---were examined in this recent study. Not surprisingly, delays in diagnosis were considerable. (That's also the case for COPD in general). Augmentation therapy and vaccinations did decrease ER visits and exacerbations. This was not a randomized controlled trial and the role of augmentation therapy is likely to remain controversial.
The recently emerging controversy regarding augmentation therapy raises two questions: What is the precise role for augmentation therapy today? Should we still screen all COPD and unremitting asthma patients as the guidelines recommend?
Given the complexity of management and multiple process issues involved in the management of patients with AAT, the controversy has not dampened my enthusiasm for screening. Those patients identified as having AAT can then be referred to appropriate centers of expertise.