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Silvia Cabrera Guerrero,1,&ast; Kjell Erik Julius Håkansson,2,&ast; Vibeke Backer,3 Charlotte Suppli Ulrik,1,4 Deepa Rastogi1,5 1Division of Pulmonary and Sleep Medicine, Children’s National Health System, Washington, DC, USA; 2Department of Respiratory Medicine, Copenhagen University Hospital - Hvidovre, Hvidovre, Denmark; 3Department of Otorhinolaryngology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; 4Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; 5Pediatrics, Genomics and Precision Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC, USA&ast;These authors contributed equally to this workCorrespondence: Kjell Erik Julius Håkansson, Respiratory Research Unit, Department of Respiratory Medicine, Copenhagen University Hospital – Hvidovre, Hvidovre, 2650, Denmark, Email kjell@kjell.dkBackground: Paediatric asthma is associated with caregiver depression, which in turn is associated with poor asthma control. Although sociodemographic risk factors are associated with parental depression among children with asthma, the contribution of these factors to caregiver depression in free-to-access universal healthcare settings is unknown.Methods: The association between childhood asthma and parental antidepressant use was investigated in a Danish nationwide cohort of children aged 2– 17 years that redeemed inhaled corticosteroids in 2015. The odds of antidepressant use were estimated in comparison to control families that were matched 1:1 on the number of siblings, residence, income, and education.Results: Among the families of 28,595 children with actively treated asthma, 12% of mothers and 6.2% of fathers were on antidepressant therapy, compared to 9.3% and 5.3% in controls (p< 0.001). Paediatric asthma was associated with increased odds of parental antidepressant use (OR 1.29 (1.23– 1.35)), even after adjusting for parental asthma. Poor asthma control, but not higher asthma severity, was associated with higher odds of antidepressant use (1.43 (1.31– 1.56)). Compared with the controls, families with two or more children with asthma had higher OR (1.42 (1.29– 1.56)) than those with a single child (OR 1.27 (1.21– 1.34)). Low socioeconomic status was associated with parental antidepressant use.Conclusion: Caregiver depression in a Danish cohort is more prevalent among mothers than among fathers and is associated with poor asthma control in children. Antidepressant use among caregivers was associated with total family asthma burden and was independent of socioeconomic status.Keywords: pediatric asthma, mental health, quality of life, pharmacoepidemiology

Kjell Erik Julius Håkansson,1 Vibeke Backer,2,3 Charlotte Suppli Ulrik1,4 1Department of Respiratory Medicine, Copenhagen University Hospital - Hvidovre, Hvidovre, Denmark; 2Center for Physical Activity Research (CFAS), Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; 3Department of ENT, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; 4Institute of Clinical Medicine, University of Copenhagen, Copenhagen, DenmarkCorrespondence: Kjell Erik Julius Håkansson, Respiratory Research Unit 237, Department of Respiratory Medicine, Copenhagen University Hospital - Hvidovre, Kettegård Allé 30, Hvidovre, 2650, Denmark, Email kjell@kjell.dkIntroduction: The impact of asthma and disease control on job absenteeism in young adults is sparsely investigated and conflicting evidence exist. Based on a nationwide cohort, the present study aims to describe the overall job absenteeism across asthma severities and describe the possible influence of asthma control.Methods: REASSESS is a nationwide cohort of Danish asthma patients aged 18– 45 using controller medication between 2014 and 2018, followed retrospectively for up to 15 years using national databases. Impact of asthma was investigated using negative binomial regression adjusted for age, sex, Charlson score and level of education and presented as adjusted incidence rate ratios with 95% confidence intervals.Results: A total of 60,534 patients with asthma (median age 33 (25, 39), 55% female, 19% uncontrolled disease and 5.7% possible severe asthma) were followed for 12.7 (6.5– 14.8) years. The prevalence of any absenteeism was more common in both mild-to-moderate and possible severe asthma compared to the background population (67%, 80% and 62%, respectively; p < 0.0001). Compared to the background population, mild-to-moderate and possible severe asthma were more likely to have temporary sick leave (1.37 (1.33– 1.42); 1.78 (1.62– 1.96)), unemployment (1.11 (1.07– 1.14); 1.26 (1.15– 1.38)) and obtain disability benefits (1.67 (1.66– 1.67); 2.64 (2.63– 2.65)). Uncontrolled asthma had increased temporary sick leave (1.42 (1.34– 1.50)), unemployment (1.40 (1.32– 1.48)) and disability (1.26 (1.26– 1.27)) when compared to controlled disease. Significant increases in absenteeism could be measured already at ≥ 100 annual doses of rescue medication (1.09 (1.04– 0.1.14)), patients’ first moderate or severe exacerbation (1.31 (1.15– 1.49) and 1.31 (1.24– 1.39), respectively). Further increases in absenteeism were observed with increasing rescue medication use and severe exacerbations.Conclusion: Across severities, job absenteeism is increased among patients with asthma compared to the background population. Increases in absenteeism was seen already at ≥ 100 annual doses of rescue medication, representing a substantial, and probably preventable, reduction in productivity among young adults.Keywords: airway diseases, burden of disease, cost of disease, observational cohort, societal cost

Kjell Erik Julius Håkansson,1 Martino Renzi-Lomholt,1 Vibeke Backer,2,3 Charlotte Suppli Ulrik1,4 1Department of Respiratory Medicine, Copenhagen University Hospital - Hvidovre, Hvidovre, Denmark; 2Center for Physical Activity Research (CFAS), Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; 3Department of ENT, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; 4Institute of Clinical Medicine, University of Copenhagen, Copenhagen, DenmarkCorrespondence: Kjell Erik Julius HåkanssonDepartment of Respiratory Medicine, Copenhagen University Hospital - Hvidovre, Kettegård Allé 30, Hvidovre, 2650, DenmarkEmail kjell@kjell.dkPurpose: In asthma, increased severity has been linked to depression assessed as assessed by patient-reported outcomes. However, little is known about predictors of antidepressant use in asthma compared to the background population.Methods: The study consists of 60,534 asthma patients aged 18– 45 and a 1:1 age- and sex-matched control group. Using national registries and prescription data, the prevalence of and risk factors for antidepressant use were investigated by logistic regression adjusted for age, sex, workforce and civil status, income- and education-level and comorbidity. Results presented as odds ratio (OR) with 95% confidence intervals (CI).Results: A total of 16% and 22%, respectively, among patients with mild-to-moderate and possible severe asthma redeemed antidepressant drugs, compared to 10% of controls. Antidepressant use was more prevalent amongst patients with high rescue medication use (> 600 annual doses) and those with a history of moderate or severe exacerbation(s). Both mild-to-moderate and possible severe asthma were independent risk factors for antidepressant use (OR 1.40 (95% CI 1.35, 1.46) and OR 1.55 (95% CI 1.41, 1.70), respectively). Female sex, age, being divorced or never married, having only primary education or currently being under education, as well as being on welfare/transfer income increased odds of antidepressant use. Completing higher education and having high income were associated with lower odds.Conclusion: In asthma, antidepressant use is significantly higher than in the background population. Even after adjusting for known risk factors, asthma remains a predictor of antidepressant use, signalling a psychologic burden related to living with asthma.Keywords: depression, anxiety, major mood disorders, airway disease, disease burden

Casper Tidemandsen,1 Anne Vejen Hansen,1 Vibeke Backer,2 Elisabeth Juul Gade,3 Zarqa Ali,4 Charlotte Suppli Ulrik1,2 1Department of Respiratory Medicine, Hvidovre Hospital, Hvidovre, Denmark; 2Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; 3Department of Gynecology and Obstetrics, Rigshospitalet, Copenhagen, Denmark; 4Department of Dermatology and Wound Healing Centre, Bispebjerg Hospital, Copenhagen, DenmarkCorrespondence: Casper TidemandsenRespiratory Research Unit Hvidovre, Department of Respiratory Medicine, Hvidovre University Hospital, Kettegård Alle 30, Hvidovre DK-2650, DenmarkTel +45 50751516Email casper.tidemandsen.01@regionh.dkBackground: Asthma has been linked with prolonged time to pregnancy compared to healthy controls, also asthma has been linked to a higher need for fertility treatment. However, knowledge of the possible association between allergy and need for fertility treatment is limited. Our aim was to explore a possible difference in having had fertility treatment in women with asthma and live births in those with perennial allergy (animals, fungi and dust mites) compared to no allergy/seasonal allergy. The primary outcome of interest was fertility treatment.Patients and Methods: Women enrolled in the Management of Asthma during Pregnancy (MAP) program at Hvidovre Hospital, DK, were included in the present analysis provided they fulfilled the following criteria: 1) diagnosed with asthma and current anti-asthma therapy and 2) first visit to the respiratory outpatient clinic within the first 18 weeks of pregnancy. Participants were divided into two groups: asthma with perennial allergy (cases) and asthma with seasonal/no allergy (controls). Logistic regression analysis was applied, and findings expressed as odds ratios (OR).Results: Among women with asthma and perennial allergy (n=544 cases), 13.8% (n=75) had fertility treatment, compared to only 10.1% (n=39) among women with asthma and seasonal/no allergy (n=388, controls) (OR 1.43, 95% CI 0.95– 2.16, p=0.087). This association remained statistically insignificant after adjusting for confounders, including BMI (OR 1.19, 95% CI 0.77– 1.84, p=0.433). In women ≥ 35 years of age, 28% (n=44) and 20% (n=19), respectively, among cases and controls had fertility treatment (OR 1.60, 95% CI 0.87– 2.94, p=0.132), and likewise, statistically insignificant after adjusting for confounders (OR 1.41, 95% CI 0.74– 2.69, p< 0.293).Conclusion: In women with asthma and live births, our study revealed a trend towards an association between perennial allergy and a higher need for fertility treatment compared to seasonal/no allergy.Keywords: asthma, allergy, pregnancy, IVF, ART, fertility, atopy

Vibeke Backer,1 Jesper Lykkegaard,2 Uffe Bodtger,3,4 Lone Agertoft,5 Lene Korshoej,6 Elvira Vaclavik Braüner7,8 1Department of Respiratory Medicine L, Bispebjerg Frederiskberg University Hospital, Copenhagen, 2Research Unit of General Practice, Institute of Public Health, University of Southern Denmark, Odense, 3Department of Respiratory Medicine, Næstved Hospital, Næstved, 4Institute of Regional Health Research, University of Southern Denmark, 5Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, 6Competence Centre for Clinical Quality and Information Technology West (KCKS West), Aarhus, 7Research Center for Prevention and Health, Center for Health, Glostrup Hospital, Capital Region of Denmark, Glostrup, 8Department of Occupational and Environmental Medicine, Bispebjerg and Frederiksberg Hospital, Capital Region of Denmark, Copenhagen, Denmark Aim of the database: Asthma is the most prevalent chronic disease in children, adolescents, and young adults. In Denmark (with a population of 5.6 million citizens), >400,000 persons are prescribed antiasthmatic medication annually. However, undiagnosed cases, dubious diagnoses, and poor asthma management are probably common. The Danish National Database for Asthma (DNDA) was established in 2015. The aim of the DNDA was to collect the data on all patients treated for asthma in Denmark and to monitor asthma occurrence, the quality of diagnosis, and management. Study population: Persons above the age of 6 years, with a specific focus on 6–44 years, are included. The DNDA links three existing nationwide registries of administrative records in the Danish health care system: the National Patient Register, the National Health Insurance Services Register, and the National Prescription Registry. For each year, the inclusion criteria are a second purchase of asthma prescription medicine within a 2-year period (National Prescription Registry) or a diagnosis of asthma (National Patient Register). Patients with chronic obstructive pulmonary disease are excluded, but smokers are not excluded. Descriptive data: A total of 366,471 prevalent patients with asthma have been identified (year 2014 – as a preliminary test search). This number is in agreement with the estimates of ~400,000 inhabitants that are available for patients with possible asthma in Denmark. Data encompass the following quality indicators: annual asthma control visits and pharmacological therapy. Main variables: The variables included are spirometry, as well as tools for diagnosis (including allergy testing), smoking status, height, weight, and acute hospital admissions and unscheduled visits. Conclusion: DNDA is available from January 1, 2016. Keywords: indicator, asthma control, asthma management, prescription data, hospital data

BACKGROUND/OBJECTIVE: Preservation of lung health requires understanding the modifiable risk factors of airflow limitation. This study investigates the association between diet and lung function in a population of Greenland Inuit residing in the Arctic (Greenland) or Western Europe (Denmark). SUBJECTS/METHODS: Two unselected Inuit populations were recruited, one living in Greenland (Urban (Nuuk) n = 358;Rural (Uummannaq) n = 207) and the other in Denmark (n = 539). Lung function was measured using spirometry and diet by a food frequency questionnaire. Factors associated with airflow limitation were assessed using multiple linear regression models. RESULTS: The dietary composition differed significantly in the two regions, with higher whale, seal and wild meat intake and lower fruit and vegetable intake in the Arctic regions compared with Denmark. Consumption of vegetables (P = 0.004) and whale and/or seal (P < 0.0001) was significantly and positively associated with [FEV.sub.1], as well as with FVC (vegetables: P = 0.001, whale and/or seal: P = 0.002). Regular fruit intake was included in the statistical models;however, it did not reach statistical significance ([FEV.sub.1]: P = 0.053;FVC: P = 0.055). CONCLUSIONS: High dietary intake of vegetables as well as intake of arctic marine mammals had independent positive associations with lung function in this cohort of Greenlandic Inuit. These findings suggest an additive role of dietary intake of antioxidants and unsaturated fatty acids in lung health, which warrants prospective evaluation. European Journal of Clinical Nutrition (2015) 69, 1262-1266; doi: 10.1038/ejcn.2015.85; published online 27 May 2015, INTRODUCTION Lung function impairment, as assessed by a reduction in the forced expiratory volume measured in the first second of exhalation (FEV1) and vital capacity(VC), contributes significantly to several major [...]