Royal College of Surgeons in Ireland
Alpha 1 Antitrypsin Deficiency and Tobacco Smoking Exploring Risk Factors and Smoking Cessation in a Registry Population.pdf (1.43 MB)

Alpha-1 antitrypsin deficiency and tobacco smoking: exploring risk factors and smoking cessation in a registry population.

Download (1.43 MB)
journal contribution
posted on 2021-02-11, 12:26 authored by Alessandro Franciosi, Mansour A Alkhunaizi, Andrew Woodsmith, Layali Aldaihani, Hamad Alkandari, Siobhán E Lee, Laura T Fee, Noel G McElvaneyNoel G McElvaney, Tomas CarrollTomas Carroll
The ZZ genotype of alpha-1 antitrypsin deficiency (AATD) is strongly associated with COPD, even in never-smokers. Moderate AATD genotypes (MZ and SZ) have been shown to increase the severity of COPD in smokers. In this comparative study, we examine the association between AATD, genotypes, and smoking cessation. Two hundred and ninety-three Irish people with AATD [MZ (n = 91), SZ (n = 72), and ZZ/rare (n = 130)] completed a custom questionnaire assessing their social and smoking histories. The primary outcomes analyzed were the predictors of ever-smoking and effect of genotype on awareness of AATD and maintained smoking cessation, using logistic regression analyses. Parental smoking exposure was associated with ever-smoking status (OR 1.84 vs. no parental smoking, p = 0.018), higher cumulative tobacco consumption (23.47 vs. 14.87 pack-years, p = 0.005) and more quit attempts required to achieve cessation among former-smokers (2.97 vs. 5.60, p = 0.007). Awareness of genotype was 67.7% versus 56.3% versus 33% for ZZ, SZ, and MZ, respectively (p < 0.001). Among ever-smokers, current-smoking was uncommon (2.5% vs. 17% vs. 16% for ZZ, SZ, and MZ, respectively, p = 0.009) with ZZs significantly less likely to be current-smokers (OR 0.15 relative to MZ, p = 0.025). These results suggest that the genetic risk of COPD in AATD families is compounded by transmission of social risk factors (via parental smoking). Increasing severity of genotype is associated with lower current-smoking rates among ever-smokers. Whether this is attributable to greater awareness of risk is an area of interest. Achieving a change in smoking habits may also result in positive health behavior in subsequent generations.



The original article is available at

Published Citation

Franciosi AN, Alkhunaizi MA, Woodsmith A, Aldaihani L, Alkandari H, Lee SE, Fee LT, McElvaney NG, Carroll TP. Alpha-1 antitrypsin deficiency and tobacco smoking: exploring risk factors and smoking cessation in a registry population. COPD: Journal of Chronic Obstructive Pulmonary Disease 2021:1-12.

Publication Date

9 February 2021

PubMed ID



  • Beaumont Hospital
  • Medicine
  • Undergraduate Research

Research Area

  • Respiratory Medicine
  • Population Health and Health Services
  • Immunity, Infection and Inflammation


Informa UK Limited


  • Published Version (Version of Record)

Usage metrics

    Royal College of Surgeons in Ireland



    Ref. manager