More testing for alpha-1 antitrypsin deficiency is needed in the UK

Chronic obstructive pulmonary disease (COPD) is a major cause of chronic morbidity and the third leading cause of death worldwide. Alpha-1-antitrypsin (AAT) deficiency significantly increases the risk of developing COPD. AAT deficiency (AATD) is a genetic disorder characterized by low serum levels of AAT, which at normal levels protects the lung alveoli from damage. Severe AATD can lead to pulmonary emphysema. Global guidance from the World Health Organization, European Respiratory Society and the Global Initiative for Chronic Obstructive Lung Disease recommends testing AAT levels in blood serum of all COPD patients.

In the UK, previous estimates of the prevalence of AATD are outdated and suggest that it is underdiagnosed. In May 2018, a REG study was published in the European Respiratory Journal that determined recent trends in testing and diagnosing AATD among COPD patients in the UK from 1990 to 2014. The Optimum Patient Care Research Database was used to identify patients with a diagnostic code for COPD from about 550 UK general practices. Analysis focused on those diagnosed with COPD before the age of 60 years.

The study identified over 100,000 patients with COPD, of whom over a quarter were diagnosed before 60 years of age. Between 1994 and 2013 the incidence of AATD diagnosis increased among all age groups and both genders, mostly due to an increase in new testing for AATD from around 0% in 1994 to around 1.3% in 2013. However, despite the increase in testing, still only 2.2% of COPD diagnosed before the age of 60 were ever tested for AATD in the period 1990-2014. Of those tested, 24% were diagnosed with AATD. These findings indicate that AATD remains markedly underdiagnosed in COPD patients in the UK and that more testing is needed.

  • Soriano JB, Lucas SJ, Jones R, Miravitlles M, Carter V, Small I, Price D, Mahadeva R. Trends of testing for and diagnosis of alpha-1 antitrypsin deficiency in the UK: more testing is needed. Eur Respir J. 2018 May 31. pii: 1800360.

http://erj.ersjournals.com/content/early/2018/05/10/13993003.00360-2018

2018 Abstract Prizes

During a very successful summit in Amsterdam, the following people were awarded Abstract Prizes for their submissions and presentations:

Eric van Ganse – REGABS18001: THERAPEUTIC RATIOS PREDICT ASTHMA CONTROL IN THE ASTROLAB
COHORT
Lakmini Bulathsinhala – REGABS18010: DEMOGRAPHIC AND CLINICAL CHARACTERISTICS OF PATIENTS WITH SEVERE ASTHMA WORLDWIDE
Boudewijn Dierick – REGABS18011: WORK ABSENCE IN PATIENTS WITH ASTHMA AND/OR COPD
Ronald Dandurand – REGABS18017: CHARACTERIZATION OF COMMUNITY PRACTICE COPD BY BLOOD
EOSINOPHILS
Rupert Jones – REGABS1021: DATABASE STUDIES IN UGANDA-AN OPPORTUNITY FOR GLOBAL RESEARCH
WHERE CHRONIC LUNG DISEASE MATTERS
Ronald Dandurand – REGABS18026: OSCILLOMETRY UPPER LIMIT OF NORMAL AT WORLD COPD DAY 2017

Congratulations to you all.

Validating the Concept of COPD Control

Chronic Obstructive Pulmonary Disease (COPD) is a major cause of chronic morbidity and mortality worldwide. COPD is considered to be controlled if treatment is minimising symptoms and reducing the risk of acute exacerbations. The concept of control in COPD has been developed as a tool to aid physicians in modifying individual patient’s treatment in order to optimise the patient’s outcomes.

This REG study, published in COPD: Journal of Chronic Obstructive Pulmonary Disease, has investigated the association between COPD control status and clinical outcomes. A retrospective, observational cohort study was conducted using electronic medical records and linked patient questionnaire data from the UK Optimum Patient Care Research Database (OPCRD).

When using the definition of COPD control proposed by Soler-Cataluña et al (2014)1, it was found that only a small proportion of patients in this UK study could be classed as having controlled COPD. Despite this the UK patient population did not have an increased risk of exacerbations, indicating that the proposed definition of control may be too strict.

Patients with mild to moderate COPD that were categorised as having uncontrolled disease experienced exacerbations sooner than patients with controlled disease.

This finding highlights the importance of having a measure of control in COPD; identifying those patients with uncontrolled disease allows treatment to be stepped up so that future exacerbations are reduced. However, the results of this study suggest that further work is still required to optimise the sensitivity and specificity of the proposed COPD control definition.

  • Soler-Cataluña JJ, Alcazar-Navarrete B, Miravitlles M. The concept of control in COPD: a new proposal for optimising therapy. Eur Respir J. 2014; 44:1072–1075.

http://www.tandfonline.com/doi/full/10.1080/15412555.2017.1350154