I suspect that you are asking “Why aren’t more patients tested for this?” when testing is indicated. There are a number of reasons: the doubt that emphysema could be the problem in such a young person; a less than optimum family history taken from the patient, leading to unawareness of the familial nature of the disease in question; lack of awareness that early onset chronic bronchitis may be the first sign of ATD and misdiagnosis of the symptoms as those of asthma, CF or simple bronchitis and, finally, a very sedentary patient who doesn’t recognize a gradual but quantitatively large loss of lung function.
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