ABSTRACT
If asthma or RAWD were strongly dependent on alA T deficiency, one should expect to see it most easily in the severely deficient subjects. Yet, as shown in Tables 1 and 2, the incidence of asthma in childhood or pulmonary symptoms before age 20 is no higher than the expected incidence of asthma, and less than 8%. In the asthmatic populations (Table 3), the association is strongest with the least deficient MS variants (and, in one case, even M2M2). Lieberman’s argument that the “ lability” of the MS variant causes a functional deficiency of antiprotease should be amplified, and therefore reinforced, in the persistent, severe deficiency found in ZZ subjects. Is the high percentage of reported asthma and wheezing and RAWD in the more recent studies of ZZ subjects cited in Table 2 a confirmation of this? Or are these findings simply nonspecific reflections of the more severe OAD and emphysema in these later series?
