A 60-year-old white man presents for evaluation of progressive dyspnea. He is a former smoker with a 20-pack-year smoking history and a 10-year history of chronic obstructive pulmonary disease (COPD). There is no family history of COPD. Severe airflow obstruction is seen on spirometry, with a forced expiratory volume in 1 second that is 40% of the predicted value. Should he be evaluated for alpha1-antitrypsin (AAT) deficiency? If AAT deficiency is documented, how should his case be managed?
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Silverman et al. (2009) studied this question.
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