The type of emphysema produced with A1AT deficiency is usually the panacinar type, and most seriously affects the lower portions of the lungs. This is a diffuse type of emphysema. Cigarette smoking in those with normal A1AT most commonly affects the upper portions of the lung; this is usually called centrilobular emphysema. Treatment of emphysema is the same, no matter what the type is; except that the more diffuse emphysema of A1AT is sometimes too diffuse for successful LVRS (Volume Reduction Surgery).