Low socioeconomic status relates to asthma and wheeze, especially in women

Low socioeconomic status (SES) has been associated with asthma and wheezing. Occupational group, educational level and income are commonly used indicators for SES, but no single indicator can illustrate the entire complexity of SES. The aim was to investigate how different indicators of SES associate with current asthma, allergic and nonallergic, and asthmatic wheeze. In 2016, a random sample of the population aged 20–79 years in Northern Sweden were invited to a postal questionnaire survey, with 58% participating (n=6854). The survey data were linked to the national Integrated Database for Labour Market Research by Statistics Sweden for the previous calendar year, 2015. Included SES indicators were occupation, educational level and income. Manual workers had increased risk for asthmatic wheeze, and manual workers in service for current asthma, especially allergic asthma. Primary school education associated with nonallergic asthma, whereas it tended to be inversely associated with allergic asthma. Low income was associated with asthmatic wheeze. Overall, the findings were more prominent among women, and interaction analyses between sex and income revealed that women, but not men, with low income had an increased risk both for asthmatic wheeze and current asthma, especially allergic asthma. To summarise, the different indicators of socioeconomic status illustrated various aspects of associations between low SES and asthma and wheeze, and the most prominent associations were found among women.Peer reviewe

High but stable incidence of adult-onset asthma in northern Sweden over the last decades

Background The prevalence of asthma has increased both among children and adults during the latter half of the 20th century. The prevalence among adults is affected by the incidence of asthma not only in childhood but also in adulthood. Time trends in asthma incidence have been poorly studied. Aims The aim of this study was to review the incidence of adult-onset asthma from 1996 to 2006 and 2006 to 2016 and compare the risk factor patterns. Methods In the Obstructive Lung Disease in Northern Sweden (OLIN) studies, two randomly selected population-based samples in the 20-69-year age group participated in postal questionnaire surveys about asthma in 1996 (n=7104, 85%) and 2006 (n=6165, 77%). A 10-year follow-up of the two cohorts with the same validated questionnaire was performed, and 5709 and 4552 responded, respectively. Different definitions of population at risk were used in the calculations of asthma incidence. The protocol followed a study performed between 1986 and 1996 in the same area. Results The crude incidence rate of physician-diagnosed asthma was 4.4 per 1000 person-years (men 3.8, women 5.5) from 1996 to 2006, and 4.8 per 1000 person-years (men 3.7, women 6.2) from 2006 to 2016. When correcting for possible under-diagnosis at study entry, the incidence rate was 2.4 per 1000 personyears from 1996 to 2006 and 2.6 per 1000 person-years from 2006 to 2016. The incidence rates were similar across age groups. Allergic rhino-conjunctivitis was the main risk factor for incident asthma in both observation periods (risk ratio 2.4-2.6). Conclusions The incidence of adult-onset asthma has been stable over the last two decades and has remained at a similar level since the 1980s. The high incidence contributes to the increase in asthma prevalence.Peer reviewe

Level of education and asthma control in adult-onset asthma

Objective Education in itself and as a proxy for socioeconomic status, may influence asthma control, but remains poorly studied in adult-onset asthma. Our aim was to study the association between the level of education and asthma control in adult-onset asthma. Methods Subjects with current asthma with onset >15 years were examined within the Obstructive Lung Disease in Northern Sweden study (OLIN, n = 593), Seinajoki Adult Asthma Study (SAAS, n = 200), and West Sweden Asthma Study (WSAS, n = 301) in 2009-2014 in a cross-sectional setting. Educational level was classified as primary, secondary and tertiary. Uncontrolled asthma was defined as Asthma Control Test (ACT) score Results In each cohort and in pooled data of all cohorts, median ACT score was lower among those with primary education than in those with secondary and tertiary education. Uncontrolled asthma was most common among those with primary education, especially among daily ICS users (42.6% primary, 28.6% secondary and 24.2% tertiary; p = 0.001). In adjusted analysis, primary education was associated with uncontrolled asthma in daily ICS users (OR 1.92, 95% CI 1.15-3.20). When stratified by atopy, the association between primary education and uncontrolled asthma was seen in non-atopic (OR 3.42, 95% CI 1.30-8.96) but not in atopic subjects. Conclusions In high-income Nordic countries, lower educational level was a risk factor for uncontrolled asthma in subjects with adult-onset asthma. Educational level should be considered in the management of adult-onset asthma.Peer reviewe

Restrictive spirometric pattern in the general adult population : Methods of defining the condition and consequences on prevalence

Background: Attempts have been made to use dynamic spirometry to define restrictive lung function, but the definition of a restrictive spirometric pattern (RSP) varies between studies such as BOLD and NHANES. The aim of this study was to estimate the prevalence and risk factors of RSP among adults in northern Sweden based on different definitions. Methods: In 2008-2009 a general population sample aged 21-86y within the obstructive lung disease in northern Sweden (OLIN) studies was examined by structured interview and spirometry, and 726 subjects participated (71% of invited). The prevalence of RSP was calculated according to three different definitions based on pre-as well as post-bronchodilator spirometry: 1) FVC 0.7 2) FVC LLN 3) FVC LLN Results: The three definitions yielded RSP prevalence estimates of 10.5%, 11.2% and 9.4% respectively, when based on pre-bronchodilator values. The prevalence was lower when based on post-bronchodilator values, i.e. 7.3%, 7.9% and 6.6%. According to definition 1 and 2, the RSP prevalence increased by age, but not according to definition 3. The overlap between the definitions was substantial. When corrected for confounding factors, manual work in industry and diabetes with obesity were independently associated with an increased risk for RSP regardless of definition. Conclusions: The prevalence of RSP was 7-11%. The prevalence estimates differed more depending on the choice of pre-compared to post-bronchodilator values than on the choice of RSP definition. RSP was, regardless of definition, independently associated with manual work in industry and diabetes with obesity. (C) 2016 The Authors. Published by Elsevier Ltd.Peer reviewe

Living with chronic obstructive pulmonary disease with focus on fatigue, health and well-being

The overall aim of this thesis was to describe and evaluate experiences of living with chronic obstructive pulmonary disease (COPD), with focus on fatigue, health and well-being. A mixed method study design was used to reach the overall aim. All studies were based on data from the Obstructive Lung Disease in Northern Sweden (OLIN) COPD study. Papers I (n=1350) and III (n=1089) included participants (aged 35-88 years) with and without a spirometric classification of COPD. Bivariate, multiple logistic regression (I, III), and correlation (III) analyses were performed. Papers II (n=20) and IV (n=10) included participants (aged 59-77 years) with moderate to very severe COPD. Semi-structured interviews were conducted, and data were analysed through qualitative content analysis. The result showed that fatigue was worse among people with COPD compared to people without COPD. Fatigue increased with disease severity, and was already worse in COPD grade I among people with respiratory symptoms compared with the non-COPD group. COPD grade II with respiratory symptoms (OR 1.65) and grade III-IV with respiratory symptoms (OR 2.66) were significant risk factors for clinically significant fatigue when adjusted for sex, age, heart disease, and smoking habits (Paper I). Fatigue was described to mainly be COPD related; it was accepted as a natural consequence of COPD, but it was unexpressed. Fatigue affected and controlled the daily life of these people, and with dyspnea, fatigue was described to be overwhelming. Planning physical activity was the most important strategy to manage fatigue (Paper II). Fatigue had a great impact on both physical and mental dimensions of the health status, irrespective of having COPD or not. Among people with clinically significant fatigue, those with COPD had significantly lower physical health scores. Fairly strong correlations existed between FACIT-Fatigue and physical as well as mental health dimensions in SF-36. Increased fatigue and decreased physical and mental dimensions of health, each predicted mortality, but only among people with COPD (Paper III). Identified aspects for increased well-being for people living with COPD were adjusting to lifelong limitations, handling variations in illness, relying on self-capacity and accessibility to a trustful care. People had to adapt to limitations and live forward by finding a balance between breathing and viability (Paper IV). In conclusion, increased fatigue can be experienced in COPD already at grade I when respiratory symptoms are present, and COPD grade ≥II is a risk factor for clinically significant fatigue. Fatigue is common but seems to be unspoken, and an increased awareness of the symptom is necessary for an early identification. It is therefore important for health care professionals to take fatigue into consideration, to objectively assess and ask patients about it. This is important, since fatigue clearly worsens the health status among people living with COPD, and furthermore is associated with mortality in COPD. To enhance health and well-being, an increased viability may facilitate self-capacity and increase the strength for illness and fatigue management among people living with COPDGodkänd; 2013; 20131105 (andbra); Tillkännagivande disputation 2013-11-15 Nedanstående person kommer att disputera för avläggande av filosofie doktorsexamen. Namn: Caroline Stridsman Ämne: Omvårdnad Avhandling: Living with Chronic Obstructive Pulmonary Disease With Focus on Fatigue, Health and Well-Being Opponent: Professor Britt-Marie Ternestedt, Ersta diakoni &amp; Ersta Sköndal Högskola, Stockholm Ordförande: Professor Siv Söderberg, Luleå tekniska universitet Tid: Fredag den 6 december 2013, kl. 10.00 Plats: Aulan Sunderby sjukhus, med sändning till A211 vid Luleå tekniska universitet</p

Att leva med fatigue vid kronisk obstruktiv lungsjukdom

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Asthma in adolescence affects daily life and school attendance : two cross-sectional population-based studies 10 years apart

AIM: The aim of this study was to study the impact of asthma on daily life, school absenteeism and physical education. In addition, to describe asthma triggers at school. DESIGN: Two cross-sectional population-based studies ten years apart. METHOD: Within the OLIN-studies, in 2003 (n = 3,327) and in 2013 (n = 2,345) adolescents (14-15 years) answered an expanded ISAAC questionnaire. Of these, 8% and 11%, respectively with current asthma participated in this study. RESULTS: Between the years 2003-2013, the proportion of adolescents reporting that asthma interfered with daily life had increased, in 2013, girls were significantly more affected than boys. The proportion reporting a worsening of asthma at school had decreased, but it was still over a quarter. The proportion of absenteeism from school and from physical education was at the same level both years. Asthma triggers were described to be poor air quality, poorly cleaned environment, allergens, strong fragrance, rebuilding projects, physical education and stress

Asthma in adolescence affects daily life and school attendance : two cross-sectional population-based studies 10 years apart

AIM: The aim of this study was to study the impact of asthma on daily life, school absenteeism and physical education. In addition, to describe asthma triggers at school. DESIGN: Two cross-sectional population-based studies ten years apart. METHOD: Within the OLIN-studies, in 2003 (n = 3,327) and in 2013 (n = 2,345) adolescents (14-15 years) answered an expanded ISAAC questionnaire. Of these, 8% and 11%, respectively with current asthma participated in this study. RESULTS: Between the years 2003-2013, the proportion of adolescents reporting that asthma interfered with daily life had increased, in 2013, girls were significantly more affected than boys. The proportion reporting a worsening of asthma at school had decreased, but it was still over a quarter. The proportion of absenteeism from school and from physical education was at the same level both years. Asthma triggers were described to be poor air quality, poorly cleaned environment, allergens, strong fragrance, rebuilding projects, physical education and stress