Given the pleiotropic anti-inflammatory effects of the AAT protein, we hypothesized that PI*MZ individuals would have increased healthcare utilization and more frequent exacerbations compared to individuals without AATD, i.e., PI*MM, and that lower AAT serum level among PI*MZ individuals would be associated with higher healthcare utilization and more frequent exacerbations. Here, SERPINA1 is linked to alpha 1-antitrypsin deficiency.