α1-Antrypsin Deficiency (AATD) is an under-recognized and under-diagnosed condition. Having a laboratory workup list may influence testing for AATD.
In a pulmonary CME conference we conducted a questionnaire survey among the physicians present about their current practices in regard to ordering diagnostic tests in general and specifically their testing for AATD. Physicians were questioned about having a post patient visit lab ordering checkout list.
The group included 46 physicians, internists (n = 21, 46%), pulmonologists (n = 13, 28%), family physicians (n = 8, 17%) and other medical specialties (n = 3, 6%). A total of 66.7% work in a hospital/clinic mixed practice, 84.4% use paper charts and 46.7% have > 20 years in practice. Of the total, 6.8% reported to test always for AATD on every new patient with chronic obstructive symptoms; 43.2% reported to test occasionally, when there is clinical suspicion; and 50% reported seldom testing. Physicians were divided by having a workup list that included AATD test (27%), having a workup list not including AATD test (27%), and not having a workup list (46%). Of the physicians with a workup list, 83.3% of the group with AATD test on their list reported testing either always or occasionally; versus a 58.3% of the group without the test on their list (not statistically significant), and 39.4% of those without any list at all (Significant difference with the first group: P of 0.0047). Analysis of the frequency of AATD testing by medical specialty showed that 92.3% of pulmonologists are testing either always or occasionally, in contrast with a 31% of the primary care physicians.
Having a laboratory workup list including AATD diagnostic testing increases proactive testing for the disease. Further education for primary care specialties may increase awareness in these groups.
Only a minority of AATD patients is recognized and interventions such as adding a workup list or education in primary care specialties may aid in increasing testing.
Franck Rahaghi, Grant monies (from sources other than industry) Grant form Betty and Stu Hamilton fund for Pulmonary Reseacrh; Grant monies (from industry related sources) Research Grant, Baxter Inc. and CSL Behring; Shareholder None; Employee None; Consultant fee, speaker bureau, advisory committee, etc. Consultant and speaker for CSL Behring and Baxter Inc.; No Product/Research Disclosure Information