Maria Ödling

Background: The long‐term prognosis of childhood asthma remains uncertain. We aimed to (1) assess the prevalence of asthma remission from childhood to young adulthood, (2) identify associated factors, and (3) evaluate whether symptom‐based remission was related to objective markers of inflammation and lung function. Materials and Methods: We analyzed data from 2698 participants in the Swedish population‐based BAMSE birth cohort, followed up to age 24 years with questionnaires and clinical examinations. Symptom‐based remission was defined as absence of asthma symptoms and medication in the preceding year. Clinical remission also required no hospital visits and optimization of lung function (postbronchodilator forced expiratory volume in 1 s ≥ 80%). Complete remission required normal eosinophil counts (< 0.3 × 10 ⁹ /L) and fractional exhaled nitric oxide levels (< 40 ppb). Results: Among 257 participants with asthma at age 8 years, 39% achieved symptom‐based remission, 29% clinical remission, and 18% complete remission at age 24 years. Male sex increased the likelihood of symptom‐based remission (odds ratio [OR] 2.4, 95% confidence interval [CI] 1.3–4.5), whereas food sensitization (OR 0.3, 95% CI 0.3–0.6) and overweight/obesity (OR 0.4, 95% CI 0.2–0.9) decreased it. Among individuals in symptom‐based remission, 27% displayed abnormal results in at least one objective marker. Conclusions: Four of 10 participants with asthma in childhood achieved symptom‐based remission by young adulthood, but rates declined when stricter, objective definitions were applied. A substantial subset of individuals with symptom‐based remission still showed signs of type two inflammation or reduced lung function, indicating that absence of symptoms does not necessarily reflect complete disease resolution.

Background: In asthma, transitions between spirometric phenotypes following bronchodilator (BD) administration provide clinically relevant insights for pharmacological optimization. Objective: To evaluate prevalences of pre- to post-BD transitions by spirometric phenotypes and to investigate perinatal and current-life factors associated with transitions from pre-BD impaired phenotypes to post-BD normal spirometry. Methods: The study population comprised 44,394 patients with asthma aged 7–49 years who had at least one paired pre- and post-BD measurement of forced expiratory volume in 1 second (FEV₁) and forced vital capacity, plus data on gestational age (GA) and birthweight. Patients were classified into spirometric phenotypes as follows: normal, PRISm (preserved ratio impaired spirometry), and airflow obstruction. Airflow obstruction was further categorized as dysanapsis, mild, moderate, or severe based on the FEV₁ z-score. Results: Normal lung function prevalence increased post-BD (Table 1), while other phenotypes decreased. Females had increased RRR of transitioning from dysanapsis or severe obstruction to normal lung function post-BD. Extremely-to-very preterm-born patients and those born small for GA (SGA) had decreased RRRs of transitioning from dysanapsis to normal lung function post-BD. Conclusions: Spirometric phenotypes shifted dynamically pre- to post-BD. Being born preterm or SGA was associated with a lower likelihood of transitioning from impaired to normal lung function. erj;68/suppl_70/PA5888/F1 F1 F1

Background: In birth-cohort studies, response rates generally decline over time. We aimed to evaluate representativeness and identify predictors of retention up to young adulthood in a population-based birth cohort originally focused on asthma and allergies. Methods: The Barn/Child, Allergy, Milieu, Stockholm, Epidemiology (BAMSE) birth cohort was established in 1994–6 in Stockholm, Sweden. We utilized data from questionnaires and Swedish registers to compare the characteristics of participants at age 24 years (n = 3064) with those of the original cohort (n = 4089) and the general population born in 1994–6 in Stockholm county (n = 68 378) and Sweden (n = 310 976). Logistic regression was used to identify predictors of retention at age 24 years. Results: The response rate declined over time and was higher in females than in males in adolescence and young adulthood (80.0% versus 70.0% at age 24 years). Compared with the original cohort, participants at age 24 years more often had dispensed asthma medications (6.6% versus 5.8%) and university education (52.6% versus 47.8%), but had less often a mother who smoked during pregnancy (9.6% versus 10.8%). Similar patterns were observed in comparisons with the general population. Female sex [odds ratio (OR) 1.75, 95% confidence interval (CI) 1.49–2.05] and high parental education (OR 1.33, 95% CI 1.12–1.59) were the predominant predictors of retention in the cohort. Conclusion: Female sex, higher socio-economic status, and asthma were predictive factors of retention in the cohort after 24 years. This may have influenced the observed prevalence rates of asthma and allergies, and associations between potential risk factors and outcomes associated with retention.

IntroductionPharmacological treatment is an important key to asthma management, with the goal of symptom control and minimizing future risks (1). These goals are most effectively reached when pharm...

Recently, we investigated separate and joint associations between perinatal factors and airflow obstruction into the fifth decade of life in patients with obstructive lung disease [1]. Results revealed that gestational age (GA) was an independent covariate of persistent airflow obstruction in patients of all ages and provided better predictions in risk sets. GA-adjusted birthweight further improved predictions. The contribution of GA and birthweight to adult lung function impairment provides an opportunity for prevention.

Rationale: Few studies have identified risk sets for perinatal factors and airflow obstruction into middle adulthood. Objectives: To investigate associations between gestational age (GA), GA-adjusted birthweight, and mode of delivery and persistent airflow obstruction among patients 7–49 years old with obstructive lung diseases. Methods: The study population encompassed 44,778 individuals with asthma or chronic obstructive pulmonary disease (COPD) and one or more registration of post-bronchodilator values of forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC) recorded in the Swedish National Airway Register in 2014–2022 and with both GA and birthweight data in the Medical Birth Register between 1973–2015. Persistent airflow obstruction was defined as a FEV1/FVC z-score below the lower limit of normal. Analyses were done separately for children, young adults, and middle-aged adults. Results: Subjects who were extremely, very, moderate, and late preterm-born all had increased odds ratios (ORs) of persistent airflow obstruction up to age 49 years compared with those term-born. Middle-aged adults born small for GA had increased OR of persistent airflow obstruction compared with those appropriate for GA (OR, 1.49; 95% confidence interval, 1.23–1.81). In the risk sets, GA was the most significant covariate for persistent airflow obstruction. GA-adjusted birthweight was an additional covariate for those born late preterm, term, or postterm. Mode of delivery did not contribute. Conclusions: GA was an independent covariate of persistent airflow obstruction and, in the risk sets, proved to be the most important covariate in patients of all ages with either asthma or COPD. GA-adjusted birthweight further improved the prediction.

Objective: Evidence‐based guidelines for transitional care of adolescents and young adults with allergy and asthma have been published, but shortcomings in the transition process have been identified. This study's aim was to gather deeper insights into healthcare professionals' experiences regarding the challenges of transitional care for adolescents and young adults with allergy and asthma.Methods: Clinically active physicians and registered nurses in Sweden were recruited through a web survey. Qualitative data were obtained through individual interviews (n = 18). The transcribed interview data, serving as the basis for this study, were analysed using systematic text condensation.Results: Four categories emerged during the analysis process: (1) ‘There is no clear structured approach that can be applied to everyone’, addressing variations in disease and individual patient needs. (2) ‘Relying only on referrals’, indicating that no other forms of communication exist. (3) ‘Tackling patients’ assumptions and verifying their knowledge’, referring to discrepancies between patients' expectations of healthcare professionals' knowledge of medical histories and the limited information actually available to healthcare professionals. (4) ‘Unprepared patients in a fragmented care chain’, implying a need to prepare patients for how healthcare services can differ.Conclusions: Based on healthcare professionals' experiences, transitional care for patients with allergies and asthma is a complex process marked by numerous challenges. Interventions for improvement should include increased guideline implementation at all levels of healthcare, better communication between healthcare professionals, and continuous patient education, including teaching adolescents and young adults to take responsibility for navigating the healthcare system for care of allergy and asthma.

Background: Type 1 diabetes (T1D) requires numerous daily self‐management decisions and, for children, parents have a crucial role in this. The aim of this study was to evaluate treatment satisfaction among parents of children with T1D and the associations with the child’s health‐related quality of life (HRQoL) and perceived diabetes control. A secondary aim was to evaluate treatment satisfaction among school children with T1D and the associations with HRQoL and perceived diabetes control. Methods: In this cross‐sectional study, 111 parents of children with T1D (0–12 years) and 75 children with T1D (8–12 years) were included. Treatment satisfaction was measured using the diabetes treatment satisfaction questionnaire (DTSQ), parent version, scored 0–60, or teens version, scored 0–48. HRQoL was measured with DISABKIDS. Differences between groups were analyzed using independent t ‐tests and one‐way analysis of variance. Linear regression was used to investigate associations between treatment satisfaction and HRQoL and perceived diabetes control. Results: The mean value for treatment satisfaction among parents was 41.0 (95% confidence interval (CI): 39.5–42.5) and among children 36.3 (95% CI: 34.5–38.0). Parents’ treatment satisfaction was associated with their child’s HRQoL (by proxy), perceived diabetes control, and diabetes duration (correlations coefficient [ R ² ] = 0.54, p < 0.001). Children’s treatment satisfaction was associated with HRQoL ( R ² = 0.29, p = 0.005). Conclusion: The child’s HRQoL and perceived diabetes control are important for treatment satisfaction among parents of children with T1D.