCID: PMC7136224 DOI: 10.1038/s41533-020-0168-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 03/03/2020] [Indexed: 01/02/2023] Open
Abstract
The aim of this study was to identify asthma phenotypes through cluster analysis. Cluster analysis was performed using self-reported characteristics from a cohort of 1291 Swedish asthma patients. Disease burden was measured using the Asthma Control Test (ACT), the mini Asthma Quality of Life Questionnaire (mini-AQLQ), exacerbation frequency and asthma severity. Validation was performed in 748 individuals from the same geographical region. Three clusters; early onset predominantly female, adult onset predominantly female and adult onset predominantly male, were identified. Early onset predominantly female asthma had a higher burden of disease, the highest exacerbation frequency and use of inhaled corticosteroids. Adult onset predominantly male asthma had the highest mean score of ACT and mini-AQLQ, the lowest exacerbation frequency and higher proportion of subjects with mild asthma. These clusters, based on information from clinical questionnaire data, might be useful in primary care settings where the access to spirometry and biomarkers is limited.
Collapse
Affiliation(s)
- Marta A Kisiel
- Department of Medical Sciences: Environmental and Occupational Medicine, Uppsala University, Uppsala, Sweden.
| | - Xingwu Zhou
- Department of Medical Sciences: Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
- Department of Medical Sciences: Clinical Physiology, Uppsala University, Uppsala, Sweden
- Department of Public Health Sciences, Karolinska Institute, Stockholm, Sweden
| | - Josefin Sundh
- Department of Respiratory Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Björn Ställberg
- Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine, Uppsala University, Uppsala, Sweden
| | - Karin Lisspers
- Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine, Uppsala University, Uppsala, Sweden
| | - Andrei Malinovschi
- Department of Medical Sciences: Clinical Physiology, Uppsala University, Uppsala, Sweden
| | - Hanna Sandelowsky
- NVS, Section for Family Medicine and Primary Care, Karolinska Institute, Stockholm, Sweden
| | - Scott Montgomery
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden
- Clinical Epidemiology Division, Department of Medicine, Karolinska Institute, Stockholm, Sweden
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Anna Nager
- NVS, Section for Family Medicine and Primary Care, Karolinska Institute, Stockholm, Sweden
| | - Christer Janson
- Department of Medical Sciences: Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| |
Collapse
|
10
|
Tonnesen P, Marott JL, Nordestgaard B, Bojesen SE, Lange P. Secular trends in smoking in relation to prevalent and incident smoking-related disease: A prospective population-based study. Tob Induc Dis 2019; 17:72. [PMID: 31768164 PMCID: PMC6830353 DOI: 10.18332/tid/112459] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 08/08/2019] [Accepted: 09/19/2019] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION We examined changes in smoking habits in the general population according to prevalence and incidence of chronic diseases affected by smoking. METHODS We included 12283 individuals enrolled from 2003 in the Copenhagen General Population Study and re-examined from 2014. Participants were classified as either healthy or suffering from chronic obstructive pulmonary disease (COPD), asthma, diabetes mellitus, heart disease or stroke. RESULTS At entry, smoking prevalence was 15.4% in healthy participants, 29.8% with COPD, 15.8% with asthma, 21.7 % with diabetes mellitus, 17.2 % with ischemic heart disease/heart failure and 18.6% in participants with previous stroke. Smoking prevalence declined during the 10 years of observation. Among healthy subjects who developed one of the above mentioned diseases during follow-up, those who developed COPD had the highest initial smoking prevalence (51.5%). Quit rates were highest in those who developed asthma resulting in smoking prevalence of 8.2% versus 27.7% in COPD. After adjustment for age, smoking severity and genotype previously associated with heavy smoking (CHRNA3 rs1051730 AA), significant predictors of quitting were new diagnosis of ischemic heart disease/heart failure (OR=2.33, 95 % CI: 1.61–3.42), new diagnosis of asthma (OR=1.84, 95% CI: 1.18–2.90) and low number of pack-years. CONCLUSIONS Individuals with prevalent smoking related diseases continued to smoke more than healthy individuals. Incident heart disease and asthma, but not incident COPD, stroke or diabetes were associated with a higher chance of quitting. Special focus on smokers with COPD, asthma, diabetes, stroke and ischemic heart disease/heart failure is warranted to decrease smoking prevalence in these groups. Smokers with a new diagnosis of diabetes, stroke and COPD need special smoking cessation support.
Collapse
Affiliation(s)
- Philip Tonnesen
- Department of Sleep Medicine, Glostrup University Hospital, Copenhagen, Denmark
| | - Jacob L Marott
- The Copenhagen General Population Study, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark
| | - Børge Nordestgaard
- The Copenhagen General Population Study, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark
| | - Stig Egil Bojesen
- The Copenhagen General Population Study, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark
| | - Peter Lange
- Department of Sleep Medicine, Glostrup University Hospital, Copenhagen, Denmark
| |
Collapse
|
11
|
Åberg J, Hasselgren M, Montgomery S, Lisspers K, Ställberg B, Janson C, Sundh J. Sex-related differences in management of Swedish patients with a clinical diagnosis of chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis 2019; 14:961-969. [PMID: 31123398 PMCID: PMC6511243 DOI: 10.2147/copd.s193311] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Accepted: 02/25/2019] [Indexed: 01/15/2023] Open
Abstract
Purpose: Women with chronic obstructive pulmonary disease (COPD) have more symptoms, more exacerbations, lower health status scores, and more comorbidity. However, it is unclear whether management of COPD differs by sex. The aim of the study was to investigate differences by sex in the care of patients with COPD. Patients and methods: The population included 1329 primary and secondary care patients with a doctor´s diagnosis of COPD in central Sweden. Data were obtained from patient questionnaires and included patient characteristics and data on achieved COPD care. Analyses included cross-tabulations, chi-squared test and multiple logistic regression using several measures in COPD management as dependent variables, female sex as independent variable, and with adjustment for age groups, previous exacerbations, COPD Assessment Test, level of dyspnea assessed by the modified Medical Research Council scale, comorbid conditions, self-rated moderate/severe disease, level of education and body mass index. Results: Women were more likely to receive triple therapy (OR 1.86 (95% CI 1.38–2.51)), to have any maintenance treatment (OR 1.82 (95% CI 1.31–2.55)), to be on sick leave (OR 2.16 (95% CI 1.19–3.93)), to have received smoking cessation support (OR 1.80 (95% CI 1.18–2.75)) and to have had pneumococcal vaccination (OR 1.82 (95% CI 1.37–2.43)), all independently of age, severity of disease or other potential confounders. Conclusion: Management of COPD differs by sex, with women being more actively managed than men. It is unclear whether this is due to patient- or care-related factors.
Collapse
Affiliation(s)
- Joakim Åberg
- School of Medical Sciences, Örebro University, Örebro 70185, Sweden
| | | | - Scott Montgomery
- Clinical Epidemiology and Biostatistics, Örebro University, Örebro 70182, Sweden.,Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden.,Department of Epidemiology and Public Health, University College, London, UK
| | - Karin Lisspers
- Department of Public Health and Caring Sciences, Family Medicine and Preventive medicine, Uppsala University, Uppsala 75122, Sweden
| | - Björn Ställberg
- Department of Public Health and Caring Sciences, Family Medicine and Preventive medicine, Uppsala University, Uppsala 75122, Sweden
| | - Christer Janson
- Department of Medical Sciences, Respiratory, Allergy & Sleep Research, Uppsala University, Uppsala 75105, Sweden
| | - Josefin Sundh
- Department of Respiratory Medicine, School of Medical Sciences, Örebro University, Örebro 70185, Sweden
| |
Collapse
|