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Clinical Trial
. 2018 Jun 28;13(6):e0198777.
doi: 10.1371/journal.pone.0198777. eCollection 2018.

Testing for alpha-1 antitrypsin in COPD in outpatient respiratory clinics in Spain: A multilevel, cross-sectional analysis of the EPOCONSUL study

Myriam Calle Rubio  1   2 , Joan B Soriano  3 , José Luis López-Campos  4   5 , Juan J Soler-Cataluña  6 , Bernardino Alcázar Navarrete  5   7 , José Miguel Rodríguez González-Moro  8 , Marc Miravitlles  9   10 , Miriam Barrecheguren  9 , Manuel E Fuentes Ferrer  2   11 , Juan Luis Rodriguez Hermosa  1   2 ; EPOCONSUL Study
Affiliations
Clinical Trial

Testing for alpha-1 antitrypsin in COPD in outpatient respiratory clinics in Spain: A multilevel, cross-sectional analysis of the EPOCONSUL study

Myriam Calle Rubio et al. PLoS One. .

Erratum in

Abstract

Background: Alpha-1 antitrypsin deficiency (AATD) is the most common hereditary disorder in adults, but is under-recognized. In Spain, the number of patients diagnosed with AATD is much lower than expected according to epidemiologic studies. The objectives of this study were to assess the frequency and determinants of testing serum α1-antitrypsin (AAT) levels in COPD patients, and to describe factors associated with testing.

Methods: EPOCONSUL is a cross-sectional clinical audit, recruiting consecutive COPD cases over one year. The study evaluated serum AAT level determination in COPD patients and associations between individual, disease-related, and hospital characteristics.

Results: A total of 4,405 clinical records for COPD patients from 57 Spanish hospitals were evaluated. Only 995 (22.5%) patients had serum AAT tested on some occasion. A number of patient characteristics (being male [OR 0.5, p < 0.001], ≤55 years old [OR 2.38, p<0.001], BMI≤21 kg/m2 [OR 1.71, p<0.001], FEV1(%)<50% [OR 1.35, p<0.001], chronic bronchitis [OR 0.79, p < 0.001], Charlson index ≥ 3 [OR 0.66, p < 0.001], or history or symptoms of asthma [OR 1.32, p<0.001]), and management at a specialized COPD outpatient clinic [OR 2.73,p<0.001] were identified as factors independently associated with ever testing COPD patients for AATD. Overall, 114 COPD patients (11.5% of those tested) had AATD. Of them, 26 (22.8%) patients had severe deficiency. Patients with AATD were younger, with a low pack-year index, and were more likely to have emphysema (p<0.05).

Conclusion: Testing of AAT blood levels in COPD patients treated at outpatient respiratory clinics in Spain is infrequent. However, when tested, AATD (based on the serum AAT levels ≤100 mg/dL) is detected in one in five COPD patients. Efforts to optimize AATD case detection in COPD are needed.

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Conflict of interest statement

Boehringer Ingelheim gave financial support with a donation for to carry out the study. The financing entity did not participate in the design of the study, data collection, analysis, publication or preparation of this manuscript. Myriam Calle Rubio received speaker fees from Boehringer Ingelheim, AstraZeneca, GlaxoSmithKline, Menarini, and Novartis and consulting fees from GlaxoSmithKline, Gebro Pharma and Novartis. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Figures

Fig 1
Fig 1. The sampling process is described in a STROBE flow chart.
A total of 17,893 clinical records of patients treated in outpatient respiratory clinics were evaluated during the study period and 5,726 clinical records of patients presumably diagnosed with COPD were selected. Of them, 4,508 patients were audited from 59 hospitals, for having all the inclusion criteria and none of the exclusion criteria. A total of 4408 patients audited from 57 hospitals with available AAT blood level determination were included for this retrospective analysis of alpha-1 antitrypsin deficiency diagnosis.
Fig 2
Fig 2. Distribution of AAT level determination in the blood.
Of the analyzed cohort, only 995 (22.5%) patients underwent AAT determination.
See this image and copyright information in PMC

References

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