A previously healthy 39-year-old woman comes to the physician for a 1-year history of worsening shortness of breath. She has smoked one-half pack of cigarettes for the past 8 years. Her father passed away from alcoholic liver disease in his 40s. Her lungs are clear to auscultation. A loud P2 is heard on cardiac examination. The point of maximal impulse is in the sub-xiphoid space. Spirometry shows a low FEV1/FVC. Which of the following is the most likely explanation for this patient’s findings?
Dynein arm defect
Increased surfactant protein D
Lamellar body insufficiency
Loss of musculature of the airways
Neutrophil elastase overactivity
Usual interstitial pneumonitis
