Alpha-1-antitrypsin deficiency (AATD) is a rare cause of bronchiectasis unrelated to cystic fibrosis. The role of augmentation therapy with alpha-1-antitrypsin (AAT) in patients with AATD with bronchiectasis without pulmonary emphysema is still unclear. A case report from authors in Heidelberg presents a patient with bronchiectasis based on AATD, where augmentation therapy reduced the number of exacerbations and improved clinical condition.