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Diagnosing and Treating Alpha-1 Antitrypsin Deficiency

Questions to Ask Your Doctor about Alpha-1

Not every individual with AAT deficiency will require treatment especially if they have one of the less severe genetic alterations to the AAT gene.

How AAT Deficiency Is Diagnosed

If you are a younger than average individual with COPD or liver disease, your doctor may decide to test you for AAT deficiency with a blood test. In most individuals with AAT deficiency, the symptoms of lung disease start to appear between the age of 30 or 40 years. Smokers with AAT deficiency tend to develop disease 10 or more years earlier than non-smokers. Liver disease does not occur in every individual with AAT deficiency; however, it usually occurs by age 40.

All individuals with COPD , regardless of age or ethnicity, should be tested for AAT deficiency. Your doctor may order a screening blood test to check the level of alpha-1 antitrypsin in your body. If your levels are low, genetic testing with another blood test may be used to identify the abnormal gene that was passed to you from your parents. You will also likely have lung function or spirometry test, a chest X-ray or CT scan of your lungs, blood testing of liver function, and in some cases an ultrasound of the liver. If you have low levels of AAT but normal liver and lung function tests, you may not need treatment; however, you will be monitored with repeat testing over time.

How AAT Deficiency Is Treated

If you are diagnosed with AAT deficiency, your doctor may or may not suggest treatment based on the results of other testing and severity of your symptoms.

  • If you have no symptoms - you may be advised to return for regular follow up. You should restrict alcohol consumption, get regular exercise and control your weight. You may be asked to get a pneumonia vaccine every 5 years and flu vaccine every year.
  • If your AAT deficiency has caused lung disease, and you are a current smoker, you must stop smoking—call the Lung HelpLine at 1-800-LUNGUSA to get help quitting. Additionally, your treatment may include prescribed inhaled medications to control symptoms of COPD, referral to a pulmonary rehabilitation program, and antibiotics and inhaled corticosteroids to control symptoms of flare ups, infections or exacerbations if needed. If you are not a current smoker and your lung function is rapidly declining, you may be considered eligible for AAT replacement therapy. Replacement therapy will increase blood levels of AAT, but currently it is not clear that it leads to longer-term improvements in lung function or survival. Replacement therapy is given intravenously. Some patients with advanced lung disease may be referred for lung volume reduction surgery (LVRS) and lung transplantation.
  • If you have liver disease– you will undergo frequent monitoring of liver function and in severe cases, you may be referred for liver transplantation.

    This content was developed in partnership with the CHEST Foundation, the philanthropic arm of the American College of Chest Physicians.

    Reviewed and approved by the American Lung Association Scientific and Medical Editorial Review Panel. Last reviewed August 4, 2016.

    Page Last Updated: July 23, 2019

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