Vickram Tejwani1, Amy S Nowacki2, Erica Fye3, Christopher Sanders3, James K Stoller4. 1. Pulmonary and Critical Care, Johns Hopkins Hospital, Baltimore, Maryland. tejwani@jhmi.edu. 2. Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio. 3. Biocerna, LLC, Fulton, Maryland. 4. Education Institute, Respiratory Institute, Cleveland Clinic, Cleveland, Ohio.
Abstract
BACKGROUND: Alpha-1 antitrypsin deficiency is frequently underrecognized. Individuals with symptoms often experience long diagnostic delays. Although a delayed diagnosis is logically presumed to be associated with adverse effects, confirmatory evidence that a delay in diagnosis confers harm is sparse. The current study characterized the association between a delayed diagnosis and the clinical status at the time of diagnosis. METHODS: Patients with newly diagnosed severe deficiency of alpha-1 antitrypsin received questionnaires that assessed self-reported diagnostic delay, the St George Respiratory Questionnaire (SGRQ) and COPD Assessment Test. Results of spirometry were retrieved and the relationship between the diagnostic delay interval and FEV1% predicted, SGRQ, and COPD Assessment Test were assessed. RESULTS: Forty subjects were recruited (31 with PI*ZZ, 9 with PI*SZ). Values for FEV1% predicted, SGRQ, and COPD Assessment Test were available for 17, 40, and 32 subjects, respectively. The relationship between the diagnostic delay interval and all outcomes was directionally consistent with an adverse impact of increasing diagnostic delay. For each additional year of diagnostic delay, the subject's FEV1% predicted decreased by 0.3% (P = .66), The SGRQ Total score increased by 1.6 points (P < .001), and the COPD Assessment Test score increased by 0.7 points (P = .004). CONCLUSIONS: The results of this analysis were consistent with a delayed diagnosis of alpha-1 antitrypsin deficiency being associated with worse COPD-related symptoms and functional status, and with a trend toward worsened air-flow obstruction. Given that alpha-1 antitrypsin deficiency is associated with accelerated emphysema progression, these findings underscore the importance of early detection of alpha-1 antitrypsin deficiency and reinforce guidelines that endorse alpha-1 antitrypsin deficiency testing in all adults with fixed air-flow obstruction and first-degree relatives of individuals with severe deficiency of alpha-1 antitrypsin.
BACKGROUND:Alpha-1 antitrypsin deficiency is frequently underrecognized. Individuals with symptoms often experience long diagnostic delays. Although a delayed diagnosis is logically presumed to be associated with adverse effects, confirmatory evidence that a delay in diagnosis confers harm is sparse. The current study characterized the association between a delayed diagnosis and the clinical status at the time of diagnosis. METHODS:Patients with newly diagnosed severe deficiency of alpha-1 antitrypsin received questionnaires that assessed self-reported diagnostic delay, the St George Respiratory Questionnaire (SGRQ) and COPD Assessment Test. Results of spirometry were retrieved and the relationship between the diagnostic delay interval and FEV1% predicted, SGRQ, and COPD Assessment Test were assessed. RESULTS: Forty subjects were recruited (31 with PI*ZZ, 9 with PI*SZ). Values for FEV1% predicted, SGRQ, and COPD Assessment Test were available for 17, 40, and 32 subjects, respectively. The relationship between the diagnostic delay interval and all outcomes was directionally consistent with an adverse impact of increasing diagnostic delay. For each additional year of diagnostic delay, the subject's FEV1% predicted decreased by 0.3% (P = .66), The SGRQ Total score increased by 1.6 points (P < .001), and the COPD Assessment Test score increased by 0.7 points (P = .004). CONCLUSIONS: The results of this analysis were consistent with a delayed diagnosis of alpha-1 antitrypsin deficiency being associated with worse COPD-related symptoms and functional status, and with a trend toward worsened air-flow obstruction. Given that alpha-1 antitrypsin deficiency is associated with accelerated emphysema progression, these findings underscore the importance of early detection of alpha-1 antitrypsin deficiency and reinforce guidelines that endorse alpha-1 antitrypsin deficiency testing in all adults with fixed air-flow obstruction and first-degree relatives of individuals with severe deficiency of alpha-1 antitrypsin.
Authors: Mark Brantly; Michael Campos; Angela M Davis; Jeanine D'Armiento; Kenneth Goodman; Kathi Hanna; Miriam O'Day; John Queenan; Robert Sandhaus; James Stoller; Charlie Strange; Jeffrey Teckman; Adam Wanner Journal: Orphanet J Rare Dis Date: 2020-04-19 Impact factor: 4.123
Authors: Tomoko Nakanishi; Vincenzo Forgetta; Tomohiro Handa; Toyohiro Hirai; Vincent Mooser; G Mark Lathrop; William O C M Cookson; J Brent Richards Journal: Eur Respir J Date: 2020-12-10 Impact factor: 16.671