To investigate the causal roles of environmental factors and viruses on exacerbations of COPD
Lead Research Organisation:
London School of Hygiene & Tropical Medicine
Department Name: Epidemiology and Population Health
Abstract
Chronic obstructive pulmonary disease (COPD) is a common lung condition most often caused by smoking. Many patients suffer from repeated flare-ups of COPD caused by chest infections. These infections are commonly caused by viruses and are important to treat and ideally prevent. Infections contribute to worsening symptoms of the disease and there is insufficient information about susceptibility to viruses to prevent chest infections or hospital admissions from happening.
This study will investigate the environmental factors such as pollution and temperature on viruses circulating in the community on every day symptoms and likelihood of catching infections in COPD. Nationally this will be studied using large central databases and then more detailed study will be done at an individual patient level. This information will be of benefit to both patients and health care providers by helping to improve the organisation of health care resources, particularly in the winter and highlight times when patients should be aware of increased symptoms and viral infections. With the future development of new antiviral treatments for COPD infections this information will also help provide information as to when these drugs should be given to maximal effect.
This study will investigate the environmental factors such as pollution and temperature on viruses circulating in the community on every day symptoms and likelihood of catching infections in COPD. Nationally this will be studied using large central databases and then more detailed study will be done at an individual patient level. This information will be of benefit to both patients and health care providers by helping to improve the organisation of health care resources, particularly in the winter and highlight times when patients should be aware of increased symptoms and viral infections. With the future development of new antiviral treatments for COPD infections this information will also help provide information as to when these drugs should be given to maximal effect.
Technical Summary
Aims and Objectives: The aim of this study is to establish the causal roles of environmental factors and viruses on exacerbations of chronic obstructive pulmonary disease (COPD) by investigating the relationship between ambient temperature, air pollution and circulating viruses on daily symptoms and COPD exacerbations. The specific objectives are;
1. To quantify the relationship between COPD exacerbations and COPD mortality with
(a) temperature and other climate factors (such as humidity and sunlight hours) and
(b) air pollution
2. To investigate the impact of environmental factors (ambient temperature and air pollution) on circulating viruses
3. To quantify the relationship between circulating viral levels and COPD exacerbations and mortality
4. To apply the results from Aims 1 to 3- to the detailed symptoms, lung function measurement and viral detection data in the London COPD cohort.
5. To establish to what extent the effect of environmental factors on COPD exacerbations and mortality are mediated or explained by viral infections
Methodology: Large scale work based on national computerized clinical data will be complimented by detailed work on Prof Wedzicha‘s ongoing cohort of approximately 300 COPD patients who have rich data on both symptoms and viral exposures. Meteorological and pollution data will be obtained from the national network of monitors, outcome measures will be obtained from Hospital Episode Statistics (HES), General Practice Research Database (GPRD), and the Office for National Statistics (mortality). Viral data will be obtained from the Health Protection Agency (HPA), the GPRD (flu consultations and upper respiratory tract infection consultations).
Scientific and Medical Opportunities: COPD is the 4th leading cause of death and prevalence is increasing. Exacerbations (commonly caused by viruses), contribute to disease progression and mortality and are the commonest cause of medical hospital admission in the UK. The forthcoming Clinical Strategy for COPD for England highlights a need to improve the quality of COPD services and decrease health care costs. Although the relationship between environmental factors and COPD exacerbations is already being assessed (Healthy Outlook?), this work adds additional detail regarding daily symptom changes and detailed virus data from the London COPD cohort. With the future development of new antiviral agents, this information may help tailor the use of these drugs to maximal effect. As climate change results in warmer winters, understanding the relationship between environmental factors and circulating respiratory viruses will prepare us for the change in exacerbation patterns likely to occur.
1. To quantify the relationship between COPD exacerbations and COPD mortality with
(a) temperature and other climate factors (such as humidity and sunlight hours) and
(b) air pollution
2. To investigate the impact of environmental factors (ambient temperature and air pollution) on circulating viruses
3. To quantify the relationship between circulating viral levels and COPD exacerbations and mortality
4. To apply the results from Aims 1 to 3- to the detailed symptoms, lung function measurement and viral detection data in the London COPD cohort.
5. To establish to what extent the effect of environmental factors on COPD exacerbations and mortality are mediated or explained by viral infections
Methodology: Large scale work based on national computerized clinical data will be complimented by detailed work on Prof Wedzicha‘s ongoing cohort of approximately 300 COPD patients who have rich data on both symptoms and viral exposures. Meteorological and pollution data will be obtained from the national network of monitors, outcome measures will be obtained from Hospital Episode Statistics (HES), General Practice Research Database (GPRD), and the Office for National Statistics (mortality). Viral data will be obtained from the Health Protection Agency (HPA), the GPRD (flu consultations and upper respiratory tract infection consultations).
Scientific and Medical Opportunities: COPD is the 4th leading cause of death and prevalence is increasing. Exacerbations (commonly caused by viruses), contribute to disease progression and mortality and are the commonest cause of medical hospital admission in the UK. The forthcoming Clinical Strategy for COPD for England highlights a need to improve the quality of COPD services and decrease health care costs. Although the relationship between environmental factors and COPD exacerbations is already being assessed (Healthy Outlook?), this work adds additional detail regarding daily symptom changes and detailed virus data from the London COPD cohort. With the future development of new antiviral agents, this information may help tailor the use of these drugs to maximal effect. As climate change results in warmer winters, understanding the relationship between environmental factors and circulating respiratory viruses will prepare us for the change in exacerbation patterns likely to occur.
