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Biomedical subjects

L Rosenhall

Publications and source records attributed to L Rosenhall.

At least 19 recordsLinked to original sources
PubMed2003

One-year safety and efficacy of budesonide/formoterol in a single inhaler (Symbicort Turbuhaler) for the treatment of asthma.

BACKGROUND: A budesonide/formoterol single inhaler has been developed for convenient treatment of patients whose asthma is inadequately controlled by inhaled glucocorticosteroids alone. OBJECTIVES: To compare long-term safety and efficacy of budesonide/formoterol single inhaler with budesonide plus formoterol via separate inhalers in adults with asthma. METHODS: In this open, randomized, parallel-group 6-month extension conducted in a subset of centres from a previous 6-month study, patients (n=321) received two inhalations bid of budesonide/formoterol (Symbicort Turbuhaler) 160/4.5 microg delivered dose or corresponding doses of budesonide (Pulmicort Turbuhaler) plus formoterol (Oxis Turbuhaler) via separate inhalers. RESULTS: Significantly fewer patients receiving budesonide/formoterol single inhaler withdrew compared with budesonide plus formoterol (9 vs. 19%, P=0.008). Incidence and severity of AEs were low and similar in both groups. No clinically important differences between groups, or changes, were identified in laboratory measurements, vital signs or ECG. Treatments produced similar improvements in lung function, ACQ scores and Mini AQLQ domains that were maintained throughout 12 months. CONCLUSIONS: Budesonide/formoterol in a single inhaler is as safe and effective in the long-term treatment of asthma as budesonide plus formoterol via separate inhalers. The lower number of withdrawals with budesonide/formoterol may reflect better adherence to treatment compared with budesonide plus formoterol.

Administration, Inhalation↗
PubMed2003

Budesonide/formoterol in a single inhaler (Symbicort) reduces healthcare costs compared with separate inhalers in the treatment of asthma over 12 months.

This open, multinational, randomised, parallel-group, six-month extension conducted in the Swedish centres of a previous six-month study compared the costs of a total of 12 months of treatment with budesonide/formoterol in a single inhaler with budesonide plus formoterol separate inhalers in 320 adults with asthma. Patients received budesonide/formoterol (Symbicort Turbuhaler) 160/4.5 mg delivered doses, two inhalations b.i.d., or corresponding doses of budesonide (Pulmicort Turbuhaler) plus formoterol (Oxis Turbuhaler). Direct costs and indirect costs were estimated. Budesonide/formoterol treatment was associated with reduced healthcare service utilisation and statistically significant reductions in direct (SEK1595, p=0.0004) and total costs (SEK1884, p=0.043) per person per year compared with budesonide plus formoterol. Budesonide/formoterol reduced the average annual emergency room admission cost per person by SEK489.7 (31% of direct cost reduction) and physician costs by SEK235.4 (15%).The direct cost of study, relief and other medication was reduced by SEK893.8 (47% of total reduction). There were no statistically significant differences in efficacy and safety parameters following treatment with budesonide/formoterol from single or separate inhalers, other than a significantly lower proportion of withdrawals with the single inhaler (9.2% vs 19.4%, p=0.008). In summary, budesonide/formoterol treatment from a single inhaler reduced 12-month treatment costs compared with separate inhalers, while maintaining at least as good control of asthma.

Administration, Inhalation↗
PubMed2000

Recombinant humanized mAb-E25, an anti-IgE mAb, in birch pollen-induced seasonal allergic rhinitis.

BACKGROUND: Allergic rhinitis is a common condition often requiring treatment. OBJECTIVE: We evaluated whether recombinant humanized (rhu)mAb-E25, a recombinant humanized construct of a murine antibody that binds to circulating IgE, could control symptoms and reduce intake of concomitant medication in seasonal allergic rhinitis (SAR) induced by birch pollen if given subcutaneously in a dose schedule predicted to reduce serum free IgE levels below 25 ng/mL. METHODS: We randomly assigned 251 adult subjects with a history of SAR and a positive skin test response to birch pollen to receive 300 mg of rhumAb-E25 or placebo given 2 or 3 times during the season, depending on baseline IgE levels. The primary efficacy variable was the subject's average daily nasal symptom severity score (sneezing, itching, runny, and stuffy nose) from diary data collected over the double-blind treatment period. Secondary efficacy variables included the average number of rescue antihistamine tablets per day, the proportion of days with any SAR medication use, and rhinoconjunctivitis-specific quality of life (QOL). RESULTS: Significant between-treatment differences in favor of rhumAb-E25 were observed in average daily nasal symptom severity scores, the average number of tablets of rescue antihistamines per day, the proportion of days with any SAR medication use, and all domains of QOL. Serum-free IgE levels were markedly lower in rhumAb-E25-treated subjects and were associated with clinical effectiveness. Recombinant humanized mAb-E25 was well tolerated. No anti-rhumAb-E25 antibodies were detected. CONCLUSION: Compared with placebo, rhumAb-E25 was safe and effective in controlling birch pollen-induced SAR symptoms, with less concomitant medication use and improved QOL. This study shows the therapeutic potential of anti-IgE antibody in SAR.

Adolescent↗
PubMed1998

Prevalence of bronchial hyper-responsiveness in the southern, central and northern parts of Sweden.

Studies have suggested that there is a higher prevalence of asthma in northern Sweden than in southern Sweden. Bronchial hyper-responsiveness (BHR) has been shown to be associated with asthma. The aim of this study was to explore the prevalence of bronchical hyper-responsiveness in different parts of Sweden. As part of the European Community Respiratory Health Survey (ECRHS), interviews, skin prick tests, lung function tests and methacholine provocation tests of the airways were performed in 1448 randomly selected subjects in southern, central and northern Sweden. The Mefar dosimeter was used according to the ECRHS protocol. The responsiveness was calculated both as the PD20 and as the dose response slope (DRS). BHR was defined as a PD20 of < or = 1.6 mg. Atopy was defined as at least one skin prick test of > or = 3 mm. The prevalence of BHR was 12.7%, 10.6% in men and 15.0% in women. No difference in prevalence was found between the three different regions of Sweden. The prevalence of BHR was higher in women than in men and higher in smokers than in non-smokers. Using multiple logistic regression, with BHR as the dependent variable, atopy, being female, having a low FEV1 (% predicted) and smoking (both own and passive) increased the odds of having BHR, while age and the region of Sweden did not influence BHR. Defining BHR as a PD20 of < or = 1.0 mg or a PD20 of < or = 2.0 mg did not change this. Multiple regression using log DRS as the dependent variable produced the same result. Both BHR and increasing DRS were associated with self-reported wheezing, attacks of shortness of breath during the daytime at rest or after strenuous activity, being awakened by a feeling of tightness in the chest or an attack of shortness of breath. In subjects without self-reported asthma, BHR was associated with self-reported wheezing and attacks of shortness of breath after strenuous activity. In conclusion, we found that the prevalence of BHR in the three investigated areas was 12.7%. We found a trend towards a higher prevalence of BHR in the most northerly of the study areas, but the difference between the areas was not statistically significant. BHR and DRS were associated with atopy, smoking, female sex and FEV1 (% predicted). The reporting of symptoms from the airways was associated with the degree of bronchical responsiveness.

Adult↗
PubMed1996

Skin prick tests and specific IgE in adults from three different areas of Sweden.

The aims of this part of the European Respiratory Health Survey were to estimate the prevalence of atopic sensitization to inhalant allergens among adults in three different areas of Sweden and to investigate the association between sensitization and certain risk factors. Randomly selected subjects aged 20-46 years from Göteborg, Uppsala, and Västerbotten were investigated with the skin prick test (SPT), analyses for specific IgE antibodies in serum (specific IgE) and total serum immunoglobulin E (total IgE), and a questionnaire. SPT was performed in 1572 subjects and analyses of specific IgE in 1470. One or more positive SPT were found in 35.6% and one or more positive specific IgE in 31.7%-approximately the same values in all three areas. Birch, grass, cat, and dog were the most frequent sensitizing agents and occurred at similar prevalences, i.e., around 15%, in all areas. The SPT to mite was positive in 14.1% in Göteborg, 7.4% in Uppsala, and 7.9% in Västerbotten. A positive SPT to pellitory of the wall (Parietaria), not described previously in Sweden, was found in 3.4% in Göteborg. Living in Göteborg was independently associated with a higher risk of a positive SPT to mite and Parietaria. Heredity, male sex, and low age were independently associated with atopy. Birth in the Scandinavian countries was independently associated with sensitization to cat, whereas birth in other countries was associated with sensitization to mite. The overall prevalence of atopy was similar in the three Swedish areas, but the sensitizing allergens varied. There is an indication that sensitization is increasing in the population, as low age was associated with sensitization. Sensitization to cat, but not to mite, appears to be particularly important in persons born in the Scandinavian countries.

Adult↗
PubMed1996

Skeletal muscle magnesium and potassium in asthmatics treated with oral beta 2-agonists.

Dietary magnesium has been shown to be important for lung function and bronchial reactivity. Interest in electrolytes in asthma has so far mainly been focused upon serum potassium, especially linked to beta 2-agonist treatment. It is known that serum levels of magnesium and potassium may not correctly reflect the intracellular status. We therefore investigated whether asthmatics treated with oral beta 2-agonists had low magnesium or potassium in skeletal muscle and serum, and whether withdrawal of the oral beta 2-agonists would improve the electrolyte levels. Magnesium and potassium levels in skeletal muscle biopsies, serum and urine were analysed in 20 asthmatics before and 2 months after withdrawal of long-term oral beta 2-agonists, and for comparison in 10 healthy subjects. Skeletal muscle magnesium in the asthmatics was lower both before (3.62 +/- 0.69 mmol.100 g-1 (mean +/- SD)) and after (3.43 +/- 0.60 mmol.100 g-1) withdrawal of oral beta 2-agonists compared with the controls (4.43 +/- 0.74 mmol.100 g-1). Skeletal muscle potassium and serum magnesium did not differ between the groups. Serum potassium was significantly lower both before (4.0 +/- 0.2 mmol.L-1) and after (3.9 +/- 0.2 mmol.L-1) the withdrawal of oral beta 2-agonists compared with the control group (4.2 +/- 0.2 mmol.L-1). The asthmatics had lower skeletal muscle magnesium and lower serum potassium than the healthy controls, both with and without oral beta 2-agonists. Whether the findings are related to asthma pathophysiology or treatment is currently being investigated.

Administration, Oral↗
PubMed1994

Epidemiology of respiratory symptoms, lung function and important determinants. Report from the Obstructive Lung Disease in Northern Sweden Project.

SETTING: Cross-sectional epidemiological study based on a representative sample of the general population in northern Sweden. OBJECTIVES: To assess the prevalence of respiratory symptoms, the role of respiratory symptoms as indicators of impairment of lung function, and to define risk factors for respiratory symptoms and lung function impairment. DESIGN: The 1340 subjects of 6610 who reported respiratory symptoms suggestive of asthma or chronic bronchitis in a postal questionnaire study were invited to a structured interview and lung function tests. A control group of 315 subjects was also invited. Risk factors were assessed from the postal questionnaire. RESULTS: 400 subjects in the symptomatic group had attacks of breathlessness and wheezing, while none in the control group had them, corresponding to 7% of the original study population. Chronic productive cough was present in 537 subjects, of whom 13 were from the control group, suggesting that 12% of the original study population had this symptom. Persistent wheeze was the symptom that predicted the greatest proportion of cases of impaired lung function. Attacks of breathlessness, wheezing, long-standing cough and sputum production were all related to age, smoking and a family history of asthma. Both chronic productive cough and impaired lung function correlated strongly with smoking and age, and their prevalences differed in different socio-economic groups. CONCLUSION: Impaired lung function can be predicted from respiratory symptoms. Data collected in postal questionnaires suffice for the identification of risk factors. Combinations of symptoms gave greater odds ratios than individual symptoms.

Adult↗
PubMed1994

Prevalence of positive skin prick tests, allergic asthma, and rhinoconjunctivitis in teenagers in northern Sweden.

The prevalence of positive skin prick tests (SPT) for common allergens and symptoms of allergic rhinoconjunctivitis or asthma was investigated in Umeå in northern Sweden in 1987. Skin prick tests with 10 allergens common in Sweden and a questionnaire were used to examine 1112 teenagers. All subjects with a positive skin prick test or symptoms were interviewed, and they were further investigated by a serum specific IgE test, a ventilatory lung function test, and a physical examination. At least one skin prick test was positive in 43% of the subjects. Ninety-three percent had at least one positive skin prick test to one of the three most common allergens: cat, timothy grass, and birch. The prevalence of current allergic rhinoconjunctivitis was 17%, current allergic asthma 2.8%, and current asthma (both allergic and nonallergic) 6.8%. Multiple logistic regression analysis showed that the most important risk factors for current asthma were sex (being a girl) and atopy. Heredity of asthma or rhinoconjunctivitis and being born in the winter (October-March) also increased the risk. In atopic subjects, having a mother who smoked and heredity of asthma increased the risk. For allergic rhinoconjunctivitis, heredity increased the risk of getting rhinoconjunctivitis.

Adolescent↗
PubMed1994

Symptoms related to asthma and chronic bronchitis in three areas of Sweden.

Does the prevalence of respiratory symptoms differ between regions? As a part of the European Community Respiratory Health Survey, we present data from an international questionnaire on asthma symptoms occurring during a 12 month period, smoking and symptoms of chronic bronchitis. The questionnaire was mailed to 10,800 persons aged 20-44 yrs living in three regions of Sweden (Västerbotten, Uppsala and Göteborg) with different environmental characteristics. The total response rate was 86%. Wheezing was reported by 20.5%, and the combination of wheezing without a cold and wheezing with breathlessness by 7.4%. The use of asthma medication was reported by 5.3%. Long-term cough and/or morning cough together with problems with phlegm was reported by 12.8%; the prevalence being highest in the most polluted area (Göteborg). When using multivariate analysis, no significant difference in asthma-related symptoms was found between the centres. Women reported cough more frequently, but otherwise gender did not influence symptom prevalence. Our results indicate that bronchitis symptoms occur more frequently in Göteborg, the most polluted of the Swedish centres, but that the prevalence rates of asthma-related symptoms do not differ between these three regions.

Adult↗
PubMed1993

An interview study to estimate prevalence of asthma and chronic bronchitis. The obstructive lung disease in northern Sweden study.

A questionnaire of respiratory symptoms and diseases completed by 6610 adults in 3 age cohorts (35-36 y; 50-51 y and 65-66 y) in northern Sweden was followed-up by interview and lung function testing of 1243 subjects with asthmatic or bronchitic symptoms and 263 subjects assessed from the postal questionnaire as being healthy. We report the results of this follow-up study. According to the criteria used, 292 subjects (5.1% of the original study sample) were diagnosed as having asthma. Out of the 1243 subjects 334 (5.9% of the original study population) were diagnosed as having chronic bronchitis. However, examination of the 263 subjects who were healthy according to the postal questionnaire showed that elderly smokers, in particular, under-reported bronchitic symptoms; taking this into account, the prevalence of chronic bronchitis is estimated to be of the order of 9%. Diagnostic difficulties were noted in 70 subjects (corresponding to 1.2% of the original study sample) in whom asthma or chronic bronchitis were strongly suspected. Further investigation of these subjects was considered necessary. In this cross-sectional study, FEV1 < 80% of predicted values was found in 36% of subjects diagnosed as having asthma and in 31% of those with chronic bronchitis. Among subjects with attacks of breathlessness and wheezing, diagnostic criteria often used for asthma in questionnaire studies, 70% were diagnosed as having asthma. Of those with chronic productive cough, 62% were diagnosed as having chronic bronchitis. We consider that trained nurses provide reliable data that may be used in epidemiological surveys of obstructive lung diseases.

Adult↗
PubMed1993

Methacholine reactivity and asthma. Report from the Northern Sweden Obstructive Lung Disease Project.

Methacholine tests were used in an epidemiologic study of the prevalence of asthma and chronic bronchitis in northern Sweden. Of 6610 subjects in three age groups from eight representative geographic areas in the northernmost province of Sweden, 5698 (86%) completed a postal questionnaire on respiratory symptoms, and 1506 underwent a structured interview and a lung function test. A total of 292 (5%) were diagnosed as having asthma. A subsample of 284 subjects (of 320 invited) classified at the interview as having asthma (n = 98) or as having respiratory symptoms that might be due to asthma but not fulfilling the interview criteria for the diagnosis of asthma (n = 186) underwent a methacholine test. Subjects who, before the interview study, already had a well-defined asthma diagnosis were not invited to the methacholine testing. Of those 98 subjects classified as having asthma, 61% reacted to methacholine doses < or = 4 mg/ml and 79% to doses < or = 8 mg/ml, while the corresponding figures in the symptomatic but nonasthma group were 20% and 34%, respectively. The results show that a carefully performed structured interview accurately diagnoses asthma in epidemiologic studies. The methacholine tests provide important diagnostic information primarily in subjects in whom the medical history is equivocal.

Adult↗
PubMed1993

Time course and duration of bronchodilatation with formoterol dry powder in patients with stable asthma.

BACKGROUND: Formoterol, a new beta 2 agonist, is long and fast acting when given as an aerosol. The aim was to determine the onset and duration of bronchodilatation with formoterol as a dry powder compared with salbutamol dry powder and with placebo. METHODS: Fifteen patients with stable asthma with a reversibility of 15% or more participated in a double blind, within patient study. On five different days the patients received formoterol 6 micrograms, 12 micrograms, or 24 micrograms, salbutamol 400 micrograms, or placebo in random order. Forced expiratory volume in one second (FEV1) was measured 10 minutes before, 30 minutes after, and then every hour for up to 12 hours after treatment. Specific airway resistance (sRaw) and specific airway conductance (sGaw) were measured immediately before and one, three, five, 10, 15, and 30 minutes after treatment. RESULTS: Formoterol 12 micrograms and 24 micrograms caused bronchodilatation as rapidly as salbutamol 400 micrograms. Peak values were not significantly different in the active treatments. The duration of action, calculated as median time with 20% or more of the maximum achieved increase in FEV1, was sustained for 9 hours and 16 minutes with salbutamol 400 micrograms, for 9 hours and 45 minutes with formoterol 6 micrograms, for 11 hours and 22 minutes with formoterol 12 micrograms, and for 11 hours and 42 minutes with formoterol 24 micrograms. CONCLUSIONS: Formoterol as a dry powder at doses of 12 micrograms and 24 micrograms produces a rapid onset of action and has a bronchodilator effect comparable with salbutamol 400 micrograms as a dry powder. The bronchodilatation was sustained for 11-12 hours. Formoterol 6 micrograms caused similar bronchodilatation but more slowly and for a shorter time.

Administration, Inhalation↗
PubMed1993

Exposure to microorganisms associated with allergic alveolitis and febrile reactions to mold dust in farmers.

STUDY OBJECTIVE: To compare exposure to microorganisms associated with allergic alveolitis (AA) and with febrile reactions to inhaled mold dust (organic dust toxic syndrome [ODTS]) in farmers and in normal subjects. DESIGN: A prospective study in which exposure was evaluated within two weeks of medical consultation for AA or ODTS. Samples were collected during normal farming (background) and during the handling of materials associated with disease or causing maximal exposure in reference farms (worst case). SETTING: Swedish farms PARTICIPANTS: Eleven farmers with a confirmed diagnosis of AA from ten farms, 16 subjects with symptoms of ODTS from 12 farms, and 17 reference farmers. MEASUREMENTS AND RESULTS: Worst-case samples representative of the exposure preceding disease were obtained on four farms where five farmers had had AA; the samples contained on average 2.6 +/- 1.8 x 10(9) (SD) spores/m3 of air. On six farms where nine farmers had had ODTS, representative samples averaged 13 +/- 13 x 10(9) spores/m3, and on reference farms this figure was 0.12 +/- 0.20 x 10(9) spores/m3. The daily spore dose associated with allergic alveolitis was 2 x 10(9) spores/d, which was ten times higher than on reference farms. The average dose associated with ODTS was 2 x 10(10) spores. Worst-case samples, collected during 10 to 30 min, contributed to more than 90 percent of the day exposure on farms where AA or ODTS had occurred. CONCLUSION: Allergic alveolitis was associated with high exposure levels on most weekdays for weeks, and ODTS was associated with extreme exposure occurring on a single day. There was no correlation with individual spore types and disease and the present results are compatible with a hypothesis that common cell wall components of microorganisms may cause "toxic" symptoms and stimulate immune reactions.

Adult↗
PubMed1993

High prevalence of asthma and related symptoms in teenagers in northern Sweden.

Recent reports have suggested an increased asthma prevalence in the Nordic countries. The prevalence of asthma and related symptoms from lower airways in Umeå, Northern Sweden, was investigated in 1987. We used a questionnaire and a skin prick test in 1,112 teenagers. Individuals with symptoms or positive skin prick tests were examined further. The clinical examination included an interview, a ventilatory lung function test, serum specific immunoglobulin E (IgE) test, and a physical examination. Individuals with symptoms from the lower airways underwent a methacholine inhalation test. Asthma was defined as recurrent attacks of dyspnoea and/or wheezing, triggered by known stimuli (excluding infections), and at least one of the following: signs of obstructive airways at examination or provocation concentration giving a 20% fall in forced expiratory volume in one second (PC20) < 8 mg.ml-1. Using this definition, the prevalence of asthma was 6.8%, with a significantly higher prevalence in girls (9.6%) than in boys (4.1%). Furthermore, 16.4% had dyspnoea, wheeze or prolonged cough but did not fulfil our criteria for asthma. The prevalence of asthma and of symptoms from lower airways is higher than has previously been found in Sweden.

Adolescent↗