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- ArticleYoung RC, Headings VE, Bose S, Hackney RL.J Natl Med Assoc. 1978 Feb;70(2):117-20.The rare association of protease inhibitor deficiency (Pi(zz) genotype) in a black American with chronic, obstructive pulmonary disease due to asthmatic bronchitis, rather than basal pan lobular emphysema, is presented. The late onset of symptoms, despite environmental exposures, is also unusual in this homozygote, as is his ethnic background.