On this basis it has been suggested that such COPD patients with Bx should be considered for additional treatment strategies as for patients with Bx alone [22] Whether these features are also true of a significant proportion of AATD patients remains to be determined but it is tempting to speculate that (as in COPD) such patients have increased inflammation and may benefit from antiproteinase therapy and specifically Cathepsin C inhibitors [27] that may reduce both the inflammation and proteinase load in Bx but also influence the proteinase dependant emphysema in AATD patients. This evidence concerns the gene CTSC and pulmonary emphysema.