Wednesday, June 14, 2006

Alpha-1 AT augmentation therapy

One of my patients is a 55 y/o woman, heterozygous for A1AT with very low serum levels of A1AT (~65-75). Unfortunately she has continued to smoke and her FEV1 is 30% of her predicted with hyperinflation and decreased DLCO. She asked about "re-checking" her serum levels and whether she would be a good candidate for augmentation therapy. I have been less than excited with the ongoing smoking and pretty advanced COPD. I would be more interested in evaluation for a possible lung Txp in the future if she ever quit smoking. Her most recent serum level was 72. Would you consider A1AT replacement?

4 comments - CLICK HERE to read & add your own!:

Jennings said...

I would not give the replacement. I would instead concentrate on aggressive smoking cessation and perhaps consideration of lung transplant listing. It seems to not be the best situation to give replacement while she is actively smoking.

Steve said...

Wouldn't replacement therapy be more protective for people who are smoking?

Jennings said...

Well, it doesn't make sense to give replacement therapy when the cause of the decline is still active and treatable (smoking). This would be much more effective than giving the replacement but having the patient continue to smoke - the smoke will accelerate the emphysema much more than any replacement therapy can stave off decline.
Another example is that we dont usually put a patient in pulmonary rehab if they are actively smoking. I makes more sense to work on the smoking cessation.

Jeff H said...

I would not offer augmentation therapy to a patient who continues to smoke.