10th September 2020

A 43-year-old man presents with worsening dyspnoea on exertion

A 43-year-old man presents with worsening dyspnoea on exertion, intermittent purulent productive cough and fatigue. He has suffered 3 chest infections in the past 18 months. He denies any haemoptysis. He was recently referred to the hepatology department for unexplained jaundice. There is a family history of early-onset emphysema and liver disease; however, he has been physically well up until 18 months ago. He has never smoked in his life and currently works as an architect. Examination reveals reduced air entry and mild wheeze bi-basally. Hepatomegaly is noted on palpation. Previous LFTs show mild derangement. Chest x-ray shows hyperinflation with lower lobe emphysema. Spirometry is performed, and results show an obstructive pattern with partial bronchodilator reversibility.

For the patient above, please select the SINGLE most likely diagnosis. Select ONE option from the list above.