Assessment and monitoring of lung disease in patients with severe alpha 1 antitrypsin deficiency: a european delphi consensus of the EARCO group

Abstract

Alpha 1 antitrypsin deficiency; Computed tomography; Plethysmography

Deficiencia de alfa 1 antitripsina; Tomografía computarizada; Pletismografía

Deficiència d'alfa 1 antitripsina; Tomografia computeritzada; Pletismografia

Background Currently, there is conflicting information and guidance on the effective management of Alpha 1 Antitrypsin Deficiency (AATD). Establishing a consensus of assessment and disease management specific to AATD is important for achieving a standardized treatment pathway and for improving patient outcomes. Here, we aim to utilize the Delphi method to establish a European consensus for the assessment and management of patients with severe AATD. Methods Two rounds of a Delphi survey were completed online by members of the European Alpha-1 Research Collaboration (EARCO). Respondents were asked to indicate their agreement with proposed statements for patients with no respiratory symptoms, stable respiratory disease, and worsening respiratory disease using a Likert scale of 1–7. Levels of agreement between respondents were calculated using a weighted average. Results Round 1 of the Delphi survey was sent to 103 members of EARCO and 38/103 (36.9%) pulmonologists from across 15 countries completed all 109 questions. Round 2 was sent to all who completed Round 1 and 36/38 (94.7%) completed all 79 questions. Responses regarding spirometry, body plethysmography, high-resolution computed tomography, and the initiation of augmentation therapy showed little variability among physicians, but there was discordance among other aspects, such as the use of low-dose computed tomography in both a research setting and routine clinical care. Conclusions These results provide expert opinions for the assessment and monitoring of patients with severe AATD, which could be used to provide updated recommendations and standardized treatment pathways for patients across Europe.

Editorial assistance was funded by CSL Behring. The funder had no role in study design, data collection, decision to publish, or preparation of the manuscript. AMT is also funded by the National Institute for Health and Care Research (NIHR) Midlands Patient Safety Research Collaboration (PSRC) and West Midlands Applied Research Collaboration (ARC), as well as the NIHR Efficacy and Mechanism Evaluation (EME) Programme and Health Technology Assessment (HTA) Programme. The views expressed are those of the author and not necessarily those of the NIHR or the Department of Health and Social Care.