Asthma and chronic obstructive pulmonary disease (COPD) are two prevalent chronic airway diseases that have a high personal and social impact. They likely represent a continuum of different diseases that may share biological mechanisms (i.e. endotypes), and present similar clinical, functional, imaging and/or biological features that can be observed (i.e. phenotypes) which require individualised treatment. Precision medicine is defined as "treatments targeted to the needs of individual patients on the basis of genetic, biomarker, phenotypic, or psychosocial characteristics that distinguish a given patient from other patients with similar clinical presentations". In this Perspective, we propose a precision medicine strategy for chronic airway diseases in general, and asthma and COPD in particular.

https://erj.ersjournals.com/content/erj/47/2/410.full.pdf

Treatable traits: toward precision medicine of chronic airway diseases.

https://www.atsjournals.org/doi/pdf/10.1513/pats.200512-129SF

Chronic obstructive pulmonary disease

National health care registries in the Nordic countries share many attributes, but different legal and ethical frameworks represent a challenge to promoting effective joint research. Internationally, there is a lack of knowledge about how ethical matters are considered in Nordic registry-based research, and a lack of knowledge about how Nordic ethics committees operate and what is needed to obtain an approval. In this paper, we review ethical aspects of registry-based research, the legal framework, the role of ethics review boards in the Nordic countries, and the structure of the ethics application. We discuss the role of informed consent in registry-based research and how to safeguard the integrity of study participants, including vulnerable subjects and children. Our review also provides information on the different government agencies that contribute registry-based data, and a list of the major health registries in Denmark, Finland, Iceland, Norway, and Sweden. Both ethical values and conditions for registry-based research are similar in the Nordic countries. While Denmark, Finland, Iceland, Norway, and Sweden have chosen different legal frameworks, these differences can be resolved through mutual recognition of ethical applications and by harmonizing the different systems, likely leading to increased collaboration and enlarged studies.

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Ethical aspects of registry-based research in the Nordic countries

COPD is the third leading cause of death in the world and its global burden is predicted to increase further. Even though the prevalence of COPD is well studied, only few studies examined the incidence of COPD in a prospective and standardized manner. In a prospective population-based cohort study (Rotterdam Study) enrolling subjects aged ≥45, COPD was diagnosed based on a pre-bronchodilator obstructive spirometry (FEV1/FVC < 0.70). In absence of an interpretable spirometry within the Rotterdam Study, cases were defined as having COPD diagnosed by a physician on the basis of clinical presentation and obstructive lung function measured by the general practitioner or respiratory physician. Incidence rates were calculated by dividing the number of incident cases by the total number of person years of subjects at risk. In this cohort of 14,619 participants, 1993 subjects with COPD were identified of whom 689 as prevalent ones and 1304 cases as incident ones. The overall incidence rate (IR) of COPD was 8.9/1000 person-years (PY); 95 % Confidence Interval (CI) 8.4–9.4. The IR was higher in males and in smokers. The proportion of female COPD participants without a history of smoking was 27.2 %, while this proportion was 7.3 % in males. The prevalence of COPD in the Rotterdam Study is 4.7 % and the overall incidence is approximately 9/1000 PY, with a higher incidence in males and in smokers. The proportion of never-smokers among female COPD cases is substantial.

/pdf/prevalence-and-incidence-of-copd-in-smokers-and-non-smokers-1o4w8s2fug.pdf

Prevalence and incidence of COPD in smokers and non-smokers: the Rotterdam study

The term ‘life course epidemiology’ was coined in 1997 with the publication of the first edition of A Life Course Approach to Chronic Disease Epidemiology.1 This book reviewed the pre-adult risk factors for cardiometabolic and respiratory disease, the catalyst being the imaginative research on the fetal origins of adult disease being driven forward at that time by Professor David Barker. We defined life course epidemiology as ‘the study of long-term biological, behavioural and psychosocial processes that link adult health and disease risk to physical or social exposures acting during gestation, childhood, adolescence, earlier in adult life or across generations’.1 Although our definition of life course epidemiology has stood the test of time, the field has evolved and there have been conceptual developments, methodological innovations which facilitate efforts to test these concepts, and an increasing corpus of empirical research demonstrating how factors from earlier life are associated with later life health and disease, as well as the pathways and biological mechanisms that may be involved. These developments have generated further ideas and challenges to life course models in an iterative process. As the theme of this special issue suggests, one important development has been the gradual shift of research focus from clinical disease endpoints to multi-faceted traits and longitudinal trajectories of functional phenotypes that can be assessed well before any clinical threshold is reached. This has naturally led on to the application of a life course epidemiological approach to ageing. The purpose of this overview is therefore to assess the development and current state of the field of life course epidemiology, including its recent application to the study of ageing as the focus of this special issue.

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The last two decades of life course epidemiology, and its relevance for research on ageing.

/pdf/lung-function-trajectories-leading-to-chronic-obstructive-47c0buuur7.pdf

Shinu Abraham

Papers

Lung-function trajectories leading to chronic obstructive pulmonary disease