The prevalence of Alpha-1-antitrypsin (α1AT) deficiency in Taiwan is not known as yet, since there are extremely rare case reports and the prevalence is normally lower among Asian countries than Western countries. We report an 18-year-old male non-smoker with the chief complaint of effort dyspnea. He was diagnosed as having α1AT deficiency-related emphysema, based on imaging studies, pulmonary function tests and the level of α1AT in the serum. This is the first case report of α1AT deficiency-related emphysema in a young adult in Taiwan. The incidence and contribution of α1AT deficiency to the development of chronic obstructive pulmonary disease among nonsmokers, and the prognosis, need further investigation in Asia.