Symptoms are made worse if the lungs or liver are placed under unusual stress, such as smoking or drinking alcohol. Alpha 1-antitrypsin deficiency is a zebra diagnosis as it's primary symptom, difficulty breathing with unsual lung sounds, are a symptom of many more common lung conditions. In addition, Alpha 1-antitrypsin deficiency often is found together with other conditions such as COPD and cirrhosis which can arise alongside normal risk factors that exacerbate the symptoms of the condition. Diagnosis can usually be confirmed by testing Alpha 1-antitrypsin levels, which will be unusually low.