Alpha1-Antitrypsin Deficiency in COPD: Clinical Implications

, College of Physicians and Surgeons, Columbia University, NY

In This Article

Role of Asthma in Progression to Emphysema

The development of asthma in patients with alpha1-ATD may predispose to irreversible airway obstruction and emphysema. Both an elevated serum IgE and atopy, markers for asthma, have been associated with the development of COPD[35,36] and a more rapid deterioration of lung function in elderly normal subjects.[37,38]

Chronic asthma may lead to airway remodeling with thickening of the basement membrane and subepithelial fibrosis. Such changes may have an adverse impact on airway function in individuals with alpha1-ATD.[39] Furthermore, the effects of childhood asthma on lung growth, particularly in those with alpha1-ATD is unknown, but potentially significant.

Unpublished data from the NHLBI Registry of patients with alpha1-ATD show a significant -- approximately 20% -- increased rate of loss of FEV1 in those subjects ever showing a bronchodilator response. Therefore, the development of asthma in patients with alpha1-ATD may accelerate the development of chronic airway obstruction.


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