Introduction Alpha-1 antitrypsin deficiency (AATD) is one of the most common hereditary disorders in adults of European descent1 and remains the most common, readily identifiable genetic risk factor for chronic obstructive pulmonary disease (COPD).2 The pulmonary manifestations of AATD include a spectrum of disorders associated with COPD3 including emphysema, chronic bronchitis, and bronchiectasis.