Experts have proposed recommendations to raise awareness and integrate self-administration of alpha-1 antitrypsin (AAT) therapy for patients with alpha-1 antitrypsin deficiency (AATD) into clinical practice.

The experts anticipate that the implementation of self-administration programs for AAT therapy will help alleviate the burden on patients, enhance their independence, and improve their overall treatment experience.

“The limited use of self-administration of AAT therapy despite its benefits is probably due to the lack of knowledge of this option by patients, as has been the case with other self-administration programs of parenteral medicines,” the experts wrote in the International Journal of Chronic Obstructive Pulmonary Disease. “It is likely that increasing awareness among HCPs about this alternative of administration would lead to better communication between healthcare professionals and the patients and, in turn, would lead to greater awareness and interest among patients with AAT in self-administration.”

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Hence, this project employed a modified nominal group technique to address important aspects of the self-administration program, resulting in comprehensive guidance:

  • Patient selection: the guidelines stress a thorough selection process, combining clinical and social criteria. Candidates must meet therapy criteria, show stability, and be capable of procedures. Socially, they should commit to training, express a desire for improved quality of life, and possess learning capacity. Exclusions include certain conditions hindering self-administration, aiming to empower patients, enhance adherence, and reduce costs.
  • Role of healthcare providers: the recommendations outline the roles of pulmonologists, nurses, and pharmacists, ensuring patient support. Pulmonologists decide suitability and provide training; nurses conduct training; pharmacists dispense and oversee adherence.
  • Nurse-led training: nurse-led training includes pretraining considerations, content, and supervision of initial infusions. Adverse event management and follow-ups are emphasized, ensuring competence and support.
  • Logistic issues: the guidelines cover self-administration logistics, including obtaining medication, handling equipment, and proper disposal.
  • Follow-up, adherence, and patient support: the guidelines stress adherence and patient follow-up for safe and effective AAT therapy. A designated nurse, supported by helplines and timed infusions, is key.

The experts advocate for further research to evaluate the outcomes of self-administration programs, particularly from the perspective of patients, to continually refine and optimize their implementation.


Torres-Durán M, López-Campos JL, Calle Rubio M, et al. Recommendations for the implementation of the self-administration of alpha-1 antitrypsin. Int J Chron Obstruct Pulmon Dis. Published online August 4, 2023. doi:10.2147/COPD.S410611