Alpha1-Antitrypsin Deficiency in COPD: Clinical Implications

, College of Physicians and Surgeons, Columbia University, NY

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Diagnosis of Asthma in the Presence of COPD

Several features point to the presence of asthma in subjects with emphysema. Absence of cough and sputum production may be associated with asthmatic features in those with alpha1-ATD (NHLBI Registry, unpublished observations). Large changes in FEV1 or FVC (greater than 200 cc) after bronchodilator in those with moderate obstruction may indicate asthma. The presence of a strong allergic history or past history of atopy and an elevated serum IgE >100 IU/mL have also been associated with asthma.[28,29,30] The diagnosis of asthma in those with alpha1-ATD requires a high index of suspicion, and the evaluation for markers and clinical features of asthma.

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