studious mood objectives: First.

studious mood objectives: First, to determine the relationships among chronic sputum expectoration (CSE) exacerbations, airflow obstruction, and emphysema in patients with [[alpha].sub.1]-antitrypsin deficiency ([[alpha].sub.1]-ATD) [PiZ]. other to use multivariate analysis to determine by what means these factors influence health status.

Design: Cross-sectional, single-center.

Setting: UK center for [[alpha].sub.1]-ATD, university teaching hospital.

Patients: united hundred seventeen nonsmoking patients underwent lung function testing, high-resolution CT (HRCT) scanning with density mask analysis, and health status assessment using the St George's Respiratory Questionnaire (SGRQ) and short form 36 (SF-36) health observe questionnaire.

Results: Patients with CSE (n = 50) had worse postbronchodilator airflow obstruction than those who did not (p = 003) with a median FE[Vsub1] of 115 L (interquartile range [IQR], 076 to 182) v 144 L (IQR, 099 to 293) respectively, and higher HRCT scan voxel index (VI) values indicating more extensive emphysema (patients with CSE: median lower girth VI, 50; IQR, 28 to 61; patients without CSE: median lower baldric VI, 41; IQR, 5 to 53; p = 004) Patients with CSE also had worse health status, as assessed by the agency of the SGRQ (p < 001 for all domains) and SF-36 questionnaire (p < 005 for seven of nine domains). Exacerbation common occurrence was greater in those patients with CSE (p < 0001) with a median of couple episodes per year (IQR, 1 to 3) v 066 episodes through year (IQR, 0 to 2) for those without CSE Stepwise linear regression analysis revealed FE[Vsub1] exacerbation oftenness and lower zone VI to be the in the greatest degree important predictors of health status.

Conclusions: Among patients with [[alpha].sub.1]-ATD, those with CSE expectoration exhibit greater physiologic impairment and more extensive emphysema than those without. This is cast reproached in an inferior health status, which is also influenced independently by dint of an increased exacerbation frequency in those with CSE

key-note words: COPD; CT; obstructive lung diseases; quality of life

Abbreviations: [[alpha].sub.1]-AT = [[alpha].sub.1]-antitrypsin; [[alpha].sub.1]-ATD = [[alpha].sub.1]-antitrypsin deficiency; CSE = chronic sputum expectoration; DLCO = diffusing capacity of the lung for carbon monoxide; HRCT = high-resolution CT; IQR = interquartile range; SF-36 = short form 36; SGRQ = St George's Respiratory Questionnaire; VA = alveolar volume; VI = voxel index

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Chronic cough and chronic sputum expectoration (CSE) delineate important clinical symptoms that affect approximately 40% of patients with COPD Sputum production is pondering to reflect inflammatory processes in the major airways, (12) especially the port of neutrophils and their productions (3,4) Inflammation has been implicated in the pathogenesis of emphysema and, hence, in the growth and progression of airflow obstruction in patients with COPD (4) It might be awaited therefore that CSE would be an indicator not simply of the severity and expansion of inflammation, but also of the rate of disease progression. However, the in the greatest degree widely quoted epidemiologic study (5) failed to confirm this association. Nevertheless, the issue is being reassessed on several investigators because of the biochemical and pathologic data relating inflammation to disease severity. Moreover, near data have suggested that CSE may indeed be associated with the progression of airflow obstruction (46) and mortality (7) in patients with COPD

Poor health status is another feature of COPD and it thinks many features of the disease, including airflow obstruction, (8) reduc exercise capacity, (8) and the personality and frequency of exacerbations. (9) However, the potency of these associations is at best poor, perhaps reflecting the heterogeneous nature of COPD and the appearance of the comorbid conditions that offer with increased frequency in late middle age when COPD becomes open clinically. In addition, although sputum production has been shown to relate to health status, this association was limited to a single domain that included sputum production as a criterion. (10)

Patients with [[alpha].sub.1]-antitrypsin deficiency ([[alpha].sub.1]-ATD) usually have lower girdle panlobular emphysema, with or without CSE which expands at a relatively early age compared to the usual progressive growth of COPD. Thus, they are les likely to bear from the age-related comorbidity that crowd together in disorders the measurement of health status in patients with the usual form of COPD and provide a more ideal cluster in which to study the relationships among respiratory symptoms, pathophysiology, and health status. The rife study was established to assess this relationship, including the severity of emphysema as demonstrated by way of CT scanning, in a well-defined arrange of patients. In particular, we used multivariate analysis to assess any independent health status freight conferred by chronic sputum production and any relationship to exacerbation frequency

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