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Signs of Hyperinflation and Ventilation Heterogeneity in Individuals With Severe Alpha-1-Antitrypsin Deficiency at
Georg Rüdiger Schramm1, Per Wollmer2, Eeva Piitulainen1
1Department of Internal Medicine, Skåne University Hospital, Malmö, Sweden, Lund University, Lund, Sweden.
Background:
Severe alpha-1-antitrypsin deficiency (AATD) is a known risk factor for early development of emphysema and COPD. By the Swedish national screening program within the years 1972-74 a cohort of individuals with severe AATD (PiZZ) was identified and regularly followed up. The aim of this study was to investigate alveolar volume (VA) and the ratio VA/Total lung capacity (VA/TLC) for the detection of signs of hyperinflation and ventilation heterogeneity in PiZZ individuals compared with an age-matched control group (phenotype PiMM), randomly selected from the population registry.
Methods:
All study participants underwent pulmonary function tests (PFT) including dynamic spirometry and total lung capacity (TLC), residual volume (RV), functional residual capacity (FRC) and alveolar volume (VA). They answered a questionnaire on smoking habits and symptoms. Quality of life was assessed by answering the Saint George´s Respiratory Questionnaire (SGRQ).
Results:
Fifty-six PiZZ and 66 PiMM individuals participated in the study. The PiZZ individuals had a significantly lower VA/TLC ratio (p=0.004) and significantly higher RV (p<0.001) and RV/TLC ratio (p=0.001) than the PiMM individuals. The 13 PiZZ ever-smokers had a significantly higher TLC (p=0.025), RV (p=0.003) and FRC (p=0.003) and a significantly lower VA/TLC ratio (p=0.006) than the 24 PiMM ever-smokers. No significant differences in RV, TLC, VA, and VA/TLC ratio were found between the never-smoking PiZZ and PiMM individuals. The ratio RV/TLC was significantly higher in the PiZZ never-smokers than in the PiMM never-smokers (p=0.026).
Conclusion:
At the age of 42 the PiZZ ever-smokers have signs of hyperinflation and ventilation heterogeneity.
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