Long-term CPAP treatment improves asthma control in patients with asthma and obstructive sleep apnoea

Both asthma and obstructive sleep apnoea cause sleep disturbance, daytime sleepiness and diminished quality of life. Continuous positive airway pressure (CPAP) is efficient in reducing symptoms related to sleep apnoea. Here we report the impact of long-term use of CPAP on asthma symptoms. A survey questionnaire was distributed to all of our obstructive sleep apnoea patients with CPAP therapy in 2013. We used the Finnish version of the Asthma Control Test (TM) (ACT) and a visual analogue scale (0 = no symptoms, 100 = severe asthma symptoms). Asthma was defined as self-reported physician-diagnosed disease and a special reimbursement for asthma medication by the Social Insurance Institution. We sent 2577 questionnaires and received 1586 answers (61 %). One hundred ninety-seven patients were asthmatics with a prevalence of asthma among CPAP users of 13 %. We studied 152 patients (58 females) whose CPAP therapy was initiated after starting asthma medication. Their mean (SD) age was 62 (10) years, duration of CPAP 5.7 (4.7) years and their CPAP daily use was 6.3 (2.4) h. Self-reported asthma severity decreased significantly from 48.3 (29.6) to 33.1 (27.4) (p <0.001), and ACT score increased significantly from 15.35 (5.3) to 19.8 (4.6) (p <0.001) without a significant change in the body mass index (BMI). The percentage of patients using rescue medication daily reduced from 36 to 8 % with CPAP (P <0.001). We noticed a significant decrease in asthma symptoms with long-term use of CPAP in patients with both asthma and obstructive sleep apnoea.Peer reviewe

The effect of CPAP treatment for obstructive sleep apnea on asthma control-study limitations-author's response

Non peer reviewe

Rakennuksen kosteusvaurioista oireileva potilas perusterveydenhuollossa

Rakennusten kosteusvauriot lisäävät hengitystieoireiden ja astman kehittymisen riskiä. Lääkärin ensisijainen tehtävä on keskittyä oireiden ja sairauksien diagnostiikkaan ja hoitoon hoitosuositusten mukaisesti riippumatta siitä, aiheutuvatko ne mahdollisesta kosteusvauriosta vai eivät. Laboratoriotutkimuksista ei ole merkittävää apua selvitettäessä kosteusvaurion yhteyttä potilaan oireisiin. Kosteusvauriot tulisi korjata ja uusien synty ehkäistä, koska se on hyväksi rakennuksen käyttäjien terveydelle sekä rakennuksen kunnolle. Muita sisäilmaongelmien aiheuttajia ovat muun muassa puutteellinen ilmanvaihto, kuiva sisäilma, korkea sisälämpötila, hajut, pöly ja muut ilman epäpuhtaudet sekä allergeenit ja tupakansavu

Digiaika astman hoidossa : Paranevatko hoitotulokset vai hoitoprosessit?

Teema : aikuisten astm

Biologiset lääkehoidot astmassa

English summaryPeer reviewe

In bronchiectasis, poor physical capacity correlates with poor quality of life

Purpose Patients with bronchiectasis (BE) who suffer frequent exacerbations are likely to experience negative effects on quality of life (QoL) and require more healthcare utilization. We aimed to discover, in a cohort of Finnish BE patients, those risk factors that influence QoL. Methods Non-cystic fibrosis BE patients of a Helsinki University Hospital cohort were examined with high-resolution computed tomography (HRCT) of the chest. They completed a disease-specific quality of life-bronchiectasis (QoL-B) questionnaire in Finnish translation. We considered scores in the lowest quarter (25%) of that QoL-B scale to indicate poor QoL. The bronchiectasis severity index (BSI), FACED score, and modified Medical Research Council (mMRC) dyspnoea scale were used. Results Overall, of 95 adult BE patients, mean age was 69 (SD +/- 13) and 79% were women. From the cohort, 82% presented with chronic sputum production and exacerbations, at a median rate of 1.7 (SD +/- 1.6). The number of exacerbations (OR 1.7), frequent exacerbations (>= 3 per year) (OR 4.9), high BSI score (OR 1.3), and extensive disease (>= 3 lobes) (OR 3.7) were all predictive of poor QoL. Frequent exacerbations were associated with bronchial bacterial colonisation, low forced expiratory volume in 1 s (FEV1), and radiological disease severity. Based on the BSI, 34.1% of our cohort had severe disease, with 11.6% classified as severe according to their FACED score. The mMRC dyspnoea score (r = -0.57) and BSI (r = -0.60) correlated, in the QoL-B questionnaire, negatively with physical domain. Conclusion The strongest determinants of poor QoL in the cohort of Finnish BE patients were frequent exacerbations, radiological disease severity, and high BSI score. Neither comorbidities nor BE aetiology appeared to affect QoL. Reduced physical capacity correlated with dyspnoea and severe disease. Study registration University of Helsinki, Faculty of Medicine, 148/16.08.2017.Peer reviewe

Occupational health check-ups and health-promoting programs and asthma

BackgroundThe focus in occupational health check-ups is in work and health, but they offer also a possibility to assess health behavior and give guidance e.g. on weight control. We wanted to study whether having occupational health checks-up, receiving physicians' advice to change health behavior or participation in health promotion programs had an effect on obesity in a five-year follow-up from 1998 to 2003 in asthmatic and non-asthmatic workers.MethodsAltogether 23,220 individuals aged 20-54years were picked up from a randomized Finnish population sample. Univariate and multivariate logistic regression analysis was used to calculate the risk for obesity in 2003. The variables used in the modelling were gender, age, smoking, asthma, depression, and physical workload.ResultsBoth asthmatic and non-asthmatic workers gained weight during the follow-up. Of the asthmatics 48 and 47% of the non-asthmatics had occupational health-check-up in the last 5years. Of the asthmatics 18 and 14% of the non-asthmatics had received physician's advice to change their health behavior (p30) in 2003 were gender (men OR 1.19), older age (OR 1.25), smoking (OR 1.07) or depression (OR 1.44).ConclusionsResults show that having occupational health checks-up or receiving physicians' advice to change health behavior or participation in health promotion programs did not stop gain of weight during a five-year follow-up. Asthmatic workers did not differ from non-asthmatics. Male gender, older age, smoking, and depression were associated with obesity but not the physical workload.Peer reviewe