Konietzke P, et al. - Whether visual semiquantitative phenotyping of computed tomography (CT) data aids the detection of individuals with &alpha1-antitrypsin deficiency (AATD) in a group of smokers with severe emphysema and airflow limitation, was determined. They found only little aid was provided by the typical emphysema distribution patterns seen on CT traditionally assigned to AATD and chronic obstructive pulmonary disease (COPD) in the differentiation of both entities. A more precise differentiation was not enabled by taking into account the airway changes. Overall, findings indicated the insufficiency of a concise standardized phenotyping-driven approach to chest CT in emphysema in order to detect AATD patients in a cohort of smokers with advanced emphysema.