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Cardiovascular diseases are the most common comorbidities in COPD, due to common risk factors such as smoking. The prevalence of current smokers in Sweden has decreased over four decades to around 10%. The aim of the present study was to investigate the prevalence, distribution and associations of cardiovascular comorbidities in COPD by disease severity in two large areas of Sweden, both with low-smoking prevalence. Data from clinical examinations in 2009-2012, including spirometry and structured interview, from two large-scale population studies, the West Sweden Asthma Study (WSAS) and the OLIN Studies in Northern Sweden, were pooled. COPD was defined using post-bronchodilator spirometry according to the fixed ratio FEV 1 /FVC <0.70 and the lower limit of normal (LLN 5th percentile) of the ratio of FEV 1 /FVC. Of the 1839 subjects included, 8.7% and 5.7% had COPD according to the fixed ratio and the LLN criterion. Medication for heart disease or hypertension among those with moderate-to-severe COPD was more common than among those without COPD (fixed ratio definition of COPD: 51% vs. 23%, p < 0.001; LLN definition: 42% vs. 24%, p = 0.002). After adjusting for known risk factors for COPD, including smoking, age, socio-economic status, and occupational exposure for gas, dust and fumes, only heart failure remained significantly, and independently, associated with COPD, irrespective of the definitions of COPD. Though a major decrease in smoking prevalence, the pattern of cardiovascular comorbidities in COPD still remains similar with previously performed studies in Sweden and in other Westernized countries as well.

Background: Smoking is a risk factor for developing rheumatoid arthritis (RA), but the mechanism remains uncertain. We previously demonstrated that smoking lowers the T cell activation threshold by limiting programmed death protein 1 (PD-1) expression., Aim: To investigate how smoking influence the levels of soluble PD-1 ligand (sPD-L1)., Method: Serum levels of sPD-L1 were measured in 246 RA patients and in 168 healthy subjects. The analysis was done with respect to inflammation, smoking, treatments, and autoantibody status. The effect of therapeutic TNF-inhibiting antibodies (TNFi) on sPD-L1 was studied in 16 RA patients at their first infliximab infusion. The expression of Fcγ-receptor (FcγR) subclass IIB and IIIA was analyzed with quantitative polymerase chain reaction in peripheral blood mononuclear cells (PBMCs) from 12 RA patients and 15 healthy controls, and in healthy PBMC exposed to IgG containing antibodies to cyclic citrullinated peptides (aCCP)., Results: The negative association between smoking and sPD-L1 in RA patients was established by multiple logistic regression (OR = 0.52, p  = 0.038). Other covariates in the regression model were serum levels of IL-1β representing inflammation (OR = 1.6, p  = 0.0076) and aCCP positivity (OR = 1.9, p  = 0.047). First infliximab infusion repressed sPD-L1 ( p  = 0.023) in patients, and low levels of sPD-L1 were found in patients with early RA treated with TNFi ( p  = 0.018). Treatment with TNFi was associated with higher sPD-L1 in patients with long disease duration ( p  = 0.041) and restored levels in smokers. In vitro exposure to aCCP+ IgG suppressed sPD-L1 ( p  = 0.036), but aCCP+ patients with long disease duration had higher sPD-L1 ( p  = 0.016). High ratio of the inhibitory FcγR subclass IIB over the stimulatory IIIA resulted in low sPD-L1 release ( p  = 0.029). Smoking was associated with a higher FcγR IIB/IIIA ratio ( p  = 0.00062) and lower levels of sPD-L1 ( p  = 0.013)., Conclusion: In RA, serum sPD-L1 was related to systemic inflammation and aCCP positivity. Smoking altered the expression of FcγRs and limited sPD-L1 in RA patients, permitting inappropriate T cell responses. Differential regulation of sPD-L1 during the early and late RA may indicate transposition from acute to chronic inflammation.

Importance: There is an ongoing debate about whether electronic cigarettes (e-cigarettes) are the solution to the tobacco epidemic or a new public health threat. Large representative studies are needed to study e-cigarette use in the general population, but hardly any have been published., Objectives: To estimate the prevalence of e-cigarette use and to investigate the association of e-cigarette use with smoking habits, demographic factors, and respiratory symptoms., Design, Setting, and Participants: Cross-sectional, population-based study of random samples of the population, performed within the Obstructive Lung Disease in Northern Sweden (OLIN) study and West Sweden Asthma Study (WSAS). The same validated questionnaire including identical questions was used in OLIN and WSAS. In 2016, OLIN and WSAS conducted postal questionnaire surveys in random samples of adults aged 20 to 75 years. In OLIN, 6519 participated (response rate, 56.4%); in WSAS, 23 753 participated (response rate, 50.1%)., Main Outcomes and Measures: Electronic cigarette use, smoking habits, and respiratory symptoms., Results: Of 30 272 participants (16 325 women [53.9%]), 3897 (12.9%) were aged 20 to 29 years; 4242 (14.0%), 30 to 39 years; 5082 (16.8%), 40 to 49 years; 6052 (20.0%), 50 to 59 years; 6628 (21.9%), 60 to 69 years; and 4371 (14.4%), 70 to 75 years. The number of current smokers was 3694 (12.3%), and 7305 (24.4%) were former smokers. The number of e-cigarette users was 529 (2.0%), and e-cigarette use was more common among men (275 of 12 347 [2.2%; 95% CI, 2.0%-2.5%]) than women (254 of 14 022 [1.8%; 95% CI, 1.6%-2.0%]). Among current smokers, 350 of 3566 (9.8%; 95% CI, 8.8%-10.8%) used e-cigarettes compared with 79 of 6875 (1.1%; 95% CI, 0.9%-1.3%) in former smokers and 96 of 15 832 (0.6%; 95% CI, 0.5%-0.7%) in nonsmokers (P < .001). Among e-cigarette users who answered the survey question about cigarette-smoking habits (n = 525), 350 (66.7%; 95% CI, 62.7%-70.7%) were current smokers, 79 (15.0%; 95% CI, 11.9%-18.1%) were former smokers, and 96 (18.3%; 95% CI, 15.0%-21.6%) were nonsmokers (P < .001 for trend). In a regression analysis, e-cigarette use was associated with male sex (odds ratio [OR], 1.35; 95% CI, 1.12-1.62); age groups 20 to 29 years (OR, 2.77; 95% CI, 1.90-4.05), 30 to 39 years (OR, 2.27; 95% CI, 1.53-3.36), 40 to 49 years (OR, 1.65; 95% CI, 1.11-2.44), and 50 to 59 years (OR, 1.47; 95% CI, 1.01-2.12); educational level at primary school (OR, 1.99; 95% CI, 1.51-2.64) and upper secondary school (OR, 1.57; 95% CI, 1.25-1.96); former smoking (OR, 2.37; 95% CI, 1.73-3.24); and current smoking (OR, 18.10; 95% CI, 14.19-23.09). All respiratory symptoms were most common among dual users and former smokers and nonsmokers who used e-cigarettes., Conclusions and Relevance: Use of e-cigarettes was most common among smokers, and dual users had the highest prevalence of respiratory symptoms. On a population level, this study indicates that the present use of e-cigarettes does not adequately serve as a smoking cessation tool.

CD8 + T cells have an emerging role in RA. Resent research indicates a causal relationship between the non-exhausted state of CD8 + T cells, defined by lost function of PD-1, and development of arthritis. We investigated how smoking contributes to the non-exhausted phenotype of CD8 + T cells and cause survivin release to serum. We compared serum survivin levels between smokers and non-smokers in 252 RA and 168 healthy subjects. Nicotine effects on CD8 + T cells were studied in peripheral blood of smoking women, bone marrow of nicotine treated mice and in sorted CD8 spleen cells in vitro using flow cytometry and quantitative PCR. Smoking increased the frequency of survivin release in serum of healthy women (OR 3.64, p = 0.025) and in RA patients (OR 1.98, p = 0.039). CD8 + T cells of smokers gained a non-exhausted PD-1 deficient phenotype. Expression of the cytotoxic marker CD107 correlated to survivin levels in serum. In the experimental setting, nicotine exposure led to an accumulation of non-exhausted PD-1 - IL-7R + CD8 + T cells in the bone marrow that is abundant with survivin producing cells. The production of the cytolytic protein perforin in bone marrow correlated to serum survivin levels. In vitro stimulation of nicotinic receptors on murine CD8 + T cells induced repressive transcription factors T-bet and Blimp-1 in support of the non-exhausted phenotype. We conclude that nicotine contributes to autoimmunity by supporting the non-exhausted state of CD8 + T cells resulting in the release of survivin. This presents a new mechanism by which smoking may contribute to the pathogenesis of RA., (Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.)

The prevalence of COPD and its risk factor pattern varies between different areas of the world. The aim of this study was to investigate the prevalence of COPD by disease severity in men and women and risk factors for COPD in northern Vietnam. From all 5782 responders to a questionnaire survey, a randomly selected sample of 1500 subjects was invited to a clinical follow-up study. The methods included a structured interview using a modified GA2LEN study questionnaire for registration of symptoms and possible determinants of disease. Spirometry was performed before and after bronchodilation. The age distribution of the sample was 23-72 years. Of 684 subjects attending, 565 completed acceptable spirometric measurements. The prevalence of COPD defined by the GOLD criteria was 7.1%; in men 10.9% and in women 3.9% (p = 0.002). Of those 3.4% had a mild disease, 2.8% a moderate and 0.9% a severe disease. In ages >50 years, 23.5% of men and 6.8% of women had COPD. Among smokers aged >60 years (all men), 47.8% had COPD. None of the women with COPD had been smokers. Increasing age, smoking and male sex were the dominating risk factors, although male sex lost its significance in a multivariate setting. The prevalence of COPD among adults in northern Vietnam was 7.1% and was considerably higher among men than women. The prevalence increased considerably with age. Increasing age and smoking, the latter among men only, were the most important determinants of COPD.

Background: After 10 years of a decrease in smoking among young people in Sweden, we now have indications of increased smoking., Aims: To provide up-to-date information on the prevalence of smoking and smoke-associated respiratory symptoms in young adults in Sweden, with a special focus on possible gender differences., Methods: In the West Sweden Asthma Study, a detailed postal questionnaire focusing on asthma, respiratory symptoms, and possible risk factors was mailed to 30,000 randomly selected subjects aged 16-75 years. The analyses are based on responses from 2,702 subjects aged 16-25 years., Results: More young women than men were smokers (23.5% vs. 15.9%; p<0.001). Women started smoking earlier and smoked more. Symptoms such as longstanding cough, sputum production, and wheeze were significantly more common in smokers. In the multiple logistic regression analysis, smoking significantly increased the risk of recurrent wheeze (odds ratio (OR) 2.0 (95% CI 1.4 to 3.0)) and sputum production, (OR 2.4 (95% CI 1.9 to 3.1))., Conclusions: The alarmingly high prevalence of smoking among young women was parallel to a similarly high prevalence of bronchitis symptoms. This is worrisome, both in itself and because maternal smoking is a risk factor for illness in the child. Adverse respiratory effects of smoking occur within only a few years of smoking initiation.

Background: The harmful effects of tobacco smoke on human health, including respiratory health, are extensive and well documented. Previous data on the effect of smoking on rhinitis and allergic sensitization are inconsistent. We sought to investigate how smoking correlates with prevalence of allergic and chronic rhinitis among adults in Sweden., Methods: The study population comprised 27 879 subjects derived from three large randomly selected cross-sectional population surveys conducted in Sweden between 2006 and 2008. The same postal questionnaire on respiratory health was used in the three surveys, containing questions about obstructive respiratory diseases, rhinitis, respiratory symptoms and possible determinants of disease, including smoking habits. A random sample from one of the cohorts underwent a clinical examination including skin prick testing., Results: Smoking was associated with a high prevalence of chronic rhinitis in both men and women and a low prevalence of allergic rhinitis in men. These associations were dose dependent and remained when adjusted for a number of possible confounders in multiple logistic regression analysis. Prevalence of chronic rhinitis was lowest in nonsmokers and highest in very heavy smokers (18.5% vs 34.5%, P < 0.001). Prevalence of sensitization to common airborne allergens was lower in current smokers (25.9%, P = 0.008) and ex-smokers (28.2%, P = 0.022) than in nonsmokers (38.5%)., Conclusion: We found that smoking was associated with a high prevalence of chronic rhinitis in both sexes and a low prevalence of allergic rhinitis in men. The associations were dose dependent and remained when adjusting for several possible confounders., (© 2013 John Wiley & Sons A/S. Published by Blackwell Publishing Ltd.)

Background: Women who smoke have higher risk of lung function impairment, COPD and lung cancer than smoking men. An influence of sex hormones has been demonstrated, but the mechanisms are unclear and the associations often subject to confounding. This was a study of wheeze in relation to smoking and sex with adjustment for important confounders., Methods: In 2008 the Global Allergy and Asthma European Network (GA(2)LEN) questionnaire was mailed to 45.000 Swedes (age 16-75 years), and 26.851 (60%) participated. "Any wheeze": any wheeze during the last 12 months. "Asthmatic wheeze": wheeze with breathlessness apart from colds., Results: Any wheeze and asthmatic wheeze was reported by 17.3% and 7.1% of women, vs. 15.8% and 6.1% of men (both p<0.001). Although smoking prevalence was similar in both sexes, men had greater cumulative exposure, 16.2 pack-years vs. 12.8 in women (p<0.001). Most other exposures and characteristics associated with wheeze were significantly overrepresented in men. Adjusted for these potential confounders and pack-years, current smoking was a stronger risk factor for any wheeze in women aged <53 years, adjusted odds ratio (aOR) 1.85 (1.56-2.19) vs. 1.60 (1.30-1.96) in men. Cumulative smoke exposure and current smoking each interacted significantly with female sex, aOR 1.02 per pack-year (p<0.01) and aOR 1.28 (p = 0.04) respectively. Female compared to male current smokers also had greater risk of asthmatic wheeze, aOR 1.53 vs. 1.03, interaction aOR 1.52 (p = 0.02). These interactions were not seen in age ≥ 53 years., Discussion: In addition to the increased risk of COPD and lung cancer female, compared to male, smokers are at greater risk of significant wheezing symptoms in younger age. This became clearer after adjustment for important confounders including cumulative smoke exposure. Estrogen has previously been shown to increase the bioactivation of several compounds in tobacco smoke, which may enhance smoke-induced airway inflammation in fertile women.

Background: In westernized countries smoking and increasing age are the most important risk factors for COPD. Prevalence and risk factors of COPD among non-smokers are not well studied., Aim: To study the prevalence and risk factors of COPD among non-smokers and to determine the proportion of non-smokers among subjects with COPD., Methods: A random sample of 2470 subjects drawn from a population-based postal survey of 10,040 (85-88% participation) adults (aged 20-77) in Norrbotten, Sweden, were invited to structured interviews and lung function tests, and 1897 participated. COPD was classified using the fixed ratio (GOLD) definition and for comparison the lower limit of normal (LLN)., Results: The prevalence of airway obstruction was 6.9% among non-smokers and strongly age related. The prevalence of GOLD stage ≥II among non-smokers was 3.5%. Both among subjects with airway obstruction and among subjects with GOLD stage ≥II, the proportions of non-smokers were 20%. Of men with airway obstruction, 14.1% were non-smokers versus 26.8% among women. Non-smokers with GOLD stage ≥II had significantly more symptoms and higher co-morbidity than non-smokers without airway obstruction. Sex, area of domicile and exposure to environmental tobacco smoke was not significantly associated to airway obstruction among non-smokers. Using LLN for defining airway obstruction yielded a similar prevalence., Conclusion: The prevalence of airway obstruction among non-smokers was close to 7% and was associated with increasing age. One out of seven men with airway obstruction, defined using the fixed ratio, versus one out of four women had never smoked., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

The aim was to estimate the incidence rate of adult-onset asthma in relation to age, sex, smoking and occupational exposures. A random sample of 18,087 subjects aged 16-75 years was investigated using a respiratory questionnaire. Adult-onset asthma was defined as "physician-diagnosed" asthma with onset at or after 16 years of age. The subjects were asked about year of asthma diagnosis and year of starting and stopping smoking. Subjects with onset of asthma before 16 years of age and physician-diagnosed chronic obstructive pulmonary disease were excluded resulting in a study population of 15,761 subjects. Incidence-rates of adult-onset asthma were calculated and relative risks were assessed using Cox-regression models. During the observation period 1990-2008, 359 new cases of asthma occurred and the cumulative incidence for adult-onset asthma was 2.3%. The crude incidence rate was 1.4/1000 person-years (95% confidence interval 1.3/1000-1.6/1000), with significantly higher incidence rate among women than among men. The incidence rate of asthma during never-smoking years was similar to that during smoking years. The rate of asthma incidence decreased with increasing age. Occupational dust and fume exposure and being female were associated with increased risk of asthma. The attributable fraction for occupational exposure to gas, dust and fumes was 9.4% in the total group, 17.3% among men and 5.1% among women. The incidence rate of asthma was higher among women than among men, and the rate declined with increasing age. A substantial proportion of the new-onset asthma cases could be attributed to occupational exposures., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

Background: While a large amount of data about the epidemiology of asthma, COPD, chronic bronchitis and respiratory symptoms are available from developed countries, the information about these diseases in developing countries in south-east Asia are scarce., Aim: Assess the prevalence of respiratory diseases and symptoms and their relation with demographic data including smoking habits among adults in rural and urban Vietnam., Methods: A random sample of subjects aged 21-70 years were invited; 3008 subjects living in an inner city area of Hanoi and 4000 in a rural area of Bavi in northern Vietnam. An internationally used questionnaire was delivered by field workers to the study subjects. The questionnaire was completed by the subjects, or when necessary, by the field workers after reading the questions for the study participants., Results: The response rate was 92% in Bavi and 70% in Hanoi. Of men in Bavi 67.8% (Hanoi 49.7%; p < 0.001) were smokers, while of women 4.2% were smokers in Hanoi (Bavi 1.2%; p < 0.001). The prevalence of ever asthma was in Hanoi 5.6% (Bavi 3.9%; p = 0.003) with no major gender difference. The most common symptom was longstanding cough (Hanoi 18.1%, Bavi 12.0%; p < 0.001) followed by sputum production, while the prevalence of symptoms common in asthma was considerably lower. Although the large difference in smoking habits, respiratory symptoms tended to be only slightly more common in men than women. Family history of asthma and chronic bronchitis, respectively, were strongly associated with both diseases., Conclusions: The prevalence of asthma in adults may have increased in both urban and rural Vietnam, as the few previous estimates have found 2% of adults having asthma. Half of men in Hanoi and two-thirds in Bavi were smokers versus a few percent of women in both areas. Bronchitic symptoms were common in both men and women., (Copyright © 2010 Elsevier Ltd. All rights reserved.)

Background Population-based studies on aspirin-intolerant asthma (AIA) are very few, and no previous population study has investigated risk factors for the condition. Objective To investigate the prevalence and risk factors of AIA in the general population. Methods A questionnaire on respiratory health was mailed to 30 000 randomly selected subjects aged 16-75 years in West Sweden, 29 218 could be traced and 18 087 (62%) responded. The questionnaire included questions on asthma, respiratory symptoms, aspirin-induced dyspnoea and possible determinants. Results The prevalence of AIA was 0.5%, 0.3% in men and 0.6% in women ( P = 0.014). Sick leave, emergency visits due to asthma and all investigated lower respiratory symptoms were more common in AIA than in aspirin-tolerant asthma (ATA). Obesity was a strong risk factor for AIA ( BMI > 35: odds ratio ( OR) 12.1; 95% CI 2.49-58.5), and there was a dose-response relationship between increasing body mass index (BMI) and risk of AIA. Obesity, airborne occupational exposure and visible mould at home were considerably stronger risk factors for AIA than for ATA. Current smoking was a risk factor for AIA ( OR 2.55; 95% CI 1.47-4.42), but not ATA. Conclusion Aspirin-intolerant asthma identified in the general population was associated with a high burden of symptoms, uncontrolled disease and a high morbidity. Increasing BMI increased the risk of AIA in a dose-response manner. A number of risk factors, including obesity and current smoking, were considerably stronger for AIA than for ATA. [ABSTRACT FROM AUTHOR]

Background In contrast to asthma and rhinitis, few studies among adults investigating the prevalence and risk factors of eczema have been published. Objectives To investigate the prevalence and risk factors of eczema among adults in West Sweden. A further aim was to study the associations between asthma, rhinitis and eczema. Methods A questionnaire on respiratory health was mailed in 2008 to 30 000 randomly selected subjects in West Sweden aged 16-75 years; 62% responded. The questionnaire included questions about eczema, respiratory symptoms and diseases and their possible determinants. A subgroup of 669 subjects underwent skin prick testing against common airborne allergens. Results 'Eczema ever' was reported by 40·7% and 'current eczema' by 11·5%. Both conditions were significantly more common among women. The prevalence decreased with increasing age. The coexistence of both asthma and rhinitis with eczema was common. The main risk factors were family history of allergy and asthma. The dominant environmental risk factor was occupational exposure to gas, dust or fumes. Smoking increased the risk. Eczema was associated with urbanization, while growing up on a farm was associated with a decreased risk. Added one by one to the multivariate model, asthma, allergic rhinitis and any positive skin prick test were associated with eczema. Conclusions Eczema among adults is a common disease with more women than men having and having had eczema. Eczema is associated with other atopic diseases and with airway symptoms. Hereditary factors and exposure to gas, dust and fumes are associated with eczema. [ABSTRACT FROM AUTHOR]