Chart 2. Indications for evaluation of alpha-1 antitrypsin deficiency.

• COPD or emphysema (regardless of age or ethnicity) • Adult-onset asthma or asthma with fixed airway obstruction • Bronchiectasis of undetermined etiology • Chronic liver disease of undetermined etiology • Necrotizing panniculitis • C-ANCA positive vasculitis, including granulomatosis with polyangiitis • First-degree relatives and partners of individuals with AATD* • Family history of emphysema, bronchiectasis, liver disease, or panniculitis

C-ANCA: cytoplasmic antineutrophil cytoplasmic antibody; and AATD: alpha-1 antitrypsin deficiency. *AATD should be diagnosed by genotyping rather than by determination of the serum concentration of AAT.