tag:blogger.com,1999:blog-12660458.post113993825193761170..comments2023-09-01T10:33:09.297-04:00Comments on Pulmonary Roundtable: When to treat Alpha-1 AntitrypsinUnknownnoreply@blogger.comBlogger4125tag:blogger.com,1999:blog-12660458.post-1139950354342222602006-02-14T15:52:00.000-05:002006-02-14T15:52:00.000-05:00She had a normal ultrasound in 2004, and her trans...She had a normal ultrasound in 2004, and her transaminases have been persistently elevated as far back in our system as 1999. Her coags are normal.<BR/><BR/>Her PCP is sending her to a hepatologist and repeating an ultrasound to see if she requires a liver biopsy.Mike Lhttps://www.blogger.com/profile/12177750268091750583noreply@blogger.comtag:blogger.com,1999:blog-12660458.post-1139945323627407922006-02-14T14:28:00.000-05:002006-02-14T14:28:00.000-05:00i also would not treat based on the normal spiro a...i also would not treat based on the normal spiro and her being asymptomatic. Would repeat spiro yearly (or earlier if symptomatic) and not intervene unless there is a change.Jenningshttps://www.blogger.com/profile/04930453447603683057noreply@blogger.comtag:blogger.com,1999:blog-12660458.post-1139945277932335942006-02-14T14:27:00.000-05:002006-02-14T14:27:00.000-05:00I agree with Jeff H about not starting enzyme repl...I agree with Jeff H about not starting enzyme replacement. I don't think she even needs bronchodilators at this point. You should monitor her periodically with PFTs and she should be counselled Re: not starting to smoke. <BR/>I am also curious about her liver function. Since she did have abnormal liver Fxn, does she have significant liver Dz?Baleeirohttps://www.blogger.com/profile/03993066135160692535noreply@blogger.comtag:blogger.com,1999:blog-12660458.post-1139943342201362732006-02-14T13:55:00.000-05:002006-02-14T13:55:00.000-05:00I would not treat with enzyme replacement, as her ...I would not treat with enzyme replacement, as her pulmonary function is "normal" and she is asymptomatic.<BR/><BR/>She's air trapping and hyperinflated. As she's asymptomatic, I don't think this is an indication for treatment; that said, I wouldn't mind trying tiotropium for 6 months to a year to satisfy my curiosity as to whether that would improve her hyperinflation...Jeff Hhttps://www.blogger.com/profile/01209432708535732499noreply@blogger.com