Entries for February 2021
Samuel Gurevich, MD1,2 Andrew Daya, MD2 Cristiana Da Silva, RRT, BS2 Christine Girard, MD2 Franck Rahaghi, MD2
Author Affiliations
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio, United States
- Department of Pulmonary Medicine, Cleveland Clinic Florida, Weston, Florida, United States
Address correspondence to:
Samuel Gurevich, MD
Respiratory Center
Cleveland Clinic Florida Weston
Building A2950 Cleveland Clinic Blvd
Weston, FL 33331
Ph: (954) 659-5450
Fax: (954) 659-5451
Email: Gurevis@ccf.org
Abstract
Alpha-1 antitrypsin deficiency (AATD) is a common but highly underdiagnosed genetic disorder that may lead to chronic obstructive pulmonary disease (COPD), bronchiectasis, and liver disease. Early diagnosis is key to altering the course of disease as well as informing family members of potential risk. This randomized, prospective observational study compares the different testing modalities for AATD testing of at-risk patients initiated in the pulmonary function testing (PFT) laboratory. Providing a recommendation with a prescription for serologic testing, providing a finger-stick testing method (AlphaKit), and providing a buccal swab testing method (AlphaID) were compared to the community standard of referring the patient back to the PFT-ordering provider only. Results show that testing directly in the PFT laboratory has an odds ratio (OR) for completing testing of 35.14 (5.33 - 999.99), p-value of <0.0001, for buccal swab testing and an OR of 17.09 (2.58 - 729.99), p-value of 0.0002, for finger-stick testing compared to the community standard. Providing a prescription was no better than referral back to the PFT-ordering provider with an OR of 2.61(0.33 - 119.36), p-value of 0.6412. Resources needed to have testing performed by the Respiratory Therapy department were minimal with an average time of 1 to 5 minutes per patient tested. Causes of testing refusal were also identified. In conclusion, direct testing for AATD by respiratory therapists at the conclusion of PFT testing shows a significant improvement in rates of testing, especially with testing that utilizes buccal swab sample collection.
Citation
Citation: Gurevich S, Daya A, Da Silva C, Girard C, Rahaghi F. Improving screening for alpha-1 antitrypsin with direct testing in the pulmonary function testing laboratory. J COPD F. 2021; 8(2): 190-197. doi: http://doi.org/10.15326/jcopdf.8.2.2020.0179