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 The Busselton Respiratory Study (BRS) : Phenotypes of Airway Disease in the General Population

A new major cross-sectional survey of adults funded by the NHMRC Project Grant scheme commenced in Busselton in early 2020 and over the next few years will investigate the factors that contribute to lung health problems such as breathlessness, cough, asthma and chronic obstructive lung disease (COPD).

There is growing recognition that these common lung problems have overlapping clinical features and symptoms. This makes accurate diagnosis difficult and results in inappropriate treatment (too much, too little, too non-specific). The Busselton Respiratory Study will measure the frequency of potentially treatable factors (phenotypes), how much they overlap and how best to detect them in the general population.

How can I take part?

People randomly selected from electoral roll in the City of Busselton are being contacted to participate.  It is important to note that the study is not just restricted to people with lung problems but we also would like people who may not have any problems with their lungs to participate too. It is really important we get a good representative snapshot of the community so please look out for and respond to a postal invitation if you receive one or alternatively call our centre to see if you or your family are on our list. Participation is free and your results will be explained and provided to you.

brs invitation

Study background

Investigators: Professor Alan James, Dr Michael Hunter, Dr Jennie Hui, Professor Bill Musk; Professor Matthew Knuiman; A/Professor Siobhain Mulrennan; Dr Claire Tobin; Dr Kevin Murray; A/Professor John Beilby.

There is increasing confusion about labelling and treating airway diseases because “asthma” and chronic obstructive pulmonary disease (“COPD”) mean different things to different people and they overlap with regard to symptoms and abnormalities in the lung. This project will define the abnormalities in the lung and relate them to symptoms in a general population, without using diagnostic labels, to establish descriptors of airway diseases that better relate to treatments and prognosis.

Aims

We are conducting a new cross-sectional survey of respiratory health of the adult Busselton population 2020 to 2023. We will use new and extant data and biological samples to:

1. Determine the current prevalence of respiratory symptoms, tobacco smoking, “asthma”, “chronic obstructive pulmonary disease” (“COPD”), chronic bronchitis, atopy, airway hyper-responsiveness and airway inflammation, together with detailed measurements of respiratory function;

2. Use the time-course data from the repeated cross-sectional studies to model age, period and cohort effects on “asthma”, “COPD” and their intermediate phenotypes;

3. Develop multidimensional models of “asthma”, “COPD”, and associated traits that reflect their true complexity and underlying pathologies validated by detailed measures of respiratory function.

Significance

The project will undertake cluster and other analyses of cross-sectional data from an unbiased, general population sample. This will allow the identification of clusters of airway disease that may be detected in general practice using simple tools and that can be targeted for treatment.

The project will develop a framework for recognizing the various diagnostic elements of airway diseases that will be useful in primary care, independent of labels such as “asthma” and “COPD”. The unbiased (blind), random sample approach of the proposed project will allow broad generalisability of the results. The data will be used to develop investigative, diagnostic, prognostic and treatment algorithms for patients presenting in primary care using accessible, validated measures.

It is the aim of the  project to characterize airway diseases to provide primary care physicians with relevant patient traits that can be used to usefully direct appropriate treatment and prevention strategies, and monitor progress.

More immediate outcomes will be:

1) the recognition of problems related to the existing confusion in labelling airway diseases, including diagnostic inaccuracy, inappropriate treatment, sub-optimal investigation;

2) relating current characteristics to longitudinal changes in lung function, airway responsiveness, atopy and smoking habits;

3) assessing the accuracy of spirometry, sputum testing, blood eosinophils, eNO and measures of airway resistance in a general population setting. Outcomes from this project will be used to develop tools / algorithms for the assessment and rational treatment of airway disease in primary care, moving away from misleading labels and inappropriate short-term trials (or inappropriately sustained) treatment.

BRS supporters 2020