Alpha-1 Antitrypsin Deficiency

Is Testing Right for Me? I Have My Test Results

Alpha-1 Antitrypsin Deficiency

Who Should Test for Alpha-1 Antitrypsin Deficiency?

Over 1 million people worldwide have Alpha-1 with severe medical problems. As many as 1 in 10 to 1 in 33 people in this country are Alpha-1 carriers. Alpha-1 can't be cured. However, treatments and lifestyle changes can lower the chances to have more severe lung and liver problems develop — especially if it is caught early.

Current medical guidelines from the American Thoracic Society say that genetic testing is recommended for people who have:

  • A brother or sister with Alpha-1
  • Signs or symptoms of Alpha-1 lung disease
    • Emphysema
    • Chronic obstructive pulmonary disease (COPD)
    • Asthma that can't be treated completely, even with medicine
    • Abnormal lung function tests and a known risk factor (smoking, job exposures), even if there aren't any symptoms
    • Unexplained liver disease at any age
  • Necrotizing panniculitis (rare skin condition)

Genetic testing should be discussed and considered for:

  • People with:
    • A family history of any of COPD or liver disease
    • A family member who has been diagnosed with Alpha-1
    • A partner who has Alpha-1 or is known to be a carrier of Alpha-1
    • A high chance for developing Alpha-1-related health problems due to smoking or job exposures
  • Adults with lung problems such as:
    • Bronchiectasis without a known cause
    • Abnormal lung function tests (persistent airflow obstruction) in people with no symptoms of Alpha-1 who have no known risk factors like smoking or job exposures
    • Anti-proteinase 3-positive vasculitis (C-ANCA)
Next: How Testing for Alpha-1 Antitrypsin Deficiency Works

Why are you considering genetic testing?

I think I might have Alpha-1, but I haven't seen a doctor yet.

I probably have Alpha-1 but have not yet had genetic testing.

I have a family member with definite or possible Alpha-1.

My partner has Alpha-1 or is a known carrier, and we want to know the risks for our children.

The symptoms you may feel from Alpha-1 Antitrypsin Deficiency are very similar to symptoms caused by many different breathing conditions. People with symptoms of breathing or liver problems may need lab tests, imaging, breathing tests, and other tests to help a doctor find the likely cause of those symptoms.

Genetic testing shouldn't be considered until all of the other common causes have been ruled out.

When testing finds two mutations, the results confirm that you have Alpha-1 antitrypsin deficiency. Knowing information about your Alpha-1 mutations can provide you with information to treat your condition and prevent complications. Your results give you information to:

  • Make informed choices about health care, lifestyle, career, and family planning
  • Take steps to slow the progression of Alpha-1
  • Avoid harmful behaviors such as smoking and alcohol consumption
  • Modify your exposure to environmental factors such as dust, pollution, and certain chemicals
  • Start appropriate treatments
  • Identify relatives who may also be at-risk for having Alpha-1
    • Your brothers and sisters would have the highest chance to also have the disease. There is a chance for other relatives as well because of how common carriers are

When testing doesn't find a mutation, the results don't completely rule out that you have Alpha-1 antitrypsin deficiency. Genetic testing cannot find all of the gene mutations that cause Alpha-1 Antitrypsin Deficiency. Additional testing, such as protein testing or gene sequencing, may be helpful if your doctor thinks the chances are very high that you have Alpha-1 even when your test results are normal.

If you have a family member with Alpha-1, your chances to have it are higher. The chance is highest if your brother or sister has Alpha-1. The first person in the family to have genetic testing should be someone most likely to have Alpha-1. If your relative(s) that might have Alpha-1 aren't available or willing to have genetic testing, you can have testing but the meaning of your results may be less clear.

  • When testing finds two mutations, you can be certain that you have inherited Alpha-1. The symptoms of Alpha-1 can be different between people in the same family. Some people have the mutations but never get symptoms at all. So, your results don't necessarily predict your future but they do mean that you need may need screening tests to check your lungs and liver. Your results give you information to:
    • Make informed choices about health care, lifestyle, career, and family planning
    • Take steps to slow the progression of Alpha-1
    • Avoid harmful behaviors such as smoking and alcohol consumption
    • Modify your exposure to environmental factors such as dust, pollution, and certain chemicals
    • Start appropriate treatments
    • Identify other relatives who may also be at-risk for having Alpha-1
  • When testing finds one mutation, you are a carrier of Alpha-1. The chance for you to develop lung or liver problems is low, especially if you don't smoke. However, you have a higher chance to have a child with Alpha-1. You may wish to consider carrier testing for your partner. If both parents are carriers, there is a 1 in 4 (25%) chance with each pregnancy to have a child with Alpha-1.
  • When testing doesn't find a mutation, there are two possible explanations – you may not have inherited either of the mutations that cause Alpha-1 in your family or the mutation that causes Alpha-1 in your family can't be found with the test that was done. In this situation, a normal result doesn't rule out the chance that you are an Alpha-1 carrier. However, it is very unlikely that you have Alpha-1 or are a carrier. Genetic testing finds about 95% of the mutations that cause Alpha-1.

If you don't have a family history of Alpha-1, the chance for you to be a carrier is between 1 in 10 and 1 in 33. The chances may be lower if your ancestors are not from Europe.

  • When testing finds a mutation, then you are a carrier of Alpha-1.
    • If your partner has Alpha-1, the chance for you to have a child with Alpha-1 is 1 in 2 (50%) with each pregnancy.
    • If your partner is a carrier of Alpha-1, the chance for you to have a child with Alpha-1 is 1 in 4 (25%) with each pregnancy.
    • Prenatal diagnosis is possible for Alpha-1. However, this testing is not useful for telling how mild or severe the disease might be, or when a child might begin to have symptoms. The chance for health problems in childhood is low.
  • When testing doesn't find a mutation, then the chance for you to be a carrier is very low. Testing detects about 95% of the mutations that cause Alpha-1. You are at a very low risk to have a child affected by Alpha-1.