International Journal of COPD · 2019 · 23 citations · 22 references
Health ProfessionsHealth SciencesEpidemiologyPulmonary Function TestingPulmonologyChronic Obstructive Pulmonary DiseaseLung VolumesObstructive Lung DiseasePulmonary Function AssessmentRespiratory DiseaseRespiratory PathophysiologyAlpha-1 Antitrypsin DeficiencyForced Expiratory Volume AssessmentForced Expiratory Volume DeclineLung Function DeclineLung Function TestingPulmonary Function DeclinePulmonary Function Screeningα1-Antitrypsin Deficiency
Background and aim: The value of the forced expiratory volume in one second (FEV 1 ) is useful in the diagnosis and prognosis of chronic obstructive pulmonary disease (COPD). Previous studies on lung function in individuals with severe alpha-1 antitrypsin deficiency (AATD) have shown a variable annual decline in FEV 1 (∆FEV 1 ). The aim of this study was to analyze ∆FEV 1 and to identify risk factors for ∆FEV 1 in individuals with severe AATD. Material and methods: Data on smoking habits, symptoms, results of lung function tests and exacerbations were obtained from the Swedish AATD Register and the Swedish National Patient Register (SNPR). The ∆FEV 1 was analyzed by random-effects modeling and adjusted for age and FEV 1 at baseline. Results: One hundred and four (9%) current smokers, 539 (48%) ex-smokers and 489 (43%) never-smokers were included in the study and followed-up from 1991 to 2016. A total of 584 (52%) individuals with severe AATD had COPD at inclusion. The median (IQR) annual severe exacerbation rate was 0.66 (1.4). The adjusted mean ∆FEV 1 was significantly higher in the current smokers compared with the ex-smokers and never-smokers (70 [95% CI 56–83] vs 42 [95% CI 36–48] and 32 [95% CI 25–38) mL·yr −1, ], in the middle–aged individuals compared with the young individuals (48 [95% CI 41–55] vs 32 [95% CI 18–45] mL·yr −1, ), in the individuals with respiratory symptoms at inclusion compared with the asymptomatic individuals (46 [95% CI 40–52] vs 30 [95% CI 22–38]mL·yr −1, ), and in the individuals with frequent exacerbations compared with those with infrequent exacerbations (57 [95% CI 47–68] vs 27 [95% CI 17–37] mL·yr −1, ). Conclusion: Active smoking, age, respiratory symptoms at baseline and repeated severe exacerbations of COPD are factors associated with an accelerated decline of lung function in individuals with severe AATD. Keywords: alpha-1 antitrypsin, decline, exacerbation, lung function, smoking
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External review and validation of the Swedish national inpatient register
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The natural history of chronic airflow obstruction.
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