Evaluation of saliva biomarkers in chronic obstructive pulmonary disease: correlation to patient reported outcomes
COPD is a debilitating chronic respiratory disease with a systemic footprint. COPD is a highly heterogeneous disease but invariably its management involves a one-size fits all approach. This fails to address individual variations in disease progression, symptom burden and functional decline. There remains a need for sensitive monitoring tools that could provide personalised care based on patients’ particular phenotypes and informative self-management.
This thesis has standardised collection protocols and processing for saliva, a complex bodyfluid which is readily accessible and user-friendly for near-patient testing. I have modified immunoassays to work in saliva with demonstrable reproducible results for quantification of C reactive protein, Procalcitonin and Neutrophil Elastase. Symptom assessment is crucial in longitudinal self monitoring of COPD. I designed a novel patient wellbeing scale incorporated into an electronic self-assessment diary, which was embraced by patients as improving symptom change recognition, education and self-management. Using sophisticated analytical tools, I have attempted to cluster/phenotype disease trajectory paths driven by a compilation of symptom scores, spirometric volumes and saliva biomarker levels and produced novel patientspecific multidimensional composite scores with significant correlation to COPD disease severity. Prodromal changes in FEV1, salivary biomarkers and self-assessment scores were reproducibly demonstrated, with potential to predict exacerbation onset.
These results could be exploited for the development of a much-needed personalised COPD monitoring eco-system, which isolates early deteriorations and prompts timely interventions, leading to beneficial disease outcomes. Patient-researcher iterative co-design has been key throughout this thesis. One outcome of this relationship is the design and production of a bespoke integral saliva collector prototype which could substitute laboratory-based processing of saliva samples in readiness for analyte testing.
In conclusion, this thesis has created the necessary tools to improve the classification and monitoring of COPD, opening new avenues for proactive patient self-management and providing the basis for future personalised and stratified care.
|Oct 1, 2016