Vibeke Backer

• MD DMSci
• Professor at University of Copenhagen

Background Systemic corticosteroid use in type 2 inflammation-associated diseases including asthma, atopic dermatitis, allergic rhinitis, and chronic rhinosinusitis has been associated with adverse outcomes, and corticosteroid-sparing treatments are available. Objective Assess temporal changes in systemic corticosteroid use and the impact of type...

Allergic rhinitis (AR) is a common inflammatory condition affecting millions globally. Emerging evidence suggests a potential link between AR and suicidality; however, this association remains underexplored compared to other atopic diseases. This systematic review and meta-analysis aimed to investigate the association between AR and the risks of su...

Treatment targets in severe asthma have evolved towards a remission‐focused paradigm guided by precision medicine. This novel concept requires a shift from evaluating the efficacy of therapies based on a single outcome at a single time point to an outcome that captures the complexity of asthma remission involving several domains assessed over a sus...

Objectives Olfactory training is a recommended treatment in patients with olfactory dysfunction after COVID‐19. However, the effectiveness of olfactory training in COVID‐19‐induced olfactory dysfunction has been studied; only a few studies have included a placebo group to compare the effect of traditional olfactory training with odor‐free olfactory...

Background & objectives Smoking is a significant risk factor for chronic bronchitis (CB). However, since not all smokers develop CB, it is essential to consider other factors such as oxidative stress, diet, and genetics. This study aimed to investigate (a) potential risk factors for CB, (b) the association between fruit and vegetable intake and CB...

Exercise is an important treatment for people with asthma and should be considered alongside pharmacological therapy when developing personalised asthma management plans. Despite this, there remains limited guidance concerning the practicalities of asthma‐specific exercise prescription. This European Academy of Allergy and Clinical Immunology task...

Background Chronic rhinosinusitis with nasal polyps (CRSwNP) significantly impacts patients’ quality of life (QoL). Standard treatments include nasal irrigations, nasal steroids, systemic corticosteroids, and functional endoscopic sinus surgery (FESS). Uncontrolled severe CRSwNP treated with monoclonal antibodies (biologic drugs) gain better diseas...

The introduction of biologics for the treatment of severe upper and lower (type 2) airway inflammation has been a gamechanger in the management of these diseases. Biologics are injectable medications targeting different molecules relevant in (type 2) inflammation in patients with severe (type 2) airway diseases, like asthma, eosinophilic chronic ob...

Remission has recently been proposed as the new goal of care in CRSwNP or Nasal Polyp Syndrome by the European Forum for Research and Education in Allergy and Airway Diseases / European Position Paper on Rhinosinusitis and Nasal Polyps (EUFOREA/EPOS) (1,2) as well as by global leaders in Rhinology (3). In CRSwNP, remission is defined as a prolonged...

Allergic rhinitis (AR), the most prevalent immunological disease, affects approximately 400 million individuals globally and can significantly impact quality of life (QoL). Despite nearly 25 years of guidelines, AR remains largely under- diagnosed, suboptimally treated and poorly controlled. In the light of new knowledge and treatment options, ther...

The European Forum for Research and Education in Allergy and Airways diseases (EUFOREA) organized the first European Biologic Training Course (EBTC) in Brussels on 1st March 2024. The aim of this hybrid EBTC including both face-to-face and web-based participation was to address the educational needs of physicians dealing with asthma and Chronic Rhi...

Chronic rhinosinusitis with nasal polyps (CRSwNP) often co-exists with asthma and non-steroidal anti-inflammatory drug- exacerbated respiratory disease (N-ERD), creating a more severe phenotype and an additional burden compared with CRSwNP disease alone (1-3). The relationship between these diseases in terms of shared immunological disbalance has b...

Key Points Eosinophilic granulocytes have characteristic morphological features. This makes them prime candidates for utilization of a single cell binary classification network. Single cell binary classification networks can reliably help quantify eosinophils in nasal polyps.

Background Phenotype classification contributes to risk assessment of asthma. Previous studies have applied this concept primarily to adult populations and in the setting of research protocol assessments which may not be applicable to clinical settings. Objective Exploring the value of routinely collected clinical data for phenotype classificati...

Background The inherited X-linked disorder, Fabry disease, is caused by deficient lysosomal enzyme α-galactosidase A, with progressive accumulation of globotriaosylceramide in multiple organs including the upper and lower airways. Objectives To assess pulmonary function at the time of the first pulmonary function test (PFT) performed among the Nat...

Asthma, which affects some 300 million people worldwide and caused 455,000 deaths in 2019, is a significant burden to suffers and to society. It is the most common chronic disease in children and represents one of the major causes for years lived with disability. Significant efforts are made by organizations such as WHO in improving the diagnosis,...

Severe chronic rhinosinusitis with nasal polyps (CRSwNP), a form of diffuse bilateral (usually type 2) CRS, is a debilitating disease with a significant impact on quality of life (QoL). With novel knowledge and treatment options becoming available, there is a growing need to update or revise key definitions to enable communication across different...

Introduction Endotyping is important for risk assessment of asthma, yet studies have primarily used adult populations and/or protocolled assessments that may be unavailable in daily clinical care. The value of routine data collection for childhood asthma endotyping remains largely unexplored. Methods Using Danish nationwide databases, 29,851 chi...

Purpose: Many athletes use long-acting beta2 -agonist formoterol in treatment of asthma. However, studies in non-athlete cohorts demonstrate that inhaled formoterol can enhance sprint performance calling into question whether its use in competitive sports should be restricted. We investigated whether formoterol at upper recommended inhaled doses (...

Objective: To evaluate if high-intensity interval training three times weekly for 12 weeks improves asthma control in overweight, postmenopausal women with uncontrolled, late-onset asthma. Methods: The reported study is a randomized clinical pilot study (www.clinicaltrials.gov; NCT03747211) that compared 12 weeks of high-intensity interval train...

Background There is limited evidence on the pathways leading to severe asthma and we are presently unable to effectively predict the progression of the disease. Aim: We aimed to describe the longitudinal trajectories leading to severe asthma and to describe clinical events preceding disease progression in a nationwide population of patients with se...

Background 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....

Purpose: When first-line chronic rhinosinusitis (CRS) treatment fails, patients can either be treated with oral or injected systemic corticosteroids. Although the EPOS and international guidelines for CRS do not mention injected corticosteroids, it is commonly used by ear, nose, and throat specialists. While the risks of systemic corticosteroids,...

In March 2023, the European Forum for Research and Education in Allergy and Airways diseases (EUFOREA) organized its bi-annual Summit in Brussels with expert panel members of EUFOREA, representatives of the EUFOREA patient advisory board, and the EUFOREA board and management teams. Its aim was to define the research, educational and advocacy initia...

Athletes often experience lower airway dysfunction, such as asthma and exercise-induced bronchoconstriction (EIB), which affects more than half the athletes in some sports, not least in endurance sports. Symptoms include coughing, wheezing, and breathlessness, alongside airway narrowing, hyperresponsiveness, and inflammation. Early diagnosis and ma...

“Epidemiology of comorbidities and their association with asthma control” (Tomisa, G., Horváth, A., Sánta, B. et al. Epidemiology of comorbidities and their association with asthma control. Allergy Asthma Clin Immunol 17, 95 (2021). https://doi.org/10.1186/s13223-021-00598-3 ) is an interesting paper reflecting data collection from more than 12,000...

Background Asthma is a common disease in childhood and adolescence with lifelong consequences particularly among those at risk of severe disease, poor control and/or frequent exacerbations. Specialist care is recommended for at-risk children and adolescents, yet access to specialist management in free-to-access healthcare settings remains poorly un...

Objective: We investigate symptoms of anxiety and depression among women with asthma prior to fertility treatment. Methods: This is a cross-sectional study of women screened for eligibility to the PRO-ART study (RCT of omalizumab versus placebo in asthmatic women undergoing fertility treatment (NCT03727971)). All participants were scheduled for...

Background: Inhaled corticosteroids (ICS) are the cornerstone of asthma treatment. However, ICS has side effects, and dose reduction is recommended when possible. Physical exercise improves asthma control, but it is unknown whether it reduces the reliance on ICS. Objective: To assess whether supervised high-intensity interval training reduces th...

Introduction As a common chronic disease seen across all ages, asthma has the potential to incur high societal and individual costs from both direct healthcare costs and loss of productivity. Most previous studies use smaller, selected populations to assess the cost of asthma, possibly reducing generalisability. We, therefore, aimed to assess the t...

Background: Use of exogenous female sex hormones is associated to development of asthma, but the question of whether the effect is protective or harmful remains unresolved. Objective: To investigate whether initiation of hormonal contraception was associated with development of asthma. Methods: We performed a register-based, exposure-matched c...

Women often report more anxiety than men, but there are divergent results regarding the putative correlation between physiological variables, such as cortisol, blood pressure and heart rate and the experienced emotional states. The aim of the present study was to evaluate sex differences in anxiety, and the relation to serum cortisol, blood pressur...

Background Chronic rhinosinusitis with nasal polyps (CRSwNP) and asthma frequently co-exist and share pathologic features. Taking a “global” treatment approach benefits diagnosis and treatment of both, but care is often siloed by specialty: joined-up clinics are uncommon. Our objectives were to explore expert opinion to give practical suggestions t...

Background Real-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. Aim In nationwide register data from Sweden, Norway, and Finland, we examined the prev...

Background The 2022 Global Initiative for Asthma guidelines emphasise the inhaled long-acting β2-agonist formoterol as part of the first treatment step, and therefore formoterol use among athletes will probably increase. However, prolonged supratherapeutic use of inhaled β2-agonists impairs training outcomes in moderately trained men. We investigat...

The 2023 Prohibited List issued by the World Anti‐Doping Agency (WADA) permits athletes to inhale beta2‐agonist vilanterol at a standard dose of 25 μg daily. But given limited data on urine pharmacokinetics, vilanterol has no urinary threshold or decision limit to discriminate therapeutic from supratherapeutic use. We investigated urine concentrati...

Introduction: Asthma is a known driver of societal cost, yet many studies tend to focus solely on the direct costs or utilize select, smaller populations. Therefore, we aim to assess the total, nationwide economic burden of asthma from both an individual and a societal perspective. Methods: The annual cost of asthma in Denmark was predicted in a n...

Background: Pediatric asthma has lifelong consequences among those with poor control. Specialist care is recommended for uncontrolled and severe asthma, yet little is known about impact of socioeconomic status (SES) on specialist care. Objective: Using a Danish nationwide cohort, we aimed to elucidate the prevalence of severe pediatric asthma, and...

Introduction: Specialist management of possible severe asthma has previously been shown to be dependent on socioeconomic status (SES), yet little is known about the influence of SES on respiratory care burden across care sectors in universal healthcare settings. Methods: The cohort comprises all asthma patients aged 18-45 during 2014-18 in active...

A bioanalytical method for detecting the ultra‐long‐acting beta2‐agonist (U‐LABA), inhaled vilanterol and its metabolites, GSK932009 and GW630200, in urine was developed to potentially monitor permitted therapeutic versus prohibited supratherapeutic use in sport. The World Anti‐Doping Agency (WADA) has established urinary concentration thresholds f...

Abstract Background Chronic cough, more than 8 weeks, can either be without co-morbidity called unexplained chronic cough (UCC) or with co-morbidity called refractory chronic cough (RCC). Using datasets from the Danish National Prescription Registry (Prescription Registry) and Danish National Patient Registry (Patient Registry) we wanted to investi...

Asthma and exercise-induced bronchoconstriction are highly prevalent in elite athletes compared with the general population. Some athletes have classic asthma with allergic sensitization; however, it seems that a proportion of athletes develop asthma as a result of several years of intensive training. It leads us to believe that asthma in athletes...

BACKGROUND: Although exercise and daily physical activity (PA) have long been known to benefit patients with chronic disorders, knowledge is limited regarding asthma.OBJECTIVE: In a Danish setting, our aim was to measure physical activity, sedentary behavior, and physical capacity among patients with asthma. We hypothesized that people with severe...

Introduction Specialist management of asthma has been shown to associate with socioeconomic status (SES). However, little is known about the influence of SES on care burden in universal healthcare settings. Methods Patients aged 18–45 years using inhaled corticosteroids (ICS) were followed in national databases. Impact of asthma was investigated u...

Background and objective: Exercise capacity is associated with health-related quality of life and symptom control in severe asthma. Thus, interventions targeting exercise capacity are likely to be beneficial. However, clinical and biological factors impacting exercise capacity in severe asthma are sparsely investigated. We aimed to describe the as...

Introduction 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 nationwi...

Asthma and infertility are the most common disorders among women of reproductive age. Time to pregnancy is prolonged in women with asthma, and importantly, age seems to be a more important risk factor regarding fertility in women with asthma compared to women without asthma. Some data have shown a higher frequency of miscarriages in women with asth...

Introduction Asthma is a known driver of morbidity, yet the impact of asthma and asthma control on welfare use in young adults with asthma over time is sparsely investigated. In a nationwide cohort, we aim to describe the overall welfare resource utilization (WRU) across asthma severities and describe the influence of asthma control. Methods RE...

Background Women with asthma appears to have an increased risk of pregnancy loss. The impact of asthma on recurrent pregnancy loss (RPL), defined as three consecutive losses, is, however, unknown. Objective The aim of this study was to investigate if having asthma before or during the fertile age is associated with pregnancy loss and RPL. Methods...

Rodent studies highlight enhancement of glucose tolerance and insulin sensitivity as potential clinically relevant effects of chronic beta2‐agonist treatment. However, the doses administered to rodents are not comparable with the therapeutic doses used for humans. Thus, we investigated the physiological effects of prolonged beta2‐agonist treatment...

Systemic inflammation is a well-established feature of Chronic Obstructive Pulmonary Disease, COPD, but less is known about inflammation in the upper airways in the disease. In the current study, we investigated the inflammatory profile in the upper airway and in serum in a cohort of patients with COPD. Patients were examined with inflammatory prof...

Purpose 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 n...

Research question Does menopausal hormone therapy with exogenous estrogens and progestogens change the use of inhaled anti-asthma medications in women with asthma? Methods In a population-based, matched cohort study using the Danish registries, we included women with asthma aged 45–65 years from June 1, 1995 to June 30, 2018. We investigated wheth...

Background Chronic cough, more than 8 weeks, can either be without co-morbidity called unexplained chronic cough (UCC) or with co-morbidity called refractory chronic cough (RCC). Using datasets from the Danish National Prescription Registry (Prescription Registry) and Danish National Patient Registry (Patient Registry) we wanted to investigate the...

Background Small Airways Disease (SAD) is a recognised part of the pathology in Chronic Obstructive Pulmonary Disease (COPD) and contributes to the symptom burden in the disease. Upper airway symptoms in COPD is an emerging field of study, and in this study, we sought to examine the co-existence of SAD and upper airways symptoms in a cohort of COPD...

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...

Background Patients with asthma are heterogeneous in clinical presentation and in response to treatment. Despite this, tools to guide treatment are limited and include mainly measures of eosinophilic inflammation and symptoms. Airway hyperresponsiveness (AHR) to mannitol is present in patients across inflammatory phenotypes and improve with inhaled...

Background There is growing evidence that upper airway symptoms coexist with lower airway symptoms in Chronic Obstructive Pulmonary Disease (COPD). Still, the prevalence and impact of upper airway disease on the nature and course of COPD remain unclear. We aimed to describe this in a cross-sectional study. Methods We examined a cohort of COPD pati...

Immune modulation is a key therapeutic tool for allergic diseases and asthma. It can be achieved in an antigen-specific way via allergen immunotherapy (AIT) or in endotype-driven approach using biologicals that target the major pathways of the type 2 (T2) immune response: IgE, IL-5 and IL-4/IL-13. COVID-19 vaccine provides an excellent opportunity...

Background Type 2 inflammation is characterized by enhanced activity of interleukin (IL)-4, -5, and -13 and treatments targeting these pathways are available for treatment of severe asthma. At present, the pattern of pathway activity and the implications overlapping of pathway activity is unknown. Objective We hypothesized that clustering of airwa...

Rationale and objectives: Thymic stromal lymphopoietin (TSLP), an epithelial upstream cytokine, initiates production of type-2 (T2) cytokines with eosinophilia and possibly airway hyperresponsiveness (AHR) in asthma. This study aimed to determine whether tezepelumab (a human monoclonal antibody targeting TSLP) decreases AHR and airway inflammatio...

Background Although socioeconomic impact on asthma control has been investigated, little is known about its relation to specialist referral of patients with possible severe asthma, especially in a public healthcare setting. The present study aims to identify socioeconomic patterns in disease control and referral of patients with asthma in a nationw...

Introduction: Late-onset asthma in postmenopausal women is characterised by poor disease control with daily symptoms and reduced quality of life despite treatment with inhaled antiasthma therapies. These patients represent a phenotype that is characterised by low eosinophilic airway inflammation, severe symptoms, moderate obesity and poor response...

Background Coronavirus disease 19 (COVID-19) is spreading globally and treatment options remain limited. A formulation of niclosamide, a potent anti-SARS-CoV-2 agent and a broad-spectrum antiviral treatment candidate, optimized for inhalation and intranasal administration (UNI91104) was developed. Methods We conducted a randomized, placebo-control...

Background Phenotypic characteristics of eosinophilic and non-eosinophilic asthma patients are not well-characterized in global, real life severe asthma cohorts. Research Question What is the prevalence of eosinophilic and non-eosinophilic phenotypes in the severe asthma population, and can they be differentiated by clinical and biomarker variable...

(246 words) Background Little is known about how the spirometric definition of airway obstruction affects the association between COPD and comorbidities and whether these associations might be due to genetic predisposition. Aim 1) To examine the impact of the spirometric definition on the associations between COPD and its comorbidities and 2) To...

Background Exercise-induced laryngeal obstruction (EILO) is a common cause of exertional breathlessness and wheeze yet is frequently misdiagnosed as asthma. Insight regarding the demographic characteristics, laryngeal abnormalities and impact of EILO is currently limited, with data only available from individual centre reports. The aim of this work...

Background Hormone replacement therapy is prescribed to millions of women worldwide. Previous studies have suggested that hormone replacement therapy has both protective and harmful effects in asthma. Research question Is hormone replacement therapy in menopause associated with new development of asthma? Study Design and Methods We undertook a ne...

Introduction: Cell differential count of induced sputum is considered the gold standard for inflammatory phenotyping of asthma but is not implemented in routine care due to its heavy time- and staff demands. Digital Cell Morphology is a technique where digital images of cells are captured and presented pre-classified as white blood cells (neutrophi...

In this study, we examined the effect of beta 2 -agonist salbutamol at oral doses during a period of resistance training on sprint performance, quadriceps contractile function, skeletal muscle hypertrophy, fiber-type composition, maximal activity of enzymes of importance for anaerobic energy turnover, and sarcoplasmic reticulum Ca ²⁺ -handling in y...

Background Severe asthma may be under-recognized in primary care. Objective Identify and quantify patients with potential severe asthma (PSA) in UK primary care, the proportion not referred, and compare primary care PSA patients with confirmed severe asthma patients from UK tertiary care. Methods Historical cohort study including patients from the...

Introduction Patients with obstructive lung diseases are possibly at risk of developing severe outcomes of COVID-19. Therefore, the aim with this study was to determine the risk of severe outcomes of COVID-19 among patients with asthma and COPD. Methods We performed a nationwide cohort study including patients with COVID-19 from February 1 to July...

Background Acute and chronic supratherapeutic treatment with the commonly used beta2‐agonist salbutamol has the potential to enhance sprint performance and muscle strength. However, little is known about the performance effects of short‐term daily permitted inhaled treatment vs oral prohibited treatment in accordance with the 2020 Prohibited List i...