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Vol. 56. Issue 2.
Pages 76-83 (February 2020)
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Vol. 56. Issue 2.
Pages 76-83 (February 2020)
Original Article
Serum Levels of Alpha1-antitrypsin and Their Relationship With COPD in the General Spanish Population
Niveles séricos de alfa-1 antitripsina y su relación con la EPOC en la población española
Sabina Janciauskienea, David S. DeLucaa, Miriam Barrechegurenb, Tobias Weltea, Marc Miravitllesb,
Corresponding author

Corresponding author.
a Department of Respiratory Medicine, Hannover Medical School, Biomedical Research in End-stage and Obstructive Lung Disease Hannover (BREATH), Member of German Centre for Lung Research (DZL), Hannover, Germany
b Pneumology Department, Hospital Universitari Vall d’Hebron/Vall d’Hebron Research Institute (VHIR), CIBER de Enfermedades Respiratorias (CIBERES), Barcelona, Spain
Scientific Committee
Participating sites and coordinators
Related content
Arch Bronconeumol. 2020;56:72-310.1016/j.arbres.2019.06.010
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Figures (3)
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Tables (4)
Table 1. General characteristics of the whole study group and subgroups.
Table 2. Associations of plasma AAT levels with clinical parameters.
Table 3. Lung function tests as a function of AAT and other parameters.
Table 4. Health status as a function of clinical parameters.
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Additional material (1)

Low plasma level of alpha1-antitrypsin (AAT) is an established risk factor for early-onset chronic obstructive lung disease (COPD). However, less attention is given to the levels of AAT in the general population.


This is a part of a multicentre, population-based study conducted at 11 sites throughout Spain. Plasma levels of AAT were available for 837 persons with a mean (SD) age of 58.05 (11.3) years: 328-smokers, 272-ex-smokers and 237 non-smokers. Out of 837, 303 (36.2%) had a diagnosis of COPD, 222 (26.5%) had respiratory symptoms but no COPD, and 312 (37.3%) were healthy controls.


In the whole cohort, the mean level of plasma AAT was 1.51 (0.47)g/L. Levels were higher in COPD patients [1.55 (0.45)g/L] and individuals with respiratory symptoms [1.57 (0.47)g/L] than in controls [1.43 (0.47)g/L], p<0.001, a finding which persisted after correction for age and CRP. Plasma AAT levels were negatively associated with FEV1/FVC ratio, after adjustment for age, sex, smoking status, CRP, TNFα, fibrinogen and albumin. The risk for COPD was significantly associated with higher AAT levels in univariate and multivariate models, with odds ratios of 1.8 and 1.5, respectively. In the univariate and multivariate models smoking status, gender, and CRP levels were also associated with COPD probability, demonstrating that they act independently.


Increased circulating levels of AAT, similarly to CRP and other markers of systemic inflammation, is an important feature of COPD. Our results highlight a complex interrelationship between levels of AAT and health of respiratory system.

Acute phase reactants
Lung function
Respiratory symptoms

Los niveles plasmáticos bajos de alfa-1 antitripsina (AAT) constituyen un factor de riesgo para el desarrollo temprano de la enfermedad pulmonar obstructiva crónica (EPOC). Sin embargo, se ha prestado una menor atención a los niveles de AAT en la población general.


Este trabajo forma parte de un estudio poblacional multicéntrico llevado a cabo en 11 centros españoles. Se incluyeron niveles de AAT de 837 personas con una edad media (DE) de 58,05 (11,3) años: 328 fumadores, 272 exfumadores y 237 no fumadores. De los 837, a 303 (36,2%) se les diagnosticó EPOC, 222 (36,5%) presentaron síntomas respiratorios pero no EPOC y 312 (37,3%) eran controles sanos.


En la cohorte total, los niveles plasmáticos medios de AAT fueron 1,51 (0,47)g/l. Los pacientes con EPOC y los individuos con síntomas respiratorios presentaron niveles más elevados (1.55 [0.45]g/l y 1.57 [0.47]g/l respectivamente) que los sujetos control (1.43 [0.47]g/l, p<0.001). Este resultado se mantuvo tras la corrección por edad y niveles de proteína C reactiva (PCR). Los niveles plasmáticos de AAT se asociaron negativamente con la relación FEV1/FVC tras el ajuste por edad, sexo, hábito tabáquico, niveles de PCR, TNFα, fibrinógeno y albúmina. El riesgo de EPOC se asoció significativamente con niveles más elevados de AAT tanto en el modelo univariante como el multivariante, con odds ratios de 1,8 y 1.5 respectivamente. En los modelos univariantes y multivariantes, el hábito tabáquico, el sexo, y los niveles de PCR también se asociaron con la probabilidad de sufrir EPOC, lo cual demostró que se trataba de variables independientes.


Un aumento de los niveles circulantes de AAT, al igual que los niveles de PCR y otros marcadores de inflamación sistémica, son características importantes de la EPOC. Nuestros resultados evidencian la compleja interrelación existente entre los niveles de AAT y la salud del aparato respiratorio.

Palabras clave:
Alfa-1 antitripsina
Reactantes de fase aguda
Función pulmonar
Síntomas respiratorios


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