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      The Diagnosis and Management of Alpha-1 Antitrypsin Deficiency in the Adult.

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          Abstract

          Background: The diagnosis and clinical management of adults with alpha-1 antitrypsin deficiency (AATD) have been the subject of ongoing debate, ever since the publication of the first American Thoracic Society guideline statement in 1989.1 In 2003, the "American Thoracic Society (ATS)/European Respiratory Society (ERS) Statement: Standards for the Diagnosis and Management of Individuals with Alpha-1 Antitrypsin Deficiency" made a series of evidence-based recommendations, including a strong recommendation for broad-based diagnostic testing of all symptomatic adults with chronic obstructive pulmonary disease (COPD).2 Even so, AATD remains widely under-recognized. To update the 2003 systematic review and clinical guidance, the Alpha-1 Foundation sponsored a committee of experts to examine all relevant, recent literature in order to provide concise recommendations for the diagnosis and management of individuals with AATD. Purpose: To provide recommendations for: (1) the performance and interpretation of diagnostic testing for AATD, and (2) the current management of adults with AATD and its associated medical conditions. Methods: A systematic review addressing the most pressing questions asked by clinicians (clinician-centric) was performed to identify citations related to AATD that were published since the 2003 comprehensive review, specifically evaluating publications between January 2002 and December 2014. Important, more recent publications were solicited from the writing committee members as well. The combined comprehensive literature reviews of the 2003 document and this current review comprise the evidence upon which the committee's conclusions and recommendations are based. Results: Recommendations for the diagnosis and management of AATD were formulated by the committee. Conclusions: The major recommendations continue to endorse and reinforce the importance of testing for AATD in all adults with symptomatic fixed airflow obstruction, whether clinically labeled as COPD or asthma. Individuals with unexplained bronchiectasis or liver disease also should be tested. Family testing of first-degree relatives is currently the most efficient detection technique. In general, individuals with AATD and emphysema, bronchiectasis, and/or liver disease should be managed according to usual guidelines for these clinical conditions. In countries where intravenous augmentation therapy with purified pooled human plasma-derived alpha-1 antitrypsin is available, recent evidence now provides strong support for its use in appropriate individuals with lung disease due to AATD.

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          Author and article information

          Journal
          Chronic Obstr Pulm Dis
          Chronic obstructive pulmonary diseases (Miami, Fla.)
          COPD Foundation
          2372-952X
          2372-952X
          June 06 2016
          : 3
          : 3
          Affiliations
          [1 ] Division of Pulmonary, Critical Care and Sleep Medicine, National Jewish Health, Denver, Colorado.
          [2 ] Pulmonary Division, Mt. Sinai Roosevelt Hospital, New York, New York.
          [3 ] Division of Pulmonary, Critical Care and Sleep Medicine, University of Florida, Gainesville.
          [4 ] Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, University of Miami School of Medicine, Miami, Florida.
          [5 ] Division of Pulmonary and Critical Care Medicine, University of California Davis, Sacramento.
          [6 ] Institute for Bioethics and Health Policy, University of Miami School of Medicine, Miami, Florida.
          [7 ] Section of Pulmonary and Critical Care Medicine, Department of Medicine, University of Chicago, Chicago, Illinois.
          [8 ] Library and Knowledge Services, National Jewish Health, Denver, Colorado.
          [9 ] Department of Medicine, University of Texas Health Science Center at Tyler, Tyler.
          [10 ] Department of Pulmonary Medicine, Cleveland Clinic, Cleveland, Ohio.
          [11 ] Division of Pulmonary and Critical Care Medicine, Medical University of South Carolina, Charleston.
          [12 ] Division of Pediatric Gastroenterology and Hepatology, St. Louis University School of Medicine, St. Louis, Missouri.
          Article
          10.15326/jcopdf.3.3.2015.0182
          5556762
          28848891

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