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J Med Case Rep. 2011 Apr 19;5:154. doi: 10.1186/1752-1947-5-154.

Alpha-1-antitrypsin deficient man presenting with lung function decline associated with dust exposure: a case report.

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  • 1505 Parnassus Avenue, M1097, San Francisco, CA 94143, USA. moshe.zutler@ucsf.edu.

Abstract

INTRODUCTION:

People with α1-antitrypsin deficiency are at increased risk for the development of chronic obstructive pulmonary disease. Previous retrospective epidemiologic studies have found that exposure to occupational dust among those with α1-antitrypsin deficiency is a risk factor at the group level for poorer lung function, but on an individual clinical basis, a causal attribution can be difficult to establish.

CASE PRESENTATION:

We describe the case of a 68-year-old Caucasian man with a 25 pack-year smoking history who presented with new-onset dyspnea on exertion in the setting of workplace dust exposure. During his evaluation, he was found to have α1-antitrypsin deficiency with evidence of development of pulmonary emphysema. Workplace spirometric monitoring over 10 years of surveillance for an on-the-job respirator fit program demonstrated a sharp downward slope in forced expiratory volume in one second, or FEV1, during his periods of most significant dust exposure, which was attenuated after discontinuation of his workplace exposure.

CONCLUSION:

Patients with α1-antitrypsin disease should be assessed for occupational exposures and closely monitored for work-accelerated progression of lung function decline. More generally, this case report supports the biological plausibility of occupationally associated chronic obstructive pulmonary disease, underscoring that work-associated pulmonary disease can be multi-factorial.

PMID:
21504560
[PubMed]
PMCID:
PMC3110131
Free PMC Article

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