Saudi Cultural Missions Theses & Dissertations
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Item Restricted The Association Between Patient-Reported Outcomes and Pulmonary Exacerbation Frequency in Patients with Alpha-1 Antitrypsin Deficiency(University of Birmingham, 2024-08) Almahmoudi, Jameelah Ahmed; Pye, AnitaIntroduction: the negative effect that pulmonary exacerbations have on alpha-1 antitrypsin deficiency patients’ lung function has been explored and proven. Nonetheless, studies addressing the association between patient-reported outcomes (PROs) and exacerbation frequency in patients with AATD are lacking. Study Aim: To analyse the association between pulmonary exacerbations, and patientreported outcomes in alpha-1 antitrypsin deficiency patients. Method: Patients’ data was extracted from The AATD cohort/registry. Information regarding patients’ demographics, genotype, smoking status, smoking rate, COPD diagnosis, and FEV1% were included. The PROs include The St. George's Respiratory Questionnaire (SGRQ), The COPD Assessment Test (CAT), Modified Medical Research Council Dyspnoea Scale (mMRC). The exacerbation frequency in the last 12 months was reported by patients. Statistical association and correlation were reported. Patients with 2 or more exacerbations were labelled as frequent exacerbators (FE), and patients with less than 2 exacerbations were labelled infrequent exacerbators (IE) in the last 12 months. Also, patients were grouped as non-exacerbators with 0 exacerbations or exacerbators with 1 or more exacerbations in the last 12 months. Results: A total of 234 patients were included in this study. The FE group (n=69) reported significantly poorer PROs when compared to the IE group (n=165), even though FEV1% was not significantly different between the two groups (p = 0.055). when comparing exacerbators to non-exacerbators, all PROs and FEV1% were significantly different with poorer results seen in the exacerbators group (p < 0.001 for SGRC and CAT and p = 0.007 for mMRC). Spearman rank correlation supported that lower FEV1% and more exacerbations are significantly correlated with poorer PROs (p ≤ 0.001 in all correlations). The regression model proved that more exacerbations and declined FEV1% are significant predictors of PROs worsening. Conclusion: Frequent exacerbations and declined FEV1% are associated with worse patientreported outcomes in patients with alpha-1 antitrypsin deficiency.15 0Item Restricted Evaluating FEV1Q as a race-neutral measurement of lung function across three diverse populations in LMICs.(University College London (UCL), 2024-08-28) ALlayadhi, Ayadh; Hurst, JohnIntroduction The adjustment of lung function for ethnicity is controversial and has led to race-neutral approaches, such as forced expired volume in 1st second quotient (FEV1Q), which expresses FEV1 as a multiple of the theoretical lower limit of survival. It is unknown whether this lower limit is similar in diverse populations in different low- and middle-income countries (LMICs) or whether FEV1Q can accurately diagnose chronic obstructive pulmonary disease (COPD). This study aimed to evaluate the FEV1Q as a race-neutral measure of lung function in these regions. Methods This study utilised 10660 participants’ spirometry and anthropometric data, aged ≥40 years, collected from Uganda, Nepal, and Peru, with even sex and site distribution. The assessment included: whether 1st percentiles of absolute FEV1 were similar across these populations, assessing the FEV1Q diagnostic ability for 999 COPD cases, and estimating FEV1Q decline rates under several circumstances. Results The 1st percentiles of absolute FEV1 (L) were similar to the previously reported values of 0.5 L for males and 0.4 L for females in the COPD group, while these percentiles differed in the entire population. FEV1Q had discriminative accuracy in diagnosing COPD (AUC = 0.87). Estimation of FEV1Q decline under normal conditions demonstrated 1 unit/18 years, while it declined every 12.5 years for current smokers and every 17.5 years with biomass exposure. Discussion Although this study addressed the lack of diverse populations in which FEV1Q has been assessed, and presented several strengths, it did not include follow-up measurements of lung function which limit quantifying long-term outcomes; and ethnicity/race categories were assumed based on site. This highlights the need for future longitudinal studies to assess FEV1Q utility, and shed light on other respiratory conditions. Conclusion FEV1Q is a simple and promising race-neutral measure of lung function; however, further studies are required.13 0Item Restricted Characteristics and Outcomes of Chronic Bronchitis in Alpha-1 Antitrypsin Deficiency Related Lung Disease: A Retrospective Longitudinal Analysis(Saudi Digital Library, 2023-10) Alsaab, Sulaiman; Turner, Alice; Ellis, PaulAbstract Background: Alpha-1 antitrypsin deficiency (AATD) is a genetic disorder associated with lung disease such as early-onset emphysema and chronic obstructive pulmonary disease (COPD). The presence of chronic bronchitis may accelerate disease progression in AATD patients, but few studies have specifically examined this phenotype. Objectives: To investigate the characteristics and outcomes such as FEV1 decline, DLCO decline, exacerbations frequency, and mortality of AATD patients with chronic bronchitis compared to those without chronic bronchitis. Methods: This retrospective cohort analysis utilised clinical data from the REDcap registry for 236 PiZZ and PiSZ AATD patients. Participants were categorised based on chronic bronchitis diagnosis and genotypes. Characteristics were compared between groups. Multiple linear regression analysis, logistic regression analysis, mixed linear model, and survival analysis are done to investigate outcomes including lung function decline, exacerbation frequency, and mortality among those patients. Results: Patients with chronic bronchitis (35% of the cohort) demonstrated significantly worse baseline lung function. FEV1 decline was steeper in PiZZ chronic bronchitis patients (-1.61% predicted/year, - 52 ml/year) versus PiZZ without chronic bronchitis (-1.07% predicted/year, - 31.5 ml/year). In the PiSZ genotype, the chronic bronchitis group similarly showed accelerated decline (-1.85% predicted/year, - 64 ml/year) versus the PiSZ without chronic bronchitis (-0.67% predicted/year, - 21 ml/year). Female sex was associated with higher odds of frequent exacerbations in both PiZZ and PiSZ individuals. There was no significance in terms of mortality between the groups. Conclusion: Chronic bronchitis in AATD is associated with impaired lung function and worse clinical outcomes compared to AATD alone. This high-risk phenotype warrants additional research into tailored interventions and closer monitoring. Larger longitudinal studies are needed to confirm the results and elucidate underlying mechanisms.19 0