Elevated HDLC levels in COPD patients have led to multiple interpretations: some believe these levels indicate a heightened COPD risk due to HDLC’s interaction with alpha-1 antitrypsin and pulmonary surfactants [38, 39]; others see it as a survival bias, given the co-existence of COPD with cardiovascular diseases (CVD) and the protective role of high HDLC against CVD [40, 41]. Here, SERPINA1 is linked to chronic obstructive pulmonary disease.