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Severe asthma is a relatively common, chronic, heterogeneous inflammatory disease affecting around 4-10% of all asthmatics. Most of these have uncontrolled eosinophilic asthma, the treatment of which accounts for >50% of healthcare costs attributed to the disease. Management of severe asthma requires a thorough investigation to exclude comorbidities and determine the underlying type of inflammation and resulting asthma phenotype, so that suitable treatments can be chosen. Systematic assessment and evaluation of treatment must then be performed every 3-6 months. Severe asthma is mostly driven by type 2 inflammation, and we now have several specific biological therapies targeting this inflammation, yet some patients remain poorly controlled due to the heterogenous nature of this disease with its many sub-phenotypes. Therefore, research must determine which clinical and patient reported outcomes as well as biomarkers best reflect response to therapy and thus should be monitored in the clinic.

Type 2 (T2) high asthma, characterized by T2 markers such as eosinophilia, is driven by type 2 innate lymphoid cells (ILC2) and allergen-activated T helper (Th2) cells. Epithelial-derived cytokines called alarmins, IL-33, TSLP, IL-25 and TL1A, acting on dendritic cells and ILC2, are key in driving both allergic and non-allergic T2 high asthma. Alarmins are produced in response to allergens, pathogens, pollutants etc. Cytokines produced by Th2 cells and ILC2 cause the immunopathology of asthma including eosinophilia, mast cell activation, goblet cell hyperplasia and fibrosis, which in turn causes airway hyperresponsiveness, bronchoconstriction, tissue remodeling and mucus hypersecretion. However, asthma also occurs in patients devoid of T2 markers. The immunological mechanisms of so called T2 low asthma seems to be related to IL-22/IL-17 cytokines and/or inflammasome activation, but much research remains to unravel the etiology and mechanisms to identify ways of effectively treating T2 low asthma.

Research has highlighted the complexities in transitional care for adolescents and young adults, including decreased healthcare contacts and dispensed medication after transfer to adult healthcare. A survey of healthcare professionals revealed that more than half do not adhere to key messages in existing national guidelines and focus more on the transfer process rather than on the transition to independent adulthood. To address the complexities in the transitional care for adolescents and young adults with asthma, there is a need for a comprehensive transition program applicable in both primary and specialist care settings, utilizing a multi-professional approach to gradually strengthen the young person's self-care skills and prepare them for adult healthcare. To bridge the gap in transitional care and improve long-term outcomes for adolescents and young adults with asthma, a pilot study is ongoing in the Stockholm region, with hopes for national implementation.

Primary care is responsible for diagnostics and follow-up of the majority of patients with asthma. The variable airway obstruction may contribute to difficulties in diagnosing asthma. The cornerstones of diagnostics are patient history and lung function measurements. Even patients with only sporadic symptoms should be treated with inhaled corticosteroids (Step 1 in the asthma treatment track). Patient education is essential for good asthma control. Optimal asthma control means normal lung function, absence of symptoms and absence of exacerbations. This must always be assessed at a patient consultation. In uncontrolled asthma, treatment barriers such as inadequate inhalation technique, insufficient adherence to treatment, exposure to asthma triggers, and possible influence of co-morbidity should be assessed.

Spirometry with bronchodilator test is the most frequently used test for asthma diagnosis.  PEF variability can prove variable airflow obstruction when asthma was not confirmed by spirometry with bronchodilator test. Bronchial challenge tests can demonstrate airway hyperresponsiveness.  Measuring exhaled nitric oxide received increased support in the recent asthma diagnosis guidelines. Peripheral airways involvement is common in asthma, can occur despite normal spirometry and be identified by oscillometry and nitrogen gas washout. It is important to continue investigation even if a certain diagnostic test shows negative results when the clinical asthma suspicion persists.

Asthma is one of the most common non-communicable chronic diseases in the world, with a prevalence that historically has increased and now seems to have plateaued at around 10 percent of the general population in high-income countries like Sweden. Some phenotypes, especially the allergic asthma, may however still be increasing. Remission is common in children but less common in adults. Future urbanization and changes in lifestyle may lead to increased asthma prevalence, while further improvements in air quality, treatment and care may lead to decreases and benefit those already affected. It is important that we continuously follow trends in asthma prevalence, incidence, remission and risk factor patterns.

The incidence of cervical cancer after a normal cytology test has been increasing, and now women with a normal cytology have a cancer risk almost as high as the general population. The incidence of cervical cancer after a negative HPV test is about 7 times lower than after a normal cytology test. The 2015 Swedish national screening program recommended HPV screening for women aged 30-70, but some regions did not start implementing HPV screening until 2021. Conceivably, high cancer risks after normal cytology could be explained if women with a recent normal cytology have not been offered HPV screening. The regional HPV test coverage varies between 62% and 89%, with higher coverage linked to lower cancer incidence (r=-0.50; p=0.022). Efforts to increase the coverage of HPV screening as soon as possible are advisable for imminent control of cervical cancer.

SRQ is a nationwide quality registry with information on disease activity and treatment of patients with rheumatic diseases. The purpose is to continuously improve the clinical management and follow-up of rheumatic diseases. Patient-reported outcome measures (PROM) are adapted to the specific rheumatic diseases and represent an important part of the description of the RA disease activity and treatment outcomes. Results from SRQ are presented for each rheumatology unit in quarterly reports. There are also several interactive reports available on the websites srq.nu and »Vården i siffror«. Data from SRQ, often combined with other national registries, form the basis for a large number of research projects.

Neuroendocrine tumours (NET) constitute a heterogenous population of malignancies most often originating from the gastrointestinal tract. NETs cause substantial morbidity, both from local growth and from their ability to produce hormones that affect systemic physiology. About 20% of patients with metastatic NET disease and carcinoid syndrome develop carcinoid heart disease, a condition dominated by primarily right-sided heart failure caused by structural deterioration of the tricuspid and pulmonary valves. Ultimately, valve replacement may be indicated and has been shown to reduce heart failure symptoms and increase long-term survival. Bioprostheses are the valves of choice but have been shown to degenerate early in some patients due to chronic tumour-associated hormonal activity. New transcatheter treatment options are emerging, both as valve-in-valve procedures but potentially also as primary interventions, both in the tricuspid and pulmonary valve position.