Beyond airflow obstruction: multicomponent COPD prognostication in personalised care

Keene, Spencer Joseph (2022). Beyond airflow obstruction: multicomponent COPD prognostication in personalised care. University of Birmingham. Ph.D.

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Abstract

COPD is increasingly recognized as a heterogeneous and multidimensional disease. Multicomponent prognostic scores account for this by measuring components beyond FEV1. This thesis used data from large cohort studies and routine health data from general practice to answer research questions under four themes: 1) demonstrate the burden of exacerbation occurence; 2) provide evidence on the external validity of prognostic scores in accurately predicting risk in various clinical settings; 3) examine the potential for extending the use of these scores to detect disease worsening; 4) further our understanding of some components that comprise prognostic scores. Severe COPD exacerbations present a significant burden to patients as they increase hospitalisation and mortality. We found that the incidence rates of severe COPD shows signs of an increase from year-to-year which highlights the importance in accurately predicting these events. We demonstrate the external discriminative validity of the BLISS and ADO scores in predicting exacerbations and mortality, respectively. However, these scores may need to be recalibrated before predicting outcomes in different time horizons or healthcare settings. Serial measurements of the ADO score may help to update prognostic risk in people with COPD. Among people screened for COPD with respiratory symptoms, we found that symptom burden over time and prognosis of persistent moderate-to-severe respiratory symptoms was similar in those with normal FEV1, compared to those with airway obstruction. Finally, weight loss due to continuous smoking is accelerated if a person has COPD, and quitting results in an accelerated weight gain compared to those without COPD.

Type of Work:	Thesis (Doctorates > Ph.D.)
Award Type:	Doctorates > Ph.D.
Licence:	All rights reserved
College/Faculty:	Colleges (2008 onwards) > College of Medical & Dental Sciences
School or Department:	Institute of Applied Health Research
Funders:	None/not applicable
Subjects:	R Medicine > R Medicine (General) R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine
URI:	http://etheses.bham.ac.uk/id/eprint/13210

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