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Andreas Horner,1 Horst Olschewski,2 Sylvia Hartl,3 Arschang Valipour,4 Georg-Christian Funk,5 Michael Studnicka,6 Monika Merkle,7 Bernhard Kaiser,1 Eva Maria Wallner,8 Stephan Brecht,8 Bernd Lamprecht1 1Johannes Kepler University Linz, Kepler University Hospital, Department of Pulmonology, Linz, Austria; 2Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, and Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria; 3Department of Respiratory and Critical Care Medicine, Klinik Penzing and Sigmund Freud University, Medical School, Vienna, Austria; 4Karl-Landsteiner-Institute for Lung Research and Pulmonary Oncology, Klinik Floridsdorf, Vienna, Austria; 5Department of Internal and Respiratory Medicine, Klinik Ottakring, Vienna, Austria; 6Department of Pulmonary Medicine, Paracelsus Medical University, Salzburg, Austria; 7Specialist Office for Pulmonology Dr. Merkle, Vienna, Austria; 8A. Menarini Pharma GmbH, Vienna, AustriaCorrespondence: Andreas Horner, Johannes Kepler University Linz, Kepler University Hospital, Department of Pulmonology, Altenberger Strasse, 69, 4040 Linz and Krankenhausstrasse 9, 4020 Linz, Austria, Email Andreas.Horner@kepleruniklinikum.atBackground: Symptoms of depression, pain and limitations in physical activity may affect quality of life in COPD patients independent from their respiratory burden. We aimed to analyze the associations of these factors in outpatients with COPD in Austria in a stable phase of disease.Methods: We conducted a national, cross-sectional study among patients with COPD. For depression, the Patient Health Questionnaire-9 (PHQ-9) and for respiratory symptoms the St. George’s Respiratory Questionnaire for COPD patients (SGRQ-C) were used along with 10-point scales for physical activity and pain.Results: After exclusion of 211 patients due to non-obstructive spirometry or missing data, 630 patients (62.5% men; mean age 66.8 ± 8.6 (SD) years; mean FEV1%pred. 54.3 ± 16.5 (SD)) were analyzed. Of these, 47% reported one or more exacerbations in the previous year, 10.4% with hospitalization. A negative depression score was found in 54% and a score suggesting severe depression (PHQ-9 score ≥ 15) in 4.7%. In a multivariate linear regression model, self-reported pain, dyspnea, and number of exacerbations were predictors for higher PHQ-9-scores. A negative pain score was found in 43.8%, and a score suggesting severe pain in 2.9% (8– 10 points of 10-point scale). Patients reporting severe pain were more often female, had more exacerbations, and reported more respiratory and depressive symptoms, a lower quality of life, and less physical activity. About 46% of patients rated their physical activity as severely impaired. These patients were significantly older, had more exacerbations, concomitant heart disease, a higher pain and depression score, and a lower quality of life (SGRQ-C – total score and all subscores).Conclusions: In Austria, nearly half of stable COPD outpatients reported symptoms of depression, which were associated with lower levels of self-reported physical activity, more pain, and respiratory symptoms. The associations were particularly strong for depression with SGRQ-C.Keywords: chronic obstructive pulmonary disease, depression, PHQ-9, pain, quality of life, St. George’s Respiratory Questionnaire, physical activity

Caspar Schiffers,1 Emiel FM Wouters,1,2 Robab Breyer-Kohansal,1,3 Roland Buhl,4 Wolfgang Pohl,5 Charles G Irvin,6 Marie-Kathrin Breyer,1,7 Sylvia Hartl1,7,8 1Ludwig Boltzmann Institute for Lung Health, Vienna, Austria; 2NUTRIM, School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, the Netherlands; 3Department of Respiratory and Pulmonary Diseases, Clinic Hietzing, Vienna Healthcare Group, Vienna, Austria; 4Pulmonology Department, Mainz University Hospital, Mainz, Germany; 5Karl Landsteiner Gesellschaft, Institute for Clinical and Experimental Pneumology, Vienna, Austria; 6Pulmonary and Critical Care, Larner College of Medicine, University of Vermont, Burlington, VT, USA; 7Department of Respiratory and Pulmonary Diseases, Clinic Penzing, Vienna Healthcare Group, Vienna, Austria; 8Sigmund Freud University, Faculty for Medicine, Vienna, AustriaCorrespondence: Caspar Schiffers, Ludwig Boltzmann Institute for Lung Health, Vienna, 1140, Austria, Email caspar.schiffers@lunghealth.lbg.ac.atBackground: Asthma is a chronic heterogeneous respiratory disease involving differential pathophysiological pathways and consequently distinct asthma phenotypes.Objective and Methods: In the LEAD Study, a general population cohort (n=11.423) in Vienna ranging from 6– 82 years of age, we addressed the prevalence of asthma and explored inflammatory asthma phenotypes that included allergic and non-allergic asthma, and within these phenotypes, an eosinophilic (eosinophils ≥ 300 cells/μL, or ≥ 150 cells/μL in the presence of ICS medication) or non-eosinophilic (eosinophils < 300 cells/μL, or < 150 cells/μL in the presence of ICS) phenotype. In addition, we compared various factors related to biomarkers, body composition, lung function, and symptoms in control subjects versus subjects with current asthma (current doctor’s diagnosis of asthma).Results: An overall prevalence of 4.6% was observed for current asthma. Furthermore, an age-dependent shift from allergic to non-allergic asthma was found. The non-eosinophilic phenotype was more prominent. Obesity was a prevalent condition, and body composition including visceral adipose tissue (VAT), is affected in current asthma versus controls.Conclusion: This broad-aged and large general population cohort identified differential patterns of inflammatory asthma phenotypes that were age-dependent. The presence of eosinophilia was associated with worse asthma control, increased asthma medication, increased VAT, and lower lung function, the opposite was found for the presence of an allergic asthma.Keywords: asthma, prevalence, phenotyping, pulmonary function testing, spirometry, general population, body composition

Franziska Kölli,1,2 Marie-Kathrin Breyer,2,3 Sylvia Hartl,1– 3 Otto Burghuber,1,2 Emiel FM Wouters,2,4 Torben Sigsgaard,5 Wolfgang Pohl,6 Gabriele Kohlböck,2 Robab Breyer-Kohansal2,3 1Sigmund Freud University, Faculty of Medicine, Vienna, Austria; 2Ludwig Boltzmann Institute for Lung Health, Vienna, Austria; 3Department of Respiratory and Critical Care Medicine, Clinic Penzing, Vienna, Austria; 4NUTRIM School of Nutrition and Translational Research in Metabolism, University Medical Center, Maastricht, The Netherlands; 5Department of Public Health, Section of Environment, Occupation & Health, Aarhus University, Aarhus, Denmark; 6Karl Landsteiner Institute for Clinical and Experimental Pneumology, Clinic Hietzing, Vienna, AustriaCorrespondence: Franziska Kölli, Ludwig Boltzmann Institute for Lung Health, Sanatroium Street 2, Vienna, 1140, Austria, Tel +436645127500, Email franziskakoelli@gmx.atBackground: Monitoring of sensitization may become a non-invasive marker of impaired epithelial barrier function related to changing environmental conditions.Objective: To longitudinally evaluate the prevalence and associated factors for positive skin prick tests (SPT) in a general population cohort.Methods: Baseline and 4-year follow-up data from the longitudinal LEAD study are used for the current analyses. Risk factors for SPT were analyzed by multivariate binary logistic regression analyses, including residence (urban/rural), sex, socioeconomic status (SES), allergic and/or respiratory diseases, lung function testing, blood eosinophils, body composition, lifestyle habits, family history, pets in household, and exposure to tobacco smoke in childhood/adolescence (6– 18 years) and adulthood (≥ 19 years).Results: In total, 1439 children/adolescents and 9844 adults with valid SPTs were included in these analyses. The prevalence of sensitization at baseline was 37.6% and was higher in males in every age group, except 10–< 15 years. Individuals with doctor´s diagnosed allergy, asthma or parental allergy were more likely to have a positive SPT; in adulthood, sensitization was more common in those with a high SES. A lower occurrence of sensitization was associated with the presence of a dog in the household in childhood/adolescence and with smoking in adulthood. The prevalence and intensity (number of positive SPT reactions) increased after a 4-year follow-up, especially in children/adolescents.Conclusion: Sensitization is common in the general Austrian population and more likely in males than females. Longitudinal monitoring of sensitization in children/adolescents may identify environmental triggers related to changes in urbanization, industrialization and domestic lifestyle. ClinicalTrials.gov NCT01727518.Keywords: allergy, sensitization, aero-allergens, childhood/adolescence, adults

Andreas Horner,1– 3 Otto C Burghuber,4 Sylvia Hartl,5 Michael Studnicka,6 Monika Merkle,7 Horst Olschewski,8 Bernhard Kaiser,1 Eva Maria Wallner,9 Bernd Lamprecht1,2 1Department of Pulmonology, Kepler University Hospital, Linz, Austria; 2Faculty of Medicine, Johannes Kepler University, Linz, Austria; 3Institute of General, Family and Preventive Medicine, Paracelsus Medical University, Salzburg, Austria; 4First Department of Respiratory and Critical Care Medicine, and Ludwig Boltzmann Institute of COPD and Respiratory Epidemiology, Otto Wagner Hospital and Sigmund Freud University, Medical School, Vienna, Austria; 5Second Department of Respiratory and Critical Care Medicine, Otto Wagner Hospital and Sigmund Freud University, Medical School, Vienna, Austria; 6Department of Pulmonary Medicine, Paracelsus Medical University, Salzburg, Austria; 7Specialist Office for Pulmonology Dr. Merkle, Vienna, Austria; 8Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, and Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria; 9A. Menarini Pharma GmbH, Vienna, AustriaCorrespondence: Andreas HornerKepler University Hospital, Department of Pulmonology, Krankenhausstrasse 9, Linz A4021, AustriaTel +43 (0) 5 7680 83 – 6911Fax +43 (0) 5 7680 83 – 6915Email andreas.horner@kepleruniklinikum.atBackground: COPD patients suffer from respiratory symptoms and limitations in daily life. We aimed to characterize the impact of disease on overall health, daily life, and perceived well-being in COPD outpatients.Methods: We conducted a national, cross-sectional study among pulmonologists and general practitioners (GPs). The St. George’s Respiratory Questionnaire for COPD patients (SGRQ-C) was used. Inclusion criteria were a physician’s diagnosis of COPD and age ≥ 40 years. Subjects with a history of lung surgery, lung cancer or COPD exacerbation within the last four weeks were excluded.Results: Sixty-seven pulmonologists and 6 GPs enrolled 1175 COPD patients. Two hundred forty-eight of those did not fulfill GOLD criteria for COPD (FEV1/FVC < 0.7) and 77 were excluded due to missing data. Finally, 850 patients (62.8% men; mean age 66.2 ± 0.3 (SE) years; mean FEV1%pred. 51.5 ± 0.6 (SE)) were analyzed. Last year, 55.4% reported at least one exacerbation, and 12.7% were hospitalized for COPD exacerbation. Mean SGRQ-C total score was 43.1 ± 0.83 (SE) and mean component scores for symptoms, activity and impacts were 55.6, 55.4 and 30.5, respectively. Half of the patients (50.3%) reported not being able to do any sports and 78.7% stated that their respiratory symptoms did not allow them doing anything they would like to do. In patients with less severe COPD (FEV1pred ≥ 50% and non-frequent exacerbations), global health status was overrated, ie, estimated as better by the physician than by the patient, while it was underrated in more severe COPD.Conclusion: In Austria, the burden of disease in COPD outpatients tends to be underestimated in patients with milder airway obstruction and less exacerbations and overestimated in patients with more severe airway obstruction and frequent exacerbations. Our finding suggests that validated assessment of global health status might decrease these differences of perception.Keywords: chronic obstructive pulmonary disease, limitations, quality of life, St. Georges Respiratory Questionnaire