Relationship of CT densitometry to lung physiological parameters and health status in alpha-1 antitrypsin deficiency: initial report of a centralised database of the NIHR rare diseases translational research collaborative

Research output: Contribution to journalArticlepeer-review


  • James Stockley
  • Charlotte E Bolton
  • Nicholas S Hopkinson
  • Ravi Mahadeva
  • Michael Steiner
  • Tom Wilkinson
  • John R Hurst
  • Bibek Gooptu
  • Robert A Stockley

Colleges, School and Institutes

External organisations

  • University Hospital Birmingham
  • Nottingham University Hospitals NHS Trust
  • Royal College of Science Imperial College
  • University of Cambridge
  • Leicester Diabetes Centre, University Hospitals Leicester
  • University of Southampton
  • University of Nottingham


OBJECTIVES: To establish a database network for the study of alpha-1 antitrypsin deficiency (AATD) and compare the results to CT lung density as the most direct measure of emphysema.

DESIGN: A central electronic database was established to permit the upload of anonymised patient data from remote sites. Prospectively collected CT data were recorded onto disc, anonymised, analysed at the coordinating centre and compared with the clinical features of the disease.

SETTING: Tertiary referral centres with expertise in the management of AATD focused on academic Biomedical Research Units and Wellcome Clinical Research Facilities.

PARTICIPANTS: Data were collected from 187 patients over 1 year from eight UK academic sites. This included patient demographics, postbronchodilator physiology, health status and CT. Analysis was undertaken at the coordinating centre in Birmingham.

RESULTS: Patient recruitment in the 12 months reached 94% of target (set at 200) covering the whole spectrum of the disease from those with normal lung function to very severe chronic obstructive lung disease. CT scan suitable for analysis was available from 147 (79%) of the patients. CT density, analysed as the threshold for the lowest 15% of lung voxels, showed statistically significant relationships with the objective physiological parameters of lung function as determined by spirometric Global Initiative for Chronic Obstructive Lung Disease (GOLD) severity staging (p<0.001) and carbon monoxide gas transfer (p<0.01). Density also correlated with subjective measures of quality of life (p=0.02).

CONCLUSIONS: Establishment of the network for data collection and its transfer was highly successful facilitating future collaboration for the study of this rare disease and its management. CT densitometry correlated well with the objective clinical features of the disease supporting its role as the specific marker of the associated emphysema and its severity. Correlations with subjective measures of health, however, were generally weak indicating other factors play a role.

Bibliographic note

© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY. Published by BMJ.


Original languageEnglish
Article numbere036045
JournalBMJ open
Issue number6
Publication statusPublished - 30 Jun 2020


  • physiology, general medicine (see internal medicine), thoracic medicine, computed tomography, emphysema, chronic airways disease