ATOPY, ASTHMA, AND EMPHYSEMA IN PATIENTS WITH SEVERE ALPHA-1-ANTITRYPYSIN DEFICIENCY

Bronchial asthma is characterized by episodic airway obstruction and a ssociated with wheezing, a bronchodilator response, an elevation in to tal serum IgE and atopy. To determine whether asthma is more common in subjects with severe alpha(1)-antitrypsin deficiency (alpha(1)-ATD) a nd airway obstruction, we compared 38 patients who had this condition (Group 1) with 22 control patients with chronic obstructive pulmonary disease (COPD) (Group 2) and with five subjects with alpha(1)-ATD and normal spirometry (Group 3). Subjects were evaluated with a symptom qu estionnaire, pulmonary function testing, intradermal allergen resting, and serum IgE measurement. Self-reported wheezing was a common sympto m In air patient groups, but attacks of wheezing with dyspnea were sig nificantly more common in Group 1. Of those patients with airway obstr uction, more than 50% showed a bronchodilator response whether sufferi ng from alpha(1)-ATD or not. Atopy was more common in Group 1 than in Group 2 (48% versus 27%). Mean serum IgE for all groups was similar bu g significantly greater in patients with atopy. We estimated the preva lence of asthma in the study groups on the basis of the criteria of at tacks of wheezing, reversible airway obstruction, atopy, and that incr eased IgE. The proportion of patients with asthma in Group 1 was signi ficantly greater than that in Group 2 (22% versus 5%, p < 0.05), Our s tudy shows that with control for the degree of airway obstruction, ast hma, as defined, is more common in patients with alpha(1)-ATD than in those without it, We suggest that a rack of alpha(1)-AT in airways inc reases the propensity to develop asthma.