Browsing by Subject "Asthma"

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  • Kotisalmi, Emma; Hakulinen, Auli; Mäkelä, Mika; Toppila-Salmi, Sanna; Kauppi, Paula (BioMed Central, 2020)
    Abstract Background Anti-IgE (omalizumab) and anti-IL5/IL5R (reslizumab, mepolizumab and benralizumab) treatments are available for severe allergic and eosinophilic asthma. In these patients, studies have shown beneficial effects in oral corticosteroid use and exacerbations. The aim of this retrospective single-center study was to evaluate the effect of biological therapy on severe asthma and to compare different therapies. Methods We collected and analysed results of anti-IL5/IL5R and anti-IgE therapies for asthma from January 2009 until October 2019 in specialized care. We compared number of exacerbations, asthma symptoms and use of per oral corticosteroids and antimicrobics because of asthma before and during biological therapy, and in a separate analysis need for per oral corticosteroids, antimicrobics or surgery due to upper respiratory tract diseases in asthmatics receiving biologicals. The analyses were done using the Chi square test, T-test or Mann-Whitney U -test, the Kruskall-Wallis test or the Wilcoxon test. Results Of 64 patients, 40 used continuous per oral corticosteroid therapy prior to biological therapy. The mean daily dose of per oral corticosteroid was reduced in those with anti-IL5/IL5R therapy (− 3.0 mg, p = 0.02). The number of annual per oral corticosteroid courses decreased in both the anti-IL5/IL5R (− 2.8 courses, p < 0.05) and anti-IgE groups (− 1.3 courses, p < 0.05). The number of annual antibiotic courses (− 0.7 courses, p = 0.04) and total number of exacerbation events (− 4.4 events/year, p < 0.05) were reduced in the anti-IL5/IL5R group. In the 55 asthma patients analysed for upper respiratory tract findings, the results suggested a reduction in need for chronic rhinosinusitis surgery during biological therapy. Conclusions Results with biological therapies in this real-life clinical setting are comparable to those reported in clinical trials. Biological therapy reduces exacerbations and per oral corticosteroid use. Trial registration NCT04158050, retrospectively registered 6.11.2019.
  • Hisinger-Mölkänen, Hanna; Honkamäki, Jasmin; Kankaanranta, Hannu; Tuomisto, Leena; Backman, Helena; Andersen, Heidi; Lindqvist, Ari; Lehtimäki, Lauri; Sovijärvi, Anssi; Rönmark, Eva; Pallasaho, Paula; Ilmarinen, Pinja; Piirilä, Päivi (2022)
    Background: Although asthma may begin at any age, knowledge about relationship between asthma age of onset and the prevalence and character of different symptoms is scarce. Objectives: The aim of this study was to investigate if adult-diagnosed asthma is associated with more symptoms and different symptom profiles than child-diagnosed asthma.Methods: A FinEsS postal survey was conducted in a random sample of 16 000 20-69-year-old Finnish adults in 2016. Those reporting physician-diagnosed asthma and age at asthma diagnosis were included. Age 18 years was chosen to delineate child-and adult-diagnosed asthma.Results: Of responders (N = 8199, 51.5%), 842 (10.3%) reported asthma diagnosis. Adult -diagnosed asthma was reported by 499 (59.3%) and child-diagnosed by 343 (40.7%). Of re-sponders with adult-diagnosed and child-diagnosed asthma, 81.8% versus 60.6% used asthma medication (p < 0.001), respectively. Current asthma was also more prevalent in adult-diagnosed asthma (89.2% versus 72.0%, p < 0.001). Risk factors of attacks of breathlessness during the last 12 months were adult-diagnosis (OR = 2.41, 95% CI 1.64-3.54, p < 0.001), female gender (OR = 1.49, 1.07-2.08, p = 0.018), family history of asthma (OR = 1.48, 1.07-2.04, p = 0.018) and allergic rhinitis (OR = 1.49, 1.07-2.09, p = 0.019). All the analysed asthma symptoms, except dyspnea in exercise, were more prevalent in adult-diagnosed asthma in age-and gender-adjusted analyses (p = 0.032-
  • Honkamäki, Jasmin; Hisinger-Mölkänen, Hanna; Ilmarinen, Pinja; Piirilä, Päivi; Tuomisto, Leena E.; Andersen, Heidi; Huhtala, Heini; Sovijärvi, Anssi; Backman, Helena; Lundbäck, Bo; Rönmark, Eva; Lehtimäki, Lauri; Kankaanranta, Hannu (2019)
    Background: Asthma is currently divided into different phenotypes, with age at onset as a relevant differentiating factor. In addition, asthma with onset in adulthood seems to have a poorer prognosis, but studies investigating age-specific incidence of asthma with a wide age span are scarce. Objective: To evaluate incidence of asthma diagnosis at different ages and differences between child- and adult-diagnosed asthma in a large population-based study, with gender-specific analyzes included. Methods: In 2016, a respiratory questionnaire was sent to 8000 randomly selected subjects aged 20-69 years in western Finland. After two reminders, 4173 (52.3%) subjects responded. Incidence rate of asthma was retrospectively estimated based on the reported age of asthma onset. Adult-diagnosed asthma was defined as a physician-diagnosis of asthma made at >= 18 years of age. Results: Among those with physician-diagnosed asthma, altogether, 63.7% of subjects, 58.4% of men and 67.8% of women, reported adult-diagnosed asthma. Incidence of asthma diagnosis was calculated in 10-year age groups and it peaked in young boys (0-9 years) and middle-aged women (40-49 years) and the average incidence rate during the examined period between 1946 and 2015 was 2.2/1000/year. Adult-diagnosed asthma became the dominant phenotype among those with physician-diagnosed asthma by age of 50 years and 38 years in men and women, respectively. Conclusions: Asthma is mainly diagnosed during adulthood and the incidence of asthma diagnosis peaks in middle-aged women. Asthma diagnosed in adulthood should be considered more in clinical practice and management guidelines.
  • Pakkasela, Johanna; Ilmarinen, Pinja; Honkamäki, Jasmin; Tuomisto, Leena E.; Andersen, Heidi; Piirilä, Päivi; Hisinger-Mölkänen, Hanna; Sovijärvi, Anssi; Backman, Helena; Lundbäck, Bo; Rönmark, Eva; Kankaanranta, Hannu; Lehtimäki, Lauri (2020)
    Background Onset of allergic asthma has a strong association with childhood but only a few studies have analyzed incidence of asthma from childhood to late adulthood in relation to allergy. The purpose of the study was to assess age-specific incidence of allergic and non-allergic asthma. Methods Questionnaires were sent to 8000 randomly selected recipients aged 20-69 years in Finland in 2016. The response rate was 52.3% (n = 4173). The questionnaire included questions on e.g. atopic status, asthma and age at asthma diagnosis. Asthma was classified allergic if also a physician-diagnosed allergic rhinitis was reported. Results The prevalence of physician-diagnosed asthma and allergic rhinitis were 11.2 and 17.8%, respectively. Of the 445 responders with physician-diagnosed asthma, 52% were classified as allergic and 48% as non-allergic. Median ages at diagnosis of allergic and non-allergic asthma were 19 and 35 years, respectively. Among subjects with asthma diagnosis at ages 0-9, 10-19, 20-29, 30-39, 40-49, 50-59 and 60-69 years, 70, 62, 58, 53, 38, 19 and 33%, respectively, were allergic. For non-allergic asthma, the incidence rate was lowest in children and young adults (0.7/1000/year). It increased after middle age and was highest in older age groups (2.4/1000/year in 50-59 years old). Conclusions The incidence of allergic asthma is highest in early childhood and steadily decreases with advancing age, while the incidence of non-allergic asthma is low until it peaks in late adulthood. After approximately 40 years of age, most of the new cases of asthma are non-allergic.
  • Calderon, M. A.; Demoly, P.; Casale, T.; Akdis, C. A.; Bachert, C.; Bewick, M.; Bilo, B. M.; Bohle, B.; Bonini, S.; Bush, A.; Caimmi, D. P.; Canonica, G. W.; Cardona, V.; Chiriac, A. M.; Cox, L.; Custovic, A.; De Blay, F.; Devillier, P.; Didier, A.; Di Lorenzo, G.; Du Toit, G.; Durham, S. R.; Eng, P.; Fiocchi, A.; Fox, A. T.; van Wijk, R. Gerth; Gomez, R. M.; Haahtela, Tari Markku Kallevi; Halken, S.; Hellings, P. W.; Jacobsen, L.; Just, J.; Tanno, L. K.; Kleine-Tebbe, J.; Klimek, L.; Knol, E. F.; Kuna, P.; Larenas-Linnemann, D. E.; Linneberg, A.; Matricardi, M.; Malling, H. J.; Moesges, R.; Mullol, J.; Muraro, A.; Papadopoulos, N.; Passalacqua, G.; Pastorello, E.; Pfaar, O.; Price, D.; Rodriguez del Rio, P.; Rueff, R.; Samolinski, B.; Scadding, G. K.; Senti, G.; Shamji, M. H.; Sheikh, A.; Sisul, J. C.; Sole, D.; Sturm, G. J.; Tabar, A.; Van Ree, R.; Ventura, M. T.; Vidal, C.; Varga, E. M.; Worm, M.; Zuberbier, T.; Bousquet, J. (2016)
    Allergic diseases often occur early in life and persist throughout life. This life-course perspective should be considered in allergen immunotherapy. In particular it is essential to understand whether this al treatment may be used in old age adults. The current paper was developed by a working group of AIRWAYS integrated care pathways for airways diseases, the model of chronic respiratory diseases of the European Innovation Partnership on active and healthy ageing (DG CONNECT and DG Sante). It considered (1) the political background, (2) the rationale for allergen immunotherapy across the life cycle, (3) the unmet needs for the treatment, in particular in preschool children and old age adults, (4) the strategic framework and the practical approach to synergize current initiatives in allergen immunotherapy, its mechanisms and the concept of active and healthy ageing.
  • Andersson, Ville; Parkkamäki, Stiina; Pohjanoksa-Mäntylä, Marika; Heikkilä, Juha (2019)
  • Bosnic-Anticevich, Sinthia; Costa, Elisio; Menditto, Enrica; Lourenco, Olga; Novellino, Ettore; Bialek, Slawomir; Briedis, Vitalis; Buonaiuto, Roland; Chrystyn, Henry; Cvetkovski, Biljana; Di Capua, Stefania; Kritikos, Vicky; Mair, Alpana; Orlando, Valentina; Paulino, Ema; Salimäki, Johanna; Söderlund, Rojin; Tan, Rachel; Williams, Dennis M.; Wroczynski, Piotr; Agache, Ioana; Ansotegui, Ignacio J.; Anto, Josep M.; Bedbrook, Anna; Bachert, Claus; Bewick, Mike; Bindslev-Jensen, Carsten; Brozek, Jan L.; Canonica, Giorgio Walter; Cardona, Victoria; Carr, Warner; Casale, Thomas B.; Chavannes, Niels H.; de Sousa, Jaime Correia; Cruz, Alvaro A.; Czarlewski, Wienczyslawa; De Carlo, Giuseppe; Demoly, Pascal; Devillier, Philippe; Dykewicz, Mark S.; Gaga, Mina; El-Gamal, Yehia; Fonseca, Joao; Fokkens, Wytske J.; Antonieta Guzman, Maria; Haahtela, Tari; Hellings, Peter W.; Illario, Maddalena; Carlos Ivancevich, Juan; Just, Jocelyne; Kaidashev, Igor; Khaitov, Musa; Khaltaev, Nikolai; Keil, Thomas; Klimek, Ludger; Kowalski, Marek L.; Kuna, Piotr; Kvedariene, Violeta; Larenas-Linnemann, Desiree E.; Laune, Daniel; Le, Lan T. T.; Carlsen, Karin C. Lodrup; Mahboub, Bassam; Maier, Dieter; Malva, Joao; Manning, Patrick J.; Morais-Almeida, Mario; Moesges, Ralph; Mullol, Joaquim; Munter, Lars; Murray, Ruth; Naclerio, Robert; Nannazova-Baranove, Leyla; Nekann, Kristof; Nyembue, Tshipukane Dieudonne; Okubo, Kimi; O'Hehir, Robyn E.; Ohta, Ken; Okamoto, Yoshitaka; Onorato, Gabrielle L.; Palkonen, Susanna; Panzner, Petr; Papadopoulos, Nikolaos G.; Park, Hae-Sim; Pawankar, Ruby; Pfaar, Oliver; Phillips, Jim; Plavec, Davor; Popov, Todor A.; Potter, Paul C.; Prokopakis, Emmanuel P.; Roller-Wirnsberger, Regina E.; Rottenn, Menachem; Ryan, Dermot; Sannolinski, Bolesfaw; Sanchez-Borges, Mario; Schunemann, Holger J.; Sheikh, Aziz; Sisul, Juan Carlos; Somekh, David; Stellato, Cristiana; To, Teresa; Todo-Bonn, Ana Maria; Tonnazic, Peter Valentin; Toppila-Salmi, Sanna; Valero, Antonio; Valiulis, Arunas; Valovirta, Errka; Ventura, Maria Teresa; Wagennnann, Martin; Wallace, Dana; Wasernnan, Susan; Wickman, Magnus; Yiallouros, Panayiotis K.; Yorgancioglu, Arzu; Yusuf, Osman M.; Zar, Heather J.; Zernotti, Mario E.; Zhang, Luo; Zidarn, Mihaela; Zuberbier, Torsten; Bousquet, Jean (2019)
    Pharmacists are trusted health care professionals. Many patients use over-the-counter (OTC) medications and are seen by pharmacists who are the initial point of contact for allergic rhinitis management in most countries. The role of pharmacists in integrated care pathways (ICPs) for allergic diseases is important. This paper builds on existing studies and provides tools intended to help pharmacists provide optimal advice/interventions/strategies to patients with rhinitis. The Allergic Rhinitis and its Impact on Asthma (ARIA)-pharmacy ICP includes a diagnostic questionnaire specifically focusing attention on key symptoms and markers of the disease, a systematic Diagnosis Guide (including differential diagnoses), and a simple flowchart with proposed treatment for rhinitis and asthma multimorbidity. Key prompts for referral within the ICP are included. The use of technology is critical to enhance the management of allergic rhinitis. However, the ARIA-pharmacy ICP should be adapted to local healthcare environments/situations as regional (national) differences exist in pharmacy care.
  • Krischer, Jeffrey P.; Cuthbertson, David; Couluris, Marisa; Knip, Mikael; Virtanen, Suvi M. (2020)
    Aims/hypothesis This paper presents the relationship between islet autoantibodies, precursors of type 1 diabetes, and the development of persistent asthma, allergic rhinitis and atopic eczema. Methods A total of 2159 newborns who had a first-degree relative with type 1 diabetes and selected HLA genotypes were followed until the youngest participant reached 10 years of age. Islet cell antibodies (ICA) were detected using indirect immunofluorescence. Autoantibodies to insulin (IAA), GAD (GADA), the tyrosine phosphatase-related insulinoma-associated 2 molecule (IA-2A) and zinc transporter 8 (ZnT8A) were quantified with the use of specific radiobinding assays. As an ancillary study, the incidence of asthma, allergic rhinitis and eczema was assessed in 1106 of these children using the International Study of Asthma and Allergies in Childhood (ISAAC) core questionnaire when the children were 9-11 years old. HRs with 95% CIs were calculated to depict the incidence of these diseases following seroconversion to autoantibody positivity. Results The cumulative incidence of atopic eczema, allergic rhinitis and persistent asthma were 22%, 9% and 7.5%, respectively, by 9-11 years of age. The occurrence of diabetes-related autoantibodies showed a protective association with subsequently reported incidence of asthma and eczema. The incidence of rhinitis was not significantly related to the occurrence of IAA or GADA (statistical power was limited), but demonstrated the same inverse relationship as did the other diseases with ICA or when multiple autoantibodies first appeared together. Conclusions/interpretation The findings add evidence to the relationships between these atopic diseases and diabetes-related autoimmunity and also suggest that, for eczema, the interaction depends upon which autoantibody appeared first.
  • Mäntylä, Jarkko; Mazur, Witold; Törölä, Tanja; Bergman, Paula; Saarinen, Tuomas; Kauppi, Paula (2019)
    Background: By definition bronchiectasis (BE) means destructed structure of normal bronchus as a consequence of frequent bacterial infections and inflammation. In many senses, BE is a neglected orphan disease. A recent pan-European registry study, EMBARC, has been set up in order to better understand its pathophysiology, better phenotype patients, and to individualize their management. Aim: To examine the aetiology and co-morbidity of BE in the capital area in Finland. Methods: Two hundred five patients with BE diagnosis and follow up visits between 2016 and 2017 in Helsinki University Hospital were invited to participate in the study. Baseline demographics, lung functions, imaging, microbiological, and therapeutic data, together with co-morbidities were entered into EMBARC database. Clinical characteristics, aetiologic factors, co-morbidities, and risk factors for extensive BE were explored. Results: To the study included 95 adult patients and seventy nine percent of the BE patients were women. The mean age was 69 years (SD +/- 13). Asthma was a comorbid condition in 68% of the patients but in 26% it was estimated to be the cause of BE. Asthma was aetiological factor for BE if it had been diagnosed earlier than BE. As 41% BE were idiopathic, in 11% the disorder was postinfectious and others were associated to rheumatic disease, Alpha-1-antitrypsin deficiency, IgG deficiency and Kartagener syndrome. The most common co-morbidities in addition to asthma were cardiovascular disease (30%), gastroesophageal reflux disease (26%), overweight (22%), diabetes (16%), inactive neoplasia (15%), and immunodeficiency (12%). Extensive BE was found in 68% of BE patients in whom four or more lobes were affected. Risk factors for extensive BE were asthma (OR 2.7), asthma as aetiology for BE (OR 4.3), and rhinosinusitis (OR 3.1). Conclusions: Asthma was associated to BE in 68% and it was estimated as aetiology in every fourth patient. However, retrospectively, it is difficult to exclude asthma as a background cause in patients with asthma-like symptoms and respiratory infections. We propose asthma as an aetiology factor for BE if it is diagnosed earlier than BE. Asthma and rhinosinusitis were predictive for extensive BE.
  • Honkamäki, Jasmin; Piirilä, Päivi; Hisinger-Mölkänen, Hanna; Tuomisto, Leena E.; Andersen, Heidi; Huhtala, Heini; Sovijärvi, Anssi; Lindqvist, Ari; Backman, Helena; Lundbäck, Bo; Rönmark, Eva; Lehtimäki, Lauri; Pallasaho, Paula; Ilmarinen, Pinja; Kankaanranta, Hannu (2021)
    BACKGROUND: Child-onset asthma is known to remit with high probability, but remission in adult-onset asthma is seem-ingly less frequent. Reports of the association between remission and asthma age of onset up to late adulthood are scarce. OBJECTIVE: To evaluate the association between asthma remission, age at diagnosis and gender, and assess risk factors of nonremission. METHODS: In 2016, a random sample of 16,000 subjects aged 20 to 69 years from Helsinki and Western Finland were sent a FinEsS questionnaire. Physician-diagnosed asthma was catego-rized by age at diagnosis to early-(0-11 years), intermediate-(12-39 years), and late-diagnosed (40-69 years) asthma. Asthma remission was defined by not having had asthma symptoms and not having used asthma medication in the past 12 months. RESULTS: Totally, 8199 (51.5%) responded, and 879 reported physician-diagnosed asthma. Remission was most common in early-diagnosed (30.2%), followed by intermediate-diagnosed (17.9%), and least common in late-diagnosed asthma (5.0%) (P < .001), and the median times from diagnosis were 27, 18.5, and 10 years, respectively. In males, the corresponding remission rates were 36.7%, 20.0%, and 3.4%, and in females, 20.4%, 16.6%, and 5.9% (gender difference P < .001). In multivariable binary logistic regression analysis, signifi-cant risk factors of asthma nonremission were intermediate (odds ratio [OR] = 2.15, 95% confidence interval: 1.373.36) and late diagnosis (OR = 11.06, 4.82-25.37) compared with early diagnosis, chronic obstructive pulmonary disease (COPD) (OR = 5.56, 1.26-24.49), allergic rhinitis (OR = 2.28, 1.50-3.46), and family history of asthma (OR = 1.86, 1.22-2.85). Results were similar after excluding COPD. CONCLUSION: Remission was rare in adults diagnosed with asthma after age 40 years in both genders. Late-diagnosed asthma was the most significant independent risk factor for nonremission. (C) 2020 American Academy of Allergy, Asthma & Immunology
  • Päivinen, Marja; Keskinen, Kari; Putus, Tuula; Kujala, Urho M.; Kalliokoski, Pentti; Tikkanen, Heikki O. (2021)
    Background Respiratory symptoms are common in competitive swimmers. However, among these and in swimmers at other activity levels the swimming distance, the total spent time in swimming halls and their medical background varies. Our objectives were, first, to assess their medical histories and the associations with respiratory symptoms among swimmers in different activity groups and then second, to study the pulmonary function findings and related medications in competitive swimmers who exercise in swimming hall environments the most. Methods First, 1118 participants consisting of 133 competitive-, 734 fitness- and 251 occasional swimmers answered questionnaires concerning their medical background, their respiratory symptoms in connection to swimming distance and their amount of time spent in swimming halls. Secondly, in 130 competitive swimmers, pulmonary function was tested by spirometry and a specific questionnaire was used to assess respiratory symptoms, medical histories and prescribed medication. Results Respiratory symptoms were reported by 18% of the studied swimmers. Competitive swimmers had significantly more symptoms than fitness- and occasional swimmers. Naturally competitive swimmers swum more than 2000 m and stayed by the pool more than 90 min, longer than the other activity groups of swimmers. Spirometry testing showed airway obstruction in 15 swimmers, which was 12% of the 130 competitive swimmers. 21 of them, had physician-diagnosed asthma and 16 of these individuals had prescribed medication for it. Conclusions Competitive swimmers had the highest swimming hall exposure and reported significantly more respiratory symptoms. A high prevalence of airway obstruction findings in competitive swimmers with asthma and allergies suggests a need for future recommendations for regular testing and special medical care for competitive swimmers.
  • Jantunen, Juha; Haahtela, Tari; Salimäki, Johanna; Pelkonen, Anna; Mäkelä, Mika; Kauppi, Paula (2018)
    Lähtökohdat Apteekeissa on seurattu barometrikyselyillä astma- tai allergialääkkeitä ostavien potilaiden oireita sekä lääkkeiden ja terveydenhuollon käyttöä. Menetelmät Kyselyyn osallistui 956 ostajaa vuonna 2016 ja 1 114 vuonna 2010; Vastaajista 60 %:lla ja 59 %:lla oli oikeus erityiskorvaukseen pysyvästä astmalääkityksestä. Vertasimme heidän ilmoittamaansa oireiden vaikeutta. Tulokset Vuonna 2016 vastaajista 2,5 % arvioi astmansa vaikeaksi, vuonna 2010 luku oli 3,8 %. Vaikeita allergiaoireita, hengenahdistusta ja hengityksen vinkumista oli merkitsevästi vähemmän vuonna 2016. Lähes joka yö astmaoireisiin heränneiden määrä väheni 15 %:sta 8 %:iin. Päivystyskäyntejä astman vuoksi oli vuoden aikana 16 %:lla ja sairaalahoitoja 6 %:lla vuonna 2016 vastanneista. Päätelmät Astmaa sairastavien vointi on Suomessa parantunut ja vain pienellä osalla tauti on vaikea. ¬Kansallisen allergiaohjelman aikana 2010–16 oireilu on edelleen hieman lieventynyt. Päivystyskäyntejä ja sairaalahoidon tarvetta voidaan vielä vähentää.
  • Tommola, Minna; Lehtimäki, Lauri; Kankaanranta, Hannu; Mazur, Witold (2021)
    Astman ja keuhkoahtaumataudin sekamuoto on ahtauttavia keuhkosairauksia sairastavilla potilailla melko tavallinen. Huolellinen anamneesi, status ja tupakointihistorian kartoitus sekä keuhkojen toimintakokeet ovat diagnostiikassa olennaisia. Hoidossa sovelletaan astman ja keuhkoahtaumataudin hoitosuosituksia yksilöllisen harkinnan mukaan. Hengitettävän glukokortikoidin (ICS) ja pitkävaikutteisen β2-agonistin (LABA) yhdistelmään pohjautuvan lääkehoidon ohella elämäntapamuutokset sekä liitännäissairauksien hoitaminen ovat tärkeitä kokonaisvaltaisen hoidon elementtejä.
  • Kauppi, Paula (2020)
  • Kauppi, Paula (2019)
  • Louhiala, Pekka; Hemilä, Harri (2014)
    In this article, we first take a critical look at the definitions of evidence-based medicine (EBM) and complementary and alternative medicine (CAM). We then explore the question of whether there can be evidence-based forms of CAM. With the help of three examples, we show that EBM and CAM are not opposites, but rather concepts pointing at different dimensions. Each of the three examples is an evidence-based treatment according to three to five randomised, double-blind placebo controlled trials with consistent findings and narrow pooled confidence intervals. The most reasonable interpretation for the existence of evidence-based CAM treatments seems to be that the opposite of CAM is ‘mainstream medicine’, and the demarcation line between CAM and mainstream medicine is not simply defined by the question of whether a treatment works or not. Some effective treatments may belong to the CAM domain for historical reasons and because of preconceptions within mainstream medicine. Therefore, some treatments that currently lie outside mainstream medicine can be evidence-based.
  • Lietzen, Raija; Virtanen, Pekka; Kivimaki, Mika; Korkeila, Jyrki; Suominen, Sakari; Sillanmaki, Lauri; Koskenvuo, Markku; Vahtera, Jussi (2017)
    Objective: This prospective, population-based cohort study of 1102 Finnish adults with asthma, examined whether exposure to stressful life events is associated with the intensity of usage of inhaled short-acting beta(2)-agonists. Methods: Survey data was collected by two postal questionnaires. Baseline characteristics were obtained in 1998 and data on 19 specific stressful events (e.g. death of a child or spouse or divorce) within the six preceding months in 2003. Exposure to life events was indicated by a sum score weighted by mean severity of the events. Participants were linked to records of filled prescriptions for inhaled short-acting beta(2)-agonists from national registers from 2000 through 2006. The rates of purchases of short-acting beta(2)-agonists before (2000 2001), during (2002 2003) and after (2004-2006) the event exposure were estimated using repeated-measures Poisson regression analyses with the generalized estimating equation. Results: Of the 1102 participants, 162 (15%) were exposed to highly stressful events, 205 (19%) to less stressful events. During the 7-year observation period, 5955 purchases of filled prescription for inhaled short-acting beta(2)-agonists were recorded. After exposure to highly stressful events, the rate of purchases of beta(2)-agonists was 1.50 times higher (95% confidence interval (CI): 1.05, 2.13) than before the stressful event occurred. Among those with low or no exposure to life events, the corresponding rate ratios were not elevated (rate ratio 0.81, 95% CI: 0.66, 0.99 and 0.95, 95% CI: 0.83, 1.09 respectively). Conclusion: An increase in beta(2)-agonist usage after severe life events suggests that stressful experiences may worsen asthma symptoms.
  • Bousquet, J.; Onorato, G. L.; Bachert, C.; Barbolini, M.; Bedbrook, A.; Bjermer, L.; de Sousa, J. Correia; Chavannes, N. H.; Cruz, A. A.; Keenoy, E. De Manuel; Devillier, P.; Fonseca, J.; Hun, S.; Kostka, T.; Hellings, P. W.; Illario, M.; Ivancevich, J. C.; Larenas-Linnemann, D.; Millot-Keurinck, J.; Ryan, D.; Samolinski, B.; Sheikh, A.; Yorgancioglu, A.; Agache, I.; Arnavielhe, S.; Bewick, M.; Annesi-Maesano, I.; Anto, J. M.; Bergmann, K. C.; Bindslev-Jensen, C.; Bosnic-Anticevich, S.; Bouchard, J.; Caimmi, D. P.; Camargos, P.; Canonica, G. W.; Cardona, V.; Carriazo, A. M.; Cingi, C.; Colgan, E.; Custovic, A.; Dahl, R.; Demoly, P.; De Vries, G.; Fokkens, W. J.; Fontaine, J. F.; Gemicioglu, B.; Guldemond, N.; Gutter, Z.; Haahtela, T.; Hellqvist-Dahl, B.; Jares, E.; Joos, G.; Just, J.; Khaltaev, N.; Keil, T.; Klimek, L.; Kowalski, M. L.; Kull, I.; Kuna, P.; Kvedariene, V.; Laune, D.; Louis, R.; Magnan, A.; Malva, J.; Mathieu-Dupas, E.; Melen, E.; Menditto, E.; Morais-Almeida, M.; Mosges, R.; Mullol, J.; Murray, R.; Neffen, H.; O'Hehir, R.; Palkonen, S.; Papadopoulos, N. G.; Passalacqua, G.; Pepin, J. L.; Portejoie, F.; Price, D.; Pugin, B.; Raciborski, F.; Simons, F. E. R.; Sova, M.; Spranger, O.; Stellato, C.; Bom, A. Todo; Tomazic, P. V.; Triggiani, M.; Valero, A.; Valovirta, E.; VandenPlas, O.; Valiulis, A.; Van Eerd, M.; Ventura, M. T.; Wickman, M.; Young, I.; Zuberbier, T.; Zurkuhlen, A.; Senn, A. (2017)
    A Good Practice is a practice that works well, produces good results, and is recommended as a model. MACVIA-ARIA Sentinel Network (MASK), the new Allergic Rhinitis and its Impact on Asthma (ARIA) initiative, is an example of a Good Practice focusing on the implementation of multi-sectoral care pathways using emerging technologies with real life data in rhinitis and asthma multi-morbidity. The European Union Joint Action on Chronic Diseases and Promoting Healthy Ageing across the Life Cycle (JA-CHRODIS) has developed a checklist of 28 items for the evaluation of Good Practices. SUNFRAIL (Reference Sites Network for Prevention and Care of Frailty and Chronic Conditions in community dwelling persons of EU Countries), a European Union project, assessed whether MASK is in line with the 28 items of JA-CHRODIS. A short summary was proposed for each item and 18 experts, all members of ARIA and SUNFRAIL from 12 countries, assessed the 28 items using a Survey Monkey-based questionnaire. A visual analogue scale (VAS) from 0 (strongly disagree) to 100 (strongly agree) was used. Agreement equal or over 75% was observed for 14 items (50%). MASK is following the JA-CHRODIS recommendations for the evaluation of Good Practices.
  • Hirvonen, Eveliina; Stepanov, Mikhael; Kilpeläinen, Maritta; Lindqvist, Ari; Laitinen, Tarja (2019)
    Introduction: Smoking has a significant impact on the development and progression of asthma and chronic obstructive pulmonary disease (COPD). Self-reported questionnaires and structured interviews are usually the only way to study patients' smoking history. In this study, we aim to examine the consistency of the responses of asthma and COPD patients to repeated standardised questions on their smoking habits over the period of 10 years. Methods: The study population consisted of 1329 asthma and 959 COPD patients, who enrolled in the study during years 2005-2007. A follow-up questionnaire was mailed to the participants 1, 2, 4, 6, 8, and 10 years after the recruitment. Results: Among the participants who returned three or more questionnaires (N = 1454), 78.5 % of the patients reported unchanged smoking status (never smoker, ex-smoker or current smoker) across the time. In 4.5% of the answers, the reported smoking statuses were considered unreliable/conflicting (first never smoker and, later, smoker or ex-smoker). The remainder of the patients changed their status from current smoker to ex-smoker and vice versa at least once, most likely due to struggling with quitting. COPD patients were more frequently heavy ex- or current smokers compared to the asthma group. The intraclass coefficient correlations between self-reported starting (0.85) and stopping (0.94) years as well as the consumption of cigarettes (0.74) over time showed good reliability among both asthma and COPD patients. Conclusion: Self-reported smoking data among elderly asthma and COPD patients over a 10-year follow-up is reliable. Pack years can be considered a rough estimate for their comprehensive consumption of tobacco products over time. We also observed that the questionnaire we used was not designed for dynamic changes in smoking which are rather common among heavy smokers especially when the follow-up time is several years, as in our study.
  • Taponen, Saara; Lehtimaki, Lauri; Karvala, Kirsi; Luukkonen, Ritva; Uitti, Jukka (2017)
    Background: This study aims to elucidate factors that among adults with asthma are associated with working full-time. Methods: This cross-sectional survey of 2613 working-age adults with asthma included questions on asthma history, symptoms and use of asthma medication, socioeconomic factors and health behavior. Full-time workers were compared to groups according to employment status: unemployed, work disability and retired due to age. Results: Adults with asthma working full time were younger and more often nonmanual workers, experienced less asthma symptoms, used less asthma medication and smoked less than subjects with work disability. After adjusting for age, gender, smoking and professional status, having frequent symptoms of asthma during last month was associated with an increase in the risk of unemployment (OR 2.3, 95% CI 1.3-4.2) and with an increase in the risk of work disability (OR 4.4, 95% CI 2.3-8.2). Conclusions: Among adults with asthma, full-time work was associated with younger age, less symptomatic asthma despite of less medication, nonmanual work and less smoking. Having more severe symptoms of asthma was associated with undesirable employment status such as unemployment or work disability. Possibilities to change from manual to nonmanual work may be important in preventing work disability and early exit from work.