AATD Testing Was Uncommon Among US Veterans With COPD or Asthma

A retrospective multicenter study in JAMA Network Open examined α1-antitrypsin deficiency (AATD) testing and augmentation therapy prescribing among 2,384,913 Veterans Health Administration patients with COPD and/or asthma during 2020–2024. Researchers used national electronic health records and adjusted regression models to assess associations with demographics, comorbidities, tobacco use, social vulnerability, residence, and travel time to specialty care. Mean age was 64.2 years, and 7.5% were female.

Overall, 138,278 patients (5.8%) underwent AATD testing. Cirrhosis (adjusted odds ratio [aOR], 6.40; 95% CI, 6.29–6.51) and bronchiectasis (aOR, 3.73; 95% CI, 3.59–3.87) were associated with higher testing odds. Older age and active tobacco use were associated with lower odds. Travel times exceeding 90 minutes versus 30 minutes or less were associated with lower testing odds (aOR, 0.63; 95% CI, 0.62–0.65), while rural–urban residence and social vulnerability categories showed similar odds.

Among 8,564 patients diagnosed with AATD, 320 (3.7%) were prescribed augmentation therapy. Prescribing was less frequent among minoritized racial and ethnic groups, active tobacco users, and patients with longer travel times. These findings identify potential gaps in testing and access, but observational associations do not establish causality. The predominantly male veteran population may limit generalizability, and the abstract does not establish how many diagnosed patients were eligible for augmentation therapy.