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Internal Medicine

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A 42-year-old female presents for follow-up after being treated for recurrent respiratory problems at an urgent care facility. She is feeling a little better after a short course of oral prednisone and use of an albuterol (Proventil, Ventolin) inhaler. She has had a gradual increase in shortness of breath, a chronic cough, and a decrease in her usual activity level over the past year. She has brought a copy of a recent chest radiograph report for your review that describes panlobular basal emphysema. She does not have a history of smoking, secondhand smoke exposure, or occupational exposures. Spirometry in the office reveals an FEV,/FVC ratio of 0.67 with no change after bronchodilator administration.Which one of the following underlying conditions is the most likely cause for this clinical presentation?

  1. a, -Antitrypsin deficiency

  2. Bronchiectasis

  3. Diffuse panbronchiolitis

  4. Interstitial lung disease

  5. Left heart failure

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