376 Letters to the Editor / Arch Bronconeumol. 2011;47(7):374–377 Is it Asthma, is it Bronchiectasis...or is it an

¿Es asma, son bronquiectasias..., o es un déficit de alfa-1-antitripsina? Dear Editor: Alpha-1-antitrypsin deficiency (A1AD) is the most frequent potentially mortal congenital disease in adults. It usually presents as pulmonary emphysema at early ages.1 A1AD is an underdiag-nosed disease and one of the causes of this notable underdiagnosis is the limited frequency with which the serum concentrations of alpha-1-antitrypsin (A1AT) are determined even in COPD patients, despite the fact that the guidelines recommend it.1 A lesser known aspect is that pulmonary disease due to A1AD can present varying symptoms and that patients with A1AD can have another respi-ratory disease not directly related with the deficiency. This makes diagnostic suspicion difficult and complicates the therapeutic deci-sion about the need to initiate substitutive therapy. We have had the opportunity of a visit with a 52-year-old woman, ex-smoker of 14 pack-years, who consulted for recurrent lobar pneumonia in different localizations and episodes of purulen