Abstract
A 56-year-old woman presents with progressive short-ness of breath on exertion for the past 4 years. Her breath-ing has deteriorated rapidly over the last year, and her walking distance has reduced to approximately 200 feet on level ground. She smoked one pack per day for 14 years, but quit smoking 10 years ago. Her father suffered from severe emphysema and died of respiratory failure at the age of 64. On physical examination, she was mildly short of breath at rest. Lung auscultation revealed bilateral in-spiratory and expiratory rhonchi. A chest radiograph showed hyperinflation of both lungs, with prominent bul-lae, mainly in the lower zones.
Arterial blood gases on room air were: pH 7.43, arterial partial pressure of carbon dioxide 33 mm Hg, arterial par-tial pressure of oxygen 62 mm Hg, bicarbonate 21.8 mEq/L, α1-antitrypsin level 32.6 mg/dL (normal range 93-224 mg/dL). Table 1 shows the results of spirometry.
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