A Scandinavian audit of hospitalizations for chronic obstructive pulmonary disease

SummaryIn Scandinavia no large audits of hospitalizations for chronic obstructive pulmonary disease (COPD) have been performed, and data on adherence to national guidelines are scarce. The aims of the present study were to audit hospitalizations for COPD exacerbations in three Scandinavian hospitals with respect to incidence, patient population and standards of hospital care.Retrospectively all hospitalizations in the Departments of Internal and Respiratory Medicine in Östersund Hospital (Sweden), Aalesund Hospital (Norway) and Trondheim University Hospital (Norway) from Jan 1 to Dec 31, 2005, with discharge ICD-10 diagnoses J43–J44, J96 + J44 or J13-18 + j44 were registered. A total of 1144 admissions (731 patients) were identified from patient administrative systems and medical charts.Among the admitted patients 27% were >80 years old, >50% had COPD stage III or IV, and 14% had respiratory acidosis at admittance. Patients with 3 or more admissions (13%) during 2005 accounted for 36% of all hospitalizations. One third of the patients were current smokers. Non-invasive ventilation was used in 14% of the admissions, with large variation between centres. In-hospital mortality was 3.7%.In this first large Scandinavian audit of COPD-hospitalizations, all centres had low in-hospital mortality. We consider this as an indication of good clinical practice in the three studied centres and possibly due to the frequent use of non-invasive ventilation

Effects of controlled diesel exhaust exposure on apoptosis and proliferation markers in bronchial epithelium – an in vivo bronchoscopy study on asthmatics, rhinitics and healthy subjects

BackgroundEpidemiological evidence demonstrates that exposure to traffic-derived pollution worsens respiratory symptoms in asthmatics, but controlled human exposure studies have failed to provide a mechanism for this effect. Here we investigated whether diesel exhaust (DE) would induce apoptosis or proliferation in the bronchial epithelium in vivo and thus contribute to respiratory symptoms.MethodsModerate (n?=?16) and mild (n?=?16) asthmatics, atopic non-asthmatic controls (rhinitics) (n?=?13) and healthy controls (n?=?21) were exposed to filtered air or DE (100 ?g/m 3 ) for 2 h, on two separate occasions. Bronchial biopsies were taken 18 h post-exposure and immunohistochemically analysed for pro-apoptotic and anti-apoptotic proteins (Bad, Bak, p85 PARP, Fas, Bcl-2) and a marker of proliferation (Ki67). Positive staining was assessed within the epithelium using computerized image analysis.ResultsNo evidence of epithelial apoptosis or proliferation was observed in healthy, allergic or asthmatic airways following DE challenge.ConclusionIn the present study, we investigated whether DE exposure would affect markers of proliferation and apoptosis in the bronchial epithelium of asthmatics, rhinitics and healthy controls, providing a mechanistic basis for the reported increased airway sensitivity in asthmatics to air pollutants. In this first in vivo exposure investigation, we found no evidence of diesel exhaust-induced effects on these processes in the subject groups investigated

Severe Asthma Standard-of-Care Background Medication Reduction With Benralizumab: ANDHI in Practice Substudy

Background: The phase IIIb, randomized, parallel-group, placebo-controlled ANDHI double-blind (DB) study extended understanding of the efficacy of benralizumab for patients with severe eosinophilic asthma. Patients from ANDHI DB could join the 56-week ANDHI in Practice (IP) single-arm, open-label extension substudy. Objective: Assess potential for standard-of-care background medication reductions while maintaining asthma control with benralizumab. Methods: Following ANDHI DB completion, eligible adults were enrolled in ANDHI IP. After an 8-week run-in with benralizumab, there were 5 visits to potentially reduce background asthma medications for patients achieving and maintaining protocol-defined asthma control with benralizumab. Main outcome measures for non-oral corticosteroid (OCS)-dependent patients were the proportions with at least 1 background medication reduction (ie, lower inhaled corticosteroid dose, background medication discontinuation) and the number of adapted Global Initiative for Asthma (GINA) step reductions at end of treatment (EOT). Main outcomes for OCS-dependent patients were reductions in daily OCS dosage and proportion achieving OCS dosage of 5 mg or lower at EOT. Results: For non-OCS-dependent patients, 53.3% (n = 208 of 390) achieved at least 1 background medication reduction, increasing to 72.6% (n = 130 of 179) for patients who maintained protocol-defined asthma control at EOT. A total of 41.9% (n = 163 of 389) achieved at least 1 adapted GINA step reduction, increasing to 61.8% (n = 110 of 178) for patients with protocol-defined EOT asthma control. At ANDHI IP baseline, OCS dosages were 5 mg or lower for 40.4% (n = 40 of 99) of OCS-dependent patients. Of OCS-dependent patients, 50.5% (n = 50 of 99) eliminated OCS and 74.7% (n = 74 of 99) achieved dosages of 5 mg or lower at EOT. Conclusions: These findings demonstrate benralizumab's ability to improve asthma control, thereby allowing background medication reduction

Förekomst av luftrörssymtom och astma hos svenska tävlingsmotionärer

Asthma prevalence is high among elite endurance athletes, but little is known about its prevalence among competitive recreational athletes. The aim of this study was to determine the prevalence of self-reported asthma and asthma medication use among competitive recreational endurance athletes, and their association with training. A web survey on asthma and medication was conducted among 38,603 adult participants of three Swedish endurance competitions (cross-country running, cross-country skiing, and swimming). Purpose: The aim of this cross-sectional study was to determine the prevalence among competitive recreational endurance athletes of self-reported physician-diagnosed asthma and asthma medication use and their association with training.Studiens syfte var att kartlägga förekomst av och riskfaktorer för luftrörsymtom och astma hos tävlingsmotionärer inom kondi- tionsidrott. Samtliga svenska medborgare över 17 års ålder anmälda till Lidingöloppet, Vasaloppet och Vansbrosimningen inviterades. De anmälda deltagarna erhöll en webenkät innan tävling. Enkäten baserades på ECHRSII-enkäten med frågor kring luftrörsbesvär, allergi, astma, som kompletterades med frågor kring träning. Vår huvudsakliga frågeställning var att beräkna förekomsten av själv-rapporterad läkar-diagnosticerad astma i studiepopulationen, indelat på kön, tävling, deltagarens huvudsakliga idrottsgren och trän- ingsmängd. Syfte: Kartlägga förekomsten av luftrörsbesvär och astma bland tävlingsmotionäre

Asthma Control and Asthma Medication Use among Swedish Elite Endurance Athletes

Background. Asthma is common in elite athletes. In this study, we examined the use of asthma medication and asthma control in endurance athletes in Sweden and compared the findings with those in a reference group of patients with asthma. Methods. The Asthma Control Test (ACT) and a questionnaire on asthma, respiratory symptoms, and medication use were posted to endurance athletes (n = 711) and the reference group of patients with asthma (n = 1026). Four hundred and sixty-nine athletes (66%) responded, of whom 141 (20%) reported physician-diagnosed asthma. In the reference group, 397 (39%) responded. Results. Seventy-seven percent of the athletes with asthma reported using asthma medication during the previous year; 39% used short/long-acting β2-agonists, 31% used inhaled corticosteroids, and 31% used both daily. According to the ACT scores, 19%, 24%, and 58% of athletes with asthma had uncontrolled, partially controlled, or well-controlled asthma, respectively. After adjustment, there was no difference in ACT scores or daily use of asthma medication between the study groups. Conclusions. Many endurance athletes had uncontrolled or partially controlled asthma, and one-third used inhaled corticosteroids and long-acting β2-agonists daily. Their adjusted ACT scores and use of asthma medication were similar to the values in the reference population

Adjusted incidence, remission, and relapse of self-reported physician-diagnosed asthma and asthma medication usage in endurance athletes

Longitudinal studies are needed to increase our knowledge of the natural history of asthma in athletes. Our aims were to estimate the incidence, remission, and relapse, of self-reported asthma among endurance athletes. A postal questionnaire on self-reported physician-diagnosed asthma, asthma medication, allergy, and respiratory symptoms was sent annually 2011–2015 to 666 Swedish elite athletes competing in cross-country skiing, biathlon, ski orienteering, or orienteering. Athletes at risk for (1) incident asthma were those without previous self-reported asthma, use of asthma medication, or asthma-like symptoms, (2) remission those who discontinued asthma medication usage and (3) relapse those who resumed asthma medication usage during the observation period. The population at risk was used as denominator in the calculations of subsequent event rate. At baseline, 89% responded, the median age was 17 years and 47% were females. Of the 373 athletes with never asthma nor use of asthma medication/asthma-like symptoms at baseline, 31 (8%) reported physician-diagnosed asthma during follow-up, giving an adjusted incidence rate of asthma of 42/1000 person years. Among the 110 athletes with self-reported asthma and use of asthma medication at baseline, 26 (24%) discontinued use of asthma medication during the follow-up, giving a remission rate of 142/1000 person years. Of the 31 athletes with previous asthma and no use of asthma medication at baseline, 9 (29%) resumed use of asthma medication during follow-up, giving a relapse rate was 148/1000 person years. Elite endurance athletes have a high incidence of self-reported physician-diagnosed asthma. The remission and relapse of self-reported asthma medication usage in endurance athletes appear similar to that of the general population

Breathing resistance in heat and moisture exchanging devices

The purpose of this study was to investigate the resistance to breathing (RES) in heat and moisture exchanging devices (HME) intended for use during physical activity in the cold. RES was investigated for seventeen HMEs, including different types of filters. In addition, the influence of headwind on RES was tested using four representative HMEs. HMEs were mounted to the face of an artificial head manufactured from ABS plastic. The HMEs were connected to a mechanical lung simulator, which delivered standardised inspiratory and expiratory air flow rates ((Formula presented.), L/s). The delta pressure (Δp, Pa) between ambient air and the air inside the HME was measured, whereupon RES was calculated. The results showed significant (p < 0.05) differences in RES between HMEs from different manufacturers, while the difference was smaller, and in some cases not significant (p > 0.05), between different models/filters within the same brand. The results also showed that RES was highly influenced by different ventilations and headwind conditions. RES increased with increased (Formula presented.) and, when a headwind was introduced, RES decreased during inspiration and increased during expiration. Calculations showed that the oxygen and energy cost for breathing through an HME was very small for most of the tested models. The effect of HME dead space on pulmonary gas fractions depends on the tidal volume. At large tidal volumes and ventilations, the effect of HMEs on pulmonary gas fractions becomes relatively small.

Exercise in Sub-zero Temperatures and Airway Health : Implications for Athletes With Special Focus on Heat-and-Moisture-Exchanging Breathing Devices

Asthma is highly prevalent among winter endurance athletes. This “occupational disease” of cross-country skiers, among others, was acknowledged during the 1990s, with the pathogenesis attributed to repeated and prolonged exposure to cold, dry air combined with high rates of ventilation during exercise. Nevertheless, more than 25 years later, the prevalence of asthma among Scandinavian cross-country skiers is unchanged, and prevention remains a primary concern for sports physicians. Heat-and-moisture-exchanging breathing devices (HMEs) prevent exercise-induced bronchoconstriction in subjects with pre-existing disease and may have potential as a preventative intervention for healthy athletes undertaking training and competition in winter endurance sports. Herein we firstly provide an overview of the influence of temperature and humidity on airway health and the implications for athletes training and competing in sub-zero temperatures. We thereafter describe the properties and effects of HMEs, identify gaps in current understanding, and suggest avenues for future research

Occupational cold exposure is associated with increased reporting of airway symptoms

Objective: To determine if exposure to cold environments, during work or leisure time, was associated with increased reporting of airway symptoms in the general population of northern Sweden. Methods: Through a population-based postal survey responded to by 12627 subjects, ages 18–70, living in northern Sweden, the occurrence of airway symptoms was investigated. Cold exposure during work or leisure time was self-reported on numerical rating scales. Binary logistic regression was used to determine the statistical association between cold exposure and airway symptoms. Results: For currently working subjects (N=8740), reporting any occupational cold exposure was associated to wheeze (OR 1.3; 95% CI 1.1–1.4); chronic cough (OR 1.2; 95% CI 1.1–1.4); and productive cough (OR 1.3; 95% CI 1.1–1.4), after adjusting for gender, age, body mass index, daily smoking, asthma, and chronic obstructive pulmonary disease. Leisure-time cold exposure was not signifcantly associated to reporting airway symptoms. Conclusions: Occupational cold exposure was an independent predictor of airway symptoms in northern Sweden. Therefore, a structured risk assessment regarding cold exposure could be considered for inclusion in the Swedish workplace legislation