The Austrian LEAD Study (Lung, Heart, social, Body)–
A longitudinal study investigating health challenges in Pulmonology
While data for mortality and morbidity of COPD is missing in Austria, a recent crosssectional study in the city of Salzburg, Austria showed that the overall prevalence of GOLD stage I or higher COPD was 26.1% (similar for women and men). Moreover this study revealed that the prevalence of GOLD stage II or higher COPD was 10.7% and 1% of the population met the criteria for GOLD stage III or IV. Although the study protocol showed limitations, e.g male and female were older than 40 years, this investigation emphasised the impact of this disease in Austria.
While the raw number of burden was investigated sufficient over time the Natural History of this disease is still under-evaluated in terms of investigating the development and aging of the lung in order to gather important information regarding the progression and prognosis of COPD and therefore to improve the assessment of ongoing strategies aimed at the early detection and treatment of COPD. The British Thoracic Society recommended in December 2006 seven priorities for respiratory research. Not surprisingly, the number one in the list was to study “… the natural history of early development of the respiratory tract and immune system and the techniques needed to understand normal air growth, development and decline in health and disease” . Epidemiology of the natural decline of lung function is indeed a hot topic in medical research. Greater knowledge of the early development of the respiratory tract is necessary, the normal growth and development of the airway and its decline with age, factors that influence the development, remission, relapse, progression and severity of the disease, the response to treatment, and on intermediate clinical events and potential biomarkers. This involves the development of non-invasive imaging and physiological techniques, the improvement of histological, biochemical, molecular and microbiological characterization of the pulmonary tissues, and the study of cohorts of subjects at different ages and stages of disease. The heterogeneity in the pathogenic processes, clinical expressions and responses to treatment can largely be explained in terms of the development of different phenotypes which reflect diverse interactions between environmental and genetic factors. Identification of these phenotypes and the study of their implications in the susceptibility, prevention, treatment and prognosis of COPD are very important areas of research in translational terms.
Epidemiological and longitudinal, multidisciplinary studies are necessary to help us to understand the variability in the prevalence of COPD between different areas as well as the importance of non-diagnosed COPD as a predictor of morbid-mortality and disability, evaluating the convenience of phenotyping the disease to make more correct epidemiological measurements, investigating co-morbidities and both their impact in the severity of the disease and the convenience of extending the prevention to them, evaluating the impact of early detection.
Accepting the natural course of lung function and associated development of COPD caused by aging of the human body, other increasing or highly prevalent diseases in our society as the metabolic syndrome, dementia and asthma may be associated comorbidities linked with COPD.
Therefore the aim of our investigation is to investigate the natural course of COPD based on the natural decline in lung function and co morbid conditions in both health and disease. Study design will be prospective, longitudinal, observational, family clustered including Austrian population from adolescence to senescence. This investigation aims to provide information on lung function and influencing factors including comorbidities and chronic diseases in male and female. This epidemiologic project will start in 2011 and first round of recruitment and examinations are expected until 2013. We aim to re-invite study population every three years for follow up in order to gather longitudinal data.