Doctor, you should test everybody with COPD for Alpha-1.
That's what the American Thoracic Society says. And the European Respiratory Society. And the World Health Organization.
You don't do that, doc. (I don't know any doctors who do.) This doesn't bother me a bit. COPD involves millions of patients, and I know you're super busy. Here's what does bother me:
You don't even test the prime suspects.
People with severe lung damage at 35 or 45 years old should be tested for Alpha-1, no exceptions. They're not being. Not by many, many doctors, including pulmonary specialists.
I often talk to these newly-diagnosed Alphas. With proper treatment, their massive lung damage might have been stopped or slowed, years ago.
That bothers me very much.