The COVID-19 pandemic has been regarded as a litmus test for our modern medical systems. One question it has raised is this: can our modern medical infrastructure cope with a fast-spreading, evasive virus, and do so in accordance with our high modern healthcare standards?
There is no use claiming victory if we are only able to nominally treat COVID-19 patients (through self-isolation for those with mild to moderate symptoms and hospital admissions for severe cases) but fail to implement policies that effectively isolate the sick, perform contact tracing, and ensure that strict hygiene is observed in crowded places.
The jury is still out on our collective performance in managing the pandemic, which is not over yet (at the time of this writing). However, it is needless to say that for most of the pandemic, we have been playing catch-up, and just barely succeeding.
An unintended consequence of the increased number of COVID-19 patients needing hospital care is that other cases that are deemed “less urgent” are set aside. (I use that term loosely, because any disease feels urgent for the patient involved.) The attention of the medical community has focused almost exclusively on COVID-19, particularly during surges in cases, meaning many elective surgeries, physiotherapy sessions, and in-person psychiatric consultations have been postponed.
Patients with alpha-1 antitrypsin deficiency (AATD) require regular IV AAT therapy. AAT therapy is itself burdensome for patients as it disrupts their weekly schedules; however, the alternative is a worsening of AATD, as well as more frequent and severe exacerbations, which is far worse.
Read more about AATD therapies
An idea that has been touted and has been put into practice in some places is the self-administration of AAT therapy. The self-administration of any drug is usually more convenient; in the COVID-19 era, it can be life-saving, especially if patients are unable to travel to their local healthcare center to receive therapy.
Strong Support Among Patients, Clinicians
Before we jump into how self-administration of AAT therapy can be taught to AATD patients so that they can perform it as safely as possible, it is worth citing potential concerns that might exclude a patient from self-administering AAT therapy.
A home setting is not like a hospital; naturally, many healthcare resources are lacking in it. The next obvious concern is whether the patient can self-administer AAT therapy in a confident and safe manner. Herth et al wrote, “One study of self-administration in patients with AATD reported issues relating to treatment infusion, including difficulties locating veins and selecting infusion sites, intravenous stick injuries, occlusion of ports with scar tissue, and problems switching from vein to port.”
Read more about AATD treatment
What do AATD patients think about self-administration of AAT therapy? One study found that 95.4% of patients were “very satisfied” with self-administered AAT therapy, while 4.6% described being “satisfied.” On the findings of this study, Chorostowska-Wynimko wrote, “The most frequently cited reason for patients not choosing self-administration was that they were satisfied with their current regimens, which highlights that self-administration is not suitable for all patients.”
But in periods of lockdown during the pandemic that many countries have faced, the option to continue current treatment regimes may be limited or unavailable altogether. Importantly, clinicians are on board with the self-administration of AAT therapy, citing potential benefits to their patients. In a survey, “100% of clinicians stated that they would consider switching patients from hospital-based or home-based AAT therapy to self-administration if these patients had the potential to benefit the most from this treatment strategy,” Herth and colleagues reported.
Safety and Training Considerations
How can the self-administration of AAT therapy be carried out in the safest possible way? Herth et al highlight a few key points:
- Aseptic conditions should be maintained.
- The concentrate should be reconstituted.
- The patient is to fill the syringe for infusion.
- IV drug infusion can then be carried out, with care not to injure the injection site and veins.
- The infusion should then be duly documented.
Before a patient can be trusted to self-administer an IV medication, training must first be provided. “In the US, a majority of self-administration training for AAT therapy has reportedly been conducted by home nursing agencies over an average of two or three sessions,” Herth and colleagues wrote.
Herth et al also provided a list of areas that self-administration training should cover:
- Overview of AATD.
- Identifying common adverse effects.
- The correct way to prepare, store, and administer AAT therapy.
- Calculating dosage.
- Practicing aseptic techniques.
- Performing cannulation.
- Disposing needles/sharps safely after use.
Alleviating Disease Burden
“Overall, self-administration may be of great value to certain patients with AATD, eg, those in employment or those who would experience difficulty in traveling to the clinic, and is currently implemented successfully by a subsection of patients in the US,” Chorostowska-Wynimko et al wrote.
As with any skill, self-administration of an IV drug requires experience and patience. However, once patients learn how to perform it routinely without having to leave the comfort of their own home, they might find it to be far less burdensome and better suited to their lifestyle wants.
Herth FJF, Sandhaus RA, Turner AM, Sucena M, Welte T, Greulich T. Alpha 1 antitrypsin therapy in patients with alpha 1 antitrypsin deficiency: perspectives from a registry study and practical considerations for self-administration during the COVID-19 pandemic. Int J Chron Obstruct Pulmon Dis. Published online November 1, 2021. doi:10.2147/COPD.S325211
Chorostowska-Wynimko J, Barrecheguren M, Ferrarotti I, Greulich T, Sandhaus RA, Campos M. New patient-centric approaches to the management of alpha-1 antitrypsin deficiency. Int J Chron Obstruct Pulmon Dis. Published online February 12, 2020. doi:10.2147/COPD.S234646.