Diagnostic delay and clinical modifiers in alpha-1 antitrypsin deficiency.
Identifieur interne : 000327 ( Main/Corpus ); précédent : 000326; suivant : 000328Diagnostic delay and clinical modifiers in alpha-1 antitrypsin deficiency.
Auteurs : Thomas Köhnlein ; Sabina Janciauskiene ; Tobias WelteSource :
- Therapeutic advances in respiratory disease [ 1753-4666 ] ; 2010.
English descriptors
- KwdEn :
- Adult (MeSH), Age of Onset (MeSH), Aged (MeSH), Austria (MeSH), Cross-Sectional Studies (MeSH), Delayed Diagnosis (MeSH), Exercise Tolerance (MeSH), Female (MeSH), Germany (MeSH), Humans (MeSH), Influenza, Human (prevention & control), Male (MeSH), Middle Aged (MeSH), Pneumococcal Infections (prevention & control), Smoking (epidemiology), Surveys and Questionnaires (MeSH), Tobacco Smoke Pollution (adverse effects), Vaccination (statistics & numerical data), alpha 1-Antitrypsin (administration & dosage), alpha 1-Antitrypsin Deficiency (diagnosis), alpha 1-Antitrypsin Deficiency (physiopathology).
- MESH :
- chemical , administration & dosage : alpha 1-Antitrypsin.
- chemical , adverse effects : Tobacco Smoke Pollution.
- geographic : Austria, Germany.
- diagnosis : alpha 1-Antitrypsin Deficiency.
- epidemiology : Smoking.
- physiopathology : alpha 1-Antitrypsin Deficiency.
- prevention & control : Influenza, Human, Pneumococcal Infections.
- statistics & numerical data : Vaccination.
- Adult, Age of Onset, Aged, Cross-Sectional Studies, Delayed Diagnosis, Exercise Tolerance, Female, Humans, Male, Middle Aged, Surveys and Questionnaires.
Abstract
BACKGROUND
Alpha-1 antitrypsin deficiency (AATD) is one of the most prevalent inherited diseases in Whites, but identification of affected patients and establishment of the diagnosis is still unsatisfactory. This study assessed the latencies and numbers of physicians involved in identifying AATD patients, and the importance of smoking, vaccination status, and specific augmentation therapy on the course of the disease.
METHOD
Patients from Germany and Austria underwent a single written interview with 28 items. Five hundred and ninety-six patients were addressed and 44.9% replied.
RESULTS
The age at symptom onset was 39.1±10.1 years, and the diagnosis was established at the age of 45.1±10.9 years. From the 6-year delay in establishing the diagnosis, 1.4±1.7 (range 0.5-10.5) years were due to patients' reluctance to seek medical attention. There were 3.2±2.4 (range 1-13) physicians involved in establishing the diagnosis. Smoking was associated with an earlier onset of respiratory symptoms and lower exercise capacity. Vaccination against pneumococci and/or influenza, and augmentation therapy resulted in significantly fewer exacerbations and fewer emergency room visits. Airway infections and passive smoking during childhood were not found to influence the onset of respiratory symptoms.
CONCLUSIONS
In conclusion, there is still a large delay between symptom onset and AATD diagnosis. Smoking history, vaccination status, and augmentation therapy have an important impact on the course of the disease.
DOI: 10.1177/1753465810376407
PubMed: 20660539
Links to Exploration step
pubmed:20660539Le document en format XML
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<author><name sortKey="Kohnlein, Thomas" sort="Kohnlein, Thomas" uniqKey="Kohnlein T" first="Thomas" last="Köhnlein">Thomas Köhnlein</name>
<affiliation><nlm:affiliation>Hannover Medical School, Respiratory Medicine, Carl-Neuberg-Strasse 1, Hannover, Germany. koehnlein.thomas@mh-hannover.de</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Janciauskiene, Sabina" sort="Janciauskiene, Sabina" uniqKey="Janciauskiene S" first="Sabina" last="Janciauskiene">Sabina Janciauskiene</name>
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<author><name sortKey="Welte, Tobias" sort="Welte, Tobias" uniqKey="Welte T" first="Tobias" last="Welte">Tobias Welte</name>
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<author><name sortKey="Kohnlein, Thomas" sort="Kohnlein, Thomas" uniqKey="Kohnlein T" first="Thomas" last="Köhnlein">Thomas Köhnlein</name>
<affiliation><nlm:affiliation>Hannover Medical School, Respiratory Medicine, Carl-Neuberg-Strasse 1, Hannover, Germany. koehnlein.thomas@mh-hannover.de</nlm:affiliation>
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<author><name sortKey="Janciauskiene, Sabina" sort="Janciauskiene, Sabina" uniqKey="Janciauskiene S" first="Sabina" last="Janciauskiene">Sabina Janciauskiene</name>
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<author><name sortKey="Welte, Tobias" sort="Welte, Tobias" uniqKey="Welte T" first="Tobias" last="Welte">Tobias Welte</name>
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<profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Adult (MeSH)</term>
<term>Age of Onset (MeSH)</term>
<term>Aged (MeSH)</term>
<term>Austria (MeSH)</term>
<term>Cross-Sectional Studies (MeSH)</term>
<term>Delayed Diagnosis (MeSH)</term>
<term>Exercise Tolerance (MeSH)</term>
<term>Female (MeSH)</term>
<term>Germany (MeSH)</term>
<term>Humans (MeSH)</term>
<term>Influenza, Human (prevention & control)</term>
<term>Male (MeSH)</term>
<term>Middle Aged (MeSH)</term>
<term>Pneumococcal Infections (prevention & control)</term>
<term>Smoking (epidemiology)</term>
<term>Surveys and Questionnaires (MeSH)</term>
<term>Tobacco Smoke Pollution (adverse effects)</term>
<term>Vaccination (statistics & numerical data)</term>
<term>alpha 1-Antitrypsin (administration & dosage)</term>
<term>alpha 1-Antitrypsin Deficiency (diagnosis)</term>
<term>alpha 1-Antitrypsin Deficiency (physiopathology)</term>
</keywords>
<keywords scheme="MESH" type="chemical" qualifier="administration & dosage" xml:lang="en"><term>alpha 1-Antitrypsin</term>
</keywords>
<keywords scheme="MESH" type="chemical" qualifier="adverse effects" xml:lang="en"><term>Tobacco Smoke Pollution</term>
</keywords>
<keywords scheme="MESH" type="geographic" xml:lang="en"><term>Austria</term>
<term>Germany</term>
</keywords>
<keywords scheme="MESH" qualifier="diagnosis" xml:lang="en"><term>alpha 1-Antitrypsin Deficiency</term>
</keywords>
<keywords scheme="MESH" qualifier="epidemiology" xml:lang="en"><term>Smoking</term>
</keywords>
<keywords scheme="MESH" qualifier="physiopathology" xml:lang="en"><term>alpha 1-Antitrypsin Deficiency</term>
</keywords>
<keywords scheme="MESH" qualifier="prevention & control" xml:lang="en"><term>Influenza, Human</term>
<term>Pneumococcal Infections</term>
</keywords>
<keywords scheme="MESH" qualifier="statistics & numerical data" xml:lang="en"><term>Vaccination</term>
</keywords>
<keywords scheme="MESH" xml:lang="en"><term>Adult</term>
<term>Age of Onset</term>
<term>Aged</term>
<term>Cross-Sectional Studies</term>
<term>Delayed Diagnosis</term>
<term>Exercise Tolerance</term>
<term>Female</term>
<term>Humans</term>
<term>Male</term>
<term>Middle Aged</term>
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<front><div type="abstract" xml:lang="en"><p><b>BACKGROUND</b>
</p>
<p>Alpha-1 antitrypsin deficiency (AATD) is one of the most prevalent inherited diseases in Whites, but identification of affected patients and establishment of the diagnosis is still unsatisfactory. This study assessed the latencies and numbers of physicians involved in identifying AATD patients, and the importance of smoking, vaccination status, and specific augmentation therapy on the course of the disease.</p>
</div>
<div type="abstract" xml:lang="en"><p><b>METHOD</b>
</p>
<p>Patients from Germany and Austria underwent a single written interview with 28 items. Five hundred and ninety-six patients were addressed and 44.9% replied.</p>
</div>
<div type="abstract" xml:lang="en"><p><b>RESULTS</b>
</p>
<p>The age at symptom onset was 39.1±10.1 years, and the diagnosis was established at the age of 45.1±10.9 years. From the 6-year delay in establishing the diagnosis, 1.4±1.7 (range 0.5-10.5) years were due to patients' reluctance to seek medical attention. There were 3.2±2.4 (range 1-13) physicians involved in establishing the diagnosis. Smoking was associated with an earlier onset of respiratory symptoms and lower exercise capacity. Vaccination against pneumococci and/or influenza, and augmentation therapy resulted in significantly fewer exacerbations and fewer emergency room visits. Airway infections and passive smoking during childhood were not found to influence the onset of respiratory symptoms.</p>
</div>
<div type="abstract" xml:lang="en"><p><b>CONCLUSIONS</b>
</p>
<p>In conclusion, there is still a large delay between symptom onset and AATD diagnosis. Smoking history, vaccination status, and augmentation therapy have an important impact on the course of the disease.</p>
</div>
</front>
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<AbstractText Label="RESULTS" NlmCategory="RESULTS">The age at symptom onset was 39.1±10.1 years, and the diagnosis was established at the age of 45.1±10.9 years. From the 6-year delay in establishing the diagnosis, 1.4±1.7 (range 0.5-10.5) years were due to patients' reluctance to seek medical attention. There were 3.2±2.4 (range 1-13) physicians involved in establishing the diagnosis. Smoking was associated with an earlier onset of respiratory symptoms and lower exercise capacity. Vaccination against pneumococci and/or influenza, and augmentation therapy resulted in significantly fewer exacerbations and fewer emergency room visits. Airway infections and passive smoking during childhood were not found to influence the onset of respiratory symptoms.</AbstractText>
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