Individual Trajectories in Asthma and Copd: a Longitudinal Perspective to Obstructive Lung Disease

......................................................................................................................................8 TIIVISTELMÄ ................................................................................................................................10 1 Introduction.............................................................................................................................11 2 Literature review .....................................................................................................................13 2.1 Asthma, COPD and Asthma COPD Overlap Syndrome (ACOS) ..........................13 2.2 Health Related Quality of Life in Asthma and COPD ..............................................14 2.3 Co-morbidities and lung function on HRQoL in Asthma and COPD ..................15 2.4 Natural history of a disease requires longitudinal assessment .................................15 2.5 Lung function and its development in COPD ...........................................................16 2.6 Heritability of lung function and its development ....................................................17 2.7 Genetic susceptibility to poor lung function and COPD .........................................17 2.8 Questionnaires and tests in studying obstructive lung disease ...............................19 2.9 Bias in epidemiological study .......................................................................................19 2.10 Retrospective data and Electronic Health Records ...................................................20 2.11 Healthcare data in research use....................................................................................21 3 Aims of the study ....................................................................................................................22 4 Material and methods ............................................................................................................23 4.1 Finnish Chronic Airway Disease (FinnCAD) cohort ...............................................23 4.2 GenMets cohort .............................................................................................................24 4.3 Statistical analysis...........................................................................................................24 4.3.1 Comorbidities in COPD – A cross-sectional analysis ................................24 4.3.2 HRQoL development in Asthma and COPD – focus on signifi cant individual trajectories ......................................................................................25 4.3.3 Lung function development in COPD – assessing the variability and identifying individual trends in unbalanced data set ..................................25 4.3.4 Genetic background of lung function development ...................................25 5 Results .......................................................................................................................................27 5.1 Poor HRQoL in COPD is associated with characteristic determinants depending on severity of disease .................................................................................27 5.2 Individual HRQoL trajectories are identifi able in Asthma and COPD ..................27 5.3 Longitudinal FEV1 presents variation in COPD, but individual trajectories are identifi able ................................................................................................................28 5.4 Heritability and genetics of lung function trajectories .............................................30 6 Discussion ................................................................................................................................32 6.1 HRQoL in mild or moderate COPD is greatly aff ected by comorbidities .............32 6.2 HRQoL in asthma and COPD during the 5-year follow-up ....................................33 6.3 Individuals with rapid decline of lung functions .......................................................33 6.4 Heritability and genetic susceptibility of lung function development ....................34 7 Conclusions ..............................................................................................................................35 ACKNOWLEDGEMENTS ...........................................................................................................37 REFERENCES .................................................................................................................................38