PiMZ Longitudinal Cohort (PiMZ Logic)

Inclusion Criteria: 1. Males and females aged 18 years and older 2. Understand the study procedures, risks, benefits, purpose 3. Able and willing to comply with the study procedures 4. Have PiMZ alpha-1 antitrypsin deficiency 5. Post bronchodilator FEV1 \< 80% predicted AND post bronchodilator FEV1/FVC \< 70% 6. Be an existing member of the Alpha-1 Foundation Clinical Cohort (also known as the Alpha-1 Foundation Research Registry) 7. Agree to have the data collected in this study be shared with the Alpha-1 Foundation Research Registry Exclusion Criteria: 1. AATD non-PiMZ status, including carriers 2. Current lung, hematologic, or solid organ malignancy other than skin or cervical Stage 1 cancers within the past 3 years 3. COPD exacerbation or other pulmonary infection within 6 weeks of baseline visit 4. Pregnancy at the time of the screening visit 5. Inability to lie still in a supine position for 15 minutes during CT acquisition 6. Inability to perform quality-controlled lung function testing 7. Allergy to albuterol 8. Currently receiving intravenous or subcutaneous immunoglobulin for any disease state 9. Past or present major surgery on the lungs including pneumonectomy or lobectomy. Wedge resections, past segmentectomy, and pleurodesis surgeries are allowed. 10. Previous lung or liver transplantation or currently on the transplant list 11. Decompensated cirrhosis 12. Current presence of endobronchial coils or valves in the lung 13. Clinically significant bronchiectasis as defined by the investigator. In general, this would exclude patients with chronic infection of the lungs requiring treatment within the past 6 months including non-tuberculous mycobacterial disease, chronic fungal disease, allergic bronchopulmonary aspergillosis, or known colonization of bronchiectasis with pseudomonas or stenotrophomonas species. 14. Participation in the active treatment arm of a therapeutic clinical trial at baseline visit unless using one of the Alpha-1 augmentation therapies in alternative doses. 15. Patient with Automatic Implantable Cardioverter Defibrillator (AICD) and permanent pacemakers (PPM) 16. Patient receiving biologic immunomodulators that will affect the assessment of the serum biomarkers (as determined by the site PI) 17. Patient with pleural catheters 18. Any condition that in the opinion of the investigator might adversely influence the study outcome