Correct!
3. The pulmonary function testing shows nonreversible airway obstruction and the CT scan shows decreased vascular markings consistent with emphysema

There is a reduction in the forced expiratory volume in 1 second (FEV1) with a normal forced vital capacity (FVC). This is consistent with obstructive lung dysfunction. Reversibility is defined by an improvement in the FEV1 of >12% and >200 ml and the FEV1 only improves 8% with a bronchodilator. There is an increase in the total lung capacity consistent with hyperinflation and a reduction in the diffusing limit for carbon monoxide (DLCO). Furthermore, there is a reduction in the vascular markings on the CT scan. These findings are all consistent with emphysema.

What is the most likely explanation for the patient's dyspnea? (Click on the correct answer to proceed to the fifth and last panel)

1. Alpha-1 antitrypsin deficiency
2. She has likely been exposed to second-hand smoke
3. She is a "closet smoker" and has COPD
4. She likely has topamax-induced emphysema
5. None of the above

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