PMID- 19229705
OWN - NLM
STAT- MEDLINE
DCOM- 20090429
LR  - 20091117
IS  - 1541-2563 (Electronic)
IS  - 1541-2563 (Linking)
VI  - 6
IP  - 1
DP  - 2009 Feb
TI  - Physician alert suggesting alpha-1 antitrypsin deficiency testing in pulmonary 
      function test (PFT) results.
PG  - 26-30
LID - 10.1080/15412550802587927 [doi]
AB  - Alpha-1 antitrypsin deficiency (AATD) is under-recognized by clinicians, with 
      long diagnostic delays between patients' first symptom and initial diagnosis. 
      Recent recommendations by official societies encourage testing for AATD in all 
      symptomatic adults with spirometric evidence of COPD, though compliance with this 
      recommendation has been variable. For 6 months, the following physician alert was 
      added to PFT reports of patients with airflow obstruction of GOLD Stage II or 
      higher: "The American Thoracic Society recommends testing for AATD in all 
      patients with FEV1 < 80% predicted and FEV1/FVC less than 0.70, if clinically 
      indicated. Appropriate counseling suggested." During the "Pre-alert Period," 821 
      spirometry tests were performed; 178 of these 821 unique patients (22%) satisfied 
      spirometric criteria of > GOLD Stage II and 11 (6%) were tested for AATD. In 
      contrast, during the "Physician Alert" intervention period, 689 spirometry tests 
      were performed on 689 unique patients, of whom 140 (20%) satisfied criteria for > 
      GOLD II airflow obstruction; AAT testing was done more frequently (18 [13%], p = 
      0.04). The overall rate of misclassifying patients' reports for testing by the 
      respiratory therapists was very low (3.3%). An analysis of "number needed to 
      test" suggests that 98-290 patients must be tested to have 95% certainty to 
      identify a single patient with severe AATD. In conclusion, implementing a 
      physician alert on PFT reports of patients with COPD can increase physicians' 
      testing for AATD. The incomplete rate of testing suggests the need for additional 
      strategies to enhance clinicians' detection of individuals with AATD.
FAU - Rahaghi, Franck
AU  - Rahaghi F
AD  - Department of Medicine, Cleveland Clinic Florida-Fort Lauderdale/Weston, 2950 
      Cleveland Clinic Blvd., Fort Lauderdale/ Weston, FL 33331, USA. rahaghf@ccf.org
FAU - Ortega, Ismael
AU  - Ortega I
FAU - Rahaghi, Nicholas
AU  - Rahaghi N
FAU - Oliveira, Eduardo
AU  - Oliveira E
FAU - Ramirez, Jose
AU  - Ramirez J
FAU - Smolley, Laurence
AU  - Smolley L
FAU - Stoller, James K
AU  - Stoller JK
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - England
TA  - COPD
JT  - COPD
JID - 101211769
SB  - IM
MH  - Aged
MH  - Female
MH  - Forced Expiratory Volume
MH  - Humans
MH  - Male
MH  - Pulmonary Disease, Chronic Obstructive/*diagnosis/*etiology
MH  - *Spirometry
MH  - Vital Capacity
MH  - alpha 1-Antitrypsin Deficiency/complications/*diagnosis
EDAT- 2009/02/21 09:00
MHDA- 2009/04/30 09:00
CRDT- 2009/02/21 09:00
PHST- 2009/02/21 09:00 [entrez]
PHST- 2009/02/21 09:00 [pubmed]
PHST- 2009/04/30 09:00 [medline]
AID - 908763149 [pii]
AID - 10.1080/15412550802587927 [doi]
PST - ppublish
SO  - COPD. 2009 Feb;6(1):26-30. doi: 10.1080/15412550802587927.