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Accuracy of a first diagnosis of asthma in primary health care.

https://arctichealth.org/en/permalink/ahliterature15359
Source
Fam Pract. 2002 Aug;19(4):365-8
Publication Type
Article
Date
Aug-2002
Author
Peter Montnémery
L. Hansson
J. Lanke
L-H Lindholm
P. Nyberg
C-G Löfdahl
E. Adelroth
Author Affiliation
Department of Clinical Neuroscience/Division of Occupational Therapy, PO Box 157, Umeå University, SE-221 00 Lund, Sweden. peter.montnémery@arb.lu.se
Source
Fam Pract. 2002 Aug;19(4):365-8
Date
Aug-2002
Language
English
Publication Type
Article
Keywords
Adult
Asthma - diagnosis - epidemiology
Family Practice
Humans
Prevalence
Primary Health Care
Research Support, Non-U.S. Gov't
Sensitivity and specificity
Sweden - epidemiology
Abstract
BACKGROUND: In a postal questionnaire study, the prevalence of asthma in southern Sweden has been found to be 5.5%. However, the register prevalence of asthma obtained from the medical records in the same municipality and age groups was found to be only 2.1%. OBJECTIVES: The aims of the study were to investigate whether the low register prevalence of asthma was caused by an underdiagnosis of asthma in primary health care and to validate a first diagnosis of asthma set by GPs in primary health care. METHODS: During a period of 3 months in 1997, all patients seeking care in the primary health care units of the municipality of Lund (population 171 877) with upper or lower airway infections, prolonged cough, allergic rhinitis, fatigue or a first positive diagnosis of asthma were recorded ( n = 3025). RESULTS: In the whole group of 3025 patients, 99 patients were found to have received a diagnosis of asthma for the first time during the study period. The diagnosis was verified in 52 of those 68 patients who attended a follow-up and examination by a respiratory physician. Among the remaining 2926 patients, 221 patients were selected randomly to constitute a control group. In this group, three patients were found to have asthma. Thus, the specificity of an asthma diagnosis set in primary health care was 0.99 [95% confidence interval (CI) 0.99-1.00] and the sensitivity was 0.59 (95% CI 0.31-0.81). CONCLUSIONS: The GPs in this study were good at excluding those who did not have asthma (specificity 99%) but less good in correctly diagnosing those who actually had current asthma (sensitivity 59%), which suggests an underdiagnosis of asthma.
PubMed ID
12110556 View in PubMed
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Adding formoterol to budesonide in moderate asthma--health economic results from the FACET study.

https://arctichealth.org/en/permalink/ahliterature10200
Source
Respir Med. 2001 Jun;95(6):505-12
Publication Type
Article
Date
Jun-2001
Author
F. Andersson
E. Stahl
P J Barnes
C G Löfdahl
P M O'Byrne
R A Pauwels
D S Postma
A E Tattersfield
A. Ullman
Author Affiliation
AstraZeneca R&D Lund, Sweden. fredrik.l.andersson@astrazeneca.com
Source
Respir Med. 2001 Jun;95(6):505-12
Date
Jun-2001
Language
English
Publication Type
Article
Keywords
Acute Disease
Adolescent
Adult
Aged
Anti-Asthmatic Agents - economics - therapeutic use
Asthma - drug therapy - economics
Budesonide - economics - therapeutic use
Cost Savings
Cost-Benefit Analysis
Drug Therapy, Combination
Ethanolamines - economics - therapeutic use
Great Britain
Health Care Costs
Humans
Middle Aged
Normal Distribution
Research Support, Non-U.S. Gov't
Spain
Sweden
Abstract
The FACET (Formoterol and Corticosteroid Establishing Therapy) study established that there is a clear clinical benefit in adding formoterol to budesonide therapy in patients who have persistent symptoms of asthma despite treatment with low to moderate doses of an inhaled corticosteroid. We combined the clinical results from the FACET study with an expert survey on average resource use in connection with mild and severe asthma exacerbations in the U.K., Sweden and Spain. The primary objective of this study was to assess the health economics of adding the inhaled long-acting beta2-agonist formoterol to the inhaled corticosteroid budesonide in the treatment of asthma. The extra costs of adding the inhaled beta2-agonist formoterol to the corticosteroid budesonide in asthmatic patients in Sweden were offset by savings from reduced use of resources for exacerbations. For Spain the picture was mixed. Adding formoterol to low dose budesonide generated savings, whereas for moderate doses of budesonide about 75% of the extra formoterol costs could be recouped. In the U.K., other savings offset about half of the extra cost of formoterol. All cost-effectiveness ratios are within accepted cost-effectiveness ranges reported from previous studies. If productivity losses were included, there were net savings in all three countries, ranging from Euro 267-1183 per patient per year. In conclusion, adding the inhaled, long-acting beta2-agonist formoterol to low-moderate doses of the inhaled corticosteroid budesonide generated significant gains in all outcome measures with partial or complete offset of costs. Adding formoterol to budesonide can thus be considered to be cost-effective.
PubMed ID
11421509 View in PubMed
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Source
Eur Respir J. 1991 Nov;4(10):1161-5
Publication Type
Article
Date
Nov-1991
Author
C G Löfdahl
N. Svedmyr
Source
Eur Respir J. 1991 Nov;4(10):1161-5
Date
Nov-1991
Language
English
Publication Type
Article
Keywords
Adrenergic beta-Agonists - adverse effects - therapeutic use
Asthma - drug therapy - epidemiology - mortality
Bronchial Hyperreactivity - drug therapy
Humans
Prevalence
Sweden - epidemiology
Notes
Comment In: Eur Respir J. 1992 Jul;5(7):894-5, author reply 898-9001354170
Comment In: Eur Respir J. 1992 Jul;5(7):896-7, author reply 898-9001354171
PubMed ID
1687127 View in PubMed
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Detection of chronic obstructive pulmonary disease (COPD) in primary health care: role of spirometry and respiratory symptoms.

https://arctichealth.org/en/permalink/ahliterature15606
Source
Scand J Prim Health Care. 1999 Dec;17(4):232-7
Publication Type
Article
Date
Dec-1999
Author
U. Nihlén
P. Montnémery
L H Lindholm
C G Löfdahl
Author Affiliation
Department of Community Health Sciences, Lund University, Sweden.
Source
Scand J Prim Health Care. 1999 Dec;17(4):232-7
Date
Dec-1999
Language
English
Publication Type
Article
Keywords
Analysis of Variance
Asthma - complications
Bronchitis - complications
Cross-Sectional Studies
Female
Humans
Lung Diseases, Obstructive - diagnosis - epidemiology
Male
Middle Aged
Prevalence
Primary Health Care
Smoking - adverse effects
Spirometry
Sweden - epidemiology
Abstract
OBJECTIVE: To evaluate the role of spirometry and respiratory symptoms in the detection of chronic obstructive pulmonary disease (COPD) in primary health care. DESIGN: A cross-sectional study. SETTING: A primary health centre in Landskrona, southern Sweden. SUBJECTS: 164 subjects who in 1992 had answered a postal questionnaire concerning obstructive pulmonary diseases and respiratory symptoms. They were aged 45-64 years, with a mean of 55 years. MAIN OUTCOME MEASURES: In 1997, the subjects were invited to perform a spirometry and a medical examination and to answer the same questionnaire as in 1992. Subjects with a forced expiratory volume in 1 second (FEV1)
PubMed ID
10674301 View in PubMed
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The economic impact of asthma and chronic obstructive pulmonary disease (COPD) in Sweden in 1980 and 1991.

https://arctichealth.org/en/permalink/ahliterature15589
Source
Respir Med. 2000 Mar;94(3):247-55
Publication Type
Article
Date
Mar-2000
Author
L. Jacobson
P. Hertzman
C G Löfdahl
B E Skoogh
B. Lindgren
Author Affiliation
Department of Community Medicine, Lund University, Sweden.
Source
Respir Med. 2000 Mar;94(3):247-55
Date
Mar-2000
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Aged, 80 and over
Ambulatory Care - economics - trends
Asthma - economics - epidemiology
Child
Child, Preschool
Drug Costs - trends
Female
Health Care Costs - trends
Hospitalization - economics - trends
Humans
Infant
Infant, Newborn
Male
Middle Aged
Mortality - trends
Pulmonary Disease, Chronic Obstructive - economics - epidemiology
Research Support, Non-U.S. Gov't
Sweden - epidemiology
Abstract
This study was carried out to estimate the direct and indirect costs associated with asthma and chronic obstructive pulmonary disease (COPD) in Sweden in 1980 and 1991, and to identify trends in the use of outpatient care, drugs and inpatient care, and the development of temporary morbidity, permanent disability and mortality for asthma and COPD. Routinely published administrative and population data were used to estimate the costs of asthma and COPD, and these figures were compared to corresponding estimates and trends for all respiratory diseases as well as for all diseases. Asthma and COPD each accounted for about SEK 3 billion, together roughly 2% of the economic cost of all diseases. Although the total costs associated with each disease were similar, the distribution of the different cost components and changes in each component over time differed. During the 1980s, the cost of drugs and out-patient care increased for both diseases. The cost of inpatient care for asthma decreased, whereas that for COPD increased. This study shows that asthma therapy has changed from inpatient to ambulatory care in Sweden, while the treatment of COPD to a higher degree still is based on inpatient care.
PubMed ID
10783936 View in PubMed
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Familial related risk-factors in the development of chronic bronchitis/emphysema as compared to asthma assessed in a postal survey.

https://arctichealth.org/en/permalink/ahliterature15478
Source
Eur J Epidemiol. 2000;16(11):1003-7
Publication Type
Article
Date
2000
Author
P. Montnémery
J. Lanke
L H Lindholm
B. Lundbäck
P. Nyberg
E. Adelroth
C G Löfdahl
Author Affiliation
Department of Community Health Sciences, Lund University, Sweden. peter.montnemery@arb.lu.se
Source
Eur J Epidemiol. 2000;16(11):1003-7
Date
2000
Language
English
Publication Type
Article
Keywords
Adult
Asthma - epidemiology - genetics
Bronchitis - epidemiology - genetics
Chi-Square Distribution
Chronic Disease
Comparative Study
Cross-Sectional Studies
Emphysema - epidemiology - genetics
Female
Humans
Logistic Models
Male
Middle Aged
Questionnaires
Risk factors
Smoking - adverse effects
Sweden - epidemiology
Abstract
There is a lack of knowledge to which extent heredity or familial risk factors are involved in the development of chronic bronchitis/emphysema (CBE). Smoking is regarded as the most important risk factor, but only about 15% of smokers develop airway obstruction. We evaluated the importance of familial risk factors compared to smoking and ex-smoking using an epidemiological approach. In 1992, a postal questionnaire was distributed to a study sample. In all, 43 questions were asked, in a previously evaluated questionnaire, regarding respiratory symptoms, self-reported lung diseases, smoking habits and familial occurrence of chronic bronchitis and asthma. The questionnaire was sent to 12,073 adults living in the southernmost part of Sweden. The age range was 20-59 years with an equal gender distribution. The study sample was drawn from the population records. The questionnaire was answered by 8469 subjects (70.1%), of whom 392 subjects (4.6%) stated that they had or had had CBE and 469 subjects (5.5%) stated that they had or had had asthma. In a model with logistic regression using the five explanatory variables gender, age, familial occurrence for asthma, familial occurrence for CBE and current or ex-smoking the most important risk factors for CBE were familial occurrence for chronic bronchitis [Odds ratios (OR): 5.19, 95% confidence interval (CI): 4.09-6.60, p = 0.000] and current or ex-smoking (OR: 1.74, 95% CI: 1.41-2.14, p = 0.000). The most important risk factors for asthma were familial occurrence for asthma (OR: 3.71, 95% CI: 3.06-4.51, p = 0.000) and current or ex-smoking (OR: 1.33, 95% CI: 1.09-1.61, p = 0.004). We have found that familial occurrence for CBE in first degree relatives together with smoking is a stronger risk factor for the development of CBE than is smoking.
PubMed ID
11421467 View in PubMed
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Health-related quality of life in asthma studies. Can we combine data from different countries?

https://arctichealth.org/en/permalink/ahliterature15274
Source
Pulm Pharmacol Ther. 2003;16(1):53-9
Publication Type
Article
Date
2003
Author
E. Ståhl
D S Postma
E F Juniper
K. Svensson
I. Mear
C-G Löfdahl
Author Affiliation
Department of Respiratory Medicine, University Hospital, Lund, Sweden.elisabeth.stahl@astrazeneca.com
Source
Pulm Pharmacol Ther. 2003;16(1):53-9
Date
2003
Language
English
Publication Type
Article
Keywords
Adult
Aged
Asthma - complications - ethnology
Comparative Study
Cultural Characteristics
Female
Greece
Health status
Humans
Male
Middle Aged
Netherlands
Norway
Quality of Life
Questionnaires
Reproducibility of Results
Sweden
Abstract
The aim was to compare health-related quality of life (HRQL) in patients with asthma from 4 countries, and to investigate the correlations between HRQL and clinical indices.341 patients; 140 (Sweden), 54 (Norway), 65 (the Netherlands) and 82 (Greece) were treated with formoterol fumarate 4.5 microg or with terbutaline sulphate 0.5mg for 12 weeks inhaled 'on demand' via Turbuhaler. The Asthma Quality of Life Questionnaire (AQLQ) and clinical indices were assessed.The mean baseline AQLQ overall scores in Sweden (4.97), in the Netherlands (5.04), in Norway (4.68) and in Greece (4.68) were in the same range, however, with a significant difference between the four countries (p=0.038). When comparing AQLQ, activity limitation and symptoms domains, the differences between the countries were not statistically significant. The cross-sectional correlations between AQLQ overall score and the clinical indices were similar in all four countries.The magnitude of change in AQLQ was consistent with the other clinical variables. The correlations between change in AQLQ overall score and change in clinical indices were low to medium in all countries.In conclusion, the consistency of cross-sectional correlations between the AQLQ overall and clinical indices across countries supports the validity of translations of the AQLQ used in this study. There were differences in baseline values between the countries. The treatment response in AQLQ differed to the same extent as other clinical indices. When combining HRQL data from different countries, there might be cultural, gender and socio-economic differences, explaining different responses to treatment.
PubMed ID
12657500 View in PubMed
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Influence of heavy traffic, city dwelling and socio-economic status on nasal symptoms assessed in a postal population survey.

https://arctichealth.org/en/permalink/ahliterature15234
Source
Respir Med. 2003 Aug;97(8):970-7
Publication Type
Article
Date
Aug-2003
Author
P. Montnémery
M. Popovic
M. Andersson
L. Greiff
P. Nyberg
C G Löfdahl
C. Svensson
C G A Persson
Author Affiliation
Department of Community Medicine/Division of Geriatric Medicine, Malmo 205 02, Sweden. peter.montnemery@smi.mas.lu.se
Source
Respir Med. 2003 Aug;97(8):970-7
Date
Aug-2003
Language
English
Publication Type
Article
Keywords
Adult
Air Pollution - adverse effects
Automobiles - statistics & numerical data
Cities
Environmental health
Female
Humans
Logistic Models
Male
Middle Aged
Nitrogen Dioxide - adverse effects
Nose Diseases - epidemiology
Prevalence
Regression Analysis
Residence Characteristics
Sex Distribution
Smoking - adverse effects - epidemiology
Socioeconomic Factors
Sulfur Dioxide - adverse effects
Sweden - epidemiology
Urban health
Vehicle Emissions
Abstract
BACKGROUND: The association between social position, living environment and nasal symptoms is inconsistent. We wanted to test how living environment, occupation and social position were associated with nasal symptoms. METHODS: In a postal survey study of a random sample of 12,079 adults, aged 20-59 years living in the southern part of Sweden the relationship between nasal symptoms, socio-economic status and environmental factors was analysed. RESULTS: The response rate was 70% (n = 8469) of whom 33% reported significant nasal symptoms. Nasal discharge, thick yellow discharge, a blocked nose, sneezing and itching were strongly associated with living close to heavy traffic or living in cities. Most of the nasal symptoms provoked by extrinsic factors were more frequently reported among subjects who lived close to heavy traffic and in cities. Apart from thick yellow discharge and nasal symptoms provoked by damp/cold air which were more common in the socio-economic position "low" no relation to the socio-economic group was found. The prevalence of self-reported hay fever was neither affected by site of living nor by socio-economic status. Nasal symptoms evoked by "allergic" factors were linked to asthma but symptoms evoked by non-allergic factors were linked to chronic bronchitis/emphysema CBE. CONCLUSIONS: To conclude, we found a strong relation between geographical site and the prevalence of self-reported nasal symptoms which emphasizes the environment as a risk factor for nasal symptoms. Only by merging the socio-economic groups into "low" and "middle/high" an association to nasal symptoms was apparent. Nasal symptoms evoked by "allergic" factors were linked to asthma but symptoms evoked by "non allergic factors" were linked to CBE.
PubMed ID
12924526 View in PubMed
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Invasive pneumococcal disease in patients with an underlying pulmonary disorder.

https://arctichealth.org/en/permalink/ahliterature115798
Source
Clin Microbiol Infect. 2013 Dec;19(12):1148-54
Publication Type
Article
Date
Dec-2013
Author
M. Inghammar
G. Engström
G. Kahlmeter
B. Ljungberg
C-G Löfdahl
A. Egesten
Author Affiliation
Section for Infection Medicine, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden; Section for Respiratory Medicine and Allergology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden.
Source
Clin Microbiol Infect. 2013 Dec;19(12):1148-54
Date
Dec-2013
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Asthma - complications
Case-Control Studies
Chronic Disease
Comorbidity
Databases, Factual
Humans
Logistic Models
Lung Diseases - complications - epidemiology
Male
Middle Aged
Pneumococcal Infections - complications - epidemiology - mortality
Pulmonary Disease, Chronic Obstructive - complications
Sweden - epidemiology
Young Adult
Abstract
Chronic pulmonary disease is a recognized risk factor for invasive pneumococcal disease (IPD). However, previous studies have often not been large enough to allow detailed analyses of less prevalent pulmonary diseases, and findings regarding case fatality have been inconsistent. We examined the associations between an underlying pulmonary disease and IPD, and the impact of these diseases on the case fatality rate. Patients with IPD =18 years of age, between 1990 and 2008, were identified in microbiological databases. The associations between IPD and the pulmonary diseases were assessed using conditional logistic regression, comparing IPD cases to ten control subjects per case, randomly selected from the general population (matched for gender, year of birth and county of residence). Adjustments were made for other co-morbidities, level of education and socio-economic status, 4085 cases of IPD and 40 353 controls were identified. A more than four-fold increased risk of IPD was seen in chronic obstructive pulmonary disease, a doubled risk in asthma and a five-fold increased risk in subjects with pulmonary fibrosis. In univariate analysis, sarcoidosis and bronchiectasis were associated with a two-fold to seven-fold increase in the risk of IPD, but there was no statistical support for the associations when adjustments for confounders were made. No increased risk was seen in subjects with a history of pneumoconiosis or allergic alveolitis. The mortality following IPD was not increased in patients with chronic obstructive pulmonary disease, asthma, pulmonary fibrosis or bronchiectasis. Several chronic pulmonary diseases increase the risk of IPD but mortality following IPD seems not to be affected.
PubMed ID
23464817 View in PubMed
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17 records – page 1 of 2.