ORIGINAL ARTICLE   Free access

Panminerva Medica 2022 June;64(2):215-27

DOI: 10.23736/S0031-0808.22.04592-X

Copyright © 2022 EDIZIONI MINERVA MEDICA

language: English

An Italian expert consensus on the management of alpha1-antitrypsin deficiency: a comprehensive set of algorithms

Bruno BALBI ¹ ✉, Federica BENINI ², Luciano CORDA ³, Angelo CORSICO ⁴, Ilaria FERRAROTTI ⁴, Nuccia GATTA ⁵ on the behalf of IDA Group 

¹ Section of Pulmonary Rehabilitation, Institute of Veruno, Istituti Clinici Scientifici Maugeri IRCCS, Novara, Italy; ² Center for the Diagnosis, Monitoring and Therapy of Alpha1-Antitrypsin Deficiency, Gastroenterology Unit, Department of Medicine, Spedali Civili, Brescia, Italy; ³ Center for Diagnosis, Monitoring and Therapy of Alpha1-Antitrypsin Deficiency, Respiratory Medicine Unit, Department of Internal Medicine, Spedali Civili, Brescia, Italy; ⁴ Center for the Diagnosis of Alpha1-Antitrypsin Hereditary Deficiency, Chest Medicine Unit, IRCCS Policlinico San Matteo Foundation, University of Pavia, Pavia, Italy; ⁵ Associazione Nazionale Alfa1-At per la tutela dei pazienti con Deficit di Alfa1-Antitripsina, Sarezzo, Brescia, Italy

BACKGROUND: Alpha1-antitrypsin deficiency (AATD) is a genetic-based risk condition, mainly affecting the lungs and liver. Despite its wide distribution, it is largely underdiagnosed, thus being considered a rare disease, and is consequently managed in ad-hoc reference centers. Unfortunately, an easy-to-use algorithm for managing such a complex disease is still lacking.
METHODS: An expert consensus meeting was conducted among experts in the management of AATD to build a comprehensive algorithm, including diagnosis, monitoring, AAT therapy, rehabilitation and lung transplantation, and liver disease, that could serve as a guide for physicians and treating centers. A panel of AATD specialists evaluated the results of their work.
RESULTS: Diagnosis is the most delicate phase, and awareness about this condition should be raised among GPs. A set of recommendations has been written about the most suitable follow-up visits. Augmentation therapy with AAT may be useful to reduce the progression of emphysema and lung function decline in selected patients. Exercise capacity may be improved by pulmonary rehabilitation and, in selected cases, by lung volume reduction or lung transplantation. Support therapies are needed for those who develop liver disease, and, in selected cases, liver transplantation may be considered. Patients should be carefully educated about their lifestyle, including smoking cessation, body weight control, and reduced alcohol intake.
CONCLUSIONS: The proposed algorithm obtained the endorsement of the Italian Society of Pneumology (SIP). However, further studies and additional clinical data are required to confirm the validity of these recommendations.

KEY WORDS: Alpha 1-antitrypsin; Algorithms; Chronic obstructive pulmonary disease; Liver diseases