Nikolas Bernhard

Sex differences in alpha-1-antitrypsin deficiency lung disease-analysis from the German registry

Abstract Alpha-1-antitrypsin deficiency (AATD) is a rare condition with clinical mani-festations of the lung and the liver. There is evidence that the gender affects the clinical presentation of non-AATD chronic obstructive lung disease (COPD). The aim of this study was to analyze gender-dependent disease pattern in AATD-based COPD. Data from 1066 individuals from the German AATD registry were analyzed by descriptive and analytical statistics. The AAT genotypes comprised 820 individuals with PiZZ (male 56%, female 45%), 109 with PI SZ (male 55%; female 45%), and others (n = 137). A subgroup of 422 patients with available post-bronchodilator FEV1% predicted was analyzed in detail after stratification in spirometric GOLD stages I-IV. The age of the registered individuals is 52.2 ± 13.4 years (male: 51.91 ± 13.86 years; female: 52.76 ± 13.39 years). Female patients with GOLD I-IV showed lower numbers of pack-years and lower BMI. The time between the first symptom and the establishment of the correct diagnosis was significantly longer in female (14.47 ± 16.46 years) as compared to male individuals (12.39 ± — 14.38 years, p = 0.04). In conclusion, the data of the registry allow to characterize the natural course of the disease and highlight differences in the clinical presentation of patients with AATD-dependent COPD.

Deterioration of quality of life is associated with the exacerbation frequency in individuals with alpha-1-antitrypsin deficiency – analysis from the German Registry

Background Alpha-1-antitrypsin deficiency (AATD) is a rare hereditary disease that is associated with a higher risk to develop chronic obstructive pulmonary disease and liver cirrhosis. Previous cross-sectional studies on AATD individuals have shown a relationship between worse St George’s Respiratory Questionnaire (SGRQ) scores and elevated exacerbation rate or high cigarette consumption. There is a lack of longitudinal data on the relationship between the exacerbation rate and worsening of SGRQ during disease. The aim of this study was to provide not only cross-sectional data but also information about the deterioration in quality of life over a follow-up period up to 7 years (median follow-up period of 3.33 years). Methods We investigated questionnaire-based data of the German AATD registry concerning the relationship between SGRQ and exacerbation frequency, smoking history, forced expiratory volume in 1 second (FEV1) and carbon monoxide diffusion capacity (DLCO) first in cross-sectional analysis and later in longitudinal analysis. Results Eight hundred sixty-eight individuals with protease inhibitor ZZ (PiZZ) genotype with an average age of 52.6±12.8 years had an SGRQ score of 45.7±20.6. SGRQ significantly correlated with the exacerbation frequency within the last 2 years (r=0.464; P<0.001), smoking history (r=0.233; P<0.001), FEV1 (r=−0.436; P<0.001), DLCO (r=−0.333; P<0.001), and patients’ age (r=0.292; P<0.001). Individuals with occupational dust exposure had significantly worse quality of life (P<0.001). Mean annual deterioration of SGRQ in all patients with available follow-up data (n=286) was 1.21±4.45 points per year. Univariate and multivariate analysis showed a significant relationship between worsening of SGRQ/year and exacerbation frequency in the follow-up period (r=0.144; P=0.015). Conclusion Worsening of SGRQ is associated with the exacerbation frequency in individuals with PiZZ AATD.

Alpha-1-Antitrypsin-Mangel: Pathophysiologie, Diagnostik und Therapie

ZusammenfassungDie chronisch obstruktive Lungenerkrankung (COPD) ist eine durch inhalative Noxen hervorgerufene chronische Erkrankung, deren Phänotyp neben Umwelteinflüssen auch durch genetische Ursachen wie einem Alpha-1-Antitrypsin(AAT)-Mangel beeinflusst wird, eine Genotypisierung kann mittels Polymerasekettenreaktion und Sequenzierung erfolgen. Um eine Progression der Erkrankung zu verlangsamen, kann AAT substituiert werden.

Alpha-1-Antitrypsin-Mangel rechtzeitig erkennen und behandeln

Der Phänotyp einer chronisch obstruktiven Lungenerkrankung (COPD) wird neben inhalativen Noxen auch durch genetische Ursachen wie einen Alpha-1-Antitrypsin-Mangel bestimmt. COPD-Patienten sollten daher frühzeitig auf einen AAT-Mangel getestet werden. Denn eine rechtzeitigen Diagnosestellung und anschließende Behandlung sind entscheidend, um die irreversible Krankheitsprogression aufhalten zu können.