Pitfalls and caveats in α1-antitrypsin deficiency testing: a guide for clinicians

Lancet Respir Med. 2019 Dec;7(12):1059-1067. doi: 10.1016/S2213-2600(19)30141-9. Epub 2019 Jul 16.


α1-antitrypsin deficiency (AATD) remains the only readily identified genetic cause of chronic obstructive pulmonary disease (COPD). Furthermore, there is growing evidence that even a moderate deficiency increases the risk of lung disease among smokers. Despite these facts, the uptake of testing for AATD in at-risk populations remains low for many reasons, and a lack of clarity among clinicians regarding the most appropriate diagnostic techniques presents a major deterrent. This Personal View addresses the benefits of diagnosis, the technical basis of the available diagnostic methods, and possible clinical confounders for each test. We include a series of unusual cases encountered at our National Centre of Expertise to provide context. The topics covered should equip clinicians with the core knowledge required to confidently assess patients for AATD.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Adult
  • Aged
  • Asthma / diagnosis
  • Asthma / etiology
  • Asthma / genetics
  • Child
  • Female
  • Genotyping Techniques / standards*
  • Humans
  • Liver Diseases / etiology
  • Liver Diseases / genetics
  • Male
  • Middle Aged
  • Phenotype
  • Pulmonary Disease, Chronic Obstructive / etiology
  • Pulmonary Disease, Chronic Obstructive / genetics
  • alpha 1-Antitrypsin
  • alpha 1-Antitrypsin Deficiency / blood
  • alpha 1-Antitrypsin Deficiency / complications
  • alpha 1-Antitrypsin Deficiency / diagnosis*
  • alpha 1-Antitrypsin Deficiency / genetics


  • SERPINA1 protein, human
  • alpha 1-Antitrypsin