The important role of primary care providers in the detection of alpha-1 antitrypsin deficiency

Jorge E. Lascano, Michael A Campos

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Objective: Alpha-1 antitrypsin deficiency (AATD) is an underrecognized genetic disorder that can cause chronic obstructive pulmonary disease (COPD) and liver cirrhosis, two clinical conditions commonly seen by primary care physicians. AATD is estimated to affect 1/4000–1/5000 people in the United States and 1–2% of all COPD cases. Methods: PubMed was searched for relevant articles using AAT/AATD-related terms. Results: Unfortunately, <10% of symptomatic individuals have been properly diagnosed primarily due to the underdiagnosis of COPD and the lack of awareness of AATD as a possible underlying cause. Because primary care providers are most likely to be the first to encounter symptomatic individuals, their role in the identification and early diagnosis of AATD patients is instrumental, particularly since therapy to slow lung disease progression is available. The diagnosis of AATD is laboratory-based rather than clinical. Testing for AATD should be part of the reflex testing that follows any COPD diagnosis or unexplained liver disease and can be performed by determining the AAT phenotype or genotype along with serum AAT levels. Both nonpharmacological and pharmacological approaches are recommended for treatment of lung disease, including smoking cessation, bronchodilators or supplemental oxygen as needed. Specific augmentation of AAT levels with regular purified AAT infusions has been found to slow lung function decline and emphysema progression in patients with moderate airflow obstruction and severely low serum AAT levels. Conclusions: Improving primary care provider awareness and promoting regular reflex testing all COPD patients for AATD may significantly improve the care of COPD patients.

Original languageEnglish (US)
Pages (from-to)1-7
Number of pages7
JournalPostgraduate Medicine
DOIs
StateAccepted/In press - Oct 6 2017

Fingerprint

alpha 1-Antitrypsin Deficiency
Primary Health Care
Chronic Obstructive Pulmonary Disease
Lung Diseases
Reflex
Inborn Genetic Diseases
Autosomal Recessive alpha-1-Antitrypsin Deficiency
Bronchodilator Agents
Emphysema
Primary Care Physicians
Smoking Cessation
Serum
PubMed
Liver Cirrhosis
Disease Progression
Liver Diseases
Early Diagnosis
Genotype
Pharmacology
Oxygen

Keywords

  • Alpha-1 antitrypsin
  • alpha-1 antitrypsin deficiency
  • chronic obstructive pulmonary disease
  • pulmonary dysfunction

ASJC Scopus subject areas

  • Medicine(all)

Cite this

The important role of primary care providers in the detection of alpha-1 antitrypsin deficiency. / Lascano, Jorge E.; Campos, Michael A.

In: Postgraduate Medicine, 06.10.2017, p. 1-7.

Research output: Contribution to journalArticle

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abstract = "Objective: Alpha-1 antitrypsin deficiency (AATD) is an underrecognized genetic disorder that can cause chronic obstructive pulmonary disease (COPD) and liver cirrhosis, two clinical conditions commonly seen by primary care physicians. AATD is estimated to affect 1/4000–1/5000 people in the United States and 1–2{\%} of all COPD cases. Methods: PubMed was searched for relevant articles using AAT/AATD-related terms. Results: Unfortunately, <10{\%} of symptomatic individuals have been properly diagnosed primarily due to the underdiagnosis of COPD and the lack of awareness of AATD as a possible underlying cause. Because primary care providers are most likely to be the first to encounter symptomatic individuals, their role in the identification and early diagnosis of AATD patients is instrumental, particularly since therapy to slow lung disease progression is available. The diagnosis of AATD is laboratory-based rather than clinical. Testing for AATD should be part of the reflex testing that follows any COPD diagnosis or unexplained liver disease and can be performed by determining the AAT phenotype or genotype along with serum AAT levels. Both nonpharmacological and pharmacological approaches are recommended for treatment of lung disease, including smoking cessation, bronchodilators or supplemental oxygen as needed. Specific augmentation of AAT levels with regular purified AAT infusions has been found to slow lung function decline and emphysema progression in patients with moderate airflow obstruction and severely low serum AAT levels. Conclusions: Improving primary care provider awareness and promoting regular reflex testing all COPD patients for AATD may significantly improve the care of COPD patients.",
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