Alpha1-antitrypsin deficiency - Diagnostic testing and disease awareness in Germany and Italy

Timm Greulich, Stefania Ottaviani, Robert Bals, Philipp M. Lepper, Claus Vogelmeier, Maurizio Luisetti, Ilaria Ferrarotti

Research output: Contribution to journalArticle

41 Citations (Scopus)

Abstract

Background Alpha1-antitrypsin (AAT) deficiency, although largely under-diagnosed, is the underlying cause of approximately 1% of COPD cases. Lack of awareness leads to long delays in diagnostic testing. Subsequently, lifestyle and treatment choices with potentially positive effects on prognosis may be postponed. Methods Data on the testing and diagnostic practices for AAT deficiency were derived from the University of Pavia, Italy, and the University of Marburg, Germany. In addition, a survey of physicians was undertaken to explore their awareness and attitudes toward AAT deficiency. Results In Pavia and Marburg, 125 and 729 patients, respectively, were identified with severe AAT deficiency between July 2006 and June 2011. The median time interval between the onset of symptoms and diagnosis was 6 years (interquartile range [IQR], 11; range, 0-40) and 7 years (IQR, 13; range, 0-73), respectively. Augmentation therapy was initiated almost immediately in Germany while treatment was delayed by 3 months in Italy (IQR, 5.25; range, 1-118). Survey data (Italy, n = 181; Germany, n = 180) revealed that pulmonologists had greater knowledge of AAT deficiency than internists and general practitioners, however, overall, only 18-25% of physicians tested all COPD patients. One-third of the respondents stated that they "sometimes" offered augmentation therapy to patients diagnosed with AAT deficiency. Conclusions Major obstacles to AAT deficiency testing are physicians' attitudes and lack of understanding of the condition. A greater adherence to the guidelines that recommend diagnostic testing of all COPD patients, coupled with simpler testing protocols, may decrease delays and positively impact patient outcomes.

Original languageEnglish
Pages (from-to)1400-1408
Number of pages9
JournalRespiratory Medicine
Volume107
Issue number9
DOIs
Publication statusPublished - Sep 2013

Fingerprint

Italy
Germany
Chronic Obstructive Pulmonary Disease
Physicians
Guideline Adherence
Therapeutics
General Practitioners
Life Style
Surveys and Questionnaires

Keywords

  • COPD
  • Genetic test
  • Rare disease
  • Screening Knowledge

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Medicine(all)

Cite this

Alpha1-antitrypsin deficiency - Diagnostic testing and disease awareness in Germany and Italy. / Greulich, Timm; Ottaviani, Stefania; Bals, Robert; Lepper, Philipp M.; Vogelmeier, Claus; Luisetti, Maurizio; Ferrarotti, Ilaria.

In: Respiratory Medicine, Vol. 107, No. 9, 09.2013, p. 1400-1408.

Research output: Contribution to journalArticle

Greulich, Timm ; Ottaviani, Stefania ; Bals, Robert ; Lepper, Philipp M. ; Vogelmeier, Claus ; Luisetti, Maurizio ; Ferrarotti, Ilaria. / Alpha1-antitrypsin deficiency - Diagnostic testing and disease awareness in Germany and Italy. In: Respiratory Medicine. 2013 ; Vol. 107, No. 9. pp. 1400-1408.
@article{81600c3d12ab40e08806a27954fd98b8,
title = "Alpha1-antitrypsin deficiency - Diagnostic testing and disease awareness in Germany and Italy",
abstract = "Background Alpha1-antitrypsin (AAT) deficiency, although largely under-diagnosed, is the underlying cause of approximately 1{\%} of COPD cases. Lack of awareness leads to long delays in diagnostic testing. Subsequently, lifestyle and treatment choices with potentially positive effects on prognosis may be postponed. Methods Data on the testing and diagnostic practices for AAT deficiency were derived from the University of Pavia, Italy, and the University of Marburg, Germany. In addition, a survey of physicians was undertaken to explore their awareness and attitudes toward AAT deficiency. Results In Pavia and Marburg, 125 and 729 patients, respectively, were identified with severe AAT deficiency between July 2006 and June 2011. The median time interval between the onset of symptoms and diagnosis was 6 years (interquartile range [IQR], 11; range, 0-40) and 7 years (IQR, 13; range, 0-73), respectively. Augmentation therapy was initiated almost immediately in Germany while treatment was delayed by 3 months in Italy (IQR, 5.25; range, 1-118). Survey data (Italy, n = 181; Germany, n = 180) revealed that pulmonologists had greater knowledge of AAT deficiency than internists and general practitioners, however, overall, only 18-25{\%} of physicians tested all COPD patients. One-third of the respondents stated that they {"}sometimes{"} offered augmentation therapy to patients diagnosed with AAT deficiency. Conclusions Major obstacles to AAT deficiency testing are physicians' attitudes and lack of understanding of the condition. A greater adherence to the guidelines that recommend diagnostic testing of all COPD patients, coupled with simpler testing protocols, may decrease delays and positively impact patient outcomes.",
keywords = "COPD, Genetic test, Rare disease, Screening Knowledge",
author = "Timm Greulich and Stefania Ottaviani and Robert Bals and Lepper, {Philipp M.} and Claus Vogelmeier and Maurizio Luisetti and Ilaria Ferrarotti",
year = "2013",
month = "9",
doi = "10.1016/j.rmed.2013.04.023",
language = "English",
volume = "107",
pages = "1400--1408",
journal = "Respiratory Medicine",
issn = "0954-6111",
publisher = "W.B. Saunders Ltd",
number = "9",

}

TY - JOUR

T1 - Alpha1-antitrypsin deficiency - Diagnostic testing and disease awareness in Germany and Italy

AU - Greulich, Timm

AU - Ottaviani, Stefania

AU - Bals, Robert

AU - Lepper, Philipp M.

AU - Vogelmeier, Claus

AU - Luisetti, Maurizio

AU - Ferrarotti, Ilaria

PY - 2013/9

Y1 - 2013/9

N2 - Background Alpha1-antitrypsin (AAT) deficiency, although largely under-diagnosed, is the underlying cause of approximately 1% of COPD cases. Lack of awareness leads to long delays in diagnostic testing. Subsequently, lifestyle and treatment choices with potentially positive effects on prognosis may be postponed. Methods Data on the testing and diagnostic practices for AAT deficiency were derived from the University of Pavia, Italy, and the University of Marburg, Germany. In addition, a survey of physicians was undertaken to explore their awareness and attitudes toward AAT deficiency. Results In Pavia and Marburg, 125 and 729 patients, respectively, were identified with severe AAT deficiency between July 2006 and June 2011. The median time interval between the onset of symptoms and diagnosis was 6 years (interquartile range [IQR], 11; range, 0-40) and 7 years (IQR, 13; range, 0-73), respectively. Augmentation therapy was initiated almost immediately in Germany while treatment was delayed by 3 months in Italy (IQR, 5.25; range, 1-118). Survey data (Italy, n = 181; Germany, n = 180) revealed that pulmonologists had greater knowledge of AAT deficiency than internists and general practitioners, however, overall, only 18-25% of physicians tested all COPD patients. One-third of the respondents stated that they "sometimes" offered augmentation therapy to patients diagnosed with AAT deficiency. Conclusions Major obstacles to AAT deficiency testing are physicians' attitudes and lack of understanding of the condition. A greater adherence to the guidelines that recommend diagnostic testing of all COPD patients, coupled with simpler testing protocols, may decrease delays and positively impact patient outcomes.

AB - Background Alpha1-antitrypsin (AAT) deficiency, although largely under-diagnosed, is the underlying cause of approximately 1% of COPD cases. Lack of awareness leads to long delays in diagnostic testing. Subsequently, lifestyle and treatment choices with potentially positive effects on prognosis may be postponed. Methods Data on the testing and diagnostic practices for AAT deficiency were derived from the University of Pavia, Italy, and the University of Marburg, Germany. In addition, a survey of physicians was undertaken to explore their awareness and attitudes toward AAT deficiency. Results In Pavia and Marburg, 125 and 729 patients, respectively, were identified with severe AAT deficiency between July 2006 and June 2011. The median time interval between the onset of symptoms and diagnosis was 6 years (interquartile range [IQR], 11; range, 0-40) and 7 years (IQR, 13; range, 0-73), respectively. Augmentation therapy was initiated almost immediately in Germany while treatment was delayed by 3 months in Italy (IQR, 5.25; range, 1-118). Survey data (Italy, n = 181; Germany, n = 180) revealed that pulmonologists had greater knowledge of AAT deficiency than internists and general practitioners, however, overall, only 18-25% of physicians tested all COPD patients. One-third of the respondents stated that they "sometimes" offered augmentation therapy to patients diagnosed with AAT deficiency. Conclusions Major obstacles to AAT deficiency testing are physicians' attitudes and lack of understanding of the condition. A greater adherence to the guidelines that recommend diagnostic testing of all COPD patients, coupled with simpler testing protocols, may decrease delays and positively impact patient outcomes.

KW - COPD

KW - Genetic test

KW - Rare disease

KW - Screening Knowledge

UR - http://www.scopus.com/inward/record.url?scp=84883055722&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84883055722&partnerID=8YFLogxK

U2 - 10.1016/j.rmed.2013.04.023

DO - 10.1016/j.rmed.2013.04.023

M3 - Article

C2 - 23786890

AN - SCOPUS:84883055722

VL - 107

SP - 1400

EP - 1408

JO - Respiratory Medicine

JF - Respiratory Medicine

SN - 0954-6111

IS - 9

ER -