PURPOSE: Alpha-1 antitrypsin deficiency (AATD) is under-recognized by clinicians, with long diagnostic delays between patients’ (pts) first symptom and initial diagnosis. Recent recommendations by official societies encourage testing for AATD in all symptomatic adults with spirometric evidence of COPD, though compliance with this recommendation has been variable. This study examines whether issuing an alert to physicians receiving PFT reports showing COPD would encourage testing for and detection of AATD.
METHODS: For 6 months, the following physician alert was added to the paper copy of PFT reports of pts with airflow obstruction of GOLD Stage I or higher: “The American Thoracic Society recommends testing for AATD in all patients with FEV1< 80% predicted and FEV1/FVC less than 0.70, if clinically indicated. Appropriate counseling suggested.” The primary outcome measure was the frequency of testing for AATD as measured by blood tests sent to several laboratories. A secondary outcome measure was the frequency with which serum levels indicated severe AATD.
RESULTS: During the “pre-alert period,” 821 spirometry tests were performed at the Cleveland Clinic Weston; 178 pts of these 821 unique patients (22%) satisfied spirometric criteria of ≥ GOLD Stage I and 11 (6%) were tested for AATD. In contrast, during the physician alert intervention period, 689 spirometry tests were performed on 689 unique pts, of whom 140 (20%) satisfied criteria for ≥ GOLD I airflow obstruction; AAT serum levels were sent more frequently (18 [13%], p = 0.04). No pts with AATD were identified during the study.
CONCLUSION: Implementing a physician alert on PFT reports of pts with COPD can increase physicians’ testing for AATD. Failure to detect pts with AATD in this series may reflect the low absolute number of patients tested.
CLINICAL IMPLICATIONS: Only a minority of “at risk” pts are tested, suggesting the need for this and additional strategies to encourage compliance with available guidelines.
DISCLOSURE: Franck Rahaghi, No Product/Research Disclosure Information; Grant monies (from industry related sources) Reasearch Funded by Cleveland Clinic Florida Pulmonary Education fund: supported in part by a grant from Baxter Healthcare, Inc.; Consultant fee, speaker bureau, advisory committee, etc. Dr. Rahaghi has attended advisory meetings or has been sponsored for speaking engagements by Baxter Healthcare Inc. and CSL Behring.