A 69-year-old woman presented with recurrent respiratory infections.
The patient reported no allergies or toxic habits, was hypertensive to treatment with amyloidosis and had hypothyroidism treated with levothyroxine.
Hysterectomized with double adnexectomy 20 years earlier.
It presents a clinical history of 10 years of evolution of frequent respiratory infections, predominantly winter, although also present in summer, consisting of cough, dyspnea, wheezing and purulent expectoration.
Ortopnea.
On physical examination, the patient presented cardiac auscultation rales, no murmurs or extracts, and pulmonary auscultation revealed an isolated roncus.
Perimaleal oedema was observed in the extremities.
Search was performed with the following outcome: FVC 67%; FEV1 56%; PEF 73%; FEV1/FVC 68%, positive bronchodilator test.
Pulmonary gas diffusion is slightly reduced, being 72.6% of the reference value.
The chest X-ray showed kyphoscoliosis without other alterations.
Computed tomography showed areas of emphysema and bronchiectasis in both bases, more evident in the middle lobe.
In the blood test only an AAT deficiency (30 mg/dl) was observed.
Fiberoptic bronchoscopy showed no significant findings.
With these results an AAT phenotype was performed, demonstrating the ZZ type.
She was diagnosed with asthma and D-AAT, and treatment for asthma was instituted with significant improvement.
Initially, no subtitutive treatment of D-AAT was performed because it maintained acceptable lung function.
