1. Improving testing for alpha-1 antitrypsin deficiency using the pulmonary function laboratory.
L.V. Luna Diaz1,2, I. Iupe2, B. Zavala2, K. Balestrini1, A.M. Guerrero1, M.D. Schweitzer1, G. Holt1,2, M. Mirsaeidi1,2, R. Calderon1,2, M. Campos1,2
1Miami VA Medical Center – Miami, FL/US. 2Division of Pulmonary and Critical Care Medicine, University of Miami – Miami, FL/US.
Background
Results
Figure 4. Appropriateness of AATD testing by the PFT Lab (From 799 subjects tested, 83.5% had a clinical indication after chart review)
Figure 1. Distribution of tested patients during study period (Jan 2013 – Dec 2016). N = 1021.
Alpha-1 antitrypsin deficiency (AATD) is an unrecognized disease.
Current guidelines recommend testing all subjects with COPD.
Despite multiple efforts done to increase testing rates, including awareness campaigns, educational activities and availability of free testing kits, detections rates of subjects at risk remain low.
We evaluated the role of Pulmonary Function Test (PFT) laboratory personnel in improving AATD testing rates in a hospital-based pulmonary practice.
Tested by Pulmonary Clinic (22%)
Ratio >70%
(5%)
Clinically appropriate
COPD
82.3%
Fixed AO
3.7%
ACOS
1.7%
Emphysema
without FAO
0.4%
Tested by
PFT Lab
(78%)
Ratio <70%
(95%)
Clinically inappropriate
Asthma
9.6%
Other
2.2%
Figure 2. Increase in the number of AATD tests since PFT program was implemented.
AO: airflow obstruction
Objectives
Table 1. COPD patients tested by PFT lab vs. clinic.
To determine the effectiveness of AATD reflex testing by PFT personnel.
To describe the prevalence of AATD and abnormal genotypes in the pulmonary patient population at risk at the Miami VA Medical Center.
All COPD
PFT Lab
Clinic
p-value N
831
642
189
Age
66.8 ± 8.2
66.8 ± 8.3
66.5 ± 7.7
0.76
Active smokers
43.90%
47.04%
33.33%
0.004
FEV1% post
56.1 ± 19.1
58.1 ± 18.6
49.0 ± 18.7
<0.001
FEV1/FVC post
53.4 ± 13.1
54.3 ± 12.8
50.1 ± 13.7
Emphysema on CT
76.99%
76.20%
79.53%
0.36
Genotype MM
90.30%
90.78%
88.89%
0.87 MS
5.90%
5.47%
7.41% MZ
2.10%
2.19%
2.12% SZ
0.36%
0.31%
0.53%
OTHER
1.20%
1.25%
1.06%
Program
started
Methods
PFT Laboratory personnel was instructed to perform AATD reflex testing to all patients with a pre- bronchodilator FEV1/FVC<70%.
PFT personnel was trained to explain patients about the nature of the test. A Brochure was given to patients.
AATD testing was performed using dry blood samples thorough the A1F Florida Detection Program.
The PFT laboratory director was the physician on record to receive results and responsible to interpret and document results in the electronic medical record and notify patients with positive results.
Approved by local IRB as a quality improvement project.
Figure 3. Increase in PFT lab AATD tested was associated with a marked decrease in clinic testing.
Conclusions
PFT Lab
Reflex AATD testing by PFT personnel is an effective way to test subjects at risk in a hospital-based pulmonary practice (VA Medical Center).
PFT lab tests COPD patients at an earlier stage (opportunity for sooner intervention).
Our veteran population had a lower than expected prevalence of abnormal AAT genotypes.
Pulmonary Clinic