Bronkotest score during exacerbations in different seasons of the year.

Bronkotest score during exacerbations in different seasons of the year.</p

Patient characteristics.

BackgroundPulmonary exacerbations in alpha-1 antitrypsin deficiency (AATD) related lung disease are a significant contributor to disease burden, as with usual COPD. Separating the early stages of an exacerbation from the day-to-day variation in stable COPD is central to the concerns of both clinicians and patients and has been identified as a research priority by NIHR. Clinical tools that distinguish baseline symptoms from those of an exacerbation could allow early and appropriate treatment of AECOPD to reduce the impact and potentially may slow disease progression thereby improving survival and quality of life. Candidate tools include symptom diaries and biomarkers of infection and acute inflammation. Urinary biomarkers of AECOPD have yet to be explored in AATD related COPD.Methods55 patients with AATD related lung disease with a history of 2 or more AECOPD in the preceding year were prospectively followed for 18 months. Each patient recorded symptom scores daily via an electronic symptom diary (eDiary) based on Bronkotest. Urinary biomarkers for AAT, NE, CRP, TIMP1 and desmosine were measured weekly using a home urinary lateral flow device. During self-reported AECOPD patients were asked to perform urine analysis on the first 7 consecutive days.ResultsType I Anthonisen exacerbations and episodes occurring in autumn/winter lasted longer than Type II/III exacerbations and spring/summer episodes respectively. Median urinary CRP concentration across all study participants increased during Type I AECOPD. eDiary adherence was 68% over a median of 17.8 months (IQR 15.7 to 18.5).ConclusionsUse of an eDiary and urinary biomarkers to detect and characterise AECOPD remotely in AATD related lung disease is feasible over a prolonged period and paves the way for precision detection of exacerbations.</div

This includes all supplementary methods, figures and tables for this manuscript.

This includes all supplementary methods, figures and tables for this manuscript.</p

Bronkotest score during exacerbations by Anthonisen type.

Unclassified exacerbations were treated episodes that did not meet Anthonisen criteria.</p

Comparison of Type I vs Type II/III Anthonisen defined exacerbations in patients with AATD related lung disease.

Comparison of Type I vs Type II/III Anthonisen defined exacerbations in patients with AATD related lung disease.</p

Bronkotest score during treated and untreated exacerbations.

Bronkotest score during treated and untreated exacerbations.</p

Urinary concentrations for A1AT, NE, TIMP1, CRP and desmosine over the time course of AECOPD for measured by home lateral flow cytometry.

Urinary concentrations for A1AT, NE, TIMP1, CRP and desmosine over the time course of AECOPD for measured by home lateral flow cytometry.</p

This file contains the STROBE checklist to ensure the manuscript complies with accepted reporting guidelines for observational studies.

This file contains the STROBE checklist to ensure the manuscript complies with accepted reporting guidelines for observational studies.</p