A 69-year-old woman came to the clinic with repeated respiratory infections. The patient reported no allergies or toxic habits, she was hypertensive treated with amlodipine and presented hypothyroidism treated with levothyroxine. She had undergone hysterectomy with double adnexectomy 20 years earlier. She reported a clinical history of 10 years of frequent respiratory infections, predominantly in winter although also present in summer, consisting of cough, dyspnoea, wheezing and purulent expectoration. He also reported orthopnoea. Physical examination revealed rhythmic cardiac auscultation, without murmurs or extratonos and pulmonary auscultation with isolated rhonchi. Perimalleolar oedema was observed in the extremities. Spirometry was performed with the following result: FVC 67%; FEV1 56%; PEF 73%; FEV1/FVC 68%, positive bronchodilator test. Lung gas diffusion is slightly reduced, being 72.6% of the reference value. Chest X-ray showed kyphoscoliosis with no other abnormalities. The CT scan showed areas of emphysema and bronchiectasis in both bases, more evident in the middle lobe. Blood tests showed only a deficit of AAT (30 mg/dl). Fibrobronchoscopy was performed with no significant findings. With these results, an AAT phenotype was performed, which showed the ZZ type. Diagnosed with asthma and D-AAT, asthma treatment was started with significant improvement. Initially, D-AAT replacement therapy was not carried out, as she maintained acceptable lung function.