Bernie Sullivan is a 73-year old retired seamstress who has never married. She w

Question

Bernie Sullivan is a 73-year old retired seamstress who has never married. She worked in the alterations department of a men's clothier for 48 years. Bernie is a chain smoker. On the job, she was never found without a cigarette hanging from her lips. When her employer announced that smoking was no longer allowed in the store, Bernie retired. Since her retirement three years ago, Bernie has not been feeling well. She fatigues easily, even with light exertion. She has shortness of breath and recently has begun to sleep on two pillows. However, despite these problems, she has refused to stop smoking. Ms. Sullivan made an appointment with her physician, who noted a prolonged expiratory phase in her breathing, expiratory wheezes, and increased anteroposterior (AP) chest diameter. Her nail beds were cyanotic, and she had moderate pitting edema at her ankles. Based on these observations and results of laboratory and pulmonary tests, the physician concluded that Ms. Sullivan has a combination of emphysema and bronchitis, called COPD, which resulted from her long history of smoking. The results of pulmonary function and laboratory tests are given below. Vital Capacit Residual Volume Functional Residual Capacit FEVi; Expiratory Flow RateDe Decreased Increased Increased Decreased 14.5 g/dL (normal is 12-15 85% 45 mm H 70 mm H 34 mEq/L (normal is 24 mEa/L g/dL Hemoglobin O2 saturation Arterial Po2 Arterial Pco bicarbonate

Explanation / Answer

Alpha-1 antitrypsin (A1AT) is the glycoprotein produced in liver. Its function is to inhibit serine protease enzyme and to to balance action of the neutrophil-protease enzymes present in lungs - eg, the neutrophil elastase which is produced by neutrophils in presence of the inflammation, and in the infection or in case of smoking. smoking causes the deficiency of this alpha 1 antitrypsin which ultimately results inntochronic obstructive pulmonary diseases. this neutrophil elastase helps in the digestion of damaged and aged cells in the lungs and alpha 1 anti trypsin used to check the function of neutrophil elastase. in case of smokers since there is damage or breadown of alpha 1 antitrypsin enzyme therefore there is an excess of neutrophil eastase which later on acts on the normal cells to which ultimately causes COPD.

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