Trends of testing for and diagnosis of α1-antitrypsin deficiency in the UK: more testing is needed

Joan B Soriano, Sarah J Lucas, Rupert Jones, Marc Miravitlles, Victoria Carter, Iain Small, David Price, Ravi Mahadeva

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α1-antitrypsin deficiency (AATD) significantly increases the risk of developing chronic obstructive pulmonary disease (COPD), and testing of all COPD patients for AATD is recommended by the World Health Organization, European Respiratory Society and Global Initiative for Chronic Obstructive Lung Disease (GOLD). We aimed to determine trends for testing and diagnosing AATD from 1990 to 2014.This study analysed all patients diagnosed with COPD from about 550 UK Optimum Patient Care Research Database general practices, including a subgroup of those diagnosed before the age of 60 years.We identified 107 024 COPD individuals, of whom 29 596 (27.6 were diagnosed before 60 years of age. Of them, only 2.2% (95% CI 2.09textendash2.43 had any record of being tested for AATD. Of those tested, 23.7% (95% CI 20.5textendash27.1 were diagnosed with AATD. Between 1994 and 2013 the incidence of AATD diagnosis generally increased. A diagnosis of AATD was associated with being male, being an ex-smoker, more severe COPD with a lower forced expiratory volume in 1 s % pred and higher GOLD 2017 stages (all~plt;0.05).Despite an increase in the frequency of AATD testing since 1990, only 2.2% of patients diagnosed with COPD before the age of 60 years were tested. AATD prevalence was 23.7% in those tested. Thus, it appears that AATD remains markedly underdiagnosed in COPD patients.AATD remains markedly underdiagnosed in COPD patients and case-finding strategies for both conditions should be implemented
Original languageEnglish
Article number1800360
JournalEuropean Respiratory Journal
Issue number1
Publication statusPublished - Jul 2018

Bibliographical note

Support statement: Optimum Patient Care Research Database and Respiratory Effectiveness Group. R. Jones was supported by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care South West Peninsula (NIHR CLAHRC South West Peninsula). Funding information for this article has been deposited with the Crossref Funder Registry.


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