The risk of developing emphysema is significantly increased in homozygous and complex heterozygous carriers, such as the most common genotype for severe AATD Pi ZZ, while the risk is only slightly increased in heterozygous carriers, such as the Pi MZ genotype, or in genotypes associated with a moderate reduction in serum AATD levels, such as the Pi SZ genotype [1]. Here, SERPINA1 is linked to pulmonary emphysema.