The present thesis follows an intensive care unit during four year of hard work and demanding organisational changes (1998-2001). The changes were mainly initiated by diminishing resources and a legislative claim to pay regard to the quality aspect of health care service. The process of implementing a quality system was the main focus for the thesis. Triangulation was used aiming at explore the process from different views. Two interviews studies were conducted one with the staff and another with the leadership. Both interviews were analysed thematically combined with a phenomenographic technique (e.g. using the how, and what aspect). A longitudinal quasi experimental time-series study was also accomplished. The correlation between staff variables and workload were measured once a year. The result show a 20 % increase in workload per staff and year. The staff judged the organisational climate for innovativeness stable over the period. Sick leave increased, and more so, than the general trend in the society. In spite of this increase the prevalence of stress related symptoms was the same. Two different systems emerged, a complex adaptive system and a mechanical system. The two systems exist and functions intertwined. Because of the construction of the patient register it is possible to see that the situation around a patients being admitted ≥ 5 days functions according to the complex systems character while the situation around the acute patients functions according to a mechanical system. Sick leave correlated with number of patient admitted ≥ 5 days (P=,000). It seemed the problem found had its root in the unawareness of the existing of a complex system. The result has implications for a need of increased awareness about how to manage the situation when the ICU is functioning according to the complex adaptive system.
Aims Since 1956, more than 100,000 Swedish soldiers have served abroad on various international missions. The aim of this paper was to determine whether there was a connection between military service abroad and sleep disorders among Swedish soldiers. Methods The prevalence of sleep disturbances among 1,080 veterans from Kosovo and Afghanistan was compared with almost 27,000 Swedes from a general population sample, using propensity score matching and logistic regression. The sleep disturbances studied were habitual snoring, difficulty inducing sleep (DIS), difficulty maintaining sleep (DMS), early morning awakenings (EMA), and excessive daytime sleepiness (EDS). Insomnia was defined as having at least one of DIS, DMS, or EMA. The covariates used in the matching and adjustments were age, gender, smoking habits, BMI, education, ever having had asthma, moist snuff, and exercise habits. Results The veterans had a significantly lower prevalence of insomnia (26.2% versus 30.4%) and EDS (22.7% versus 29.4%) compared with a matched group from the reference population, using propensity score matching. Analyses with logistic regression showed that belonging to the military population was related to a lower risk of having DMS (adjusted OR (95% CI) 0.77 (0.64-0.91)), insomnia (OR 0.82 (0.71-0.95)), and EDS (OR 0.74 (0.63-0.86)), whereas no significant difference was found for snoring, DIS, and EMA. Conclusion Swedish veterans have fewer problems with insomnia and daytime sleepiness than the general Swedish population. The explanation of our findings may be the selection processes involved in becoming a soldier and when sampling personnel for military assignments abroad.
Background: The premenstrual syndrome (PMS) causes clinically relevant psychological and physical symptoms in up to 20% of women of reproductive age. To date, no studies have investigated the relationship between PMS and residential surrounding greenspace, although a green living environment has been reported to have beneficial associations with overall and reproductive health. Objective: To investigate whether lifelong exposure to residential surrounding greenspace is associated with PMS and whether such an association is mediated by BMI, air pollution or physical activity. Methods: This study used data collected in 2013-2015 from 1069 Scandinavian women aged 18-49 years, participating in RHINESSA, a European multi-centre and population-based cohort. Satellite-derived Normalised Difference Vegetation Index was used as a proxy of greenspace. Presence of eight common PMS symptoms and their sum (PMS symptom count) were used as outcomes. The associations were assessed by adjusted multilevel logistic and negative binomial regressions. Subsequently we carried out mediation analyses for physical activity, BMI and air pollution exposure. Results: Higher exposure to residential surrounding greenspace was associated with "Anxiety or tension" (Odds Ratio 0.82, 95% Confidence Interval (CI): 0.70 - 0.95), "Depression or hopelessness" (0.84, 0.73 - 0.98), "Difficulty with sleeping" (0.82, 0.68 - 1.00) and "Breast tenderness and abdominal bloating" (0.84, 0.71 - 0.99) before or around the start of the menstrual period. There was also an association with a lower PMS symptom count (Risk Ratio: 0.94, 95% CI: 0.91 - 0.99). These associations were robust to sensitivity analyses and were not mediated by BMI, physical activity or air pollution. Conclusions: Living in greener areas may be beneficial against PMS symptoms. Further studies are needed to confirm these novel findings and to explore the underlying biological mechanisms. ; Kai Triebner has received a postdoctoral fellowship from the University of Bergen. Payam Dadvand is funded by a Ramón y Cajal fellowship (Grant: RYC-2012–10995) awarded by the Spanish Ministry of Economy and Finance. The present analyses are part of a project funded by the Norwegian Research Council (Grant: 228174). Co-ordination of the RHINESSA study has received funding from the Research Council of Norway (Grants No. 274767, 214123, 228174, 230,827 and 273838), ERC StG project BRuSH #804199, the European Union's Horizon 2020 research and innovation programme under grant agreement No. 633,212 (the ALEC Study WP2), the Bergen Medical Research Foundation, and the Western Norwegian Regional Health Authorities (Grants No. 912011, 911892 and 911631). Study centre Bergen has further received local funding from the above-named grants for study establishment and co-ordination and in addition from the World University Network, the Norwegian Labour Inspection, and the Norwegian Asthma and Allergy Association. Iana Markevych is supported from the "NeuroSmog: Determining the impact of air pollution on the developing brain" (Nr. POIR 040.04.00-1763/18-00) which is implemented as part of the TEAM-NET programme of the Foundation for Polish Science, co-financed from EU resources, obtained from the European Regional Development Fund under the Smart Growth Operational Programme. The funding sources were not involved in the conduct of the research and/or preparation of the article, in study design, in the collection, analysis and interpretation of data, in the writing of the report or in the decision to submit the article for publication.
To access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked Download ; Purpose: To study changes in lung function among individuals with a risk of obstructive sleep apnoea (OSA), and if asthma affected this relationship. Methods: We used data from the European Community Respiratory Health Survey II and III, a multicentre general population study. Participants answered questionnaires and performed spirometry at baseline and 10-year follow-up (n = 4,329 attended both visits). Subjects with high risk for OSA were identified from the multivariable apnoea prediction (MAP) index, calculated from BMI, age, gender, and OSA symptoms at follow-up. Asthma was defined as having doctor's diagnosed asthma at follow-up. Primary outcomes were changes in forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC) from baseline to follow-up. Results: Among 5108 participants at follow-up, 991 (19%) had a high risk of OSA based on the MAP index. Participants with high OSA risk more often had wheeze, cough, chest tightness, and breathlessness at follow-up than those with low OSA risk. Lung function declined more rapidly in subjects with high OSA risk (low vs high OSA risk [mean ± SD]: FEV1 = - 41.3 ± 24.3 ml/year vs - 50.8 ± 30.1 ml/year; FVC = - 30.5 ± 31.2 ml/year vs - 45.2 ± 36.3 ml/year). Lung function decline was primarily associated with higher BMI and OSA symptoms. OSA symptoms had a stronger association with lung function decline among asthmatics, compared to non-asthmatics. Conclusion: In the general population, a high probability of obstructive sleep apnoea was related to faster lung function decline in the previous decade. This was driven by a higher BMI and more OSA symptoms among these subjects. The association between OSA symptoms and lung function decline was stronger among asthmatics. Keywords: Asthma; Lung function; Lung function decline; Sleep apnoea. ; Uppsala University European Union (EU)
Publisher's version (útgefin grein) ; Objectives To compare the prevalence of different insomnia subtypes among middle-Aged adults from Europe and Australia and to explore the cross-sectional relationship between insomnia subtypes, respiratory symptoms and lung function. Design Cross-sectional population-based, multicentre cohort study. Setting 23 centres in 10 European countries and Australia. Methods We included 5800 participants in the third follow-up of the European Community Respiratory Health Survey III (ECRHS III) who answered three questions on insomnia symptoms: difficulties falling asleep (initial insomnia), waking up often during the night (middle insomnia) and waking up early in the morning and not being able to fall back asleep (late insomnia). They also answered questions on smoking, general health and chronic diseases and had the following lung function measurements: forced expiratory volume in 1 s (FEV 1), forced vital capacity (FVC) and the FEV 1 /FVC ratio. Changes in lung function since ECRHS I about 20 years earlier were also analysed. Main outcome measures Prevalence of insomnia subtypes and relationship to respiratory symptoms and function. Results Overall, middle insomnia (31.2%) was the most common subtype followed by late insomnia (14.2%) and initial insomnia (11.2%). The highest reported prevalence of middle insomnia was found in Iceland (37.2%) and the lowest in Australia (22.7%), while the prevalence of initial and late insomnia was highest in Spain (16.0% and 19.7%, respectively) and lowest in Denmark (4.6% and 9.2%, respectively). All subtypes of insomnia were associated with significantly higher reported prevalence of respiratory symptoms. Only isolated initial insomnia was associated with lower FEV 1, whereas no association was found between insomnia and low FEV 1 /FVC ratio or decline in lung function. Conclusion There is considerable geographical variation in the prevalence of insomnia symptoms. Middle insomnia is most common especially in Iceland. Initial and late insomnia are most common in Spain. All insomnia subtypes are associated with respiratory symptoms, and initial insomnia is also associated with lower FEV 1. ; Financial support for ECRHS III: Australia: National Health & Medical Research Council. Belgium: Antwerp South, Antwerp City: Research Foundation Flanders (FWO), grant code G.0.410.08.N.10 (both sites). Estonia: Tartu- SF0180060s09 from the Estonian Ministry of Education. France: (all) Ministère de la Santé. Programme Hospitalier de Recherche Clinique (PHRC) national 2010. Bordeaux: INSERM U897 Université Bordeaux segalen; Grenoble: Comite Scientifique AGIRadom 2011; Paris: Agence Nationale de la Santé, Région Ile de France, domaine d'intérêt majeur (DIM). Germany: Erfurt: German Research Foundation HE 3294/10–1; Hamburg: German Research Foundation MA 711/6–1, NO 262/7–1. Iceland: Reykjavik: The Landspitali University Hospital Research Fund, University of Iceland Research Fund, ResMed Foundation, California, USA, Orkuveita Reykjavikur (Geothermal plant), Vegagerðin (The Icelandic Road Administration (ICERA). The Icelandic Research found - grant no 1 73 701–052. Italy: all Italian centres were funded by the Italian Ministry of Health, Chiesi Farmaceutici SpA, in addition Verona was funded by Cariverona foundation, Education Ministry (MIUR). Norway: Norwegian Research council grant no 214123, Western Norway Regional Health Authorities grant no 911631, Bergen Medical Research Foundation. Spain: Fondo de Investigación Sanitaria (PS09/02457, PS09/00716 09/01511) PS09/02185 PS09/03190), Servicio Andaluz de Salud, Sociedad Española de Neumología y Cirurgía Torácica (SEPAR 1001/2010). Sweden: all centres were funded by The Swedish Heart and Lung Foundation, The Swedish Asthma and Allergy Association, The Swedish Association against Lung and Heart Disease. Fondo de Investigación Sanitaria (PS09/02457); Barcelona: Fondo de Investigación Sanitaria (FIS PS09/00716); Galdakao: Fondo de Investigación Sanitaria (FIS 09/01511); Huelva: Fondo de Investigación Sanitaria (FIS PS09/02185); and Servicio Andaluz de Salud Oviedo: Fondo de Investigación Sanitaria (FIS PS09/03190). Sweden: all centres were funded by The Swedish Heart and Lung Foundation, The Swedish Asthma and Allergy Association, The Swedish Association against Lung and Heart Disease. Swedish Research Council for health, working life and welfare (FORTE); Göteborg also received further funding from the Swedish Council for Working life and Social Research. Umea also received funding from Vasterbotten Country Council ALF grant. Switzerland: The Swiss National Science Foundation (grants no 33CSCO-134276/1, 33CSCO-108796, 3247BO-104283, 3247BO-104288, 3247BO-104284, 3247-065896, 3100-059302, 3200-052720, 3200-042532 and 4026-028099), The Federal Office for Forest, Environment and Landscape, The Federal Office of Public Health, The Federal Office of Roads and Transport, the Canton's Government of Aargan, Basel-Stadt, Basel-Land, Geneva, Luzern, Ticino, Valais and Zürich, the Swiss Lung League, The Canton's Lung League of Basel Stadt/ Basel, Landschaft, Geneva, Ticino, Valais and Zurich, SUVA, Freiwillige Akademische Gesellschaft, UBS Wealth Foundation, Talecris Biotherapeutics GmbH, Abbott Diagnostics, European Commission 018996 (GABRIEL), Wellcome Trust WT 084703MA, UK: Medical Research Council (Grant Number 92091). Support also provided by the National Institute for Health Research through the Primary Care Research Network. ; Peer Reviewed
Introduction: The study aim was to examine the association of snoring and nocturnal gastro-oesophageal reflux (nGOR) with respiratory symptoms and lung function, and if snoring and/or nGOR associated with a steeper decline in lung function. Methods: Data from the third visit of the European Community Respiratory Health Survey (ECRHS) was used for cross-sectional analysis. Pre- and post-bronchodilator spirometry was performed, and information on sleep, nGOR and respiratory symptoms was collected (n=5715). Habitual snoring and nGOR were assessed by questionnaire reports. Pre-bronchodilator spirometry from ECRHS I, II and III (20 years follow-up) were used to analyse lung function changes by multivariate regression analysis. Results: Snoring and nGOR were independently associated with a higher prevalence of wheeze, chest tightness, breathlessness, cough and phlegm. The prevalence of any respiratory symptom was 79% in subjects with both snoring and nGOR versus 56% in those with neither (p<0.001). Subjects with both snoring and nGOR had more frequent exacerbations (adjusted prevalence 32% versus 19% among "no snoring, no nGOR", p=0.003). Snoring but not nGOR was associated with a steeper decline in forced expiratory volume in 1 s over 10 years after adjusting for confounding factors (change in % predicted -5.53, versus -4.58 among "no snoring", p=0.04) and forced vital capacity (change in % predicted -1.94, versus -0.99 among "no snoring", p=0.03). Conclusions: Adults reporting both habitual snoring and nGOR had more respiratory symptoms and more frequent exacerbations of these symptoms. Habitual snoring was associated with a steeper decline in lung function over time. ; The ALEC Study is funded by the European Union's Horizon 2020 Research and Innovation programme under grant agreement number 633212. Funding information for this article has been deposited with the Crossref Funder Registry.
Publisher's version (útgefin grein). ; Background: Menopause is associated with a number of adverse health effects and its timing has been reported to be influenced by several lifestyle factors. Whether greenspace exposure is associated with age at menopause has not yet been investigated. Objective: To investigate whether residential surrounding greenspace is associated with age at menopause and thus reproductive aging. Methods: This longitudinal study was based on the 20-year follow-up of 1955 aging women from a large, population-based European cohort (ECRHS). Residential surrounding greenspace was abstracted as the average of satellite-based Normalized Difference Vegetation Index (NDVI) across a circular buffer of 300 m around the residential addresses of each participant during the course of the study. We applied mixed effects Cox models with centre as random effect, menopause as the survival object, age as time indicator and residential surrounding greenspace as time-varying predictor. All models were adjusted for smoking habit, body mass index, parity, age at menarche, ever-use of contraception and age at completed full-time education as socio-economic proxy. Results: An increase of one interquartile range of residential surrounding greenspace was associated with a 13% lower risk of being menopausal (Hazard Ratio: 0.87, 95% Confidence Interval: 0.79–0.95). Correspondingly the predicted median age at menopause was 1.4 years older in the highest compared to the lowest NDVI quartile. Results remained stable after additional adjustment for air pollution and traffic related noise amongst others. Conclusions: Living in greener neighbourhoods is associated with older age at menopause and might slow reproductive aging. These are novel findings with broad implications. Further studies are needed to see whether our findings can be replicated in different populations and to explore the potential mechanisms underlying this association. ; Kai Triebner has received a postdoctoral fellowship from theUniversity of Bergen. Payam Dadvand is funded by a Ramón y Cajalfellowship (Grant: RYC-2012-10995) awarded by the Spanish Ministryof Economy and Finance. The present analyses are part of a projectfunded by the Norwegian Research Council (Grant: 228174).Coordination of the ECRHS I was supported by the EuropeanCommission as part of the"Quality of Life"program and the authorsand participants are grateful to the late C. Baya and M. Hallen for theirhelp during the study and K. Vuylsteek and the members of the COMACfor their support. Coordination of the ECRHS II was supported by theEuropean Commission as part of the"Quality of Life"program (Grant:QLK4-CT-1999-01237). The coordination of the ECRHS 3 was fundedthrough the Medical Research Council (Grant: 92091). NDVI calcula-tions were conducted within the framework of the Ageing Lungs InEuropean Cohorts study that was funded by the European Union'sHorizon 2020 research and innovation program under (Grant: 633212).Bodies funding the local studies are listed in the online data supple-ment. The funding sources were not involved in the conduct of theresearch and/or preparation of the article, in study design, in the col-lection, analysis and interpretation of data, in the writing of the reportor in the decision to submit the article for publication. ; Peer Reviewed
Introduction Sleep length has been associated with obesity and various adverse health outcomes. The possible association of sleep length and respiratory symptoms has not been previously described. The aim of this study was to investigate the association between sleep length and respiratory symptoms and whether such an association existed independent of obesity. Methods This is a multicentre, cross-sectional, population-based study performed in 23 centres in 10 different countries. Participants (n=5079, 52.3% males) were adults in the third follow-up of the European Community Respiratory Health Survey III. The mean±SD age was 54.2±7.1 (age range 39–67 years). Information was collected on general and respiratory health and sleep characteristics. Results The mean reported nighttime sleep duration was 6.9±1.0 hours. Short sleepers (<6 hours per night) were n=387 (7.6%) and long sleepers (≥9 hours per night) were n=271 (4.3%). Short sleepers were significantly more likely to report all respiratory symptoms (wheezing, waking up with chest tightness, shortness of breath, coughing, phlegm and bronchitis) except asthma after adjusting for age, gender, body mass index (BMI), centre, marital status, exercise and smoking. Excluding BMI from the model covariates did not affect the results. Short sleep was related to 11 out of 16 respiratory and nasal symptoms among subjects with BMI ≥30 and 9 out of 16 symptoms among subjects with BMI <30. Much fewer symptoms were related to long sleep, both for subjects with BMI <30 and ≥30. Conclusions Our results show that short sleep duration is associated with many common respiratory symptoms, and this relationship is independent of obesity. ; The ALEC Study is funded by the European Union's Horizon 2020 Research and Innovation programme under grant agreement No 633212. ; Peer Reviewed
To access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked Files ; Introduction Sleep length has been associated with obesity and various adverse health outcomes. The possible association of sleep length and respiratory symptoms has not been previously described. The aim of this study was to investigate the association between sleep length and respiratory symptoms and whether such an association existed independent of obesity. Methods This is a multicentre, cross-sectional, population-based study performed in 23 centres in 10 different countries. Participants (n=5079, 52.3% males) were adults in the third follow-up of the European Community Respiratory Health Survey III. The mean +/- SD age was 54.2 +/- 7.1 (age range 39-67 years). Information was collected on general and respiratory health and sleep characteristics. Results The mean reported nighttime sleep duration was 6.9 +/- 1.0 hours. Short sleepers (= 9 hours per night) were n=271 (4.3%). Short sleepers were significantly more likely to report all respiratory symptoms (wheezing, waking up with chest tightness, shortness of breath, coughing, phlegm and bronchitis) except asthma after adjusting for age, gender, body mass index (BMI), centre, marital status, exercise and smoking. Excluding BMI from the model covariates did not affect the results. Short sleep was related to 11 out of 16 respiratory and nasal symptoms among subjects with BMI >= 30 and 9 out of 16 symptoms among subjects with BMI = 30. Conclusions Our results show that short sleep duration is associated with many common respiratory symptoms, and this relationship is independent of obesity. ; European Union
Background The diagnosis of chronic obstructive pulmonary disease is based on the presence of persistent respiratory symptoms and chronic airflow limitation (CAL). CAL is based on the ratio of forced expiratory volume in 1 s to forced vital capacity (FEV1:FVC) after bronchodilation, and FEV1:FVC less than the fifth percentile is often used as a cut-off for CAL. The aim was to investigate if increasing percentiles of FEV1:FVC were associated withany respiratory symptom(cough with phlegm, dyspnoea or wheezing) in a general population sample of never-smokers and ever-smokers. Methods In a cross-sectional study comprising 15 128 adults (50-64 years), 7120 never-smokers and 8008 ever-smokers completed a respiratory questionnaire and performed FEV(1)and FVC after bronchodilation. We calculated theirz-scores for FEV1:FVC and defined the fifth percentile using the Global Lung Function Initiative (GLI) reference value, GLI(5)and increasing percentiles up to GLI(25). We analysed the associations between different strata of percentiles and prevalence ofany respiratory symptomusing multivariable logistic regression for estimation of OR. Results Among all subjects, regardless of smoking habits, the odds ofany respiratory symptomwere elevated up to the GLI(15-20)strata. Among never-smokers, the odds ofany respiratory symptomwere elevated at GLI(= 25)(OR 1.33, 95% CI 1.00 to 1.75). Conclusions The association between percentages of FEV1:FVC and respiratory symptoms differed depending on smoking history. Our results support a higher percentile cut-off for FEV1:FVC for never-smokers and, in particular, for ever-smokers. ; Funding Agencies|Swedish Heart and Lung FoundationSwedish Heart-Lung Foundation; Knut and Alice Wallenberg FoundationKnut & Alice Wallenberg Foundation; Swedish Research Council (Swedens innovation agency); VINNOVA (Swedens innovation agency)Vinnova; University of Gothenburg; Sahlgrenska University Hospital; Karolinska University HospitalKarolinska Institutet; Lund University; Skane University Hospital; Uppsala University; Swedish government; Swedish county councils, the ALF agreement; Linkoping University; University Hospital; Umea University; Karolinska InstitutetKarolinska Institutet
Publisher's version (útgefin grein) ; Objectives: Menopause involves hypoestrogenism, which is associated with numerous detrimental effects, including on respiratory health. Hormone replacement therapy (HRT) is often used to improve symptoms of menopause. The effects of HRT on lung function decline, hence lung ageing, have not yet been investigated despite the recognized effects of HRT on other health outcomes. Study design: The population-based multi-centre European Community Respiratory Health Survey provided complete data for 275 oral HRT users at two time points, who were matched with 383 nonusers and analysed with a two-level linear mixed effects regression model. Main outcome measures: We studied whether HRT use was associated with the annual decline in forced vital capacity (FVC) and forced expiratory volume in one second (FEV1). Results: Lung function of women using oral HRT for more than five years declined less rapidly than that of nonusers. The adjusted difference in FVC decline was 5.6 mL/y (95%CI: 1.8 to 9.3, p = 0.01) for women who had taken HRT for six to ten years and 8.9 mL/y (3.5 to 14.2, p = 0.003) for those who had taken it for more than ten years. The adjusted difference in FEV1 decline was 4.4 mL/y (0.9 to 8.0, p = 0.02) with treatment from six to ten years and 5.3 mL/y (0.4 to 10.2, p = 0.048) with treatment for over ten years. Conclusions: In this longitudinal population-based study, the decline in lung function was less rapid in women who used HRT, following a dose-response pattern, and consistent when adjusting for potential confounding factors. This may signify that female sex hormones are of importance for lung ageing. ; Kai Triebner has received a postdoctoral fellowship from the University of Bergen. The present analyses are part of a project funded by the Norwegian Research Council (Project No. 228174) as well as part of the Ageing Lungs in European Cohorts (ALEC) Study (www.alecstudy.org), which has received funding from the European Union's Horizon 2020 research and innovation program (Grant No. 633212). The European Commission supported the European Community Respiratory Health Survey, as part of the "Quality of Life" program. Bodies funding the local studies are listed in the online data supplement. The funding sources had no involvement in the conduct of the research and/or preparation of the article, in study design, in the collection, analysis and interpretation of data, in the writing of the report or in the decision to submit the article for publication. ; Peer Reviewed
Publisher's version (útgefin grein) ; Background: Emerging evidence suggests that androgens and estrogens have a role in respiratory health, but it is largely unknown whether levels of these hormones can affect lung function in adults from the general population. This study investigated whether serum dehydroepiandrosterone sulfate (DHEA-S), a key precursor of both androgens and estrogens in peripheral tissues, was related to lung function in adult women participating in the European Community Respiratory Health Survey (ECRHS). Methods: Lung function and serum DHEA-S concentrations were measured in n = 2,045 and n = 1,725 women in 1999–2002 and in 2010–2013, respectively. Cross-sectional associations of DHEA-S levels (expressed as age-adjusted z-score) with spirometric outcomes were investigated, adjusting for smoking habits, body mass index, menopausal status, and use of corticosteroids. Longitudinal associations of DHEA-S levels in 1999–2002 with incidence of restrictive pattern and airflow limitation in 2010–2013 were also assessed. Findings: Women with low DHEA-S (z-score<-1) had lower FEV1 (% of predicted, adjusted difference: -2.2; 95%CI: -3.5 to -0.9) and FVC (-1.7; 95%CI: -2.9 to -0.5) and were at a greater risk of having airflow limitation and restrictive pattern on spirometry than women with higher DHEA-S levels. In longitudinal analyses, low DHEA-S at baseline was associated with a greater incidence of airflow limitation after an 11-years follow-up (incidence rate ratio, 3.43; 95%CI: 1.91 to 6.14). Interpretation: Low DHEA-S levels in women were associated with impaired lung function and a greater risk of developing airflow limitation later in adult life. Our findings provide new evidence supporting a role of DHEA-S in respiratory health. ; The current study is part of the Ageing for Lungs in European Cohorts (ALEC) study ( www.alecstudy.org ), ALEC has received funding from the European Union's Horizon 2020 research and innovation program [grant agreement No. 633212]. The coordination of the ECRHS was supported by the European Commission [grant agreement no. QLK4-CT-1999–01237] and the Medical Research Council [grant agreement no. 92091]. The hormones measures at ECRHS III were funded by the Norwegian Research Council [grant agreement no. 228174]. Hormones measures at ECRHS II were funded by the local budget of the ECRHS Paris team, INSERM U700, Epidemiology, with further support from the Comité National contre les Maladies Respiratoires (CNMR), the centre d'Investigation Clinique (CIC), Bichat Hospital, and the French Agence Nationale de la Recherche (ANR). Bodies funding the local studies are listed in the Online Supplement. The funding sources had no role in the writing of the manuscript or the decision to submit it for publication. The corresponding authors had full access to all the data in the study and had final responsibility for the decision to submit for publication. ; Peer Reviewed
