Relationship between frequency, length, and treatment outcome of exacerbations to baseline lung function and lung density in alpha-1 antitrypsin-deficient COPD
Kesavaperumal Vijayasaratha,1 Robert A Stockley2
1Lung Investigation Unit, 2Research and Development, University Hospital Birmingham NHS Trust, Birmingham, UK
Background: Diary cards are useful for analyzing exacerbations in chronic obstructive pulmonary disease (COPD), although factors influencing the length and frequency of each episode are poorly understood. This study investigated factors that influence the features of exacerbations in patients with alpha-1 antitrypsin (AAT) deficiency (PiZ phenotype) and COPD.
Methods: Daily diary cards were collected over 2 years. Patients had emphysema visualized and quantified by computed tomography scan, and had at least one documented exacerbation in the previous year.
Results: The patients (n = 23) had a mean age of 52.5 years, forced expiratory volume in one second (FEV1) of 1.2 L (38.4% predicted), corrected gas transfer (KCO) of 0.90 mmol/min/kPa/L (59.7% predicted), and 15th percentile lung density of 44.55 g/L. Two hundred and sixty-three exacerbations (164 treated) were identified. The frequency of treated exacerbations correlated negatively with KCO% predicted (r = −0.432; P = 0.022). Exacerbation length (determined for 17 of the patients for whom diary card data through the episode were available) correlated negatively with baseline 15th percentile lung density (r = −0.361; P = 0.003), and increased the longer treatment was delayed (r = 0.503; P < 0.001). Treatment delay was shorter with higher day 1 symptom score, lower baseline FEV1, FEV1/forced vital capacity, and lower 15th percentile lung density (r = −0.368, 0.272, 0.461, and 0.786; P = 0.004, 0.036, <0.001, and <0.001, respectively). Time to resolution of exacerbation after treatment initiation was not affected by treatment delay, but correlated negatively with KCO% predicted (r = −0.647; P = 0.007).
Conclusion: In alpha-1 antitrypsin deficiency, the frequency and length of resolution of exacerbation were related to baseline gas transfer. Treatment delay adversely affected exacerbation length, and lung density was the best independent predictor of delay in starting treatment.
Keywords: alpha-1 antitrypsin deficiency, antibiotic, exacerbation, gas transfer, lung density, lung function
This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution - Non Commercial (unported, v3.0) License. By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms.Download Article [PDF] View Full Text [HTML]
Readers of this article also read:
Buhl R, Banerji D
Published Date: 19 March 2014
El-Mitwalli A, Bediwy AS, Zaher AA, Belal T, Saleh AB
Published Date: 13 March 2014
Preferences of patients and health professionals for route and frequency of administration of biologic agents in the treatment of rheumatoid arthritis
Huynh TK, Østergaard A, Egsmose C, Madsen OR
Published Date: 20 January 2014
Sato M, Yasuhara Y, Tanioka T, Iwasa Y, Miyake M, Yasui T, Tomotake M, Kobayashi H, Locsin RC
Published Date: 17 January 2014
Stafyla E, Kerenidi T, Gourgoulianis KI
Published Date: 6 November 2013
Quantitative assessment of walking time and postural change in patients with COPD using a new triaxial accelerometer system
Kawagoshi A, Kiyokawa N, Sugawara K, Takahashi H, Sakata S, Miura S, Sawamura S, Satake M, Shioya T
Published Date: 2 September 2013
Peripheral drive in Aα/β-fiber neurons is altered in a rat model of osteoarthritis: changes in following frequency and recovery from inactivation
Wu Q, Henry JL
Published Date: 19 March 2013
Hirao K, Kobayashi R, Yabuwaki K
Published Date: 8 November 2012
Halpin DMG, Decramer M, Celli B, Kesten S, Liu D, Tashkin DP
Published Date: 21 September 2012
Published Date: 2 April 2012