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Ersöz H, Torres-Durán M, Turner AM, Tanash H, García CR, Corsico AG, López-Campos JL, Miravitlles M, Clarenbach CF, Chapman KR, Pérez JMH, Guimarães C, Bartošovská E, Greulich T, Barrecheguren M, Koczulla AR, Höger P, Rivera AO, Herth F, Trudzinski FC. Sex-Differences in Alpha-1 Antitrypsin Deficiency: Data From the EARCO Registry. Arch Bronconeumol 2024:S0300-2896(24)00244-8. [PMID: 39068055 DOI: 10.1016/j.arbres.2024.06.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Revised: 06/19/2024] [Accepted: 06/20/2024] [Indexed: 07/30/2024]
Abstract
BACKGROUND Sex and gender influence many aspects of chronic obstructive pulmonary disease (COPD). Limited data are available on this topic in alpha-1 antitrypsin deficiency (AATD). We therefore aimed to investigate sex issues in the EARCO registry, a prospective, international, observational cohort study. METHODS Baseline data from PiZZ individuals, enrolled in the registry with complete data on sex and smoking history were analysed by group comparisons and binary logistic regression analyses. RESULTS 1283 patients with AATD, 49.3% women were analysed. Females reported less tobacco consumption (16.8±12.2 vs. 19.6±14.5 PY, p=0.006), occupational exposures towards gases, dusts or asbestos (p<0.005 each) and consumed less alcohol (5.5±7.6 vs. 8.4±10.3u/week, p<0.001). Females reported COPD (41% vs. 57%, p<0.001) and liver disease (11% vs. 20%, p<0.001) less often. However, they had a higher prevalence of bronchiectasis (24% vs. 13%, p<0.001). Despite better lung function (FEV1%pred. 73.6±29.9 vs. 62.7±29.5, p<0.001) females reported a similar symptom burden (CAT 13.4±9.5 vs. 12.5±8.9, p=ns) and exacerbation frequency (at least one in the previous year 30% vs. 26%, p=ns) compared to males. In multivariate analyses, female sex was an independent risk factor for exacerbations in the previous year OR 1.6 p=0.001 in addition to smoking history, COPD, asthma and bronchiectasis and was also identified as risk factors for symptom burden (CAT≥10) OR 1.4 p=0.014 besides age, BMI, COPD and smoking history. CONCLUSION Men had higher rates of COPD and liver disease, women were more likely to have bronchiectasis. Women's higher symptom burden and exacerbation frequency suggest they may need tailored treatment approaches.
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Affiliation(s)
- Hilal Ersöz
- Department of Pneumology and Critical Care Medicine, Thoraxklinik University of Heidelberg, Heidelberg, Germany; Translational Lung Research Center Heidelberg (TLRC-H), German Center for Lung Research (DZL), Heidelberg, Germany
| | - María Torres-Durán
- Pneumology Service Hospital Alvaro Cunqueiro, Vigo, Institute for Health Research Galicia Sur (IISGS), Vigo, Spain; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - Alice M Turner
- Institute for Applied Health Research, University of Birmingham, Birmingham B15 2TT, United Kingdom; University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Hanan Tanash
- Department of Respiratory Medicine and Allergology, Skåne University Hospital, Lund University, Malmö, Sweden
| | - Carlota Rodríguez García
- Department of Pulmonology, Hospital Clínico-Universitario de Santiago, Santiago de Compostela, Spain; Interdisciplinary Research Group in Pulmonology, Institute of Health Research of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Angelo Guido Corsico
- Department of Internal Medicine and Therapeutics, University of Pavia, Italy; Respiratory Diseases Division, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - José Luis López-Campos
- Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla, IBiS/Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Spain; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - Marc Miravitlles
- Pneumology Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus - Health Care Provider of the European Reference Network on Rare Respiratory Diseases (ERN LUNG), Barcelona, Spain
| | - Christian F Clarenbach
- Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland; Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | | | - Jose Mª Hernández Pérez
- Pneumology Department, Hospital Universitario Nuestra Señora de La Candelaria, Santa Cruz de Tenerife, Spain
| | - Catarina Guimarães
- Pulmonology Department,Hospital Senhora da Oliveira, Guimarães, Portugal
| | - Eva Bartošovská
- Thomayer hospital, Charles University, Prague, Czech Republic
| | - Timm Greulich
- University Medical Centre Giessen and Marburg, Philipps-University, Deparment of Medicine, Pulmonary and Critical Care Medicine, Member of the German Centre for Lung Research (DZL), Marburg, Germany
| | - Miriam Barrecheguren
- Pneumology Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus - Health Care Provider of the European Reference Network on Rare Respiratory Diseases (ERN LUNG), Barcelona, Spain
| | - Andreas Rembert Koczulla
- Pneumologische Rehabilitation, Deutsches Zentrum für Lungenforschung, Philipps-Universität Marburg, Marburg, Germany; Schön Klinik Berchtesgadener, PMU Salzburg, Austria
| | - Philipp Höger
- Department of Pneumology and Critical Care Medicine, Thoraxklinik University of Heidelberg, Heidelberg, Germany; Translational Lung Research Center Heidelberg (TLRC-H), German Center for Lung Research (DZL), Heidelberg, Germany
| | - Arturo Olivares Rivera
- Department of Pneumology and Critical Care Medicine, Thoraxklinik University of Heidelberg, Heidelberg, Germany; Translational Lung Research Center Heidelberg (TLRC-H), German Center for Lung Research (DZL), Heidelberg, Germany
| | - Felix Herth
- Department of Pneumology and Critical Care Medicine, Thoraxklinik University of Heidelberg, Heidelberg, Germany; Translational Lung Research Center Heidelberg (TLRC-H), German Center for Lung Research (DZL), Heidelberg, Germany
| | - Franziska C Trudzinski
- Department of Pneumology and Critical Care Medicine, Thoraxklinik University of Heidelberg, Heidelberg, Germany; Translational Lung Research Center Heidelberg (TLRC-H), German Center for Lung Research (DZL), Heidelberg, Germany.
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Calle Rubio M, Miravitlles M, López-Campos JL, Soler-Cataluña JJ, Alcazar Navarrete B, Fuentes-Ferrer ME, Rodriguez Hermosa JL. Detection of Alpha-1 Antitrypsin Levels in Chronic Obstructive Pulmonary Disease in Respiratory Clinics in Spain: Results of the EPOCONSUL 2021 Audit. J Clin Med 2024; 13:955. [PMID: 38398268 PMCID: PMC10889736 DOI: 10.3390/jcm13040955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 01/29/2024] [Accepted: 02/01/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Alpha-1 antitrypsin deficiency (AATD) is an underdiagnosed condition despite being one of the most common inherited disorders in adults that is associated with an increased risk of developing chronic obstructive pulmonary disease (COPD). The aim was to evaluate the frequency of performing AAT levels and associated factors in COPD patients in an audit conducted in 2021-2022, as well as to compare with a previous audit conducted in 2014-2015. METHODS EPOCONSUL 2021 is a cross-sectional audit that evaluated the outpatient care provided to COPD patients in respiratory clinics in Spain based on available data from medical registries. RESULTS 4225 patients with a diagnosis of COPD from 45 centers were audited in 2021. A total of 1670 (39.5%) patients underwent AAT determination. Being treated at a specialized COPD outpatient clinic (OR 1.88, p = 0.007), age ≤ 55 years old (OR 1.84, p = 0.007) and a FEV1 < 50% (OR 1.86, p < 0.001) were associated with a higher likelihood of being tested for AAT, while Charlson index ≥ 3 (OR 0.63, p < 0.001) and genotyping of AATD availability (OR 0.42, p < 0.001) showed a statistically significant negative association. The analysis of cases included in respiratory units that participated in both audits showed an increase in the proportion of cases with AAT serum level testing available (adjusted OR 2.81, p < 0.001). The percentage of individuals with serum AAT levels < 60 mg/dL (a severe AATD) was 4%. CONCLUSIONS Our analysis identifies significant improvements in adherence to the recommendation to test AAT levels in COPD patients, performed in 4 out of 10 patients, being more likely at younger ages and with higher COPD severity, and with a detection of severe AATD of 4% among those tested, suggesting that clinicians still perform AAT testing in COPD patients selectively. Therefore, efforts are still needed to optimize AATD screening and establish new early detection strategies to reduce morbidity and mortality in these patients.
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Affiliation(s)
- Myriam Calle Rubio
- Pulmonology Department, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain;
- Department of Medicine, School of Medicine, Universidad Complutense de Madrid, 28040 Madrid, Spain
| | - Marc Miravitlles
- Pulmonary Department, Hospital Universitari Vall d’Hebron, Vall d’Hebron Institut de Recerca (VHIR), Vall d’Hebron Barcelona Hospital Campus, 08035 Barcelona, Spain;
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, 28029 Madrid, Spain;
| | - José Luis López-Campos
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, 28029 Madrid, Spain;
- Respiratory Disease Medical-Surgical Unit, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/Universidad de Sevilla, 41009 Sevilla, Spain
| | - Juan J. Soler-Cataluña
- Pulmonology Department, Hospital Arnau de Vilanova-Lliria, 46015 Valencia, Spain;
- Medicine Department, Valencia University, 46010 Valencia, Spain
| | - Bernardino Alcazar Navarrete
- Pulmonary Department, Hospital Universitario Virgen de las Nieves, Instituto Biosanitario de Granada, 18014 Granada, Spain;
| | - Manuel E. Fuentes-Ferrer
- Unidad de Investigación, Hospital Universitario Nuestra Señora de Candelaria, 38010 Santa Cruz de Tenerife, Spain;
| | - Juan Luis Rodriguez Hermosa
- Pulmonology Department, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain;
- Department of Medicine, School of Medicine, Universidad Complutense de Madrid, 28040 Madrid, Spain
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Newnham M, Quinn M, Turner AM. Estimating the Prevalence of AATD Patients in the UK to Identify Underdiagnosis and Determine the Eligibility for Potential Augmentation Therapy. Int J Chron Obstruct Pulmon Dis 2023; 18:1197-1205. [PMID: 37332838 PMCID: PMC10276585 DOI: 10.2147/copd.s395663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 05/13/2023] [Indexed: 06/20/2023] Open
Abstract
Purpose Alpha 1 antitrypsin deficiency (AATD) is a genetic risk factor for chronic obstructive pulmonary disease (COPD). Whilst testing for the condition is relatively simple, there is a disconnect in published literature between genetic epidemiology and numbers of patients known to specialists. This makes planning services for patients difficult. We aimed to estimate the number of patients likely to have lung disease eligible for specific AATD therapy within the UK. Patients and Methods The THIN database was used to determine the prevalence of AATD and symptomatic COPD. This, and published rates of AATD were used to extrapolate THIN data to the population size of the UK to give an indicative population size for symptomatic AATD patients who have lung disease. The Birmingham AATD registry was used to describe age at diagnosis, rate of lung disease and symptomatic lung disease for patients with PiZZ (or equivalent) AATD, together with the time from symptom onset to diagnosis, in order to aid interpretation of the THIN data and improve modeling. Results THIN data showed COPD prevalence of 3%, and AATD prevalence of 0.005-0.2%, depending on how stringently AATD diagnostic codes were applied. The majority of Birmingham AATD patients were diagnosed between the ages 46-55, whilst patients recorded in THIN tended to be older. The rate of COPD was similar in the THIN and Birmingham patients diagnosed with AATD. Modelling to the size of the UK demonstrated a likely symptomatic AATD population of between 3016 and 9866 people. Conclusion AATD is likely to be under-diagnosed in the UK. Based on projected patient numbers an expansion to specialist services is desirable, in particular if specific therapy for AATD such as augmentation were to be introduced to the healthcare system.
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Affiliation(s)
- Michael Newnham
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- University Hospitals Birmingham, Birmingham, UK
| | - Mark Quinn
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Alice M Turner
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- University Hospitals Birmingham, Birmingham, UK
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4
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Miravitlles M, Herepath M, Priyendu A, Sharma S, Vilchez T, Vit O, Haensel M, Lepage V, Gens H, Greulich T. Disease burden associated with alpha-1 antitrypsin deficiency: systematic and structured literature reviews. Eur Respir Rev 2022; 31:210262. [PMID: 35321931 PMCID: PMC9488933 DOI: 10.1183/16000617.0262-2021] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 01/24/2022] [Indexed: 12/14/2022] Open
Abstract
Alpha-1 antitrypsin deficiency (AATD) is a rare genetic disorder characterised by reduced levels of circulating alpha-1 antitrypsin and an increased risk of lung and liver disease. Recent reviews of AATD have focused on diagnosis, epidemiology and clinical management; comprehensive reviews examining disease burden are lacking. Therefore, we conducted literature reviews to investigate the AATD disease burden for patients, caregivers and healthcare systems. Embase, PubMed and Cochrane libraries were searched for AATD publications from database inception to June 2021, in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Most published AATD studies were small and short in duration, with variations in populations, designs, measures and outcomes, complicating cross-study comparisons. AATD was associated with significant pulmonary and hepatic morbidity. COPD, emphysema and bronchiectasis were common lung morbidities, where smoking was a key risk factor. Fibrosis and steatosis were the most common liver complications reported in patients with a PiZ allele. Health status analyses suggested a poorer quality of life for AATD patients diagnosed with COPD versus those with non-AATD-associated COPD. The burden for caregivers included loss of personal time due to caring responsibilities, stress and anxiety. AATD was also associated with high direct medical costs and healthcare resource utilisation.
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Affiliation(s)
- Marc Miravitlles
- Pneumology Dept, Hospital Universitari Vall d'Hebron/Vall d'Hebron Research Institute (VHIR), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
- CIBER de Enfermedades Respiratorias (CIBERES), Barcelona, Spain
| | | | - Asim Priyendu
- Access Consulting, HEOR, Parexel International, Mohali, India
| | - Sheetal Sharma
- Access Consulting, HEOR, Parexel International, Mohali, India
| | | | | | | | | | | | - Timm Greulich
- Dept of Medicine, Pulmonary and Critical Care Medicine, University Medical Centre Giessen and Marburg, Philipps-University, Centre for Lung Research (DZL), Marburg, Germany
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5
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Sandhaus RA. Foreword. Ther Adv Chronic Dis 2021; 12_suppl:2040622320974875. [PMID: 34408827 PMCID: PMC8367203 DOI: 10.1177/2040622320974875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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6
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Estey MP, Tahooni T, Nelson TN, Parker ML, Agbor TA, Yang HM, Jen R, Barakauskas VE, Lam GY, Matthews A, Mattman A. Is the diagnostic rate for the common subtypes of A1AT deficiency consistent across two Canadian Provinces? Clin Biochem 2021; 95:84-88. [PMID: 33964271 DOI: 10.1016/j.clinbiochem.2021.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 04/29/2021] [Accepted: 05/03/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND The diagnosis of alpha-1-antitrypsin (A1AT) deficiency has been hindered by obscurity concerning the testing process and treatment implications. In this study, we aimed to identify regional differences in the diagnostic rates for A1AT deficiency in the western Canadian provinces of British Columbia (BC) and Alberta (AB). METHODS The number of A1AT deficiency variant genotype (ZZ, SZ, MZ, SS, and MS) diagnoses were reviewed for BC and AB. The regional diagnostic rates for A1AT deficiency variants in these two provinces, normalized for the predicted population prevalence of each variant genotype, was defined as the annual provincial diagnostic rate (APDR) for a given variant genotype. Sex specific variations in the mean age at diagnosis for the five variant genotypes were compared both within and between provinces. RESULTS The SZ and MZ genotype APDRs were significantly increased in the AB population compared to the BC population. The SS and MS APDRs were similar between AB and BC. There was a significantly decreased mean age of diagnosis for AB males, as compared to BC males (for the SZ, MS, and MZ genotypes) and as compared to AB females (for the MS, MZ, and SS genotypes). There were no significant differences in the mean age of diagnosis between the females and males in BC, or between females in AB and BC, for any genotype. CONCLUSION The notably higher APDR for more severe A1AT deficiency genotypes, and lower mean age of diagnosis for most variant genotypes in AB males, deserves further investigation to determine the explanation(s) for these differences.
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Affiliation(s)
- Mathew P Estey
- DynaLIFE Medical Labs, 200, 10150 102 St, Edmonton, AB T5J 5E2, Canada; Department of Laboratory Medicine and Pathology, University of Alberta, 5B4.02 Walter C. Mackenzie Health Sciences Centre, Edmonton, AB T6G 2R7, Canada.
| | - Tania Tahooni
- Department of Pathology and Laboratory Medicine, St Paul's Hospital, 1081 Burrard St, Vancouver, BC V6Z 1Y6, Canada
| | - Tanya N Nelson
- Department of Pathology and Laboratory Medicine, BC Children's & BC Women's Hospitals, Children's and Women's Health Centre of British Columbia, 4480 Oak Street, Room 2J10, Vancouver, BC V6H 3V4, Canada; Department of Pathology and Laboratory Medicine, University of British Columbia, Rm. G227 - 2211 Westbrook Mall, Vancouver, BC V6T 2B5, Canada.
| | - Michelle L Parker
- DynaLIFE Medical Labs, 200, 10150 102 St, Edmonton, AB T5J 5E2, Canada; Department of Laboratory Medicine and Pathology, University of Alberta, 5B4.02 Walter C. Mackenzie Health Sciences Centre, Edmonton, AB T6G 2R7, Canada.
| | - Terence A Agbor
- DynaLIFE Medical Labs, 200, 10150 102 St, Edmonton, AB T5J 5E2, Canada; Department of Laboratory Medicine and Pathology, University of Alberta, 5B4.02 Walter C. Mackenzie Health Sciences Centre, Edmonton, AB T6G 2R7, Canada.
| | - Hui-Min Yang
- Department of Pathology and Laboratory Medicine, University of British Columbia, Rm. G227 - 2211 Westbrook Mall, Vancouver, BC V6T 2B5, Canada; Department of Pathology and Laboratory Medicine, Vancouver General Hospital, 910 W 10th Ave., Vancouver, BC V5Z 1M9, Canada
| | - Rachel Jen
- Department of Medicine, Division of Respiratory Medicine, University of British Columbia, 7th Floor, 2775 Laurel Street, BC V5Z 1M9, Canada; Department of Medicine, Division of Pulmonary Medicine, University of Alberta, 11302 83 Ave NW, Edmonton, AB T6G 2G3, Canada
| | - Vilte E Barakauskas
- Department of Pathology and Laboratory Medicine, BC Children's & BC Women's Hospitals, Children's and Women's Health Centre of British Columbia, 4480 Oak Street, Room 2J10, Vancouver, BC V6H 3V4, Canada; Department of Pathology and Laboratory Medicine, University of British Columbia, Rm. G227 - 2211 Westbrook Mall, Vancouver, BC V6T 2B5, Canada.
| | - Grace Y Lam
- Department of Medicine, Division of Pulmonary Medicine, University of Alberta, 11302 83 Ave NW, Edmonton, AB T6G 2G3, Canada.
| | - Allison Matthews
- Department of Pathology and Laboratory Medicine, BC Children's & BC Women's Hospitals, Children's and Women's Health Centre of British Columbia, 4480 Oak Street, Room 2J10, Vancouver, BC V6H 3V4, Canada; Department of Pathology and Laboratory Medicine, University of British Columbia, Rm. G227 - 2211 Westbrook Mall, Vancouver, BC V6T 2B5, Canada
| | - Andre Mattman
- Department of Pathology and Laboratory Medicine, St Paul's Hospital, 1081 Burrard St, Vancouver, BC V6Z 1Y6, Canada; Department of Pathology and Laboratory Medicine, University of British Columbia, Rm. G227 - 2211 Westbrook Mall, Vancouver, BC V6T 2B5, Canada.
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Quinn M, Ellis P, Pye A, Turner AM. Obstacles to Early Diagnosis and Treatment of Alpha-1 Antitrypsin Deficiency: Current Perspectives. Ther Clin Risk Manag 2020; 16:1243-1255. [PMID: 33364772 PMCID: PMC7751439 DOI: 10.2147/tcrm.s234377] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 11/30/2020] [Indexed: 11/23/2022] Open
Abstract
This review summarizes the current research and outlooks regarding the obstacles to diagnosing and treating early alpha-1-antitrypsin deficiency (AATD). It draws on prior systematic reviews and expert surveys to discover precisely what difficulties exist in early diagnosis and treatment of AATD and elucidate potential solutions to ease these difficulties. The perceived rarity of AATD may translate to a condition poorly understood by primary care physicians, and even many respiratory physicians, which results in opportunities for diagnosis being missed, especially in mild or asymptomatic patients. There are diagnostic techniques involving biomarkers and home testing methods which could improve the rate of early diagnosis. With respect to treatment, AATD involves treating two separate pathologies, lung disease and liver disease. The only specific AATD treatment, augmentation therapy, has proven ability in treating lung disease but not liver disease. Alpha-1-antitrypsin (AAT) synthesized in the liver can form damaging polymers that also result in reduced circulating AAT levels and, whilst liver transplantation is used to effectively treat AATD, it is inappropriate in early disease. Novel therapeutic areas such as gene editing and increasing autophagy are therefore being researched as future treatments. Ultimately, diagnosis and treatment are intrinsically linked in AATD, with earlier diagnosis leading to better treatment options and thus better patient outcomes.
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Affiliation(s)
- Mark Quinn
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Paul Ellis
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Anita Pye
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Alice M Turner
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK.,University Hospitals Birmingham, Birmingham, UK
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Horváth I, Canotilho M, Chlumský J, Chorostowska-Wynimko J, Corda L, Derom E, Ficker JH, Kneussl M, Miravitlles M, Sucena M, Thabut G, Turner AM, van ’t Wout E, McElvaney NG. Diagnosis and management of α 1-antitrypsin deficiency in Europe: an expert survey. ERJ Open Res 2019; 5:00171-2018. [PMID: 30863774 PMCID: PMC6409083 DOI: 10.1183/23120541.00171-2018] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 12/12/2018] [Indexed: 01/09/2023] Open
Abstract
Despite recent improvements, α1-antitrypsin deficiency (AATD) remains a rarely diagnosed and treated condition. To assess the variability of AATD diagnosis/treatment in Europe, and to evaluate clinicians' views on methods to optimise management, specialist AATD clinicians were invited to complete a web-based survey. Surveys were completed by 15 physicians from 14 centres in 13 European countries. All respondents perceived the AATD diagnosis rate to be low in their country; 77% of physicians believed that ∼15% of cases were diagnosed. Low awareness was perceived as the greatest barrier to diagnosis. Spirometry was considered more practical than quantitative computed tomography (QCT) for monitoring AATD patients in clinical practice; QCT was considered more useful in trials. AAT therapy provision was reported to be highly variable: France and Germany were reported to treat the highest proportion (∼60%) of diagnosed patients, in contrast to the UK and Hungary, where virtually no patients receive AAT therapy. Most clinicians supported self-administration and extended dosing intervals to improve convenience of AAT therapy. This survey indicates that AATD diagnosis and management are highly heterogeneous in Europe; European cooperation is essential to generate data to support access to AAT therapy. Improving convenience of AAT therapy is an ongoing objective.
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Affiliation(s)
- Ildikó Horváth
- Dept of Pulmonology, National Koranyi Institute for Pulmonology in Budapest, Budapest, Hungary
| | - Maria Canotilho
- Dept of Pneumology, Hospital of Santo Andre – Centro Hospitalar de Leiria, Leiria, Portugal
| | - Jan Chlumský
- Dept of Pneumology, Thomayer Hospital, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Joanna Chorostowska-Wynimko
- Dept of Genetics and Clinical Immunology, National Institute of Tuberculosis and Lung Diseases, Warsaw, Poland
| | - Luciano Corda
- Dept of Internal Medicine, Respiratory Disease Unit, Spedali Civili, Brescia, Italy
| | - Eric Derom
- Dept of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium
| | - Joachim H. Ficker
- 3rd Medical Dept, Nuremberg General Hospital/Paracelsus Medical University, Nuremberg, Germany
| | - Meinhard Kneussl
- Dept of Internal Medicine II and Pneumology at Wilhelminenspital Wien, Vienna, Austria
| | - Marc Miravitlles
- Pulmonology Dept, University Hospital Vall d'Hebron, CIBER de Enfermedades Respiratorias (CIBERES), Barcelona, Spain
| | - Maria Sucena
- Pulmonology Dept, Centro Hospitalar de São João, Porto, Portugal
| | - Gabriel Thabut
- Dept of Pneumology and Lung Transplantation, Bichat Hospital, Paris, France
| | - Alice M. Turner
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Emily van ’t Wout
- Leiden University Medical Centre, Dept of Pulmonology, Leiden, Netherlands
| | - N. Gerard McElvaney
- Dept of Respiratory Medicine, Beaumont Hospital, Royal College of Surgeons in Ireland, Dublin, Ireland
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9
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Clinical Experience with SERPINA1 DNA Sequencing to Detect Alpha-1 Antitrypsin Deficiency. Ann Am Thorac Soc 2018; 15:266-268. [DOI: 10.1513/annalsats.201708-694rl] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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10
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Bernhard N, Lepper PM, Vogelmeier C, Seibert M, Wagenpfeil S, Bals R, Fähndrich S. Deterioration of quality of life is associated with the exacerbation frequency in individuals with alpha-1-antitrypsin deficiency - analysis from the German Registry. Int J Chron Obstruct Pulmon Dis 2017; 12:1427-1437. [PMID: 28553095 PMCID: PMC5439990 DOI: 10.2147/copd.s130925] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Alpha-1-antitrypsin deficiency (AATD) is a rare hereditary disease that is associated with a higher risk to develop chronic obstructive pulmonary disease and liver cirrhosis. Previous cross-sectional studies on AATD individuals have shown a relationship between worse St George's Respiratory Questionnaire (SGRQ) scores and elevated exacerbation rate or high cigarette consumption. There is a lack of longitudinal data on the relationship between the exacerbation rate and worsening of SGRQ during disease. The aim of this study was to provide not only cross-sectional data but also information about the deterioration in quality of life over a follow-up period up to 7 years (median follow-up period of 3.33 years). METHODS We investigated questionnaire-based data of the German AATD registry concerning the relationship between SGRQ and exacerbation frequency, smoking history, forced expiratory volume in 1 second (FEV1) and carbon monoxide diffusion capacity (DLCO) first in cross-sectional analysis and later in longitudinal analysis. RESULTS Eight hundred sixty-eight individuals with protease inhibitor ZZ (PiZZ) genotype with an average age of 52.6±12.8 years had an SGRQ score of 45.7±20.6. SGRQ significantly correlated with the exacerbation frequency within the last 2 years (r=0.464; P<0.001), smoking history (r=0.233; P<0.001), FEV1 (r=-0.436; P<0.001), DLCO (r=-0.333; P<0.001), and patients' age (r=0.292; P<0.001). Individuals with occupational dust exposure had significantly worse quality of life (P<0.001). Mean annual deterioration of SGRQ in all patients with available follow-up data (n=286) was 1.21±4.45 points per year. Univariate and multivariate analysis showed a significant relationship between worsening of SGRQ/year and exacerbation frequency in the follow-up period (r=0.144; P=0.015). CONCLUSION Worsening of SGRQ is associated with the exacerbation frequency in individuals with PiZZ AATD.
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Affiliation(s)
- Nikolas Bernhard
- Department of Internal Medicine V – Pulmonology, Allergology, Intensive Care Medicine, Saarland University Hospital, Homburg
| | - Philipp M Lepper
- Department of Internal Medicine V – Pulmonology, Allergology, Intensive Care Medicine, Saarland University Hospital, Homburg
| | - Claus Vogelmeier
- Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Center Giessen and Marburg, Philipps-University Marburg, Member of the German Center for Lung Research (DZL)
| | - Martina Seibert
- Department of Internal Medicine V – Pulmonology, Allergology, Intensive Care Medicine, Saarland University Hospital, Homburg
| | - Stefan Wagenpfeil
- Faculty of Medicine, Institute of Medical Biometry, Epidemiology and Medical Informatics, Saarland University, Campus Homburg, Germany
| | - Robert Bals
- Department of Internal Medicine V – Pulmonology, Allergology, Intensive Care Medicine, Saarland University Hospital, Homburg
| | - Sebastian Fähndrich
- Department of Internal Medicine V – Pulmonology, Allergology, Intensive Care Medicine, Saarland University Hospital, Homburg
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Soriano JB, Mahadeva R. α1-Antitrypsin deficiency: count me in please! Eur Respir J 2017; 49:49/1/1601941. [DOI: 10.1183/13993003.01941-2016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 10/05/2016] [Indexed: 11/05/2022]
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Abstract
α1-Antitrypsin deficiency is an autosomal codominant condition that predisposes to emphysema and cirrhosis. The condition is common but grossly under-recognized. Identifying patients' α1-antitrypsin deficiency has important management implications (ie, smoking cessation, genetic and occupational counseling, and specific treatment with the infusion of pooled human plasma α1-antitrypsin). The weight of evidence suggests that augmentation therapy slows the progression of emphysema in individuals with severe α1-antitrypsin deficiency.
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Affiliation(s)
- Umur Hatipoğlu
- Respiratory Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, Desk A-90, Cleveland, OH 44195, USA.
| | - James K Stoller
- Education Institute, Cleveland Clinic Lerner School of Medicine, Cleveland Clinic, NA 22, Cleveland, OH 44195, USA
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