Utility of the new gold classification for COPD in alpha one antitrypsin deficiency

Pillai, Anilkumar (2017). Utility of the new gold classification for COPD in alpha one antitrypsin deficiency. University of Birmingham. M.D.

Preview

Pillai17MD.pdf
PDF - Accepted Version
Download (1MB)

Abstract

Background
The revised 2011 GOLD strategy presented a new classification and treatment of usual Chronic Obstructive
Pulmonary disease (COPD) based on symptom assessment by CAT or mMRC and risk assessment based on exacerbations estimated from the spirometric grade or number of exacerbations in previous year (1). This new strategy has not previously been applied to patients with Alpha one antitrypsin deficiency (AATD).
Aims
To apply new GOLD strategy/categories in AATD and assess comparable symptom thresholds and predictability of mortality, future exacerbations and lung function decline (FEV1, Kco) and the role of comorbidities.
Results
The results have validated the strategy/classification in AATD with a suggested threshold of 13 rather than 10 for CAT to match with mMRC 1. Mortality and Kco decline was worse in the more severe category D which also had patients with more comorbidity. Applying COTE index to patients with AATD did not help in predicting mortality.
Conclusion
The new GOLD classification helps identify AATD patients who are at risk of poorer outcome based on lung function decline, mortality and exacerbation risk with patients in group D being most at risk. Presence of comorbidities does not appear to influence outcomes in AATD although they do tend to indicate a poorer quality of life.
References
1. Vestbo J, Hurd SS, Agusti AG, Jones PW, Vogelmeier C, Anzueto A, et a!. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary. American journal of respiratory and critical care medicine. 2013;187(4):347-65.

Type of Work:

Thesis (Higher Doctorates > M.D.)

Award Type:

Higher Doctorates > M.D.

Supervisor(s):