Prospective Cohort Study to Understand Impact of Viral Infection in Chronic Lung Disease

Individuals with chronic lung disease are characterised by exacerbations (episodes of increased symptoms such as breathlessness, sputum production etc) which have been shown to be important drivers of disease severity. Viral infections are well recognised causes of asthma exacerbations but the same detail of understanding regarding the effect of viral infection on other chronic respiratory conditions such as chronic obstructive pulmonary disease (COPD) and bronchiectasis is lacking. During the COVID-19 pandemic, when isolation measures were in place for individuals with chronic respiratory disease, episodes of exacerbation were substantially decreased, suggesting a causal link between viruses and exacerbations. Such information is critical in an age with increasing concerns regarding antibiotic resistance and may change practice towards early administration of antiviral agents for respiratory disease exacerbations. To date, prospective surveillance studies in chronic lung disease have been predominantly cross sectional and focussed on hospitalised individuals where presentation is often late with reduced sensitivity for viral detection and no understanding of baseline disease state. The our study will establish closely monitored prospective patient cohort in order to assess their viral and immune status at baseline and in the early phases of an exacerbation in order to better understand the role of respiratory viruses in chronic lung disease.

Specifically, this unique study design will allow us to study the following important areas in unprecedented detail and depth: (i) Early identification and diagnosis of clinical deterioration / exacerbations to comprehensively understand the role played by viruses in chronic lung disease exacerbations. (ii) Full capture of all clinical deterioration / exacerbation events experienced by patients with chronic lung disease including mild, typically unreported episodes. (iii) Evaluation of the immune and microbiological dynamics associated with recovery from exacerbation episodes and the impact upon longer term disease progression.

Clinical Visits and Sampling:

(i) Baseline study visit: All eligible individuals will undergo screening when clinically stable including clinical history/ examination, respiratory function testing (spirometry) and a severity assessment with the use of validated questionnaires (COPD assessment test (CAT), Bronchiectasis Health Questionnaire (BHQ)). Clinical information including microbiology cultures, the underlying lung disease and other medical conditions and medication history will be obtained from medical records.

Prior imaging including CT images will be pseudoanonymised and stored for radiological scoring and analysis. At the first study visit the following biological samples will be taken to address the study objectives: