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What is the risk of lung disease for an MZ?

There is some disagreement on the risk of lung disease for an MZ. Some sources say there is no increase in risk, some say there is a small increase in risk. The one thing that the experts and studies do agree on is the danger smoking poses to an MZ. Dr. Sandhaus has said that those MZs who smoke are 10 times more likely to end up with COPD than MMs who smoke.

In summary, we have specifically shown a gene-by-environment interaction in PiMZ heterozygotes leading to an increased risk of COPD in ever-smokers. There was no increased risk because of PiMZ genotype in never-smokers. This challenges some of the underlying tenets of the protease-antiprotease theory of the pathogenesis of COPD and makes it imperative to diagnose PiMZ heterozygotes early to avoid smoking initiation or provide another reason for smoking cessation to reduce the risk of COPD.

Clarification of the Risk of Chronic Obstructive Pulmonary Disease in α1-Antitrypsin Deficiency PiMZ Heterozygotes – Feb 15, 2014

Those who smoke are at greater risk for COPD than smokers in the general population.

Occupational and environmental exposures may also influence lung disease in smokers.

Those who do not smoke are not at an increased risk for COPD.

Alpha-1-To-One, Winter 2018 – Alpha-1 Foundation