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Occupational COPD and emphysema: two case histories.

Early-onset emphysema may have genetic and environmental causes. This case study reports on two cases that draw attention to the importance of taking a careful occupational history.

### Patient 1

A 51-year old male presented with a 10-year history of progressive breathlessness on exertion, noticed initially while training a youth football team. By the time of assessment in 2003 he was unable to run and had stopped work as a window fitter due to breathlessness. He had an intermittent cough and wheeze with daily clear sputum production. There was no diurnal variation in breathlessness, nocturnal cough, or history of asthma and atopy. He took no regular medication, and had never smoked, though both parents smoked at home when he was a child. His father died of ischaemic heart disease and emphysema at the age of 67 years. Computerised tomography (CT) scan of the lungs showed severe emphysema (Figure 1). Lung function was typical of centriacinar emphysema with mild airway obstruction (FEV1/FVC = 53%; FEV1 = 2.77 L, 73% predicted; FVC = 5.19 L, 109% predicted), significant air trapping (residual volume = 3.02 L, 135% predicted) and severely reduced gas transfer (DLCO = 3.96 mmol/min/kPa, 37% predicted). Liver function tests and alpha-1 antitrypsin phenotype (MM) and level (1.93 g/L) were normal. He was treated with inhaled beta-agonist, corticosteroid, and antimuscarinic drugs, and attended pulmonary rehabilitation. There was a steady decline …