Characteristics of alpha-1 antitrypsin deficiency related lung disease exacerbations using a daily symptom diary and urinary biomarkers
Ellis, Paul Parekh, Gita Duvoix, Annelyse Watson, Lynne Sharp, Alex Mobeen, Farah Pye, Anita Stockley, Robert Turner, Alice
Ellis, Paul
Parekh, Gita
Duvoix, Annelyse
Watson, Lynne
Sharp, Alex
Mobeen, Farah
Pye, Anita
Stockley, Robert
Turner, Alice
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Ellis P, Parekh G, Duvoix A, Watson L, Sharp A, Mobeen F, Pye A, Stockley R, Turner A. Characteristics of alpha-1 antitrypsin deficiency related lung disease exacerbations using a daily symptom diary and urinary biomarkers. PLoS One. 2024 Feb 2;19(2):e0297125. doi: 10.1371/journal.pone.0297125.
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2024-02-02
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Abstract
Background: Pulmonary 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.
Methods: 55 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.
Results: Type 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).
Conclusions: Use 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.
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Ellis P, Parekh G, Duvoix A, Watson L, Sharp A, Mobeen F, Pye A, Stockley R, Turner A. Characteristics of alpha-1 antitrypsin deficiency related lung disease exacerbations using a daily symptom diary and urinary biomarkers. PLoS One. 2024 Feb 2;19(2):e0297125. doi: 10.1371/journal.pone.0297125.
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