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Obstacles to Early Diagnosis and Treatment of Alpha-1 Antitrypsin Deficiency: Current Perspectives

Authors Quinn M, Ellis P, Pye A, Turner AM

Received 6 October 2020

Accepted for publication 30 November 2020

Published 16 December 2020 Volume 2020:16 Pages 1243—1255


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 5

Editor who approved publication: Professor Garry Walsh

Mark Quinn,1 Paul Ellis,1 Anita Pye,1 Alice M Turner1,2

1Institute of Applied Health Research, University of Birmingham, Birmingham, UK; 2University Hospitals Birmingham, Birmingham, UK

Correspondence: Alice M Turner
Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
Tel +44 121 371 3885

Abstract: This review summarizes the current research and outlooks regarding the obstacles to diagnosing and treating early alpha-1-antitrypsin deficiency (AATD). It draws on prior systematic reviews and expert surveys to discover precisely what difficulties exist in early diagnosis and treatment of AATD and elucidate potential solutions to ease these difficulties. The perceived rarity of AATD may translate to a condition poorly understood by primary care physicians, and even many respiratory physicians, which results in opportunities for diagnosis being missed, especially in mild or asymptomatic patients. There are diagnostic techniques involving biomarkers and home testing methods which could improve the rate of early diagnosis. With respect to treatment, AATD involves treating two separate pathologies, lung disease and liver disease. The only specific AATD treatment, augmentation therapy, has proven ability in treating lung disease but not liver disease. Alpha-1-antitrypsin (AAT) synthesized in the liver can form damaging polymers that also result in reduced circulating AAT levels and, whilst liver transplantation is used to effectively treat AATD, it is inappropriate in early disease. Novel therapeutic areas such as gene editing and increasing autophagy are therefore being researched as future treatments. Ultimately, diagnosis and treatment are intrinsically linked in AATD, with earlier diagnosis leading to better treatment options and thus better patient outcomes.

Keywords: emphysema, cirrhosis, diagnostic screening programs, chronic obstructive pulmonary disease

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