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(Chest. 2001;120:687.)
© 2001 American College of Chest Physicians

Augmentation Therapy in {alpha}1-Antitrypsin Deficiency

Jonathan G. W. Burdon, MD; Sue Brenton, B Appl Sc; Monna Ayad, BSc and Kenneth Knight, PhD

Australasian {alpha}1-Antitrypsin Research Program

Correspondence to: Jonathan G. W. Burdon, MD, Suite 68, Sixth Floor, Mercy Private Hospital, Consulting Suites, 166 Gipps St, East Melbourne, Australia 3002

To the Editor:

Dr. Lieberman’s article (November 2000)1 provides important new information about the effect, or lack thereof, of {alpha}1-antitrypsin in patients deficient in this important protein. Although as yet unproved, the use of augmentation therapy in this group of patients may reduce the rate of decline of lung function2 3 and pulmonary tissue loss,4 at least in some individuals. Dr. Lieberman’s data indicate that there may be other significant benefits to both the patient and community as a result of the reduction in morbidity (respiratory infection) with its consequent economic savings.

Dr. Lieberman’s data build on observations made by Cantin and Woods5 and Barker et al6 in 1994. The latter group retrospectively analyzed a group of {alpha}1-antitrypsin-deficient patients who had received augmentation therapy. They observed that "the conditions of individuals in our program remained clinically and functionally stable with several subjects having fewer hospitalizations than before augmentation therapy was initiated." Thus, there may be other benefits from augmentation therapy. Further study of augmentation therapy would seem sensible.

References

  1. Lieberman, J (2000) Augmentation therapy reduces frequency of lung infections in antitrypsin deficiency: a new hypothesis with supporting data. Chest 118,1480-1485[Abstract/Free Full Text]
  2. Seersholm, N, Wencker, M, Banik, N, et al (1997) Does {alpha}1-antitrypsin augmentation therapy slow the annual decline in FEV1 in patients with severe hereditary {alpha}1-antitrypsin deficiency? Eur Respir J 10,2260-2263[Abstract]
  3. Wencker, M, Banik, N, Buhl, R, et al (1998) Long-term treatment of {alpha}1-antitrypsin deficiency-related pulmonary emphysema with human {alpha}1-antitrypsin. Eur Respir J 11,428-433[Abstract]
  4. Dirksen, A, Dijkman, JH, Madsen, F, et al (1999) A randomized clinical trial of {alpha}1-antitrypsin augmentation therapy. Am J Respir Crit Care Med 160,1468-1472[Abstract/Free Full Text]
  5. Cantin, AM, Woods, DE (1999) Aerosolized prolastin suppresses bacterial proliferation in a model of chronic Pseudomonas aeruginosa lung infection Am J Respir Crit Care Med 160,1130-1135[Abstract/Free Full Text]
  6. Barker, AF, Siemsen, F, Pasley, D, et al (1994) Replacement therapy for hereditary {alpha}1-antitrypsin deficiency: a program for long-term administration. Chest 105,1406-1410[Abstract/Free Full Text]

Jack Lieberman, MD, FCCP

Northridge, CA

Correspondence to: Jack Lieberman, MD, FCCP, Professor Emeritus of Medicine, UCLA School of Medicine, 17813 Lemarsh St, Northridge, CA 91325

To the Editor:

I deeply appreciate the comments by the members of the Australasian {alpha}1-Antitrypsin Research Program regarding my article. Their insight into the significance of my report supports my findings and acknowledges the thoughtful consideration by the editors of CHEST for allowing its publication. The article is one of the first, or one of only a few, articles to report research conducted via an Internet questionnaire, so that the reluctance of some reviewers to recommend its publication is understood. The role of {alpha}1-antitrypsin in protecting the human organism from various types of infections is just coming to light, so that a myriad of future publications by various authors should be expected.





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