title: Individualized lung function trends in alpha-1-antitrypsin deficiency: a need for patience in order to provide patient centered management?
abstract: BACKGROUND
  Chronic obstructive pulmonary disease (COPD) is characterized by fixed airflow obstruction and accelerated decline of forced expired volume in 1 second (FEV1). Alpha-1-antitrypsin deficiency is a genetic cause of COPD and associated with more rapid decline in lung function, even in some never smokers (NS) but the potential for individualized assessment to reveal differences when compared to group analyses has rarely been considered.
  
  
  METHODS
  We analyzed decline in post-bronchodilator FEV1 and gas transfer (% predicted) over at least 3 years (mean= 6.11, 95% CI 5.80-6.41) in our unique data set of 482 patients with alpha-1-antitrypsin deficiency (PiZ) to determine individual rates of decline, implications for prognosis, and potential clinical management.
  
  
  RESULTS
  There was a marked variation in individual rates of FEV1 decline from levels consistent with normal aging (observed in 23.5% of patients with established COPD, 57.5% of those without) to those of rapidly declining COPD. Gas transfer did not decline in 12.8% of NS and 20.7% of ex-smokers with established COPD (33.3% and 25.0%, respectively, for those without COPD). There was no correlation between decline in gas transfer and FEV1 for those with COPD, although a weak relationship existed for those without (r=0.218; P<0.025).
  
  
  CONCLUSIONS
  These data confirm differing individual rates of lung function decline in alpha-1-antitrypsin deficiency, indicating the importance of comprehensive physiological assessment and a personalized approach to patient management.
authors.affiliation: Department of Lung Function and Sleep, University Hospitals Birmingham NHS Foundation Trust.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Stockley
authors.affiliation: Department of Lung Function and Sleep, University Hospitals Birmingham NHS Foundation Trust.
authors.forename: Ross G
authors.initials: RG
authors.lastname: Edgar
authors.affiliation: Department of Lung Function and Sleep, University Hospitals Birmingham NHS Foundation Trust.
authors.forename: Anilkumar
authors.initials: A
authors.lastname: Pillai
authors.affiliation: Department of Inflammation and Ageing, University of Birmingham, Edgbaston, Birmingham, UK.
authors.forename: Alice M
authors.initials: AM
authors.lastname: Turner
mesh_terms: D000328:Adult; D000367:Age Factors; D018450:Disease Progression; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D008168:Lung / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D018802:Patient-Centered Care; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D011656:Pulmonary Emphysema / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D012042:Registries; D012129:Respiratory Function Tests; D012307:Risk Factors; D012720:Severity of Illness Index; D012907:Smoking / Q000009:adverse effects; D013997:Time Factors; D019896:alpha 1-Antitrypsin Deficiency / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology
keywords: COPD; alpha-1-antitrypsin deficiency; emphysema; lung function