VII Scandinavian Copd Research Symposium, Holmenkollen, Oslo 18th-19th November 2016

Peer reviewe

Sairaalahoito astmaatikon selviytymisen kuvaajana:rekisteritutkimus sairaalahoidossa olleiden astmaatikkojen ikä- ja sukupuolijakaumasta, uusien hoitojaksojen määrästä, hoitojaksojen vuodenaikavaihtelusta lapsilla, varusmiehillä ja aikuisilla sekä kuolleisuuden vuodenaikavaihtelusta

Abstract This thesis discusses the age and sex distribution of previously hospitalised asthmatics and the number of new asthma-induced treatment periods as a proportion of all asthma-related hospital admissions. Seasonal fluctuations in treatment periods were analysed with respect to age, and seasonal fluctuations in mortality among previously hospitalised asthmatics by combining the hospital discharge register with the mortality statistics on the basis of the patients social security numbers. A total of 364,871 asthma-induced treatment periods were reported to the hospital discharge register in 1972-1992, of which 192,195 occurred in 1.1.1983-31.12.1992, and 28.6% of these were new cases. Treatment periods relative to population amounted to 2.76/1000 in 1972 and 3.43/1000 in 1992. The number of treatment periods among children was greatest at the age of 1 year, 11.2/1000 for boys and 5.5/1000 for girls, and lowest at 17 years among the boys, and 13 years among the girls. The numbers rose slowly in early adulthood (with the exception of men aged 18-22 years), reaching a new peak at 73 years of age for men, 10.3/1000, and 75 years for women, 9.5/1000, and decreasing gradually thereafter. A half of the treatment periods recorded for patients aged under 1 year or for men aged 20 years represented new cases, whereas otherwise the vast majority of the treatment periods were being readmissions. The seasonal peaks among the total of 59,624 hospital periods involving persons aged under 15 years reported to the discharge register in 1972-1992 occurred in May and October, and the lowest figures in January and July. Conscripts aged 18-22 years experienced 4894 asthma-induced treatment periods in 1982-1992, representing incidence rates of 8.5/1000 in 1982 and 27.7/1000 in 1992. The figure was highest in the month in which the conscripts entered service and the month following that. A total of 81,243 asthma-induced treatment periods were recorded for persons aged over 24 years in 1987-1992, the figures being highest in January-May, 18.2% above the monthly trend in January, and lowest in July, 26.1% below the monthly trend. 7622 of the asthmatics first admitted in 1977-1992 died at an age of over 24 years in 1987-1993, mortality being highest in December and January and lowest in August. Obstructive pulmonary diseases were the primary cause of death for 1283 persons, including 489 who died of asthma itself. Apart from children and men aged 18-22 years, asthma gives rise to a large number of treatment periods among the middle-aged and the elderly. Measures should be taken to diagnose it at an early stage in these groups and to intensify the treatment provided. In addition, the factors provoking asthma during military service should be minimised and preventive measures enhanced in the case of children in May and September. As far as adults are concerned, asthma-related hospitalisation may involve a greater fatality risk in winter, so that aggravations occurring in winter should be treated with particular care

Aikuisen astman ilmiasujen kirjo on laaja:ilmiasu ohjaa hoidon valintaa

Tiivistelmä Aikuisen astman ilmiasua määrittelee astman alkamisikä. Aikuisen astma voi olla allerginen, lapsuudessa alkaneen astman kaltainen sekä elinympäristön, altisteiden, lääkehoidon, ikääntymisen ja liitännäissairauksien vuosien kuluessa muokkaama. Aikuisena alkaneen astman eri ilmiasuja on viime aikoina tunnistettu, ja niihin vaikuttavat tavanomaisten astmamekanismien lisäksi merkittävästi lihavuus, tupakointi ja monisairastavuus. Aikuisena alkavan astman ilmiasujen kirjo on laaja. Tulehdustyyppi vaihtelee, ja ilmiasu vaikuttaa hoidon valintaan. Eri ilmiasujen ennuste ja hoitovaste vaihtelevat. Ikääntyneen astma voi olla varhain ilmaantunut ja koko eliniän jatkunut allerginen astma. Iäkkään uusi astma taas on usein ei-atooppinen, ja remissio on harvinainen. Useat samanaikaiset sairaudet, merkittävä astmaan liittyvä sairastavuus, monilääkitys sekä lääkkeiden yhteis- ja haittavaikutukset tekevät iäkkäiden astman hoidosta vaativaa.Abstract The phenotype of asthma in adults is determined by the age of onset of asthma. Adult-onset asthma can be allergic, reminiscent of childhood asthma, or shaped over the years by the living environment, exposure, drug treatments, aging, and comorbidities. Various phenotypes of adult-onset asthma have recently been identified and are significantly influenced by obesity, smoking and multimorbidity in addition to the usual mechanisms of asthma. The spectrum of phenotypes of adult-onset asthma is wide. The type of inflammation varies and phenotype influences the choice of therapy. The prognosis and treatment response of different phenotypes vary. Asthma in the elderly can be an early-onset allergic asthma having persisted throughout life. New-onset asthma, on the other hand, is often non-atopic and remission is rare. Multiple concurrent diseases, significant asthma-related morbidity, multiple medications, and drug interactions and adverse effects make the treatment of asthma in the elderly challenging

COPD comorbidities predict high mortality:asthma-COPD-overlap has better prognosis

Abstract The purpose of this study was to investigate the characteristics and survival of patients with COPD and asthma-COPD overlap (ACO) and how these patient groups differ from each other. We examined the impact of different comorbidities, multimorbidity, lung function and other factors have on survival in COPD and ACO patients. We also examined the causes of death to determine how many patients die of other than respiratory diseases. This retrospective study includes 214 patients with an exacerbation of COPD requiring hospitalisation during the year of 2005. The patients were followed up until the end of year 2015. The survival of ACO patients was significantly higher than COPD patients (4.7 vs. 1.7 years, p = 0.001). Poor lung function predicted worse survival in both patient groups, but the prognosis was still better in ACO patients with both FEV1 over and under 50% of predicted (median survival 8.4 years vs. 5.8 years, p < 0.001) compared to COPD (4.9 and 3.1 years, respectively). In this study setting, the negative effect of having three or more comorbidities on survival was significant in both groups. We didn’t see major differences in the profiles of comorbidity patterns, in the underlying cause of deaths or in the pulmonary functions between ACO and COPD groups at the beginning of follow-up. Patients with a BMI over 25 seemed to have a trend for better survival (p = 0.055), but no differences were found between ACO and COPD groups

Sähkösavukkeiden terveyshaitat

Tiivistelmä Sähkösavukkeet sisältävät haitallisia yhdisteitä, joiden pitkäaikaisvaikutuksista ei ole tarpeeksi tietoa. Myös passiivinen altistus kemikaaleille voi olla riski. Niiden käyttöä tupakasta vieroitukseen ei ole tutkittu riittävästi. Nykytiedon mukaan niistä ei ole merkittävää apua. Sähkösavuke on etenkin nuorille reitti nikotiinituotteiden käyttöön. Eläin- ja solutason tutkimukset osoittavat, että sähkösavukkeilla on monia negatiivisia vaikutuksia, vaikkakaan ne eivät näyttäisi olevan yhtä moninaisia kuin tavallisella tupakalla.English summary Adverse health effects of electronic cigarettes Electronic cigarettes (ECIGs) are devices that generate aerosols from liquids by vaporizing. They are used to inhale nicotine and other products and they contain potentially toxic chemicals. However, compared to conventional cigarettes, toxic chemicals are fewer and in lower concentrations. Second-hand exposure to ECIG chemicals can represent a potential risk, but the data are still scarce. Moreover, scientific evidence to support ECIGs as an aid to smoking cessation is still low, due to lack of controlled trials, especially those comparing ECIGs with other stop-smoking treatments such as nicotine replacement therapy. On the contrary, the use of ECIGs may promote excessive nicotine use, especially in adolescents. Animal studies and cell culture experiments have shown that ECIGs can have multiple negative effects. Further, the long-term effects of ECIGs are still unknown, thus there is no evidence that ECIGs are safer than tobacco in the long term, and therefore, negative health effects cannot be ruled out

Maternal smoking trajectory during pregnancy predicts offspring’s smoking and substance use:the Northern Finland birth cohort 1966 study

Abstract The aim was to characterize the association of maternal smoking trajectory during pregnancy with offspring’s smoking, alcohol and substance use behavior. We used the prospective Northern Finland Birth Cohort 1966 study including 11,653 mothers and their offspring followed up from mothers’ mid-pregnancy to age of 46 years. Main exposure was number of smoked cigarettes per day at each month of pregnancy. Outcome measures were offspring’s smoking, alcohol and drug use at age 14, starting age of smoking, ever-smoking, and smoked pack-years until age 46. Four maternal smoking trajectories during pregnancy were identified with latent class trajectory modelling, namely “non-smokers” (86.0% of mothers), “early quitters” (2.0%), “late quitters” (2.1%), and “consistent smokers” (9.9%). In comparison to non-smokers, all maternal smoking was associated with offspring’s increased odds of lifetime smoking adjusted for sex of the child, father’s smoking, occupational status and place of residence of family, marital status and mood of mother, and desirability of pregnancy. The consistent smoker’s class was associated with offspring’s number of smoked pack years by midlife (median [interquartile range]: 8.3 [1.4–17.4] vs. 4.8 [0.0–13.0], p = 0.028), and alcohol use in young age (odds ratio 1.23 [95% confidence interval 1.05–1.43]). Overall, to prevent parent-offspring transmission of smoking, the cessation support should target women planning pregnancy. Negative effects of maternal continuous smoking during pregnancy include all substance use and reach up to offspring’s middle age

Lifelong smoking trajectories of Northern Finns are characterized by sociodemographic and lifestyle differences in a 46-year follow-up

Abstract Smoking remains among the leading causes of mortality worldwide. Obtaining a comprehensive understanding of a population’s smoking behaviour is essential for tobacco control. Here, we aim to characterize lifelong smoking patterns and explore underlying sociodemographic and lifestyle factors in a population-based birth cohort population followed up for 46 years. Our analysis is based on 5797 individuals from the Northern Finland Birth Cohort 1966 who self-reported their tobacco smoking behaviour at the ages of 14, 31 and 46. Data on sex, education, employment, body mass index, physical activity, alcohol consumption, and substance addiction were also collected at the follow-ups. We profile each individual’s annual smoking history from the age of 5 to 47, and conduct a latent class trajectory analysis on the data. We then characterize the identified smoking trajectory classes in terms of the background variables, and compare the heaviest smokers with other classes in order to reveal specific predictors of non-smoking and discontinued smoking. Six smoking trajectories are identified in our sample: never-smokers (class size 41.0%), youth smokers (12.6%), young adult quitters (10.8%), late adult quitters (10.5%), late starters (4.3%), and lifetime smokers (20.7%). Smoking is generally associated with male sex, lower socioeconomic status and unhealthier lifestyle. Multivariable between-class comparisons identify unemployment (odds ratio [OR] 1.28–1.45) and physical inactivity (OR 1.20–1.52) as significant predictors of lifetime smoking relative to any other class. Female sex increases the odds of never-smoking and youth smoking (OR 1.29–1.33), and male sex increases the odds of adult quitting (OR 1.30–1.41), relative to lifetime smoking. We expect future initiatives to benefit from our data by exploiting the identified predictors as direct targets of intervention, or as a means of identifying individuals who may benefit from such interventions

Smoking effect on the ultrastructural properties of cultured lung myofibroblasts

Abstract This study aimed at an ultrastructural characterization of myofibroblasts cultured from different compartments of lung from never-smokers and smokers with or without COPD. In addition, we evaluated the expression of alpha smooth muscle actin (α-SMA), a marker for myofibroblasts, and contractile properties. Stromal cells cultured from central and corresponding peripheral or only from peripheral lung of never-smokers, smokers without COPD and COPD patients were analyzed by transmission electron microscopy (TEM), immunoelectron microscopy (IEM), Western analysis and/or by collagen gel contraction assay. TEM revealed that myofibroblasts cultured from smokers and COPD had less prominent intracellular actin filaments. We also examined fibronexus (FNX), which is a typical ultrastructural feature of myofibroblasts, and observed that patients with COPD more frequently had tandem-like FNX as compared to other samples. Western analysis showed that the samples derived from the central lung of never-smokers expressed higher levels of α-SMA than those of smokers and COPD patients. Cells from central lung were less contractile than those from peripheral lung. We conclude that myofibroblasts have variable ultrastructural and functional properties based on their localization in the lung and, moreover, these properties are affected by both smoking history and COPD