The Swedish National Airway Register (SNAR): development, design and utility to date.

BACKGROUND: The Swedish National Airway Register (SNAR) was initiated in 2013 to ensure and improve the quality of care for patients with asthma and COPD. AIM: To describe the development and design of SNAR, and to study the 2019 data to evaluate its potential utility related to improvement of quality of care. METHODS: SNAR includes data from patients with asthma (both children and adults) and COPD from primary, secondary and tertiary care, and also, for COPD inpatient care. Data on diagnostic investigations (e.g. spirometry, blood sample, skin prick test), symptom-scores, comorbidities and prescribed treatments are registered. The registrations are entered manually by healthcare professionals, or directly transferred from electronic medical records to a web-based platform. RESULTS: In 2019, 1000 clinics participated and data were directly transferred by about 88% of them. The register included data on 205,833 patients with asthma and 80,372 with COPD (of these, 5% had both diagnoses). Registrations of new patients and follow-up visits from primary and secondary/tertiary care in 2019 were completed for 75,707 patients with asthma (11,818 children <12 yr, 6545 adolescents 12-17 yr, and 57,344 adults >17 yr) and 38,117 with COPD. Depending on age and disease group, 43-77% had performed spirometry, 36-65% Asthma Control Test, and 60% COPD Assessment Test. The prevalence of current smoking was about 2% in adolescents, 10% in adults with asthma, and 34% in COPD. For these, smoking cessation support was offered to 27%, 38% and 51%, respectively. Overall, limited data were available on investigation of allergy, 6-min walk test, patient education and written treatment plans. Regarding asthma, sex-differences in disease management were evident. CONCLUSION: SNAR has cumulatively registered data from over 270,000 individuals, and the register is important for patients, caregivers, authorities, politicians and researchers to evaluate the effect of treatment and to ensure high and equal quality of care nationwide.

Obesity and nocturnal gastro-oesophageal reflux are related to onset of asthma and respiratory symptoms.

Several studies have identified obesity as a risk factor for asthma in both children and adults. An increased prevalence of asthma in subjects with gastro-oesophageal reflux (GOR) and obstructive sleep apnoea syndrome has also been reported. The aim of this investigation was to study obesity, nocturnal GOR and snoring as independent risk factors for onset of asthma and respiratory symptoms in a Nordic population. In a 5-10 yr follow-up study of the European Community Respiratory Health Survey in Iceland, Norway, Denmark, Sweden and Estonia, a postal questionnaire was sent to previous respondents. A total of 16,191 participants responded to the questionnaire. Reported onset of asthma, wheeze and night-time symptoms as well as nocturnal GOR and habitual snoring increased in prevalence along with the increase in body mass index (BMI). After adjusting for nocturnal GOR, habitual snoring and other confounders, obesity (BMI >30) remained significantly related to the onset of asthma, wheeze and night-time symptoms. Nocturnal GOR was independently related to the onset of asthma and in addition, both nocturnal GOR and habitual snoring were independently related to onset of wheeze and night-time symptoms. This study adds evidence to an independent relationship between obesity, nocturnal gastro-oesophageal reflux and habitual snoring and the onset of asthma and respiratory symptoms in adults.

[Health-related quality of life informative measure of outcome in clinical trials. Practical examples: asthma/chronic obstructive lung disease]. / Hälsorelaterad livskvalitet informativt effektmått i kliniska studier. Tillämpningsexempel: astma/kroniskt obstruktiv lungsjukdom.

Methods for measuring health-related quality of life have been developed and proven valid during the past two decades. It was accomplished through international collaborations between clinicians and method experts. Standardized questionnaires, self-administered by patients, include key domains such as symptoms, functional limitations and well-being from a physical, mental and social perspective. The commonly used instruments are adapted and validated for Swedish conditions. Clinical trials can be powered also according to these outcome measures, as they show documented responsiveness to important changes in patients' everyday functioning and well-being. Patient-reported outcome of treatment efficacy is nowadays adequately standardized for scientific reviews according to the conventional criteria of evidence based medicine. Most importantly, health-related quality of life measures will provide new information of clinical value as demonstrated here in the example of asthma/chronic obstructive pulmonary disease. Thus, outcome can be better assessed by changes in the total burden of disease and its consequences than in terms of pulmonary function tests or biochemical markers.

How often is the diagnosis bronchial asthma correct?

BACKGROUND: There are studies indicating that bronchial asthma is often underdiagnosed, while only a little research has been conducted as concerns overdiagnosing asthma. OBJECTIVE: We aimed to estimate the number of patients who have been given the wrong diagnosis of asthma. METHODS: All patients aged above 18 years who had visited two GPs during 1994 or 1995, with the diagnosis of bronchial asthma confirmed in the medical register, were examined by a specialist in allergies. RESULTS: One hundred and twenty-three patients fulfilled the criteria for being included in the study. Eighty-six patients (70%) attended the examination. Of these, 51 (59%) had bronchial asthma, six (7%) asthma in combination with chronic obstructive pulmonary disease (COPD) and 29 (34%) no asthmatic disease. CONCLUSION: The study indicates that more accuracy is needed when diagnosing bronchial asthma.

The risk of asthma in relation to occupational exposures: a case-control study from a Swedish city.

The purpose of this study was to estimate the risk of adult asthma in relation to certain occupational exposures. The study was designed as a case-control study in Göteborg, including 321 subjects with asthma, born between 1926 and 1970. Controls (n=1,459) were randomly selected from the same area from registers of the 1986 population. Questionnaire information was collected in 1996, and included occupational exposures and smoking habits. Odds ratios were calculated for exposure before asthma onset, stratified by sex and age-class. The highest risks for asthma were associated with exposure to grain dust (odds ratio (OR) 4.2, 95% confidence interval (CI) 1.6-10.7) and flour dust (OR 2.8, 95% CI 1.1-7.2). Among males, significantly increased risks were observed after exposure to flour dust, welding fumes, man-made mineral fibres, and solvents. Among females, increased risks for asthma were associated with exposures to paper dust and textile dust. In logistic regression models controlling for age, smoking, sex and interacting exposures, increased risks were seen for welding fumes (OR 2.0, 95% CI 15-3.4), man-made mineral fibres (OR 2.6, 95% CI 1.4-7.3) and solvents (OR 2.2, 95% CI 1.2-3.2). The fraction of asthma attributed to occupational exposures after adjusting for sex, smoking and age was 11% (95% CI 7-14%). In conclusion, exposure to welding fumes, man-made mineral fibres, solvents and textile dust is associated with increased risk for asthma.

Airways inflammation, atopy, and (1--> 3)-beta-D-glucan exposures in two schools.

This study investigated two schools, one of which had previous mold problems. Pupils aged 6 to 13 yr were investigated using a questionnaire on symptoms and a skin prick test. The amount of airborne (1--> 3)-beta-D-glucan was measured in the classrooms. The levels were significantly higher in the problem school than in the control school (15.3 versus 2.9 ng/m3). The extent of respiratory as well as general symptoms was higher among the pupils in the problem school. Among the atopics, the extent of symptoms of dry cough, cough with phlegm, and hoarseness was similar to the nonatopics in the control school, but significantly higher in the problem school. The results suggest that (1--> 3)-beta-D-glucan, either by itself or as an indicator of molds, is a risk indicator of airways inflammation.

Predictors of self-assessed work ability among subjects with recent-onset asthma.

The objective of the study was to find predictors for work disability among adults with recent-onset asthma. The study was performed in a group of 332 subjects with recent-onset asthma. The predictors were ascertained by structured interviews, pulmonary function measurements, methacholine challenge tests and skin prick tests. Asthma severity was classified into mild, moderate or severe, based on the minimum medication required to maintain asthma control. Work ability was based on self-assessment by inquiring about the subjects' present work ability, expressed in percent. The self-reported work ability decreased significantly with increasing number of days off work, indicating that self-reported work ability reflects the actual work ability. The majority (56%) of the subjects reported 100% working ability. Among women, but not among men, working ability was negatively correlated (rs = -0.33) with age. Among subjects with PC20 < 16 mg ml-1 work ability increased with increasing PC20. There was no relation between FEV1, FVC and working ability. Asthma severity and current respiratory symptoms at the work place showed a significant negative relation with work ability. In a logistic regression model, when controlling for age, gender, smoking and weekly working hours, decreased work ability was associated with asthma severity, respiratory symptoms at the workplace and PC20 < or = 4 mg ml-1. In conclusion, the work ability was assessed as normal in most asthmatic subjects. Significant predictors for decreased work ability were asthma severity, workplace-associated respiratory symptoms and bronchial hyperresponsiveness. The results indicate that work ability among asthmatics could be improved by reducing the workplace-associated symptoms, either by reducing the exposure to triggers or by improving the asthma therapy.

Emotions and asthma II.

Factors such as the patient's coping mechanisms and their prognostic value are discussed. Different psychotherapeutic methods as a complement to conservative treatment are reviewed, especially hypnosis. The author stresses the multifactorial etiology of asthma. He points out the need for controlled studies of psychotherapeutic methods of treatment and objective verification of their efficacy.