The Italian program distributing DBS AATD tests to hospitals and clinics suggested testing of individuals with early-onset emphysema and familial cluster of COPD, with a plasma AAT level <80 mg/dl or first degree relatives of subjects with known AATD (including Pi*MZ heterozygosity) [19, 20]. Here, SERPINA1 is linked to alpha 1-antitrypsin deficiency.