Charlotte Ulrik | University of Copenhagen (original) (raw)

Papers by Charlotte Ulrik

European Clinical Respiratory Journal, 2015

Objective: The best strategy for diagnosing asthma remains unclear. Accordingly, the aim of this ... more Objective: The best strategy for diagnosing asthma remains unclear. Accordingly, the aim of this study was to evaluate diagnostic strategies in individuals with possible asthma referred to a respiratory outpatient clinic at a university hospital. Methods: All individuals with symptoms suggestive of asthma referred over 12 months underwent spirometry, bronchodilator reversibility test, Peak expiratory flow rate (PEF) registration, and bronchial challenge test with methacholine and mannitol on three separate days. The results of these tests were compared against an asthma diagnosis based on symptoms, presence of atopy and baseline spirometry made by a panel of three independent respiratory specialists. Results: Of the 190 individuals examined, 63% (n 0122) were classified as having asthma. Reversibility to b 2-agonist had the lowest sensitivity of 13%, whereas airway hyperresponsiveness to methacholine had the highest (69%). In contrast, specificity was the highest for reversibility testing (93%), whereas methacholine had the lowest specificity (57%). The combination of reversibility, peak-flow variability, and methacholine yielded a cumulative sensitivity of 78%, albeit a specificity of 41%. In comparison, a combination of reversibility and mannitol resulted in a specificity of 82% and a sensitivity of 42%. Conclusion: In this real-life population, different diagnostic test combinations were required to achieve a high specificity for diagnosing asthma and a high sensitivity, respectively: Our findings suggest that the diagnostic test approach should be based on whether the aim is to exclude asthma (high sensitivity required) or confirm a diagnosis of asthma (high specificity required).

Scandinavian Journal of Work, Environment & Health, Nov 12, 2013

This review on occupational chronic obstructive pulmonary disease (COPD) addresses some of the po... more This review on occupational chronic obstructive pulmonary disease (COPD) addresses some of the potential limitations of earlier assessments by restricting the studies included to high quality epidemiological analysis involving only spirometrically confirmed air-flow obstruction as the outcome. The authors combined this with minimal requirements for exposure characterization allowing for analysis of population-based studies.

Background: Overweight both in childhood and adolescence is an increasing challenge word-wide and... more Background: Overweight both in childhood and adolescence is an increasing challenge word-wide and associated with an increased incidence of asthma. However, the mechanisms underlying this association are incompletely understood. In the present study, we investigated if overweight in childhood and adolescence is associated with an increased risk of airway hyperresponsiveness (AHR), a hallmark of asthma, in adulthood. Methods: Of 537 subjects from a random population sample of children and adolescents (7 to 17 years) examined in 1986 (baseline visit), 189 completed a follow-up visit in 2006. Both visits included assessment of height and weight, spirometry and case history, including asthma and allergic diseases. At both visits, bronchial provocation tests were performed using either histamine (baseline visit) or metacholine (follow-up visit). Results: Subjects who were overweight or obese at baseline visit (n=26) (paediatric definition, body mass index (BMI) ≥85%percentile), had a significant higher BMI at follow-up visit, compared with participants of normal weight at baseline visit (n=163) (mean (SD) 30.9 (7.0) vs. 24.8 (3.1), respectively, p Conclusion: In children and adolescence, being obese or overweight seems not to be associated with an increased risk of having airway hyperresponsiveness to metacholine in adulthood.

Clinics in Chest Medicine, Sep 1, 2021

There are many unique aspects of asthma in women. Compared with men, women go through several hor... more There are many unique aspects of asthma in women. Compared with men, women go through several hormonal stages over the life span-childhood, menarche, reproductive years, pregnancy, menopause, and postmenopause-and each affects asthma. Onset of asthma in women differs from men. Asthma in women is more often associated with obesity and women are over-represented among patients with severe asthma, including those being prescribed biologic therapies. Asthma affects fertility and pregnancy, and female hormone replacement therapy has been found to affect asthma onset as well as asthma severity. We explore the unique aspects of asthma in women.

Journal of Asthma, 2006

Knowledge of secular trends in the prevalence of allergy among children stems in large part from ... more Knowledge of secular trends in the prevalence of allergy among children stems in large part from questionnaire surveys, whereas repeated cross-sectional studies using objective markers of atopic sensitization are sparse. To investigate whether the prevalence of skin prick test (SPT) positivity in Danish children has changed from 1986 to 2001. Serial cross-sectional studies of two different random population samples of children aged 7 to 17 years of age, living in urban Copenhagen, Denmark, were performed 15 years apart. The first cohort was investigated in 1986 (n = 527) and the second in 2001 (n = 480). Skin test reactivity to nine common aeroallergens was measured at both occasions. The prevalence of positive SPT to at least one allergen decreased from 24.1% in 1986 to 18.9% in 2001, (p = 0.05). We found a declining prevalence of sensitization to most allergens tested, statistically significant; however, only for mugwort and Alternaria iridis. Among subjects, who were sensitized to only one allergen, we found significantly fewer individuals with reactions to D. pteronyssinus and mugwort. The prevalence of atopic sensitization as judged by SPT positivity has decreased or remained unchanged among Danish children during the 15-year period from 1986 to 2001. The increase in prevalence of allergic disease often reported in comparable studies using questionnaires as sole diagnostic criterion could not be reproduced in this study where objective markers of allergic sensitization were included in the design.

ERJ Open Research

BackgroundReal-life evidence on prevalence and management of severe asthma is limited. Nationwide... more BackgroundReal-life evidence on prevalence and management of severe asthma is limited. Nationwide population registries across the Nordic countries provide unique opportunities to describe prevalence and management patterns of severe asthma at population level. In nationwide register data from Sweden, Norway and Finland, we examined the prevalence of severe asthma and the proportion of severe asthma patients being managed in specialist care.MethodsThis is a cross-sectional study based on the Nordic Dataset for Asthma Research (NORDSTAR) research collaboration platform. We identified patients with severe asthma in adults (aged ≥18 years) and in children (aged 6–17 years) in 2018 according to the European Respiratory Society/American Thoracic Society definition. Patients managed in specialist care were those with an asthma-related specialist outpatient contact (only available in Sweden and Finland).ResultsOverall, we identified 598 242 patients with current asthma in Sweden, Norway an...

Clinical Microbiology and Infection

Annals of the American Thoracic Society

Authors' contributions: KHA, STS, MT, and UB (Research group, i.e., 'steering committee') contrib... more Authors' contributions: KHA, STS, MT, and UB (Research group, i.e., 'steering committee') contributed substantively to the concept and design of this trial. The chief investigator (KHA) developed manuals (recruitment, assessment, and treatment) and written information, applied for grants, assigned for approvals, registered at ClinicalTrials.gov, introduced and supervised the recruitment, assessment, and treatment procedures to all involved nurses and physiotherapists and, and led the data collection, and data verification. UB, STS, and MT gave feedback. STS specifically contributed in description of the statistical analyses. KHA analyzed data and drafted the manuscript.

Journal of Ultrasound

Purpose Several studies have reported thromboembolic events to be common in severe COVID-19 cases... more Purpose Several studies have reported thromboembolic events to be common in severe COVID-19 cases. We sought to investigate the relationship between lung ultrasound (LUS) findings in hospitalized COVID-19 patients and the development of venous thromboembolic events (VTE). Methods A total of 203 adults were included from a COVID-19 ward in this prospective multi-center study (mean age 68.6 years, 56.7% men). All patients underwent 8-zone LUS, and all ultrasound images were analyzed off-line blinded. Several LUS findings were investigated (total number of B-lines, B-line score, and LUS-scores). Results Median time from admission to LUS examination was 4 days (IQR: 2, 8). The median number of B-lines was 12 (IQR: 8, 18), and 44 (21.7%) had a positive B-line score. During hospitalization, 17 patients developed VTE (4 deep-vein thrombosis, 15 pulmonary embolism), 12 following and 5 prior to LUS. In fully adjusted multivariable Cox models (excluding participants with VTE prior to LUS), all LUS parameters were significantly associated with VTE (total number of B-lines:

International Journal of Infectious Diseases, 2021

Hydroxychloroquine has been proposed as a primary prophylactic agent against coronavirus disease ... more Hydroxychloroquine has been proposed as a primary prophylactic agent against coronavirus disease 2019 (COVID-19). This study aimed to investigate if patients treated with hydroxychloroquine for a non-COVID-19 indication had a lower risk of verified infection with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) compared with matched controls. Methods: A cohort comprising all persons in Denmark collecting hydroxychloroquine prescriptions in 2020 and 2019 (i.e., both during and before SARS-CoV-2 was confirmed in Denmark), matched by age and sex with controls, was studied. Data were collected using the Danish national registries, which contain complete information on patient health data, prescriptions and microbiological test results. The main outcome was microbiologically verified SARS-CoV-2 infection. Results: In total, 5488 hydroxychloroquine users were matched with 54,486 non-users. At baseline, the groups differed in terms of diagnoses of pulmonary disease, cardiovascular disease, renal disease, gastrointestinal/metabolic disease and dementia, as well as treatment with antirheumatic drugs. The final model was adjusted for these potential confounders. Use of hydroxychloroquine for non-COVID-19 indications was not associated with any change in confirmed SARS-CoV-2 (hazard ratio 0.90, 95% confidence interval 0.76-1.07). This result was robust in the propensity-score-matched sensitivity analysis. Conclusion: This study, which is the largest to date to investigate the primary prophylactic effect of hydroxychloroquine against SARS-CoV-2, does not support any prophylactic benefit of hydroxychloroquine in the prevention of infection with SARS-CoV-2.

Idiopathic interstitial pneumonias, 2021

The Journal of Allergy and Clinical Immunology: In Practice, 2021

Background: Clinicians are increasingly recognising severe asthma patients in whom biologicals an... more Background: Clinicians are increasingly recognising severe asthma patients in whom biologicals and other add-on therapies lead to dramatic improvement. Currently, there is no agreed upon superresponder (SR) definition. Objective: To survey severe asthma experts using a modified Delphi process in order to develop an international consensus-based definition of a severe asthma 'super-responder'. Methods: The Delphi panel comprised 81 participants (94% specialist pulmonologists or allergists) from 24 countries and consisted of 3 iterative online voting rounds. Consensus on individual items, whether acceptance or rejection, required at least 70% agreement by panel members. Results: Consensus was achieved that the SR definition should be based on improvement across 3 or more domains assessed over 12 months. Major SR criteria included exacerbation elimination, a large improvement in asthma control (≥ 2x the minimal clinically important difference) and cessation of maintenance of oral steroids (or weaning to adrenal insufficiency). Minor SR criteria comprised a 75% exacerbation reduction, having well controlled asthma and a 500mL or greater improvement in FEV1. The SR definition requires improvement in at least 2 major criteria. In the future, the SR definition should be expanded to incorporate quality of life measures, though current tools can be difficult to implement in a clinical setting and further research is needed. Conclusions: This international consensus-based definition of severe asthma super responders is an important prerequisite for better understanding super-responder prevalence, predictive factors and the mechanisms involved. Further research is needed to understand the patient perspective and measure quality of life more precisely in super-responders.

European Respiratory Journal, 2021

BackgroundCombining the antibiotic azithromycin and hydroxychloroquine induces airway immunomodul... more BackgroundCombining the antibiotic azithromycin and hydroxychloroquine induces airway immunomodulatory effects, with the latter also having in vitro antiviral properties. This may improve outcomes in patients hospitalised for coronavirus disease 2019 (COVID-19).MethodsPlacebo-controlled double-blind randomised multicentre trial. Patients aged ≥18 years, admitted to hospital for ≤48 h (not intensive care) with a positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) reverse transcription PCR test were recruited. The intervention was 500 mg daily azithromycin for 3 days followed by 250 mg daily azithromycin for 12 days combined with 200 mg twice-daily hydroxychloroquine for all 15 days. The control group received placebo/placebo. The primary outcome was days alive and discharged from hospital within 14 days (DAOH14).ResultsAfter randomisation of 117 patients, at the first planned interim analysis, the data and safety monitoring board recommended stopping enrolment due t...

ESC Heart Failure, 2020

AimsThe present study had two aims: (i) compare echocardiographic parameters in COVID‐19 patients... more AimsThe present study had two aims: (i) compare echocardiographic parameters in COVID‐19 patients with matched controls and (2) assess the prognostic value of measures of left (LV) and right ventricular (RV) function in relation to COVID‐19 related death.Methods and resultsIn this prospective multicentre cohort study, 214 consecutive hospitalized COVID‐19 patients underwent an echocardiographic examination (by pre‐determined research protocol). All participants were successfully matched 1:1 with controls from the general population on age, sex, and hypertension. Mean age of the study sample was 69 years, and 55% were male participants. LV and RV systolic function was significantly reduced in COVID‐19 cases as assessed by global longitudinal strain (GLS) (16.4% ± 4.3 vs. 18.5% ± 3.0, P < 0.001), tricuspid annular plane systolic excursion (TAPSE) (2.0 ± 0.4 vs. 2.6 ± 0.5, P < 0.001), and RV strain (19.8 ± 5.9 vs. 24.2 ± 6.5, P = 0.004). All parameters remained significantly redu...