Cristopher Czaja, MD MPH

What are the risks for Alphas contracting H1N1?  What are the symptoms?  Should an Alpha get an prescription for Tamiflu to have on hand much like they do with antibiotics?  If so, when should they start taking the Tamiflu?

Alphas may be at increased risk of complication of influenza, mainly pneumonia, if they have emphysema or bronchiectasis.  Symptoms of novel H1N1 Influenza are similar to that of the seasonal flu, and include fever, cough, sore throat, runny nose, and if  severe, shortness of breath.  Muscle aches and headache are common.  Sometimes symptoms include nausea and vomiting.  Tamiflu may help prevent complications of novel and seasonal influenza, especially if taken within 48 hours of onset of symptoms.  I feel its probably best to consult a physician before taking Tamiflu in order to make sure the diagnosis is influenza and to undergo an evaluation for other causes of similar symptoms.

What is pseudamonis and MAC?  How are they different and how should they be treated?

Pseudomonas is a bacteria that is found in the airways of persons with severe or chronic sinusitis, bronchiectasis or emphysema.  It is acquired through extensive contact with the healthcare system and is associated with frequent prior antibiotic use.  Pseudomonas can cause sinusitis, pneumonia, and exacerbations of COPD and bronchiectasis.  It sometimes can be treated with an antibiotic such as Ciprofloxacin but often requires intravenous antibiotics, because it develops resistance to the few oral options.

MAC stands for Mycobacterium Avium Complex.  This is a complex of environmental bacteria that can cause chronic pneumonia.  Symptoms of fever, cough, sputum production and fatigue can be subtle and may last for months or years before a diagnosis is made.  Treatment requires 12-18 months of multiple oral antibiotics, on average.  A standard regimen would include Azithromycin, Ethambutol, and Rifampin taken daily or three times per week.  Relapse and reinfection often occur after antibiotics are discontinued. 

Should Alphas with bronchiestasis have an infectious disease doc on speed dial?  It seems that those Alphas with bronchiestasis pick up bugs more frequently than those without it.

Alphas may be at increase risk of infection, especially if they have severe COPD or bronchiectasis.  I think its most important to have a good primary physician or pulmonologist that knows a lot about Alpha-1 Antitrypsin Deficiency.  They will have the best understanding of what Alphas may be at risk for. An infectious diseases physician would be most helpful if infection is a recurrent or chronic problem, or if there is a complicated infection such as Chronic Pseudomonas or MAC.