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Background: COPD exacerbations (AECOPD) are frequently associated with bacterial infection, but the distinction as well as the clinical significance between pneumonia vs non-pneumonia in AECOPD is unclear. We aimed to examine the prognostic value of pneumonia vs non-pneumonia in AECOPD. Methods: We evaluated 320 COPD patients admitted to hospital due to AECOPD. Pneumonia was defined as the presence of a lung infiltrate on chest x-ray combined with a clinical diagnosis of pneumonia made by a physician. All patients had a clinical diagnosis of COPD, and were former or current smokers. Patients were followed up to 2 years recording continuous AECOPD admissions, and up to 5 years regarding mortality. Cox-regression and negative binomial regression models were fitted for the statistical analyses. Results: 98 of 320 patients (31 %) had pneumonia at first admission. 185 patients had one or more re-admissions. 100-day and 5-year mortality was 26 (8 %) and 188 (59 %) of 320 patients, respectively. All patients with pneumonia and 168 (77 %) of patients with non-pneumonia were treated with antibiotics. Patients with pneumonia did not have a significantly higher 100-day or 5-year mortality, HR 1.15 (0.49-2.69, p=0.75) and HR 1.18 (0.85-1.63, p=0.32) respectively, adjusted for sex, age and use of antibiotics. Similarly, pneumonia was not associated with early re-admission, HR 1.24 (0.90-1.73, p=0.19) or a higher 2-year total re-admission count, IRR 1.00 (0.81-1.23, p=0.99), adjusted values. The use of antibiotics was not significantly associated with neither mortality nor re-admissions. Conclusion: COPD exacerbations with pneumonia did not have a higher mortality or re-admission frequency than non-pneumonia exacerbations.

Background Perfusion assessment of the pancreas is challenging and poorly evaluated. Pancreatic affection is a prevalent feature of cystic fibrosis (CF). Little is known about pancreatic perfusion in CF. We aimed to assess pancreatic perfusion by contrast-enhanced ultrasound (CEUS) analysed in the bolus-and-burst model and software. Methods We performed contrast enhanced ultrasound of the pancreas in 25 CF patients and 20 healthy controls. Perfusion data was analysed using a dedicated perfusion model providing the mean capillary transit-time (MTT), blood flow (BF) and blood-volume (BV). CF patients were divided according to exocrine function. Results The pancreas insufficient CF patients had longer MTT (p ≤ 0.002), lower BF (p

Although a minority of asthma patients suffer from severe asthma, they represent a major clinical challenge in terms of poor symptom control despite high-dose treatment, risk of exacerbations, and side effects. Novel biological treatments may benefit patients with severe asthma, but are expensive, and are only effective in appropriately targeted patients. In some patients, symptoms are driven by other factors than asthma, and all patients with suspected severe asthma (‘difficult asthma’) should undergo systematic assessment, in order to differentiate between true severe asthma, and ‘difficult-to-treat’ patients, in whom poor control is related to factors such as poor adherence or co-morbidities. The Nordic Consensus Statement on severe asthma was developed by the Nordic Severe Asthma Network, consisting of members from Norway, Sweden, Finland, Denmark, Iceland and Estonia, including representatives from the respective national respiratory scientific societies with the aim to provide an overview and recommendations regarding the diagnosis, systematic assessment and management of severe asthma. Furthermore, the Consensus Statement proposes recommendations for the organization of severe asthma management in primary, secondary, and tertiary care.

Volume output failure is a feature of decreasing exocrine pancreatic function. This parameter is assessed by secretin-stimulated MRI in several studies. Our purpose was to evaluate ultrasonography of the fluid in the descending duodenum and Wirsung duct (WD) after secretin stimulation as a measure of pancreatic fluid flow in patients expected to have severe output failure.We included subjects with chronic pancreatitis (CP), cystic fibrosis (CF) and a group of healthy controls in a prospective observation study. Transabdominal ultrasonography was performed before and during 15 min after secretin i.v. duodenal juice was collected by endoscopic short test (EST), and bicarbonate concentration measured. Patient groups were classified according to exocrine pancreatic function.Pancreatic insufficient CF (CFI) patients and CP insufficient (CPI) patients showed less duodenal fluid filling compared to other groups (p0.001). Measures of the WD diameter could only identify the most severe failure in the CFI group (p0.001).Secretin-stimulated ultrasonography can be used to assess pancreatic fluid flow and may be combined with EST in the evaluation of exocrine pancreatic function. Fluid filling in the descending part of duodenum was the most accurate predictor of pancreatic insufficiency in both patient groups. The test demonstrated better diagnostic accuracy diagnosing exocrine pancreatic failure in the CF patients than in CP patients.

Secretin-stimulated magnetic resonance imaging (s-MRI) is the best validated radiological modality assessing pancreatic secretion. The purpose of this study was to compare volume output measures from secretin-stimulated transabdominal ultrasonography (s-US) to s-MRI for the diagnosis of exocrine pancreatic failure in cystic fibrosis (CF). We performed transabdominal ultrasonography and MRI before and at timed intervals during 15 minutes after secretin stimulation in 21 CF patients and 13 healthy controls. To clearly identify the subjects with reduced exocrine pancreatic function, we classified CF patients as pancreas-sufficient or -insufficient by secretin-stimulated endoscopic short test and faecal elastase. Pancreas-insufficient CF patients had reduced pancreatic secretions compared to pancreas-sufficient subjects based on both imaging modalities (p < 0.001). Volume output estimates assessed by s-US correlated to that of s-MRI (r = 0.56–0.62; p < 0.001). Both s-US (AUC: 0.88) and s-MRI (AUC: 0.99) demonstrated good diagnostic accuracy for exocrine pancreatic failure. Pancreatic volume-output estimated by s-US corresponds well to exocrine pancreatic function in CF patients and yields comparable results to that of s-MRI. s-US provides a simple and feasible tool in the assessment of pancreatic secretion. • Cystic fibrosis patients with affected pancreas have reduced pancreatic secretions. • Secretin-stimulated sonography is a simple and feasible method to assess pancreatic output. • Secretin-simulated MRI is a more precise method to assess pancreatic secretions. • The sonographic and MRI methods yielded comparable pancreatic secretory output estimates.

Secretin-stimulated magnetic resonance imaging (s-MRI) and pancreatic diffusion weighted imaging (DWI) are novel non-invasive imaging techniques for assessment of exocrine pancreatic insufficiency (EPI). The aim was to validate s-MRI assessed pancreatic secreted volume using novel semi-automatic quantification software, and to assess the ability of s-MRI with DWI to diagnose EPI in patients with cystic fibrosis (CF). s-MRI and DWI was performed in 19 patients with CF (median age 21 years; range 16–56; eight men) and in 10 healthy controls (HC) (median age 46 years; range 20–65; four men). Sequential coronal T2-weighted images covering the duodenum and small bowel and axial DWI were acquired before and 1, 5, 9, and 13 min after secretin stimulation. A short endoscopic secretin test was used as reference method for EPI. CF patients with EPI had lower apparent diffusion coefficient before secretin in the pancreatic head (P

Background: CAT (COPD Assessment Test) is a validated 8-item questionnaire designed to evaluate symptoms in COPD patients. Our study aimed to evaluate COPD symptoms as a marker for mortality, measured in total CAT-score as well as individual symptom scores. Methods: We included 285 patients with an established COPD diagnosis, admitted with COPD-exacerbation to several hospitals in Western Norway, using data from the Norwegian COPD Registry. All patients completed a CAT questionnaire before discharge, in addition, the patients performed a spirometry, arterial blood gas sampling, and had their BMI and co-morbidities evaluated. The patients were followed for up to 5 years. Mortality was evaluated using cox-regression, adjusting for sex, age, FEV1, BMI and blood gas analysis (hyperkapnia). Results: 118 of 285 patients died within follow up. Median CAT score at discharge was 24 of maximum 40 points. Increasing CAT score was significantly associated with higher mortality, HR 1.02 (1.01-1.04, p Conclusion: Increasing CAT score is associated with higher mortality, however, simply asking about breathlessness at stair walking or domestic activity limitations may give a better indication of mortality risk.

Aims: To explore whether gender differences in the Scandinavian Cystic Fibrosis (CF) patients exist in the areas of key clinical parameters, complications, and medication. Methods: Cross-sectional data on 890 (416 female) pancreatic insufficient CF patients were evaluated regarding chronic infection, body mass index, lung function, medication, and diabetes, as well as data of Pseudomonas infection status, antibiotic treatment and hospitalization from 1-year follow-up. Results: We found no differences in lung function, body mass index, or frequency of diabetes. The adult group consisted of more males than females (208:168). We found no significant difference in prevalence of chronic Pseudomonas aeruginosa infection, but during the follow-up the incidence of new chronic infection was higher in adult females (10/33 vs. 4/56). Females had higher prevalence of Burkholderia infection (21/416 vs. 11/474). Adult females had more days on intravenous antibiotics (median 39 vs. 26 days/year), and days in hospital (median 2 vs. 0 days/year). More adult females received inhaled and oral steroids. In the pediatric cohort, females were treated more often with macrolides as an anti-inflammatory agent. Conclusion: We found no gender difference in key clinical parameters in our CF population. However, our study showed a higher risk of Pseudomonas and Burkholderia infection among the female patients. Additionally, we found that female patients require more intensified treatment regarding antibiotics, macrolides, steroids and days of hospitalization, indicating a true female disadvantage even with modern aggressive treatment. The finding of more males than females in the adult population suggesting a male advantage, warrants a mortality study. Pediatr Pulmonol. 2010; 45:959-965. (C) 2010 Wiley-Liss, Inc.

Background A diet rich in fish or cod oil might possibly reduce the risk for asthma and atopic diseases. However, previous studies show conflicting results and no studies have assessed the potential long-term effects of childhood fish intake on adult asthma. Objective To investigate whether childhood and adult fish and cod oil intake was related to adult asthma. Methods In a large population-based study, Respiratory Health in Northern Europe (RHINE), 16 187 subjects aged 23-54 years answered a postal questionnaire. The relations of fish and cod oil intake with asthma symptoms and asthma were analysed using multiple logistic and Cox regression analyses, with adjustment for gender, adult hayfever, smoking, age, body mass index, household size, dwelling, parental education and centre, and for maternal smoking and family history of hayfever and asthma in a subsample (n=2459). Results Subjects from Iceland and Norway reported much more frequent intake of fish both in childhood and adulthood as compared with subjects from Sweden, Estonia and Denmark. Current fish intake less than weekly in adults was associated with more asthma symptoms, while more frequent fish intake did not appear to decrease the risk further. No dose-response association was found between childhood fish intake and adult asthma, but those who never ate fish in childhood had an increased risk for asthma and earlier asthma onset. Adult consumption of cod oil had a u-shaped association with asthma, with the highest risks in those taking cod oil never and daily. Conclusion A minimum level of weekly fish intake in adulthood was associated with protection against asthma symptoms in this large North-European multi-centre study. Subjects who never ate fish in childhood were at an increased risk for asthma. Both indicate a possible threshold effect of fish on asthma.

Objective: Some studies have shown an association between lower maternal age at delivery and increased asthma in children and young adults. It is unclear whether this represents an effect of maternal ageing or a protective effect of siblings. In a North-European population based study, we investigated whether mother's age at delivery was associated with risk for asthma and hay fever in adult offspring, taking into account relevant confounders. Methods: A total of 16,190 subjects (74%) aged 23-54yr answered a postal questionnaire in a follow-up of the European Community Respiratory Health Survey (ECRHS I). Results: The associations of maternal age at delivery with hay fever, respiratory symptoms and diagnosed asthma were analysed using logistic regression, adjusting for household size, dwelling, parental education, centre, gender, adult hay fever, smoking, age and body mass index (BMI). The adjusted odds ratios (95% CI) for wheeze with breathlessness, wheeze without a cold and asthma in the offspring were 0.94 (0.90-0.99), 0.89 (0.86-0.94) and 0.92 (0.88-0.97), respectively, per 5yr increase in maternal age. No heterogeneity between centres was found (p = 0.84). The estimates remained similar in sub-sample analyses when adjusting for siblings, maternal smoking (n = 3109) and for birth weight (n = 1686). Hay fever was more common among those with the youngest and oldest mothers. Conclusions: In this large North-European multi-centre study, asthma was less common with increasing maternal age. This effect was consistent between centres and persisted with adjustment for several potential confounders, suggesting that the association may possibly be explained by biological changes related to maternal ageing.

behandlingsliner (2), og terminologien, til do-mes pasientforlop, «critical-/clinical pathway», «care track», varierer (2). European Pathway Association (E-P-A, sja www.e-p-a.org) er ein non-profit organisasjon for nettverk, brukar-grupper, akademiske institusjonar, sjukehus, stotteorganisasjonar og tilsette i helsetenestene som ynskjer bidra til utvikling og implemente -ring av standardiserte behandlingsliner. Orga -nisasjonen har sterkt fokus pa evidensbaserte tiltak og forsking. E-P-A definerer ei standardi-sert behandlingsline («care pathway») slik (3, 4): «Ei behandlingsline er ein kompleks inter-vensjon som har gjensidig taking av avgjerder og organisering av behandlingsprosessen for ei definert gruppe pasientar i ein definert tidspe-riode som mal. Karakteristika ved ei standar-disert behandlingsline er (2-4):›

The impact of active smoking, passive smoking, and obesity on habitual snoring in the population is mainly unknown. We aimed to study the relationship of habitual snoring with active and passive tobacco smoking in a population-based sample. A total of 15,555 of 21,802 (71%) randomly selected men and women aged 25-54 years from Iceland, Estonia, Denmark, Norway, and Sweden answered a postal questionnaire. Habitual snoring, defined as loud and disturbing snoring at least 3 nights a week, was more prevalent among current smokers (24.0%, p0.0001) and ex-smokers (20.3%, p0.0001) than in never-smokers (13.7%). Snoring was also more prevalent in never-smokers exposed to passive smoking at home on a daily basis than in never-smokers without this exposure (19.8% vs. 13.3%, p0.0001). The frequency of habitual snoring increased with the amount of tobacco smoked. Active smoking and passive smoking were related to snoring, independent of obesity, sex, center, and age. Ever smoking accounted for 17.1% of the attributable risk of habitual snoring, obesity (body mass indexor = 30 kg/m(2)) for 4.3%, and passive smoking for 2.2%. Smoking, both current and ex-smoking, is a major contributor to habitual snoring in the general population. Passive smoking is a previously unrecognized risk factor for snoring among adults.

Objectives Pancreas insufficiency prevalence (PIP) has been suggested by Ooi and co-workers as a tool for predicting pancreatic disease in cystic fibrosis (CF). We aimed to correlate PIP to pancreatic phenotype. Methods We included 42 CF patients. Exocrine pancreatic function was examined by faecal elastase or endoscopic secretin test. CFTR genotype was assessed by standard CFTR screening kits or CFTR sequencing. PIP corresponding to the least severe mutation was adapted from Ooi, or calculated from our own database. Pancreatic ultrasonography was performed: First a secretin-stimulated ultrasonography with area tracing of the fluid filled descending duodenum, then a dedicated ultrasonography of the pancreas including contrast enhancement by Sonovue® and pancreas/liver signal-intensity measures. Perfusion data were calculated by DCE-US software. PIP score grouped patients according to genotype severity as severe genotype (PIP Results We found reduced f-elastase, d-bicarbonate and pancreatic volume output (d-Area), increased pancreatic echo-intensity (LP SIR) and reduced pancreatic blood flow in the group with severe compared to the group with mild pancreatic genotype. Results are presented in the table. Severe PIP (n = 22)Mild PIP (n = 22)pF-Elastase (mg/g)0 (0–3.5)571 (535–634) 3 (meq/L)11.0 (10.5–21.0)118 (94.8–127) 2 )1.29 (1.12–2.92)4.14 (2.89–6.23) Conclusion Severe PIP predicts affected pancreas represented by exocrine pancreatic failure, fatty infiltration and reduced pancreas perfusion.

Summary Background There is evidence that atopic disorders may begin in intra-uterine life; however, studies of birth characteristics and atopy show conflicting results. Methods We wanted to investigate the association of birth weight and head circumference with serum total or specific IgE, allergic rhinitis or eczema while addressing the influence of demographic and geographical factors. In this historic prospective cohort study, data were collected from birth records for 1683 men and women born in 1947–1973, from six Nordic–Baltic populations participating in the European Community Respiratory Health Survey. Blood tests for the measurement of serum total and specific IgE were available for 1494 subjects. In multiple regression analyses, adjustments were made for birth length, gender, age, study centre, adult body mass index, level of education, parental and adult smoking. Results There was no association of birth weight (n=1230) and head circumference (n=285) with serum total IgE, specific IgE antibodies, allergic rhinitis or eczema. There were neither significant interactions by gender or age, nor heterogeneity between the study centres in the analyses of birth weight and adult atopy. Conclusion Birth size was not associated with atopy among adults in this large Nordic–Baltic population study.

Studies of birth characteristics and respiratory outcomes show contradictory findings. We wanted to investigate the association of birth weight with adult lung function as well as asthma symptoms while addressing the influence of demographic and environmental factors.Data was collected from the birth records of 1683 men and women born in 1947–1973 who were included in 6 Nordic-Baltic population samples investigated within the European Community Respiratory Health Survey (ECRHS).In the adults, an increase in birth weight from below 2500g to above 4000g was associated with an increase from 96% to 104% predicted one-second forced expiratory volume (P

Background: Dry powder inhalers (DPIs) are the most commonly used devices in asthma treatment in the Nordic countries. As new DPIs become available, patients are likely to be exposed to more than one type of device, with variable optimal handling. The aim was to examine real life storage and retention of multidose DPIs in patients with asthma. Methods: This patient-reported survey on real life storage and retention of DPIs included asthma patients using multidose DPIs. Basic patient characteristics, information on inhaler use and storage, check of expiry date, and concurrent inhaler use was examined using an on line questionnaire. Results: A total of 738 patients were included with a median age of 41 years, out of which 83 % were women. Sixty-three per cent reported storage conditions pre-defined as risk locations for their maintenance inhaler and 38 % of the responding patients had more than one maintenance inhaler in use at the same time. Two thirds of the study population checked inhaler expiry date less than monthly or not at all. Use after expiry date was frequently reported. Two thirds of the patients had not received information on DPI storage, either from their doctor and/or nurse or at the pharmacy. Conclusions: This patient reported survey indicates that two thirds of the patients store their inhaler devices in suboptimal conditions, and only a minority had received instruction regarding inhaler handling. Non awareness of inhalers’ expiry dates and use of more than one maintenance inhaler simultaneously was common. As inhaler mishandling may impact device functionality, improved communication and patient education is needed.