Evaluation of COPD, emphysema and liver disease. Alpha 1 antitrypsin levels are reduced in Acute hereditary α1-antitrypsin deficiency as seen in cases of hepatitis and progressive liver cirrhosis in childhood or in adults as severe pulmonary emphysema. If the result is below the reference range phenotyping will also be performed, which is referred to North Bristol NHS Trust. Patients with ZZ, SZ, SS, MZ or null phenotypes show increased risk of lung (emphysema) or liver disease (cirrhosis).