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Toppila-Salmi S, Bjermer L, Cardell LO, Cervin A, Heinikari T, Lehtimäki L, Lundberg M, Richter JC, Sillanpää S. Multi-Disciplinary Expert Perspective on the Management of Type 2 Inflammation-Driven Severe CRSwNP: A Brief Overview of Pathophysiology and Recent Clinical Insights. J Asthma Allergy 2024; 17:431-439. [PMID: 38745838 PMCID: PMC11093112 DOI: 10.2147/jaa.s447093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Accepted: 03/01/2024] [Indexed: 05/16/2024] Open
Abstract
Severe chronic rhinosinusitis with nasal polyposis (CRSwNP) is a disabling airway disease that significantly impacts patients' lives through the severity of symptoms, the need for long-term medical treatment and the high risk of recurrence post-surgery. Biological agents targeting type 2 immune responses underlying the pathogenesis of CRSwNP have shown effectiveness in reducing polyp size and eosinophilic infiltrate, and in decreasing the need for additional sinus surgeries. However, despite recent progress in understanding and treating the disease, type 2 inflammation-driven severe CRSwNP continues to pose challenges to clinical management due to several factors such as persistent inflammation, polyp recurrence, heterogeneity of disease, and comorbidities. This article presents the findings of a scientific discussion involving a panel of ear, nose and throat (ENT) specialists and pulmonologists across Sweden and Finland. The discussion aimed to explore current management practices for type 2 inflammation-driven severe CRSwNP in the Nordic region. The main topics examined encompassed screening and referral, measurements of disease control, treatment goals, and future perspectives. The experts emphasized the importance of a collaborative approach in the management of this challenging patient population. The discussion also revealed a need to broaden treatment options for patients with type 2 inflammation-driven CRSwNP and comorbid conditions with shared type 2 pathophysiology. In light of the supporting evidence, a shift in the disease model from the presence of polyps to that of type 2 inflammation may be warranted. Overall, this discussion provides valuable insights for the scientific community and can potentially guide the future management of CRSwNP.
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Affiliation(s)
- Sanna Toppila-Salmi
- Department of Otorhinolaryngology, Kuopio University Hospital and School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
- Skin and Allergy Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Leif Bjermer
- Department of Clinical Sciences, Respiratory Medicine and Allergology, Lund University, Lund, Sweden
| | - Lars-Olaf Cardell
- Division of ENT Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Department of Otorhinolaryngology, Karolinska University Hospital, Stockholm, Sweden
| | - Anders Cervin
- Centre for Clinical Research, University of Queensland, Brisbane, Australia
- Faculty of Medicine, Lund University, Lund, Sweden
| | - Tuuli Heinikari
- Skin and Allergy Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Lauri Lehtimäki
- Allergy Centre, Tampere University Hospital, Tampere, Finland
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Marie Lundberg
- Department of Otorhinolaryngology – Head and Neck Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Jens C Richter
- Department of Asthma and Allergology, Clinic of Lung Medicine, Skåne University Hospital and Lund University, Lund, Sweden
| | - Saara Sillanpää
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Department of Otorhinolaryngology and Head and Neck Surgery, Tampere University Hospital, Tampere, Finland
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Perez-de-Llano L, Scelo G, Tran TN, Le TT, Fagerås M, Cosio BG, Peters M, Pfeffer PE, Al-Ahmad M, Al-Lehebi RO, Altraja A, Bergeron C, Bjermer LH, Bjerrum AS, Bulathsinhala L, Busby J, Cano Rosales DJ, Canonica GW, Carter VA, Charriot J, Christoff GC, Denton EJ, Dorscheid DR, Fernandez Sanchez MJ, Fonseca JA, Gibson PG, Goh CYY, Heaney LG, Heffler E, Hew M, Iwanaga T, Katial R, Koh MS, Kuna P, Larenas-Linnemann DES, Lehtimäki L, Mahboub B, Martin N, Matsumoto H, Menzies-Gow AN, Papadopoulos NG, Popov TA, Porsbjerg CM, Patel P, Rhee CK, Sadatsafavi M, Taillé C, Torres-Duque CA, Tsai MJ, Ulrik CS, Upham JW, von Bülow A, Wang E, Wechsler ME, Price DB. Exploring Definitions and Predictors of Severe Asthma Clinical Remission Post-Biologic in Adults. Am J Respir Crit Care Med 2024. [PMID: 38701495 DOI: 10.1164/rccm.202311-2192oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 05/03/2024] [Indexed: 05/05/2024] Open
Abstract
RATIONALE There is no consensus on criteria to include in an asthma remission definition in real-life. Factors associated with achieving remission post-biologic-initiation remain poorly understood. OBJECTIVES To quantify the proportion of adults with severe asthma achieving multi-domain-defined remission post-biologic-initiation and identify pre-biologic characteristics associated with achieving remission which may be used to predict it. METHODS This was a longitudinal cohort study using data from 23 countries from the International Severe Asthma Registry. Four asthma outcome domains were assessed in the 1-year pre- and post-biologic-initiation. A priori-defined remission cut-offs were: 0 exacerbations/year, no long-term oral corticosteroid (LTOCS), partly/well-controlled asthma, and percent predicted forced expiratory volume in one second ≥80%. Remission was defined using 2 (exacerbations + LTOCS), 3 (+control or +lung function) and 4 of these domains. The association between pre-biologic characteristics and post-biologic remission was assessed by multivariable analysis. MEASUREMENTS AND MAIN RESULTS 50.2%, 33.5%, 25.8% and 20.3% of patients met criteria for 2, 3 (+control), 3 (+lung function) and 4-domain-remission, respectively. The odds of achieving 4-domain remission decreased by 15% for every additional 10-years asthma duration (odds ratio: 0.85; 95% CI: 0.73, 1.00). The odds of remission increased in those with fewer exacerbations/year, lower LTOCS daily dose, better control and better lung function pre-biologic-initiation. CONCLUSIONS One in 5 patients achieved 4-domain remission within 1-year of biologic-initiation. Patients with less severe impairment and shorter asthma duration at initiation had a greater chance of achieving remission post-biologic, indicating that biologic treatment should not be delayed if remission is the goal. This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License 4.0 (http://creativecommons.org/licenses/by-nc-nd/4.0/).
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Affiliation(s)
| | - Ghislaine Scelo
- Observational and Pragmatic Research Institute, Singapore, Singapore, Singapore
- Optimum Patient Care Global, Cambridge, United Kingdom of Great Britain and Northern Ireland
| | - Trung N Tran
- AstraZeneca, Gaithersburg, Maryland, United States
| | - Tham T Le
- AstraZeneca R&D Gaithersburg, 468090, Gaithersburg, Maryland, United States
| | | | - Borja G Cosio
- Hospital Universitari Son Espases, 375118, IdISBa and Respiratory Medicine, Palma de Mallorca, Spain
- Ciber Enfermedades Respiratorias (Ciberes), Madrid, Spain
| | - Matthew Peters
- Concord Hospital, Department of Thoracic Medicine, Sydney, Australia
| | - Paul E Pfeffer
- Queen Mary University of London, 4617, William Harvey Research Institute, London, United Kingdom of Great Britain and Northern Ireland
| | - Mona Al-Ahmad
- Kuwait University, Al-Rashed Allergy Center, Ministry of Health, Microbiology Department, College of Medicine, Kuwait , Kuwait
| | - Riyad O Al-Lehebi
- King Fahad Medical City, 37849, Department of Pulmonology,, Riyadh, Saudi Arabia
- Alfaisal University, 101686, Riyadh, Saudi Arabia
| | - Alan Altraja
- University of Tartu and Lung Clinic, Tartu University Hospital, Department of Pulmonology, Tartu, Estonia
| | - Celine Bergeron
- Vancouver General Hospital, 8167, Vancouver, British Columbia, Canada
- The University of British Columbia, 8166, Vancouver, British Columbia, Canada
| | - Leif H Bjermer
- Skåne University Hospital Labmedicin Skane, 405121, Respiratory Medicine and Allergology, Lund, Skåne, Sweden
| | - Anne S Bjerrum
- Aarhus Universitetshospital, 11297, Department of Respiratory Medicine, Aarhus, Denmark
| | - Lakmini Bulathsinhala
- Observational and Pragmatic Research Institute Pte Ltd, 614173, Singapore, Singapore
- Optimum Patient Care UK, 601419, Cambridge, England, United Kingdom of Great Britain and Northern Ireland
| | - John Busby
- Queen's University Belfast, Centre of Experimental Medicine, Belfast, United Kingdom of Great Britain and Northern Ireland
| | | | - Giorgio W Canonica
- IRCCS Humanitas Research Hospital, 9268, Personalized Medicine, Asthma and Allergy, Rozzano, Lombardia, Italy
- Humanitas University, 437807, Department of Biomedical Sciences, Milan, Italy
| | - Victoria A Carter
- Optimum Patient Care, Cambridge, United Kingdom of Great Britain and Northern Ireland
- Observational and Pragmatic Research Institute, Singapore, Singapore
| | - Jeremy Charriot
- PhyMedExp, Univ Montpellier, CNRS, INSERM, CHU Montpellier, Montpellier, France
| | | | | | | | - Maria J Fernandez Sanchez
- Hospital Universitario San Ignacio, 173049, Pulmonary Unit, Bogota, Colombia
- Pontificia Universidad Javeriana, 27964, Faculty of Medicine, Bogota, Colombia
| | - João A Fonseca
- Faculty of Medicine, University of Porto, CINTESIS, Porto, Portugal
- CUF Porto, Allergy Department, Senhora da Hora, Portugal
| | - Peter G Gibson
- University of Newcastle, 5982, Callaghan, New South Wales, Australia
| | - Celine Y Y Goh
- Observational and Pragmatic Research Institute Pte Ltd, 614173, Singapore, Singapore
| | - Liam G Heaney
- Belfast City Hospital, Regional Respiratory Centre, Belfast, United Kingdom of Great Britain and Northern Ireland
| | - Enrico Heffler
- Universita degli Studi di Catania, 9298, Clinical and Experimental Medicie, Catania, Italy
| | - Mark Hew
- Alfred Hospital, 5390, Allergy, Asthma & Clinical Immunology, Melbourne, Victoria, Australia
- Monash University Faculty of Medicine Nursing and Health Sciences, 22457, School of Public Health & Preventive Medicine, Melbourne, Victoria, Australia
| | - Takashi Iwanaga
- Kindai University Hospital, 326473, Osakasayama, Osaka, Japan
| | - Rohit Katial
- AstraZeneca US, 33366, BioPharmaceuticals Medical, Gaithersburg, Maryland, United States
| | - Mariko S Koh
- Singapore General Hospital, 37581, Department of Respiratory and Critical Care Medicine, Singapore, Singapore
| | - Piotr Kuna
- Medical University of Lodz, 37808, Division of Internal Medicine Asthma and Allergy, Lodz, Lodzkie, Poland
| | | | - Lauri Lehtimäki
- University of Tampere, 7840, Immunopharmacology reserach group, Tampere, Pirkanmaa, Finland
| | | | - Neil Martin
- AstraZeneca R&D Cambridge, 468087, Respiratory and Immunology, BioPharmaceuticals Medical, Cambridge, Cambridgeshire, United Kingdom of Great Britain and Northern Ireland
- University of Leicester, 4488, Leicester, Leicestershire, United Kingdom of Great Britain and Northern Ireland
| | - Hisako Matsumoto
- Kindai University Faculty of Medicine, Department of Respiratory Medicine & Allergology, Osakasayama, Osaka, Japan
| | - Andrew N Menzies-Gow
- AstraZeneca UK Limited, 4978, Cambridge, United Kingdom of Great Britain and Northern Ireland
- Royal Brompton and Harefield Hospitals, 4964, London, United Kingdom of Great Britain and Northern Ireland
| | - Nikolaos G Papadopoulos
- University of Athens, Allergy Dpt, 2nd Pediatric Clinic, Athens, Greece
- University of Manchester, Centre for Paediatrics and Child Health, Institute of Human Development, Manchester, United Kingdom of Great Britain and Northern Ireland
| | - Todor A Popov
- Medical University Sofia, Clinic of Allergy & Asthma, Sofia, Bulgaria
| | - Celeste M Porsbjerg
- Bispebjerg Hospital, 53166, Department of Respiratory Medicine, Copenhagen NV, Denmark
- University of Copenhagen, 4321, Institute of Clinical Medicine, Kobenhavn, Denmark
| | - Pujan Patel
- Royal Brompton Hospital, 156726, London, United Kingdom of Great Britain and Northern Ireland
| | - Chin K Rhee
- Catholic university of Korea, Internal medicine, Seoul, Korea (the Republic of)
| | - Mohsen Sadatsafavi
- University of British Columbia, Institute for Heart and Lung Health, Vancouver, British Columbia, Canada
| | - Camille Taillé
- Inserm, Pathophysiology and Epidemiology of respiratory diseases. Epidemiology team, Paris, France
- Assistance Publique-Hôpitaux de Paris,, Paris, France
| | - Carlos A Torres-Duque
- Fundación Neumológica Colombiana, Research Department, Bogotá, Colombia
- Universidad de La Sabana, 27989, Chia, Colombia
| | - Ming-Ju Tsai
- Kaohsiung Medical University Hospital, Kaohsiung Medical University, Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung, Taiwan
| | - Charlotte S Ulrik
- Hvidovre Hospital, 53137, Respiratory Medicine, Hvidovre, Denmark
- University of Copenhagen, Institute of Clinical Medicine, Denmark
| | - John W Upham
- The University of Queensland, School of Medicine, Brisbane, Queensland, Australia
| | - Anna von Bülow
- Copenhagen University Hospital Bispebjerg, Department of Respiratory Medicine, Copenhagen, Denmark
| | - Eileen Wang
- National Jewish Health, 2930, Division of Allergy and Clinical Immunology, Department of Medicine, Denver, Colorado, United States
| | - Michael E Wechsler
- National Jewish Health, Department of Medicine, Denver, Colorado, United States
| | - David B Price
- University of Aberdeen, Academic Primary Care, Aberdeen, Scotland, United Kingdom of Great Britain and Northern Ireland;
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Perez-de-Llano L, Scelo G, Canonica GW, Chen W, Henley W, Larenas-Linnemann D, Peters MJ, Pfeffer PE, Tran TN, Ulrik CS, Popov TA, Sadatsafavi M, Hew M, Máspero J, Gibson PG, Christoff GC, Fitzgerald JM, Torres-Duque CA, Porsbjerg CM, Papadopoulos NG, Papaioannou AI, Heffler E, Iwanaga T, Al-Ahmad M, Kuna P, Fonseca JA, Al-Lehebi R, Rhee CK, Koh MS, Cosio BG, Perng Steve DW, Mahboub B, Menzies-Gow AN, Jackson DJ, Busby J, Heaney LG, Patel PH, Wang E, Wechsler ME, Altraja A, Lehtimäki L, Bourdin A, Bjermer L, Bulathsinhala L, Carter V, Murray R, Beastall A, Denton E, Price DB. Impact of pre-biologic impairment on meeting domain-specific biologic responder definitions in patients with severe asthma. Ann Allergy Asthma Immunol 2024; 132:610-622.e7. [PMID: 38151100 DOI: 10.1016/j.anai.2023.12.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 12/19/2023] [Accepted: 12/20/2023] [Indexed: 12/29/2023]
Abstract
BACKGROUND There is little agreement on clinically useful criteria for identifying real-world responders to biologic treatments for asthma. OBJECTIVE To investigate the impact of pre-biologic impairment on meeting domain-specific biologic responder definitions in adults with severe asthma. METHODS This was a longitudinal, cohort study across 22 countries participating in the International Severe Asthma Registry (https://isaregistries.org/) between May 2017 and January 2023. Change in 4 asthma domains (exacerbation rate, asthma control, long-term oral corticosteroid [LTOCS] dose, and lung function) was assessed from biologic initiation to 1 year post-treatment (minimum 24 weeks). Pre- to post-biologic changes for responders and nonresponders were described along a categorical gradient for each domain derived from pre-biologic distributions (exacerbation rate: 0 to 6+/y; asthma control: well controlled to uncontrolled; LTOCS: 0 to >30 mg/d; percent-predicted forced expiratory volume in 1 second [ppFEV1]: <50% to ≥80%). RESULTS Percentage of biologic responders (ie, those with a category improvement pre- to post-biologic) varied by domain and increased with greater pre-biologic impairment, increasing from 70.2% to 90.0% for exacerbation rate, 46.3% to 52.3% for asthma control, 31.1% to 58.5% for LTOCS daily dose, and 35.8% to 50.6% for ppFEV1. The proportion of patients having improvement post-biologic tended to be greater for anti-IL-5/5R compared with for anti-IgE for exacerbation, asthma control, and ppFEV1 domains, irrespective of pre-biologic impairment. CONCLUSION Our results provide realistic outcome-specific post-biologic expectations for both physicians and patients, will be foundational to inform future work on a multidimensional approach to define and assess biologic responders and response, and may enhance appropriate patient selection for biologic therapies. TRIAL REGISTRATION The ISAR database has ethical approval from the Anonymous Data Ethics Protocols and Transparency (ADEPT) committee (ADEPT0218) and is registered with the European Union Electronic Register of Post-Authorization studies (ENCEPP/DSPP/23720). The study was designed, implemented, and reported in compliance with the European Network Centres for Pharmacoepidemiology and Pharmacovigilance (ENCEPP) Code of Conduct (EUPAS38288) and with all applicable local and international laws and regulation, and registered with ENCEPP (https://www.encepp.eu/encepp/viewResource.htm?id=38289). Governance was provided by ADEPT (registration number: ADEPT1220).
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Affiliation(s)
- Luis Perez-de-Llano
- Pneumology Service, Lucus Augusti University Hospital, EOXI Lugo, Monforte, Cervo, Spain
| | - Ghislaine Scelo
- Observational and Pragmatic Research Institute, Singapore, Singapore; Optimum Patient Care Global, Cambridge, United Kingdom
| | - G Walter Canonica
- Personalized Medicine, Asthma and Allergy, IRCCS Humanitas Research Hospital, Rozzano, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| | - Wenjia Chen
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - William Henley
- Observational and Pragmatic Research Institute, Singapore, Singapore; Optimum Patient Care Global, Cambridge, United Kingdom; Health Statistics Group, Institute of Health Research, University of Exeter Medical School, Exeter, United Kingdom
| | | | - Matthew J Peters
- Department of Thoracic Medicine, Concord Hospital, Sydney, Australia; Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
| | - Paul E Pfeffer
- Department of Respiratory Medicine, Barts Health NHS Trust, London, United Kingdom; Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Trung N Tran
- BioPharmaceuticals Medical, AstraZeneca, Gaithersburg, Maryland
| | - Charlotte Suppli Ulrik
- Department of Respiratory Medicine, Copenhagen University Hospital - Hvidovre, Hvidovre, Denmark
| | - Todor A Popov
- University Hospital Sv. Ivan Rilski, Sofia, Bulgaria
| | - Mohsen Sadatsafavi
- Respiratory Evaluation Sciences Program, Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, Canada
| | - Mark Hew
- Allergy, Asthma & Clinical Immunology Service, Alfred Health, Melbourne, Australia; Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Jorge Máspero
- Clinical Research for Allergy and Respiratory Medicine, CIDEA Foundation, Buenos Aires, Argentina; University Career of Specialists in Allergy and Clinical Immunology at the Buenos Aires University School of Medicine, Argentina
| | - Peter G Gibson
- Australian Severe Asthma Network, Priority Research Centre for Healthy Lungs, University of Newcastle, Newcastle, Australia; Department of Respiratory and Sleep Medicine, Hunter Medical Research Institute, John Hunter Hospital, New Lambton Heights, Australia
| | | | - J Mark Fitzgerald
- Department of Medicine, The University of British Columbia, Vancouver, Canada
| | - Carlos A Torres-Duque
- CINEUMO, Respiratory Research Center, Fundación Neumológica Colombiana, Bogotá, Colombia; Universidad de La Sabana, Chia, Colombia
| | - Celeste M Porsbjerg
- Department of Respiratory Medicine and Infectious Diseases, Research Unit, Bispebjerg Hospital, Copenhagen, Denmark
| | - Nikolaos G Papadopoulos
- Division of Infection, Immunity & Respiratory Medicine, University of Manchester, Manchester, United Kingdom; Allergy Department, 2nd Pediatric Clinic, University of Athens, Athens, Greece
| | - Andriana I Papaioannou
- 2nd Respiratory Medicine Department, National and Kapodistrian University of Athens Medical School, Attikon University Hospital, Athens, Greece
| | - Enrico Heffler
- Personalized Medicine, Asthma and Allergy, IRCCS Humanitas Research Hospital, Rozzano, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| | | | - Mona Al-Ahmad
- Microbiology Department, College of Medicine, Kuwait University, Kuwait City, Kuwait; Al-Rashed Allergy Center, Ministry of Health, Kuwait City, Kuwait
| | - Piotr Kuna
- Division of Internal Medicine Asthma and Allergy, Medical University of Lodz, Lodz, Poland
| | - João A Fonseca
- CINTESIS@RISE, MEDCIDS, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Riyad Al-Lehebi
- Department of Pulmonology, King Fahad Medical City, Riyadh, Saudi Arabia; Alfaisal University, Riyadh, Saudi Arabia
| | - Chin Kook Rhee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Mariko Siyue Koh
- Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore, Singapore
| | - Borja G Cosio
- Son Espases University Hospital-IdISBa-Ciberes, Mallorca, Spain
| | - Diahn-Warng Perng Steve
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Bassam Mahboub
- Rashid Hospital, Dubai Health Authority (DHA), Dubai, United Arab Emirates
| | - Andrew N Menzies-Gow
- AstraZeneca, Cambridge, United Kingdom; Lung Division, Royal Brompton & Harefield Hospitals, London, United Kingdom
| | - David J Jackson
- Guy's Severe Asthma Centre, Guy's Hospital, King's College London, London, United Kingdom
| | - John Busby
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, Northern Ireland, United Kingdom
| | - Liam G Heaney
- Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast, Northern Ireland, United Kingdom
| | - Pujan H Patel
- Respiratory Medicine, Royal Brompton Hospital, London, United Kingdom
| | - Eileen Wang
- Division of Allergy and Clinical Immunology, Department of Medicine, National Jewish Health and University of Colorado School of Medicine, Denver and Aurora, Colorado
| | - Michael E Wechsler
- NJH Cohen Family Asthma Institute, Department of Medicine, National Jewish Health, Denver, Colorado
| | - Alan Altraja
- Department of Pulmonology, University of Tartu and Lung Clinic, Tartu University Hospital, Tartu, Estonia
| | - Lauri Lehtimäki
- Allergy Centre, Tampere University Hospital, Tampere, Finland; Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Arnaud Bourdin
- PhyMedExp, Univ Montpellier, CNRS, INSERM, CHU Montpellier, Montpellier, France
| | - Leif Bjermer
- Respiratory Medicine and Allergology, Department of Clinical Sciences, Skåne University Hospital, Lund University, Lund, Sweden
| | - Lakmini Bulathsinhala
- Observational and Pragmatic Research Institute, Singapore, Singapore; Optimum Patient Care Global, Cambridge, United Kingdom
| | - Victoria Carter
- Observational and Pragmatic Research Institute, Singapore, Singapore; Optimum Patient Care Global, Cambridge, United Kingdom
| | - Ruth Murray
- Optimum Patient Care Global, Cambridge, United Kingdom
| | - Aaron Beastall
- Observational and Pragmatic Research Institute, Singapore, Singapore; Optimum Patient Care Global, Cambridge, United Kingdom
| | - Eve Denton
- Allergy, Asthma & Clinical Immunology, Alfred Health, Melbourne, Australia; Department of Medicine, Central Clinical School, Monash University, Melbourne, Australia
| | - David B Price
- Observational and Pragmatic Research Institute, Singapore, Singapore; Optimum Patient Care Global, Cambridge, United Kingdom; Division of Applied Health Sciences, Centre of Academic Primary Care, University of Aberdeen, Aberdeen, United Kingdom.
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Porsbjerg CM, Townend J, Bergeron C, Christoff GC, Katsoulotos GP, Larenas-Linnemann D, Tran TN, Al-Lehebi R, Bosnic-Anticevich SZ, Busby J, Hew M, Kostikas K, Papadopoulos NG, Pfeffer PE, Popov TA, Rhee CK, Sadatsafavi M, Tsai MJ, Ulrik CS, Al-Ahmad M, Altraja A, Beastall A, Bulathsinhala L, Carter V, Cosio BG, Fletton K, Hansen S, Heaney LG, Hubbard RB, Kuna P, Murray RB, Nagano T, Pini L, Cano Rosales DJ, Schleich F, Wechsler ME, Amaral R, Bourdin A, Brusselle GG, Chen W, Chung LP, Denton E, Fonseca JA, Hoyte F, Jackson DJ, Katial R, Kirenga BJ, Koh MS, Ławkiedraj A, Lehtimäki L, Liew MF, Mahboub B, Martin N, Menzies-Gow AN, Pang PH, Papaioannou AI, Patel PH, Perez-De-Llano L, Peters MJ, Ricciardi L, Rodríguez-Cáceres B, Solarte I, Tay TR, Torres-Duque CA, Wang E, Zappa M, Abisheganaden J, Assing KD, Costello RW, Gibson PG, Heffler E, Máspero J, Nicola S, Perng (Steve) DW, Puggioni F, Salvi S, Sheu CC, Sirena C, Taillé C, Tan TL, Bjermer L, Canonica GW, Iwanaga T, Jiménez-Maldonado L, Taube C, Brussino L, Price DB. Association between pre-biologic T2-biomarker combinations and response to biologics in patients with severe asthma. Front Immunol 2024; 15:1361891. [PMID: 38711495 PMCID: PMC11070939 DOI: 10.3389/fimmu.2024.1361891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 03/29/2024] [Indexed: 05/08/2024] Open
Abstract
Background To date, studies investigating the association between pre-biologic biomarker levels and post-biologic outcomes have been limited to single biomarkers and assessment of biologic efficacy from structured clinical trials. Aim To elucidate the associations of pre-biologic individual biomarker levels or their combinations with pre-to-post biologic changes in asthma outcomes in real-life. Methods This was a registry-based, cohort study using data from 23 countries, which shared data with the International Severe Asthma Registry (May 2017-February 2023). The investigated biomarkers (highest pre-biologic levels) were immunoglobulin E (IgE), blood eosinophil count (BEC) and fractional exhaled nitric oxide (FeNO). Pre- to approximately 12-month post-biologic change for each of three asthma outcome domains (i.e. exacerbation rate, symptom control and lung function), and the association of this change with pre-biologic biomarkers was investigated for individual and combined biomarkers. Results Overall, 3751 patients initiated biologics and were included in the analysis. No association was found between pre-biologic BEC and pre-to-post biologic change in exacerbation rate for any biologic class. However, higher pre-biologic BEC and FeNO were both associated with greater post-biologic improvement in FEV1 for both anti-IgE and anti-IL5/5R, with a trend for anti-IL4Rα. Mean FEV1 improved by 27-178 mL post-anti-IgE as pre-biologic BEC increased (250 to 1000 cells/µL), and by 43-216 mL and 129-250 mL post-anti-IL5/5R and -anti-IL4Rα, respectively along the same BEC gradient. Corresponding improvements along a FeNO gradient (25-100 ppb) were 41-274 mL, 69-207 mL and 148-224 mL for anti-IgE, anti-IL5/5R, and anti-IL4Rα, respectively. Higher baseline BEC was also associated with lower probability of uncontrolled asthma (OR 0.392; p=0.001) post-biologic for anti-IL5/5R. Pre-biologic IgE was a poor predictor of subsequent pre-to-post-biologic change for all outcomes assessed for all biologics. The combination of BEC + FeNO marginally improved the prediction of post-biologic FEV1 increase (adjusted R2: 0.751), compared to BEC (adjusted R2: 0.747) or FeNO alone (adjusted R2: 0.743) (p=0.005 and <0.001, respectively); however, this prediction was not improved by the addition of IgE. Conclusions The ability of higher baseline BEC, FeNO and their combination to predict biologic-associated lung function improvement may encourage earlier intervention in patients with impaired lung function or at risk of accelerated lung function decline.
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Affiliation(s)
- Celeste M. Porsbjerg
- Department of Respiratory Medicine and Infectious Diseases, Research Unit, Bispebjerg Hospital, Copenhagen, Denmark
| | - John Townend
- Observational and Pragmatic Research Institute, Singapore, Singapore
- Optimum Patient Care Global, Cambridge, United Kingdom
| | - Celine Bergeron
- Department of Medicine, Centre for Lung Health, Vancouver General Hospital, Vancouver, BC, Canada
- Department of Medicine, The University of British Columbia, Vancouver, BC, Canada
| | | | - Gregory P. Katsoulotos
- Woolcock Institute of Medical Research, The University of Sydney, Sydney, NSW, Australia
- School of Medicine, Sydney Campus, The University of Notre Dame, Sydney, NSW, Australia
| | | | - Trung N. Tran
- BioPharmaceuticals Medical, AstraZeneca, Gaithersburg, MD, United States
| | - Riyad Al-Lehebi
- Department of Pulmonology, King Fahad Medical City, Riyadh, Saudi Arabia
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Sinthia Z. Bosnic-Anticevich
- Woolcock Institute of Medical Research, The University of Sydney, Sydney, NSW, Australia
- Macquarie Medical School, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
| | - John Busby
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, United Kingdom
| | - Mark Hew
- Allergy, Asthma and Clinical Immunology Service, Alfred Health, Melbourne, VIC, Australia
- Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | | | - Nikolaos G. Papadopoulos
- Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, United Kingdom
- Allergy Department, 2nd Pediatric Clinic, University of Athens, Athens, Greece
| | - Paul E. Pfeffer
- Department of Respiratory Medicine, Barts Health National Health Services (NHS) Trust, London, United Kingdom
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | | | - Chin Kook Rhee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Mohsen Sadatsafavi
- Respiratory Evaluation Sciences Program, Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, BC, Canada
| | - Ming-Ju Tsai
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Internal Medicine, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Charlotte Suppli Ulrik
- Department of Respiratory Medicine, Copenhagen ;University Hospital - Hvidovre, Copenhagen, Denmark
| | - Mona Al-Ahmad
- Microbiology Department, College of Medicine, Kuwait University, Kuwait City, Kuwait
- Al-Rashed Allergy Center, Ministry of Health, Kuwait City, Kuwait
| | - Alan Altraja
- Department of Pulmonology, University of Tartu and Lung Clinic, Tartu University Hospital, Tartu, Estonia
| | - Aaron Beastall
- Observational and Pragmatic Research Institute, Singapore, Singapore
- Optimum Patient Care Global, Cambridge, United Kingdom
| | - Lakmini Bulathsinhala
- Observational and Pragmatic Research Institute, Singapore, Singapore
- Optimum Patient Care Global, Cambridge, United Kingdom
| | - Victoria Carter
- Observational and Pragmatic Research Institute, Singapore, Singapore
- Optimum Patient Care Global, Cambridge, United Kingdom
| | - Borja G. Cosio
- Son Espases University Hospital-Institut d’Investigació Sanitària Illes Balears (IdISBa)-Ciberes, Mallorca, Spain
| | - Kirsty Fletton
- Observational and Pragmatic Research Institute, Singapore, Singapore
- Optimum Patient Care Global, Cambridge, United Kingdom
| | - Susanne Hansen
- Respiratory Research Unit, Bispebjerg University Hospital, Copenhagen, Denmark
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Liam G. Heaney
- Wellcome-Wolfson Institute for Experimental Medicine, Queen’s University Belfast, Belfast, United Kingdom
| | - Richard B. Hubbard
- Observational and Pragmatic Research Institute, Singapore, Singapore
- Optimum Patient Care Global, Cambridge, United Kingdom
- Respiratory Medicine at the School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Piotr Kuna
- Division of Internal Medicine Asthma and Allergy, Medical University of Lodz, Lodz, Poland
| | | | - Tatsuya Nagano
- Division of Respiratory Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Laura Pini
- Department of Clinical and Experimental Sciences – University of Brescia, Spedali Civili di Brescia, Brescia, Italy
| | | | - Florence Schleich
- Centre Hospitalier Universitaire (CHU) Sart-Tilman, GIGA I3, University of Liege, Liège, Belgium
| | - Michael E. Wechsler
- Department of Medicine, National Jewish Health (NJH) Cohen Family Asthma Institute, National Jewish Health, Denver, CO, United States
| | - Rita Amaral
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
- CINTESIS@RISE, MEDCIDS, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Arnaud Bourdin
- PhyMedExp, Univ Montpellier, National Center for Scientific Research (CNRS), The National Institute of Health and Medical Research (INSERM), Centre Hospitalier Universitaire (CHU) Montpellier, Montpellier, France
| | - Guy G. Brusselle
- Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium
- Departments of Epidemiology and Respiratory Medicine, Erasmus Medical Center Rotterdam, Rotterdam, Netherlands
| | - Wenjia Chen
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Li Ping Chung
- Department of Respiratory Medicine, Fiona Stanley Hospital, Perth, WA, Australia
| | - Eve Denton
- Allergy, Asthma and Clinical Immunology Service, Alfred Health, Melbourne, VIC, Australia
- Department of Medicine, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Joao A. Fonseca
- CINTESIS@RISE, MEDCIDS, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Flavia Hoyte
- Division of Allergy and Clinical Immunology, Department of Medicine, National Jewish Health, Denver, CO, United States
| | - David J. Jackson
- Guy’s Severe Asthma Centre, Guy’s Hospital, King’s College London, London, United Kingdom
| | - Rohit Katial
- Division of Allergy and Clinical Immunology, Department of Medicine, National Jewish Health, Denver, CO, United States
| | - Bruce J. Kirenga
- Department of Medicine, Lung Institute, Makerere University Lung Institute, Kampala, Uganda
| | - Mariko Siyue Koh
- Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore, Singapore
| | | | - Lauri Lehtimäki
- Allergy Centre, Tampere University Hospital, Tampere, Finland
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Mei Fong Liew
- FAST and Chronic Programmes, Alexandra Hospital, National University Health System, Singapore, Singapore
- Division of Respiratory and Critical Care Medicine, Department of Medicine, National University Hospital, National University Health System, Singapore, Singapore
| | - Bassam Mahboub
- Rashid Hospital, Dubai Health Authority (DHA), Dubai, United Arab Emirates
- Dubai Academic and Health Corporation, Dubai, United Arab Emirates
| | - Neil Martin
- BioPharmaceuticals Medical, AstraZeneca, Gaithersburg, MD, United States
- Department of Respiratory Medicine, University of Leicester, Leicester, United Kingdom
| | - Andrew N. Menzies-Gow
- BioPharmaceutical Medical, AstraZeneca, Cambridge, United Kingdom
- Lung Division, Royal Brompton and Harefield Hospital, London, United Kingdom
| | - Pee Hwee Pang
- Department of Respiratory and Critical Care Medicine, Tan Tock Seng Hospital, Singapore, Singapore
| | - Andriana I. Papaioannou
- 2nd Respiratory Medicine Department, National and Kapodistrian University of Athens Medical School, Attikon University Hospital, Athens, Greece
| | - Pujan H. Patel
- Respiratory Medicine, Royal Brompton Hospital, London, United Kingdom
| | - Luis Perez-De-Llano
- Pneumology Service, Lucus Augusti University Hospital, Sergas (Galician Healthcare Service) Integrated Management Structure (EOXI) Lugo, Cervo, Spain
| | - Matthew J. Peters
- Department of Thoracic Medicine, Concord Hospital, Sydney, NSW, Australia
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
| | - Luisa Ricciardi
- Allergy and Clinical Immunology, G. Martino Hospital, University of Messina, Messina, Italy
| | | | - Ivan Solarte
- Pulmonary Unit, Hospital Universitario San Ignacio, Bogotá, Colombia
- School of Medicine, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Tunn Ren Tay
- Department of Respiratory and Critical Care Medicine, Changi General Hospital, Singapore, Singapore
| | - Carlos A. Torres-Duque
- Centro Internacional de Investigación en Neumología (CINEUMO), Respiratory Research Center, Fundación Neumológica Colombiana, Bogotá, Colombia
- Universidad de La Sabana, Doctoral Biosciences, Chia, Colombia
| | - Eileen Wang
- Division of Allergy and Clinical Immunology, Department of Medicine, National Jewish Health, Denver, CO, United States
- Division of Allergy and Clinical Immunology, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, United States
| | - Martina Zappa
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - John Abisheganaden
- Department of Respiratory and Critical Care Medicine, Tan Tock Seng Hospital, Singapore, Singapore
- Health Services and Outcomes Research, National Healthcare Group, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Karin Dahl Assing
- Department of Respiratory Medicine, Aalborg University Hospital, Aalborg, Denmark
| | - Richard W. Costello
- Department of Respiratory Medicine, Clinical Research Centre, Smurfit Building Beaumont Hospital, Royal College of Surgeons Ireland (RCSI), Dublin, Ireland
| | - Peter G. Gibson
- Australian Severe Asthma Network, Priority Research Centre for Healthy Lungs, University of Newcastle, Newcastle, NSW, Australia
- Department of Respiratory and Sleep Medicine, Hunter Medical Research Institute, John Hunter Hospital, Newcastle, NSW, Australia
| | - Enrico Heffler
- Personalized Medicine, Asthma and Allergy, Istituto Clinico Humanitas, Humanitas Cancer Center (IRCCS) Humanitas Research Hospital, Rozzano, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| | - Jorge Máspero
- Clinical Research for Allergy and Respiratory Medicine, CIDEA Foundation, Buenos Aires, Argentina
- University Career of Specialists in Allergy and Clinical Immunology at the Buenos Aires University School of Medicine, Buenos Aires, Argentina
| | - Stefania Nicola
- Allergy and Immunology Unit, L'Azienda Ospedaliera (AO) Ordine Mauriziano di Torino, Turin, Italy
| | - Diahn-Warng Perng (Steve)
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Francesca Puggioni
- Personalized Medicine, Asthma and Allergy, Istituto Clinico Humanitas, Humanitas Cancer Center (IRCCS) Humanitas Research Hospital, Rozzano, Italy
| | - Sundeep Salvi
- Pulmocare Research and Education Foundation, Pune, India
| | - Chau-Chyun Sheu
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Internal Medicine, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | | | - Camille Taillé
- Department of Respiratory Diseases, Bichat Hospital, l'Assistance publique – Hôpitaux de Paris (AP-HP) Nord-Université Paris Cité, Paris, France
| | - Tze Lee Tan
- Department of Family Medicine, National University Health System, Singapore, Singapore
| | - Leif Bjermer
- Respiratory Medicine and Allergology, Department of Clinical Sciences, Skåne University Hospital, Lund University, Lund, Sweden
| | - Giorgio Walter Canonica
- Personalized Medicine, Asthma and Allergy, Istituto Clinico Humanitas, Humanitas Cancer Center (IRCCS) Humanitas Research Hospital, Rozzano, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| | | | - Libardo Jiménez-Maldonado
- Universidad de La Sabana, Doctoral Biosciences, Chia, Colombia
- Fundación Neumológica Colombiana, ASMAIRE REXPIRA (Atención integral y rehabilitación en asma or Comprehensive Care and Rehabilitation in Asthma) Program, Bogotá, Colombia
| | - Christian Taube
- Department of Pulmonary Medicine, University Medical Center Essen-Ruhrlandklinik, Essen, Germany
| | - Luisa Brussino
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - David B. Price
- Observational and Pragmatic Research Institute, Singapore, Singapore
- Optimum Patient Care Global, Cambridge, United Kingdom
- Centre of Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom
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5
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Nurmi E, Vähätalo I, Ilmarinen P, Andersén H, Tuomisto LE, Sovijärvi A, Backman H, Lehtimäki L, Hedman L, Langhammer A, Nwaru BI, Piirilä P, Kankaanranta H. Agreement between self-reported and registered age at asthma diagnosis in Finland. BMC Pulm Med 2024; 24:133. [PMID: 38491499 PMCID: PMC10943976 DOI: 10.1186/s12890-024-02949-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 03/04/2024] [Indexed: 03/18/2024] Open
Abstract
INTRODUCTION In epidemiological studies, the age at asthma onset is often defined by patients' self-reported age at diagnosis. The reliability of this report might be questioned. Our objective was to evaluate the agreement between self-reported and registered age at asthma diagnosis and assess features contributing to the agreement. METHODS As part of the FinEsS respiratory survey in 2016, randomly selected population samples of 13,435 from Helsinki and 8000 from Western Finland were studied. Self-reported age at asthma diagnosis was compared to age at asthma diagnosis registered in the Finnish register on special reimbursement for asthma medication. The reimbursement right is based on lung function criteria according to GINA and Finnish guidelines. If the difference was less than 5 years, self-reported diagnosis was considered reliable. Features associated with the difference between self-reported and registered age at asthma diagnosis were evaluated. RESULTS Altogether 197 subjects from Helsinki and 144 from Western Finland were included. Of these, 61.9% and 77.8%, respectively, reported age at diagnosis reliably. Median difference between self-reported and registered age at diagnoses was - 2.0 years (IQR - 9.0 to 0) in Helsinki and - 1.0 (IQR - 4.3 to 0) in Western Finland indicating earlier self-reported age at diagnosis. More reliable self-report was associated with non-allergic subjects and subjects who reported having asthma diagnosis more recently. CONCLUSIONS Agreement between self-reported and registered age at asthma diagnosis was good especially with adult-onset asthma patients. Poor agreement in early-onset asthma could be related to delay in registration due to reimbursement criteria.
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Affiliation(s)
- Elias Nurmi
- Tampere University Respiratory Research group, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
- Department of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland.
| | - Iida Vähätalo
- Tampere University Respiratory Research group, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Department of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland
| | - Pinja Ilmarinen
- Tampere University Respiratory Research group, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Department of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland
| | - Heidi Andersén
- Tampere University Respiratory Research group, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Oncology Unit, Vaasa Keskussairaala, Vaasa, Finland
| | - Leena E Tuomisto
- Tampere University Respiratory Research group, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Department of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland
| | - Anssi Sovijärvi
- Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Department of Clinical Physiology and Nuclear Medicine, Unit of Clinical Physiology, HUS Medical Imaging Center, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland
| | - Helena Backman
- Department of Public Health and Clinical Medicine, Section of Sustainable Health, The OLIN Unit, Umeå, Sweden
| | - Lauri Lehtimäki
- Tampere University Respiratory Research group, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Allergy Centre, Tampere University Hospital, Tampere, Finland
| | - Linnea Hedman
- Department of Public Health and Clinical Medicine, Section of Sustainable Health, The OLIN Unit, Umeå, Sweden
| | - Arnulf Langhammer
- Department of Public Health and Nursing, HUNT Research Centre Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology, Levanger, Norway
- Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Bright I Nwaru
- Krefting Research Centre, Institute of Medicine, Dept of Internal Medicine and Clinical Nutrition, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Wallenberg Centre for Molecular and Translational Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Päivi Piirilä
- Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Department of Clinical Physiology and Nuclear Medicine, Unit of Clinical Physiology, HUS Medical Imaging Center, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland
| | - Hannu Kankaanranta
- Tampere University Respiratory Research group, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
- Department of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland.
- Krefting Research Centre, Institute of Medicine, Dept of Internal Medicine and Clinical Nutrition, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
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6
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Csonka L, Tikkakoski A, Tikkakoski AP, Karjalainen J, Lehtimäki L. Relation of changes in PEF and FEV1 in exercise challenge in children. Clin Physiol Funct Imaging 2024; 44:179-185. [PMID: 37933772 DOI: 10.1111/cpf.12864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 09/12/2023] [Accepted: 10/30/2023] [Indexed: 11/08/2023]
Abstract
Decrease in forced expiratory volume in one second (FEV1 ) of 10% or 15% in exercise challenge test is considered diagnostic for asthma, but a decrease of 15% in peak expiratory flow (PEF) is recommended as an alternative. Our aim was to assess the accuracy of different PEF cut-off points in comparison to FEV1 . We retrospectively studied 326 free running exercise challenge tests with spirometry in children 6-16 years old. FEV1 and PEF were measured before and 2, 5, 10 and 15 min after exercise. Receiver operating characteristics (ROC) analysis, sensitivity, specificity, positive and negative predictive values (PPV and NPV) and ϰ-coefficient were used to analyse how decrease in PEF predicts decrease of 10% or 15% in FEV1 . In the ROC analysis, areas under the curve were 0.851 (p < 0.001) and 0.921 (p < 0.001) for PEF decrease to predict a 10% and 15% decrease in FEV1 , respectively. The agreement between changes in PEF and FEV1 varied from slight to substantial (ϰ values of 0.199-0.680) depending on the cut-points. Lower cut-off for decrease in PEF had higher sensitivity and NPV, while higher cut-off values had better specificity and PPV. Decrease of 20% and 25% in PEF seemed to be the best cut-offs for detecting 10% and 15% decrease in FEV1 , respectively. Still, a fifth of the positive findings based on PEF were false. Change in PEF is not a precise predictor of change in FEV1 in exercise test. The currently recommended cut-point of 15% decrease in PEF seems to be too low and leads to high false positive rate.
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Affiliation(s)
- Leon Csonka
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Antti Tikkakoski
- Department of Clinical Physiology and Nuclear Medicine, Tampere University Hospital, Tampere, Finland
| | - Anna P Tikkakoski
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Jussi Karjalainen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Allergy Centre, Tampere University Hospital, Tampere, Finland
| | - Lauri Lehtimäki
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Allergy Centre, Tampere University Hospital, Tampere, Finland
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7
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Ojanperä L, Lehtimäki L, Kelemen B, Csonka P. Salbutamol delivery in small children: Effect of valved holding chamber and breathing patterns. J Allergy Clin Immunol Pract 2024; 12:509-511.e3. [PMID: 37979688 DOI: 10.1016/j.jaip.2023.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 11/06/2023] [Accepted: 11/09/2023] [Indexed: 11/20/2023]
Affiliation(s)
- Laura Ojanperä
- Centre for Child Health Research, Tampere University and Tampere University Hospital, Tampere, Finland.
| | - Lauri Lehtimäki
- Allergy Centre, Tampere University Hospital, Tampere, Finland; Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Balázs Kelemen
- Centre for Child Health Research, Tampere University and Tampere University Hospital, Tampere, Finland
| | - Péter Csonka
- Centre for Child Health Research, Tampere University and Tampere University Hospital, Tampere, Finland; Department of Pediatrics, Terveystalo Healthcare, Tampere, Finland.
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8
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Chen W, Tran TN, Sadatsafavi M, Murray RB, Boon Wong NC, Ali N, Ariti C, Bulathsinhala L, Garcia Gil E, FitzGerald JM, Alacqua M, Al-Ahmad M, Altraja A, Al-Lehebi R, Bhutani M, Bjermer L, Bjerrum AS, Bourdin A, von Bülow A, Busby J, Canonica GW, Carter V, Christoff GC, Cosio BG, Costello RW, Fonseca JA, Gibson PG, Yoo KH, Heaney LG, Heffler E, Hew M, Hilberg O, Hoyte F, Iwanaga T, Jackson DJ, Jones RC, Koh MS, Kuna P, Larenas-Linnemann D, Lehmann S, Lehtimäki L, Lyu J, Mahboub B, Maspero J, Menzies-Gow AN, Newell A, Sirena C, Papadopoulos NG, Papaioannou AI, Perez-de-Llano L, Perng Steve DW, Peters MJ, Pfeffer PE, Porsbjerg CM, Popov TA, Rhee CK, Salvi S, Taillé C, Taube C, Torres-Duque CA, Ulrik C, Ra SW, Wang E, Wechsler ME, Price DB. Reply to "Exploring the long-term effects of biologic initiation in severe asthma: Insights from the International Severe Asthma Registry". J Allergy Clin Immunol Pract 2024; 12:536-539. [PMID: 38336403 DOI: 10.1016/j.jaip.2023.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 12/01/2023] [Indexed: 02/12/2024]
Affiliation(s)
- Wenjia Chen
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | | | - Mohsen Sadatsafavi
- Respiratory Evaluation Sciences Program, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Ruth B Murray
- Optimum Patient Care Global, Cambridge, United Kingdom
| | | | - Nasloon Ali
- Optimum Patient Care Global, Cambridge, United Kingdom; Observational and Pragmatic Research Institute, Singapore
| | - Con Ariti
- Optimum Patient Care Global, Cambridge, United Kingdom; Observational and Pragmatic Research Institute, Singapore
| | - Lakmini Bulathsinhala
- Optimum Patient Care Global, Cambridge, United Kingdom; Observational and Pragmatic Research Institute, Singapore
| | | | - J Mark FitzGerald
- Department of Medicine, the University of British Columbia, Vancouver, BC, Canada
| | | | - Mona Al-Ahmad
- Microbiology Department, College of Medicine, Kuwait University, Kuwait City, Kuwait; Al-Rashed Allergy Center, Ministry of Health, Kuwait City, Kuwait
| | - Alan Altraja
- Department of Pulmonology, University of Tartu and Lung Clinic, Tartu University Hospital, Tartu, Estonia
| | - Riyad Al-Lehebi
- Department of Pulmonology, King Fahad Medical City, Riyadh, Saudi Arabia; Alfaisal University, Riyadh, Saudi Arabia
| | - Mohit Bhutani
- Division of Pulmonary Medicine, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Leif Bjermer
- Respiratory Medicine and Allergology, Department of Clinical Sciences, Skåne University Hospital, Lund University, Lund, Sweden
| | - Anne-Sofie Bjerrum
- Department of Respiratory Medicine and Allergy, Aarhus University Hospital, Aarhus, Denmark
| | - Arnaud Bourdin
- PhyMedExp, Univ Montpellier, CNRS, INSERM, CHU Montpellier, Montpellier, France
| | - Anna von Bülow
- Respiratory Research Unit, Bispebjerg University Hospital, Copenhagen, Denmark
| | - John Busby
- Centre for Public Health, Queen's University Belfast, Belfast, United Kingdom
| | - Giorgio Walter Canonica
- Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center IRCCS, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Victoria Carter
- Optimum Patient Care Global, Cambridge, United Kingdom; Observational and Pragmatic Research Institute, Singapore
| | | | - Borja G Cosio
- Son Espases University Hospital-IdISBa-Ciberes, Mallorca, Spain
| | - Richard W Costello
- Clinical Research Centre, Department of Respiratory Medicine, Smurfit Building Beaumont Hospital, RCSI, Dublin, Ireland
| | - João A Fonseca
- Department of Community Medicine, Information and Health Decisions (MEDCIDS), Health Information and Decision Sciences Department (MEDCIDS) & Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine of University of Porto, Porto, Portugal
| | - Peter G Gibson
- Australian Severe Asthma Network, Priority Research Centre for Healthy Lungs, University of Newcastle, Newcastle, NSW, Australia; Department of Respiratory and Sleep Medicine, Hunter Medical Research Institute, John Hunter Hospital, New Lambton Heights, NSW, Australia
| | - Kwang Ha Yoo
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Konkuk University School of Medicine, Seoul, South Korea
| | - Liam G Heaney
- Wellcome-Wolfson Centre for Experimental Medicine, Queen's University Belfast, Belfast, United Kingdom
| | - Enrico Heffler
- Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center IRCCS, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Mark Hew
- Allergy, Asthma & Clinical Immunology Service, Alfred Health, Melbourne, VIC, Australia; Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Ole Hilberg
- Medical Department, Vejle University Hospital, Vejle, Denmark
| | - Flavia Hoyte
- Division of Allergy & Clinical Immunology, Department of Medicine, National Jewish Health, Denver, Colo
| | | | - David J Jackson
- Guy's Severe Asthma Centre, Guy's Hospital, King's College London, UK
| | - Rupert C Jones
- Research and Knowledge Exchange, Plymouth Marjon University, Plymouth, United Kingdom
| | - Mariko Siyue Koh
- Respiratory & Critical Care Medicine, Singapore General Hospital, Singapore
| | - Piotr Kuna
- Division of Internal Medicine, Asthma and Allergy, Medical University of Łódź, Łódź, Poland
| | | | - Sverre Lehmann
- Section of Thoracic Medicine, Department of Clinical Science, University of Bergen, Bergen, Norway; Department of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway
| | - Lauri Lehtimäki
- Allergy Centre, Tampere University Hospital, Tampere, Finland; Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Juntao Lyu
- Griffith University, Centre for Applied Health Economics, Nathan, Australia
| | - Bassam Mahboub
- Rashid Hospital, Dubai Health Authority, Dubai, United Arab Emirates; Dubai Academic and Health Corporation, Dubai, United Arab Emirates
| | - Jorge Maspero
- Clinical Research for Allergy and Respiratory Medicine, CIDEA Foundation, Buenos Aires, Argentina; University Career of Specialists in Allergy and Clinical Immunology, Buenos Aires University School of Medicine, Buenos Aires, Argentina
| | - Andrew N Menzies-Gow
- AstraZeneca, Cambridge, United Kingdom; Lung Division, Royal Brompton & Harefield Hospitals, London, United Kingdom
| | - Anthony Newell
- Observational and Pragmatic Research Institute, Singapore; Optimum Patient Care, Brisbane, QLD, Australia
| | | | - Nikolaos G Papadopoulos
- Division of Infection, Immunity & Respiratory Medicine, University of Manchester, Manchester, United Kingdom; Allergy Department, 2nd Pediatric Clinic, University of Athens, Athens, Greece
| | - Andriana I Papaioannou
- 2nd Respiratory Medicine Department, National and Kapodistrian University of Athens Medical School, Attikon University Hospital, Athens, Greece
| | - Luis Perez-de-Llano
- Pneumology Service, Lucus Augusti University Hospital, EOXI Lugo, Monforte, Cervo, Lugo, Spain
| | - Diahn-Warng Perng Steve
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Matthew J Peters
- Department of Thoracic Medicine, Concord Hospital, Sydney, NSW, Australia; Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
| | - Paul E Pfeffer
- Department of Respiratory Medicine, Barts Health NHS Trust, London, United Kingdom; Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Celeste M Porsbjerg
- Department of Respiratory Medicine and Infectious Diseases, Research Unit, Bispebjerg Hospital, Copenhagen, Denmark
| | - Todor A Popov
- University Hospital "Sv. Ivan Rilski," Sofia, Bulgaria
| | - Chin Kook Rhee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, the Catholic University of Korea, Seoul, South Korea
| | - Sundeep Salvi
- Pulmocare Research and Education Foundation, Pune, India
| | - Camille Taillé
- Department of Respiratory Diseases, Bichat Hospital, AP-HP Nord-Université de Paris, Paris, France
| | - Christian Taube
- Department of Pulmonary Medicine, University Medical Center Essen-Ruhrlandklinik, Essen, Germany
| | - Carlos A Torres-Duque
- CINEUMO, Respiratory Research Center, Fundación Neumológica Colombiana, Bogotá, Colombia; Universidad de La Sabana, Chia, Colombia
| | - Charlotte Ulrik
- Department of Respiratory Medicine, Copenhagen University Hospital-Hvidovre, Hvidovre, Denmark
| | - Seung Won Ra
- Department of Internal Medicine, Division of Pulmonology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea
| | - Eileen Wang
- Division of Allergy & Clinical Immunology, Department of Medicine, National Jewish Health, Denver, Colo; Division of Allergy & Clinical Immunology, Department of Medicine, University of Colorado School of Medicine, Aurora, Colo
| | - Michael E Wechsler
- NJH Cohen Family Asthma Institute, Department of Medicine, National Jewish Health, Denver, Colo
| | - David B Price
- Optimum Patient Care Global, Cambridge, United Kingdom; Observational and Pragmatic Research Institute, Singapore; Centre of Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom.
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Juntunen P, Salmela P, Pakkasela J, Karjalainen J, Lehtimäki L. Diagnoses and prescription patterns among users of medications for obstructive airway diseases in Finland. BMC Pulm Med 2024; 24:64. [PMID: 38297257 PMCID: PMC10829254 DOI: 10.1186/s12890-024-02870-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 01/19/2024] [Indexed: 02/02/2024] Open
Abstract
BACKGROUND Asthma and chronic obstructive pulmonary disease (COPD) are common diseases mostly treated in primary care. However, the usage patterns of drugs for obstructive airway diseases (R03 drugs) at the national level are not known. OBJECTIVE The aims of this study were to describe (1) for which diagnoses each class of R03 drugs were used, (2) the usage pattern of different drug classes for asthma and COPD, and (3) how often these medications were used without a diagnosis of asthma or COPD in Finland. METHODS We sent questionnaires that included questions on physician-diagnosed asthma and COPD to a random sample of 2000 Finnish subjects who had been dispensed R03 medications in the previous year. Details of R03 medications dispensed were retrieved from national registries. RESULTS Altogether, 803 subjects (40.6%) responded. Of these, 61.6% had asthma, 5.7% had both asthma and COPD, 5.1% had COPD, and 27.5% had neither asthma nor COPD. Among subjects with asthma or asthma and COPD, inhaled corticosteroids (ICS) were the most frequently dispensed class of drugs (93.7% and 97.8%, respectively). Even among subjects with COPD, ICS were dispensed as frequently (68.3%) as long-acting bronchodilators (70.7%). Antileukotrienes were dispensed mainly to asthmatic individuals only (18.4%) but far less frequently than ICS. The use of theophylline and roflumilast was rare. CONCLUSIONS R03 medications are dispensed far more frequently for asthma than for COPD and often also for subjects without asthma or COPD. In line with guidelines, asthma is treated mainly with ICS, but there seems to be overuse of ICS for COPD.
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Affiliation(s)
- Pekka Juntunen
- Department of Respiratory Medicine, Tampere University Hospital, PO Box 2000, Tampere, N33521, Finland.
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
| | - Petri Salmela
- Department of Respiratory Medicine, Tampere University Hospital, PO Box 2000, Tampere, N33521, Finland
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Johanna Pakkasela
- Department of Respiratory Medicine, Tampere University Hospital, PO Box 2000, Tampere, N33521, Finland
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Jussi Karjalainen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Allergy Centre, Tampere University Hospital, Tampere, Finland
| | - Lauri Lehtimäki
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Allergy Centre, Tampere University Hospital, Tampere, Finland
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10
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Kankaanranta H, Viinanen A, Ilmarinen P, Hisinger-Mölkänen H, Mehtälä J, Ylisaukko-Oja T, Idänpään-Heikkilä JJ, Lehtimäki L. Comorbidity Burden in Severe and Nonsevere Asthma: A Nationwide Observational Study (FINASTHMA). J Allergy Clin Immunol Pract 2024; 12:135-145.e9. [PMID: 37797715 DOI: 10.1016/j.jaip.2023.09.034] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 09/21/2023] [Accepted: 09/22/2023] [Indexed: 10/07/2023]
Abstract
BACKGROUND Asthma, affecting more than 330 million people worldwide, is associated with a high level of morbidity, mortality, and socioeconomic costs. OBJECTIVE In this cross-sectional study, we analyzed the comorbidity burden in patients with severe asthma compared with nonsevere asthma and investigated the role of corticosteroid use on the risk of comorbidities. METHODS All adults (≥18 y) with a diagnosis of asthma (International Classification of Diseases-10th revision code J45.x) between 2014 and 2017 were identified and data were collected until 2018 from Finnish nationwide registers. Asthma was defined as continuously or transiently severe or nonsevere based on annual dispensed inhaled corticosteroids (ICS), oral corticosteroids (OCS), and hospitalizations. RESULTS Of 193,730 adult identified patients diagnosed with asthma, 86.3% had nonsevere, 8.1% transiently severe, and 5.6% continuously severe asthma. Excess prevalence of pneumonia was observed in continuously (22%) and transiently severe (14%) compared with nonsevere patients after adjusting for age and sex. Cataract, osteoporosis, obesity, heart failure, and atrial fibrillation were also more frequent in severe asthma patients. The ICS and/or OCS use contributed to the risk of several comorbidities in a dose-dependent manner, particularly pneumonia, osteoporosis, obesity, heart failure, and atrial fibrillation. High OCS use and the presence of comorbidities were associated with increased health care resource use. CONCLUSIONS Patients with severe asthma have a high burden of comorbidities, especially pneumonia. Many of the comorbidities have a strong dose-dependent association with ICS and OCS treatment, suggesting that corticosteroid doses should be carefully evaluated in clinical practice.
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Affiliation(s)
- Hannu Kankaanranta
- Krefting Research Centre, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland; Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
| | - Arja Viinanen
- Pulmonary Diseases and Clinical Allergology, Turku University Hospital, Turku, Finland; Department of Pulmonary Diseases and Clinical Allergology, University of Turku, Turku, Finland
| | | | | | | | | | | | - Lauri Lehtimäki
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland; Allergy Centre, Tampere University Hospital, Tampere, Finland
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11
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Pakkasela J, Salmela P, Juntunen P, Karjalainen J, Lehtimäki L. Adherence to treatment guidelines and good asthma control in Finland. Eur Clin Respir J 2023; 10:2149918. [DOI: 10.1080/20018525.2022.2149918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Johanna Pakkasela
- Department of Respiratory Medicine, Tampere University Hospital, Tampere, Finland
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Petri Salmela
- Department of Respiratory Medicine, Tampere University Hospital, Tampere, Finland
| | - Pekka Juntunen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Jussi Karjalainen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Allergy Centre, Tampere University Hospital, Tampere, Finland
| | - Lauri Lehtimäki
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Allergy Centre, Tampere University Hospital, Tampere, Finland
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12
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Mäki-Heikkilä R, Karjalainen J, Parkkari J, Huhtala H, Valtonen M, Lehtimäki L. Acute respiratory infections hamper training and competition in cross-country skiers, especially in those with asthma. Int J Circumpolar Health 2023; 82:2223359. [PMID: 37311117 DOI: 10.1080/22423982.2023.2223359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 05/21/2023] [Accepted: 06/06/2023] [Indexed: 06/15/2023] Open
Abstract
Acute respiratory infections (ARinf) are one of the leading causes that prevent athletes from training and competing. The aim of this study was to investigate the burden of ARinfs during one season among cross-country skiers. All Finnish cross-country skiers enrolled in the largest national competitions in winter 2019 (n = 1282) were sent a postal questionnaire. A higher proportion of skiers with than without asthma had to refrain from competitions because of ARinf (76.9% vs. 62.2%, p = 0.011) but there was no significant difference in refraining from training (91.2% vs. 83.8%, p = 0.084). In skiers with asthma, the median duration of a single ARinf episode was longer (5.0 days, IQR 3.8-6.8 vs. 4.0 days, IQR 3.0-6.7, p = 0.017), and they had more days of absence because of ARinf throughout the season (median 15 days (IQR 8-28) vs. 10 days (IQR 6-18), p = 0.006) in comparison to non-asthmatics. However, many of the skiers either trained (54.4%) or competed (22.5%) during an ARinf.
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Affiliation(s)
| | - Jussi Karjalainen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Allergy Centre, Tampere University Hospital, Tampere, Finland
| | - Jari Parkkari
- Tampere Research Center of Sports Medicine, UKK Institute, Tampere, Finland
- Tampere University Hospital, Tampere, Finland
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Heini Huhtala
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Maarit Valtonen
- Finnish Institute of High Performance Sport KIHU, Jyväskylä, Finland
| | - Lauri Lehtimäki
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Allergy Centre, Tampere University Hospital, Tampere, Finland
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13
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Cushen B, Koh MS, Tran TN, Martin N, Murray R, Uthaman T, Goh CYY, Vella R, Eleangovan N, Bulathsinhala L, Maspero JF, Peters MJ, Schleich F, Pitrez P, Christoff G, Sadatsafavi M, Torres-Duque CA, Porsbjerg C, Altraja A, Lehtimäki L, Bourdin A, Taube C, Papadopoulos NG, Zsuzsanna C, Björnsdóttir U, Salvi S, Heffler E, Iwanaga T, al-Ahmad M, Larenas-Linnemann D, van Boven JFM, Aarli BB, Kuna P, Loureiro CC, Al-lehebi R, Lee JH, Marina N, Bjermer L, Sheu CC, Mahboub B, Busby J, Menzies-Gow A, Wang E, Price DB. Adult Severe Asthma Registries: A Global and Growing Inventory. Pragmat Obs Res 2023; 14:127-147. [PMID: 37881411 PMCID: PMC10595155 DOI: 10.2147/por.s399879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 09/11/2023] [Indexed: 10/27/2023] Open
Abstract
Aim The International Severe Asthma Registry (ISAR; http://isaregistries.org/) uses standardised variables to enable multi-country and adequately powered research in severe asthma. This study aims to look at the data countries within ISAR and non-ISAR countries reported collecting that enable global research that support individual country interests. Methods Registries were identified by online searches and approaching severe asthma experts. Participating registries provided data collection specifications or confirmed variables collected. Core variables (results from ISAR's Delphi study), steroid-related comorbidity variables, biologic safety variables (serious infection, anaphylaxis, and cancer), COVID-19 variables and additional variables (not belonging to the aforementioned categories) that registries reported collecting were summarised. Results Of the 37 registries identified, 26 were ISAR affiliates and 11 non-ISAR affiliates. Twenty-five ISAR-registries and 4 non-ISAR registries reported collecting >90% of the 65 core variables. Twenty-three registries reported collecting all optional steroid-related comorbidity variables. Twenty-nine registries reported collecting all optional safety variables. Ten registries reported collecting COVID-19 variables. Twenty-four registries reported collecting additional variables including data from asthma questionnaires (10 Asthma Control Questionnaire, 20 Asthma Control Test, 11 Asthma Quality of Life Questionnaire, and 4 EuroQol 5-dimension 5-level Questionnaire). Eight registries are linked to databases such as electronic medical records and national claims or disease databases. Conclusion Standardised data collection has enabled individual severe asthma registries to collect unified data and increase statistical power for severe asthma research irrespective of ISAR affiliations.
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Affiliation(s)
- Breda Cushen
- Department of Respiratory Medicine, Beaumont Hospital, Dublin, Ireland
| | - Mariko Siyue Koh
- Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore, Singapore
| | | | - Neil Martin
- AstraZeneca, Gaithersburg, MD, USA
- Department of Respiratory Medicine, University of Leicester, Leicester, UK
| | | | - Thendral Uthaman
- Observational Pragmatic Research Institute, Singapore, Singapore
| | - Celine Yun Yi Goh
- Optimum Patient Care Global, Cambridge, UK
- Observational Pragmatic Research Institute, Singapore, Singapore
| | - Rebecca Vella
- Optimum Patient Care, Brisbane, Queensland, Australia
| | - Neva Eleangovan
- Optimum Patient Care Global, Cambridge, UK
- Observational Pragmatic Research Institute, Singapore, Singapore
| | - Lakmini Bulathsinhala
- Optimum Patient Care Global, Cambridge, UK
- Observational Pragmatic Research Institute, Singapore, Singapore
| | - Jorge F Maspero
- Clinical Research for Allergy and Respiratory Medicine, CIDEA Foundation, Buenos Aires, Argentina
- University Career of Specialists in Allergy and Clinical Immunology at the Buenos Aires University School of Medicine, Buenos Aires, Argentina
| | - Matthew J Peters
- Department of Thoracic Medicine, Concord Hospital, Sydney, Australia
| | - Florence Schleich
- CHU Sart-Tilman, GIGA I3, University of Liege, Liège, Wallonia, Belgium
| | - Paulo Pitrez
- Pulmonology Division, Hospital Santa Casa de Porto Alegre, Porto Alegre, Brazil
| | | | - Mohsen Sadatsafavi
- Respiratory Evaluation Sciences Program, Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, Canada
| | - Carlos A Torres-Duque
- CINEUMO, Respiratory Research Center, Fundación Neumológica Colombiana, Bogotá, Colombia
- Universidad de La Sabana, Chia, Colombia
| | - Celeste Porsbjerg
- Department of Respiratory Medicine and Infectious Diseases, Research Unit, Bispebjerg Hospital, Copenhagen, Denmark
| | - Alan Altraja
- Department of Pulmonology, University of Tartu and Lung Clinic, Tartu University Hospital, Tartu, Estonia
| | - Lauri Lehtimäki
- Allergy Centre, Tampere University Hospital, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Arnaud Bourdin
- PhyMedExp, Univ Montpellier, CNRS, INSERM, CHU Montpellier, Montpellier, France
| | - Christian Taube
- Department of Pulmonary Medicine, University Medical Center Essen-Ruhrlandklinik, Essen, Germany
| | - Nikolaos G Papadopoulos
- Division of Infection, Immunity & Respiratory Medicine, University of Manchester, Manchester, UK
- Allergy Department, 2nd Pediatric Clinic, University of Athens, Athens, Greece
| | - Csoma Zsuzsanna
- Asthma Outpatient Clinic, National Koranyi Institute for Pulmonology, Budapest, Hungary
| | - Unnur Björnsdóttir
- Department of Allergy and Respiratory Medicine, University Hospital, Reykjavik, Iceland
| | - Sundeep Salvi
- Pulmocare Research and Education Foundation, Pune, India
| | - Enrico Heffler
- Personalized Medicine, Asthma and Allergy, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | | | - Mona al-Ahmad
- Microbiology Department, College of Medicine, Kuwait University, Kuwait, Al-Rashed Allergy Center, Ministry of Health, Kuwait City, Kuwait
| | | | - Job F M van Boven
- University of Groningen, University Medical Center Groningen, Groningen Research Institute for Asthma and COPD (GRIAC), Department of Clinical Pharmacy & Pharmacology, Groningen, the Netherlands
| | - Bernt Bøgvald Aarli
- Department of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Piotr Kuna
- Division of Internal Medicine Asthma and Allergy, Medical University of Lodz, Lodz, Poland
| | - Cláudia Chaves Loureiro
- Pneumology Unit, Hospitais da Universidade de Coimbra, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
- Centre of Pneumology, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Riyad Al-lehebi
- Department of Pulmonology, King Fahad Medical City, Riyadh, Saudi Arabia, Alfaisal University, Riyadh, Saudi Arabia
| | - Jae Ha Lee
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Nuria Marina
- Pneumology Service, Biocruces, Cruces University Hospital, Barakaldo, Spain
| | - Leif Bjermer
- Respiratory Medicine and Allergology, Department of Clinical Sciences, Skåne University Hospital, Lund University, Lund, Sweden
| | - Chau-Chyun Sheu
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Internal Medicine, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Bassam Mahboub
- Rashid Hospital, Dubai Health Authority (DHA), Dubai, United Arab Emirates
| | - John Busby
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, Northern Ireland, UK
| | | | - Eileen Wang
- Division of Allergy and Clinical Immunology, Department of Medicine, National Jewish Health and University of Colorado School of Medicine, Denver and Aurora, CO, USA
| | - David B Price
- Optimum Patient Care Global, Cambridge, UK
- Observational Pragmatic Research Institute, Singapore, Singapore
- Centre of Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, Scotland, UK
| | - On behalf of ISAR Inventory Study Group
- Department of Respiratory Medicine, Beaumont Hospital, Dublin, Ireland
- Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore, Singapore
- AstraZeneca, Gaithersburg, MD, USA
- Department of Respiratory Medicine, University of Leicester, Leicester, UK
- Optimum Patient Care Global, Cambridge, UK
- Observational Pragmatic Research Institute, Singapore, Singapore
- Optimum Patient Care, Brisbane, Queensland, Australia
- Clinical Research for Allergy and Respiratory Medicine, CIDEA Foundation, Buenos Aires, Argentina
- University Career of Specialists in Allergy and Clinical Immunology at the Buenos Aires University School of Medicine, Buenos Aires, Argentina
- Department of Thoracic Medicine, Concord Hospital, Sydney, Australia
- CHU Sart-Tilman, GIGA I3, University of Liege, Liège, Wallonia, Belgium
- Pulmonology Division, Hospital Santa Casa de Porto Alegre, Porto Alegre, Brazil
- Faculty of Public Health, Medical University, Sofia, Bulgaria
- Respiratory Evaluation Sciences Program, Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, Canada
- CINEUMO, Respiratory Research Center, Fundación Neumológica Colombiana, Bogotá, Colombia
- Universidad de La Sabana, Chia, Colombia
- Department of Respiratory Medicine and Infectious Diseases, Research Unit, Bispebjerg Hospital, Copenhagen, Denmark
- Department of Pulmonology, University of Tartu and Lung Clinic, Tartu University Hospital, Tartu, Estonia
- Allergy Centre, Tampere University Hospital, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- PhyMedExp, Univ Montpellier, CNRS, INSERM, CHU Montpellier, Montpellier, France
- Department of Pulmonary Medicine, University Medical Center Essen-Ruhrlandklinik, Essen, Germany
- Division of Infection, Immunity & Respiratory Medicine, University of Manchester, Manchester, UK
- Allergy Department, 2nd Pediatric Clinic, University of Athens, Athens, Greece
- Asthma Outpatient Clinic, National Koranyi Institute for Pulmonology, Budapest, Hungary
- Department of Allergy and Respiratory Medicine, University Hospital, Reykjavik, Iceland
- Pulmocare Research and Education Foundation, Pune, India
- Personalized Medicine, Asthma and Allergy, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Kindai University Hospital, Osakasayama, Japan
- Microbiology Department, College of Medicine, Kuwait University, Kuwait, Al-Rashed Allergy Center, Ministry of Health, Kuwait City, Kuwait
- Centro de Excelencia en Asma y Alergia, Hospital Médica Sur, Ciudad de México, Mexico
- University of Groningen, University Medical Center Groningen, Groningen Research Institute for Asthma and COPD (GRIAC), Department of Clinical Pharmacy & Pharmacology, Groningen, the Netherlands
- Department of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Division of Internal Medicine Asthma and Allergy, Medical University of Lodz, Lodz, Poland
- Pneumology Unit, Hospitais da Universidade de Coimbra, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
- Centre of Pneumology, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
- Department of Pulmonology, King Fahad Medical City, Riyadh, Saudi Arabia, Alfaisal University, Riyadh, Saudi Arabia
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
- Pneumology Service, Biocruces, Cruces University Hospital, Barakaldo, Spain
- Respiratory Medicine and Allergology, Department of Clinical Sciences, Skåne University Hospital, Lund University, Lund, Sweden
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Internal Medicine, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Rashid Hospital, Dubai Health Authority (DHA), Dubai, United Arab Emirates
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, Northern Ireland, UK
- Lung Division, Royal Brompton & Harefield Hospital, London, UK
- Division of Allergy and Clinical Immunology, Department of Medicine, National Jewish Health and University of Colorado School of Medicine, Denver and Aurora, CO, USA
- Centre of Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, Scotland, UK
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14
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Pakkasela J, Salmela P, Juntunen P, Karjalainen J, Lehtimäki L. Age at asthma diagnosis and onset of symptoms among adults with allergic and non-allergic asthma. Eur Clin Respir J 2023; 10:2269653. [PMID: 37869726 PMCID: PMC10586087 DOI: 10.1080/20018525.2023.2269653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 10/06/2023] [Indexed: 10/24/2023] Open
Abstract
Background Childhood-onset allergic asthma is the best-known phenotype of asthma. Adult-onset asthma, also an important entity, is instead often shown to be more non-allergic. There is still a lack of studies concerning the association of allergies and age at asthma onset from childhood to late adulthood. The aim of the study was to assess the age at onset of asthma symptoms and age at asthma diagnosis among adults with allergic and non-allergic asthma. Methods Questionnaires were sent to 2000 randomly selected Finnish adults aged 18-80 years who were dispensed medication for obstructive airway diseases during the previous year. The corrected sample size was 1978 subjects after exclusion of non-analysable data. The response rate was 40.6%. Self-reported doctor-diagnosed asthma was considered allergic if a concomitant self-reported doctor-diagnosed pollen and/or animal allergy was reported with asthma symptoms upon allergen exposure. Results Of the 496 participants with asthma, 42.7% were considered to have allergic asthma. The median ages at asthma diagnosis and onset of asthma symptoms were 31 (IQR 17-46) and 20 (9.25-40) years in participants with allergic asthma and 49 (37.75-58) and 40.5 (30-50) years in participants with non-allergic asthma (p < 0.001), respectively. Of the participants with asthma diagnosed at ≥30 years of age, 18% of allergic and 7% of non-allergic participants reported having had asthma symptoms under 20 years of age. Conclusions Both the onset of symptoms and diagnosis occurred at a younger age among adults with allergic asthma than among those with non-allergic asthma. Only a minority of adults with non-allergic asthma had already had symptoms in younghood.
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Affiliation(s)
- Johanna Pakkasela
- Department of Respiratory Medicine, Tampere University Hospital, Tampere, Finland
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Petri Salmela
- Department of Respiratory Medicine, Tampere University Hospital, Tampere, Finland
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Pekka Juntunen
- Department of Respiratory Medicine, Tampere University Hospital, Tampere, Finland
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Jussi Karjalainen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Allergy Centre, Tampere University Hospital, Tampere, Finland
| | - Lauri Lehtimäki
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Allergy Centre, Tampere University Hospital, Tampere, Finland
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15
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von Bülow A, Hansen S, Sandin P, Ernstsson O, Janson C, Lehtimäki L, Kankaanranta H, Ulrik C, Aarli BB, Geale K, Tang ST, Wolf M, Backer V, Hilberg O, Altraja A, Backman H, Lúdvíksdóttir D, Björnsdóttir US, Kauppi P, Sandström T, Sverrild A, Yasinska V, Kilpeläinen M, Dahlén B, Viinanen A, Bjermer L, Bossios A, Porsbjerg C. Severe asthma trajectories in adults: findings from the NORDSTAR cohort. Eur Respir J 2023; 62:2202474. [PMID: 37620041 PMCID: PMC10492664 DOI: 10.1183/13993003.02474-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 07/03/2023] [Indexed: 08/26/2023]
Abstract
BACKGROUND There is limited evidence on the pathways leading to severe asthma and we are presently unable to effectively predict the progression of the disease. We aimed to describe the longitudinal trajectories leading to severe asthma and to describe clinical events preceding disease progression in a nationwide population of patients with severe asthma. METHODS We conducted an observational study based on Swedish data from the NORdic Dataset for aSThmA Research (NORDSTAR) research collaboration platform. We identified adult patients with severe asthma in 2018 according to the European Respiratory Society/American Thoracic Society definition and used latent class analysis to identify trajectories of asthma severity over a 10-year retrospective period from 2018. RESULTS Among 169 128 asthma patients, we identified 4543 severe asthma patients. We identified four trajectories of severe asthma that were labelled as: trajectory 1 "consistently severe asthma" (n=389 (8.6%)), trajectory 2 "gradual onset severe asthma" (n=942 (20.7%)), trajectory 3 "intermittent severe asthma" (n=1685 (37.1%)) and trajectory 4 "sudden onset severe asthma" (n=1527 (33.6%)). "Consistently severe asthma" had a higher daily inhaled corticosteroid dose and more prevalent osteoporosis compared with the other trajectories. Patients with "gradual onset severe asthma" and "sudden onset severe asthma" developed type 2-related comorbidities concomitantly with development of severe asthma. In the latter group, this primarily occurred within 1-3 years preceding onset of severe asthma. CONCLUSIONS Four distinct trajectories of severe asthma were identified illustrating different patterns of progression of asthma severity. This may eventually enable the development of better preventive management strategies in severe asthma.
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Affiliation(s)
- Anna von Bülow
- Respiratory Research Unit, Department of Respiratory Medicine and Infectious Diseases, Bispebjerg Hospital, Copenhagen, Denmark
- Shared first authorship
| | - Susanne Hansen
- Respiratory Research Unit, Department of Respiratory Medicine and Infectious Diseases, Bispebjerg Hospital, Copenhagen, Denmark
- Centre for Clinical Research and Prevention, Frederiksberg Hospital, Copenhagen, Denmark
- Shared first authorship
| | | | - Olivia Ernstsson
- Quantify Research, Stockholm, Sweden
- Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Stockholm, Sweden
| | - Christer Janson
- Department of Medical Sciences: Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | - Lauri Lehtimäki
- Allergy Centre, Tampere University Hospital, Tampere, Finland
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Hannu Kankaanranta
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Krefting Research Centre, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland
| | - Charlotte Ulrik
- Respiratory Research Unit Hvidovre, Department of Respiratory Medicine, Copenhagen University Hospital-Hvidovre, Hvidovre, Denmark
| | - Bernt Bøgvald Aarli
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway
| | - Kirk Geale
- Quantify Research, Stockholm, Sweden
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | | | | | - Vibeke Backer
- Department of Otorhinolaryngology, Head and Neck Surgery, and Audiology, Rigshospitalet, Copenhagen, Denmark
| | - Ole Hilberg
- Department of Medicine, Vejle Hospital, Vejle, Denmark
| | - Alan Altraja
- Department of Pulmonology, University of Tartu and Lung Clinic, Tartu University Hospital, Tartu, Estonia
| | - Helena Backman
- Department of Public Health and Clinical Medicine, Section for Sustainable Health, Umeå University, Umeå, Sweden
| | - Dóra Lúdvíksdóttir
- Department of Respiratory Medicine, Landspitali University Hospital, University of Iceland, Reykjavik, Iceland
| | | | - Paula Kauppi
- Heart and Lung Center, Department of Pulmonary Diseases, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Thomas Sandström
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Asger Sverrild
- Respiratory Research Unit, Department of Respiratory Medicine and Infectious Diseases, Bispebjerg Hospital, Copenhagen, Denmark
| | - Valentyna Yasinska
- Department of Respiratory Medicine and Allergy, Karolinska University Hospital, Huddinge, Stockholm, Sweden
- Department of Medicine, Karolinska Institutet, Huddinge, Stockholm, Sweden
| | - Maritta Kilpeläinen
- Division of Medicine, Department of Pulmonary Diseases, Turku University Hospital, Turku, Finland
- Department of Pulmonary Diseases and Clinical Allergology, University of Turku, Turku, Finland
| | - Barbro Dahlén
- Department of Respiratory Medicine and Allergy, Karolinska University Hospital, Huddinge, Stockholm, Sweden
- Department of Medicine, Karolinska Institutet, Huddinge, Stockholm, Sweden
| | - Arja Viinanen
- Division of Medicine, Department of Pulmonary Diseases, Turku University Hospital, Turku, Finland
- Department of Pulmonary Diseases and Clinical Allergology, University of Turku, Turku, Finland
| | - Leif Bjermer
- Department of Respiratory Medicine and Allergology, Skåne University Hospital, Lund, Sweden
| | - Apostolos Bossios
- Department of Respiratory Medicine and Allergy, Karolinska University Hospital, Huddinge, Stockholm, Sweden
- Department of Medicine, Karolinska Institutet, Huddinge, Stockholm, Sweden
- Division of Lung and Airway Research, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Celeste Porsbjerg
- Respiratory Research Unit, Department of Respiratory Medicine and Infectious Diseases, Bispebjerg Hospital, Copenhagen, Denmark
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16
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Chen W, Tran TN, Sadatsafavi M, Murray R, Wong NCB, Ali N, Ariti C, Bulathsinhala L, Gil EG, FitzGerald JM, Alacqua M, Al-Ahmad M, Altraja A, Al-Lehebi R, Bhutani M, Bjermer L, Bjerrum AS, Bourdin A, von Bülow A, Busby J, Canonica GW, Carter V, Christoff GC, Cosio BG, Costello RW, Fonseca JA, Gibson PG, Yoo KH, Heaney LG, Heffler E, Hew M, Hilberg O, Hoyte F, Iwanaga T, Jackson DJ, Jones RC, Koh MS, Kuna P, Larenas-Linnemann D, Lehmann S, Lehtimäki L, Lyu J, Mahboub B, Maspero J, Menzies-Gow AN, Newell A, Sirena C, Papadopoulos NG, Papaioannou AI, Perez-de-Llano L, Perng Steve DW, Peters M, Pfeffer PE, Porsbjerg CM, Popov TA, Rhee CK, Salvi S, Taillé C, Taube C, Torres-Duque CA, Ulrik C, Ra SW, Wang E, Wechsler ME, Price DB. Impact of Initiating Biologics in Patients With Severe Asthma on Long-Term Oral Corticosteroids or Frequent Rescue Steroids (GLITTER): Data From the International Severe Asthma Registry. J Allergy Clin Immunol Pract 2023; 11:2732-2747. [PMID: 37301430 DOI: 10.1016/j.jaip.2023.05.044] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 05/29/2023] [Accepted: 05/30/2023] [Indexed: 06/12/2023]
Abstract
BACKGROUND Effectiveness of biologics has neither been established in patients with high oral corticosteroid exposure (HOCS) nor been compared with effectiveness of continuing with HOCS alone. OBJECTIVE To examine the effectiveness of initiating biologics in a large, real-world cohort of adult patients with severe asthma and HOCS. METHODS This was a propensity score-matched, prospective cohort study using data from the International Severe Asthma Registry. Between January 2015 and February 2021, patients with severe asthma and HOCS (long-term OCSs for ≥1 year or ≥4 courses of rescue OCSs within a 12-month period) were identified. Biologic initiators were identified and, using propensity scores, matched 1:1 with noninitiators. The impact of biologic initiation on asthma outcomes was assessed using generalized linear models. RESULTS We identified 996 matched pairs of patients. Both groups improved over the 12-month follow-up period, but improvement was greater for biologic initiators. Biologic initiation was associated with a 72.9% reduction in the average number of exacerbations per year versus noninitiators (0.64 vs 2.06; rate ratio, 0.27 [95% CI, 0.10-0.71]). Biologic initiators were 2.2 times more likely than noninitiators to take a daily long-term OCS dose of less than 5 mg (risk probability, 49.6% vs 22.5%; P = .002) and had a lower risk of asthma-related emergency department visits (relative risk, 0.35 [95% CI, 0.21-0.58]; rate ratio, 0.26 [0.14-0.48]) and hospitalizations (relative risk, 0.31 [95% CI, 0.18-0.52]; rate ratio, 0.25 [0.13-0.48]). CONCLUSIONS In a real-world setting, including patients with severe asthma and HOCS from 19 countries, and within an environment of clinical improvement, initiation of biologics was associated with further improvements across multiple asthma outcomes, including exacerbation rate, OCS exposure, and health care resource utilization.
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Affiliation(s)
- Wenjia Chen
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | | | - Mohsen Sadatsafavi
- Respiratory Evaluation Sciences Program, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ruth Murray
- Optimum Patient Care Global, Cambridge, United Kingdom
| | | | - Nasloon Ali
- Optimum Patient Care Global, Cambridge, United Kingdom; Observational and Pragmatic Research Institute, Singapore
| | - Con Ariti
- Optimum Patient Care Global, Cambridge, United Kingdom; Observational and Pragmatic Research Institute, Singapore
| | - Lakmini Bulathsinhala
- Optimum Patient Care Global, Cambridge, United Kingdom; Observational and Pragmatic Research Institute, Singapore
| | | | - J Mark FitzGerald
- Department of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Mona Al-Ahmad
- Microbiology Department, Faculty of Medicine, Kuwait University, Al-Rashed Allergy Center, Ministry of Health, Kuwait City, Kuwait
| | - Alan Altraja
- Department of Pulmonology, University of Tartu and Lung Clinic, Tartu University Hospital, Tartu, Estonia
| | - Riyad Al-Lehebi
- Department of Pulmonology, King Fahad Medical City, Riyadh, Saudi Arabia; College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Mohit Bhutani
- Division of Pulmonary Medicine, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Leif Bjermer
- Respiratory Medicine and Allergology, Department of Clinical Sciences, Skåne University Hospital, Lund University, Lund, Sweden
| | - Anne-Sofie Bjerrum
- Department of Respiratory Medicine and Allergy, Aarhus University Hospital, Aarhus, Denmark
| | - Arnaud Bourdin
- PhyMedExp, Univ Montpellier, CNRS, INSERM, CHU Montpellier, Montpellier, France
| | - Anna von Bülow
- Respiratory Research Unit, Bispebjerg University Hospital, Copenhagen, Denmark
| | - John Busby
- Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland
| | - Giorgio Walter Canonica
- Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center IRCCS, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Victoria Carter
- Optimum Patient Care Global, Cambridge, United Kingdom; Observational and Pragmatic Research Institute, Singapore
| | | | - Borja G Cosio
- Son Espases University Hospital-IdISBa-Ciberes, Mallorca, Spain
| | - Richard W Costello
- Department of Respiratory Medicine, RCSI Clinical Research Centre, Smurfit Building Beaumont Hospital, Dublin, Ireland
| | - João A Fonseca
- Health Information and Decision Sciences Department (MEDCIDS) & Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine of University of Porto, Porto, Portugal
| | - Peter G Gibson
- Australian Severe Asthma Network, Priority Research Centre for Healthy Lungs, University of Newcastle, Newcastle, New South Wales, Australia; Department of Respiratory and Sleep Medicine, Hunter Medical Research Institute, John Hunter Hospital, New Lambton Heights, New South Wales, Australia
| | - Kwang-Ha Yoo
- KonKuk University School of Medicine, Seoul, Korea
| | - Liam G Heaney
- Wellcome-Wolfson Centre for Experimental Medicine, Queen's University Belfast, Belfast, Northern Ireland
| | - Enrico Heffler
- Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center IRCCS, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Mark Hew
- Allergy, Asthma & Clinical Immunology Service, Alfred Health, Melbourne, Victoria, Australia; Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Ole Hilberg
- Medical Department, Vejle University Hospital, Vejle, Denmark
| | - Flavia Hoyte
- Division of Allergy & Clinical Immunology, Department of Medicine, National Jewish Health, Denver, Colo; Division of Allergy & Clinical Immunology, Department of Medicine, University of Colorado School of Medicine, Aurora, Colo
| | - Takashi Iwanaga
- Center for General Medical Education and Clinical Training, Kindai University Hospital, Osakasayama, Japan
| | - David J Jackson
- UK Severe Asthma Network and National Registry, Guy's and St Thomas' NHS Trust, London, United Kingdom; School of Immunology & Microbial Sciences, King's College London, London, United Kingdom
| | - Rupert C Jones
- Research and Knowledge Exchange, Plymouth Marjon University, Plymouth, United Kingdom
| | - Mariko Siyue Koh
- Respiratory & Critical Care Medicine, Singapore General Hospital, Singapore; SingHealth Duke-NUS Lung Centre, Singapore
| | - Piotr Kuna
- Division of Internal Medicine, Asthma and Allergy Medical University of Łódź, Łódź, Poland
| | | | - Sverre Lehmann
- Section of Thoracic Medicine, Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Lauri Lehtimäki
- Allergy Centre, Tampere University Hospital, Tampere, Finland; Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Juntao Lyu
- Observational and Pragmatic Research Institute, Singapore; Optimum Patient Care, Brisbane, Queensland, Australia
| | - Bassam Mahboub
- College of Medicine, University of Sharjah, Sharjah, United Arab Emirates; Rashid Hospital, Dubai Health Authority, Dubai, United Arab Emirates
| | - Jorge Maspero
- Clinical Research for Allergy and Respiratory Medicine, CIDEA Foundation, Buenos Aires, Argentina; University Career of Specialists in Allergy and Clinical Immunology at the Buenos Aires University School of Medicine, Buenos Aires, Argentina
| | | | - Anthony Newell
- Observational and Pragmatic Research Institute, Singapore; Optimum Patient Care, Brisbane, Queensland, Australia
| | | | - Nikolaos G Papadopoulos
- Division of Infection, Immunity & Respiratory Medicine, University of Manchester, Manchester, United Kingdom; Allergy Department, 2nd Pediatric Clinic, University of Athens, Athens, Greece
| | - Andriana I Papaioannou
- 2nd Respiratory Medicine Department, National and Kapodistrian University of Athens Medical School, Attikon University Hospital, Athens, Greece
| | - Luis Perez-de-Llano
- Pneumology Service, Lucus Augusti University Hospital, EOXI Lugo, Monforte, Cervo, Lugo, Spain; Biodiscovery Research Group, Health Research Institute of Santiago de Compostela, Santiago de Compostela, Spain
| | - Diahn-Warng Perng Steve
- Division of Clinical Respiratory Physiology, Chest Department, Taipei Veterans General Hospital, Taipei, Taiwan; COPD Assembly of the Asian Pacific Society of Respirology, Tokyo, Japan
| | - Matthew Peters
- Department of Thoracic Medicine, Concord Hospital, Sydney, New South Wales, Australia
| | - Paul E Pfeffer
- Department of Respiratory Medicine, Barts Health NHS Trust, London, United Kingdom; Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Celeste M Porsbjerg
- Respiratory Research Unit, Bispebjerg University Hospital, Copenhagen, Denmark
| | - Todor A Popov
- University Hospital "Sv. Ivan Rilski," Sofia, Bulgaria
| | - Chin Kook Rhee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sundeep Salvi
- Pulmocare Research and Education Foundation, Pune, Maharashtra, India
| | - Camille Taillé
- Department of Respiratory Diseases, Bichat Hospital, AP-HP Nord-Université de Paris, Paris, France
| | - Christian Taube
- Department of Pulmonary Medicine, University Medical Center Essen-Ruhrlandklinik, Essen, Germany
| | - Carlos A Torres-Duque
- CINEUMO, Respiratory Research Center, Fundación Neumológica Colombiana, Bogotá, Colombia
| | - Charlotte Ulrik
- Department of Respiratory Medicine, Copenhagen University Hospital-Hvidovre, Hvidovre, Denmark
| | - Seung-Won Ra
- Division of Pulmonology, Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Eileen Wang
- Division of Allergy & Clinical Immunology, Department of Medicine, National Jewish Health, Denver, Colo; Division of Allergy & Clinical Immunology, Department of Medicine, University of Colorado School of Medicine, Aurora, Colo
| | - Michael E Wechsler
- NJH Cohen Family Asthma Institute, Department of Medicine, National Jewish Health, Denver, Colo
| | - David B Price
- Optimum Patient Care Global, Cambridge, United Kingdom; Observational and Pragmatic Research Institute, Singapore; Division of Applied Health Sciences, Centre of Academic Primary Care, University of Aberdeen, Aberdeen, United Kingdom.
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Leivo-Korpela S, Rantala HA, Piili RP, Lehtimäki L, Lehto JT. Palliation of Dyspnea With Mouthpiece Ventilation in Patients With Chronic Obstructive Pulmonary Disease: A Pilot Feasibility Study. J Palliat Med 2023; 26:1261-1265. [PMID: 37155710 DOI: 10.1089/jpm.2023.0039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023] Open
Abstract
Background: Mouthpiece ventilation (MPV) reduces hypoventilation, but its efficacy in relieving dyspnea in patients with acute chronic obstructive pulmonary disease exacerbation (AECOPD) is unclear. Objective: To assess the feasibility of MPV in relieving dyspnea among patients with AECOPD. Methods: In this prospective single-arm pilot study, the change in dyspnea on numeric rating scale (NRS) after using MPV and side effects of the treatment were studied in 18 patients with AECOPD. Results: The median decrease in dyspnea was 1.5 (95% confidence interval = 0.0-2.5, p = 0.006) on NRS after the intervention lasting a median of 16.9 minutes. Of the patients, 61% found MPV beneficial. The use of MPV did not increase the sense of anxiety or pain. Conclusions: MPV is feasible and may relieve dyspnea in patients with AECOPD, but the intervention needs further evaluation. clinicaltrials.gov study number: NCT03025425.
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Affiliation(s)
- Sirpa Leivo-Korpela
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Palliative Care Centre and Department of Geriatrics, Tampere University Hospital, Tampere, Finland
| | - Heidi A Rantala
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Department of Respiratory Medicine, Tampere University Hospital, Tampere, Finland
| | - Reetta P Piili
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Palliative Care Centre and Department of Oncology, Tampere University Hospital, Tampere, Finland
| | - Lauri Lehtimäki
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Allergy Centre, Tampere University Hospital, Tampere, Finland
| | - Juho T Lehto
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Palliative Care Centre and Department of Oncology, Tampere University Hospital, Tampere, Finland
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18
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Viinanen A, Aakko J, Lassenius MI, Telg G, Nieminen K, Kaijala S, Lehtimäki L, Kankaanranta H. Type 2 Low Biomarker Stability and Exacerbations in Severe Uncontrolled Asthma. Biomolecules 2023; 13:1118. [PMID: 37509154 PMCID: PMC10377379 DOI: 10.3390/biom13071118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 06/29/2023] [Accepted: 07/03/2023] [Indexed: 07/30/2023] Open
Abstract
We investigated the stability of T2 low status, based on low levels of T2 biomarkers, and exacerbation rates in T2 low and non-T2 low asthma from clinical retrospective data of severe uncontrolled asthma patients. Knowledge of the T2 low biomarker profile is sparse and biomarker stability is uncharted. Secondary care patients with severe uncontrolled asthma and at least two blood eosinophil counts (BEC) and fractional exhaled nitric oxide (FeNO) measured for determination of type 2 inflammation status were evaluated from a follow-up period of 4 years. Patients were stratified into four groups: T2 low150 (n = 31; BEC < 150 cells/µL and FeNO < 25 ppb), non-T2 low150 (n = 138; BEC > 150 cells/µL and/or FeNO > 25 ppb), T2 low300 (n = 66; BEC < 300 cells/µL and FeNO < 25 ppb), and non-T2 low300 (n = 103; BEC > 300 cells/µL and/or FeNO > 25 ppb). Exacerbation rates requiring hospital care, stability of biomarker status, and cumulative OCS and ICS doses were assessed during follow-up. Among patients with severe uncontrolled asthma, 18% (n = 31) were identified as T2 low150, and 39% (n = 66) as T2 low300. In these groups, the low biomarker profile was stable in 55% (n = 11) and 72% (n = 33) of patients with follow-up measures. Exacerbation rates were different between the T2 low and non-T2 low groups: 19.7 [95% CI: 4.3-45.6] in T2 low150 vs. 8.4 [4.7-13.0] in non-T2 low150 per 100 patient-years. BEC and FeNO are useful biomarkers in identifying T2 low severe uncontrolled asthma, showing a stable follow-up biomarker profile in up to 72% of patients. Repeated monitoring of these biomarkers is essential in identifying and treating patients with T2 low asthma.
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Affiliation(s)
- Arja Viinanen
- Division of Medicine, Department of Pulmonary Diseases, Turku University Hospital, 20014 Turku, Finland
- Department of Pulmonary Diseases and Clinical Allergology, University of Turku, 20014 Turku, Finland
| | | | | | | | | | | | - Lauri Lehtimäki
- Allergy Centre, Tampere University Hospital, Faculty of Medicine and Health Technology, Tampere University, 33014 Tampere, Finland
| | - Hannu Kankaanranta
- Krefting Research Centre, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, 417 56 Gothenburg, Sweden
- Faculty of Medicine and Health Technology, Tampere University, 33014 Tampere, Finland
- Department of Respiratory Medicine, Seinäjoki Central Hospital, 60220 Seinäjoki, Finland
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19
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Mäki-Heikkilä R, Koskela H, Karjalainen J, Parkkari J, Huhtala H, Valtonen M, Lehtimäki L. Cross-country skiers often experience respiratory symptoms during and after exercise but have a low prevalence of prolonged cough. BMJ Open Sport Exerc Med 2023; 9:e001502. [PMID: 37342789 PMCID: PMC10277524 DOI: 10.1136/bmjsem-2022-001502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/25/2023] [Indexed: 06/23/2023] Open
Abstract
Background Cross-country skiers train and compete during the winter for long periods of time in subfreezing conditions, which strains the airways and provokes respiratory symptoms. This study aimed to compare the prevalence of exercise-related symptoms and prolonged cough in competitive cross-country skiers versus the general population and to investigate the association between these symptoms and asthma. Methods A questionnaire was sent to Finnish cross-country skiers (n=1282) and a random sample of the general population (n=1754), with response rates of 26.9% and 19.0%, respectively. Results Both groups were mostly asymptomatic at rest, but symptoms were increased in both groups during and after exercise. Cough was more prevalent after exercise in skiers and phlegm production was more common during and after exercise in skiers. Asthma did not provoke specific symptoms, but symptom prevalence was higher in asthmatic individuals. Skiers had a higher prevalence of cough after exercise (60.6% vs 22.8%, p<0.001) compared with controls, but controls had a higher prevalence of prolonged cough (4.1% vs 9.6%, p=0.004). In participants without asthma, cold air triggered symptoms more often in skiers than controls, while strong odours triggered symptoms more often in asthmatic controls than skiers. Chronic cough lasting more than 8 weeks was rare, reported by 4.8% of controls and 2.0% of skiers. Conclusion Cross-country skiers, especially those with asthma, experience a higher burden of exercise-related respiratory symptoms compared with controls. However, repeated exposure to cold air does not appear to result in long-term hypersensitivity of the cough reflex arc.
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Affiliation(s)
| | - Heikki Koskela
- Unit for Medicine and Clinical Research, Pulmonary Division, Kuopio University Hospital, Kuopio, Pohjois-Savo, Finland
- Institute of Clinical Sciences, Faculty of Health Sciences, University of Eastern Finland School of Medicine, Kuopio, Pohjois-Savo, Finland
| | - Jussi Karjalainen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Allergy Centre, Tampere University Hospital, Tampere, Pirkanmaa, Finland
| | - Jari Parkkari
- Tampere Research Center of Sports Medicine, UKK Institute, Tampere, Pirkanmaa, Finland
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyvaskyla, Finland
| | - Heini Huhtala
- Faculty of Social Sciences, Tampere University, Tampere, Pirkanmaa, Finland
| | - Maarit Valtonen
- Finnish Institute of High Performance Sport KIHU, Jyväskylä, Finland
| | - Lauri Lehtimäki
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Allergy Centre, Tampere University Hospital, Tampere, Pirkanmaa, Finland
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Tamminen P, Järnstedt J, Numminen J, Lehtinen A, Lehtimäki L, Rautiainen M, Kivekäs I. Ultra-low-dose CBCT: new cornerstone of paranasal sinus imaging. Rhinology 2023:3085. [PMID: 37283512 DOI: 10.4193/rhin22.385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND This study evaluates the clinical image quality (IQ) and usability of a sinonasal ultra-low-dose (ULD) cone-beam computed tomography (CBCT) scan. The results are compared to those of a high resolution (HR) CBCT scan to identify the strengths and weaknesses of a ULD CBCT protocol. METHODOLOGY Sixty-six anatomical sites in 33 subjects were imaged twice using two imaging modalities: HR CBCT (Scanora 3Dx scanner; Soredex, Tuusula, Finland) and ULD CBCT (Promax 3D Mid scanner; Plandent, Helsinki, Finland). IQ, opacification and obstruction, structural features and operative usability were assessed. RESULTS The overall IQ in subjects with "no or minor opacification" was excellent: 100% (HR CBCT) and 99% (ULD CBCT) of ratings were evaluated as sufficient for every structure. Increased opacification reduced the quality of both imaging modalities, resulting conchtoethmoidectomy, frontal sinusotomy, sphenotomy and posterior ethmoidectomy in cases with greater opacification. CONCLUSIONS IQ of paranasal ULD CBCT is sufficient for clinical diagnostics and should be considered for surgical planning. We recommend it as the primary imaging protocol for all patients who meet imaging criteria due to recurrent or chronic nasal symptoms. Additional or conventional imaging might be needed for patients with extensive chronic rhinosinusitis and/or indications of frontal sinus involvement.
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Affiliation(s)
- P Tamminen
- Department of Otorhinolaryngology - Head and Neck Surgery, Tampere University Hospital, Tampere, Finland
- Department of Otorhinolaryngology, Satasairaala, Pori, Finland
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
- Allergy Centre, Tampere University Hospital, Tampere, Finland
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - J Järnstedt
- Medical Imaging Centre, Department of Radiology Tampere University Hospital, Tampere, Finland
| | - J Numminen
- Department of Otorhinolaryngology - Head and Neck Surgery, Tampere University Hospital, Tampere, Finland
| | - A Lehtinen
- Medical Imaging Centre, Department of Radiology Tampere University Hospital, Tampere, Finland
| | - L Lehtimäki
- Allergy Centre, Tampere University Hospital, Tampere, Finland
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - M Rautiainen
- Department of Otorhinolaryngology - Head and Neck Surgery, Tampere University Hospital, Tampere, Finland
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - I Kivekäs
- Department of Otorhinolaryngology - Head and Neck Surgery, Tampere University Hospital, Tampere, Finland
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
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21
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Tikkakoski AP, Tikkakoski A, Sipilä K, Kivistö JE, Huhtala H, Kähönen M, Karjalainen J, Lehtimäki L. Exercise-induced bronchoconstriction is associated with air humidity and particulate matter concentration in preschool children. Pediatr Pulmonol 2023; 58:996-1003. [PMID: 36530015 DOI: 10.1002/ppul.26284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 12/11/2022] [Accepted: 12/15/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Long-term exposure to air pollution is connected to asthma morbidity in children. Exercise-induced bronchoconstriction (EIB) is common in asthma, and the free running test outdoors is an important method for diagnosing asthma in children. It is not known whether momentary air pollution exposure affects the results of outdoor exercise tests in children. METHODS We analyzed all reliable exercise challenge tests with impulse oscillometry in children (n = 868) performed between January 2012 and April 2015 at Tampere University Hospital. Pollutant concentrations (PM2.5 , NO2 , and O3 ) at the time of the exercise test were collected from public registers. We compared the pollutant concentrations with the proportion and severity of EIB and adjusted the analyses for air humidity and pollen counts. RESULTS Pollution levels were rarely high (median PM2.5 6.0 µg/m3 , NO2 12.0 µg/m3 , and O3 47.0 µg/m3 ). The relative change in resistance at 5 Hz after exercise did not correlate with O3 , NO2 or PM2.5 concentrations (p values 0.065-0.884). In multivariate logistic regression, we compared the effects of PM2.5 over 10 µg/m³, absolute humidity (AH) over 10 g/m³ and alder or birch pollen concentration over 10 grains/m³. High (over 10 g/m3 ) AH was associated with decreased incidence (OR 0.31, p value 0.004), and PM2.5 over 10 µg/m³ was associated with increased incidence (OR 1.69, p value 0.036) of EIB. CONCLUSIONS Even low PM2.5 levels may have an effect on EIB in children. Of the other properties of air, only AH was associated with the incidence of EIB.
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Affiliation(s)
- Anna P Tikkakoski
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Antti Tikkakoski
- Department of Clinical Physiology, Tampere University Hospital, Tampere, Finland
| | - Kalle Sipilä
- Department of Clinical Physiology, Tampere University Hospital, Tampere, Finland
| | - Juho E Kivistö
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Allergy Centre, Tampere University Hospital, Tampere, Finland
| | - Heini Huhtala
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Mika Kähönen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Department of Clinical Physiology, Tampere University Hospital, Tampere, Finland
| | - Jussi Karjalainen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Allergy Centre, Tampere University Hospital, Tampere, Finland
| | - Lauri Lehtimäki
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Allergy Centre, Tampere University Hospital, Tampere, Finland
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22
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Nynäs P, Vilpas S, Kankare E, Karjalainen J, Lehtimäki L, Numminen J, Tikkakoski A, Kleemola L, Uitti J. Laboratory Test Results in Patients with Workplace Moisture Damage Associated Symptoms—The SAMDAW Study. Healthcare (Basel) 2023; 11:healthcare11070971. [PMID: 37046898 PMCID: PMC10093791 DOI: 10.3390/healthcare11070971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 03/25/2023] [Accepted: 03/28/2023] [Indexed: 03/31/2023] Open
Abstract
The mechanisms of health effects of moisture damage (MD) are unclear, but inflammatory responses have been suspected. The usefulness of laboratory and allergy tests among patients in secondary healthcare with symptoms associated with workplace MD were examined. Full blood count, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), total serum immunoglobulin E (IgE), fractional exhaled nitric oxide (FeNO), and skin prick testing were assessed and analyzed in relation to multiple chemical sensitivity (MCS) and perceived stress in 99 patients and 48 controls. In analysis, t-tests, Mann-Whitney tests, and chi-squared tests were used. Minor clinically insignificant differences in blood counts were seen in patients and controls, but among patients with asthma an elevated neutrophil count was found in 19% with and only in 2% of patients without asthma (p = 0.003). CRP levels and ESR were low, and the study patients’ FeNO, total IgE, or allergic sensitization were not increased compared to controls. The level of stress was high among 26% of patients and 6% of controls (p = 0.005), and MCS was more common among patients (39% vs. 10%, p < 0.001). Stress or MCS were not significantly associated with laboratory test results. In conclusion, no basic laboratory or allergy test results were characteristic of this patient group, and neither inflammatory processes nor allergic sensitization were found to explain the symptoms among these patients. While the value of basic laboratory tests should not be ignored, the use of allergy tests does not seem necessary when symptoms are indicated to be workplace-related.
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Affiliation(s)
- Pia Nynäs
- Faculty of Medicine and Health Technology, Tampere University, 33520 Tampere, Finland
- Correspondence:
| | - Sarkku Vilpas
- Department of Phoniatrics, Tampere University Hospital, 33520 Tampere, Finland
| | - Elina Kankare
- Department of Phoniatrics, Tampere University Hospital, 33520 Tampere, Finland
| | - Jussi Karjalainen
- Faculty of Medicine and Health Technology, Tampere University, 33520 Tampere, Finland
- Allergy Centre, Tampere University Hospital, 33520 Tampere, Finland
| | - Lauri Lehtimäki
- Faculty of Medicine and Health Technology, Tampere University, 33520 Tampere, Finland
- Allergy Centre, Tampere University Hospital, 33520 Tampere, Finland
| | - Jura Numminen
- Allergy Centre, Tampere University Hospital, 33520 Tampere, Finland
| | - Antti Tikkakoski
- Department of Clinical Physiology and Nuclear Medicine, Tampere University Hospital, 33520 Tampere, Finland
| | - Leenamaija Kleemola
- Faculty of Medicine and Health Technology, Tampere University, 33520 Tampere, Finland
| | - Jukka Uitti
- Faculty of Medicine and Health Technology, Tampere University, 33520 Tampere, Finland
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23
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Pfeffer PE, Ali N, Murray R, Ulrik C, Tran TN, Maspero J, Peters M, Christoff GC, Sadatsafavi M, Torres-Duque CA, Altraja A, Lehtimäki L, Papadopoulos NG, Salvi S, Costello RW, Cushen B, Heffler E, Iwanaga T, Al-Ahmad M, Larenas-Linnemann D, Kuna P, Fonseca JA, Al-Lehebi R, Rhee CK, Perez-de-Llano L, Perng Steve DW, Mahboub B, Wang E, Goh C, Lyu J, Newell A, Alacqua M, Belevskiy AS, Bhutani M, Bjermer L, Bjornsdottir U, Bourdin A, von Bulow A, Busby J, Canonica GW, Cosio BG, Dorscheid D, Muñoz-Esquerre M, FitzGerald JM, Gil EG, Gibson PG, Heaney LG, Hew M, Hilberg O, Hoyte F, Jackson DJ, Koh MS, Ko Bruce HK, Lee JH, Lehmann S, Chaves Loureiro C, Lúðvíksdóttir D, Menzies-Gow AN, Mitchell P, Papaioannou AI, Popov TA, Porsbjerg CM, Salameh L, Sirena C, Taillé C, Taube C, Tohda Y, Wechsler ME, Price D. Comparative effectiveness of Anti-IL5 and Anti-IgE biologic classes in patients with severe asthma eligible for both. Allergy 2023. [PMID: 36929509 DOI: 10.1111/all.15711] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 12/13/2022] [Accepted: 12/22/2022] [Indexed: 03/18/2023]
Abstract
BACKGROUND Patients with severe asthma may present with characteristics representing overlapping phenotypes, making them eligible for more than one class of biologic. Our aim was to describe the profile of adult patients with severe asthma eligible for both anti-IgE and anti-IL5/5R and to compare the effectiveness of both classes of treatment in real life. METHODS This was a prospective cohort study that included adult patients with severe asthma from 22 countries enrolled into the International Severe Asthma registry (ISAR) who were eligible for both anti-IgE and anti-IL5/5R. The effectiveness of anti-IgE and anti-IL5/5R was compared in a 1:1 matched cohort. Exacerbation rate was the primary effectiveness endpoint. Secondary endpoints included long-term-oral corticosteroid (LTOCS) use, asthma-related emergency room (ER) attendance and hospital admissions. RESULTS In the matched analysis (n=350/group), the mean annualized exacerbation rate decreased by 47.1% in the anti-IL5/5R group and 38.7% in the anti-IgE group. Patients treated with anti-IL5/5R were less likely to experience a future exacerbation (adjusted IRR 0.76; 95% CI 0.64, 0.89; p<0.001) and experienced a greater reduction in mean LTOCS dose than those treated with anti-IgE (37.44% vs 20.55% reduction; p=0.023).) There was some evidence to suggest that patients treated with anti-IL5/5R experienced fewer asthma-related hospitalizations (IRR 0.64; 95% CI 0.38, 1.08), but not ER visits (IRR 0.94, 95% CI 0.61, 1.43). CONCLUSIONS In real life, both anti-IgE and anti-IL5/5R improve asthma outcomes in patients eligible for both biologic classes, however anti-IL5/5R was superior in terms of reducing asthma exacerbations and LTOCS use.
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Affiliation(s)
- Paul E Pfeffer
- Department of Respiratory Medicine, Barts Health NHS Trust, London, UK.,Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Nasloon Ali
- Observational and Pragmatic Research Institute, Singapore, Singapore.,Optimum Patient Care Global, Cambridge, UK
| | | | - Charlotte Ulrik
- Department of Respiratory Medicine, Copenhagen University Hospital-Hvidovre, Hvidovre, Denmark
| | | | - Jorge Maspero
- Clinical Research for Allergy and Respiratory Medicine, CIDEA Foundation.,University Career of Specialists in Allergy and Clinical Immunology at the Buenos Aires University School of Medicine, Argentina
| | - Matthew Peters
- Department of Thoracic Medicine, Concord Hospital, Sydney, Australia
| | - George C Christoff
- Medical University-Sofia, Faculty of Public Health, Sofia, Bulgaria; 11Respiratory Evaluation Sciences Program, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | - Alan Altraja
- Department of Pulmonology, University of Tartu and Lung Clinic, Tartu University Hospital, Tartu, Estonia
| | - Lauri Lehtimäki
- Allergy Centre, Tampere University, Hospital, Tampere, Finland; 15Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Nikolaos G Papadopoulos
- Division of Infection, Immunity & Respiratory Medicine, University of Manchester, Manchester, UK.,Allergy Department, 2nd Pediatric Clinic, University of Athens, Athens, Greece
| | - Sundeep Salvi
- Pulmocare Research and Education Foundation, Pune, India
| | - Richard W Costello
- Clinical Research Centre, Smurfit Building Beaumont Hospital, Department of Respiratory Medicine, RCSI, Dublin, Ireland
| | - Breda Cushen
- Department of Respiratory Medicine, Beaumont Hospital, Dublin, Ireland
| | - Enrico Heffler
- Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center IRCCS, Rozzano, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Takashi Iwanaga
- Center for General Medical Education and Clinical Training, Kindai University Hospital, Osakasayama, Japan
| | - Mona Al-Ahmad
- Microbiology Department, College of Medicine, Kuwait University, Kuwait, Al-Rashed Allergy Center, Ministry of Health, Kuwait
| | | | - Piotr Kuna
- Division of Internal Medicine, Asthma and Allergy Medical University of Łódź, Poland
| | - João A Fonseca
- Health Information and Decision Sciences Department (MEDCIDS), CINTESIS@RiSE, Faculty of Medicine of University of Porto, Porto, Portugal
| | - Riyad Al-Lehebi
- Department of Pulmonology, King Fahad Medical City, Riyadh, Saudi Arabia. Alfaisal University, Riyadh, Saudi Arabia.,Alfaisal University, Riyadh, Saudi Arabia
| | - Chin Kook Rhee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Luis Perez-de-Llano
- Pneumology Service, Lucus Augusti University Hospital, EOXI Lugo, Monforte, Cervo.,Biodiscovery Research Group, Health Research Institute of Santiago de Compostela, Spain
| | - Diahn-Warng Perng Steve
- Division of Clinical Respiratory Physiology Chest Department, Taipei Veterans General Hospital.,COPD Assembly of the Asian Pacific Society of Respirology
| | - Bassam Mahboub
- College of Medicine, University of Sharjah, Sharjah, United Arab Emirates.,Rashid Hospital, Dubai Health Authority, Dubai, United Arab Emirates
| | - Eileen Wang
- Division of Allergy & Clinical Immunology, Department of Medicine, National Jewish Health, Denver, CO, USA.,Division of Allergy & Clinical Immunology, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Celine Goh
- Observational and Pragmatic Research Institute, Singapore, Singapore.,Optimum Patient Care Global, Cambridge, UK
| | - Juntao Lyu
- Observational and Pragmatic Research Institute, Singapore, Singapore.,Optimum Patient Care, Queensland, Australia
| | - Anthony Newell
- Observational and Pragmatic Research Institute, Singapore, Singapore.,Optimum Patient Care, Queensland, Australia
| | | | - Andrey S Belevskiy
- Department of Pulmonology, N.I. Pirogov Russian State National Research Medical University, Moscow, Russian Federation
| | - Mohit Bhutani
- Division of Pulmonary Medicine, Department of Medicine, University of Alberta
| | - Leif Bjermer
- Respiratory Medicine and Allergology, Department of Clinical Sciences, Skåne University Hospital, Lund University, Lund, Sweden
| | - Unnur Bjornsdottir
- Department of Allergy and Respiratory Medicine,, University Hospital, Reykjavik, Iceland; 45PhyMedExp, Univ Montpellier, CNRS, INSERM, CHU Montpellier, Montpellier, France
| | | | - Anna von Bulow
- Respiratory Research Unit, Bispebjerg University Hospital, Copenhagen, Denmark
| | - John Busby
- Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland
| | - Giorgio Walter Canonica
- Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center IRCCS, Rozzano, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Borja G Cosio
- Son Espases University Hospital-IdISBa-Ciberes, Mallorca, Spain
| | - Del Dorscheid
- Department of Medicine, Center for Heart, Lung Innovation, The University of British Columbia, Vancouver, Canada
| | - Mariana Muñoz-Esquerre
- Department of Respiratory Medicine, Bellvitge University Hospital- Bellvitge Biomedical Research Institute (IDIBELL).,University of Barcelona, Barcelona, Spain
| | - J Mark FitzGerald
- Department of Medicine, The University of British Columbia, Vancouver, Canada
| | | | - Peter G Gibson
- Australian Severe Asthma Network, Priority Research Centre for Healthy Lungs, University of Newcastle, Newcastle, Australia.,Hunter Medical Research Institute, Department of Respiratory and Sleep Medicine, John Hunter Hospital, New Lambton Heights, Australia
| | - Liam G Heaney
- Wellcome-Wolfson Centre for Experimental Medicine, Queen's University Belfast, Belfast, Northern Ireland
| | - Mark Hew
- Allergy, Asthma & Clinical Immunology Service, Alfred Health, Melbourne, Australia.,Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Ole Hilberg
- Medical department, Vejle University Hospital, Denmark
| | - Flavia Hoyte
- Division of Allergy & Clinical Immunology, Department of Medicine, National Jewish Health, Denver, CO, USA.,Division of Allergy & Clinical Immunology, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - David J Jackson
- UK Severe Asthma Network and National Registry, Guy's and St Thomas' NHS Trust.,School of Immunology & Microbial Sciences, King's College London, London, UK
| | - Mariko Siyue Koh
- Respiratory & Critical Care Medicine, Singapore, General Hospital, Singapore.,SingHealth Duke-NUS Lung Centre, Singapore
| | - Hsin-Kuo Ko Bruce
- Division of Respiratory Therapy, Department of Chest Medicine, Taipei, Veterans General Hospital, Taiwan, ROC
| | - Jae Ha Lee
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Sverre Lehmann
- Section of Thoracic Medicine, Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway
| | - Cláudia Chaves Loureiro
- Pulmonology Unit, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal & Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Dóra Lúðvíksdóttir
- Department of Allergy, University Hospital, Reykjavik, Iceland; Department of Respiratory Medicine, University Hospital, Reykjavik, Iceland
| | | | | | - Andriana I Papaioannou
- 2nd Respiratory Medicine Department, National and Kapodistrian University of Athens Medical School, Attikon University Hospital, Athens, Greece
| | - Todor A Popov
- University Hospital "Sv. Ivan Rilski", Sofia, Bulgaria
| | - Celeste M Porsbjerg
- Department of Respiratory Medicine and Infections Diseases, Research Unit, Bispebjerg Hospital, Copenhagen, Denmark
| | - Laila Salameh
- College of Medicine, University of Sharjah, Sharjah, United Arab Emirates.,Rashid Hospital, Dubai Health Authority, Dubai, United Arab Emirates
| | | | - Camille Taillé
- Department of Respiratory Diseases, Bichat Hospital, AP-HP Nord-Université de Paris; Paris, France
| | - Christian Taube
- Department of Pulmonary Medicine, University Medical Center Essen-Ruhrlandklinik, Germany
| | - Yuji Tohda
- Kindai University Hospital, Osakasayama, Japan
| | - Michael E Wechsler
- NJH Cohen Family Asthma Institute, Department of Medicine, National Jewish Health, Denver, CO, USA
| | - David Price
- Observational and Pragmatic Research Institute, Singapore, Singapore.,Optimum Patient Care Global, Cambridge, UK.,Centre of Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom
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24
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Abstract
Asthma is one of the most common chronic non-communicable diseases worldwide and is characterised by variable airflow obstruction, causing dyspnoea and wheezing. Highly effective therapies are available; asthma morbidity and mortality have vastly improved in the past 15 years, and most patients can attain good asthma control. However, undertreatment is still common, and improving patient and health-care provider understanding of when and how to adjust treatment is crucial. Asthma management consists of a cycle of assessment of asthma control and risk factors and adjustment of medications accordingly. With the introduction of biological therapies, management of severe asthma has entered the precision medicine era-a shift that is driving clinical ambitions towards disease remission. Patients with severe asthma often have co-existing conditions contributing to their symptoms, mandating a multidimensional management approach. In this Seminar, we provide a clinically focused overview of asthma; epidemiology, pathophysiology, diagnosis, and management in children and adults.
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Affiliation(s)
- Celeste Porsbjerg
- Department of Respiratory and Infectious Diseases, Bispebjerg Hospital, Copenhagen, Denmark; Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
| | - Erik Melén
- Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet and Sachs' Children and Youth Hospital, Stockholm, Sweden
| | - Lauri Lehtimäki
- Allergy Centre, Tampere University Hospital, Tampere, Finland; Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Dominick Shaw
- National Institute for Health and Care Research Nottingham Biomedical Research Centre, Division of Respiratory Medicine, School of Medicine, University of Nottingham, Nottingham, UK
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25
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Tamminen P, Järnstedt J, Lehtinen A, Numminen J, Lehtimäki L, Rautiainen M, Kivekäs I. Ultra-low-dose CBCT scan: rational map for ear surgery. Eur Arch Otorhinolaryngol 2023; 280:1161-1168. [PMID: 36112187 PMCID: PMC9483469 DOI: 10.1007/s00405-022-07592-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Accepted: 08/04/2022] [Indexed: 02/07/2023]
Abstract
PURPOSE This study will evaluate the clinical quality and usability of peripheral image data from the temporal bone area obtained using a sinonasal ultra-low-dose (ULD) cone-beam computed tomography (CBCT) scan and compare them to those obtained using a high-resolution (HR) CBCT. METHODS The population consisted of 66 anatomical sites (ears of 33 subjects) imaged using two modalities: an HR CBCT (Scanora 3Dx scanner; Soredex, Tuusula, Finland) and a ULD CBCT (Promax 3D Mid scanner; Plandent, Helsinki, Finland). The image quality (IQ) for every anatomical site in each image was rated using a Likert scale from 0 to 5. RESULTS The quality of ULD CBCT scans was clinically sufficient in over 95% of the assessed images of the sigmoid sinus, jugular bulb, epitympanum and mastoid antrum as well as external acoustic meatus (all p > 0.05 compared to HR CBCT). The IQ was clinically sufficient in 75-94% of the assessed images of the scutum, mastoid segment of the facial nerve, cochlea and semicircular canals (all p < 0.05 compared to HR CBCT). The overall IQ of the HR CBCT scans was good or excellent. CONCLUSION CBCT imaging and the data at image margins are underutilized. CBCT can produce excellent structural resolution with conventional imaging parameters, even with off-focus images. Using ultra-low doses of radiation, the produced IQ is clinically sufficient. We encourage ear surgeons to check the patients' imaging history and to consider the use of imaging modalities that involve lower radiation doses especially when conducting repetitive investigations and with children.
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Affiliation(s)
- Pekka Tamminen
- Department of Otorhinolaryngology-Head and Neck Surgery, Tampere University Hospital, Elämänaukio 2, 33520, Tampere, Finland.
- Department of Otorhinolaryngology, Satasairaala, Sairaalantie 3, 28500, Pori, Finland.
- Department of Internal Medicine, Tampere University Hospital, Elämänaukio 2, 33520, Tampere, Finland.
- Faculty of Medicine and Health Technology, Tampere University, Arvo Ylpön Katu 34, 33520, Tampere, Finland.
| | - Jorma Järnstedt
- Medical Imaging Centre, Department of Radiology, Tampere University Hospital, Teiskontie 35, 33520, Tampere, Finland
| | - Antti Lehtinen
- Medical Imaging Centre, Department of Radiology, Tampere University Hospital, Teiskontie 35, 33520, Tampere, Finland
| | - Jura Numminen
- Department of Otorhinolaryngology-Head and Neck Surgery, Tampere University Hospital, Elämänaukio 2, 33520, Tampere, Finland
| | - Lauri Lehtimäki
- Allergy Centre, Tampere University Hospital, Elämänaukio 2, 33520, Tampere, Finland
- Faculty of Medicine and Health Technology, Tampere University, Arvo Ylpön Katu 34, 33520, Tampere, Finland
| | - Markus Rautiainen
- Department of Otorhinolaryngology-Head and Neck Surgery, Tampere University Hospital, Elämänaukio 2, 33520, Tampere, Finland
- Faculty of Medicine and Health Technology, Tampere University, Arvo Ylpön Katu 34, 33520, Tampere, Finland
| | - Ilkka Kivekäs
- Department of Otorhinolaryngology-Head and Neck Surgery, Tampere University Hospital, Elämänaukio 2, 33520, Tampere, Finland
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26
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Hansen S, von Bülow A, Sandin P, Ernstsson O, Janson C, Lehtimäki L, Kankaanranta H, Ulrik C, Aarli BB, Fues Wahl H, Geale K, Tang ST, Wolf M, Larsen T, Altraja A, Backman H, Kilpeläinen M, Viinanen A, Ludviksdottir D, Kauppi P, Sverrild A, Lehmann S, Backer V, Yasinska V, Skjold T, Karjalainen J, Bossios A, Porsbjerg C. Prevalence and management of severe asthma in the Nordic countries – findings from the NORDSTAR cohort. ERJ Open Res 2023; 9:00687-2022. [PMID: 37020835 PMCID: PMC10068510 DOI: 10.1183/23120541.00687-2022] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 12/29/2022] [Indexed: 02/11/2023] Open
Abstract
BackgroundReal-life evidence on prevalence and management of severe asthma is limited. Nationwide population registries across the Nordic countries provide unique opportunities to describe prevalence and management patterns of severe asthma at population level.AimIn nationwide register data from Sweden, Norway, and Finland, we examined the prevalence of severe asthma and the proportion of severe asthma patients being managed in specialist care.MethodsThis is a cross-sectional study based on the NORdic Dataset for aSThmA Research (NORDSTAR) research collaboration platform. We identified patients with severe asthma in adults (≥18 years) and in children (6–17 years) in 2018 according to the ERS/ATS definition. Patients managed in specialist care were those with an asthma-related specialist outpatient contact (only available in Sweden and Finland).ResultsOverall, we identified 598 242 patients with current asthma in Sweden, Norway, and Finland in 2018. Among those, the prevalence of severe asthma was 3.5%, 5.4% and 5.2% in adults and 0.4%, 1.0%, and 0.3% in children in Sweden, Norway, and Finland, respectively. In Sweden and Finland, 37% and 40% of adult patients with severe asthma and ≥2 exacerbations were managed in specialist care; in children the numbers were 56% and 41%, respectively.ConclusionIn three Nordic countries, population-based nationwide data demonstrated similar prevalence of severe asthma. In children, severe asthma was a rare condition. Notably, a large proportion of patients with severe asthma was not managed by a respiratory specialist, suggesting the need for increased recognition of severe asthma in primary care.
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27
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Honkamäki J, Ilmarinen P, Hisinger-Mölkänen H, Tuomisto LE, Andersén H, Huhtala H, Sovijärvi A, Lindqvist A, Backman H, Nwaru BI, Rönmark E, Lehtimäki L, Pallasaho P, Piirilä P, Kankaanranta H. Nonrespiratory Diseases in Adults Without and With Asthma by Age at Asthma Diagnosis. J Allergy Clin Immunol Pract 2023; 11:555-563.e4. [PMID: 36441098 DOI: 10.1016/j.jaip.2022.10.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 10/16/2022] [Accepted: 10/19/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Chronic nonrespiratory diseases are seemingly more prevalent in subjects with than without asthma, and asthma seems to differentiate by age of onset. However, studies with comparison of nonrespiratory diseases in subjects with and without asthma, considering asthma age of onset, are scarce. OBJECTIVE To compare the quantity and type of chronic nonrespiratory diseases in adults with and without asthma considering age at asthma diagnosis. METHODS In 2016, a FinEsS questionnaire was sent to 16,000 20- to 69-year-old adults randomly selected in Helsinki and Western Finland populations. Physician-diagnosed asthma was categorized to early (0-11), intermediate (12-39), and late-diagnosed (40-69 years). RESULTS A total of 8199 (51.5%) responded, and 842 (10.3%) reported asthma and age at diagnosis. In age and sex-adjusted binary logistic regression model, the most represented nonrespiratory disease was treated gastroesophageal reflux disease in early-diagnosed (odds ratio, 1.93; 95% CI, 1.17-3.19; P = .011) and osteoporosis in both intermediate-diagnosed (odds ratio, 3.45; 95% CI, 2.01-5.91; P < .001) and late-diagnosed asthma (odds ratio, 2.91; 95% CI, 1.77-4.79; P < .001), compared with subjects without asthma. In addition, gastroesophageal reflux disease, depression, sleep apnea, painful condition, and obesity were significantly more common in intermediate- and late-diagnosed asthma compared with without asthma, and similarly anxiety or panic disorder in intermediate-diagnosed and hypertension, severe cardiovascular disease, arrhythmia, and diabetes in late-diagnosed asthma. In age-adjusted analyses, having 3 or more nonrespiratory diseases was more common in intermediate (12.1%) and late-diagnosed asthma (36.2%) versus without asthma (10.4%) (both P < .001). CONCLUSIONS Nonrespiratory diseases were more common in adults with asthma than in adults without asthma. The type of nonrespiratory diseases differed, and their frequency increased by increasing age at asthma diagnosis.
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Affiliation(s)
- Jasmin Honkamäki
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Pinja Ilmarinen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland; Department of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland
| | | | - Leena E Tuomisto
- Department of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland
| | - Heidi Andersén
- Karolinska University Hospital, Thoracic Oncology Unit, Tema Cancer, Stockholm, Sweden
| | - Heini Huhtala
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Anssi Sovijärvi
- Unit of Clinical Physiology, HUS Medical Imaging Center, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland
| | - Ari Lindqvist
- Research Unit of Pulmonary Diseases, Helsinki University Hospital, University of Helsinki and Clinical Research Institute HUCH Ltd, Helsinki, Finland
| | - Helena Backman
- Department of Public Health and Clinical Medicine, Section of Sustainable Health/the OLIN Unit, Umeå University, Umeå, Sweden
| | - Bright I Nwaru
- Krefting Research Centre, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Eva Rönmark
- Department of Public Health and Clinical Medicine, Section of Sustainable Health/the OLIN Unit, Umeå University, Umeå, Sweden
| | - Lauri Lehtimäki
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland; Allergy Centre, Tampere University Hospital, Tampere, Finland
| | | | - Päivi Piirilä
- Unit of Clinical Physiology, HUS Medical Imaging Center, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland
| | - Hannu Kankaanranta
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland; Department of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland; Krefting Research Centre, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
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Mäki-Opas I, Hämäläinen M, Moilanen LJ, Sood H, Leppänen T, Kummola L, Junttila IS, Lehtimäki L, Moilanen E. TRPA1 Mediates Contact Hypersensitivity Induced by 2,4-Dinitrochlorobenzene. J Invest Dermatol 2023; 143:1104-1108.e4. [PMID: 36634816 DOI: 10.1016/j.jid.2022.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 10/28/2022] [Accepted: 12/12/2022] [Indexed: 01/11/2023]
Affiliation(s)
- Ilari Mäki-Opas
- The Immunopharmacology Research Group, Faculty of Medicine and Health Technology, Tampere University and Tampere University Hospital, Tampere, Finland.
| | - Mari Hämäläinen
- The Immunopharmacology Research Group, Faculty of Medicine and Health Technology, Tampere University and Tampere University Hospital, Tampere, Finland
| | - Lauri J Moilanen
- The Immunopharmacology Research Group, Faculty of Medicine and Health Technology, Tampere University and Tampere University Hospital, Tampere, Finland
| | - Heini Sood
- The Immunopharmacology Research Group, Faculty of Medicine and Health Technology, Tampere University and Tampere University Hospital, Tampere, Finland
| | - Tiina Leppänen
- The Immunopharmacology Research Group, Faculty of Medicine and Health Technology, Tampere University and Tampere University Hospital, Tampere, Finland
| | - Laura Kummola
- Biodiversity Interventions for Well-being, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Ilkka S Junttila
- Cytokine Biology Research Group, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland; Fimlab Laboratories, Tampere, Finland; Northern Finland Laboratory Centre (NordLab), Oulu, Finland; Research Unit of Biomedicine, Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Lauri Lehtimäki
- Allergy Centre, Tampere University Hospital, Tampere, Finland; Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Eeva Moilanen
- The Immunopharmacology Research Group, Faculty of Medicine and Health Technology, Tampere University and Tampere University Hospital, Tampere, Finland
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29
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Pihlaja H, Rantala H, Leivo-Korpela S, Lehtimäki L, Lehto JT, Piili RP. Specialist Palliative Care Consultation for Patients with Nonmalignant Pulmonary Diseases: A Retrospective Study. Palliat Med Rep 2023; 4:108-115. [PMID: 37095866 PMCID: PMC10122226 DOI: 10.1089/pmr.2022.0068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2023] [Indexed: 04/26/2023] Open
Abstract
Background Few patients with chronic nonmalignant pulmonary diseases receive specialist palliative care consultation, despite their high symptom burden in end of life. Objectives To study palliative care decision making, survival, and hospital resource usage in patients with nonmalignant pulmonary diseases with or without a specialist palliative care consultation. Methods A retrospective chart review of all patients with a chronic nonmalignant pulmonary disease and a palliative care decision (palliative goal of therapy), who were treated in Tampere University Hospital, Finland, between January 1, 2018 and December 31, 2020. Results A total of 107 patients were included in the study, 62 (58%) had chronic obstructive pulmonary disease (COPD), and 43 (40%) interstitial lung disease (ILD). Median survival after palliative care decision was shorter in patients with ILD than in patients with COPD (59 vs. 213 days, p = 0.004). Involvement of a palliative care specialist in the decision making was not associated with the survival. Patients with COPD who received palliative care consultation visited less often emergency room (73% vs. 100%, p = 0.019) and spent fewer days in the hospital (7 vs. 18 days, p = 0.007) during the last year of life. When a palliative care specialist attended the decision making, the presence and opinions of the patients were recorded more often, and the patients were more frequently referred to a palliative care pathway. Conclusions Specialist palliative care consultation seems to enable better end-of-life care and supports shared decision making for patients with nonmalignant pulmonary diseases. Therefore, palliative care consultations should be utilized in nonmalignant pulmonary diseases preferably before the last days of life.
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Affiliation(s)
- Hanna Pihlaja
- TUNI Palliative Care Research Group, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Palliative Care Centre, Department of Oncology, Tampere University Hospital, Tampere, Finland
- Address correspondence to: Hanna Pihlaja, MD, TUNI Palliative Care Research Group, Faculty of Medicine and Health Technology, Tampere University, Kauppi Campus, Arvo Building, Arvo Ylpön katu 34, Tampere 33520, Finland.
| | - Heidi Rantala
- TUNI Palliative Care Research Group, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Department of Respiratory Medicine, Tampere University Hospital, Tampere, Finland
| | - Sirpa Leivo-Korpela
- TUNI Palliative Care Research Group, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Palliative Care Centre and Department of Geriatrics, Tampere University Hospital, Tampere, Finland
| | - Lauri Lehtimäki
- TUNI Palliative Care Research Group, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Allergy Centre, Tampere University Hospital, Tampere, Finland
| | - Juho T. Lehto
- TUNI Palliative Care Research Group, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Palliative Care Centre, Department of Oncology, Tampere University Hospital, Tampere, Finland
| | - Reetta P. Piili
- TUNI Palliative Care Research Group, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Palliative Care Centre, Department of Oncology, Tampere University Hospital, Tampere, Finland
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30
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Backer V, Cardell LO, Lehtimäki L, Toppila-Salmi S, Bjermer L, Reitsma S, Hellings PW, Weinfeld D, Aanæs K, Ulrik CS, Braunstahl GJ, Aarli BB, Danielsen A, Kankaanranta H, Steinsvåg S, Bachert C. Multidisciplinary approaches to identifying and managing global airways disease: Expert recommendations based on qualitative discussions. Front Allergy 2023; 4:1052386. [PMID: 36895864 PMCID: PMC9989256 DOI: 10.3389/falgy.2023.1052386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 01/17/2023] [Indexed: 02/25/2023] Open
Abstract
Background Chronic rhinosinusitis with nasal polyps (CRSwNP) and asthma frequently co-exist and share pathologic features. Taking a "global" treatment approach benefits diagnosis and treatment of both, but care is often siloed by specialty: joined-up clinics are uncommon. Our objectives were to explore expert opinion to give practical suggestions to identify adults needing global airways care; enhance cross-specialty working; and widen knowledge to support diagnosis and management, integrate with existing care pathways, and supplement existing guidelines. Methods Sixteen practicing physicians from northern Europe were invited for their national and/or international standing in treating asthma and/or chronic rhinosinusitis. Appreciative Inquiry techniques were used to guide their discussions. Results Key themes arising were screening and referral, collaboration on management, awareness and education, and research. Provided are screening criteria and suggestions for specialist referrals, and pointers for physicians to optimize their knowledge of global airways disease. Collaborative working is underscored, and practical suggestions are given for multidisciplinary teamworking within global airways clinics. Research gaps are identified. Conclusion This initiative provides practical suggestions for optimizing the care of adults with CRSwNP and asthma. Discussion of the role of allergy and drug exacerbations on these conditions, and care for patients with other global airways diseases were beyond scope; however, we expect some principles of our discussion will likely benefit patients with related conditions. The suggestions bridge asthma and CRSwNP management guidelines, envisioning interdisciplinary, global airway clinics relevant to various clinical settings. They highlight the value of joint screening for early recognition and referral of patients.
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Affiliation(s)
- Vibeke Backer
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, Copenhagen University, Copenhagen, Denmark
| | - Lars Olaf Cardell
- Division of ENT Diseases, CLINTEC, Karolinska Institute, Stockholm, Sweden.,Department of Otorhinolaryngology, Karolinska University Hospital, Stockholm, Sweden
| | - Lauri Lehtimäki
- Allergy Centre, Tampere University Hospital, Tampere, Finland.,Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Sanna Toppila-Salmi
- Department of Allergology, Skin and Allergy Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Leif Bjermer
- Department of Respiratory Medicine and Allergology, Skåne University Hospital, Lund University, Lund, Sweden
| | - Sietze Reitsma
- Department of Otorhinolaryngology - Head and Neck Surgery, Amsterdam University Medical Centers, Location AMC, Amsterdam, Netherlands
| | - Peter W Hellings
- Department of Otorhinolaryngology - Head and Neck Surgery, Amsterdam University Medical Centers, Location AMC, Amsterdam, Netherlands.,Department of Otorhinolaryngology, University Hospitals Leuven, Leuven, Belgium.,Department of Otorhinolaryngology, Upper Airways Disease Research Group, University of Ghent, Ghent, Belgium
| | - Dan Weinfeld
- Asthma and Allergy Clinic Outpatient Unit (Adults), Department of Internal Medicine, South Alvsborgs Central Hospital, Boras, Sweden
| | - Kasper Aanæs
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, Copenhagen University, Copenhagen, Denmark
| | - Charlotte Suppli Ulrik
- Department of Respiratory Medicine, Copenhagen University Hospital-Hvidovre, Hvidovre, Denmark.,Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Gert-Jan Braunstahl
- Department of Pulmonology, Franciscus Gasthuis & Vlietland, Rotterdam, Netherlands.,Department of Pulmonology, Erasmus Medical Center, Rotterdam, Netherlands
| | - Bernt Bøgvald Aarli
- Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway
| | - Arild Danielsen
- Department of ENT & Allergy, The Multidisciplinary Clinic "BestHelse", Oslo, Norway
| | - Hannu Kankaanranta
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Department of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland.,Krefting Research Centre, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Sverre Steinsvåg
- Department of Otolaryngology, Head and Neck Surgery, Haukeland University Hospital, Bergen and Sørlandet Sykehus, Kristiandsand, Norway
| | - Claus Bachert
- Division of ENT Diseases, CLINTEC, Karolinska Institute, Stockholm, Sweden.,Department of Otorhinolaryngology, Upper Airways Disease Research Group, University of Ghent, Ghent, Belgium.,Department of Otorhinolaryngology, International Airway Research Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
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Ojaniemi I, Salmivesi S, Tikkakoski A, Karjalainen J, Lehtimäki L, Schultz R. Are peanut oral food challenges still useful? An evaluation of children with suspected peanut allergy, sensitization to Ara h 2 and controlled asthma. Allergy Asthma Clin Immunol 2022; 18:100. [PMID: 36451230 PMCID: PMC9714138 DOI: 10.1186/s13223-022-00743-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 11/16/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Sensitization to Ara h 2 has been proposed as a promising biological marker for the severity of peanut allergy and may reduce the need for oral food challenges. This study aimed to evaluate whether peanut oral food challenge is still a useful diagnostic tool for children with suspected peanut allergy and an elevated level of Ara h 2-specific IgE. Additionally, we assessed whether well-controlled asthma is an additional risk for severe reactions. METHODS A retrospective analysis of 107 children with sensitization to Ara h 2-specific IgE (> 0.35 kU/l) undergoing open peanut challenges during 2012-2018 in the Tampere University Hospital Allergy Centre, Finland. RESULTS Of the 107 challenges, 82 (77%) were positive. Serum levels of Ara h 2 -sIgE were higher in subjects with a positive challenge than in those who remained negative (median 32.9 (IQR 6.7-99.8) vs. 2.1 (IQR 1.0-4.9) kU/l), p < 0.001) but were not significantly different between subjects with and without anaphylaxis. No correlation was observed between the serum level of Ara h 2-sIgE and reaction severity grading. Well-controlled asthma did not affect the challenge outcome. CONCLUSIONS Elevated levels of Ara h 2-specific IgE are associated with a positive outcome in peanut challenges but not a reliable predictor of reaction severity. Additionally, well-controlled asthma is not a risk factor for severe reactions in peanut challenges in children with sensitization to Ara h 2.
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Affiliation(s)
- Iida Ojaniemi
- grid.412330.70000 0004 0628 2985Allergy Centre, Tampere University Hospital, PL 2000, 33521 Tampere, Finland
| | - Susanna Salmivesi
- grid.412330.70000 0004 0628 2985Allergy Centre, Tampere University Hospital, PL 2000, 33521 Tampere, Finland
| | - Antti Tikkakoski
- grid.412330.70000 0004 0628 2985 Department of Clinical Physiology and Nuclear Medicine, Tampere University Hospital, Tampere, Finland
| | - Jussi Karjalainen
- grid.412330.70000 0004 0628 2985Allergy Centre, Tampere University Hospital, PL 2000, 33521 Tampere, Finland ,grid.502801.e0000 0001 2314 6254Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Lauri Lehtimäki
- grid.412330.70000 0004 0628 2985Allergy Centre, Tampere University Hospital, PL 2000, 33521 Tampere, Finland ,grid.502801.e0000 0001 2314 6254Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Rüdiger Schultz
- grid.412330.70000 0004 0628 2985Allergy Centre, Tampere University Hospital, PL 2000, 33521 Tampere, Finland ,Pihlajalinna Medical Centre, Tampere, Finland
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Toppila‐Salmi S, Hällfors J, Aakko J, Mannerström B, Nieminen K, Telg G, Lehtimäki L. The burden of chronic rhinosinusitis with nasal polyps and its relation to asthma in Finland. Clin Transl Allergy 2022; 12:e12200. [PMID: 36246729 PMCID: PMC9549071 DOI: 10.1002/clt2.12200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 08/17/2022] [Accepted: 08/26/2022] [Indexed: 11/30/2022] Open
Abstract
Background Chronic rhinosinusitis with nasal polyps (CRSwNP) is commonly associated with asthma. Treatment of CRSwNP includes intranasal and systemic corticosteroids, with non‐responsive patients commonly considered for endoscopic sinus surgery (ESS). This nationwide register‐based study evaluated the incidence, prevalence, and treatment burden of CRSwNP in Finland, and their association with the presence and severity of comorbid asthma. Methods Electronic health records of patients diagnosed with CRSwNP between 1.1.2012 and 31.12.2018 in Finnish specialty and primary care were included in the study. The patients were divided into subgroups based on presence, severity, and control of asthma: no asthma, mild to moderate asthma, severe controlled asthma, and severe uncontrolled asthma. A mean cumulative count of ESS was calculated over time per subgroup. Results The prevalence of CRSwNP increased from 602.2 to 856.7 patients per 100,000 population between years 2012 and 2019 (p < 0.001). A total of 18,563 patients (59.9% male) had incident CRSwNP between 2012 and 2019, with 27% having asthma, 6% having severe asthma, and 1.5% having severe uncontrolled asthma. In the no asthma, severe controlled asthma, and severe uncontrolled asthma subgroups, systemic corticosteroids were used by 54.1%, 94.9% and 99.3% (p < 0.001), respectively, while the ESS count 3 years post diagnosis was 0.49, 0.68 and 0.80, respectively. Conclusions The prevalence of CRSwNP showed a significant increase in the recent decade in Finland. Comorbid asthma, and in particular severe asthma, increased the probability of receiving systemic corticosteroids and undergoing ESS. Thus, improved management of CRSwNP in patients with comorbid asthma is urgently needed.
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Affiliation(s)
- Sanna Toppila‐Salmi
- Department of AllergologyDepartment of Pulmonary Medicine, Heart and Lung CenterSkin and Allergy HospitalHelsinki University Hospital and University of HelsinkiHelsinkiFinland
| | | | | | | | | | | | - Lauri Lehtimäki
- Faculty of Medicine and Health TechnologyTampere University Respiratory Research GroupTampere UniversityTampereFinland,Allergy CentreTampere University HospitalTampereFinland
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Frix AN, Heaney LG, Dahlén B, Mihaltan F, Sergejeva S, Popović-Grle S, Sedlak V, Lehtimäki L, Bourdin A, Korn S, Zervas E, Csoma Z, Lúðvíksdóttir D, Butler M, Canonica GW, Grisle I, Bieksiene K, Ten Brinke A, Kuna P, Chaves Loureiro C, Nenasheva NM, Lazic Z, Škrgat S, Ramos-Barbon D, Leuppi J, Gemicioglu B, Bossios A, Porsbjerg CM, Bel EH, Djukanovic R, Louis R. Heterogeneity in the use of biologics for severe asthma in Europe: a SHARP ERS study. ERJ Open Res 2022; 8:00273-2022. [PMID: 36299366 PMCID: PMC9589318 DOI: 10.1183/23120541.00273-2022] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 08/08/2022] [Indexed: 12/04/2022] Open
Abstract
Introduction Treatment with biologics for severe asthma is informed by international and national guidelines and defined by national regulating bodies, but how these drugs are used in real-life is unknown. Materials and methods The European Respiratory Society (ERS) SHARP Clinical Research Collaboration conducted a three-step survey collecting information on asthma biologics use in Europe. Five geographically distant countries defined the survey questions, focusing on seven end-points: biologics availability and financial issues, prescription and administration modalities, inclusion criteria, continuation criteria, switching biologics, combining biologics and evaluation of corticosteroid toxicity. The survey was then sent to SHARP National Leads of 28 European countries. Finally, selected questions were submitted to a broad group of 263 asthma experts identified by national societies. Results Availability of biologics varied between countries, with 17 out of 28 countries having all five existing biologics. Authorised prescribers (pulmonologists and other specialists) also differed. In-hospital administration was the preferred deliverance modality. While exacerbation rate was used as an inclusion criterion in all countries, forced expiratory volume in 1 s was used in 46%. Blood eosinophils were an inclusion criterion in all countries for interleukin-5 (IL-5)-targeted and IL-4/IL-13-targeted biologics, with varying thresholds. There were no formally established criteria for continuing biologics. Reduction in exacerbations represented the most important benchmark, followed by improvement in asthma control and quality of life. Only 73% (191 out of 263) of surveyed clinicians assessed their patients for corticosteroid-induced toxicity. Conclusion Our study reveals important heterogeneity in the use of asthma biologics across Europe. To what extent this impacts on clinical outcomes relevant to patients and healthcare services needs further investigation. This study, based on a three-step survey among 28 European countries, has demonstrated some similarities but also great disparities in the availability and use of biologics for severe asthma in Europehttps://bit.ly/3pqwlC5
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Hisinger-Mölkänen H, Honkamäki J, Kankaanranta H, Tuomisto L, Backman H, Andersen H, Lindqvist A, Lehtimäki L, Sovijärvi A, Rönmark E, Pallasaho P, Ilmarinen P, Piirilä P. Age at asthma diagnosis is related to prevalence and characteristics of asthma symptoms. World Allergy Organ J 2022; 15:100675. [PMID: 36185544 PMCID: PMC9489807 DOI: 10.1016/j.waojou.2022.100675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 06/24/2022] [Accepted: 07/05/2022] [Indexed: 11/15/2022] Open
Abstract
Background Although asthma may begin at any age, knowledge about relationship between asthma age of onset and the prevalence and character of different symptoms is scarce. Objectives The aim of this study was to investigate if adult-diagnosed asthma is associated with more symptoms and different symptom profiles than child-diagnosed asthma. Methods A FinEsS postal survey was conducted in a random sample of 16 000 20-69-year-old Finnish adults in 2016. Those reporting physician-diagnosed asthma and age at asthma diagnosis were included. Age 18 years was chosen to delineate child- and adult-diagnosed asthma. Results Of responders (N = 8199, 51.5%), 842 (10.3%) reported asthma diagnosis. Adult-diagnosed asthma was reported by 499 (59.3%) and child-diagnosed by 343 (40.7%). Of responders with adult-diagnosed and child-diagnosed asthma, 81.8% versus 60.6% used asthma medication (p < 0.001), respectively. Current asthma was also more prevalent in adult-diagnosed asthma (89.2% versus 72.0%, p < 0.001). Risk factors of attacks of breathlessness during the last 12 months were adult-diagnosis (OR = 2.41, 95% CI 1.64–3.54, p < 0.001), female gender (OR = 1.49, 1.07–2.08, p = 0.018), family history of asthma (OR = 1.48, 1.07–2.04, p = 0.018) and allergic rhinitis (OR = 1.49, 1.07–2.09, p = 0.019). All the analysed asthma symptoms, except dyspnea in exercise, were more prevalent in adult-diagnosed asthma in age- and gender-adjusted analyses (p = 0.032-<0.001) which was also more often associated with 5 or more asthma symptoms (p < 0.001) and less often with non-symptomatic appearance (p < 0.001) than child-diagnosed asthma. Conclusion Responders with adult-diagnosed asthma had more often current asthma and a higher and multiform asthma symptom burden, although they used asthma medication more often compared to responders with child-diagnosed asthma.
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Affiliation(s)
| | - Jasmin Honkamäki
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Hannu Kankaanranta
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Department of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland.,Krefting Research Centre, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Leena Tuomisto
- Department of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland
| | - Helena Backman
- Department of Public Health and Clinical Medicine, Division of Occupational and Environmental Medicine/ the OLIN Unit, Umeå University, Umeå, Sweden
| | - Heidi Andersen
- Karolinska University Hospital, Thoracic Oncology Unit, Tema Cancer, Stockholm, Sweden
| | - Ari Lindqvist
- Clinical Research Unit of Pulmonary Diseases, Helsinki University Hospital, Helsinki, Finland
| | - Lauri Lehtimäki
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Allergy Centre, Tampere University Hospital, Tampere, Finland
| | - Anssi Sovijärvi
- Faculty of Medicine, University of Helsinki, Helsinki, Finland.,Unit of Clinical Physiology, HUS Medical Imaging Center, Helsinki University Central Hospital, Helsinki, Finland
| | - Eva Rönmark
- Department of Public Health and Clinical Medicine, Division of Occupational and Environmental Medicine/ the OLIN Unit, Umeå University, Umeå, Sweden
| | | | - Pinja Ilmarinen
- Department of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland
| | - Päivi Piirilä
- Faculty of Medicine, University of Helsinki, Helsinki, Finland.,Unit of Clinical Physiology, HUS Medical Imaging Center, Helsinki University Central Hospital, Helsinki, Finland
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Vähätalo I, Lehtimäki L, Tuomisto LE, Karjalainen J, Niemelä O, Ilmarinen P, Kankaanranta H. Long-Term Use of Short-Acting β 2-Agonists in Patients With Adult-Onset Asthma. J Allergy Clin Immunol Pract 2022; 10:2074-2083.e7. [PMID: 35398551 DOI: 10.1016/j.jaip.2022.03.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 03/15/2022] [Accepted: 03/25/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Short-term studies have associated high use of short-acting β2-agonists (SABA) with increased risk of exacerbations, emergency visits, and asthma-related costs. However, no studies exist on long-term SABA use, and previous studies on the topic have not included information about adherence to inhaled corticosteroids (ICS) nor disease control, both affecting the need of SABA. OBJECTIVE To evaluate the clinical characteristics of SABA and ICS usage in newly diagnosed adult-onset asthma patients during a 12-year follow-up period. METHODS In the Seinäjoki Adult Asthma Study, 203 patients with adult-onset asthma were followed for 12 years. Information on dispensed SABA and ICS during the follow-up was obtained from the Finnish Social Insurance Institution. High SABA use was defined as ≥36 canisters in 12 years, corresponding to an average of ≥3 dispensed canisters/y. RESULTS Patients were dispensed median 6 (interquartile range: 3-16) SABA canisters and 48 (18-67) ICS canisters over 12 years, corresponding to 2 (1-4) and 11 (5-16) puffs/week, respectively. Only 10% of the patients were classified as high SABA users during this period. Obesity (body mass index ≥30) and high Airways Questionnaire 20 symptom scores at baseline predicted high long-term SABA use (incidence rate ratio: 1.53 [1.01-2.30] and 1.04 [1.00-1.08], respectively). High SABA users had higher ICS adherence, higher blood neutrophil counts, more comorbidities, and used more oral corticosteroid and antibiotic courses versus low SABA users. CONCLUSION High SABA use was infrequent in patients with confirmed adult-onset asthma. However, as high SABA use is associated with more severe asthma, these patients should be recognized in clinical practice.
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Affiliation(s)
- Iida Vähätalo
- Department of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland; Tampere University Respiratory Research Group, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
| | - Lauri Lehtimäki
- Tampere University Respiratory Research Group, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland; Allergy Centre, Tampere University Hospital, Tampere, Finland
| | - Leena E Tuomisto
- Department of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland; Tampere University Respiratory Research Group, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Jussi Karjalainen
- Tampere University Respiratory Research Group, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland; Allergy Centre, Tampere University Hospital, Tampere, Finland
| | - Onni Niemelä
- Tampere University Respiratory Research Group, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland; Department of Laboratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland
| | - Pinja Ilmarinen
- Department of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland; Tampere University Respiratory Research Group, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Hannu Kankaanranta
- Department of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland; Tampere University Respiratory Research Group, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland; Krefting Research Centre, Institute of Medicine, Department of Internal Medicine and Clinical Nutrition, University of Gothenburg, Gothenburg, Sweden
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Tamminen P, Kerimov D, Viskari H, Aittoniemi J, Syrjänen J, Lehtimäki L. Nasal nitric oxide is decreased in acute mild COVID-19 and related to viral load. J Breath Res 2022; 16. [PMID: 35772381 DOI: 10.1088/1752-7163/ac7d6a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 06/30/2022] [Indexed: 11/12/2022]
Abstract
Gaseous nitric oxide levels from the lungs (FeNO) and from the nose (nNO) have been demonstrated to react to acute infection or influenza vaccination. There are no published data on nNO levels during acute COVID-19, but normal levels of FeNO have been reported in one study. Our aim was to assess if acute mild COVID-19 alters nasal or bronchial NO output at the time of acute infection and at a 2-month follow up, and if this is related to symptoms or viral load. This study included 82 subjects with mild acute airway infection who did not need hospitalisation: 43 cases (RT-PCR-positive for SARS-CoV-2 in routine testing from nasopharynx) and 39 age- (+/- 5 years) and gender-matched controls (RT-PCR-negative for SARS-CoV-2). During acute infection, the cases had lower nNO compared to controls (526 [345-688] vs. 773 [677-929] ppb; p<0.001), but after two months, there was no significant difference between the groups (766 [597-965] vs. 893 [739-1066] ppb; p=0.162). There was no difference in FeNO between the groups at either of the visits. Nasal NO correlated with the cycle threshold (Ct) value of the nasopharyngeal RT-PCR test for SARS-CoV-2 (Spearman's rs=0.550; p<0.001), that is, nNO was lower with a higher viral load. Nasal NO output was decreased in acute COVID-19 in relation to higher viral load, suggesting that the type and intensity of inflammatory response affects the release of NO from airway mucosa. In these subjects without significant lower airway involvement, there were no clinically relevant findings regarding FeNO.
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Affiliation(s)
- Pekka Tamminen
- Tampere University Hospital, Elämänaukio 2, Tampere, 33521, FINLAND
| | - Dominik Kerimov
- Department of Clinical Microbiology, Fimlab Laboratories, Arvo Ylpön Katu 4, Tampere, 33520, FINLAND
| | - Hanna Viskari
- Tampere University Hospital, Elämänaukio 2, Tampere, Pirkanmaa, 33521, FINLAND
| | - Janne Aittoniemi
- Department of Clinical Microbiology, Fimlab Laboratories, Arvo Ylpön Katu 4, Tampere, 33520, FINLAND
| | - Jaana Syrjänen
- Department of Internal Medicine, Tampere University Hospital, Elämänaukio 2, Tampere, Pirkanmaa, 33521, FINLAND
| | - Lauri Lehtimäki
- Faculty of Medicine and Health Technology, Tampere University, Arvo Ylpön Katu 34, Tampere, 33520, FINLAND
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Mäki-Heikkilä R, Karjalainen J, Parkkari J, Huhtala H, Valtonen M, Lehtimäki L. High training volume is associated with increased prevalence of non-allergic asthma in competitive cross-country skiers. BMJ Open Sport Exerc Med 2022; 8:e001315. [PMID: 35865073 PMCID: PMC9240872 DOI: 10.1136/bmjsem-2022-001315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2022] [Indexed: 11/06/2022] Open
Abstract
Background Cross-country skiers have a high prevalence of asthma, but its phenotypes and association with success in competitions are not known. Objective To investigate, by means of a postal survey, the relative proportions of allergic and non-allergic asthma in competitive cross-country skiers compared with the general population, to study how performance level and training volume are related to asthma and its type and to assess the possible risk factors for allergic and non-allergic asthma in competitive skiers. Methods All Finnish cross-country skiers enrolled in the largest national competitions in winter 2019 (n=1282), and a random sample (n=1754) of the general population of the same age were sent a postal questionnaire. The response rate was 27.4% (n=351) for skiers and 19.5% (n=338) for the controls. International Ski Federation (FIS) ranking points measured the level of success in skiers. Asthma was defined as self-reported, physician-diagnosed asthma. Asthma was considered allergic if associated with doctor-diagnosed allergy, and exposure to allergens provoked asthma symptoms. Results The prevalence of asthma was higher in skiers than in the controls (25.9% vs 9.2%, p<0.001), and it was the highest (56.1%) in the most successful quartile of skiers. Asthma was more often non-allergic in skiers than in the controls (60.1% vs 38.7%, p=0.036). Being a skier came with a higher risk for non-allergic (OR 5.05, 95% CI 2.65 to 9.61) than allergic asthma (OR 1.92, 1.08–3.42). Using multivariable regression analysis, training volume was associated with non-allergic asthma, while age, family history of asthma and allergic rhinitis were associated with allergic asthma. Conclusion The prevalence of asthma is the highest in the most successful cross-country skiers. The asthma in skiers is mostly non-allergic compared with the general population of the same age. The most important risk factor for non-allergic asthma in skiers is high training volume.
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Affiliation(s)
| | | | - Jari Parkkari
- Tampere Research Center of Sports Medicine, Tampere, Finland
- University of Jyvaskyla, Jyväskylä, Finland
| | - Heini Huhtala
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | | | - Lauri Lehtimäki
- Tampere University, Tampere, Finland
- Allergy Centre, Tampere University Hospital, Tampere, Finland
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Lehtimäki L, Arvidsson M, Erdemli B, Nan C, Nguyen TM, Samant A, Telg G. Regional variation in intensity of inhaled asthma medication and oral corticosteroid use in Denmark, Finland, and Sweden. Eur Clin Respir J 2022; 9:2066815. [PMID: 35529252 PMCID: PMC9067971 DOI: 10.1080/20018525.2022.2066815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Oral corticosteroids (OCS) are often prescribed to patients with asthma that remains uncontrolled with maintenance therapy. We performed a real-world analysis to describe the geographic distributions of patients with asthma and OCS dispensed in Nordic countries. This observational, retrospective study examined patient-level data from nationally prescribed drug registries from January to December 2018 for individuals aged ≥12 years in Denmark, Finland, and Sweden. Using an algorithm based on asthma treatment combinations defined by the Global Initiative for Asthma (GINA), we identified patients with asthma, those on GINA Step 4–5 treatments, and those being dispensed ≥2 courses of OCS and determined volumes of OCS dispensed to these patients over the 1-year analysis period. Data were plotted geographically within each country using colour-coded heat maps. The overall asthma prevalence rates were 7.4% in Denmark, 11.6% in Finland, and 8.1% in Sweden. In Denmark, Finland, and Sweden, respectively, the frequencies of patients on GINA Step 4–5 treatments were 19%, 15%, and 16%; among whom 10%, 23%, and 5% received ≥2 courses of OCS. The rates of patients on GINA Step 4–5 treatments who were dispensed OCS in each country were 23%, 30%, and 46%, of which 22%, 17%, and 10% were dispensed doses averaging ≥5 mg/day over the year. Heat maps revealed considerable heterogeneity in geographic densities of patients with asthma and OCS claims within each country. Taken together, these results demonstrate regional variations in estimated asthma severity, control, and OCS dispensed within and between countries. Patterns of medication use suggest that a high proportion of patients in Denmark, Finland, and Sweden are on GINA Step 4–5 treatments, many of whom are dispensed OCS; this poses a considerable corticosteroid burden to these patients. Geographic differences in medication use within and between Nordic countries may reflect variations in population characteristics and/or treatment approaches.
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Affiliation(s)
- Lauri Lehtimäki
- Faculty of Medicine and Health Technology, Tampere University; Allergy Centre, Tampere University Hospital, Tampere, Finland
| | - Monica Arvidsson
- Respiratory Medicine and Allergy, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Bora Erdemli
- Department of Statistics, ZS Associates, Zurich, Switzerland
| | - Cassandra Nan
- Department of Epidemiology, AstraZeneca, Mölndal, Sweden
| | | | | | - Gunilla Telg
- Medical Department, AstraZeneca Nordic, Södertälje, Sweden
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39
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Janson C, Bjermer L, Lehtimäki L, Kankaanranta H, Karjalainen J, Altraja A, Yasinska V, Aarli B, Rådinger M, Hellgren J, Lofdahl M, Howarth PH, Porsbjerg C. Eosinophilic airway diseases: basic science, clinical manifestations and future challenges. Eur Clin Respir J 2022; 9:2040707. [PMID: 35251534 PMCID: PMC8896196 DOI: 10.1080/20018525.2022.2040707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Eosinophils have a broad range of functions, both homeostatic and pathological, mediated through an array of cell surface receptors and specific secretory granules that promote interactions with their microenvironment. Eosinophil development, differentiation, activation, survival and recruitment are closely regulated by a number of type 2 cytokines, including interleukin (IL)-5, the key driver of eosinophilopoiesis. Evidence shows that type 2 inflammation, driven mainly by interleukin (IL)-4, IL-5 and IL-13, plays an important role in the pathophysiology of eosinophilic airway diseases, including asthma, chronic rhinosinusitis with nasal polyps, eosinophilic granulomatosis with polyangiitis and hypereosinophilic syndrome. Several biologic therapies have been developed to suppress type 2 inflammation, namely mepolizumab, reslizumab, benralizumab, dupilumab, omalizumab and tezepelumab. While these therapies have been associated with clinical benefits in a range of eosinophilic diseases, their development has highlighted several challenges and directions for future research. These include the need for further information on disease progression and identification of treatable traits, including clinical characteristics or biomarkers that will improve the prediction of treatment response. The Nordic countries have a long tradition of collaboration using patient registries and Nordic asthma registries provide unique opportunities to address these research questions. One example of such a registry is the NORdic Dataset for aSThmA Research (NORDSTAR), a longitudinal population-based dataset containing all 3.3 million individuals with asthma from four Nordic countries (Denmark, Finland, Norway and Sweden). Large-scale, real-world registry data such as those from Nordic countries may provide important information regarding the progression of eosinophilic asthma, in addition to clinical characteristics or biomarkers that could allow targeted treatment and ensure optimal patient outcomes.
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Affiliation(s)
- Christer Janson
- Department of Medical Sciences: Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | - Leif Bjermer
- Department of Respiratory Medicine and Allergology, Skane University Hospital, Lund, Sweden
| | - Lauri Lehtimäki
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Allergy Centre, Tampere University Hospital, Tampere, Finland
| | - Hannu Kankaanranta
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Krefting Research Centre, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.,Department of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland
| | - Jussi Karjalainen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Allergy Centre, Tampere University Hospital, Tampere, Finland
| | - Alan Altraja
- Department of Pulmonology, University of Tartu and Lung Clinic, Tartu University Hospital, Tartu, Estonia
| | - Valentyna Yasinska
- Department of Respiratory Medicine and Allergy, Karolinska University Hospital, Huddinge, Sweden
| | - Bernt Aarli
- Department of Clinical Science, University of Bergen and Department of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway
| | - Madeleine Rådinger
- Krefting Research Centre, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Johan Hellgren
- Department of Otorhinolaryngology, University of Gothenburg, Gothenburg, Sweden
| | | | - Peter H Howarth
- Respiratory Medical Franchise, GSK, Brentford, Middlesex, UK
| | - Celeste Porsbjerg
- Department of Respiratory Medicine, Bispebjerg Hospital and Copenhagen University, Copenhagen, Denmark
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40
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Tikkakoski AP, Karjalainen J, Sipilä K, Kivistö JE, Kähönen M, Lehtimäki L, Tikkakoski A. Outdoor pollen concentration is not associated with exercise-induced bronchoconstriction in children. Pediatr Pulmonol 2022; 57:695-701. [PMID: 34894109 DOI: 10.1002/ppul.25782] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 11/07/2021] [Accepted: 12/01/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND Free running exercise test outdoors is an important method to diagnose asthma in children. However, the extent of how much exposure to pollens of outdoor air affects the results of the test is not known. METHODS We analyzed all reliable exercise challenge tests with impulse oscillometry in children (n = 799) between January 2012 and December 2014 in Tampere University Hospital. Pollen concentrations at the time of the test were collected from the register of Biodiversity Unit of the University of Turku. We compared the frequency of exercise-induced bronchoconstriction and pollen concentrations. RESULTS The analyses were restricted to birch and alder pollen as high counts of grass and mugwort pollen were so infrequent. The relative change in resistance at 5 Hz after exercise or the frequency of exercise-induced bronchoconstriction were not related to alder or birch pollen concentrations over 10 grains/m3 (p = 0.125-0.398). In logistic regression analysis comparing the effects of alder or birch pollen concentrations, immunoglobulin E (IgE)-mediated alder or birch allergy and absolute humidity over 10 g/m3 only absolute humidity was independently associated with change in airway resistance (odds ratio [OR]: 0.32, confidence interval [CI]: 0.13-0.67, p: 0.006). CONCLUSIONS In our large clinical sample, outdoor air pollen concentration was not associated with the probability of exercise-induced bronchoconstriction in free running test in children while low absolute humidity was the best predictor of airway obstruction.
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Affiliation(s)
- Anna P Tikkakoski
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Jussi Karjalainen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Allergy Centre, Tampere University Hospital, Tampere, Finland
| | - Kalle Sipilä
- Department of Clinical Physiology, Tampere University Hospital, Tampere, Finland
| | - Juho E Kivistö
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Allergy Centre, Tampere University Hospital, Tampere, Finland
| | - Mika Kähönen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Department of Clinical Physiology, Tampere University Hospital, Tampere, Finland
| | - Lauri Lehtimäki
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Allergy Centre, Tampere University Hospital, Tampere, Finland
| | - Antti Tikkakoski
- Department of Clinical Physiology, Tampere University Hospital, Tampere, Finland
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Tamminen P, Kerimov D, Viskari H, Aittoniemi J, Syrjänen J, Lehtimäki L. Lung function during and after acute respiratory infection in COVID-19 positive and negative outpatients. Eur Respir J 2022; 59:13993003.02837-2021. [PMID: 35058250 PMCID: PMC8785400 DOI: 10.1183/13993003.02837-2021] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 12/21/2021] [Indexed: 11/23/2022]
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been associated with prolonged post-acute symptoms in at least 10% of patients [1, 2]. The majority of published data evaluates hospitalised patients with severe SARS-CoV-2 disease (COVID-19) with symptoms and pulmonary function defects several months after discharge [1]. Most of the infected subjects develop mild symptoms and are treated as outpatients. Though they are also reported to suffer from prolonged symptoms, their lung function is studied far less. Furthermore, the prolonged symptoms and objectively measurable findings are usually not compared to a group suffering from airway infection caused by other pathogens [2]. As spirometry and other aerosol-producing procedures are minimised during the pandemic, there are no reports on lung function during acute COVID-19. At acute phase, outpatients with mild COVID-19 had more symptoms, higher small airway resistance and poorer lung elasticity compared to outpatients with other respiratory infections, but there was no difference between the groups after 2 monthshttps://bit.ly/3nalPye
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Andersén H, Ilmarinen P, Honkamäki J, Tuomisto LE, Hisinger-Mölkänen H, Backman H, Lundbäck B, Rönmark E, Haahtela T, Sovijärvi A, Lehtimäki L, Piirilä P, Kankaanranta H. NSAID-exacerbated respiratory disease (N-ERD): a population study. ERJ Open Res 2022; 8:00462-2021. [PMID: 35083326 PMCID: PMC8784895 DOI: 10.1183/23120541.00462-2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Accepted: 11/15/2021] [Indexed: 11/05/2022] Open
Abstract
Background Nonsteroidal anti-inflammatory drugs (NSAIDs) may exacerbate respiratory symptoms. A recent European Academy of Allergy and Clinical Immunology position paper recommended the use of an acronym, N-ERD (NSAID-exacerbated respiratory disease), for this hypersensitivity associated with asthma or chronic rhinosinusitis with or without nasal polyposis. Our aim was to estimate the prevalence of N-ERD and identify factors associated with N-ERD. Methods In 2016, a cross-sectional questionnaire survey of a random adult population of 16 000 subjects aged 20–69 years was performed in Helsinki and Western Finland. The response rate was 51.5%. Results The prevalence was 1.4% for N-ERD, and 0.7% for aspirin-exacerbated respiratory disease (AERD). The prevalence of N-ERD was 6.9% among subjects with asthma and 2.7% among subjects with rhinitis. The risk factors for N-ERD were older age, family history of asthma or allergic rhinitis, long-term smoking and exposure to environmental pollutants. Asthmatic subjects with N-ERD had a higher risk of respiratory symptoms, severe hypersensitivity reactions and hospitalisations than asthmatic subjects without N-ERD. The subphenotype of N-ERD with asthma was most symptomatic. Subjects with rhinitis associated with N-ERD, which would not be included in AERD, had the fewest symptoms. Conclusion We conclude that the prevalence of N-ERD was 1.4% in a representative Finnish adult population sample. Older age, family history of asthma or allergic rhinitis, cumulative exposure to tobacco smoke, secondhand smoke, and occupational exposures increased odds of N-ERD. N-ERD was associated with significant morbidity. Population-based prevalence of N-ERD is 1.4%. N-ERD is symptomatic, with a rhinitis subgroup. The risk factors for N-ERD are older age, family history of asthma or allergic rhinitis, long-term smoking and exposure to environmental pollutants.https://bit.ly/3HxGftP
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Tuomisto LE, Ilmarinen P, Lehtimäki L, Niemelä O, Tommola M, Kankaanranta H. Clinical value of bronchodilator response for diagnosing asthma in steroid-naïve adults. ERJ Open Res 2021; 7:00293-2021. [PMID: 34912880 PMCID: PMC8666574 DOI: 10.1183/23120541.00293-2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 09/24/2021] [Indexed: 11/05/2022] Open
Abstract
Spirometry and testing for bronchodilator response have been recommended to detect asthma, and a bronchodilator response (BDR) of ≥12% and ≥200 mL has been suggested to confirm asthma. However, the clinical value of bronchodilation tests in newly diagnosed steroid-naïve adult patients with asthma remains unknown. We evaluated the sensitivity of BDR in forced expiratory volume in 1 s (FEV1) as a diagnostic test for asthma in a real-life cohort of participants in the Seinäjoki Adult Asthma Study. In the diagnostic phase, 369 spirometry tests with bronchodilation were performed for 219 steroid-naïve patients. The fulfilment of each test threshold was assessed. According to the algorithm of the National Institute for Health and Care Excellence, we divided the patients into obstructive (FEV1/forced vital capacity (FVC) <0.70) and non-obstructive (FEV1/FVC ≥0.70) groups. Of the overall cohort, 35.6% fulfilled ΔFEV1 ≥12% and ≥200 mL for the initial FEV1, 18.3% fulfilled ΔFEV1 ≥15% and ≥400 mL for the initial FEV1, and 36.1% fulfilled ΔFEV1 ≥9% of predicted FEV1 at least once. One-third (31%) of these steroid-naïve patients was obstructive (pre-bronchodilator FEV1/FVC <0.7). Of the obstructive patients, 55.9%, 26.5% and 48.5%, respectively, met the same thresholds. In multivariate logistic regression analysis, different thresholds recognised different kinds of asthma patients. In steroid-naïve adult patients, the current BDR threshold (ΔFEV1 ≥12% and ≥200 mL) has low diagnostic sensitivity (36%) for asthma. In obstructive patients, sensitivity is somewhat higher (56%) but far from optimal. If the first spirometry test with bronchodilation is not diagnostic but asthma is suspected, spirometry should be repeated, and other lung function tests should be used to confirm the diagnosis.
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Affiliation(s)
- Leena E Tuomisto
- Dept of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland
| | - Pinja Ilmarinen
- Dept of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland.,Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Lauri Lehtimäki
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Allergy Centre, Tampere University Hospital, Tampere, Finland
| | - Onni Niemelä
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Dept of Laboratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland
| | - Minna Tommola
- Dept of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland.,Dept of Respiratory Medicine, Central Finland Central Hospital, Jyväskylä, Finland
| | - Hannu Kankaanranta
- Dept of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland.,Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Krefting Research Centre, Dept of Internal Medicine and Clinical Nutrition, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
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Abstract
Objectives: Patients with chronic respiratory insufficiency suffer
from advanced disease, but their overall symptom burden is poorly described. We
evaluated the symptoms and screening of depression in subjects with chronic
respiratory insufficiency by using the Edmonton symptom assessment system
(ESAS). Methods: In this retrospective study, 226 subjects with
chronic respiratory insufficiency answered the ESAS questionnaire measuring
symptoms on a scale from 0 (no symptoms) to 10 (worst possible symptom), and the
depression scale (DEPS) questionnaire, in which the cut-off point for depressive
symptoms is 9. Results: The most severe symptoms measured with ESAS
(median [interquartile range]) were shortness of breath 4.0 (1.0-7.0), dry mouth
3.0 (1.0-7.0), tiredness 3.0 (1.0-6.0), and pain on movement 3.0 (0.0-6.0).
Subjects with a chronic obstructive pulmonary disease as a cause for chronic
respiratory insufficiency had significantly higher scores for shortness of
breath, dry mouth, and loss of appetite compared to others. Subjects with DEPS
≥9 reported significantly higher symptom scores in all ESAS categories than
subjects with DEPS <9. The area under the receiver operating characteristic
curve for ESAS depression score predicting DEPS ≥9 was 0.840
(P < .001). If the ESAS depression score was 0, there was an
89% probability of the DEPS being <9, and if the ESAS depression score was
≥4, there was an 89% probability of the DEPS being ≥9. The relation between ESAS
depression score and DEPS was independent of subjects’ characteristics and other
ESAS items. Conclusions: Subjects with chronic respiratory
insufficiency suffer from a high symptom burden due to their advanced disease.
The severity of symptoms increases with depression and 4 or more points in the
depression question of ESAS should lead to a closer diagnostic evaluation of
depression. Symptom-centered palliative care including psychosocial aspects
should be early integrated into the treatment of respiratory insufficiency.
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Affiliation(s)
- Heidi A Rantala
- Department of Respiratory Medicine, Tampere University Hospital, Tampere, Finland.,Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Sirpa Leivo-Korpela
- Department of Respiratory Medicine, Tampere University Hospital, Tampere, Finland.,Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Lauri Lehtimäki
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Allergy Centre, Tampere University Hospital, Tampere, Finland
| | - Juho T Lehto
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Department of Oncology, Palliative Care Unit, Tampere University Hospital, Tampere, Finland
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45
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Kerimov D, Tamminen P, Viskari H, Lehtimäki L, Aittoniemi J. Sampling site for SARS-CoV-2 RT-PCR-An intrapatient four-site comparison from Tampere, Finland. PLoS One 2021; 16:e0260184. [PMID: 34784386 PMCID: PMC8594827 DOI: 10.1371/journal.pone.0260184] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 11/03/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND SARS-CoV-2 diagnosis relies on the performance of nasopharyngeal swabs. Alternative sample sites have been assessed but the heterogeneity of the studies have made comparing different sites difficult. OBJECTIVES Our aim was to compare the performance of four different sampling sites for SARS-CoV-2 samples with nasopharynx being the benchmark. STUDY DESIGN COVID-19 positive patients were recruited prospectively, and samples were collected and analysed for SARS-CoV-2 with RT-PCR from all four anatomical sites in 43 patients, who provided written informed consent. RESULTS All anterior nasal and saliva samples were positive, while two oropharyngeal samples were negative. There was no significant difference in the cycle threshold values of nasopharyngeal and anterior nasal samples while saliva and oropharynx had higher cycle threshold values. CONCLUSIONS Anterior nasal swab performs as good as nasopharynx swab with saliva also finding all the positives but with higher cycle threshold values. Thus, we can conclude that anterior nasal swabs can be used for SARS-CoV-2 detection instead of nasopharyngeal swabs if the situation would require so.
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Affiliation(s)
- Dominik Kerimov
- Department of Clinical Microbiology, Fimlab Laboratories, Tampere, Finland
| | - Pekka Tamminen
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
- Department of Otorhinolaryngology–Head and Neck Surgery, Tampere University Hospital, Tampere, Finland
| | - Hanna Viskari
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Lauri Lehtimäki
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Allergy Centre, Tampere University Hospital, Tampere, Finland
| | - Janne Aittoniemi
- Department of Clinical Microbiology, Fimlab Laboratories, Tampere, Finland
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46
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Andersén H, Ilmarinen P, Honkamäki J, Tuomisto LE, Hisinger-Mölkänen H, Backman H, Lundbäck B, Rönmark E, Lehtimäki L, Sovijärvi A, Piirilä P, Kankaanranta H. Influence of Childhood Exposure to a Farming Environment on Age at Asthma Diagnosis in a Population-Based Study. J Asthma Allergy 2021; 14:1081-1091. [PMID: 34522104 PMCID: PMC8434911 DOI: 10.2147/jaa.s323504] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Accepted: 08/21/2021] [Indexed: 11/26/2022] Open
Abstract
Purpose Asthma is a heterogeneous disease, and factors associated with different asthma phenotypes are poorly understood. Given the higher prevalence of farming exposure and late diagnosis of asthma in more rural Western Finland as compared with the capital of Helsinki, we investigated the relationship between childhood farming environment and age at asthma diagnosis. Methods A cross-sectional population-based study was carried out with subjects aged 20–69 years in Western Finland. The response rate was 52.5%. We included 3864 participants, 416 of whom had physician-diagnosed asthma at a known age and with data on the childhood environment. The main finding was confirmed in a similar sample from Helsinki. Participants were classified as follows with respect to asthma diagnosis: early diagnosis (0–11 years), intermediate diagnosis (12–39 years), and late diagnosis (40–69 years). Results The prevalence of asthma was similar both without and with childhood exposure to a farming environment (11.7% vs 11.3%). Allergic rhinitis, family history of asthma, ex-smoker, occupational exposure, and BMI ≥ 30 kg/m2 were associated with a higher likelihood of asthma. Childhood exposure to a farming environment did not increase the odds of having asthma (aOR, 1.10; 95% CI, 0.87–1.40). It did increase the odds of late diagnosis (aOR, 2.30; 95% CI, 1.12–4.69), but the odds were lower for early (aOR, 0.49; 95% CI, 0.30–0.80) and intermediate diagnosis of asthma (aOR, 0.75; 95% CI, 0.47–1.18). Conclusion Odds were lower for early diagnosis of asthma and higher for late diagnosis of asthma in a childhood farming environment. This suggests a new hypothesis concerning the etiology of asthma when it is diagnosed late. ![]()
Point your SmartPhone at the code above. If you have a QR code reader the video abstract will appear. Or use: https://youtu.be/BdY2eA86hV8
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Affiliation(s)
- Heidi Andersén
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Pinja Ilmarinen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Jasmin Honkamäki
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Leena E Tuomisto
- Department of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Etelä-Pohjanmaa, Finland
| | | | - Helena Backman
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Norrbotten, Sweden
| | - Bo Lundbäck
- Department of Internal Medicine, Krefting Research Center, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Västra Götaland, Sweden
| | - Eva Rönmark
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Norrbotten, Sweden
| | - Lauri Lehtimäki
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Anssi Sovijärvi
- Faculty of Medicine, University of Helsinki, Helsinki, Uusimaa, Finland
| | - Päivi Piirilä
- Faculty of Medicine, University of Helsinki, Helsinki, Uusimaa, Finland
| | - Hannu Kankaanranta
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
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47
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Honkamäki J, Ilmarinen P, Hisinger-Mölkänen H, Tuomisto LE, Andersen H, Huhtala H, Sovijärvi A, Lindqvist A, Backman H, Lundbäck B, Nwaru B, Rönmark E, Lehtimäki L, Pallasaho P, Piirilä P, Kankaanranta H. Non-respiratory diseases in adults with and without asthma by age at diagnosis. Epidemiology 2021. [DOI: 10.1183/13993003.congress-2021.oa4219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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48
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Andersén H, Ilmarinen P, Honkamäki J, Tuomisto LE, Hisinger-Mölkänen H, Backman H, Lundbäck B, Rönmark E, Lehtimäki L, Sovijärvi A, Piirilä P, Kankaanranta H. Late Breaking Abstract - Childhood farming environment: Association to age at asthma diagnosis in a population-based study. Epidemiology 2021. [DOI: 10.1183/13993003.congress-2021.oa1327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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49
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Mäki-Heikkilä R, Karjalainen J, Parkkari J, Huhtala H, Valtonen M, Lehtimäki L. Higher prevalence but later age at onset of asthma in cross-country skiers compared with general population. Scand J Med Sci Sports 2021; 31:2259-2266. [PMID: 34449953 DOI: 10.1111/sms.14040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 08/03/2021] [Accepted: 08/25/2021] [Indexed: 11/27/2022]
Abstract
Cross-country skiing causes strain in the airways because skiers train and compete in cold air. The aim of this survey was to investigate the prevalence and age at onset of asthma, asthma control, and use of asthma medication in Finnish competitive cross-country skiers. All cross-country skiers who were enrolled in the largest national competitions in winter 2019 (n = 1282) were invited to the study via the Finnish Ski Association. A control group (n = 1733) was matched for the responding skiers by age, gender, and region. The response rate was 27.4% (n = 351) for skiers and 19.5% (n = 338) for the controls. The prevalence of asthma was 25.9% in skiers and 9.2% in the controls (p < 0.001). Median (IQR) age at first asthma-related symptoms was higher in skiers than in the controls (13.0 (8.25-16.0) vs. 8.0 (2.25-11.75) years, p < 0.001), and the difference in asthma prevalence was evident only after the start of skiing career. Median (IQR) Asthma Control Test (ACT) score in skiers and controls with asthma was 22.0 (21-24) vs. 22.0 (19-24) (p = 0.611), and 89.0% of skiers and 77.4% of controls had well-controlled asthma (ACT score ≥20). In skiers with asthma, 82.4% used regular inhaled corticosteroids (ICS), and 80.2% used bronchodilators. A fixed combination of ICS +long-acting β2-agonist was regularly used by 47.3% of the skiers and 22.6% of the controls with asthma (p = 0.016). In conclusion, asthma prevalence is about 2.5 times higher, and age at onset of asthma is later in skiers compared with the controls. Asthma in cross-country skiers is mostly well controlled and on regular maintenance treatment.
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Affiliation(s)
| | - Jussi Karjalainen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Allergy Centre, Tampere University Hospital, Tampere, Finland
| | - Jari Parkkari
- Tampere Research Center of Sports Medicine, UKK Institute, Tampere, Finland.,Tampere University Hospital, Tampere, Finland
| | - Heini Huhtala
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Maarit Valtonen
- KIHU - Research Institute for Olympic Sports, Jyväskylä, Finland
| | - Lauri Lehtimäki
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Allergy Centre, Tampere University Hospital, Tampere, Finland
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50
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Nynäs P, Vilpas S, Kankare E, Karjalainen J, Lehtimäki L, Numminen J, Tikkakoski A, Kleemola L, Uitti J. Clinical Findings among Patients with Respiratory Symptoms Related to Moisture Damage Exposure at the Workplace-The SAMDAW Study. Healthcare (Basel) 2021; 9:1112. [PMID: 34574886 PMCID: PMC8466522 DOI: 10.3390/healthcare9091112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 08/22/2021] [Accepted: 08/24/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Respiratory tract symptoms are associated with workplace moisture damage (MD). The focus of this observational clinical study was patients with workplace MD-associated symptoms, to evaluate the usefulness of different clinical tests in diagnostics in secondary healthcare with a special interest in improving the differential diagnostics between asthma and laryngeal dysfunction. METHODS In patients referred because of workplace MD-associated respiratory tract symptoms, we sought to systematically assess a wide variety of clinical findings. RESULTS New-onset asthma was diagnosed in 30% of the study patients. Laryngeal dysfunction was found in 28% and organic laryngeal changes in 22% of the patients, and these were common among patients both with and without asthma. Most of the patients (85%) reported a runny or stuffy nose, and 11% of them had chronic rhinosinusitis. Atopy was equally as common as in the general population. CONCLUSIONS As laryngeal changes were rather common, we recommend proper differential diagnostics with lung function testing and investigations of the larynx and its functioning, when necessary, in cases of prolonged workplace MD-associated symptoms. Chronic rhinosinusitis among these patients was not uncommon. Based on this study, allergy testing should not play a major role in the examination of these patients.
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Affiliation(s)
- Pia Nynäs
- Faculty of Medicine and Health Technology, Tampere University, 33520 Tampere, Finland; (L.L.); (L.K.); (J.U.)
| | - Sarkku Vilpas
- Department of Phoniatrics, Tampere University Hospital, 33520 Tampere, Finland; (S.V.); (E.K.)
| | - Elina Kankare
- Department of Phoniatrics, Tampere University Hospital, 33520 Tampere, Finland; (S.V.); (E.K.)
| | - Jussi Karjalainen
- Allergy Centre, Tampere University Hospital, 33520 Tampere, Finland; (J.K.); (J.N.)
| | - Lauri Lehtimäki
- Faculty of Medicine and Health Technology, Tampere University, 33520 Tampere, Finland; (L.L.); (L.K.); (J.U.)
- Allergy Centre, Tampere University Hospital, 33520 Tampere, Finland; (J.K.); (J.N.)
| | - Jura Numminen
- Allergy Centre, Tampere University Hospital, 33520 Tampere, Finland; (J.K.); (J.N.)
| | - Antti Tikkakoski
- Department of Clinical Physiology and Nuclear Medicine, Tampere University Hospital, 33520 Tampere, Finland;
| | - Leenamaija Kleemola
- Faculty of Medicine and Health Technology, Tampere University, 33520 Tampere, Finland; (L.L.); (L.K.); (J.U.)
| | - Jukka Uitti
- Faculty of Medicine and Health Technology, Tampere University, 33520 Tampere, Finland; (L.L.); (L.K.); (J.U.)
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