31st SEPAR winter meeting

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The city of Burgos hosted the 31st Joint Winter Meeting of SEPAR Areas, which took place at the Burgos Congress Palace and Auditorium on November 24 and 25.

Topics related to smoking, respiratory rehabilitation, respiratory nursing, Sleep and Ventilation, ILD (interstitial lung diseases), COPD (Chronic Obstructive Pulmonary Disease) and AATD (Alpha-1 Antitrypsin Deficiency), EROM (occupational respiratory diseases and environmental) and TIR (tuberculosis and respiratory infections).

In our case, our coordinator from the Alfa 1 Andalusian Center, Doctor Francisco Casas, developed his presentation on the following topic.

What have we learned from alpha-1 antitrypsin deficiency to manage and treat COPD?

His speech began by introducing the initial problem that affects the diagnosis of AATD and its underdiagnosis, whose headline highlighted that AATD is not a rare condition, but rather an infrequently diagnosed disease.

He stressed that it is estimated that only 10% of people who suffer from this disease are diagnosed.

And, in addition, there is a delay between 7 and 10 years, sometimes needing to go to more than 5 doctors to finally reach the diagnosis.

Early diagnosis is very important and to this end, the World Health Organization and various Scientific Societies recommend determining AAT once in a lifetime for any patient with COPD.

Pulmonology specialists do not follow the recommendations of the Clinical Practice Guidelines regarding the determination of AAT, which is requested in less than 40% of patients with COPD who attend outpatient clinics.

What is the purpose of determining AAT levels?

• To implement healthy lifestyle habits: exercise, healthy diet and prevent smoking or provide treatment for smokers to stop smoking.
• Improve clinical management, that is, establish the diagnosis in individuals at risk of disease.
• Optimize the treatment of COPD and offer, in those who meet the criteria for it, a specific treatment for AAT such as the administration of AAT intravenously.
• Offer genetic counseling to patients and family members.

What population should be tested for the AAT?

• Patients with COPD
• Adults with bronchiectasis
• Partially reversible adult asthma
• Blood relatives of patients with known AATD
• Symptoms of dyspnea and chronic cough in many members of a family
• Hepatopathy of unknown cause
• People with absence of the alpha-1 peak in the proteinogram
• Patients with Panniculitis or vasculitis of unknown cause

Conclusions of the 31st SEPAR winter meeting

We strongly recommend that all centers that care for patients with COPD apply a pre-established program for detecting patients with AATD.

The main objective is early diagnosis to prevent lung deterioration from being in an advanced phase.

To highlight the importance of early detection, we have based ourselves on the following data:

1. 1-2% of COPD and up to 2% of emphysema are due to DAAT.
2. 50-60% of severe AATDs develop COPD.
3. COPD due to AAT presents symptoms similar to COPD of other etiologies.
4. There is no clinical, radiological or functional characteristic that helps us identify a patient with AATD.

For all these reasons, it is necessary that all doctors who care for these patients request AAT determination for all their patients. This test is available in all health centers, but it is requested in less than 40% of COPD patients treated in pulmonology. We encourage all professionals to perform the tests within their reach to diagnose this not so rare, but underdiagnosed disease, AATD.

Fuente: Centro Andaluz Alfa 1