PiMZ Longitudinal Cohort (PiMZ Logic)

This study follows people with a specific genetic variant of alpha-1 antitrypsin deficiency (AATD) called PiMZ — a condition where the liver doesn't make enough of a protective lung protein, which can lead to lung disease (COPD). The goal is to track how the disease progresses over time and to build a better understanding of this specific variant. **You may be eligible if...** - You are 18 or older with confirmed PiMZ alpha-1 antitrypsin deficiency - You have reduced lung function (FEV1 below 80% predicted and an abnormal FEV1/FVC ratio) - You are already a member of the Alpha-1 Foundation Clinical Cohort or registry - You are willing to share your data with the registry **You may NOT be eligible if...** - You have a different AATD variant (not PiMZ) - You have active cancer other than early-stage skin or cervical cancer - You have had a COPD flare or lung infection in the last 6 weeks - You are pregnant - You are unable to lie still for a CT scan or perform lung function tests - You are allergic to albuterol Talk to your doctor to see if this trial is right for you.