Relationship between respiratory exacerbations in patients with Chronic Obstructive Pulmonary Disease (COPD), Asthma and Bronchiectasis and Alpha-1-Antitrypsin Deficiency (AATD) in hospitalized patients.

<bold>Introduction:</bold> COPD, asthma, and bronchiectasis are often linked to acute exacerbations (AE), negatively affecting disease progression and patients' quality of life. Imbalance in proteases and antiproteases in AATD patients increases the risk of exacerbations. The underdiagnosis of AATD is mainly due to a low clinical suspicion index. This study aims to determine the relationship between AATD and AE in patients with COPD, asthma, or bronchiectasis admitted to the pulmonology ward of a tertiary hospital. <bold>Materials and Methods:</bold> Genotyping via buccal swabs was performed on patients admitted to the Pulmonology ward for AE of COPD, asthma, or bronchiectasis from June to October 2023. Comparisons were made between patients with a single admission and those admitted two or more times within a year. <bold>Results:</bold> Genotyping included 84 patients (mean age 68±10 years). Of them, 18 exhibited genomic alterations (21.4%): 17 were M/S (20.2%), and 1 was M/Z (1.2%). By diagnosis, 22% of COPD patients, 18.7% of asthmatics, and 22.2% of bronchiectasis patients had AATD alterations. Comparing AATD frequency based on hospital admissions, patients with one admission annually had a frequency of 17.5% (n=7), and those with two or more admissions had 25% (n=11), with no significant differences observed. <bold>Conclusions:</bold> Implementing an AATD screening program for patients admitted for an AE could enhance efficiency in diagnosing AATD. Although further research is needed, preliminary results suggest this approach is crucial for early disorder identification.