Why Screen All COPD Patients for AAT Deficiency?

Alpha-1 Screening Guidelines

Five major clinical organizations recommend an alpha-1 screening test for all COPD and treatment-resistant asthma patients: the COPD Foundation, American Thoracic Society (ATS), Global Initiative for Chronic Obstructive Lung Disease (GOLD), World Health Organization (WHO), and American College of Chest Physicians (CHEST)1-4:

The ATS recommends screening all COPD patients regardless of age, smoking history, ethnicity, or FEV1 status, and in addition1:

  • All adults with symptomatic COPD, regardless of smoking history
  • All adults with symptomatic emphysema, regardless of smoking history
  • All adults with symptomatic asthma whose airflow obstruction is incompletely reversible after bronchodilator therapy
  • Asymptomatic patients with persistent obstruction on pulmonary function tests and with identifiable risk factors (eg, smoking, occupational exposure)
  • All immediate family members of individuals with AAT deficiency

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FEV1, forced expiratory volume in 1 second.

References:

  1. American Thoracic Society/European Respiratory Society. American Thoracic Society/European Respiratory Society statement: standards for the diagnosis and management of individuals with alpha-1 antitrypsin deficiency. Am J Respir Crit Care Med.  2003;168(7):818-900.
  2. Global Initiative for Chronic Obstructive Lung Disease. Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease. 2023 Report. https://goldcopd.org/wp-content/uploads/2023/03/GOLD-2023-ver-1.3-17Feb2023_WMV.pdf.  Accessed August 29, 2023.
  3. World Health Organization. a1-antitrypsin deficiency: memorandum from a WHO meeting. Bull World Health Org. 1997;75(5):397-415.
  4. CHEST Foundation. Diagnosing AAT Deficiency. https://foundation.chestnet.org/lung-health-a-z/alpha-1-antitrypsin-deficiency/?Item=Diagnosis. Accessed September 8, 2023.